Spring 2015

May 12, 2015


Plaza Family Care, P.C. is pleased to announce the addition of Unnati Tailor, D.O. to our Medicine staff. Dr. Tailor received her Doctor of Osteopathic Medicine from New York College of Osteopathic Medicine, Old Westbury, NY and her Bachelor’s Degree in Science from New York of Technology, Old Westbury, NY. Dr. Tailor completed her Internship and Residency at Christ Hospital/UMDNJ­SOM, Jersey City, NJ. She is Board Certified in Family Medicine and will be caring for adult patients.

The following is a Letter to the Editor of the Star­Ledger, written by our own Dr. Caruso:

Helmets Needed for Female Lacrosse Players

On April 8, the Star Ledger Sports section showed a picture of three female lacrosse players with their sticks up high in the air, all reaching for a flying ball. While male players wear a full helmet and face mask, these players wore only goggles and mouth guards. As a pediatrician who has had a lot of experience in treating head injury in high school and college athletes, my question is: why don’t we protect the girls as well as the boys?

While it is true that the boys’ game is more aggressive, anyone who knows these athletes realizes that there is not much difference between genders in their enthusiasm and commitment to win. The excuse put forth by US Lacrosse is that if helmets are required, the game will become more aggressive. That is not only a sexist viewpoint­­it’s also like saying our children will ride their bikes in a safer way if we don’t have them wear bike helmets. I have seen many lacrosse injuries from not only sticks to the head but impacts of the ball, too. It is a significant source of morbidity to our female athletes.

In 2007, Randall Dick, reviewing 16 years of NCAA injury data in the J​ournal of Athletic Training,​found that 56% of above the neck injuries in women’s lacrosse resulted from contact with a stick, and 20% were from contact with a ball. A 3­year prospective study by Hinton, et al in t​he American Journal of Sports Medicine​in 2005 found that female players had higher rates of overall head injuries than their male counterparts, mostly involving contact with sticks and balls. In 2001, a 10 year analysis of the National Electronic Injury Surveillance System by Diamond and Gale showed that the head and face were the most common areas injured, being significantly more prevalent in females (30%) than males (18%). Their recommendation was: “ W​omen and children lacrosse players are at risk of serious injury to the head and face region. The use of protective head/face gear should be encouraged.​“

Perhaps the most compelling study, by Lincoln et al in the A​merican Journal of Sports Medicine​in 2007, found that high school girls’ head, face and eye injuries (0.54/1000 athletic exposures) were significantly higher than for boys, and while concussions were higher in the boys and men, women sustained significantly more facial injuries, primarily resulting from stick or ball contact.

In the early sixties, hockey players wore no helmets and goalies no masks. It does not seem the addition of these pieces of safety equipment has ruined the game at all. Even though there is no checking in the girls’ game, this does not prevent the inevitable accidents that occur in any sporting event. The above referenced articles support this. Many of these injuries are not only game injuries but may carry life­long consequences. While the situation in professional sports is well known, my colleagues and I are seeing an increasing number of head injuries in all amateur sports, with women’s lacrosse making up a significant proportion of these incidents. When the governing bodies will not act, those of us who care for these athletes must speak up. Isn’t it time we protect the girls as well as the boys?

Patrick A. Caruso, MD, FAAP
Clinical Associate Professor of Pediatrics Mount Sinai School of Medicine
Goryeb Children’s Medical Center Morristown, NJ


by Gina Consalvo, MA, RD, LDN, CDE, NCC

It is time to spring clean your diet and break free from winter comfort foods! This does not mean restricting your intake or relying on juice cleanses and detoxes, but committing to a whole, unprocessed foods diet. This spring, the goal is to take advantage of nutrient­-packed seasonal fresh produce, drink more water, cut back on alcohol and focus on what you are eating and drinking. Here are my 8 tips for freshening up your diet to help you take charge of your health.

Research proves that skipping breakfast is associated with a higher body mass index (BMI) and an increased obesity risk. By skipping breakfast, you are throwing your body into feast/famine mode so the food you eat at lunch is more likely to be stored rather than burned off for energy. It has also been found that breakfast eaters have a greater reduction in impulsive snacking between meals and overeating during meals. Those who skip breakfast tend to be tired, irritable and restless, whereas in comparison, breakfast eaters tend to be more awake, productive and effective, and have better morale.

Eating a rainbow of foods is a great way to load up on fiber, vitamins, antioxidants and phytonutrients. The pigments that give fruits and vegetables their colors are vital antioxidants. Colorado State University researchers found that subjects who ate a wide variety of produce had lower levels of DNA oxidation than those who focused on a limited number of plant foods. Try to eat at least three different colors at each meal and one or two colors at snacks. Scramble eggs with spinach and red bell pepper. Add strawberries and apricots to green salads. Brighten up sandwiches with shredded carrot and arugula.

Refined grains, like white flour, white rice, and processed grains are stripped of beneficial fiber, vitamins and minerals. These grains add calories, but are not rich in nutrients. Since refined grains are lower in fiber, they are not as satisfying as whole grains. Read ingredient lists to ensure you are choosing “whole” grains with at least 3 grams of fiber. Other great choices include amaranth, quinoa, lentils, millet, and barley. These grains are loaded with healthy nutrients and fiber to help fuel your day.

Going vegetarian once a week may reduce your risk of chronic preventable conditions like cancer, cardiovascular disease, diabetes and obesity. Consuming beans or peas results in higher intakes of fiber, protein, folate, zinc, iron and magnesium with lower intakes of saturated fat and total fat.

Drink at least 48 ounces of water a day. Dehydration can impact your metabolism, leave you sluggish, and can mask itself as hunger. Replace sodas and sweet lattes with green or herbal tea, water sweetened naturally with fruit and unsweetened iced tea. Load up on water­-rich produce, such as lettuce, celery and fruits.

Most of us eat too much sugar. On average, Americans consume 475 calories of added sugars every day (that’s 30 teaspoons), which is much more than what the American Heart Association recommends (6 teaspoons per day for women, 9 for men). High intake of added sugar is linked with risk factors for heart disease, such as high blood pressure and high triglyceride levels. Sweeteners deliver empty calories and encourage overeating, both of which lead to weight gain. Natural sugars in dairy, vegetables, and fresh or unsweetened dried fruit don’t count as added sugars. But corn syrup, evaporated cane juice, dextrose, and other sugar impersonators in yogurt, cereals, granola bars, and even pasta sauces certainly do. Scan ingredients on packaged foods and choose those with little, if any, added sweeteners. Replace sugary breakfast cereals, flavored yogurts, and reduced­fat peanut butter with steel­cut oats, plain yogurt, and natural nut butter. Skip processed foods and when you want a sweet treat, reach for fruit for a natural sugar fix.

Saturated fats raise your “bad” LDL cholesterol, which can damage arteries. Saturated fats are found in whole milk, cheese, butter and meat. Limit your intake of animal fats and swap them for healthier monounsaturated fats from plant foods like nuts, avocados and olive oil.

By getting rid of processed, pre­packaged foods in your diet, you can easily minimize your intake of added sugars, salt and trans and saturated fat. Make homemade freezer meals by cooking in bulk and freezing individual servings.

[Gina is available for consultation for adults and children in our Hackettstown office. Also, keep an eye out on the website and in the office for announcements about group classes that she offers.]


by Kristen Walsh, M.D., F.A.A.P

[Dr. Walsh volunteers as the school physician for the Somerset Hills Learning Institute, an area school for children with autistic spectrum disorder.]

April was Autism Awareness Month, and in the past few years, we have seen many new research studies about autism causes, diagnosis, and treatment. Autism spectrum disorder (ASD) is a brain­based disorder that affects a child’s behavior, communication, and social skills. Because most children with ASD will master early motor skills such as sitting, crawling, and walking on time, parents may not initially notice delays in social and communication skills.

ASD affects an estimated 1 out of every 68 children. The number of children reported to have ASD has increased since the early 1990’s for reasons that are unclear. The increase is likely caused by multiple factors. Parents are more aware of ASD, and pediatricians are doing more screening (we here at Plaza have added additional autism screening to your child’s toddler visits in the past few years). In addition, there have been changes in how ASD has been defined and diagnosed: now, children with milder symptoms are being identified and treated.

Research has shown that there is a genetic predisposition to ASD. Although many chromosomal and gene abnormalities have been associated with symptoms of ASD, none of these are present in all affected children. Older paternal age and maternal viral infections during pregnancy are additional factors that have been associated with increased likelihood of a child having ASD. The newest studies, on the leading edge of autism research, are identifying abnormalities in the womb for babies who are later diagnosed with ASD. This would seem to indicate that whatever abnormalities cause ASD, they occur prior to birth. Along these lines, one factor NOT associated with ASD is vaccines (which, of course, occur after birth). We have so many huge studies that show NO association between vaccines and autism, that scientists and doctors would very much like to stop wasting research money on this issue. As many parents are now aware, an old research article that proposed a link between the MMR vaccine and autism has been officially retracted (permanently removed from scientific publication) because the lead researcher falsified data and took money illegally from attorneys for the fraudulent research.

Research shows that starting an intervention program as soon as possible can improve outcomes for many children with ASD, so children can and should be referred for diagnosis and early intervention (EI) as soon as the ASD symptoms are noted. New studies are showing that with intensive, early treatment, a certain (relatively small) percentage of children seem to be able to be completely cured of ASD (this developmental disorder had previously been thought to be modifiable, but not curable­­which is still the case for most children). This is exciting news, and doctors are hopeful that it will help convince state and national government to help fund more intensive, early treatment for these children. With the help of all available resources, the long­-term outcomes of children with ASD should continue to improve.


Recent current events have confirmed some of the things that we, as doctors, know to be true. Vaccines save lives, and without them, life­threatening diseases come back quickly. It took only one infected person at Disneyland to cause the biggest measles outbreak in this country in many years. The measles virus is so infectious that if there is one infected person coughing in the rear of an airplane, over 90% of susceptible (unvaccinated) people will be infected by the end of the flight. The epidemic gained a foothold in this country because of parents who turned down a life­saving vaccine that was readily available to their children. I went on a medical mission in Peru with my father when I was in medical school, and I will never forget the long lines of parents waiting for hours in the rain and cold to get their children vaccinated. They were willing to do that because they saw vaccine­preventable diseases killing people they knew and loved on a daily basis. Measles seems like a far­away threat to many parents in this country, but it isn’t. Sometimes, it’s only a cough­­or sneeze­­away.

I’m sure some parents feel that we, as doctors, sometimes sound like broken records on the subject of vaccines. Believe us­­we feel like broken records sometimes, too! But we will continue to advocate for vaccines on behalf of children, for the simple reason that they are safe, effective, simple interventions that have saved millions and millions of lives. Pediatricians find it very frustrating when parents turn down safe and effective vaccines for their children. From our perspective, the frustration comes from the fact that we know vaccines to be a “home run”­­the very best that science, medicine and public health has to offer. They are both extremely safe, and extremely effective at preventing diseases. The way we see it, the decision to vaccinate should be a “no­brainer”­­and mandatory for all school children. We worry about parents who refuse vaccines, in part because it becomes a trust issue: if you don’t trust us on the “easy” medical decisions like vaccines, what happens if things become more complicated? What happens if your child develops a chronic illness, or suffers a severe injury? If you don’t trust our judgment, we lose the ability to help your child.

We understand that parents want information about vaccines. We support that! But given the fear­mongering and wild expostulating that exists on the Internet, please, p​lease​get your information from reputable websites. There are only a few that are really trustworthy:

  1. https://www.healthychildren.org​ (The American Academy of Pediatrics website for parents­­very extensive and constantly updated)
  2. https://www.cdc.gov/vaccines/ ​(The Centers for Disease Control and Prevention)
  3. https://vec.chop.edu/service/vaccine­education­center​ (Children’s Hospital of Philadelphia)

Those are the big three. Please feel free to ask us any questions about vaccines that come up as you peruse these websites. Remember, we are here for one reason: to help your children. We want the best for them­­just like you do. The best medical care happens when parents and doctors work together for children, on the same team.

by Kristen Walsh, M.D., F.A.A.P.

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