Ask the Doctor: Dr. Rosemary Ojo

Posted on by Michael Chananie

Eight-month-old Jonathan is perched on his mother’s lap in a doctor’s office. Wearing a blue onesie, he sucks on a pacifier as his eyes cruise the room. Jonathan’s father takes the video that now boasts more than nine million views on YouTube. A doctor can be heard off–screen, narrating the process as he plays with the levels of Jonathan’s new cochlear implant. Prompted by the doctor, Jonathan’s mother begins speaking to him.

“Can you hear me Jonathan?” she coos.

Jonathan looks up at his mother, eyes wide, and drops the pacifier from his mouth. A toothless grin stretches across his face as he stares up at his mother and hears her voice for the first time.

Videos such as this one have gone viral for years. Jonathan himself is now eight years old and likely no longer remembers a time when he couldn’t hear. Cochlear implants, too, have come a long way since then. Rosemary Ojo, MD, a highly specialized ear surgeon, who performs cochlear implants has a passion to treat conditions, including unusual ones, that affect hearing and the ear in patients from eight months to 90 years old.

Who is a candidate for a cochlear implant?

Dr. Ojo: People for whom a cochlear implant is appropriate have such severe hearing loss that it affects the inner ear structure called the cochlea, which contains the organ of Corti. Regular hearing aids are ineffective in these cases. I tell my patients that a cochlear implant is like a computer that we put in the cochlear organ. The implant bypasses the damaged part of the ear, and via electrodes directly stimulates the hearing nerve that allows the brain to hear.

Is cochlear implant surgery a large part of your practice?

Dr. Ojo: Yes, there are very few physicians in our area who do the procedure—and I want people to know that they don’t have to cross the bridge to see a highly specialized ear surgeon.

What are the most common conditions you treat as an ENT?

Dr. Ojo: I see patients with a range of conditions, including age-related hearing loss, tinnitus (ringing in the ear), and large buildup of wax—usually the result of using cotton swabs, which over time push wax back into the ear. Patients also come to me with sinus complaints—usually infections, allergies, or post-nasal drip. Some patients have coughs that don’t go away after a cold, or acid reflux. Occasionally, I treat a patient who has cancer or a rare condition like Meniere’s disease or some other balance disorder.

Posted October 2018

Ask the Doctor: Dr. Tracy Scheller

Posted on by Michael Chananie

To be healthy means more than just being disease free. Our health comprises our physical, psychological, emotional, and social lives. Just as we eat healthfully and exercise to support our bodies, it is important to develop habits that support the other pillars of health, as well. We need to find ways to manage stress, maintain social connections, live mindfully, and deal with emotional issues in the best way possible. This is where integrative medicine comes in.

What is integrative medicine?

Dr. Scheller: Integrative medicine refers to the use of conventional and complementary therapies together in a coordinated and evidence-based way, to facilitate the healing process. In integrative medicine, we consider the patient as a whole person and develop a plan for healing that addresses all aspects of health.

What is the difference between alternative medicine and integrative medicine?

Dr. Scheller: Alternative medicine refers to a non-mainstream approach that is used instead of conventional medicine. What we’re doing at the Graf Center for Integrative Medicine at Englewood Health is better described as complementary medicine: We use non-mainstream therapies together with conventional medicine, and all our treatments are supported by research and evidence.

Who might be a good candidate for integrative medicine?

Dr. Scheller: Anyone! You don’t have to have a disease or diagnosis to explore integrative medicine. This is the right move for those who want to take control of their health, make good lifestyle changes, and boost their overall wellness.

A central concept of integrative medicine is that the patient and practitioner operate as partners in the healing process. Why is this kind of relationship important?

Dr. Scheller: This kind of relationship gives patients the sense that they are part of the team. It is important because people need to take an active role in their own health and wellness. When you think about health, it’s a state of complete physical, mental, and social well-being—not just the absence of disease. We want people to take part in changing their nutrition, lifestyle habits, and stress levels.

Posted October 2018

Ask the Doctor: Dr. Mindy Goldfischer

Posted on by Michael Chananie

October is National Breast Cancer Awareness Month – a great time for women of all ages to learn more about their breast health and double their efforts in surveilling for irregularities in their breast tissue.

Who is at high risk?

Dr. Goldfischer: Most women who develop breast cancer have no known risk factors. Only 5–10 percent of breast cancers occur in women with a genetic mutation, usually BRCA1
or BRCA2.

  • Women with a history of breast cancer are at increased risk for another breast cancer.
  • Women with a genetic mutation or a first-degree relative with one. Women of Ashkenazi Jewish descent are at increased risk for BRCA mutation, as well as other less-common mutations, such as CHEK2.
  • Women with multiple family members (maternal or paternal), especially first-degree relatives, who have had breast cancer. The age at diagnosis is important, with premenopausal occurrence increasing risk.
  • Chest radiation before the age of 30 increases the risk of breast cancer (as well as cardiac disease).
  • Women who have had one or more breast biopsies for ADH (atypical ductal hyperplasia) or LCIS (lobular carcinoma in situ).

At what age should women begin breast cancer screening?

Dr. Goldfischer: The American College of Radiology (ACR) recommends that women with an average risk of developing breast cancer begin annual screening mammography at age 40. Because younger women tend to have dense breast tissue, which can obscure masses, annual mammograms are important; sometimes supplemental breast ultrasound is indicated. High-risk women—those who have a first-degree relative (mother, sister, daughter) with breast cancer or who have a BRCA gene mutation—should begin annual screening 10 years earlier, but not before the age of 25. After the age of 75, women should consult their physician to determine whether they need additional screening.

What are the advantages of 3D mammography?

Dr. Goldfischer: At Englewood, almost all mammograms are 3D. With the traditional 2D mammogram, the X-ray tube is stationary and the breast tissue overlaps in the image. With a 3D mammogram, the X-ray tube moves in an arc around the breast. Images are obtained from multiple angles and synthesized by a computer, which creates thin slices that can be viewed individually. A special computer algorithm achieves 3D mammograms with the same radiation dose as 2D mammograms.

Posted October 2018

Ask the Doctor: Dr. Nimesh Nagarsheth

Posted on by Michael Chananie

Nimesh Nagarsheth, MD, director of gynecologic oncology, practices gynecology, and gynecologic oncology at Englewood Health. Each year in September, we recognize Gynecologic Cancer Awareness Month— a good time for women of all ages to learn more about the cancers that affect the cervix, ovaries, uterus, vagina, and vulva. Raising awareness about cancers that occur “below the belt” in women is vital, as the key to survival is early detection and medical intervention. Until recently, public awareness of gynecologic cancers has been low, as many are uncomfortable talking about women’s reproductive health.

If a woman is diagnosed with a gynecologic cancer, what are her treatment options?

Dr. Nagarsheth: Treatment options depend on the type and stage of cancer; they may include surgery, radiation, chemotherapy, targeted therapy, immunotherapy, or a combination of these. At Englewood Health, we take a multidisciplinary approach to cancer. We customize the treatment plan in tandem with the patient, so every patient receives the most appropriate treatment.

Truth or myth: If you contract HPV, you will eventually get cervical cancer.

Dr. Nagarsheth: Myth. Not every patient with HPV develops cervical cancer. Though most cases of cervical cancer are caused by HPV, the majority of women with HPV do not develop cervical cancer. We’re in the process of learning why some patients with HPV are more susceptible than others to cervical cancer.

How is ovarian cancer typically detected?

Dr. Nagarsheth: There is no good screening process for ovarian cancer. Unfortunately, it is typically detected in its more advanced stages, when patients come to us with symptoms that are secondary to the ovaries having become enlarged or the tumor having spread. Patients frequently report intestinal discomfort, abdominal pain—symptoms of that nature.

Truth or myth: Young women don’t need to be concerned about gynecologic cancers.

Dr. Nagarsheth: Myth. Every woman, no matter her age, should know the warning signs and symptoms of gynecologic cancer. If not for yourself, then for the women around you. Problems such as postmenopausal bleeding, persistent nausea, vomiting, and abdominal distention should never be ignored. It’s all about knowing what is normal for your body and then taking action when something seems off.

Posted September 2018

The Average Heart Beat More Than 1,000 Times per Day. What Can You Do if Yours Beats Irregularly?

Posted on by Michael Chananie

What is the most common heart rhythm disorder?

Atrial fibrillation (AFib) is the most common heart rhythm disorder in the United States, affecting close to 10 percent of people over 65, according to the Centers for Disease Control. Other common disorders are atrial flutter, tachycardia (fast beats), bradycardia (slow beats) and premature ventricular contractions.

What is a cardiac electrophysiologist?

Cardiac electrophysiologists are specialists in heart rhythm disorders. As “electricians” of the heart, we specialize in the complex electrical system that controls the heartbeat and pumping of the heart.

What is your approach to treating patients?

My philosophy has always been to lay out all the options for patients and let them ask all the questions they need to, so they can make an informed decision.

Are there new technologies to treat atrial fibrillation?

Yes. Procedures that used to take eight to 10 hours now take an hour to an hour and a half. For example, catheter ablation (a minimally invasive procedure that uses either radio frequency energy or very low temperatures to “ablate,” or destroy, the problematic electrical pathway) is now done on an outpatient basis. 3D mapping for ablation procedures now enables us to pinpoint the exaction location of the arrhythmia. This reduces the time the procedure takes, avoiding excess radiation exposure and increasing patient safety. The Watchman™ Device: Left Atrial Appendage Closure (LAA) is another new technology. The Heart and Vascular Institute at Englewood Hospital now offers the FDA-approved Watchman™ LAA closure device. Closing off the LAA (a small pouch off the left atrium) can greatly reduce the risk of stroke from atrial fibrillation. For many patients, it is considered safer than blood thinners.

Any words of wisdom for people with AFib?

With atrial fibrillation, you used to just have to live with it. Now there are ways to fix it. You don’t have to compromise on quality of life. There are options for treating your heart rhythm disorder with excellent results.

Posted September 2018

Bare-Bones Advice: Breaking Down the ‘Kneed’-to-Know Info on Orthopedic Health

Posted on by Michael Chananie

Many people don’t think about bone and muscle health on a daily basis, or realize they have a need for treatment. But when the seasons change, our choice of physical activity often changes. And if we’re not prepared, injuries can arise. Taking simple precautionary measures, adjusting our daily routines, tailoring our seasonal activities appropriately, and listening to our bodies can help us prevent injuries and best heal those that do develop.

Who should see an orthopedist?

People should be tested for their bone health in general, but especially if they have a family member with osteoporosis or osteomalacia. These conditions can be passed on, but are treatable. Those with targeted issues such as shoulder pain or arthritis pain should also take special care.

How can people prevent injury in the fall and winter months?

In the fall and winter, people are starting to clean their gutters, tend their lawns, rake leaves, and shovel snow—all activities that rely on your low back, your quads, and your shoulders. So it’s important to spend a lot more time on your core exercises, stretching out your quads, and strengthening your back to get those muscles activated again. And if you’re an avid skier, remember that you have to get your body trained again before picking up a set of skis.

And with the holidays around the corner, how can people avoid accidents while celebrating?

We see a tremendous increase in fractures when families bring elderly loved ones home for the holidays, taking them out of their controlled environments. Make the home environment safe — remove loose rugs from the bathroom, fix unstable handles or balusters on the railings. When you’re waiting on calls from family and friends, don’t jump up to get the phone—take those extra few seconds to avoid injury. We also see wrist fractures and ankle sprains from people falling on snow and ice, so wear appropriate footwear for the weather. Lifting and moving heavy objects, like boxes of holiday decorations, also takes a toll. Always bend at your knees and hips, rather than your spine, and lift with your legs.

When do you know if you should see a specialist for an injury?

When in doubt, get checked, particularly if pain is disrupting your life or an injury is impacting your function. We always look to treat patients with the least invasive approach possible, using noninvasive or minimally invasive techniques to help them safely get back to enjoying normal activities. The majority of issues can be treated conservatively with anti-inflammatories, like Advil, Tylenol, or over-the-counter medications, and physical therapy.

Posted September 2018

What You Need to Know About Colorectal Cancer

Posted on by Michael Chananie

Dr. Anna Serur, chief of colorectal surgery at Englewood Health, shares the latest recommendations about screening and prevention, a topic she says is not often discussed during regular health check-ups.

What is the most important information to know about colorectal health and cancer risk?

Dr. Serur: Recent data from the American Cancer Society has shown an increased prevalence of colorectal cancer in younger patients. However, most people only need to have a colonoscopy every 5-10 years, beginning at age 45. Screenings may detect abnormalities like inflammation or precancerous polyps—growths on the lining of the colon and rectum—that can then be removed, which is cancer prevention at its best. The most important recommendation to otherwise young, healthy patients is to share all symptoms with their primary care doctors or gastroenterologists. This includes any change in bowel habits, abdominal pain, blood in the stool, fatigue, or unintended weight loss. Many people may assume their symptoms are unrelated to colon health, ignoring signs that there may be something more serious going on. If you experience two or more of these symptoms, make an appointment to see your doctor immediately.

What are the causes of colorectal cancer?

Family history or genetic risk can be a major factor for people who are diagnosed with colorectal cancer. Colon polyps and genetic conditions, such as hereditary polyposis syndrome, should be actively monitored by a gastroenterologist. Environmental and lifestyle factors including physical inactivity, diets high in processed food and red meat, obesity, stress, alcohol consumption, and smoking are also known risk factors for developing cancer. If you engage in two or more of these lifestyle habits, you should develop an immediate plan to reduce these risk factors in your life.

What are some steps people can take to reduce their risk?

Staying active, maintaining a healthy weight, and reducing stress can lessen your cancer risk. Follow up regularly with your primary care doctor, and reach out right away if you notice symptoms. As a colorectal specialist, I work closely with patients’ primary doctors to make sure we’re monitoring those at high risk for developing a GI cancer. Being proactive can positively affect your overall well-being, while minimizing your cancer risk.

For those hesitant to get a colonoscopy, can you offer any reassurance?

Think of your colonoscopy as a safe juice cleansing—all the rage lately! The procedure itself is quick and painless. Also, talk to your doctor about what screening options are right for you. If you’re 50 and older with an average risk for colon cancer— and without symptoms—you may be able to do noninvasive screening, right from the comfort of your home, using stool sample kits that can detect abnormalities.

Any advice for managing colon health and cancer risk?

The gastrointestinal tract is sensitive to emotion. Anger, anxiety, sadness, elation—all of these feelings (and others) can trigger symptoms in the gut. There is, undoubtedly, a gut/brain connection. If you’re looking to manage stress to improve your gut health, try out acupuncture, yoga, massage, or meditation. If you’re not sure where to start making changes to your diet, consider nutritional counseling to help improve your eating habits and avoid high-risk foods we encounter every day.

Updated February 2023

Heart to Heart: Taking a Proactive Role in Your Cardiac Health

Posted on by Michael Chananie

Cardiovascular disease is currently the leading cause of death worldwide. However, there are steps we can take to reduce our chances of developing this serious condition. According to the American Heart Association, 80 percent of heart disease and stroke events may be preventable through education, lifestyle changes, and risk-factor modification.

For those looking to get serious about heart health, but not sure where to start, what simple lifestyle changes would you recommend?

One of the easiest and most important changes people can make is diet modification. Here are a few “dos and don’ts” to remember.

  • Do eat the rainbow. Aim to include a wider variety of “color” in your foods.
  • Consume unprocessed healthy foods rich in nutrients and vitamins, such as green leafy vegetables, fresh berries and fruits, fish, lean meats, and whole grains.
  • Do stop the salt. You don’t have to cut it out all at once, but reduce the amount you use with each meal, and work toward preparing foods with little or no salt.
  • Don’t regularly indulge in sweets. Read labels and minimize the amount of sugar you consume in beverages and prepared foods. Opt for Valentine’s Day flowers over jumbo heart-shaped boxes of chocolate.

Diet aside, what habits can people change to be heart-smart?

There’s still time to stick to those New Year’s resolutions. It’s important to maintain a healthy weight, not only to care for your heart, but also for your overall well-being. Make sure you’re not sitting still all day—move more! Build exercise into your weekly schedule so it becomes a habit. Aim for at least 30 minutes of moderate-intensity aerobic activity, five days a week. If you have a job that keeps you deskbound, take breaks to stretch and go for a walk. It’s also the perfect time to quit smoking. Even casual smoking can do a lot of damage—so don’t start if you haven’t already! And limit your alcohol intake to one drink per day. If you do overindulge, don’t be too hard on yourself and don’t give up. Each new day counts when it comes to heart health.

How does stress affect the heart, and how can we better manage it?

Stress and anxiety affect the entire body in a number of ways. Stress itself can cause and aggravate hypertension. It can also lead to unhealthy coping mechanisms such as smoking, excessive drinking, overeating, and physical inactivity, causing high blood pressure and cholesterol—both of which increase the risk of heart disease. So the most important advice I can give is to relax more. Learn healthy ways to cope with stress—a hobby, a new exercise routine, time with family and friends. The Graf Center for Integrative Medicine at Englewood Health offers yoga, guided meditation, massage, acupuncture, aromatherapy, Reiki, nutritional counseling, and various other services to help relax the mind and body.

What are the key takeaways, and how can we track our progress?

This year, focus on you.

  • Manage and prevent high blood pressure, high cholesterol, obesity, and diabetes through proper nutrition, exercise, medication (if necessary), and regular follow-up visits with your physician.
  • Come prepared to discuss your family history, which can influence your risk factors for heart disease.
  • Know your numbers. What are your blood pressure, cholesterol, and glucose levels? Ask for printouts of your lab work or make use of your physician network’s online portal. Taking steps to reduce these levels if elevated can significantly decrease your risk of developing heart disease.
  • Take note of your activity and behavior changes between visits, as well as any resultant changes in your levels.
  • Most important, don’t ignore the warning signs. If you develop new chest discomfort or experience difficulty breathing, palpitations, lightheadedness, or are feeling faint, be sure to reach out to your doctor immediately, as these could be symptoms of heart disease.

Posted September 2018; Updated January 2023

Minimally Invasive Treatment for Colorectal Cancer at Englewood Health

Posted on by Michael Chananie

When Anna Serur, MD, was a little girl in her home country of Russia, she dreamed of becoming a doctor. “My mother says that from the time I was three, I always said I wanted to be a doctor…a surgeon. There was never anything else; not a ballerina, not an actress, always a surgeon.”

“When my parents decided to move to the United States from Moscow, when I was 15 years old, I was glad. I wasn’t sure I would be able to get into medical school in Russia because I was Jewish. Here in the U.S. it wasn’t an issue.”

Dr. Serur received her medical degree from SUNY Downstate in Brooklyn, then completed a surgical residency at NewYork–Presbyterian Hospital and a fellowship in colorectal surgery at North Shore–LIJ Medical Center. She became director of colorectal surgery at Maimonides Medical Center in Brooklyn, where she was an attending surgeon for 10 years. Today, she is chief of colon and rectal surgery at Englewood Health. She specializes in minimally invasive and robotic colon and rectal surgery.

“At Englewood,” says Dr. Serur, “we can perform even the most complex surgeries, such as rectal cancer or ulcerative colitis surgery, using a minimally invasive approach: robotically or laparoscopically. We have excellent outcomes and very low complication rates.

“Minimally invasive surgery is easier on the patient because it causes fewer physiological changes and leads to an easier recovery. The surgery is performed using the same principles, regardless of how it’s done: robotically, laparoscopically, or open. With robotic surgery there is less blood loss, greater precision, and a quicker return to normal activities.”

Modern Colorectal Surgery

The techniques used to perform colon and rectal surgery have become more routine over the past 10 years. This is important because research has shown that the way the surgery is done, and who does it, strongly influences the outcome. “You want to go to a surgeon who does the surgery day in and day out. It’s extremely important. Particularly in rectal surgery, where the first treatment is critical,” adds Dr. Serur.

“Crohn’s disease and ulcerative colitis are common in Ashkenazi Jews. A person who has had ulcerative colitis for more than eight years—even if it is well controlled—is has a higher risk of colorectal cancer. It is important to find a physician with a lot of experience, someone with whom you are comfortable and can connect to. Our colon and rectal surgery team also performs surgery for diverticulitis, rectal prolapse, and chronic constipation not responsive to medical treatment.”

 Don’t Ignore Symptoms

“We are seeing an increase in younger patients with colorectal cancer—sometimes patients 30 years old or younger,” says Dr. Serur, explaining that the national increase in obesity, changes in dietary habits, and increased sugar intake are likely having an impact.

“Do not ignore your symptoms,” she emphasizes. “If you start seeing blood in your stool or your bowel habits change, it doesn’t matter if you are 23 or 63, it should always be brought to the attention of a medical professional. Unfortunately,” she adds, “with colorectal cancers, it is often very late in the game when people are diagnosed. The current recommendation is age 50 for first colonoscopy, unless there is a personal or family history of ulcerative colitis, Crohn’s disease, or polyps. Then it should be earlier.”

 A Team Approach

“Multidisciplinary care is so important in the treatment of cancer. At Englewood Hospital and Medical Center, we take a team approach,” explains Dr. Serur. “You get oncologists, surgeons, geneticists, a nutritionist, and other specialists. Good minds are put together, and a personalized pathway is developed for each patient. We really see each person as a person, not as a disease.”

 Why colorectal surgery?

“I like treating cancer and being specialized. Of course, it’s very satisfying when a worried patient comes to me with a potentially life-threatening disease, and two weeks later all visible cancer is gone. It gives me a lot of satisfaction. For those with more advanced disease, I let them know that we are there for them, and that we will do everything in our power to make them well. I also treat a lot of benign conditions. When patients get better from something that was taking over their life, it’s a big blessing.”

How do you work with patients?

“Number one, I’m honest with them—I believe in sharing information with patients. I want to make sure that my patients understand that many cancers are potentially curable and that they understand the procedure they are about to undergo. I’m thorough in my explanation, and I try to bring it to their level of comprehension. Number two, I see the patient as my family member. It’s my mother, my grandmother, my sister. I treat them as I would want to be treated myself.”

Posted September 2018