What is Dry Drowning and Secondary Drowning?

The idea that your child could “drown” on dry land is admittedly terrifying, and makes many parents feel helpless. But these rare incidents can be prevented. Get the facts you need to help keep your kids as safe as possible in and out of the water.

The terms “dry drowning” and “secondary drowning” (also called submersion injuries) are often used interchangeably but they’re actually different conditions. In dry drowning, someone takes in a small amount of water through his or her nose and/or mouth, and it causes a spasm in the airway, causing it to close up. In secondary drowning, the little bit of water gets into the lungs and causes inflammation or swelling that makes it difficult or impossible for the body to transfer oxygen to carbon dioxide and vice versa. Dry drowning usually happens soon after exiting the water, but with secondary drowning, there can be a delay of up to 24 hours before the person shows signs of distress.

Dry drowning and secondary drowning incidents, while incredibly scary, are rare and account for only about 1 to 2 percent of drowning incidents. Dry drowning or secondary drowning (submersion injury) doesn’t happen out of nowhere. You’re going to see warning signs.

No matter your child’s age, be on the lookout for:

  • Water rescue. Any child pulled from the pool needs medical attention.
  • Coughing. Persistent coughing or coughing associated with increased work of breathing needs to be evaluated.
  • Increased “work of breathing.” Rapid shallow breathing, nostril flaring, or where you can see between the child’s ribs or the gap above their collarbone when they breathe, means they’re working harder to breathe than normal.
  • Sleepiness. Your kid was just excitedly playing in the pool, and now he/she is fatigued? It could mean not enough oxygen is getting into to her blood. Don’t put them to bed until the doctor gives you the go-ahead.
  • Forgetfulness or change in behavior. Similarly, a dip in oxygen level could cause your child to feel sick or woozy.
  • Throwing up. Vomiting is a sign of stress from the body as a result of the inflammation and sometimes a lack of oxygen, also from persistent coughing and gagging.

Any time you’re concerned about your child and think he could have symptoms of dry or secondary drowning, whether you’re in your backyard pool or on a beach vacation, call the pediatrician right away for advice. Your child’s doctor should be able to talk you through it and might advise you to go to the hospital, a primary care doctor, or an urgent care center.

Prevention is the same for dry drowning and secondary drowning as it is for any other kind of drowning:

  • Swim lessons. Kids who are comfortable and skilled at moving around in the water are less likely to go under and take in water. Around age 4 is a good time to start.
  • Supervision. Monitor kids closely in and around the water, and enforce pool safety rules.
  • Water safety measures. Children should wear floatation devices on boats; pools should have four-sided fencing around them; and you should never leave standing water where a child could get into it.

As long as you practice water safety, pay close attention to your kids after swimming, and get them checked out if you notice any signs of trouble breathing, you shouldn’t have to stress about dry drowning or secondary drowning.

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Healthy Beginnings: Giving your baby the best start





Marian Seliquini, CM, LM, MS

The childbearing year is an incredible journey. Pregnancy, birth, and the early days with a new baby are significant and unique events in the life of any woman. This is a time full of huge physical, emotional, and psychological changes. Standard prenatal care appointments address important medical needs, but we know that women welcome the chance to engage more deeply during this time. With that in mind, Cornerstone Family Healthcare is excited to launch Healthy Beginnings, a new prenatal group program for patients receiving prenatal care in the Ob/Gyn department of our practice.

This program will consist of two sessions, with each session meeting monthly. Session 1, Pregnancy ABC’s, is aimed at women in the beginning of pregnancy and focuses on normal pregnancy changes, coping with common discomforts, healthy pregnancy habits, and stress reduction. Session 2, Birth and Baby’s First Days, is aimed at women in their third trimester and focuses on preparation for labor and birth, breastfeeding basics, early newborn care, and postpartum expectations. At all sessions, an Ob/Gyn provider is present for health assessments, healthy snacks are available, and local resources are highlighted.  Most importantly, these sessions aim to bring women together to share their experiences with each other. Whether expecting her first baby or her third (or her fifth!), every woman has something to share which is of value to the other participants in the group.

More information about the Healthy Beginnings program, including our current schedule of meetings, is available by contacting Cornerstone’s Health Educator at (845) 563-8043. Stay tuned for updates on this program!

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Men’s Health Month





Allan M. Fernandez, MD, Cornerstone Family Healthcare

It’s that time again where we celebrate men’s health for the month of June. There are many conditions we can discuss that would pertain to men’s health such as the prostate, cardiovascular health, diabetes, adequate sleep, smoking and drinking, etc. However, the most important element of all is having your routine visit with your primary care provider. They would know what to look for, what to screen for, and above all, what to treat for.

When we think of men’s health, one of the health conditions we often think almost immediately is prostate cancer. According to the Center of Disease Control (CDC), prostate cancer is the most common non-skin cancer among American men. Over 30 million men suffer from prostate conditions that impact their quality of life. Each year over 230,000 men will be diagnosed with prostate cancer and about 30,000 will succumb from it.

Two common ways of screening for prostate cancer is either through a Digital Rectal Exam (DRE) and/or checking for prostate specific antigen, otherwise known as PSA. According to the American Cancer Society, average-risk men are typically screened after the age of 50. However, men with higher risk, such as those with a family history of prostate cancer or exposure to carcinogens, are typically screened at an earlier age. When your provider performs a DRE, they are determining the size, shape, and contour of your prostate.  Normally, it is often described as a smooth walnut-sized gland. If there are any abnormalities, further studies need to be conducted. In addition, a PSA can also be checked and as a rule of thumb, higher levels of PSA may pose an issue. Keep in mind that there are several factors that can cause an elevation of PSA such as age, race, enlarged prostate, medications, and infections. As you can see, the list is endless. A simple visit with your provider and discussing options is likely the better decision.

According to the U.S. Department of Health and Human Services, men are more likely to smoke, drink, make unhealthy risks or choices, and put off regular checkups and medical care. By not caring for your health, you may be limiting your life expectancy. On the other hand, by seeking care for your health by getting screening tests that are right for you, making sure you are up to date on important shots/vaccinations, watching out for signs of health problems like diabetes or depression and eating healthy and staying active may be the best choice. It is never too late to start healthy regardless of age.  By making a fresh start or even continuing your healthy lifestyle, you reduce your blood pressureblood sugarscholesterol, and weight. With an active and healthy lifestyle, you decrease your chances of diabetes mellitus type 2 and cardiovascular disease.

Keep in mind that preventative medicine is the best medicine. Most people think that visiting your primary care provider is for when you get sick, however, we are also here to prevent you from getting sick. Don’t be embarrassed to talk about your health and your concerns. We, at Cornerstone Family Health are here to help. As experienced health professionals, we are here to answer your questions and provide you with the best health care.

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Exercising in the Heat

As the weather gets warmer and summer quickly approaches, it is important to know how to enjoy being active in the heat as well as how to stay safe in the heat. Don’t let the heat interfere with your personal fitness goals. Follow the tips below to exercise safely in hot weather.

      1. Drink plenty of water!

Exercising in hot weather increases our body temperature. Our bodies have built-in cooling systems that help us adjust to heat. That’s why we perspire, but this natural cooling system can fail if we’re exposed to soaring temperatures for too long. The result may be heat exhaustion and even heat stroke. To keep cool, make sure that you’re drinking plenty of water. Since our bodies are about 50 to 60% water, it is vital to maintain this amount. We tend to lose about 2 to 3% during typical exercise and activity, especially on hot days.

Also know that it is possible to drink too much water; this is called overhydration. To avoid this, drink during and after exercise and other physical activities. At other times of the day, drink when thirsty.

        2. Take it slow.

If you normally run, jog or walk. If you’re a brisk walker, slow it down. As your body adapts to the heat, gradually increase the pace and length of your workout.

       3. Avoid the hottest part of the day.

Wake up extra early to catch the cool times of the morning, or go out around sunset. Don’t take the chance of heat exhaustion by going out in prime heat time; jump in the pool instead!

      4. Eat snacks throughout the day to keep your energy up.

Have a nice juicy snack like fruit. The last thing you need in scorching heat are dry snacks like crackers, popcorn, or energy bars that require your body to add water. Plus, dry snacks are often dense with calories, which means they can easily foil weight-loss goals, summer or winter.

      5. Lastly, know when it is time to go inside.

Always listen to your body and look out for symptoms like:

  • Weakness
  • Light-headedness
  • Dizziness
  • Paling of the skin
  • Headache
  • Muscle cramps
  • Nausea or vomiting
  • Rapid heartbeat

If you notice any of these symptoms, find air-conditioning right away.

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Protective Eye Wear

Cornerstone Family Healthcare’s Optometrist, Dr. Neha Dada, OD

Our eyes are precious; unfortunately, without adequate protection, our eyes are at an increased risk for damage or injury. For instance, UV light, harmful glare, blue light, sports/work related injuries are all factors that can put our eyes at risk. Taking care of our eyes with a healthy diet and lifestyle can help in many ways; however it is equally important to wear the correct protective eye wear. Help reduce your chances of injury or damage by choosing the correct eye wear to protect your eyes.

Too much UV light exposure can raise the risk for early onset cataracts, growths on the eyes, macular degeneration, and ocular cancers. Protect your eyes from UV light by wearing good coverage sunglasses with 100% UV A/B protection.  Even on a cloudy day, the sun’s UV light passes through clouds, so it’s still important to wear sunglasses even if you don’t see the sun.

Harmful glare can be very distracting while driving, playing sports, or while enjoying leisure activities. Sunlight can produce glare as light is reflected off surfaces in our surroundings. Polarized sunglasses make for an ideal solution, they filter glaring light allowing you to see clearer and be safer, this is especially important when you drive.

Do you use a computer, tablet or smartphone? Unfortunately, these devices and other sources of light, such as fluorescent or LED, emit a high amount of blue light. A particular range of blue light wavelength has been identified as increasing the risk for macular degeneration. You can now protect your eyes with blue-light filtering lenses. Many companies now use this technology in their anti-reflective coatings. Be sure to ask your local eye care professional about this, as not all anti-reflective coatings protect your eyes from blue light.

Often times eye care professionals treat sports and work related eye injuries.  Unfortunately, sports related injuries are most commonly seen in children. Yet, still only a small percentage of children wear protective eye wear. It’s important for children to wear protective eye wear, such as sports goggles, when playing sports.  Choose materials that meet impact standards set by the American Standard for Testing and Materials (ASTM). Protecting your eyes while you work is equally important. All too often patients present to an eye doctor’s office for removal of a piece of metal or another material that became lodged in the delicate structures of the eye while at work.

Have you have been diagnosed with any condition or disease that compromises your vision? These conditions may include lazy eye (amblyopia), glaucoma, macular degeneration, or many others. In these instances protecting the better-seeing-eye is imperative. Often times, strong polycarbonate lenses are prescribed to help protect your better eye from injury.

Remember, there are many ways in which our eyes can become damaged or injured. Protecting your eyes at all ages is key! If you have any questions about eye protection or would like to make an appointment at Cornerstone, please call (845) 563-8000 or visit us online at www.cornerstonefamilyhealthcare.org.

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Getting to Know Portions

Cornerstone Family Healthcare’s Nutritionist: Barbara Moschitta, MPS, RD, CDN

Our eyes are bigger than our stomach and the concept of portions are changing. The traditional plate and cup sizes have increased over the years. The availability of supersized portions, and “suggested” serving size on product labels make it difficult for us to understand what the real recommend serving sizes are. We are also unaware of what a true portion is. Brian Wansink, PhD, nutrition professor, food psychologist and author of “Mindless Eating,” sheds light on our food behaviors and how food marketing has deceived us and he also explains “why we eat more than we think.” I often suggest to patients that if it is larger than the palm of your hand it is more than one portion. Measuring utensils are useful and give us more exact information of what a standard portion size is.

You can also purchase portion size plates with dividers, or purchase a lean frozen entrée, and afterwards using the container for portioning. In many cases starchy foods like potatoes, corn, rice and pasta go by standard 1/3-1/2 cup portions cooked. Nuts and seeds are a mere ¼ cup, and cheese three dice cubes or two tablespoons. Juice is four ounces. When I show patients what this looks likes, it is no wonder why we have so much obesity in our country, as the standard juice bottle drink is 15-20 ounces, and suggested serving size on bottle states “1 bottle” which is really 5x the standard portion translating to 5x the calories at 240 kcal vs. 48 calories! An option for reducing portions of starch is using open face sandwiches, lettuce wraps, or “thin” flat versions of your favorite bagel, bread, or wrap while checking grams of carbohydrates; one serving is 15 grams, a slice of pizza depending on size can equal three servings, where a bagel is equal to six slices of bread!

These basic tips are helpful, but often we are pressed for time, so try your best to plan what’s on your plate with these simple rules:

  • ½ plate of non-starchy vegetables/greens
  • ¼ plate starch or grain
  • ¼ plate protein

For more information on how to portion for a healthier diet or to make an appointment with our nutritionist, please visit www.cornerstonefamilyhealthcare.org or call (845) 563-8000.

You can also check out these resources:

  • DiabeticLivingOnline.com
  • Eatright.org
  • ChooseMyPlate.Gov
  • •AmericanDiabetesAssociation.org

You can also check out these books :

  • The Portion Teller-Dr. Lisa Young
  • Mindless Eating –Btian Wansink PhD.
  • Volumetrics –Barbara Rolls PhD.

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Skin, Sun, and Sunscreen









Tracy Lucas, FNP,  Chief of Ambulatory Pediatrics, Cornerstone Family Healthcare

As the weather becomes warmer and the sun gets a little bit stronger it is important to remember sunscreen. In observance of Skin Cancer Detection and Prevention Awareness Month, we recognize how sunburn effects an abundance of people; some worse than others. Cornerstone Family Healthcare’s Chief of Ambulatory Pediatrics, Tracy Lucas, FNP helped us to understand the best way to protect your children and yourself from sunburn this summer by answering some frequently asked questions.

Who needs sunscreen?

Everyone needs sunscreen, including those with darkly pigmented skin. Even though skin may be darker, it does not preclude the risk of skin cancer which may be in their genetic makeup.

How do you determine the right sunscreen to use?

SPF 30 is generally recommended or SPF 50 if you will be outside for long periods of time.

When should sunscreen be used?

Anytime you are outside, including cloudy days. The sun is strongest between the hours of 10am and 4pm.

How much do we need to use and how often should it be applied?

One ounce every two hours should be used; especially when in the water.

How do you apply sunscreen effectively?

Cover all areas that are exposed, use adequate amounts to cover skin.

Broad-spectrum sunscreens protect against both UVA and UVB rays. What is the difference between the rays?

UVB rays peak at mid-day, while UVA rays last all day long.

Is a high-number SPF better than a low-number one?

Yes a high-number SPF is better. SPF 15 or higher to achieve adequate protection and 30 or higher is recommended for extended time spent outside.

How do you protect a baby or toddler from the sun?

Newborns to six months of age should be kept out of the sun. Babies six months or older can use sunscreen. It is best to keep babies in the shade with a wide brim hat, long sleeves and long pants. Any exposed skin should have sunscreen applied. Sunglasses with UV protection that are sized for the little one are also a good idea. It is also helpful to have sun shades in the car windows on car trips.

Can I use the sunscreen I bought last summer, or do I need to purchase a new bottle each year? Does it lose its strength?

Sunscreen generally has an expiration date and is good for about 3 years.

Will using sunscreen limit the amount of vitamin D we get?

No. Once your body has completed making an adequate amount the mechanism shuts down.

How do you treat sunburn?

Mild sunburn can be treated with cool compresses, NSAID medication such as Ibuprofen, moisturizing lotion or aloe and drinking plenty of fluids. Any sunburn in a baby under a year old is a medical emergency.

How do you know if your sunburn is worth an urgent medical visit?

Blisters, fever, pain, not feeling well all indicate medical attention is necessary.

How much sunburn can result in skin cancer?

Any sunburn!

If you would like more information on how to protect your children and yourself from sunburn please call Cornerstone Family Healthcare at (845) 563-8000 or visit us at www.cornerstonefamilyhealthcare.org to make an appointment today!

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Every Kid Healthy Week









Adeola Ayodeji, MD, FAAP

Every Kid Healthy Week was created to celebrate school health and wellness achievements. Observed the last week of April each year, this special week shines a spotlight on the great efforts school partners are doing to improve the health and wellness of their students and the link between nutrition, physical activity and learning. Everyone in the country can get involved and be a part of the celebration to help support sound nutrition, regular physical activity and health programs in schools.

At Cornerstone Family Healthcare, our pediatrics department is constantly working to improve the health of children in the communities we serve. Dr. Adeola Ayodeji, MD, FAAP a pediatrician at Cornerstone explained some important ways to help kids stay healthy while in school since they spend a large portion of their time in the classroom!

A nutritious lunch is a major factor in staying healthy in school. Students need to have healthier options for food and remove choices that are unhealthy. If a packed lunch is given to a child, the My Plate model of nutrition is a great example of what to include in your child’s lunch box.

Some things to include rather than sweets and snacks could be:

  • Pre-cut veggies in a clear container
  • 6-8 ounces of 100% fruit juice
  • Lots of water
  • Apple sauce
  • Fresh Fruit
  • Deli meat roll-ups
  • Crackers and Hummus

Vegetables and fruits rather than snack foods are easy to include in lunch because they can be prepared beforehand and stored in the refrigerator.

Younger children tend to get multiple snack times during the school day. This is a great time for those pre-cut veggies and fruits! And don’t forget lots of water.

For older kids, unless there is a medical condition, there is no need for multiple snacks a day. Have a good breakfast and a good lunch. Even if students have a later lunch, eating breakfast should help with hunger cravings throughout the day. Foods given to older kids should be limited on saturated fats and sugars. High cholesterol can also be an issue in older kids because of their diet. It is encouraged for kids to learn how to check out food labels and be conscious of what they are consuming.

Another important factor in staying healthy in school is making sure kids get enough exercise. It is recommended for kids six years old and under to get at least 60 minutes each day of active play. With more vigorous activity at least three days per week.

Younger children get recess time most days as well as participating in gym class, but older children tend to avoid gym or physical activity in general.

It is crucial that kids are actually participating in gym no matter how old they are in school.

Middle school kids are tough when it comes to participating in physical activities. Girls in gym class commonly stand off to the side and not participate, while young men will be much more active.

If you would like more information on ways to help your child stay active in their daily activities or would like to make an appointment to visit with one of Cornerstone’s pediatricians visit our website at www.cornerstonefamilyhealthcare.org or call at (845) 563-8000.

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Poison Ivy: “Leaves of Three, Let them Be”





Kate Michalak, L.Ac., PA-C, Cornerstone Family Healthcare

What is Poison Ivy?

It is a rash comes from the oil of certain plants.  The oil is called urushiol.  The rash is itchy and can spread to wherever the oil touches.  The rash tends to be patchy or linear, raised and fluid filled, and very itchy.

Is it contagious?

The rash is not contagious, however the oil is present on and object and that object touch the skin the rash and break out.  An example is if the oil get on a pair of gardening gloves any area of skin that those gloves touch, may break out in the rash.

How do I avoid getting it?

The best way to avoid getting the rash is to know what the plant looks like, and remember the rhyme “Leaves of three, let them be.”


If you see any of these in your yard, garden, or play area avoid them.  If possible cover all skin with clothing and gloves and remove plants, then wash clothing in hot water to dissolve the oils.  If you think you came into contact with the plants or oils, shower in hot/warm water with soap, and wash all clothing hot water.  This will dissolve the oil and prevent it from spreading.  There are some commercial preparations that are available over the counter  for washing, such as Technu.

Is it serious?

The rash for poison ivy is general not serious just uncomfortable and last 2-3 weeks.  It can be more serious if it is on the face and around the mouth and eyes.  Some individuals that are highly allergic may have swelling.  If there is any swelling of mouth or tongue, or if any shortness of breath it is import to seek medical care immediately.  It is also possible to develop an infection due to breaks in the skin.  If there is any signs of increasing redness, pain, warmth to area seek medical attention.

How is it treated?

The rash is treated differently based on severity and location.  Treatments range from topical steroid creams, to oral antihistamines and steroids.  The treatments don’t lessen the duration of the rash, but they do help lessen itching and discomfort.

If you are concerned about symptoms of the rash, please contact your doctor. You can also visit our Urgent Care. A list of our hours are listed here: http://www.cornerstonefamilyhealthcare.org/locations/

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Oral Cancer Awareness Month

Tiana Osbourne, DDS, Cornerstone Family Healthcare


Can you imagine life without your tongue or the ability to taste and chew your favorite foods?  This could be a potential reality of surviving aggressive oral cancer treatment.

Each year about 50,000 people are diagnosed with oral cancer. Oral cancer accounts for four percent of all cancers, but has a higher death rate than more common cancers like thyroid, endocrine or cervical. Not because it is a more aggressive than the rest; many times it is not diagnosed until its later stages.

What is oral cancer?

Oral cancer refers to any cancer that appears on any part of the mouth, including the lips, gums, tongue, floor and roof of the mouth.

What are signs and symptoms of oral cancer?

  • Red or white patches that do not go away
  • Swelling around the jaw
  • Painful or loose teeth
  • Bleeding or numbness in the mouth
  • Pain or tenderness in the lips or mouth
  • Difficulty chewing, swallowing, and moving your tongue or jaw

What are the risk factors for oral cancer?

People who heavily smoke or chew tobacco, drink alcohol and are over the age of 50 are at an increased risk for developing oral cancer. About 75 percent of head and neck cancers are caused by smoking tobacco and consuming alcohol. Men are twice as likely to develop oral cancer as women. In non-smoking patients, the HPV version 16 virus is a sexually transmitted disease that increases the risk of oral cancer. People with weak immune systems and infectious diseases are also more at risk development of oral cancer.

How is it treated?

Most cases of oral cancer are curable! The earlier the diagnosis, the easier it will be to treat.  Many times oral cancer is treated with a combination of therapies such as surgery, targeted drug therapy, chemotherapy and radiation.  Patients who are treated early for cancer reduce their chances of post-operative disfigurement, while those whose cancer is caught at a later stage, surgical removal of the lymph nodes, jawbone or tongue may be necessary. So don’t delay, get you oral cancer screening completed today!

How do I get screened for oral cancer?

Dental Professionals are trained to look for common signs and symptoms of oral cancer.  In a typical exam, we check for abnormalities and enlarged lymph nodes in your head, neck and mouth. The best way to improve your chances of diagnosing oral cancer in its early stages is to be seen for routine dental treatments. Stop by one of Cornerstone Family Healthcare’s dental offices, where an oral cancer screening will be completed as part of your routine comprehensive oral exam.

Visit our website at www.cornerstonefamilyhealthcare.org or call (845) 563-8000 to make an appointment today!

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  • Blog Authors

  • Providers involved include:

    Monica Francis, PA

    Avi Silber, MD, FAAP
    Tracy Lucas, FNP
    Adeola Ayodeji, MD, FAAP

    Chanchal Singh, MD
    Sneha Shrivastava, MD
    Penelope Guccione, FNP

    Julie A. O’Connor, CM, LM, MS
    Marian Seliquini, CM, LM, MS

    Koreen E. Thomas, FNP
    Andrea Giovinazzo, FNP-C

    Kate Michalak L.Ac., RPAC

    Alban Burke, DDS

    Neha Dada, O.D.

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