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Advances: Medical News for Patients December 2018

Amazing Stories: Steven Dampf

Steven Dampf

Junior year of high school is stressful no matter what else students have going on in their lives. Preparing for college entrance exams, studying for advanced placement tests, and getting ready to apply to college can be overwhelming. As a student at Weston High School in Connecticut, Steven Dampf enjoyed running on the varsity cross country team and playing on the varsity tennis team — and was even ranked 14th in the state for tennis. His junior year was turning out to be the best academic year of his high school career when he received the news that he would need open heart surgery.

It was not entirely unexpected: Steven was born with a bicuspid aortic valve, a defect in the valve that regulates blood flow between the left ventricle and the aorta (the body's largest blood vessel). In Steven's case, there was a backflow of blood that increased the strain on his ascending aorta (the part coming out of the heart), which caused a bulge in the aortic wall. Dr. Michael Snyder — a pediatric cardiologist at NewYork-Presbyterian Morgan Stanley Children's Hospital — had been monitoring Steven's enlarged heart and told him, just before Christmas 2016, that the surgery must take place in the next two to three months. "We learned when Steven he was 9 or 10 that he had this heart defect and we had been watching it, but most people who have it don't need surgery until they're adults," explains his mother, Vanessa.

Steven, then 16, preferred a valve repair over a replacement because it allowed him to avoid lifelong blood thinners and live without activity limitations. His surgeons made no promises, noting that a valve replacement was a possibility if they found out during surgery that the valve could not be saved. A team of pediatric cardiac surgeons led by Dr. Emile Bacha worked a miracle: Using an approach called the David procedure, they were able to repair the valve and replace the defective part of his aorta with a synthetic graft. "It was the scariest thing I've ever been through, but I was relieved when I woke up and learned that everything went well," Steven notes.

He was told he might spend one to two weeks in the hospital but was able to go home after just four days. His GPA was the highest it had ever been, and he was determined to keep it there. Tutors came to his home starting two weeks after surgery and continued to work with him until he was back at school full time. He returned to school in April for short days, building himself up to full school days after six weeks. His teachers never went easy on him, and he completed all of his missed work. On top of that, he took the SAT exam just five weeks after surgery with the rest of Connecticut's juniors, and the ACT a week after that.

"We couldn't be happier with the whole experience at NewYork-Presbyterian," says Vanessa. "Everyone was so supportive. There was a dedicated nurse in the ICU and always a place for us to sleep. After he came home, they continued to call to make sure Steven was doing okay."

The Connecticut Varsity Tennis State Championship was quickly approaching, and Steven — who had been undergoing physical therapy after the surgery — was determined to play. His tennis coach told him he could go with his doctor's permission. After pleading with Dr. Snyder, Steven had a stress test in May and received the green light to return to his varsity tennis team. He practiced with the team for one week and then began the week-long Championship, making it to the finals playing doubles. "I didn't expect to make it that far!" says Steven, crediting his family, his coach, and his team for supporting his recovery. As a finalist, he also made the All-State team.

Today he sees Dr. Snyder just once a year for follow-up. He teaches tennis to children and goes to the gym five days a week. He can now lift weights and engage in contact sports — activities he could not pursue before the surgery. Because he had a valve repair instead of a replacement, he may need another heart surgery as an adult, but it is likely to be decades away.

Steven graduated high school in 2018 and will be attending Colgate University, where he plans to study pre-med — perhaps studying neuroscience. He is also a licensed EMT. "I was very impressed with the way NewYork-Presbyterian handled my surgery. It is a dream of mine to be part of a program like that," he says. "I'm grateful to my surgeons and my team at NewYork-Presbyterian. They did all they could to help me recover as quickly as possible."

To learn more about our pediatric cardiac services, visit nyp.org/pediatrics. To find a pediatric specialist, call 800-245-KIDS (5437).

Six ways to strengthen your relationship with your children during the holidays

Parent and child receiving donation clothes and toys

Parents play a vital role in the lives of their children — one that impacts their physical, mental, and emotional well-being into adulthood.

“Our relationships with our children serve as a blueprint that guides their relationships with others throughout their lives,” says Jo Hariton, PhD, of the Social Skills Training Program for Children and Adolescents at NewYork-Presbyterian Hospital Westchester Division. “Having a positive connection with parents helps children feel good about themselves, and serves as a building block to help them form healthy relationships with others.”

Sometimes, however, relationships go awry for a host of reasons. The good news is that it’s never too late to make inroads to repair them. “Teaching a child that mistakes can be made and then corrected shows them that parents are not perfect; everyone can make mistakes. But the most important lesson it shows is that you are committed to your relationship to your children — and they will sense this from your actions,” notes Dr. Hariton.

Our brains are wired to connect with those around us, and parents can serve as positive role models in strengthening those connections, particularly within the family. Despite the demands associated with the holidays, it is a good time to jump-start everyone’s yearning for a warm and inviting family environment.

Some tips:

  1. Create holiday rituals: This can be anything from making holiday cookies, wrapping presents, picking out the tree, having game night, or relaxing after a holiday meal when the whole family is present. Put aside your cell phones and spend real time creating positive family dynamics.
  2. Uphold family traditions: Kids love to hear stories about how the holidays were celebrated when their parents were growing up. Don’t worry if these stories are repeated, as they become part of family lore that kids love to know about. Let them ask questions, show them photos, and talk about the extended family that is a part of their heritage.
  3. Give back to the community: Helping children learn the value of community service can be a regular tradition at holiday time. Helping in a soup kitchen or packing warm items for the homeless, selecting a charity that they would like the family to give to, or contributing to an environmental cause are all ways to instill the idea that they are part of a broader community. Depending upon their age, the kids can do some research to select the charity for their gift list. Their choices should be celebrated and talked about as a family.
  4. Practice the art of conversation: Given these turbulent times, the family is even more important as a safe haven in an insecure world. Let the kids express their worries and help them develop perspective. Make room for this type of discussion even in a season when everyone thinks they should be merry. Children feel more secure when they feel listened to and guided.
  5. Take time to de-stress: If you, as a caregiver, become stressed by all there is to do, take time to relax, so that your stress does not become misdirected toward your children.
  6. Make space for family time on a regular basis: In the big picture, it is the most important gift that you can give your children. Learn to recognize your child’s expression of emotions as a way to help them connect with others. A weekly family meeting can be a good way to keep communication open and to problem solve when needed.

Finally, Dr. Hariton notes, “There is always room to grow with regard to good parent/child relationships. Following these simple tips can prove very effective in creating a family dynamic that is positive and productive for all involved.”

Managing the effects of ankle arthritis

Runner holding onto their ankle

When people think of arthritis, affected body parts that typically come to mind are the knee, the hip, and maybe the lower back. But the fact is that wherever there are joints in the body, they are susceptible to the condition — including the ankles.

“As in other joints, ankle arthritis is a progressive disease where the cartilage has worn away, and the bones grind with weight bearing or motion,” says Dr. Justin Greisberg, an orthopedic foot and ankle specialist with NewYork-Presbyterian/Columbia University Irving Medical Center. “Hip or knee arthritis often happens from wear and tear over time. By contrast, ankle arthritis is almost never from normal wear. Its most common cause is post-traumatic, typically from an ankle fracture that may have occurred 20 years ago, or just two years ago. Ankle arthritis can also set in after a series of severe ankle sprains.”

Pain is typically felt in the lower shin, back of the foot, or middle of the foot. The pain can vary in intensity and frequency. It may be aching and dull or sharp and intense; it can come and go, or it can be a steady and chronic low level of pain with occasional flare-ups of more intense pain. There can be swelling and bone friction that makes the ankle stiff and less flexible, or a patient may hear a crunching or popping sound when pointing or flexing the toes, a sign that cartilage has worn away.

Managing the symptoms and the pain

Physicians must eliminate other conditions before making an ankle arthritis diagnosis. “With the right treatment regime, the degeneration can usually be slowed and pain controlled. Treating ankle arthritis is more than just relieving pain; it is restoring function, health, and vitality to a person,” says Dr. Greisberg. Some lifestyle changes can make a big difference, including:

Compresses: Using a warming pad or whirlpool for a few minutes can loosen a stiff ankle joint, making activity easier. Icing the ankle joint for 15 or 20 minutes after activity can decrease swelling and provide some immediate pain relief.

Change the workout routine: Engage in activities that put less stress on the ankles — try lower impact options, such as an exercise bike or swimming. Also, a physical therapist can give the patient specific exercises to stretch the ankle joint’s soft-tissues and build surrounding muscles.

Wear supportive footwear: Wear shoes that provide good support and discourage ankle “rolling” that causes a foot to turn in or out. High heels and flip-flops should be avoided. High top shoes and boots may help stabilize the ankle. Cushioning shoe inserts and orthopedic products such as walking canes and ankle braces can help stabilize the foot. Most drug stores sell an elastic ankle sleeve, which can be worn during the day to decrease swelling. An orthopedic ankle specialist can prescribe a lace-up brace for more support.

Lose weight: Shedding even 10 pounds of extra body weight will almost certainly make the ankle feel less sore, exerting less pressure on the joints.

Medication:  As long as your primary care doctor says it is okay, anti-inflammatory medications can be helpful. Rather than every day, it might be safer to use medication an hour before an exercise session.

If symptoms persist and lifestyle changes have no effect, medical interventions are usually the next step. Says Dr. Greisberg, “Injections can be of some value, especially when looking for short-term pain relief. In the most severe cases, surgery can be considered. Some patients will be candidates for smaller bone spur shaving procedures. Ankle fusions have been successful for decades, and ankle replacements, with an artificial joint, can be extremely effective at both relieving pain and restoring motion. Says Dr. Greisberg, “Ankle replacements have come a long way in the past 20 years. The procedure can be a real home run for the right patient.”

Give a boost to your health by lowering your salt intake

Hand pouring salt

Here we are, nearing the beginning of a new year — a fresh start and a renewed opportunity to do things better than before. Topping the list of many people’s resolutions: living a healthier lifestyle, which typically starts with diet. Katie Campbell, RD, CDN, a registered dietitian at NewYork-Presbyterian Lawrence Hospital in Bronxville, discusses how something as simple as reducing sodium intake can boost your health by lowering your numbers — everything from blood pressure to weight.

Why should reducing salt intake be part of a healthy eating plan?
Even if you currently don’t have high blood pressure, it is important to monitor your sodium intake to prevent a rise in blood pressure that can occur naturally with age. High blood pressure can lead to a multitude of other health conditions so taking preventative measures are essential in living a long and healthy life.

What are the health dangers of too much salt?
A diet high in salt can cause a host of conditions, particularly high blood pressure, which can lead to heart attack, stroke, heart failure, kidney disease, and osteoporosis. Too much salt in the diet also makes the body retain water, which gives us that bloated feeling and can contribute to weight gain.

What are the latest USDA guidelines for daily sodium intake?
The average American should have less than 2,300mg per day and ideally less than 1,500mg per day, especially if you already have hypertension or prehypertension. The guidelines do not differ per age or gender.

Why is some salt/sodium important in the diet?
Sodium is a mineral that is essential for life, but your body only requires 500mg per day, which is easy to achieve.

Which foods are typically high in salt and should be avoided?
Let’s face it: salt tastes good and helps bring out the flavor in foods. But it’s significant to note that seventy-five percent of the sodium we, as Americans, consume comes from processed, prepackaged foods and restaurant food. The American Heart Association also identifies the “Salty Six” — bread and rolls, pizza, soup, sandwiches, cold cuts and cured meats, and poultry. Limiting these foods by cooking at home and incorporating more fresh ingredients, can drastically reduce sodium intake. Remember, it’s impossible to completely eliminate sodium, but the goal is to make healthier, more mindful choices to reduce your overall intake.

Can you offer some tips for reducing salt in the diet – without sacrificing flavor?
Here are some effective ways I always recommend:

  • Always read labels and try to stay within the 2,300mg per day guideline
  • Prepare your own foods and avoid purchasing convenience foods such as canned soups, frozen dinners, instant cereals, and gravy sauce mixes.
  • Purchase fresh items – fresh fruits, vegetables, whole grains, and meat and seafood products. Check the packaging on meat and seafood to see if salt water or saline has been added.
  • Choose condiments wisely. Many condiments are packed with sodium. Read labels and always look for the reduced or low sodium versions.
  • Buy unsalted snack items.
  • Drain and rinse canned vegetables and beans.
  • Always use low sodium versions to cook with such as low sodium chicken stock.
  • If you go out to eat, specify how you want your food prepared, for example, ask for sauce or dressing on the side. And look for key words such as pickled, brined, cured, smoked, soy sauce or teriyaki sauce — these words mean the food will be higher in sodium content.

Try a homemade spice blend with no salt. Two examples:

Cajun Spice Blend
2T Cumin
2T Coriander
2T Paprika
1 1/2t Black Pepper
Cayenne Pepper to taste
1T Dried Oregano
Use on chicken, fish, shrimp, steak, & thick cut veggies

Greek Spice Blend
1T Garlic Powder
1T Dried Basil
1T Dried Oregano
1-1/2t Black Pepper
1-1/2t Dried Parsley
1-1/2t Dried Rosemary
1-1/2t Dried Thyme
Use on veggies, chicken, pork, beef, or lamb

To try more tasty and nutritious recipes, visit nyp.org/nutrition. To find a primary care doctor, please call 877-697-9355.