PHELPS T O D A Y. Coronary Artery Disease Infertility Fever In Children Westchester s First Baby of Phelps Memorial Hospital Center SPRING 2011

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1 PHELPS News T O D A Y SPRING 2011 from Pheps Memoria Hospita Center Coronary Artery Disease Infertiity Fever In Chidren Westchester s First Baby of 2011 Sarina DiStefano, MD, who deivered Westchester s first baby of 2011 (second from eft) and three other babies on New Year s Day.

2 Dear Friends of Pheps, It is our peasure to report on recent deveopments and achievements at Pheps. Stear Joint Commission Survey: In November of 2010, the internationa accrediting body, The Joint Commission, recognized the high quaity of care provided by our nurses, doctors, and staff. Their six-member team of surveyors was truy impressed with Pheps staff, commenting on their dedication, enthusiasm, compassion, ski, teamwork, and commitment to The Joint Commission s goas of quaity and safety. They cited 18 specific exampes of where Pheps is an exempary hospita. Recognition: The exceence of our services has aso been recognized by severa other respected organizations: The New York State Department of Heath paced Pheps among the top 10 hospitas statewide with the highest percentage of mothers who excusivey breastfeed their newborns. The American Heart Association and American Stroke Association presented Pheps with the God Pus Performance Achievement Award for exceence in stroke care achieved in a remarkaby short period after the creation of our Stroke Center. The Bue Cross and Bue Shied Association designated Pheps as a Bue Distinction Center for Knee and Hip Repacement for demonstrating expertise in deivering quaity heathcare in this speciaty. Medica Student Education: Another form of recognition is Pheps continuing roe in physician education. Two years ago, our hospita became a training site for second-year medica students from New York Medica Coege. This year, we have had a magnificent opportunity to make a difference by training tweve members of the next generation of physicians. It is a testament to our medica staff to have been seected to teach these students how to examine their first patients. Our reationship with New York Medica Coege expanded further just recenty when, for the first time, third-year medica students rotated to Pheps for seectives in geriatrics, hyperbaric medicine, and anesthesioogy. Our senior physicians have fuy embraced these opportunities to share their skis as outstanding mentors and teachers. We are proud to report on these endorsements of Pheps quaity. They shoud reassure you of the sincere efforts of our staff to provide the very best care to the community. We wish you a heathy and joyfu spring. Sincerey, David W. Couam Chairman, Board of Directors Keith F. Safian, FACHE President & CEO

3 Coronary Artery Disease...2 Enfermedad coronaria...4 Caendar...6 Pheps Supporter Lisina Hoch Named ADO Phianthropist of the Year...10 Maternity & Baby Care Casses...11 Infertiity: A Q & A with Dr. Rache Bennett...12 Fever in Chidren...14 La fiebre en os niños...16 Breaking News on Vaccination and Autism...18 Finding a Path to Smoother Speech...19 Pheps Receives God Pus Award for Exceence in Stroke Care...20 Teddy Bear Cinic...20 Westchester s First Baby of 2011 Born at Pheps...21 Pheps Recognized by State Department of Heath for High Breastfeeding Rates...21 Are You a Knitter?...22 Pheps Becomes a Tobacco-Free Campus...22 Second Annua James House Mansion Craft Fair...22 New Pain Center...23 Request Your Appointment Onine! Appointments for many of Pheps outpatient services can now be made on the hospita s website, incuding: cardiovascuar, diabetes, hyperbaric, infusion, nutrition counseing, occupationa and physica therapy, pain center, pumonary/respiratory, radioogy/x-ray, senior services, seep, speech & hearing, voice & swaowing, and wound heaing. You can even make an appointment to donate bood onine. Just go to and cick on Request an Appointment any time of the day or night! Contents PHELPS TODAY Editor Bruce Heckman, MD, MPH Managing Editor Mary Sernatinger Editoria Advisors Lucy C. Engehardt, RN Kenneth C. Kapan, MD Keith F. Safian, FACHE PHELPS TODAY is a pubication of Pheps Memoria Hospita Center. Pheps is a member of the Stearis Heath Network and the Hudson Vaey s excusive affiiate of Memoria Soan-Kettering Cancer Center. Visit to see our annua reports, videos, physician directory, caendars and more. pheps today 1

4 Coronary Artery Disease A Lifeong Chaenge We now know that a heathy diet, reguar exercise, and, when necessary, medications for bood pressure and ipid-modifying therapy wi reduce the prevaence and progression of coronary artery disease. In the past 30 years, great strides have been made in the prevention and treatment of coronary artery disease (CAD), aso known as coronary atheroscerosis. Mortaity rates from the disease have decined substantiay during this period. Nonetheess, CAD remains the eading kier of both men and women in the United States. According to a recent artice by Arthur E. Fass, MD, chief of cardioogy at Pheps, in the journa Cardioogy in Review, new evidence about the nature of chronic coronary artery disease has come to ight. However, current treatment often does not yet propery refect this new knowedge. What is coronary artery disease? The coronary arteries are the major bood vesses that suppy your heart with bood, oxygen and nutrients. Coronary artery disease deveops when choestero-containing deposits (or paques) buid up in the vesses, narrowing them and compromising coronary bood fow. As paques continue to accumuate in the coronary arteries, they become increasingy narrow, and symptoms such as chest pain, known as angina, and shortness of breath may deveop. Risk factors that contribute to CAD are smoking, high bood pressure, high choestero, diabetes, obesity and physica inactivity. The most devastating compications of chronic coronary artery disease are sudden death, which is usuay caused by extensive atheroscerosis and strikes approximatey 500,000 peope a year in the U.S., and acute myocardia infarction (heart attack). The main causes of both of these events are the rupture of coronary paques and formation of a cot at the rupture site. The primary aim of treatment, therefore, shoud be the prevention and stabiization of paque. When does coronary artery disease begin? Contrary to popuar beief, coronary artery disease is not found ony in the midde aged and edery. In fact, CAD is thought to begin as eary as chidhood. Studies performed in sodiers who died in the Korean and Vietnam Wars reveaed a surprisingy high prevaence of CAD in this young popuation. Another study, of 2 pheps today

5 262 heart donors with an average age of 33, reveaed that 52% had at east one atheroscerotic site, and 17% of the donors aged aready had evidence of atheroscerosis. According to Dr. Fass, the high prevaence of coronary artery disease in the genera popuation cas for aggressive preventive measures in individuas from chidhood on. The current treatment approach The current approach in addressing coronary artery disease emphasizes angiopasty, a procedure in which vesses are opened and diated, accompanied by stenting, in which a sma wire mesh tube is inserted to hep prop the artery open. The majority of angiopasty interventions in the U.S. are performed not for acute coronary events but for the management of chronic stabe CAD. Whie these procedures reieve the immediate bockage, they do not prevent the progression of coronary disease, heart attacks or sudden death. In fact, after many of these invasive coronary interventions, symptoms tend to recur as a resut of atheroscerosis in other coronary arteries. The probem is that many peope view coronary disease as a pumbing probem, but it s not so simpe, says Dr. Fass. It s a diffuse disease that affects the whoe system of coronary arteries, so the treatment shoud be systemic. The answer is to address CAD at its eary stages with diet and ifestye modifications and pharmacoogica interventions, when necessary, says Dr. Fass. Preventing and Managing CAD Primary prevention ifestye modifications for everyone Prevention of coronary artery disease among the genera popuation shoud incude dietary modifications and reguar exercise beginning in chidhood. Evidence suggests that adopting a Mediterranean-type diet high in fruits and vegetabes, oive oi, nuts, fish and chicken and avoidance of trans-fats, refined carbohydrates and processed foods reduces the risk of CAD. Exercise for at east 20 minutes a day shoud be obtained and coud consist of waking, jogging, bicycing, swimming, etc. activities that are practica and can be done on a daiy basis. Secondary prevention medica therapy for peope with known CAD For patients with known coronary artery disease, a modified diet and exercise program must be accompanied by medications to contro high bood pressure and treatment with statins. Statins bock the body s production of choestero and reduce infammation, which may be a major cause of paque destabiization. Statins have become one of the mainstays of primary and secondary coronary prevention. Antipateet therapy, incuding aspirin and copidogre (Pavix), are aso widey used for primary and secondary prevention of cardiovascuar events. The COURAGE Tria of 2007, which compared the effectiveness of medica management versus angiopasty for patients with chronic coronary artery disease, concuded that for patients with stabe chronic CAD, aggressive pharmacoogic treatments proved to be just as effective as aggressive invasive treatments. Other trias have ikewise faied to demonstrate an advantage of angiopasty over medica therapy. When invasive interventions are appropriate Invasive coronary interventions, incuding angiopasty and bypass surgery, are most appropriate for acute coronary patients who are in the midst of an acute coronary event such a unstabe angina or a heart attack. Device therapies such as defibriators can aso hep reduce the incidence of sudden death in seected patients who have suffered heart damage. Eradicating the Scourge of the 20th Century We now know that a heathy diet, reguar exercise, and, when necessary, medications for bood pressure and ipid-modifying therapy wi reduce the prevaence and progression of coronary artery disease, says Dr. Fass. It is ikey that in the future targeted drug therapies wi be deveoped to interrupt the disease process of CAD at severa eves. We have witnessed decining morbidity and mortaity from cardiovascuar disease, and appication of new research wi aow this trend to acceerate. By appying the new preventive and treatment methods, we can now reaisticay anticipate that the scourge of the 20th century wi be eradicated in the 21st. We have witnessed decining morbidity and mortaity from cardiovascuar disease, and appication of new research wi aow this trend to acceerate. By appying the new preventive and treatment methods, we can now reaisticay anticipate that the scourge of the 20th century wi be eradicated in the 21st. Arthur Fass, MD, is chief of cardioogy at Pheps Memoria Hospita. He earned his medica degree at New York Medica Coege. He competed an internship and residency in interna medicine at Metropoitan Hospita Center in New York and a feowship in cardioogy at Westchester Medica Center. Dr. Fass is board certified in interna medicine and cardiovascuar disease. He and feow cardioogists Frankin Zimmerman, MD, and Dina Katz, MD, have offices in Briarciff Manor ( ). pheps today 3

6 Enfermedad coronaria: un desafío de por vida Ahora sabemos que una dieta saudabe, ejercicio reguar, y, cuando sea necesario, medicamentos para a presión sanguínea y terapia modificadora deípidos, reducirán a prevaencia y progresión de a enfermedad coronaria. En os útimos 30 años se han ogrado importantes avances en a prevención y e tratamiento de a enfermedad coronaria (CAD), también conocida como ateroscerosis coronaria. Los índices de mortandad por a enfermedad han disminuido considerabemente en este período. Sin embargo, a CAD sigue siendo a causa principa de muerte de hombres y mujeres en Estados Unidos. Según un artícuo reciente de Arthur E. Fass, MD, jefe de cardioogía de Pheps, pubicado en a revista Cardioogy in Review, se han encontrado nuevas evidencias sobre a índoe de a enfermedad coronaria crónica. Sin embargo, e tratamiento actua a menudo no refeja adecuadamente este nuevo conocimiento. Qué es a enfermedad coronaria? Las arterias coronarias son os vasos sanguíneos principaes que suministran de sangre, oxígeno y nutrientes a corazón. La enfermedad coronaria se desarroa cuando depósitos que contienen coestero (o pacas) se acumuan en os vasos sanguíneos, haciéndoos más estrechos y afectando e fujo de sangre coronaria. A medida que as pacas continúan acumuándose en as arterias coronarias, éstas se hacen cada vez más estrechas y pueden desarroarse síntomas como door en e pecho, conocido como angina y fata de aiento. Los factores de riesgo que contribuyen a a CAD son fumar, ata presión sanguínea, coestero ato, diabetes, obesidad e inactividad física. Las compicaciones más devastadoras de a enfermedad coronaria son a muerte súbita, que usuamente es causada por una ateroscerosis extensiva y afecta a aproximadamente 500,000 personas a año en EE.UU. y e infarto agudo de miocardio (ataque a corazón). Las causas principaes de estos dos sucesos son a ruptura de as pacas coronarias y a formación de un coáguo en e ugar de a ruptura. Por o tanto, e principa objetivo de tratamiento debe ser a prevención y estabiización de a paca. Cuando empieza a enfermedad coronaria? Contrario a a creencia popuar, a enfermedad coronaria no se encuentra únicamente en as personas de edad madura y en os ancianos. De hecho, se piensa que a CAD empieza en a niñez. Estudios reaizados en sodados que murieron en as guerras de Corea y Vietnam revearon una prevaencia sorprendentemente ata de CAD en esta joven pobación. Otro estudio, de 262 donadores de corazón con un promedio de edad de 33 años, reveó que e 52% tenía por o menos un sitio arterioscerótico y e 17% de os donadores de entre 12 y 17 años de edad ya tenían evidencia de ateroscerosis. Según e Dr. Fass, a ata prevaencia de a enfermedad coronaria en a pobación genera 4 pheps today

7 requiere de medidas preventivas agresivas en as personas a partir de a niñez. E abordaje actua de tratamiento E abordaje actua para tratar a enfermedad coronaria enfatiza a angiopastia, un procedimiento en e que os vasos sanguíneos se abren y diatan, en conjunción con a coocación de un stent, durante a cua se inserta un tubo de maa metáica para ayudar a mantener abierta a arteria. La mayoría de as intervenciones de angiopastia de EE.UU. son reaizadas no por sucesos coronarios agudos, sino para e manejo de una CAD crónica estabe. Aunque estos procedimientos aivian e boqueo inmediato, no previenen a progresión de a enfermedad coronaria, os ataques a corazón o a muerte súbita. De hecho, después de muchas de estas intervenciones coronarias invasivas, os síntomas tienden a recurrir como resutado de a ateroscerosis en otras arterias coronarias. E probema es que muchas personas ven a enfermedad coronaria como un probema de pomería, pero no es tan simpe, dice e Dr. Fass. Es una enfermedad difusa que afecta a todo e sistema de arterias coronarias, por o que e tratamiento debe ser sistémico. La respuesta es abordar a CAD en sus etapas iniciaes con modificaciones a a aimentación y a estio de vida e intervenciones farmacoógicas, cuando sea necesario, dice e Dr. Fass. Prevención y manejo de CAD Prevención primaria: modificaciones de estio de vida para todos La prevención de a enfermedad coronaria entre a pobación genera debe incuir modificaciones a a dieta y ejercicio reguar a partir de a niñez. La evidencia sugiere que a adopción de una dieta tipo mediterráneo con un ato contenido de frutas y vegetaes, aceite de oiva, nueces, pescado y poo, y que evite as grasas trans, os carbohidratos refinados y os aimentos procesados reduce e riesgo de CAD. Se debe hacer ejercicio por o menos 20 minutos a día, que puede consistir en caminar, correr, andar en biciceta, nadar, etc., actividades que son prácticas y se pueden hacer diariamente. Prevención secundaria: terapia médica para personas que ya tienen CAD Para os pacientes que padecen de enfermedad coronaria, una dieta modificada y un programa de ejercicio deben acompañarse de medicamentos para controar a hipertensión y de tratamiento con estatinas. Las estatinas boquean a producción de coestero de cuerpo y reducen a infamación, que puede ser una causa importante de desestabiización de as pacas. Las estatinas se han convertido en una de as bases de a prevención coronaria primaria y secundaria. La terapia antipaquetas, incuyendo aspirina y copidogre (Pavix), también se usa ampiamente para a prevención primaria y secundaria de eventos cardiovascuares. E estudio COURAGE de 2007, que comparó a eficacia de manejo médico contra a angiopastia en pacientes con enfermedad coronaria crónica, concuyó que en pacientes con CAD crónica estabe, os tratamientos farmacoógicos agresivos comprobaron ser tan eficaces como os tratamientos invasivos agresivos. De mismo modo, otros estudios no han podido demostrar una ventaja de a angiopastia sobre a terapia médica. Cuando intervenciones invasivas son apropiadas Las intervenciones coronarias invasivas, incuyendo a angiopastia y cirugía de derivación, son más adecuadas para os pacientes con enfermedad coronaria aguda que están en medio de un evento coronario agudo como una angina inestabe o un ataque a corazón. Las terapias de dispositivos como os desfibriadores también pueden ayudar a reducir a incidencia de muerte súbita en ciertos pacientes que han sufrido daños a corazón. Erradicar e azote de sigo XX Ahora sabemos que una dieta saudabe, ejercicio reguar, y, cuando sea necesario, medicamentos para a presión sanguínea y terapia modificadora de ípidos, reducirán a prevaencia y progresión de a enfermedad coronaria, dice e Dr. Fass. Es probabe que en e futuro se desarroen terapias farmacoógicas para interrumpir e proceso de enfermedad de CAD en varios nivees. Hemos sido testigos de una menor morbiidad y mortandad por enfermedades cardiovascuares, y a apicación de as nuevas investigaciones permitirá que esta tendencia se aceere. A apicar os nuevos métodos preventivos y de tratamiento, podemos ahora de modo reaista prever que e azote de sigo XX será erradicado en e sigo XXI. Hemos sido testigos de una menor morbiidad y mortandad por enfermedades cardiovascuares, y a apicación de as nuevas investigaciones permitirá que esta tendencia se aceere. A apicar os nuevos métodos preventivos y de tratamiento, podemos ahora de modo reaista prever que e azote de sigo XX será erradicado en e sigo XXI. Arthur Fass, MD, es e jefe de cardioogía de Pheps Memoria Hospita. Obtuvo su títuo en e New York Medica Coege. Competó un internado y residencia en medicina interna en e Metropoitan Hospita Center de Nueva York y una beca en cardioogía en e Westchester Medica Center. E Dr. Fass está certificado por e consejo en medicina interna y enfermedades cardiovascuares. É y sus compañeros cardióogos Frankin Zimmerman, MD y Dina Katz, MD, tienen sus consutorios en Briarciff Manor ( ). pheps today 5

8 H E A L T H Y L I F E C A L E N D A R ATPHELPS MARCH Bereavement Support Groups Support groups for aduts strugging with the oss of a oved one. 8-week support group Tuesday evenings from 6:30 8 pm, beginning in Apri. Pease ca (914) for starting date. Ongoing support group Thursday afternoons from 2 3:30 pm on the foowing dates: March 10 and 24, Apri 14 and 28, May 12 and 26, and June 9 and 23 Bess Steiger, CSW Bereavement Coordinator Suggested donation: $10 per session Conference Room North Broadway on Pheps Campus Ca (914) or emai for information. Stroke Support Group A support group for stroke survivors, their famiies, friends and caregivers, providing education, friendship and support. Hed the first Wednesday of every month. 3:30 4:30 pm Wakway Conference Room For more information, ca (914) Monday, March 7, 2011 Look Good... Fee Better This free program is for women who are going through treatment for a types of cancer. Look Good...Fee Better teaches women beauty techniques to hep manage the appearance-reated side effects of cancer treatment. Makeup kits donated by cosmetic companies are given to each participant to take home. The program is offered in partnership with the American Cancer Society, The Nationa Cosmetoogy Association, and the Cosmetic, Toietry and Fragrance Association (CTFA) Foundation. Sheri Siver, cosmetoogist 7 9 pm Wakway Conference Room Advance registration is required. Ca (800) Tuesday, March 8, 2011 Better Breathers Cub Opening meeting for the spring season of the Better Breathers Cub for individuas with ung disease. Gaa ceebration wi incude refreshments and gifts from the American Lung Association. Serena Arrabito, Esq., American Lung Association, New York 6-7 pm Pumonary Lab Ca (914) to register. Saturday, March 26, 2011 Haf-Marathon Running Event Pheps is sponsoring a haf-marathon (13.1 mie) running event with the Viage of Seepy Hoow and the Rivertown Runners Cub of Seepy Hoow. More than 500 runners are expected to participate. 6 pheps today

9 9:30 am Begins at Town Ha in Seepy Hoow To register, ca (914) or register onine at rivertownrunners.org. APRIL Monday, Apri 4, 2011 Look Good... Fee Better This free program is for women who are going through treatment for a types of cancer. Look Good...Fee Better teaches women beauty techniques to hep manage the appearance-reated side effects of cancer treatment. Makeup kits donated by cosmetic companies are given to each participant to take home. The program is offered in partnership with the American Cancer Society, The Nationa Cosmetoogy Association, and the Cosmetic, Toietry and Fragrance Association (CTFA) Foundation. Sheri Siver, cosmetoogist 7 9 pm Wakway Conference Room Advance registration is required. Ca (800) to register. Wednesday, Apri 6 Stroke Support Group A support group for stroke survivors, their famiies, friends and caregivers, providing education, friendship and support. Hed the first Wednesday of every month. 3:30 4:30 pm Wakway Conference Room For more information, ca (914) Monday and Tuesday, Apri 11 and 12, 2011 Defensive Driving Two-evening certification program. Lowers insurance premiums, reduces vioation points, and sharpens driving skis. Robert Foge 5:30 8:30 pm Auditorium Fee: $45 Ca (914) to register. Tuesday, Apri 12, 2011 Better Breathers Cub Acupuncture and Its Benefits for Lung Disease Learn about how acupuncture can be used as a therapy for individuas with ung disease. The session wi incude a demonstration by a icensed acupuncturist. Jiian C. Schwartz, L.Ac., Dip.O.M., acupuncturist 12-1 pm Pumonary Lab Ca (914) to register. Wednesday, Apri 13, 2011 An Update on In-Vitro Fertiization (IVF) Are you having troube conceiving? Do you think or have you been tod that you might need in-vitro fertiization? Learn about IVF from a board-certified reproductive endocrinoogist when it might be indicated, how it is performed and the newest technoogies associated with it. Rache A. Bennett, MD, OB/GYN, Reproductive Endocrinoogy and Infertiity 6:30 pm Board Room Ca (914) to register. Thursday, Apri 14, 2011 Snoring and Seep Apnea Seep apnea is a condition that causes pauses in breathing during seep and resuts in ower eves of oxygen in the bood. The most common symptom of seep apnea is snoring. Learn about the atest diagnostic methods and therapies for this condition and how treatment can improve your quaity of ife. Michae Bergstein, MD, otoaryngoogist, Surgica Director of the Pheps Seep Center and Assistant Cinica Professor of Otoaryngoogy at Mt. Sinai Schoo of Medicine 7 pm Auditorium Ca (914) to register. Monday, Apri 25, 2011 Chronic Cough Cinic Peope often have a chronic cough despite numerous doctor visits, medications, and diagnostic tests. Coughing associated with throat cearing, voice changes, troube swaowing, nighttime cough, and voca spasms can often be caused by chronic aryngopharyngea refux disease. Aternativey, some peope often fee a ticke in the throat that precedes a cough, a dry spot or dryness in the throat, which may be caused by an irritation of a nerve. Screenings for these types of coughs wi be offered. Craig H. Zavan, MD, aryngoogist, Medica Director, Pheps Institute for Voice and Swaowing Disorders 8:30 10 am Prompt Care Ca (914) to register. MAY Annua Bereavement Memoria Service Ca Bereavement Coordinator Bess Steiger at for detais. pheps today 7

10 Monday, May 2, 2011 Look Good... Fee Better This free program is for women who are going through treatment for a types of cancer. Look Good...Fee Better teaches women beauty techniques to hep manage the appearance-reated side effects of cancer treatment. Makeup kits donated by cosmetic companies are given to each participant to take home. The program is offered in partnership with the American Cancer Society, The Nationa Cosmetoogy Association, and the Cosmetic, Toietry and Fragrance Association (CTFA) Foundation. Sheri Siver, cosmetoogist 7-9 pm Wakway Conference Room Advance registration is required. Ca (800) to register. Tuesday, May 3, 2011 Swaow Screening Do you sometimes fee food or iquid go down the wrong pipe? Does food get stuck? Do you have pain when you swaow? Do you experience food or iquid coming back up? If you answered yes to any of these questions, then you shoud attend this free swaow screening cinic. Erin Baker, MS-CCC/SLP Andrea Bracciante-Ey, MSP-CCC/SLP Paua Dinu, MS-CCC/SLP 9:30 11 am Wakway Conference Room Ca (914) to register. Wednesday, May 4, 2011 Stroke Support Group A support group for stroke survivors, their famiies, friends and caregivers, providing education, friendship and support. Hed the first Wednesday of every month. 3:30 4:30 pm Wakway Conference Room For more information, ca (914) Monday, May 9, 2011 Larygopharyngea Refux (LPR) Sient Refux Screening Changes in voice, throat cearing, mucus in the throat with discomfort, chronic cough not responding to medications, and swaowing probems are a symptoms of Laryngopharyngea Refux (LPR). In addition, chronic asthma, recurrent sinusitis, denta disease and even cancer can a be caused or exacerbated by LPR. LPR is not GERD. Craig H. Zavan, MD, aryngoogist, Medica Director of Pheps Institute for Voice and Swaowing Disorders 8:30 10 am Prompt Care Ca (914) to register. Tuesday, May 10, 2011 Better Breathers Cub This workshop wi focus on stress management for patients with ung disease. Come earn or refresh stress management techniques. Pat Duquette, LCSWR, CASAC, Pheps Counseing, Behaviora Heath Unit 6 7 pm Pumonary Lab Ca (914) to register. Wednesday, May 11, 2011 Poycystic Ovarian Syndrome (PCOS): Do You Have It? Do you or someone you know have irreguar periods or troube with excess body hair? Have you been tod you have PCOS? Come hear about PCOS from a board-certified reproductive endocrinoogist what causes it, how to treat it. Rache Bennett, MD, OB/GYN, Reproductive Endocrinoogy and Infertiity 6:30 pm Board Room Ca (914) to register. Monday and Tuesday, May 23 and 24, 2011 Defensive Driving Two-evening certification program. Lowers insurance premiums, reduces vioation points, and sharpens driving skis. Robert Foge 5:30 8:30 pm Auditorium Fee: $45 Ca (914) to register. JUNE Monday, June 6, 2011 Look Good... Fee Better This free program is for women who are going through treatment for a types of cancer. Look Good...Fee Better teaches beauty techniques to hep manage the appearance-reated side effects of cancer treatment. Makeup kits donated by cosmetic companies are given to each participant to take home. The program is offered in partnership with the American Cancer Society, The Nationa Cosmetoogy Association, and the Cosmetic, Toietry and Fragrance Association (CTFA) Foundation. Sheri Siver, cosmetoogist 7 9 pm Wakway Conference Room Advance registration is required. Ca (800) to register. 8 pheps today

11 Saturday, June 11, 2011 Annua James House Mansion Craft Fair Join us at the second annua James House Mansion Craft Fair featuring more than 30 vendors seing jewery, handbags, pottery and more. Refreshments wi be sod. 10 am 5 pm James House Mansion on the Pheps Campus Rain date is Sunday, June 12. Wednesday, June 15, 2011 Infertiity 101 Are you trying to conceive? Does it fee ike everyone is getting pregnant but you? Come to this informative ecture by reproductive endocrinoogist Dr. Rache Bennett, who wi discuss the causes of infertiity, diagnostic testing, and treatments avaiabe to hep you conceive incuding artificia insemination and in-vitro fertiization. Rache Bennett, MD, OB/GYN, Reproductive Endocrinoogy and Infertiity 6:30 pm Board Room Ca (914) to register. Thursday, June 16, 2011 Baoon Sinupasty For five years, peope with sinus pain have been heped by a revoutionary procedure caed baoon sinupasty. Learn about this aternative to traditiona sinus surgery that enabes most patients to resume norma activities within two days. Dr. Bergstein is the most experienced surgeon in Westchester in performing baoon sinupasty, having accompished more than 200 procedures. Michae Bergstein, MD, otoaryngoogist, Senior Attending at Pheps and Assistant Cinica Professor of Otoaryngoogy at Mt. Sinai Schoo of Medicine 7 pm Auditorium Ca (914) to register. Monday, June 20, 2011 Strong Bones for Life Learn about the prevention, diagnosis and treatment of osteoporosis. Identify your risk factors, understand your bone density test resuts, earn how to optimize your nutrition and discuss other steps you can take to reduce risk factors for bone oss and/or osteoporosis. You wi be empowered with the knowedge to promote stronger bones for ife! Shari Siverstein, RN, MS and Michee Mosner, RD, CDN, Co-Coordinators of the NY State Osteoporosis Prevention and Education Program 7 pm Board Room Ca (914) to register. Caendar on the web We were disappointed to earn that the previous issue of Pheps Today was not deivered to some peope unti after the caendar events and screenings had begun. To be sure that you do not miss any programs in the future, pease reguary visit and cick on caendar of events to earn about the atest offerings. Receive Emai News If you woud ike to receive announcements and heath information via e-mai, pease e-mai pmhc.us. Appointments are required. Schedues for a programs are subject to change. pheps today 9

12 Pheps Supporter Lisina Hoch Named ADO Phianthropist of the Year For more than 50 years, Mrs. Hoch, aong with her ate husband, Frank, has been a major benefactor to a wide array of oca and internationa sociay responsibe organizations. Her ong record of phianthropy as a eader, vounteer and donor spans the gobe. Pictured at one of the Bhutanese training sessions is Lisina Hoch (right), vice president of the Bhutan Foundation, with Tashi Tenzin, MD, director of the emergency department at Bhutan s Nationa Referra Hospita, and orthopedic surgeon Ugyen Thiney, MD. Lisina Hoch, a ong-time Irvington resident and a generous supporter of Pheps, was named 2010 Phianthropist of the Year by the Association of Deveopment Officers (ADO), a nonprofit organization dedicated to the advancement of fundraising and phianthropy in the Hudson Vaey. For more than 50 years, Mrs. Hoch, aong with her ate husband, Frank, has been a major benefactor to a wide array of oca and internationa sociay responsibe organizations. Her ong record of phianthropy as a eader, vounteer and donor spans the gobe. Mrs. Hoch s affiiation with Pheps began in 1955, when she worked as a vounteer shorty after the hospita opened. Over the years, she has served on numerous hospita committees, and she is currenty a member of the Deveopment Committee. The Hochs funded numerous projects at Pheps, incuding the Hoch Center for Emergency Education, which serves communities in the Hudson Vaey and throughout the Northeast. The Hoch Center provides ife support programs and emergency preparedness training for emergency medica service providers, medica and nursing staff, businesses, organizations and community members. We are so proud that Lisina was named ADO s Phianthropist of the Year, said Keith Safian, President and CEO of Pheps. We are peased that her extraordinary efforts on behaf of Pheps and so many other non-profit organizations have been recognized in such a fitting way. Mrs. Hoch has a specia abiity to weave her phianthropic activities together. She is vice president of The Bhutan Foundation, and in 2009, sponsored a group of six medica personne from the Himaayan region to come to the Hoch Center. The doctors and nurses received training on how to create Bhutan s first emergency medica services system no easy task for a remote, mountainous country of 700,000 citizens. In just one year, those six heathcare professionas trained hundreds of Bhutanese citizens incuding taxi drivers, teachers and nuns to serve as medica first responders. Lisina and her famiy aso purchased the first fuy equipped ambuance for Bhutan. In 2010, a second group of Bhutanese medica professionas came to Pheps for training. In addition to her work with Pheps, Lisina Hoch has aso generousy donated her time and resources to The Asia Society; the Woods Hoe Oceanographic Institute; Scenic Hudson, the argest environmenta organization in the Hudson Vaey; and Exodus Transitiona Community, Inc., an organization that heps reeased prisoners begin the difficut work of reentry into society. Described as the quintessentia phianthropist, Lisina Hoch personifies the concept of responsibe and unsefish generosity. Her eadership has inspired many to be phianthropic, and her chidren are continuing in her footsteps. Mrs. Hoch s phianthropic work has without a doubt made Pheps, the Hudson Vaey and the word a better pace. 10 pheps today

13 Maternity & Baby Care Casses The Chidbirth Experience/ LaMaze Method Weeknights 7:30 9:30 pm for 5-6 weeks Start dates: Apri 6, Apri 26, May 18, June 7, June 29 or Weekend sessions, 10 am 3 pm: Apri 9-10, May 14-15, June 11-12, Juy Cost: $170 per coupe Breastfeeding: First Choice for Babies Apri 7, May 2, June 2, Juy pm Cost: $45 per coupe ABCs of Baby Care Apri 4, 21, 28; May 5, 19; June 6, 20 or 30 6 pm Cost: $65 per coupe care eary in their pregnancy. Care is provided at Open Door during the first 36 weeks of pregnancy and at Pheps Memoria Hospita during the remainder of the pregnancy and for deivery. For information, ca (914) Atención Prenata: Pheps Memoria Hospita Center en Seepy Hoow y Open Door Famiy Medica Centers, participantes en e Programa de Asistencia de Atención Prenata de Medicaid, auspician conjuntamente un Programa Prenata. La atención de mujeres embarazadas es provista por un persona biingüe y soidario, atamente capacitado. No se rechaza a nadie basándose en sus ingresos económicos o seguro. Se aienta a as mujeres a recibir atención prenata o más temprano posibe durante su embarazo. La atención es provista en Open Door durante as primeras 36 semanas de embarazo y en Pheps Memoria Hospita durante e resto de embarazo y e parto. Para mayor información, sírvase amar a (914) Big Brother/Big Sister: Sibing Preparation Apri 16, May 21, June 18, Juy 23 10:30 am Cost: $20 per chid Totsaver Program: American Heart Association CPR for Famiy and Friends Apri 2, May 7, June 4, Juy 9 9 am $55 per person For up-to-date schedue, visit hospita.org or ca (914) for information or to register. Prenata Cinic: Pheps Memoria Hospita Center and Open Door Famiy Medica Centers, participants in the Medicaid Prenata Care Assistance Program, jointy sponsor a Prenata Program. Care for expectant mothers is provided by a highy trained, caring, biingua staff. No one is turned away based on income or heath insurance. Women are encouraged to seek prenata pheps today 11

14 Infertiity A Q & A with Dr. Rache Bennett If you are under 35 and have been attempting conception for at east one year, it s appropriate to see a fertiity speciaist. If you are over 35, a visit to a speciaist is recommended after six months of trying. My husband and I want to have a baby, but I can t get pregnant. Shoud I see a speciaist? It depends on your age and how ong you ve been trying to have a baby. If you are under 35 and have been attempting conception for at east one year, it s appropriate to see a fertiity speciaist. If you are over 35, a visit to a speciaist is recommended after six months of trying. In some cases, it s a good idea to seek advice from a fertiity speciaist before attempting to get pregnant or shorty after. For femaes and maes, this appies to anyone with a history of infertiity or a history of cancer and/or radiation or chemotherapy. Femaes with a history of sexuay transmitted disease, pevic infammatory disease (PID) or previous abdomina or gynecoogica surgery shoud consider seeing a speciaist, as shoud maes who have a history of testicuar infection, infammation, trauma or surgery. If we aren t ready to see a speciaist yet, are there ifestye changes my husband and I can make that might hep us get pregnant? Yes, you shoud avoid tobacco and marijuana, which reduce sperm counts. Avoid excessive acoho use, which may damage eggs or sperm, and avoid harmfu chemicas. Maintain a body weight that is recommended for your height to hep prevent hormone imbaances. In genera, eat a heathy diet with adequate servings of fruits and vegetabes, and whenever possibe choose whoe grains rather than refined carbohydrates. Try to be as reaxed as possibe, as stress may have an effect on fertiity. What testing and treatments wi be done to hep me conceive? First, your hormone eves wi be checked. If your thyroid is underactive or overactive, you wi be given medication. Likewise, if your eve of the hormone proactin, which is produced by the brain, is eevated, medication can hep. If you re ovuating irreguary or aren t ovuating at a, fertiity medications can be prescribed to induce ovuation. If you have poycystic ovarian syndrome, it can be treated by exercise, diet and/or medication as we as ovuation induction with fertiity medications. A procedure caed hysterosapingography (HSG) can determine if there are anatomica causes for infertiity. HSG is an x-ray examination of a woman s uterus and faopian tubes that uses a specia form of x- ray caed fuoroscopy and a contrast materia. If the HSG demonstrates intrauterine fibroids or poyps, these can be surgicay removed in a procedure caed a hysteroscopy. If faopian tubes are bocked, surgery (aparoscopy) can be considered to unbock them, or in vitro fertiization (IVF) can be performed. Another condition that sometimes causes infertiity is endometriosis, in which the tissue that ines the inside of the uterus aso grows outside of the uterus. Endometriosis can cause painfu periods, painfu sexua intercourse, irreguar beeding and generaized chronic pevic pain. Endometriosis can be diagnosed surgicay during a aparoscopy, at which time it can be surgicay removed to enhance fertiity. What tests wi be done to determine my husband s fertiity? Mae infertiity is a resut of ow sperm production, misshapen or immobie sperm, or bockages or other probems that prevent sperm from being deivered. 12 pheps today

15 Your husband s semen wi be anayzed to determine how much is produced as we as the number and quaity of sperm in the semen. If the resuts show any abnormaity, the test may be repeated or he may be referred to a uroogist. Enarged testicuar veins caed varicocees are a common cause of ow sperm production and decreased sperm quaity. Varicocees are easiy diagnosed and can be repaired surgicay by a uroogist. Your husband s hormone eves may be checked. If there is a hormone imbaance, particuary in the thyroid or pituitary gands, it can be treated with medication. What if my husband and I undergo testing but no probems are discovered? Sometimes, the reasons for infertiity cannot be expained. In such cases, ovuation enhancement with fertiity medications combined with artificia insemination (IUI) or in vitro fertiization (IVF) may be used with or without intracytopasmic sperm injection (ICSI). Can you describe some of these treatments? Ovuation induction or enhancement can be achieved by: Taking a pi most commony comiphene citrate (Comid) for five days at the beginning of the menstrua cyce. Ovuation often occurs five to nine days after the ast pi is taken. Administration of Foice Stimuating Hormone (FSH) injections for an average of 10 consecutive days at the start of the menstrua cyce. During the injection period, frequent visits to the doctor take pace so that estrogen eves can be checked, and utrasounds are done to observe growth of the foices that contain the eggs. Dosage adjustments can be made if necessary. Artificia Insemination (IUI) Artificia insemination is usuay performed in the doctor s office. A semen sampe is obtained and processed using a method that separates heathy sperm from weak or abnormay shaped sperm. The sperm is then inserted into the uterus with a soft catheter. The procedure takes ess than haf an hour and is usuay painess. The hope is that the sperm wi swim into the faopian tubes and fertiize a waiting egg, resuting in pregnancy. In Vitro Fertiization (IVF) or In Vitro Fertiization with Intracytopasmic Sperm Injection (IVF/ICSI) The first phase of in vitro fertiization invoves the injection of Foice Stimuating Hormone with the goa of producing mutipe mature eggs. The eggs are retrieved during a 15-minute procedure caed foicuar aspiration, which is usuay done under anesthesia. With standard IVF, a semen sampe is taken and the good sperm are processed and paced in the dish with the eggs. Aternativey, the sperm can be injected directy into the eggs, during the process caed intracytopasmic sperm injection (ICSI). In both cases, the eggs are kept in the dish in an incubator for two to five days, where they grow and deveop. When the embryos are ready, they are paced into the uterus in a painess procedure using a soft catheter. The extra embryos can be frozen for future use through a process caed embryo cryopreservation, so that they wi be avaiabe if the cyce does not work or if a coupe wants to have another baby in the future. Other anciary procedures such as assisted hatching or pre-impantation genetic diagnosis (PGD) may be used in some cases. Assisted hatching is used frequenty with in vitro fertiization to improve the chances of the embryo impanting successfuy in the uterine wa. Pre-impantation genetic diagnosis invoves testing of embryos for the most common chromosome abnormaities and using ony norma embryos to attempt a pregnancy. Each in vitro fertiization cyce, therefore, has a better potentia outcome, since embryos screened in this way have been shown to have a higher rate of impantation in the uterus, ower spontaneous oss rate, and a reduced risk of Down syndrome. What is the success rate for artificia insemination and in vitro fertiization? Typicay, artificia insemination yieds a 10-20% success rate per cyce. Pregnancy rates per cyce for in vitro fertiization are as high as 60-70% for women under 35, with ower rates for oder women. Pease refer to the caendar of events in this issue of Pheps Today for information about presentations by Dr. Bennett on Apri 13, May 11 and June 15. Rache Bennett, MD, earned her medica degree at Mount Sinai Medica Center. She competed a residency in obstetrics/ gynecoogy at New York-Presbyterian Hospita/Wei Corne Medica Center and a feowship in reproductive endocrinoogy at Harvard s Brigham and Women s Hospita in Boston. Dr. Bennett is board certified in obstetrics and gynecoogy and reproductive endocrinoogy. Her fertiity practice, Westchester Reproductive Medicine, is ocated in Mount Kisco (914) ; com. pheps today 13

16 I understand that parents become concerned when a fever deveops, says Dr. Stiman, but fever is ony part of the picture. It is a sign that your body s immune system is fighting an infection. Our job as pediatricians is to determine if your chid has a vira infection, such as a common cod, and can fight the infection himsef, or if it is a bacteria infection that wi need an antibiotic. Fever in Chidren Perhaps one of the most common distress cas that parents make to their pediatrician is My chid has a fever! When pediatrician Margaret Stiman answers such a ca, her first question is What other symptoms are there? Pediatricians evauate fevers every day. I understand that parents become concerned when a fever deveops, says Dr. Stiman, but fever is ony part of the picture. It is a sign that your body s immune system is fighting an infection. Our job as pediatricians is to determine if your chid has a vira infection, such as a common cod, and can fight the infection himsef, or if it is a bacteria infection that wi need an antibiotic. Signs and Symptoms Pediatricians try to hep parents identify the signs and symptoms that shoud raise concern by asking some key questions: Are there signs of a typica eary vira iness with runny nose and cough? Is your chid aert? Is there any pain? If so, where does it hurt? Is he abe to swaow and drink fuids? Is there vomiting or diarrhea? If so, can your chid keep fuids down? Are the ony symptoms a fever and a sore throat? This coud point to strep throat, which is a bacteria infection. If your chid had a cod and a cough without any fever, did a fever suddeny deveop? This coud signa that a secondary bacteria infection has deveoped. Did your chid have a sight cough that turned into coughing non-stop a night ong? This coud be a sign of pneumonia, which can be either vira or bacteria. If your baby is ess than 3 months od, any temperature over shoud prompt a ca to your pediatrician to be safe. Definition of Fever It is generay accepted that a recta temperature over or an ora temperature over 99.5 is a fever. Parents ask at what temperature they shoud be concerned. It is reay not the precise temperature as much as how the chid is acting. If the chid s behavior improves after the temperature is brought down by a fever reducer, that is reassuring. It is aso hepfu to know 14 pheps today

17 that fevers often go up in the ate afternoon and evening (as does the norma body temperature). It woud not be surprising for a chid who has a temperature of 100 at 8 in the morning to have a temperature of 102 by the evening. That shoud not be aarming. Measuring the Temperature The most accurate temperature is a recta temperature using a digita thermometer. An ora digita thermometer can be used in a chid over 4 or 5. Ear thermometers are ess accurate, but often used by parents because they are easy to use. They are not reiabe in infants ess than 6 months od. Effects of Fever There was a time when some pediatricians did not recommend giving medication to reduce a high temperature, because it was beieved that fever was important in heping a chid get we faster. Whie there has not been any scientific data to prove the benefits of fever, it is generay agreed that fever itsef is not harmfu. Contrary to common misconceptions, fever does not cause brain damage and it does not cause epiepsy. The decision to give medication to reduce fever shoud be based on how your chid is feeing. If your chid seems comfortabe and is paying and eating, there is no need to treat the fever. However, if your chid is seepy, irritabe or not taking anything to drink or eat, it woud be a good idea to treat the fever. Pease be aware that if you decide not to treat a fever, your chid wi need to drink more iquids to prevent becoming dehydrated. Controing Fever Either acetaminophen or ibuprofen can be used to reduce a fever. Aspirin is not recommended for chidren under 18 years of age because of its association with Reye s syndrome, a rare but serious condition that causes sweing in the iver and brain. Determining how much medicine to give your chid depends on his weight. The dosage amounts for acetaminophen and ibuprofen are different, so it is very important to read the instructions. Acetaminophen and ibuprofen preparations are aso different for infants and chidren. If you have any doubt about what the correct and effective dose is for your chid, ca your pediatrician with the medication in your hand so you can te her which preparation you have at home. You aso need to te the doctor how much your chid weighs. Check the ingredients on the botte to make sure nothing has been added to the acetaminophen or ibuprofen, as some preparations may incude a decongestant, antihistamine or some other ingredient. Teething Teething does not cause a high fever. If your teething chid s temperature is more than degrees, it is not just from teething something ese is going on and you shoud ca your pediatrician. Immunizations When your chid receives an immunization, he may react with a sight fever. The benefits of immunizations far outweigh such mid effects, however. Consider the fact that in the 1950s, many chidren were cripped by poio, a disease conquered by the poio vaccine. Thanks to the haemophius (Hib) vaccine and the pneumococcus vaccine, the incidence of meningitis, pneumonia, and other serious infections associated with high fevers has decreased dramaticay over the past years. Visiting the Emergency Department If your chid with a high fever ooks very i, has a severe cough or experiences a first-time seizure and you are unabe to see your pediatrician, you shoud take him to the Emergency Department. If you come to Pheps, a pediatric hospitaist, who speciaizes in taking care of chidren in the hospita, wi be avaiabe to evauate and treat your chid. She is just one of the many speciaists from Maria Fareri Chidren s Hospita who care for pediatric patients at Pheps. Some of the speciaists have offices right on the Pheps campus. The decision to give medication to reduce fever shoud be based on how your chid is feeing. If your chid seems comfortabe and is paying and eating, there is no need to treat the fever. However, if your chid is seepy, irritabe or not taking anything to drink or eat, it woud be a good idea to treat the fever. Margaret Stiman, MD, earned her medica degree at Coumbia University Coege of Physicians and Surgeons. She competed an internship and residency in pediatrics at Babies Hospita in New York and a feowship in behaviora pediatrics at the University of Maryand Medica System in Batimore. Dr. Stiman is board certified in pediatrics and is the Director of the Department of Pediatrics at Pheps. She and her coeagues, Drs. Harry Lube, Caroine Cho and Emiy Koesch, see their young patients at 245 North Broadway in Seepy Hoow (914) pheps today 15

18 Yo entiendo que os padres se preocupen cuando a temperatura sube, dice a Dra. Stiman, pero a fiebre es soo parte de cuadro genera. Es un signo de La fiebre en os niños que e sistema inmunitario de cuerpo está uchando contra una infección. Nuestro trabajo como pediatras es determinar si su niño tiene una infección vira, por ejempo un resfrío, y si é mismo podría uchar contra a infección, o si es una infección bacteriana que necesita un antibiótico. Ta vez una de as amadas más comunes en situación de angustia que os padres hacen a su pediatra es: Mi niño tiene fiebre! Cuando a pediatra Margaret Stiman responde a una amada ta, su primera pregunta es: Qué otros síntomas tiene? Los pediatras evaúan fiebres todos os días. Yo entiendo que os padres se preocupen cuando a temperatura sube, dice a Dra. Stiman, pero a fiebre es soo parte de cuadro genera. Es un signo de que e sistema inmunitario de cuerpo está uchando contra una infección. Nuestro trabajo como pediatras es determinar si su niño tiene una infección vira, por ejempo un resfrío, y si é mismo podría uchar contra a infección, o si es una infección bacteriana que necesita un antibiótico. Signos y síntomas Los pediatras tratan de ayudar a que os padres identifiquen os signos y síntomas que deberían ser preocupantes haciéndoes agunas preguntas cave: Hay signos de comienzo típico de una enfermedad vira con corredera nasa y tos? Su niño está aerta? Hay agún door? Si es así, dónde e duee? Su niño puede tragar y beber íquidos? Tiene vómitos o diarrea? Si es así, su niño puede retener os íquidos? Soo hay un fiebre y un door de garganta? Estos son síntomas que podrían indicar un estreptococo en a garganta, que es una infección bacteriana. Si su niño tuvo un resfrío y un tos sin fiebre, aparecióó fiebre repentinamente? Esto podría indicar que desarroó una segunda infección bacteriana. Tuvo su niño un poco de tos y uego pasó a toser sin parar durante toda a noche? Esto podría ser un signo de neumonía, que puede ser vira o bacteriana. Si su bebé tiene menos de 3 meses, cuaquier temperatura superior a os es motivo para amar a su pediatra, por seguridad. Definición de fiebre Por o genera se acepta que una temperatura recta superior a os o una temperatura ora superior a os 99.5 es fiebre. Los padres preguntan a qué temperatura deberían preocuparse. En reaidad no es a temperatura exacta, sino cómo e niño está actuando. Si a conducta de niño mejora después que a temperatura baja con una medicación para bajar a fiebre es un buen signo. También ayuda saber que a fiebre a menudo sube a fina de a tarde y comienzo de a noche (como pasa con a temperatura corpora norma). No sorprendería que un niño con una temperatura de 100 a as 8 a.m. tenga una temperatura de 102 a comenzar a noche. Eso no debería aarmar. 16 pheps today

19 Medición de a temperatura La temperatura más exacta es a temperatura recta medida con un termómetro digita. Un termómetro digita ora puede usarse en un niño mayor de 4 o 5 años. Los termómetros de oído son menos precisos, pero os padres a menudo os prefieren porque son fácies de usar. Estos termómetros no son fiabes en bebés de menos de 6 meses. Efectos de a fiebre En una época, agunos pediatras no recomendaban dar medicación para bajar una temperatura ata, porque se creía que a fiebre era importante para ayudar a niño a sanar más rápido. Si bien no ha habido una base científica que compruebe os beneficios de a fiebre, generamente e consenso es que a fiebre en sí misma no es dañina. Contrariamente a fasos conceptos comunes, a fiebre no causa daño cerebra y no causa epiepsia. La decisión de dar medicación para bajar a fiebre debe basarse en cómo su niño se siente. Si su niño se ve cómodo, está jugando y se aimenta, no hay necesidad de tratar a fiebre. Sin embargo, si su niño está somnoiento, irritabe o no quiere comer ni beber nada, tratar a fiebre sería una buena idea. Por favor, sea consciente que si usted decide no tratar a fiebre, su niño necesitará beber más íquidos para prevenir una deshidratación. Contro de a fiebre E acetaminofeno o e ibuprofeno pueden usarse para bajar a fiebre. La aspirina no está recomendada para niños menores de 18 años por su asociación con e síndrome de Reye, una condición rara pero grave que causa infamación en e hígado y e cerebro. Determinar a cantidad de medicina para dar a su niño depende de peso de niño. Las cantidades en as dosis de acetaminofeno e ibuprofeno son diferentes, así que es muy importante eer as instrucciones. Las preparaciones de acetaminofeno e ibuprofeno también son diferentes para bebés y para niños. Si tiene cuaquier duda acerca de qué dosis es correcta y efectiva para su niño, ame a su pediatra con a medicación en su mano y así podrá decire qué preparación usted tiene en su casa. Usted también necesitará decire a médico cuánto pesa su niño. Controe os ingredientes en e frasco para asegurarse que nada se añadió a acetaminofeno o ibuprofeno, porque agunas preparaciones pueden incuir un descongestivo, un antihistamínico o agún otro ingrediente. La dentición La dentición no causa una fiebre ata. Si a temperatura de su niño, a que e está creciendo un diente, es más de grados, eso no es simpemente por a dentición, ago más está pasando y usted debe amar a su pediatra. Inmunizaciones (vacunas) Cuando su niño recibe una vacuna, é o ea puede reaccionar con una fiebre eve. Pero os beneficios de as vacunas superan ampiamente esos efectos eves. Considere que a fines de a década de 1950, muchos niños quedaban inváidos por a poio, una enfermedad vencida por a vacuna contra a poio. Gracias a a vacuna contra e hemófio (Hib) y a vacuna contra e neumococo, a incidencia de meningitis, neumonía y otras infecciones graves asociadas con fiebres atas ha descendido drásticamente a o argo de os útimos 10 a 20 años. Visita a Departamento de Emergencias Si su niño que tiene una fiebre ata se ve muy enfermo, tiene una tos muy fuerte o sufre por primera vez una convusión y usted no puede ver a su pediatra, debe evaro a Departamento de Emergencias. Si usted viene a Pheps, un médico hospitaista pediátrico, que se especiaiza en a atención de niños en e hospita, estará disponibe para evauar y tratar a su niño. Este profesiona es sóo uno de os muchos especiaistas de Maria Fareri Chidren s Hospita que atiende pacientes pediátricos en Pheps. Agunos de estos especiaistas tienen sus consutorios en e mismo campus de Pheps. La decisión de dar medicación para bajar a fiebre debe basarse en cómo su niño se siente. Si su niño se ve cómodo, está jugando y se aimenta, no hay necesidad de tratar a fiebre. Sin embargo, si su niño está somnoiento, irritabe o no quiere comer ni beber nada, tratar a fiebre sería una buena idea. Margaret Stiman, MD, obtuvo su títuo de médica en a Facutad de Medicina y Cirugía de a Universidad de Coumbia. Ea competó una pasantía y residencia en pediatría en Babies Hospita en New York y un postgrado en pediatría conductua en e Sistema Médico de a Universidad de Maryand en Batimore. La Dra. Stiman es médica certificada en pediatría y es a Directora de Departamento de Pediatría en Pheps. Ea y sus coegas, os doctores Harry Lube, Caroine Cho y Emiy Koesch, ven a sus pacientes pediátricos en 245 North Broadway en Seepy Hoow (914) pheps today 17

20 Breaking News on Vaccination and Autism Ronad I. Jacobson, MD Chief of Pediatric Neuroogy at Maria Fareri Chidren s Hospita Associate Cinica Professor of Neuroogy and Pediatrics at New York Medica Coege In the ongoing research for autism causes, the newest area of great interest is the discovery of sma changes in the DNA of chidren with autism. On Wednesday, January 5, 2011, ABC-TV s Breaking News of the day was yet another piece in the ong debate about whether vaccines such as those protecting us from meases, mumps, and rubea might cause autism and/or autism-reated gastrointestina probems. Eary that evening I was interviewed by Jim Doan of Channe 7 News, who asked me the a-too-famiiar question, How has the news about vaccination fears affected your patients? This is a daiy question for me in my pediatric neuroogy practice, and I am sure an even more frequent concern of parents in their quest for information from their pediatricians. The study that originay gained so much notice was pubished in The Lancet in 1998 by the British physician Dr. Andrew Wakefied. However, The Lancet ater retracted the pubished artice due to concerns about inaccuracies. Eventuay many coauthors aso rejected the artice and its caims. Now the British Medica Journa has pubished an investigative artice and an editoria stating that the origina Lancet artice was more than miseading, it contained misrepresentations of the medica histories of the chidren in the study. Caims of dishonesty, misconduct, and now fraud have circuated through the scientific and ay press. By January 13, 2011, a week after the ABC report, more information was reveaed in the British Medica Journa, caiming financia gain was a possibe motivation for the unsubstantiated research originay pubished in The Lancet. When I was interviewed by Jim Doan, my fina comment was that the controversy has diverted attention from the rea concern what is, or are, the cause or causes of autism, whether environmenta or genetic? It is a shame that the focus on this misinformation distracted the scientific community from pursuing rea opportunities to serve our patients and to search for the truth. In the ongoing research for autism causes, the newest area of great interest is the discovery of sma changes in the DNA of chidren with autism. Recent studies have shown that about 18-20% of chidren with autism have sma DNA changes caed Copy-Number Variations (CNVs). These are aterations of DNA that can be caused by deetions, dupications, inversions, and/or transocations, which jumbe the proper reading of the genetic code contained in the genome (the bioogica information needed to buid and maintain a iving organism). Commercia abs are now abe to do genetic evauations for CNVs; however, doing routine tests on a chidren with autism may be premature. This area of research is rapidy evoving, with better tests being deveoped every few months. Understanding the changes in brain function caused by the CNVs associated with autism or simiar disorders may hep us gain insight into proper diagnosis, and eventuay ead us to treatments designed to improve the resutant brain dysfunction. That is my dream and hope for breaking news stories in the future. 18 pheps today

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