Details

Written by Stacie M. Waldman

Published: 20 August 2019

Created: 20 August 2019

Last Updated: 20 August 2019

Hits: 6963

Anyone who has lived through an episode of shingles has a story and the stories are all similar. Victims of the nasty virus bemoan the extended length of the illness (a few weeks to a couple of months), the extreme and unrelenting pain experienced and the shock of the diagnosis. Should you get the vaccine and spare yourself the pain?

“The worst pain of my life was from shingles. The second worst was after having three C-sections.” This is how one young mom described her experience with shingles. Her case never progressed to blisters because she quickly began taking an anti-viral medication thanks to a rapid diagnosis, but she still experienced the excruciating burning pain that people often associate with shingles. She was in her mid-30s.

Andy, a corporate lawyer who lives in the Heathcote area, was initially diagnosed with an eye and sinus infection and given a course of antibiotics. A couple of nights later, the pain in his face got so bad that his wife had to call a doctor at midnight and beg for pain medication. He mentioned to the on-call doctor that he had a strange blister on his nose as well; that doctor immediately and correctly diagnosed Andy with shingles. The pain, swelling and blistering got worse as he began anti-virals, then slowly got better over a month. An infection persisted in his eye, however, and he could barely see at one point. He was scared he would lose his eyesight. It was almost impossible to work. As the eye infection began to clear with the help of a corneal specialist, the itching phase started. “Mentally, this proved to be the most devastating part of the whole experience,” Andy said. “The itching was out of control, I could not stop it, it affected every aspect of my existence. I walked around at home and at work with ice packs on my head to try to numb things…when the itching flared up, I did what I could to exist but really I couldn't do anything else,” he added. Although Andy has mostly recovered, he does still have episodes of intense itching in his scalp and around his eye. Andy was in his late 40s at the time.

Joyce had her daughter in July of 2015, moved to Scarsdale in August, went back to work in October and hosted eight additional people for Thanksgiving. “I think it was stress that activated the shingles,” she said. “I had to fly to a conference the Monday after Thanksgiving… and I went with a rash on my forehead thinking it was contact dermatitis. When I got back from my conference,” she continued, “I remember being in a lot of pain…I went to [an urgent care] and the … doctor there took one look at me and said it was shingles.” She was put on anti-virals and saw an eye doctor to make sure she had no eye complications. “It cleared up after 4-5 weeks, but I have some scarring on my forehead from the blisters.” Joyce was 35 at the time.

Sarah’s shingles began with a tingling sensation under her rib cage, deep under the skin. She felt like she had been punched but couldn’t see any signs of injury. The pain got worse and she developed small bumps that resembled bug bites at first, but quickly grew into a very painful rash. She saw diagnosed around day 4 and was given anti-virals but doesn’t think it helped much. It took 6-8 weeks for the pain to go away. “At times, I could barely move off the couch and it was very difficult to sleep,” she said. “I could barely wear a bra. I had a bad scar on my mid-section that took a very long time to heal.” She approached her doctor about getting the vaccine after her shingles subsided but was told there was a vaccine shortage and couldn’t get it, even if paying cash and even though she is a Type II diabetic (and higher risk) until she is 50. “…every little twitch I feel in my body makes me paranoid that I have shingles again. I went to the doctor last week insisting I be seen urgently because I thought I had shingles again, but it turned out to be just a series of bug bites,” she said. “I felt a little silly but I just couldn’t imagine going through the disease process again.” Sarah was 37 when she had shingles.

Many others shared stories like this and all emphasized the importance of being diagnosed properly and in a timely manner. According to CDC (Centers for Disease Control and Prevention), the incidence of shingles is increasing. Research is ongoing to determine why this upward trend is continuing.

How is shingles diagnosed and what is it like?
Shingles can present in a multitude of ways. It often presents as a painful “burning” rash on one side of the face or body, most commonly the mid-section. Some people never develop a rash and some people develop a rash but have little pain associated with it, others develop blisters that are extremely painful; some blisters are not painful at all. The blisters scab over in a week to 10 days. “The …thing I didn't know, but I do now, is that having pain on just one side of the face [or body] is…a telltale sign of shingles,” said Andy. Other common symptoms are fever, headache, chills and upset stomach. Most people recover fully within 2-4 weeks. Diagnosis can be tricky as shingles can mimic other infections and it does not present the same way in every patient. “The other thing I learned from my experience,” added Andy, “is that every day that passes can significantly increase the severity of the infection.” Joyce, like many people, incorrectly thought that shingles mainly affects older people. Several people who responded to me said that their shingles was so bad and lasted so long that they felt depressed during the illness.

Can shingles be treated?
An anti-viral drug can be used after diagnosis to reduce the length and the severity of the illness. Correct diagnosis of shingles early on is important for the treatment to work. For Andy, the delay in his diagnosis (about two weeks) likely increased the severity of his case of shingles. For the young mom of 3, early diagnosis and treatment likely prevented her from having a more severe case of shingles. Treatment for the itching includes typical anti-itch creams and medications. Oatmeal baths can help soothe the skin as well.

Are there any long-term effects from shingles?
Long term effects from shingles can occur. Post-Herpetic Neuralgia (PHN) is severe pain at the sites of the shingles rashes that last for months or even years. It occurs in 10-18% of people and the pain from it can be completely debilitating.

Other potential long-term problems include vision loss if shingles occurs near the eye, nerve damage causing facial paralysis or hearing and balance problems, and skin infections as a result of the blisters and itching. Although Andy’s eyesight has completely returned, he has small scars inside his eye that occasionally make his vision a bit cloudy. “I continue to get some itching in my scalp and more frequently around my eye, but these are just momentary events that don't impact my life in any way,” he said. Andy also has some dead spots (no feeling) on his nose from the more severe blisters.

Is shingles contagious?
Shingles is caused by the reactivation of the virus that causes chickenpox. It can affect anyone who has had chickenpox or has not been vaccinated against it. After a person has had the chickenpox, the virus lies inactive in nerve tissues near your spinal cord and brain. If the immune system is weakened, the virus may start to multiply along the affected nerve pathway eventually reaching the skin. Therefore, although shingles itself is not contagious, a person with shingles can infect someone with the chickenpox virus (during the blister phase) if they have not been previously exposed or vaccinated. It is recommended that people with shingles remain isolated from babies, the elderly and people who are immunocompromised. Andy said that people would often ask him if his shingles was contagious. “I would have to explain to them that you can't catch shingles from another person, it's always a reactivation of virus already in your body. Many people don’t understand how a person gets shingles.”

Can shingles be prevented?
A shingles vaccine (called Shingrix) is available and recommended by CDC (Centers for Disease Control and Prevention) for healthy adults ages 50 and up. The vaccine is administered in two doses, 2-6 months apart. It is more than 90% effective at preventing shingles and provides protection longer than the previous approved vaccine called Zostavax. Your doctor’s office should carry the vaccine and most pharmacies will provide it as well. A person can get shingles more than once. It is important to note that people under 50 can and do get shingles, but the risk of serious side effects from shingles is less.

Does the vaccine have side effects?
Most side effects are limited to redness and soreness at the injection site like any other vaccine. Some people felt tired, had muscle pain, a headache, shivering, fever, stomach pain, or nausea. In fact, Andy had fever, chills and nausea from the vaccine, but it cleared up overnight. About 1 out of 6 people who got Shingrix experienced side effects that prevented them from doing regular activities. Lisa from Heathcote had a small reaction to the booster from Shingrix (low fever and sore arm) but she argues that it’s completely worth getting the vaccine. “My husband had no side effects,” she said. “My mom got the original vaccine but unfortunately got shingles while she was undergoing radiation treatment for cancer right before she had planned to get the updated vaccine. She ended up in the hospital on IV drips of morphine and anti-virals…she was in a lot of pain.”

The response I got on the Scarsdale Moms Facebook from a post asking for people to share their experiences with shingles and/or the vaccine was overwhelming and thank you to all who replied. I couldn’t share all of your stories, but please feel free to share in the comments. Shingles can be severe and it is does not only affect the elderly. In fact, of the 15 responses I received from people who got shingles, only one person was over the age of 50. The vaccine cannot cause shingles. Shingles itself is not contagious but can cause chicken pox in an unvaccinated person or in someone who never had chicken pox. Everyone who responded with a shingles experience stressed how important it is to recognize (or have a doctor recognize) the signs and symptoms early so treatment can begin before the pain or disease severity increases. Talk to your doctor to learn more about vaccination.

Details

Written by Stacie M. Waldman

Published: 05 September 2019

Created: 05 September 2019

Last Updated: 05 September 2019

Hits: 7090

Goodbye ice cream. Goodbye bread that stays fresh for weeks. Goodbye easy mid-week frozen pizzas and “healthy” frozen rice and veggie bowls. Goodbye easy on-the-go kids Clif bars? Goodbye everything that comes in a box or a bag whether it’s organic or not? Goodbye protein bars that are finally palatable?

In 2018, a report in the British Medical Journal (BMJ) suggested a link between ultra-processed foods and an increased risk for cancer. More recently, a study from JAMA Internal Medicine (published April 1, 2019) revealed that French adults 45 years or older who consumed 10% more ultra-processed food had a 14% higher risk of all-cause mortality. Another study in younger adults showed an even greater risk of death from ultra-processed foods. (According to published research studies, other ways to die an earlier death include sitting too much, eating fried chicken or seafood daily and smoking.)

“Ultra-processed” is not just a media buzz word or a new food avoidance trend. It is a term (and now commonly accepted food classification system) coined by Carlos Monteiro, a Professor of Nutrition and Public Health in Brazil. In 2009, Monteiro and colleagues suggested a link between the global surge in obesity and chronic disease to increasingly popular food production practices. Rather than just studying the effect food has on health by fat, carbohydrates, sugar, salt, protein, organic/non-organic for example, Monteiro created a classification system called NOVA that groups foods by their degree of processing: unprocessed (or minimally processed), processed and ultra-processed.

The NOVA system classifies foods this way:

Unprocessed foods have not been refined and do not have any added ingredients. Examples include fresh produce, dairy, whole grains, meat and fish. Think “farmer’s market”.

Processed foods have been altered in some way from their original state. Minimally processed foods include canned vegetables, canned broth, salted nuts, canned fish, plain yogurt, bran cereals, whole grain breads, tofu, cheese and smoked meats. These foods contain minimal additives and therefore have short ingredient lists. Pasta sauce and flavored yogurts are slightly more processed with added flavors and texturizers.

Ultra-processed foods, according to BMJ, are defined as “…formulations of food substances often modified by chemical processes and then assembled into ready-to-consume hyper-palatable food and drink products using flavors, colors, emulsifiers and . . . other cosmetic additives.” The formulation and the ingredients of ultra-processed foods make them highly convenient (packaged, ready-to-eat), highly palatable and highly profitable (due to low-cost ingredients). Because they are tasty, cheap and easy to eat, these products are consumed by people in ever-increasing proportions over natural/whole foods and freshly prepared meals. Examples include frozen meals, soft drinks, chips, candy, store-bought ice cream and ice pops, instant noodles, infant formula, energy bars and reconstituted meat products.

Ultra-processed foods are often high in sodium, sugar and fat. They usually have a low fiber content. They tend to be associated with a high glycemic response and become substitutes for unprocessed or minimally processed foods. Ultra-processed foods may contain additives like sulfites, be changed during the production process (e.g. high heat), or be packaged in materials that may be associated with adverse health effects like bisphenol A.

We all eat ultra-processed food. Fruits and vegetables have a short shelf life, but packaged mandarin oranges, for example, have a long shelf life. It takes time to make homemade granola but it’s easy and inexpensive to buy it in a box. Something labeled organic or natural that is in a box, bag or frozen is often ultra-processed. The “Healthy Choice” brand may not be so healthy after all. So how do we navigate this without getting overwhelmed?

Elizabeth DeRobertis, MS, RD, CDN, CDE, is Director of the Nutrition Center at Scarsdale Medical Group and has some suggestions for how to realistically decrease the amount of ultra-processed food in our lives. “I think it is unrealistic to avoid this completely,” she admits. “I think in moderation it is okay despite the headlines that are designed to scare us.” Elizabeth warns that we don’t want to instill the fear of eating anything unhealthy in our kids (called orthorexia), but that there are ways to buy, prepare and consume more conscientiously.

For breakfast, she suggests an omelet with fresh veggies. “For someone with less time, you can make ‘egg muffins’ (eggs and veggies baked in a muffin tray) in advance and just heat them up in the mornings. Hard-boiled eggs are another great option and you can purchase them already boiled and peeled at the grocery store.”

For lunch, she suggests trying to avoid the packaged breads with long lists of ingredients. “Instead, try to buy freshly baked bread or a brand like Dave’s Killer Bread that has minimal ingredients. And instead of ultra-processed bologna, salami or pepperoni, try fresh sliced turkey that only has salt and turkey on the ingredient list,” she says.

For snacks, Elizabeth agrees that whereas it would be great to always snack on fresh fruits and veggies, it’s generally unrealistic. “Sometimes the nutritional benefit outweighs things like a little bit of salt,” she says. “Some packaging also helps with portion size. Just because it’s packaged does not mean it’s ultra-processed.” Some healthier snack examples include 100-calorie bags of almonds, 100-calorie cups of guacamole with veggies, freeze-dried fruit packages and yogurt with fruit. As far as yogurt, Elizabeth recommends Siggi’s because even though there is added sugar, the total carbohydrate count is only 13 grams which is about the amount of sugar in a small piece of fruit. It also has 15 grams of protein and 150mg of calcium so it’s packed full of nutrients. Rx Bars offers bars for kids and have a very short, healthy ingredient list. (I personally always find these to be very sticky on the teeth.)

For dinner, Elizabeth recommends investing in an air fryer if your family likes the taste and consistency of fried or crispy food. “They have become very popular,” she said. “You can make the much beloved chicken fingers and chicken nuggets. You can make healthier versions of French fries, too.” For some healthier air fryer recipes, click here. For hot dogs, she suggests switching to a brand like Applegate Farms as they have far less ingredients than others, all of which can be identified. Another quick dinner suggestion is chicken lime burgers from Trader Joe’s. The ingredient list is a great example of the type to look for (short with things you can pronounce): ground chicken, onions, bell peppers, garlic, cilantro, natural flavor, salt, lime juice concentrate, red pepper flakes. Inspired by Elizabeth, I grilled these last night and they are rather delicious on a bun. (Of course, I then realized that my bun had about 104 ingredients.)

The bottom line is that though we cannot eliminate ultra-processed foods from our diets completely, if we understand the definition of ultra-processed versus minimally processed versus unprocessed, we can try to make more informed decisions when food shopping, cooking, packing lunches and snacks for school, getting take-out and eating at restaurants without going overboard.

Elizabeth recommends starting small with some healthier snacks. Please comment below if you have suggestions to share for less-processed meals or snacks that work for you and your family.

Details

Written by Joanne Wallenstein

Published: 11 August 2019

Created: 11 August 2019

Last Updated: 11 August 2019

Hits: 4073

This year, one of Scarsdale’s most notable businesses celebrates their fiftieth anniversary. Advocate Insurance and the Binday and Koslowsky families -- who run the agency -- are well known in town, insuring many properties here and donating generously to many community organizations. Since multiple generations of the family live here as well, they are friends, neighbors and your advocate in Scarsdale.

We asked Denise Koslowsky to tell us about Advocate and here is what she shared:

Who founded Advocate and how did it all begin?

Advocate was founded by my mother, Roz Binday, at the recommendation of my father who was an Allstate Agent. At a dinner party, it was discussed that this would be a great tax write off. My mother was pregnant with me, her third child, and was not devoting time to attend insurance school just for a tax write-off. With her, it was all for real or for nothing. So that is how Roz’s embryonic insurance career began.

50 years ago, what did people insure? What was Advocate’s primary business?

The story goes, my mother sold insurance to every single person she met everywhere she was. Mostly small commercial businesses. We lived in the Mamaroneck strip at that time, and her office was on Garth Road. Thus, she insured many businesses on Garth Road and Mamaroneck Avenue in the Village of Mamaroneck. Through an abundance of client recommendations, the business continued to grow and spread to other areas.

Through the years, how has at the business changed?

What started as a “Mom” and Pop (but mostly Mom) shop really evolved to a full-fledged corporation with a wonderful family owned corporate culture at our core. Sometime in the mid 1980’s Roz landed the Jordache Jeans account and that really propelled our business to another level. Ron retired from Allstate and officially joined Advocate, as did Glenn, followed by me. Our community focus also has gained us substantial business in Scarsdale, Westchester, and New York City, as well as the rest of the country. Today we are one of Chubb’s top Cornerstone agents nationwide. We also sit at the top of Pure as a Paragon Agent, Berkley One as one of their partner agents, Cincinnati as a top performer and a Travelers partner agent.

Tell about some rare or unusual items the company has insured.

We have insured many fantastic art collections with Chagall, Old Masters such as Rubens, Titian, and some important contemporary collections. A while ago, we insured a 17th century castle that came from England, piece by piece and was reassembled in NY in 1924. Our clients have since sold it.

Did you insure any notable or famous people’s property that you can discuss?

We currently insure a world renowned photographer whose name I cannot mention, we have insured Mary Stuart Masterson, some famous authors, famous designers, and top lawyers and doctors in the NYC area, along with major real estate moguls.

Who in the family is still involved in the business today?

Still to this day the business is run by the Binday family. Roz and Ron Binday are very much involved. Glenn, Denise, and Jeffrey Koslowsky are responsible for the day to day running of the business.

With the world become more and more virtual and more volatile, where do you see the insurance business going in the next 50 years?

Super service is essential. With the world becoming ever more impersonal, we see our business moving into a concierge service focus along with our commitment to really get to know and understand our clients’ needs. It takes time and patience to educate them. Technological advancements will continue to help us remain efficient in this world, and we expect to remain fiercely independent during this era of mergers and consolidations.