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PHELPS
Fall 2017
Today
nwh_constellation_01
Inside:
Phelps: Training Family
Doctors for Five Years
The Patient at the
Center of Cancer Care
How to Know When
It’s Time to Stop Driving
Unusual Symptoms of
Heart Disease
Falls Are Not an Inevitable
Part of Aging
Plus:
Fall Calendar
Letter from the
Chairman and President
Dear Friends,
We are pleased to announce that the Northwell Health Cancer Institute at Phelps
has officially opened. In addition to offering this new state-of-the-art base on campus
for comprehensive cancer care, Phelps is also reaching out to the community with
education and support. In April, for example, our physicians and their colleagues hosted
a luncheon and panel discussion for the community at the DoubleTree by Hilton in
Tarrytown. This educational event was well attended, and guests appreciated the unique
opportunity to interact personally with our physicians who provide oncologic, surgical
and diagnostic services for cancer patients.
Phelps also sponsored the American Cancer Society’s Relay for Life and participated in
the Northwell Health Walk at Westchester, with proceeds benefiting the cancer programs
at Phelps and Northern Westchester Hospital. In June, Phelps joined organizations
nationwide by hosting a Cancer Survivors celebration.
While the shortage of primary care physicians remains a concern across the country,
the Family Medicine Residency program at Phelps continues to play an important role
in developing top-notch family medicine doctors, many of whom have chosen, after
graduation, to remain and practice in our communities. This program, which began
with just six residents five years ago, will have 24 residents training annually by 2020.
Increasingly, members of our community are seeking their primary and specialty care
from our Phelps Medical Associates (PMA) physicians. The personalized, quality care
and attention that PMA patients receive is garnering real attention. In fact, in surveys,
more than 90 percent of PMA patients indicated they were likely to recommend their
physician to friends or family.
We are also pleased to announce the arrival of noted family medicine physician Robbins
Gottlock, MD, as Phelps’ new VP and Associate Medical Director. In this role, Dr. Gottlock
leads the panel of PMA physicians. In addition to being a highly regarded family medicine
practitioner himself, Dr. Gottlock also holds an MBA and has worked extensively with a
global consulting group.
Finally, we are especially pleased with the progress being made with our private room
renovation, already underway in the hospital’s north wing. This is part and parcel of
our ongoing program to make Phelps a comfortable, welcoming place – a place where
patient experiences are the very best they can be.
Wishing you a wonderful autumn . . .
Sincerely,
Kenneth Taber Daniel Blum
Board Chairman President & CEO
2 Fall 2017 | Phelps Today
Table of Contents
nwh_constellation_01 The Patient at the Center of Cancer Care
nwh_constellation_02 4
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PHELPS TODAY
Editor Phelps: Training Family Doctors for Five Years 6
Mary Sernatinger
How to Know When It’s Time to Stop Driving 10
msernatinger@pmhc.us
nwh_constellation_01 nwh_constellation_02 nwh_constellation_03
Not Just an Elephant Sitting on Your Chest:
Managing Editor
the Unusual Symptoms of Heart Disease 12
Tina Dorfman
Medical Editor People and Services Exemplifying Excellence 16
Bruce Heckman, MD, MPH
Kenneth Taber Named Chair of Board of Directors 17
Editorial Advisors
Daniel Blum Phelps Medical Associates News 18
Lucy C. Engelhardt, RN Falls Are Not an Inevitable Part of Aging 20
Mary McDermott, RN nwh_constellation_04 nwh_constellation_05 nwh_constellation_06
nwh_constellation_04 Healthy Life Calendar nwh_constellation_05 22
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PHELPS TODAY is a publication of Phelps
Hospital, a 238-bed, not-for-profit acute care Maternity and Baby Care Classes 25
community hospital located in Sleepy Hollow,
NY. Phelps, part of Northwell Health, has been Patient Portal: A Place to Review Your Health Information 26
providing medical and mental health services
to Westchester and surrounding communities Cuándo es el momento de dejar de conducir 28
since 1955.
No es solamente un elefante sentado en su pecho
If you would like to be removed from the Phelps Síntomas inusuales de insuficiencia cardiaca 30
nwh_constellation_07 nwh_constellation_08 nwh_constellation_09
Today mailing list, please call (914) 366-3100 or
email crobinson10@northwell.edu.
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Visit us on Facebook: Request Your Appointment Online!
http://www.facebook.com/
PhelpsHospitalNorthwell Appointments for many of Phelps’ outpatient services can be made on the
hospital’snwh_constellation_10_live
website, including: cardiovascular, diabetes, infusion, nutritionnwh_constellation_12_live
nwh_constellation_11_live counseling,
Visit us on Twitter:
occupational and physical therapy, pain center, pulmonary/respiratory, radiology/
https://twitter.com/
#!/phelpshospital x-ray, senior services, sleep, speech & hearing, voice & swallowing, and wound healing.
Just go to www.phelpshospital.org and click on “Request an Appointment” – any time
Visit us on Instagram: of the day or night!
Instagram@PhelpsHospital
Phelps’ Community Service Plan
Phelps Hospital is committed to improving the health and well-being of the
community. To see our latest Community Service Plan and learn about our activities
and initiatives, please visit phelpshospital.org/about-phelps
nwh_constellation_10_outline nwh_constellation_11_outline and click nwh_constellation_12_outline
on
“Community Service Plan.” A printed copy of this publications may be requested
nwh_constellation_10_live by calling 914-366-3108.nwh_constellation_11_live nwh_constellation_12_live
Fall 2017 | Phelps Today 3
The Patient Over the past several decades, not only have survival rates for cancer
patients increased dramatically, but the manner in which patients
at the
receive care has also evolved.
1970s: Cancer was a see a breast surgeon, radiation oncologist
Center of
and/or medical oncologist to learn about
whispered word different treatment approaches. Options
If you watched the television series Mad may range from surgery alone to surgery
Cancer Care
Men, set in the 1960s and 70s, you might followed by radiation therapy with or
remember an episode where Betty Draper without chemotherapy, or a combination
Francis was diagnosed with lung cancer. of hormone therapy and chemotherapy.”
Her doctor didn’t tell her that he had Anna Komorowski, MD, medical oncologist,
discovered tumors. Instead, he called her adds, “Sometimes, chemotherapy or
husband to let him decide whether to hormone therapy might be recommended
break the news. It was typical in those days prior to or instead of surgery, depending
for cancer to be a whispered word, and on the size and biology of the tumor.”
sometimes family members would keep
the diagnosis a secret from the patient.
Coordinated care –
not fragmented
Today: Cancer patients partner
Whatever the approach, the overall
with specialist teams experience for patients is less stressful
Today, cancer patients who have the most when all aspects of care are provided in
favorable outcomes are fully informed one location. Traveling miles from home to
and have the opportunity to communicate different locations, from the suburbs to the
readily with the team of specialists involved city for testing, retrieving medical records,
in providing their care. surgery and therapy can be exhausting, and
it often leads to fragmented care.
At Phelps, for certain cases, our physicians
meet at a gathering called a Tumor Board, Some cancer patients have chronic medical
where a multidisciplinary team including conditions that must be managed at the
medical oncologists, surgeons, radiation same time they are undergoing cancer
oncologists and nurses review images and treatment. “At Phelps, our patients benefit
biopsies and discuss their assessments of from seamless, coordinated care,” says
the patient. Then, based on their combined Dr. Komorowski. “By having just one go-to
knowledge and experience, they agree center for everything, it is possible for
upon the best plan of care for the patient. patients to be more relaxed, so they can
focus on taking care of themselves.”
“A patient who has been diagnosed with
breast cancer, for example,” says May Lim, In addition, by obtaining all services at
MD, radiation oncologist at the Northwell one location from a connected physician
Health Cancer Institute at Phelps, “may group, patients’ electronic medical records
4 Fall 2017 | Phelps Today
(EMRs) are readily available to every Anna Komorowski, MD,
specialist involved – both for their cancer is Acting Director
care and treatment for other medical of the Division of
conditions, such as heart disease or Medical Oncology
diabetes. With easy access to our patients’ and Hematology.
medical records and simplified scheduling Dr. Komorowski is
with various specialists, it is possible to board certified in
coordinate sequencing of treatments medical oncology and
and appointments. “Delays are avoided,” hematology and has been in practice for
says Dr. Lim, “and everything can happen over 10 years. Dr. Komorowski earned her
exactly when it is supposed to, and at the medical degree at the Medical University
convenience of our patients.” of Warsaw. She completed her training
in internal medicine at New York Medical
Support College and Our Lady of Mercy Medical
“Undergoing cancer treatment affects
Center, where she also served as chief
medical resident and subsequently The Northwell
patients in many ways, both physically
and emotionally, so we do everything
completed a fellowship in hematology
and medical oncology. Dr. Komorowski Health Cancer
we can to help them maintain their
strength and quality of life,” says Dr. Lim.
sees general hematology and medical
oncology patients at 777 North Broadway, Institute at Phelps
A dietitian may provide a patient Suite 102 and 207, and can be reached at
undergoing chemotherapy with advice on 914-366-1625. “It is an important achievement
ways to boost nutrition or ease digestion, or for us,” says Daniel Blum, Phelps
a physical therapist can help patients who May Lim, MD, MPH, President and CEO, “to be able
develop lymphedema (a collection of fluid is board certified in to provide our community with
that causes swelling in the arms and legs). radiation oncology comprehensive cancer care – not
and recently returned just superb physicians and medical
A nurse navigator assists with many to Northwell Health therapies, but also a wide range of
aspects of the journey through cancer Physician Partners as support services to meet the many
care, from insurance and transportation Physician-in-Chief of needs of our patients during their
to coordinating appointments, providing the Department of months of care.”
education and helping patients find Radiation Medicine at Phelps. She was
peace amidst emotional upheaval. previously medical director of Northern The Northwell Health Cancer
“The navigator is a liaison with patients, Boulevard Radiation Oncology/Queens Institute at Phelps offers
their families, physicians, clinical staff and Medical Radiotherapy and was an associate innovative and supportive cancer
other specialists,” says Dr. Komorowski. attending physician at Long Island Jewish services under one roof, including
“She assists all patients with medical Medical Center. While at Northwell Health, hematology and medical oncology,
oncology, radiation oncology and infusion, she served as the clinical research director infusion, radiation oncology and
from diagnosis to survivorship.” for the Department of Radiation Medicine. general and sub-specialty cancer
Dr. Lim earned her medical degree at the surgery, all on the Phelps campus.
Patients also have access to a wide
Celebrating survivorship University of Massachusetts Medical School
and completed an internship in medicine range of renowned expert surgical
In June, in recognition of National specialists who are members of
at New England Medical Center/Faulkner
Cancer Survivors month, the Cancer the Phelps medical staff, including
Hospital and a residency in radiation
Institute at Phelps held a special thoracic, breast, colorectal and
oncology at the Joint Center for Radiation
luncheon for people in the community thyroid surgeons. “We realize how
Therapy at Harvard Medical School.
who have survived or are undergoing difficult it is for patients when their
Dr. Lim also has a master’s degree in public
treatment for cancer. Celebrating survivors cancer care is provided in multiple
health from Harvard School of Public
does not just occur in June, however. locations. That’s why our cancer
Health. She sees patients at 777 North
Patients are celebrated in many ways specialists are all on-site, working
Broadway, Suite 100, and can be reached
throughout their treatment. A patient who closely with local physicians,
at 855-927-6622.
has completed radiation treatment at a ensuring that our patients have
Northwell Cancer Institute, for example, access to complete and coordinated
doesn’t just walk quietly out the door. care all in one place, close to home,”
Instead, she is handed a mallet, everyone says Blum.
gathers around, and she hits a gong. As
the sound reverberates, it symbolizes that
her treatment journey has ended and her
survivorship journey has begun. Fall 2017 | Phelps Today 5
Phelps:
Training Family Doctors for Five Years
Proudly celebrating its fifth year of educating residents and now and an expanding pool of accomplished
alumni. To date, nearly one-third of the
welcoming a new collaboration with Hofstra Northwell School of
program’s 19 graduates have gained
Medicine, the Phelps Family Medicine Residency Program (formerly employment through Phelps or Open Door
NYMC Phelps Family Medicine Residency Program) is stronger than Family Medical Centers, the organization
ever. With a thriving alumni network, unprecedented application that oversees the outpatient family
medicine clinic in Sleepy Hollow where
rates, and an indelible impact on patients at Phelps, Open Door residents train. The program was initially
Family Medical Centers and the greater community, the program is credentialed for 18 residents through
embracing its next chapter. the Accreditation Council for Graduate
Medical Education (ACGME) but was
In 2010, Dr. Shantie Harkisoon became the has been to educate the next generation approved in 2014 to expand up to 24.
founding program director of a new family of physician leaders while helping to The increased number of residents being
medicine residency program at Phelps address the shortage of family doctors trained is expected to broaden the impact
Hospital. A family medicine physician in New York State and nationally. Now, that residents have at Phelps, where
provides continuing, comprehensive just five years later, the program has they are an integral part of the medical
healthcare to individuals of all ages, blossomed “from an idea into a soon-to- team. “The expansion comes with greater
from infancy through old age, addressing be 24-resident program with a dedicated opportunities for residents to spend time
biological, clinical and behavioral issues. team of 10 faculty members and in rotations, serve on hospital committees
considerable achievements.” and do community outreach,” says London
When the program was in its infancy, Muse, MD, medical director of Sleepy
Dr. Harkisoon recalls that it was, “still an In 2012, the program welcomed its Hollow Open Door and an alumna of the
idea with no name, space or residents.” first class of six residents and today program’s inaugural class.
The mission of the program from the start it boasts three classes of graduates
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6 Fall 2017 | Phelps Today
“We now have access to Northwell Health, including its 62,000
employees. Residents will be able to enjoy this vast resource, not
just through Hofstra Northwell School of Medicine’s many residency nwh_constellation_01 nwh_constellation_02
programs, but for future employment opportunities.”
Joining Hofstra Northwell
School of Medicine
Phelps Family Medicine Residency nwh_constellation_04 nwh_constellation_05
Program started its next chapter in July
2017, when it officially began receiving
academic sponsorship through Hofstra
Northwell School of Medicine. Northwell
Health sponsors 140 accredited graduate
medical education programs and trains
more than 1,650 medical residents and
fellows annually. The collaboration with the
school of medicine will allow the residency nwh_constellation_07 nwh_constellation_08
program to fully realize the wealth of
opportunities available through the
Northwell system.
“We are expanding our network while
continuing to collaborate with New York Residents gather together regularly for groups designed to foster
Medical College,” reflects Dr. Harkisoon. better doctor-patient relationships.
“We now have access to Northwell Health,
including its 62,000 employees. Residents
will be able to enjoy this vast resource, not Dr. Tochi Iroku-Malize, chair of the Residency Program:
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just through Hofstra Northwell School of Department of Family Medicine, remarks,
Medicine’s many residency programs, but “We are delighted to add the Phelps
Mission & Alumni
for future employment opportunities.” The Family Medicine Residency Program to our Over the past five years the residency has
Phelps program will be the fifth to join the department. We pride ourselves on having seen three classes of residents graduate
school of medicine’s community of family various training programs, each unique to and move on to prestigious fellowships
medicine programs. the community it serves, with outstanding and positions, achieving the program’s
results. The addition of the Phelps program early mission. Many alumni have chosen to
Phelps Family Medicine Residency to our department helps to expand the remain in the local community at Phelps
Program has enjoyed the support of pool of quality family physicians to care for and Open Door, the outpatient clinic where
Northwell’s Department of Family Medicine the diverse patient populations we serve.” residents see patients throughout
nwh_constellation_10_outline the
nwh_constellation_11_outline
and the Department of Academic Affairs Similarly, Andrew Yacht, MD, senior vice three years. Half of the residents of the first
as it has transitioned into their network of president of academic affairs and chief graduating class have been hired to teach
graduate medical education programs. academic officer, states, “We are pleased current residents as program faculty, a role
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to welcome the Phelps program to our they relish. When asked about how her time
community of training programs, which in residency impacted her, Dr. Muse points
are dedicated to the academic growth, to the support of the program in helping
clinical skills attainment and well-being of her realize her goal of teaching: “I have
our residents and fellows. We are proud always been interested in a faculty position,
Photo on opposite page:
to add another excellent, patient-focused and my residency faculty were extremely
Residents care for a patient at Phelps
residency program to support the growing supportive of this dream. They helped me
alongside residency program faculty.
From left: Heidi Mandry, MD, ’17, Jessica Zaks, primary care needs of our communities,
MD, ’16, and faculty members Batel Isenstein, region and nation.” Continued on Page 8
MD, ‘15 and Samantha Rai, MD.
Fall 2017 | Phelps Today 7
develop my teaching skills as a resident so
that by the time I graduated I felt ready to
become a full-time faculty physician.”
Dr. Harkisoon subsequently supported
Dr. Muse in completing a yearlong
Emerging Leaders Fellowship, which
provided her with additional skills that
she now uses as the medical director of
Sleepy Hollow Open Door, a position she
has held since January 2017.
As the residency program has grown,
alumni have remained an integral part
of its community. Since many alumni
work locally, they are able to share in
residency celebrations, attend graduations
and spend time with the faculty members
who once mentored them. Alumni have
also shown their support each year through Shantie Harkisoon, MD, founding program director of the Phelps Family
generous contributions to the program’s Medicine Residency Program, teaching residents in Phelps’ emergency room.
annual fundraising campaign, “The From left: Seth Revels, MD, ’17, Lince Varughese, MD, ’17, Shantie Harkisoon, MD,
Gratitude Fund.” and Carmen Tamayo, MD, ’16.
nwh_constellation_01 nwh_co
Open Door and will double capacity in the clinic’s new variety of different quality measures. The
The next iteration of the program space.” Last spring, Sleepy Hollow Open report metrics include cancer screening
expansion will be realized this fall, Door collected patient satisfaction surveys rates, screening rates for women’s
when the Sleepy Hollow Open Door clinic, with strong initial results: 96% of patients health and mental health, treatment of
fully staffed by program residents and surveyed reported they were “likely to asthma, regulation of high blood pressure
faculty, is slated to move into an expanded recommend” the practice. Furthermore, and diabetes as well as measures that
location. In the new location, greater the volume of patients seen at the Sleepy gauge vaccination rates and pediatric
services will be available to patients Hollow clinic continues to grow with obesity management. After analyzing
in the community, including enhanced numeous new patients seeking care daily. this information, residentsnwh_constellation_04
can address nwh_co
women’s health and dental services as challenges as soon as they are detected.
well as increased learning opportunities Open Door Medical Centers is widely Findings from this data have inspired the
for residents. The expansion comes on the recognized for its innovative use of medical team at Open Door to spearhead
heels of five consecutive years of increased electronic health records to address large-scale research projects including
patient volume. “We have developed a community health needs, and residents a study about pediatric obesity and the
great team at our outpatient clinic, and have had the opportunity to learn from implementation of various interventions
through residents’ and faculty’s hard work, the clinic’s extensive data management and prevention efforts.
we have been able to improve care for our expertise. At Sleepy Hollow Open Door,
patients,” says Dr. Muse. “We have doubled residents regularly review reports that track Five Years of Extraordinary
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patient visits at Sleepy Hollow Open Door the health of the patient population on a
Accomplishments
Reflecting back on the start of the
residency, Dr. Harkisoon says, “We are
now a truly team-driven entity. It has been
inspiring for me to watch more people
“We have doubled patient visits at take ownership of graduates and to hear
feedback from our alumni about how well
Sleepy Hollow Open Door and will double they feel they were trained. I credit this to
capacity in the clinic’s new space.” the residents as well asnwh_constellation_10_live
the support they nwh_conste
receive during residency from each and
every person they work with.”
8 Fall 2017 | Phelps Today
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Resident Stories:
Having a Baby at Phelps
Over the years, four residents have
selected Phelps for the birth of
their children during their residency.
Batel Isenstein, MD, a graduate
of the program’s inaugural class; nwh_constellation_01
Julia Krim, DO, a 2016 graduate;
Seth Revels, MD, a 2017 graduate; and
Meghan Auten, MD, who is expected
to graduate in 2018. All had wonderful
experiences. “I had a truly amazing
birthing experience at Phelps,” says
Dr. Isenstein. “The care was unmatched –
holistic and compassionate. I will be
forever grateful to the entire labor/
delivery and postpartum team
for helping me to fulfill my dream Left: Batel Isenstein, MD, a graduate of the residency program’s first class and a current faculty
of becoming a mother.” member in the program, gave birth to her daughter, Maya Rose, at Phelps during her final year
of residency. Dr. Isenstein is pictured here with Maya in the delivery room at Phelps.
Right: Meghan Auten, MD, a current resident at Phelps, with her husband and newborn, Beatrice.
Learning Hyperbaric Medicine at Phelps Julia Krim, DO, Educating Phelps’
Lince Varughese, MD, a recent graduate of the Inpatient Team
residency program, became interested in hyperbaric Julia Krim, DO, accepted a position as
medicine when he rotated with Owen O’Neill, MD, a hospitalist at Phelps shortly after
and the hyperbaric team at Phelps. While spending graduation. Today, she is teaching residents
time in the department, he saw the effectiveness of nwh_constellation_04
as part of the inpatient teaching team. Of
Phelps’ unique 12-person hyperbaric chamber, the her role teaching residents, Dr. Krim says,
largest, most state-of-the-art hyperbaric chamber “I love being a part of the inpatient team
in the Northeast. Reflecting on that experience, at Phelps and really enjoy teaching the
Dr. Varughese says, “I didn’t know about the benefits residents. It’s personally very satisfying to
of hyperbaric medicine until I came to Phelps. Thanks help the residents develop and to see what
to Dr. O’Neill’s passion and excellent clinicians they all
footprint at Phelps, my become. I also think it raises
interest in hyperbaric medicine the standard of care at Phelps,
Dr. Varughese, a recent graduate of was ignited and propelled because teaching makes for
Phelps Family Medicine Residency me to pursue a fellowship smarter teachers as well.” Dr.
Program, started at Louisiana State position. This fellowship is an Krim was recognized with the
University’s Undersea & Hyperbaric extension of what I did on a Society for Teachers of Family
Medicine Fellowship in August 2017. daily basis during residency: Medicine’s resident teacher
provide comprehensive care award when she graduated
to my patients.” Dr. Varughese from residency in 2016.
matched with Louisiana As members of the inpatient
State University’s Undersea team, residents are able to
& Hyperbaric Medicine ensure seamless continuity
Fellowship, where he started of care between Phelps
in August of 2017. and the patient’s primary
care provider. If an Open Door patient is
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hospitalized, that patient sees the same
resident physicians at Phelps that he sees in
the outpatient setting at Open Door.
Fall 2017 | Phelps Today 9
How to Know When
It’s Time to Stop Driving
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Telling an elderly person that it may benwh_constellation_05
nwh_constellation_04 time to stop driving How Does Aging Affect Driving?
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is extremely difficult for family members or friends. Especially in There has been a huge boom in the elderly
our car-centric society, losing the ability to drive is often seen as population in the U.S. In 1900, people over
age 65 made up just 3% of the population.
a loss of independence and can cause emotional distress or anger. By 2000, that percentage had grown to
This is a very sensitive issue. Family members are hesitant to be 13%. By 2050, it is projected that 21% of
the ones to take away the keys, but if the physician delivers the Americans will be over 65. The biggest
increase is in people over 85.
news, it may negatively affect the physician/patient relationship.
Some elderly drivers who realize their driving skills are diminished For the most part, elderly drivers are
may even avoid going to the physician for fear of being reported safe drivers, but driving ability can vary
from person to person. Unfortunately,
to the authorities. older drivers have a disproportionately
high rate of car accidents. It’s the most
common cause of accidental death
for people 65-74 and the second most
common for those 75-84. Only individuals
under 25 have a higher death rate due to
automobile accidents.
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10 Fall 2017 | Phelps TodayThe drivers at greatest risk of accidents
are those with dementia, because they
can lack judgment and may be unable
“When I evaluate an elderly patient who is
to recognize their limitations. Dementia
caused by Alzheimer’s disease and other
having difficulty driving, I ask a close family
conditions is becoming an increasingly
prevalent problem as the population ages.
member to join us so I can work with the
It affects 5% of people over 65, 20% of those
over 80 and nearly 50% of people over 85.
patient and family as a team.”
In addition to dementia, other factors that
make older drivers at greater risk are: “If I find that the patient exhibits signs The Road Test
• Slower response time of dementia or a disability that would
• Decreased vision and depth perception The second part of the evaluation is a
impact the ability to drive safely, I speak
• Diminished hearing road test. Individuals who pass the clinical
to the patient and family, recommending
• Drowsiness due to medications assessment are referred to a driving
that the person stop driving. If I determine
on_03 • Less muscle strength and flexibility that the person may be able to continue
school for an on-road assessment, which
• Reduction in ability to concentrate must be completed within two weeks.
driving, I refer him or her to a driver
• Lower tolerance for alcohol The driving school may provide special
evaluation program,” says Dr. Devons.
adaptive equipment, if necessary. The
results of the clinical assessment and the
Warning Signs of Problem Drivers Dr. Devons points out that although
road test are then sent to the referring
The following are some signs to look out physicians have a legal and ethical
physician, who can make an objective
for that may indicate an elderly person is obligation to keep information about their
decision regarding whether or not the
having difficulty driving: patients confidential, that obligation does
person should continue driving and advise
• Driving at an inappropriate speed (too not apply when the health of the public
the individual and his/her family.
slowly or too quickly) is concerned. According to the American
• Failing to yield to cars or pedestrians Medical Association’s Council on Ethical
The two-part driver’s evaluation will
who have the right-of-way and Judicial Affairs, if a person has a driving
result in one of two possibilities:
• Drifting between lanes impairment that is a threat to him/herself
1. It will help enable the person to continue
• Getting lost and the public, and the person has been
driving safely, possibly with some
• Driving at night without headlights on advised to stop driving but disregards the
modifications, such as with adaptive
• Difficulty turning the head advice, his/her physician has an ethical duty
equipment or being limited to local or
• Ignoring or not obeying traffic signs to notify the Department of Motor Vehicles.
daytime driving.
2. It will confirm that the person should
The Physician Evaluation Getting a Driver’s Evaluation stop driving.
on_06
“When I evaluate an elderly patient If you know of someone who is having
driving difficulties, you may want to The occupational therapy portion of the
who is having difficulty driving, I ask a
suggest that they have a driver’s evaluation, driving evaluation is normally covered
close family member to join us so I can
which consists of two parts. A prescription by insurance. The road test is not usually
work with the patient and family as a
is required to get started. covered and generally costs $100-$140.
team,” says Phelps geriatrician Cathryn
Devons, MD. Before the evaluation,
I suggest that the family member ride The Clinical Assessment
in the patient’s car as a passenger, especially To schedule a driving evaluation
The first part, performed by an
if it has been a long time since they have clinical assessment with the
occupational therapist, consists of a
done so. If a son or daughter or other clinical assessment that measures the Occupational Therapy Department
family member is afraid to drive with their skills needed for driving. This assessment at Phelps, call 914-366-3717.
elder, the individual should not be driving.” includes testing for vision, hearing,
cognition, trunk and limb mobility, strength,
During the evaluation, Dr. Devons performs coordination and reaction time. The
a complete medical history, including person’s ability to read and interpret road
cognitive tests, an inventory of medications signs and symbols is also tested. People
being taken and alcohol consumption. who do not pass the clinical assessment
A physical exam for gait, neurological are referred back to their referring
on_09 problems and strength is conducted. physician, who will discuss the results
with the individual and his/her family.
Fall 2017 | Phelps Today 11Not Just an Elephant Sitting on Your Chest
Know the Unusual
Symptoms of Heart Disease
By Yan Li, MD, FACC
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12 Fall 2017 | Phelps Today
nwh_constellation_07 nwh_constellation_08 nwh_constellation_09Consider the following real-life scenarios:
A 55-year-old man with high blood pressure had recurrent episodes of “gall bladder”
attacks. He finally went to see his gastroenterologist, who immediately sent him to the
emergency room.
An 88-year-old woman who had been healthy all her life experienced unrelenting
“heartburn” and nausea for two days before she called her daughter, who took her
to the emergency room.
A 79-year-old woman had intense shoulder pain after a dental procedure
on_03
and thought it was arthritis.
A 55-year-old executive with insulin-dependent diabetes felt a little short of breath
and “did not think much of it.” He mentioned it to his primary care doctor, who
performed an electrocardiogram (EKG).
What these individuals all had in common pain or discomfort can be felt in the Another woman felt only extreme
without knowing it was acute coronary upper abdomen, shoulders, arms, fatigue and couldn’t get out of bed for
syndrome (ACS), a range of conditions hands, neck, throat, lower jaw and teeth. two days. While these symptoms are not
associated with sudden, reduced blood Angina can be mistaken for heartburn/ specific, too often they are dismissed as
flow to the heart. They eventually got acid reflux, inflammation of the gall something else.
medical attention, and luckily all of them bladder, arthritis, temporomandibular joint
survived – although for some the heart disorder (TMJ), and more. One patient, an Silent Heart Attack and
had already suffered irreversible damage. 80-year-old woman who was experiencing
only a burning sensation in her throat, was Silent Ischemia
Heart disease can manifest in many found to have multiple blocked coronary Heart attack and ischemia, lack of oxygen
different ways. Most people are familiar arteries that required coronary artery to the heart muscle, can be especially
with the description of an “elephant bypass surgery. Studies have shown that difficult to detect in people with diabetes.
sitting on the chest” as a sign of angina almost 50% of patients with obstructive So-called “silent ischemia” and “silent
and possible heart attack. Unfortunately, coronary artery disease do not have chest heart attack” can happen without the
on_06 that is only one of many symptoms that pain. Moreover, in younger heart attack person having any symptoms. This is due
can come with heart disease. Knowing patients under the age of 50, about 40% of to nerve damage known as neuropathy
some of the unusual symptoms, and, women and 30% of men did not have any that is prevalent in diabetic patients. In
more importantly, “trusting your gut” and chest pain. these patients, heart attack or ischemia
seeking help right away when something are often detected by routine EKG or
does not feel right, can help to save your While many people have heard that non-invasive cardiac testing such as an
life and the lives of others. women tend to have atypical symptoms echocardiogram or stress test. And silent
of heart disease, they are not aware that ischemia occurs twice as often when a
men can have symptoms just as vague patient has cardiovascular autonomic
Angina and misleading. Furthermore, symptoms neuropathy (CAN), which includes
Angina, or chest pain due to blocked may not be localized or limited to one symptoms such as; an elevated resting
arteries, can be notoriously vague and part of the body. For example, one man heart rate; a low tolerance for exercise;
difficult to pinpoint. This is because who suffered a heart attack, which is
caused by a sudden lack of blood flow to Continued on Page 14
the heart has “referred” pain due to an
overlapping of nerves. With angina, the heart muscle, thought he “had the flu.”
Fall 2017 | Phelps Today 13
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It is impossible to know all of the unusual
ways heart disease can present. However,
the most important thing to know is to seek
help, whether at the emergency
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room or the
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doctor’s office, when symptoms are new,
unusual, persistent or severe.
orthostatic hypotension (an exaggerated A decreased ability to exercise can be a
drop in blood pressure when one changes result of coronary artery disease, heart
position from lying down to sitting or failure (which may result from coronary
standing); and cardiovascular instability artery disease, valvular heart disease,
during non-cardiac surgeries. etc.) or arrhythmia. Many people consider
being unable to exercise as much as they
Heart Failure and Arrhythmia used to “a normal part of aging” and do not
pay attention to it or mention it to their
Other heart diseases such as heart failure, doctor. However, if the change in exercise
when the weakened heart muscle cannot capacity is sudden and unexpected, the
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pump blood as well as it should, and probability of structural heart disease is
arrhythmia, an irregular heartbeat, can especially high.
also present with symptoms that can be About the Author
mistaken for something else. Last but not least, arrhythmia can Cardiologist Yan Li, MD, FACC, a
sometimes be mistaken as “anxiety” Phelps Medical Associates physician,
“Cardiac wheeze” or “cardiac asthma” is is board certified in internal medicine,
or a “panic attack.” A young woman
one example. Patients who experience cardiovascular disease and nuclear
who was told and believed she had panic
wheezing during physical exertion and/or cardiology. She is also a Registered
attacks “all her life” was eventually Physician in Vascular Interpretation
in the middle of the night – they often have found to have supraventricular tachycardia (RPVI). Dr. Li has extensive training in
to sleep on many pillows or sit up – may (SVT), an abnormally rapid heart rate clinical cardiology as well as cardiac
think they are having asthma attacks, when caused by incorrect electrical impulses in imaging, including transesophageal
in fact they are experiencing symptoms of the upper part of the heart. She underwent echocardiography, stress echo and
congestive heart failure. Another example successful cardiac ablation, a procedure peripheral vascular imaging. Her clinical
of an unusual symptom is unexplained that eliminates the abnormal electric interests include valvular heart disease,
weight gain, especially when it happens impulse that is causing the problem, and heart failure, coronary artery disease,
suddenly. The weight gain is often a result she is no longer afraid to walk out the door cardiovascular disease prevention and
of fluid accumulation in the body due to risk stratification, and women’s heart
every day.
heart failure. It may be present in the legs health. She sees patients in Dobbs Ferry
or abdomen, and can precede symptoms and Briarcliff Manor (914-269-1900).
It is impossible to know all of the unusual
of shortness of breath. ways heart disease can present. However,
the most important thing to know is to
seek help, whether at the emergency room
or the doctor’s office, when symptoms are
new, unusual, persistent or severe.
14 Fall 2017 | Phelps TodayDon’t let hip pain stand in your way.
Is it becoming harder to get up Our talented and caring orthopaedic surgeons use
the latest, minimally invasive techniques – including
from the couch? Are even short the anterior approach to hip replacement – so you
drives in the car uncomfortable? can spend less time recovering and more time doing
what you love.
When hip pain makes the simplest
of tasks more difficult, it’s time to Take the first step toward reclaiming
see a specialist. your active lifestyle. Call our orthopaedic
team at (888) 888-2311 or visit us at
Phelpshospital.org/ortho.
Phelps Hospital
701 North Broadway
Route 9 at Route 117
Sleepy Hollow, NY 10591
OrthopaedicsPeople and Services
Exemplifying Excellence
Hyperbaric Medicine Department Accredited Phelps Hospice Earns Its
with Distinction! 4th Star in We Honor
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Veterans Program
Phelps Hospice
is a participating
partner in the
We Honor
Veterans Program
established by the
National Hospice
and Palliative Care Organization and the
Veterans Administration. As a partner,
Hospice works collaboratively to
continuously improve its ability
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the unique needs of veterans receiving
hospice care in our community.
Now, thanks to the efforts of Hospice
social worker Melissa Eisele-Kaplan, LCSW,
who has spearheaded the advancement of
this program, Phelps Hospice has achieved
Level 4 status, the highest possible level.
The Hyperbaric Medicine Department at Phelps has achieved
Level Two Accreditation with Distinction from the Undersea & To reach Level 4, Hospice was required to
Hyperbaric Medical Society (UHMS). The department received its implement the following:
first four-year accreditation in 2013. Achieving “with distinction”
this year means the team exceeded the precise requirements of Veteran recognition and nwh_constellation_08
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UHMS evaluation. “We strive to maintain a center of excellence pinning ceremonies
for clinical hyperbaric oxygen therapy at Phelps, where our quality During this ceremony, often performed
measure has always been patient safety,” says Gary Willard, MD, in the patient’s home, veterans are visited
Hyperbaric Medicine Medical Director. by a Hospice volunteer who presents them
with a branch-specific military certificate
Hyperbaric Oxygen therapy (HBO therapy) is a medical treatment where patients and a VA/Hospice Partnership pin. The
breathe 100% pure oxygen while sitting inside a pressurized chamber. Used alone ceremony also presents veterans with an
and in combination with standard treatments, HBO therapy contributes to better opportunity to share their stories.
outcomes for patients because it increases the amount of oxygen in the blood.
This helps new blood vessels grow, allowing more oxygen to be delivered to tissues Veteran-to-Veteran Volunteer Program
and organs of the body, which promotes the healing process. HBO therapy is sometimes In recognition of the unique needs of
used for complicated wounds that don’t heal, often associated with diabetes. HBO veterans at the end-of-life, a Veteran-
therapy is also a well-established treatment for carbon monoxide poisoning and to-Veteran volunteer program has been
decompression sickness, a hazard of scuba diving. implemented at Phelpsnwh_constellation_11_live
nwh_constellation_10_live through which
veteran patients are paired with Hospice
The UHMS survey team evaluated the department on many criteria, including: volunteers who are also veterans.
delivery of care, facility safety, training and continued competence of team members,
maintenance and operation of equipment, and thoroughness of patient education. Outreach to veterans groups
The accreditation has over 600 requirements, specifications and guidelines specific to Hospice staff regularly engages with
hyperbaric and dive medicine. veterans groups and the VA to ensure that
veterans are aware of and have access to
all of the hospice and other end-of-life
16 Fall 2017 | Phelps Today benefits available to them.
nwh_constellation_10_outline nwh_constellation_11_outlineKenneth Taber
Named New Chair
of Phelps Board
of Directors
Phelps Achieves Highest Level Award for Excellence in Stroke Kenneth Taber
was recently
Care from American Heart/Stroke Associations elected Chair
Year after year, Phelps is “We earned the ‘Elite Plus’ designation of the Board
awarded by the American for administering the clot-busting of Directors of
Heart/American Stroke drug tPA in less than 45 minutes to 50% Phelps Hospital.
Associations for providing or more of our stroke patients for whom Mr. Taber, who
excellent stroke care this therapy is appropriate. Achieving this joined the
according to nationally designation is a result of the skillful and Phelps Board in
recognized, research- efficient team effort of our emergency, 2015, has served
based guidelines. This neurology and radiology departments, from on various
year, Phelps has received the Get With The the time a patient enters our doors,” says committees, including Phelps’ Quality
Guidelines®– Stroke Gold Plus Achievement Paul Lleva, Medical Director of the Phelps Assurance Committee and the Legal
Award with Target: StrokeSM Honor Roll Stroke Center. “These awards recognize Affairs Committee of Northwell Health,
Elite Plus, the highest level award. Phelps the quality of care we provide to our the hospital’s health system.
earned this award by meeting specific stroke patients, from the emergency room
quality achievement measures and throughout their entire hospitalization.” Mr. Taber is a partner in the New York
complying with AHA/ASA guidelines for the City office of the national law firm
diagnosis and treatment of stroke patients. Pillsbury Winthrop Shaw Pittman LLP,
known as Pillsbury. For more than a
decade, he led the firm’s 200-attorney
Litigation section. His clients have
Richard J. Sinni Honored for Extraordinary Leadership by included former Mayor Michael
United Hospital Fund Bloomberg and the City of New York,
which he represented in what The New
Richard J. Sinni, until recently Chair of the Phelps Board of York Times called “landmark” litigation
Directors, was one of 31 trustees from New York area hospitals brought by the City to stem the flow
and healthcare organizations presented with a Distinguished of illegal guns. Mr. Taber is currently a
Trustee Award by the United Hospital Fund at a luncheon held in member of the Board of Directors for the
May. The honorees, who were nominated by their institutions, Harlem School of the Arts, and serves on
were recognized for their extraordinary leadership and service that Board’s Executive Committee. He is
to hospitals, nursing homes or home care organizations also a member of the Board of the San
throughout the five boroughs of New York City and Long Island, Francisco-based Law Center to Prevent
Westchester and New Jersey. Mr. Sinni continues to serve on the Gun Violence.
Phelps Board as a Vice Chair.
“My top priorities as board chair include
those points where Phelps regularly
interacts with our community – places
Shantie Harkisoon, MD, Receives National like our Emergency Department and
our obstetrics/gynecology practice,
Honor for Residency Program Directors where lifelong relationships with the
Shantie Harkisoon, MD, Program Director of the Phelps families in our community often begin,”
Family Medicine Residency Program (previously NYMC Phelps says Mr. Taber. He also emphasizes the
Family Medicine Residency Program), has been honored with importance of Phelps’ strong integration
a Program Director Recognition Award by the Association of with Northwell Health – already over
Family Medicine Residency Directors (AFMRD). The award was two years old – as a “top priority.”
presented at the association’s annual meeting held in Kansas
City, Missouri last March. The rigorous criteria for the award
included over 30 requirements in categories such as tenure, training, scholarly activity,
peer development, professional development, advocacy and service to family medicine
organizations. Dr. Harkisoon has led the residency program since its founding in 2010.
Fall 2017 | Phelps Today 17Phelps Medical Associates News
Phelps Medical Associates, Phelps Hospital’s primary and specialty care medical group, continues to enhance
care by adding top-notch specialists to its staff in locations on the hospital campus and in the surrounding
communities. In addition to offering primary care, the group has specialists in cardiology, endocrinology,
gastroenterology, geriatrics, hematology/oncology, midwifery, nephrology, neurology, obstetrics/gynecology,
orthopedic surgery, pain management, palliative care, podiatry, pulmonology & sleep medicine, radiation
oncology, rheumatology, thoracic surgery, urology, vascular surgery and wound healing.
The following physicians have recently joined Phelps Medical Associates:
Robbins Gottlock, Yan Li, MD, FACC, Steven A.
MD, a family a cardiologist, Thau, MD, is a
medicine physician, has been an pulmonologist,
is Vice President active member intensivist
and Associate of the Phelps (critical care
Medical Director medical staff physician) and
at Phelps Hospital. since 2006 and sleep specialist.
In this position, he has worked He is board
has supervisory closely with her certified in
responsibility for Phelps colleagues, pulmonary
Phelps Medical Associates and other employed caring for cardiac patients in the medicine, critical care and sleep
physicians as well as the hospital’s family surrounding Westchester communities. medicine as well as hospice and
medicine residency program, clinical trials and Board certified in internal medicine, palliative care. Most recently, he was
research, education, and clinical information cardiovascular disease and nuclear medical director of the intermediate
technology. cardiology, Dr. Li is also a Registered care unit and associate medical director
Physician in Vascular Interpretation of sleep medicine at Stamford Hospital.
Dr. Gottlock began his medical career in 2002 (RPVI).She has extensive training in His clinical interests include COPD,
at Beth Israel Hospital (now Mount Sinai Beth clinical cardiology as well as cardiac emphysema, asthma, critical care,
Israel). While at Beth Israel, he earned an MBA imaging, including transesophageal pulmonary hypertension, pulmonary
from the NYU Stern School of Business. In echocardiography, stress echo and fibrosis, sleep apnea and restless leg
2010, Dr. Gottlock left the medical field for peripheral vascular imaging. Her clinical syndrome.
two years to serve as a business consultant for interests include valvular heart disease,
the global Boston Consulting Group, handling heart failure, coronary artery disease, Dr. Thau received his medical degree
clients that included pharmaceutical and cardiovascular disease prevention and risk from the Albert Einstein School of
biotech companies and health systems. He stratification, and women’s heart health. Medicine of Yeshiva University. He
returned to Beth Israel in 2012, working as an Prior to joining Phelps Medical Associates, completed his residency in internal
internal consultant for senior administrators she was an attending cardiologist and medicine at the Hospitals of the
and seeing patients. When Beth Israel merged director of the echocardiology laboratory University of Pennsylvania and his
with Mount Sinai in 2014, he was asked to at Montefiore Tarrytown Cardiology. fellowship in pulmonary, critical care
lead the hospital’s 100-physician outpatient and sleep medicine at Yale University
multispecialty medical group. Dr. Li received her undergraduate degree School of Medicine. He sees patients on
from Harvard University and studied the Phelps campus in the 777 Building,
Dr. Gottlock earned his medical degree at medicine and healthcare management Suite 308.
University of Utah School of Medicine and at Tufts University School of Medicine.
completed his family medicine residency After graduating with a joint degree of
at Swedish Family Medicine at the University MD and MBA, she completed an internal
of Washington in Seattle. He has a special medicine residency at Lenox Hill Hospital
interest in providing healthcare for and a fellowship in cardiovascular disease
adolescents, adults and the LGBTQ community. at Mount Sinai Medical Center. She sees
Dr. Gottlock sees patients at 362 North patients in Dobbs Ferry at 11 Ashford
Broadway in Sleepy Hollow. Avenue and in Briarcliff Manor at 465
North State Road, and is available for in-
18 Fall 2017 | Phelps Today hospital consultations.Phelps Welcomes
New Medical Director
for Physical Medicine
and Rehabilitation
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Family medicine Jock Avolio, MD, recently joined
physician Scott Northwell Health’s physician
Kerstetter, DO, group, Physician Partners, and is the
received his new medical director of Physical
medical degree from Medicine and Rehabilitation at
the Philadelphia Phelps. He is a board-certified
College of Osteopathic rehabilitation specialist with more
Medicine and than 20 years of clinical experience.
completed his family His area of interest is the management
medicine residency of inpatient rehabilitation patients
who require a combination of physical, occupational and speech
at York Hospital in York, Pennsylvania.
therapies for a wide range of diagnoses. This includes patients
Dr. Kerstetter has many years of experience
recovering from: acute stroke or other neurologic conditions;
in occupational medicine, which focuses on
cardiac conditions, especially post-CABG (coronary artery bypass
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the prevention, evaluation, treatment and
grafting), valve repair or replacement; orthopedic conditions
resolution of health conditions caused by
such as fractures and joint replacements; and other conditions
the workplace environment. He is also a
that make it difficult to return safely to the home.
certified Medical Review Officer (MRO),
a licensed physician responsible for receiving
In addition to his love of inpatient rehabilitation, Dr. Avolio
and reviewing laboratory results generated
has spent years treating outpatients in a practice geared toward
by an employer’s drug testing program.
the conservative management of neck and low back pain,
Dr. Kerstetter’s interests are in the areas of
Parkinson’s disease and general weakness, and patients with
preventive medicine and the management a history of falls, especially the elderly. Many of these patients
of diabetes. He sees patients at 362 North have been successfully managed with physical/occupational
Broadway in Sleepy Hollow and at 20 Beacon therapy programs he has prescribed.
Hill Drive in Dobbs Ferry.
Dr. Avolio received an MD, PhD from the Albert Einstein
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College of Medicine. He completed a rehab residency in 1995 at
Columbia Presbyterian and was a chief resident in 1994-1995.
His PhD was earned in the department of anatomy and cell
biology at Albert Einstein, where for several years he taught
gross anatomy to medical students.
To make an appointment with
nwh_constellation_01 nwh_constellation_02 nwh_constellation_03 Dr. Avolio, who lives in New Jersey with his wife and son,
a Phelps Medical Associates is a passionate cook and bread baker, having studied at the
physician, call 914-269-1900 or visit Culinary Institute of America, the French Culinary Institute
phelpsmedicalassociates.org. and abroad.
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Fall 2017 | Phelps Today 19
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