A Range of Treatments for Prenatal Kidney Issues
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- Written by Joanne Wallenstein
- Category: Health
(Submitted by Dr. Amanda C. North, Pediatric Urology at White Plains Hospital)
Unlike conditions of the heart, liver, and other singular organs, most people can live normal lives with just one kidney. However, a condition called prenatal hydronephrosis – essentially the swelling of a kidney in a fetus or infant – may require medical intervention to make sure the developing child is on the right path to good health.
Prenatal hydronephrosis affects between 0.5 to 1% of all pregnancies. The condition is typically brought on by a buildup of urine in the kidney due to a blockage somewhere in the urinary tract – that is, the ureter, urinary bladder, or urethra. The most common type of blockage is a ureteropelvic junction (UPJ) obstruction, involving a blockage where the kidney joins the ureter, which is the thin tube that carries urine to the bladder.
In prenatal cases, hydronephrosis is usually diagnosed during the second trimester via ultrasound. One clue can be low levels of amniotic fluid in the womb; as a fetus’ urine is part of the amniotic fluid, a significantly low level of the latter may indicate that the fetus is not passing enough urine. A swollen abdomen in the fetus can also raise suspicions. In such cases, parents are referred to a pediatric urologist before the baby is born so that they understand and are prepared moving forward.
Usually a sonogram will be given on the newborn within 48 hours of birth; the delay is due to the fact that the amount of fluid in the kidneys depends upon how well hydrated the newborn is. Although hydronephrosis may correct itself, the pediatric urologist will assign a ranking of 1 to 3 to the infant’s situation, with 1 being a minimal case and 3 being a severe one. Persistent mild and moderate cases can often be treated through watchful waiting with or without preventative antibiotics, followed by ultrasounds to measure improvement.
Surgery may be necessary in severe cases, with the aim of reducing the pressure in the kidney by relieving the obstruction. A pyeloplasty, used to address a UPJ obstruction, involves removing the blocked part of the ureter and reconnecting the healthy portion to the kidney’s drainage system.
¬With the less common ureterovesical junction (UVJ) obstruction – a blockage at the point where the ureter joins the bladder – a ureterostomy may be performed. This involves disconnecting the ureter from the bladder and making a surgical incision called a stoma, which drains into a diaper. The ureter will later be re-inserted into the bladder as the baby grows. In older babies and children, the ureter may be reimplanted into the bladder directly without first requiring a ureterostomy.
Depending on the age and general health of the patient, robotic surgery may be an option. In any case, such operations usually take between 1 ½ and 3 hours and have a 97-98% success rate for patients of all ages.
The prospect of surgery for a baby is an emotional and complicated one for any parent. But there are solutions when it comes to prenatal hydronephrosis. Consult with your pediatrician and a pediatric urologist to get the right answers for you and your child.
It is also important to note that hydronephrosis can occur at any age. Severe cases may lead to kidney damage and even kidney failure. Depending on the severity, dialysis or a kidney transplant may be advisable for older patients. The good news is that around 90% of hydronephrosis cases – whether prenatal or postnatal – do not require any intervention; they essentially resolve themselves, or the unaffected kidney does the job of both without any complications.
Dr. Amanda C. North is Chief of Pediatric Urology and an attending physician at the Children’s Hospital at Montefiore (CHAM). To make an appointment, call 914-849-5437.
Health Matters
The original version of this article was published in Health Matters, a White Plains Hospital publication.
How Seriously Should You Take a Smartwatch’s AFib Alert?
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- Written by Joanne Wallenstein
- Category: Health
(The following was submitted by Martha G. Ferrara, Nurse Practitioner at White Plains Hospital)
Advancements in technology continue to occur at a rapid pace – so rapid, in fact, that they may cause your heart to beat a little faster. But when it comes to smartwatches, they can convince someone that their altered heartbeat means they have atrial fibrillation (AFib), a serious condition that poses an increased risk of stroke and heart failure.
AFib is a quivering or irregular heartbeat (arrhythmia) that can lead to those and other heart-related complications. Over 12 million people are projected to have AFib by 2030, according to the American Heart Association, which says the condition increases the risk of stroke fivefold.
We all want to be aware of potential risks to our health, but in this case, a little information can perhaps not be enough. Our office is, on many days, overwhelmed with owners of an Apple Phone, Fitbit, Samsung Galaxy, and similar devices that have provided a “you may have AFib” alert – and who are understandably concerned.
Smartwatches use a kind of electrocardiogram (ECG) technology that monitors blood flow and heart rate throughout the day; any irregular rhythms are then “alerted.” One of the problems we are encountering is that the technology may be outpacing the reality.
I am certain that most of us have at some point felt that odd sensation indicating an irregular heartbeat or even the “skipping” of a beat. But is that enough to conclude that you have AFib?
The answer is “no,” according to the U.S. Preventive Services Task Force (USPSTF). That organization issued a report in January 2022 finding that the likes of smartwatches and smartphone apps, automated blood pressure cuffs, and pulse oximeters are no match for an ECG screening of an asymptomatic patient in a healthcare provider’s office when it comes to an accurate AFib screening.
To be clear, the USPSTF is not saying that such devices’ alerts are invalid – just that there is not enough data to conclude that asymptomatic patients should completely trust those devices’ suggestive diagnoses.
Fortunately, technology companies appear to be aware of this ever-more-complex situation. Representatives from many areas and disciplines, such as cardiac device industry, tech companies, entrepreneurs, scientists, and engineers attend the annual HRX meeting – a digital health conference sponsored by the Heart Rhythm Society, the leading scientific organization on cardiac pacing and electrophysiology, now in its third year. They are joined by electrophysiologists and nurse practitioners like me, as well as physicians and many stakeholders in this area, to engage in an open and collaborative discussion about the current situation and the exciting potential for digital health “wearable” tools going forward.
In addition, White Plains Hospital’s Cardiac Electrophysiology program remains at the forefront of the specialty, having been selected to participate in a study sponsored by the National Institutes of Health and Johns Hopkins University. The multi-year, nationwide study known as the REACT-AF trial is a randomized, controlled trial exploring the incorporation of wearable technologies into the management of AFib and usage of anticoagulation (“blood thinners”) therapy.
I believe that such collaborative sharing of knowledge and information is the wave of the future – one that will no longer find patients stranded somewhere in the middle but focus our patients at the center of care.
In the meantime, if you do receive an AFib alert and are concerned about what it could mean, contact your primary care physician to discuss. Feeling heightened anxiety or even panic is never a good thing, especially without understanding your own medical history. Your PCP should be able to set your mind, at least partly, at ease by either ruling out AFib or by recommending you see a specialist.
Martha G. Ferrara is the Assistant Director of Electrophysiology Services at White Plains Hospital. For an appointment, call 914-849-2690.
Health Matters
The original version of this article was published in Health Matters, a White Plains Hospital publication.
Whole-Body Deodorant: What to Know
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- Written by Joanne Wallenstein
- Category: Health
(The following was submitted by Dr. Lauren Adams)
When most of us think of deodorant, we think of our armpits – the usual source of body odor that can be embarrassing. But a wave of products being advertised as “whole-body deodorants” appears to be gaining traction in the marketplace through media ccoverage and a seemingly ceaseless series of TV commercials.
As the name implies, whole-body deodorants are for use on the whole body … up to a point. Dr. Lauren Adams, a board-certified dermatologist at WPHPA Westchester Dermatology and Mohs Surgery in Mount Kisco, notes that such products “should be used externally only,” even when using in the underwear area.
Indeed, she adds, using any product with a fragrance on or near one’s private parts should be done with caution. These are delicate areas and fragranced products can lead to skin irritation or allergy, even if they are being promoted as “natural” or “skin-safe.”
Dr. Adams says the same advice applies to any scented skincare products for those with sensitive skin, as patients with a history of eczema or skin allergies are even more likely to develop rashes in areas where fragranced products are applied.
The dermatologist notes that deodorants and antiperspirants, while synonymous in some people’s minds, are actually quite different. In fact, deodorants are considered cosmetic, while antiperspirants are classified as an over-the-counter drug and are regulated by the Food and Drug Administration (FDA). Antiperspirants are typically manufactured using aluminum compounds that temporarily plug up the sweat gland and prevent perspiration – while deodorants simply address the odor.
Sweating is a normal body function, Dr. Adams notes, so people may want to try a deodorant before committing to an antiperspirant to gauge the results.
She further notes that body odors are typically caused not by the body parts, or even the sweat glands themselves – of which there are between 2 and 4 million throughout the body but just around 25,000 in the armpits. Instead, body odor production requires a second ingredient: bacteria.
There are two types of sweat glands on the skin. The apocrine sweat glands, which are associated with hair follicles, are concentrated in the groin and armpits. The make-up of this sweat, which is slightly oily and includes cholesterol and fats, when combined with bacteria in these areas produce the body odors with which we are all familiar.
The eccrine sweat glands, which are located diffusely throughout the remainder of the body, produce sweat that is mostly water, electrolytes, and some antimicrobial peptides. This sweat is only malodorous in areas with significant amounts of bacteria, which is common to happen under the breasts or on the feet.
Although Dr. Adams says she hasn’t encountered patients asking about whole-body deodorants, the fact remains that they are on the rise. Usually credited with kicking off the trend is Dr. Shannon Klingman, an OB/GYN in Minnetonka, Minnesota who, according to her website, developed women’s deodorant Lumé in 2017, followed by male-friendly Mando a few years later, in order to address other sources of body odor.
While Lumé and Mando may not yet be household names, big-name competitors are entering the marketplace. Secret Whole Body Deodorant and Old Spice Total Body Deodorant, both owned by Procter & Gamble, debuted in February; the Ban Total Body Sweat & Odor Collection followed in March; and Unilever’s Dove Men+Care line launched its Whole Body Deo in April.
For all that, Dr. Adams says washing oneself with antibacterial soap, and drying thoroughly, should be sufficient for most people – and if not, they should see their dermatologist for evaluation. “Some degree of body odor is normal, and part of being human,” she remarks. “But if these products leave people feeling more confident and better about themselves, I think that’s a positive.”
Dr. Lauren Adams is a dermatologist at WPHPA Westchester Dermatology and Mohs Surgery in Mount Kisco. To make an appointment, call 914-242-2020.
Health Matters
The original version of this article was published in Health Matters, a White Plains Hospital publication.
The HIV/AIDS Epidemic Is Still with Us
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- Written by Dr. Gary Zeitlin
- Category: Health
(Submitted by Dr. Gary Zeitlin, Infectious Disease at White Plains Hospital)
Fortunately, waves of major diseases rise and fall. This is most immediately apparent with COVID-19, which at its peak in 2021 caused over 2.5 million hospitalizations in the U.S. (and an associated 450,000 deaths) but by 2023 contributed to “only” about 900,000 hospitalizations and 75,000 deaths.
Although the numbers in the U.S. continue to decline, the World Health Organization (WHO) still considers COVID-19 to be a pandemic, given its ongoing strength in other parts of the world. Both WHO and the U.S. federal government ended their declarations of a public emergency in May 2023 – but that is hardly the same as saying the coronavirus is a thing of the past.
You may be surprised to learn that the same is true of the HIV virus, which can cause AIDS. First recognized as a new disease in 1981, AIDS is still considered to be a pandemic by WHO, and with good cause. New cases are on the decline, but that does not mean it has been defeated. During the past 40-plus years, most people have become more aware of the potential pitfalls of unprotected sex, and needle-sharing. Even so, we still see people living with HIV, as do hospitals across the country and throughout the world.
One invaluable tool against the HIV virus has been Pre-exposure prophylaxis (PrEP), a general term for using medications to prevent the spread of disease in people who have not yet been exposed to it, and Post-exposure prophylaxis (PEP), which reduces the risk of someone exposed to HIV from having the virus infect them. It is not, however, 100% effective, and is meant to be taken only in emergency situations. PrEP has been the preferred treatment – and a highly successful public health approach – for the last few years.
Chimeric antigen receptor (CAR) technology also shows promise with HIV, having already been established as a viable treatment for many types of cancer, including leukemia. The therapy involves collecting a patient’s T cells and re-engineering them in a lab to produce proteins that are then reintroduced into the patient’s body. These CAR-T cells then seek out and eliminate cancer cells.
Even with these and other methods to prevent and treat the virus, however, the disease has not gone away. According to the Joint United Nations Programme on HIV and AIDS (UNAIDS), there were about 39 million people worldwide with HIV in 2022: 37.5 million adults, and 1.5 million children under the age of 15.
Lack of awareness, as well as socioeconomic disparities here and abroad, are commonly cited reasons for the disease’s continuing threat; untreated adults may pass the virus to their partners and children, continuing the cycle.
Nevertheless, UNAIDS reports that an estimated 1.3 million individuals worldwide acquired HIV in 2022 – a 38% decline in new HIV infections since 2010, and a 59% decrease since 1995’s peak. The group has targeted 2030 as when it believes HIV/AIDS’ pandemic status can end, depending on cooperation from governmental and other leaders throughout the world.
It is definitely a hopeful goal, one that UNAIDS announced last summer that it believes is still achievable. In the meantime, let us all remain vigilant against this and other viruses by supporting behaviors that reduce risk for ourselves and others.
Dr. Gary Zeitlin is an attending physician and Chief of the Infectious Disease Division at White Plains Hospital. To make an appointment, call 914-948-0500.
Health Matters
The original version of this article was published in Health Matters, a White Plains Hospital publication.
Amy Paulin Comments on Supreme Court Bump Stock Decision
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- Written by Joanne Wallenstein
- Category: Health
From NYS Assemblywoman Amy Paulin: Supreme Court’s reckless bump stocks decision endangers the safety of our families
Yesterday the U.S. Supreme Court issued a disastrous ruling that reversed the federal ban on bump stocks. This is an irresponsible and alarming decision that will make our communities less safe. It’s also another example of this iteration of the Court’s seeming indifference toward commonsense gun regulations.
Bump stocks can be used to replace the standard stock of a semi-automatic firearm, enabling it to fire at the rate of an automatic weapon. In recent years, we have seen mass shooters use this modification device on multiple occasions. The most horrific instance was the 2017 Las Vegas massacre, in which the shooter used bump stocks to modify his guns to fire rapidly, killing 60 people and injuring hundreds more in the deadliest shooting in our country’s history. Yesterday’s Supreme Court decision recklessly increases the chances of something like this happening again.
Criminals seek out bump stocks solely to cause more carnage than they could with conventional firearms, and measures to keep them out of the wrong hands are crucial to protecting our communities. In 2020, in an effort to combat gun violence, I fought for and voted to ban bump stocks in New York State. That legislation passed, is still in effect, and is now more important than ever. We must continue to place the highest value on people’s right to live safely and without fear. This is the right that I’ll continue to fight for and legislate to protect.
