A Troubling Trend: Stroke Risk in Young Populations
- Details
- Written by Joanne Wallenstein
- Category: Health
(Submitted by Dr. Paul Lleva, MD, Neurology at White Plains Hospital)
After shoveling and carrying heavy groceries, a young woman begins to feel dizzy and unsteady. Noticing one eyelid drooping, she heads to the emergency room. Although her CAT scan appears normal, further tests reveal high blood pressure and a blood-vessel blockage caused by a dissected carotid artery. At just 30 years old, she has suffered a stroke.
This recent case, shared by Dr. Paul Lleva, Director of Stroke Services at White Plains Hospital, highlights a growing concern: the rise in stroke rates among younger individuals.
Nearly 800,000 people have strokes in the United States each year. Most occur after the age of 65, but new data suggests one in seven strokes now occur in adults ages 15 to 49. Furthermore, a report from the Centers for Disease Control shows a concerning 15% rise in strokes among adults under 65 over the past decade, while rates for seniors have remained consistent.
“Many health issues are now occurring at a younger age,” says Dr. Ivo Bach, a Neuro-Endovascular Surgeon and Vascular Neurologist with White Plains Hospital Physicians Associates. Young adults have seen recent rises in obesity, high blood pressure, and diabetes, as well as opioid use — all factors experts say likely correlate to the rise of strokes. “A lot of it boils down to lifestyle — health, exercise, diet,” says Dr. Bach. “Those are modifiable risks we can alter or stop to prevent strokes.”
For patients under 50 who are active, trauma is often the cause of the stroke. Sports injuries and accidents that twist or jerk the neck can tear arteries, creating clots that may break off and block blood flow to the brain. Updated protocols for such injuries have also led to increased identification of stroke.
“In the old days, if someone was playing football, how many of those kids were brought to the hospital after neck injury? How many were scanned with vascular imaging? Probably only a few,” Dr. Lleva explains. “Now, more patients are screened following traumatic incidents and that is one reason why we are seeing this trend.”
White Plains Hospital offers the most comprehensive treatments for patients of all ages suffering a stroke. In the cases of a dissected carotid artery, the specialized team performs advanced stenting procedures to restore blood flow. During an ischemic stroke, where a blood clot interrupts blood flow to the brain, the team performs a mechanical thrombectomy. Time is of the essence, as with each passing minute, about 1.9 million brain cells die, increasing risk for impairment, disability, and death.
Dr. Paul Eugene P. Lleva
A mechanical thrombectomy is the gold standard for stroke care and is a minimally invasive procedure in which specialty trained physicians thread a catheter to the brain to remove clots. Last year, White Plains Hospital received a Thrombectomy-Capable certification from The Joint Commission, indicating that it meets rigorous standards for performing endovascular thrombectomy and providing post-procedural care. “It means if you come to the Hospital for stroke care, we have a specialized team which is ready 24/7 to provide the most advanced care,” Dr. Bach says.
Learn more about Stroke Care at White Plains Hospital.
Dr. Paul Eugene P. Lleva is the Director of Stroke Services at White Plains Hospital. To make an appointment, call 914-849-4800.
Dr. Ivo BachDr. Ivo Bach is a neuro-endovascular surgeon and vascular neurologist with White Plains Hospital Physician Associates (WPHPA), with offices in our WPHPA Neurosurgery & Neuro-Endovascular Surgery location in White Plains. To make an appointment, call 914.849.5300.
Health Matters
The original version of this article was published in Health Matters, a White Plains Hospital publication.
The Link Between Alcohol and Several Types of Cancer
- Details
- Written by Joanne Wallenstein
- Category: Health
(Submitted by Dr. Yael Sadan Zack, Hematology and Medical Oncology, White Plains Hospital)
Most of us are aware that smoking is a leading cause of cancer, and that drinking alcohol can also have deleterious effects on our health. But the U.S. Surgeon General recently published an advisory underscoring that alcohol consumption is the third leading preventable cause of cancer in the U.S., after tobacco and obesity – and increases the risk for at least seven types of cancer.
While scientific evidence for this connection has been growing over the past four decades, less than half of Americans recognize it as a risk factor for cancer, according to Surgeon General Dr. Vivek Murthy. “Alcohol is a well-established, preventable cause of cancer responsible for about 100,000 cases of cancer and 20,000 cancer deaths annually in the United States – greater than the 13,500 alcohol-associated traffic crash fatalities per year in the U.S. – yet the majority of Americans are unaware of this risk,” said Dr. Murthy said upon releasing the advisory on Jan. 3.
The advisory outlines the scientific evidence for the causal link between alcohol consumption and increased risk for such cancers as breast (in women; 16.4% of total breast cancer cases are attributable to alcohol consumption), colorectum, esophagus, voice box, liver, mouth, and throat. The type of alcohol being consumed – beer, wine, or spirits – does not matter, the admonition states.
Medical oncologist and hematologist Dr. Yael Zack, who founded and leads the Young Women’s Program for Cancer Care at White Plains Hospital’s Center for Cancer Care, has long advised against alcohol consumption and applauds the Surgeon General’s latest move. “For cancer prevention, we should avoid alcohol altogether,” she says, “but my general guidelines are to limit alcohol intake to 1-2 times per week, or even less frequently.”
Just as there is no “safe” number of cigarettes you can smoke per day, any amount of alcohol consumption can also raise your cancer risk.
Alcohol can damage your DNA in multiple ways as your body works to break it down, possibly resulting in mutations and DNA strand breaks which ultimately increase the risk of cancer, especially in tissues exposed to high levels of alcohol like the mouth and throat.
The timing of the Surgeon General’s advisory is made even more relevant by the annual arrival of “Dry January,” an initiative first developed by UK charity Alcohol Change UK in 2013. As its name suggests, the program challenges participants to forego all alcohol for the month of January, in the hopes that the resulting weight loss and other benefits may encourage curtailing or even eliminating alcohol use after Jan. 31.
Dr. Zack says that, in addition to Dry January, she recommends the following tips she learned from White Plains Hospital Registered Dietician Cheryl Leslie:
• Have alcohol-free days
• Find other outlets for relaxation instead of having an alcoholic beverage
• Don’t make having a glass of wine part of your food prep
• Limit alcohol consumption to only when socializing
• Alternate every other drink with a glass of water or seltzer
• Have a wine spritzer instead of a glass of wine
• Offer to be the designated driver at gatherings
• Enjoy many of the alcohol-free options that are now available
These recommendations underscore how, for many people, one’s alcohol consumption can be prudently self-regulated. “Essentially I tell patients that since we have control over this risk factor, we should definitely take control,” Dr. Zack says.
Of course, self-management may not be sufficient in some cases. For those patients, Dr. Zack recommends consulting a therapist; a list of White Plains facilities can be found here.
Dr. Yael Zack is a medical oncologist and hematologist at the White Plains Hospital Center for Cancer Care and founded and leads the Young Women's Program for Cancer Care. To make an appointment with Dr. Zack, call 914.849.7600.
Health Matters
The original version of this article was published in Health Matters, a White Plains Hospital publication.
What Women Don’t Know About Heart Disease
- Details
- Written by Dr. Jeannette L. Yuen
- Category: Health
(Contributed by Dr. Jeannette L. Yuen, Cardiologist at White Plains Hospital)
Although heart disease has long been the leading cause of death, both in the U.S. and worldwide, a Harris poll conducted on behalf of the American Heart Association (AHA) found that 51% of respondents were unaware of that fact. It is no surprise then that the AHA and healthcare providers continue to push education about the deadly disease each year during February, known as “American Heart Month.”
In the past, men have been more likely to be diagnosed with heart disease than women. Although there is more ongoing research to explore women’s risks of the condition, it was not until 1999 that the AHA and American College of Cardiology issued the first clinical report on preventing of heart disease in women. This lag is now mitigated by robust research with gender-specific studies.
Men and women present with heart disease in mostly similar manners, but the how’s and why’s differ. One major factor in this disparity is the presence of female hormones, particularly estrogen. Pre-menopausal women are less likely to develop heart disease, as estrogen increases the “good” cholesterol (HDL) so that the “bad” (LDL) cholesterol is proportionally lower. This helps to reduce plaque buildup and inflammation in the arteries, common causes of developing of heart disease.
Women in general have smaller bodies than men, with smaller internal organs, including hearts, and vascular structures so effects of medications and outcomes of procedures can differ from those of men. In addition, as all people age, hypertension (high blood pressure) becomes more prevalent, as aging arteries become less flexible and less resilient, negatively affecting blood flow. Weight gain can also occur as we age, as metabolism slows down and activity levels decline. Obesity can also lead to sleep apnea, a condition that remains underdiagnosed for both genders.
Like men, women present with the following symptoms:
• Chest pain or tightness (angina)
• Pain in the neck, shoulder, arm, or back
• Shortness of breath
• Fatigue
• Nausea (less common in men)
• Abdominal discomfort (less common in men)
Unfortunately, women often underreport these symptoms. Most women are caregivers and tend to place others’ needs ahead of their own, often minimizing their symptoms which may delay much-needed medical attention.
Women are also more likely to develop broken-heart syndrome (Takotsubo cardiomyopathy), where an intensely stressful event occurs and can result in a weakening of the heart muscle. Fortunately, this is often a reversible condition.
I highly recommend anyone experiencing such symptoms to see their physician as soon as possible or, if the symptoms are severe, to go to their local emergency department.
One can never be “too cautious” when it comes to heart health. I recently saw an older retiree who had suffered from chest pain for two weeks before seeking medical advice; she had been taking care of an ill family member. Unfortunately, she had developed congestive heart failure from a massive heart attack that was not treated in a timely fashion.
You may be surprised to learn that you can have a heart attack and not necessarily know it; these are called “silent heart attacks” and can be brought on by the same factors that cause symptomatic heart attacks:
• Diabetes
• Excess weight
• Family history of heart disease
• High blood pressure
• High cholesterol
• Lack of exercise
• Tobacco use
Although doctors are always recommending giving up using tobacco, I want to emphasize that smoking can have profoundly negative effects on your heart and blood vessels. A recent study showed that women aged 18-49 who smoke are 13 times more likely than their non-smoking contemporaries (men in the same age group who smoke are 9 times more likely to suffer the same fate). In addition, those who have vaped are 19% more likely to develop heart failure than those who have never done it before.
As you can see, a delay in diagnosis can result in a delay in proper medical care, which in turn can result in a heart attack or stroke – with the attendant life-altering effects. Many of the seemingly insignificant symptoms can be a sign of serious illness. Do not become a statistic; learn about your risk for heart disease and how you can proactively address it.
Dr. Jeannette Yuen is a Cardiologist with Scarsdale Medical Group, seeing patients at the Harrison location. To make an appointment, please call 914-723-8100.
Health Matters
The original version of this article was published in Health Matters, a White Plains Hospital publication.
You Only Have One Heart: A Young Woman’s Journey to Better Health
- Details
- Written by Joanne Wallenstein
- Category: Health
Written by Dr. Anthony Mercando, Cardiologist at White Plains Hospital
Many of us know that having high cholesterol can increase one’s risk for heart disease and stroke, as it can build up plaque in the arteries. While high cholesterol can often be remedied with lifestyle changes, including alterations to diet and exercise, in many cases, a patient’s genetics play a role in their cholesterol levels, and medical intervention is needed.
Such was the case for Amanda Bulfamante, 33, a New Rochelle-based hairstylist who has a family history of cardiac events as well as high cholesterol. “I've never been able to get my cholesterol under control, even after changing my diet and losing weight,” she shares. When Amanda experienced heart palpitations, she made an appointment to see Dr. Anthony Mercando, a board-certified cardiologist at White Plains Hospital Physician Associates in White Plains.
“When Amanda came in, we reviewed her personal health history as well as her family history,” he says. “Since members of her family have experienced heart attacks at a young age, it was especially important to fully evaluate her risk.” To get the most accurate picture of Amanda’s heart health, Dr. Mercando ordered a long-term electrocardiogram test and blood test to check her cholesterol levels. In addition, he ordered a test known as a lipoprotein (a), or LP(a) test.
While Amanda’s heart palpitations proved to be benign and did not require treatment, two indications of elevated cardiovascular risk were evident from her blood tests. She had “a very high cholesterol level, and elevated levels of LP(a),” shares Dr. Mercando.
While there is currently no approved treatment for lowering LP(a), “an elevated value of LP(a) in a patient tells me that other risk factors and other lipids need to be aggressively treated,” he explains. High levels of LP(a) typically run in families as well are associated with arterial sclerosis, or hardening of the arteries.
As part of Amanda’s treatment plan, she now takes a statin medication to bring her cholesterol down in addition to continuing to eat a balanced diet and exercising regularly. “For many patients with a genetic predisposition to high cholesterol, even if they live the healthiest lifestyle possible, medication is needed to get their cholesterol to a healthy range and lower their risk for heart disease,” says Dr. Mercando.
Amanda was hesitant to start a medication regimen, especially given her young age. “I was concerned about potential side effects, but Dr. Mercando helped to put me at ease,” she shares. “I know that I am being as proactive as I can to stay healthy.”
Complicating matters even further was a near-simultaneous diagnosis of Multiple Sclerosis. “The DMT (disease-modifying therapies) I’m taking for the MS are very strong medications, and we continue to monitor how I react to that and the statin medications that Dr. Mercando put me on.”
Even with regular trips to a cardiologist and a neurologist, Amanda says she feels much better by getting checked early. “My advice would be to just go and get checked,” she declares. “It's really important. Some people may not take their heart health seriously because they think, ‘Oh, nothing's going to happen to me because I’m young and I don’t smoke.’”
“Taking care of yourself is so important,” she concludes. “You only have one heart.”
“I encourage everyone to discuss their family history of heart disease with their loved ones,” adds Dr. Mercando. 
Dr. Anthony Mercando“Genetics play an important role heart health, and taking a proactive approach as Amanda has can make a meaningful difference in living a longer and healthier life.”
Click here to learn more about White Plains Hospital’s Cardiac Services Program.
Dr. Anthony Mercando is a board-certified cardiologist at White Plains Hospital Physician Associates. To make an appointment, call 914-849-4800.
Health Matters
The original version of this article was published in Health Matters, a White Plains Hospital publication.
No Need to Flake Out: Avoiding Dry Skin in Cold Weather
- Details
- Written by Joanne Wallenstein
- Category: Health
(The following was submitted by Dr. ChangHyun (Mike) Kim, Dermatology at White Plains Hospital)
As the weather grows colder, you may notice your body getting more itchy – or in some cases, skin flaking off or even cracking, particularly in such areas as your elbows and knees.
Unless it’s indicative of such diseases as psoriasis, eczema or dermatitis – in which case hopefully you’re already seeing a dermatologist – dry skin in and of itself is nothing to be too concerned about … although the itchiness and appearance may be unpleasant. The reason for dry skin during the cold months is simple: cold air holds less moisture, which means your skin will become drier. Indoor heaters can also dehydrate your skin.
To avoid such developments, I recommend the following:
Take brief, lukewarm showers or baths. This may seem counterintuitive when it’s cold outside, but just as hot air will dry out your skin, so too will hot water, which can leach out your body’s natural oils. Keeping the water temperature down will prevent additional dehydration, as will keeping your bathing brief. Pat yourself dry afterwards.
Apply moisturizing ointments or creams after drying off. I recommend doing this over your entire body each time you bathe. Try using thicker products instead of thinner ones, which tend to be watered down don’t have as great an effect. Lotions, which typically contain more water than oil, are also generally less effective for the same reason.
Use a humidifier. Such a device can be a great help throughout the day. When the environment around you is drier, your skin gets drier, too. And outdoor elements aren't the only factor — the heaters we turn on when the temperature drops can dry out the indoor air too.
Remember the age factor. The previous steps are encouraged for everyone, but keep in mind that as we age our skin naturally produces less oil and decreases our ability to retain moisture. Older people may want to consult with a dermatologist to make sure they’re taking the proper steps to avoid or reduce dry skin.
Don’t forget the sunscreen. Most of us are used to applying a sunscreen with an SPF of at least 30 during the summer. But just because you’re not lying on a beach doesn’t mean you should forego sunscreen during the winter. The sun and its UV rays are still there, even if it’s less intense, and while you’re usually well-wrapped when going outside (hat, coat, gloves), there may still be parts of your body exposed to the sun. Again, an SPF of 30 blocks approximately 97% of the sun’s rays.
What if you’ve already got dry-skin symptoms? I suggest the following steps:
Moisturize well at least 1 to 2 times a day. Moisturizing ointments and petroleum jelly may be the best solution, as they contain no water to dilute them.
Avoid products that contain alcohol and scents, such as deodorizing soaps; the chemicals in the latter can further dry out your skin.
Stay hydrated. Making sure you drink plenty of water is always a good idea; during the winter you can further avoid developing dry skin by drinking four to six cups of plain water each day. Your physician can help further refine that amount depending on your gender, weight, pre-existing conditions, and other factors.
Changhyun Kim MDFollowing these steps can help you avoid or reduce dry skin. If you are still having difficulties after taking such steps, see a dermatologist. They can provide additional advice on how to enjoy the winter without all that itching and flaking.
Dr. ChangHyun (Mike) Kim is a board-certified dermatologist at Scarsdale Medical Group in Harrison. To make an appointment, call 914.723.7800.
Health Matters: The original version of this article was published in Health Matters, a White Plains Hospital publication.
