Friday, Sep 30th

mommakeoverDr. Alessandrina Freitas, a Plastic & Reconstructive Surgeon at White Plains Hospital has answers for you!

I often hear from women who want to know how best to rejuvenate their bodies and get back to feeling as strong and vibrant as they did before they had children. Many of my patients are wondering if now is a good time for the so-called “mommy makeover,” a concept that has gotten lots of buzz in recent years. Most of these women are not looking for a “makeover,” however; they are simply looking to turn the clock back a little bit on the bodies that they already have.

In order to decide if this set of restorative surgeries could be a good fit for you, here are answers to some of the questions I’m asked most commonly by my potential patients.

What is the “mommy makeover”?

There isn’t one specific set of surgeries that are always performed as part of a mommy makeover. Rather, it is typically some combination of operations, done in sequence, which focus on improving the appearance of a woman’s abdomen and breasts—the two areas of the body that bear the brunt of the “damage” from pregnancy, postpartum recovery and breastfeeding.

Common surgeries in a mommy makeover include the following:

Abdominoplasty: Also known as a “tummy tuck,” this is done to remove excess skin, typically of the lower abdomen, as well as repair the rectus (or “six-pack”) muscles that often separate during pregnancy. Abdominoplasty helps to make the abdomen appear flatter and firmer.

Breast surgery: To combat the breast deflation or “drooping” (ptosis) that is a normal part of the body’s post-pregnancy progression, many women seek restorative breast surgery, including breast implants (ideal for women experiencing mild breast sagging or desiring more volume) or a mastopexy (commonly known as a breast lift) to improve the appearance of the breasts. Some patients need a combination of both a breast lift and an implant.

Liposuction: This surgery removes fat from specific areas of the body including the abdomen, hips, thighs, buttocks, arms, or neck.

Am I an ideal candidate for a mommy makeover?WhitePlainsHospitalSponsorBanner

Most of my patients come in with an idea of what areas they would like to target for improvement. However, not every mom is an ideal candidate for these procedures. Abdominal surgeries, breast surgeries, and liposuction are best for women who:

• Are in generally good health and close to their ideal pre-baby weight. It’s important to understand that these are not weight-loss surgeries; if you are still working toward losing significant weight, it’s probably not yet the right time for a mommy makeover.

• Are not planning any future pregnancies. You don’t want to invest the time and money into surgeries if you are planning to have more children.

• Will not be picking up and carrying young children around frequently. I recommend my patients wait until their youngest child is at least 18 months old before having surgery. This way the child is old enough where Mom will be able to recover from surgery more easily and not have to worry about lifting them during the first few weeks post-op.

• (For breast surgeries) Have finished breastfeeding for at least one year. This is a rule in my practice. Your milk ducts still retain a lot of fluid for a long time and that can complicate a breast surgery.
• No nicotine use, as this adversely affects healing.

What should I expect for surgery and recovery?

Of all the common mommy makeover procedures, the abdominoplasty requires the most significant downtime. You’ll need about 4-6 weeks to heal. However, you will be able to go home the night of surgery and you will soon be up and able to move around without much difficulty. You’ll need to wear post-operative compression garments and you’ll have some drains to take care of for a week or so, but you’re definitely not incapacitated. Breast-surgery patients can expect an easier recovery. My breast patients probably take two weeks off from work after their surgery, but during the recovery time they are home with their families and living their daily life without too much disruption.
Are the surgeries done on a specific timeline?

With some very select patients, you can combine the procedures and do them at the same time, but my preference is to do the abdominal and breast surgeries in two different operations, separated by a minimum of six months.

What are the risks?

As with any surgery, the mommy makeover procedures carry certain risks, including:
• Infection
• Fluid build-up
• Risk of blood clots, including DVTs and pulmonary embolisms. This risk is slightly higher with abdominoplasty than with other plastic surgeries, so we try to mitigate by giving patients medications that prevent blood clots.
• Breast surgery can affect your future ability to breastfeed and your nipple sensitivity

The best risk prevention is making sure that you’re always seen by a Board Certified Plastic and Reconstructive Surgeon who operates in an accredited facility with licensed anesthesiologists.

Freitas AlessandrinaDr. Alessandrina Freitas sees patients in White Plains at the Center for Advanced Medicine & Surgery as well as at WPH Medical & Wellness in Armonk. To make an appointment, call 914-683-1400.

InstrumentsWith recent court rulings casting doubt on how much longer masks will be required in schools, everyone is wondering what the future holds for learning in the third year of the COVID-19 pandemic. Students have divergent views. Some advocate for continuing the mask mandate, saying, “We need to stay protected,” while others are comfortable if protective measures are no longer in place.

As detailed in an email from Scarsdale Schools Superintendent Thomas Hagerman this week, a New York State Supreme Court Justice in Nassau County ruled that the Commissioner of Health’s mask mandate in schools was unconstitutional. The NYS Attorney General subsequently filed a Notice of Appeal which triggered an automatic stay of the lower court’s ruling pending a further decision by the Appellate Division, Second Judicial Department. Thus, for now, the mask mandate for schools is in place.

We asked a few students how they felt about masks. In the event of an uplifting of the mask mandate, Scarsdale High School upperclassmen #1 (who elected to remain anonymous) said, “I would feel just as comfortable if the mask mandate was lifted [as compared to now].” Scarsdale High School upperclassmen #2 (who also opted to remain anonymous) had a staunchly differing view, claiming, “I would not feel comfortable if the mask mandate was lifted because I have a high-risk family.”

Both agree that the mask requirements have affected their learning experiences, with #1 stating, “Wearing masks has negatively affected my learning experience by making communication with teachers more difficult.” #2 concurred, “Masks have made it difficult to communicate with teachers and classmates.”

When asked about whether the school has done a sufficient job at balancing COVID-19 protection and in-person learning to the best extent possible, they also had similar responses. #1 said, “The only correct balance is all in-person learning.” #2 added, “This year, strictly doing in-person has benefitted learning, but hybrid last year made teachers’ jobs harder and students more confused and stressed.”

Whether school should be all in-person or hybrid is still debated, though the consensus seems to be for in-person school. However, there is less agreement on the extent to which the school should enforce indoor protections against COVID-19. Some believe legislation signals the optimal time to remove masks from everyday life, whereas many others are patiently waiting for the infection rates to drop.

Some school districts have already had their first experience without mandated masks in the days the rule was being argued in court.

At Eastchester High School, many teachers and students scrapped their masks at the first instance possible. Eastchester student Ines Constantin described the day in detail -- information Scarsdale students and teachers may want to weigh before making their own decisions about mask-wearing when the mandate is lifted. Constantin said, “When I walked into school and saw so many people without masks, I was more shocked by the abundance of silence towards it. This didn’t feel like a step forward and getting ‘back to normalcy.’ It felt chaotic and threatening, seeing so many people unbothered by the number of cases and deaths, without an ounce of respect for others, simply because they didn’t feel like putting on an extra piece of fabric - a piece of fabric that has the power to save lives.”

The range of student opinion in both the county and town varies heavily, but, in my view, people should consider the science before making decisions made by legislators rather than doctors.

cardiologistsWhite Plains Hospital Physician Associates welcomes Drs. Gary Gabelman, Douglas Hart, Gabriela Grasa, Anthony Mercando, and Mitchell Fishbach, formerly associated with NewYork-Presbyterian Medical Group Westchester. This new cardiology group expands the number of impressive physicians in White Plains Hospital’s Division of Cardiology. White Plains Hospital continues to bolster its comprehensive cardiology services through the addition of top physicians, geographic expansion, and programmatic growth, including two cardiac catherization labs, specialists in heart failure and electrophysiology and most recently, the launch of its cardiac surgery program in November of 2021 in partnership with Montefiore.

Specializing in preventative and non-invasive cardiology, nuclear cardiology, and echocardiography, Drs. Gabelman, Hart, Grasa, Mercando and Fishbach are now seeing patients at White Plains Hospital’s Center for Advanced Medicine & Surgery, located at 122 Maple Avenue in White Plains.

Dr. Gary Gabelman oversees the practice and specializes in heart disease, echocardiography and nuclear cardiology. He graduated from Mount Sinai School of Medicine and completed his internship, residency, and fellowship at Montefiore Medical Center. Among his honors, Dr. Gabelman has been a named a Top Doctor by Castle Connolly annually since 1993 and was also named a Top Doctor multiple times by New York magazine and Westchester Magazine. He has served as principal investigator or co-investigator for over 30 clinical trials and his work has appeared in such peer-reviewed publications as The Journal of the American College of Cardiology, The American Journal of Cardiology, and Postgraduate Medicine.

Dr. Douglas Hart
helps lead echocardiography services for the practice and also specializes in cardiovascular disease and nuclear cardiology. After graduating from the University of Michigan School of Medicine, Dr. Douglas Hart completed a fellowship in circulatory physiology at Columbia-Presbyterian Medical Center and then completed a full cardiology fellowship at Georgetown University Medical Center with special concentration on echocardiography and nuclear cardiology. Dr. Hart has been frequently named a Top Doctor by Castle Connolly and was also named a Top Doctor multiple times by New York magazine and Westchester Magazine. Dr. Hart has been published in several peer-reviewed medical journals, including Circulation and The Journal of the American College of Cardiology.

Dr. Gabriela Grasa
specializes in cardiology, nuclear cardiology and echocardiography and is responsible for developing relationships for the group with community members and providers throughout the region. She graduated from the Carol Davila Medical School and completed her internship at St. Andrew Hospital, both in Romania. She completed her residency in internal medicine at Washington Hospital Center and her fellowship in cardiology at Mount Sinai Medical Center. Dr. Grasa has been frequently named a Top Doctor by New York magazine, Westchester Magazine, Castle Connolly, and was also included in Castle Connolly’s “Exceptional Women in Medicine” in both 2020 and 2021. She has been published in several medical journals and has presented her work at annual medical meetings of the American College of Physicians.

Dr. Anthony Mercando
specializes in preventive cardiology, pacing and implantable cardioverter defibrillator (ICD) therapy, and medical informatics. He holds a Bachelor's degree in Electrical Engineering from Manhattan College and a medical degree from Harvard Medical School and the Harvard‐MIT Division of Health Sciences and Technology. Dr. Mercando completed his internal medicine internship, residency, and a fellowship in clinical cardiology at Montefiore Medical Center. He has frequently been named a Top Doctor by Castle Connolly and has had authored or co-authored over 50 articles published in peer-reviewed publications, with topics ranging from angiographic coronary artery disease and heart failure, to ventricular tachycardia and complex ventricular arrhythmias.

Dr. Mitchell Fishbach is board-certified in internal medicine and cardiovascular diseases. He graduated from Albert Einstein College of Medicine, and completed his internship, residency, and fellowship at Montefiore Medical Center. From 2004-2015, Dr. Fishbach was Chief of Cardiology at Lawrence Hospital. He has been named a Top Doctor by Castle Connolly annually since 1997 and his research in cardiology has been widely published.

To schedule an appointment with these physicians, call (914) 849-4800.

backpain2The numbers of Americans suffering from neck and/or back pain are truly staggering. According to the National Health Institute (NHI) at Georgetown University, nearly 65 million people report a recent episode of back pain, with 16 million of adults – 8% – experiencing persistent or chronic back pain.

In addition, as many as 70% of adults will experience a degree of neck pain that prevents them from engaging in their daily activities during their lifetime.

As might be expected, the average occurrence of such conditions increases with age; the National Center for Health Statistics (NCHS), part of the CDC, reports that the percentage of adults with back pain rises from nearly 28% for those aged 18–29 and 35% for those aged 30–44 to nearly 44% for those aged 45–64 and 46% for those aged 65 and over.

This is a natural part of the aging process. As we get older, the standard wear and tear on our spines can result in the discs between our vertebrae to dry out and shrink. In turn, that can lead to osteoarthritis in the spine, which can cause even greater pain – including pinched nerves in the back and legs, leading to sciatica.

But not all pains are alike. Sleeping in an awkward position, lifting something unusually heavy – or, sometimes, for no reason at all – can result in back and neck pain. Common solutions are:

• Applying heat to the affected area.
• Taking an anti-inflammatory medication – as long as the individual is not already taking a blood thinner, is a significant factor to keep in mind for older people.
• Engaging in low-impact exercise like walking, sessions on an elliptical machine or exercise bike or, best of all, swimming.

MORE SERIOUS PAIN


If, however, the pain continues to linger after a few weeks, it is probably time to see a physician. As is the case with most conditions, it is important to remember that not all back- and neck-pain patients will require the same type of care. Unless the pain has become truly unbearable and is preventing one from enjoying their usual routines, oftentimes physical therapy or a tailored exercise program can be the solution.

Ultimately, however, surgery may be necessary. Three of the most typical back surgeries are:

• Discectomy, where a herniated or “slipped” disc is partially or completely removed.
• Laminectomy, where the surgeon eases pressure on the spinal cord or nerve roots by removing part or all of the vertebral bone (lamina).
• Spinal fusion. The most common, involving fusing the vertebrae together to stop the problematic motion.

MY ADVICE

AndrewCasdenIn addition to the above preventive measures, staying well-hydrated is also important, as is trying to maintain a supportive posture. The latter can be a challenge as we age, and bad postural habits formed earlier in life – from bending over a desk, piece of machinery, or nowadays our phones – certainly will not have helped. But making a concerted effort to walk as erectly (yet comfortably) as possible can have a number of positive effects.

And if these measures prove to be insufficient, by all means visit a physician or orthopedic specialist to discuss a comprehensive treatment plan. There is no reason to put up with such a debilitating condition when there are so many options available.

Dr. Andrew Casden is Chief of Orthopedic Surgery and Spine Surgery at White Plains Hospital. To make an appointment, please call 914-849-7897.

babyfoodFiguring out when to introduce babies and children to foods that have a high potential of causing an allergic reaction can be one of the trickiest questions to consider as a parent. To help soothe parents’ anxiety and ensure they are giving their children the proper introduction to these foods, I work closely with families to update them on the latest food-allergy guidelines. Here are some tips that will help you confidently introduce these foods to your kids.

What foods are the most likely to cause potential allergies?

The major food allergens include milk, egg, wheat, soy, peanut, tree nuts, fish, shellfish, and sesame. The most common food allergens for children are peanut and milk, with cow's milk the most common food allergen in early life.

What is the right approach for early introduction of these potential food allergens?

Fearing adverse reactions, many parents historically preferred to wait before introducing these potential food allergens to their kids. But that’s no longer the prevailing wisdom among experts. Doctors no longer believe that waiting until baby is older prevents food allergy. In fact, there is evidence that introduction to peanut in the first year of life can prevent the development of peanut allergy. Especially in infants who are at high risk of developing food allergy, the emphasis is now on early introduction of peanut and egg, rather than avoidance.

Typically, in babies without eczema or any food allergy, I recommend introducing age-appropriate allergenic foods in the first year of life in accordance with family preferences and cultural practices. I suggest prioritizing the introduction of peanut and egg, which has demonstrated evidence of benefit. There are currently no specific guidelines on order of egg and peanut introduction but it should be a shared decision made between parents and the baby’s doctor.

For babies with mild to moderate eczema, we recommend introducing peanut-containing foods at around 6 months of age. If your baby has severe eczema, you are concerned that he/she has an egg allergy and you have not yet introduced peanut, I recommend seeing an allergist as early as 4 to 6 months of age to determine if peanut should be introduced and, if so, the preferred method of introduction. If your baby has severe eczema and/or egg allergy, and you had already introduced peanut which he/she tolerates without any problem, please continue feeding your baby peanut to reduce the risk of peanut allergy once you start avoidance.WhitePlainsHospitalSponsorBanner

What is the best way to introduce these foods?

Once your baby has successfully eaten other solid foods (like single-grain cereals, followed by fruits, vegetables), you can begin to introduce allergenic foods in age-appropriate forms. That doesn’t mean Eggs Benedict or a PBJ sandwich, of course! Follow these tips for easy introduction of these tricky foods:

• Start with a small amount: just a spoonful or two of any allergenic food is enough to give baby a taste of the flavor and watch for potential allergic reaction.

• For peanut, the National Institute of Allergy and Infectious Diseases (NIAID) recommends infant-safe forms in the amount of 2 teaspoons, 3 times per week (for a total of 6 grams of peanut protein).

• To prevent choking in infants, try thinning peanut butter with water, milk, or pureed fruit. This dilution may be necessary until children are able to safely eat foods with the consistency of peanut butter spread thin—that can be after 12 months of age or based on individual developmental abilities.

• During the initial feeding period, serving single-ingredient foods, one at a time, is recommended to observe for symptoms of allergy. Once foods are tolerated, they can be combined.

• There is no evidence guiding how long a given food must be fed before moving on to the next new food. However, generally, when offering a potential food allergen, I advise parents to give baby an age-appropriate serving size at least 3 times over 3-5 days to confirm tolerance.

What are the different types of allergic reactions in infants and toddlers—and how serious are they?

Recognizing allergic reactions in infants and toddlers can be challenging for not only parents and caregivers, but also providers, as your baby is unable to verbalize what they are feeling/experiencing when they are having an adverse food reaction. Behavior changes that may be noted during a reaction can include clinginess, fussiness, or inconsolability, but it is important to note that these behaviors alone may also be present in healthy infants not experiencing an allergic reaction.

Skin, gastrointestinal, and respiratory symptoms were most frequently reported in infants and toddlers, although symptoms involving other organ systems can also occur.

• The type of skin reaction may be “itching, rash, hives or swelling.” Please note the location of the skin reaction with respect to where the skin had contact with the allergen so we can determine if the reaction was the result of a topical contact reaction or a systemic reaction, the latter of which is more concerning. Please take pictures as they are worth a thousand words when you seek consultation with an allergist.

• The most common gastrointestinal symptom is vomiting, although diarrhea can also be considered a potential allergic symptom.

• Belly breathing, fast breathing, nasal flaring, chest or neck “tugging,” wheezing, hoarse voice, hoarse cry, and repetitive cough are all examples of respiratory symptoms.

Timing of the adverse reaction relative to when your baby consumed a potential culprit food is extremely essential, as there are different types of food-induced reactions including scenarios where administration of epinephrine, the first-line treatment of anaphylaxis (a severe life-threatening allergic reaction) is indicated. Diagnostic testing and management can be very different for each type of food-induced reactions; for example, skin testing and an epinephrine auto-injector prescription likely are not appropriate for food intolerances,and concerns that certain foods may exacerbate underlying eczema would warrant a separate discussion. I recommend keeping a food diary when you start to notice these reactions in your baby, particularly if they become recurrent so that you and your allergist can have a full conversation about how to proceed.

While introducing baby to allergenic foods can be a stressful experience, it is so important for their growth and development! The goals of early infant feeding are to introduce foods of varying flavors and textures to encourage future food preference, and to provide nutrition in a balanced and proportional manner for growth and development. Increasing the diversity of both food and food allergen intake in the first year of life is associated with a lower prevalence of food allergy—something all parents are hoping for.

Dr. Angela Chan is a board-certified pediatrician and allergist-immunologist at the Scarsdale Medical Group in Harrison. For an appointment, please call 914-723-8100.

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