Amy Shein, GCM « The Professional Geriatric Care Manager’s Blog

Too Much Sugar in Our Diet!

January 19, 2012 at 10:30 am | Posted in Amy Shein, GCM | Leave a comment
Tags: Diet, Education, Health, Life, Personal, Tips

At first I was not sure what I wanted to blog about for this week, but then I went to a great event last night and it hit me there. I went with my fellow co-workers from Distinctive Care to a wonderful health fair over at the Ridgewood YMCA/YWCA. The keynote speaker was Amanda Arlauskas from NBC’S Biggest Loser Season 8. She did an amazing job speaking about her weight loss venture as a participant on the trendiest show on TV today. She said that she had to make huge changes in her diet and behavior in order to lose her weight and regain her health. She said the hardest part was in the very beginning when she needed to give up some of her favorite foods. She said it was a shock to her body to give up the junk food, which mainly consisted of high amounts of sugar. I thought that would be a great topic of interest for some of my elder clients.

Since many of my clients tend to have high sugar or high simple carbohydrates in their diets, I have been working with clients in the home, assisted living and skilled nursing facilities. I observe what they eat and what they crave most. It is the high sugar foods that many of them really want. We have one gentleman that goes through at least one bag of candy per day. Another client would refuse to eat any of her protein or vegetables from her tray and would just rather eat her dessert first and then would not touch anything else afterwards.

I can only think that the reason so many older adults prefer and like sweets is that much of their taste is altered from the medications that they take. But, maybe they just like the comfort of the refined sugar or sweets they just know and love over the many years? Most older adults need to be careful of developing Type 2 Diabetes, elevated triglyceride levels which leads to coronary artery disease and risk of stroke.

It is recommended that on a 1,600-2,000 a day calorie diet, that one should only be consuming 5-8 teaspoons of sugar per day, or no more than 50 grams of carbohydrate in the form of sugar (one teaspoon of sugar provides 4 grams of carbohydrates). The United States Department of Agriculture (USDA) recommends limiting sugar to 6 to 10% of calories from sugar. This is based on weight maintenance and not for weight loss. To give you an example of how much sugar we consume, I will provide you with a list of high sugar foods/beverages and their sugar content;

12oz can of Coca Cola= 39 grams (10 teaspoons of sugar) 140 calories

2 Fig Newton’s = 12 grams (3 teaspoons of sugar) 90 calories

½ c. of Vanilla Ice Cream=21 grams of sugar (5 ½ teaspoons of sugar) 270 calories

8oz. Cranberry Juice Cocktail=30 grams (7 teaspoons of sugar) 120 calorie

1 Piece of Hard Candy=3.8 grams(1 teaspoon) 24 calories

If you want to learn more about sugar content of some of your favorite foods, take a look at this site, but after you review this website you they might not be your favorites anymore!

After completing some of this research and learning about sugar content on some of these foods, it really gave me a wakeup call. No matter if we are young or old, we need to be aware of what we are putting into our body at all times.

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York. We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care. Please contact us in our Ramsey or Ridgewood Office to schedule a consultation. 201-587-5283.

145 N. Franklin Turnpike, Suite 311, Ramsey, NJ 07446

45 N. Broad St., Suite 503, Ridgewood, NJ 07450

Move Over Rice and Pasta, Here’s Quinoa!

January 12, 2012 at 10:30 am | Posted in Amy Shein, GCM | Leave a comment
Tags: Diet, Education, Health, Life, Tips

Last week I had the pleasure of educating a client on healthy food choices. She wants to lose weight and increase the amount of fiber in her diet. She informed me that she eats a lot of pasta and rice in her diet and has heard that white rice and pasta are not all that good for a person. I told her that she was right and then I provided her with a better alternative to her bland, white rice and pasta. We sat in her kitchen, as I explained to her about the benefits of Quinoa (pronounced keen-wah).

Quinoa is technically a seed, but is cooked and eaten like a grain and is related to spinach, chard and beets. It is found and grows best in mountainous regions and thrives in poor soil, thin air and extreme weather. Quinoa stalks are 3 to 6 feet tall, each plant can produce up to a cup of seeds. The seeds are about the same size as sesame seeds, and come in a rainbow of colors. They are red to purple to green to yellow in color, but the quinoa that is most commonly found in stores is an off-white color. I just bought tricolor quinoa at Trader Joe’s. You can also find quinoa in bulk section of natural food stores or in the organic section of your supermarket.

Quinoa is a complete protein, which means that it contains all the amino acids necessary for our nutritional needs. A four ounce serving contains over 22 grams of protein. This is considered enough protein to meet the daily needs for an average size child. It is also high in iron and calcium and is a good source of manganese, magnesium and copper, as well as fiber. Quinoa is naturally gluten-free and is very easily tolerated for people who suffer from celiac disease, crohn’s, or has allergies to wheat flour.

Before cooking with quinoa, you should give it a thorough rinsing; this will remove any remaining saponin, a soapy resin that protects the seeds while they are growing. Saponin can leave a bitter taste if not removed well from rinsing. It is very easy to cook quinoa. You only need to combine one cup rinsed quinoa to two cups water or broth (I use low sodium broth), bring to a boil, then simmer to 10-15 minutes, until the seed become translucent and the germ of the seed uncoils to form a “tail”. Quinoa has a fluffy texture and a light nutty taste. It is great to be added to salads, soups and stews. Here is a very easy recipe that you can try with Quinoa. So delicious.

Original Recipe Yield 4 cups

Ingredients

2 cups water
2 cubes chicken bouillon
1 clove garlic, smashed
1 cup uncooked quinoa
2 large cooked chicken breasts – cut into bite size pieces
1 large red onion, diced
1 large green bell pepper, diced
1/2 cup chopped kalamata olives
1/2 cup crumbled feta cheese
1/4 cup chopped fresh parsley
1/4 cup chopped fresh chives
1/2 teaspoon salt
2/3 cup fresh lemon juice
1 tablespoon balsamic vinegar
1/4 cup olive oil

Directions

Bring the water, bouillon cubes, and garlic to a boil in a saucepan. Stir in the quinoa, reduce heat to medium-low, cover, and simmer until the quinoa is tender and the water has been absorbed, 15 to 20 minutes. Discard the garlic clove and scrape the quinoa into a large bowl.
Gently stir the chicken, onion, bell pepper, olives, feta cheese, parsley, chives, and salt into the quinoa. Drizzle with the lemon juice, balsamic vinegar, and olive oil. Stir until evenly mixed. Serve warm or refrigerate and serve cold.

Enjoy!

How Much Is Too Much?

December 29, 2011 at 10:30 am | Posted in Amy Shein, GCM | Leave a comment
Tags: Aging, Diet, Health, Holidays, Life, Safety

New Year’s Eve is approaching us very soon. With that, I sometimes think of alcohol and why people consume too much of it on that particular day, or any day for that matter. I have attended educational programs and have learned that drug and alcohol abuse is becoming more common in the elderly population. The fact is, many family members, friends, and health care professionals often overlook their concerns about older adults’ drinking habits. Sometimes trouble with alcohol in older people is mistaken for other conditions that happen with age. Alcohol use deserves special attention, because the aging process affects how the body handles alcohol; the same amount of alcohol can have a greater affect as a person grows older. Over time, someone whose drinking habits have not changed may find that he or she has a problem.

Facts about Alcohol and Aging

It has been shown that as people age they become more sensitive to alcohol’s effects. The same amount of alcohol can have a greater affect on an older person than on someone who is younger.
Some medical risks, such as high blood pressure, ulcers and diabetes can worsen with alcohol use.
Both prescription and over the counter medications can be dangerous or even deadly when mixed with alcohol. This is a worry for older people, because the average person over the age of 65 takes at least two medicines a day. Examples: aspirin can cause bleeding in the stomach and intestines. If you mix with alcohol, the risk of bleeding is much higher. Cold and allergy medicines (antihistamines) often make people sleepy and when combined with alcohol, it can make drowsiness worse and driving even more dangerous. Alcohol used with large doses of acetaminophen (Tylenol) can raise the risk of lever damage. If you are taking any over the counter or prescription medications, ask your doctor of pharmacist if you can safely drink alcohol.

Effects of Alcohol

Even drinking a small amount of alcohol can impair judgment, coordination, and reaction time. It can increase the risk of work and household accidents, including falls and hip fractures. It also adds to the risk of car crashes. Heavy drinking over time also can cause certain cancers, liver cirrhosis, immune system disorders & brain damage.

Alcohol can make some medical concerns hard for doctors to find and treat. For example, alcohol causes changes in the heart and blood vessels. These changes can dull pain that might be a warning sign of a heart attack. Drinking also can make older people forgetful and confused. These symptoms could be mistaken for signs of Alzheimer’s disease.

How to Know if Someone Has a Drinking Problem

There are two types of problem drinkers: early and late onset. Some people have been heavy drinkers for many years. But, as with great Uncle George, over time the same amount of liquor packs a more powerful punch. Other people, like Grandma Betty, develop a drinking problem later in life. Sometimes this is due to major life changes like shifts in employment, failing health, or the death of friends or loved ones. Often these life changes can bring loneliness, boredom, anxiety, and depression.

Not everyone who drinks regularly has a drinking problem, and not all problem drinkers drink every day. You might want to get help if you or a loved one:

Drink to calm your nerves, forget your worries, or reduce depression.
Lose interest in food.
Gulp down drinks.
Frequently have more than three drinks in one day. (A standard drink is one 12-ounce bottle or can of beer or a wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits.)
Lie about or try to hide drinking habits.
Drink alone.
Hurt yourself, or someone else, while drinking.
Were drunk more than three or four times last year.
Need more alcohol to get high.
Feel irritable, resentful, or unreasonable when not drinking.
Have medical, social, or financial worries caused by drinking.

Resources for Help

The National Institute on Alcohol Abuse and Alcoholism, part of the National Institutes of Health, recommends that people over age 65 who choose to drink have no more than one drink a day. Drinking at this level usually is not associated with health risks.

National Institute on Alcohol Abuse and Alcoholism (NIAAA)
6000 Executive Boulevard
Bethesda, MD 20892-7003
Phone: 301-443-3860
Website: www.niaaa.nih.gov

National Drug and Treatment Referral Routing Service
National Clearinghouse for Alcohol and Drug Information
Substance Abuse and Mental Health Services Administration
Phone:
Website: http://www.niaaa.nih.gov/Resources/RelatedWebsites/Referral.htm

Alcoholics Anonymous (AA)
Grand Central Station
P.O. Box 459
New York, NY 10163
Phone: 212-870-3400
Website: www.aa.org

National Council on Alcoholism and Drug Dependence, Inc. (NCADD)
20 Exchange Place, Suite 2902 New York, NY 10005

The Benefits of Unsaturated Fats

December 22, 2011 at 10:30 am | Posted in Amy Shein, GCM | Leave a comment
Tags: Health, Life, Tips

Tonight is the second night of Hanukah. I was not sure what I was going to write about during this week’s blog. Since I usually blog about nutritional support in regards to health care, I decided to write about the using and eating of healthy oils.

During Hanukah you are suppose to eat foods made with oil, to symbolize the oil that was used to supply light in the time when the Jew’s had to leave Egypt. That oil was only supposed to last for one night. Amazingly, the oil lasted for eight nights. During this time, we are to eat lots of potato latke’s fried in oil.

My mother and mother in law only use peanut oil to fry their latkes. Peanut, Canola, Olive, Almond and Avocado oils are all Monounsaturated fats. Flaxseed, Walnut, Grapeseed, Flaxseed, Fish, Sunflower and Safflower Oil are all polyunsaturated fats. Monounsaturated fats are usually liquid at room temperature, but can turn into solids when in the refrigerator. Monounsaturated fats are commonly thought of as “healthy fats.” There is evidence that they may lower our risk of heart disease and stroke.

There are two main types of polyunsaturated fats; omega-3 fats and omega-6 fats. These are essential fatty acids, which means that our body cannot manufacture them and that we must supply our body with these fatty acids through our diet or supplements. Lately a big trend in recent years has been the addition of taking increased quantities of omega-3 fish oil to help with lowering total cholesterol and triglyceride levels. Doctors have also felt that people who tend to consume more of the unsaturated fats and oils do tend to lower their cholesterol levels because they are using less saturated fats that where the main cause for their elevated cholesterol levels in the first place.

To be aware of what you are eating, you need to be good at reading food labels. Everything we purchase in the store is required to have a full nutritional label to inform us of what we are consuming. This is regulated by the FDA (Food and Drug Administration). So, the next time you go to purchase butter to cook or fry with, look instead at the many healthy oils that we have to choose from in our grocery stores. This change will only help you in the many years to come.

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York. We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care. Please contact us in our Ridgewood Office at 201-587-5283 to schedule a consultation

Fish is the New Brain Food!

December 8, 2011 at 10:30 am | Posted in Amy Shein, GCM | Leave a comment
Tags: Education, Health, Life, Memory, Personal, Research, Study

I just finished reading an interesting article that was sent to me a few days ago from Emaxhealth. The title of the article was “Baked Fish, Not Fried May Reduce Alzheimer’s Risk.” We have known for many years that fish contains omega-3 fatty acid which has been very helpful for lowering cholesterol levels. According to a new study presented by the Radiological Society of North America annual meeting, at least one serving of baked or broiled fish per week helps preserve gray matter of the brain, strengthening the area of the brain deemed critical to memory and cognition. This is particularly important for people with dementia or leading to Alzheimer’s disease.

A study took place at the University of Pittsburgh Medical Center, Mercy Hospital. They found study participants that ate baked and broiled fish (not fried) had larger brains. They had larger brain cells in areas of the brain most responsible for memory and learning. This area is known as the gray matter. It was noted that these brain areas are at higher risk for Alzheimer’s disease. After five years of following the effects seen with eating fish one to four times a week, the study showed mild cognitive impairment went down significantly in these participants. It is easy as including broiled or baked fish at least once a week into your diet that may help reduce your risk of developing Alzheimer’s disease.

I had my weekly dose of fish tonight. Baked Salmon, delicious!

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York. We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care. Please contact us in our Ridgewood Office at 201-587-5283 to schedule a consultation.

What Hospice Can Do!

December 1, 2011 at 10:30 am | Posted in Amy Shein, GCM | Leave a comment
Tags: Aging, Caregiver, Health, Help, Life, Personal

Last week was difficult one for me. I experienced my first loss of a client as a Geriatric Care Manager. I was with this client for over 16 months and she was actually one of my first clients with Distinctive Care. She was 92 years old and lived a full life. Working so closely with this woman, who had severe Dementia, and with her family, was so rewarding, both spiritually and educationally. It was a beautiful relationship that I had worked so hard to develop and embrace.

As a nurse for 16 years, I have experienced death of a patient in many different ways. When death happens in the hospital it seems to be so much worse. Patients come to the hospital to find answers and healing to prevent the worst possible outcome. This particular client was placed on hospice during the last 3 weeks of her life (she was on hospice once before for 2 months last year, then eventually graduated off) while she was living in a skilled nursing facility. Hospice is a special way of caring for people who are terminally ill, as well as care for their family members. She received excellent palliative care, love and compassion from the local hospice nursing team and so did her family.

Hospice was even amazing to the entire team that worked directly with my client. The team included her physician, skilled nursing staff, private caregiver and me. Hospice was able to educate her family and her team with frequent updates of her declining status on a daily basis. The family was so grateful to the entire team that assisted with their loved one during her last few days of life. This was my first “close” experience working with hospice. It was truly an amazing occurrence that my so sweet client rightly deserved. Hospice is covered under Medicare, Medicaid and most private insurances. It is best to speak to your physician and health care team to learn more about the benefits of hospice services.

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York. We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care. Please contact us in our Ridgewood Office at 201-587-5283 to schedule a consultation.

Healthy Weight in the Geriatric Patient

November 10, 2011 at 10:30 am | Posted in Amy Shein, GCM | Leave a comment
Tags: Diet, Eldercare, Health, Life, Safety

As a Geriatric Care Manager who is a registered nurse and holds a bachelor’s degree in nutrition, I can offer a lot to my individual clients. I try to use preventative medicine through the use of food. I have always felt that a person’s weight can determine the effects on their health. Being overweight can lead to diabetes, heart disease, hypertension and certain cancers. Being underweight can lead to malnutrition, and also a decreased immune system. Recently, one of my clients had been losing weight due to being so cautious of her cholesterol and sodium intake in her diet. We went to her doctor and received a clean bill of health. We were able to problem solve, and found she was mainly eating salads, fish and all low fat dairy products. Her calorie intake was not supporting a healthy weight for her. She looked and felt rather weak. She had been on Ensure Plus three times per day, but was not enjoying the taste and necessary amount that she needed to consume for the extra calories. I knew that we had to change her diet and add more healthy calories from higher fat proteins and dairy into her diet. She was thrilled about eating her taylor ham and whole milk once again.

One of my fellow Geriatric Care Managers from DC spoke to me about a “Magic Milk Shake” with the use of Carnation Instant Breakfast, ice cream, whole milk and what ever else that would taste good(fruit, even a cupcake). Most of these shakes can be up and over 600 calories for 8oz. My client usually has one to two a day and sips it throughout the day. She is eating higher calorie foods and really enjoying the taste and texture of these foods. Her weight has gone up nice and slow, about 1 pound per week. This weight gain has been a very positive one for my client. She has been feeling stronger and able to do more of her daily activities that she was not able to do with her decline in weight.

Always check with your doctor before you make any changes to your diet or medication. You may want to have your doctor check for any underlining reason for recent weight gain or loss.

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York. We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care. Please contact us in our Ridgewood Office at 201-587-5283 to schedule a consultation.

Breast Cancer Awareness for the Older Adult

October 20, 2011 at 10:30 am | Posted in Amy Shein, GCM | Leave a comment
Tags: Aging, Education, Health, Life, Prevention, Tips

During the month of October, we celebrate breast cancer awareness. The American Cancer Society (ACS), states there is no age limit for having mammograms. The society urges individuals who are in good health to get an annual mammogram regardless of age. The ACS feels women should begin in their 20’s with breast self-examination. Then by her 40’s receive annual mammography and clinical breast examinations. Screening should continue for as long as a woman is in good health and would be a candidate for treatment “if life expectancy is > 5 years.”

The American Geriatric Society encourages women to have a mammogram every two or three years past the age of 75. The United States Preventive Services Task Force feels strongly to continue with mammograms at older ages, either annually or every two years, as long as their life expectancy is not decreased by another serious illness.

These guidelines I listed are just three of many societies/organizations that doctor’s use to screen patients for breast cancer by either performing a clinical breast exam or from regular mammograms. It has always been a rule of thumb that early detection is what saves lives from breast cancer. Breast screening for older women and men should be based on the individual, their health, and other serious illnesses, such as congestive heart failure, end-stage kidney disease, chronic obstructive pulmonary disease, and moderate to severe dementia. An individual’s age alone should not be the reason to stop having regular screenings and mammograms. As long as an individual is in good health and would be a candidate for treatment, they should continue to be screened with clinical breast exams and mammograms.

As we age, we are placed in a moderately higher risk factor of developing breast cancer. Our risk for breast cancer increases as we age. The American Cancer Society states that about 77% of women diagnosed with breast cancer each year are over age 50, and almost half are age 65 and older. Breast cancer in men is rare, accounting for only 1% of all breast cancers. Most cases of male breast cancer are detected in men between the ages of 60 and 70. Older women and men need to be equipped with the knowledge and confidence to detect breast changes and get them checked by a doctor.

The most common sign of breast cancer is a new lump or mass. Other possible signs of breast cancer include:

Swelling of all or part of the breast (even if no lump is felt).
Skin irritation or dimpling.
Breast or nipple pain.
Nipple retraction (turning inward).
Redness, scaliness, or thickening of the nipple or breast skin.
Nipple discharge.

Those who opt to continue to go for regular breast examinations and mammograms regardless of their age are doing right for early detection. If you feel strongly about having a mammogram done, tell your doctor.

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York. We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care. Please contact us in our Ridgewood Office at 201-587-5283 to schedule a consultation.

The Facts of White Fruits for Stroke Prevention

October 13, 2011 at 10:30 am | Posted in Amy Shein, GCM | Leave a comment
Tags: Health, Life, Prevention, Research, Study, Tips

Last month a new study was released by a Dutch researcher by the name of Linda M. Oude Greip, with evidence that fruits and vegetables that are mostly white in color may lower your risk of stroke more than any other fruits and vegetables. It stated that for every 25 grams per day of white fruits and vegetables consumed there was a 9 percent decrease in the risk of stroke. Apples and pears were the most commonly consumed “white fruit” according to the study, published in this month’s issue of Stroke (American Heart Association/American Stroke Association).

Oude Greip said that they are not exactly sure what components in white fruit might be protective means for stroke, but she suspects that the dietary fiber and the flavonoids are the main reason for their findings. Apples and pears are high in flavonoids called quercetin. Flavonoids are antioxidants and they are biologically the trigger to produce a natural enzyme that fights disease. It is important to eat all kinds of fruits and vegetables, of all colors. Many others may protect you against other chronic diseases. She stressed to continue to have a variety of fruits and vegetables in your diet, and that you should be eating at least 3-4 of them throughout each day. Fruits and vegetables that are listed in the white category were apples, pears, bananas, cauliflower, chicory, cucumber and mushrooms. If you would like to read more about this new study, you can read about it in November’s issue of Stroke.

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York. We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care. Please contact us in our Ridgewood Office at 201-587-5283 to schedule a consultation.

Seniors Staying in the Workforce

October 6, 2011 at 10:30 am | Posted in Amy Shein, GCM | Leave a comment
Tags: Aging, Life, News, Research

This past Sunday night was Andy Rooney’s final broadcast on 60 Minutes. At the age of 92 and still working as a writer, a profession that he has loved since starting out in the Army during WWII. He stated that he will not be seen on the television anymore, but he will never stop being a writer and will continue to write. I have always liked his ending commentaries at the end of 60 Minutes and looked forward to them each week. I could not believe how old he really was when I watched his last episode on Sunday.

I was visiting a client last week at a nursing home. The facility was celebratring the Assistant Director of Activities 85th birthday. She told me she loves her job and does not know anything different, but to get up each morning and go to work helping others. I see it in my own family. My father is 79 and my father in law is 81. They both go to work in their longtime careers everyday. Except when they go to Florida for a month or two.

I read from the Federal Bureau of Labor Statistic on a current population survey, shows the number of workers age 75 years and older has steadily risen since 1985. Last year more than 1.2 million people age 75 and up were still in the workforce. It was said that seniors that are closer to age 65 are working because the cannot survive on their pensions or their retirement savings. Some researchers now say it is a different reason for the older senior, most of whom now work for social interaction and for the sense of fulfillment and keeping their mind and body functioning. They want to maintain their quality of life and feel that working is the ticket to keeping mentally and physically well.

After reading an article from Mind Power News about 70 Ways to Increase Your Brain Power, Number 13- is writing is good for your mind by telling your memory what is important and so you can recall things more easily. Number 33 is learning. So when an older person is still working, they are always learning or educating themselves and others. The best way to end this blog, is by stating; my kids love Betty White…

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York. We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care. Please contact us in our Ridgewood Office at 201-587-5283 to schedule a consultation.

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