A Personalized and Dynamic Amputation Treatment and Rehabilitation Plan

As each amputation patient carries with them a range of unpredictable factors – which limb or limbs have been amputated, age, fitness levels, reason for amputation, mental health and far more – it is essential that the Mount Sinai Department of Rehabilitation Medicine offer a treatment and rehabilitation plan that is as personalized, flexible and dynamic as it is cutting-edge, empathetic and motivating. When a patient is young and is standing on the threshold of a brilliant life ahead, we offer a treatment plan that gives them the physical and emotional tools to return to the path that was interrupted by amputation. When the patient is an avid sports person, our goal is to make sure that through physical and occupational therapy – along with the help of one of our leading prosthetists – they can get back on the field, surf board or even resume extreme hobbies like jumping out of an airplane as soon as possible. For patients who have suffered a traumatic amputation, we lovingly nurturer them back to physical health, offer robust and caring emotional and group therapy and guide them to a place of peace and acceptance where they can begin to see the light at the end of their harrowing tunnel. 

These examples barely scratch the surface of the spectrum of patients we look after at the Mount Sinai Department of Rehabilitation Medicine – and yet it shows that a ‘one-size-fits–all’ plan will not cut it. Our patients require a treatment and rehabilitation plan that takes into consideration their physical condition and life outside of a rehab setting, their age, life goals and temperament, with a robust emphasis on providing the emotional support so that they can pursue a post-amputation life that is comfortable and fulfilling. 

Each personalized and dynamic amputation and treatment rehabilitation plan is focused on the following features:

• Access to and care from Mount Sinai’s world-leading team of physicians who will look after you and any potentially complex medical needs from the moment of amputation until you fully recover.
• Compassionate and evidence-based care from our rehabilitation nurses who will help patients with goal-setting and managing pain and discomfort.
• Therapy from our physical and occupational therapists who will begin working with patients from the moment they wake up from general anesthesia until they are pursuing life again on their own terms, as well as increasing independence and teaching self-care and Activities of Daily Living (ADLs).
• Access to and care from psychologists who will help patients develop coping skills to emotionally handle the stresses that may come with experiencing amputation as well as community re-integration.
• Access to and care from dietitians who will work to make sure patients’ diets are nutritious, promote healing and mitigate the potential for diabetes and other conditions.
• Being put in the hands of an expert prosthetists who will make sure the patient has the full range of prosthetics they require to live life to the fullest.
• Access to our Limb Loss Support Group, our monthly peer support for patients following an amputation. It is led by a psychologist and discusses topics like body image, social acceptance and techniques for maintaining a positive attitude. 

At the Mount Sinai Department of Rehabilitation Medicine the full weight of our expertise and experience in treating and rehabilitating amputee patients is passed through a bespoke prism to ensure that it is personalized, dynamic and that it seamlessly fits into the patients needs and sensibilities so they can return to their old selves again.

If you are – or somebody you know is – scheduled to have an amputation and you would like to discuss the ways in which the Mount Sinai Department of Rehabilitation Medicine can offer a personalized and dynamic post-amputation treatment and rehabilitation program, please get in touch with us at (212) 241-6321.

Compassion and Understanding Motivate Amputees to Recovery

One thing that all amputees can likely agree on is that limb-loss is a life-altering experience. The only question that remains for many is whether it is an unfortunate blip in an otherwise healthy and active life, or is it a blow that sinks the patient into depression, immobility and serious mental health issues. In the case of elderly and less-fit patients, the struggle is trying to recover and maximize quality of life and avoid succumbing to the palpable physical and emotional loss that comes with amputation. In both cases, amputee patients exist on a threshold where ‘Door 1’ opens to an arduous path that culminates in an amazing recovery and return to a happy and vibrant life, and ‘Door 2’ where the patient feels alone, empty, scared and a shell of their former self. If it were as easy as merely opting for ‘Door 1’, the recovery process would be easy; unfortunately it is not. And yet, even after something as life-altering as amputation, safely navigating the long and difficult journey to recovery is very possible and actually likely, provided you have the right medical treatment and support.  By putting yourself in the hands of our specialists and therapists at the Mount Sinai Department of Rehabilitation Medicine, you can guarantee to have among the world’s leading experts motivating you to a brilliant return to the ‘old-you’ through our cutting-edge medical services that are informed and guided by compassion and understanding.

In the first instance amputation seriously disrupts the little things that you might have previously taken for granted, like going to the toilet or doing the dishes. It can affect mobility and all that entails, including nipping out to the shop for some milk or going out to meet friends for a meal. It can also create a seemingly insurmountable wall preventing you from staying physically active, including riding a bike, rock climbing or participating in the sports you love. And, of course, there are a range of implications for the ways in which your physical limitations might impact on your family, not to mention your social and love life. Yet, perhaps counter-intuitively the most palpable adversity an amputee faces is mental and emotional, including anger, denial, depression, poor body image, self-esteem, quality of life and even thoughts of suicide. Those who have suffered traumatic amputations can even suffer from post-traumatic stress disorder (PTSD). Beyond this, even the most physically fit, upbeat and positive amputee patient might find their spirits dampened when faced with the almost-always long and hard road to recovery, mobility and activity that involves countless hours of physical therapy. One could say that an amputee’s best friend is patience, positive energy and their mental health; and yet, these are the aspects on which patients are often most challenged, which can impede and derail the return to a fulfilling and physically active life without the proper medical, emotional and psychological support. 

Through your whole journey to recovery – beginning with pre-amputation – it is imperative that you are guided by specialists and therapists with the expertise to make you better and the compassion and understanding to prepare you to face successfully the challenges that amputation will present. Our amputation treatment plans at the Mount Sinai Department of Rehabilitation Medicine are always personalized and consider your physical condition, mental and emotional health and life outside of a rehabilitation setting. We make sure that all patients have a full range of necessary emotional support at their disposal, including group, family and one-on-one therapy. We know how difficult it is to experience an amputation, but we also know the amazing life that is waiting for you at the end of your recovery. As such your treatment plan will guide you sensitively but with encouragement so you are able to fulfill your rehabilitation goals. We are proud to have as the foundation of our treatments the fact that we are New York City’s first amputation and prosthetic training program to be accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF), which recognizes our expertise in and commitment to supporting the needs of amputees by always improving our program and becoming the standard for modern amputation and prosthetic training care.

Here is a snapshot of some of our key inpatient and outpatient services that will guide you to recovery:

• Developing coping skills to handle the emotional stresses that may come with experiencing amputation.
• Helping you set goals every step of the way from preparation for your prosthetic to getting you ready for full mobility and participating in your favorite outdoor and sports activities.
• Helping you manage pain and discomfort.
• Providing support to increase independence and self-care.
• Access to our Limb Loss Support Group, a program designed to provide peer support to patients following amputation. It meets monthly and is led by a psychologist to discuss issues relating to body image, social acceptance and techniques for maintaining a positive attitude. 

If you are scheduled to have an amputation – or are a family member or friend of somebody who is – and would like to discuss the ways in which our specialists’ and therapists’ expertise, compassion and understanding can motivate you through the recovery process, please get in touch with us at (212) 241-6321.

Return to the Pre-Injury ‘You’ With Our Orthopedic Clinical Specialists

Surgery is always a big deal and is generally only recommended when non-operative treatments and therapies are no longer seen as viable ways to return to pre-injury mobility. Yet, if you are about to undergo or have undergone an operation on the hip, shoulder, knee, wrist, hand, neck, foot, ankle, spine or any other part of the musculoskeletal system, the surgery is but a very important step in the process that will restore you to your pre-injury self. The far longer bit that takes you from the moment in which the anesthesia wears off to you finally jogging, mountain biking or playing soccer like the pre-injury you again is the absolutely essential post-operative rehabilitation program through which your Mount Sinai Orthopedic Clinical Specialist (OCS) will guide you. 

After surgery, your ability to regain normal motion, strength and to return to your pre-injury self, is dependent on the restorative orthopedic rehabilitation plan your OCS will devise for you. Orthopedic rehabilitation will bring you through a range of exercises to strengthen the muscles around the affected joint(s). Strong muscles are not only necessary so your body functions as it once did, but they will lower the risk of the once-injured joint re-injuring or dislocating itself by protecting it and absorbing any force that might occur during physical activity. Orthopedic rehabilitation will also improve circulation and flexibility to the affected areas to aid and hasten the healing process, prevent the appearance of blood clots and to gradually increase your range of motion to its pre-injury level.

Your Mount Sinai OCS is your post-operative guide to returning to the pre-injury ‘you’. An OCS is specifically trained to restore your strength and range of motion without compensation and to help prevent re-injury during the recovery process. When you are working with an OCS, you are under the expert care of the most qualified and experienced physical therapists available. All OCSs are recognized by the American Board of Physical Therapy Specialists as clinicians with the highest levels of expertise and specialization in orthopedic physical therapy. What is more, to attain the celebrated distinction of OCS, a therapist must have a minimum of 2,000 hours of direct patient care in the area of orthopedics. 

Among the first people you will see when you wake up from your surgery will be your OCS who will first give you a thorough evaluation and then set you a structured post-operative physical therapy plan to minimize pain and swelling and to restore normal movement, flexibility and function as soon as possible. Your first session with your OCS will likely be in your hospital bed or in a chair. As you heal and progress, the exercises will become more dynamic and might include a medley of ankle pumps, squats, flexions, abductions, rotations, extensions, contractions, bends, raising exercises and stretching. As you move toward a full recovery, your OCS might recommend swimming or pool exercises, cycling or even low impact activities like golf and dancing. Sports like basketball, soccer, football and others that require high impact movements – as well as weight training – should be avoided until your OCS gives you the go-ahead. 

Are you interested in what your recovery from orthopedicsurgery might look like? Do you have any questions about our Orthopedic Clinical Specialists and their transformative rehabilitation programs? Please get in touch with us at (212) 241-6321.

Smart Technology to Enhance Your Home Rehabilitation

Returning home from inpatient rehabilitation can be a daunting process. Alongside the potential changes in your daily routines, it may be necessary to change the functionality of your house. In order to make this process as seamless as possible, we have developed a mobile app to evaluate your home situation. Use the smart technology funded by the Craig H. Neilsen Foundation to revolutionize your rehabilitative recovery.

A home evaluation consists of documenting the dimensions of rooms, hallways, door widths, obstacles, and other facets of you home after a serious surgery or return from impatient rehabilitation. Usually, the patient will be unable to complete this process alone and a friend or family will complete the home evaluation on paper.

The patient will receive the necessary equipment and alterations to their home to assist with their recovery. This includes new beds, wheelchairs, commodes, tub benches, and other utilities to give the patient as much independence as possible.

If the home evaluation is not done properly, the recipient could end up receiving the wrong materials, products, and equipment – or even equipment that is unsafe or unusable. A common issue with this process is slight miscalculations and poor recordings of dimension by the family member. This has a knock-on-effect of the products later distributed by the therapist not fitting the requirements of your property, which often leads to a frustrating process of rectification.

Our innovative technology curtails this issue by making the assessment form easier to fill in. This provides more accurate and reliable measurements, which allows for better decisions to be made by the clinician. The app will develop, test, and disseminate an accurate quantitative description of your house and create a precise floorplan. With accurate data, therapists can better draft appropriate changes to your home surroundings – making post inpatient rehabilitation a little easier.

For the moment, the app is being used around the country by clinicians and family members of patients at Mount Sinai as we test the Beta model. Going forward we will test it with rehabilitative facilities around the country before using feedback from community partners to develop the final versions. The application will then be available for general use.

If you believe that our home evaluation app could help you after inpatient rehabilitation, please contact us at Mount Sinai Department of Rehabilitative Medicine for a walkthrough on how to access it. Contact our switchboard at: (212) 241-6321

Sports: How To Look After Yourself "In Season"

Being involved with sports brings a wealth of health to your life. Regular exercise increases our average lifespan, helps with mental health difficulties, and generally keeps our body well-oiled. There isn’t much regular exercise doesn’t have a positive effect on. From children to the elderly, we all can benefit from a daily dosage of activity. However, being involved in sports and exercise regimes does bring with it some risk, especially considering games like American Football, and Ice Hockey, which of course are considerably more perilous than going for jogs around the local park or lifting light weights at the gym.  Let’s take a look at how we can take a preventative step toward long-term damage in sports and other exercise regimes by taking some precautionary steps.

Stretching

From Grandpa-Joe to Hulk Hogan, everyone needs to stretch both before and after exercise. Stretching make our muscles suppler, increases heart-rate, and increases long-term flexibility. Most importantly, stretching reduces injuries such as ligament tears, muscle tears, and strains and sprains which can have a lasting effect on your body, and take months of rehab to fix. Stretching, therefore, is an important part of any exercise regime or sports. Make sure your warm-up is suitable for the sport you are doing, and don’t overdo the warm-up. There is nothing worse than tearing a hamstring during your hamstring stretch because you rushed into sprints.

Knowledge and Self Awareness

Some sports-enthusiast-readers will be uber-keen to improve fast. Whether that means getting stronger, faster, or fitter you should be aware of your current level of fitness and work to improve and excel and not jump the limit. Do not push your body beyond its current level of fitness as it is dangerous and unnecessary. Even if you feel that you are quickening the path to your goal by pushing yourself like this, you will harm yourself. Be aware of the level you should be training at and stick to it to avoid serious damage. It is also useful to understand and use the correct equipment.

It is important for runners to wear the right-soled shoes, and American Football Players to wear gum-guards. Increase your knowledge and understanding of exercise so you can reap the benefits and avoid the perils. A fantastic way of doing this is listening to your coach. They usually have a wealth of information stored to reduce risk when engaging in sports. They can also advise you on different aspects of maintaining your health, from the best ways to warm-up and cool-down to the correct diet. Bathe in their wisdom.

 

Eating Well.

Mount Sinai is a huge advocate for healthy diets. Eating well and drinking plenty of water can reduce the risk of damaging yourself in sports. A nutritious diet allows muscles to repair and regenerate after exercise reducing the risk of harming or overusing a muscle group which can lead to tier-3 tears, and months of rehab. Knowledge of your sport can help you ascertain what kind of diet you should be following.

These three top-tips are the most effective preventative steps you can take to seriously harming yourself whilst engaging in sports. Precautionary steps can save you time in the long run by reducing the risk of severe damage and rehab.

If you have suffered a sports-related injury, please contact us at Mount Sinai Department of Rehabilitative Medicine for a bespoke rehab plan. Contact our switchboard at: (212) 241-6321

SAD – Nature’s Effect on Nurture

Historically, Seasonal Affective Disorder (SAD) has been understood as being the result of one of two binary positions: biological (your genetic composition) or environmental (learned behaviours and other external influences). In more recent years, it has become widely accepted that the two elements feed into each other. That means that while people have predispositions toward depression, that depression is simultaneously affected by an external influence (in this case winter). SAD is made distinct from other types of depression due to its temporal pattern. Major episodes begin in the winter, and there is always a full emission in the spring.

Let’s take a quick look at the two factors before seeing how they link into each other.

Is It in The Genes?

The bracket of “Biological Vulnerability” covers a vast field of potential reasons one experiences SAD – but is generally understood as a rhythmic abnormality in the winter. This simply means, a biological composition or a natural disposition to biological changes in winter causes SAD. Some of the most well understood reasons are as follows: there could be a delay or advance in the release of melatonin (the hormone that tells us it’s time to sleep), a retinal sensitivity to light, a dysfunction between neurotransmitters (the chemical substance which sends messages between nerves), a genetic variation in brain composition, and a reduced release of serotonin. 

SAD can be a result of one or more of these biological aspects, but more often than not, they are emphasized by psychological factors.

How Our Environment Can Make Us SAD

Depression is understood as an interaction between a cognitive vulnerability to depression (as we looked at above) and a stressor. There are different cognitive models that propose different vulnerabilities, let’s take a look at the main ones.

Alongside the genetical predisposition, it is common for the sufferer to also be affected by one of the following: a dysfunctional attitude (learned negative attitudes and outlook on the world), rumination (focusing attention on dysphoric moods and/or potential negative consequences), and a negative attributional style (catastrophizing negative events to a global scale). These aspects are usually interwoven.

Once a predisposition is influenced by one of these negative cognitive aspects, this combinatorial (see below for a visual representation of this process). All of these cognitive aspects are stressors.

Combining the Two. 

Source: Biological and Psychological Mechanisms of Seasonal Affective Disorder: A Review and Integration. Kelly J. Rohan, Kathryn A. Roecklein, and David A.F. Haaga. Current Psychiatry Reviews, 2009, 5., 37-47

As we can see following the graph, the environmental aspect (on the left) can run its own path to SAD, as can the biological (on the right). It is widely accepted that the psychological vulnerability and the physiological vulnerability feed into each other (as seen with the double-arrow that links the two sides together).

If you would like to learn more about the symptoms of SAD click here.

If you would like an introduction to one of our physicians that specializes in SAD click here.

SAD can have an extremely negative impact on your quality of life. If you need a consultation, or are suffering from any of the symptoms outlined at the end of the article, please contact us on (212) 241-6321 to book an appointment.

A Physician That Can Stop You Feeling SAD – Dr Wayne A Gordon (PhD)

In a previous article, we explored Seasonal Affective Disorder (SAD), its manifestations, and some ways in which you can cope with this type of depression. As we said, symptoms tend to get better on their own, but sometimes they don’t. That is why this week we introduce Dr Wayne A Gordon, Mount Sinai’s response to SAD in the Department of Rehabilitation Medicine.

Dr. Gordon is the Jack Nash Professor and Vice Chair of the Department of Rehabilitation Medicine at the Icahn School of Medicine. He holds a PhD in Psychology from Yeshiva University alongside an internship in Neuropsychology from Rusk Institute. His specialization in Rehabilitative Psychology has finessed his clinical expertise toward dealing with SAD.

His clinical focus is centred around brain rehabilitation. That extends to fields of Anxiety, Concussion, Dementia, Insomnia, Parkinson’s, and all manifestations of Depression. His work in academia prove his profound understanding of how to help deal with SAD, and other types of Depression. He has published more than 100 articles and book chapters, and has received several awards during his career including recognition for “visionary work” in TBI (Traumatic Brain Injury).

When is the best time to see a physician about SAD?

One of the primary concerns with SAD is that it is difficult to diagnose, and equally sensitive to manage. The first step to dealing with SAD is diagnosis. This job is best done by a physician such as Dr Gordon, who can remove possibilities of other disorders that have similar symptoms. At this stage, it is possible to manage SAD using the step-by-step we supplied here. 

It is also important to see a physician if you feel the disorder is unmanageable. The step-by-step is helpful to some patients, but not to all. The symptoms of SAD don’t need to be managed alone. Dr Gordon has dedicated his life to helping people deal with SAD and equipping them with effective bespoke methods to deal with their personal battles. This can range from learning to deal with your symptoms to understanding what your symptoms are. SAD can manifest itself in “cycles” and become self-feeding. Dr Gordon can give you a metaphorical manual to your disorder which will help you understand what you are going through. This makes SAD manageable.

SAD can have an extremely negative impact on your quality of life. If you need a consultation, or are suffering from any of the symptoms outlined at the end of the article, please contact us on (212) 241-6321 to book an appointment.

How Can We Deal with Being SAD?

We all feel unhappy sometimes, but depression is more than a feeling of unhappiness. It is a mental disorder that makes someone feel persistently sad for several weeks or months. Depression can be hereditary, triggered by another mental disorder such as a “low” in bi-polar disorder, a side-effect of drug abuse, but it can also be triggered by external forces, like the season. Seasonal affective disorder (SAD) is a type of depression that occurs at a certain time of the year, usually in the winter.

SAD manifests itself similarly to other types of depression. There is no way of accurately diagnosing depression without knowing a patient’s history and state-of-mind, as there is no “test” for SAD. Your health care provider can make a diagnosis by asking about your symptoms. There are two main ways SAD can affect your life, mentally and physically.

The mental effect of SAD can be as follows. As with all types of depression, sufferers will tend to experience a feeling of hopelessness in all facets of life and catastrophize events past and present. Due to this, sufferers of SAD will be unhappy and irritable, and may begin to withdraw themselves socially. The disorder may begin to make the patient feel the need to eat more (as weight loss is more common with other forms of depression).

SAD manifests itself physically as a need for more sleep, a loss of energy and ability to concentrate.

There is a loss of interest to the sufferer’s work, his partner and friends, and other activities (especially social activities). Their movements may become sluggish and, they will more likely than not become socially reclusive.

These symptoms are not mutually exclusive, and they usually feed into each other which make the disorder more difficult to cope with. The mental facets of SAD will reinforce the social behaviour and vice-versa.

If you, or someone you know, is suffering from a handful of these symptoms then it is worth visiting your physician. Your health care provider can make a diagnosis by asking a series of questions about your symptoms and history. They can also perform physical exam and blood tests to rules out other disorders that are similar to SAD such as chronic fatigue.

If you are struggling to make an appointment, or are unable to see a physician for whatever reason, we have some tips that will help manage your depression at home. Remember, it is always better to see your physician.

Some tips on dealing with SAD

Firstly, make sure you are getting enough sleep. A fully-grown adult should get between seven to eight hours a night – although some people may need as few as five, and some as much as ten. Know how much sleep you need, and make sure you are getting it. Oversleeping is never advised.

Make sure you are eating healthy foods. This doesn’t mean you need to eat bland food, it means you need to have a balanced diet. For example: make sure you are getting a healthy dose of vitamins and minerals every day and avoid binging on sugar and hydrogenated fats.

Do not use alcohol or illegal drugs, these often make depression worse – and have been correlated to suicidal thoughts during episodes of SAD.

Try to exercise often. Proven time and time again, exercise is a fantastic way of battling depression. Force yourself to start a social sport or activity, but most importantly – do activities that make you happy.

Learn to watch your symptoms and understand that you are dealing with a disorder. This is especially effective in the early days of SAD, it will allow you to take control of your disorder, change your routine, and book in to see your health care provider.

Finally, if you have seen your health care provider, make sure you take your medicines right away, and ensure you ask your provider how to manage any side effects. There is a multitude of ways of dealing with SAD that your health care provider can offer. Symptoms tend to get better on their own, but there is no “cure” for SAD. Tackling SAD is a matter of managing symptoms and learning to with the disorder.

Get medical attention immediately if you have thoughts of hurting yourself or anyone else.

How to Deal With Sciatica, The Do’s and Don’ts

How to deal with sciatica, the do’s and don’ts

This week, we are going to look at ways of managing sciatica. In our previous blog we looked at what sciatica is, and suggested some causes of the problem. To quickly recap, sciatica is the compression of the sciatic nerve – which in turn causes pain down the lower back, through the hamstring all the way to the foot. What is most important to remember when dealing with sciatica, is that is a symptom, and not the underlying problem itself.

The first step when dealing with sciatica is diagnosing the underlying issue. The root of the problem can be anything from a slipped disc in the spine, to a spinal stenosis, or in more serious cases, a tumor. It could even come from a small fracture in the hip. Although we can treat sciatica without dealing with the genesis of the problem, you are more likely to experience a reoccurrence of sciatic pain if we do not.

We recommend that if you suffer from sciatica, get a diagnosis on what caused it. That way we can deal with the pain alongside remedying the original problem, and reduces the chances of it reoccurring.

For now, let’s look at some of Mount Sinai’s recommendations for dealing with sciatica at home.

Conservative (non-surgical) treatment is best in most cases. When you are suffering from sciatica, or begin suffering due to some other cause, apply heat or ice to the painful area. Try the ice first (48-72hrs); then use heat on the pain. Over the counter pain relievers such as ibuprofen or acetaminophen can also help with inflammation and general pain relief.

Surprisingly to a lot of patients, bed rest is not recommended. Although short term bed rest may be needed for patients in extreme pain, staying inactive and reclined for long periods of time weakens the body and extend the life of agonizing symptoms.

Upon first suffering the symptoms of sciatica, it is recommended to tone down your physical activity for the first few days, and gradually work your way back to your daily routine.

You should reduce your activity in the first couple of days – and gradually adjust your body to your usual activities. This will ensure you do not overstress any of the damaged components, and give your body time to adapt.

Patients are recommended to start exercising again after around 2-3 weeks. You should include exercises to strengthen your abdominal muscles and improve flexibility in your spine.

If weightlifting or contact (collision) sports such as American Football are part of your usual exercise routine, you should not return to your sport/hobby for at least 6 weeks since the pain began. Do not lift heavy objects or twist your back. Your physician can help identify good exercises to remedy sciatica.

More serious complications depend on the causes of sciatica, such as slipped discs or spinal stenosis. Call a provider immediately if you have:

·        Unexplained fever with back pain

·        Back pain after a severe blow or fall

·        Redness or swelling on the back or spine

·        Pain traveling down your legs below the knee

·        Weakness or numbness in your buttocks, thigh, leg, or pelvis

·        Burning with urination or blood in your urine

·        Pain that is worse when you lie down, or awakens you at night

·        Severe pain and you cannot get comfortable

·        Loss of control of urine or stool (incontinence)

Also call if:

·        You have been losing weight unintentionally (not on purpose)

·        You use steroids or intravenous drugs

·        You have had back pain before, but this episode is different and feels worse

·        This episode of back pain has lasted longer than 4 weeks

Sciatica usually goes away on its own if you follow our guidelines. However, if you need a consultation, or are suffering from any of the symptoms outlined at the end of the article, please contact us on (212) 241-6321 to book an appointment.

Introducing Parag Sheth

Introducing Parag Sheth – Mount Sinai’s Carpal Syndrome Tunnel Expert

This month, with our continued aim of ensuring our patients know and trust our physicians, Mount Sinai presents to you our long-standing Assistant Professor of rehabilitation medicine, Dr Parag Sheth. Dr Sheth holds a certification in Physical Medicine and Rehabilitation; his specialisation lies in Carpal Tunnel Syndrome (CTS).

Dr Sheth’s expertise is grounded in his rich and varied academic career. Beginning his studies receiving honors at Johns Hopkins University, Dr Sheth moved on to study at Stony Brook School of Medicine, and subsequently held the position of Chief Resident at St. Vincent’s Medical Center’s Rehabilitation Residency Program. Dr Sheth is now a fellow of The Mayo Clinic, where he specialised in Musculoskeletal Rehabilitation; and he has been with us at Mount Sinai for over 20 years. During his time practicing with us, Dr Sheth has always gone beyond the call-of-duty to ensure patient satisfaction.

CTS, Dr Sheth’s specialization, manifest itself as a tingling, numbness and sometimes pain in the hand and fingers. This is caused by a compression of the median nerve, which controls sensation and movement in the hand. It can sometimes be hard to identify as the symptoms are common and often go unchecked. Dr Sheth is renowned for his ability to exercise expert judgement on patient’s symptoms, but always communicates in way understandable to the patient; we believe this to be paramount to a patient’s happiness. Dr Sheth has often been praised for his ability to listen carefully, and explain the process of treatment and aftercare in a concise and easy to follow way; this has made him a patient favorite. 

His clinical focus also extends to: back pain, electrodiagnostic testing, epidural steroid injections, herniated disk, knee pain, low back pain, shoulder pain, neck pain, and spine stimulation.

Outside of his professional career with us, Dr Sheth also teaches a yearly cadaveric dissection and weekly musculoskeletal lectures where he has been awarded the Avital Fast Award and the Department Teacher of the Year award. His research has been published in Nature, Lancet, and The American Journal of Sports Medicine. 

Dr Sheth is “Board Certified” and accepts insurance plans. For more details on appointment availabilities and plan coverages, please contact our call center at: (212) 241-6321.

What Causes Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome (CTS) is the compression – and sometimes squashing – of the median nerve that passes through the wrist. Its symptoms can include numbness, tingling and pain in the thumbs, fingers and wrists, which can travel as far as to the arms and even to the shoulder. Modern medicine has a firm grip on what CTS is; what causes it is quite a different story.

Diagnosing CTS can be done through a relatively simple physical examination. One test is called the ‘flick signal’, for which the patient is asked, ‘what do you do when your symptoms are worse?’ If the patient responds with a hand movement that resembles the shaking of a thermometer, there is good reason to suspect CTS. There are plenty of other tests such as Phalen’s Test and Tinel’s Sign – yet, despite the relative wealth of ways to diagnose CTS, there actually isn’t any kind of test to identify the precise cause CTS, and – except for patients suffering from underlying diseases – the biological mechanisms that create this inflammatory disorder remain unknown. 

It is a common story that CTS is caused through repetitive and often high-stress tasks that involve the wrists and hands – typing, using a computer mouse, manual labour to even playing the piano. While the correlation between CTS and tasks of this nature is undoubted, there is minimal evidence to suggest any clear causality.

In fact, most studies today indicate that CTS’ causes go above and beyond mere so-called ‘workplace factors’ and that they are rather linked to ailments that cause swelling in the wrist (osteoarthritis and rheumatoid arthritis) and others that obstruct blood flow (hypothyroidism and diabetes). We also see CTS pop up in clusters within a family, which suggests that something genetic is at play. Lifestyle also appears to play a significant factor, as those who smoke, drink alcohol excessively, consume excessive salt and who are obese all show increased risk of developing CTS. Women are also three times more likely to develop CTS than men, particularly after childbirth and during menopause.

Despite the range of medical, physical, genetic and life-style related items that are linked to an increased risk in developing CTS, their relationship is that of a correlation and not one of cause and effect. A modicum of clarity might be achieved, however, by overlapping both ends of the spectrum – the ‘workplace effect’ with medical/genetic/lifestyle factors. When somebody is susceptible to CTS – whether it be through genetics, a medical condition or an unhealthy or stressful lifestyle – and they also subject their hands and wrist to frequent, repetitive task, the likelihood of suffering from CTS will be at its greatest.

If you believe you are at risk of developing CTS, we would like to encourage you to seek medical advice on how to prevent it; if you believe you might already be suffering from it, we suggest you speak to one of our specialists for a suitable treatment. The earlier CTS is treated, the more likely – and easier – a full recovery will become.