Friday, November 22, 2013

On-Call with Editor Donna Thomas

Oral Well Being and Overall Health have a stronger link than you think. Read on to learn how.

We tend to underestimate the importance of oral health to our overall wellness and physical condition.  When most people think of oral health, the first thing that typically comes to mind is appearance.   After all, no one ever wants yellowed or otherwise imperfect teeth.  Ideally, we all want a winning smile.  Farther down the list are more tangible oral health issues, like gum disease and traditional dental issues like wisdom teeth and impacted molars.  But generally, when we think about oral health issues, we don’t group them in the same category as chest pains or stomach pains.  We just don’t take them as seriously as other issues. We are wrong to do so.

Oral health is far more important than we realize.  For example, it’s a statistical fact that people with gum disease are far more likely to have some type of chronic condition associated with it.  As the American Academy of Periodontology points out, destructive conditions such as diabetes are more prevalent in people with periodontal issues than it is with people who don’t have gum problems.  And the problem works both ways: diabetes patients are more likely to develop periodontal problems, while periodontal disease makes the treatment of diabetes more difficult.

Heart disease is also correlated to gum problems, according to the Academy.  Studies show that periodontal issues increase the risk of heart disease.  The cause and effect relationship has not yet been fully established, but the statistical reality is that it clearly exists.  And the list of cardiovascular ailments linked to gum disease does not stop with heart issues: strokes are also more prevalent with those suffering from periodontal disease.

And the linkages don’t stop with cardiovascular problems and diabetes. Cancer, perhaps the most dreaded of all illnesses, is also correlated to gum disease.  According to the Academy, researchers have found that men with gum disease are 49% more likely to develop kidney cancer, 54% more likely to develop pancreatic cancer, and 30% more likely to develop a blood related cancer.

Gum disease can also lead to other illnesses.  Respiratory conditions like pneumonia can be caused and aggravated by the bacteria that grow in the oral cavity, which can be breathed into the lungs.  Researchers have also found linkages between osteoporosis and bone loss in the jaw.  Such bone loss may eventually lead to loss of teeth as well.

As such, with all these linkages researchers have found, we need to be mindful of good oral health.  Gum disease, as the Academy notes, is often silent and stealthy, and may not truly manifest until it is in an advanced state.  But this does not mean that periodontal problems don’t leave some clue.  We should be on the lookout for red, swollen or tender gums, or other types of pain.  The presence of blood while brushing or flossing is also a signal, as is loose or separating teeth.  Even something as apparently harmless as persistent bad breath could indicate a more disturbing problem.

All in all, modern medical research shows us that the body is a giant, complex and highly integrated system.  What happens in one area can easily impact another.  Proper dental care and attentiveness to our oral health, can not only lead to having that winning smile, but It can also help us detect and deal with the health issues that can hurt us the most. 

Monday, November 18, 2013

On-Call with Editor Donna Thomas

Please join me on congratulating Dr. Azzariti for his recognition by New Jersey Monthly Magazine’s Top Doctors award.
HackensackUMC Physicians Selected as
Top Doctors in New Jersey Monthly Magazine
We are proud to announce that 84 HackensackUMC physicians have been recognized as Top Doctors, according to New Jersey Monthly magazine. A total of 23,713 New Jersey-based physicians were invited to submit their recommendations for this year’s list. It yielded 974 top doctors in 68 medical specialties.

The following HackensackUMC physicians are listed as New Jersey Monthly Top Doctors:

Allergy & Immunology: Mary Ann Michelis, M.D.; Cardiac Electrophysiology: Grant Simons, M.D.; Cardiovascular Disease: Dusan Knezevic, M.D., Domenic Mariano, D.O., Sanjeev Patel, M.D.; Clinical Genetics – Pediatric: Helio Pedro, M.D.; Dermatology – Pediatric: Helen Shin, M.D.; Endocrinology, Diabetes & Metabolism: Joseph Schwartz, M.D., Mark Wiesen, M.D.; Family Medicine: Mark Dombrowski, M.D., Michael Giuliano, D.O., George Leipsner, M.D.; Gastroenterology: Eric Avezzano, M.D., Anthony DeLillo, M.D., Robert Levine, M.D.; Geriatric Medicine: Lisa Tank, M.D.; Gynecologic Oncology: Karen Houck, M.D., Babak Litkouhi, M.D., Ami Vaidya, M.D.; Infectious Disease: Steven Sperber, M.D.; Internal Medicine: Allen Griggs, D.O.; Nephrology: Benjamin Aronoff, M.D., Rosy Joseph, M.D., Jeffrey Kozlowski, M.D., Thomas Salazer, M.D., Howard Weizman, M.D.; Oncology & Gynecology: Kamal Dutta, M.D., Andrew Rubenstein, M.D., Michael Sbarra, M.D.; Otolaryngology: David Henick, M.D., Rakesh Patel, M.D., Christopher Shaari, M.D.; Pediatrics, Critical Care: Mark Siegel, M.D.; Pediatrics, Endocrinology: Javier Aisenberg, M.D.; Pediatrics, General: Russell Asnes, M.D., George Azzariti, M.D., Jeffrey Bienstock, M.D., Ruth Borgen, M.D., Lynn Sugarman, M.D., Edward Zajkowski, M.D., Scott Zucker, M.D.; Pediatrics, Infectious Disease: Aryeh Baer, M.D., Jeffrey Boscamp, M.D., Julia Piwoz, M.D.; Kevin Slavin, M.D. ; Pediatrics, Nephrology: Kenneth Lieberman, M.D.; Pediatrics, Oncology/Hematology: Michael Harris, M.D.; Pediatrics, Orthopedics: Douglas Avella, M.D.; David Konigsberg, M.D.; Pediatrics, Pulmonology: Donna Lee, M.D.; Pediatrics, Rheumatology: Kathleen Haines, M.D., Yukiko Kimura, M.D., Jennifer Weiss, M.D.; Pediatrics, Surgery: Frederick Alexander, M.D., David Friedman, M.D.; Pediatrics, Urology: Jeffrey Stock, M.D.; Pulmonary Disease: Renuka Mapitigama, M.D.; Radiation Oncology: Glen Gejerman, M.D., Anthony Ingenito, M.D.; Radiology, Interventional: George Ferrone, M.D.; Surgery, Bariatric: Amit Trivedi, M.D.; Surgery, Colorectal: Gregory Gallina, M.D.; Surgery, General: Joseph Manno, M.D., Stephen Pereira, M.D.; Surgery, Hand: Frederick Fakharzadeh, M.D., Richard Kim, M.D., Roger Rosenstein, M.D.; Surgery, Neurological: Hooman Azmi Ghadimi, M.D., George Kaptain, M.D., Patrick Roth, M.D.; Surgery, Oncologic: Donald McCain, M.D., Ph.D.; Surgery, Orthopedic: Dante Implicito, M.D., Sivaram Rajan, M.D.; Surgery, Plastic & Reconstructive: Anthony Berlet, M.D., Rick Winters, M.D., Luis Zapiach, M.D., Surgery, Vascular: Peter Kagan, M.D., Massimo Napolitano, M.D., Gregory Simonian, M.D.; Urology: Mutahar Ahmed, M.D., Michael Esposito, M.D., Debra Fromer, M.D., Gregory Lovallo, M.D., Ravi Munver, M.D., Ihor Sawczuk, M.D.

Congratulations to all of our Top Doctors and thank you for providing such world-class care to our patients.

Saturday, May 18, 2013

On-Call with Editor-in Chief, Donna Thomas

It is thast time of the year when we can wait to spend as much time outdoors as possible! However, those lazy, hazy days of summer, can cause significant health issues if prevention is not in your beach bag!

I hope you will find this detailed article informative. Of course any questions you may have, consult with your doctor.

May is Skin Cancer Awareness Month

May is Skin Cancer Awareness Month and it is very important to have your dermatologists examine your skin for any unusual moles. Melanoma screening is vital, as it can diagnose cancer at the earliest stage.

·         Skin cancer is the most common form of cancer in the United States. More than 3.5 million skin cancers in over two million people are diagnosed annually.

·         Each year there are more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung and colon.

·         Over the past three decades, more people have had skin cancer than all other cancers combined

·         Of the seven most common cancers in the US, melanoma is the only one whose incidence is increasing. Between 2000 and 2009, incidence climbed 1.9 percent annually.

The good news is that you can do a lot to protect yourself and your family from skin cancer, or to catch it early enough so that it can be treated effectively. Most skin cancers are caused by too much exposure to ultraviolet (UV) rays. Most of this exposure comes from the sun, but some may come from man-made sources, such as indoor tanning beds.

You don’t need any x-rays or blood tests to find skin cancer early, – just your eyes and a mirror. If you have skin cancer, finding it early is the best way to make sure it can be treated effectively.

Are some people more likely to get sun damage?

Everyone’s skin and eyes can be affected by the sun and other forms of UV rays. People with light skin are much more likely to have sun damage, but darker-skinned people, including African Americans and Hispanic Americans, also can be affected.

The skin tans when it absorbs UV radiation. The tan is caused by an increase in the activity and number of melanocytes, the cells that make the pigment melanin. Melanin helps to block out damaging UV rays up to a point, which is why people with naturally darker skin are less likely to get sunburned, while people with lighter skin are more likely to burn. Sunburns are thought to increase your risk of skin cancer, including melanoma. But UV exposure can raise skin cancer risk even without causing sunburn.Aside from skin tone, other factors can also affect your risk of damage from UV light.

You need to be especially careful in the sun if you:

· Had skin cancer before

· Have a family history of skin cancer, especially melanoma

· Have lots of moles, irregular moles, or large moles

· Have freckles and burn before tanning

· Have fair skin, blue or green eyes, or blond, red, or light brown hair

· Live or vacation at high altitudes (the strength of UV rays increases the higher up you are)

· Live or vacation in tropical or subtropical climates

· Work indoors all week and then get intense sun exposure on weekends

· Spend a lot of time outdoors

· Have certain autoimmune diseases, such as systemic lupus erythematosus (SLE, or “lupus”)

· Have had an organ transplant

· Take medicines that lower your immunity

· Take medicines that make your skin more sensitive to sunlight

Ask your doctor, nurse, or pharmacist if you are taking any medicines that could increase your sensitivity to sunlight.

How do I protect myself from UV rays?

You don’t have to avoid sunlight completely, and it would be unwise to reduce your level of

activity by avoiding the outdoors, because physical activity is important for good health. But too much sunlight can be harmful. There are some steps you can take to limit your exposure to UV rays.

Some people think about sun protection only when they spend a day at the lake, beach, or pool. But sun exposure adds up day after day, and it happens every time you are in the sun.

Simply staying in the shade is one of the best ways to limit your UV exposure. If you are going to be in the sun, “Slip! Slop! Slap! and Wrap” is a catch phrase that can help you remember some of the key steps you can take to protect yourself from UV rays:

· Slip on a shirt.

· Slop on sunscreen.

· Slap on a hat.

· Wrap on sunglasses to protect the eyes and sensitive skin around them.

Seek shade. An obvious but very important way to limit your exposure to UV light is to avoid being outdoors in direct sunlight too long. This is particularly important between the hours of 10 am and 4 pm, when UV light is strongest. If you are unsure about the strength of the sun’s rays, use the shadow test: if your shadow is shorter than you are, the sun’s rays are the strongest, and it is important to protect yourself.

UV rays reach the ground all year, even on hazy days, but the strength of UV rays can be different based on the time of year and other factors. The UV rays become more intense in the spring, even before temperatures get warmer. People in some areas may get sunburned when the weather is still cool because they may not think about protecting themselves if it’s not hot out. Be especially careful on the beach or in areas with snow because sand, water, and snow reflect sunlight, increasing the amount of UV radiation you receive. UV rays can also reach below the water’s surface, so you can still get a burn even if you’re in the water and feeling cool.

Some UV rays can also pass through windows. Typical car, home, and office windows block most of the UVB rays but a smaller portion of UVA rays, so even if you don’t feel you’re getting burned your skin may still get some damage. Tinted windows help block more UVA rays, but this depends on the type of tinting. UV radiation that comes through windows probably doesn’t pose a great risk to most people unless they spend long periods of time close to a window that receives direct sunlight.

If you plan to be outdoors, you may want to check the UV Index for your area first. The UV Index usually can be found in local newspaper, TV, radio, and online forecasts. It is also available on the EPA’s web site at and in a variety of smartphone apps.

Protect your skin with clothing when you are out in the sun, wear clothing to protect as much skin as possible. Clothes provide different levels of UV protection, depending on many factors. Long-sleeved shirts, long pants, or long skirts cover the most skin and are the most protective. Dark colors generally provide more protection than light colors. A tightly woven fabric protects better than loosely woven clothing. Dry fabric is generally more protective than wet fabric.

Be aware that covering up doesn’t block out all UV rays. If you can see light through a fabric, UV rays can get through, too. Some companies now make clothing that is lightweight, comfortable, and protects against UV exposure even when wet. It tends to be more tightly woven, and some have special coatings to help absorb UV rays. These sun-protective clothes may have a label listing the UV protection factor (UPF) value – the level of protection the garment provides from the sun’s UV rays (on a scale from 15 to 50+). The higher the UPF, the higher the protection from UV rays. Some children’s swim suits are now made from sun-protective fabric and are designed to cover the child from the neck to the knees.

Newer products, which are used in the washing machine like laundry detergents, can increase the UPF value of clothes you already own. They add a layer of UV protection to your clothes without changing the color or texture. This can be useful, but it’s not exactly clear how much it adds to protecting you from UV rays, so it is still important to follow the other steps listed here.

Use sunscreen

A sunscreen is a product that you apply to your skin for protection against the sun’s UV rays. But it’s important to know that sunscreen does not provide total protection against all UV rays. Therefore, a sunscreen should not be used as a way to prolong your time in the sun. Even with proper sunscreen use, some rays get through, which is why using other forms of sun protection, is also important. Sunscreens are available in many forms – lotions, creams, ointments, gels, sprays, wipes, and lip balms, to name a few.

Read the labels

When choosing a sunscreen product, be sure to read the label before you buy. Sunscreens with broad spectrum protection (against UVA and UVB rays) and with sun protection factor (SPF) values of 30 or higher are recommended. The SPF number is the level of protection the sunscreen provides against UVB rays − a higher number means more protection. When using an SPF 30 sunscreen and applying it thickly, you get the equivalent of 1 minute of UVB rays for each 30 minutes you spend in the sun. So, 1 hour in the sun wearing SPF 30 sunscreen is the same as spending 2 minutes totally unprotected. People often do not apply enough sunscreen, so the actual protection they get is less. 

Sunscreens labeled with SPFs as high as 100+ are now available. Higher numbers do mean more protection, but many people do not understand the SPF scale. SPF 15 sunscreens filter out about 93% of UVB rays, while SPF 30 sunscreens filter out about 97%, SPF 50 sunscreens about 98%, sunscreen protects you completely. Regardless of the SPF, sunscreen should be reapplied often for maximal protection.

The SPF number indicates protection against UVB rays only. Sunscreen products labeled “broadspectrum” provide some protection against both UVA and UVB rays, but at this time there is no standard system for measuring protection from UVA rays. Products that contain avobenzone (Parsol 1789), ecamsule, zinc oxide, or titanium dioxide can provide some protection from UVBand most UVA rays.

Check the expiration date on the sunscreen container to be sure it is still effective. Most sunscreen products are effective for at least 2 to 3 years, but after a long time in storage you may need to shake the bottle to remix the sunscreen ingredients.

Some sunscreen products can irritate your skin. Many products claim to be hypoallergenic or dermatologist tested, but the only way to know for sure if a product will irritate your skin is to try it.

Be sure to apply the sunscreen properly

Always follow the label directions. Most recommend applying sunscreen generously. When putting it on, pay close attention to your face, ears, neck, arms, and any other areas not covered by clothing. If you’re going to wear insect repellent or makeup, put on the sunscreen first. Be generous Ideally, about 1 ounce of sunscreen (about a palmful) should be used to cover the arms, legs, neck, and face of the average adult. For best results, most sunscreens must be reapplied at least every 2 hours and even more often if you are swimming or sweating. Products labeled “waterproof” may provide protection for at least 80 minutes even when you are swimming or sweating. Products that are “water resistant” may protect for only 40 minutes.

Remember that sunscreen usually rubs off when you towel yourself dry, so you will need to put more on. Sunless tanning products, such as bronzers and extenders (described in the section, “What about tanning pills and other tanning products?”), give skin a tan or golden color. But unlike sunscreens, these products provide very little protection from UV damage.

Wear a hat. A hat with at least a 2- to 3-inch brim all around is ideal because it protects areas such as the ears, eyes, forehead, nose, and scalp that are often exposed to intense sun, such as the ears, eyes, forehead, nose, and scalp. A dark, non-reflective underside to the brim can also help lower the amount of UV rays reaching the face from reflective surfaces such as water. A shade cap (which looks like a baseball cap with about 7 inches of fabric draping down the sides and back) also is good, and will provide more protection for the neck. These are often sold in sports and outdoor supply stores.
Wear sunglasses that block UV rays UV-blocking sunglasses are important for protecting the delicate skin around the eyes, as well as the eyes themselves. Research has shown that long hours in the sun without protecting your eyes increase your chances of developing some eye diseases.

Children need smaller versions of real, protective adult sunglasses – not toy

sunglasses. Ideally, all types of eyewear, including prescription glasses and contact lenses, should absorb the entire UV spectrum.

Avoid tanning beds and sunlamps. Many people believe the UV rays of tanning beds are harmless. This is not true. Tanning lamps give out UVA and usually UVB rays as well. Both UVA and UVB rays can cause long-term skin damage, and can contribute to skin cancer.

Protect children from the sun Children need special attention, since they tend to spend more time outdoors, can burn more easily, and may not be aware of the dangers. Parents and other caregivers should protect children from excess sun exposure by using the steps above.

 Older children need to be cautioned about sun exposure as they become more independent. It is important, particularly in parts of the world where it is sunnier, to cover your children as fully as is reasonable. You should develop the habit of using sunscreen on exposed skin for yourself and your children whenever you go outdoors and may be exposed to large amounts of sunlight. If you or your child burns easily, be extra careful to cover up, limit exposure, and apply sunscreen.

Babies younger than 6 months should be kept out of direct sunlight and protected from the sun using hats and protective clothing. Sunscreen may be used on small areas of exposed skin only if adequate clothing and shade are not available.

Skin exams

Most skin cancers can be found early with skin exams. Both regular exams by your doctor and checking your own skin frequently can help find cancers early, when they are easier to treat. Get your skin checked by your doctor. As part of a routine cancer-related checkup, your doctor should check your skin carefully. They should be willing to discuss any concerns you might have about this exam.

Check your own skin. It’s important to check your own skin, preferably once a month. A skin self-exam is best done in a well-lit room in front of a full-length mirror. You can use a hand-held mirror to look at areas that are hard to see. A spouse or close friend or family member may be able to help you with these exams, especially for those hard-to-see areas like your back or scalp. The first time you examine your skin, spend time carefully going over the entire surface. Learn the pattern of moles, blemishes, freckles, and other marks on your skin so that you’ll notice any changes next time. Be sure to show your doctor any areas that concern you.

 *Copyright American cancer Society at 2013

Additional resources

More information from your American Cancer Society. The following information may also be helpful to you. These materials may be ordered through their toll-free number, 1-800-227-2345.

  • A Parent’s Guide to Skin Protection (also available in Spanish)
  • Melanoma Skin Cancer (also available in Spanish)
  • Skin Cancer: Basal and Squamous Cell (also available in Spanish)
  • Sun Basics: Skin Protection Made Simple (brochure for children aged 8 to 14)
  • Why You Should Know About Melanoma (also available in Spanish)
  • National organizations and Web sites*

In addition to the American Cancer Society, other sources of information and support include:

American Academy of Dermatology

Toll-free number: 1-888-462-3376 (1-888-462-DERM)

Web site:

Wednesday, April 17, 2013

On-Call with... Editor, Donna Thomas

Even though the flu season is coming to a close, your children will still have to be careful in preventing the spread of germs in the months to come. Adopting these simple guidelines from and oral health perspective can become a good habit to adopt for next flu season. Donna shares with Pedimedica important tips recommended by Dr. Joe Kavitz on why...

A Healthier mouth = A Healthier You!

1.Each member of your family should use their own tube of toothpaste. Sharing the same tube spreads the virus as it can reside on the outside edge of the tube. Germs can sit on the outside surface of the toothpaste container and thereby spread to your toothbrush as well. *Toothbrushes should be changed every 3 months!

2.Wash your hands before brushing your mouth. The hands can carry germs that infect your mouth and spread throughout your body. do get sick, replace your toothbrush immediately. It is likely to host the virus. We find it useful to keep spare toothbrushes to supply to you and your family as needed.

4.Do not keep family toothbrushes together in a cup. The colds and viruses can spread to the other toothbrushes transferring the infection from one person to another.

5.Rinse with a mouthwash after brushing. Brushing your mouth only removes some of the bad germs. Rinsing with mouthwash has been shown to reduce bacterial and virus counts on the oral cavity.

6.Refrain from kissing others. As soon as you, your family, spouse, or friend can detect the a cold, do not kiss them or allow them to kiss others. The flu virus in particular is very contagious and can easily spread through mouth to mouth contact.

7.Do not share food or drink. Just as kissing is contagious, so is sharing food and drink.

8.Eat foods from the garden. Fruits and vegetables can boost your immune system naturally. There are nutrients in garden foods that help in resisting viruses.

For more information go to www.discoveryfit&
Dr. Joe Kravits, DDS,  2013

Wednesday, March 20, 2013

On-Call with… Martha Miqueo, DDS, Vizstara Dental

The importance of teaching your child good
oral hygiene from a young age!

Since Children’s Dental Health Month just passed, here are some important tips to keep in mind all year long! Dr. Miqueo, DDS, Pediatric Dentist and Orthodontist shares her recommendations with Pedimedica parents.
·         New parents should seek a pediatric dentist soon after their child’s birth.  A pediatric dentist

can show you how to care for your infants gums after every feeding and can discuss breast feeding, bottle feeding, pacifier use, suckling habits and their effects on the developing oral cavity.

·         Fluoride toothpaste should be introduced soon after the child has learned to rinse properly.

·         Toothbrushes should be replaced every two months or sooner if the bristles are worn out.

·         Remember, a child typically has the full primary dentition by the age of 3 and the permanent dentition begins to erupt by age 6.

·         Have your child evaluated for sealants when they turn 6 years old.

·         Bring your child to an orthodontist to evaluate the craniofacial growth by the age of 7.

Sometimes early orthodontic intervention can prevent extractions of permanent teeth and can yield better results preventing orthognathic surgery.

·         Make sure your children have a dental check up and cleaning every 6 months to maintain good oral health.

Early prevention practices help your child develop confidence in caring for their smile and avoids pain and suffering associated with dental emergencies.

Wishing you a beautiful Smile and lifelong savings! 

Dr. Miqueo is Co-Founder and VP of VIZSTARA, a Multispecialty Dental Facility. She is Director of Family Practice, Pediatric Dentistry, and Orthodontics. Dr. Miqueo is an expert in the management of pediatric patients with cleft lip and palate, as well as in the application of the laser technique for both soft and hard tissue. Dr. Miqueo graduated from New York University College of Dentistry where she also served on the faculty.