Josyann Abisaab

Winter is fast approaching, and along with cold, stormy weather comes the influenza virus. To be more accurate, the flu is actually a group of many different viruses which all cause similar symptoms. Each winter international teams of researchers and doctors estimate which types and strains of viruses will spread the most widely throughout the world in any given year, and then vaccines are prepared to protect against the three  strains of flu considered most dangerous or likely to spread worldwide.

There are three ways to receive a flu shot which are delivered via  needle, usually in the arm: the normal shot which is approved for all people older than 6 months; a high-dose vaccine which is approved for those over 65 years old; and an intradermal shot for those between 18 and 64 years old.

Also available for use in healthy people ages 2 to 49 who are not pregnant is the nasal-spray flu vaccine. This is made with live, but weakened flu viruses, as opposed to the ‘shot’ which uses killed viruses. The nasal spray is also called LAIV, which stands for “Live Attenuated Influenza Vaccine.”

The best time to get vaccinated is as soon as the vaccine comes available. It takes about two weeks after administration of the shot to develop immunity to the flu, so the sooner the vaccine is given, the sooner people are protected. However, just because it may be late in the season is not a reason to refrain from getting the flu shot. The CDC recommends getting vaccinated from October all the way to May, reasoning that different viruses circulate in different places at different times, and it is always wise to get protection.

Josyann Abisaab, MD wishes all a healthy flu season this winter.

Knowing when to go, and when to refrain from going to the emergency room can not only save you time, and money, but it can also save your life.

When the flu strikes there is no question that you should be examined by a health care professional, but the question is how urgent is it that you are checked immediately, or can you wait to make a short-notice appointment with your doctor?

The determination of whether or not to go to the emergency room should be based on how ill you are. Also, if there are other chronic conditions present as well. For instance, if someone with diabetes, asthma, COPD or congestive heart failure develops flu symptoms, he/she should be seen within one day by their regular doctor. If a short-notice appointment cannot be made, then a trip to the emergency room is in order.

Pregnant women should also take the flu seriously, more so than non-pregnant women. Other generally healthy people, including children are usually better off staying home, even if they are not eating during their illness. As long as the patient is holding down liquids, there is no immediate health threat if a person, including a child, does not eat for a week, or even two.

The following symptoms may indicate that the patient may need antiviral drugs like Tamiflu, or even the need for hospitalization:

•    Fever of 102 degrees or higher
•    Serious fatigue
•    Stubborn cough with either yellow or green phlegm
•    Difficulty breathing, shortness of breath
•    Confusion
•    Feeling light-headed or thirsty from dehydration which can be caused by vomiting and/or diarrhea.

Josyann Abisaab, MD, is an emergency room physician at New York-Presbyterian, as well as an Assistant Professor of Clinical Medicine at the Weill Cornell Medical College.

NewYork-Presbyterian Hospital/Weill Cornell Medical Center

New York-Presbyterian Hospital offers New Yorkers and others from nearby locations cutting edge emergency medical care at no less than three locations: Weill Cornell at 525 East 68th Street; Columbia Hospital at 622 West 168th Street; and at the Allen Hospital at 5141 Broadway at 220th Street.

New York-Presbyterian Hospital prides itself on its goal to provide the highest quality care possible, using the most modern and cutting edge techniques and equipment available, to all New Yorkers no matter their background. The emergency medical facility also offers quaternary referral centers for those arriving at the emergency room with complicated medical or surgical issues from all over the globe.

Josyann Abisaab, MD, is an emergency room physician at New York-Presbyterian, as well as an Assistant Professor of Clinical Medicine at the Weill Cornell Medical College. In her capacity as a physician working in the front lines of emergency care, Dr. Josyann Abisaab is able to bring back to the classroom the lessons of the emergency room. This is just one part of the uniqueness and strength that makes New York-Presbyterian Emergency Medicine strategically positioned, in both the academic and clinical realms, to advance successfully into the future of state-of-the art emergency care.

Due to increased need for all aspects of health care to cut costs, emergency rooms are relying more and more on the services of what are called physician’s assistants, (PAs.) PAs can diagnose and treat patients, and their lower cost can help keep the price of running an emergency room down while helping to speed up the turnaround time for patients.

Until recently most PAs worked in family practice medicine. However, between 1996 and 2008 the percentage of PAs working in this area decreased substantially from almost 40% to only 26%. The decrease is attributed to the move of PAs from family practice to emergency room practice as their presence in the emergency room became more accepted while patient use of emergency rooms went up during the same period by 32%.

Patients should always be aware who is treating them, and whatever diagnosis that is made should be verified with a staff physician.

Josyann Abisaab, MD is an emergency room physician practicing in the Columbia Presbyterian Medical Center in New York City.

The question of when a visit to the emergency room is warranted and when to just go to the doctor or wait it out is sometimes a difficult one, especially with children. According to Elda Ramirez, PhD, RN, you should bring your child in after an injury if you feel at all uncomfortable. She believes in trusting the parents’ instincts about their children’s health.

“You know your kid, how they respond, how they behave. Better to be sent home from the ER than to have wished you had made the trip,” says Ramirez, an associate professor of clinical nursing for emergency nurse practitioners at The University of Texas School of Nursing at Houston.

The types of injuries or illnesses that can happen are many and each one must be assessed with care. These emergencies include, but are not limited to:

1.    Head injuries- any loss of consciousness, vomiting, sleepiness is a sign of a concussion and should be checked. Lacerations with head injuries indicate a hard impact and should also be attended to. But even without loss of consciousness, if your child just doesn’t seem to be “herself” could be a good enough reason for a visit to the emergency room.

2.    Bone and spine injuries- injuries of the spine, especially the neck should be examined by a doctor. Numbness, tingling or lingering pain is suspicious. Broken bones which are obvious, such as legs bent backwards or bones sticking up out through the skin not only require the emergency room, but transport there in an ambulance. If the tips of the fingers or toes or blue or whitish, this can indicate a break and needs immediate attention.

3.    Stomach ailments- don’t let a “mere stomach-ache” catch you off guard. Yes, usually it is just a tummy ache, but if there is severe vomiting or diarrhea in which fluids are not retained by the body, it is crucial that children or older people be seen within 24 hours. Dehydration can be life threatening, and can happen with lightning speed.

Josyann Abisaab is an Assistant Attending Physician at New York Presbyterian Hospital, where all these injuries and illnesses, and a lot more, are treated by her and the expert staff of doctors found there. The bottom line is to be cautious and alert to the signs of illness or serious injury, and respond responsibly and promptly.

We all hope to never have to visit an emergency room, but if you ever do find that you need to visit it is better to come there prepared than not, so that your time there is as productive and pleasant as possible. We hope these tips will also make your visit as safe as possible and help save you money, too.

Prepare in advance a folder with all your medical information such as past doctor visits, tests you have taken, medicine you use, allergies you may have, any vitamins or other nutritional supplements you may be taking, and all other relevant information that could help a doctor know about you and your state of health without having to discuss it with you. You may be in pain or be nervous, and you might forget to tell the doctor something, or not want to talk at all.

Find out from your health insurance company which hospitals your insurance will pay for and keep this list in a handy place so you don’t have to search for it when the emergency arises.

When you go to the ER be sure to bring with you the folder you prepared in advance, and come expecting to have to wait. Many emergency rooms are extremely busy places. The ER at New York Presbyterian Hospital where Josyann Abisaab is on staff is one of the country’s busiest and best. Although you can expect excellent care in such a place, you may have to wait for it. Therefore it is a good idea to come prepared for such an eventuality with comfort items like  water, hand sanitizer, coins for vending machines and pay phones (if you don’t have a cell phone), tissues, snacks, something to read.

There are many reasons people visit emergency rooms- such as the ER at New York Presbyterian Hospital where Josyann Abisaab is an emergency room physician. Often young children are brought in due to fever, pain, runny nose, which could very likely be caused by an ear infection, also called acute otitis media. This illness happens to be the most common reason doctors prescribe antibiotics for children in the United States. It is estimated that more than 15 million prescriptions for antibiotics are written each year to treat ear infections at a cost of millions of dollars.

About two thirds of cases of AOM are caused by bacteria, with the remaining due to viral infection. AOM is an illness that affects mostly young children, with very few cases in children over five years old. According to an article published in the American College of Emergency Physicians’ Newsletter, if AOM goes untreated, 80% of the cases will resolve on their own, with no medical intervention needed.

Therefore it is relevant to ask the question if it is good medical practice to prescribe antibiotics every time a child presents with a runny nose, a slight fever and a tympanic membrane only slightly erythematous. Of increasing concern is the growing worldwide problem that overprescribing of antibiotics has led to an increase in the prevalence of antibiotic-resistant bacteria, making many illnesses that used to be easily treatable more dangerous, and even deadly in some cases.

In the Netherlands physicians have been treating AOM with a different strategy for the past 20 years. Instead of immediately prescribing antibiotics to children with AOM, they instead treat the symptoms of pain and fever with analgesics and antipyretics such as ibuprofen or acetaminophen and observe the patient for 2-3 days. Only in the few cases in which the child does not improve or gets worse during those 2-3 days, are antibiotics prescribed.

Due to this practice the number of patients prescribed antibiotics is much reduced, amounting to only 31% of the cases and the occurrence of the resistant strain of S. pneumonia is only 1%. This is an important achievement and worth emulating in the United States.

Dr. Josyann Abisaab is an Assistant Attending Physician at New York Presbyterian Hospital in New York City. In addition, she is an Assistant Professor of Clinical Medicine in the Department of Internal Medicine at Weill Cornell Medical College in New York City.  She has held both of these positions since 1992.

Educated at the American University of Beirut in Lebanon where she received a Bachelor’s of Science Degree, Dr. Abisaab went on to complete her medical degree at the University of Rochester School of Medicine.  Her numerous academic honors included receiving the Janet H. Glasgow Memorial Achievement Citation and being part of the Alpha Omega Alpha Honor Society.

She is board certified by the American Board of Internal Medicine, the American Board of Emergency Medicine and by the State of New York. She is affiliated with the American College of Emergency Physicians (ACEP), the American Medical Association (AMA), and the American Board of Emergency Medicine (ABEM).

Dr. Abisaab, along with N. Nevadunsky and N. Flomenbaum, published an article which appeared in the November, 2004 issue of the Annals of Emergency Medicine: “Emergency department presentation of bilateral carotid artery dissections in a postpartum patient”.