Jan. 14, 2012 Does this sound too good to be true? In fact, Dr. Erik Cohen, an Armonk resident, offers his patients this unique service.
Dr. Cohen completed his pediatric residency in the Hartford area at the University of Connecticut, and stayed there for three years. He worked in both a traditional pediatric office and the emergency room of Connecticut Children's Medical Center.
"It’s a big children’s hospital” where there are 3 to 5 pediatric subspecialists in every field including Cardiology, Pulmonology, Orthopedics, Surgery, and Endocrinology. “It was culture shock for me to return to Westchester and not have the immense selection of children’s specialists at Greenwich Hospital, where I have staff privileges,” said Dr. Cohen.
Dr. Cohen received a B.S. in Bioengineering from the University of Pennsylvania and a Master's Degree in Physiology and Biophysics from Georgetown University. He attended medical school at Temple University School of Medicine.
While in private practice and making hospital rounds in Hartford, Dr. Cohen saw as many as 30 to 60 children a day. "We didn't have the time to get to know the kids, because of the way the practice was set up. We had to see a certain number of patients each day, and if a kid needed sutures or an IV, I had to send him or her to the hospital Emergency Room.” The irony is that the next day, he may have been the physician in that same ER administering those IV fluids or stitching that laceration.
The ER had its limitations as well. Although Dr. Cohen had the time and resources to do procedures, he laments the limited relationship with the families. "When I would come in, I didn't know the kids, yet I had to gain their confidence immediately; then they would leave and I'd never see them again. It was not gratifying,” he added.
Dr. Cohen grew up in Croton, and his family still lives in the Westchester County and New York City area. He has two young children, and wanted them to have a bicultural experience, since his wife is from France. Their son Max was enrolled in the French School in Scarsdale, and has since transferred to Byram Hills. Dr. Cohen's original plan was to open in Armonk, but another pediatric practice, which has since closed, opened before he completed construction.
Five years ago, Dr. Cohen opened a practice in Greenwich. His practice, NEXT Generation Pediatrics, limits the number of families. He commented, "This means I have a lot more time with each kid.” Instead of seeing 40 to 60 kids per day, each doctor only sees an average of 8 to 10.
This enables he and his partner Dr. Sharon Newport to provide a full hour physical, and there is never a wait to see a doctor. Even ear infections are scheduled for a half an hour visit.
Dr. Cohen loves what he does, and his approach to well care and sick visits is unique. He likes to get to know his patients, and spends time with the kids. He’ll even make home visits, whenever possible. Because he limits the number of patients he sees, he can accomplish things that other doctors can't. "Yes, it’s terrific to spend an hour with the kids and in addition to my asking if they can walk or crawl, and how many words they can speak, I watch them play for an hour. By making the home visits, I can see what the home life is, determine if the house is properly child-proofed, and see who is involved.” and who is there.
"The well visit is always in the office, but we will always do a home visit, if requested, for anything else. There are many reasons my patients can't make it to the office: the baby just fell asleep, the other one is vomiting all over the place and this one is tugging at his ear,“ said Dr. Cohen. Home visits are offered at the same cost, but require more flexible scheduling.
Dr. Cohen would like to expand his practice with families in Armonk. Being able to provide home visits for his neighbors in the morning before or on his way home from work would be ideal. "I have a young boy who is afraid to have his blood drawn. I stop by his house in the morning when he is relaxed, watching TV. It’s no big deal, which makes it easier for him."
Dr. Cohen enjoys getting to know his families. Some of his patients have become his best friends. He understands their ideologies. "I have a family who is afraid of antibiotics. I'll say to them, ‘This is an ear infection: Let's give it some time, and it might drain on its own. We'll try a neti pot (for nasal cleaning) and numb the ear with a little olive oil. And we’ll see how he does.’ Dr. Cohen offers half an hour sick visits. “I explain what we are looking for, what to watch for, and that parents can call me at anytime,” he said.
Dr. Cohen said, “I don't have an answering service, so calls go straight to my cell phone. Also, anyone can email me directly. It depends on the time, but if I'm called on my cell phone, first thing in the morning before school, I'll say, ‘Let me come by the house in fifteen minutes and we can determine if they go to school or not." Since he loves what he does, Dr. Cohen doesn't mind being so accessible.
“I have a parent who lives in California and often calls me. She said, 'I think we have pink eye.'
I said, ‘Take a picture and send it to me. I responded, ‘Yes’, and electronically sent a prescription to California.”
“I had a family visiting Florida, and their child had a bead in his nose. They called and said they had to go into the emergency room. I told them to hold on, go on Skype, and show me where the bead was. They showed me. I walked them through how to get it out, it popped out and we were done. I learned half of what I know in the pediatric ER, a quarter in medical school and the rest from surviving with my kids."
Most pediatric practices make more money from sick visits than from well visits. Dr. Cohen explains that the finances of his office do not work that way. His sick visit rate is well below the national pediatric average. In his office, sick children equal only about 55% of all his visits in comparison to other practices where they account for about 85% of the visits. Dr. Cohen said, "I didn't expect that to happen, but if we are making more money on well visits than sick visits, our incentive is to keep people well. On the other hand, if a practice is making more money on sick visits then well visits, the incentive is to have more sick patients."
NEXT Generation Pediatrics does not bill insurance companies directly. He said, "We offer a free consultation, explaining how we work. People pay at the end of a visit, and then we'll submit the paperwork for the family.” Families will never have to fill out the confusing insurance forms required for reimbursement.
We discussed the topic of children’s nutrition. Dr. Cohen commented, "As far as nutrition goes, I tell parents that their job is to decide where and when they eat and what is served. Sitting at the table together is good family time. You decide when you eat, provide three meals and two or three snacks a day. You decide which food is placed in front of them. Once you have done that, your job is finished. Let the kids decide how much they will eat of what you have offered. The less a parent gets involved in fighting about food, the more the child will follow his or her natural instincts. If a child grows up learning to eat a good variety of food, making healthy choices, and is given small portions (they can always have more), you are ahead of the game.”
“If that doesn't work out, we have a nutritionist on staff who will go to your home, look at the pantry, evaluate your diet and set up a nutrition plan to make it more concrete."
Within the next year and a half, Dr. Cohen plans to expand and merge with an internal medicine practice. This will provide a family practice for both children and adults.
Dr. Aaron Katz - From the Bench to the Patient
Nov. 16, 2011 Dr.
Aaron Katz is a board certified urologist. He graduated from New York
Medical College in Valhalla. He followed medical school with a residency
in urology at the Maimonides Medical Center in Brooklyn. Then he had a
two-year urology fellowship at the Columbia University Medical Center,
which ended in 1994. He has stayed at Columbia as a full time Professor
of Urology.
Katz's proudest accolades are that he has been rated for five consecutive years as one of New York Magazine's Best Doctors and has received an award for Best Teacher from Columbia University.
Dr. Katz started as an instructor at Columbia's Department of Urology, then became an assistant professor, an associate professor and now a full professor with an endowment in the Department of Urology. His focus and research has been in prostate disease. Katz's research includes basic-science and clinical trials in the laboratory. He is interested in prostate cancer and using natural therapies, herbal compounds and vitamins to see if there is any way to prevent, halt or reverse the progression of prostate cancer. He says that is the most common cancer in men now. One in six men will be diagnosed with prostate cancer. Katz is also trained in testicular, penis, urethra, and bladder and kidney cancer.
Katz says there is a lot of controversy on how prostate cancer is detected. The best way, he says, is the Prostate Specific Antigen test (P.S.A.) that is done by means of a blood test. This fall, the U.S. Preventative Services Task Force, an organization of doctors, recommended that men over 50 not take the P.S.A. when there are no indicative symptoms. Katz says, "Sometimes doctors not in the field are making recommendations such as women not doing mammogram screening for breast cancer prevention."
Five days a week, Katz is busy with patients doing prostate biopsies and cystoscopies to look inside the bladders and the prostate to check for cancer. He says that the majority of men he sees have no symptoms and that becomes a challenge since the majority of mens' prognoses of prostate cancer today are only diagnosed because of a P.S.A. blood test, not because they have symptoms. He says the challenge is to tell a 55-year old man that he has cancer when he feels well. Often the cancer cells that are detected are not the biological cancer cells that are going to spread and cause symptoms. The decision is whether to intervene with treatments. Unfortunately the treatments can have life altering sexual and urinary side effects. You say to someone, "We can take the cancer out and cure you." But the question is: Do you really need to be cured? And do you really need to risk potentially losing your sex life or becoming incontinent and wearing diapers for the rest of your life?
"I see several hundred men in my practice who have been told they have cancer and need treatment. They come to me asking, do I really need treatment? I've taken them on as patients and provide active surveillance. I follow their P.S.A. results every three months and do a biopsy every year to make sure the cancer hasn't gotten worse. I change their diet and recommend certain vitamins and herbal compounds that we have found in our lab that can alter the course of the disease. They may not get rid of of the cancer cells, but may allow a man to live with the cancer for many years."
Katz says the alternative of a dietary approach is real and he has focused on that in his book, "The Definitive Guide to Prostate Cancer from Integrated to Conventional Medicine." He goes into all the different kinds of therapy, including active holistic surveillance. This involves not treating the cancer, but changing a man's lifestyle and diet. There is evidence that a lot of these cancers feed on fats, red meats, and white flour. There is a lower incidence of prostate cancer in the Asian countries where the diet is more plant, fish and soy based. Katz says medical literature leads him to believe that soy compounds have an active compound called genistein that may interfere with cancer growth.
Katz says that in his 12 years of medical school there were maybe 30 minutes of discussion on what we should eat and how diet may affect our lives. "When I first started working at Columbia in 1993 I got a phone call from the late Dr. Robert Atkins, founder of the Atkins Diet and the Atkins Center for Complementary Medicine and Nutritionals." He called and said that they had many prostate patients and asked Dr. Katz to evaluate them at the center, which was also in Manhattan. Every Tuesday for about three years, Katz went down to the Atkins Center. This exposed him to a whole new world that he never knew existed. The world of integrated or alternative medicine. "I saw patients who were using diets and herbs to modify their prostate cancer. They were urinating well and their P.S.A. scores were going down."
In 1998, Katz opened up the first center of Holistic Urology at Columbia University where he is the director. It does clinical trials and herbal laboratory research, and has an acupuncturist and a nutritionist. The center fully evaluates the whole body rather than just tiny little cells.
"I've been working with prostate cancers everyday for the last 20 years and you get a sense after a while, if you read the literature and understand the biology of the cells, what maybe the best therapy is for certain people." Some people might need surgery and other people can go holistic. If he sees a 50-year old patient who wants holistic treatment and has an aggressive prostate cancer, he's probably going to recommend that the patient has his prostate removed through robotic surgery. "We have something called the Gleason Grading system. On a scale of two to ten, a higher number means more aggressive cells. The more aggressive the cells, the more likely the cancer cells can bore a hole through the prostate and get into the lymph node and the bone." Katz says, "Nobody dies of prostate cancer or breast cancer if it stays in the breast or the prostate. It becomes a problem when it gets into the lymph node, or the bone, then gets into the liver and lung." If a man has cancer cells in the prostate, he still can have a long life. Within eight years, however, if he doesn't do anything, the cancer cells could get out of the prostrate and spread. And if it does spread, then it is incurable.
Katz's latest book, "The Definitive Guide to Prostate Cancer from Integrated to Conventional Medicine," takes the reader first through anatomy. What is the prostate, where is it, and what does it do? The prostate provides the proper nutrients for sperm to enter into the uterus and allow for fertilization. The book then takes you through the P.S.A. test and the controversy. "What does it mean when your doctor calls you and says we've got bad news, your test is high?" Does that mean you have cancer, does that mean you need a biopsy? Could you have a urinary tract infection? Is it high because you had sex the night before? Is it a benign prostate enlargement? The latter three can falsely elevate the P.S.A. results, says Katz.
The question is: if you have an elevation in your P.S.A. scores, do you take the next step, which would be a biopsy? A lot of men don't want to have a biopsy because it can be uncomfortable. It is usually done in the doctor's office. But doctors are seeing one problem with the biopsies now that they didn't see years ago: they are causing urinary tract infections. Even though antibiotics are given before and after the biopsy, they are seeing more bacteria that is resistant to the antibiotics. About 5% of the men undergoing biopsies are getting a high fever and have to be admitted to a hospital. This has led to changes in the way the biopsies are done today, which is rectally rather than through the urethra.
In his book, Katz says, we take the man through the diagnostic of prostate cancer: what does it mean; what is the Gleason score; and do you need additional tests such as a Cat Scan or bone scan to see if the cancer has spread?(Not everyone does.) Scans may unnecessarily expose someone to excess radiation, as well as increase the cost of medical bills. He then talks about the newer ways of treating patients with robotic surgery. Almost 95% of major hospitals have the da Vinci® robot. The robot assists the surgeon in removing the prostate, kidney, uterine, or cardiovascular value replacement. This procedure also reduces the hospital stay because the blood transfusions have drastically been reduced. The robot also allows for the visual magnification of the nerve bundle to the prostate gland, which allows a surgeon to spare the nerves. If nerves are damaged the male will become impotent.
Certain patients can't have surgery because of complications, so Katz also provides Cryotherapy which is not major surgery but rather freezes the prostate cancer. He has done thousands of these procedures all over the country. The cancer in frozen to death. "When a man comes to him who has aggressively recurring cancer and I use the Cryotherapy and the cancer is completely gone, the man says, 'You saved my life. I can't thank you enough.' That is very rewarding."
There is no one right treatment for everyone and what Katz tries most is to be honest. He offers a protocol that takes a holistic approach to patients, not just focusing on the symptoms but what is the underlining cause. "We do a P.S.A. every three months for the first two years. They have a protocol with diet, supplements, and exercise. I see some men who are good candidates for holistic approach but some men are so anxious about the cancer that even though it is not aggressive, they need to have treatment and can't live with it." In these cases he recommends treatment and the holistic method to prevent recurrence.
You can hear more on the radio or call in to Dr. Katz and his co-host Dr. Phillipa Cheetham, a British urologist and Clinical Fellow in Robotic Surgery and Prostate Cryosurgery at Columbia, on Katz's s Corner every Sunday morning at 7:00AM on WABC radio at 770 AM. Or you can listen to the podcasts on www.wabcradio.com.
Dr. Anca Tchelebi
Park Avenue Medical Spa's Wide Range of Skin Treatments By Alison Simon July 29, 2011 The hot summer sun can be a welcome relief from last winter’s record breaking snowfall and subzero temperatures. Finally we can shed some layers and enjoy the great outdoors. But stripping down and spending more time outside is not without potentially very serious consequences. Outdoor fun brings increased exposure to the sun, which can have harmful effects on our health and appearance.
The more scientists study the risks of overexposure to the sun--skin cancer, wrinkles and over-pigmentation--the more we understand the importance of limiting ones' hours in strong sun. We slather on sunscreen and wear protective clothing, sit in the shade and wear dark glasses and big hats, but what about the damage already done? How do we reverse the damage caused in our youth by hours baking with baby oil and iodine? Fortunately, there are individualized strategies to repair such damage.
The Park Avenue Medical Spa, parkavenuemedicalspa.com, located on Main Street in Armonk, offers a unique approach to preventive measures and personal rejuvenation. The spa was established by Dr. Tchelebi-Moscatello, a board-certified radiation oncologist who is trained in medical aesthetics.
Dr. Tchelebi spent years working with patients suffering from skin cancer and related complications and quickly realized "the importance of prevention in protecting the body from the ravages of sunlight, pollution, unhealthy eating habits, and other harmful factors.” Her expertise in pinpoint deliveries of highly radioactive therapy to skin cancer patients gave her a unique understanding of the physics and biology of light therapy. With a scientific approach to the skin, Dr. Tchelebi creates personalized programs to medically and/or aesthetically repair skin damage caused by harmful environmental exposure.
Dr. Tchelebi's medical approach and Park Avenue's spa environment provide an array of services ranging from facelifts to aesthetic services such as state-of-the-art laser technologies, IPL (Intense Pulsed Light), facial fillers such as BOTOX® and medical-grade microdermabrasion, as well as more traditional spa services such as massage and facials designed in accordance with the spa’s philosophy of “total beauty, wellness and relaxation.”
Dr. Tchelebi says the services offered at The Park Avenue Medical Spa differ from services offered at salons and gyms because the Medical Spa is physician-supervised and offers more advanced treatments. She continues to study under leaders in the fields of dermatological aesthetics in order to learn the newest and most innovative techniques and procedures, and says she will only introduce new services if they have proven to be both beneficial and risk-free to her clients.
One common symptom of sun damage is blotchy patches of increased pigmentation, sometimes referred to as sun spots or age spots. Although this condition is not dangerous, it is unsightly and, according to Dr. Tchelebi, can generally be corrected using Intense Pulsed Light Therapy (IPL). IPL is a non-invasive procedure where multiple wave lengths of light are pulsed across the skin to reduce pigmentation and even out skin tone, resulting in a smoother brighter texture.
A series of 3 to 5 IPL treatments are performed three weeks apart. During the treatments, which last 10 to 20 minutes, pulsed light is absorbed into the melanin in the skin cells, which destroys the damaged cells. At first, pigmentation increases as damaged cells move closer to the surface, but then, in 2 to 3 days, the overly pigmented cells are shed, creating a more even skin color. IPL also stimulates collagen production in the skin, which creates a more youthful, tighter and brighter appearance. IPL is said to reduce pore size and can be also used to treat broken capillaries.
People of most skin types can benefit from this procedure. To highlight the positive attributes of IPL and demonstrate the ease and success of this procedure, Dr. Tchelebi offered to provide a series of treatments to a staff writer for AllAboutArmonk.com. As I personally have considerable facial skin discoloration as the result of years of overexposure to the sun, I gladly volunteered for the assignment. Because this procedure initially increases the skin’s sensitivity, it should not be done during the summer or during periods of prolonged sun exposure. I will begin IPL treatments in late September and report on the results and overall procedure by November.
One Woman’s Fight By Alice Levine
July 29, 2011 Armonk resident Barbara DiGiacinto, a retired school teacher who taught English for over 30 years, faced the most challenging battle of her life in 1999 after receiving a diagnosis of breast cancer. Barbara won the fight and now helps other women cope when they are faced with a similar diagnosis.
After Barbara found a lump in her breast during self-examination, she immediately made an appointment to see her gynecologist; when a suspicious cyst was found, he scheduled an appointment for Barbara with a surgeon in a local medical group. After the pathology report revealed breast cancer, Barbara’s doctor advised her to get a second opinion at Sloan Kettering. “I wanted to stay with my local doctor since I had a long relationship with him and a great comfort level. He strongly advised me to get another opinion. The advice turned out to be a lifesaver because the doctors at Sloan-Kettering diagnosed my particular type of breast cancer, a very rare type of cancer which did not seem to play by the rules,” Barbara explained.
Barbara stressed the importance of trying to view cancer as a temporary bump in the road. It can be overwhelming to consider it a lifelong disease. Barbara added, “I can’t overemphasize the importance of how you approach cancer. Of course I was scared, but I made up my mind to take charge and not see myself as a victim. While friends and family members wanted to bring me to chemo treatments, I felt a sense of peacefulness and inner strength by going myself. Of course, some people may not feel well enough to go to their treatments by themselves, but I was fortunate that I was able to.”
Barbara was pleasantly surprised by the warmth and compassion of both the nurses and doctors at Sloan Kettering. “I expected a very impersonal experience because it was a big New York City hospital, but it was just the opposite. On a day when I was waiting a long time for my chemo treatment, my oncologist, Dr. Maria Theodoulou, noticed me waiting and sensed my anxiety. She suggested I join her to run some errands and pass the time. She also gave me her home phone number and told me not to be afraid to call when I needed her,” Barbara said. Barbara also discussed how important it is for women to expect to wait sometimes for medical appointments, tests and treatments. “Bring a book and don’t waste energy getting upset if you need to wait. It’s almost always due to an emergency, and it’s out of your hands,” she added.
After eight surgeries and several chemotherapy treatments during which the cancer would temporarily go away and come back, Barbara’s doctors recommended a mastectomy to be followed by more aggressive chemotherapy. The news was of course startling and disappointing, but Barbara did her best to take it in stride. “During this time I took great comfort in the support of the American Cancer Society. They are available 24/7 to answer questions and provide support. Anyone who is diagnosed with cancer should add their number to her speed dial. They helped me move on to the next phase of my treatment with a feeling of strength and positive energy. Again, I was determined to stay calm and continue my fight,” Barbara said.
Thankfully, Barbara’s surgery and chemotherapy were successful in removing the cancer. She has now been cancer-free for 11 years, and she enjoys helping other women who have been diagnosed with breast cancer.
Barbara offered some helpful suggestions for women. She stressed the importance of self-examination, which helped save her own life. “Unfortunately, many women neglect to do a self-exam or don’t take action even after discovering a lump. One of my friends waited almost a year before seeing her doctor, and tragically, it was too late to save her, once she finally decided to seek medical treatment,” Barbara said. Barbara also recommended getting in touch with the American Cancer Society immediately. “One of the first things I did was read their 120 page booklet on breast cancer. It helped me understand my cancer so that I was ready with questions when I first met with my doctor. Always bring a pad and be prepared to ask questions and write down answers, since it’s easy to forget what the doctor said later on,” she stressed. Finally, she recommended always getting a second opinion. “Even if you totally trust your doctor, you must get a second opinion. I recommend going to a cancer treatment hospital, such as Sloan Kettering, when possible. The doctors are cancer specialists and the treatment is cutting-edge. The nurses at Sloan are trained in working with oncology patients and you feel their empathy immediately. It’s so important to know you’re going to feel comfort and support every time you go for a treatment,” added Barbara.
Barbara never takes for granted how fortunate she is to have survived breast cancer and to be cancer-free. She said, “While it was obviously an experience I would never have wished for, I feel more empowered and I am thankful for every day.”
Barbara expressed these sentiments: “Accept what you cannot change. Do not look into the future unless your vision is positive as it does no good to see the future as doom and gloom.”
“These two beliefs helped keep me positive and I embraced these words every single day of my ordeal. They helped me survive and stay positive,” Barbara concluded.
