Smoothing Out the Bumps

For bunion and hammertoe sufferers, minimally invasive surgery is where the rubber meets the road.

Your feet are not tires. When they wear out, there is no replacing them. That being said, there are a number of painful podiatric conditions that can now be resolved with minimally invasive surgical procedures. It’s not like purchasing a brand-new set of Michelins, of course, but in many cases the end result is a smooth, bump-free “new tire” feel. Two of the most common foot deformities, in fact, are now correctable through a tiny, two-millimeter incision: hammertoe and bunions.

Have questions about bunion, hammertoe, or other foot surgeries to reduce pain? Contact Trinitas today!

These specialized techniques have been around for a while, notes Dr. Aqsa Siddiqui, DPM, who performs the surgeries at Trinitas, however, “not many podiatrists have been trained in this procedure, so it’s not done at every hospital. It has an excellent track record and very high rate of success, so as a result, we’re seeing more and more podiatrists being trained now. Bunions and hammertoe are different deformities with different plans, of course. However, we are able to treat both with minimally invasive surgery and correct each of those problems.”  Hammertoe is a biomechanical imbalance in the foot, due to an imbalance of muscles at the top and bottom of the foot, which causes contraction, typically at a toe’s middle joint. It is a democratic (small d) condition that breaks roughly 50-50 male/female, from all ages and walks of life, and from all nationalities and cultural backgrounds.

“We do see a fair number of young people with this condition,” Dr. Siddiqui says. “But typically my patients tend to have had the condition for a very long time—10, 20 even as long as 40 years—and it is causing constant pain and discomfort. They have already gone through other options, including trying different shoes with, say, a more spacious toe box, or orthotics or other conservative treatments, but nothing has helped.

Now they need something a bit more aggressive to correct the deformity.” Minimally invasive hammertoe correction involves a two-millimeter incision, through which podiatrists trained in this technique can go in and release the tendon and capsule, and then make small cuts to the bone to bring the toe up and reposition it properly, so it is no longer contracted. The surgery doesn’t involve any screws or plates; a special splinting of the toe is added within the post-operative dressing, and the bone naturally heals in the correct position within a few weeks. If a patient has multiple hammertoes, Dr. Siddiqui says she prefers to do one toe first and monitor how it responds to the procedure. “After that,” she says. “I will do the remaining ones together.”

The traditional surgery to correct hammertoe involves a recovery time up to six weeks for the toe to fully heal. The recovery time for the minimally invasive procedure, by contrast, is very quick. The patient leaves the hospital or surgical center in a walking boot (so there is no real down time) and the post-operative pain is minimal. A few days of Motrin usually quells any discomfort. The splint is removed after a week and, after two weeks, patients transition into a surgical shoe and can begin range-of-motion exercises. Between two and four weeks, they are fully healed. After that, they are good to slowly return to normal activities, including sports.

Dr. Siddiqui’s affiliation with Trinitas dates back a decade. After graduating from the New York College of Podiatric Medicine in 2012, she completed her three-year residency at TRMC. From there she accepted a wound-care and limb-salvage specialty fellowship before returning to Trinitas as an attending physician, working with residents and performing minimally invasive procedures. She began gravitating toward this specialty after her uncle, who lived in Pakistan, suffered a wound on his toe and ended up having to have it amputated. “I was studying here at the time,” she recalls, “and I think that was probably what got me interested in podiatry. I soon realized that it’s a great field. There is such a variety of things you can do to help people and make a difference…and still have your own personal life.”

The recovery time for minimally invasive bunion correction is similar to that of the hammertoe procedure: You’re walking out of the hospital in a boot, which you’ll wear for a week or two, before transitioning into a shoe. Within four weeks, patients are fully healed.  Whereas the causes of hammertoe tend to be consistent, not all bunions are created equal. The people limping into Dr. Siddiqui’s office may have developed bunions from a lifetime of repetitive stress or a genetic predisposition or as a result of flat feet—or some combination of causes. A mechanical imbalance of the muscles and tendons can also cause the deformity. Bunions are sometimes bilateral, but usually one foot is more severe than the other. What is unusual about the human foot that makes a bunion likely to form where it does, in the metatarsophalangeal joint of the big toe?

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“The MTP joint is a very important joint that we use when we’re walking,” Dr. Siddiqui explains. “We roll off that joint. When there is an imbalance of the muscles, it can deviate that joint, causing that deformity. This in turn can cause damage to the cartilage in that area. Over time, the natural progression is that the big toe moves inward, overlapping or underlapping the second toe, or just squeezing against it. If the condition is not corrected, it progresses further and further into a severe deformity.” Traditional corrective surgery for bunions often involves opening up the entire toe and inserting plates and screws—frankly, to the layman it can sound a bit medieval.

Plus, there are occasional healing issues and complications and in some cases the pain and the bump can return after a certain amount of time. That is one reason bunion sufferers tend to opt for more conservative fixes, even before considering a minimally invasive procedure. Dr. Siddiqui is on board with this approach. “When a patient comes to me with pain in that joint, we like to begin with conservative treatments—injections, orthotics, physical therapy, comfortable shoes,” she says. “But if that isn’t helping, or if the pain returns, then surgery is an option.”

As with the hammertoe procedure, the bunion surgery involves a two-millimeter incision, through which a tiny drill can go in and shave off the bump, after which a cut can be made in the bone in such a way that it enables the surgeon to move the head of the metatarsal and reposition the toe. The technique involves a specific cut at a specific angle, which can be accomplished through the tiny incision. Can bunions come back? “Sometimes bunions do come back,” she says, “but from what I’ve seen—and this is echoed by other podiatrists who have been doing this for many years—compared to traditional surgeries, patients undergoing the minimally invasive procedure do really well in that regard.” So when is it time to kick the tires on bunion correction surgery? That’s an individual choice, of course.

And yes, Dr. Siddiqui is aware that there are folks out there who think they’ll just tough it out. “However, they should be aware that bunions don’t go away and tend to get worse,” she cautions. Indeed, the road to a more severe deformity can be paved with nerve damage, pain in the other toes, bursitis and eventually arthritis. Unfortunately, at the point when cartilage damage has progressed to where the joint doesn’t move anymore (hallux limitus), your options for a u-turn will likely be few and far between.

Editor’s Note: Dr. Aqsa Siddiqui, DPM, performs all of her minimally invasive procedures at Trinitas. She is in private practice in Carteret at The Foot Care Center of New Jersey, (908) 652–6077.

 

The Shape of Water

Why you need it. How it works.

Three little atoms, two hydrogen and one oxygen, not only support all life on Earth (and who knows where else), they have defined the course of human history. We not only need H2O to survive, we’re mostly made of it. It is the largest component in our bodies, the percentage depending on age, gender, percent body fat and other factors. Muscle has higher water content than body fat so, as women naturally have more body fat than men, they are made up of slightly less water. Generally speaking, though, the human body is about 60-70% water. Which is why proper hydration enables every system in the body to perform at optimal levels.

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Isn’t it amazing, in retrospect, that it took until just about a generation ago for corporate America to tap into the money-making potential of water? Now there are more than 80 bottled brands of the clear stuff in the U.S. alone. Water is vital to our health and we’re willing to pay for it—ironically, to the point that the plastic it comes in is now becoming a major health threat. We are so overexposed to the commercial hype of water that sometimes it’s easy to lose sight of why and how it helps, how much is enough, and when enough teeters on the edge of too much.

According to the USDA, your absolute minimum water requirement varies depending on the amount of water lost through perspiration, respiration, urination and metabolism. For instance, those who engage in prolonged exercise or live in hot, humid climates will have a higher water intake requirement than those who do not. Most scientists and health professionals agree that the average human needs anywhere from 1 to 4 liters of water intake per day to prevent dehydration. A diet that includes fruits and vegetables supplies about 20% of the needed fluids, while water and other beverages take care of the rest. For many years, the “8 x 8” rule has been something of a standard: eight eight-ounce glasses a day. Those eight glasses can include any beverage—such as morning coffee and sugary soda—but water is the best choice.

Interestingly, the “8 x 8” rule doesn’t have a ton of science behind it; it’s just easy to remember. You’d think it was a marketing ploy to get you to buy more Poland Springs. The truth is that “8 x 8” may actually undersell water’s benefits. NASEM (the U.S. National Academies of Science, Engineering and Medicine), which has been issuing scientific reports for more than a century, says the average woman should consume 11 ½ cups of fluid a day (75 ounces, when you factor in food) and the average man should drink 15 ½ cups (98 ounces, factoring in food).

 

As mentioned, the water you’re replacing leaves your body through sweating, breathing and bathroom visits. Strenuous yard work, a set of tennis or an afternoon of pick-up basketball on a summer day can sweat away as much as 10% of your body’s water. That may not sound like a lot until you consider that most studies show that, at just 2%, dehydration can ensue and performance starts to decline. Fatigue sets in, brain function starts to diminish, headaches are more likely and even mild dehydration can impair your mood. Most everyone knows that continuous hydration during this type of activity is important, but far fewer are aware that downing a pint of water before you begin exercise can be a big difference-maker.

H2O’s CV

Let’s take a look at water’s “résumé,” because it’s pretty impressive. Among the many benefits and qualities of water are that it…

  • Helps maximize physical performance
  • Significantly affects energy levels and brain function
  • Can aid in weight loss by suppressing appetite and increasing calorie burning
  • Boosts skin health and beauty
  • Maintains electrolyte balance
  • Carries nutrients to your cells
  • Flushes bacteria out of your bladder
  • Regulates body temperature (especially this time of year)
  • Helps to regulate blood pressure
  • Cushions joints by providing lubrication
  • Decreases constipation (particularly water rich in sodium and magnesium)
  • Dilutes concentration of minerals that can contribute to kidney stones

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Water is also extremely helpful in mitigating hangover symptoms, especially when consumed intermittently while partaking of alcohol. Most people know that “having a few” leads to excess urination and dehydration, but don’t know why. The answer is that alcohol dulls the connection between your brain and your kidneys, so your kidneys don’t know how much water to keep in storage. The instructions your brain issues to your kidneys is done partially through the posterior pituitary gland, which tells your body how much fluid to excrete through urination (and also how much to hold on to).

Finally, anyone who’s been on any kind of a weight-loss diet recognizes the importance water plays. Water consumption increases your metabolic rate slightly and, as mentioned, makes you feel “full” if you drink a pint or so a half-hour prior to each meal.

In most cases, your body will tell you when it’s time to rehydrate. It’s called being thirsty and, thanks to millions of years of evolution, it works more or less the same for humans as almost every other mammal. If your fluid reserves get too low, your brain triggers the thirst mechanism, so you know it’s time to drink. One reason the elderly become dehydrated is because this brain-kidney communication can become less sharp with age.

“Thousands have lived without love,” the 20th century poet W.H Auden famously wrote, but “none without water.” Famous because one can tease out multiple meanings—about human relationships, about the environment and, on the purest biological level, about the basic functioning of the human body. A person in excellent health can survive without food for a month of more. Deny that same individual access to water and prospects for survival become grim within hours. It all comes down to those three critical atoms joining forces in just the right way.

 

Editor’s Note: Dr. Muniba Naqi is an internal medicine specialist and Medical Director of Hospitalist Medicine at Trinitas. Dr. Naqi has been the founding Medical Director for the Trinitas Hospitalist Department for the past seven years.

 

Smooth Move

While the skincare industry touts its latest, greatest miracle-working scientific formulations, actual science increasingly links healthy skin to what you put IN your body, not ON it.

Skin is the largest organ of the body. It’s the only one that is instantly visible. And it is vulnerable to all sorts of attacks, including dryness, excess oil, wrinkles, sunburn, acne, dermatitis, rosacea, eczema, psoriasis, seborrhea, and various forms of cancer. Millions of consumers shell out billions of dollars on topical skincare products each year in an effort to improve the look and feel of their skin. All the while, they may be missing a more obvious, cheaper, and better way to reach their goal. Food.

In their book Beauty Basics for Teens, Dianne York-Goldman and Mitchel P. Goldman, M.D., urge a balanced diet that includes carbohydrates, protein, nutrients and fiber, but is low in saturated fats and empty calories. They also advise drinking at least eight 8-ounce glasses of water each day for proper hydration. The goal is to eat foods rich in vitamins, minerals, antioxidants, and healthy fats. Melody L. Meyer of Albert’s Organics, a California-based natural products distributor, suggests leafy green vegetables for iron and calcium, sweet juicy fruits (especially at breakfast), a variety of whole grains, and easy-to-digest proteins like legume soups, paneer (cheese made from boiling milk, adding lemon and straining solids), and lassi (diluted yogurt and spice drinks).

Carotenoids, which are found in red and orange fruits as well as in yellow and dark green vegetables, are recommended by Sharrann Simmons of Cognis Nutrition & Health, an Illinois-based food technology company. She says that carotenoid lutein has been shown to protect skin against UV-damage, improve skin hydration, encourage elasticity and enhance beneficial lipid levels. For its “Beauty from Within” campaign, DSM Functional Food Marketing of New Jersey also enlists carotenoids, as well as antioxidant vitamins C and E, green tea extracts, omega-3 fatty acids (which can be found in fish and flaxseed), and polyphenols (derived from olives). Consumers seem to be getting the message. A recent study by the Mintel Group, a market research fi rm, notes that 2008 saw the debut of more than twice as many new beauty foods and beverage products as there were in 2007.

Dermatologist and author Nicholas Perricone urges a diet loaded with these essential proteins: fish, poultry and, occasionally, lean beef, pork or ham. He also suggests consumption of soy foods like tofu and tempeh, egg whites, low-fat cottage cheese, low-fat milk, and yogurt. For carbs, he favors squash, spinach, onions, green beans, asparagus, cabbage, cauliflower, eggplant, collard greens, escarole, green peppers, strawberries, raspberries, apples, blackberries, blueberries, cantaloupe, honeydew, and kiwi. Recommended fats include oils derived from olives, walnuts, safflower, soybeans, rapeseed (canola), and sunflowers, as well as nut butters and avocado.

Perricone also is high on the following ten “Superfoods”: Aτai (pronounced ah-sigh-ee), a high-energy berry that grows in the Amazon The allium family of foods, including garlic, onions, leeks, scallions, shallots, and chives, all of which are rich in flavonoids. Barley, which is not only low on the Glycemic Index, but high in both soluble and insoluble fiber. Green foods, which are derived from cereal grasses and blue-green algae. Buckwheat, also low on the glycemic scale, and which may be substituted for less healthful grains like rice, wheat, and corn. Beans and lentils, an alternative to fattier meat proteins. Hot peppers, which are high in heart-healthy, anti-inflammatory compounds. Nuts and seeds, which are a source of good fats. Sprouts for their enzyme content.

Yogurt and kefir, fermented dairy products that add digestion-aiding probiotics to the diet. J.T. Ryan is a licensed physical therapist and owner of Healing Touch in Howell. The company makes and markets handmade natural body-care products. She emphasizes the need for trace minerals and electrolytes, which she calls “a key to cellular regeneration.” For example, Ryan says, a deficiency in copper will lead to scar formation during the skin’s 40-day cycle period. Foods rich in copper include most nuts (especially Brazils and cashews), seeds (especially poppy and sunflower), chickpeas, liver and oysters. Are there foods that should be shunned if your goal is shiny, smooth skin? Most definitely. This is particularly true if you are worried about acne. Naturopath Alan C. Logan, who teamed with dermatologist Valori Treloar on the 2007 book The Clear Skin Diet, cautions against the foods most popular with American teenagers—pizza, hamburgers, cookies, crackers, fried potatoes, salty snacks and sweetened beverages.

Even milk consumption is “strongly associated with acne,” the authors claim. In place of these no-no’s, Logan argues for a diet that focuses on the omega-3 fatty acid eicosapentaenoic acid (EPA), found in fish like mackerel, sardines and salmon, tomato extract with the carotenoid lycopene, marine fish that are rich in collagen, and a high-flavanol cocoa extract. Logan explains that inflammation is at the core of acne, and that oxidative stress, a byproduct of the standard American diet, “fans the flames of inflammation.” Fish oil, he says, especially EPA, blocks the production of the inflammatory chemicals. This also is why antioxidant fruits and vegetables are so important. Does this mean you have to toss away all your lotions, creams and ointments? Of course not. They definitely serve a purpose. But keep in mind that if you really want a smooth, healthy complexion, a good nutritional foundation is where you should start.

Editor’s Note: New Jersey-based freelance writer Alan Richman is the former editor of Whole Foods Magazine.

Is 90 the New 60?

At TRMC’s Health & Fitness Center, sometimes anything seems possible  

Judy Christianson, RN, cardiac rehab nurse, monitors Antonetta Paul’s workout as she gets exercise designed to strengthen her upper body.

A 40-something woman pulls to keep the pounds off on the rowing machine. Another woman in her early 60s pedals the recumbent bike to strengthen her heart following heart valve repair surgery. Over by the weights, two men— maybe 20 and 50—swap workout stories. Welcome to the world of movers and shakers at Trinitas Regional Medical Center’s Health and Fitness Center in Elizabeth. So naturally, it is 90-year-old Antonetta Paul who inspires everyone with her grit and determination whenever she comes into the Trinitas Rehabilitation and Fitness Center at the medical center’s main campus.

Antonetta is a firm believer in staying active to stay young and healthy. A cardiac patient who underwent a quadruple bypass in 2003, Antonetta is one of the oldest members of the Health and Rehabilitation Center at Trinitas Regional Medical Center. How she got into the workout regime is the story of attentive doctors and good follow-up care. While under the care of cardiologists David Pinnelas, MD, and Edward G. Williams, MD, Antonetta visited the office for a stress test.

Within a moment of stepping onto the treadmill, Dr. Pinnelas advised that she should step off and come into his office. “When I got there, he told me that I had serious cardiac problems,” recalls Antonetta. “He recommended that I undergo a quadruple bypass. Well, I told him the surgery would have to wait a few days since I had plans to visit the Liberty Bell in Philadelphia with my children and grandchildren.” The Elizabeth resident, who can remember noticing only some fatigue, had the surgery performed at Beth Israel Hospital in Newark at the age of 82. Following a short stay in the hospital, Antonetta spent a few weeks in a nursing home setting. But since then she has been living independently in Elizabeth. Since the major surgery, fatigue is a thing of the past and her heart health couldn’t be better for this woman who is one of the most frequent and consistent users of the Health and Rehabilitation Center.

Her three-day-a-week schedule begins at about 7 and includes 20 to 25 minutes on the stationary bicycle; 6 to 10 minutes on the treadmill and 8 minutes (“sometimes I do 12 minutes or more”) on the Nu-Step recumbent bicycle. She finishes with 4 minutes of arm exercise on a bicycle-like apparatus designed to improve upper body strength. It’s especially helpful for women who have less upper body strength than men. At every step of the way, Antonetta’s progress in each workout session is monitored under the guidance and supervision of Exercise Physiologist Hugh Rappaport, and the watchful eyes of the Center’s cardiac rehabilitation nurses, Judy Christianson and Jean Mikita. They all consider Antonetta a major success story and hosted a 90th birthday celebration for her this summer. “I enjoy the time I spend at the Center,” Antonetta says. “I look forward to it and it helps me get my day started. Jean, Judy and Hugh tease me a bit about how I’m a ‘flirt’ but they just like to bring a smile to my face.”

Antonetta appreciates the care she received from Dr. Pinnelas at the time of her surgery. She recalls a visit to his office a few years back, when he told her he was leaving the Elizabeth area to establish an office in Neptune at the Jersey Shore. “He asked me if I would be willing to visit his new office once a month so he could keep on eye on me,” she explains. “Well, I looked at him and said, ‘I tell you what, how about if you come up to the office here in Elizabeth to see me once a month?’ He couldn’t stop laughing.” It’s that kind of gumption, independence and belief in herself that makes Antonetta Paul the “poster child” of the Trinitas Health and Rehabilitation Center.

 Editor’s Note: In addition to her editorial role with EDGE, Kathryn Salamone is editor of weekly, monthly and on-demand publications for the Trinitas organization. An award-winning communicator, Kathy’s press releases appear in numerous local and regional media.

Sliced, Diced & Discouraged

If that’s how dieting makes you feel, then it’s time for a new Rx

If sticking to a diet were literally to boil down to a life-ordeath choice, could you do it? Anyone who’s fought an unsuccessful battle of the bulge has, at one time or another, considered this extreme set of circumstances. The fact that we actually wonder about such things says a lot about our attitude toward dieting. It suggests that, for a great many of us, eating healthy and living healthy won’t start until we have a gun pressed to our heads. Or some other vital organ. In his practice at Trinitas Regional Medical Center, Dr. Ari S. Eckman, M.D., sees a steady stream of patients dealing with diabetes—a disease approaching epidemic proportions— and also hypothyroidism, another disorder that is growing, particularly among women. When asked if his high-risk patients were better dieters than most, the Chief of TRMC’s Division of Endocrinology, Diabetes & Metabolism said that yes, initially they are. “But many do lapse over time,” he admits. Apparently, risk alone is no guarantee of success. Dr. Eckman is quick to confirm this fact. He maintains that dieting is not so much about food as it is about lifestyle. The root of the word “diet” actually comes from the Greek word diaita, which means a “prescribed way of living.” Dieting, he insists, doesn’t have to mean depriving. That being said, he cautions, the whole point of dieting is to lose weight. “Make no mistake about that.” The Power of Positive Eating Google “diet” on your computer and the results are overwhelming. You’ll discover page after page of sites that are overflowing with imaginative menus and mouthwatering recipes. Whichever one you choose, says Dr. Eckman, you can increase the chance for success by following these ground rules: Spice Up Your Life Although salt can amp up flavor, there are a lot of other herbs and spices, both dried and fresh, that can compensate: pepper, oregano, basil, cumin, garlic, cilantro and the well-sung quartet of parsley, sage, rosemary, and thyme. Most Americans need to reduce their daily salt intake. This is doubly true for people trying to lose weight. Think Outside the Box Get creative in your kitchen. Take advantage of seasonal produce. Cook veggies several different ways (roast, steam, grill) for different taste and texture…and raw is always beautiful. Make fruit a part of your meal to stave off a major sugar craving. Dress Up Your Diet Visually feast, don’t just blindly eat! Set a pretty plate. Garnish your heart out. Color-coordinate healthy food choices. Use your best china. Sip water out of a crystal goblet. Presentation goes a long way—cater to all of your senses, not just your taste buds. Move Away from the Kitchen At home, dine someplace other than where the food is, namely the kitchen. You’ll have to get up for second helpings. The extra steps will make you take notice of how much you’re consuming. Work In a Workout A diet without exercise is a recipe for failure. Find 30 minutes each day to break a sweat with some cardio activity, and not necessarily all in a single interval. Park your car a little farther from the office or the supermarket. If you work at home, devote the commuting time saved to exercise. No buts to getting off your butt. Lead Yourself Not into Temptation Drive by the driveins. Clean out your cupboards. Eat five to six small meals a day rather than only two; your body seeks to metabolize— deny it by skipping a meal and you’ll overeat at the next. Monitor the Usual Suspects Forego the fad diets; better to identify your specific food weaknesses and just stay away from them. That way a minor slip-up won’t lead to a major binge! Among the same search-engine results that yield great recipes for different diets, you will also find lengthy dissertations on the challenges to success: temptation, boredom, stress, self-indulgence and the need for instant gratification. To that, says Dr. Eckman, you can add resentment. Nothing can sabotage a diet’s success more than hating the fact that you have to diet at all. Ultimately, he says, we will comfort ourselves by giving in to cravings. We’ll indulge ourselves with dangerous “treats.” We’ll eat, drink and yet we still won’t feel particularly merry. Denial is also a definite diet-killer, adds Dr. Eckman. “Too often I hear patients claim that they don’t eat much! The problem is how much is ‘much’ to them? And it may not even be how much they eat, but how wrong they eat,” he says. “If you can’t see the real you when you look in the mirror, then maybe you need to go out and buy a good scale…and then be sure to step on it.” The numbers won’t lie. EDGE  

Editor’s Note: Dr. Eckman completed a fellowship in Endocrinology and Metabolism at Johns Hopkins University. In addition to providing medical treatment for Diabetes and Thyroid conditions, his practice, Premier Diabetes & Endocrinology (tel: 908 994 5187), extends to a broad range of health conditions, including polycystic ovarian syndrome, osteoporosis and other calcium disorders, low testosterone levels and lipid abnormalities.

Food Fight

When it comes to picky eaters, the truth may not be that hard to swallow

We’ve all heard the stories—the child who completely shuns vegetables or refuses to consume anything but white foods. They’re funny if you aren’t the parent trying to get healthy food into a picky eater. If the kid is yours, however, it’s no joke. There are reasons for your child’s peculiar eating habits, and things you can do to broaden his or her culinary horizons. First off, you may be surprised to learn that it’s hardly ever a matter of taste. Picky eating is a natural part of toddlerhood, as children express their independence. What parents may believe is a fussy eater may not actually be that at all. “Children don’t tend to eat as much at meals as adults expect them to eat, and babies spit out their food, leading parents to believe that they don’t like it,” says Dr. Maria Padron, a pediatric and adolescent psychiatrist at Trinitas Regional Medical Center. “But babies taste food by spitting it out and licking it, and if parents believe their child doesn’t like it and don’t continue to introduce that food, it becomes a foreign food to them.” Well-meaning parents may try to cater to a picky eater, but experts say that that only backfires. “They create a monster,” Dr. Padron explains. “Unless there’s a medical contraindication, children should be ‘helped’ to eat everything that the family eats.” Easier said than done, right? Don’t give up until you’ve exhausted these strategies: Offer variety earlier. “Kids often become picky eaters because they haven’t been exposed to a lot of foods,” Dr. Padron says. “You should slowly expose children to different kinds of foods.” Hold your ground. Your child may decide to go on a hunger strike for a meal or two if you suddenly stop being a short order cook and insist that he eats what you’re eating, but he won’t hold out forever. “Kids may refuse to eat for a few meals, but as long as they’re healthy and still drinking liquids, it’s fine,” Dr. Padron says. “When he’s hungry, your child will eat.” Keep reintroducing the same food. “Parents need to be patient when they’re introducing new foods, and not get upset if kids aren’t jumping to eat broccoli right away,” Dr. Padron advises. Even if your children didn’t like asparagus the first few times, all it may take is the repetition (or a new way of serving it) to make them like it the 10th time around. You just need to insist on one bite each time you serve it— if they still don’t like it, don’t force it. Get your kids involved. Take your kids along to the grocery store and let them choose something new to try in the produce department—and if you have the time, let them get involved in preparing the dinner, too. By allowing your child to have a say in what they’re eating and an investment in the meal, you may find that they’re more willing to eat the fruit they picked out or the side dish they helped make. Minimize distractions at dinnertime. If there are other forms of entertainment beyond eating—a TV, books or toys—that can keep kids from attending to the task at hand. Instead, look for ways to make the meal itself more entertaining, with a colorful variety of vegetables or interesting presentations. Seek help. Get your pediatrician on board, especially if it’s been a long-standing issue, where your child’s eating habits may have become ingrained. For more severe cases, your pediatrician may recommend speaking to an expert, such as a counselor or a speech or occupational therapist. Indeed, in some instances, picky eating can be the sign of a more serious issue—a sensory disorder or a mechanical issue with feeding. So when is the right time to call in professional help? “In children with feeding issues, it could be a textural or tactile issue, often with mushy foods like bananas or yogurt,” says Kevin Nelson, occupational therapist and Manager of Trinitas Children’s Therapy Services. “Or it can be a mechanical issue, where they simply don’t have the musculature in their mouth to handle that food.” Whatever the cause of a child’s pickiness, in the end the key is to work slowly. Your kid won’t become an adventurous eater overnight, and if the issues are more sensory or mechanical in nature, you may need to follow a much gentler, slower path toward introducing these foods.

“Seeing a therapist is not the first step in a long and expensive process.”

“We slowly try to introduce the textures to them,” Nelson explains. “If they have an issue with mushy textures, we might start to do some play with finger paint or shaving cream to get them comfortable with that texture. Then we’ll have them sit at a table with the yogurt on the table, then put a dab on their finger, maybe have them smell it. Finally, we’ll put a dab on their tongue. We slowly try to get it closer to get them to tolerate it.” Depending on the severity of the issues, this process could take months. However, if you consistently work with children at home as well as in therapy, you may find that you’ll move faster toward turning your child into a well-rounded eater. Also, understand that seeing a therapist is not the first step in a long and expensive process. On the contrary, says Nelson. “You may need to see a therapist for an initial consultation, just to get started in the right direction and get trained on how to handle it.” “A lot of our job is educating parents on what’s appropriate,” he says, “and how to deal with different situations.” EDGE

 Editor’s Note: Lisa Milbrand is a New Jersey-based writer whose articles on health and relationships appear in Parents, Arthritis Today and Modern Bride. Her blog themamahood.com celebrates the life of a working mother.

 

 

Nothing to Sneeze At

Nothing to Sneeze At

Dealing with dander can be a matter of life and death

Dogs may qualify as man’s best friend, but they won’t do you any favors if you’re among the estimated 10 percent of Americans who have animal-related allergies. That means your allergic antibodies—aka immunoglobulin E—have declared pet dander and saliva as enemies of the state. The casualty list in this epic, microscopic battle being waged within your body includes a runny nose, scratchy throat, watery eyes, itchy hives and, in the most serious cases, a potentially lifethreatening asthma attack. “Pet dander can activate cells in the immune system,” confirms Samuel D. Kahnowitz, MD, FCCP, FACP, Chief of Pulmonary Medicine and Medical Director of Respiratory Therapy at Trinitas Regional Medical Center. “The body then makes inflammatory substances that constrict the muscles around the airway, and cause swelling on the inside of the airways, making it harder to breathe.” Reactions to pet allergies account for an increasing number of doctor and emergency room visits in this country, so the medical community is taking this trend seriously. To a layman, at least, the obvious question is, “Has pet dander somehow gotten ‘worse’ or are people becoming more sensitive to it?” Actually the same question could be asked about our food and environment—allergies in general seem to be more prevalent, and more serious, than ever. It turns out that we may be the problem. Indeed studies suggest that our country’s obsession with cleanliness may be to blame for creating hypersensitive immune systems, which now react to harmless things around us. “Our environment has improved, so we don’t have to worry about fighting off dangerous parasites,” explains Richard J. Bukosky, MD, an allergist in Linden. “The allergic antibody doesn’t have a whole lot to do. It starts to ‘pick’ on things that we’re exposed to in the environment that are completely harmless.” While there is still no permanent cure for pet allergies, there are plenty of options available for minimizing their effects on your life—and many of them don’t require finding a new home for Fluffy or Fido: Minimize exposure to pets. The less exposure to the offending pet, the better. Opting to find a new home for your pet may help in the long run, though it can take up to 20 weeks after the pet leaves before the allergen levels really dissipate. If your dog or cat is here to stay, make sure to keep it out of your bedroom—the place where you spend most of your time—and wash your hands thoroughly after you’ve touched your pet. Weekly bathing or grooming (done by someone other than the person with the allergies) may also help keep allergens at bay. Keep it clean. Daily vacuuming and washing-down of surfaces can help clear some of the allergens—especially if you use a vacuum with a HEPA filter that can trap the tiny particles. Removing carpeting, drapery, stuffed toys and other soft fabrics can help reduce the number of places where pet dander can become trapped. “I really push for them to allergy-proof the bedroom—get rid of the carpeting and the animals, get a dehumidifier and a HEPA filter, avoid down comforters and get allergy-proofing casing for the pillows and mattresses,” Dr. Bukosky says. Consider that it might not be your pet. Even if allergy testing turns up an allergic reaction, it may not actually be your animal that’s causing the wheezing. “Dogs roam around, and it might not be the dog himself—it may be an irritant he’s picking up outside, like wood chips or rag weed,” says Dr. Kahnowitz. Take antihistamines. Newer over-the-counter formulations, like Zyrtec and Claritin, are more potent and less likely to cause drowsiness and other unpleasant side effects. Try a more serious approach. Doctors have become more aggressive in treating allergies, often including steroids in the treatment plan. “We’re pushing steroids more,” Dr. Bukosky says. “We used to use a montelukast (Singulair) a lot, but we’ve started to use inhaled steroids more—for nasal allergies, internasal steroids are a good option.” Of course, pet allergies can also be treated with a program of allergy immunizations. “We push for immunizations, which make it less likely that you’ll develop asthma,” says Dr. Bukosky. The regimens generally start with weekly shots, then as the treatment progresses, patients can go longer and longer between injections. Finally, there’s the do-nothing approach. These are the people who claim they have built an immunity to their animal. Is this really possible? The answer is yes…and no. Dr. Bukosky warns that what these pet owners believe to be happening may not actually be the case. “With daily exposure to the pet, a person with allergies may be having mild allergy-like attacks each day that use up the IgE antibody—just not enough to cause symptoms,” he says. “Then the child goes off to college, or is away from the pet for a long vacation, and has an asthma attack. So you may become ‘used to’ your pet, but you have to be in constant contact with it to avoid a serious reaction.”

Dog Days

Heart attack victims who have pets tend to live longer. Watching fish in a tank can lower blood pressure. In senior adults, canine companionship can keep mental health complications from turning into physical deterioration. Indeed, considerable evidence supports the healing potential of pet therapy. There is plenty of history to back up the power of pet therapy, too. The first documented account of animal therapy dates back to the 9th century in Gheel, Belgium, where farm animals were used to help disabled people cope. In Washington, D.C. in 1919, psychiatric patients at St. Elizabeth’s Hospital had dogs available for their recognized therapeutic value. And in the decades since, the medical community has come to embrace this interactive approach to improving the quality of life, both for patients in recovery and for those whose health may be in decline. For the record, today the more politically correct term for pet-related therapy is either Animal-Assisted Activities (AAA) or Animal-Assisted Therapy (AAT). AAA is a more casual meet-and-greet approach to hands-on contact between patients and pets, while AAT is a more formal clinical approach with patients who may be challenged physically, emotionally, or mentally.

PAWS FOR HEALTH Among the myriad patient services offered by Trinitas Regional Medical Center is its own Animal-Assisted Activities program, headed by Carol Pepe, Director of Case Management Services. Whether politically correct or not, everyone at Trinitas still calls it the “pet therapy program” and, indeed, this is Pepe’s pet program. She launched it almost five years ago with the approval of a multi-discipline committee of hospital representatives. To date, the AAA program’s success can be measured by the more than 3,700 visits arranged for older inpatients and cancer treatment outpatients. The Trinitas program utilizes dogs only, although many AAAs and AATs involve a variety of animals ranging from cats, birds and horses to more exotic creatures. One, in Thailand, uses elephants. The dog handlers at Trinitas are typically employee volunteers. A volunteer escort is always present, as well, to monitor overall pet–patient interaction. Currently, there are six participating therapy dogs at Trinitas: four males (Winston, Murphy, Buddy and Harley) and two females (Ribbon and Bonnie). Males and females of all breeds, including mixed, are potential candidates. Temperament always trumps sex or bloodlines. Trinitas has a close working relationship with St. Hubert’s Animal Welfare Center in Madison. Through their Paws for People program, St. Hubert’s trains and certifies both dogs and their owners/handlers. All pets are temperament-tested to assure that only appropriately friendly, stable and disciplined dogs make the cut. The owner/handler must attend a three-hour class, and both dog and owner must complete rigorous homework exercises to be certified.

THEY CALL IT PUPPY LOVE Linda Reynolds, Director of the Adult Outpatient Unit in the Department of Behavioral Health and Psychiatry, is in charge of a similar pet therapy program, which she launched only two months ago. Currently, she is the sole owner/handler of a canine “therapist,” her five-year old beagle, Murphy. Both have been certified by St. Hubert’s. Reynolds recognized early on that Murphy had the necessary qualifications, since he had become an ambassador of goodwill in her own neighborhood, particularly among senior residents. Currently, the psych department’s group sessions are held at Trinitas, with special visits paid to the on-site nursing facility—the domain of Harley, another gifted pet “therapist.” The adult outpatient groups are often organized according to particular challenge. Two of the currently active groups are focusing on anxiety relief and partial vs. unconditional love. Reynolds refers to these sessions as her “puppy love” groups. “I really just knew I had to share him,” Reynolds says of Murphy, who wears a hospital staff photo ID badge, as do all the therapy dogs. It is attached to his favorite bandana; Reynolds realized that Murphy needed a work wardrobe and provided it. Murphy is typically on the job two or three days a month. A typical day includes sessions with two to three groups, each with five to ten patients. Patients are not the only recipients of Murphy’s healing powers. Staff members having a bad day often drop by for a visit and a pet. Murphy is happy to oblige. “No stranger is too strange for Murphy,” Reynolds says.

JUST SCRATCHING THE SURFACE The immense potential of animal-assisted therapy is particularly clear to Reynolds and Pepe, each of whom has special memories of pet–patient bonding. Pepe recalls one terminally ill patient who related incredibly to Bonnie, spending her last three weeks with regular visits. In Bonnie’s company, the patient was more relaxed and less stressed because there was no need to put on the brave face she did for family members. She even occasionally let Bonnie borrow her wig, which elicited peals of laughter from patient, handler and escort—not to mention Bonnie’s joy at being the center of so much attention. The patient was able to share some smiles and also some tears with Bonnie until the very end. Reynolds remembers a bipolar patient in a group session who had vehemently verbalized her dislike of dogs—which only encouraged Murphy to make friends. He ultimately won her heart and brought a smile to someone who hadn’t smiled in months. Pepe herself underwent surgery two years ago and became an active participant in her own program. The owner of three dogs, she experienced a case of severe pet withdrawal while in-hospital. Through some therapy dog visits, Pepe can now personally attest to the healing comfort that comes from simply petting a friendly, furry, four-legged creature. “We’re in the business of small miracles,” Pepe says. “The dogs bring smiles where before there was only pain.” EDGE  

Editor’s Note: Every word you read in EDGE has to go through Christine Gibbs first. This is the first story she has authored for EDGE since joining the staff in 2009. Chris freelanced in the finance, international business and healthcare sectors as a technical writer and editor before coming aboard.

Strength in Numbers

Keeping a marriage on track takes hard work and an open mind. The obstacles are unrelenting. The rewards sometimes seem few and far between. Money, job stress, child rearing and personal growth (or lack thereof) are among the big-picture challenges. Just as vexing are all the little conflicts that must be resolved merely to stay focused on moving the relationship forward. Then one day you wake up, look at your mate and wonder, “Do I really know this person?” Or worse, “Do I really know myself?” The good news is that successful couples find a way to muddle through and come out stronger on the other side. As a rule, they learn to divide their stress load as time and circumstances dictate. However, they make sure to deal with the “big stuff” as a team. This strategy is vitally important when facing the health issues that crop up as couples age. Almost every family will have to deal with a major illness at some point. How couples get through it can depend as much on their teamwork as it does on their doctors. That is why the medical field is placing increasing emphasis on providing the highest quality information and support to patient and spouse long before the physical healing process even begins.

“Patients’ emotional stability is as important as their physical well being, which is why—if and when possible—they should embark on this journey with their significant other,” says Alan P. Krieger, MD, whose patients include men undergoing prostate cancer treatment. “Couples should absolutely go through the initial steps together. Both need to understand what’s going to happen, and that works best when the doctor is able to meet both patient and partner.” Indeed, where once spouses were spared the unpleasant details of a surgical procedure—and as a result were unprepared to deal with the aftermath—now full disclosure is a crucial part of recovery.

That begins with understanding the options. For instance, most people understand that hysterectomies are performed for several reasons (ranging from unusual conditions such as ovarian carcinoma to something relatively common, such as irregular bleeding or pelvic pain). Yet they have no idea how many ways this procedure can be performed. At Trinitas Regional Medical Center, many operations—including prostate surgery and hysterectomies—are now done with the da Vinci robotic surgical system. “Good vision and maneuverability translates into more precision and a faster recovery for the patient,” says Kamran Khazaei, MD, FACOG. “The da Vinci lets surgeons see in high-definition. And by using the robotic arms with both hands, we are able to perform very delicate procedures. In many cases where patients used to need four or five days to recover, they are walking and eating the next day. In the more aggressive surgeries, recovery has been reduced from weeks to days.”

Not all cases can be addressed robotically, Khazaei cautions, ovarian cancer being one example. Likewise, not all options involve surgery. “You have to cater to each patient individually,” he says. “With medications. Injections. Therapy. As physicians, our job is to treat our patients in the least invasive way possible.” “In issues related to menopause,” he adds, “we are sensitive to the fact that women experience it, but also that men deal with it. We look for ways to keep both parties sane.” Sanity also comes into play with another medical issue that has become increasingly common among couples: Obesity. The patients treated by Joao A. Lopes, MD, and Muhammad S. Feteiha, MD, FACS, often are at the end of their rope. After years of yo-yo dieting and deteriorating health, they want to discuss a surgical option, either a gastric bypass or a gastric band. Lopes can quote the statistics on both procedures chapter and verse. Bypass patients achieve around 80 percent of the weight they anticipated losing, while band patients drop about 40 percent. That easily outweighs the option of doing nothing.

Those who fail to address their obesity in a substantial way (through diet, exercise, surgery or a combination of the three) are 300 times more likely to die 15 years earlier than people who keep their weight under control. The number that impresses Lopes most, however, is that more than 70 percent of the patients he sees come in as couples. “Success depends greatly on the understanding and support of partners and spouses,” he says. “It helps tremendously to have someone encouraging your new lifestyle, exercising with you and taking part in the process. A husband or wife must take part in their new eating behavior and move toward healthier types of foods.” As with most medical procedures, sorting through the options as a couple is the first step in a successful outcome. In the case of a band or bypass, knowing what has to happen afterwards is just as crucial. “Bariatric surgery patients really have to understand the new diet and what they’re getting into in terms of the process after surgery,” says Lopes. “The support of a spouse is tremendous, and we have a bariatric coordinator here in the office to help. Basically, we get through it together.” To help support his recovering patients, Dr. Krieger actually started the first New Jersey chapter of Us TOO, which counsels prostate cancer survivors and their partners. “My main goal is to cure the cancer,” he says, “but a key part of the recovery is for couples to know how they can work together to improve their lives and their relationship.”

 Editor’s Note: Rachel Rutledge is EDGE’s ace Editorial Assistant. Lisa Milbrand, who usually writes our Healthy Edge feature, conducted the interviews for  this story.

Deadly Souvenirs

Globetrotting microbes are keeping New Jersey doctors on their toes.

There are some souvenirs you want to bring back from your travels—local handicrafts, beautiful jewelry—and then there are the ones that you don’t. These range from the inconvenient

(Montezuma’s Revenge) to the catastrophic (raging infections). Thanks to ever-adventurous New Jerseyans and newcomers from developing countries, doctors in the Garden State often find themselves treating patients with unusual, challenging-to-diagnose, and even hard-to-cure diseases. By the time they arrive at Trinitas Regional Medical Center, their condition is typically dire. Sometimes, it’s desperate.

The rundown of rare diseases that doctors are currently fighting in New Jersey includes the tropical maladies with which world travelers are now familiar. Interestingly, these are showing up less frequently. Indeed, one would expect that the incidence of, say, typhoid, malaria, and dengue fever might be on the rise. But Dr. Clark Sherer, Chief of Infectious Diseases at Trinitas, says the number of cases of these tropical diseases has remained low for the 20 years he has worked in infectious diseases.

CONFRONTING THE “CLASSICS”

“We’re not seeing more than we’re used to—just a case or two of malaria a year, and a case of dengue fever every few years,” he says.

Dr. Sherer credits the availability of immunizations and preventative medicine with keeping the numbers small. “There are people who go out into the jungle for a week on tour and never get pills to prevent malaria,” he says. “But, if you take the proper precautions regarding vaccinations, food and water, and insect and mosquito control, you can stay healthy.”

When treating some of the rarer cases, like dengue fever and typhoid, the biggest challenge for doctors can be staying abreast of the latest treatments. “Since we see them infrequently, when we make the diagnosis, we have to

familiarize ourselves with any developments in treatment,” Dr. Sherer says. “You don’t feel quite as comfortable dealing with something you only see rarely.”

TB OR NOT TB

Tuberculosis is another disease that people associate with exotic locales. And recently, headlines about drug-resistant strains of TB may have struck fear in people’s hearts. Yet Dr. Sherer says that the incidence of drug-resistant TB is relatively low.

“Tuberculosis has been out there and is still out there, but most of the cases we’re seeing are completely sensitive to treatment,” he maintains.

While the number of cases of TB has grown, Dr. Sherer says there’s little need for the general public to worry. “Most of the cases we’re seeing here are in foreign-born people who are on the younger side. They were exposed in another country where TB is endemic, and later develop active TB.”

BAD BUGS

The most challenging cases the doctors are seeing involve bacterial infections, whether it’s unusual strains of mycobacteria brought back from a trip to a developing country or the homegrown variety of infections that are antibiotic-resistant.

Necrotizing fasciitis—a rapidly spreading infection that can kill off large swaths of soft tissue in a matter of hours— can be especially life-threatening.

“They have to be treated surgically immediately,” says Dr. Morteza Khaladj of The Center for Wound Healing and Hyperbaric Medicine. “We clean and drain the infection. Sometimes we have to remove the bone and large sections of soft tissue. Then patients are treated with IV antibiotics.”

The most troubling new infectious disease—methicillin-resistant Staphylococcus aureus (MRSA)— started right in our own backyard. MRSA began cropping up in hospitals as people with weakened immune systems began to develop

antibiotic-resistant staph infections in the skin, which often spread to surgical wounds, bones, and joints, and even into the major organs. This new strain of Staph infection has grown resistant to many antibiotics. Then a new strain developed—community-acquired MRSA—which can cause skin infections and pneumonia.

“Healthy people are coming into the hospital with overwhelming staph infections, very resistant strains of E. coli and other bacteria—some are resistant to all antibiotics,” Dr. Sherer says. “It’s a big concern—there are not many new antibiotics out there, so our resources are limited in treating some of these infections. MRSA has become a huge issue that we’re dealing with on a daily basis.”

So should you be worried? Most medical experts say that with the proper precautions, you can get through life safely, whether you’re jetting halfway around the world or driving to the local Wawa for a quart of milk.

“I don’t think the average person needs to be concerned,” Dr. Sherer says. “Just follow the CDC’s recommendations regarding the precautions you should take when you travel someplace where you might be at risk, and you should be fine.”

Call of Duty

New ideas keep one of the nation’s oldest nursing schools on the cutting edge.

By Diane Alter

Every nurse has a story about the path he or she chooses. Most insist that nursing is not simply a career, but a calling. That calling may not come from an audible voice or divine sign from above.

Masters degrees. They come from myriad cultural backgrounds and from different parts of the region. But they all come for the same reason: to make a difference.

Not surprisingly, they follow the lead of the school’s Dean, Mary E. Kelley.
“I always knew I wanted to be a nurse,” she says. “There was never any question what I would do.”

Kelley not only embodies what it means to devote yourself to the profession, but where the profession can take you in a relatively short amount of time. Just eight years after graduating from Boston College School of Nursing—ready to dedicate herself to “devoted service for human welfare”—Kelley was named Dean of the Trinitas School of Nursing. “Things were different back then,” Kelley says, downplaying the accomplishment. “Yes, I was young. But I was ready for the responsibility.”

The Trinitas School of Nursing first opened its doors in 1891 as Elizabeth General Hospital and Dispensary School of Nursing. It went by several names over the ensuing years, before taking its current name in 2000 when Elizabeth General Medical Center and St. Elizabeth’s Hospital consolidated to form Trinitas Regional Medical Center. The school was accredited by the National League for Nursing in 1959 and, in 1971, formed a Cooperative Nursing Program with Union County College. This enables students to receive an Associate in Science along with the Diploma in Nursing. At this time, the school made a commitment to serve educationally disadvantaged students, non-traditional nursing candidates, and those looking to switch careers.

By the mid 1970’s, the school had opened the country’s first full-time evening division in a diploma program, enrolling many students who previously would not have been able to pursue nursing. The school launched an innovative weekend division in 1987. It was the first of its kind in the region and one of the first in the country. Students pursuing a career in nursing could now do so while maintaining full-time employment and seeing to the needs of their families during the week. The inaugural weekend class achieved an astounding 100% National Council Licensure Examination-RN passage rate. Since 1990, the school’s overall passage rate has averaged 97 percent.

“Our open access philosophy and our flexible day, night, weekend, part- and full-time classes enable many aspiring nursing students to realize their dream,” Kelley says proudly.

How does an old school stay current? With pioneering instruction. The Trinitas School of Nursing is one of the first in the country to integrate simulation technology into its curriculum. Its Learning/Simulation Center is equipped with state-of-the art equipment, which enables students to log critical hands-on experience. “We use patient simulators and program them with specific ailments,” Kelley explains. “One might be having a heart attack or appendicitis—we can even program a simulator to give birth. These lifelike kinds of situations provide invaluable experience, promote active learning and steer students toward their professional role as safe and capable nurses.”

In 2007, the school became the first in the U.S. at which every eligible faculty member had earned a Certified Nurse Educator credential from the National League for Nursing. In 2008, the League officially recognized the School of Nursing as a Center of Excellence in Nursing Education—the first school in the Garden State (and the first Cooperative Nursing Program in the country) to receive such recognition. Re-designation must be earned every three years through an arduous re-application process. In 2011, the school was awarded re-designation, confirming its high standards and consistent excellence. Kelley herself was recognized in 2011 when she was awarded the Unity Achievement Award from the Union County Human Relations Commission for her extra-ordinary contributions to the promotion of respect for human rights, human dignity and cultural diversity in Union County.

“The school’s success is not about me,” she is quick to point out. “It’s about a team of people with the same vision, goals and objectives. I definitely didn’t do this alone. I have a great staff. That’s how I get things done. I don’t take or want any credit. I couldn’t have gotten anything done by myself.”

Editor’s Note: Tough though it may be, nursing continues to grow in popularity as a career choice. Trinitas’s January 2013 class of 96 graduates (85 women and 11 men) was its largest ever. Anastasia Filonova, Jane Mone and Romina Tara received High Nursing Honors. For more information on Trinitas School of Nursing visit www.TrinitasSchoolofNursing.org or call (908) 659-5200.

Team Players

As a loved one approaches a time when mental problems appear to be imminent, there is no real roadmap for how to prepare for that change. The person you once knew may not be there much longer. Roles suddenly have to be reversed—the person who once took care of you becomes the one in need of care. Do you send that parent or grandparent to a living facility? Do you rely on emergency room visits? Or do you play it by ear and shoulder the responsibility of potential round-the-clock care yourself?

There is no “right answer” to any of these questions. However, now there is an encouraging alternative when it comes to treating seniors suffering from mental deficiencies. The government-funded Statewide Clinical Outreach Program for the Elderly (aka S-COPE) provides a mental health outreach team that ensures crisis response and clinical follow-up to senior citizens aged 55 and up. According to Deborah L. Humphreys, a Licensed Clinical Social Worker in Elizabeth, the program gives nursing homes and other care centers a go-to resource before simply dropping the elderly off at emergency rooms.

The idea actually was first proposed by Trinitas Regional Medical Center in 2012, when Governor Christie’s administration was looking for a way to accomplish its goal of expanding community care programs across New Jersey. The proposal built off of the SCCAT (Statewide Clinical Consultation and Training) program, which brought care to adults with developmental disabilities. The Department of Behavioral Health and Psychiatry of Trinitas now manages the S-COPE program.

“S-COPE is a program that fills an important need in the local communities,” Humphreys explains. “The staff offers a great mix of education, care, and advocacy that improves the lives of seniors, as well as family and caregivers. It is the consultation and training that we highly value in helping us to meet the needs of seniors, as well as fulfilling the highest standards of care with expertise, dedication, creativity, and common sense.”

As Trinitas behavioral health professionals observed that people who took care of senior citizens with mental issues relied too much on ER drop-offs, they wanted to bring about a different choice for those with special needs.

S- COPE brings the care to the patients themselves and provides hands-on care to the afflicted. After obtaining approval from the Department of Human Services, Trinitas received $1.3 million in grants and was able to successfully move forward with the program. In S-COPE’s short history, this outreach program has been able to:
• Become fully operational in all 21 counties of New Jersey
• Helped four Facilities establish Behavior Response Teams
• Received 545 referrals from nursing facilities, screening centers, and in-patient units
• Provided more than 2,157 face-to-face and phone interventions in response to crisis situations
• Conducted more than 70 training sessions to facilities, seven regional trainings, and one annual conference to educate people on
S- COPE

A year has passed since S-COPE was created. By any measure, the program has been a triumph. The program continues to expand, and patients and care providers have given Trinitas a major thumbs-up for its commitment to making it work. Toni Loyas, for one, has nothing but great things to say about the program.

“My experience with S-COPE has been nothing but positive,” says the COO of Lincoln Park Care Center, a 24-hour skilled nursing care facility. “They have been extremely responsive. Training in behavioral techniques, dementia and severe persistent mental illness for older adults has been outstanding. They are very involved in helping our residents remain in their home. I would recommend this team to any facility.”

Though the S-COPE program represents important progress in a growing area of concern, there is still work to be done to fully understand mental illness, and responding to the needs of seniors suffering from dementia. Trinitas is compiling research from all of its findings to further fine-tune its methodology and training. One area of promise is increasing the presence of technology in the form of video conferencing with patients in order to bring immediate attention to those in need. Training has already begun at facilities all over New Jersey.

Editor’s Note: The first annual S-COPE Conference took place in March 2013. For more information on the S-COPE program, call 908-272-3606.

Hot Commodity

As a rule, and often out of necessity, interventional cardiologists are as cool and detached as they come. Fayez Shamoon is the exception that proves the rule.

By Jennifer L. Nelson

How frail the human heart must be. When Sylvia Plath penned those words she could hardly have anticipated the work of Dr. Fayez Shamoon, the newly appointed Medical Director of Cardiovascular Services at Trinitas Regional Medical Center. Whether performing a heart-valve replacement procedure, or springing into action to save a patient’s life after suffering a heart attack, Dr. Shamoon blends world-class technical skill in interventional cardiology with a level of personal involvement which, for decades, has set him apart from his peers.

“Cardiology is a fascinating, procedure-oriented field,” he says, “but it’s the time I spend with patients that I find most rewarding. Once you do something for them, you can just tell how much they appreciate it.”

Learning Curve

Although he keeps himself busy consulting with patients and providing life-saving cardiac procedures, Dr. Shamoon remains committed to the pursuit of education. Along with co-authoring some 50 peer-reviewed articles, he actively participates in clinical trials and studies to do his part to advance the field of cardiac care. He is currently the Program Director of the General Cardiology Fellowship and Interventional Fellowship programs at Seton Hall University’s School of Health and Medical Science. Since graduating from medical school, he has shared his knowledge at a range of academic institutions in various capacities. “One of the most enjoyable parts of what I do is interacting with residents and fellows,” he says. “I’m a teacher by nature, and never believed I belonged in private practice.”

Dr. Fayez Shamoon, Director of Cardiovascular Services (left) confers with Dr. John D’Angelo, Chairman of the Department of Emergency Medicine, about the life-saving potential of field as-sessments of patients suffering heart attacks caused by blocked arteries, known as STEMI.

That’s the easy part of the job, Dr. Shamoon insists. In an environment where technology and procedure are ever-changing, he must remain laser-focused on the latest surgical practices and treatments. “Cardiology is such a progressive, high-tech field…and there are so many advances in the pipeline,” he says. “It’s very exciting.”

Among Dr. Shamoon’s proudest moments as a cardiologist are when he succeeds in keeping a patient out of the operating room; his expertise in the latest cardiac procedures can often spare patients from traditional open-heart surgery. While on-site at Trinitas, he can almost always be found in the Cardiac Catheterization Lab. When a patient is suffering from a heart attack, Dr. Shamoon is among the first on call. Every minute counts (with 90 minutes of arrival being the industry-accepted maximum), and the team at Trinitas routinely cuts 15 to 20 minutes off its “door-to-balloon” time — significantly improving the success rate of a life-saving angioplasty procedure. Trinitas remains one of the only medical centers in New Jersey to provide a direct line to cardiac care by allowing patients experiencing an ST segment elevation myocardial infarction (STEMI)—in layman’s terms a heart attack caused by a blocked coronary artery—to bypass the emergency room and head straight for the cardiac unit. “This is really my major work,” Dr. Shamoon explains.

Janice Learn, RN, Director of the Cardiac Catheterization Labora-tory, works closely with Dr. Shamoon in caring for patients who undergo elective and emergency cardiac procedures at Trinitas.

Dr. Shamoon also makes himself available to perform an array of clinical procedures—including aortic valve replacements where patients may need him in other institutions in Northern New Jersey. One of his specialties is a cutting-edge technique that allows surgeons to replace a heart valve through a catheter inserted into a small incision in a patient’s groin, ultimately sparing them from open-heart surgery. “They wake up the next day and it’s like nothing ever happened,” he smiles.

Dr. Shamoon received his medical degree and training overseas at the University of Jordan and Jordan University Hospital. He spent years as an ER physician at hospitals in Northern New Jersey and then established a private practice in North Arlington in the late 1990s. But, the cardiologist has always felt the tug of the community. Now in Elizabeth, he has planted himself firmly in the realm of hospital care, where his breadth of experience can benefit the widest possible audience.

“Trinitas is truly a community hospital, and I pride myself on being able to provide a real service for the region,” he says. “When patients need me, I can offer my skills to them right where they live.”

Editor’s Note: You can contact Dr. Shamoon in his office at (908) 994-5333.

All in the Family

Mother-daughter relationships are as complex as they come. At least, they’re supposed to be.

Following in the footsteps of a parent can be a perilous journey. Expectations are high, comparisons are many, and the challenge to measure up to that legacy can result in an enduring personal struggle. Not so for Dr. Michelle Cholankeril, whose choice to follow her mother, Mary, into oncology not only proved to be the simple one, but the right one, too.

“All of my life, I have watched my family do charitable work,” she explains. “My grandfather was a physician, my mother was a physician, and through them doing their jobs, I felt like this was a career I wanted to pursue—where I could actually go out into the community to help people and gain personal satisfaction from contributing to medical society.”

Dr. Cholankeril practices hematology and medical oncology at the Trinitas Comprehensive Cancer Center. She is the one beaming as she walks through the doors of her hospital each day, ready to take on any and all challenges. And those conversations with her mother—as both a colleague and a daughter gathering insight?That’s a wonderful bonus.

Trinitas Regional Medical Center is something of a second home to Dr. Cholankeril. She has been working at the hospital since high school. She started as a volunteer behind the entrance desk in the main lobby, worked in the ICU as a medical student, and continued to maintain a family connection to Trinitas in the years that followed. In 2013, her career came full circle, as it were, when she joined the Trinitas staff as an M.D.

Working in hematology and oncology has a particular appeal to Dr. Cholankeril. “These are the most grateful patients, in a sense, because not only do they value their life, but they also understand the value of the diagnoses they have,” she says. “It’s really great to be involved in a field where you can witness a cure in some of your own patients. It’s quite fulfilling to be a part of something so extraordinary.”

Needless to say, Dr. Cholankeril is a student of her specialty as well as a practitioner. She helps submit abstracts to the American Association for Cancer Research (AACR) and the American Society of Clinical Oncology (ASCO). She is currently a part of clinical trials run by Trinitas, and also does work with the Jefferson Kimmel Cancer Center in Philadelphia to further expand clinical trials. The progress she has witnessed firsthand in her field convinces her that cancer will ultimately be defeated through advancements that have been made in just the last few years.

“A lot of what we know about cancer today is based on the research we obtained from yesterday,” she says. “If you are involved in research today, then you are able to be a part of the future of oncology. So far it has been a great learning experience.”

Dr. Cholankeril’s career path might have been paved by doctors in the generations before her, but at the end of the day she leaves footprints of her own, building on the wisdom of her mother and grandfather. As she treks through the daily challenges and triumphs, however, she is keenly aware that the apple hasn’t fallen all that far from the tree. And she’s okay with that.

“My mother always said to pursue what my calling is, whatever that may be,” she points out. “She never suggested one thing or another. I suppose she thought I was responsible enough to make my own decisions, so she told me to follow a career path that makes me happy. And that’s what I ended up doing.”   EDGE

Editor’s Note: You can contact Dr. Cholankeril in her Trinitas office at (908) 994-8771.

What’s Up, Doc?

News, views and insights on maintaining a healthy edge.

Movers & (Salt) Shakers

Remember the row over Michael Bloomberg’s ban on super-sized sodas? Well, the Big Apple is now taking aim on sodium. New York’s Department of Health proposed that chain restaurants operating in the five boroughs add a salt-shaker icon to menu items that contain more than the recommended daily limit of 2,300 milligrams (roughly a teaspoon). “Studies show that those of us who consume higher amounts of sodium are more likely to develop hypertension, and those who already have high blood pressure are likely to develop heart problems and stroke as a result of higher sodium intake,” says

Michelle Ali, RD
Director, Food and Nutrition, Trinitas Regional Medical Center 908.994.5396

Michelle Ali, RD, Director of Food and Nutrition at Trinitas. You may not want to hear this (or you may know it already and don’t care) but every major chain has at least one delicious-sounding entrée that pushes past 3,000 mg of salt. And they aren’t always the obvious ones. Ali points out that, while most fruits and vegetables are naturally low in sodium, when they are prepared, sodium/salt is sometimes added to improve flavor. “Nutrition information is a tool that can guide consumers to make better food choices,” she says. “If a dish exceeds the recommended amount of sodium, move on to another food choice with less. Do portion control; take a portion home. Finally, add a salad, limit the dressing, and finish off with fresh fruit for dessert.” A final vote on the sodium “warning” should occur this September and the little shakers may be popping up on menus in time for the holiday season.

Bum Deal for New Yorkers

What are those folks across the river up to these days? Not much, according to a study by NYU’s School of Medicine. According to findings published in the latest issue of Preventing Chronic Disease, the average New Yorker sits more than seven hours a day. The study involved 3,600 subjects who wore devices that monitored whether they were moving or sedentary during waking hours. The seven hours broke down to four during the day and three in the evening. Manhattanites actually logged eight hours on their fannies. The stats for men and women were equal. Trinitas Endovascular Surgeon

Ajay Dhadwal, MD RPVI
Endovascular Surgeon, Trinitas Regional Medical Center (Assistant Professor, Rutgers New Jersey Medical School) 973.972.9371

Ajay Dhadwal, MD RPVI, observes that the ill effects of a sedentary lifestyle influence almost every aspect of one’s health, from vascular disease in the blood vessels supplying the brain and the legs, to joint pains and obesity, to heart disease. “Endovascular surgeons often see conditions which, at their worst, can lead to stroke and eventual amputation of the legs,” he says. “Even a minimal increase in activity level can help reduce future risk, especially for those who smoke. For certain patients, regular walking can be as beneficial in the long term as stenting blood vessels of the leg in improving the distance they can walk. To see an overall positive impact, take the stairs more often or walk 20 minutes a day.”

$150 Up in Smoke

The Holy Grail for anti-tobacco groups is an idiot-proof way to stop smoking. Patches, gums and hypnotherapy are effective in some cases but not in others. A recent study of 2,500 smokers took a different approach and yielded some breathtaking results. The key ingredient was bribery. Subjects were divided into four groups and offered different types of financial incentives. Two groups were offered financial rewards for quitting. Two had to put their own cash on the line. Smokers who had to make a $150 deposit and stop smoking to get it back had a success rate twice as high as the first two groups. More revealing is that the $150 group had a success rate five times that of smokers who undergo traditional cessation programs.

Nothing Rotten in the State of Denmark

Allergy awareness in grade schools has been growing for a good two decades now. In some schools, the presence of a single peanut is enough to trigger a lockdown. But do school lunches actually have the potential to positively impact childhood allergies? A study published in the European Journal of Clinical Nutrition this summer attempted to answer this question. Nine Danish schools gave 3rd and 4th Graders their typical pre-packed lunches for three months, and then meals rich in fish, vegetables and fiber for another three months. At the end of each period, parents were asked to evaluate the status of their children’s asthma and/or allergies. The difference? None. Although undoubtedly healthier, the nutritionally balanced school lunches did not “perform” any better than the usual items the kids were eating when it came to allergies. Research on childhood allergies is critical, says

Kevin Lukenda, DO
Chairman, Family Medicine Department
908.925.9309

Dr. Lukenda, DO, Chairman of the Trinitas Family Medicine Department, even when the results are not headline-grabbing. “A child who experiences a full blown anaphylactic response to a food allergen can experience lifelong effects and anxieties,” he says. “This research doesn’t change the fact that having a peanut-free table or classroom can have a tremendous upside benefit for the student and their family, as it allows them to focus on school and not worry about a potentially life-threatening situation.”

Link Between Heartburn & Heart Attacks

Back in June, acid reflux drugs were in the news after a study conducted by researchers at Stanford University and Houston Methodist Hospital showed a link between their use and an increased risk of heart attacks. The drugs in question are proton pump inhibitors (PPIs), which are among the most widely used and prescribed in the United States and are marketed under names such as Prilosec, Prevacid and Nexium. The researchers scanned the medical records of 2.9 million patients for key words like “heart attack” and found that they occurred at a rate 15 to 20 percent higher with people who used PPIs. The same correlation did not exist with patients who treated their acid reflux with H2 blockers, including Tagamet and Zantac. It’s worth noting that this is a highly unconventional approach to big data, and although the media grabbed it and ran, the medical community looks at the methodology with natural skepticism. This type of conclusion is typically the result of a randomized control trial, where PPIs would be compared to a placebo to see if the drug did actually produce the specific effect. On the other hand, the fact that H2 blockers did not show a heart attack link supports the idea that more research on PPIs is probably warranted. Until that happens, patients taking PPIs—whether prescribed or over the counter—should talk to their doctors before their next trip to the pharmacy.

CBT Helping Insomniacs Hit the Snooze Button

Recent findings published in Annals of Internal Medicine show that people with severe sleep issues can benefit from Cognitive Behavior Therapy (CBT). This conclusion was the result of an evidence review of 20 separate studies, and showed that insomniacs (individuals who have trouble sleeping for at least a month) who underwent CBT fell asleep 20 minutes faster and reduced the time they were awake once they fell asleep by a half hour. The data was generated by comparisons between groups that took sleeping pills and groups that underwent short sessions with therapists. The CBT group learned new strategies for falling asleep and staying asleep. A major component of CBT is stimulus control, which involves meditative exercises and relaxation techniques.

One interesting item that emerged is that getting out of bed and “hitting the reset button” is better than endless tossing and turning.

Anwar Y. Ghali, MD, MPA Chairman, Psychiatry 908.994.7454

Dr. Anwar Y. Ghali, MD, MPA, Chairman of Psychiatry at Trinitas, agrees that this strategy can help. “Patients who wake up in the middle of the night should not stay awake in bed for longer than about 30 minutes,” he says. “They should avoid keeping an eye on a watch or a clock, since that may interfere with the ability to go back to sleep. Leave the bed and engage in other activities until you feel sleepy again, then go back to bed. Don’t go to the refrigerator for a midnight snack. You may end up perpetuating the habit of getting up in the middle of the night for that trip to the refrigerator.”

Vipin Garg, MD
Director, Trinitas Comprehensive Sleep Disorders Center 908.994.8880

Dr. Vipin Garg, MD, Medical Director of the Trinitas Comprehensive Sleep Disorders Center, agrees that getting to sleep and staying asleep can become a matter of habit. “Many times, specialists in sleep medicine like me recommend sleep restriction technique for insomnia,” he says. “Patients are advised to get into the habit of a certain number of hours of sleep and maintain a certain bedtime and wake-up time. Once they are in this pattern, patients are advised to refrain from going to bed earlier than their normal time, even if they feel sleepy. Often, those who suffer from insomnia are shocked to hear this, since the common belief is that the more time you spend in bed, the more sleep you get. Sleep restriction therapy consolidates fragmented sleep to continuous and deeper sleep.”

For less severe cases of insomnia, there are a number of websites that can help (including calm.com), and the occasional intake of Rozerem or Silenor. However, given that insomnia has been linked to a wide range of health issues—including weight gain, depression, anxiety, heart disease and diabetes—and that sleeping pills aren’t a good long-term solution, chances are you’ll be hearing more and more about CBT and other sleep-related therapies.

What’s Up, Doc?

News, views and insights on maintaining a healthy edge.

They Do More Than Play Football at LSU

The health benefits of dark chocolate have been shown in study after study. Thanks to researchers at Louisiana State University, we now understand why. The good microbes in our colon, specifically Bifidobacterium and lactic acid bacteria, love the chocolate compounds that our bodies are unable to break down. As they digest the cocoa fibers, they produce new compounds that are able to be absorbed by our bodies. These compounds lessen the inflammation of cardiovascular tissue.

The Five-Second Rule: A Second Look

Is it okay to consume food dropped on the floor if it’s picked up within five seconds? A team of British biology students have the answer to this question: It depends on the food…and the floor. The study, conducted at Aston University, measured the transfer of bacteria—specifically E. coli and Staphylococcus—on a variety of foods dropped on a variety of flooring for between 3 and 30 seconds. Wet and sticky food, such as noodles and candy, attracted the most bacteria. Carpeting proved to be “safer” (if you don’t mind the fibers and grit) than tile and laminate flooring. Not surprisingly, the longer food stayed on the floor, the more bacteria it attracted. In other words, you’re much better off plucking a chip off the carpet than consuming a chicken leg that tumbled off the kitchen counter.

Surprising Findings in Oral Cancer Study

A joint study conducted by researchers in Germany and Scotland looked at the relationship between oral health behavior and the risk of developing cancers of the mouth and throat. Nearly 4,000 individuals were involved in the study. The results, published in Oral Oncology, turned up one really surprising piece of information. Heavy users of mouthwash—for example, three times a day—appeared to have a higher risk of cancer than those who brushed regularly but used mouthwash infrequently or not at all. The research team did not analyze the types of mouthwashes being used, and stated that this finding required further research. Another interesting conclusion the study drew was that denture wearers were at the same risk of developing serious oral problems as non-denture wearers if they did not schedule regular dental office visits. “Over the years, a number of studies such as this one have suggested that there may be a correlation between excessive use of mouthwash and the development of cancers of the mouth and throat,”

Barry Levinson, MD
Medical Director, Trinitas Comprehensive Cancer Center 908.994.8772

Barry Levinson, MD, Medical Director of the Trinitas Comprehensive Cancer Center points out. “It appears that the number of patients in this study who fell into the category of excessive users of mouthwash did not present enough statistical significance for the study to lend any strong support to drawing a connection to cancers of the mouth and throat. Smoking, drinking, and overall poor oral hygiene are much more important factors that lead to the development of oral cancer.”

Home Games

When we think of common musculoskeletal injuries, we tend to picture weekend warriors writhing in pain with fractures and tears suffered on a court or playing field. The truth is that about half of all musculoskeletal injuries occur at home. Sprains, strains and other soft-tissue injuries are actually the most common musculoskeletal injuries. They can cause a significant amount of pain, dysfunction, and disability and are also a major source of time missed from work, school, and recreation—which burdens both the individual and the healthcare system. According to

Christopher R. Ropiak, MD Union County Orthopaedic Group 908.486.1111

Dr. Christopher Ropiak of the Union County Orthopedic Group, many of the more common home-based injuries occur due to repetitive motion or significant straining in the setting of poorly conditioned or underprepared muscles. Consequently, many injuries might be prevented by routine and regular fitness programs, especially those that focus on core muscle strength and functional movements. “Even among people that do exercise regularly, too many of us focus on exercises that do not translate well into everyday life,” Dr. Ropiak points out. “While there are some benefits to body building or long hours on the elliptical machine, these types of exercises are often not very helpful in avoiding common injuries like back strains, muscle tears, etc.” Going to a gym or a trainer is great but for many of us, he adds, due to time and money constraints, that is just not a realistic option for everyone. Dr. Ropiak encourages his patients to explore some of the home-exercise programs that require a fraction of the time and money that it takes to go to the gym…“and might keep you out of the doctor’s office.”

Number One Not So Fun

Time to break out the “purple dye”…it turns out that peeing in the pool can actually create a significant health hazard. New findings from a study at Purdue University confirm that uric acid, when mixed with common pool chemicals (including chlorine), can actually create dangerous compounds—including called cyanogen chloride, which is toxic to organs when inhaled, and trichloramine, which can injure the lungs. “Parents need to educate themselves—as well as their children—about public health and safety issues,” says

Kevin Lukenda, MD
Chairman of Family Medicine, Trinitas Regional Medical Center 908.925.9309

Dr. Kevin Lukenda, Chairman of Family Medicine at Trinitas. “They should stress the basics of hygiene: the importance of frequent hand-washing and sanitizing, the proper handling of paper money, shared cell phone use, and of course, ‘peeing in the pool.’ All are potential health risks that can be avoided through proper education.” Urinating in the pool is controllable behavior but we all know people do it anyway assuming it’s harmless. Well, it’s not. Who are the worst offenders? Competitive swimmers. P.S. They don’t fall for the old purple dye trick.

 

An Arm’s Length Relationship

When it comes to hands and shoulders, Dr. Richard Mackessy connects the dots every day.

Dr. Richard P. Mackessy, a board-certified microsurgeon, ranks among the region’s preeminent “hand guys.” Which is why he loves to talk about…shoulders. “The shoulder is the pivotal joint to the hands, so pardon the pun,” he smiles, “but they do go hand-in-hand.” Indeed, much of Dr. Mackessy’s practice actually involves shoulder issues.

And, not surprisingly, most of his shoulder surgeries involve the rotator cuff. That being said, he has also performed more extensive shoulder surgery, mainly in the 60 to 65 age group.

Photo credit: iStockphoto/Thinkstock

Yet, at the end of the day, Dr. Mackessy is a board-certified hand surgeon, and that is where his passion lies.

Carpal tunnel issues predominate, especially among his patients in their 40s. Fortunately, he points out, they usually present with trauma requiring physical therapy before surgery even becomes an option. Their complaints range from difficulty opening a jar of peanut butter, to grasping a tough-to-turn doorknob, to extracting a stubborn car key. His professional advice to these patients?

“Get a special kitchen wrench for the jar situation, leave the door open, and get a car with a pushbutton start.”

Richard P. Mackessy, MD Chairman/Orthopedics, Trinitas Regional Medical Center 908.486.1111

Dr. Mackessy chose to focus on hands because that was a popular area when the time came to pick an orthopaedic subspecialty. More importantly, he felt that hands represented an opportunity to focus on microvascular techniques, thereby broadening his surgical skill set. In recent years, those techniques have been accompanied by technological leaps in surgical science.

For example, he cites Dupuytrens Disease, a seriously debilitating genetic contracture of the fingers. What used to require invasive surgery—followed by three to four months of rehab—has now been replaced by a single injection of Ziaphlex to dissolve scar tissue, with a mere two to four weeks of physical therapy. Another advance is the development of specialized plates that result in minimal impact on the patient’s daily activities for injuries such as a distal radius fracture (aka a broken wrist). And recently, a man in Denmark received a hand prosthesis that has enabled him to actually “feel” the items he touches.

In the area of shoulder repair, months of post-op recovery and cumbersome external fixators (such as casts and splints) are no longer required. Rotator cuff surgery is now arthroscopic and, in the extreme, reverse total shoulder replacements are available, much like those for knees and hips.

Leonor Gonzalez of Elizabeth who suffers chronic shoulder dislocation is one of the many patients under the care of orthopedic surgeons at Union County Orthopedic where Dr. Richard Mackessy practices. Physical Therapy Assistant J.L. Tracy Witter at the Trinitas Health and Rehabilitation Center guides the patient in the use of a Thera-bar to perform resisted shoulder flexion.

In analyzing his patients further, Dr. Mackessy says the younger ones typically show up after a sports-related injury and lean toward rehab. The over-35 group is ready for whatever state-of-the-art surgical solution is available to quickly solve a problem. Women, who outnumber his men patients, are typically more circumspect and weigh their options more carefully. Why so many female patients? “They just take better care of themselves,” he believes.

Editors Note: Chris Gibbs pulled this assignment because she has a long history with carpal tunnel syndrome. In other words, it’s personal. Is the computer, she asked, the culprit in the rise in cases? Dr. Mackessy says the jury is still out on that connection. The same goes for texting and thumb issues. Instead he is convinced that almost everyone will suffer from some degree of rotator cuff or carpal or other hand damage once they reach a certain age—through the normal wear and tear of everyday life.

Simply Breathtaking

New procedures are changing how we treat lung disease.

Heavy breathing is music to Carlos Remolina’s ears. No, it’s not what you think. Dr. Remolina is a man who takes breathing—all breathing—personally. As an asthma sufferer himself, he is in his third decade of practicing pulmonary medicine, treating diseases including chronic bronchitis, asthma, COPD, sleep apnea, pulmonary emphysema, lung cancer, pleural effusions, and other conditions. At Trinitas, Dr. Remolina is breathing new life into his field with procedures that are slashing the length of hospital stays, streamlining procedures and improving patient outcomes, and, of course, saving lives.

Photo credit: iStockphoto/Thinkstock

“It’s very important to me to make a diagnosis as early as possible to save a patient from having to undergo a major surgical procedure,” he says. “So the fact that we’re able to be on the cutting-edge and perform the procedures that are only being done in major medical centers is very rewarding.”

Dr. Remolina’s latest groundbreaking procedures is what he refers to as EBUS: an endobronchial ultrasound. “We can go right to a mass and then an ultrasound allows us to get inside the tumor itself and access areas of the lung we never could,” he says. By performing a bronchoscopy with the help of an ultrasound, he explains, patients need only undergo one procedure that will allow his team to diagnose and treat a bronchial condition—saving them from having to pay a visit to a surgeon and await the results of a biopsy. “The value of this procedure is that now not only can we make a diagnosis of cancer, but we can also stage it—we’ll know right away if the cancer is too advanced to operate and what the most effective method of treatment will be.”

Anyone admitted to Trintias in need of an endobronchial valve treatment can also rest assured that Dr. Remolina will spare them from unnecessary, painful surgeries; his endobronchial valve procedure enables doctors to perform a bronchoscopy and inflate a balloon to locate and stop a leak without the need for an uncomfortable chest tube insertion. “We send the patient home and six weeks later, they can come back to have the valve removed,” he says. “Hospitals are always focused on reducing the length of patient stays, so by taking away the need for patients to remain in the hospital in order for us to monitor a chest tube, we’re making it easier on the patient and preventing them from having to admit themselves for an extended hospital stay.”

Carlos Remolina, MD, FCCP, PA Chief/Pulmonary Diseases, Trinitas Regional Medical Center Director, Care One LTACH 908.241.2030

Dr. Remolina is working to ensure that the entire staff at Trinitas is trained to perform the latest in pulmonary medicine techniques. Among the hospital’s future plans, he says, is the acquisition of a navigational system that will enhance the capabilities of tools such as a bronchoscope. “It’s basically like a GPS that would allow us to find even the smallest tumor and do a biopsy,” he explains. “That way, we can detect cancer sooner and enable surgeons to operate more efficiently and with greater precision. Nobody else around here is doing what we’re doing…our ultimate goal is to provide the best pulmonary medicine in the area.” EDGE

Editor’s Note: Carlos Remolina, M.D., F.C.C.P., P.A. is board-recertified in internal medicine and pulmonary medicine. He currently serves as the division chief of pulmonary diseases at TRMC and medical director of Care One LTACH (Long Term Acute Care Hospital) at Trinitas. He completed medical school at the University of Medicine in Zaragoza, Spain before moving on to complete his residency at the New York Infirmary Hospital. Dr. Remolina completed his fellowship in pulmonary diseases at the New Jersey College of Medicine and Dentistry, Rutgers Medical School in Piscataway. His practice is located in Linden.

Fear Factor

The stigma attached to Alzheimer’s—and a dearth of clinical trial volunteers—may be slowing the development of a breakthrough drug.

When I was doing my post-doctoral fellowship, I was in the room with a neurologist who gave a patient an Alzheimer’s diagnosis and then left. I think the family forgot I was still in the room. The man turned to his wife and said, “We really need smarter people working on this problem.”

Well, in the two-plus decades since, there have been a lot of smart people working on it, and progress has been made. New drugs have come on the market: Cognex in 1993, Aricept in 1996, Exelon in 2000, Razadyne in 2001, and Namenda in 2003. In 2011, for the first time in 27 years, a revision of the initially proposed 1986 consensus criteria for Alzheimer’s Disease were established, which incorporate all of the data and technological and clinical advances that have been amassed over the past several decades of research. Since we now know that people suffering from Alzheimer’s have probably had plaques and tangles developing in their brains for decades, the emphasis on early intervention is greater than ever.

We are currently in a better position to identify pre-symptomatic patients so that, if we had a disease-modifying medication, we could catch people early and possibly prevent the disease from progressing. There are a lot of companies looking for that breakthrough Alzheimer’s drug, which is why clinical trials are so important.

Ironically, the biggest obstacle right now in finding a cure for Alzheimer’s Disease may be the lack of participants in the studies being run on these new drugs and therapies.

Pharmaceutical companies are way behind in recruiting volunteers. Timelines for enrolling subjects are usually not met. This means critical data is coming out too slowly. We have not had an investigational Alzheimer’s drug get past Phase III in years.

WHO CAN PARTICIPATE?

The profile of a trial participant ranges from someone with cognitive impairment or concern to individuals who have received an Alzheimer’s diagnosis but are otherwise healthy. About half of the participants in the trials we run come through our clinic, the Cognitive and Research Center of New Jersey; these are people with whom we have already established trust and rapport. Others are referred by groups of neurologists, internists and gerontologists. We also get participants as a result of the public outreach I do personally. I am a big advocate of Alzheimer’s education and do a lot of speaking at churches, synagogues, senior centers, and other venues.

So why the lack of participants? Some are afraid that they’re agreeing to be “guinea pigs” for drug companies. That’s a valid objection, but people with this objection may not appreciate that these trials are very highly regulated by the government. It is very hard for a drug company to start a clinical trial. The FDA and other regulatory agencies have to be convinced that the potential benefits outweigh any risk; patient safety is concern number-one. Each trial has a set of strict criteria, and always errs on the side of safety.

www.istockphoto.com

There are other factors that make it difficult for clinics to find an adequate number of volunteers. Alzheimer’s trials have a high rate of screening failure. Even here—where we are highly specialized—the screening failure rate can range up to 50% after we’ve done urine, blood and EKG testing. Sometimes, people don’t meet criteria for a study because of preexisting medical conditions or medication regimens. There are always lists of medications that can’t be taken with the drug that’s being tested, and the patient can’t stop taking a particular medication.

www.istockphoto.com

Something else that impacts Alzheimer’s trials is that there will be a “study partner” involved. This is someone who knows the patient well and is in close enough proximity to acknowledge that the medication is being taken, and who can generate qualitative information, such as new symptoms, the level of caretaker burden, the patient’s mood and daily living skills—and just answering the question How are they doing? This is usually an immediate family member, but can also be a close friend. Without a committed study partner, it is unlikely an individual would be able to participate in an Alzheimer’s (or even a cognitive impairment) trial.

Finally, there is the stigma associated with Alzheimer’s, which I hope is changing. People think it’s a mental illness instead of a progressive medical disease. That could well be at the root of the recruiting problem pharmaceutical companies are experiencing in their trials. My perception is that a lot of people delay getting a diagnosis, mostly out of fear or perhaps denial. Incredibly, in fact, more than half the people who have Alzheimer’s never actually receive a diagnosis—even as they are being prescribed medications such as Aricept.

TRIAL BENEFITS

Among the major benefits of participating in a clinical trial is access to some of the better technology that is being developed. There are a number of procedures a patient’s insurance might not cover, including amyloid PET scans, which are very expensive. Thanks to this technology, we can actually detect microscopic changes in the brain that can give us a more concrete diagnosis.

All of the assessments a patient receives during a study are free. And sometimes there is a stipend for patients and their study partners.

Perhaps the most compelling reason to get involved in an Alzheimer’s study is the fact that people who are in clinical trials do better than people who are not—even those who are in the placebo group. Receiving attention from four or five specialists, talking about your condition, and receiving constant feedback is very therapeutic for the patient and for the study partner. In fact, most people who have completed one trial here want to get right into another.

The length of a clinical trial can vary from months to years. The length of each visit could take 45 minutes or four to five hours depending on what kind of evaluations are being done. Typically the clinic visits are more frequent at the beginning of a trial so that we can establish eligibility and collect baseline measures.

Whether volunteering for a clinical trial is appealing or not, families facing the prospect of a loved one with Alzheimer’s Disease need to take action. This disease is hard to deal with on your own, without support. The longer a family waits for a diagnosis, the sooner they’ll find themselves dealing with things in disaster mode.

The Alzheimer’s Disease Association estimates that 5.3 million Americans suffer from Alzheimer’s, and that number will continue to rise as the Baby Boomers age.

Unfortunately, right now less than half of these individuals are actually being told they have it. They don’t want to hear the diagnosis. So large numbers of patients and their families are suffering through the disease with no help.

They need to be educated to plan for the future and understand changes in behavior, and to prepare for the practical and emotional issues of care they will face. When we conduct our initial neuropsychological evaluations, everyone leaves with a folder containing information about relevant resources. People may be hesitant to use those resources initially, but they are good to have on file. Also, individuals who get linked with resources fare much better than people who put off being evaluated.

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The first step for many patients and their families is to deal with the overwhelming idea that once you have Alzheimer’s, there’s nothing anyone can do. The fact is there are things we can do. And the trials that clinics like ours are conducting hold great promise that soon we’ll be able to do much, much more.

Editor’s Note: Michelle Papka is a neuropsychologist specializing in Alzheimer’s Disease and mild cognitive impairment. For more information log onto thecrcnj.com or email info@thecrcnj.com.

 

Hello Kidney

Renal Patients Learning to THRIVE Through Education & Intervention

The best-kept secret in Linden isn’t a chic boutique. It’s not a trendy eatery, nor is it a new after-hours hot spot. According to Joseph McTernan, it’s the Trinitas Renal Services Unit, which has made the difference in countless thousands of lives since opening in 1993.

“Right here in Linden, we offer world-class expertise in both the diagnosis and treatment of renal disease,” says McTernan, Senior Director of Community and Clinical Services for Trinitas Regional Medical Center. “Our renal program has won a national award for excellence in patient care, and our highly qualified physicians and staff boast years of experience. We have won a five-star rating from the Center for Medicare and Medicaid Services, which puts us in the top 10 percent of dialysis centers around the country. It’s a designation that affirms the strength of our renal care outcomes.”

Ruby Codjoe, Nurse Manager of the Linden Dialysis Center, Peggy Custode, Renal Clinician at the Dialysis Center at the Williamson Street Campus, and Dr. James Mc Anally, Chair of the Nephrology Division at Trinitas, regularly review patient cases. On a weekly basis, the Linden Center treats up to 90 Chronic Kidney Disease patients while the Williamson Street Renal Dialysis Unit treats up to 75 patients.

How does one measure such a thing? It’s a numbers game, says Dr. James McAnally, Chair of the Division of Nephrology: ER visits, hospital admissions, and infection rates. And the Trinitas numbers are indeed outstanding.

“Our patients require 40 percent fewer emergency department visits than the national average, and 43 percent fewer hospital admissions,” says Dr. McAnally.  “Our rate of infection is less than half of the national average.”

Besides its Linden location, which treats chronic patients, the Renal Services Unit also has a location at the main campus on Williamson Street and another at the New Point campus, both in Elizabeth.

10 STEPS TO RENAL HEALTH

  • Exercise regularly
  • Don’t overuse over-the-counter painkillers or NSAIDs
  • Control your weight
  • Get an annual physical
  • Follow a healthy diet
  • Know your family’s medical history
  • Monitor blood pressure & cholesterol
  • Don’t smoke or abuse alcohol
  • Talk to your doctor about getting tested if you’re at risk for chronic kidney disease
  • Learn about kidney disease

“If you have high blood pressure, diabetes, a family history of kidney failure, or are over age 60, the best thing you can do is to get tested for kidney disease annually by a doctor,” Sean Roach, Public Relations Manager for the National Kidney Foundation tells EDGE. “Usually, a urine test is all you need.”

 

Chronic kidney disease (CKD) is found in 26 million adults in the United States. The most common causes of CKD are diabetes and hypertension. Data shows that African Americans and Hispanics are disproportionately effected.

So, what’s the plan of attack to diagnose and treat all those who have chronic kidney disease?

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INTERVENTION & EDUCATION

“Education is a big part of what we do,” Dr. McAnally points out. “We teach patients how to take the best care of themselves. We have them meet with nutritionists and other professionals to make every day the best day possible.”

The first step on this journey toward living the best days possible is The High Risk-Intervention Via Education (THRIVE) Program at Trinitas, which Dr. Mc Anally founded more than 20 years ago. It addresses CKD in its early stages.  Dr. Mc Anally explains: “The goal of the THRIVE program is not only to educate and to empower patients regarding CKD and its various treatment options, but more importantly to develop strategies to slow the progression of CKD.

With the support of the National Kidney Foundation, Trinitas has conducted annual screenings to help community members become aware of the likelihood that they may develop CKD based on hereditary or lifestyle factors. “Through our efforts, we have reached more than 500 people who have participated in our Kidney Early Evaluation Program (KEEP),” explains Peggy Custode, Renal Clinician.

The THRIVE program is based on the five “E’s” of rehabilitation:

  1. Encouragement. The THRIVE team gives patients with impending kidney failure the encouragement they need to adopt a positive attitude toward rehabilitation.
  2. Education. The THRIVE team gives patients and their families the education they need to handle the sometimes profound life changes associated with chronic illness, including coping strategies for successful adaptation.
  3. Exercise. Gradual decline in muscle strength and endurance is a result of inactivity. THRIVE patients are encouraged and counseled about exercise. There are many levels of activity to fit varying degrees of functional ability, from vigorous workouts for the otherwise healthy patient to stretching exercises for the chairbound.
  4. Employment Referrals. Occasionally there is a need to alter the work environment to address healthcare needs. The THRIVE staff assists patients in meeting these needs.
  5. Evaluation. Identifying patients early and educating them about kidney disease—and how to comply with a treatment plan—enables them to manage their own health, which will improve outcomes.

These 5 E’s of rehabilitation work.  As a result of the THRIVE program, most patients begin renal therapy electively in an outpatient setting.  “Such therapy has been associated with decreased morbidity, decreased mortality and lower costs overall,” reveals Dr. Mc Anally.

“Our mission isn’t simply helping patients survive,” McTernan adds. “It’s about showing them how to thrive.”

DIABETES & KIDNEY DISEASE

How prevalent is kidney disease? Sean Roach of the National Kidney Foundation says that 26 million American adults—nearly one in 10—have kidney disease. “And, most don’t know it,” he says. “That figure is projected to climb to 14.4% in 2020, and 16.7% in 2030.”

Dr. McAnally says the current diabetes epidemic is largely to blame for the increasing number of kidney disease cases. Diabetes is one of America’s leading killers, as well as the number-one cause of kidney failure. Also, signs and symptoms of kidney disease are often nonspecific. That means they can be caused by other illnesses. And because kidneys are highly adaptable and able to compensate for lost function, signs and symptoms may not appear until irreversible damage has occurred.

“Dr. Mc Anally’s professional career has been devoted to nephrology and to teaching patients how to manage their kidney disease,” says Joe Mc Ternan. “He has encouraged people who have hypertension or diabetes to take responsibility for their renal care before they experience significant kidney failure.”