TODAY. Daniel Blum Appointed President & CEO. Phelps Joins North Shore-LIJ Health System. State-of-the-Art SurgiCenter Opens

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1 phelps News from Phelps Memorial Hospital Center Spring 2015 TODAY Daniel Blum Appointed President & CEO Phelps Joins North Shore-LIJ Health System State-of-the-Art SurgiCenter Opens The All-Important Kidneys: Your Body s Filter The Inner Ear and Balance Daniel Blum President & CEO Chickenpox

2 Letter from the President and Chairman Dear Friend, A lot has been happening at Phelps over the past several months. In November, after 25 years at the hospital s helm, Keith Safian stepped down from his position as President & CEO. This change occurred shortly before Phelps joined the North Shore-LIJ Health System, becoming the system s first hospital in Westchester County. It is exciting for us to be part of this superb organization, and we look forward to the benefits that the hospital and our community will realize from this relationship. In February, the much-anticipated opening of our new SurgiCenter took place. The facility has exceeded all expectations in terms of functionality and patient comfort and satisfaction. The combination of the state-of-the-art facility and our outstanding surgical staff makes the Phelps SurgiCenter one of the top surgery centers in the region. We continue to expand Phelps Medical Associates, our primary care and multispecialty medical group, with plans to establish practices at additional locations in the coming year. In our roles as Chair of the Board and the new President & CEO, we look forward to working together to fulfill Phelps mission to serve the healthcare needs of our community. We wish you the best of health in the warm months to come. Sincerely, Richard J. Sinni Chair, Board of Directors Daniel Blum President & CEO 2 PHELPS TODAY

3 Table of Contents PHELPS TODAY Editor Mary Sernatinger Managing Editor Tina Dorfman Medical Editor Bruce Heckman, MD, MPH Editorial Advisors Daniel Blum Lucy C. Engelhardt, RN Robert R. Lane Mary McDermott, RN PHELPS TODAY is a publication of Phelps Memorial Hospital Center, a 238-bed, not-forprofit acute care community hospital located in Sleepy Hollow, NY. Phelps, part of the North Shore LIJ Health System, 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 Daniel Blum Appointed Phelps President & CEO 5 Vincent DeSantis Named a 2014 Westchester CFO of the Year 5 Phelps Becomes Part of North Shore-LIJ Health System 6 The SurgiCenter: A Milestone in Phelps History 8 The All-Important Kidneys: Your Body s Filter 10 Relief from Carpal Tunnel Syndrome 13 Family Medicine Residency Program Thrives in Third Year 15 Don t Call It a Comeback: Chickenpox Has Been Here for Years 18 Dizziness and the Inner Ear 21 Phelps Medical Associates News 23 Vitality: Why Preventing Falls Is So Important 27 Healthy Life Calendar 30 Los tan importantes rinones: El filtro de su cuerpo 33 No la llame un retorno: La varicella ha estado aquí por años 36 Report from Auxiliary President Mark Frederich 39 CARE 60Years CELEBRATING P HELPS PATIENT EXCELLENT 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! Visit us on Facebook: PhelpsMemorialHospitalCenter Visit us on Twitter: https://twitter.com/ #!/phelpshospital Phelps Community Service Plan Phelps Memorial Hospital Center is committed to improving the health and well-being of the community. To see our Community Service Plan ( ) and learn about our current and planned activities and initiatives, please visit phelpshospital.org/about-phelps and click on Community Service Plan. A summary of the hospital s 2013 community service is described in our Caring for Our Community publication, which is also available at the same address (click on Caring for Our Community ). A printed copy of these publications may be requested by calling PHELPS TODAY 3

4 Exciting Projects to Begin at Phelps! Two major construction projects will begin at Phelps this spring. A new MRI facility featuring the most advanced technology will be built in the area of the current main lobby. The front of the 755 Building will be expanded to create a magnificent new main lobby. During construction, it will be necessary to close the road that runs in front of the hospital and the 755 Building, but it will still be possible to get from one side of the campus to the other by driving behind the hospital. Access to Admitting and the main hospital will be through the West Wing entrance, shown on the map at right as New Main Entrance. The new main lobby will be a grand entrance to Phelps Memorial Hospital. Signs will be posted, and we will do our best to minimize any inconvenience. Thank you for your understanding as Route 9 Tappan Zee Bridge Use New Main Entrance to access Admitting and Hospital Bus Stops Phelps Lane South Parking Residence Building Hudson River New Main Entrance Park here for Admitting and Hospital Emergency Dept. 707 MRI 777 Building West Wing Robin s Nest Southwest Parking Riverview Auditorium 701 Entrance Closed Road Closed we make these major improvements to our hospital. Kendal on Hudson West Parking Entrance Closed James House 755 North Entrance 755 Building Use 755 North Entrance to access physicians and services in the 755 Bldg. N Rockefeller State Park Preserve Garage Park here for 755 Bldg. Pedestrian Access / Elevators To Route 117 Northeast Parking Park here for 755 Bldg. Kendal Way Garage Entrance Access to the 755 Building will be through its back entrance, directly across from the garage. Route 9 North Broadway Tim Grajek illustration & design 4 PHELPS TODAY

5 Daniel Blum Appointed Phelps President and CEO Daniel Blum has officially assumed the role of President and CEO of Phelps Memorial Hospital Center, following the resignation of Keith Safian, who led the hospital for 25 years. From 2009 until assuming his new role, Mr. Blum served as Phelps Senior Vice President. We believe that Daniel Blum s exceptional knowledge and experience will ensure Phelps continuing success as we transition to become a member of the North Shore-LIJ Health System, said Richard J. Sinni, Chair of the Phelps Board. While he was Senior Vice President, Mr. Blum developed Phelps Medical Associates, the hospital s multi-specialty medical group, and was responsible for implementing the hospital s strategic plans and overseeing its clinical and ancillary services. He serves as collaborating administrative executive on Phelps Graduate Medical Education Committee and Chairman of the Board of Robin s Nest, the hospital s child care center. Prior to joining Phelps, Mr. Blum was Senior Vice President of White Plains Hospital Center, Vice President of Operations of the Stellaris Health Network, and Operations Manager at St. Vincent s Hospital and Medical Center in New York City. He began his healthcare career as a paramedic and paramedic instructor in New York City and worked at several New York City hospitals in clinical and administrative capacities. Mr. Blum holds a bachelor s degree in philosophy and a master s degree in healthcare administration, both from New York University. He is a member of the American College of Healthcare Executives and Medical Group Management Association. Mr. Blum is also Chairman of the NYS Department of Health Emergency Medical Advisory Council. Vincent DeSantis Named a 2014 Westchester CFO of the Year Phelps VP of Finance and Chief Financial Officer Vincent DeSantis was honored as 2014 Westchester CFO of the Year in the large company category. He accepted his award at a ceremony hosted by Westfair Communications last fall at the Wainright House in Rye. When Mr. DeSantis came to Phelps in 2001, he brought more than 25 years of experience in accounting and auditing. Prior to joining Phelps, he was associate executive director/cfo of Long Island Jewish Medical Center in New York City, part of the North Shore-LIJ Health System. Earlier in his career, he spent 18 years at the accounting firm Deloitte & Touche, LLP, where he was senior manager of the healthcare division. Mr. DeSantis earned his BBA and MBA at Iona College in New Rochelle, NY, and is a New York State CPA. He was an adjunct professor of healthcare finance in the graduate division at Iona College and in the bachelor of science general accounting program at Mercy College School of Business. A Healthcare Association of New York State (HANYS) report pertaining to profitability, liquidity and capital structure has ranked Phelps consistently among the top 10 percent of all acute care hospitals in New York State throughout Mr. DeSantis s tenure as the hospital s CFO. Being a CFO is a hard job, he noted in his acceptance speech, but it s also an exciting job that allows me to be creative, generate growth and go beyond the numbers. He accepted the award on behalf of the leadership team and all of his colleagues in the financial departments at Phelps. I work with the most amazing people in all areas of the hospital, and I thank them for their trust and confidence. PHELPS TODAY 5

6 Phelps Becomes Part of the North Shore-LIJ Health System Phelps was honored by the presence of North Shore-LIJ top executives at the SurgiCenter Ribbon Cutting. Pictured left to right: Daniel Blum, Phelps President & CEO; Avraham Merav, MD, Medical Director, Surgical Services; Mark J. Solazzo, Executive Vice President and Chief Operating Officer, North Shore-LIJ Health System; Michael J. Dowling, President and CEO, North Shore-LIJ Health System; and Richard Sinni, Chair, Phelps Board of Directors. Across the country, healthcare organizations are changing, as hospitals and physician groups partner with large health systems. In Westchester, nearly all of the community hospitals have made such alliances. Phelps, which has achieved financial stability for more than 25 years, recognizes that an ever-changing healthcare environment creates financial challenges for all hospitals. Being a member of a large, stable health system helps hospitals increase efficiency, lower operating costs and improve quality, enabling them to continue to serve the people who rely on them for their healthcare needs. Formerly Stellaris Phelps was previously a member of the Stellaris Health Network, which included three other Westchester community hospitals. Recognizing the need to connect with larger systems, each of the Stellaris hospitals decided to explore opportunities for partnerships with other health networks in There were a number of possible choices for Phelps, and each was carefully examined. In the end, one system stood out as the one that would benefit our hospital and our community the most. North Shore-LIJ Health System The North Shore-LIJ Health System shares the same commitment to 6 PHELPS TODAY

7 community and quality as Phelps. The system s goal, as stated by President and CEO Michael Dowling, is to be better tomorrow than we are today, a sentiment that Phelps supports with regard to the hospital and everyone who comes to us for care. North Shore-LIJ considered Phelps a good partner because our hospital has long been financially stable and is highly regarded in Westchester. Importantly, the system will enable Phelps to continue to serve as our community s hospital, as stated by Mr. Dowling: We are committed to strengthening and expanding the clinical services that Phelps provides, ensuring that the hospital will continue to fulfill its mission as a full-service community hospital. New York State s largest private employer, the system has 19 hospitals and about 54,000 employees throughout Long Island, New York City and, now, Westchester. North Shore-LIJ will support Phelps in developing services, enhancing facilities, acquiring the latest technology and expanding our medical staff. Phelps will have access to high-level expertise and knowledge and education and research opportunities. Phelps success has been based on continued growth, and our partnership with North Shore-LIJ will accelerate our rate of growth while ensuring the delivery of high-quality, patient-centered care. Being Part of the North Shore-LIJ Family Phelps relationship with North Shore- LIJ has just begun, but the hospital has already been embraced as part of the system s family. When a major blizzard threatened in January, for example, various North Shore-LIJ departments reached out to their counterparts at Phelps, offering assistance with preparation and communication. They were even prepared to bring us an additional generator if the need arose. It is reassuring to know that the system s experts are available to support us whenever we need them. The Future Being part of the North Shore-LIJ Health System will enable Phelps to participate in new healthcare models such as population health management and accountable care organizations (ACOs), initiatives that a community hospital could not undertake on its own. The goal of these programs is to identify the most common health problems among the people we serve, and provide education and care to prevent and manage chronic diseases. Through these programs, we will deepen our connection to the community and fulfill our commitment to improving the wellness of all who look to Phelps for their healthcare needs. Phelps success has been based on continued growth, and our partnership with North Shore-LIJ will accelerate our rate of growth while ensuring the delivery of high-quality, patient-centered care. PHELPS TODAY 7

8 The SurgiCenter A Milestone in Phelps History At the SurgiCenter ribbon cutting, left to right: Mary McDermott, Sr. VP, Patient Care Services & CNO; Richard Sinni, Chair, Board of Directors; Daniel Blum, President & CEO; Kathleen Scherf, Nursing Director, Surgical Services; Avraham Merav, MD, Medical Director, Surgical Services; Richard Peress, MD, Director, Department of Surgery; Lawrence Faltz, MD, Chief Medical Officer; and Kerry Pisano, VP, Support Services. The opening of Phelps new operating suite the SurgiCenter marks a milestone in the hospital s history. Designed by a team of Phelps surgeons, nurses and other clinical staff, the facility s spacious operating rooms, state-of-theart technology and unique configuration provide an optimal environment for both ambulatory and inpatient surgery. The 20,000-square-foot facility is located on the third floor of the 755 North Broadway building. A connecting bridge links the SurgiCenter to the main hospital, allowing for easy circulation of supplies, equipment and staff. It is a safer surgi- cal environment than freestanding surgery centers, because the bridge ensures quick access to the full capabilities of the hospital and teams of medical subspecialists, such as cardiologists, pulmonologists and internists, notes Richard Peress, MD, Director of Surgery. While patients who are seriously ill or need complex surgery cannot be treated at a freestanding surgery center, they can be safely cared for in the SurgiCenter. The Latest Technology and Systems Considerable resources were allocated toward acquiring the latest technologyto make the SurgiCenter among Westchester s most advanced operating facilities. The five large operating rooms were designed to house the most modern and technologically advanced equipment and facilitate delivery of the highest quality surgical care. Suspension of equipment from ceiling booms enables exact positioning of technology and operating lights and keeps floor space clear. Video monitors positioned around the operating table project images from laparoscopic cameras as well as CAT scan, MRI, fluoroscopic and X-ray images, which are transmitted from a central computer. Anesthesiologists use an advanced computerized medication dispensing system. Phelps is one of only a few hospitals in New York State to install the STERIS RealView Visual Workflow 8 PHELPS TODAY

9 Management System, which provides real-time, instant updates on patient locations and perioperative status (admission, anesthesia, surgery and recovery). The system has two types of digital display screens one for families to keep them informed about the patient s status; the other for the surgical team that displays schedules, patient location and alerts regarding any special circumstances about the patient. Families can also request updates via text messages, which can be sent anywhere in the world. The SurgiCenter has an advanced, environmentally friendly waste disposal system that fully cleanses surgical waste water and utilizes reusable plastic containers. This significantly reduces the hospital s contribution to landfill and eliminates the need for removing the waste with diesel trucks. Admission and recovery rooms RealView display to keep visitors apprised of patient status Unprecedented Beauty and Comfort The décor in the SurgiCenter is a combination of contemporary and traditional, creating an overall timeless, elegant look. The space was designed to be very welcoming, comforting and warm. It includes a stone accent wall in the reception area, wall coverings in natural tones, and dark wood doors and trim throughout. Unlike the patient admission and recovery rooms at freestanding surgery centers, which are usually separated simply by curtain partitions, the Surgi- Center features rooms with solid walls and sliding glass doors, providing ample space, comfort and privacy. Soft, low lighting illuminates the patient s bed, Nursing station with brighter spot lighting above the chairs to allow visitors to read or use electronic devices. The combination of the new facility and the dedicated Phelps staff will enhance the hospital s attractiveness to patients and surgeons, according to Dr. Peress. We expect our SurgiCenter, which reflects the many ideas of surgeons and staff about how to create the best possible environment for patients, providers and changing technology, will meet our needs for decades to come. Spacious, technologically advanced operating rooms Considerable resources were allocated toward acquiring the latest technology to make the SurgiCenter among Westchester s most advanced operating facilities. PHELPS TODAY 9

10 The All-Important Kidneys: Your Body s Filter Just below the rib cage on either side of the spine are two fist-sized organs that are vital to our survival our kidneys. They each have about a million microscopic filters called nephrons, which process all of the blood in our bodies several times each day. This process filters toxins from about 150 quarts of blood, creating up to two quarts of urine that contains wastes and excess bodily fluid. The urine drains down tubes called ureters to the bladder and is emptied from the bladder through a tube called the urethra. The two images above are of the same kidney, which is filled with stones. The left image is an X-ray used for diagnosis. On the right is the image that the urologist obtained from an endoscope a narrow tube with a camera at the end that is inserted into the body. The urologist viewed the endoscopic image while removing the kidney stones. The kidneys are important to our health for many reasons. They prevent the buildup of wastes and fluid in the body. They stabilize electrolytes such as sodium, potassium and phosphate, which are essential for the normal functioning of our cells and organs. And they generate hormones that help produce red blood cells, regulate blood pressure and maintain bone strength. Kidney Disease Sometimes the kidneys slowly stop functioning. Without treatment, this decline can progress to chronic kidney disease, also called chronic renal insufficiency or chronic kidney failure. The cause of chronic kidney disease is not always known, but any condition that damages blood vessels can negatively affect the kidneys. One common cause is diabetes, because elevated blood sugar levels over a long period of time damage the kidneys blood vessels. There is also a relationship between kidney disease and high blood pressure (hypertension). High blood pressure can damage blood vessels, and if that causes kidney disease, the failing kidneys, in turn, can cause even higher blood pressure. Preventing Kidney Failure When kidney function falls below a certain point, it is called kidney failure. As with any condition, the earlier kidney disease is detected, the sooner treatment can begin to slow down its progression and prevent kidney failure. The first step is to determine and treat the underlying cause. Since diabetes and high blood pressure account for 66 percent of chronic kidney disease, preventing or managing those conditions through diet, exercise and appropriate medication is vitally important in protecting the kidneys. It is possible to survive with only a part of one kidney if it is still functioning. If neither kidney works, however, a machine has to be used to clean the blood (dialysis) or a new kidney has to be transplanted. Leading-Edge Treatment Phelps offers patients a higher level of care for the prevention of renal diseases and disorders than is typically available at community hospitals. My colleagues and I are experienced in performing the most advanced laparoscopic and minimally invasive reconstructive procedures through small access sites without large incisions, says urologist Michael Grasso, MD. As a result, our patients heal more quickly and are able to return to normal activities much sooner. There is also less pain than with open surgery. Dr. Grasso adds, In general, urologists who have broad surgical experience with the latest technology and who follow a surgical team approach are able to 10 PHELPS TODAY

11 provide improved treatments and better patient outcomes for conditions such as kidney stones, ureteral obstruction and kidney cancer. Kidney Stones Kidney stones are formed from the crystallization of certain substances in urine, such as calcium, oxalate, or uric acid. The stones can affect any part of the urinary tract from the kidneys to the bladder. Kidney stones are more common among men. Symptoms of kidney stones include severe pain in the side and back below the ribs, which may spread to the lower abdomen and groin. Pain may be in waves and fluctuate in intensity. Urine is usually red, brown, pink or cloudy and may be foul smelling. Fever and chills occur if there is an infection. Phelps offers patients a higher level of care for the prevention of renal disease and disorders than is typically available at a community hospital. Small kidney stones often pass out of the body in the urine and may go completely unnoticed. But in the ureter, larger stones can block the flow of urine and be excruciatingly painful as they move toward the bladder. Painful or not, kidney stones usually do not cause any permanent damage. While drinking large quantities of water is sometimes all that is necessary to pass a kidney stone, if the stone is large, a procedure by a urologist may be the only solution. The good news is that kidney stones can often be eliminated without any surgical incisions, usually in an outpatient setting. In a procedure called ureteroscopy, a small viewing instrument called a ureteroscope is inserted into the urethra, through the bladder The yellow line outlines a polypoid tumor so called because it has the appearance of a polyp. The urologist removed the tumor endoscopically, saving the kidney. In this 3D CT image, the white arrow points to a blockage in the kidney where accessory vessels crossed. The urologist reconstructed the drainage portion of the kidney and moved the extra vessels away from the blockage, restoring kidney function. In this image, the area outlined in blue is cancerous, the area outlined in yellow is a cyst. The red outline indicates the portion of the kidney that was removed. The rest of the kidney was saved. PHELPS TODAY 11

12 and the ureter to where the kidney stone is located. Once the stone is in view, the urologist can capture it with forceps or a basket. Another non-surgical technique, Extracorporeal Shock Wave Lithotripsy (ESWL), uses shock waves to break larger stones into pieces small enough to pass in the urine. The best method for eliminating very large, complex kidney stones is Percutaneous Nephrolithotomy (PCNL), which involves a small incision and placement of a tube into the kidney through which instruments can be introduced to break up and remove the stone. Ureteral Obstruction Urine travels from the kidneys to the bladder through thin, muscular tubes called ureters. There is one ureter for each kidney, and each is 8 to 10 inches long. Sometimes the ureters become blocked and the flow of urine to the bladder is impeded. The most common cause of ureteral obstruction is ureteral or kidney stones. Other causes include congenital conditions, scarring or injury from previous abdominal or pelvic surgery, blood clots, tumors, ureter wall swelling, inflammation of organs around the ureters, a tiny swelling in the ureter called a ureterocele, endometriosis, severe constipation and pregnancy. Symptoms include pain in the lower back or lower belly toward the sides, painful urination, increased urinary frequency or urgency, reduced urine output, blood in the urine, swollen legs or fever. To diagnose ureteral obstruction, a urologist will conduct a physical exam, measure blood pressure and check for blood or infection in the urine. An abdominal ultrasound or CT scan may also be done. The goal of treatment is to reduce or eliminate the blockage. Severe cases usually require surgery to repair the underlying cause of the obstruction. Kidney Cancer The incidence of kidney cancer is growing in the United States. Fortunately, most kidney cancers are detected before they metastasize (spread) to other organs. Historically, a diagnosis of kidney cancer led to removal of the entire kidney in an operation called a nephrectomy. Today, the majority of kidney tumors are removed in a partial nephrectomy, in which advanced laparoscopic techniques and special imaging are used to remove the tumor and some tissue around it without a large incision. The healthy part of the kidney is saved, and good kidney function is maintained. Additionally, techniques using tiny endoscopes (lighted, flexible instruments for visualizing inside the body) and powerful, precise lasers are used to treat tumors on the lining of the kidneys, ureters, and bladder, removing malignancies while saving the remaining organ. In fact, with these new techniques for treating kidney cancer, the entire organ is rarely removed. Michael Grasso, MD, is Professor and Vice Chairman of the Department of Urology at New York Medical College, as well as Regional Director of Urology for the North Shore-LIJ Health System. He annually teaches instructional courses in advanced urological procedures at the American Urologic Association meeting and the European Urologic Association meeting. Dr. Grasso and his colleagues, Andrew I. Fishman, MD, and Christopher Dixon, MD, specialize in leading-edge, minimally invasive procedures for the treatment of kidney disease. Dr. Fishman is an Assistant Professor and Dr. Dixon is Director of Reconstructive Urology at New York Medical College. Their Westchester office is on the Phelps campus in the 755 North Broadway building, Suite 510. The urologists perform outpatient and inpatient surgical procedures in the new SurgiCenter at Phelps. To contact Dr. Grasso, Dr. Fishman or Dr. Dixon, call PHELPS TODAY

13 Relief from Carpal Tunnel Syndrome S ay the words carpal tunnel syndrome, and most people think of wrist pain resulting from too much time spent at a computer keyboard. Interestingly, studies looking at the connection between excessive computer use and carpal tunnel syndrome have not found enough evidence to support a link. In fact, although a number of factors have been associated with carpal tunnel syndrome including anatomy (a smaller carpal tunnel), gender (it s more common in women), nerve damaging conditions, inflammation and thyroid disorders none of these factors has been established as a direct cause of carpal tunnel syndrome. What Is Carpal Tunnel Syndrome? The carpal tunnel is a narrow passageway located inside the palm side of the wrist that is surrounded by bones, tendons and a wide band called the transverse carpal ligament. The tunnel protects the median nerve a main nerve running from the forearm into the palm of the hand that controls sensations to the palm side of the thumb and fingers, except for the little finger. The nerve also controls impulses to some small muscles in the hand that allow the fingers and thumb to move. Carpal tunnel syndrome results when a thickening from irritated tendons or other inflammation narrows the tunnel and causes the median nerve to be compressed. Median nerve Synovium Symptoms of carpal tunnel syndrome include: pain or numbness in the hand, wrist or forearm numbness or pain in the fingers that causes waking at night loss of thumb function and hand dexterity reduced strength and grip in the fingers, thumb and hand Patients with carpal tunnel syndrome typically complain of numbness or pain at night, which frequently wakes them from sleep. Many patients come in with bags under their eyes due to months or even years of poor sleep, says Phelps hand surgeon Jeffrey Jacobson, MD. Diagnosis There are other conditions that cause symptoms similar to those of carpal tunnel syndrome, including injury to the muscles, ligaments, tendons or bones; nerve problems in the fingers, elbow or neck; and arthritis in the thumb joint or wrist. Flexor tendons Transverse carpal ligament To diagnose whether you have carpal tunnel syndrome, your doctor will: Review your symptoms, making note of when symptoms occur Conduct a physical examination, testing the feeling in your fingers and the muscle strength in your hand Your doctor may also conduct a nerve conduction study or an electromyogram, which is a test that measures the electrical activity of your muscles and can rule out muscle damage and other conditions. A recent nerve conduction study is very helpful when discussing how much nerve damage has already taken place. It is not uncommon for patients to already have had nerve tests performed at the direction of their primary care physicians before they arrive in my office for a consultation, says Dr. Jacobson. Nonsurgical therapy Carpal tunnel syndrome should be treated as early as possible after symptoms begin. If the condition is diagnosed early, nonsurgical methods may help improve PHELPS TODAY 13

14 carpal tunnel syndrome. Methods may include wrist splinting, non-steroidal anti-inflammatory drugs, or corticosteroids. Splinting and other conservative treatments are more likely to help someone with mild to moderate symptoms that have been present for less than six months. Surgery If symptoms are severe or persist for more than six months, despite trying nonsurgical therapy, surgery may be the most appropriate option. Carpal tunnel release is one of the most common surgical procedures performed in the U.S. Traditional Surgery In performing standard open surgery, which is done under local anesthesia or with sedation from an anesthesiologist, the surgeon makes a two-inch incision in the palm of the hand above the carpal tunnel and cuts through the ligament. This enlarges the carpal tunnel and frees the nerve. Following surgery, soreness or weakness may persist for several weeks to a few months. Patients generally return to work in two to six weeks, depending on their occupation. Endoscopic Carpal Tunnel Release (ECTR) During the minimally invasive procedure known as an Endoscopic Carpal Tunnel Release or ECTR, the surgeon makes a tiny incision (1/2 inch) in the wrist and inserts an endoscope (a telescopelike device with a tiny camera attached to it) to see inside the carpal tunnel. He then divides the ligament, relieving the pressure. The procedure takes approximately minutes and can be comfortably performed under local Cross-section of the carpal tunnel anesthesia with the patient fully awake or with light sedation from an anesthesiologist. The incision site needs no bandage and patients can shower immediately after surgery. ECTR is a very specialized procedure and should be performed only by a surgeon who has performed it many times. Dr. Jacobson, who has performed hundreds of these procedures, recently brought the technique to Phelps, one of the few Westchester facilities where it is offered. Surgery brings permanent relief to almost all patients, says Dr. Jacobson. Compared to traditional open carpal tunnel release surgery, patients typically have significantly less pain afterwards and return to work and leisure activities more quickly. Office workers are usually back at work within two to four days, and those who perform physical labor can return to work as soon as they feel up to it, often in less than two weeks. There is some soreness in the palm for a few days, but no bandage is required and there are no restrictions regarding showering. The change in his patients physical appearance after surgery is remarkable, says Dr. Jacobson. When they no longer have numbness and pain, patients stop waking up at night. This often results in Carpal tunnel release, decompressing the median nerve their looking refreshed and healthier, even by their first follow-up visit two weeks later. Often their only complaint is having to come in for the follow-up appointment at all, since they re feeling so good! Jeffrey Jacobson, MD, received his medical degree from SUNY-Stony Brook and completed a residency in plastic surgery at Georgetown University Hospital. Board certified in plastic surgery, Dr. Jacobson is fellowship trained in orthopedic hand and wrist surgery with a specialty in microvascular and peripheral nerve surgery at University of Pittsburgh Medical Center. In addition to hand surgery, he performs the full breadth of plastic surgery. Dr. Jacobson has offices in Harrison and Katonah ( ). 14 PHELPS TODAY

15 Family Medicine Residency Program Thrives in Its Third Year, Inaugural Class Prepares to Enter the Field Second-year residents Julia Krim, DO, and Carmen Tamayo, MD, review an EKG. for everything is something I think is really important, so that even when we refer patients to specialists, they feel confident that someone who knows them very well is overseeing their care. Alittle over three years ago, Phelps welcomed six newly graduated MDs into a brand new residency program. Today, the NYMC Phelps Family Medicine Residency Program, established by Phelps in partnership with New York Medical College and Open Door Family Medical Centers, is a well-established and highly respected program. The three-year program was originally designed for 18 residents (six per year). Last year, the Accreditation Council for Graduate Medical Education granted a program expansion that allowed eight residents in the third-year residency class, so that there are currently 20 residents in training at Phelps. Photo by Leslie Fass What Are Family Medicine Physicians? Family medicine physicians are primary care providers who treat the whole person in every stage of life, focusing on the prevention and treatment of disease. They are trained to take care of the entire family, dealing with medical issues that may affect more than one family member and creating long-term, personal relationships with their patients. A family medicine doctor can provide continuity of care for patients in virtually every medical setting, says Co-Chief Resident London Muse, MD. We see infants, children, adolescents, pregnant women, adults and geriatric patients on a daily basis. Having one provider Residency Program A residency is a period of advanced medical training that follows medical school and involves supervised practice in a hospital and outpatient settings. During family medicine residency training, doctors complete clinical rotations in areas including adult inpatient and outpatient medicine, obstetrics and gynecology, cardiology, geriatrics, orthopedics and adult and pediatric emergency medicine. Developing the NYMC Phelps Family Medicine Residency Program has been a phenomenal experience, says Dr. Shantie Harkisoon, a family physician and director of the residency program. As a family doctor, I never expected to wear so many different hats from designer of the residency headquarters to trainer of physicians. My guiding principle has been for us to do whatever it takes to create an extraordinary training program, and I think we ve done that. I could not have wished for better resources or greater support from PHELPS TODAY 15

16 the community and the wonderful, inspiring people with whom I work. We have an extraordinary group of residents as a result. Much of the success of the program stems from the involvement of Phelps physicians and other clinicians and staff. The thing I like most about our program is the people we work with from faculty, specialists and other residents to nurses, medical assistants, hospital volunteers and, most importantly, our patients and their families. The bond, consideration and care we have for one another really cannot be matched. says second-year resident Molly Kilpatrick, MD. In addition to providing training that is founded on evidence-based medical care, the program focuses on giving residents skills that enable them to listen and relate to their patients. Residents receive specialized behavioral medicine training to help them maintain their own wellbeing, enabling them to better protect the wellbeing of their patients. Integrative Training Because of the evolving nature of healthcare, family medicine training is more integrative than ever before. Residents in the NYMC Phelps program receive their clinical training at Phelps and at Open Door Family Medical Center in Sleepy Hollow. The program also has a special relationship with Westchester Medical Center and Maria Fareri Children s Hospital, where residents learn to care for pediatric patients who have more serious medical conditions. Training at these various locations enables the residents to refine their medical skills Third-year resident Anesh Badiwala, MD, reviews a patient s X-rays in the Emergency Department under varying circumstances and provides them with experience in working with diverse groups of patients. According to Hira Qureshi, MD, Pediatric Chief Resident at Westchester Medical Center, Phelps residents bring to the Department of Pediatrics a sense of dedication to all patients, a willingness to learn about the pediatric patient, and a zeal that is needed to fuel their drive while on this short but momentous residency journey. Though they are initially faced with daunting tasks that might scare first-year residents, by the end of the rotation, they seem to overcome most if not all that is daunting and are able to accomplish such tasks with grace. We appreciate their unique perspective and enjoy learning from them as much as we hope they enjoy learning from us. Photo by Leslie Fass In addition to providing training that is founded on evidence-based medical care, the program focuses on giving residents skills that enable them to listen and relate to their patients. 16 PHELPS TODAY

17 Community It s great working at a community hospital because it s small, you know everyone in the hospital, you build relationships with patients and learn about different cultures, says Farah Ansari, MD, first-year resident. The residents have created a bond with the community by volunteering at local events and getting to know the people in the towns where they live. Recent events include managing a teddy bear clinic for children at the Sleepy Hollow Street Fair or volunteering in the Phelps medical tent during a triathlon. With the increased demand for primary healthcare comes a need for more internal medicine and family medicine doctors. Many Westchester physician practices have been recruiting the soonto-be-graduates. Dental Residency Program Completes Third Year 2014 also marked the third year for the general dental practice residency program at Phelps, sponsored by the New York Medical College Department of Dental Medicine. This one-year program, with a two-year option, was recently granted approval to expand from four to eight resident positions by the American Dental Association Commission on Dental Accreditation. The dental residents complete their rotations in anesthesia and emergency medicine at Phelps. Throughout the year, they provide on-call emergency dental/oral surgery coverage for the Emergency Department 24/7 and perform comprehensive dental services in the operating room for patients with special needs who require general anesthesia. As for outpatient assignments, in addition to treating patients at the Open Door Family Medical Center site in Port Chester, all incoming residents will also treat outpatients at Open Door s Brewster location. It has been so exciting watching the program evolve and reach its full complement, says Kimberly Andron, LCSW-R, MSW, Director of Behavioral Medicine for the residency. The success of all of our efforts is becoming apparent as our inaugural class makes plans to enter the field. Dr. Harkisoon agrees: Thanks to the involvement and enthusiasm from faculty and staff, we have developed a superb program that is creating outstanding family physicians. Andrea Lochan, DMD Scott Levitz, DDS Cindi Bane, DDS Zachary Logozio, DDS PHELPS TODAY 17

18 Don t Call It a Comeback: Chickenpox Has Been Here for Years By Jillian Elliott, MD Primary care physicians seldom receive the accolades of other specialties. TV shows are about neurosurgeons or cardiologists, not primary care doctors. But what we may miss out on in glamour, we more than make up for with the satisfaction of having the opportunity to prevent so many illnesses from occurring or worsening. I have been asked more times than I can remember, Did you become a doctor to help sick people? My answer to that is always: Yes, but the main reason I became a doctor is so that I can help 18 PHELPS TODAY people before they get sick. Prevention of disease is the main goal of primary care medicine, and keeping patients healthy and free of major illnesses is my primary objective as a physician. One of the main ways to accomplish this goal is with vaccinations. The Varicella Vaccine The varicella vaccine is given to prevent chickenpox a highly contagious viral infection caused by the varicellazoster virus. The vaccine has been invaluable in decreasing the incidence of childhood chickenpox. As of 2007, childhood deaths from chickenpox had been cut by 97%. Prior to the introduction of the vaccine in 1995, 50 children in the U.S. died each year and thousands more were hospitalized. Knowing that the vaccine is made up of live-attenuated virus sometimes causes people to worry that they could catch chickenpox from being vaccinated. A varicella-like rash may develop in 1-6 percent of people following vaccination, but the more common reaction is fever and pain, redness or swelling at the site of injection. Except for individuals who have some sort of immune deficiency or are allergic to the vaccine, its benefits far outweigh the risks for the overwhelming majority of people.

19 While most people know that it is important to vaccinate children, many do not realize that it is also important for adults to get the vaccine and booster. This is especially true for people who had chickenpox in childhood but show no immunity to it in adulthood. For older people and those with weakened immune systems, shingles is also a concern. Caused by the reactivation of the chickenpox virus, shingles manifests as a painful rash. There are vaccines available to reduce the risk of shingles. Chickenpox Transmission and Course of the Disease Chickenpox can be transmitted either by directly touching the fluid in a lesion on someone s skin or by breathing in the secretions from an infected person s nose. After exposure to the virus, it takes approximately days before the initial signs of infection, which include fever, fatigue, sore throat and loss of appetite. The rash develops approximately 24 hours after these symptoms appear and presents itself in crops, typically on the face, trunk, arms and legs. Because new lesions develop each day for approximately four days, both fluid-filled lesions and scabbed lesions may be present at the same time. Approximately six days after the initial signs and symptoms, all the lesions will scab over and will no longer be infectious. As benign as all of this may sound, chickenpox can unfortunately become more serious for some patients. Severe complications from the virus include secondary bacterial skin infections, pneumonia and encephalitis, which is a swelling of the brain. The primary method for preventing the most serious While most people know that it is important to vaccinate children, many do not realize that it is also important for adults to get the vaccine and booster. This is especially true for people who had chickenpox in childhood but show no immunity to it in adulthood. aspects of chickenpox is through vaccination. While it is reported to be 44% effective in preventing chickenpox, the vaccine is 86% effective in preventing severe complications. Immunity I recall having chickenpox when I was five years old and being covered from head to toe in lesions that caused such a severe itch. Luckily, I did not develop any complications. When my parents were children, they were brought to visit friends who had chickenpox so they could get the virus and later overcome it. There was no vaccine at that time, and this was simply the only way to build immunity. Prior to the implementation of the varicella vaccine in 1995, the natural course of chickenpox immunity was this: You got chickenpox as a child and developed immunity. Then, in adulthood, you were exposed to young children with chickenpox, and that provided your immunity with a boost. Through this process, you developed a lifelong immunity to chickenpox. However, now that children are being vaccinated, adults are no longer being re-exposed to chickenpox, so the boost does not occur. Who Should Get the Vaccine Vaccination is recommended for all children between the ages of months who have no evidence of immunity, and a second dose is given between the ages of four and six years old. Experience has taught us that with just one dose, children can still become infected with chickenpox, which is why the second dose is needed. All adults should be tested by their doctor to see if they have immunity to the virus, even if they had chickenpox as a child. If immunity is not detected, a varicella booster is recommended. Adults should receive two doses of the vaccine four to eight weeks apart. Protection against chickenpox is especially important for adults who work in healthcare or daycare or who are exposed to people with weakened immune systems. In addition, women of childbearing age who show no immunity should be vaccinated; however, they should not get pregnant for at least four weeks after receiving the vaccine. Herd Immunity With my patients, I stress the importance of getting the varicella vaccine, not only to protect themselves but also those around them. In fact, outbreaks can PHELPS TODAY 19

20 be prevented by something called herd immunity, whereby a critical portion of a community is immunized against a disease, and any cases that crop up cannot spread among the people who have been vaccinated. A tragic example of what can happen when large numbers of people fail to be vaccinated occurred in 2012, when a four-year-old girl with leukemia died after being exposed to a cousin with a rash that turned out to be chickenpox. She could not get the varicella vaccine because she was undergoing chemotherapy and her immune system was too weak. Sadly, she could have been protected if herd immunity had prevented her cousin from becoming sick. While we have nearly eliminated chickenpox with vaccination, recent news shows us how viruses can re-emerge. Vaccinations can become a victim of their own success by being so effective, people undervalue their benefit and fail to get vaccinated. The truth is that the vaccine is vital, not only to keep you safe, but to keep your loved ones safe as well. I became a primary care physician to prevent illness, and vaccines allow me to do that for chickenpox and many other diseases. I believe my most important role is to educate my patients about vaccines and the many other steps they can take to protect their health. Jillian Elliott, MD, is an internal medicine physician and a member of Phelps Medical Associates. Board certified in internal medicine, Dr. Elliott received her medical degree from New York Medical College and completed a residency in internal medicine at Montefiore Medical Center. She sees patients on the Phelps campus in suite 417 of the 755 North Broadway Building ( ). 20 PHELPS TODAY

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