Saturday, Nov 26th

hearingaidHearing aids have undeniably been a boon for many patients over the years. But as many of those patients will attest, hearing aids do a very good job making things louder – but they can fall short in making things clearer.

A common complaint about using hearing aids is that it can be difficult to separate speech from the ambient background “noise,” such as in a movie theater. This was the situation faced by one of my older patients who used a hearing aid. He is a practicing attorney who was beginning to feel he could no longer do his job as effectively as he had in the courtroom, due to other people talking and other background sounds. As a result, he tended to work primarily from his office, feeling that he was being pushed into retirement by his loss of hearing.

Fortunately he was the right candidate for a cochlear implantation surgery. The difference his cochlear implant made was huge – at work, at home, at restaurants, and so on. He thanked me profusely in what proved to be a very emotional moment for both of us.

To rewind a bit: the cochlea is a part of the inner ear that is involved with hearing. The implant itself is a small electronic device that electrically stimulates the cochlear nerve; its external part sits behind the ear and picks up sounds with a microphone. Those sounds are then processed and transmitted to the implant’s internal part.
WhitePlainsHospitalSponsorBannerThat part, placed under the skin behind the ear, includes a thin wire and small electrodes that lead to the cochlea in the inner ear. The wire sends signals to the cochlear nerve, which in turn sends sound information to the brain to produce a hearing sensation, essentially duplicating what a person’s cochlea normally does.

It is important to note that this procedure, which typically takes about two hours, does not “recover” lost hearing, but it can improve the patient’s hearing experience. And one should not expect to immediately return to hearing things as well as they did earlier in life. Some retraining of the brain is required to make sense of the sounds that are suddenly detectable again. This can take weeks, even months, but ultimately the clarity of speech that can be detected will be much better.

Cochlear Implant Candidacy

The ideal cochlear implantation candidate is one with significant – that is, moderate to profound – hearing loss, and who, having used hearing aids in the past, no longer derives benefit from them. And while many of us may associate such hearing loss with age, which can definitely be a factor, you may be surprised to learn that patients as young as eight months old can benefit from the procedure.

To determine the severity of a patient’s hearing loss, a series of tests are conducted. These include a pure tone audiogram – familiar to most of us as the “when you hear the tone, raise your hand” exercise – and a pair of audiometry tests. The first of those involves your being asked to repeat a list of words to determine the lowest volume at which you can hear speech.
The second audiometry test is conducted in a similar fashion, but is used to determine how well you can understand speech at a certain level. Typically, someone with significant hearing loss will have difficulty hearing sibilant, high-frequency sounds like “s,” “sh,” “ch” and “j.”

BrianNicholasAs research continues into addressing hearing loss, so too will forward strides be made in auditory-related surgery. But for countless individuals, cochlear implantation procedures have made all the difference. If you have concerns about your own hearing, get in touch with an audiologist, or consult with your physician about your options.

Dr. Brian D. Nicholas is the Director of Hearing and Balance at White Plains Hospital and sees patients at 122 Maple Avenue in White Plains and at 21 Laurel Avenue, Suite 290, in Cornwall. To make an appointment, call 914-849-3755.

facemaskWith COVID rates falling steeply and the New York State mask mandate for schools set to expire on February 21, 2022, some parents are urging the Scarsdale Schools to relax COVID restrictions. Currently Scarsdale’s rules exceed state requirements, and some parents want the district to allow children to eat lunch and converse with friends, sip water when they want it and permit parents to come inside the school to see their children’s classrooms.

At the Scarsdale Board of Education meeting on February 14, 2022, Tali Newman and Kim Liebowitz both gave impassioned comments asking the Board to act.

Here is what they said:

Tali Newman

I respectfully ask that the Board answer in specific terms what it is doing to help reclaim normal life for our children.

I want to make sure that all listening to this meeting are aware of the things that were once taken for granted which have been taken away from our children. The children wear masks all day.

They are not allowed to take them off except for one or two mask breaks and a short lunch. If they are lucky, they get outdoor recess. They are not allowed to speak during lunch or snack. They are permitted to drink water only twice a day during mask breaks. They watch movies during indoor recess. Group projects are replaced with ipad time. They are not allowed to have family members visit school. I have never seen the inside of my son's school. All of this is causing a profound negative impact on their mental health. None of this is mandated by the state. This is a choice that you – the BOE and our administration – are making.

I recently sent the Board via email the Urgency of Normal Toolkit. The Toolkit — Children, COVID, and the urgency of normal. The Toolkit was written by 15 nonpartisan doctors and his since been signed by over 1000 healthcare providers.

As mentioned in the toolkit, CDC data shows that COVID poses very little threats of serious disease for students, and yet they are subject to disproportionate restrictions. Teachers, staff and family members are well protected by vaccination.

Two years in, protecting the mental, social and emotional health of students should be our priority at this point.

Indicators of student mental health and distress are alarming.

Policies to improve and protect student mental health are urgently needed.

Depressive and anxiety symptoms doubled during the pandemic, with 25% of youth experiencing depressive symptoms and 20% experiencing anxiety symptoms.

A study of eating disorder hospitalizations found a 120% increase.

According to national CDC surveillance data, ER visits for suspected suicide attempts in adolescent girls increased 51% in 2021.

Health is about more than the mere absence of COVID-19. Reclaiming normal life for our children is the best way to support and protect them. In lieu of simply allocating resources to our children's mental health, let's correct one of the causes of their distress.

In that regard, I wanted to point you to one of the Scarsdale Board's stated goals for this year:

Participate in legislative advocacy impacting public education via efforts suggested by our Administration or coordinated by the New York School Boards Association (NYSSBA) and Westchester Putnam School Boards Association (WPSBA).

On Wednesday evening, February 9th, the Eastchester Board of Education adopted the following resolutions: (read those in bold)

WHEREAS, due to recent changes, the District is no longer legally obligated to conduct contact tracing of close contacts; and

WHEREAS, the Board deems it to be in the best interests of the District’s students to relax certain social distancing, outdoor masking and other Covid-19 protocols to the extent such protocols adversely affect student education, mental health or physical, social or emotional wellness as soon as practicable, consistent with legally enforceable laws.

RESOLVED, that the District’s Reopening Plan and social distancing and other Covid-19 protocols be promptly reviewed and modified or eliminated, to the extent necessary or appropriate, to eliminate any adverse impact thereof on student education, mental health or physical, social or emotional wellness, including as necessary or appropriate to (1) relax restrictions on District visitors and events, (2) eliminate all outdoor masking requirements and (3) relax lunch restrictions and allow all students to eat lunch under normal conditions comfortably in each building; and be it further

BOARDS CAN ACT. In light of the Board's stated goal of advocacy, I respectfully request that the Board let the community know what IT is doing to advocate for and prepare for the removal of the state's mask mandate and to return normalcy to our children's school experiences (i.e., no more silent lunch, no more social distancing, no more drinking water only 2x a day, parents IN the building).

 Thank you

Dr. Kimberly Greene-Liebowitz

I want to speak to you tonight about COVID mitigation measures in our schools. Thank you for the announcement that masks will become optional upon termination of the mask mandate.

OUR CHILDREN NEED NORMAL

Our understanding of COVID has evolved over the past two years as has the virus, which is now more contagious but less pathogenic. A zero-COVID strategy is not achievable for four key reasons:
1. Frequent mutations
2. Nonhuman hosts
3. Asymptomatic spread
4. Waning immunity

With that in mind, we need to focus on vulnerable populations and treatment rather than elimination of infections. I know you are all aware of this.

Children, even unvaccinated ones, are at extremely low risk of adverse events or death due to COVID. One study of 199 hospitals showed zero pediatric COVID deaths Dec 26-Jan 15, 2022 vs 495 deaths in persons over 50. In New York, the difference is stark: 56 deaths in children 0 to 19 since the pandemic began vs 28,391 over 70 years. Children make up 0.1% of the fatalities.

With this in mind, it is past time that we end the majority of the mitigation measures in place in the schools. These measures have a small effect on reducing disease spread, but given the airborne nature of Omicron – and likely of future variants, given that evolution has been trending towards airborne – their benefit has significantly declined over the past two years. Children and adults in this community go to restaurants, theater, museums. They fly on planes and stand in line in stores. In all these situations they are closer to strangers than our children would be with their friends at lunch. These children are together all day, every day, and there is little utility to separating them at lunch or in the classroom.

Costs exceed benefits.

Limiting spectators is illogical. If people can go to Madison Square Garden with thousands of people who don’t live in this community, they can surely sit next to their neighbors for a school play or a sporting event. Both parents. And grandparents. And siblings.

Childhood is time limited and can never be recaptured. These years that have been stolen from our children are gone forever, never to return. I realize some may find these words inflammatory, but they are the truth. 85% of the brain’s development occurs by the time children are five years old. Social-emotional development occurs in grade school and beyond, and kids cement their knowledge during these formative years. We can’t lose any more of that time to mitigation measures. These kids will never be able to make up for the loss.

Our children need normal lunch. Normal snack. Normal breaks. Normal water consumption. Normal room temperatures. Normal celebrations. Normal events. NORMAL CHILDHOOD.

Please tell the community tonight that you will eliminate all mitigation measures now.

Let our children grow up normally.

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.

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.

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.

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