Basilar Invagination

Posted on March 11, 2026 by Patrick Hercules

Basilar invagination is a rare condition that occurs when the top of the spine gets pushed into the base of the skull. This can lead to pinching or pressure on the brainstem, which is the group of nerves connecting the brain to the spinal cord. This condition is painful and can cause various neurological symptoms.

The spine is made of seven vertebrae and is numbered from C1 to C7; this is called the cervical vertebrae. The C1 vertebrae is at the top of the spine, supporting the skull. The C2 vertebrae lies below the C1 and has an upward peg that enters a hole in the C1, which lets the C1 vertebrae pivot on the C2, allowing the head to turn sideways.

If the peg of the C2 vertebra moves too far upward into the C1 vertebra, it can put pressure on the brainstem. The brainstem normally passes from the skull into the spinal canal through an opening at the base of the skull called the foramen magnum.

In basilar invagination, the C2 vertebra moves upward toward this opening. As it pushes into the foramen magnum, the space for the brainstem becomes smaller. This reduced space can lead to compression of the brainstem.

Basilar invagination occurs when a person has problems with the bones in the neck or vertebrae. It can also be caused by platybasia, which is the flattening of the base of the skull. Basilar invagination can be present at birth. However, it can develop later due to illness or injuries resulting from vehicle or bicycle accidents, falls, or accidents during activities such as diving.

Basilar invagination may occur in people with conditions, such as:

Rheumatoid arthritis

Tumors

Paget’s disease

Brittle bone disease

Marfan syndrome

Rickets

The symptoms of basilar invagination can vary based on the pressure on the brainstem, spinal cord, or nerves. Symptoms may become noticeable when a person bends their neck. Symptoms of basilar invagination include:

Headache or pain in the back of the head

Weakness in the neck, arms, and legs

Tingling when bending the neck

Tingling or numbness in the hands or feet

Difficulty swallowing or talking due the loss of muscle control caused by nerve damage

Inability to tell the position of body parts without looking

Twitching eye movements or nystagmus

Loss of feeling or sensation in limbs

Dizziness or lightheadedness

Confusion

A person may also feel a shock down their back when they bend their neck forward or may experience paralysis.

If basilar invagination goes untreated, it can cause complications such as hydrocephalus or syringomyelia, which are conditions that occur when the flow of fluid around the brain and spinal cord is blocked and the fluid collects in the brain or spinal cord. What’s more, if the lower brainstem gets compressed, it may result in death.

Basilar invagination is diagnosed when a healthcare provider performs an examination to look for symptoms of the condition as well as discusses a person’s medical history. They will also use tests to check if a person’s spine and nerves are affected. These tests include:

X-rays

CT scan

Myelography

Nerve conduction studies

The treatment for basilar invagination depends on its symptoms and severity of the condition. If a person has basilar invagination that presents without signs of brainstem compression pressure on the spinal cord, a healthcare provider will use:

Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin to relieve pain or swelling

Neck traction, which involves gently stretching the neck to increase the space between the bones to relieve pressure

A neck collar or brace to support the neck and limit movement

Physical therapy that consists of neck exercises

If a person has signs of brainstem compression and nerve problems, they will need surgery. Surgery can be performed through the nose or mouth and can also be performed at the junction of the head and neck. Healthcare providers aim to use surgery to decompress or relieve the pressure on the brainstem or spinal cord and stabilize the joint in the neck.

If you or a loved one is experiencing symptoms associated with basilar invagination, you can receive treatment at Flushing Hospital Medical Center’s Ambulatory Care Center. To schedule an appointment, please call (718) 670-5486.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Dumping Syndrome

Posted on March 6, 2026 by Patrick Hercules

Dumping syndrome or rapid gastric emptying is a condition that occurs when food and gastric juices move abnormally quickly from the stomach to the small intestine after eating.

Dumping syndrome most commonly occurs after stomach surgery due to it altering the stomach, which can increase the risk of developing the condition. These surgeries are performed mostly to treat obesity, but they can also treat stomach cancer. Dumping syndrome can also happen after esophageal surgery, such as surgery to treat esophageal cancer. Surgeries for other conditions can cause dumping syndrome, including:

Bariatric surgery

Esophagectomy

Gastrectomy

Vagotomy

Fundoplication

Pyloroplasty

Symptoms of dumping syndrome generally start within minutes after eating, especially meals containing high levels of table sugar and fruit sugar. Symptoms include:

Nausea

Vomiting

Feeling bloated or too full after eating

Stomach cramps

Diarrhea

Rapid heart rate

Dizziness or lightheadedness

Flushing

Late dumping syndrome starts one to three hours after eating a meal that is high in sugar. It takes time for symptoms to develop because the body releases large amounts of insulin to absorb the sugars entering the small intestine after eating. This process results in low blood sugar levels. Symptoms of late dumping syndrome can include:

Rapid heart rate

Sweating

Weakness

Dizziness or lightheadedness

Flushing

Some people can have both early and late symptoms.

A healthcare provider can diagnose dumping syndrome by using the following methods:

Discussing medical history and performing a medical evaluation

Testing blood sugar

Performing a gastric emptying test

If a person has early dumping syndrome, the condition is likely to resolve itself on its own within three months. In the interim, dietary changes may help ease symptoms. If dietary changes don’t help, an antidiarrheal medicine will be prescribed and injected under the skin to slow food from emptying into the intestine.

If medication doesn’t work, surgical procedures such as reconstructing the pylorus of a reverse gastric bypass may be recommended.

There are dietary strategies that can help maintain good nutrition and minimize symptoms, including:

Eating smaller meals

Drinking 6-8 cups of fluids per day

Drinking most of your fluids between meals

Lying down for 30 minutes after meals

Changing your diet

Increasing fiber intake

If you are going to drink alcohol, it is important to speak with your healthcare provider before doing so. Drinking alcohol beverages can worsen dumping syndrome symptoms because they can be absorbed quickly and can have high sugar content, which can lead to blood sugar levels rising rapidly and cause a significant insulin spike and then eventually low blood sugar.

If you or a loved one is experiencing symptoms associated with dumping syndrome, you can receive treatment at Flushing Hospital Medical Center’s Ambulatory Care Center. To schedule an appointment, please call (718) 670-5486.

Appendicitis

Posted on February 19, 2026 by Patrick Hercules

Appendicitis occurs when the appendix becomes clogged, infected, and inflamed. It can cause acute pain in your lower abdomen; however, for most people, pain begins around the belly button and then moves. As inflammation worsens, appendicitis pain typically increases and eventually becomes serious.

Symptoms of appendicitis include:

Sudden pain that begins on the right side of the lower belly
Sudden pain that begins around the belly button and often shifts to the lower right belly
Pain that worsens with coughing, walking, or making other jarring movements
Nausea and vomiting
Loss of appetite
Low-grade fever that may rise as the illness worsens
Constipation or diarrhea
Belly bloating
Gas

Additional symptoms that may develop later in some people can include:

Malaise
Urinary symptoms- needing to go more frequently or more urgently
Bowel paralysis

The size and location of the appendix make it easy for it to become clogged and infected. Your large intestine is home to many bacteria. If they become trapped in your appendix, they overgrow and cause an infection. The bacteria then multiply quickly, causing the appendix to become inflamed and filled with pus. If it is not treated right away, the appendix may burst or break open.

Some common causes of inflammation, swelling, obstruction, and infection in your appendix include:

Hardened poop (appendix stones)
Lymphoid hyperplasia
Colitis

Other factors that could block the opening of your appendix can include:

Tumors
Parasites
Cystic fibrosis

Risk factors for appendicitis include:

Age – anyone can develop appendicitis, but it most often happens in people between the ages of 10 and 30
Your sex – men have a slightly higher risk of appendicitis than women

To help diagnose appendicitis, a healthcare provider will likely take a history of symptoms and examine the abdomen. Tests used to diagnose appendicitis can include:

A physical exam
Blood tests
Urine tests
Imaging tests

Appendicitis may spontaneously resolve if the cause suddenly goes away on its own. This might happen if an obstruction in your appendix gets unblocked and passes through the intestines, or if an infection causing lymphoid hyperplasia in your appendix suddenly improves. However, you shouldn’t assume this will happen or that it has happened, even if your pain has reduced.

The standard treatment includes medicine such as antibiotics and surgery to remove the appendix. The surgical procedure to remove the appendix is called an appendectomy, and it can be performed using robot-assisted technology.

Appendicitis is considered an emergency, so it is treated in the emergency room.

If you are experiencing symptoms of appendicitis, visit Flushing Hospital Medical Center’s Ambulatory Care Center. To schedule an appointment, please call (718) 670-5486. If there is an emergency, please call 911.

Common Myths About Robotic Surgery De-Bunked

Posted on February 11, 2026 by Patrick Hercules

The way surgical procedures are performed has evolved. Today, surgeons use advanced technology such as robotic surgery to perform delicate operations and improve patient outcomes.

During robotic surgery, a surgeon performs surgical procedures using a robotic device, which features a three-dimensional camera and a robotic arm that can hold small surgical instruments and is more dexterous than a human’s hand.

There are several myths about this surgical technique:

Myth #1: The surgical robot performs surgery on its own

Some people believe that robots perform surgery on their own. The truth is that robot surgery is robot-assisted. A surgeon is specially trained to control the robotic system and always controls it

Myth #2: Robotic surgery has more risks than traditional surgery

Robotic surgeries are minimally invasive and are safer and more effective than traditional open surgeries. Robot-assisted surgical technology is designed to reduce the physical impact of surgery on the body, as patients will experience:

Smaller incisions

Reduced pain and fewer complications

Faster recovery

Myth #3: Robotic surgery is only for complex or high-tech surgical procedures

Robotic surgery is often used for complex procedures; however, robotic-assisted techniques can also be used for routine procedures, such as hernia repairs and gallbladder removals.

Myth #4: Robotic surgery is always more expensive than traditional surgery

People commonly believe that robotic surgery is too expensive or that it isn’t covered by insurance. Like traditional surgery, robotic-assisted surgical procedures are typically covered by insurance providers when they are considered medically necessary. Robotic surgery may reduce overall healthcare costs because it is minimally invasive.

Robotic surgery has its advantages and disadvantages. The use of this surgical technique depends on the patient’s needs. This is why it is important to consult with a healthcare provider and surgical team, as they will deem what the best course of action for that patient.

For more information about robotic surgery or to learn more about other surgical options at Flushing Hospital Medical Center, call (718) 670-5000 to make an appointment.

Meet Our Doctors- Dr. Andrew Bi

Posted on February 5, 2026 by Patrick Hercules

Flushing Hospital Medical Center is proud to introduce Dr. Andrew Bi, the newest member of our orthopedic surgical team.

Dr. Bi was born in Chicago, Illinois, and raised in East Lyme, Connecticut, and currently resides in Queens. He graduated from the University of Connecticut magna cum laude with honors. He then graduated from Northwestern University Feinberg School of Medicine summa cum laude with Alpha Omega Alpha honors. He then completed his orthopedic surgery residency training at NYU Langone Orthopedics, where he served as Executive Chief resident. Dr. Bi later underwent subspeciality training at Midwest Orthopaedics at Rush in a sports medicine fellowship, where he served as assistant team physician for the Chicago Bulls, Chicago White Sox, Chicago Steel, and DePaul University.

Dr. Bi has received numerous awards for teaching, clinical care, and research, including the Ralph Lusskin Senior Resident Teaching Award, the Marian Frauenthal Sloane Clinical Research Award, and the Rush Annual Thesis Day Award.

Dr. Bi treats all aspects of orthopedic injuries with a special interest in the management of all shoulder, elbow, hip, and knee conditions, including, but not limited to robotic-assisted joint replacements for arthritis, minimally invasive arthroscopic surgeries for sports injuries, such as anterior cruciate ligament (ACL), meniscus, cartilage, rotator cuff, and labrum injuries, and the fixation of fractures. His current research efforts involve anterior cruciate ligament injuries, meniscal allograft transplantations, rotator cuff tears, hip arthroscopy, and orthobiologics.

Dr. Bi is excited to begin at the Medisys family at Jamaica Hospital, bringing with him a sports medicine subspecialization expertise, as well as his Chinese heritage, to take care of the diverse population surrounding the hospital.

If you are experiencing any conditions or injuries affecting your bones, muscles, ligaments, and tendons, you can schedule an appointment at Flushing Hospital Medical Center’s Ambulatory Care Center. Please call (718) 670-5486.

Holiday Eating Tips After Bariatric Surgery

Posted on December 19, 2025 by Patrick Hercules

It’s the holiday season, and as we spend time with our family and friends, we enjoy each other’s company over delicious meals. Unfortunately, the holiday season can be a time when we run into problems with weight gain. It can be especially challenging after bariatric surgery. Fortunately, there are many ways to manage our weight during the holiday season. Here are 10:

Don’t save your calories. It may be tempting to skip meals to save calories for holiday treats, but it is better to stick to your regular eating patterns. You are more likely to overeat if you arrive at a holiday function hungry

Remember the basics. Just because it is the holidays doesn’t mean you can’t maintain the same healthy eating habits you had during the rest of the year. Pay attention to your portion sizes, start with protein, eat slowly, and track what you eat. Keeping these basic rules in mind can help you avoid overeating

Be mindful of how much you are eating. Eating while socializing can easily lead to eating too much. Enjoy the company and conversation and save eating for a time when you can focus on your meal

Avoid the buffet table and the kitchen. Standing close to where the food is being served may result in mindless noshing. Carefully select the food you truly want to try, and then walk away

Limit alcohol consumption. Drinks containing alcohol are full of empty calories. It is better to eat your calories than to drink them. Additionally, alcohol doesn’t just add calories; it can also dehydrate you. Be aware that alcohol can affect you differently after bariatric surgery. You may feel the effects much sooner, even after consuming less alcohol. You are also more likely to overeat at the buffet table after a couple of drinks

Stay hydrated. It is important to drink plenty of water and plan ahead. This ensures that you can avoid drinking within 30 minutes of eating and still get in the recommended 64 ounces a day

Exercise. The holiday season can be a busy time, and our exercise routines may suffer because of it. It is easier to get out of the habit of exercising than it is to get back into it after the holidays. Consider creating a workout schedule or organizing activities for the family that get everyone moving

Bring a healthy dish to share. This will ensure that there is a healthy food option at the gathering

Find healthy alternatives for your favorite recipes. Look for healthier substitutions that cut the fat and calories of recipes. Some examples include:

Using skim milk instead of whole milk in mashed potatoes

Using fat-free creamed soups in recipes rather than full-fat versions

Replacing sugar with unsweetened apple sauce or noncaloric sweeteners in desserts

Adding flavor with garlic, spices, and herbs rather than fats such as butter and gravy

Combining ¼ cup of Greek yogurt with ½ cup of butter to replace 1 cup of butter in a recipe

Replacing each egg with two egg whites and substitute evaporated skim milk in place of heavy cream when baking your favorite holiday treats

Be kind to yourself. You may overeat a bit or sample more treats than you should. However, that doesn’t mean all is lost. It is important to forgive yourself and recommit to healthy patterns and move forward. It is okay to have a treat once in a while.

Undergoing bariatric surgery requires preparation, dedication, and several lifestyle adjustments. Adopting a whole different way of eating can be challenging, and it will take some time to get used to it. Following these tips can help you plan and enjoy your food in moderation.

For more information about the Bariatric Surgery Services at Flushing Hospital or procedures performed by our doctors, please call 718-408-6977 or 718-670-8908.

Chronic Venous Insufficiency

Posted on November 7, 2025 by Patrick Hercules

Chronic venous insufficiency (CVI) is a form of venous disease that occurs when the veins in the legs become damaged and do not work properly.

Normally, the valves in the legs keep blood flowing back up to the heart. CVI damages those valves, causing blood to pool in the legs, increasing pressure in the veins, and causing symptoms such as swelling and ulcers.

Chronic venous insufficiency can happen due to damage to any of the leg veins. These can include:

Deep veins, which are the large veins deep in the body that run through muscle

Superficial veins, which are close to the skin’s surface

Perforating veins, which connect the deep and superficial veins

CVI may cause mild symptoms at first. However, this condition can interfere with a person’s quality of life and lead to serious complications over time. There are several signs and symptoms of chronic venous insufficiency, including:

Legs that feel tired or achy

A burning or prickly feeling in the legs

Reddish brown colored skin

Varicose veins

Flaking or itching on the legs or feet

The feeling of fullness or heaviness in the legs

Cramping in the legs at night

Swelling in the lower legs and ankles, especially after standing for a while or at the end of the day

Leathery-looking skin on the legs

Ulcers that form near the ankles, which can become infected and painful

Chronic venous insufficiency usually affects people over the age of 50. The risk of developing the disease rises the older a person gets. Overall, chronic venous insufficiency affects about one in 20 adults.

Venous disorders are a general category for many possible vein issues, including CVI. They have various stages that are based on clinical signs, which a healthcare provider can see or feel when they examine your legs. The stages of venous disorders range from 0 to 6. These stages include:

Stage 0: There are no visible signs; however, a person may feel fatigued or achy

Stage 1: superficial veins, such as spider veins, are visible

Stage 2: varicose veins that are at least three millimeters wide

Stage 3: swollen limbs that don’t have any changes to the skin

Stage 4: changes to the color and/or texture of the skin

Stage 5: an ulcer that has healed

Stage 6: an open ulcer

Chronic venous insufficiency is diagnosed at stage 3 or above.

There are three causes of valve malfunction: congenital, primary, or secondary.

Congenital causes of valve malfunction are deformities in the leg veins that a person is born with. Some people can be born without valves in their legs
Primary causes of valve malfunction are any changes to the leg veins that stop them from working correctly. A vein may get too wide, preventing its valve from completely closing
Secondary causes of valve malfunction are other types of medical issues that damage the leg veins. This is usually caused by deep vein thrombosis (DVT), the most common cause of CVI. The blood clot, or thrombus, leaves behind scar tissue, damaging the valve

Chronic venous insufficiency is diagnosed through a physical exam and ultrasound imaging.

Treatment for CVI involves lifestyle changes, such as leg elevation, exercise, weight management, and compression therapy. If these measures are not enough, a healthcare provider may recommend a procedure or surgery. The best treatment depends on how far the condition has progressed and the other medical conditions a person has.

The goals of treatment are to help the blood flow better through the veins, help ulcers heal and limit their chances of returning, improve the skin’s appearance, and reduce pain and swelling.

If you are experiencing symptoms of chronic venous insufficiency, you can schedule an appointment with a vascular surgeon from our Division of Vascular and Endovascular Surgery at Jamaica Hospital in New York or learn more about the services at our vascular surgery center in New York. Please call 718-206-6713.

Common Misconceptions About Bariatric Surgery

Posted on October 27, 2025 by Patrick Hercules

Bariatric, or gastric bypass surgery for weight loss, is a surgical treatment for severe obesity that involves making changes to the digestive system. It is performed when diet and exercise haven’t worked, or when a person is at risk for serious health problems due to their weight.

There are several myths and misconceptions about bariatric surgery and its outcomes, including:

Bariatric surgery is unnecessary, and people just need to eat less and exercise more
Bariatric surgery is dangerous
Bariatric surgery will make a person thin
Bariatric surgery and weight loss will make a person happy and improve their relationships
Bariatric surgery will prevent a person from overeating
Bariatric surgery is an easy way out
Most people will gain the weight back after surgery

Bariatric surgery can be a lifesaving solution for many people who are overweight. Bariatric surgery, along with a commitment to lifestyle changes, not only provides long-term weight loss but it significantly improves the health and quality of life for many.

For more information about the Bariatric Surgery Services at Flushing Hospital or procedures performed by our doctors, please call 718-408-6977 or 718-670-8908.

Benefits of Robotic Surgery vs Laparoscopic Surgery

Posted on October 22, 2025 by Patrick Hercules

When a patient requires a surgical procedure, a healthcare provider and surgical team determine the most appropriate surgical method based on the patient’s condition. Two types of surgical methods that can be used are laparoscopic and robotic.

Laparoscopic surgery is a minimally invasive surgical technique performed by hand and involves the use of a thin rod with a two-dimensional camera attached, called a laparoscope, which helps the surgeon visualize the abdominal and pelvic cavities through tiny keyhole incisions.

Robotic surgery is also a minimally invasive surgical technique. However, a surgeon performs surgical procedures using a robotic device. The device features a three-dimensional camera and a robotic arm that can hold small surgical instruments and is more dexterous than a human hand.

There are several advantages of laparoscopic surgery, including:

· It causes less trauma to the abdominal wall and inside of the stomach

· It causes less blood loss and a lower risk of hemorrhage

· It leaves smaller scars

· It causes less risk of infection

· It allows for a shorter hospital stay

· It has a faster recovery time

· It causes less pain during healing

Laparoscopic surgery can also have its disadvantages, including:

· It can only be performed by a surgeon with laparoscopic surgical training

· It can cause bleeding from the incision

· It can cause injury to nearby organs and blood vessels

· It can be expensive, especially if multiple procedures are needed

Robotic surgery can have several advantages, including:

· It is more precise and accurate than laparoscopic surgery

· It is less invasive

· It reduces blood loss

· It has a faster recovery time

· It creates fewer scars

· It gives the surgeon a better range of motion

· It gives the surgeon a better view of the surgical site, leading to more accurate and effective surgeries

The disadvantages of robotic surgery include:

· It gives the surgeon limited tactile feedback- It may not provide the same feedback as a surgeon’s hands.

· There can be technical difficulties, which are extremely rare.

Both laparoscopic and robotic surgery have advantages and disadvantages. It all depends on the patient’s needs and what the healthcare provider and surgical team deem as the best course of action for that patient. For more information about robotic surgery or to learn more about other surgical options at Flushing Hospital Medical Center, call (718) 670-5000 to make an appointment.

Robotic Surgery: Hernia Repair

Posted on July 17, 2025 by Patrick Hercules

An inguinal hernia happens when part of the membrane lining the abdominal cavity or intestine protrudes through a weak spot in the abdomen, often along the inguinal canal.

Some signs and symptoms of an inguinal hernia include:

A bulge in the area on the pubic bone, which becomes more obvious when upright, especially during a cough or strain

A burning or aching sensation at the site of the bulge

Pain or discomfort in the groin, especially when bending over, coughing, or lifting

A heavy or dragging sensation in the groin

Weakness or pressure in the groin

Occasional pain and swelling around the testicles occur when the protruding intestine descends into the scrotum

Some inguinal hernias have no apparent cause. Other causes of hernias can include:

Increased pressure within the abdomen

A preexisting weak spot in the abdominal wall

Straining during bowel movements or urination

Strenuous activity

Pregnancy

Chronic coughing or sneezing

Some risk factors that can contribute to developing an inguinal hernia include:

Being male

Being older

Family history

Premature birth or low birth weight

Previous inguinal hernia or hernia repair

Typically, a physical examination is sufficient to diagnose an inguinal hernia. A healthcare provider will check for a bulge in the groin area. They can also ask you to stand and cough or strain because standing and coughing can make a hernia more prominent.

Healthcare providers recommend surgery for most inguinal hernias. The types of surgeries used to repair inguinal hernias include:

Open surgery

Laparoscopic surgery

Robot-assisted surgery

Robot-assisted surgery can repair smaller hernias or rebuild the entire abdominal wall. There are many potential advantages of robot-assisted surgery over other types of surgery, including:

Robot-assisted surgery provides the surgeon with 3D images of the inside of the abdomen that create a clearer picture for them to reference as they operate, compared to the 2D images used during laparoscopic surgery

Under the surgeon’s direction, the robot can move more freely and with more versatility than a human hand

You will have a few tiny scars rather than one large incision (as with open surgery)

You are more likely to experience less pain and less bleeding after surgery, compared to open surgery

You are more likely to have a quicker recovery time than with open surgery

For more information about robotic surgery or procedures performed by our surgeons, please call Flushing Hospital Medical Center’s Department of Surgery at 718-670-3135 to schedule an appointment.