3 Hospital Plaza, Suite 200
Old Bridge, NJ 08857


“If man were meant to fly…” goes the old saying, yet for most of us, flying is a safe way to travel. But the pressurized cabin can potentially affect passengers with existing or sometimes unknown medical conditions, says family medicine physician Jennifer Turkish, M.D., and can cause problems for passengers who have recently undergone surgery or have abdominal health problems, or blocked ears or sinuses.
In passengers suffering from heart or lung disease, or blood disorders such as anemia, lower cabin oxygen levels can lead to oxygen deprivation, or hypoxia.
Before you board, Dr. Turkish suggests checking with your physician if you are experiencing any of the following:
• Heart attack, heart failure, angina or stroke.
• Chronic bronchitis or emphysema, pneumothorax (a collapsed lung), pulmonary embolism or asthma epilepsy
• A recent head injury
• Stomach or bowel problems
• Cancer
• An infectious disease
• Ear or sinus pain
• Pregnancy
• Limb injuries, including fractures
• Psychiatric problems
• Any recent surgery
Dr. Turkish urges anyone flying to take simple precautions: “Good hand washing can keep germs at bay. Use hand wipes on food trays, seats and seat belts.”

DEEP VEIN THROMBOSIS – A Serious Health Threat

Deep Vein Thrombosis (DVT) is a blood clot that forms in a deep vein, usually in the legs. “The clots can break loose and travel through the bloodstream to the lungs,” says Dr. Turkish, “leading to a potentially life-threatening pulmonary embolism and long-lasting vein damage.”
Each year, between 350,000 and 600,000 people develop a blood clot in the legs or lungs. Symptoms include swelling and redness, warm or achy limbs, and pain that remains constant. If the blood clot is small, it may not cause these symptoms but can go directly to the lungs. Your doctor can identify your risk of DVT and treat it with medication.
Prevent DVT during flight by walking up and down the aisle hourly, pointing your feet and toes every 20 minutes, and drinking plenty of water. Those at risk of DVT may be advised by their physician to wear compression stockings during journeys longer than eight hours.
You May Be At Risk of DVT if You:
  • Have prolonged bed rest
  • Have an inherited condition that inhibits blood clotting
  • Have had recent surgery or injury
  • Have cancer, even during treatment
  • Are paralyzed from a spinal injury
  • Are currently using hormone therapy
  • Are pregnant or have recently given birth
  • Have varicose veins
  • Have a history of heart attack or stroke
  • Have inflammatory bowel syndrome
  • Smoke or are obese


As use of drugs and alcohol by teens increases across the U.S., it’s important for parents to establish an open dialogue with their children as they explore tobacco, alcohol and prescription or illegal drugs.
“No child is immune,” says psychiatrist Danielle Parisi, D.O. “We can’t rely solely on law enforcement or schools to protect our children from becoming victims of substance abuse. While we should all work together, parents need to model the behavior we expect from our children. Begin talking early about smoking, drugs and alcohol, and continue talking as your children get older. It’s a sad reality that individuals who do become addicted often have their first experiences at a young age.”
Here are a few practical suggestions to help you talk with your teen:
  1. Take a stance of curiosity rather than control. So often we try to convince, coerce, and control our teens, which evokes an immediate defense. Seek to ask, understand, and align with your teen’s curiosities, desires and decisions. This does not mean you agree with your teen, but you are helping to explore these life decisions.
  2. Be realistic as you discuss the possible consequences of substance abuse. It is tempting to use scare tactics, but keep your conversations realistic. Help your child build an attitude resistant to drug use. Create significant consequences to discourage exploration of inappropriate substances.
  3. Know your teen’s friends. Playing an active role in your child’s life is a proven way to help prevent underage drinking and drug use. Find ways to be involved in their daily lives. Encourage them to have friends over, but don’t allow your child to go to parties, sleepovers or other activities that aren’t supervised by an adult you trust.
  4. Talking with your teen early is one of the best ways to avoid problems later. The average onset of first use is 14 years old, so consider having these conversations by 12 years old.
If your child is exhibiting behaviors that are concerning, or if you suspect that he or she has already developed a substance abuse problem, talk with your physician and seek help for your child and your family. Some kids may have an underlying, undiagnosed anxiety or depression disorder and use drugs to self-medicate.
“If you are concerned about your child’s behavior or possible substance abuse, or if you feel as though your child could benefit from having someone other than a parent to talk with, schedule a consultation with a behavioral health professional,” urges Dr. Parisi.
To make an appointment at Bay Behavioral Health, call 732-324-5199.


If you think that heart health is something only older people need to think about, first know the numbers.
“Heart disease is still the number one killer of men and women over age 20,” says family medicine physician Sandra Arango- Fahmy, D.O. “There are steps you can take – starting right now – that will help you keep your ticker in tiptop shape. Schedule an annual physical today and ask your doctor to help you improve your heart health.”
Start by learning your family history of heart disease, says Dr. Fahmy. “Like so many other health conditions, your genes influence your heart disease risk. Fortunately, making lifestyle changes can dramatically lower the likelihood of repeating your family’s heart health history.”
You can count on one hand these simple tips to keep your ticker in tiptop shape:
Know Your Numbers.
“You owe it to yourself to take an active role in your own health,” says Dr. Fahmy. Your doctor can test your cholesterol and blood pressure through a simple screening. If the numbers aren’t optimal, along with your weight, your doctor can help bring them in line by recommending medication, and diet and lifestyle changes.
Quit Smoking For Good.
As soon as you go cold turkey your heart will start rebounding. Smoking dramatically increases the risk of heart disease and is one of the most preventable causes of premature death. In addition, when you stop smoking, you help lower your blood pressure and lower your LDL (bad) cholesterol. “If you want to live longer, stop smoking. There are many smoking cessation programs and support groups available to help you kick the habit of tobacco dependence,” says Dr. Fahmy. Even being around smoke increases the risk for heart disease and death. Avoid secondhand smoke whenever possible.
Process Out Processd Foods.
In 2013, try switching out just one processed food each month for something you make yourself. Switching over from processed foods, which are usually high in sodium, can make a big difference in your blood pressure and overall health. Load up on salads and whole grains, keep salt and sugar to a minimum, and of course, control portions to keep weight gain to a minimum.
Get Moving.
Your heart is a muscle and like all muscles, working it out keeps it healthy by strengthening tissue and improving circulation. “It’s easy to be sedentary,” says Dr. Fahmy, “particularly if you drive to work and sit at a computer all day. Small steps can make a big difference.” Try parking further away from the office, choosing the stairs, taking a walk after lunch and standing up every hour at your desk to stretch. If you have a pedometer, aim for 10,000 steps a day. If not, try to get 20 to 30 minutes of moderate activity a day, or 150 minutes a week.
Spread Awareness.
It still comes as a surprise to many people when they learn that heart disease is the number one killer of men and women over age 20. It’s up to all of us to inform our circle of family and friends about heart risks and the actions a person can take to minimize those risks. What seems like a simple conversation could save someone’s life.


Our body’s natural stress response – the “fight or flight” response – was meant to protect us against predators. Such threats are rare today, but that doesn’t mean that our lives are stress-free.
We each face multiple stresses every day, such as huge workloads, making ends meet, and just getting through the rush hour. Our bodies react to too much stress by pumping out increased levels of hormones, including adrenaline and cortisol. The long-term activation of the stress-response system — and the subsequent overproduction of hormones —disrupts our body’s processes and puts us at increased risk of heart disease, digestive issues, sleep problems, obesity, depression, memory impairment, and chronic skin conditions, such as eczema. “We can fight back,” says mental health counselor Jennifer Rerngsamai, LCSW. “We don’t have to let stress control our lives.”
Jen suggests carving out time to unwind, even if it’s just taking a break with your iPod. “Make time to do something you enjoy every day,” says Jen, “even if it’s just for half an hour. Schedule the time on your calendar, just like a regular appointment.”
Jen also advises list-making. “We unburden ourselves by putting our ‘to dos’ down on paper, and we derive a sense of accomplishment as we check items off our list.” Set limits on what you can reasonably do for others.
Getting enough sleep, eating a healthy diet, and exercising to increase endorphin levels also help handle stress.
When You’re Too Stressed
“If someone recognizes that their stress level is more than they can handle, it’s time to see a counselor who can guide you step by step to improve both your mental and physical well being,” says Jen. “We can help you to set goals, work through obstacles, and assess medications for better overall health. Call for an appointment. You don’t have to do it alone.”
Call for an appointment at Bay Behavioral Health:
Perth Amboy (732) 324-5199
Old Bridge (732) 360-0287

Lowering Your Stroke Risk

Risk factors are things that make you more likely to have a health problem,” says family medicine physician, Sandra Fahmy, M.D. “You are at risk for a stroke if you have high blood pressure, but your risk is even higher if you have high blood pressure and are over the age of 50.” Use the quiz to the right, from the American Stroke Association, to learn your risk factors for stroke. The more “yes” answers, the higher your potential risk for stroke. 

“By learning your risk factors, you and your doctor can devise a plan to reduce your chances of having a stroke,” says Dr. Fahmy. “There’s a lot you can do to help prevent stroke. Watching what you eat and being physically active are high on the list.”

Stroke is the fourth leading cause of death in the U.S. and the number one cause of adult disability. The most effective treatment for stroke is to prevent it from happening in the first place. High blood pressure is the top risk factor for stroke. Have your blood pressure checked regularly, advises Dr. Fahmy, and follow your doctor’s recommendations for medication and lifestyle changes. If you smoke, get help to quit.

“The consequences of stroke can be severe,” says Dr. Fahmy. “Preventative measures become the main line of defense against the conditions that invite stroke. Together, you and your doctor can form a treatment plan to reduce your risk of stroke.”

  • Do you smoke?
  • Do you have high blood pressure?
  • Do you have high cholesterol?
  • Do you have atrial fibrillation?
  • Do you have diabetes?
  • Are you African-American?
  • Are you older than 50?
  • Are you overweight?
  • Do you walk or exercise fewer than three times a week?
  • Do you often eat greasy, fried or salty foods?
  • Do you have more than two alcoholic drinks a day?
  • Have your mother, father, sister, brother or grandparent had a stroke; or your father or brother had a heart attack before age 55; or your mother or sister had a heart attack before age 65?
  • Have you been told that you have carotid artery disease, or have had a stroke or TIA (transient ischemic attack); or have disease of the leg arteries, a high red blood cell count, or sickle cell anemia?

Your Thyroid: Too Much or Too Little?

The thyroid gland is a bowtie-shaped organ in your neck, below the larynx. It secretes hormones that control how fast your heart beats, how quickly you digest food, how much you sweat, the speed at which you burn calories, and many other activities, according to the American Academy of Otolaryngology. Millions of people in the U.S. have thyroid diseases. Most of them are women.

“The thyroid is one of the endocrine glands in the body;” says family medicine physician Jennifer Turkish, M.D. “Thyroid disorders can range from a small, harmless goiter to life-threatening cancer. Most frequently, thyroid disease affects the hormone levels that govern your body’s metabolism.”

“If you have a thyroid disease,” says Dr. Turkish, your body uses energy more slowly or quickly than it should. A thyroid gland that is not active enough, called hypothyroidism, is far more common. It can make you gain weight, feel fatigued and have difficulty dealing with cold temperatures. If your thyroid is too active, it makes more thyroid hormones than your body needs. That condition is hyperthyroidism. Too much thyroid hormone can make you lose weight, speed up your heart rate and make you very sensitive to heat.”

“Because the symptoms of thyroid conditions can be very subtle, I urge patients to have their thyroid checked annually as part of an annual physical,” says Dr. Turkish. “A physical exam can identify enlarged thyroids and nodules, and a simple blood test can diagnose hormone levels. Your physician can then prescribe medication to reset your body’s metabolism to its normal rate.”

Varicose Veins? Give Your Legs The Care They Deserve

Varicose veins and spider veins are common disorders affecting up to half of all adults in the U.S. over age 50.

Veins return blood to the heart from throughout the body. “Leg veins have an especially uphill battle as they must overcome the pressures of body weight and the force of gravity to do their job,” says family medicine physician Sandra Arango-Fahmy, D.O. “Normally, one-way stop valves in the veins prevent blood from flowing downward, but if the valves  become weak, blood can leak backward and cause congestion of the vein, causing it to enlarge and leading to varicose or spider veins,” says Dr. Fahmy.

Varicose veins are dark purple or blue in color, protrude from the skin surface and appear twisted like rope. Spider veins are small red, blue or purple veins on the skin’s surface. Symptoms of varicose veins include pain, fatigue, heaviness, aching, burning, throbbing, swelling, itching and restless legs. While these conditions are not life-threatening, they can lead to painful eczema, inflammation and ulceration, in addition to being unsightly. In some cases, veins become swollen or inflamed, leading to a condition called thrombophlebitis.

Many factors increase a person’s chances of developing varicose or spider veins. “Increasing age, family medical history, obesity, lack of movement, hormonal changes, sun exposure and pregnancy can contribute to the development of vein disorders,” says Dr. Fahmy.

Thanks to highly effective, minimally invasive procedures, varicose and spider veins can usually be treated on an out-patient basis. Jennifer R. Syrek, M.D., a vascular surgeon on staff at Raritan Bay Medical Center, offers diagnostics, evaluation and treatment for varicose and spider veins. “Using stateof- the-art equipment and the latest laser and other techniques, we can determine the site of valve malfunctions and then help patients decide on the best individual treatment options,” she says.

Your Passport to Healthy Travel Worldwide

Passport? Luggage? Pre-travel immunizations, counseling and medication? You may not be ready to go if you haven’t consulted your physician to help protect you and your family.

“Good health is key to memorable vacations,successful business trips and other factors that mightcause you to travel, including volunteer and mission trips abroad, adoptions, and government work assignments outside the U.S.,” says family medicine physician Jennifer Turkish, M.D.

“Your physician will review your medical history and itinerary, then administer and prescribe immunizations and medications to reduce your risk of illness,” says Dr. Turkish.

Your physician can also discuss risk management during yourtrip, including travel-specific health hazards, such as food and water precautions, insect bite prevention and medications to prevent motion sickness, travelers’ diarrhea and for protection in malariaendemic areas. Some travelers might also want to take extra precautions while on a cruise, traveling extensively by air, or visiting extreme climates or high altitudes.

“Travelers can also help themselves,” says Dr. Turkish. “Take adequate supplies of prescription medications in original containers with you, along with a copy of the prescription. Anyone with a history of heart disease should carry a baseline EKG with them to facilitate onboard or overseas medical care, should it be required.”

When To See Your Physician Before You Travel
The Centers for Disease Control and Prevention (CDC) recommend that you make an appointment with your physician four to six weeks before your trip for advice on the travel medicine, information and immunizations you need before you travel.

Most vaccines take time to become effective in your body and some vaccines must be given in a series over a period of days or sometimes weeks. If it is less than four weeks before your departure, you should still see your doctor. You may still benefit from shots or medications and other information about how to protect yourself from illness and injury while traveling.

Some immunizations are routine, some are required, and some are recommended, depending on your destination. Infants and children, adults, senior citizens and anyone with altered immunocompetence due to illnesses such as diabetes or HIV have different needs. Your physician can help you decide what’s best for you.

For more information on required and recommended vaccines for travelers to specific countries, visit the Centers for Disease Control and Prevention (CDC) at http://wwwnc.cdc.gov/travel/page/vaccinations.htm.

Understanding ADHD

“If a child is exhibiting a combination of lack of attention at home and school, hyperactivity and impulsive behavior, it may indicate ADHD, or attention deficit hyperactivity disorder,” says
board certified psychiatrist Nanditha Krishnamsetty, M.D.

“Too often, difficult children are incorrectly labeled with ADHD. On the other hand, manychildren who do have ADHD remain undiagnosed,” Dr. Krishnamsetty says.

“For ADHD to be diagnosed, the symptoms must be out of the normal range for a child’s ageand development, and they must be causing significant difficulties in many settings, including home, school, and in relationships with peers.”

Inattentive symptoms can include difficulties organizing tasks and activities. Hyperactivity can include running about in inappropriate settings and constant fidgeting. Blurting out answers
before questions have been completed and interrupting others are signs of impulsivity.

“If ADHD is suspected, the child should have a thorough evaluation by a psychiatrist and psychologist as well as parent and teacher questionnaires, plus a physical check-up by the child’s pediatrician,” says
Dr. Krishnamsetty.

“Treating ADHD is a partnership between the health care provider, parents or caregiver, and the child. A combination of medication and behavioral treatment often works best.”

“You want to think long-term for your child,” continues Dr. Krishnamsetty, “providing them with the ability to finish school and maintain their self-esteem. Children with untreated ADHD can become angry and depressed. They may fall victim to drug and alcohol abuse, failure in school, and have problems keeping a job. With treatment, we can help prevent the complications of low self-esteem and depression, and put children on the path to a better quality of life. As adults, while they may continue to have troublesome symptoms of inattention or impulsivity, they can become more capable of controlling behaviors and compensating for these difficulties.”

“There is no way to prevent ADHD but early identification and treatment can prevent many of the problems associated with ADHD,” Dr. Krishnamsetty concludes.