NewYork-Presbyterian | Advances | A Monthly Health Newsletter for Patients

A monthly health newsletter for patients

May 2018

Amazing Stories: Richard Mandaro

A lawyer’s life was saved thanks to quick thinking emergency medical technicians and NewYork-Presbyterian’s mobile stroke treatment unit.

May 24, started like any other day for 48-year-old Richard Mandaro. The father of teenage twins went to his early morning fitness class before getting on the Long Island Railroad to head into the city for work. But something happened when he got off the New York City Metropolitan Transit Authority 7 train at Grand Central.

“As I was coming out of the subway, I felt my right hand getting ice cold. I started feeling odd,” he says.

“I thought, maybe it was because I didn’t have breakfast, so I went to the coffee cart on the corner near my office. I was waiting on line, still not feeling well, so I started leaning on cart,” he adds. “When I got to the window, I put my hand in my pocket to get my money, and I couldn’t feel anything. I could see the money in my pocket, but I couldn’t feel it. It was like an out of body experience. Then unknowingly,  someone told me I dropped my money on the sidewalk.”

With the assistance of some passersby, Richard was able to collect his money to pay for his regular order, all without saying a word to the coffee vendor. With coffee in hand, Richard was able to walk to his office building and made his way up to the law firm where he works as an intellectual property litigator.

“I got up to my office and sat down at my desk hoping I would feel better. But a few minutes later I knew something still wasn’t right.  I heard two secretaries talking outside of my office. I tried to call to them to get help, but I couldn’t say anything. That’s when I really got scared.  I was able to get up and went to them to try to speak, but nothing was coming out right,” he remembers. “That’s when they called 9-1-1.”

When the city’s emergency medical service paramedics arrived, they determined he was having a stroke, which caused him to develop aphasia—the inability to comprehend or formulate language because of damage to the brain.

“One of the EMTs said to me, ‘I heard of this really cool mobile stroke unit, I’ve never seen it, but it’s supposed to come with a doctor on board, a CT scanner, and they can give you medicine for a stroke right on sight. Do you mind if I call it?’ I gave him the thumbs up.”

In 2016, NewYork-Presbyterian—in partnership with Weill Cornell Medicine, Columbia University Medical Center, and the Fire Department of the City of New York—launched the first mobile stroke treatment unit (MSTU) on the East Coast. The MSTU is intended to provide immediate care to people who may be having a stroke by cutting down the time to treatment.

For people having a stroke, the amount of time between the onset of symptoms and treatment plays a significant role in outcomes. It is estimated, the typical stroke patient loses 1.9 million neurons each minute in which a stroke is untreated. Each hour the stroke goes untreated, the brain loses as many neurons as it does in almost four years of normal aging, according to the American Stroke Association.

“By the time the EMTs got me packed up, on a stretcher and down to the lobby, a NewYork-Presbyterian neurologist was there. The EMT updated the doctor on my status, and he took over from there,” Richard remembers.

In the mobile stroke unit, the technician began a computerized tomography (CT) scan of Richard’s brain, which was then transmitted to the hospital, where the emergency medicine doctors at the hospitals were preparing for his arrival. He was given clot-busting medication, tPA, to help break up any blood clots in his brain and avoid any additional strokes from occurring.

“On the way to the hospital, I immediately felt the medication working. I started feeling better, and my speech began to get better” he says. “I got the tPA within 75 to 78 minutes after my first symptoms, which was so important because it’s not effective after three to four hours. Timing is everything, that’s why this mobile stroke unit is great because it gets treatment to people earlier.”

Once he arrived at the NewYork-Presbyterian/Weill Cornell Medical Center, Richard got a magnetic resonance imaging (MRI) test which confirmed his stroke and was transferred to the neurologic intensive care unit (ICU).

“One of the neurologists who treated me, Dr. Halina White, wanted to know why a young guy like me would have a stroke. In my case, she thought I might have a patent foramen ovale (PFO) that caused the stroke.”

A PFO is a hole in the heart that occurs after birth when the foramen ovale doesn’t close completely. All fetuses have the foramen ovale—it allows blood to bypass the fetus lung, which cannot work until they are exposed to air—that closes within a few months of birth. However, for about 25 percent of people, the PFO does not completely close. In a majority of cases, an open PFO isn’t a problem, but for some the hole serves as a portal for blood clots to travel from the heart to the brain, causing a stroke.

“When they did the MRI, they saw where I had the stroke in the left side of my brain but they also saw another part of my brain where I had a previous stroke, which I didn’t know about. The doctors were overly concerned. So, they did a lot of tests to find out why I was forming these blood clots,” he says. “Dr. White recommended having a heart sonogram. That didn’t find the PFO initially.”

He later underwent a transesophageal echocardiogram (TEE), a test that uses high-frequency sound waves to produce detailed pictures of the heart, which found the PFO. Richard was referred to an interventional cardiologist, who performed the PFO closure at NewYork-Presbyterian/Columbia University Medical Center.

Since his stroke and subsequent procedures, Richard is getting back to his regular life — helping to raise his children, working, and working out.

“Since May I’ve been a medical wonder,” Richard jokes. “It makes you appreciate that everything is OK.  I’m extremely thankful for the amazing medical care and treatment I’ve received.”

To learn more about the mobile stroke treatment unit, visit To find a neurologist, call 877-697-9355.

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Know What To Do If You See Someone Having A Stroke

There are two words every person should remember if they see someone having a stroke: act fast! That’s because human nerve tissue is rapidly lost as stroke progresses. It is estimated that two million cells in the brain can die each minute when deprived of oxygen, so the longer the delay in treatment, the more damage can be done to the brain.

“A stroke is a ‘brain attack,’ and is the leading cause of adult disability in the U.S.,” says Dr. Douglas D. Sankar, a neurologist with NewYork-Presbyterian Hudson Valley Hospital in Cortlandt Manor. “Stroke causes the death of cells in a part of the brain or, sometimes, the spinal cord from the disruption of blood flow to the area.”

“The symptoms of a stroke can be very variable, and are related to what part of the brain is affected. Often, strokes are painless, although headaches are common with hemorrhagic stroke,” notes Dr. Sankar.  Symptoms can include weakness that involves specific body parts, or one or both sides of the body; numbness and sensory loss; changes in speech, both the ability to speak and/or the ability to understand speech; changes in vision; loss of coordination and vertigo, to name a few. “However, for an accurate diagnosis, a patient’s history and a physical examination should be performed to distinguish between other disorders that can mimic stroke, such as seizure, fainting spells, and low blood sugar,” he says.

“Time is brain.” This phrase, used commonly in the medical community, emphasizes that human nerve tissue is rapidly lost as stroke progresses. Rapid and accurate diagnosis of the kind of stroke and the exact location of its damage is critical to successful treatment. That’s why if you suspect someone is having a stroke, call 9-1-1 immediately and know what to do while you’re waiting for help to arrive:

Do’s and don’ts if you see someone having a stroke

  • Don't: drive to the hospital. Call 9-1-1 immediately. Paramedics are faster and can recognize when someone is in trouble and needs emergency assistance.
  • Don’t: give the person aspirin. For many strokes, aspirin is good—but for many other strokes, aspirin will make things much, much worse. Leave it to medical personnel to decide what’s best.
  • Don’t: give the person anything to eat or drink. Stroke can cause difficulty with muscle control, including the ability to swallow.
  • Do: write down the time. This will greatly help the emergency team to act as efficiently as possible. Knowing when the symptoms started can help doctors determine the appropriate treatment. If you are not sure when the symptoms started, knowing when the person was last seen “normal” is helpful as well.
  • Do: help the person lie down. Keep stroke victims on their side with the head slightly elevated to promote blood flow.
  • Do: Loosen any restrictive clothing. This helps the stroke victim breathe more easily. Avoid pulling or straining any weakened limbs.
  • Do: check for breathing if the person is unconscious. Check for pulse and breathing. If there is no pulse, begin CPR immediately.

According to Dr. Sankar, “The death rate and level of disability resulting from strokes can be dramatically reduced by prompt medical care. The sooner treatment is started, the more likely there will be a good outcome.” 

To learn more about the mobile stroke treatment unit, visit To find a neurologist, call 877-697-9355.

Amazing Stories: Medical Mission to Haiti

A Team of orthopedic surgeons at NewYork-Presbyterian/Columbia University Irving Medical Center are helping to improve musculoskeletal care in Haiti.

Long before the 7.0 magnitude earthquake hit Haiti in January 2010, the small island nation struggled to adequately provide healthcare. The most impoverished country in the Western Hemisphere, almost half of the population had no access to health services, according to the World Health Organization. The quake shredded what was left of the tattered healthcare system — hospitals building collapsed, and already strained non-governmental organizations (NGO) worked to care for the injured.

But tragedy gave rise to new hope, as the international medical community rallied to provide emergency care. In the years since the earthquake, one team of orthopedic surgeons at NewYork-Presbyterian/Columbia University Irving Medical Center continue to help as the Haitian medical community attempts to rebound and grow.

“We felt a great desire to help. About two weeks after the earthquake, we made a trip to Santo Domingo, in the Dominican Republic, which shares the island with Haiti. We set up an initial base of operations there because they didn’t have sterile hospital facilities in Haiti to do surgeries,” says Dr. Melvin Rosenwasser , the director of the Trauma Training Center and the Hand, Elbow & Microvascular Fellowship  at NewYork-Presbyterian/Columbia University Irving Medical Center. “At the end of the trip, we went to Haiti with supplies and set up a base of operations that we’ve been going to every year since.”

With support from NewYork-Presbyterian, Columbia University Irving Medical Center, and the Foundation for Orthopaedic Trauma  — a professional organization dedicated to orthopedic education and research, Dr. Rosenwasser takes a team of physicians and nurses on a weeklong medical mission to the Hôpital Adventiste d’Haiti  in Port-au-Prince, just 16 miles from the epicenter of the earthquake. This year, the team — three orthopedic surgeons, three orthopedic residents, one hand surgery fellow, two scrub nurses, and a research assistant — set out to provide care for congenital cases and injuries.

“The types of injuries we treat change from year to year, although we still see a few patients that were earthquake victims with deformities that needed correction. So even after eight years, there are patients out there with untreated or partially treated injuries,” Dr. Rosenwasser says. “On this last trip, we did 44 operations in one week. We saw trauma injuries — vehicular accidents, various birth injuries, cerebral palsy, vitamin and nutritional deficiency, and infections that are rampant that can change the way the skeleton grows in children and adults. And things you’d see here in the US like degenerative diseases.”

He adds: “Many of these conditions are quite advanced because of lack of expertise or training. So when we get there, we are dealing with things you wouldn’t routinely see in the United States because they are caught and treated earlier. Each time we go to Haiti, we’re also training their medical students and residents.”

Dr. Rosenwasser says, although there are many Haitian orthopedic surgeons in the United States and other countries, few remain on the island. Haiti has a physician shortage for all medical specialties, especially orthopedic surgery. A 2002 survey by the Surgeons d’Haiti Orthopedic and Trauma found there were 67 practicing orthopedic surgeons in Haiti. In the years since the earthquake, that number has almost doubled to 127.

The orthopedic team at NewYork-Presbyterian/Columbia is just one group of many medical organizations from around the world going to Haiti and other medically deprived countries to provide care throughout the year. In addition to orthopedic missions, NewYork-Presbyterian, and its academic partners Columbia University Irving Medical Center and Weill Cornell Medicine, help sponsor tropical disease missions to Brazil, diabetic care missions in Ghana, and HIV/AIDS treatment missions in India. Each mission coordinates with a local hospital or medical clinic to gather patients in need of specialized care.

“Each day, there was a mass of humanity that gathered. There was always more patients than we could take care of. But those cases are passed on to the next team. Hopefully, they have the expertise to provide care for those patients,” Dr. Rosenwasser says.

The Benefits of Physical Exercise for Mental Health Patients

When mind and body connect in harmony, the benefits are clear thinking, more energy, confidence, and better overall physical and psychological health. The mind’s influence on the body can have remarkably therapeutic effects — helping patients to heal faster, lessen their chronic pain, or attain physical goals they once thought impossible.

However, mental illness can short circuit these benefits.  Depression can rob a person of motivation and energy. Anxiety can cripple a person, keeping them housebound. A person suffering with an eating disorder such as anorexia nervosa is sometimes too weak for everyday tasks. Instances like these, when coupled with the right exercise regimen, however, can make a positive difference.

According to Dr. Danielle Struble-Fitzsimmons, Senior Physical Therapist at New York-Presbyterian Hospital Westchester Division, “Starting to exercise requires a change in behavior that is especially hard for a person with mental illness. The physical therapist is the main external support for a person’s exercise regimen and uses a variety of strategies to get him moving. They can include motivational language and praise, making plans to confront fear or anxiety, and helping patients challenge their negative beliefs and emotions about exercise. We establish a positive therapeutic relationship through communication. Once a person feels comfortable expressing his concerns, personal goals and preferences, we can begin treatment.”

Physical therapy treatments

  • Balance exercises promote and help maintain equilibrium. 
  • Flexibility exercises promote mobility in joints and muscles.
  • Strengthening exercises promote stronger movement, improved posture and coordination.
  • Endurance/aerobic exercises promote heart and lung health. These include walking, stair climbing, swimming, bicycling, and hiking.

 “Using these four types of exercise, we can develop a specific plan for an individual’s needs and physical health status,” Dr. Struble-Fitzsimmons explained. “For example, people with depression are more likely to have muscle weakness and poor endurance related to sedentary behavior. Patients with schizophrenia may have difficulty with walking and balance and are at a higher risk for weight gain related to medications. Some patients with eating disorders exercise excessively, and this increases risk for overuse injuries such as tendonitis and fractures.”

Action vs. obstacles

Even for someone who is doing well and exercising regularly, there can be a time when circumstances beyond his or her control make exercise less of a priority.  Imagine then the challenges to get moving for a person suffering with mental illness.

A lack of social support from friends and family, barriers to healthcare access, including difficulty securing transportation or home services needed to maintain their recovery, can all be major challenges for people with psychological disorders from engaging in exercise.  Another consideration is their state of mind. Patients with depression often have low motivation, and the idea of starting a new exercise program can be daunting,” commented Dr. Struble-Fitzsimmons. “This can be true even for people who once liked to exercise. So we create initial exercises and activities that are functionally driven, such as getting out of a chair, walking, climbing the stairs. Short, attainable goals build motivation and encourage forward thinking.”

Mind/body connection

Exercise improves mental health by reducing anxiety and depression and improving self-esteem, which helps alleviate depression by increasing serotonin, a chemical found in the brain responsible for maintaining mood balance.  Physical activity increases the speed with which serotonin is signaled in the brain, and exercise, especially endurance exercise, can naturally decrease depression.

Sometimes depression descends unexpectedly. Some may find themselves suffering from anxiety or ridden with unreasonable guilt. Fatigue, lack of sleep, long periods of sitting, staring into space, staying in bed for hours without physical illness, are psychological and physical symptoms. Intervention can help because of the strong mind and body connection. Says Dr. Struble-Fitzsimmons, “The benefits of physical exercise for a mentally ill patient are the same as for anyone — improved memory and cognitive function, more energy, improved sleep, and greater strength. The key is to make an effort each day.”

To find a physician visit or call 877-NYP-WELL.

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