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A Message from the President – Leonard Newman, MD

SPRiNg/SuMMeR 2016, Vol. 1, No. 1

PEDIATRIC SPECIALTIES

CWPW Officially Rebranded as Boston Children's Health Physicians

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or the last several years we’ve been using the pages of this newsletter to showcase the high level of care we provide to our patients every day, and to champion the many successes we’ve achieved here at CWPW, thanks to our roster of incredibly talented physicians and health care professionals. Now, with our newly formed relationship with Boston’s Children’s Hospital, we have even more positive news to share. We’ve adopted a completely new brand image, ranging from our new name – Boston Children’s Health Physicians – to a new logo, and a fresh look for this newsletter. We’re very excited about our relationship with Boston Children’s Hospital – one of the premier pediatric health care facilities in the nation, and among the largest – and equally enthusiastic about our new name and image. Our affiliation with Boston Children’s Hospital will mean an even higher level of care, and access to some of the finest minds in pediatric medicine. Founded nearly 150 years ago, the facility was ranked the #1 children’s hospital in the nation for 2015-2016, according to U.S. News & World Report. So, we are in very good hands, indeed. Along with our new look and logo, this edition of our newsletter includes some very interesting stories, along with some valuable information. The idea of Quality Initiatives is gaining in importance nationally, as well as here at BCHP. In this newsletter, Suzanne Kaseta, MD, MMM, CPE, FAAP, shares her insights regrading this new thrust toward improving efficiencies that produce optimal patient outcomes. Dr. Kaseta,

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who will direct the Quality Initiatives for our group, will be reporting on a different facet Leonard Newman, MD of the Quality Initiatives program with each ensuing newsletter. She is extremely devoted to the endeavor, and we look forward to hearing from her. The Armond V. Mascia, MD Cystic Fibrosis Center, staffed by the Division of Pediatric Pulmonology, Allergy, Immunology, and Sleep Medicine of Boston Children’s Health Physicians, is involved in numerous clinical trials, under the direction of Allen J. Dozor, MD, Chief of Pediatric Pulmonology, Allergy, Immunology, and Sleep Medicine at BCHP. Finding new drugs to treat dreaded conditions such as cystic fibrosis is paramount to Dr. Dozor and his team, who are adhering to the tenets of Precision Medicine to zero in on drugs that can alleviate the suffering and help patients to live longer, fuller lives. There’s also a very heartwarming story about Joshua Winslow, a little boy who came to us a few years back and was diagnosed with neuroblastoma. Thanks to the herculean efforts of pediatric hematologists and oncologists Oya Tugal, MD, and Fevzi Ozkaynak, MD, and pediatric surgeon Whitney McBride, MD, young Joshua received the superior care he needed. Today he is a thriving 6-year-old boy, attending school, playing sports, and making progress by the day. As I pointed out, these are exciting times for us. Please keep in touch, and let us know how you like our new image and the updated design of our newsletter. BCHP

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Specialty Referral Hotline 844-4-MD-BCHP

www.bchphysicians.org

New Drugs Offer Hope to Children and Adults Suffering from Cystic Fibrosis

PRECISION MEDICINE AT BOSTON CHILDREN’S HEALTH PHYSICIANS

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he concept of Precision Medicine — an initiative championed by President Obama and gaining widespread acceptance among physicians and patients nationwide — takes into account the biological, allen J. Dozor, MD environmental and behavioral influences on disease in order to better understand and treat them; and, ultimately, find cures. With research the backbone of the initiative, Precision Medicine puts the focus on developing individualized treatments for patients. The Armond V. Mascia, MD Cystic Fibrosis Center, staffed by the Division of Pediatric Pulmonology, Allergy, Immunology, and Sleep Medicine of Boston Children’s Health Physicians (BCHP), played a vital role in the clinical trials that led to FDA approval of two new drugs, and is currently studying three more drugs this year. These new medications could dramatically change the lives of children and adults who suffer from cystic fibrosis (CF), a terrible and debilitating disease. CF is a life-threatening genetic disorder in which mucus builds up in the lungs, intestines, pancreas and liver. There is no cure. There are less than 30,000 CF patients nationwide, and over 1,800 genetic mutations have been described. According to Allen J. Dozor, MD, Chief of Pediatric

Pulmonology, Allergy, Immunology, and Sleep Medicine, at BCHP, matching therapy to specific genetic mutations is the most exciting breakthrough in CF in decades. “Unlike asthma, diabetes or heart disease, in which there are dozens of genes involved, CF really lends itself well to Precision Medicine because it is a singlegene mutation disease,” Dr. Dozor explains. “The first step was to unravel the science; that is, the molecular and cellular consequences of each genetic mutation. Next, academic investigators collaborated with the biotech industry to develop new drugs that alter these basic disease-causing mechanisms. Finally, patients with these specific mutations have to be identified and agree to participate in the clinical trials required for FDA approval.” Dr. Dozor explains that the Cystic Fibrosis Foundation, which was established over 60 years ago in Westchester County, initiated an effort to convince pharmaceutical companies to produce drugs that focus on specific CF mutations. It is an uphill battle to persuade companies to develop drugs for so-called ‘orphan diseases,’ those with fewer than 200,000 patients nationwide. In spite of this uphill battle, Dr. Dozor says there has been progress: “Decades of hard work is finally bearing fruit. “The Foundation realized that if pharmaceutical companies develop new

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potential therapies, the CF community should recognize that studying these drugs is the most expeditious way possible,” Dr. Dozor points out. “If clinical trials cannot be performed quickly, with adequate numbers of patients enrolled, companies will move on.” So, over a decade ago, the Foundation established its Therapeutics Development Network. The Armond V. Mascia, MD Cystic Fibrosis Center at New York Medical College, with Dr. Dozor as Director, has been a member of the Network since its inception. (The Center is the only one in the Hudson Valley.) The Network gives direct support to the Center to hire research staff and free up physician-investigators to perform clinical trials. The division now includes 16 pediatric pulmonologists, and all of them are devoted to enrolling CF patients. “We have recently increased our research staff from one coordinator to six; and all of this work would have never been possible without the help of all of my co-investigators, particularly Drs. Welter, Krishnan, DeLaRiva-Velasco, and Lowenthal.” Two important drugs have resulted from the efforts of the Network. Kalydeco™ was given the green light by the FDA in 2012; it was originally approved to treat 4% of patients with CF, and now is being prescribed for almost 20%. For many patients, this drug promises to add decades to their life expectancy, for a price tag of about $300,000 per year. Orkambi™ is the second drug; it gained FDA approval in July 2015, and is applicable to about 50% of all patients. “So now 70% of patients have precision drugs for them,” Dr. Dozor states. He adds, however, that Orkambi™ “may not always be as effective as Kalydeco™.” Developed by Vertex, a small biotechnology firm in Massachusetts, the firm has developed a newer drug currently in clinical trials that may replace Orkambi™. In 1953, the average age of survival for CF patients was three years; by 1985 that age increased to 19. Today, Dr. Dozor points out, the average age has soared to 40. “I’m still going to too many wakes and funerals,” he laments. “In one sense, it’s a victory.” But without a cure, CF offers a grueling death sentence. “It’s a horrible death,” he says, noting that he has seen his fair share. As patients are living longer with CF, the health care industry is slowly learning how to care for patients in their 40s and 50s and beyond. “We now have adult pulmonologists, gastroenterologists Continued on page 11

Superior Care, Improved Efficiencies and Lower Costs Are Paramount

QUALITY INITIATIVES

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nsuring that quality standards are achieved, information is disseminated and that all of BCHP physicians’ offices are fully informed of all pertinent healthcare endeavors is a Suzanne Kaseta, MD herculean task by anyone’s standards. Yet it’s one that Suzanne Kaseta, MD, MMM, CPE, FAAP, has assumed with great fervor, and equal enthusiasm. Dr. Kaseta is BCHP’s first Chief Quality Officer for Ambulatory Care, a position she assumed in May of last year. Her role is multifaceted, involving virtually every aspect of medical care, and melding it all fluidly and flawlessly into the administrative aspect of health care management and execution. A physician with BCHP’s Washingtonville Pediatrics, she is uniquely qualified to take the leading role in instituting the organization’s Quality Initiatives (QI) effort. With a Master’s degree in Medical Management from Carnegie Mellon and as a Certified Physician Executive, it’s her job to implement the concept of Quality Initiatives throughout the BCHP organization. “Quality Initiatives are extremely important for us to have,” Dr. Kaseta explains. Where until recently she practiced medicine on a full-time basis, today Dr. Kaseta sees her young patients one day a week; the bulk of her time is devoted to implementing QI at BCHP. “It was the administration’s vision to bring QI front and center,” she points out. “At the heart of our QI initiatives are our combined efforts to produce optimal patient outcomes, while at the same time improving efficiencies and enhancing communications throughout gerard Villucci, the medical practice,” said Chief executive officer Gerard Villucci, CEO. “Everyone’s most important job at BCHP, is ensuring that the highest quality of care is provided to our patients.” “Many problems that individual offices encounter are actually quite similar,” Dr. Kaseta explains. “Physicians often approach problems in different ways; that makes for variability.” Some ways, she admits, are better than others. “Evidence-based efforts are best because you have better outcomes. It’s the best way, with the best results, and the most cost-effective.” Implementing the QI standards, many of which are pre-determined by the American Academy of Pediatrics (AAP), can be

challenging, particularly within an organization like BCHP, with so many distinct offices and sub-specializations. “So, it’s trying to reduce variability and work together,” Dr. Kaseta says. “You try to look at the best ways to achieve goals, examine the evidence, and look closely at offices that are succeeding. This is my approach.” Among the most urgent of the Quality Initiatives, according to Dr. Kaseta, is the issue of vaccinating children and young adults against the Human Papillomavirus, or HPV. She points out that HPV causes cervical, vulvar and vaginal cancer in females, penile cancer in males, and anal and oropharyngeal cancer in males and females, and is easily transmitted. “All those cases are preventable,” she stresses. HPV also causes approximately 320,000 cases of genital warts annually, she says. “It results in lots of unnecessary procedures — and a lot of money.” Dr. Kaseta formed a Best Practices Committee among her pediatrician peers; recently her group released a Guidance Statement on preventing HPV infection in primary care pediatrics. “The HPV vaccine is an amazing discovery,” Dr. Kaseta notes, adding that it is “completely safe; it’s been around for decades. “Unfortunately,” she says, “rates of children getting the vaccine are low.” She is determined to reverse that trend through her work on QI. The Guidance Statement outlines the benefits of the vaccine, and how physicians can improve vaccination rates for their patients. “This is an initiative that can have a huge

impact on the well-being of our patients,” Dr. Kaseta insists. “It really works and it’s really safe, and it can significantly reduce health care costs.” Recent changes in health care highlight the importance of primary care, Dr. Kaseta says. “It’s about preventative care; we’re now on the front line of medicine, and it’s very exciting.” “My emphasis is to have the whole office involved,” she notes, “because I have strong opinions that the front desk person also should be well educated about initiatives. I’m trying to educate all offices about the importance of HPV vaccination.” Patient-centered Medical Home is another initiative that is of paramount importance to Dr. Kaseta. The concept, initially promulgated by the American Academy of Pediatrics, involves providing advanced primary care “with the goal of addressing and integrating high-quality health promotion, acute care and chronic condition management in a planned, coordinated, and family centered manner,” according to the AAP. “The plan is for all BCHP offices to become Level 3 Patient Centered Medical Homes by March 2018,” Dr. Kaseta explains. “Much has to be done to do achieve this goal. All offices have to be coordinated, and have Electronic Health Records up and running. There are about 150 procedures or guidelines that have to be put into place and well documented,” Dr. Kaseta adds. Level 3 can only be achieved when the organization has earned 85 of 100 points in Continued on page 11

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BCHP Announcements

CONGRATS TO ROBERT AMLER, MD

CONGRATS TO HEATHER BRUMBERG, MD

We at BCHP congratulate Robert Amler, MD, on being a recipient of The American Academy of Pediatrics 2015 Outstanding Achievement Award in Epidemiology, Public Health and Child Health Robert amler, MD Advocacy The American Academy of Pediatrics has awarded the 2015 Outstanding Achievement Award in Epidemiology, Public Health and Child Health Advocacy to Robert Amler, MD. This award is cosponsored by the Academy’s Section on Epidemiology, Public Health, and Evidence, and the Council on Community Pediatrics.The award recognizes a seminal role in pediatric epidemiology to improve children’s health. In particular, Dr. Amler co-founded and secured Congressional funding for a national network of Pediatric Environmental Health Specialty Units (PEHSU), which emerged as a logical outcome of a Presidential Task Force subcommittee that he co-chaired. BCHP

AMY BROWN

New Pulmonologist

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eonates and children with pulmonary issues have yet another set of caring hands to help them to lead amy Brown, MD full, productive lives. Amy Brown, MD, MBE, has recently joined Boston Children’s Health Physicians. Dr. Brown is based in Valhalla, with occasional visits to the Environmental Health and Pediatric Pulmonology office at Vassar Brothers Medical Center in Poughkeepsie. In addition to serving as an attending physician at Maria Fareri Children’s Hospital at Westchester Medical Center (WMC) and as an Assistant Professor of Pediatrics at New York Medical College (NYMC), Dr. Brown also holds a Master of Science degree in Bioethics. She is working under the aegis of Allen J. Dozor, MD, Chief of Children’s Environmental Health and Pediatric Pulmonology at BCHP. While in her third year of Fellowship at Columbia University - New York Presbyterian, Dr. Brown interviewed at WMC, and was subsequently contacted by Dr. Dozor, who asked if she would be interested in joining the team. “After one meeting, I was hooked,” Dr. Brown recalls. “With my prior interests and with their program, it seemed like a good fit.” While her practice is predominantly clinical, she is pleased that Dr. Dozor encourages physicians “to explore opportunities in the non-clinical realm of research,” Dr. Brown says. She has taken it

to heart, and today is engaged in a variety of endeavors that meld her understanding of prenatal pulmonology with her ken in bioethics. Having recently reconnected with a former mentor in bioethics, Dr. Brown is currently involved in a research project involving prenatal testing for cystic fibrosis, and the concomitant ethical issues that it presents. “I’m exploring the ethical issues ahead of the game,” she explains. She is also working with the City School District of New Rochelle developing a program for school-based intervention for children with asthma. “There is a lot of care needed,” she insists, as well as a heightening of communication between doctors and parents. Stronger relationships are also encouraged between school nurses and parents regarding asthma, she says. “It’s a very big issue.” Dr. Brown is among a group of physicians involved with Boston Children’s Health Physicians working on optimizing ways to wean newborns with chronic lung disease off of oxygen. “They gave a wonderful presentation and they set parameters and outlined the technology that parents can plug in at home for microsaturation,” she explains. “We’re looking at the protocols: Is 20 minutes enough? It’s all very interesting.” Lastly, Dr. Brown says that Dr. Dozor has asked her to become involved on the Medical Education Committee at NYMC. “One of the things he’s hoping to do is to allow me to become medical student rotation coordinator,” she says, which will allow her to conduct teaching sessions

Specialty Referral Hotline 844-4-MD-BCHP 4

Heather Brumberg, MD, Elected as Vice President of the American Academy of Pediatrics Chapter 3, District 2 We at BCHP congratulate Heather Brumberg, Heather Brumberg, MD MD, on being elected as Vice President of the American Academy of Pediatrics - Chapter 3, District 2. Upon the completion of her two-year term, Dr. Brumberg will then assume the position of President Chapter 3, District 2 at the American Academy of Pediatrics. BCHP

“and work a little more closely with the medical school.” In addition to an interest in cystic fibrosis and integrated therapies for asthma management, Dr. Brown also brings to Boston Children’s Health Physicians a desire to enhance pulmonary management of children with complex, chronic medical conditions. BCHP

JEAN LAVIN NYC Marathon

"For the past 17 years as a registered nurse I have worked with and cared for children born with, or acquired, heart disease,” said Jean Lavin. “I plan to run once again in the New York City Marathon in honor of my patients and their brave parents who have taught me the meaning of true strength. I will be running in the marathon to raise money for Maria Fareri Children’s Hospital/WMC and the American Heart Association.” BCHP

GROUNDBREAKING MEDICINE – Smart Decision-making and First-ever Use of Innovative Technique Combine to Save a Young Girl’s Life

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ometimes, even in the face of disaster, there lies a silver lining. Such was the case this spring when an 11-year-old girl was rushed to Maria Fareri Children’s Hospital in Valhalla, New York, following Michael H. gewitz, MD a serious automobile accident. The girl suffered a variety of injuries in the crash, from multiple broken bones to lung contusions. A CT scan revealed something more pernicious, and life threatening: a large pseudo- gustavo Stringel, MD aneurysm in her aorta, the large artery that carries oxygen-rich blood from the left ventricle of the heart to other parts of the body. Once the patient was stabilized, the pediatric Markus erb, MD cardiologists and cardiothoracic surgeons were faced with having to make a vital decision in order to repair the ruptured aorta and essentially save the girl’s life. One option would involve radical surgery — opening the child’s chest to seal the leaking aorta. “She was going to need some kind of intervention,” explains Michael H. Gewitz, MD, Chief of Pediatric Cardiology, Vice President of Boston Children’s Health Physicians (BCHP), also in Valhalla, and Physician-in-Chief at Maria Fareri Children’s Hospital (MFCH).” The radical surgery “would have been a high-risk option,” Dr. Gewitz says. While Dr. Gewitz and Gustavo Stringel, MD, Chief of Trauma of MFCH and Chief of Pediatric Surgery at BCHP urged the team treating the young accident victim to consider all options, including an “experimental” catheter-based approach, Markus Erb, MD, pediatric cardiologist, and Director, Pediatric Cardiac Catheterization at MFCH and Interventional Cardiology Director at BCHP, agreed that the FDA’s Expanded Access protocol, would be implemented in order to allow the physicians to save the child’s life without a traditional, risky intervention. (The FDA uses its discretion to permit the use of an as-yet unapproved investigational device or procedure outside of clinical trials if a patient’s life is deemed at risk.) “The girl suffered a Level Three traumatic injury,” Dr. Erb explains. Patients presenting

with Level Four traumatic injury typically don’t survive. If the patient had been an adult, physicians would have brought her to the OR and inserted a self-expanding covered endovascular stent to seal the aorta. “The difference here is that because she is 11 years old, there wasn’t an appropriate stent,” Dr. Erb says. “In pediatrics, as a general rule, we don’t use the self-expanding stents because we have to allow for growth.” The stent has to be the right fit for the young adolescent’s aorta today, in five years, and in ten years from now, with the ability to be further expanded as she grows. Dr. Erb knew about a stent device that is being adapted for use in pediatric patients and currently undergoing clinical trials. The device, known as the covered Cheathamplatinum stent, produced by NuMED, Inc., is mounted on a balloon catheter, allowing physicians to place the stent exactly where they want it. “The difference between what we were doing and what was available through adult trauma services is that their stent comes in a long tube,” Dr. Erb points out, “while ours is balloon-expandable. We can slowly dial up the balloon to put the stent into place so that the size and the location of the stent can be regulated with more precision. An additional advantage is that we can return later to make it larger as needed when she grows.” The minimally invasive procedure was performed at the Interventional Cardiology and Catheterization Unit at Maria Fareri Children’s Hospital/Westchester Medical Center. In opting for the covered Cheatham platinum stent device, the team invoked the FDA’s Emergent Use protocol. Large pseudoaneurysms resulting from motor vehicle accidents are extremely rare. It marked the first time that this stent, currently part of clinical trials centered at Johns Hopkins Medicine in Baltimore and at Boston Children’s Hospital, was applied successfully in a child in this region, according to Dr. Gewitz. “This specific indication, because it’s so unusual, will add in demonstrating the efficacy of this device,” Dr. Gewitz explains. The FDA notes that, “There may be circumstances under which a health care provider may wish to use an unapproved device to save the life of a patient

or to help a patient suffering from a serious disease or condition for which no other alternative therapy exists.” Such was the case when BCHP’s physicians chose the covered stent. “Patients/physicians faced with these circumstances may have access to investigational devices,” the FDA adds, providing they subscribe to one of a series of stipulations; Emergent Use is among them. Dr. Erb has nothing but praise for those who smoothed the pathway for the device to be used in this fashion. It required reams of paperwork, and New York Medical College and Maria Fareri Children’s Hospital/Westchester Medical Center's Institutional Review Board (IRB) had to approve the use of the stent. “The people at Johns Hopkins Medicine who are heading the trial were extremely helpful as well,” Dr. Erb states. The entire procedure took less than two hours. “It went smooth as silk,” Dr. Erb says. “She’s been fine since. There is no evidence of an aneurysm.” The girl, who is now at home, will have routine follow-up care at BCHP; Dr. Erb sees no reason why she won’t be able to resume all of her normal activities, including playing softball. Dr. Gewitz, who was enthusiastic about using the device, is more than pleased with the outcome. “I’m glad we were able to do it,” He says. “And I’m glad that we are here for children who have these problems. That’s what we’re all about, both as an institution, and as staff.” “The dad is certainly smiling,” Dr. Erb remarks, “because for a week he didn’t know whether his daughter would survive.” The girl’s mother was also injured in the accident. Thanks to these skilled physicians, life will go on for a fortunate 11-year-old patient and her family. BCHP

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In the News DISEASES ON THE RISE: WHAT TO WATCH OUT fOR

Vaccines Can Prevent Many Illnesses, Including Whooping Cough

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lu isn't the only illness you'll want to have on your radar this year. A new report from the U.S. Centers for Disease Control and Prevention summarizes data on all infectious and Robert amler, MD non-infectious diseases reported to health departments across the country, allowing for a “side by side comparison,” said Dr. Robert Amler, dean of the School of Health Sciences and Practice at New York Sheila Nolan, MD Medical College. Data in the summary is from 2013, the most recent year available. "For the first time we're going to see, in the same document, what's happening with measles and what's also happening with blood lead levels in adults,'' said Amler, whose career includes a nearly 25-year stint with the CDC. "And we're going to see what's happening with Lyme disease at the same time as we're counting outbreaks of food-borne illness, which can be just as problematic."

Here are some diseases to watch out for in our area: Whooping cough: Pertussis, also known as whooping cough, is more prevalent than it was in the 1990s and early 2000s, said Dr. Sheila Nolan, chief of pediatric infectious diseases at Children's and Women's Physicians of Westchester and Maria Fareri Children's Hospital at Westchester Medical Center. According to the CDC, pertussis rates were highest among infants under 1 year. More than 28,000 cases of the disease were reported in 2013. Meningococcal disease: In 2013, rates of the disease remained low. But outbreaks of serogroup B strains of the bacteria were reported at two universities, in New Jersey and California, causing one death. Even if your child had the Menactra shot, a quadrivalent vaccine, it doesn’t protect against serogroup B strains, said Nolan. The ACIP (Advisory Committee on Immunization Practices) recommends a MenB vaccine for 16- to 18-year-olds, which does protect against serogroup B. According to the National Meningitis Association, serogroup B outbreaks also affected two colleges this year, in Oregon and Rhode Island.

Chlamydia: In 2013, 1.4 million cases of the sexually transmitted disease were reported, down 1.5 percent from the previous year. It still remains the most common notifiable disease in the United States, according to the CDC. Chlamydia can be asymptomatic in women, said Nolan, and can lead to pelvic inflammatory disease and chronic issues that may cause infertility. Screening for the disease can now be done with a urine sample, she said. Condoms remain the best form of protection against STDs. Influenza: Children are particularly vulnerable to serious effects from the flu. In 2013, 161 pediatric deaths from influenza were reported to the CDC. About 46 percent of children who die from the flu do not have underlying medical conditions, said Nolan. “People say, ‘Oh, it’s just the flu. My kid’s a healthy kid, they’re going to be fine.’ That’s not necessarily true.” It is vital to get vaccinated every year, said Amler. “We’re already seeing flu in Westchester. That’s what flu does. It surprises.” Measles: This year, 189 people from 24 states and the District of Columbia were reported to have measles, according to the latest CDC data. Most of those cases were part of an outbreak that started at Disneyland in California. Make sure your child is up to date on vaccines, and tell your pediatrician if you're planning a trip outside the United States. Measles is endemic in many countries, said Kesh, and your doctor may want to accelerate your children’s vaccination schedule before you travel. Babesiosis: In 2013, 95 percent of cases of this tick-borne disease were reported in residents of seven states, including New York, New Jersey and Connecticut. Deer ticks can transmit a variety of diseases, including Lyme and anaplasmosis, said Kesh. Risks are lower in the fall and winter, but it’s important to use caution when hiking through wooded areas, and to inspect skin carefully after every outing. According to Dr. Gary Wormser, director of the Lyme Disease Diagnostic Center at New York Medical College, deer tick virus (a variant of Powassan virus) and borrelia miyamotoi are also associated with ticks, Also keep in mind: HIV: Nearly 34,000 cases of HIV were reported nationwide in 2013. "Especially if you look at New York City-specific

Editor’s note: Robert Amler, MD, is also an attending pediatrician at BCHP

Specialty Referral Hotline 844-4-MD-BCHP

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numbers for HIV (2,297), they're high,'' said Nolan. "It's still a very significant problem, and clearly people are not practicing safe sex." Kesh believes more attention needs to be paid to HIV prevention. "We see a lot of cases that are contracted from city contact,'' she said. "The unfortunate reality is that, among some of the sexually active gay male population, there's not as much focus on prevention because there's this misunderstanding that it's treatable, like a chronic condition." HIV is indeed treatable, said Kesh, but the medication has side effects. "The treatment is not something you want to take for the rest of your life." Food - and water-borne diseases. Outbreaks can happen anywhere at any time, said Amler. Nearly 13,000 cases of shigellosis, a diarrheal disease caused by a group of bacteria called Shigella, were reported nationwide in 2013. Early this year, an outbreak swept through Rockland County, causing fever, bloody diarrhea and abdominal pain in children and adults. Good hand hygiene and proper disinfection are critical in preventing outbreaks of illnesses like shigellosis that are spread via the fecal-oral route. Shots you may need before a trip. Kesh recommends the Hepatitis A vaccine if you're headed anywhere but Western Europe, and the typhoid vaccine for certain areas, including Thailand. Many people don't recognize they should take antibiotics or malaria pills on a trip, and that they may need vaccines. "They'll come back with infections that are highly preventable,'' she said. Shingles. The shot is about 50 percent effective, but those who get the virus will have a much lower likelihood of developing post-herpetic neuralgia, a chronic pain condition, said Kesh, who recommends the vaccine to all her patients over 50. She's even seen people in their 30s and 40s develop shingles, she said. Complications may include encephalitis. BCHP

In the News

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THE 20-PERSON TASK fORCE WILL WORK TO EDUCATE PLAYERS AND TRAINERS, COACHES AND PARENTS

high school athlete takes a blow to the head and falls to the ground. The athlete feels confused and dizzy, but doesn’t mention anything to a coach and chooses to stay on the field. Ronald Jacobson, MD Incidents like these, which often signal a concussion, occur too often, says County Executive Rob Astorino, who on Monday launched a “Safer Sports” initiative. “It’s about educating our parents, educating our coaches, and dealing with issues and injuries if they happen,” Astorino said. The Safer Sports task force, composed of 20 doctors, athletic trainers and school officials in Westchester will work to teach concussion prevention measures and educate parents, athletes and educators about post-concussion symptoms. “Our goal is to evaluate how the districts and health care professionals are working

together to ensure the everyone involved understands the impact concussions can have on a child,” said Mark Herceg, Commissioner of the Department of Community Health and head of the Safer Sports initiative. Herceg has been leading the charge in high school concussion testing, but the new task force will brings together a team of experts with experience brain-related injuries. One of those experts is Ron Jacobson, Chief of Pediatric Neurology at Maria Fareri Children’s Hospital, who believes treatment of concussions in high school sports in often mishandled. “Concussions are often over-diagnosed and simultaneously under-diagnosed,” Jacobson said. In 2012, 3.8 million athletes ages 8 to 19 reported sports-related concussions — double the amount reported just 10 years earlier, according to the Centers for Disease Control and Prevention.

New York State’s concussion management law, enacted in 2012, encourages school athletic trainers to stand on the sidelines during games and practices, but doesn’t require them to, Herceg noted. “Athletic trainers are the first line of defense,” said Dave Byrnes, President of the Section 1 Athletic Trainers Society and trainer at Yorktown High School. “They’re critical to ensuring the safety of the athletes on the field.” The gap between players and trainers, coaches and parents is where Safer Sports hopes to help, by providing readily available information for all sports. “Education is the foundation for this program,” Byrnes said. “If parents and student-athletes get educated, we can make a difference in how concussions are managed.” BCHP

Editor’s note: Ronald Jacobson, MD, is also Chief of Pediatric Neurology at BCHP

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In the News THE fUTURE LIES IN ALTERNATIVE CANCER THERAPIES

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lu isn't the only illness you'll want to have on your radar this year. That's when he gets an email from a former patient, who was diagnosed with acute myeloid leukemia at 16. Mitchell Cairo, MD It's an annual thank-you note, one that marks the anniversary of a lifesaving bone marrow transplant that Cairo performed in 1987. Today, that patient is happily married, with three teenagers of his own. "He's grateful every day that he's here," Cairo says. "It always makes me feel great when I get that email." Over the past 30 years, Cairo has cared for thousands with cancer and blood disorders. Now, the Armonk resident is chief of pediatric hematology/oncology and stem cell transplantation at New York Medical College in Valhalla and head of the Children's and Adolescent Blood Disease and Cancer Center at Maria Fareri Children's Hospital at Westchester Medical Center. A prominent specialist in stem cell biology, molecular oncology and experimental immunology, Cairo has dedicated his career to cutting-edge research and advancing break through treatments. Cairo acknowledges that chemotherapy is standard protocol in most cancer cases. It's been particularly effective in children: Pediatric cancers tend to respond better to chemo, and overall, youngsters tolerate

chemo drugs better than adults. Even so, Cairo insists that the future lies in alternative therapies with a less toxic effect on the body. "We're using medications that, in 100 years or so, will be looked upon like blood letting in the Middle Ages," he says. "It works quite well and we have used it to patients' advantage over the last 60 years. However, I don't think a lot of people believe it's the end-all for how we should go about treating cancer." One promising strategy Cairo is investigating is targeted cellular immunotherapy, where doctors genetically rearrange immune cells to attack and kill specific cancer cells. Another is a form of regenerative therapy using stem cells, from sources such as cord blood. (Cord blood – found in the placenta and umbilical cord of newborns – is rich in early-forming stem cells that can assist the body in repairing damaged cells and tissue.) For Cairo, what's exciting about these therapies – targeted cell therapy, in particular – is that they are more organic ways of combating cancer. "It seems logical if we're trying to incorporate a more natural approach in the long term, that's going to be better for the patient and have the least amount of side effects," he says. Finding new ways to battle cancer at both the medical center and college, Cairo oversees about two-dozen colleagues

charged with researching new ways to treat these lethal diseases. Under his direction, the hospital will also soon open the Cell and Tissue Engineering Laboratory (CTEL), a 7,800-square-foot facility that can manufacture a variety of therapeutic cells to be used in transplants, clinical trials and new drug applications. Cairo anticipates that at least 100 patients will receive cells made at CTEL in the next year. At the same time, he's responsible for every child in WMC's pediatric cancer program. So unlike many experts in the field, Cairo wears two hats: clinical researcher and personal physician. He's convinced that the combination makes him a better doctor, allowing him to treat each patient with a more personalized approach. "There's only one philosophy," he says. "If this was my child, what would I want done?" Before joining Westchester Medical Center and NYMC in 2011, Cairo held posts at the University of California, Irvine Medical Center. Georgetown University Medical Center. and Columbia University. Since receiving his medical degree from the University of California at San Francisco, he's been amazed by the dramatic improvement in survival rates for childhood cancer. In 1975, only about half of children diagnosed before age 20 lived for at least five years. Today, according to the National Cancer Institute, that figure has risen to more than 80 percent. "This is a radical change," Cairo says. "Now instead of going to 4 out of 5 funerals, I go to 1 out of 5." He's able to go to his patients' weddings, too. Back in the 1980s, he diagnosed a 15year-old with Hodgkin's lymphoma, just six months after she'd lost her mother to cancer. To put her mind at ease, he told the girl that he'd cure her – if she promised to dance with him at her wedding. They never discussed that promise again, but years later, he received a wedding invitation and flew to California to attend. Sure enough, during the reception, he was called out onto the dance floor. "I was crying, and everyone else was crying when they heard the story," Cairo recalls. After all, he adds, "Once you've taken care of these patients, you develop a lifelong bond." BCHP

Editor’s note: Mitchell Cairo, MD, is also Director, Children’s and Adolescent Cancer and Blood Diseases Center at BCHP

Specialty Referral Hotline 844-4-MD-BCHP 8

In the News

Fox News Channel program, Fox & Friends interviewed Suzanne Kaseta, MD, Chief Quality Officer for Ambulatory Care and Managing Partner of Washingtonville Pediatrics on the topic of questions that new mothers should ask of their physicians.

BEHIND THE VEIL: BARRIERS AND BIAS Esra Caylan, MD, a pediatric pulmonologist with BCHP, says her young patients and their parents are sometimes shocked by her Muslim clothing.

"Sometimes, I can see on their face they are like, 'Who is this?'" Dr. Caylan says. "When they know you are a good doctor, doing a good job with their kid, it doesn't matter where you are coming from or what you are wearing." Many Muslim women say that one of the biggest misconceptions about their religion is that they are treated unfairly. Women are often required to cover up with headscarves to enter their mosques and pray. Many wear similar cover in public.

Still, Muslim women's attire here in the U.S. can often draw unwanted or unnerving attention from strangers.

And Dr. Caylan says she was once heckled in the middle of the street in Manhattan.

But behind the veil, Dr. Caylan says she wants what all mothers want, happiness for their children.

Sheila Nolan, MD, Chief of Infectious Disease with BCHP was recently interviewed by FOX 5 television reporter Antwone Lewis on the subject of the impact of bed bugs found in a Westchester County movie theater.

www.bchphysicians.org 9

RECOVERING fROM NEUROBLASTOMA, SIx-YEAR-OLD JOSHUA WINSLOW IS THRIVING.

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he physicians in the In addition to being ensconced in all things related to the First Grade, Joshua has also Pediatric Hematology/ discovered football. “He’s enjoying it all very Oncology and Surgery much,” his mother says. departments at BCHP are no Joshua sees Dr. Tugal four times a year strangers to sick children, yet so that she can monitor his progress. “Once they never tire of celebrating an oncology patient, always an oncology the success of a young oya tugal, MD patient,” observes Ms. Winslow. Joshua patient who, thanks to their receives scans every six months to ensure medical prowess, beats a that he is remaining cancer-free. “Once he serious illness and heads gets out of the danger zone for relapsing, home to resume a happy, they’ll just monitor him annually,” his healthy childhood. mother notes. “That will be for the rest of Such is the case of sixhis life.” year-old Joshua Winslow of Joshua is truly a success story for the Highland, New York. As Whitney McBride, MD physicians at BCHP. Yet it has been a long Joshua’s mother, Shannon and arduous road to the First Grade and to Winslow, explains it, to spend football practice with his young friends. time with the cheery, active Back in the winter of 2012, the perspective child, you’d never know that was different. “It started with a droopy eye,” he was seriously ill just a few Ms. Winslow recalls. When it persisted, she short years ago. Diagnosed took Joshua to her pediatrician, who in February 2012 with recommended BCHP’s team of pediatric neuroblastoma, a form of Mehmat fevzi ozkaynak, MD cancer specialists. “Finally a CAT scan pediatric cancer affecting revealed three lesions around his eye, so the nervous system, Joshua underwent a we went to Maria Fareri Children’s Hospital series of procedures, therapies and in Westchester County for further testing.” operations under the deft hands of lead Dr. Tugal recalls that Joshua was physician Oya Tugal, MD, a pediatric admitted after being brought to the hematologist and oncologist, and Whitney Emergency Room at Maria Fareri Children’s McBride, MD, a pediatric surgeon, both of Hospital at Westchester Medical Center. “He BCHP. Joshua was treated at Maria Fareri was limping, he was pale, and he was not Children’s Hospital. feeling well,” Dr. Tugal explains. He “Today he’s a normal six-year-old child, developed dark circles around his eyes, had and it’s awesome,” beams Ms. Winslow. In swelling over his left eye socket, and fact, Joshua entered the First Grade this complained of pain in his lower extremities. past September, after a successful year in An initial CAT scan was normal; a Kindergarten “He was excited to go to subsequent scan revealed a lesion in the school; he’s reached a lot of milestones,” orbital and temporal lobes of Joshua’s head. He had a mass in his abdomen, his right leg was swollen, and he had trouble walking. Another scan pointed to a fourinch mass on his adrenal gland. Bone and head lesions were also diagnosed. A final biopsy confirmed Dr. Tugal’s suspicion: “We made the diagnosis of neuroblastoma.” Joshua underwent several rounds of chemotherapy at 28-day intervals, as well as two rounds of stem cell transplantation. “He continued on treatment with a regimen developed by Fevzi Ozkaynak, MD, in our group and widely used in the US for children with high risk neuroblastoma,” Dr. Tugal explains. This is an immunotherapy involving tumor antigenspecific monoclonal antibody called CH14.18, along with the interleukin-2, Ms. Winslow remarked last spring as Joshua GM-CSF and cis-retinoic acid (Accutane). was still immersed in Kindergarten. “His response to the treatments was “Today,” she notes, “he’s doing fantastic.”

Specialty Referral Hotline 844-4-MD-BCHP 10

excellent,” Dr. Tugal says. “Joshua remains in remission and we are very hopeful of his outcome.” The child today is almost three years into remission. Dr. Tugal is pleased with the outcome. “It requires a lot of close follow-up, and you have to be very meticulous,” she says. “Attaining remission is very important; it’s one of the predictors of the outcome.” The surgery to remove Joshua’s tumor was performed laparoscopically, Dr. McBride explains, which calls for a radically smaller incision compared with traditional surgery. The child’s range of symptoms “were not uncommon with a neuroblastoma,” he adds. Dr. McBride conducted a biopsy and, once neuroblastoma was confirmed, prepared Joshua to be administered chemotherapy to reduce the size of the malignancy. Dr. McBride subsequently set about removing the tumor. “It was wrapped around some major blood vessels; it took over quite a large portion of the abdomen,” Dr. McBride recalls. “The chemo shrank the tumor down in size, allowing us to safely resect it.” Dr. McBride and his surgical team were able to remove the tumor without damaging any contiguous organs. “It was a challenging case, yet in many respects it was run of the mill,” Dr. McBride says. His team sees about a half-dozen such cases annually. “They can be complicated, whether they’re infants or in their teen years,” he explains. “This was a good outcome for Joshua,” Dr. McBride says, reflecting on the case. “We’re pleased with the results, and we’re happy for their family. Joshua has a Continued on page 11

RECOVERING fROM NEUROBLASTOMA

PRECISION MEDICINE AT BOSTON CHILDREN’S HEALTH PHYSICIANS

Continued from page 10

Continued from page 2

devoted mother, and he’s a cute child. It’s satisfying that I was able to help him, and that he’s doing well.” The child underwent six rounds of chemotherapy, and two stem cell transplants with a round of chemo before each transplant. He endured 20 days of radiation as well as six rounds of immunotherapy as an inpatient. Joshua was also administered Accutane, a chemotherapy drug, which he took for one year. Dr. Tugal served as Joshua’s primary physician through his diagnosis and treatment. “We saw them at the infusion center,” Ms. Winslow recalls. “Dr. McBride understood that there was so much for me to take in; he showed me each and every scan. He answered my questions no matter how many times I asked the same questions — because it’s emotionally devastating to take it all in when you’re dealing with this diagnosis.” Ms. Winslow went on a leave of absence from her job at a nursing home in New Paltz two days before Joshua’s diagnosis, when the CAT scan showed lesions around Joshua’s eye. Today she is working toward attaining her Associate’s Degree at SUNY Ulster County in Stone Ridge, with the goal of becoming a hospital social worker. “He’s reached a lot of milestones in school,” she says. Joshua will wear hearing aids for the rest of his life, and receives speech therapy due to his lack of exposure to other children, and due to his hearing loss. “But he has been doing really well,” Ms. Winslow says. “I’m very proud of him!” Joshua’s resilience, fueled by the excellent care he received from BCHP physicians, has prompted Ms. Winslow to consider starting a foundation. “It would help families in need, and promote understanding” of pediatric cancer, she says. “The foundation would raise awareness and help families that are in need. I’m a very grateful person; I want to pass that gratitude along.” BCHP

QUALITY INITIATIVES Continued from page 3

six separate categories. The non-profit National Committee for Quality Assurance has established HEDIS, or the Healthcare Effectiveness Data and Information Set, which measures performance on essential aspects of medical care and service, including the QI rating. Medical Home has emerged as a major component of the Quality Initiatives process. “With the implementation of Medical Home,

and endocrinologists at our CF Center.” The CF Foundation, like many ‘diseaseoriented’ non-profits, “found it hard to convince drug companies to work on certain diseases, especially ‘orphan diseases’,” Dr. Dozor explains. The traditional model of raising funds to allow drug companies to develop new medicines was proving untenable. “They can drop out at any time; they’re in business to make money,” Dr. Dozor says. So, he notes that the CF Foundation launched “something new and exciting that has taken the pharmaceutical industry by storm.” Tapping into a somewhat revolutionary model called ‘venture philanthropy,’ the Foundation took a percentage of ownership of a biotechnology company — in this case, Vertex, the developers of Kalydeco™ and Orkambi™. In 2014 the CF Foundation discovered a futures market in London where companies can sell future royalties from products. “They sold the royalties for $3.3 billion; that’s money they now have for research,” Dr. Dozor explains. “This is harnessing capitalism at its best to help a disease!” “They chose extremely wisely in Vertex,” Dr. Dozor observes. “They hit gold when (Kalydeco™) was approved in 2012.” But Dr. Dozor and his team still face an uphill battle when it comes to attracting patients to participate in clinical trials. “Our biggest problem is to convince parents and patients that if they want to change the future, they have to participate in clinical trials,” he says. “Presently between 5-10% of patients are doing the heavy lifting for the other 90 or 95%. I get it; it’s a little scary to sign up for untested drugs with unknown risks. These are often yearlong studies with quality goes up, costs go down, and patient satisfaction increases,” Dr. Kaseta says. Maintaining a thriving practice allows Dr. Kaseta to put much of her QI work to the test at an active site. “At Washingtonville Pediatrics, we have an 11,000-square-foot building, six doctors, two nurse-practitioners, and all the latest state-of-the-art equipment,” she explains. “Whatever I do here has to make a difference.” She cites the HPV initiative as an example. “It’s really important, and it’s something I’m very

visits every month, numerous blood tests and study procedures. And some of the patients will find out at the end that they were only taking a placebo." “One real advantage for patients that enroll in clinical trials,” Dr. Dozor adds, “is that if they prove to be both safe and effective, they’ll get early access to drugs a year or two or three before they’re available commercially. We need to encourage patients to sign up — but not give false hope. We need to explain that there are both known and unknown risks, and that not all drugs will work.” Patients also have to meet strict criteria in order to participate in trials. Not all patients who want to volunteer will be able to. “We have four new trials for CF patients starting up,” Dr. Dozor says. “Twenty-five years ago, our Center was not well known, and we would not be chosen to participate in clinical trials. Now, our reputation is well established, and I never seem to have enough staff or space.” Dr. Dozor says the work his group is achieving is exemplary, and he remains optimistic about the development of new drugs that will lengthen life spans and make every day more tolerable for those afflicted with CF. “I’m very proud of our Cystic Fibrosis Center, and of our research team; we’re responding to a real need. “I would like nothing more than to see a cure for CF,” Dr. Dozor says. The CF Foundation “is setting its sights not just on what we’re currently doing, which is controlling symptoms, it’s also focusing on the next big thing — curing the disease.” Those wishing to participate in upcoming clinical trials can contact Meighan Gallagher, Division Research Manager, in Dr. Dozor’s office, at 914-493-7585. BCHP

excited about.” Dr. Kaseta’s new role as Chief Quality Officer at BCHP finds her at executive offices at Valhalla three days a week, with the balance of her time spent visiting every BCHP office throughout the Hudson Valley and Connecticut, chiefly to institute and monitor the QI Medical Home initiative. The entire QI program, she insists, is essential to operating a competitive, high-functioning, well-implemented health care system that puts the emphasis on quality care for patients. BCHP

www.bchphysicians.org 11

Westchester County

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Pediatric Associates of Westchester 701 Bedford Road, Suite B Bedford Hills, NY 10507 • general Pediatrics – (914) 723-7444

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Central Avenue Pediatrics 1075 Central ave Scarsdale, NY 10583 • general Pediatrics – (914) 472-4300

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Pediatric Associates of Westchester 688 Post Road, Suite 232 Bronxville Women's Care Scarsdale, NY 10583 1 Pondfield Road, Suite #302 • general Pediatrics – (914) 725-5252 Bronxville, NY 10708 • obstetrics/gynecology – (914) 337-3715 Briarcliff Pediatric Associates 755 North Broadway, Suite 500 Polly Kanganis, MD Sleepy Hollow, NY 10591 4 Studio arcade • general Pediatrics – (914) 366-0015 Bronxville, NY 10708

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• obstetrics/gynecology – (914) 771-9441 Medical Service Building at Phelps Memorial Hospital Douglas Savino, MD 755 North Broadway, Suites 400 & 540 1 Pondfield Road West, Suite 7 Sleepy Hollow, NY 10591 Bronxville, NY 10708 • endocrinology – (914) 366-3400 • general Pediatrics – (914) 771-8900 • Neurology – (914) 358-0188/0190 Chappaqua Pediatrics Pediatrics of Sleepy Hollow 175 King Street 150 White Plains Road, Suite #101 Chappaqua, NY 10514 tarrytown, NY 10591 • general Pediatrics – (914) 238-8550 • general Pediatrics – (914) 332-4141 NWH at Chappaqua Crossing Village Pediatric Group 480 Bedford Rd (formerly Reader's Digest) 115 Main Street, Suite # 301 Chappaqua, NY 10514 tuckahoe, NY 10707 • Hematology/oncology – (914) 493-7997 • general Pediatrics – (914) 771-7070 • Pediatric Surgery – (914) 493-7620, (914) 761-5437 Boston Children's Health Physicians of Westchester LLP at Grasslands Road Mid Hudson Gastroenterology 503 grasslands Road, Suites 200 & 201 1985 Crompond Rd, Building D Valhalla, NY 10595 Cortlandt Manor, NY 10567 • Developmental – (914) 304-5250 • adult gastroenterology – • gastroenterology – (914) 367-0000 (914) 739-2400 • Medical genetics/Metabolic – Croton Pediatrics (914) 304-5280 130 grand Street Gastrointestinal & Hepatobiliary Consultants Croton-on-Hudson, NY 10520 19 Bradhurst ave, Suite 2550 • Developmental – (914) 304-5250 Hawthorne, NY 10532 • general Pediatrics – (914) 271-4727 • adult gastroenterology – Eastchester Pediatric Medical Group (914) 493-7337 266 White Plains Road, Suite a3 Nephrology Associates of Westchester eastchester, NY 10709 19 Bradhurst, Suite #200 • general Pediatrics – (914) 337-3960 Hawthorne, NY 10532 Hartsdale Pediatrics • adult Nephrology – (914) 493-7701 280 North Central avenue, Suite 303 Bridgespan Medicine Hartsdale, NY 10530 222 North Westchester ave, Suite 201 • general Pediatrics – (914) 472-0300 White Plains, NY 10604 Boston Children's Health Physicians of • adolescent Medicine – (914) 698-5544 Westchester LLP at Bradhurst

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19 Bradhurst avenue, Suites 800, 1400, 2400 & 2550 Hawthorne, NY 10532 • Cardiology – (914) 594-2222 • endocrinology – (914) 366-3400 • Hematology/oncology – (914) 493-7997 • infectious Disease – (914) 493-8333 • Nephrology – (914) 493-7583 • Neonatology follow-up Program – Referral only • Pediatric Surgery – (914) 493-7620, (914) 761-5437 • Psychology – (914) 493-7697 • Pulmonology/allergy – (914) 493-7585 • Rheumatology – (914) 594-2270

40 Saw Mill River Road 40 Saw Mill River Road, Suite ll-4 Hawthorne, NY 10532 • general Pediatrics – (914) 593-8850 • adolescent Medicine – (914) 304-5288 • adult/Pediatric allergy & immunology – (914) 493-7585 • Pediatric and Young Women’s gynecology – (914) 304-5254

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Caring Pediatrics of White Plains 280 Dobbs ferry Road, # 203 White Plains, NY 10604 • general Pediatrics – (914) 287-2022

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Children’s Rehabilitation Center 317 North Street White Plains, NY 10605 • Neonatology – (914) 597-4080/4115

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Peter Liebert, MD 222 Westchester avenue, Suite # 403 White Plains, NY 10604 • Pediatric Surgery – (914) 428-3533

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Westchester Park Pediatrics 222 North Westchester ave, Suite 202 White Plains, NY 10604 • general Pediatrics – (914) 761-1717

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Yorktown Specialty Center 1940 Commerce Street, Suite 206 Yorktown Heights, NY 10598 • endocrinology – (914) 366-3400 • gastroenterology – (914) 367-0000 • Sleep Medicine – (914) 493-7585 • Pediatric and Young Women’s gynecology– (914) 304-5254 or (914) 302-7758 Rockland County

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Bardonia Pediatrics 446 Route 304 Bardonia, NY 10954 • general Pediatrics (845) 623-8031

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North Rockland Pediatric Associates 171 Ramapo Road garnerville, NY 10923 • general Pediatrics – (845) 947-1772

Pediatrics and Adolescent Medicine of New City 337 North Main Street, Suite 4 New City, NY 10956 • general Pediatrics – (845) 634-7900

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Orangetown Pediatrics 30 Ramland Road - Suite 200a orangeburg, NY 10962 • general Pediatrics – (845) 359-0010

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Pomona Pediatrics 4 Medical Park Drive, Suite C Pomona, NY 10970 • general Pediatrics – (845) 362-0202

Suffern Medical Pavilion at Good Samaritan Hospital 257 lafayette avenue, Suites 370 & 390 Suffern, NY 10901 • Cardiology – (914) 594-2222 • endocrinology – (914) 366-3400 • gastroenterology – (914) 367-0000 • Medical genetics/Metabolic – (914) 304-5280 • Neonatology follow-up Program – Referral only • Nephrology – (914) 493-7583 • Neurology – (914) 358-0188/0190 • Pulmonology – (914) 493-7585

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Orange County

Boston Children's Health Physicians of Westchester at Middletown 100 Crystal Run Road, Suite 108 Middletown, NY 10941 • Cardiology – (914) 594-2222 • Developmental – (914) 304-5250 • endocrinology – (914) 366-3400 • gastroenterology – (914) 367-0000 • Hematology/oncology – (914) 493-7997 • infectious Disease – (914) 493-8333 • Neonatology follow-up Program – Referral only • Neurology – (914) 358-0188/0190 • Pediatric Surgery – (914) 761-5437 • Pulmonology – (914) 493-7585

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Orange Pediatric Associates 400 Midway Park Drive Middletown, NY 10940 • general Pediatrics – (845) 343-0728

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Pediatric Arts of Monroe 91 lakes Road Monroe, NY 10950 • general Pediatrics – (845) 782-8608

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Pediatric Care of the Hudson Valley 266 North Street, Suite a Newburgh, NY 12550 • general Pediatrics – (845) 565-5437 • endocrinology – (914) 366-3400

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Medical Center of New Windsor 575 Hudson Valley avenue, Suite 203 New Windsor, NY 12553 • Cardiology – (914) 594-2222 • gastroenterology – (914) 367-0000 • Pulmonology – (914) 493-7585

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Herbert Kania Pediatric Group 10 Ronald Reagan Blvd. Warwick, NY 10990 • general Pediatrics – (845) 986-2058 Washingtonville Pediatrics 10 Weathervane Drive Washingtonville, NY 10992 • general Pediatrics (845) 496-5437

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Putnam County

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Virgilio Monteleone , MD 263 North Brewster Road Brewster, NY 10509 • general Pediatrics (845) 279-5161

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Carmel Pediatrics 11 fair Street Carmel, NY 10512 • general Pediatrics (845) 225-7337

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Putnam Pediatrics 667 Stoneleigh avenue, Suite #111 Carmel, NY 10512 • general Pediatrics – (845) 279-5131

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Bennett Pallant, MD 906 Route 6 Mahopac, NY 10541 • general Pediatrics (845) 628-2015 Dutchess County

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Kathleen Ennabi, MD 2529 Route 52, Suite #3 Hopewell Junction, NY 12533 • general Pediatrics (845) 227-0123

Boston Children's Health Physicians of Westchester LLP at Poughkeepsie 104 fulton ave Poughkeepsie, NY 12601 • Cardiology – (914) 594-2222 • endocrinology – (914) 366-3400 • Neonatology – (914) 493 - 8431 • Nephrology – (914) 493-7583 • Neurology – (914) 358-0188/0190 • Pediatric Surgery – (914) 761-5437 • Pulmonology – (914) 493-7585

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Pediatric Sub-Specialty Center at Vassar Brothers Medical Center 45 Reade Place Poughkeepsie, NY 12601 • Cardiology – (914) 594-2222 • gastroenterology – (914) 367-0000 • Hematology/oncology – (914) 493-7997 • Medical genetics/Metabolic – (914) 304-5280 • Pulmonology – (914) 493-7585

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Boston Children's Health Physicians of Westchester, LLP at Riverdale Skyview Shopping Mall 5683 a Riverdale avenue, Bronx, NY 10471  • Cardiology – (914) 594-2222 • endocrinology – (914) 366-3400 • gastroenterology – (914) 367-0001 • general Pediatrics – (347) 843-6136 • Pulmonology – (914) 493-7585

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Pediatric Associates of North Riverdale, PC 3765 Riverdale avenue, Suite #4 Bronx, NY 10463  • general Pediatrics – (718) 548-7300

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Robin Schiff, MD 2711 Henry Hudson Parkway Bronx, NY 10463 • general Pediatric – (718) 549-6229

Boston Children's Health Physicians of Westchester, LLP at Woodlawn 4350 Van Cortlandt Park east Bronx, NY 10470 • allergy – (347) 226-6437 • Pediatric and Young Women’s gynecology – (914) 304-5254 • Cardiology – (914) 594-2222 • Developmental – (914) 304-5250 • endocrinology – (347) 226-6437 • gastroenterology – (914) 367-0000 • general Pediatrics – (718) 231-6565 • Hematology/oncology – (914) 493-7997 • Medical genetics/Metabolic – (914) 304-5280 • Pulmonology – (914) 493-7585

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Kings County

Wyckoff Heights Medical Center Family Health Center 75-54 Metropolitan avenue Middle Village, NY 11379 • Pediatric gastroenterology – (718) 894-4200

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Southern Connecticut

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Brookfield Children’s Physicians 2 old New Milford Road, Suite 2D Brookfield, Ct 06804 • general Pediatrics – (203) 489-5437

Boston Children's Health Physicians of Westchester, LLP at Danbury 67 Sandpit Road, Suite 204 Danbury, Ct 06810 • Cardiology – (914) 594-2222 • gastroenterology – (914) 367-0000 • Hematology/oncology – (914) 493-7997 • Medical genetics/Metabolic – (914) 304-5280

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Children’s Medical Group of Greenwich 42 Sherwood Place greenwich, Ct 06830 • general Pediatrics – (203) 661-2440

Spring/Summer 2016 Vol 1. No. 1

Children’s Specialty Center at Norwalk Hospital 30 Stevens avenue Norwalk, Ct 06856 • Cardiology – (914) 594-2222 • gastroenterology – (914) 367-0000 • Pulmonology – (914) 493-7585

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East Avenue Specialty Center 148 east avenue, Suite 2N Norwalk, Ct 06851 • gastroenterology – (203) 853-7170 • Pediatric and Young Women’s gynecology – (203) 838-5054

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Ridgefield Pediatric Associates 38B grove Street Ridgefield, Connecticut 06877 • general Pediatrics – (203) 438-9557

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Tully Health Center 32 Strawberry Court, Suite 7 Stamford, Ct 06902 • Pediatric and Young Women’s gynecology – (914) 304-5254 • gastroenterology – (914) 367-0000 Suffolk County

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Branch Pediatrics and Adolescent Medicine 300 east Main Street, Suite 4/5, Smithtown, NY 11787 (631) 979-6466

BCHP Newsletter is published two times a year by Boston Children's Health Physicians (formerly CWPW). Skyline Suite # 1N-C08, 40 Sunshine Cottage Road, Valhalla, NY 10595 • Phone: 844-4-MD-BCHP www.bchphysicians.org

New Jersey

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Herbert Kania Pediatric Group Bald eagle Commons 179 Cahill Cross Road, Suite 210 West Milford, NJ 07480 • general Pediatrics – (973) 728-4480

Specialty Referral Hotline

Please contact our one-call concierge service for specialty appointment scheduling! 844-4-MD-BCHP (1-844-463-2247)

leonard Newman, MD, President Michael H. gewitz, MD, Vice President gerard Villucci, Chief executive officer Publisher: Yaeger Public Relations editor: Harold Clark art Director: Denise Stieve

Skyline Suite #1N-C08 • 40 Sunshine Cottage Road • Valhalla, NY 10595

Welcome to BCHP We are pleased to announce that we have three new affiliates that have recently joined Boston Children’s Health Physicians: Caring Pediatrics of White Plains, PC

Led by Vanessa Sukra, MD, Caring Pediatrics of White Plains, PC is located at 260 Dobbs Ferry Road, Suite 203, White Plains, New York, 10607.

Ridgefield Mid-Hudson Gastroenterology Associates Pediatric Associates

Led by Herman Kleinbaum, MD, and Mitchell Josephs, MD, Mid-Hudson Gastroenterology Associates is located at 1985 Crompond Road, Building D, Cortlandt Manor, New York, 10567.

Led by Anil Britto, MD, Jane Brotanek, MD, Joanne Angiello, MD, and Eitan Kilchevsky, MD, Ridgefield Pediatric Associates is located at 38B Grove Street, Ridgefield, Connecticut, 06877.