AI promises to play a game-changing role in radiology, but the algorithms have a long way to go.

No topic has been hotter in the media this year than the coming of artificial intelligence. AI is getting better and getting faster and, some fear, getting a bit ahead of our ability to understand and control it. That is up for debate—and there will be debate—but most of AI’s proponents are more focused on the best ways to harness it. AI has the awesome potential to make us smarter, safer, faster and more productive. And that has people in the medical profession very interested.

The fact is that artificial intelligence is nothing new. You’ve been using it since the first time you followed directions from a GPS app. AI has been a part of medicine for a while now, too. Computer-aided detection, for example, was being used in mammography in the 1990s. And many FDA-cleared algorithms are currently in use, including at Trinitas. What’s new are some profound advances in deep learning, which combines algorithms with massive amounts of input data to create a level of “expertise” that will enable doctors to perform faster and more efficiently. And theoretically, one day, AI will be able to see and predict things that humans cannot.

In radiology, AI has already revealed its game-changing potential. The digital images that have traditionally been interpreted by radiologists are now being translated into quantitative data, which is then used to create algorithms to detect anomalies that might be invisible to the human eye. This in turn can alert a doctor to a situation that he or she can address sooner than ever before. If you know someone in the radiology field, then you know that it can be a high-stress job with little or no margin for error—either missing something important or producing a false positive. Sophisticated AI-supported clinical decision-making can only help.

Far From Perfect

Dr. Albert Li, a vascular and interventional radiology specialist—who considers himself the “champion of AI” in his practice—cautions that, although the potential is exciting, currently it’s far from perfect. “Right now,” he says, “it’s meant to augment the experience of radiologists, who are trained to interpret what the AI is telling them and then either accept it or dismiss it. The thing to understand about AI is that it doesn’t ‘know’ what it’s looking at—or what it means—it only understands how to look for the patterns it has been programmed to look for.”

www.istockphoto.com

Patients should be reassured, Dr. Li adds, that the algorithms currently being deployed are indeed meant to help radiologists perform more accurately and faster. They are good at detection (detection of tumors, detection of brain bleed) and at triage—in the sense that, when the computer sees a grave abnormality, it tells the radiologist to prioritize its interpretation.

“My goal as a radiologist is that AI must be safe for my patients—not to make money, not to generate revenue. Whatever we employ, it needs to be effective and safe.”

While the benefits of AI in respect to outcomes and patient safety are obvious, less obvious is the fact that the same deep learning skills can be applied to almost every aspect of the patient experience—from scheduling to imaging decisions to examination protocols, as well as managing workflow for the hospital staff, which has become a higher priority throughout the industry post-COVID. AI also has the potential to decrease by 30 to 50 percent the time it takes to produce a scan and to pull together an image, which enables radiology departments to see many more patients a day. And of course, AI doesn’t get “tired.”

Needless to say, some big tech companies are working to make AI a bigger part of healthcare, including Google, Siemens and Canon.

Big Picture

www.istockphoto.com

One area that could benefit greatly from AI is the whole-body scan. By measuring and analyzing hundreds of biomarkers, both individually and as part of the body’s system, the chances of identifying and accurately predicting future medical issues are greatly increased. Right now, whole-body scans are too time-consuming and expensive to be available to the general population. That could change in the not-so-distant future as better deep-learning algorithms and scanning equipment are developed. For instance, AI may observe that a patient has a probability of developing a disease like cancer in the future, even though there is absolutely no sign of the disease at that moment. Dr. Li jokes that this reminds him a little of the movie Minority Report.

“I don’t know that we’ll see something like this in the next 10 years,” he says. “A lot of people talk about diagnosis, but that’s far away. The training data is not robust enough yet—we’ll need more clean data to make that happen. On the one hand, it will take time; but on the other, it’s becoming more robust because of better, cheaper computer power. That’s actually where we’ve seen the biggest jumps recently.”

Finally, AI holds considerable promise in an aspect of oncology that can be daunting for both the doctor and patient: deciding on exactly the right treatment strategy, especially as the number of therapeutic options continue to broaden. An AI-supported decision would take into account hundreds of data points (including genomic information) above and beyond the radiological data—and help doctors understand which patients might respond best to various therapies.

Again, the concept of deep learning is that, if you upload enough data, algorithms will start revealing patterns that humans don’t see.

Will AI replace radiologists? That is highly unlikely. A machine can’t look you in the eye and deliver good news or bad news or discuss options. Also, there is the issue of “machine drift,” a somewhat alarming phenomenon that results from the fact AI equates “the past” with “the future”—producing some weird results. In the end, AI is merely a medical device and a doctor needs to be on the interpretive end of things.

While many in the medical profession were skeptical when the role of AI was first being brainstormed, few if any need much of a push to recognize its potential anymore. There is still some natural trepidation, but the promise of being better and more efficient at what they do—and having back-up support driven by an ocean of data—is increasingly appealing.

In the meantime, AI developers will continue working with radiologists and others in the medical field to not only ensure that their products meet expectations, but exceed them.

Editor’s Note:

Dr. Albert C. Li is an Interventional Radiologist at Trinitas. He received his medical degree from Rutgers New Jersey Medical School and has been in practice for more than 20 years. For LDCT screening appointments, call (732) 955-8825. University Radiology at Trinitas is located at 415 Morris Avenue in Elizabeth.

Trinitas mental health screeners partner in a groundbreaking de-escalation program.

www.istockphoto.com

Ask any law enforcement professional what the most volatile response situations are and you’ll get a near-unanimous answer: mental health crises. They can go sideways in an instant, putting the well-being of officers and the individuals in distress at grave risk. Nearly a quarter of all people killed by police in America suffer from a known mental illness. They are far more likely to be injured in these encounters, too.

Existing research suggests that the presence of mental health professionals during a service call decreases the use of force and arrests, while increasing the use of mental health resources. In the spring of 2022, Trinitas helped put that research into real-world action when it joined a pilot program called ARRIVE Together, expanding an initiative that had begun in South Jersey to the cities of Elizabeth and Linden.

ARRIVE is an acronym for “Alternative Responses to Reduce Instances of Violence & Escalation.”

As part of the program, Trinitas has been providing certified behavioral health screeners to the Elizabeth and Linden police departments to respond to 911 calls involving mental health crises. The Trinitas screeners accompany plainclothes officers in unmarked vehicles on daytime calls, helping to defuse explosive situations and connecting those is crisis to appropriate mental-health resources. The program has already met its primary goal: to save lives and then start rebuilding them.

In recent years, police officers in New Jersey (and around the country) have found themselves increasingly having to deal with individuals in distress who have slipped through the cracks of social services, or whose conditions have worsened for myriad reasons, including stress related to the COVID-19 pandemic. Law enforcement training and experience covers these encounters to some extent, but it has become clear that a different type of “first responder” is often needed to ensure all-around safety and produce the safest outcomes.

In May 2023, the Brookings Institution released findings on ARRIVE Together, looking at data from more than 300 calls between December 2021 and January of this year—including critically important Officer Narrative Reports. Dr. Rashawn Ray, a Senior Fellow in Governance Studies, joined New Jersey Attorney General Matthew Platkin on a panel that included Lisa Dressner of RWJBarnabas Health, who is Vice President of the Department of Behavioral Health at Trinitas.

Among the more noteworthy data unveiled by Brookings was that arrests were largely avoided on ARRIVE Together responses, and that use of force was avoided, as well, in more than 97% of the ARRIVE Together calls.

“In addition, we did not find racial differences in the likelihood of being arrested or a use of force,” Dr. Ray points out. “That’s huge given what we know about racial disparities. This is extremely important and, I think, extremely uplifting in terms of what we might see moving forward.”

And move forward it will. In 2023, Attorney General Platkin expanded ARRIVE Together to additional municipalities, including Cranford and Roselle Park. In June, the program began to expand throughout Union County. Governor Phil Murphy has earmarked $10 million a year to support ARRIVE Together going forward.

“ARRIVE Together and specialized programs like this are critical in helping us to use best practices to most effectively respond to individuals experiencing a mental health crisis,” Dressner adds. “It helps people trust that they can call for help when they need it and to ensure that the people responding to these mental health emergencies have the training and resources available, and that they provide people with the support they need—also that, when people do have to come into the hospital to be evaluated or be admitted, that they arrive safely.”  

10 Questions About Bad Breath

Call it halitosis, call it oral malodor, call it morning breath—call it whatever you want—but bad breath by any name is big business. The mouthwash and breath freshener industry will generate between $6 and $7 billion this year…because no one wants to see the look on someone’s face when we gas them out.

What causes bad breath?

Typically, but not always, halitosis begins in the mouth. Common causes include poor dental hygiene, xerostomia (aka “dry mouth”), certain foods and spices, tobacco use, some medications, and infections from sores, gum disease or oral surgery. Acid reflux, certain diseases (including some cancers) and metabolic disorders can also cause bad breath. Your tongue harbors odor-causing bacteria, too.

Why do I have bad breath after eating garlic?

After digesting certain foods, including garlic and onions, they can enter your bloodstream and find their way into your lungs, which can affect your breath.

What’s the story behind halitosis?

It is as old as human history. Ancient people boiled herbs and spices to create chewable “breath mints” so we know halitosis had been a concern for thousands of years. Indeed, Halitosis is actually Latin for “diseased breath.” The late-1800s saw the manufacture of the first mouthwash, Listerine, which was named in honor of Dr. Joseph Lister, a pioneer in antiseptic surgery. However, it didn’t catch on with the public until the 1920s, when Listerine began claiming it could “Cure Halitosis”—which sounded more like a serious medical condition than bad breath.

How did bad breath become such big business?

“Often a bridesmaid but never a bride.” That was Poor Edna, the “star” of Listerine’s most successful ad campaign. Everything about her was desirable…except her halitosis. Thanks to Edna, by the end of the 1920s, annual sales rose from $100,000 to $4 million—a forty-fold increase. During the 1940s and ’50s, Chlorophyll offered a less medicine-y option and made Clorets one of the world’s top selling breath fresheners. Readers of a certain age may remember the brilliant 1960s marketing campaign behind Scope, the minty mouthwash that went head-to-head with Listerine. The best way to let someone know they had bad breath was to leave a bottle in the mailbox with a note: Once in the morning does it! Signed The Green Phantom. More recently, Tic Tacs became the go-to solution for halitosis.

www.istockphoto.com

Does mouthwash do any good?

That depends…because there are two types of mouthwash: Cosmetic and Therapeutic. Cosmetic products control bad breath and leave a sweet or minty taste in your mouth, but don’t provide any long-term benefit because they don’t kill odor-causing bacteria. Of course, that may be all you need if you just had raw onions on your burger or some fish sauce with your Thai food. Therapeutic rinses—which are sold over the counter and are also prescription products—contain active ingredients that reduce the causes of bad breath.

What are the main foods that cause bad breath?

According to the good folks at Listerine, the “Top 5” foods that cause bad breath are 1) Garlic 2) Onions 3) Dairy 4) Canned Tuna 5) Horseradish. Yes, horseradish. Its strong, eye-watering smell—which is created by the organosulfur compound allyl isothiocyanate—can trigger halitosis. That’s no surprise, considering its purpose in nature is to drive off hungry herbivores.

Wait. Why do dairy products cause bad breath?

Because the bacteria that lives on your tongue actually feeds on the amino acids in milk and cheese, creating an unpleasant odor.

Is bad breath a sign of something more serious?

It can be. Bad breath often accompanies dental infections and acid reflux (aka GERD). A metallic odor or fruity taste are also signs that should trigger concern.

www.istockphoto.com

Can bad breath also be “good” breath? Is that a dumb question?

First of all, that’s two questions. However, there is nothing dumb about it. In the sense that it may provide early clues to major health issues, bad breath can indeed be a “positive.” Studies have been conducted over the last decade that hold great promise in the detection of lung cancer and cardiovascular issues, including heart failure. Don’t be surprised if, one day, “breath tests” replace invasive procedures as a first line of detection.

Which foods naturally fight bad breath?

Gingerol-6, the chemical in ginger, helps break down sulfur compounds, so chewing on ginger or drinking ginger tea (or ale) can help. Cherries can neutralize methyl mercaptan, the gas produced by mouth bacteria that smells like old cabbage. So can lettuce. Cinnamon contains an essential oil with antimicrobial and antiseptic properties, so pop a cinnamon Altoid or chew on a cinnamon stick. The vitamin C in oranges and other citrus fruits can help control bacterial activity in your mouth and neutralize unpleasant odors. Fresh spinach is high in zinc, which prevents the build-up of sulfur compounds.

Bonus Question

How do I know if I have bad breath?

Ask someone you know and trust. Smelling your own breath is a lot like taking your temperature by putting your hand on your forehead. It doesn’t really work.

Age eligibility for lung cancer screening is lowered by five years.

One of the many overlooked medical stories during the COVID-19 pandemic was an announcement by the US Preventative Services Task Force (USPTF) that it had expanded the eligibility guidelines for lung screening. The decision came in March 2021, a year into the pandemic and, somewhat ironically, flew under the radar at a time when we were all hyper-focused on the health of our lungs.

www.istockphoto.com

The USPTF tweaked its 2013 recommendation, which had encouraged people 55 to 80 with a 30-year pack history of smoking (or current smokers) to undergo annual screenings. The new recommendation now includes adults 50 to 80 with a 20-year pack history who are either current smokers or who had quit within the past 15 years. The 2021 USPTF also suggested that screenings be discontinued once a person has not smoked for 15 years—or has developed a health problem that substantially limits life expectancy or the ability/willingness to have curative lung surgery.

The expanded eligibility is, in part, a result of reviewing evidence from clinical trials that screening with low-dose computed tomography (LDCT) provides benefit in younger patients and patients with lighter smoking histories. LDCT is an established safe technology that is more accurate than traditional x-rays for lung cancer screening. According to Dr. Albert C. Li, an Interventional Radiologist at Trinitas, the evidence supports the wider age range and there is clearly “value.” Medicare agrees with the increased value, as it announced expansion of coverage for lung cancer screening with LDCT for eligible Medicare beneficiaries.

“If you screen patients in the new range, you will save more lives,” says Dr. Li. “In eligible patients, low-dose CT for lung cancer screening should be performed once a year.”

The lowering of the age recommendation to 50 differs from other health organization—including the American Cancer Society, National Comprehensive Cancer Network and American Association of Thoracic Surgery—all of which currently are at 55.

www.istockphoto.com

Earlier screening, of course, increases the chances of earlier detection and treatment—and a greater chance for cure. Currently, nearly 80% of patients who present with lung cancer are already at the point where it has spread to nearby lymph nodes or, worse, metastasized to other parts of the body. Metastasized lung cancer has a five-year survival rate in the single digits.

When lung cancer is diagnosed while it is still a localized disease, survival rates soar well over 50%. The problem is that lung cancer is caught that early in only 17% of people. Dr. Li wants to see that number increase through early detection via participation in a lung screening program, such as the program that exists at Trinitas.

“That will happen through patient education, as well as reaching out to primary care doctors to remind them that lung screening eligibility has expanded,” he says. “If you are reading this and meet the criteria, talk to your doctor about getting screened.”

As with any screening test, there are risks and benefits, Dr. Li adds.

“However, there is good evidence that lung cancer screening will give a moderate net benefit for our patients with increased risk.”

Editor’s Note: Dr. Albert C. Li is an Interventional Radiologist at Trinitas. He received his medical degree from Rutgers New Jersey Medical School and has been in practice for more than 20 years. For LDCT screening appointments, call (732) 955-8825. University Radiology at Trinitas is located at 415 Morris Avenue in Elizabeth.

An ailing photographer provides a snapshot of the integrated care experience at Trinitas.

Trinitas Regional Medical Center

In 2020, Brazilian photographer Sonia Braga came to New Jersey to help care for her daughter and grandson. She had been diagnosed with cancer in her home country, for which she had received treatment and believed she was cured. Unfortunately, prior to her arrival in the US, the cancer had returned and had metastasized. Braga transferred her care to Trinitas, and informed her medical team that she had also been diagnosed with depression, starting at the age of 11. Over the course of many decades, Braga had seen numerous doctors who prescribed different medications, all of which had unpleasant side effects.

“When I met Sonia, her journey was already a long journey and the first thing that struck me was that it was taking a huge toll on her, not only physically but mentally,” says Dr. Michelle Cholankeril (above), the hospital’s Division Chief of Medical Oncology. “I felt that it might be beneficial to send her for a wellness checkup, because it’s really important that the medications we give in oncological services work well with the medications that are used for psychiatric illness.”

Trinitas Regional Medical Center

In a traditional model of healthcare, patient experience is often siloed into different pieces. In a case like Braga’s, for instance, it would probably involve finding a medical provider to address her physical symptoms and then going out and identifying a behavioral health provider to talk about the mental side of the equation—and then coping with the added challenge of cobbling all the various pieces together.

“What we do at Trinitas is offer an integrated-care experience that relieves the patient of the burden of having to try to navigate a system themselves,” explains Lisa Dressner, VP of Behavioral Health, who adds that this approach “provides the best possible outcomes for our patients.”

Braga enrolled in an eight-week outpatient program that looked at the entirety of her treatment and prescribed the appropriate medication for her depression.

“The program made so much difference,” Braga says. “I suffer from depression, but that doesn’t make me a weak person. I’m actually a strong person. I worked with a psychologist and was able to talk and explain what I was going through.”

At the same time, Dr. Cholankeril was able to prescribe a medication that she suspected would be a good fit—not just for the cancer, but for Braga as a human being.

Self-Punishment • Sonia Braga

“The second and third time I saw Sonia, there was such a huge difference,” says Dr. Cholankeril. “It was really nice to see.”

Trinitas Regional Medical Center

The Girl Outside • Sonia Braga

Braga returned to Brazil and, unfortunately, began experiencing abdominal pain, which was caused by metastatic cancer in a different area. This time, however, she remained positive as her doctors put her on alternate medication. Dr. Cholankeril believes that the therapy Braga received at Trinitas helped her accept the recurrence and remain in high spirits.

Braga agrees.

The Old Girl • Sonia Braga

“The mental health treatment helped me to deal with the cancer,” she says. “I want to go through this in the best way, to enjoy every step. I will use this cancer to be better, to live better.”

This is clearly evident in her photography, she adds.

“If you look at the work I did before, while suffering from depression, you can see the pain,” she says. “After that, my photos have more life, more hope.”

At Trinitas, Braga says, they made her feel welcome and special, treating her as a person, not just a patient.

“And it’s not just the doctors,” she points out. “It starts at the front desk. You feel safe here…because everything works with love.”

www.istockphoto.com

Doctors and patients can do more to recognize IPF… an elusive disease that literally takes your breath away.

Three years ago, very few people gave serious thought to the health and function of their lungs. As a result of the Covid pandemic, the public gained a profound appreciation for these vital organs. It is one thing to suffer a heart attack or contract a long-term disease, or even to be the victim of an unlucky accident. It is quite another, however, to be unable to breathe. It is truly terrifying.

www.istockphoto.com

As a pulmonologist, I see patients every day struggling with a variety of breathing issues. Some are curable and others manageable but, unfortunately, some do not have a good long-term prognosis. One in particular is of what happens to the lungs in patients that suffer from Idiopathic pulmonary fibrosis. Idiopathic pulmonary fibrosis, or IPF for short. Fibrosis means that the lungs are getting thick and hard. To understand, think of an individual breathing in and out with a normal lung. That lung is like a sponge—you can squeeze it and it comes right back. No problem. Now imagine that sponge is thrown in the backyard for a couple of weeks—and think about how hard and stiff it would feel when you squeeze it. That gives you an idea of what happens to the lungs in patients that suffer from Idiopathic pulmonary fibrosis.

The number of patients officially diagnosed with IPF suggests it is an exceedingly uncommon disease. There are as many as 132,000 cases in the US, with 50,000 new cases diagnosed annually. The fact is that, because the symptoms are not specific, IPF can be mistaken for other more common diseases, such as COPD, which means the actual number of cases is likely much higher. IPF commonly goes undiagnosed, often for many months to years. If the possibility of IPF is overlooked on the initial visit, it takes three to five doctors before the correct diagnosis is secured.

Which is a problem, because IPF patients are living on borrowed time. From diagnosis to death, they may only have five years.

What complicates the situation is that the symptoms of IPF are not specific. They include a cough that is dry and non-productive, as well as increasing shortness of breath. However, if a doctor examines patients with the possibility of IPF in mind, there are several signs that can point towards the appropriate diagnosis. They include clubbing of the fingers, Velcro crackles and acrocyanosis—a bluish discoloration of the extremities—among others. More on these symptoms later.

It is a lack of awareness of signs like these that causes a delay in the diagnosis, which is why I have devoted a great deal of time toward raising awareness among healthcare providers and the public of IPF.

Slow and Insidious

Interstitial Lung Disease (ILD) encompasses a diverse group of conditions that cause lung fibrosis. There are approximately 150 different diseases that are part of ILD, one of which is Idiopathic pulmonary fibrosis. These are fairly rare diseases—so much so that most doctors do not always think of them. When patients are referred to doctors with shortness of breath and cough, those patients will be diagnosed most likely with COPD, bronchial asthma, or chronic bronchitis. That translates into thousands of people who go on living their lives while they are actually dying from IPF, believing they have something else. The fact is that many doctors do not think of IPF when the disease might just be staring them right in the face.

IPF is slow and insidious. It usually begins with a cough or increasing shortness of breath to the point where patients realize that they cannot do the things they’re used to doing, such as walking a few blocks or going up a staircase. That’s what triggers the initial physician visit. If there is a history of smoking, COPD is the immediate suspect and the IPF diagnosis may be missed in that critical initial visit.

IPF occurs more frequently in men than women, typically in the later years, after age 60. IPF patients tend to be, or have been, smokers; they have been ignoring what they believe is a “smoker’s cough.” When healthcare providers listen to them with a stethoscope, they don’t really hear anything. Often they figure it is bronchitis, prescribe them an antibiotic, and that’s it.

Eventually, a patient’s persistent, repetitive cough does not improve and the shortness of breath gets noticeably worse…that is when doctors will start looking for other, less-obvious causes.

The unfortunate thing, as mentioned earlier, is that patients might see several doctors with the same symptoms before they are correctly diagnosed. It takes time before the patient is sent to a specialist, and not all specialists are focused on making the diagnosis. Pulmonologists are trained how to diagnose and treat IPF; they are your best bet for getting to an appropriate diagnosis.

Why is IPF so elusive? One reason is that the signs and symptoms are non-specific, and because of all the different diseases that can present similarly. Consequently, in its early stages, some symptoms of IPF may look like other conditions. It is important for doctors to have an open mind and consider the diagnosis of ILD and pursue a differential diagnosis that will lead them to the diagnosis of IPF.

IPF Clues

There are clues that doctors can look for that will lead them down the path toward an IPF diagnosis. The most important is the cough. It is a cough that is dry, non- productive and repetitive. That cough is the most common presentation. The others, as mentioned earlier, are increasing shortness of breath and the inability of Also, when I listen to a COPD patient’s lungs, I hear distant sounds, diffuse rhonchi or expiratory wheezes. By contrast, in IPF, I hear those Velcro crackles—that distinct sound similar to when you separate one piece of Velcro from another. patients to exert themselves as they had before. COPD, by contrast, usually has a cough that produces phlegm.

Other clues I look for include a patient who may be breathing faster than normal and, sometimes, when I look at a patient’s hands with IPF I may observe a rounding condition of the nails called “clubbing.” Also, I may observe Raynaud’s phenomenon, where their fingers feel cold and are discolored. In patients with scleroderma, one may see “sausage fingers.” All of these can be associated with ILD, although they are not exclusive to the disease.

Surprisingly, chest x-rays are not very helpful in diagnosing Idiopathic pulmonary fibrosis. The ideal test is a non-contrast high-resolution CT scan. It can provide doctors with some clues that are otherwise difficult to detect, including honeycombing, subpleural reticulation and traction bronchiectasis, which is a “pulling” on the bronchi. If I see those three things in a CT scan, chances are a patient has IPF. Needless to say, it is important that a radiologist knowledgeable in ILD is looking for these signs, too. We are also encouraging pathologists to recognize signs of IPF when an open lung biopsy is done, because that is not always the case.

Unfortunately, there is no cure for IPF. However, in some cases, we can consider lung transplantation. For a variety of reasons, the number of transplants is very small, including the fact that many IPF patients are elderly and they might not have the strength to survive a procedure like this, or because the disease has progressed too far. Also, there is a shortage of donors. In my practice, we’ve been working with different medical centers on lung transplants. Recently, I have had patients receive transplants at Temple University in Philadelphia; Mt. Sinai and NYU Langone in New York, and Newark Beth Israel Medical Center, where I have been working closely with Dr. Joshua Lee. For many diseases, a major issue in treatment, is that patients wait too long to go to the doctor. For the most part, this is not the case with IPF. I cannot stress enough that Idiopathic pulmonary fibrosis is a disease where, the more closely a doctor looks, the more a doctor will find. The lack of awareness across a broad spectrum of disciplines—including primary caregivers, radiologists, pathologists and others—makes this diagnosis elusive. It is incumbent upon us to recognize IPF when we first encounter it because, for these individuals, the clock is ticking.

Finally, if you are a patient who has been told you have COPD and you are not satisfied with that diagnosis, seek another opinion. If your condition persists and you’re not getting better, get someone else to look at it. Sometimes a pair of different eyes can make all the difference.

www.istockphoto.com

A Nobel-winning breakthrough and lessons from the pandemic

have cancer researchers rushing to develop and test new vaccines.

Understanding how and why the human body works, and when and why it doesn’t, has led to countless health and wellness breakthroughs—including innovative treat-ments, therapies, medications and vaccines. Breast Cancer Awareness Month, which concluded in October, focused our attention on the impact of the disease, as well as the importance of access to screenings. Another component of Breast Cancer Awareness Month is fundraising earmarked for research. In recent years, more and more of that research has concentrated in an area with which we have all become intimately familiar these past few years: vaccines.

The search for clues on how the immune system might be enlisted in the battle against cancer has intensified thanks in part to: 1) COVID having taught us how to dramatically accelerate the production of new vaccines, and 2) a Nobel Prize-winning discovery that clears the path for new cancer vaccines to be tested. Much of this research has been devoted to understanding cancer itself, particularly the ways in which a tumor’s defenses are able to thwart the immune system. Researchers are not only getting a firmer grasp on how this happens but, just as importantly, how well the human body already eliminates rogue cells as they develop. There is even a word for it: immunosurveillance.

“This is a very exciting time to be an oncologist,” says Clarissa Henson, MD, Chairman of Radiation Oncology at Trinitas Comprehensive Cancer Center (left). “The fields of virology, immunology and oncology have been rapidly joining forces to combat and cure cancer.”

Trinitas patients now have access to a wide range of advanced treatment options such as immunotherapy, precision medicine, and clinical trials—many of which are not available elsewhere—thanks to RWJBarnabas Health’s partnership with Rutgers Cancer Institute of New Jersey, the state’s only National Cancer Institute-designated Comprehensive Cancer Center. Researchers there are focused on translating discoveries directly to patients to reduce the incidence of cancer and improve outcomes.

MUC1

Many of those researchers believe that tumors are formed by cells that have found a way to escape immunosurveillance by “looking” normal—sort of a microscopic cat-and-mouse game going on inside our bodies all the time. If this is indeed the case, then the key to effective cancer vaccines may be learning how both the cat and the mouse do what they do. This information would be used to “teach” the immune system how to recognize the cells that elude it now so that they can be neutralized.

One exciting recent breakthrough, by a team at the University of Pittsburgh, was the identification of an antigen specific to tumors—in other words, a molecule or protein that exists on cancer cells but not on normal ones. Researchers believe this is a critical first step in teaching the immune system what to target. Among the cancers that have this antigen, which is called MUC1, is breast cancer. MUC1is also present on cells related to colon, lung, pancreatic and prostate cancer. That’s quite a list of targets, which explains the excitement in the vaccine community. Initial trials have been focused on preventing pre-malignant lesions, such as polyps, from becoming malignant. A similar trial at Pittsburgh on early breast cancer is already gearing up.

Another branch of cancer vaccine research that holds great promise is the field of neoantigen vaccines. These vaccines address mutations unique to one person’s tumor—a “personalized” vaccine, one might say. A neoantigen vaccine is created using a sample of an individual’s tumor, and is then used to prime that person’s immune system to attack the cancer cells. Trials on melanoma patients have shown great promise, prompting research on a neoantigen vaccine targeting pancreatic cancer. An exciting aspect of these types of vaccines is that, once effective versions have been developed, they could be produced very rapidly thanks to the work that was done to scale up production of coronavirus vaccines.

Although it is encouraging to think that we all might have personalized vaccines one day, that may not be necessary because, as mentioned earlier, many different cancers share similar antigens. A case in point is HER2-positive breast cancer, which accounts for about a quarter of all breast cancers and frequently relapses and metastasizes. The HER2 molecule is considered a driver antigen, meaning that it instructs cells to keep dividing. Without these instructions, the cancer cannot grow. A vaccine that prompts the immune system to make its own HER2 antibodies would be a game-changer.

www.istockphoto.com

An early version of that game-changer has already been through initial trials at the Mayo Clinic. A HER2 vaccine was given to 22 patients with invasive breast cancer. Two-plus years later, 20 of the 22 showed no sign of recurrences. It is a small sample, but the results are encouraging. The same team is also working on a vaccine that might prevent breast cancer in women at high risk for the disease.

“We are still learning more every day about the human body and how the immune system fights illness, viruses and cancer,” says Dr. Henson, who adds that the pandemic provided an impetus for some important research, including a study at Emory University.

“Radiation is used to kill both viruses and cancer, UV light is used for sterilization and to kill bacteria and viruses, while higher-energy x-rays are used to kill cancer,” she explains. “During the pandemic, the Emory study showed that low-dose radiation to the lungs in patients with COVID-19 related pneumonia resulted in quicker recovery times, lower rates of intubation and quicker time to hospital discharge.”

Checkpoint Inhibitors

If we are indeed, as top researchers are optimistic, approaching an age of breast cancer breakthroughs, it is due in no small part to an earlier breakthrough that has made research in therapeutic cancer vaccines possible. That would be the development of checkpoint inhibitors, which are now combined with the vaccines given to patients in many test trials.

Chemotherapy suppresses the body’s response to an immunologic stimulus. So, too, does cancer itself. Because cancer vaccines are tested on people with cancer, it can be challenging to accurately gauge the effectiveness of the vaccines. Checkpoint inhibitors stimulate immune checkpoints, counteracting the effects of cancer. This has cleared the path for critical research. In 2018, the Nobel Prize was awarded to James P. Allison and Tasuku Honjo for “their discovery of cancer therapy by inhibition of negative immune regulation.”

Checkpoint inhibitors technically fall under the heading of immunotherapy. Immunotherapy is another area of intense focus that has yielded possible breakthroughs in the fight against breast cancer. An article earlier this year in JAMA Oncology reported work by Korean researchers on a new treatment for HER2-postive breast cancer that works as well as current drugs, but without the often-devastating side effects. Many HER2 patients receive TCHP chemotherapy before surgery with fairly good results; about half go into remission. But TCHP is highly toxic, especially to gastric mucosal cells, which can result in severe diarrhea and even sepsis. It is hard on bone marrow, too. So TCHP is not recommended on elderly patients or women with certain comorbidities.

The Korean phase-2 study replaced carboplatin—the “C” in TCHP—with a monoclonal antibody called atezolizumab and enrolled 67 HER2-positive patients in a yearlong trial. After surgery, patients received more targeted immunotherapy and, at the end of the trials, 61% responded completely. There were still side effects (including immune-related events in 6% of trial participants), but mostly they were aches and pains and some skin conditions.

In other words, another encouraging step in the development of new weapons in the breast cancer arsenal.

Buzzing Under the Radar

In this year of vaccine hyper-awareness, the first-ever vaccine against the deadliest of all human parasites has gone almost unnoticed.

By Mark Stewart

Over the past year, chances are that you have heard more facts and figures about vaccines than in all of the other years of your lifetime combined. Yet while we have all become intimately familiar with the COVID-19 vaccine, there is another vaccine on the market, which—in any other year—would have been the real headline-maker. Last year, the World Health Organization (WHO) announced that it had approved use of the first-ever vaccine that is effective against malaria, a mosquito-borne disease that can kill within 24 hours of its flu-like symptoms appearing.

“Malaria vaccines have been in development since the 1960s,” says Dr. William E. Farrer, Chief of Infectious Diseases at Trinitas (left). “On October 6, WHO released a recommendation for widespread use of the RTS,S/AS01 malaria vaccine among children living in sub-Saharan Africa and other regions with moderate to high P. falciparum malaria transmission.”

Plasmodium falciparum is the parasite that transmits falciparum malaria, the deadliest form of the disease, which accounts for roughly 50% of cases worldwide and virtually all malarial deaths. For the record, that makes P. falciparum the deadliest of all human parasites. “The vaccine requires three primary shots and a booster,” Dr. Farrer explains. “In large trials, it decreased clinical and severe malaria by about 30%. This is only moderate efficacy, but represents a historic step forward in controlling malaria and could prevent many cases of this dread disease and many deaths.”

Dr. Tedros Adhanom Ghebreyesus, WHO Director General, also described it as a historic moment, predicting it would prevent thousands of deaths a year. Currently, malaria is estimated to kill more than a quarter-million young people annually and over 400,000 in all (estimates fluctuate wildly depending on the source, but the numbers are undeniably huge). Even when it does not kill, malaria can return to sicken the same person several times over the course of a lifetime, or even in the same year—devastating the immune system over time, which makes it vulnerable to other diseases.

The new vaccine, which has been recommended for children five years old and younger, marks a significant step in an effort to conquer malaria that has seen worldwide deaths drop by 60% in the last two decades, and the number of cases cut nearly in half. Unfortunately, progress reached a kind of plateau around 2015 and the numbers have remained more or less constant since then. The recent breakthrough, which activates the immune system to battle the malaria pathogen, owes much to the work done in speeding COVID vaccines to market.

That being said, malaria is not caused by a virus, like COVID, nor by bacteria. Malaria is spread through a parasite which has over 5,000 genes, as opposed to SARS-CoV-2, which has only 11. That is a major reason why malaria has been so good at befuddling vaccine researchers. Indeed, the new RTS,S vaccine will still need to be combined with conventional malaria-prevention strategies—insecticides, netting and artemisinin-based drug therapies—in order to be fully effective. Artemisinin, discovered in 1972, is extracted from sweet wormwood, a plant used in traditional Chinese medicine; it earned the woman who discovered the breakthrough medicine, Tu Youyou, a Nobel Prize. The maddening aspect of fighting malaria is that a vaccine series must target the parasite at all of the different stages of its life cycle. The idea is to “get it” at one stage if it “misses it” at another, with the goal being to kill the parasite before it infects the liver.

Impact on the Home Front

Does the malaria vaccine have any relevance here in New Jersey? Absolutely. More than 2,000 malaria cases are reported in the United States each year, the vast majority coming from Americans vacationing in tropical countries or returning to their countries of origin to visit friends and family. Malaria can be transmitted to a fetus by its mother when bitten by a mosquito carrying the disease, resulting in low birth weight or premature delivery, as well as other more serious (and potentially deadly) health problems to a newborn.

The number of reported cases in Western Hemisphere nations with strong ties to the Garden State—including Mexico, Brazil, Colombia, the Dominican Republic, Nicaragua and Haiti—top 5 million annually. That pales in comparison to India, which recently topped 100 million cases. Vietnam and Indonesia may have more than an estimated half-billion cases in a typical year.

Humans and mosquitoes both thrive near water, and thus have lived together for countless thousands of years—so long, in fact, that this relationship has “imprinted” itself on our genome. The origin of sickle cell anemia, for instance, is a genetic variation that very likely began as a result of malaria. Most people develop antibodies against malaria by the time they reach adulthood, but it takes a grim toll on children, particularly in Africa, where more than 90% of the world’s cases are recorded. The new vaccine completed its first trial run from 2019 to 2021 in Ghana, Kenya and Malawi. It proved particularly effective against Plasmodium falciparum—as mentioned earlier, the deadliest malaria parasite (there are five in all).

www.istockphoto.com

Perhaps because humans and mosquitoes share an evolutionary history, the disease has shown an ability to mutate in response to everything we’ve done to fight it. It is anticipating the next mutation (and the next and the next and the next) that also proved challenging to the development of an effective vaccine. An example of this is the discovery in 2019 of a malarial strain that is resistant to Artemisinin. The mutation took place in Africa instead of Southeast Asia (where malaria mutations typically take place), further raising concerns because the parasite would have mutated independently to resist treatment.

A First Step, But Hardly the Last

The new RTS,S vaccine is not the be-all end-all in the fight against malaria, as Dr. Farrer pointed out. The 30% effectiveness number has drawn criticism from those who would wait for a more effective vaccine before launching the ambitious four-dose campaign in some of the world’s most remote, at-risk regions. However, it is an enormously encouraging first step upon which better vaccines can be built. The mRNA technology wielded against COVID, for instance, holds huge promise in this regard.

www.istockphoto.com

The new vaccine, which goes by the brand name Mosquirix, is the culmination of a research and development partnership, spearheaded by the pharmaceutical giant GlaxoSmithKline, that began in 1987. In recent years, it has been funded by the Bill & Melinda Gates Foundation, among others. In addition to being the first malaria vaccine, Mosquirix holds the distinction of being the first-ever vaccine for any parasitic disease.

An uptick in HS cases has the Trinitas Wound Center on alert.

By Mark Stewart

www.istockphoto.com

Healthcare consumers are always encouraged to seek second opinions if they have doubts or questions about a diagnosis or course of treatment. But we don’t always do that, do we? Especially not for the “small stuff”—for instance, conditions or maladies that don’t seem like a big deal at first. Unfortunately, small stuff can become a big deal, leaving us embarrassed and confused about whom to trust and where to find someone who’ll get it right. The Trinitas Center for Wound Healing and Hyperbaric Medicine sees more than its fair share of cases like this. The combination of a missed diagnosis and/or a patient’s frustration/fear/procrastination can result in the kinds of tough cases that Dr. Michael Zaboski, Medical Director of the Wound Center, encounters almost every day.

Recently, Dr. Zaboski noticed an uptick in the number of patients presenting with advanced cases of Hydradenitis Suppurativa—HS, for short—and it has him puzzled and concerned. “We had four active cases here in February, and each individually had been chronically ill for years,” he says. “That may not seem like a lot, but in my entire career here I’ve seen maybe 15 or 20.”

HS is a painful and unsightly skin condition for which there is currently no cure. However, it is treatable and manageable when caught early. The problem is that some doctors, including experienced dermatologists, do not recognize HS in its early stages, leading to misdiagnosis.

BMC Dermatology

HS outbreaks occur when the tiny sebaceous gland, which opens into a hair follicle and secretes “lubricant” for the hair and skin, does not produce properly and becomes blocked, creating a small, painful bump. These bumps occur in clusters near apocrine (sweat) glands, most commonly in the underarm and groin areas—including the gluteal, perineal and sacral regions—under the breasts and occasionally on the neck. HS may look like a bad case of acne at first, but despite the fact that it frequently starts in a person’s late teens or early 20s, it’s not acne at all.

“Hydradenitis Suppurativa ranges from a field of dark red boils or painful bumps in the underarm or private areas—which can be mistaken for acne—to more severe bumps that form sinuses that connect and spread, almost like a prairie dog field,” Dr. Zaboski explains, noting that these correspond to Class 1 and 2 on the Hurley scale—a severity assessment tool developed by dermatologist H.J. Hurley in the 1980s. “Class 3 is when these sinuses become confluent with large bags of pus and open sores and lesions. For the majority of HS patients, the condition is painful and hygienically difficult. It’s embarrassing and disfiguring.”

Most cases of HS are caught early and treated. However, when the Wound Center sees HS patients, they tend to be undiagnosed—or have not responded to dermatological treatment. Others come to the Emergency Department with an abscess, having no idea what the cause is.

Hidradenitis Awareness

“These cases can be extraordinarily advanced,” says Dr. Zaboski. “I have treated two young men, both in their 20s, who have no job and didn’t go to college, and blamed it on the disease. They were basically unable to function. It was too painful to walk and too painful to sit. Another man came to us with a quarter of his body area covered with lesions and had almost no normal skin from his waist all the way down his thighs. He’d had this for five years.”

HS is associated with several comorbidities, including obesity, diabetes, high cholesterol and hypertension (and often a combination of two or more). As diabetes and obesity increase in the population, so too will HS. There also appears to be a strong family component. Not surprisingly, depression, is common with this disorder.

Although there is no cure for HS, many patients respond well to Metformin, a drug that controls blood sugar. In the past, many HS patients had their boil-like bumps lanced, but incision and drainage simply prolonged the disease and also caused scarring. Steroid injections into the lesions can quiet the disease until other medicines kick in. Treatment is a long-term proposition, which typically involves anti-inflammatories and antibiotics until there is improvement. The goal is to stabilize patients medically and, if they haven’t improved, refer them for a surgical procedure, which goes under the skin to remove glandular tissue. This can get very complicated and may involve skin grafts and plastic surgery.

“The earlier we treat it, the better,” says Dr. Zaboski. “Also, a recent study suggests that large-scale weight loss may lead to a cure, so bariatric surgery may be an option. And HS can go into remission. Even in those instances, however, it requires chronic maintenance to prevent it from flaring up and getting worse.”

Planning to step up your game after the holidays? Worried that you’re not up to the challenge? Listen to your body (and your doctor) and you’ll avoid the sprains, trains and stress that send others to the bench.  

Three cheers for medical science. Although staying fit still takes hard work and commitment, remaining injury-free is easier than ever. Whether you’re a weekend warrior training for your first triathlon or you live on the tennis courts, you have two missions when you’re pushing the performance envelope: Do your best… and make it home in one piece. The key to success (or survival, depending on your sport) is recognizing that there are three important components where your body is concerned: BEFORE, DURING, and AFTER. Understanding the basics of each not only gets you on the court or field or road—it’s what ultimately will keep you there.

BEFORE

The right preparation can save you a world of hurt, but often people skip this step. Here’s how to ensure you’re ready to take on all comers:

• Check yourself out. Most people know it’s wise to consult your doctor before starting a new exercise routine, but there’s another professional who might be just as key. “I’m a strong advocate of having a person trained in physical therapy take a look at the muscular-skeletal system,” says Jim Dunleavy, PT, MS, Administrative Director of Rehabilitation Services for Trinitas Regional Medical Center. “We all come with little quirks that we may not know we have. For instance, if someone has resisted motion in their hip, that could cause a knee or ankle problem. After the assessment, they can make sure that their exercise program attends to those potential issues.”
• Ditch the heels. Women who wear heels put themselves at risk for injuries in sports. “If you wear heels during the day, your calf is shortened all day long, and you won’t have the flexibility and the strength to participate in your activity without hurting,” Dunleavy says. You’ll need to engage in some extensive stretching of your lower legs before and during your activity to help minimize the chances of injury.
• Be sure you’re balanced. You may be working hard to get your muscles in shape for your particular sport, but you can’t ignore the rest of your muscular system. “You need to pay a little attention to your core muscles, to A Special Health & Wellness Section from Trinitas Regional Medical Center balance things,” says Dr. Richard Mackessy, Chairman of the Orthopedics Department at Trinitas. “If you overdevelop one area, like your chest, but haven’t done anything to the back, you’ve created an imbalance in your shoulders that makes it so they’re pulled forward constantly, and creates a risk of pain.”

DURING

While you may be concentrating on squaring up to the ball or keeping your marathon pace, there are other things to keep in mind before you shift into high gear:

• Warm up. There’s been so much debate on how to get rolling—just stretching, stretching and warm-up, or full speed ahead—but most experts agree that a warmup is essential. “You don’t want to just walk onto the field and play the toughest match without doing anything,” Dr. Mackessy says. “We recommend going through a period of warming up, where you’re going at half the pace. If you’re playing tennis, you might hit balls at a very relaxed pace for a few minutes, then stop and do some stretches before you really start playing.”
• Don’t go crazy. Weekend warriors may be all gung-ho about doing the activities they love when they have the time, but it’s best to work up to an all-day round-robin. “If you’re working 9 to 5, your body is not built up to withstand the constant stress that’s placed on the body with a prolonged sports activity,” Dunleavy says. “Your body can only take so much—overuse can result in inflammation, making it very difficult to use that area without pain.”
• Stop if you have pain. Forget that old No pain, no gain adage—if you’re hurting, take a break. “If you have pain, you need to stop playing,” Dr. Mackessy insists. “You don’t need to hurt yourself and be laid up for six weeks.”

AFTER

When you’re ready to pack it in for the day, there are a few tricks you can use to help ensure you’ll be ready to achieve peak performance the next time out:

• Stretch it out. After a brief cool-down (like the warmup, you’re going at a more relaxed pace), be sure to give your muscles a well-deserved stretch to keep them limber. “Hit all the common stretches—legs, arms, shoulders,” Dr. Mackessy suggests.
• Nurse your wounds. If you do have pain and inflammation—the most common results of overuse injuries—there are a number of steps you can take to decrease the swelling, either at home or under a doctor’s care. “Swelling is going to retard the healing process, so you need to cool down the tendon with ice,” Dunleavy suggests. “We can also try to stimulate the healing process by increasing blood supply with electricity, heat and ultrasound, or by injecting medications, like cortisone or steroids. We can even load medication into an electrode and use electricity to drive medication into an area.”
• Assess your performance. Play Monday morning quarterback and see what you can improve at your next sporting event. “John MacEnroe once said that he learns more from losing than from winning,” says Dr. Rodger Goddard, Chief Psychologist and Director of Wellness Management Services for Trinitas Regional Medical Center. “Being able to look back at what was disappointing in our performance and devise a plan to improve our technique, execution and strategy in these areas is an important skill.”

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.

Shiny hair and teeth, longer legs, firmer abs, cooler apartments, faster cars—the list of differences between TV docs and the real-life ones is practically endless. Yet from a practical standpoint, the difference that matters the most to real-life patients is this: Can you help me? That’s when the TV docs disappear and the true problem-solvers hit their mark.  

Let’s face it. Who doesn’t love a good medical drama? When some “Doc Hollywood” sinks his teeth into a perplexing patient, we are transfixed. These television characters will crack the case—we know it and, on some level, we know they know it, too. The medical dramas that play out on hospital floors every day present the same challenges and demand the same out-of-the-box thinking. However, when a patient stares desperately into a doctor’s eyes, that’s not acting. It’s the real deal. We asked a trio of the top docs at Trinitas to “state their case”—the one that intrigued or challenged them, surprised or gratified them, the kind that makes real-life doctoring far better than doctoring As Seen On TV.

A HELPING HAND For Dr. Richard Mackessy, the chairman of Trinitas’ orthopedics department and a specialist in hand surgery, the toughest patients are often the youngest. He’s spent the past 20 years donating his surgical expertise to Healing the Children, a nonprofit that helps children from around the world come to the U.S. to receive treatment. “Most of the kids have congenital problems with their legs that keep them from getting around,” he says. “We usually have to amputate and give them a prosthesis, but the results are amazing—it allows them to be up and walking around, independent and functional.” Healing the Children sponsored two of Dr. Mackessy’s most memorable patients—a pair of children from Russian orphanages who had severe hand deformities. The first, a boy, was missing a thumb due to a congenital condition. Dr. Mackessy was able to utilize the index finger to create a thumb for the little boy. “You situate the index finger in a different way, attach different muscles, and take one of the bones out of it, and you’ve created a thumb.” The surgery helped the child gain use of his hand. Another, a little girl, was missing most of her left arm below the elbow, and the fingers on the right hand were fused together. Dr. Mackessy was able to separate the thumb and fingers on the right hand, and perform surgery to make her left arm more useable. Both kids not only regained the use of their hands, they gained something else—while they were in America for their surgeries, they were adopted by U.S. families. Dr. Mackessy says he constantly sees the power of medicine. “[This work] makes you see life differently—it shows you what medicine can do for people.”

THE HEART OF THE MATTER For Dr. Arthur Millman, head of Trinitas’ cardiology center, mending broken hearts is all in a day’s work. One of his most interesting patients was a 70-something lady who wanted to skydive. “She wanted to get a letter from us that said that she could go, but she was in severe heart failure, with a leak in the mitral valve,” he recalls. After she was stabilized, Dr. Millman was able to surgically repair her valve. “While you can replace the valve, doing so damages the heart muscle and creates illness in the patient,” he says. “If you are able to fix the valve instead, it’s still you, not some piece of plastic or something that came from a cow or a pig.” With this valve repair, he was able to give the patient a whole new lease on life. “She can take care of herself now, go shopping—things she couldn’t do beforehand. I still tell her that skydiving isn’t a good idea, though.”

SOLVING A MEDICAL MYSTERY When a young diabetic patient came to Dr. Paul Vaiana early in his medical career complaining of numbness in his hands and feet, the now-president of Trinitas Regional Medical Center’s Medical and Dental Staff, might have assumed that the problem stemmed from a failure to take his medications. But Dr. Vaiana noticed something that concerned him. “He had no motor strength, and that made me think that something else was happening.” A spinal tap revealed the cause—Guillain-Barré syndrome, a disorder in which the nervous system comes under attack by the body’s immune system. At the time, not much was understood about the disease, but Dr. Vaiana knew his patient was running out of time. “I knew it needed to be addressed quickly with a very specialized treatment,” he recalls. “If you aren’t able to wash the patient’s blood, they became ventilator-dependent quickly.” Dr. Vaiana and the hospital were able to locate a plasmapheresis machine within 24 hours to cleanse the patient’s blood and get him on the road to recovery. “Everyone worked together on this young man and in three days he was out of the woods,” he remembers. “We were so aggressive in treating it, and now that is the standard care of this disease.” Three decades later, that young man is still Dr. Vaiana’s patient. “I love practicing medicine and having a relationship with my patients,” Dr. Vaiana says. “It’s not the money driving care here—I’m glad to be part of a team who really goes out of their way to help people in their time of need.”

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.

A kidney transplant was a no-brainer for Khalil Bell… he just had to wrap his mind around it.

A little more than five years ago, Khalil Bell was at a crossroads in his life. Born with one non-working kidney, and the other functional but deformed, he was looking at a condition that was irreversible, knowing he would have some difficult choices ahead. Bell had to begin a dialysis regimen at 30 years old—a good 20 years earlier than the majority of patients with kidney disease. That made him an ideal candidate for a kidney transplant.

Trinitas Regional Medical Center

But for seven years he put it off.

The issue for Bell was his weight. He tipped the scales at well over 300 pounds and was told the procedure would not be safe until he had dropped 100 or so. Bell’s doctors at Trinitas put him on a strict dietary program, but he wasn’t responding as well as they’d hoped. For a time, he got used to the regimen at Trinitas’ Linden Dialysis Clinic, which, because of his weight, took five hours a visit instead of the typical three-and-a-half for other patients. Ruby Codjoe, Director of Renal Services at Trinitas (right), could see Bell was becoming increasingly frustrated. These were years he would never get back.

“Are you prepared to do this the rest of your life?” she asked one day.

“Ruby,” Bell answered, “you tell me what to do.”

“Transplant,” she said.

Turning Point

“I needed help,” Bell recalls. “I had to overcome my own ego and a certain amount of arrogance about my situation. Ruby Codjoe really helped me turn my life around.”

“When you are in your 30s and dialysis is the rest of your life, that means stopping everything and coming in three times a week,” she says. “This illness is no joke.”

To qualify for a transplant, he’d first need to drop a significant amount of weight—a process that involved bariatric surgery—in addition to making a dramatic change in his eating habits. Codjoe helped Bell navigate the complicated process of scheduling bariatric surgery and, eventually, getting added to a kidney recipient list. With her support, Bell adopted a diet and workout routine that led to a total body transformation and, ultimately, a new kidney.

“Ruby and everyone at Trinitas were amazing,” he says. “I felt really fortunate that they were with me throughout the process.”

Not that any of this was a slam-dunk for Bell. On the contrary, just three months after he lost the weight and was added to the kidney recipient list, he got the call in the middle of the night that there was a match for him. He knew that some patients wait years for this call, but he said Thanks but no thanks.

Mentally and emotionally, Codjoe says, he just wasn’t ready. “It was just too soon.”

Fortunately, when the call came again six months later, Bell was good to go. A donor kidney is only viable for four to six hours. He was instructed not to eat anything until the hospital was certain it was a perfect match. When Bell got the thumbs-up a while later, he made his way to the kidney transplant program at Cooperman Barnabas Medical Center, in Livingston. The procedure went smoothly, taking about three hours, and Bell was discharged a week after doctors determined his new kidney was functioning.

Rock Solid

Five years later, Bell (right) is eating well, working out religiously, and dealing with the cocktail of anti-rejection drugs he must take for the rest of his life. He is also a rock-solid 230 pounds.

“You would think he’s a championship body builder,” Codjoe says. “His life has changed totally.”

“The hardest part was the lifestyle change,” he says. “Getting up early to hit the gym every day, making better food choices, just having that discipline. Actually, the working out has been the easy part.”

Bell will be the first to tell you that the journey to significant, sustained weight loss is a formidable one—both mentally and physically. He’ll also be the first to tell you that if this is what stands between you and a lifetime of dialysis, it’s a journey worth toughing out…and that, if you need someone to walk with you on that journey, he’ll be the first to sign up. Bell is just a phone call away from the team at the Linden Dialysis Center. When the Trinitas staff needs someone to speak with a patient who’s losing hope, or to deliver a motivational talk to potential kidney transplant candidates, he’s happy to oblige.

“Today, when I have somebody who is struggling—especially a morbidly obese younger person,” says Codjoe, “I call Khalil and tell him there’s someone here who needs his support, someone who needs to hear from him what’s involved in the bariatric surgery and the transplant process.”
“I’m happy for the chance to share my story if it helps others,” Bell says. “I feel blessed every day.” EDGE
Editor’s Note: Erik Slagle has been writing health stories for EDGE for a decade. He was among the first to sound the alarm on the hidden dangers of vaping in the 2018 feature “Blowing Smoke.”

By pulling out all the stops, have we inadvertently pulled the rug out from under our best young athletes?

The intense pressure experienced by athletes at the top of their sport and the apex of their abilities is nothing new. It comes with the territory and is amplified exponentially when the stakes are highest, the competition is fiercest and the whole world is watching. The best of the best separate themselves from the pack at these make-or-break moments, digging deep and finding ways to meet or exceed the fantastic expectations heaped upon them. Until, one day, they can’t. Or don’t. Or won’t.

And we are stunned.

We know that Simone Biles and Naomi Osaka are made of flesh and blood and sinew—they may be marvels of sport, but they are not part of the Marvel Universe. Yet we don’t really understand what nudges them off the rails, do we? Biles opted out of the Olympic all-around gymnastics competition when her internal wiring betrayed her. Osaka took a mental-health vacation from tennis at the height of the spring/summer season. More surprising than their decisions—and more alarming than some of the public criticism they shouldered—is the eye-opening realization that they are not the exception in sports. They are actually the rule.

An Unexpected Twist

On July 27, 2021, inside the physically crowd-less Ariake Gymnastics Centre, Simone Biles (right), leading her team into the Tokyo Olympics finals against the Russian contender

Fernando Frazão/Agência Brasil Fotografias

s, elevated off the mat with her usual power and grace…and failed to perform the 2 ½ rotation vault she had nailed countless times. She scored only 13.766 points, putting Team USA behind in the competition for the first time in almost a decade. Her failure on her sport’s biggest stage left television commentators stunned and her teammates speechless. What Biles did next shocked the world of competitive sports: She publicly withdrew from the Olympic finals, citing non-injury related mental health issues.

Peter Menzel

“I just felt like it would be a little bit better to take a back seat, work on my mindfulness,” Biles told reporters. “I just need to let the girls do it and focus on myself.”
Sian L. Beilock, the president of Barnard College and a cognitive scientist told The New York Times, “I applaud the fact [Simone Biles] was able to ascertain that she wasn’t in the right state of mind and step back. What a hard thing to do. There was so much pressure to continue. And she was able to find the strength to say, ‘No, this is not right.’”

Biles later credited Naomi Osaka (left)—who withdrew from the 2021 French Opens to focus on her own mental health and depression—as providing the motivation and courage she needed to put her own mental health first. Osaka had disclosed her decision to withdraw during the French Open on Twitter; she had been unable to manage her mental health, depression and press conference anxiety ever since her controversial 2018 US Open finals victory over Serena Williams, during which she endured the jeers and boos of a crowd that favored Williams.

Both Biles and Osaka had their critics, of course, some quite harsh. However, they received an outpouring of support from fellow elite-level athletes, who understood the immense, round-the-clock pressure to which they are subjected. Knowledgeable fans by and large echoed this support, as did most in the media. The two young champions compete in sports that favor youth physically, but demand a level of mental maturity that appeared to be beyond their grasp. And it just got to be too much.

An Epidemic

The thing is, Simone Biles and Naomi Osaka are not one-offs. Indeed, every year, countless young elite-level athletes on the fast track to stardom—many still young teens or pre-teens—are overwhelmed by pressure and expectations placed upon them by parents, coaches, fans and friends, and begin to hate the thing they loved the most. Unless you know them, or they are your kids, their stories go untold. Most youth sports programs, in fact, are set up to cull out the physically fragile or easily upended and push the rest ever forward. Although the survivors may gain confidence in their growing skills, the pressure cooker only grows more intense as they near the top of their sport.

Past a certain level, athletes will acknowledge that this unrelenting pressure—as Billie Jean King once said—is a “privilege.” But how do you explain the meltdown of a superstar? And, more importantly, what does that tell us about how young athletes are being raised today?

Studies done on the mental health issues of elite athletes give us the same picture over and over, and it’s kind of stunning. A study on NCAA Division I athletes found that 23.6% of the individuals included in the study met the clinically relevant level of depressive symptoms, with female athletes being nearly twice as likely as male athletes to experience depression. The prevalence rate for American college students, if you’re wondering, is between 7% and 9% depending on the study.

A UK study found the prevalence of mental health issues among elite athletes to be 47.8% for depression and anxiety and 26.8% for signs of distress. A similar study in Australia found the prevalence rate for mental health disorders overall to be 46.4%. A study in Sweden revealed that lifetime prevalence of mental health problems in elite athletes was 51.7% (females 58.2%, males 42.3%).

“The professional consensus is that the incidence of anxiety and depression among scholastic athletes has increased over the past 10 to 15 years,” says Marshall Mintz, a New Jersey-based sports psychologist who has worked with teenagers for three decades.

Isabella and Vinny

Swimming World Magazine

The story of Isabella [last name withheld], a prodigal lacrosse player who started to play when she was in first grade, is not unusual. Excelling at the game from the start, she gave up on other sports she enjoyed, including basketball and soccer, to optimize her shot at a college scholarship. Sure enough, Isabella earned a full ride from an elite college during her sophomore year in high school. What she loved most about lacrosse was the attention it garnered in her hometown. Everyone was rooting for her, and that made her play and practice the sport even harder. That summer, Isabella tore her ACL and was unable to play for eight months.

“It was my worst year ever,” she recalls. “I’d grown up playing lacrosse, and I had no other hobbies. So when you don’t have it, you’re like, What am I going to do?”

Like so many other young athletes, she had been pushed and pressured by her peers, her parents and coaches to focus solely on the sport she was good at—naturally, with love and caring and unqualified support. She practiced day in and day out, cultivated an athletic identity and, in the end, all this over-practice made her more vulnerable to her knee injury. With nothing else to occupy her mind, and the sight of her peers moving ahead with their lacrosse tournaments while she had to take up painful physical therapy, Isabella soon developed an eating disorder. In the end, she chose to give up on the sport to which she had devoted a decade of her young life, deciding instead to pursue a university degree and a career outside lacrosse.

Isabella’s story is hardly unique. Thanks to the changing nature of youth sports, there is an Isabella in almost every town in the country. In 2018, the American Academy of Orthopaedic Surgeons (AAOS) cited two independent studies that strongly suggested that an intense, year-round focus on one sport leads to a much higher risk of burnout and injury in young athletes, as they routinely spend excessive hours per week training. “Youth sports has experienced a paradigm shift over the past 15 to 20 years,” the AAOS noted. “Gone are the days filled with pick-up basketball games and free play. Kids are increasingly specializing in sports.”

Vinny Marciano, a swimming prodigy from New Jersey, was considered by Swimming World and other authorities in the sport to be one of America’s best young swimmers in the run-up to the 2016 Olympic Games. He was the New Jersey 100-yard freestyle champion, and the 2015-16 All Daily Swimmer of the Year, propelling Randolph High School to win the team title despite suffering tendinitis earlier that same year. He missed making the 2016 Olympic by just 0.27 seconds in the 100-meter backstroke. A year later, Marciano all but disappeared from the world of competitive swimming.

In a sport where obscurity and glory are often separated by mere fractions of a second, Marciano knew what he had to do. After failing in the Olympic trials, he joined an even more intense swimming club 90 minutes from home, where he had to put in three-hour practice sessions straight after school, stay overnight with a teammate, get up early and get through two more hours of practice before arriving late to school the next day. For six miserable months, these were his Mondays, Wednesdays and Fridays, with additional solo sets by a coach at a local YMCA. His grades tanked and, finally, he told his parents he did not want to keep going like this.

According to Jay Coakley, a leading sports sociologist and author of Sports in Society: Issues and Controversies, parental pressure doesn’t need to be explicit and heavy-handed in order to push a young athlete past his or her comfort level. Instead, just the child’s awareness of the time and money sacrificed by their parents is enough pressure to make the child keep playing long past enjoyment.

In the end, Marciano completely gave up on competitive swimming to get away from the misery of always trying to climb up a never-ending ladder. He found challenge and enjoyment in a much more leisurely sport: rock climbing. Had it not been for the intense training pressure felt by Marciano—a swimming prodigy by most accounts—after coming up short in Olympic qualifying, the swimming world might have witnessed another Michael Phelps.

Is This PTSD?

The Oxford English Dictionary defines post-traumatic stress syndrome (PTSD) as a condition of persistent mental and emotional stress occurring as a result of injury or severe psychological shock. While the PTSD symptoms in athletes with traumatic injuries, such as a concussion or a torn ACL, are well-studied, that is not the case for a very large number of elite athletes who are subject to emotional and psychological trauma in the form of bullying, humiliation, body shaming, being belittled in front of teammates by coaches or any other similar traumatizing emotional experience.
Former Olympic martial artist and (now) sports psychologist Caroline Anderson brings some personal insight into her new profession. “In my private practice,

I see a lot of athletes—many of them quite young—who have been traumatized in some way as a result of being an athlete and their involvement in sport,” she says, adding that, in addition to serious injury, trauma ranges from conflict with coaches, teammates and sporting bodies to bullying, politics, unfair selection processes and the embarrassment and shame that accompanies less-than-expected performance.

In some cases, the source of PTSD symptoms can be something entirely separate from the performance pressure of an athlete’s chosen sport. Simone Biles was among the scores of U.S. gymnasts sexually abused by team doctor Larry Nasser. During testimony before a Senate Judiciary Committee, Biles was reduced to tears when discussing her experience and its long-term aftermath.
“I can assure you,“ she told the committee, “that the impacts of this man’s abuse are never over or forgotten.”

PTSD symptoms affect a significant percentage of young athletes in some way or form, and for those without proper support, they linger long past the trauma. What matters most is having good support and people who actually understand their struggles. Perhaps that explains why the prevalence of PTSD appears to be much lower among traditional team sports athletes.
Basketball Hall of Famer Magic Johnson, who decades ago said, “Ask not what your teammates can do for you…ask what you can do for your teammates,” may have been on to something. Team sports inherently provide a much bigger support net for the mental health of young athletes who devote themselves to a single sport. Often, they sacrifice their social lives in their quest for excellence. In lieu of close friendships, however, they have teammates that rely upon one another for mental support.

Though not a perfect answer, it’s an improvement over the situation individual-sport athletes like Vinny Marciano live with, as they get stuck in a Sisyphean cycle of chasing perfection and dealing with often overwhelming pressure to always perform better. Indeed, a 2019 study found that individual-sport athletes are more likely to report anxiety and depression, and tend to play less “for fun” and more for goals than team-based sports athletes.

The culture of elite-level athletics, from teen sports to the pros, places a high value on mental resilience. Ironically, that culture has also been largely apathetic to the mental health needs of athletes until relatively recently. USC Sports Psychologist Robin Scholefield may have put it best when she observed that the whole healthy person is the most consistent peak performer. “If you’re not right with yourself,” she insists, “you’re not going to be okay as an athlete.”

Michael Phelps is one of the few elite-level male athletes to step forward and talk about his mental health issues, including a struggle with depression that only worsened during the pandemic. He encourages others to speak out, as he did prior to the 2016 Olympics. “It wasn’t easy to admit I wasn’t perfect,” he says. “But opening up took a huge weight off my back.”

Agência Brasil Fotografias

In 2021, three major college sports conferences—the Atlantic Coast Conference, Big Ten and Pac-12—launched a joint initiative called Teammates for Mental Health. So things are changing. Of course, the hard work still begins at home.

As a parent or as a coach, remember that not a single person has ever succeeded by blindly burning themselves out on a sport that makes them miserable. It is healthy for children to have sports dreams, but what is equally important is to make sure that the child learns other skills to fall back on in case their dreams are not achieved or are not all that they wanted them to be.

Multiple generations are responsible for creating the mess of mental health issues that can consume young elite-level athletes. Perhaps this generation of athletes, with their public platforms and social media followings, will follow the lead of Simone Biles, Naomi Osaka and a handful of others in making the world of sports more in tune with the mental health needs of athletes. Hopefully, their willingness to open up on the subject, to the possible detriment of their image and the value of their “brand,” triggers the kind of culture change that will swing the mental-health pendulum back in favor of the next generation of young, high-performance athletes. EDGE

Editor’s Note: Chuka Erike has been involved in the sports industry since his college days. In 2016, while working for the NBA, Chuka won the league’s Community Assist Award. During a career in sports that stretches back more than 15 years, he has devoted himself to working with young athletes who face high pressure and unrealistic expectations. He recently mentored Joey Spallina, the nation’s top-ranked lacrosse recruit, who is headed for Syracuse University in the fall.

Is your OTC medication doing more harm than good?

Over-the-counter (OTC) medication is one of the safest, most convenient and most affordable pieces of the healthcare picture. The average American household spends nearly $450 a year on OTC medication and related products. We trust OTC drugs, and with good reason: They are FDA-regulated, securely packaged and, where appropriate, most doctors are comfortable recommending them before jumping right into prescriptions. They are marketed well, too. Who can say how many hours of headache, back ache and joint ache commercials the average adult has watched in a lifetime? They are so ubiquitous that we pretty much ignore them at this point.

Unfortunately, there is another aspect of OTC medication that we tend to ignore, and that’s the labeling. The FDA assures their safety only when all labeled directions are followed and all warnings are carefully considered. In theory, most of us understand what this means. In practice, however—particularly while experiencing pain and discomfort—we do stupid things. And that is when OTC drugs can become unsafe. This is particularly true for individuals with coronary vascular disease (CVD). For these individuals, OTC medication can have a serious impact on heart health.
“My patients who suffer from various heart diseases are mostly older and therefore very vulnerable to indiscriminate use of OTCs,” says Dr. Fayez Shamoon, Director of Cardiac Services at Trinitas. “One very real problem for them is that taking OTCs might interfere with compliance about taking their prescribed medications.”

www.istockphoto.com

“Popular remedies such as decongestants and nasal constrictors for the common cold can lead to serious heart consequences,” he adds, “including tachycardia and arrhythmia.”

Do I have a cold or is it really the flu? Is this indigestion or a possible heart attack? What is it about human nature that convinces us that we’re qualified to answer questions like these? Particularly when self-diagnosis only amplifies the risk when we grab an inappropriate product off the shelf. Relying on personal rather than professional diagnoses, especially when cardiac symptoms are involved, can lead to “more harm than good” consequences—for instance, choosing a popular non-steroidal anti-inflammatory (NSAID) to relieve arthritic lower back pain…only to find yourself in the ER after a life-threatening side effect.

For his part, Dr. Shamoon considers NSAIDs to be the most abused and dangerous class of OTC drugs. Relief from pain too often supersedes the potential risk of serious consequences, even to a healthy heart, he explains. He encourages his patients to exercise good sense and ask before adding any store-bought medication.

“I am always available to help them make wise decisions to protect their heart health when dealing with OTC meds,” he says.

Matters of the Heart

According to the CDC, heart disease has surpassed cancer as the leading cause of death by more than 100,000 annual fatalities. Another recent wake-up-call statistic is that one American dies every 37 seconds from CVD, which works out to roughly one in four deaths. CVD is a condition that affects not only the heart but the vascular system that services it, which can lead to a heart attack, angina or a stroke. Also very concerning is that around a third of adults suffer from high blood pressure, which can trigger serious heart complications.
Then there is the issue of cholesterol. While a normal level of “good” HDL is necessary for healthy cell production, a high level of “bad” LDL indicates the presence of excessive fatty deposits in blood vessels that inhibit the flow of blood. This interruption of blood flow can lead to a heart attack or stroke. High LDL is not typically accompanied by noticeable symptoms, requiring a blood test to diagnose. The Mayo Clinic recommends cholesterol screenings every year or two for men ages 45 to 65 and for women ages 55 to 65, while seniors over 65 should be tested annually.

What’s in Store

Meanwhile, the aisles at your local pharmacy are overflowing with products that promise to address medical conditions ranging from a simple cold or occasional headache to more aggressive-sounding treatments for pain and its sources. And because you’re making choices when you are not at your best, sometimes it’s difficult to remember these are only safe when used responsibly—in other words with full awareness of all positive and negative effects. It would be nice to get your doctor on the phone to help with these decisions, but that’s not always possible. In these cases, ask the pharmacist, especially if you are shopping at your “home” store. Pharmacists can access your current medications or at the very least ask you some key questions. They are perfectly positioned to recommend a specific OTC product or, more importantly, steer you away from one that may be problematic.

“Be thoughtful before you go to the pharmacy,” Sharon Greasheimer, a Registered Pharmacist and Director of the Trinitas Pharmacy Department, advises. “Go to the Internet or another reliable resource and do a little homework. Plan ahead. Put the whole picture together—your age, any diagnosed medical conditions, any other medications prescribed—and then call ahead to see if your pharmacist might be available for a brief consultation if needed.”

In the Trinitas Pharmacy, Greasheimer notes, every drug—whether over-the-counter or otherwise—requires a script from the attending physician before it can be dispensed at the hospital. The pharmacy also follows up for possible side-effects or drug reactions. However, once at home, patients shoulder the responsibility for good decision-making when it comes to OTCs.
“These are self-treatment remedies that can be useful—but only if the user is also aware of any potential risks or side effects,” she says.

When considering the purchase of NSAIDs, heart patients need to be doubly cautious. Different NSAIDs, whether prescription or OTC, work in different ways, so it’s important to ask your doctor or pharmacist which is right for you, even if you’re in tip-top health. They all come with side effects. Topping the list are digestive problems, such as stomach upset, heartburn and ulcers. More serious complications can include kidney injury, internal bleeding and severe allergic reactions. The possible risks from use of unprescribed NSAIDs are escalated when a heart issue, diagnosed or not, is present. When considering whether to start a NSAID regimen, there is currently no clear consensus regarding safe dosages and extended-use prohibitions. The best approach? Ask your physician (or cardiologist) before even setting foot in the store.

www.istockphoto.com

Survey Says…

The multibillion-dollar OTC marketplace is a battleground for your business. Over the years, ad agencies have found that the most effective way to earn the trust of consumers is with “take it from me…” testimonials, which are often accompanied with or followed by a list of side-effects, legalese and assorted other caveats and disclaimers. They work because we focus on the actors (yes, they are actors) who remind us of us, and don’t seriously evaluate the validity of what they are saying. Data collected in a recent study at Dartmouth College indicated that “80 percent of over-the-counter drug ads were found to be misleading or false.” If you’re curious, the same study also suggested that 60% of new prescription drugs being advertised were also misleading (or false).
So how surprised were we to find out that the old “aspirin a day” advice has now come under serious question? In the hallowed halls of Harvard and the Mayo Clinic, some experts are refuting the popular recommendation to take a daily low-dose aspirin to prevent heart problems. New studies reveal that aspirin therapy for healthy adults may actually be more harmful than helpful. As with most OTC medicines, aspirin can have negative side effects, such as gastrointestinal upset, ulcers and internal bleeding—especially when taken in combination with other blood-thinners. On the positive side, there are some indications that aspirin can be a helpful preventative for those patients who have been diagnosed with heart conditions. Consequently, aspirin as a preventative measure is now often reserved only for those patients with a prior history.

A monthly pharmaceutical journal, The Pharmacy Times, found that nearly nine of every 10 Americans use OTC products regularly. That’s more than 260 million consumers who make about three billion trips annually to purchase their OTC meds—at a price that can be one-tenth of a prescription drug. This space is booming, with many former Rx drugs transitioning onto already crowded shelves. In our minds, they have become “consumer goods” even though they are not.

FDA approval, easy access and attractive pricing do not make OTC drugs heart-healthy, especially where patients with cardiac issues are concerned. In the end, it is your body and thus your job to be a vigilant consumer, and that means asking the right people the right questions before bringing a cold medicine or pain reliever to the checkout counter. You never know…it could be a life or death decision.

Clean living. Prudent diet. Sunscreen savvy. All vital to healthy skin. And all easier said than done.

People spend billions of dollars a year on products that promise to make their skin firmer, fresher and younger. But doctors who focus on caring for the skin insist that the body’s largest organ needs more than over-the-counter potions to maintain its health and radiance—and to do what it was designed to do. “Skin is the protector of our body and the first line of defense,” says Dr. Kamran Khazaei, head of Nouvelle Confidence, the Center for Cosmetic Laser & Rejuvenation. “The first thing that’s affected when you come in contact with pollutants, bacteria and other toxins is the skin—that’s why you have to continually do maintenance on the skin, to allow it to work its best.” Everything we eat, breathe, and do affects our skin, and the results aren’t always pretty—especially when people neglect the basics of skin health.

Here’s how to ensure you protect the skin that protects you. SKIN RAVAGERS While genetics can play a role in how easily you burn or scar, whether you freckle and how soon you show signs of aging, experts say that lifestyle choices have the biggest impact on your skin’s health. Smoking, eating an unhealthy diet, exposure to pollutants and even a lack of sleep and exercise can cause premature aging and other skin problems. “Smoking and a poor diet absolutely damage the skin,” says Dr. Khazaei. “Any type of toxin in the body affects the whole body, including the skin.” But when it comes down to it, sun exposure continues to have the most punishing effects on a person’s skin. “The worst enemy of the skin is the sun,” says Dr. Khazaei. “Everyone thinks they look healthier by tanning themselves under the sun, but that’s the worst thing to do for skin health.” It’s hard to avoid news reports on the dangers of sun exposure, but surprisingly it hasn’t had a huge effect on people’s behavior.

Recent CDC studies have shown that 40 percent of adults don’t use sunscreen, and 70 percent of those who use sunscreen don’t bother to reapply when it’s recommended. It’s the ultraviolet radiation that causes most of the trouble—particularly UVA rays. “UV radiation is a known carcinogen, and is associated with both an increased risk of skin cancer and an increase in skin aging,” says Dr. Joseph Alkon, a plastic and reconstructive surgeon at Trinitas Regional Medical Center, who specializes in treating skin cancers. Unfortunately, many people have taken their desire for darker skin straight to a more dangerous spot—the tanning bed—where UVA rays are three times more potent than in natural sunlight. “There has been a rise in the number of people using tanning salons, including teens and younger patients,” says Dr. Alkon. “More than one million people use tanning salons on a typical day in this country—70 percent of whom are females in their late teens to late 20s.” Tanning bed use, he adds, may put you at even more risk of cancer and other damage.

SAVING YOUR HIDE You may think you’re a lost cause after decades of sunscreen-free sunning at the shore, but there’s still plenty to be done to improve the health—and look—of your skin. Dr. Khazaei uses laser and microdermabrasion treatments to help combat the signs of skin damage. “Laser treatments help regenerate collagen formation to rejuvenate the skin, and can be used to treat freckles and age spots,” he says. “Microdermabrasion removes dead skin cells that are produced by the sun, exposing the younger, healthier skin beneath.” Customized skin care products—like Dr. Khazaei’s own line—can help clear away dead cells and revitalize the skin beneath. But the best protection is prevention—and that means stopping smoking, getting more sleep, eating better, and most importantly, using sunscreen regularly. “Even on a cloudy day, you need sunblock to protect the skin—the rays that cause the most damage can still pass through the clouds,” Dr. Khazaei warns. “If you take care of your skin, it naturally stays younger and lasts longer.”

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.

“Everyone knows someone who has lost their job… people have a lot on their minds.”Your house is worth a half-million less than it was last summer. Your portfolio is in freefall. That Christmas bonus was a little short. And you’ll be waiting a bit longer to retire. It’s enough to give you nightmares—if you could actually fall asleep. As stress rises, so does the risk of insomnia and other sleep disorders. In these trying times, more and more people will try anything to get some decent shuteye.

Unfortunately, chronic insomnia isn’t something you can make up for with a Starbucks run. Consistent sleep problems can take their toll on everything from your mood to your mortality. “There is no substitute for sleep,” says Vipin Garg, MD, Medical Director of the Comprehensive Sleep Disorders Center at Trinitas Regional Medical Center, who is board certified in pulmonary medicine and sleep medicine. “If you don’t get adequate sleep, you’re going to have consequences.” “People who have chronic sleep problems find it hard to concentrate and are often much more irritable,” adds Christopher Jagar, MD, a psychiatrist with the Department of Behavioral Health & Psychiatry at Trinitas Regional Medical Center. “It can affect performance on even the simplest tasks.”

It can lead to dozing off for milliseconds at a time, called microsleep. That can affect your ability to carry on a conversation, follow a meeting—or get behind the wheel safely. And sleeping disorders often go hand in hand with other serious health issues, which makes it doubly important to diagnose and treat them. Sleep apnea, a chronic interruption of a person’s breathing during sleep, has been linked to several life-threatening conditions, including heart attack, congestive heart failure, hypertension, obesity and diabetes. “Treating sleep apnea can not only affect the quality of your life, but also how many years you live,” Dr. Garg says. While disorders like sleep apnea have their roots in physical issues, many of us bring our nightly problems on ourselves. “Lifestyle is often a factor,” Dr. Garg says. “Using stimulants— caffeinated beverages, cigarettes, chocolate—can cause sleep problems. If the room isn’t dark enough, or if you leave a TV on, that can interfere with sleep. Engaging in some sort of stimulating activity, like an office conference, an argument or a workout, can make it hard to fall asleep.” Even something that’s often considered a sleep aid—we’re talking nightcap here—can backfire. “Alcohol may make you drowsy enough to fall asleep, but you’ll wake up again in a few hours,” explains Cheryl Krempa, RPh, MBA, Director of the Pharmacy at Trinitas.

Routine Tweaks

The upside? You may be able to cure your own insomnia with a few tweaks to your routine. Dr. Garg recommends keeping a diary of your daily activities, diet and sleep quality, to see if any patterns emerge—like a case of insomnia every time you knock down an order of crab-cakes. Or watch CNBC. Or talk to your mother. If stress is causing your sleep issues, try some common stress reducers—regular exercise early in the day, meditation, deep breathing—and take time to wind down before bed without bright lights or stimulating activities.

Even something as simple as a notebook by the bed could help you relax. “You can write down your thoughts in your diary before bed, so you’ve unloaded the problems that are keeping you up at night,” Dr. Garg suggests. If anxiety, depression or another issue is contributing to your insomnia, consult with a mental health professional. “Treating the underlying psychiatric problem usually solves the sleep issue as well,” says Dr. Jagar. Should lifestyle changes fail as a fi x, resist the temptation to load up on Tylenol PM or other sleep aids. “Over-the-counter sleep-inducing products use diphenhydramine hydrochloride, the active ingredient in Benadryl, to help you fall asleep,” Krempa says. “But they can make you feel drowsy the next day, so you’ll need more caffeine to be alert, and a vicious cycle begins.”

Instead, it may be time to see your doctor. “If you try all these techniques and they don’t work, you should see a physician to determine what could be causing it, so it can be dealt with correctly,” Dr. Garg recommends. Following diagnosis at an accredited sleep disorder center, apnea patients are often set up with positive airway pressure machines (CPAPs or BiPAPs), which keep the airways from becoming obstructed and enable a good night’s sleep. Other sleep problems may disappear after starting cognitive therapy or even light therapy, when you spend part of each morning lounging under a bright, sun-like light. Dr. Garg sometimes restricts the amount of sleep a patient gets each night to try to concentrate the sleep and avoid frequent night wakings. Still, stress-related sleep disorders can sometimes be even more difficult to overcome. “People have a lot going on right now—everyone knows someone who has lost their job. Things are dire,” says Dr. Jagar. “People who are under a lot of stress have a lot on their minds, and they often have a harder time falling asleep and staying asleep. They simply don’t feel rested.”

If the lifestyle changes and stress relievers don’t work, your doctor may be able to prescribe one of the newer medications that have fewer side effects and are less likely to cause next-day drowsiness. “There are numerous formulations out there, so it’s easier to tailor the prescription to your exact problem,” Krempa says. Some medications, like Sonata (zaleplon) and Ambien (zolpidem) wear off quickly, so they work best for people who just need help falling asleep; others, like Lunesta (eszopiclone) help you stay asleep. It may take a few tries to hit upon the solution to your sleep issues, but once you do, you’ll feel like a whole new person. “Sleep disorders affect every part of your life—you become more irritable and take it out on your loved ones, and you have a harder time enjoying the things you love when you’re fatigued all the time,” Dr. Jagar says. But after you’ve caught up on your rest, you’ll be ready to take on the world, with all of its worries.

Editor’s Note: For more on sleep and sleep disorders log onto njsleepdisorderscenter.com or call (908) 994–8694.

I’m so tired, I haven’t slept a wink… I’m so tired, my mind is on the blink.

Photo credit: iStockphoto/Thinkstock

Beatles aficionados will recognize these lyrics from the Let It Be album. Truth be told, the group’s weary words should resonate with anyone who has ever been sleep-deprived for more than a night or two. The fact is, we’ve all been there—from punching the snooze button for an extra five minutes, to skipping that 5:45 a.m. spin class in hope of additional Zs, to heading straight for the couch after a long workday. So why is feeling fatigued so common? Why is having a healthy sleep so important? And what would be the downside if we just let it be? Health and sleep are inherently intertwined. Sleeping is a regenerative process for both the mind and body. A sufficient amount of quality slumber helps to maintain a healthy heart, metabolism and endocrine system.

Since most of us spend one-third of our lives buried in a pillow, it is important to have healthy and consistent sleep on a regular nightly basis. For some, however, nights featuring the cardinal eight hours are few and far between. According to the National Heart, Lung and Blood Institute, about 70 m llion people in the U.S. have a sleep problem and 40 million of these are chronic problems. Maybe you are a habitual snorer; you wake in the night and have difficulty falling back asleep; you’ve gained a significant amount of weight in the past year; or you kick during sleep. All of these symptoms and more can be associated with sleep disorders, though they are often under-diagnosed. All are curable. If left untreated, however, they can lead to serious health issues. Insomnia (the inability to fall asleep or stay asleep), for example, results in loss of concentration, reduced productivity and poor alertness.

Over time, insufficient sleep creates chaos within metabolic hormones, which can lead to obesity and diabetes. Sleep Apnea (breathing stoppage and diminished oxygen levels) can affect one’s blood pressure, heart and brain. It can lead to serious cardiovascular complications, including hypertension and strokes. While sleep disorders are prevalent in adults, they are increasing for children. If untreated, children may experience emotional, behavioral and learning disorders. As with most diseases, the symptoms triggered by sleep disorders can escalate over time. That being said, not all sleep-related difficulties are actually classified as disorders. There are many modifications that can be performed to improve sleep habits, such as shortening naps, avoiding caffeine and alcohol, and fixing a bedtime and wake-up time.

SEEING A SPECIALST If making a few lifestyle changes doesn’t do the trick, the next move is seeing a sleep specialist and undergoing a sleep study, which can diagnose and ultimately cure the disorder. Unfortunately, many people shy away from submitting to this type of procedure. They picture themselves in a bleak hospital sub-basement, on an uncomfortable cot, with wires connecting them to a bank of machines. The reality is quite different. At the Trinitas Comprehensive Sleep Disorders Center, for example, homey bedrooms await the troubled sleeper. The state-of- the-art facility offers monitored diagnostic sleep studies that are designed to quickly reveal the disorder. Trained sleep specialists and technicians work together on each study and conduct follow-up appointments with a subject’s physician. All cases are reviewed by Dr. Vipin Garg, the center’s Medical Director. Dr. Garg is board- certified as a Sleep Specialist, as well as in Pulmonary Medicine, Critical Care and Internal Medicine.

One of the center’s goals is to make patients feel as comfortable as possible during their stay. The center on the TRMC campus consists of four bedrooms—each with a personal bathroom and television and other amenities. To fulfill the growth and demand for more space, the center expanded to the Homewood Suites by Hilton in Cranford early in 2010. There are now two fully equipped bedrooms at this property. Dr. Garg notes how important it is to feel comfortable and at ease during a sleep study in order to gather the most helpful results. “The psychological mind-state of sleeping in a center is not the same as being at home,” he explains. “We try to make it feel as if you are in a hotel, rather than a hospital. We have access to all resources from the hospital’s many departments, and facilities at the hotel are extended to patients, including breakfast and the gym.” Sleep studies and treatment provided at the center are personalized for each type of sleep disorder. The staff is certified and trained in many disciplines and an array of treatment options is available.

If the problem is neurological, a neurologist will meet with the patient. For breathing issues, a pulmonologist will be present. If significant weight-loss is deemed beneficial to a sleep apnea patient, dieticians and surgery options are at hand. All sleep disorders are curable and patients have the opportunity to choose from treatment types. For example, if diagnosed with sleep apnea, depending on the case, one can undergo surgery for tonsil removal or sleep with a CPAP machine, which delivers additional air through the nose.

ONE NIGHT ONLY Typically, a single night of monitoring can result in a lifetime of quality sleep. The process is simple. Patients are instructed to do what they would typically do before any night of sleep, to ensure regularity and comfort, such as reading or watching TV. Patients are hooked up to leads that measure eye and leg movement, heart rate, airflow measurements and more—all while specialists watch the sleep behavior on video monitors. After roughly one week, the patients are asked to come back, results are reported and treatment arrangements are made. For those who cannot (or will not) leave home to participate in a study, Dr. Garg proposes an alternative possibility: an at-home sleep study, using a new portable device that collects the same useful data. Success stories are hardly few and far between at Trinitas Comprehensive Sleep Disorders Center. On the contrary, the center conducted nearly 1,500 studies in 2012, including adults and children. One of Dr. Garg’s favorite stories concerns an eight-year-old boy, who was prescribed ADHD medication after meeting with a psychiatrist and pediatrician for hyperactivity and inattention in school.

The boy’s mother mentioned his nightly snoring to the pediatrician, who recommended a sleep study. Dr. Garg diagnosed a severe case of Obstructive Sleep Apnea. After addressing the apnea, the ADHD medications were no longer needed, the boy’s performance in school drastically improved, and he became more energetic after losing weight. “The importance of sleep is an issue that has been previously ignored,” Dr. Garg laments. “Many times an internist fails to realize sleep disorders may be the problem at hand, because different questions are asked during a physical than during a sleep study. The impact of a sleep study is huge. It is a very natural, non-invasive process with no known side effects. The technology is getting better day by day, and we have had a lot of success.” Healthy sleep is imperative for us as individuals. By diagnosing and treating a sleep disorder, future serious issues can be avoided. The Trinitas Comprehensive Sleep Disorders Center is one of many centers that can help in the journey of pursuing quality sleep habits. Don’t let it be. If you are experiencing sleep difficulties, talk to your physician or sleep specialist about a center near you, and get on the road to a dreamy recovery.

Editor’s Note: The Trinitas Comprehensive Sleep Disorder Center is accredited by the American Academy of Sleep Medicine. It is located at 210 Williamson St. in Elizabeth. For more information, call 908.994.8694 or log onto njsleepdisorderscenter.com.

Six Gifts that Keep on Giving

Getting your over-50 friends and family members into the exercise groove is tough, but what if you gifted a gadget that made the experience more engaging and fun? Here are a half-dozen innovative and practical gift ideas that can jump-start a new post-holiday fitness routine…

• The Striiv Pedometer not only counts your daily walking steps, it sets up challenges for your routine and lets you earn points for your achievements. The folks at Striiv design personalized challenges tailored to your activity levels, and turn 10,000 steps a day into playing a game, donating to charity and competing with friends.

• For practical health, Fitbit’s Aria Scale doesn’t just measure your weight (which, FYI, isn’t the truest measure of health)—it also measures body mass index and body fat (which are more revealing). The information is transmitted wirelessly to your computer and assists in making sure you are on-track to reach your goals.

• Tired? The adidas Energy Boost Running Shoe boasts micro cells embedded in the sole engineered to return energy with each step you take. Runners’ World magazine gave the shoe high marks.

• Creativity keeps things interesting with the Zombies, Run! smartphone app. As you run or walk, the narrator gives instructions to dodge zombies and other threats. Novelist Naomi Alderman provides the storyline here— the website promises “you will go on an epic adventure that motivates you to run further and faster than ever before.” Better than having your brains eaten, right?

• For a more serene app, try Pocket Yoga, which lets you follow yoga routines from anywhere. An extensive library demonstrates everything from downward-facing dog to warrior. The nice thing about the app is that it allows you to create your own yoga routine, rather than forcing you to adhere to an instructor’s “most liked” poses.

• Swimming is one of the best activities you can do for your body! It’s easy on the joints and involves nearly every muscle, all while working your heart and lungs. There’s also a meditative rhythm to swimming steady laps. The problem is that swimming can be a bore at times. FiNIS SwiMP3 Headphones transmit music through your cheekbones and are fully submersible. Long-distance swimmers can even listen to audiobooks and podcasts.

For many people 50 and over, exercising sporadically just isn’t cutting it in terms of helping to maintain a healthy body mass index, or a strong heart and lungs. These are what I like to call our 30 bonus years…let’s use technology to keep our bodies in sound working condition so we can rise to the physical challenges that potentially await us later in life.  

 Editor’s Note: Gerontologist Alexis Abramson, PhD appears frequently as an on-air expert for NBC’s Today show, and also on CNN, CBS and MSNBC. Her commitment to baby boomers and mature adults has been featured in TIME, Forbes, The Wall Street Journal, People and other national publications. To see more of her thoughts on aging gracefully (and intelligently), log onto alexisabramson.com.

News, views and insights on maintaining a healthy edge.

Flip-Flopping in the Classroom The back-to-school season always holds some surprises for educators, kids and parents. This year, many noticed a rise in foot pain among returning students. The popularity of cheap, stylish flip-flops has more than a little to do with this, according to the American College of Foot and Ankle Surgeons. Right into the mid-teens, kids have new bone growing in their heels. Flip-flops offer no support or cushioning for this part of the foot, and summer-long repetitive stress can manifest itself in pain and injuries once students switch back to traditional school footwear. If your child is experiencing pain, it’s important to explore an immediate remedy—stretching exercises, ice massage, anti-inflammatory medications, and custom or over-the-counter shoe inserts are certainly worth exploring. Obviously, if the pain worsens or persists, a visit to the podiatrist is called for.

Follow-Up on NYC Soda Ban  New York’s short-lived soda ban spurred a slew of studies on the actual impact of obesity-focused legislation. A recent article published in the American Journal of Agricultural Economics suggests that strategies such as taxing sugary beverages would not reduce obesity, because consumers would simply switch to un-taxed options. Public health advocates have posited that higher prices would deter unhealthy food purchases. But according to research economists, that simply isn’t the case. In New York, a court ruled that the Board of Health exceeded its authority in instituting the ban, which was pushed by Mayor Michael Bloomberg. Among the criticisms of an “obesity tax” is that it would target lower-income consumers who tend to buy more high-calorie foods and beverages, and thus would be a regressive tax. Even so, the search for a “social solution” will continue; more than a third of U.S. adults, and one in six children, are technically obese. The medical costs associated with obesity are between $125 and $150 billion a year.

Drug Wonder Downunder A pair of Australian medical researchers have been recognized for their breakthrough work with Duchenne Muscular Dystrophy, a condition caused by mutations in the dystrophin gene on the X chromosome—which means it mostly affects boys. DMD patients are wheelchair-dependent by age 12 and often don’t survive past their early 20s. The researchers have developed a drug that works by skipping over the faulty part of the gene, producing a functional version of the protein dystrophin. This protein stabilizes the muscle fiber during muscle contraction. Without dystrophin, muscle fibers are replaced by scar tissue. In clinical trials, boys on the drugs have been walking up hills, operating pedal cars and whistling after 90 weeks. “It is extremely exciting to see that genetic testing is finally coming to the forefront of clinical medicine,” says Dr. Kevin Lukenda, Chairman of TRMC’s Family Medicine Department. “For years, this information was limited to research and academia. With a simple swab of a patient’s saliva in my office, we can detect over 30 possible genetic mutations within an individual’s DNA. This is the future of early diagnoses and treatment in clinical medicine.”

 Kevin Lukenda, DO Chairman, Family Medicine 908.925.9309   

You Snooze, You Lose Don’t lose sleep over junk food purchases. Seriously, don’t. A new study shows that lack of sleep can lead people to buy more food—and more high-calorie items— when they shop. Researchers gave 14 normal-weight men a budget of $50 and instructed them to purchase as much as they could out of a possible 40 food items, which included 20 high-calorie and 20 low-calorie foods. They conducted this exercise after a night of sleep deprivation and again after a good night’s sleep. They bought 18 percent more food— and 9 percent more calories—after a night of sleep deprivation. “Another recent study showed that the pleasure centers of the brain were activated more when sleep-deprived people looked at pictures of junk food,” adds Dr. Vipin Garg, Director of the Trinitas Comprehensive Sleep Disorders Center. “Lack of sleep can prevent the brain from making an intelligent decision regarding healthy food choices. Getting enough quality sleep can help weight control by allowing people to make proper nutritional decisions and also provide energy to exercise to achieve better overall health.” There are plans in the works for follow-up studies to see how sleep deprivation affects other buying decisions.

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

Word of Mouth Unreliable Where Strokes are Concerned So what’s the deal with the “Crooked Tongue” story making the rounds on social media? According to countless emails and Facebook postings, a woman who was suffering from a stroke but didn’t exhibit the typical symptoms was diagnosed by an alert ER physician who asked her to stick out her tongue. When she did so, and her tongue presented to one side rather than straight out, he was able to correctly diagnose the stroke and save his patient’s life. Is the “crooked tongue” technique a reliable way to diagnose stroke? According to Dr. John D’Angelo, Chairman of Trinitas Regional Medical Center’s Emergency Department, the story has all the earmarks of an urban legend. “I can find no reference to this suggestion from any reliable source, such as the Heart and Stroke Foundation, the American Heart Association or the National Institute of Neurological Disorders and Stroke,” he says. “Lingual deviation can indicate a host of issues that are typically associated with a tumor or other type of lesion. So a crooked tongue is a sign that something is wrong, but it’s not a reliable sign you are having a stroke.” The T in the American Stroke Assoc

iation’s STR test—which stands for Smile, Talk & Raise both arms—may have erroneously morphed into tongue. “Cranial nerves 9 and 12, the glossopharyngeal and hypoglossal nerves respectively, are associated with the tongue,” Dr. D’Angelo explains. “CN IX receives sensory information from the 1/3 posterior portion of the tongue—the taste buds. CN XII controls the muscles of the tongue. In neuroa

natomy and neurology, we learn that the tongue points to the affected side of the brain. CN XII is located on either side of the medulla oblongata, which is not a typical locale for a stroke.”

John D’Angelo, DO Chariman, Emergency Medicine 908.994.5273    

New Hormone Promises Diabetes Breakthrough Harvard researchers have discovered a hormone called Betatrophin, which holds promise for a more effective treatment of Type 2 Diabetes, which currently affects more than 25 million Americans. In the Harvard study, Belatrophin caused mice to produce insulin-secreting pancreatic beta cells at up to 30 times the normal rate. The new cells produce insulin only when called upon by the body. This offers the potential for natural regulation of insulin, as well as a reduction in the complications associated with diabetes. There is hope that this treatment may also have an impact on juvenile diabetes. It could eventually mean that instead of taking insulin injections three times a day, you might take an injection of this hormone once a week or once a month or—in the best case—maybe even once a year, explains Doug Melton, one of the researchers. “This new hormone offers optimism for researchers lo

oking to discover a cure for diabetes,” says Dr. Ari Eckman, who heads up the Trinitas Division of Endocrinolo

gy, Diabetes & Metabolism. “It should be noted, however, that this hormone was seen in a mouse model—whether or not this translates to humans is yet to be determined. It is obviously way too early to speculate

if this will work in humans, but certainly this may one day be a novel approach to managing diabetes.”

Ari Eckman, MD Chief of Endocrinology and Metabolism 908.994.5187  

Be Mindful About Smoking Take a long, slow deep breath…close your eyes….relax…and get rid of that cigarette! According to the University of Oregon’s Department of Psychology, learning meditation techniques makes it easier for smokers to taper off. Mindful Meditation—a technique that encourages people to relax, focus on the current moment and “go with the flow” of thoughts and sensation—has already been shown to have a positive impact on cold and flu, hot flashes and irritable bowel syndrome. In the Oregon study, 60 people received five hours of either relaxation training or Mindful Meditation training. Among the smokers in the study, there was no difference in the amount the relaxation group smoked. However, the smokers in the meditation group had cut back by 60 percent. Researchers admit that the smoking findings are surprising, and caution that the study was very small. Also, the participants were all college students. On the other hand, none of the subjects were told they were taking part in a smoking study. And the Oregon study found that the brains of the smokers who learned meditation techniques were more active in an area linked to self-control. More work in this area is warranted.

  News, views and insights on maintaining a healthy edge.

  Painkiller Overdoses Spiking Among Women A new report from the Centers for Disease Control offers some eye-opening facts on the abuse of painkillers among women. Since 1999, the number of women who have died from a painkiller overdose has increased by a factor of four. “Mothers, wives, sisters, and daughters are dying at rates that we have never seen before,” says Dr. Thomas Frieden, Director of the CDC. Among the more alarming aspects of the report are: 1) On average, 18 women die from painkiller overdoses in the U.S. every day; 2) More women die from prescription drug overdoses than from car accidents; 3) Some 50,000 women between the ages of 25 and 34 will be taken to U.S. emergency rooms as a result of painkiller overdoses this year. In its report, the CDC recommended that healthcare providers exercise greater caution when prescribing prescription medications—and suggested that states and the federal government could turn this trend around by doing a better job educating women on the dangers of prescription painkillers. “We are seeing an increase in the numbers of women and young people presenting in the emergency room with prescription pain and anxiety medications—many of whom have legitimate prescriptions for a physical or mental health disorder, and others who are accessing prescription meds from others or on the street,” Lisa Dressner confirms. Dressner is Program Director of TRMC’s Psychiatric Emergency Services. “Too often, alternatives to these highly addictive medications are not explored, and primary care or pain management doctors may not fully assess someone’s potential or history of substance abuse.” There is an urgent need, she adds, for more education to consumers around the potential for addiction to commonly prescribed pain meds, and medications for problems related to anxiety or sleep, so that risk for abuse of these medications, and increased depression, withdrawal and suicidality is minimized.

Lisa Dressner Program Director of TRMC’s Psychiatric Emergency Services 908.994.7152

 Good News on HPV Virus Michele Bachman can rest easy. The HPV vaccine does not make young women “mentally retarded.” In fact, according to a report released by the Centers for Disease Control in June, the prevalence of Human Papilloma Virus (HPV) infections has been cut in half since 2006. The Journal of Infectious Diseases reported that researchers were surprised by this result—not because of the vaccine’s effectiveness, but because the rate of vaccination in the U.S. lags far behind other developed countries. Only a third of American girls have been fully vaccinated; in other countries (including Rwanda!) the rate is closer to 80 percent. HPV causes 19,000 cases of cancer among women in the U.S. each year. It also accounts for 8,000 cases in men, a statistic brought to light by actor Michael Douglas, whose throat cancer was identified as being HPV-related. “The study showed that less than four years later the prevalence of the vaccine strains among young women aged 14–19 years had fallen by 56%,” points out Dr. William Farrer, Associate Program Director and Associate Professor of Medicine of the Seton Hall University School of Health and Medical Sciences at TRMC. “This was despite the fact that in 2010, only 32% of 13–17 year-olds had received the full 3-dose series of vaccine. Rates of HPV infection in older women had not fallen, probably reflecting the fact that they were not the target group for the vaccine.The researchers also reported that ‘Sexual behavior among females aged 14–19 years overall was similar in the two periods.’ This should reassure opponents of the HPV vaccine who expressed concern that somehow use of the vaccine would encourage promiscuity.”

 William Farrer, MD Department of Medicine, Infectious Diseases Division 908.994.5455 

 Air Pollution Linked to Sleep Disorders in Children While we watch the Arab Spring unfold in Egypt in dramatic fashion, some dramatic health news has come out of that country that is relevant right here in New Jersey. In July, University of Cairo researchers announced the results of sleep study on school-age children, which shows a link between air pollution and sleep disorders. The 276 children in the study exhibited significant disorders of initiating and maintaining sleep, and excessive somnolence when exposed to PM10 (particulate matter smaller than 10 micrometers) in the air. PM10 particles can settle in the lungs and cause health problems. Larger particles are typically filtered by the nose and throat. In treating the pediatric population at the Trinitas Comprehensive Sleep Disorders Center, Vipin Garg, MD, Director of the Center notes that, “Small particles or large particles of pollution can irritate the airways of children, especially those who have large adenoids. Children who have to breathe through their mouths because of enlarged adenoids bypass the normal filtering process of the nose and that can have an irritant effect on both the upper and lower airways. This may result in a significant sleep disturbance especially if sleep is already compromised. Also lower airway irritation can lead to asthma-like symptoms.”

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

 Walking the Walk While the medical profession has long promoted the benefits of daily exercise, a new study out of the Middle East pinpoints how short, brisk walks taken after meals are an effective way to diminish the risk of developing Type 2 diabetes. The results, published in the latest issue of Diabetes Care, focus on how post-meal strolls reduce blood sugar levels. “Blood sugar levels are the highest after meals and as we age our pancreas is less effective in releasing insulin, a hormone that helps lower blood sugar,” explains Dr. Mahmoud Ali Zirie, who ran the study out of Qatar. “This leads to higher blood sugar that can increase the risk of diabetes. A short walk two hours after meals can help normalize blood sugar levels. To achieve maximum health benefits walking should be moderate intensity. In other words, it needs to be faster than a stroll and brisk enough to raise your heart rate.” Those who are new to this type of exercise should begin slowly, stay hydrated and avoid excessive heat, and build toward a regular and rigorous regimen. Kathleen McCarthy, RN, a Certified Diabetes Educator at Trinitas, offers these tips: “Whether you have diabetes or you are trying to keep diabetes at arm’s length, you will benefit from a regular exercise regimen of 30 minutes a day, five days a week, or more. Short brisk walks, two hours after a meal, improve post-prandial (after meal) glucose readings. Walking also improves circulation, heart and lung function, and releases endorphins which help control of stress and pain. As you build muscle mass, your metabolism will increase which then gives you more energy and will lead to weight loss over time. The benefits of aerobic exercise last up to 12 hours after exercise. Exercise is a key ingredient to improve or maintain optimal health.”

 Kathleen McCarthy, RN Certified Diabetes Educator 908.994.5490

   Mild Depression and Alzheimer’s A recent aging study conducted by researchers in the U.S. and Asia has found that the onset of Alzheimer’s Disease appears to be accelerated by depression. The study suggested that individuals with depressive symptoms progressed from mild cognitive impairment to full-blown Alzheimer’s at a much faster rate than those who did not exhibit signs of depression. Indeed, depression doubled the risk of developing Alzheimer’s in this particular study. These findings have opened up a number of debates about what actually triggers the cognitive decline. However, it strongly suggests that decisive steps to intervene or mediate depression among people at risk for Alzheimer’s need to be taken. “Occasionally, depression in the elderly, even in the absence of dementia, has been known to result in impairment of cognitive functions,” adds Dr. Anwar Y. Ghali, Chairman of Psychiatry at Trinitas. “Especially the memory, in a condition referred to as ‘depressive pseudo dementia.’ Hence, one would expect that this might occur at a higher rate with patients already diagnosed with Alzheimer’s. Therefore, physicians should always evaluate Alzheimer’s patients for the possibility of a co-morbid depression. With adequate treatment of depression, patients should be relieved of suffering and also experience reduced possibility of suicide—a complication of depression that occurs at a higher rate with the elderly, especially in males and particularly for those suffering from an additional illness.”

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

 Landmark Diabetes Study Completed The recently completed Look AHEAD study by the University of Pittsburgh has brought into question the value of lifestyle intervention programs for overweight and obese Type 2 diabetes patients. The study covered more than 5,000 people at 16 clinical centers across the country, over more than a decade. One group in the study followed an aggressive program of weight management and increased physical activity. The other was only provided with health information and support related to diabetes. In terms of strokes and heart attacks, there was no significant difference between the two groups. The biggest difference between the groups was in the area of weight loss. The information and support group lost relatively little weight, while the intervention group lost 8.7 percent of their body weight and had excellent success keeping it off. A 5 percent weight loss is considered clinically significant, particularly in the controlling of cholesterol, blood pressure and blood sugar. “While the findings from the Look AHEAD study did not support that engagement in a weight-loss intervention was effective for reducing the onset of cardiovascular disease incidence or mortality, this does not mean that overweight adults with diabetes should not lose weight and become more physically active,” says John Jakicic of the Department of Health and Physical Activity in Pitt’s School of Education. Dr. Ari Eckman, Chief of Endocrinology and Metabolism at Trinitas, adds that there is an overwhelming amount of evidence from this study to date that has shown that weight loss and physical activity were associated with numerous other health benefits: “While weight loss alone was not shown to significantly decrease this incidence in the recent Look AHEAD study, there is strong support from numerous studies supporting the benefits of weight loss and physical activity for many other health benefits. Further studies are recommended to determine the full effect weight loss has on cardiovascular disease prevention. It is still strongly recommended for people with diabetes who are overweight or obese to lose weight and maintain a healthy lifestyle.”

Ari Eckman, MD Chief of Endocrinology and Metabolism 908.994.5187