Ask Dr. D’Angelo

Surf’s Up! What’s your Beach IQ?

Countless thousands of Garden Staters will head to the Jersey Shore this summer to enjoy a day at the beach. For an unlucky few, that will translate into a night in the ER. Or worse. Truth be told, luck has very little to do with beach-related emergencies. Playing it smart while you play in the water not only keeps you and your family safe, it can help prevent long-term medical issues, too.

How much sun is too much sun?

Emergency Department physicians deal with the pain experienced by patients who have gotten too much sun exposure. I’ve heard some dermatologists say, “A good tan could be the first sign of skin cancer.” That is an extreme statement, but the sun’s ultraviolet rays can damage unprotected skin in as little as 15 minutes. Wear sunscreen with UVA and UVB protection with a Sun Protective Factor (SPF) of 15 or higher, and reapply it often.

How often is often?

Every 2 to 4 hours, especially after swimming or sweating. That’s also true far from the beach, particularly at higher elevations.

What other precautions should I take?

Seek shade, especially during the midday hours [10 a.m. to 3 p.m.) when the sun is strongest. Wear a hat to protect your head and clothing to protect exposed skin. Also, wear sunglasses with UV ray protection to protect your eyes.

How about kids?

Keep babies less than 6 months of age out of the sun, and do not put sunblock on them. The chemicals in sunblock could potentially harm babies. Otherwise, the same basic sunscreen and sun-exposure rules for adults apply to children. It’s really important, by the way, to teach them the importance of protecting their skin, because you won’t always be supervising them when they are outdoors.

How dangerous is the water along the Atlantic Coast?

I worked in Florida for the first 6 years of my career and had the unfortunate experience of witnessing the unthinkable, so trust me when I say never, ever turn your back on the ocean, or underestimate its power—even on the most placid beach days. Drowning is the fifth-leading cause of unintentional injury death in the United States. It is the leading cause of death among boys 5 to 14 years of age worldwide and the second-leading cause of injury-related death among children 1 to 4 years of age in the United States.

What are some precautions I can take when my kids are in the water?

Supervise young children at all times, even when they are only near the water. And by water I am including creeks, canals, rivers, lakes, hot tubs, pools and bathtubs. It can take only a matter of seconds for a child to accidentally drown. At the beach, make sure each child is swimming with a “buddy”—not another child, but an adult who is designated to enter the water with them. Obviously, you want to teach children to swim and make sure they understand basic water safety. For example, they should know that if they are swept up by a rip current to swim parallel to the shore instead of fighting against it. Adults should know this, too. Many don’t.

In a potential drowning emergency, what do I do?

Identify your surroundings and call for help—make sure a lifeguard or someone with a phone calls 911 to initiate an emergency response medical team. If an unconscious victim is in shallow water (where you can stand) administer five short rescue breaths while still in the water and then proceed to land. Once on land, the victim should be placed on his or her back, airway open. Check to see if the victim is breathing. If not, give another 5 rescue breaths and check for a pulse. If there is no pulse, begin CPR: 30 chest compressions followed by 2 rescue breaths, then repeat the cycle. If vomiting occurs, turn victim onto his side to clear the airway.

Wait, I have to learn CPR?

Yes. Not only for your children’s sake, but for the safety of everyone at the beach. You don’t have to become an expert in ocean rescues—remember, you need to be a strong swimmer before attempting to rescue a swimmer in distress or you could become a victim yourself—but you should be able to administer CPR to a near drowning victim.

Isn’t that the lifeguard’s job?

Yes, again. Which is why you want to swim near areas that have lifeguards on duty whenever possible. But there could come a time when you are the person standing between life and death, and it might be a friend or family member in need of attention.

What are some common water safety mistakes boaters make?

Alcohol consumption is a big one. Consuming alcohol impairs cognitive function which can lead to poor judgment. Another is not having a sufficient number of Coast Guard approved life jackets for the passengers aboard. Make sure there are age-appropriate life jackets for children, and do not accept foam toys or air-filled toys as substitutes for life jackets. A classic mistake boaters make is not checking the weather conditions before heading to the water.

RED MENACE

When it comes to protecting the skin from the sun, some people need to be more cautious than others. You are likely to be at highest risk for melanoma—the third most common skin cancer—if you have…

• a history of multiple sunburns
• lighter skin color*
• red or blond color hair
• multiple moles on your skin
• a suppressed immune system
• a personal history of skin cancer
• a family history of skin cancer

* The risk of melanoma is 10 percent greater for light-skinned people than for dark-skinned people, but everyone should protect their skin— and schedule routine skin exams by a physician or dermatologist.

Did You Know?

Your eyes are covered with ‘skin’ called the cornea. It too, can burn and suffer irreparable sun damage. A good pair of sunglasses in summer should be as important as carrying your cell phone.

 

Editor’s Note: John D’Angelo, DO, is the Chairman of Emergency Medicine at Trinitas Regional Medical Center. He has been instrumental in introducing key emergency medical protocols at Trinitas, including the life-saving Code STemi, which significantly reduces the amount of time it takes for cardiac patients to move from the emergency setting to the cardiac catheterization lab for treatment.

2 4 6 8

Problem-solving by the numbers

By Dr. Rodger Goddard

Life is a journey with constant challenges.  We all face issues and problems on a daily basis.  Some of us enjoy and embrace the life challenges that cross our path, while some of us fear, dislike and run from them.  Some of us are invigorated and some of us are overwhelmed by our issues. It is difficult to know what makes some of us enjoy problem-solving and some of us fear problems.  The 2–4–6–8 Method can help give you the power to know when and how to solve problems yourself…and, just as important, when to seek help.

The 2–4–6–8 Method holds that there are 2 approaches to solving problems, 4 types of problems, 6 ways to assess our problems and 8 basic problem-solving strategies…

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The two approaches to problem-solving involve either solving a problem yourself or getting help from someone else.  People who try to solve problems on their own are sometimes successful, however, sometimes they get stuck. People who reach out to others—whether friends or professionals—often get the help and support they need to sail through the stormy waters of life. That being said, it is not always an either/or situation. It can be self-defeating to either avoid getting help from others or be overly dependent on others and not trust your own problem solving skills.

The four types of problems that you may face are:

  • Work Problems, which may involve job, financial, money, coworker or boss difficulties;
  • Love Problems, which may involve
  • Family Problems, which may involve difficulties or conflict with parents, siblings or children;
  • Internal Problems, which may involve dealing with childhood wounds, past traumas or intense inner emotions

The six ways to assess a problem are by looking at the areas of Thought, Emotion, Action, Frequency, Duration and Intensity. Thought refers to how we think about and view our problem. Are our thoughts, for example, helping to solve our problem? Or are they self-critical, condemning or working against us and therefore exaggerating or making our problem worse? Emotion refers to the feelings that a problem brings up in us, and how we handle those feelings. Can we name what we are feeling (e.g. sad, anxious, guilty, angry, insecure, shame or rage)? Are we able to make friends with our feelings and get information from them about what we want and need? Or do we let our emotions overwhelm and injure our health? Action refers to the positive or negative behaviors that we do in response to our problem. Does our problem lead us to say bad things to people—or try to shop, drink, smoke, drug or eat our problem away? Frequency refers to how often a problem or difficulty occurs. Does it trouble us once a month, week, day, hour or minute? Duration refers to how long our problem lasts when it comes. Does it cause us to feel bad for a couple of minutes and then go away, or do we feel terrible for hours, days, weeks, months or years? Finally, Intensity refers to the degree of distress the problem causes. Does it lead us to be mildly uncomfortable and irritable, or so intensely upset that we are ready to explode?

The eight problem-solving strategies in the 2–4–6–8 Method are Communication, Love, Creativity, Fight, Action, Steady Patient Work, Finding Meaning and Emotional Intelligence. To keep them straight, I find it helpful to use the metaphor of the mythical meaning of the planets in our solar system. For example, in mythology, Mercury represents Communication. Strategy #1 involves communicating with others to resolve problems.

Venus represents Love. Strategy #2 involves finding better ways to care for yourself or the people around you in order to feel better and solve your problems.

In mythology, Earth is the Goddess Gaea. Gaea represents mother, birth and Creativity. Problem-solving Strategy #3 involves being artistic, creative and using innovative thoughts to find solutions. The next planet, Mars, is the God of War. Strategy #4—a Martian strategy, as it were—involves being tough and willing to Fight against the negative thing you are facing in the world or in yourself. Jupiter (Zeus) represents power, leadership and control. Strategy #5 involves creating a plan to take charge of the issues that you face and putting that plan into Action.

Saturn is the God of time. People who use a Saturn strategy—Strategy #6—take time to digest and respond to their problems. This involves patience, long-term planning and Steady, Patient Work over a long period of time. They know that continual small actions enable them to change a situation, whether it’s something about themselves, another person or a relationship.

Uranus is the God of heavens and the night sky, and is often viewed as representing a person’s embracing their uniqueness and individuality. Strategy #7 involves Finding Meaning in the larger-life aspects of your problems, of seeing your life as a spiritual journey of discovery. Neptune, the god of the sea, represents Strategy #8, Emotional Intelligence. The turbulent sea represents emotions and everything going on beneath the surface. People who employ a Neptune strategy use their feelings and emotions to guide them. They penetrate into the underlying core meaning and essence of a problem and use their feelings to find direction and answers.

If you are someone who embraces and uses active problem-solving strategies, keep up the great work. The 2–4–6–8 Method is an important and effective thing to have in your toolbox. However, if you find yourself overwhelmed by your problems—if the frequency, duration and intensity of your problems are high, and you have trouble using effective strategies to solve your problems—then it may be time to get professional help. Professional help today involves building your problem-solving skills, so you can still use the 2–4–6–8 Method to better understand your situation and your resources for solving it.

Life is a journey of discovery and challenges on a stormy sea. The 2–4–6–8 Method can help you determine whether you can navigate these challenges on your own, or if you need help in getting to peaceful, calm waters. May the journey of your life be invigorating, fun, spiritual, challenging and fulfilling. I wish you good sailing.

Editor’s Note: Dr. Rodger Goddard has served as the Chief Psychologist at Trinitas Regional Medical Center for over 25 years. He is the director of Wellness Management Services, which provides workshops, presentations and programs to companies and schools to improve individual and organizational success. He is also the director of the hospital’s APA-accredited psychology internship program. He can be reached at rgoddard@trinitas.org or (908) 994-7334.

Prescription for Change

The Trinitas Emergency Department will double its size by the end of 2017.

By Caleb MacLean

Trinitas Regional Medical Center celebrated its 15th anniversary last month by unveiling plans to renovate and expand its Emergency Medicine Department. During the decade and a half since the merger of Elizabeth General and St. Elizabeth Hospital (which created TRMC), ER visits have been steadily increasing. The $18 million makeover will add 24,000 square feet of space and take place in three stages, to be completed some time in 2017.

“In 2013, we saw nearly 72,000 emergency department visits,” says Trinitas President and Chief Executive Officer Gary S. Horan. “With the expansion, we’ll be better able to continue to offer the highest level of patient care possible.”

Mercedittas “Mercy” Mallari, RN, MSN, Director of Nursing, Emergency Department, Gary S. Horan, FACHE, President and CEO, Maribeth Santillo, RN, MS, Senior Director, Emergency and Ambulatory Care, and John D’Angelo, DO, Chairman/Emergency Medicine, display the architectural rendering of the new Emergency Department expansion and renovation project that is expected to be completed in 2017.

 

The expanded Emergency Department, adds Horan, will offer patient care more rapidly and efficiently through new equipment that is positioned much closer to Emergency Department treatment areas.

“The expansion will include a new ultrasound room and a CT Suite for a 128-slice CT Scanner, which will reduce the need to transport patients to other testing areas.”

Besides doubling the number of treatment areas from the current 26 to a total of 52, the new facility will also provide an environment to reduce patient anxiety and offer a private area for families needing quiet time. The staff, meanwhile, will be trained to direct potentially disruptive patients to an area where they are less likely to distract doctors and other ER patients. A new lounge will also be created for First Responders from the various EMS squads that transport patients to the hospital.

Why the steady climb in emergency visits? According to Dr. John D’Angelo, Chairman of Emergency Medicine, many in the community do not have easy access to a primary-care physician. “They rely on Trinitas for treatment of the flu and urinary tract infections that might be more commonly treated in routine visits to a primary care physician,” he explains. “Also, with a population that is growing older, we see more cardiac and stroke cases due to age-related factors.”

Trinitas has successfully integrated advanced emergency lifesaving treatment methods into the emergency angioplasty treatment process, Dr. D’Angelo points out. “Our team effort uses a ’30-30-30’ rhythm. 30 minutes for EMS responders to reach the patient, perform an EKG, and get the patient to us.  30 minutes for the Emergency Team to receive, stabilize and transport the patient to the cath lab. Then, 30 minutes for the Catheterization Team to open the occluded artery.”

“Simply put,” he says, “every minute we save means a better outcome for patients.”

Trending Downward

Colon cancer rates drop as screenings increase.

By Christine Gibbs

This February marks the 15th anniversary of the start of Colon Cancer Awareness Month. President Bill Clinton made it official in the final year of his presidency and, in the ensuing decade-and-half, nationwide initiatives have gotten the word out on the importance of exercise, healthy eating and regular screenings for individuals 50 and over. That being said, there is a long way to go.

Colon cancer is often used synonymously with the larger group of cancers that is more accurately named colorectal cancer. Although both colon and rectal cancer affect the large intestine, they are distinguished by both location and function (colon cancer affects the higher portion and rectal the lower portion). Colorectal cancer ranks #2 in the U.S. as a cause of cancer deaths and #3 overall in terms of the number of cases diagnosed.

Despite its prevalence, the early symptoms of colon cancer still frequently go unnoticed. The good news is that it is among the most treatable (and preventable) cancers, so as awareness continues to grow, there is every reason to believe that the number of deaths will decrease…dramatically. Currently, these are the facts—as collected by the American Cancer Society, the National Cancer Institute and the Centers for Disease Control and Prevention:

  • About 1 in 20 (or 5 percent) of all Americans will develop colorectal cancer.
  • 90% of new cases occur in individuals 50 years or older.
  • People with a close relative (parent, sibling or child) with colon cancer are 2 to 3 times more likely to develop it themselves.
  • Median age at diagnosis is 69.
  • While the number of cancer diagnoses in older adults has dropped since 1985, studies by the National Cancer Institute indicate that the rate for those under 50 has risen. Why? “More people over age 50 are getting colonoscopies, resulting in a higher number of pre-cancerous polyps being discovered in that population,” explained Andrea Zimmern, MD, Colorectal Surgeon at Trinitas Regional Medical Center.
  • It has been estimated that 60% of deaths could be prevented with screening.
  • The annual cost of colorectal cancer treatment recently in the US is $8.4 billion.

UNDERSTANDING THE BASICS

The news isn’t all bad. A recent study showed a decrease of 30 percent in cases (and also deaths) in adults 50 or over. This change is being attributed primarily to the increase in the number of colonoscopies per year. There are actually more than 1 million colorectal cancer survivors in the US today. The American Cancer Society has outlined several major factors that impact dealing with Colon cancer:

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Genetics

Certain tests have been developed—including Oncotype Dx Colon Cancer Assay, ColoPrint, and ColDx—to examine the role of genetic influences in forming colon cancer tumors in order to identify individuals who have a higher risk that an existing cancer will spread. Other tests are available to identify a predisposition to such tumors. According to studies by the Memorial Sloan Kettering Cancer Center, about 5 to 10 percent of all colorectal cancers are caused by a genetic mutation that can be passed from parent to child. For those individuals with a strong family history, professional genetic counselors can be consulted to help assess the level of potential risk.

Staging

Staging describes how far the cancer has spread in the body. For colorectal cancer, the stage is identified by whether the cancer has grown into the intestinal wall or other nearby structures, or if it has spread to the lymph nodes or distant organs. The importance of staging is that it helps with prognosis and treatment options. The staging process involves a physical exam, biopsies, and imaging tests such as CT or MRI scans.

The daVinci Robotic Surgery System is used at Trinitas for a wide variety of procedures, including colon and rectal surgery.

Treatment

Surgical options are constantly being evaluated and improved. It is the early-stage cancer that is best addressed with surgery. Approximately 95% of Stage I and 65%-80%of Stage II are surgically curable, according to Johns Hopkins researchers. Laparoscopic and robotic surgeries are becoming more widely used than invasive traditional techniques.

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Chemotherapy involves administering specific drugs that have been shown to kill certain cancer cells. Delivery can be via injection, intravenously, or even in pill form. Unfortunately, the drugs not only can kill rapidly growing cancerous cells, but healthy cells as well, which can cause debilitating side effects. Targeted therapy involves newer drugs that attack the specific cancer with fewer side effects. These are typically administered to advanced cases and can be very expensive. Research is also being conducted on immunotherapy alternatives, which involve developing vaccines that can boost the patient’s own immune system to help fight the cancer. Radiation therapy is another option, although it is used much more often for rectal cancer, according to Dr. Zimmern.

THE IMPORTANCE OF SCREENING

In the majority of cases, colorectal cancer is eminently treatable in its early stages, and even preventable through regular screening. Since its symptoms can go undetected, prevention requires attention and action. Popular TV anchor and personality, Katy Couric—whose husband succumbed to Stage IV colon cancer—became a well known advocate for colonoscopy screening by allowing her own procedure to be televised in March of 2000.

Colon cancer begins as a small, easily removed polyp growing on the lining of the colon or large intestine. A colonoscopy is the surest way to detect such a growth in its very early pre-cancerous stages. For anyone who is squeamish about this relatively painless outpatient procedure, investigating the computerized virtual colonoscopy may be worthwhile, although Dr. Zimmern advises caution. “Regular colonoscopy is still the best and only option that is both diagnostic and therapeutic. If we see a polyp we can remove it on the spot.” On average, a screening colonoscopy will discover polyps in 25 to 50 percent of asymptomatic patients, according to The American Society of Colon and Rectal Surgeons Textbook of Colon and Rectal Surgery. “This means that up to 50 percent of people who have a computerized virtual colonoscopy will need to go in for a regular colonoscopy afterwards,” Dr. Zimmern explains.

As with many cancers, lifestyle changes can also help to prevent colon cancer. It’s no surprise that increased risk factors include a diet of high-fat animal foods, being overweight, smoking, and inactivity. The secret to avoiding colon cancer is simple: stay healthy, stay informed…and get scoped!

Andrea S. Zimmern, MD, FACS

Colorectal Surgeon

908.994.8449

Ask Dr. D’Angelo

Emergencies can arise any time, day or night, any time of the year. By definition, you never know when you, a friend, relative or co-worker—or a complete stranger—will need emergency assistance…and if you will be the one who has to make the call. In 2015, the number of 911 calls made in the U.S. is likely to top a quarter-billion. The number of emergency calls has continued to rise as cell phones become more prevalent, which puts a lot of pressure on the 911 operators who field those calls—especially in a medical emergency. To make sure you get the help you need fast, the key is to remain calm and be precise. Dr. John D’Angelo, Chairman of TRMC’s Emergency Medicine Department, answers EDGE readers’ questions on emergency calls.

When should I call 911?

You should call 911 for any emergency situation, defined as an injury to a person, animal or property. The emergency situation should be called in while in progress. It’s important to place that call as quickly as possible as the emergency is happening. You should not wait to call 911 after an event has occurred. If someone is not breathing, unconscious, bleeding profusely, seizing or convulsing or experiencing some other life-threatening situation, make the call—even of you are in doubt.

What medical emergencies in adults are “time-sensitive” and should generate a 911 call?   

Let’s talk a little bit about “alarming symptoms.” If you or someone around you experiences chest pain, shortness of breath, weakness in an arm or leg, or a speech deficit, you should call 911. Heart attacks and strokes are especially time-sensitive disease entities. Heart attack and stroke patients who present early to the Emergency Department fare much better than those who come in after a long delay. Abdominal pain in the elderly is another time-sensitive disease. The longer such pain in the elderly goes undifferentiated, the greater the likelihood for a poor outcome.

How about children? When should I call 911 for them?

Alarming symptoms for children are generally respiratory in nature. Alarming signs observed by a parent or caretaker include a child with nasal flaring, grunting, retractions, and new or refractory wheezing. All warrant a call to 911. Ingestions of any possible harmful or toxic solutions or products are another reason to call 911.  In this situation, I recommend you also place a call to a poison control center. The New Jersey Poison Center number is 1–800–222–1222.

What should I bring to the ER?

In the case of a child who has swallowed something harmful, bring the container or a picture of the ingested agent with you to the emergency department. This is important because all caustics—such as household cleaners, presciption and over-the-counter medications—are not created equally. The poison center, as well as your emergency providers, need as much information as possible to adequately explore an effective antidote. Also, it is imperative to obtain as much information as possible from caregivers regarding the time of ingestion and quantity consumed.

Who answers my 911 call?

It really depends on your geographic location. When you call 911, your call will be fielded by either a Public Safety Answering Point (PSAP) or a Public Safety Dispatch Point (PSDP). The 911 call-taker will ask you, “What’s your emergency…?” They will then handle the call themselves or transfer you to the local Emergency Dispatch Center that can best manage the emergency. In New Jersey, most 911 calls are handled by the local municipalities.

What other questions should I be prepared to answer when I call 911?

Where is the emergency taking place? Who is involved in the emergency? When did the emergency occur? The key to answering these questions is to be concise. The Emergency Medical Dispatcher is listening for what service a caller needs. They will take the information you give them and connect you with the appropriate dispatch unit—Fire, Emergency Medical Services or Police.

What if the person calling 911 is not fluent in English?

Municipalities actually contract with multilingual vendors who can assist with any language.

Does it make a difference if I call 911 from a land line or my cell phone?

It could. A land line ensures rapid dispatch to your exact location. If you call from a cell phone, your call may be picked up by the closest tower, then rerouted or transferred to the local municipality capable of handling the call. If possible, use a land line.

Why do you have to “stay on the line” while waiting for help to arrive?

Emergency Medical Dispatchers will assist you with pre-arrival instructions. They may assist with CPR instructions, basic life support, or fire safety. They will also help you to remain calm until help arrives, or answer questions if the emergency situation suddenly changes.

COLOR ME READY

You never know if a child will be the person making the call in a 911 situation. The state of New Jersey’s Department of Human Services actually offers a coloring book with simple language and images

for children, showing them how to respond to emergencies.  You can download this helpful teaching tool at state.nj.us/911/kids/book/911book.pdf.

Do you have a hot topic for Dr. D’Angelo and his Trinitas ER team?

Submit your questions to AskDrD@edgemagonline.com

Editor’s Note: John D’Angelo, DO, is the Chairman of Emergency Medicine at Trinitas Regional Medical Center. He has been instrumental in introducing key emergency medical protocols at Trinitas, including the life-saving Code STemi, which significantly reduces the amount of time it takes for cardiac patients to move from the emergency setting to the cardiac catheterization lab for treatment.

 

What’s Up, Doc?

News, views and insights on maintaining a healthy edge.

Experimental Drug Looks Good vs. MRSA

Antibiotic-resistant superbugs that have hospitals and doctors gravely concerned, including MRSA, may have a new superhero in the form of the experimental drug, Staphefekt. In a recent trial conducted by the Dutch biotech company that makes it, five of six patients with the MRSA infection on their skin were cured. Staphefekt works differently than traditional antibiotics, which need to penetrate bacteria to be effective. Staphefekt latches onto the wall of the bacteria and releases an enzyme that eats a hole through the membrane to get inside. The hope is that bacteria won’t be able to adapt to this type of attack. “This is an exciting new concept in our fight against harmful bacteria,” observes William Farrer, MD, Chief of Infectious Disease at Trinitas. “However, I would stress that Staphefekt can be used only on superficial Staph skin infections such as acne and impetigo, not on more serious infections such as abscesses, pneumonia, or blood stream infections.

William Farrer, MD Chief of Infectious Disease 908.994.5455

” Hopefully, adds Dr. Farrer—who also serves as Associate Professor of Medicine at Seton Hall’s School of Health and Medical Science—the technology will be extended to other bacteria and for systemic use. Indeed, some scientists believe this type of antibiotic can be “trained” to kill only bad bacteria and not the beneficial bacteria in our bodies.

A Blunt Assessment of Marijuana

As state after state legalizes marijuana, the medical community is looking more closely at the effects of THC, the psychoactive ingredient in marijuana, on human brains. It is well accepted that THC impacts short-term memory and that marijuana-using adolescents can experience long-term impact on the developing brain. A recent study conducted jointly by Northwestern and Harvard Universities showed that the concentration of THC in marijuana may be a key contributing factor. The researchers noted that currently available marijuana is three to four times more potent in terms of THC concentration than 20 years ago. College students who used marijuana four times a week underwent brain scans and all were found to have slight structural abnormalities of the nucleus accumbens—an area associated with pleasure and pain and, by extension, motivation. “This may explain the amotivational syndrome that has been described in earlier literature as a complication of marijuana use,” according to Anwar Y. Ghali, MD, MPA, Chairman of the

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

Department of Psychiatry at Trinitas. “Also, studies have demonstrated that marijuana use accelerates the precipitation of schizophrenia in 40 percent of patients who developed that illness. In addition, studies also have shown that many of those who use marijuana go on to abuse other and more addictive substances.” One of the Harvard-Northwestern study co-authors commented, that if he were to design a substance that’s bad for college students, “it would be marijuana.”

Obesity and the Brain

More bad news about the effects of a poor diet—this from the November meeting of the Society for Neuroscience. New research findings presented during Neuroscience 2014 suggest disturbing connections between obesity and brain function. For example, exposure to a high-fat diet in the womb may alter a child’s brain “wiring” in ways that alter eating habits later in life. Another study suggests that being overweight is associated with shrinkage of a part of the brain involved in long-term memory of older adults. “We are aware there is an association between obesity and the brain, and how the food we eat plays a major role in our overall health and well being,” notes

Ari Eckman, MD
Chief of Endocrinology and Metabolism 908.994.5187

Dr. Ari Eckman, Chief, Division of Diabetes, Endocrinology and Metabolism. “What is not clear is what the exact mechanism of that association is. Since none of these findings is conclusive, further research is needed to determine the impact of obesity on the brain, but this information presented at Neuroscience 2014 certainly sheds light on another possible danger of being obese.” One more bit of alarming research from the conference hinted that a high-fructose diet during adolescence could affect the brain’s response to stress and also exacerbate depressive behavior.

What Happens After?

Trinitas is primed to face the tsunami of mental health challenges created by COVID-19.

Long after we are clear of COVID-19, the fallout from the pandemic is likely to impact us for a lifetime. Exactly what the scope of those after-effects will be is difficult to say. However, healthcare systems are dealing with many of them now, including a dramatic uptick in mental health issues. It’s no surprise. Prior to the past year, tens of millions of people across the U.S. were already struggling with mood disorders, with only about half likely to seek professional treatment—a sobering assessment that comes from the National Institute of Mental Health. The deluge of negative news and emotional triggers (much of it delivered on the devices that were keeping us connected) has only made this situation worse.

There is a silver lining in this dark cloud.

Our obsessive connectivity has created greater awareness about what mood disorders are and knowing when and where to seek help. Thanks to expanded public education campaigns and a culture of sharing on social media, more people are willing to speak up and self-advocate when they realize their emotional state involves more than just these occasional experiences. Also, it appears that people have a better understanding that occasional bouts of sadness, anxiety and stress are normal, even healthy.

For more than five decades, Trinitas has filled that role, offering care and support for those suffering from mood disorders. Now, a comprehensive expansion—including a $5 million investment in its facilities and treatment programs—has made two new options available: esketamine and unilateral Electroconvulsive therapy (ECT). Along with the financial and material invest-ments, the introduction of these services complements an advanced, future-focused rethinking of how mood disorders are evaluated and treated.

Mood disorders, which distort an individual’s emotional state and can affect his or her ability to carry on a normal life, can include any impairment that leaves a person feeling unusually sad, depressed, or anxious. Manic conditions, in which a person’s mood quickly alternates between extreme depression and excessive happiness, also fall under this heading. At Trinitas, each patient’s care is tailored to his or her particular symptoms, history and lifestyle, according to Dr. James McCreath, Vice President of Behavioral Health. “Our approach to delivering treatment to our patients always centers on what’s most suitable for the individual,” he says. “Introducing new options this year allows us to further tailor our treatments.”

Redefining the Evidence Base

Part of the shifting treatment landscape for Behavioral Health stems from what Dr. Salvatore Savatta, Chair of Psychiatry at Trinitas, calls a “dramatic expansion” over the last 15 years in relevant research and the volume of information sources from which practitioners can draw:
“The ‘evidence base’ of ‘evidence-based medicine’ in psychiatry is profoundly deeper than it used to be. Twenty years ago, physicians typically treated patients in accordance with their own institutional preference, residency training, and personal experience. The available peer-reviewed evidence was extremely weak. Now, however, there is a relevant evidence base for almost every question a physician faces.”

Personalized treatment programs combine evidence-based psychotherapies with psychiatric medications; adding esketamine and unilateral ECT gives the team a fuller range of options. Esketamine, delivered as a nasal spray, is beneficial to patients with more challenging forms of depression. The unilateral ultra-brief pulse delivery of ECT now in use at Trinitas has been shown to be nearly as effective as the previous bi-lateral approach, and with far fewer side-effects. Both of these treatments can be considered when a patient fails to respond to more traditional antidepressants—promising brighter outcomes for patients at one of New Jersey’s largest hospital-based mood disorder programs.

Dr. Salvatore Savatta, Chair of Psychiatry at Trinitas, points out how important it is for people to consider all available options—including ECT—when undergoing treatment for severe mood disorders.

“There are many misconceptions about how today’s ECT affects the mind, even what this treatment looks like,” he says. “People base it on what they’ve heard or seen on TV and in the movies. And even those depictions of old-fashioned ECT treatments were largely inaccurate. We need to remove the stigma surrounding this treatment so more people can feel comfortable seeking out and receiving the help they need.”

In addition to improved methods for delivering ECT, the field of behavioral health has seen seismic changes in the way patients are evaluated and treated. According to Dr. McCreath, who brings 45 years of experience to his role, psychotherapy treatments have improved dramatically in both the number of options available and the effectiveness of those options. He also points out that, as a society, we’ve become more comfortable talking about mental illness— a key point in expanding access to treatment.

Quicker, Stronger

Esketamine is a more potent and faster-acting form of ketamine, which is most often used as a surgical anesthetic and has been around for 50 years. Esketamine has an immediate effect on treatment-resistant depression and also appears to reduce suicide ideation. Delivering the drug in a nasal spray means it is absorbed by a different receptor than pills are—providing a much faster route to the brain, where it targets multiple brain connections at once.

“People struggling with mental illness—be it major depressive disorder, bipolar disorder, seasonal affective disorder, generalized anxiety, or any other disorder—now see it as acceptable, and are encouraged to talk about what they’re experiencing and to seek professional help earlier in their journey,” he says. “There’s a greater willingness to get treatment and they find larger, more impactful support networks among their friends and loved ones.”

McCreath also cites a greater emphasis in recent years on short-term treatment versus long-term hospitalization, along with a societal recognition that having a mental illness isn’t an impediment to enjoying a productive life.

The Trinitas Department of Behavioral Health and Psychiatry provides treatment to patients of all ages, as well as family services. The center offers a 98-bed inpatient facility and a specialized unit for adults with mental or developmental disabilities. Prior to the pandemic, Trinitas logged more than 15,000 outpatient visits a month. The team of practitioners includes psychiatrists, psychologists, social workers, substance abuse counselors, creative arts therapists and many others. Specialized services include parenting groups, women’s services, geropsychiatry, an adolescent residential program, and programs for individuals with HIV. Survivors of domestic violence and sexual abuse can also receive specialized care, as can juvenile offenders or persons requiring justice-involved services.

“People who come to Trinitas for behavioral health treatment will find a vibrant, young, and experienced team of forward-thinking providers who have all of today’s treatment options at the ready,” Dr. Savatta says. “We strive to show compassion at all times to our patients, and to their families.”

Considered individually, psychotherapies, medications, and technological advancements in fields like ECT offer promise to the millions across the country suffering from mental illness. The holistic approach in practice at Trinitas—in combination with the team’s skill, experience and humanity—provides relief and hope that no technology in itself can offer. Whatever the post-COVID landscape looks like, the Department of Behavioral Health and Psychiatry will be ready to respond.

Editor’s Note: For more information on behavioral health services at Trinitas, call (908) 994-7556.

All That Jasmine

Trinitas welcomes a familiar face to the nursing staff.

Barack Obama famously said that he was just starting to figure out who he was sometime in the 10th grade. Jasmine Jones has the 44th president beaten by two years. As an 8th grader, Jones decided to take the first step on a path that would lead her to the highest levels of the healthcare field when she devoted a good chunk of her summer to volunteering at Trinitas. In 2020, Jasmine Jones returned as a nurse in the hospital’s Emergency Department—at a time of profoundly critical need.  It was a homecoming in more ways than one; the connection to Trinitas has been a near constant in her life.

During her high school years at Union County Vo-Tech’s Allied Health School, Jones took part in a Medical Mentoring program and Nursing Camp at Trinitas, laying the foundation of skills and academics on which she built her professional plans. Her undergraduate studies at Drexel University—funded partly by a scholarship from Trinitas—propelled her ever forward and enhanced her passion for the business of healthcare. 

As an Emergency Department nurse at Trinitas, Jones enters the field at a time unlike any we’ve seen before, when a global pandemic has claimed hundreds of thousands of lives and placed healthcare workers at considerable risk. Yet like those who have come before her, she puts the lives of her patients first as she follows the path she began carving out almost a decade ago. 

“The calling is greater than me as an individual,” she explains. “Nurses are like firefighters—we run toward a fire. There are so many incredible nurses here at Trinitas, and I’m just hoping to be half as good as them.” 

While finishing her Bachelor of Science degree in Nursing at Drexel (she graduated in June, with a minor in Journalism), Jones worked as a Certified Nursing Assistant. She applied to Trinitas after graduation, received a job offer in August, and joined the Emergency Nurse Residency Program on September 14. As an 8th grader, she recalls, her time spent volunteering at “7 South” in Telemetry sparked this dream. Jones found further inspiration in her parents, both of whom worked in healthcare-related industries: her mother in insurance, her father in pharmaceuticals. 

“The experience I gained at Trinitas was invaluable,” Jones says. “I helped make patients’ beds and performed tasks like bringing them water to make sure they were comfortable. It was eye-opening for me at that young age, and it cemented my belief that I had found my calling.” 

One patient in particular stands out during that experience—a woman who spoke little English, and with whom Jones could communicate in basic Spanish.  

“She called me enfermera, which is Spanish for ‘nurse,’ and I tried to explain that I was just una voluntaria,’” she says. “She kept calling me ‘nurse’ anyway, because she saw compassion in me–something that is so core to nursing, but also something you can’t teach. She was what truly inspired me to pursue a nursing career.”  

Jones’s undergraduate experience at Drexel was also a game-changer. 

“For a goal-oriented person like me, I knew Drexel would set me up for success and provide some amazing opportunities,” she says. “For example, I had the chance to study abroad in Australia and learn about how another country carries out its healthcare system.”

That experience planted another seed for Jasmine Jones: the possibility of one day putting her journalism skills to use by traveling the world, tracking her experiences in a memoir, and using her expertise to impact healthcare policy. At the moment, as one of Trinitas’s promising new Emergency Department RNs, she’ll remain close to home and family. Her own, as well as the Trinitas family…which she’s been a part of now going on ten years. 

DID YOU KNOW? 

The World Health Organization proclaimed 2020 “Year of the Nurse and Midwife.” Little did they know! There are about four million registered nurses in the U.S., with more than half over the age of 50. Male RN’s make up between 9 and 10% of the nursing population. About 18% of nurses hold a graduate-level degree (an MSN, for example). More than half of U.S. nurses work in hospitals.

Life in the Fast Lane

With each 9-1-1 call, two award-winning Trinitas teams spring into action.

Terror. Pain. Confusion. A swirl of sounds and people. The fear that this might be a one-way trip. This is the part of a cardiac emergency you don’t see on TV medical dramas. Yet it is in these first moments when help arrives that difference-making action begins. The target window of time during which an individual in this situation needs to receive emergency care is 90 minutes—so says the American Heart Association. Which is why the right call is a 9-1-1 call. Indeed, according to Gerard “Rod” Muench, Trinitas Regional Medical Center Administrative Director of the Emergency and Emergency Medical Services Departments, a good chunk of that critical window can be wasted by driving that individual to the hospital in a personal vehicle. Dialing 9-1-1 initiates a System of Care that makes the most of those precious minutes.

Trinitas has been the recipient of Mission: Lifeline awards from the American Heart Association in each of the last four years. The departments receiving this honor are under the director- ship of Muench and Kathleen Azzarello, head of Cardiovascular Services—two professionals who excel at administering critical emergency-treatment response. Muench’s team is focused on saving the lives of severely distressed cardiac (and other) patients by streamlining the trip of EMS personnel from point of contact to the Emergency Department at Trinitas. Azzarello’s team, which includes the cardiac catheterization lab, is at the receiving end when the ambulance arrives with patients in cardiac distress.

Muench and his team deliver approximately 1,000 patients each year to Azzarello and her staff. On average, their coordinated care probably saves 50 patients a year—about one a week—whose extreme coronary distress would have resulted in death under almost any other scenario.

The Three C’s

The common goal of emergency System of Care protocols can be defined by three important C’s: Cooperation, Collaboration and Communication. The goal of the EMS team is to administer treatment at the very first moment that the EMTs make contact with the patient. Trinitas pre-hospital personnel is trained in procedures such as administering CPR, providing medication, inserting an IV, and transmitting an EKG to the hospital prior to the patient’s arrival. Once delivered to the Emergency Department, no time is wasted in turning over those in need of immediate cardiac care to the Cardiovascular Services Department.

The overall success of response to cardiac emergencies starts with expediting what used to be called “door-to-needle” time. The clock starts ticking at the point of first medical contact—in the home, in the car, at work, or on the phone with a 911 dispatcher—and doesn’t stop until a patient is transported by an emergency vehicle to the catheterization lab or cardiovascular department, where life-saving treatment can be initiated before time runs out. At Trinitas, first contact typically goes through the hospital’s Mobile Intensive Care Unit. The MICU operates in coordination with the Elizabeth Fire Department, which initiates on-site stabilization and treatment.

Everyone trained and supervised by Rod Muench appreciates that every minute matters when it comes to coronary patient outcomes, making the MICU an “Emergency Dept. on wheels.” He has been at Trinitas for 11 years, previously served as ED/EMS Administrator, and is often described as a paramedic educator. He has developed and implemented a thorough regimen for the hospital’s staff of EMTs, including a first-contact philosophy.

“Learning how to communicate with the patient is key,” Muench explains. “Good people skills are essential to a good emergency medical technician.”

The need to combine empathy with speed and accuracy is echoed by Kathleen Azzarello and her team, which deals with extreme pressure situations on a round-the-clock basis. In assembling that team, she looks for individuals who are “a bit of an adrenaline junkie,” adding that they need to stay calm under fire and also appreciate the ultimate rewards of being a critical caregiver. What is her reward?

“It’s an amazing privilege to watch a cardiac patient go from near death upon arrival to wanting to leave the hospital as soon as treatment has been administered.”

Needless to say, COVID-19 has complicated the work of everyone involved in emergency care. It has also created a growing number of post-COVID coronary infections, a story that was under-reported in 2020. Given the added stress of the pandemic, Azzarello and Muench are understandably proud of the Mission: Lifeline recognition their teams received in 2020—the Gold Plus award to the ED/EMS departments and the Gold Mission: Lifeline for ST Elevation Myocardial Infarction (STEMI) Receiving Department. Neither, however, is quick to take personal credit.

STEMI

According to the CDC, even in the pandemic year of 2020, heart disease was the number-one cause of death in the United States. A quarter-million people fall victim to the most fatal type of heart attack—ST Elevation Myocardial Infarction, or STEMI—which blocks blood flow to the heart. These extreme cases are prime examples of the difference that a 9-1-1 call to Trinitas can make.

“I am only doing so well,” Muench points out, “because my staff at Trinitas is a unique breed of highly skilled and motivated people who make my job easier.”

“I am supported by a staff of passionate, humble and unspoiled individuals from diverse backgrounds,” adds Azzarello. “We have become a family that is willing to walk that extra mile to help a patient in need.”

Zak Williams

On October 27th, mental health advocate  Zak Williams shares the virtual stage with Jack Ford at the Trinitas Health Foundation’s Peace of Mind Event. The son of actor and comedian Robin Williams, Zak has focused his entrepreneurial skills on mental health advocacy. He will be sharing his personal story to address the challenges and stigma associated with mental health issues. He is the former Chief Operating Officer of Crossing Minds and Director of Business Development for Condé Nast, and a graduate of Columbia Business School.     

EDGE: How would you characterize your approach to mental health advocacy? 

ZW: My approach is primarily systems-based— how we think about making a difference across a collection of avenues to ultimately provide a better, more comprehensive approach for individuals and communities. 

EDGE: Is that more dependent on top-down or bottom-up strategies as a catalyst for good things to happen? 

ZW: It involves taking both a bottom-up and top- down approach. It requires grassroots initiatives—people understanding the needs of people—as well  as top-down policy considerations, organizational considerations and considerations in the private sector. Also cultural considerations, which involve both bottom-up and top-down strategies.  

EDGE: What does a systems-based approach to advocacy in this space look like? 

ZW: I break things down into five categories where change can happen: Programming, which involves development of curricula and potential applications; Experience, which involves mental health awareness and campaigns focused on, for example, reducing stigma; Research, which is done by institutions nationally and abroad; Advocacy, involving strategic thinking and how organizations and different constituents communicate and coordinate around making change; and then there’s Policy, which occurs mainly in the public sector and includes educating policymakers to make pragmatic and thoughtful decisions about crafting policy that ultimately impact their constituents for the best. 

EDGE: I hear the entrepreneur in you talking. What strengths do you bring from that realm to this one? 

ZW: My role as an advocate bleeds into what I do in the private sector. In terms of how I operate as a business executive, as I said I’m very much a systems-based advocate. I rely upon metrics and data to make decisions. But for me it’s very much about establishing belief systems that impact society, culture and people for the better. You can take an advocacy approach whether you’re in the private sector or the not-for-profit world. It’s just a particular style of management and organization and leadership

EDGE: When you speak at events like the one for Trinitas, is it similar to giving a presentation in front of a group of potential investors? 

ZW: It’s exactly like giving a presentation in front of  a group of investors. The key thing is tying storytelling to impact and data. If you can tell a story with the numbers, it’s extremely compelling because, at the  end of the day, the human element of mental health support and advocacy is absolutely  critical. The numbers element helps tell a story at scale. So tying the  two together is critical for sustained investment into  the category.   

EDGE: Because of its proximity to both urban and suburban populations, Trinitas extends its mental health service to a very wide and diverse audience. Is that type of “parity” the focus of most advocacy organizations? 

ZW: Yes it is, especially on a policy basis. From a technical standpoint, it can be boiled down to something pretty straightforward, which is providing a foundation for mandating that insurers provide equal coverage around mental health programs. That is extremely important when it comes to providing quality of care. So organizations that take a leadership role within the space of mental health parity are on the vanguard of what mental health support will look like. 

EDGE: And what will it look like? 

ZW: Expanded services and high-quality care for all constituencies that need it. We’re getting there. Slowly. The California state legislature recently passed a mental health parity law that ultimately mandates that insurers take an egalitarian approach to providing services. People deserve high-quality care across the board, regardless of whether they come from means or they don’t. The more we can think about how to implement that on a systems level, the more people will have access to preventative care, just as they have access to chronic and crisis-oriented care. 

EDGE: What role do you think technology will play in moving this forward

ZW: I’m taking Dr. Ronald Kessler’s lens here in  terms of how he talks about technology. He’s an epidemiologist and policy expert at Harvard Medical School. He says there are “tech extenders” and “people extenders.” Tech extenders are telehealth platforms that enable care to be extended to places that might not have in-person, offline resources that would enable people to have the quality of care that they need. People extenders would include providing behavioral coaching services and additional social services, whatever they may be, training people to create higher-quality coverage in areas and regions that might not have, say, the level of psychiatrists needed across an entire population. So that might look like behavioral coaches or students or residents that can provide preventative-level care before it becomes a chronic or crisis issue requiring psychiatric interventions. You want to match people to the level of care that’s needed.  

Prepare for Takeoff  

In 2020, Zak Williams launched a new company, PYM Health. PYM stands for Prepare Your Mind. According to Williams,  it is focused on “providing lightweight to middleweight solutions for stress and anxiety,” he says. “Our first product is a chew that contains primarily natural amino acid compounds that provide stress/anxiety support.”   

Original Mood Chews are available online through the company’s website and other ecommerce channels. “Ultimately, we hope to be available in stores throughout the nation,” Williams says.

EDGE: What other goals do you have in the area of mental health advocacy? 

ZW: The privilege of being able to do the work I do is something that I hope other people will explore. Within the communities that I’m a part of, we hope to empower others to advocate for causes associated with mental health. Ultimately, I hope to support people along their journey and create more communities of advocates that will create change on a systems level. The fact that we’re able to have this conversation, I’m very grateful.  

EDGE: Going from “son of…” to “father of…” status is a turning point for a lot of people, whether your dad is a celebrity, as yours was, or not. In what ways has fatherhood changed your perspective?  

ZW: When it comes to raising my son, to parenting, it’s caused me to prioritize empathy and openness and understanding. It has certainly changed my perspective in how I think about mental health advocacy and advocating for change. My son is 15 months old. He doesn’t think about mental health, but I am very heartened by how young people think about mental health and the stigma associated with it. I’m 37, which I guess makes me a late-stage Millennial. Generations younger than myself tend to have an openness and orientation toward thinking about mental health as being essential to a balanced and healthy lifestyle. I want to take the long view here, that future generations have an opportunity to remove the stigma and biases associated with mental health and ultimately create a more tolerant society and world. 

Photo courtesy of Zak Williams

Zak is on the board of Bring Change to Mind (bringchange2mind.org), a nonprofit founded by Glenn Close, that works to end the stigma and discrimination surrounding mental illness. He’s an advisor for Inseparable (inseparable.us), a national organization focused on creating pragmatic mental health policy.

 

Have You Heard

Trinitas helps get Tony Testa back on his feet. 

By Erik Slagle 

Tony Testa’s life has always been about giving it his all for the fans. As the original guitarist for the beloved doo-wop group The Duprees—and now their leader and frontman—Testa’s charisma and give-and-take with the audience make every show dynamic and unforgettable. The band  formed in the early 1960s in Jersey City and shot to fame with hits like “You Belong to Me,” “It’s No Sin” and the classic “Have You Heard.”  

Extensive touring and physical wear and tear on Testa over the years resulted in a hip condition that took him off his feet earlier this year. A born performer, Testa knew he couldn’t take chances with anything other than the best care and technology when it came to receiving an artificial hip—a critical joint for someone who needs to command the stage for a living. After researching hip replacement procedures, Testa decided to seek out a facility that uses the Hana Orthopedic Table (right) in its OR. The Hana Table has transformed how hip replacement surgeries are carried out: patient positioning via the table means the surgery can be minimally invasive, less painful, and with much faster recovery time. It all adds up to a vastly improved experience compared to hip replacements of even the recent past.  A friend who had recently undergone surgery of his own recommended that Testa—who lives in Jackson Township—look into the work being done at Trinitas, which uses the Hana Table in its OR.  After speaking to another friend, Nadine Brechner,  Chief Development Officer and Vice President of the Trinitas Health Foundation, Testa chose Trinitas even though Elizabeth is 50-plus miles north of his home. 

“I’ve known Nadine Brechner for some time now, and she told me about the facilities and staff there who could perform my hip replacement,” Testa says. “I made the decision that Trinitas, even though it was a little far, would be the best place to have this surgery.” 

Then, however, came COVID-19. The pandemic caused many to rethink the decision to undergo elective surgeries. Testa, though, says he never seriously considered postponing his operation: “I was reasonably sure it would be safe. Hospitals are always ensuring of a healthy and clean environment, and given the crisis, I was especially confident every precaution would be taken.”  

For Testa, who like other entertainers had his touring schedule postponed, the timing was ideal, as he would have plenty of time to recover and recuperate. Live concerts for The Duprees—and special events like Holland America’s Malt Shop Cruise, which features the group in its all-star lineup—are set to resume sometime in 2021.  

The effort to get Testa back into the spotlight co-starred orthopedic surgeon Dr. Mark Ghobrial, anesthesiologist (and Chair of the Department of Anesthesiology) Dr. Leon Pirak and the Trinitas nursing team—all of whom Testa describes as “nothing short of incredible

As New Jersey flattened its curve and hospitalizations began slowing in the spring, Testa’s procedure was carried out as planned. In fact, with extra safety measures and disinfection procedures in place, hospitals soon became some of the safest places to be in terms of potential COVID-19 exposure. Trinitas, of course, was no exception. 

The Duprees

“The whole staff was extremely attentive to health and safety protocols,” Testa says. “They made sure everyone had masks, were always taking people’s temperatures  and wiping everything down. As a patient, I never felt unsafe or like corners were being cut. Dr. Ghobrial was terrific. Dr. Pirak? Top-notch. And the nurses, I can’t say enough about them. I would recommend Trinitas to everyone. I had the surgery on a Tuesday and was out of the hospital by Thursday morning. I was walking again almost immediately

According to Testa, he could have been back on stage by September. Whenever that happens, for fans of the Duprees, it won’t be a moment too soon.

A Shot in the Arm

When New Jersey desperately needed more nurses,  Trinitas grads answered the call…in record numbers.

By Erik Slagle 

Unprecedented. Among the myriad adjectives we’ll be using to capture the magnitude of 2020 in the years to come, unprecedented might not be as vivid as devastating or frightening or horrifying, but it captures the positive along with the negative—and that makes it a word we should embrace. For instance, the dedication and courage of healthcare professionals in the face of a tsunami of unknowns brought about by COVID-19 was truly unprecedented, although hardly surprising. At Trinitas and other hospitals around the state, workers put their lives on the line every day because, well, that’s what they do, isn’t it? 

Also unprecedented in 2020 was the surge in interest among young New Jerseyans in entering the healthcare field—specifically nursing—at a time when there was no small amount of risk accompanying that decision.  

The 2020 graduating class of the Trinitas School of Nursing was the largest ever, with nearly 190 graduates immediately entering the workforce when their communities needed them most—a new generation of frontline heroes joined the fight against the pandemic.  

“COVID-19 actually affirmed, for me, that I made the right decision in starting a nursing career,” says Patience Opaola, who graduated from the School of Nursing in January and now works at Trinitas as a registered nurse (RN). After graduating from Linden High School in 2016, she started her RN education at 18, unsure of where she should go next in life. Opaola admits it wasn’t an easy adjustment moving later from the classroom to the front lines, but says she was met with a great deal of support. 

“I wanted to quit so many times,” she says of her early days on the Medical-Surgical floor. “But I’m glad I saw it through. You learn how to ask for help…everyone’s ready to lend a hand.” 

“These nurses and students are amazing individuals who want to work with patients that are very, very sick,” says Dr. Roseminda Santee, Dean of the Trinitas School of Nursing. “Our students want to serve their communities and take on the challenge of the COVID-19 battle.” 

Between January and May, a record 188 graduates earned their credentials at Trinitas, and Dr. Santee says that, during the worst months of the pandemic, the school continued to see extraordinarily high numbers of applicants. Most were new to the healthcare field, while some were Certified Nurse Aides or Licensed Practical Nurses, completing their education to become RNs. The cohort overall was a diverse mix of ethnic and cultural backgrounds, and included a number of male candidates, as well—more so than usual, according to Dr. Santee. 

The coronavirus outbreak, of course, forced the physical closure of schools at all levels, and the School of Nursing had to quickly pivot toward online instruction. Faculty and students alike stepped up and made the transition a smooth one. Looking ahead toward 2021, challenges are likely to continue until an effective vaccine is made widely available, as social-distancing measures limit the number of seats permitted in each class. However, says Dr. Santee, the school is up to the task. 

“I wish I could take every single one of our applicants,” she says, noting that some will have to be waitlisted. “It’s a balancing act, meeting the New Jersey Board of Nursing demand for more licensed nurses while adhering to state-mandated health protocols in our classrooms. We also have to bear in mind the guidelines required by the New Jersey Office of the Secretary of Higher Education.” 

The school’s ability to master that balancing act helped garner its fourth designation as a Center of Excellence in Nursing Education by the National League for Nursing—one of only 17 institutions across the country to receive the recognition for another four years. The relationship between Trinitas and Union County College is a key to the School of Nursing’s ongoing success. 

“Trinitas has been such an open and helpful partner,” she adds. “It’s a collaborative effort between the hospital and college to ensure we’re meeting the standards of nursing education and graduating enough nurses to meet the hiring needs of our healthcare facilities.” 

To help meet demand, the New Jersey Board of Nursing has approved “temp” new graduate nurse hiring, meaning candidates receive temporary work permits while waiting to take the licensing examination. These exams were also impacted by COVID-19 because of the social-distancing requirement for examinees. 

For more than a decade, the Trinitas School of Nursing has enjoyed a reputation for rigorous curricula, an outstanding teaching staff, and an admissions policy ensuring that only the best students—representative  of the community served by the school—are admitted as future healthcare professionals. Based on recent applicants, enrollees and graduates, the school will maintain its status as one of New Jersey’s top destinations for students looking to lead the fight for our nation’s health for years to come. 

“Getting into the hospital after finishing school may be a bit of a shock,” says Opaola, reflecting on her advice to others thinking of following her path. “You might feel small in the beginning, but you’ll have a lot of support. And that support starts with your faculty and classmates at the School of Nursing.” 

DID YOU KNOW? 

The World Health Organization  Designated 2020 as the International Year of the Nurse and Midwife in honor of the 200th “birthday” of Florence Nightingale.

Staying Centered

Role of Ambulatory Surgery becomes more vital as Covid-19 subsides

By Yolanda Navarra Fleming

The numbers are tricky to pin down as Covid-19 cases rise and fall from coast to coast, but it appears that at least a third of Americans put off needed healthcare in the first four months of the pandemic. That figure covers everything from scheduled tests and screenings to minor procedures to actual emergency room visits. Caution is never a bad thing, but fear—especially fear fueled by a lack of accurate information (or sometimes way too much of it)—can exert a powerful influence on our decision-making. Often to our own detriment.

As Trinitas worked to stay a step ahead of the coronavirus this past spring and deliver a high level of healthcare to those who needed to be admitted, another part of the hospital—the Ambulatory Surgery Center (ASC)—was closed and waiting to safely reopen, and is now firing on all cylinders. “Ambulatory” in the case of the ASC reflects its Latin root (abulatore: to walk).  The ASC is an outpatient facility that allows our clients to have same-day procedures. Although there is always some risk in any type of surgery, the layer-upon-layer of Covid-19 precautions that have been adopted, as Trinitas doctors learn more about the virus, has minimized the risk of contracting and spreading the virus in the main hospital as well.

“Our Ambulatory Surgery Center provides an optimal environment for our patients and their families, as we do not treat Covid-19 patients in this facility,” says Donna Leonard, Peri-Operative Managing Director. “The atmosphere there is warm, calm, and peaceful. The ASC staff is professional, knowledgeable, and empathetic, in addition, our equipment is state-of-the-art. An important consideration when choosing an ASC site is knowing that we are a hospital-based facility, and all of the resources of Trinitas Regional Medical Center are at our disposal at any time, for any reason.”

The doctors, nurses, and technicians at the Ambulatory Surgery Center are skilled and experienced in a wide range of specialties and outpatient procedures. The ASC Operating Room handles:

  • General Surgery
  • Laparoscopic Surgery
  • Vascular Surgery
  • Plastic Surgery
  • Gynecological Surgery
  • Ear/Nose/Throat Surgery
  • Pain Management
  • Orthopedic Surgery

More complex procedures are performed in the Main Operating Room at Trinitas, where the same rigorous cleaning and sanitizing procedures take place.  These procedures include all of the above in addition to the following:

  • Robotic Surgery
  • Total Joint Replacement Surgery
  • Genito-Urinary Surgery
  • Ophthalmic Surgery
  • Complex ENT Surgeries

Both OR areas are staffed by Board Certified Anesthesiologists, all nursing personnel are certified in Basic Life Support (BLS), they also have or are working towards becoming Advanced Cardio Life Support (ACLS) certified. Many Trinitas RNs are bi-lingual and multi-lingual. Most Registered Nurses have their Bachelor’s degree or are currently in a program working towards obtaining a BSN. We have several RN’s with BSN’s who are now Master’s degree holders in Nursing, and several more currently pursuing this highly regarded professional degree.

The $5.2 million 9,500 square-foot Ambulatory Surgery Center opened in 2014. Since then, more than 10,000 patients have been treated there.

“It’s only natural to have a little fear where medical care is concerned, especially given the current environment,” says Leonard. “The medical community has expressed concern that necessary testing and procedures have been delayed due to the fear of being exposed to the virus if they choose to come to the hospital. The ASC center has taken and continually updates all precautions to keep our patients and staff safe. We confidently state that we are offering a safe environment for the return of patients to our facility.”

Editor’s Note: The Thomas and Yoshiko Hackett Ambulatory Surgery Center at Trinitas is part of the hospital’s main campus at 225 Williamson Street in Elizabeth. For more information, visit njambulatorysurgery.com.

Answering the Call

When Covid-19 hit, Trinitas hit back…with a true team effort.

By Yolanda Navarra Fleming

You don’t have to be in healthcare to comprehend the gravity of the COVID-19 pandemic. Gary S. Horan, President & CEO of Trinitas Regional Medical Center, says it’s been unlike anything he has experienced in his many years in healthcare administration. As he details, Trinitas staff members met the challenges of the patient surge in the spirit of skill, compassion, and innovative teamwork.

EDGE:  How has Trinitas Regional Medical Center adapted to the “new normal” conditions created by the COVID-19 pandemic?

GH: It was a challenge we didn’t expect but were prepared for, partly because Trinitas is no stranger to innovation. Innovation is the key in responding to something as novel as the COVID-19 pandemic.  We had to get creative about a lot of things, including making additional space for COVID patients during the surge. We have taken every precaution to keep our population safe, including patients, staff members, and the outside community.

EDGE: How did the staff handle the surge?

GH: Well, prior to the surge, we activated our Emergency Command Center, which is staffed by senior administration, safety personnel, and infection-prevention personnel.  Meetings and institution-wide conference calls were held every day to address the many issues that we knew were coming up. It was and still is a very volatile time, but saving lives is our business. We have such a dedicated, well-rounded, and fearless staff, who are not focusing on the negatives. But they needed help. As part of the Heroes Helping Heroes initiative, we were fortunate enough to have 20 registered nurses from Centura Health in Colorado come to Trinitas to assist in our efforts. They were extremely helpful in our Emergency Department and the Medical/Surgical units for more than four weeks.

EDGE: With a decline in the number of cases, do you expect another surge?

GH: There is certainly the possibility of another surge, but it drastically depends on how people behave in the upcoming weeks, and whether or not they observe the safety precautions. If people choose not to wear masks, use proper hand hygiene, follow the guidelines of social distancing, and avoid crowds, I’d say another surge is likely. If it comes to that, we are prepared and will do our best to carry out the Trinitas mission, just as we did the first time around.

EDGE: In the meantime, what do you say to people who may be staying away from the hospital because they’re afraid to return?

GH: The fear is understandable, but unwarranted. We use advanced technology as part of many steps to disinfect the entire hospital.  We were an early user of the Surfacide Disinfection UV-C system. This technology uses ultraviolet light to sterilize surfaces after they’ve already been wiped down with bleach. We’re asking our community to not neglect their health by putting off elective procedures and diagnostic testing because they think it might be unsafe to come to the hospital. It’s actually one of the safest places to be at the moment because of this technology and our attention to the matter.

EDGE:  How has the pandemic affected your organization as a whole? Is there such a thing as a “silver lining” in this environment?

GH: I think so. The fact that Trinitas is a Catholic teaching hospital means that we possess a strong sense of faith as an institution. In spite of the challenges we’re facing, we are grateful for the ways we had to rise to the occasion. So, I would say a silver lining is seeing a great team spirit to fight and win against this pandemic.

 

The Smart Approach

Two decades in, the Trinitas HIV program has set new standards for success.

By Erik Slagle

A few years ago, Shawn Sullivan was at a barbecue. “No red meat for me,” she told the cook at the grill.  “Can’t have it with my HIV.” Later, a young woman who had overheard the remark approached Shawn and said she, too, was HIV-positive. She didn’t know where to turn, and didn’t have anyone she could talk to about her condition. She asked Shawn for any advice or direction she could provide. “Come to the Trinitas HIV clinic,” Shawn told her. “I gave her my phone number and told her, ‘I’ll bring you. You won’t be alone

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For 20 years, the HIV program at Trinitas Regional Medical Center has served as a beacon of hope for members of the community living with the virus. Without a lot of fanfare—or the publicity that comes with, say, breakthroughs in cancer treatments or heart disease—the program has provided care to thousands of HIV-positive patients…and helped them learn to care for themselves.

“This is a program that goes above and beyond for the population it serves,” says Judith Lacinak, Director of HIV Services. “We don’t only treat the patients who come to us. We seek them out, offer free testing to people who think they might be at risk, and break down the stigma that’s still attached to having HIV

Nearly 3,000 people in Union County are living with HIV or AIDS, Lacinak adds. “And from anywhere in the county, they can come to us for help.”

Dr. Julius Salamera of the hospital’s Infectious Disease Department has worked with the HIV program at Trinitas for more than three years.  He says the program currently serves about 600 patients—providing medical help but also supporting them through counseling with family issues and, when needed, substance-abuse treatment

“One of things we try to do at Trinitas is get to the root of each patient’s particular problem,” he explains. “For example, why have they stopped taking their medication?Some might prioritize narcotics over the meds they need to stay healthy. Others might encounter insurance problems with their prescriptions. We want to help them understand that, if you’re on medication, then you’re under control. People are living as long as 30 years or more with HIV, and the public at large needs to be educated about this.”

These days, Dr. Salamera explains, HIV is viewed in the medical field as a chronic disease – the same as diabetes or hypertension. The right combination of meds and therapy means the outlook for people living with the virus has greatly improved since AIDS first came into the public consciousness more than three decades ago. Shawn Sullivan is an example of how the evolution of HIV treatment, and the emergence of programs like the one at Trinitas, have altered the landscape.

“I’ve lived with HIV for almost 20 years,” she says. “And the clinic at Trinitas has been a big part of that. I wouldn’t be in the position I’m in now if it wasn’t for them. And I wish—everyone at the clinic wishes—more people with HIV would come in for help.”

A combination of obstacles (the stigma of admitting to having HIV, an increasingly complicated insurance field, lack of familial support, and in some cases the problem of substance abuse) keeps many with HIV from getting treated for the disease. In addition, finding those who need help can be one of the most challenging aspects of running an HIV program, but it’s one the Trinitas team is meeting head-on.

“We can meet the demand,” Lacinak says. “But the demand doesn’t always present itself.”

Getting a patient in the door is sometimes just the first step. If a patient stops coming in for his or her scheduled appointments, the team proactively goes out in search of the patient. A substance-abuse counselor will go out into the community, while the staff won’t hesitate to involve the police and paramedics if they sense something is wrong. It’s all part of the HIV clinic’s larger role as a presence in the community, not just a department in the hospital.

The HIV program at Trinitas works with homeless shelters and houses of worship to reach out to people who may need help, and the team takes part in local health fairs to spread the word about the services that are available. They provide mental health assessments, linkage to proper care, literature and educational events in conjunction with pharmaceutical companies, and permanency planning when needed. Lacinak credits the clinic staff for its tireless advocacy on behalf of HIV patients in and around Union County.

“We have a truly amazing team,” she says. “Our case managers are the backbone of the clinic. They work so very hard to make sure people show up for their appointments and are connected to the services and support they need. It’s like being someone’s personal assistant. It’s just an incredible group, and we’ve all got the same goal: helping patients manage their health and have a non-detectable virus

Today, more than 80 percent of patients at the Trinitas clinic are considered non-detectable. The program is helping them remain healthy, while keeping their HIV disease under control. Not everyone, however, succeeds. Patients may drop out, end up in jail, leave the area or, ultimately, lose their battle with the disease.

To people like Sullivan, the impact of these programs is immeasurable. “People need programs like this,” she says. “If they didn’t have this center, they’d have nothing. Look at me, look at the outcomes. Communities need these kinds of services.”

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The Trinitas clinic, she adds, is more than simply a medical center for people with an illness. “The people there become like a second family…your HIV family.”  

Sullivan, whom the Trinitas team has affectionately dubbed “The Mayor,” is always looking for ways to give back for the new life she’s been afforded by the clinic. “When I meet someone who is HIV-positive, I encourage them to come to the clinic and start getting the help they need,” she says. “I tell them, this is what you’re going to do. You’re coming to the clinic—I’m going with you. We’re going to work on living. When you’re ready, I’ll be there with you

When the community needs support and a partner in the fight against HIV, the Trinitas HIV clinic is there with those affected by the virus. For Shawn Sullivan, and thousands of others throughout the last two decades, it has been a lifeline. For a patient group still stigmatized by a three-letter diagnosis, it’s a haven. And it’s another example of how Trinitas Regional Medical Center is going above and beyond for the community at large

Editor’s Note: The Trinitas HIV Clinic is located at 655 Livingston Street in Elizabeth—about a mile east of TRMC’s main campus on Williamson Street. For more information, call (908) 994-7600. 

 

Ask Dr. D’Angelo

The Big Chill

The human body possesses an amazing ability to maintain thermoregulation at a temperature not too hot or not too cold. It’s almost like there’s a thermostat that balances heat production and heat loss. Hypothermia occurs when extreme cold sends the body’s temperature below 95° F. However, hypothermia can occur at any temperature lower than normal body temperature. Factors including body fat, age, alcohol consumption and, especially, wetness can affect how long hypothermia takes to strike. So you don’t always see hypothermia coming—which is why we often use the term accidental hypothermia.    

What are some of the early warning signs of accidental hypothermia?    

Warning signs include uncontrolled shivering, memory loss, disorientation, incoherence, slurred speech, drowsiness and obvious exhaustion. 

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Who’s most at-risk?

The elderly and the very young. The next time you visit your parents or grandparents, notice how thin their skin appears. As we age, we lose the insulating protection of muscle, soft tissue and fat under our skin. Children, on the other hand, have a higher metabolic demand, requiring more heat production. 

Besides freezing cold, do other elements come into play?

Yes. Wind and water also play a pivotal role in temperature control. Both elements can precipitously cool the body to perilous temperatures in rapid order.

How is it that some people—like the ones on reality television shows set in Alaska—can tolerate extremely frigid temperatures?

It’s called the “hunting response.” In most of us, cold leads to vasoconstriction, which is narrowing of the blood vessels.  Repeated exposure to the cold, however, causes an adaptive physiology to occur. Those in Arctic climates possess the ability to vasodilate blood vessels in a cyclical pattern. When the extremities and skin begin to lose heat, the body shunts warmed blood to the skin, effectively warming the extremities. This occurs in a repetitive pattern to maintain thermoregulation.

Is shivering a bad thing?

On the contrary, shivering is essential to thermoregulation. In colder temperatures, you shiver to produce heat in your muscles. Small children will shiver after a bath in an attempt to raise their temperature immediately. Shivering is a very effective way to produce heat. It’s nature’s way of keeping our temperature from falling below 98.6° F.

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What can you do to treat accidental hypothermia?

Passive re-warming methods should be carried out for most mild hypothermia patients. A person should be removed from the cold environment. Moist, wet clothing should be removed. The body should be examined for signs of cold-related injuries. Warm clothing in layers should be applied. Passive re-warming methods typically raise the temperature by 0.5° C to 2° C per hour.

What about using warm water to raise body temperature?

I have my reservations. Immersing a foot or a hand is very effective at warming an extremity. However, my trepidation resides with the possibility of incurring a thermal burn during the process. Even simple heating packs or pads can lead to burns.

Does alcohol warm the blood?

No. Alcohol dilates blood vessels, leading to heat loss. Also, alcohol impairs judgment, which could potentiate cold-related injuries.  

How Do I Know if I Have Frostbite?

Warning signs of frostbite include numbness and lack of color. Fingers, toes, ear lobes, and the tip of the nose are the areas most susceptible to cold-related injuries. At or below 0° C, blood vessels close to the skin constrict and shunt blood away from the extremities.

This “life vs. limb” response is designed to protect vital organs such as the brain and the heart.
Typically, in our region, we see frostnip and chilblains. These are less severe cold-related extremity injuries in which the tissue never completely freezes. Burning and itching occur, followed by red and yellow patches. Transient numbness can occur but the damage is not permanent.

Is It True You Should Hold Your Breath in an Avalanche?

Avalanche victims typically die either through direct trauma or asphyxia. The snow becomes packed in the mouth, leading to suffocation. Avalanche survivors have better outcomes when they are recovered with their mouth closed. Assuming you survive the trauma of an avalanche, then hopefully you’ll find an air pocket to breathe. 

Of course, you’re not out of the woods at that point. Hypothermia sets in rapidly, slowing the metabolism down until your heart stops beating.  If a rescue team can get to the victim relatively quickly, people have survived at body temperatures as low as 64° F. Thirty-five minutes seems to be the magic number associated with favorable outcomes.

John D’Angelo, DO Chairman/Emergency Medicine Trinitas Regional Medical Center

Editor’s Note: John D’Angelo, DO, is the Chairman of Emergency Medicine at Trinitas Regional Medical Center. He has been instrumental in introducing key emergency medical protocols at Trinitas, including the life-saving Code STemi, which significantly reduces the amount of time it takes for cardiac patients to move from the emergency setting to the cardiac catheterization lab for treatment. 

What’s Up, Doc?

News, views and insights on maintaining a healthy edge.

Be Kind to Your Roomba       

One day, perhaps sooner than you think, robots will be playing important roles in our everyday lives. In anticipation of that day, researchers at Japan’s Toyohashi University of Technology initiated a study of how we are likely to interact with humanoid robots. What they found for the first time is neurophysiological evidence that humans are capable of empathizing with robots. When the study group watched humans and robots experiencing pain, they empathized with both in similar ways…only not as deeply with the robots. Researchers accounted for the difference by speculating that humans are unable to see things from a robot’s perspective. The study will help develop human-friendly robots for which we’ll feel more sympathy and be more comfortable with. Rodger Goddard, PhD, Chief Psychologist and Director of Wellness Services at Trinitas

Rodger Goddard, PhD
Chief Psychologist, Trinitas Regional Medical Center Director of Wellness Management Services 908.994.7334

, is not surprised that people feel concern and care for robots. “Many of us already have a personal relationship to our cars, computers and other precious possessions,” he says. “We feel the pain when our car gets dented, bruised, or is in an accident. Our children are comforted by, and connected to, their teddy bears, toys and action figures. And movies already show us how we can sympathize with the feelings of an R2D2 robot.” Besides, such connections are hardwired in the human psyche, Dr. Goddard explains. Primitive people have always ascribed human emotion and intelligence to the things in their surrounding world.  We now talk to Siri, OK Google, Amazon Echo and our car’s GPS—proof that our gadgets are very responsive to our questions and needs. Meanwhile, Facebook sharing has already replaced much of what would have been face-to-face interactions. “People who lived 50 to 100 years ago would not have been able to imagine the technologically connected world we live in today,” he continues. ““We also cannot imagine how our world will look—and how much more we will be connected to our machines—50 to 100 years from now.”

An 80% Jump in Autism Rates? 

If you look only at the recently released statistics from the CDC and National Center for Health Statistics (NCHS), you’d think that a tidal wave of autism hit the United States in 2014. Indeed, the prevalence of autism in children 3–17 jumped 80 percent in one year. The story behind the numbers? According to epidemiologist Benjamin Zablotsky of the NCHS, in previous years many parents of children diagnosed with autism spectrum disorder reported it as a developmental disability instead of (or in addition to) autism because “developmental disability” was listed first. The 2014 questionnaire flipped the two categories. The silver lining of this story, of course, is that more children will receive help earlier. And the earlier they have access to care, services and treatment, the more likely they are to progress.

Carole Soricelli, MS, OTR
Director, Trinitas Children’s Therapy Services
973.218.6394

Carole Soricelli, Director of Trinitas Children’s Therapy Services (TCTS) in Springfield, can attest to that. “Our occupational, physical and speech-language therapists work with many children diagnosed with Autism Spectrum Disorder (ASD) in schools and in our Therapy Center,” she says. “In recent years, more and more self-contained classrooms accommodate the many individualized needs of the ASD population by providing smaller adult-to-student ratios, classroom environments that facilitate optimal learning for students that have a variety of sensory processing considerations, and related services support. Most curriculums have moved toward a Universal Design for Learning (UDL) model to improve and optimize teaching and learning for all people, based on scientific insights into how humans learn. The result is a learning environment characterized by flexible goals, methods, materials, and assessments that empower educators to meet the varied needs of all students.”

Happy Results from SAD Study     

A recent study published in the American Journal of Psychiatry has cast a shadow on the long-held belief that the best way to fight the winter blues is with light. Light therapy used to treat seasonal affective disorder (SAD) has proved to be effective, especially in acute cases. However, a new type of cognitive behavioral therapy designed for SAD sufferers was found in the study to be significantly better when it came to preventing relapses. Forty-six percent of subjects receiving light therapy experienced a recurrence of depression two winters later as compared to 27 percent who received the cognitive behavioral therapy. The depressive symptoms were also more severe in the light therapy group. About 14 million Americans suffer from SAD. 

Walk This Way

Older adults who make an effort to exercise daily stand an excellent chance of delaying cognitive decline and prolonging their independence. A study at Boston University, published in the Journal of the International Neuropsychological Society, compared a group of young adults and older adults who engaged in rigorous physical activity and then took memory, planning and problem-solving tests. The study found that members of the older group (ages 55–82) who took  more steps (and more vigorous steps) performed better on these tests—particularly one that involved recalling which name went with a person’s face. This result is exciting because it suggests that physical activity will extend long-term memory, which is the type of memory that is negatively impacted by aging.

Jim Dunleavy, PT DPT MS
Director, Rehabilitation Services
908.994.5406

Jim Dunleavy, PT DPT MS, Doctor of Physical Therapy and Director, Rehabilitation Services, notes that, “while rigorous activity is the level cited in this study, we have seen improvement in patients even with sub-maximal exercise/activity. If a person is sedentary, just starting a walking program can make big changes in physical and mental wellbeing.” 

Can You Hear Me Now? 

Can hearing loss make you dumber? No, not exactly. However, people with a hearing impairment who choose not to wear a hearing aid, may be devoting way too much of their cognitive resources in order to figure out what others are saying. A report issued by the University of Texas at El Paso (UTEP) maintains that untreated hearing loss can lead to serious emotional and social issues, reduced job performance and a diminished quality of life. And also interfere with cognitive abilities. This is particularly important for the 10 million Americans between the ages of 46 and 64 suffering from hearing loss—80 percent of whom do not use a hearing aid. The UTEP study looked at subjects in their 50s and 60s who had never worn hearing aids. After only two weeks of use, they did better recalling words in working memory and selective attention tests, and improved the processing speed at which they responded.

Is There Really A ‘Fat’ Gene? 

According to the National Institutes of Health, there is. NIH researchers announced this fall that they believe a single variation in the gene for brain-derived neurotropic factor (BDNF) may influence obesity, both in adults and children. Dr. Jack A. Yanovski, an investigator at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development, notes that this less-common version may predispose people to obesity by producing lower levels of BDNF protein, which is a regulator of appetite. “The BDNF gene has previously been linked to obesity, and scientists have been working for several years to understand how changes in this particular gene may predispose people to obesity,” says Yanovski. Rather than being a rare mutation, the less common variation of BDNF actually occurs in the general population and that’s an important fact.  So, is there any way we can increase BDNF level in the body?

Yelena Samofalov, MD Trinitas Pediatric Health Center 908.994.5750

Dr. Yelena Samofalov, Trinitas Pediatric Center, believes so.  “Previously, it was thought that only vigorous exercise could stimulate production of this less-common version of BDNF,” she explains. “However, recent research shows that simple walking or doing light housework or yardwork can present benefits of not only staying fit, but increasing synthesis of BDNF in the brain.”  Dr. Samofalov and Dr. Yanovski concur that boosting BDNF protein levels could offer help to people with the gene variation—which tends to occur with greater frequency in Hispanics and African Americans than in Caucasians.  

New Advance in  Artificial Intelligence      

University of Chicago bioengineers have developed a mathematical algorithm that can sense what the human body “wants” to do in everyday situations. They believe it is that help people overcome obstacles and disturbances—from cars that steer out of icy skids to prosthetics that help stroke patients complete simple tasks smoothly. “If you know how someone is moving and what the disturbance is, you can tell the underlying intent,” explains Justin Horowitz, who authored the study, who adds that machines programmed with these algorithms could react and correct in a fraction of the time it takes average humans—who sometime freeze and don’t react at all.

Now In My Backyard

Tales from the front lines of New Jersey’s heroin epidemic.

By Mark Stewart 

Welcome to Heroin Town. That eye-catching headline ran last December on the NJ.com web site. The story posited that, if one were to take all of New Jersey’s heroin addicts and put them in one place, the population would work out to about 128,000 people—making it the fourth-largest city in the state. The scope of the heroin problem in New Jersey has grown over the last decade, claiming 5,000 victims and ruining the lives of countless hundreds of thousands since the mid-2000s. The optics of heroin addiction have changed, as well. It’s now someone you know, someone you work with. Maybe it’s someone teaching your kids. Or maybe it is your kid.  

Or, possibly, it’s you.

Michele Eichorn, Addiction Therapist

According to Michele Eichorn (left), an addiction therapist who runs the Hospitalwide Screening for Substance Use Disorders project for Trinitas Regional Medical Center, the Hollywood version of the zonked-out junkie in an abandoned building or trash-strewn alleyway is not what heroin addiction looks like anymore. 

“The face of addiction has changed,” she says. “Now everybody knows someone with a heroin problem. Chances are, you have a neighbor or a friend or a co-worker or a family member with a drug addiction. It could be that sweet cheerleader who was a friend of your daughter’s 15 years ago. Now she’s hooked on painkillers, or worse. More than ever, this is a problem that’s in people’s backyards.”

Eichorn offers the example of a woman she calls Jane. Jane is a 40-something well-adjusted woman with a college degree, solid work history and a family. Jane was in a motor vehicle accident and had terrible pain. She was put on pain medication, which affected her performance at work. Eventually, she was laid off from her job, lost her insurance and could no longer afford the medication. So she started using heroin because it was the only thing she could afford that made the pain bearable. 

“That’s actually a case that happened here and it was heartbreaking,” Eichorn says.

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IT ALL BEGINS WITH PAIN

Heroin addiction stretches across the full socioeconomic spectrum. It’s a problem in the inner city, to be sure, but its impact is felt in small working-class towns and sprawling suburbs, too. Addiction doesn’t discriminate, it’s not particularly picky and it almost always begins with physical pain. A twist, a tear, a sprain, a strain. An operation. A work accident. A car accident. A prescription for 30 Oxycontin—enough to help manage the discomfort, enough to get a patient over the hump. 

However, when the little orange container runs out and reality sets in, we really miss those pills. Some of us a lot more than others. How one deals with that need can alter the course of a life, a family, a career. 

The first call is typically to the doctor to renew the prescription. Most physicians have become hyper-aware of the addiction risks, and also that they are at the fulcrum of a growing problem. A Los Angeles doctor was recently convicted of murder and sentenced to 30 years after three of her patients overdosed. No physician wants to swap a lab coat for an orange jumpsuit. So they prudently move patients to a less-addictive option. Alas, the warm, fuzzy high isn’t there and sometimes those patients look for pills in other places. On the street, of course, there’s no copay plan. Each pill costs $25 or more. For someone accustomed to gobbling a half-dozen a day, that works out to thousands a month. Some stick with that model until their bank accounts and 401k’s are drained. Or until the shut-off notices start piling up. Others sell their possesions, however and wherever they can. In the end, though, addiction usually boils down to a matter of dollars and cents: How can I achieve my next high for as little as possible? It’s all about today. Tomorrow matters less and less the deeper a person tumbles into addiction.

This is where heroin typically enters the picture. Oxycontin and other prescription opioids are basically pharmaceutical spins on heroin. Heroin may not be as neat or as clean or as “safe” as pills, but with heroin an addict can stay afloat all day for the same cost as a single street-purchased Oxy. And heroin is available everywhere. Take a look at your local police blotter and see where the arrests are taking place. In office buildings. At shopping malls. Outside convenience stores and fast-food joints. The places you already go every day.

A VORACIOUS ANIMAL

Sadly, people overdose and die from painkillers every day. It is a growing problem. Heroin, however, is an entirely different animal, and lately it’s been voracious. According to the Centers for Disease Control and Prevention, since 2010 overdose deaths among heroin users have tripled in the United States. About 1 in 50 addicts will die of an overdose. In New Jersey, the problem is far worse—at least three times worse, in fact. This year, heroin overdoses will kill more New Jerseyans than automobile accidents, homicide, suicide or AIDS. What that number will be—700, 800, 1,000, more—is anyone’s guess. But it will be a big number.

Michele Eichorn, Addiction Therapist

What is being done about this problem? First off, it’s not really a law enforcement issue. Heroin is so widely available in New Jersey that arresting dealers is like playing a carnival Whack-a-Mole game. Smash one down and another pops up immediately. Doctors have become more vigilant about over-prescribing and monitoring their patients’ use/abuse of painkillers, which certainly can stop a problem before it starts. However, there is some thought that closing down pill mills and, in general, being more judicious about refilling prescriptions simply drives more people underground for their drugs, and ultimately into the arms of a heroin dealer. Also, in terms of the overdose epidemic, the availability of the life-saving drug Naloxone may actually embolden heroin users, who regard it as a sort of get-out-of-jail-free card, often with deadly results.

So we are left to deal with addiction in emergency rooms, in rehabilitation facilities, in jails and in the morgue. 

ON THE FRONT LINES

Trinitas has been a leader in the field of treating addiction, initially with its Substance Abuse Services Department and, beginning in 2014, with its Hospitalwide Screening for Substance Use Disorders project. Now every adult patient who is medically admitted to the hospital—regardless of how they present—sits down with a nurse and has a conversation about alcohol and drug use, during which an Alcohol Use Disorders Identification Test (AUDIT) is administered and scored on a scale of 1 to 10. Some of these patients arrive at Trinitas through the ER with drug- or alcohol-related injuries, while others come to the hospital for scheduled procedures, such as removal of a gall bladder or foot surgery. Regardless of what brings them to Trinitas, when patients score an 8, 9 or 10, Michele Eichorn’s team is called in.

“At that point, we do a brief intervention using a technique called motivational interviewing,” she explains. “We have an honest conversation with the patient and really listen. If the person is agreeable, we’ll refer them to treatment and come up with a plan quickly, usually within a matter of hours, or at most a couple of days. It’s a very short window. And in order to ensure that people really are getting to treatment, we have a team of people—an addiction specialist who encourages them, a case manager who conducts outreach and helps people get into programs, and a therapist who is available to work with the individuals.”

Eichorn, who holds a masters degree in Social Work from Columbia University, initially became interested in the field of substance abuse while serving in the Army. She worked with veterans’ drug and alcohol issues and later did an internship at the National Institute of Addiction and Substance Abuse. Eichorn’s research showed that substance abuse as a whole was growing. She saw a challenge and wanted to be on the front lines. When she first arrived at Trinitas, she ran a program for drug-addicted mothers and pregnant women.

During the two short years the Hospitalwide Screening for Substance Use Disorders project has been up and running, between seven and 14 patients a month have been plucked out of the patient population and placed into drug or alcohol treatment. In the years prior, less than two percent of the patients for whom Trinitas counselors recommended treatment actually went. The project has already established itself as a difference-maker, Eichorn believes. 

50–50

On the drug-addiction front, perhaps the most eye-opening number to come out of the Trinitas project is the breakout of alcoholism referrals vs. drug referrals: “What we noticed immediately was that, among the patients our team saw, there was a 50-50 split between chronic alcoholism and serious drug addiction,” Eichorn says. “That includes heroin and other opioids, medications like Xanax, and so-called club drugs. A number of people fell into both groups.”

While the Hospitalwide Screening for Substance Use Disorders project can help heroin users get into the in-patient rehab programs they need, the lack of detox beds available can mean addicts may have to wait two months to start. That delay often has tragic consequences.

“The demand for treatment has increased so much that now folks are literally dying on the waiting list,” Eichorn confirms. “The problem we face is related to the availability of heroin. People are overdosing while they are waiting to get into programs. We know we may only have one shot to engage these people and get them into treatment.”

What stands out the most among the heroin users she sees?

“I’m a therapist so that’s what I can talk about,” Eichorn says. “What I will say is that many patients report that they have trauma in their background. And they have never been part of what we think of as ‘heroin culture’—communities where people are just hanging out and drugs are rampant. A lot of the individuals we see just don’t fit that profile at all. Something unfortunate happened and suddenly they are in this terrible, heartbreaking situation.”  EDGE

Editor’s Note: The Hospitalwide Screening for Substance Use Disorders project is funded by Medicaid’s Delivery System Reform Incentive Payment (DSRIP) program. Michele Eichorn LCSW, LCADC was a recipient of the 2015 Lester Z. Lieberman Award for Humanism in Healthcare from the Healthcare Foundation of New Jersey. She says if she could change two things about the current substance-abuse landscape it would be to make therapy services more readily available to a larger percentage of people, and to reduce the stigma attached to seeking help for substance abuse. “Rather than dealing with people in desperate situations, we could be dealing with them much earlier.”

The Gift That Keeps On Giving

Spring initiative highlights organ donation.

By Caleb MacLean

On any given day, more than 120,000 people in America are waiting for an organ transplant. On average, 22 people a day die for lack of a donated organ. There are currently more than 5,000 New Jerseyans on various transplant lists. How this precious material gets from donors to recipients is a mystery to most people. That is where groups like NJ Sharing Network come in.   

NJ Sharing Network is a non-profit, federally designated organ procurement organization. It was formed three decades ago at about the same time the government passed legislation that required hospitals to present the option of donation to families of potential donors. Since then, organ donation has quadrupled in New Jersey, saving, extending or restoring countless thousands of lives. NJ Sharing Network coordinates the efforts of hospitals, transplant centers, medical examiners and funeral directors, as well as increasing public awareness through education and media outreach. The organization will be particularly busy this April, during National Donate Life Month. Schools, community groups, businesses, elected officials and, of course, hospitals around the country will be demonstrating their support of organ and tissue donation, and encouraging people to start talking about what they would do if a family member becomes a candidate for donation.

“Everyone needs to have the conversation with their family members about what they would do if they could give the gift of life,” says Jackie Lue Raia, Assistant Director of Resource Development for NJ Sharing Network. “The idea behind National Donate Life Month is to get the community talking about organ and tissue donation.”

In New Jersey, most people are exposed to the concept of donation through the Motor Vehicles donor registry; 34 percent say yes to donation on their driver’s licenses. However, at bedside, that number soars to more than 60 percent, which means there is room for immediate improvement. The need for greater participation is magnified by the fact that less than 1 percent of deaths can actually give the gift of life. A person must be in a hospital, on a ventilator—typically as the result of a stroke, heart attack, aneurysm or auto accident with a traumatic brain injury. 

Last year, NJ Sharing Network facilitated 531 transplants. According to Lue Raia, that made it the “best year ever.”

NJ Sharing Network operates a fully accredited, state-of-the-art transplant lab, which performs compatibility testing between donors and recipients, and also pre- and post-transplant evaluations—a critical component in assuring the success of transplants for hard-to-treat individuals. The lab handles compatibility determination for a number of regional hospitals, including Trinitas. The organization also has a Family Services division for donor families. 

According to Mary McTigue, RN, the VP of Patient Care Services at Trinitas, as well as Chief Nursing Officer, the professional relationship between the hospital and the Sharing Network is very strong. “Both staffs always work in close collaboration to ensure a caring and compassionate approach towards potential donors and their families,” she says. “The skill and expertise of the staff recognizes the sensitive needs of a potential donor family, as well as the drive for a successful outcome for the potential organ recipient.”

The engine that powers NJ Sharing Network is its robust corps of volunteers (above). They handle the outreach initiatives that educate the public about donation and transplantation by participating in events or civic groups, businesses, community centers and houses of worship. 

“If the community is more open to talking and being proactive, we would be able to save more lives,” says Lue Raia. “Particularly in the area of tissue donation, which encompasses procedures including bone grafts, ACL and rotator cuff repairs and breast reconstruction. Volunteers can speak at pubic events, facilitate programs at worksites, or work at hospitals. Each is highly trained and vetted, with a thorough background check. Anywhere we send our ambassadors, you’re getting the best of the best.”

What do NJ Sharing Network volunteers have in common?Most have a personal connection to the organization. Jackie Lue Raia herself was a “donor daughter.” Six years ago, she was driving back from Newark Liberty Airport with her mother and son when a tractor-trailer slammed into their car on the New Jersey Turnpike. Her mother suffered fatal injuries in the crash. Her organs and tissues ended up going to 43 people. Two years later, Lue Raia decided to meet the two kidney recipients (right). One was the same age as she was, the other the same age as her mom. Soon after, she noticed a job opening at NJ Sharing Network. Needless to say, her experience with organ and tissue donation has proved invaluable.

“In part because my mother had not made the decision to be an organ donor,” she explains. “We’d never had that conversation. The clock was running out and the siblings had to make a decision. That was my first encounter with NJ Sharing Network. A volunteer met with us and convinced us that this was something my mother would want to do.”  

Editor’s Note: On June 5 in New Providence, NJ Sharing Network is sponsoring a USATF certified 5K race. For more information on this event call (908) 514–1761. For info on NJ Sharing Network itself, log onto njsharingnetwork.org or call (800) 742–7365. Promotional materials and kits for National Donate Life Month can be downloaded from the web site.

 

Emotional Intelligence

No matter the variables, treating patients like family is part of the Trinitas equation. 

By Erik Slagle

When Martin Mintz went into cardiac arrest on September 30th, 2015, he was far from home and the hospitals he was familiar with. A 95-year-old resident of Brooklyn, Martin was visiting family in Elizabeth when the heart attack occurred. The responding paramedics administered the “Code Frosty” protocol—induced hypothermia that preserves brain function in patients following cardiac arrest—and rushed him to Trinitas. There, says his daughter Selena, he experienced a level of care and compassion that met or exceeded that of the most prestigious New York medical centers, making his stay in an unfamiliar hospital a little easier.

Martin, a Holocaust survivor, spent five years in a concentration camp in Poland. The Jewish faith is an indomitable trait of the Mintz family, and at a time of crisis they were able to find some solace in the hospital’s Bikur Cholim Room. Bikur Cholim is the Hebrew phrase for “visiting the sick,” and Martin’s family was impressed that Trinitas, a Catholic hospital, makes this accommodation available for Jewish families in need of support and a place to come together in prayer.

Beyond the spiritual support, Selena says the medical care her father received was equally outstanding.  “The doctors were thorough, attentive and caring,” she says. “The nursing staff was very helpful and calm as they went about their work. They made sure all the patients were comfortable. One of the nurses even offered to work with my father on her day off because she was so concerned about him.  Our family was so very impressed with the whole staff.”

Several of her father’s doctors, adds Selena, stand out for reasons that went beyond just their medical expertise. Dr. Maria Khazai of the Nephrology Department told her, “I’m taking care of him like that is my father in the bed.”  Selena appreciated the candor of cardiovascular specialist Dr. Mehrewan Joshi in assessing Martin’s condition. Along with Drs. Arthur Millman, Clark Scherer, Ying Tao, and Michael Chen—and ICU Director Dr. Michael Brescia—they formed

a team of constant support. Selena also singles out Dr. Leon Pirak for the attention and assistance he provided during Martin’s care.

“Dr. Pirak was simply unbelievable,” she says. “He oversaw everything and ensured that our family always got answers to our questions, and were always fully aware of what was happening.  We were able to discuss everything with him and make sure all aspects of my father’s care were being addressed. Everyone here is an advocate for family members—they constantly check to see how they are doing, if there’s anything they need, down to little details like a cup of coffee to pick someone up. Everyone we came into contact with at Trinitas was simply wonderful.”

Martin passed away later that autumn, but Selena says it was a comfort knowing he was so well cared for in his final days. The doctors, nurses and staff at Trinitas made every effort to give care—“beyond what we had seen when my father was admitted to other hospitals in Brooklyn and New York City.” 

“My father was treated with great dignity and humanity,” she says. “We’re very grateful to Trinitas for the way he was tended to and the care he was given.”