Defending Your Life

10 Ways to Live Longer (and Better)

You may be one of the 47% who “doesn’t pay taxes,” but that other inevitability—death—is a little harder to sidestep. Indeed, sooner or later the predator time catches us all. The trick, of course, is to push “later” as far forward as possible. We do this by eating well, exercising and not smoking. At least, that is what we are told to do. The reality is quite different. According to the CDC, one third of our population qualifies as obese, and a Duke University study projects a rise to 42% by 2030—adding $550 billion to national healthcare obligations. With obesity running rampant through America, some of us actually breathe a sigh of relief that we are merely “overweight.” Meanwhile, we spend billions on exercise equipment that gathers more dust than sweat, gym memberships that can’t be cancelled, and workout wardrobes that still have their tags on—more than $70 billion a year, according to the Sporting Goods Manufacturers Association. And although we have come a long way from idolizing the Marlboro Man and athletes sponsored by Virginia Slims, smoking is actually on the rise among women and teens. We all know what to do. So why aren’t we doing it? What is it that triggers yo-yo dieting, couch potato-ing, and closet smoking? We all want to live longer…so why are we so bad at it? In many cases, it turns out, the prospect of making major life changes is so daunting or dispiriting that folks unconsciously have given up before they even begin; one bump in the road and they revert back to bad habits. A successful outcome is far more likely if you take on small, achievable challenges and fold them into your current lifestyle. In that spirit, we’ve identified 10 smart ways to keep you going strong:

1 DRINK UP The Mayo Clinic has adjusted the longstanding “8 by 8” rule (eight 8-ounce glasses of water daily) to include any healthy fluids. And a Loma Linda University study indicates that as little as 5-8 ounces daily can be helpful.

2 SWEET SURRENDER According to a 15-year study conducted by Dutch researchers, eating about 4 grams of cocoa a day could cut your risk of heart disease. Dark chocolate with a high cocoa content is ideal.

3 LAUGHTER IS THE BEST MEDICINE According to a study by Dr. Michael Miller at the University of Maryland, laughter can reduce blood pressure, lower cholesterol and improve blood flow to the heart by as much as 50%. Start DVR-ing The Colbert Report!

4 ACID TEST The International Journal of Cardiology tells us that chronic heartburn can lead to a heart attack. A high acid level in the esophagus, when untreated, can decrease blood flow to the heart by 20%. According to a CNN report last year, if you suffer from heartburn you might try sleeping on your side to reduce acid reflux.

5 CATCH SOME Zs According to the CDC, 41 million Americans don’t get enough sleep, with consequences ranging from a higher risk of diabetes to depression to slower reaction time in emergencies. How much sleep is right for you? The next time you have a totally free weekend—or better yet, a vacation—go to bed when you’re tired and wake up when you want. If you get through the day without feeling tired, that’s probably your “sleep number.”

6 CURRY FLAVOR Rutgers University scientists have determined that combining curry with cruciferous vegetables (cabbage, bok choi, turnips, broccoli, cauliflower) appears to help ward off prostate cancer.

7 GO NUTS Loma Linda University researchers tracking the lifestyle habits of 34,000 Seventh-Day Adventists (a population famous for its longevity), discovered that those who munched on two ounces of nuts almost daily lived on average almost three years longer.

8 PERK UP Numerous studies have linked coffee drinking (often 2-3 cups per day) with a positive impact on diabetes, heart attacks and strokes—and even Parkinson’s and Alzheimer’s.

9 STAND UP FOR YOURSELF Whether in front of the TV, computer or anywhere, sitting for long periods at work or at home can be almost as risky as smoking or being obese, particularly for your heart. Dr. James Levine, a professor at the Mayo Clinic, suggests that even sitting for an hour straight is sitting too long.

10 THINK POSITIVE A Yale University study of older adults showed that those with a positive outlook on aging lived about seven years longer than those with less optimism.

Dr. Kevin Lukenda, who chairs the Family Medicine Department at Trinitas, also believes in keeping things simple. He advises his patients to live by the following 10 rules:

1 Reduce stress by not taking anything too seriously.

2 Set aside quality time with friends and family; share your feelings, thoughts and fears with them.

3 Do something selfish and productive for 15 minutes every day.

3a Do something selfish and productive for one hour once a week.

4 Read a book, magazine, newspaper—anything.

5 Do nothing to the extreme.

6 Keep your carbs to a minimum.

7 Get enough sleep!

8 Life is hard—be a strong person rather than asking for an easier life.

9 Take walks.

10 See your family doctor as needed. Regardless of which (or whose) nuggets of wisdom you follow, the good news is that you have a lot of interesting and attainable options. Still better news is that some of them you might even enjoy! The best news? All of these not only add up to living longer. They add up to living better.


Editor’s Note: Log onto for six more ambitious ways to improve and extend your life.

What’s Up, Doc?

News, views and insights on maintaining a healthy edge.      

Pumped Up Patches Drug delivery via patch works for some medicines but not for others. That could change very soon, thanks to a device pioneered at the Birck Nanotechnology Center at Purdue University. A micro-pump containing small amounts of yeast and sugar has been built into drug patches. The micro-pump is 1.5 centimeters long and uses water activated by body heat to begin a fermentation process that releases tiny amounts of carbon dioxide gas. The gas then powers the pump continually for several hours. The greatest impact of this device would probably be in powering micro-needle arrays used to deliver cancer and autoimmune drugs. These drugs involve molecules too large to be delivered through the skin with traditional patches. The new technology differs from other micro-pumps on the market because it does not use a battery.

Don’t Just Sit There! Thanks to a new study out of Australia, you can add one more thing to the list of long-term health no-no’s that includes smoking, drinking, lack of exercise and a high-fat diet: Sitting. Research by the Sax Institute of adults 45 and over found that those who sat for 11 or more hours a day had a 40% higher risk of dying within the next three years than people who sat less than four hours a day. The study adjusted for an array of other lifestyle and medical issues, but even for those who exercised regularly, the risk of death still rose with every additional hour spent in a chair.

New Road Map for Families of Teen Diabetics For many parents, coping day-to-day with their teenagers is the most difficult, aggravating and exhausting phase of the child-rearing process. For parents of teens with Type 1 Diabetes, managing the disease and the young man or woman can prove next to impossible. The Eunice Kennedy Shriver National Institute of Child Health and Human Development recently provided a road map that families should find helpful. Their findings suggest that kids between ages 12 and 15 with Type 1 Diabetes benefitted dramatically from a two-year program (of three to four meetings a year) with parents and a health advisor to discuss shared responsibilities, goals and strategies for solving diabetes management problems that arose. Meeting with a health advisor during regular diabetes clinic visits, researchers reported, helped families better manage the changes that occur as children take on more responsibility for their day-to-day diabetes care.

Impact of the NYC Soda Ban The announcement of an impending ban in New York City on large, sugary drinks has prompted many people—both inside and outside of the medical profession—to chime in on what, if any, effects this will have on overall health. Obviously, gulping down quarts of soda, energy drinks and sweetened teas a week is not a smart idea. But will shaving a few ounces off this total make a difference? The consensus thus far is that it will—but only a small difference. Obesity is a complex disease, involving a lot of variables. That being said, if the “soda ban” pushes forward the national discussion about the dangers of consuming too much sugar—and overeating in general—it could have a significant impact. Lifestyle changes are often triggered by cultural changes; if the culture of junk-food consumption is altered through publicity and awareness that begins in New York, we may look back on this law as a true game-changer.

Genetic Connection to Blindness More than 15 million people around the world suffer from blindness brought on by Primary Angle Closure Glaucoma (PACG). The problem is especially pronounced among Asian populations, which account for about 12 million of these cases. A collaborative international research effort launched in Singapore recently identified three previously unknown genes associated with PACG. The medical community has long suspected the disease to be strongly hereditary, but these findings—published in the journal Nature Genetics—confirm the fact. This opens the door to possibilities of novel treatments, as well as the potential of early identification of people at risk for PACG. “These data are the first critical steps toward a better understanding of the underlying molecular events responsible for this blinding disease,” explains Dr. Janey Wiggs, Professor of Ophthalmology at Harvard Medical School.

New Study on Job Stress When Johnny Paycheck recorded the country hit “Take This Job and Shove It” back in the 1970s, it turns out he was way ahead of his time. Doctors in England recently completed a study that shows workers who feel over-pressured yet powerless run a risk of coronary disease that is 23% greater than those who are content in their work environment. The study covered around 200,000 workers in a wide range of occupations, from civil servants to factory workers. Subjects were asked about the type of work they did, the workload, deadlines and freedom to make decisions.

EQ vs. IQ

Which Gray Matter Matters Most?

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Think of the smartest person you know. Now ask yourself: Is that person successful? Is that person happy? Stop right there. The two are not necessarily the same thing. A robust IQ may look good on paper, but there is a new way of measuring abilities called the Emotional Quotient (EQ)—or, more specifically, Emotional Intelligence (EI)—which is proving to be a more accurate predictor of your potential for a happy and successful life. Emotional intelligence is best defined as a set of life skills. It’s the ability to handle challenging situations by managing your own emotions, and the emotions of those around you.

These skills can improve not only your personal life, but your work environment as well. On a corporate level, companies that have implemented emotional intelligence training have noticed an increase in production and profits. Schools that have incorporated emotional intelligence into their curricula have reported improvement in grades and test scores. A person with high emotional intelligence and an average IQ has a greater chance of flourishing—both personally and professionally—than a person who possesses a high IQ with low emotional intelligence. Emotional intelligence is a relatively new term. But it’s been around for as long as humankind has existed. In the 19th century, we called it “horse sense” and in the 20th century, “street smarts.” It was how we described individuals able to manage themselves in new or stressful situations, who demonstrated the kind of level-headedness that led to successful decision-making. It was all about understanding your own emotions as well as someone else’s, and governing yourself accordingly.

In the 1980s and 1990s, researchers began to look at emotional intelligence with a more scientific eye. Right away, there were some distinguishing characteristics. For instance, with IQ, there is a standardized test that measures your cognitive abilities. You either have a high IQ, or you don’t, and it’s going to be about the same at age 15 and age 50. Emotional intelligence, on the other hand, is a part of your reasoning capabilities, and these can be learned; you don’t necessarily have to have been born with a high EQ. Here’s another eye-opening tidbit. When your parents told you to stop watching TV and read a book—or go outside and play—to keep your brain from turning to mush, they actually were right. With use, the brain is forming and expanding. This is called neuroplasticity. Neuroplasticity describes the brain’s ability to change by forming new connective tissue. A single cell can grow 15,000 new connections. The area of the brain that deals with our emotions, the amygdala, expands when our EQ improves, by forming new axons (connections). The amygdala is the brain’s center for emotional memory, emotional reactivity, and helps us be resilient when dealing with emotional distress. Emotional intelligence requires effective communication between the emotional and the rational centers of the brain. So, the higher our EQ becomes, the more connective tissue is formed, giving us an improved brain. 

THERE’S A TEST FOR THAT Is there an emotional intelligence test? Yes, but only a handful have been proofed with extensive research and accepted by the Consortium for Research on Emotional Intelligence in Organizations (CREIO). Reuven Bar-On, Ph.D., a clinical psychologist and a leading pioneer in the field of emotional intelligence, developed the EQ-I (Emotional Quotient Inventory) test after 18 years of research. The test was published in 1997 and was the first accepted measurement of emotional intelligence. It has been distributed worldwide in 30 different languages, and covers five different scales of EQ:

  • Intrapersonal (self-awareness and self-expression)
  • Interpersonal (social awareness and interpersonal-relationship)
  • Stress Management (emotional management and regulation)
  • Adaptability (change management)
  • General Mood (self-motivation)

Another highly accepted test is the Mayer-Salovey- Caruso Emotional Intelligence Test (MSCEIT 2.0). This test went through a grueling evaluation process, with detractors expressing concern about the viability of standardizing what is a right or wrong response when dealing with emotions. After much point and counterpoint, the MSCEIT emerged as another highly valued and widely employed test. It measures the four branches of EI based on the John C. Mayer and Peter Salovey model:

  • Perceiving emotions
  • Using emotions to facilitate thought
  • Understanding emotions
  • Managing emotions

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EQ IN THE WORKPLACE Most EQ tests take anywhere from 30-45 minutes to complete. Because a higher EQ has been shown to not only increase your mental health by lowering stress (which can lead to anxiety, depression and physical problems), but also your relationships and performance in a complex work environment—the place you are most likely to encounter an EQ test is in the workplace, or at least when applying for a job. Indeed, many companies have now incorporated emotional intelligence training into their practices, with spectacular results. Typically, they report anywhere from 55% to 70% improvement in both individual and corporate production. Emotional intelligence has also become a key factor in differentiating a mediocre business leader or manager from a highly effective one. The ability to understand the moods and behavior of employees—coupled with the management of the leader’s own emotions when dealing with stressful situations—leads to better interactions with co-workers.

This results in a more approachable team leader who is more readily available, who can maintain emotional flexibility to positively direct the energies of others, and who creates a more conducive work environment. This translates into greater trust and respect for the leader. Conversely, the lack of emotional intelligence may help explain why really smart people do really dumb things that end up ruining their careers. In his paper Bringing Emotional Intelligence to the Workplace, Daniel Goleman, Ph.D., writes that unlike “the brilliant executive who does everything well except get along with other people, or the technically gifted manager who can’t handle stress and whose career falters,” leaders with good emotional intelligence tend to advance more successfully in their field and remain happier throughout the process. “The super salesperson whose ability to sense what is most important to the clients and to develop a trusting relationship with them, or the service employee who is excellent in dealing with irate customers by helping to calm, and diffuse the situation,” are two examples of how emotional intelligence is used in the work environment with positive results.

IQ may get you in the door, but EQ will help you manage the stress and emotions of the job. Indeed, what research is available on the subject suggests that the higher one advances in an organization, the more important EQ becomes—with EQ skills accounting for 90 percent of what separates good leaders from average ones. For the record, Goleman is probably the most famous of the emotional intelligence experts. He has published numerous books and papers on EI. The most popular book, Emotional Intelligence, was written in 1995 and sold over 5,000,000 copies worldwide in 40 different languages. His second book, Working with Emotional Intelligence, deals with EI in the business world. 

GIRLS RULE? In terms of basic skills for leading a happy and successful life, almost every test for EQ finds that women have an edge over men. However, Goleman warns, “It’s not that simple.” Keep in mind that these tests have a basic four-part scale: self-awareness, managing emotions, empathy, and social skills. In response to a blog posted in 2011, “Are women more emotionally intelligent than men?”, Goleman answered, “Yes, and yes and no.” Women, on average, are better at some forms of empathy, while men are better at managing distressing emotions. Yet, as Goleman points out, “There are two very different and distinct Bell Curves that lead to an overlap where it can switch.” He explains further, “There are three different kinds of empathy: cognitive empathy (being able to know how another person sees things); emotional empathy (feeling what the other person feels); and empathic concern or sympathy (being ready to help someone in need).” Goleman maintains that women tend to be better at emotional empathy, which fosters rapport and chemistry with others. For example, if another person is upset, a woman can stay with the feelings of distress for a longer period of time than a man.

A man will sense the feeling for a moment, then tune out the emotions and switch to an area of his brain that will try to solve the problem at hand. The part of the brain that registers empathy is called the insula. Neuroscientists tell us that, when we empathize with someone, our brain mimics what that person is feeling, and the insula reads that pattern and tells us what that feeling is. So, when a man’s brain clicks into tune-out mode, he’s no longer using the insula; he’s switched to another part of the brain. This helps him to stay calm while everyone else is in high emotional distress, enabling him to focus on finding a solution. Conversely, a woman’s tendency to stay in-tune with an emotionally upsetting situation helps her to nurture and support others. “So, one is not better than the other, just different,” Goleman concludes. Tune in, tune out—it’s a brain difference. Since women do tend to score higher than men on the empathy card, they have the edge when it comes to the work environment. However, as psychologist Ruth Malloy of the Haygroup Boston (which studies business leaders) says, “When it comes to top leaders in business, gender differences in emotional intelligence level out.” The men are as good as the women and the women are as good as the men.”

Editor‘s Note: J.M. Stewart’s other contribution to this issue—her interview with Sandra Oh—actually started with a discussion with the actress about the subject of EQ. Oh is not a big fan of media, but is passionate on this particular subject. You can read an extended version of EQ vs. IQ—including a look at how educators view the subject—at


Joint Decision

When Is Replacement Surgery the Right Call?

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According to the American Academy of Orthopedic Surgeons, over 500,000 total knee replacements are performed each year. In addition, close to 300,000 total hip replacements are performed annually. As a physical therapist, I am often asked about total joint replacements. Many individuals are not sure if they are candidates for a replacement; some are concerned about what they have to do in order to regain function after the operation, while others are a bit nervous about the operation itself—and the potential of pain and how it will impact their lives. My answer is that in the past 50 years, refined operative techniques, advancements in total joint component design and enhanced rehabilitative techniques have totally changed the game in rehabilitative medicine. We can get a person moving again without the arthritic pain that many people experience for years prior to their joint replacement.

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Decisions, Decisions As we age, everyone seems to have an ache or a pain someplace. Changes in the surfaces of our joints—with osteoarthritis being the most prevalent cause—are a major source of pain for many people. While some individuals can work through the pain and not have it affect their daily lives, others experience pain that limits everyday functions to a point where it is difficult for them to take care of themselves. Also, many of us—especially those of the baby boomer generation—want to continue very active lifestyles, which the arthritis in their joints makes difficult to do. When does the discussion about joint replacement begin? A family physician will typically conduct a physical exam, do blood tests and take x-rays to determine the cause of joint pain. Once it is established that the joint surfaces are the likely source of the pain, patients are referred to an orthopedist, who can determine whether or not total joint replacement is warranted. Surgery is not a foregone conclusion at this point. On the contrary, an orthopedist often will refer patients to physical therapy in order to determine if maximizing muscle function can decrease pain to a point where one can manage discomfort and lead an active life without undergoing an operation. Some do gain enough pain relief and are able to return to a level of function without a joint replacement. Others—even those in good shape, muscle function-wise—still find the pain and loss of movement at a level that leads them to explore the possibility of a total joint replacement. By the way, as a physical therapist, I believe all these patients are in a better place than they were before. For those who do decide to go down the path of joint replacement, they are in much better shape heading into the surgery than they would have been without this period of physical therapy.

Walking the Walk How long before a patient can go home after surgery? The national average for total joint replacement patients’ stay in the hospital is approximately four days, depending on the type of surgery, age of the patient and any other medical conditions a person may have. However, both total-hip and total-knee patients are up and walking immediately—in some cases starting the afternoon of their surgery!

From there, physical and occupational therapists provide the skills and encouragement necessary to achieve early, major gains in function. While patients experience normal postoperative discomfort, most notice that the pain they had before the operation is almost gone. The reason for this is simple—the source of that pain (the roughed surfaces of bone in the joint) is now gone. Pain reduction, new methods of non-narcotic pain control, early movement and function are all the hallmarks of today’s modern total joint replacement experience. We have indeed come a long way. After discharge from the hospital, whether one goes to a sub-acute rehab center or home with homecare, the real work begins. I have found that those patients who really push themselves in their rehab routine at home—and later, when they start their outpatient program—are the ones who achieve the greatest success. Unfortunately, our society still has a bit of a passive approach to healthcare; many still just want to swallow a pill and move on with their lives. Not so with total joint replacements. These patients are fully engaged in their own treatment and progress. Persons with total joint replacements find themselves doing more with each passing day, experiencing less pain than they ever thought possible.  

Editor’s Note: Jim Dunleavy is the Director of Physical Therapy and Rehabilitation for Trinitas Regional Medical Center.


What’s Up, Doc?

News, views and insights on maintaining a healthy edge.

A Shift in Workplace Health A meta-analysis of studies covering more than two million people shows that people who do shift work have a 23% greater risk of heart attack—and a 5% increase in risk of stroke—than those who work other types of jobs. The group that conducted the research at the Stroke Prevention and Atherosclerosis Research Centre in Ontario, Canada, believes their findings have profound implications for public policy and occupational medicine. Shift work disrupts the body clock (aka circadian rhythm) and is associated with an increased risk of high blood pressure, high cholesterol and diabetes. However, this is the first time its link to vascular disease has been established. Shift work is defined as evening shifts, irregular or unspecified shifts, mixed schedules, night shifts and rotating shifts; and workers who pull a “normal” 9 to 5 work day were used as the control group.


 The Ankle Bone’s Connected to the…What? That broken ankle may lead to bigger problems. So say researchers at Texas Tech, who recently established a link between ankle injuries and life-threatening complications, including deep vein thrombosis and pulmonary embolisms. The study suggested that treating physicians should assess patients with ankle fracture for their risk of developing a venous thromboembolic event on an individual basis, and also provide thromboprophylaxis (prevention of thrombosis) for those with an increased risk of developing such complications.


Let’s Do (it at) Lunch As a rule, people don’t mind paying the tab to achieve healthy, beautiful skin. Finding the time to make it happen is often the greater obstacle. According to plastic surgeon Dr. Joseph D. Alkon, there are a number of non-invasive, “lunchtime” treatments that can make your skin look and feel its best. “A chemical peel helps those with dry skin, uneven tone, acne, discoloration and/or mild wrinkles,” Dr. Alkon says. “This office-based procedure uses a special liquid to remove the harsh outer layers of skin, while leaving smoother and healthier layers intact. Peels vary from mild to aggressive depending on the skin being treated.” Microdermabrasion also works to remove unhealthy, dry, flaky outer skin, he adds. This procedure uses a gentle tool or wand to remove the outer layers of skin. This leaves behind fresh, healthy skin. Although commonly performed on the face, other body parts can benefit from both chemical peels and microdermabrasion. “A facial is another popular, relaxing and rejuvenating service,” Dr. Alkon says. “It’s often performed by a licensed esthetician, and includes a skin analysis followed by customized exfoliation, extraction, massage, and application of toners, moisturizers, and sunscreens customized to your skin type. A facial can leave the skin clean, clear, hydrated, and rejuvenated.”    

New Alzheimer’s Drug May Be on Horizon The medical profession has accepted the fact that there is no “cure” for Alzheimer’s. However, a trial just concluded found that patients who had injections every two weeks of the drug immunoglobulin—made from antibodies in human blood—showed no decline in cognition, memory, daily functioning or mood for a period of three years. Immunoglobulin is normally given to patients who suffer from an immune deficiency, and is extremely costly. If all goes well, however, the drug would be on the market within 10 years. “This is probably the most exciting drug we know about that is currently in the late stages of research,” says Clive Ballard, Director of Research at the Alzheimer’s Society. “We now know it is safe. But the real test will be whether these initial promising results can subsequently be replicated in larger groups.” As life spans increase, the likelihood that a person over the age of 65 will develop some form of dementia is about one in three. Currently, there are only three drugs for Alzheimer’s in the early to moderate stages, and they are effective in some patients but not in others.


Smile and Say “Aaaaaah” Do you experience nausea, bloating, heartburn, constipation, or a feeling of fullness? These may be symptoms of a motility disorder, such as gastroparesis and chronic constipation. Gastropathy is a common condition in long standing diabetic people, especially if not well controlled. People with gastropathy can suffer from postprandial indigestion, abdominal discomfort, nausea, and vomiting. Fortunately, the guesswork has been removed from diagnosis of these conditions thanks to the SmartPill, a wireless motility capsule procedure. “The SmartPill capsule travels through your GI tract, collects data, which is then recorded for your doctor to evaluate,” explains Samiappan Muthusamy M.D. of the Center for Digestive Diseases (, which offers this state-of-the art procedure. According to Dr. Muthusamy, the SmartPill can also diagnose Diffuse Colonic Dysfunction (aka lack of colon motility), an extremely serious condition that can present as constipation. Of course, causes such as a poor diet, lack of fluids, sluggish thyroid, colon cancer and constipating medications are ruled out first. “In modern medicine,” adds Dr. Muthusamy, “living with gastropathy and constipation is a thing of the past. They are treatable.”


UGNJ Strikes Gold The Urology Group of New Jersey (UGNJ) recently earned The Joint Commission’s Gold Seal of Approval for its continuous standards of healthcare quality and safety in ambulatory care. By receiving this accreditation award, UGNJ is now the only Urology physician practice in the nation to achieve this status. Recognition followed a rigorous unannounced on-site survey of all 12 UGNJ offices in March 2012 by a team of expert surveyors, who evaluated the group’s standards of care specific to the needs of patients—including prevention of infection, leadership and medication management. “Achieving accreditation from The Joint Commission is a team effort that will bring confidence to our patients and give us a framework to provide the best care possible,” says Dr. Alan Krieger, UGNJ’s President.


Mapping Menopause A study published in July by the Endocrine Society suggests that the primary barrier to women receiving hormone therapy to treat menopausal symptoms is patients’ fears about the risks, and their unwillingness to discuss the option. What is interesting about this study is that it was conducted with internal medicine, family practice and OB/GYN physicians—and not patients. “Nearly every physician participating in the survey said menopausal symptoms have a negative impact on quality of life,” says William F. Young, Jr., MD, president of The Endocrine Society. “It’s important for a woman to know what hormonal and non-hormonal treatment options may be best for them to provide symptom relief.” To that end, the Society has created what it calls the Menopause Map, an online interactive tool that guides a woman through the different options available to get relief from her symptoms. The map uses a series of prompting questions about those symptoms and her personal health history, and also has links to questionnaires that help assess current risk for breast cancer, heart disease, and stroke. The tool weighs hormonal and non-hormonal therapies against the risks based on individual symptoms and medical history. The url is


Regarding Henry

As one patient learned the hard way, time does not heal all wounds.

Henry Schroeding, a 66-year old Delaware resident, was one of the more than five million Americans who deal with chronic, non-healing wounds. He tried self-treating a leg injury he incurred in the summer of 2009, employing over-the counter remedies for about 6 months. But the infection only became worse. Schroeding then opted for professional help at two reputable wound care centers in Delaware, where he underwent various treatments, including a vascular closing and a skin graft—unfortunately without much permanent improvement. In fact, a trip to the beach the following summer resulted in the wound festering still further into a situation so serious that it could easily have become limb-threatening. Out of sheer frustration and in near panic, Schroeding resorted to doing his own research on the Internet and identified two out-of-state hospitals with highly renowned wound care centers: Johns Hopkins in Baltimore and Trinitas Regional Medical Center in Elizabeth. The Hopkins website cited a 60-70% heal rate, whereas Trinitas claimed more than 90% overall. That made the choice easy.

Within two days of his initial phone call (and much to his pleasant surprise), Schroeding had an appointment at The Center for Wound Healing & Hyperbaric Medicine at Trinitas. His attending physician was Dr. Morteza Khaladj, DPM, FACPPM, Chief of Podiatry and Director of the Podiatric Surgical Residency program at Trinitas since 2006. Dr. Khaladj assured Schroeding that the Wound Center, which opened in 1997, is acknowledged to be one of the finest in the country, having received the Robert Warriner III, MD, “Center of Excellence” award from Diversified Clinical Services (DCS) in recognition of its excellent clinical results and its record for successful healing outcomes and overall patient satisfaction.

Dr. Khaladj attributes the center’s high ranking to its ongoing research, its challenging residency program, and its internal product testing and evaluation system. “That’s what keeps Trinitas in the vanguard of healing centers,” he says. The Trinitas Wound Center specializes in treatment of very serious and chronic wounds, many of which have undergone failed treatments elsewhere. It offers therapeutic treatments using three of the latest wound technologies: • Hyperbaric Oxygen Therapy or HBOT: administered typically to patients presenting with non-healing wounds from conditions such as gangrene, carbon monoxide poisoning or unsuccessful skin grafts. This involves placing the patient in a special chamber that delivers a healing 100% oxygen-rich environment through the bloodstream to the wound. • Apligraf Living Skin Device: utilizes a biological dressing produced under laboratory conditions that was first used in New Jersey at Trinitas, bringing relief to many patients suffering from limb-threatening venous leg ulcers and other types of hard-to-heal wounds. • Vacuum Assisted Closure (VAC): exerts controlled negative pressure, which helps to remove infectious material and promotes the growth of new blood vessels in preparation for successful grafting. Each patient is different, of course, but when pressed for an average healing time statistic at the Trinitas Wound Center, Dr. Khaladj indicated it typically might range from 4-6 weeks up to 2-3 months.

He affirmed that any individual suffering with a wound that shows no improvement within two weeks should be examined by a medical professional. For individuals with serious chronic conditions such as diabetes, any significant wound should be examined at least by a general practitioner as soon as possible. If the wound persists despite medical attention, then a wound treatment center should be consulted to benefit from their expertise and technologically advanced treatment alternatives. In Schroeding’s case the VAC therapy was determined to be the best treatment. After initial testing and final diagnostic assessment, he was admitted to Trinitas for a surgical procedure that involved removal of some affected muscle tissue. He continued to undergo weekly VAC treatments for the next 2 months. He also underwent a second skin graft, which this time was a total success.

Throughout his treatment, Schroeding did experience some pain, but at a level that was manageable with daily doses of aspirin and sometimes a more serious pain killer. Finally, after a total of almost 10 months of treatment, his wound was no more. As an overall assessment of his experience at the Trinitas Wound Center, Schroeding says that it was “way over 10 on a scale of 1 to 10”—and that his stay was the best time he ever spent in a hospital. “When I hit the call button, someone actually came right away. Amazing!” In short, although Trinitas was approximately 160 miles away, Schroeding gladly made the weekly 300-mile roundtrip that totaled more than 14,000 miles over his more than nine months of treatment. Dr. Khaladj adds, “Through all of our ongoing research and successful patient treatments, we know what works and what doesn’t work.” That would account for the center’s heal rate of 98%…and Henry Schroeding’s response to the question How are you doing? “Terrific!”

EDGE Editor’s Note: Henry Schroeding was interviewed while undergoing his treatment. Both he and Dr. Khaladj can be seen on YouTube at watch?v=LfjrlDVbTwQ. For more information on the Trinitas Center for Wound Healing and Hyperbaric Medicine, call 908-994-5480 or

He Said: She Said

When relationships go from hopelessly devoted to just plain hopeless, it may be time to talk to a professional. Psychologists Dr. Rodger Goddard and Dr. Patricia Neary-Ludmer look at the ins and outs of Couples Therapy. 

Goddard: Marriage and long-term, committed relationships pose intense challenges. They are strained by drinking, infidelity, parenting differences, stress, overwork, house-chore inequality, unresolved fights, emotional wounds from one’s childhood, anger, abuse, financial stress, instigation from in-laws, drug use, grudges and many other problems. The divorce rate in the U.S. is extremely high—estimates range between 45 and 55 percent. If you were to factor in break-ups in other committed relationships, there would be no telling how high that number might climb.

Neary-Ludmer: In isolation—in other words, just the one-on-one aspect of a relationship—couples generally communicate and connect fairly well. Otherwise they would go their separate ways. However, once they commit to each other the challenge begins. I believe most couples know how to communicate. If there is a problem, it’s likely due to the external pressures of life.

Goddard: Good communication skills are definitely essential. Couples should strive to be each other’s best friend. They need to be able to talk things out, articulate their inner feelings, and share their stress, emotions and thoughts with each other. Too often the hyperactivity of modern life, work and responsibilities do not leave time for enjoying each other’s company. Laundry needs to be washed, dinners served, children chauffeured, floors cleaned, shopping done, homework finished and hundreds of other chores carried out before affection, intimacy, friendship and romance can take place.

Neary-Ludmer: A common error couples make is focusing on building a beautiful marriage and family life without securing and feeding the foundation. They characteristically will sacrifice themselves to make sure their children’s needs and wants are being met, often at the expense of their own relationship. They forget about the importance of balance. A child needs to have parents that are happy and healthy. Otherwise the family structure will begin to crumble.

Goddard: I call it BC and AD. BC (Before Children) a couple focuses on each other. AD (After Da Kids) presents new challenges. The connection between couples now becomes a triangle pointed downward with a focus on the children. The connection between the couple can suffer. A new and revitalized couple connection needs to be reestablished and strengthened.

Neary-Ludmer: In our practices we see challenges to marriage that are very difficult and often require clinical intervention. They include coping with infertility, raising children with special needs, various types of addictions, the loss of a child, mental illness, and caring for elderly or sick parents. All of these put incredible stress on a relationship. For instance, untreated substance abuse or mental illness can be very detrimental to a marriage and family. Often it leads to lies, disappointment, betrayals and financial ruin. It causes the healthy spouse—and the family—untold pain and suffering. If the impaired spouse is unwilling to address the problem it often leads to divorce.

Goddard: Couples therapy is often extremely useful. Infidelity is an issue that often necessitates couples therapy. I enjoy doing couples therapy because it can be very easy to get a couple to remember what they love about each other, and how to treat each other special. Couples therapy is extremely helpful because it can provide a referee who lays down the rules of the game. A good therapist calls fouls and levels the playing field into one that supports both parties. Job number one is establishing guidelines for good communication. Sports and life necessitate effective game rules (e.g., no hitting below the belt, no clips, bring-downs, take-downs, or offensive fouls). It is critical for couples to focus on the specific things that they want from each other in the present and future, and not on all those horrific things that the other person did to them five, ten and 15 years ago. Too often couples get into endless nobody-wins power struggles.

Neary-Ludmer: Arguing and shutting down creates a disconnect; communication breaks off and the relationship suffers. Reestablishing that connection opens communication back up. And that happens by showing compassion and love. I believe that time is key. Make time to connect, just as you might schedule a music or tutoring lesson for your child. And protect that time. I encourage “date night”—not to focus on problems, but rather to laugh and talk and rekindle. Words are not necessary. Go to the gym together, garden together. Communication will follow.

Goddard: Among the most common important relationship problems I find is that couples often hold onto resentments, grudges and irritations with an iron grip. Another is the frustration that people feel when their viewpoint or emotions are not recognized or affirmed. It seems incredibly easy for two grown-up people to figure out who should take out the garbage on what day. And yet they do not, because… “He just doesn’t understand all the things I do around here” or “She just doesn’t understand that I need to unwind when I get home” or “He doesn’t show me decent respect when he speaks to me” or “Everything is a criticism from her” or “He is never available” …and on and on. Of course, these things need to be resolved. But a critical ingredient involves the other person feeling that their emotions, thoughts or desires are being understood. It is almost a primary motivation of ours to feel understood. When this need is not satisfied, bad things tend to follow.

Neary-Ludmer: Building a life together in today’s times requires hard work and discipline. It becomes quite the challenge to find time and energy for each other. And that work should really begin before committing to a long-term partnership. Ask yourself if you are being realistic about your relationship and being in love. Are you addicted to, or searching for, those early-on “honeymoon” feelings. Remember that falling in love is generally based on excitement, sexual energy and a desire to become one— to fill our loneliness and secure a future. Ask yourself, “Is this love? Is this really sustainable?”

Goddard: For a marriage to work, couples need to be able to “fight clean.” All too often when conflict arises, a spouse is likely to fight dirty—criticize, blame, shame and name everything the other person ever did wrong. When arguing, try to first “feed back” what you think the other person feels and wants. Change from being defensive— trying to overpower the other person, getting on the witness stand and arguing your point—to listening better, accepting the other person’s viewpoint and admitting imperfections. Let the other person feel they have a right to their emotions and what they want.

Neary-Ludmer: Almost every long-term relationship goes off the tracks at one time or another. If you’ve been doing the work all along, it’s much easier to get things back on track. Some of the guidelines I think are helpful include: • Be comfortable in your relationship…but do not take your spouse for granted. • Voice concerns…don’t build resentments. • Focus on the positives of your spouse…substitute critical thoughts with positive attributes. Remember that nobody is perfect, and the grass always seems greener on the other side. • Try to preserve trust… surviving lies and infidelity is very difficult. • Avoid trying to control…search rather for satisfying solutions that are mutual. • Allow yourself to be vulnerable…wearing emotional armor keeps out hurt, but also keeps out love and connection!  

Editor’s Note: Dr. Rodger Goddard is Chief Psychologist at Trinitas and Director of the hospital’s wellness program, which provides companies, agencies and schools with on-site programs to improve health and productivity. Dr. Patricia Neary-Ludmer is the Director of the Family Resource Center in Cranford, an affiliate of the Trinitas Department of Behavioral Health and Psychiatry.  

What’s Up, Doc?

News, views and insights on maintaining a healthy edge.


Don’t Walk Sign Are you a sleepwalker? If so, you’re definitely not alone. New research by the Stanford University School of Medicine found that somnambulism is far more prevalent than previous studies suggested. About 3.6 percent of American adults are prone to nocturnal wandering. That translates to 8.4 million. The same research suggests that sleepwalking is linked to anxiety and depression. A subject of humor and silliness in popular culture, this disorder can actually have serious consequences. Sleepwalkers have been known to injure themselves and others. They are also prone to psychosocial disorders. The Trinitas Sleep Disorders Center deals with sleepwalking and other problems every day. For information call 908-994-8694.

Oh, Canada The never-ending legal debate over medical marijuana acquired an intriguing new wrinkle in May after a report in the Canadian Medical Association Journal on the results of a new study on patients with Multiple Sclerosis. A group of MS sufferers with muscle spasticity (hard-to-control muscles) who had not responded well to traditional treatment showed a 30% reduction in spasticity and a 50% reduction in pain after smoking marijuana over a threeday period. The side effects were hardly a surprise. Patients showed a drop in cognitive ability and experienced some dizziness and nausea. A few reported feeling “too high.” The study only looked at short-term effects on the MS patients, but results were encouraging enough to warrant more extensive research.

New Options for Hospice Care One of the greatest concerns in hospices is preventing sudden and deep depression. Standard antidepressant medications are only marginally successful in this setting, as they take time to achieve their desired effect—and time is something hospice patients don’t have. That explains the buzz at the recent annual meeting of the American Academy of Hospice and Palliative Medicine when it was reported that methylphenidate and oral ketamine are showing considerable promise as extremely rapid-acting, safe, and cost-effective treatments. Ketamine in particular is a drug already used in hospices to deal with pain. According to Dr. Scott Irwin, director of psychiatry programs at the Institute for Palliative Medicine at San Diego Hospice, more research is needed. Clinical trials are problematic in hospices because of the high death rate, as well as informed consent issues.

Answering the Call A college student who lives in New Jersey has filed a patent for a smaller, less invasive implantable cardioverter defibrillator—the battery powered device used to prevent sudden cardiac arrests in people who suffer from arrhythmia. Benjamin Strauss, a volunteer ambulance crew chief, came up with the idea after two calls to the same patient in Bergenfield in a span of two months. A biomedical engineering major at Cooper Union in New York, Strauss delivered the student commencement address this past May. The one-inch square defibrillator, which he dubbed iRescue, was created as his senior project. “I wanted to do something that would enable me, at some point, to actually contribute to making people’s lives better,” Strauss explains. “And I didn’t find anything that made this kind of treatment less invasive.”

Another Link Between TV & Obesity From the “Wait, Didn’t We Know that Already?” department comes the news that kids who watch a lot of TV have poorer overall diets than kids whose exposure to television is limited. “The more TV you watch, the less likely you were to eat fruits and vegetables every day, and the more likely you were to eat things like candy and soda, eat at a fast-food restaurant and even skip breakfast,” says study author Leah Lipsky of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The research doesn’t prove that TV watching influences what kids eat, but strongly suggests a link between TV, snacking and a lack of exercise. Add questionable parenting to the mix and you have yet another contributing factor to America’s epidemic of childhood obesity. The average age of the children in the study was 13.


Doubling Up with da Vinci

Enters a New Dimension

Labib E. Riachi, MD, Interim Chairman of OB/GYN at Trinitas, has the distinction of being one of the busiest robotic surgeons in the Northeast United States. He has completed over 250 robotic cases during the last two years.

Doctors ‘Doubling Up’ with the da Vinci System Two heads are better than one. That old saying holds especially true when the topic is robotic surgery. The da Vinci Surgical System, which enables doctors to sit comfortably at a console and operate remotely with incredible dexterity and precision—and a super-magnified 3-D view—has proved invaluable for a wide range of minimally invasive procedures since arriving at Trinitas Regional Medical Center in 2009. Indeed, during that time, Trinitas has become the busiest hospital on the East Coast for gynecological surgeries using the da Vinci, not to mention the first place in New Jersey where robotic bariatric surgery was ever performed. Beyond the headline-generating benefits of da Vinci, however, is the growing realization that the system‘s dualconsole set-up creates a stunning array of new possibilities both for doctors and patients.

For example, if a complication arises during an operation, a second surgeon can literally “sit in” and assist in his or her specialty without missing a beat. “We also have realized that the two consoles enable us to schedule ‘hybrid’ procedures, where two surgeons work together at once,” says Dr. Labib Riachi, Interim Chairman of the OB/GYN Department at Trinitas. “With a single console, one surgeon would have to step away to allow another surgeon to step in. With two this is not an issue. The benefit to the patient is immeasurable.” Another advantage of having two consoles is in training doctors in robotic applications. “While one surgeon performs a procedure,” Dr. Riachi explains, “the other can appreciate both visually and manually what we are doing. There is also amazing simulator software that enables trainees to teach themselves on a ‘virtual’ patient.”

All of this happens, he adds, in three dimensions—with 10X magnification and 360-degree rotation. This enables doctors to identify structures (such as small blood vessels and nerves) they couldn’t fully appreciate with traditional laparoscopic methods, and also perform suturing more efficiently. According to OB/GYN physician Dr. David Herzog, who uses the system for a number of procedures, including hysterectomies, the da Vinci has truly revolutionized surgery. The movements of the robotic instruments perfectly mimic the surgeon’s hand movements, allowing doctors to cut, cauterize and sew with the same freedom as if the patient were wide open. “The robot has allowed us to perform complex surgeries through tiny incisions which, in the past, would have necessitated large, painful incisions,” Dr. Herzog explains. “These tiny incisions make the recovery process quick and comfortable. So in the case of a hysterectomy, this enables my patients to return to work usually within one week, as opposed to eight weeks after the classic incision procedure.” The technology is constantly improving, he adds. “And that translates into excitement for the doctors and great care for the patients.”

He Said: She Said

Trinitas psychologists Dr. Patricia Neary-Ludmer and Dr. Rodger Goddard get to the bottom of getting steamed.

Goddard: Anger is a serious issue. Stories of road rage, shootings, domestic violence, workplace assault and bullying fill our airwaves. Movies and television shows are populated with dangerous, angry, vengeful, criminal characters. Anger, aggression and violence are ever-present in our lives. Anger fuels violent crimes, rapes, murder and war. The model of dealing with threat that we see in the media is one of threatening back, upping the ante and retaliation. We often ascribe to the Clint Eastwood, Dirty Harry Go ahead make my day school of conflict resolution.

Neary-Ludmer: We become angry when we—or someone we care about—is threatened, or when another person has wronged us or those we care about. Anger also can be the result of frustration when our needs, desires, goals are not being met, or when we feel a lack of control.

Goddard: We may experience anger in dealing with our husbands, wives, boyfriends, girlfriends, sons, daughters, mothers, fathers and work relationships. We experience anger in our bodies, thoughts, urges, heart and soul. Anger can express itself on a continuum of intensity ranging from annoyance, tension, dislike, frustration and resentment, to fury, rage, aggression and violence. Anger makes us do and say horrible things. Anger makes the heart pound and thoughts race. Anger infiltrates our daily lives in the form of stress, frustration, dissatisfaction, anxiety, argument, discomfort, illness and relationship problems. Anger is unhealthy. It takes a toll on the quality and quantity of our lives. Living with chronic states of anger injures our immune system and contributes to heart disease, stroke, ulcer, stomach problems, headaches and countless other illnesses. We hold anger in our bodies. It leads to subtle and sometimes intense muscle tightening that we may have for days, weeks or years. Many of us have favorite body areas for holding our anger. We may constrict the muscles of our lower back, forehead, neck, jaw, face or stomach. We can begin to reverse the negative effects of anger by first learning how to tell how tense our muscles are, and secondly, by learning how to release our muscles tension.

Neary-Ludmer: One of the ideas I try to convey to the people I see with anger issues is that anger does far more damage to them than to others. I try to explain that it’s okay to forgive—it doesn’t mean you have to forget. Just breath in, breathe out, and move on. Often I will use quotes to help people understand their anger. There are three in particular that are really effective. Buddha said that holding onto anger is like “grasping a hot coal with the intent of throwing it at someone else—you are the one who gets burned.” Gandhi observed that “an eye for an eye makes the whole world go blind.” And Ralph Waldo Emerson pointed out that for every minute you remain angry, “you give up 60 seconds of peace of mind.”

Goddard: Anger and frustration often come from not being in control—not getting something we want or not getting our way with others. Regaining control in our lives is an important key to overcoming chronic anger. Many people do not understand the difference between anger and aggression. Anger is an emotion. Emotions and anger are actually good. Emotions are a sixth sense. They tell us very important things about ourselves and others— what we want and what we need. Emotions, however, can be used, experienced or expressed in positive or negative/constructive or destructive ways. Aggression, on the other hand, is a negative action that is harmful, destructive, threatening and/or violates the rights of another. Anger can give us important messages and can be positive fuel which can provide us with the motivation and energy to make needed changes.

Neary-Ludmer: There are some basic steps involved in getting anger under control. First, a person with anger problems has to admit he/she has a problem. This is a fundamental step in addressing virtually all self-destructive behavioral issues. Next, a person needs to learn relaxation techniques that target the emotional and psychological components of anger; feelings of anger protect us from other more vulnerable feelings, such as hurt, insecurity, anxiety or fear. Part of anger control also involves learning to challenge the thinking that creates hostility and inflammation. Finally, a person with anger problems must develop the positive communication skills of assertiveness and conflict resolution.

Goddard: Two skills that I give to my clients and audiences concerning anger are the MAD skill and the SURF Method of Assertion. The MAD skill involves, M for Muscles Relax, A for Ask Nicely for What I Want and D for Do Not Insult or Drop It. SURF Assertion involves S for Specifics, U for Understanding, R for Repetition and F for Firmness or Find a Compromise.

Neary-Ludmer: Knowing how to deal with someone else’s anger is also a valuable skill. Rule number one is to remember that it takes two—do not take the bait! Do not respond to anger with anger in kind, or it could set off an escalation process that could turn violent and even deadly. Adopt a non-escalation policy by being the emotionally mature person. For instance, if a driver believes you slighted him by cutting him off, taking his parking space or looking at his girlfriend, defuse the situation. Apologize even if you don’t mean it. You never know whom you may be dealing with. Be the bigger person. Show empathy for their feelings.

Goddard: If someone you know has serious difficulty with managing anger, there is no quick or easy solution. Confronting this type of person can definitely be dangerous and is often not helpful. Chronic aggression or anger indicates a serious problem and needs to be dealt with by getting professional help.

Neary-Ludmer: Something that has definitely hit the Anger Management radar in recent years is the role technology plays. Rage-induced emails, texts and tweets require the mere tap of a Send button and they are on their way. Many a job, marriage and friendship have been lost over impulsiveness with this type of technology—not to mention the legal problems this communication can cause. If you are angry, don’t hit Send. Reread, rethink, reconsider, sleep on it. Chances are you won’t send it.

Goddard: The point is not to eliminate anger, but to understand and manage it. Anger is an important part of life. Anger is fuel, energy and power. Like any hot and powerful energy we need to learn how to handle and channel it. We can get a message from our anger, control it, embrace it and use it in positive ways. Or, we can let it control us, take us over and allow it to injure our health and relationships. Dealing productively with anger necessitates building self-calming, assertion and anger management skills. The next time you get angry try identifying exactly what you want and use the MAD skill or SURF Method of Assertion to calm down, relax your body tension and get what you need from yourself or others.

Neary-Ludmer: To deal successfully with anger, it’s also helpful to recognize a few of the myths about it. Anger isn’t inherited. The expression of anger is learned. That’s good news, because it means that appropriate ways of communication can be learned, too. Intense anger does not automatically trigger aggressive behaviors. One can develop skills to challenge hostile, negative or irrational feelings and beliefs. And contrary to earlier beliefs, “venting” anger in aggressive ways—such as screaming or punching a pillow—is not a good idea. It merely reinforces aggressive behavior.  

Editor’s Note: Dr. Rodger Goddard is Chief Psychologist at Trinitas and Director of the hospital’s wellness program which provides companies, agencies and schools with on-site programs to improve health and productivity. Dr. Patricia Neary-Ludmer manages the Family Resource Center in Cranford, an affiliate of the Trinitas Department of Behavioral Health and Psychiatry.

What’s Up, Doc?

What’s Up, Doc?

News, views and insights on maintaining a healthy edge. 

Smoking While Pregnant: Are Friends Actually Foes? Most people are aware that smoking and pregnancy don’t mix. Yet expectant mothers continue to puff away, or live in smoking environments. A recent study published in the journal Addictive Behaviors looked at some of the reasons this situation persists. It was no shock to find that nearly half of pregnant women who smoke had a partner who also smoked. It was a surprise, however, to find that women who had close friends that smoke were far more likely to smoke themselves. In fact, the influence of friends was actually higher than the influence of family members. The study, conducted by researchers at SUNY Buffalo from 2006 to 2011, will continue, and focus on generating data on the children of pregnant smokers.


 Cold or Allergies? One of the toughest calls for a parent to make is whether their runny-nosed child is fighting a spring cold or suffering from spring allergies. Both can involve sneezing and congestion, making that call even trickier. Knowing some basic differences can help parents decide how to proceed. For example, the severe part of a cold only lasts a few days; allergic symptoms tend to persist. Allergies are often accompanied by itchy eyes, while colds are not. According to the Children’s Hospital in Boston, if you suspect your child is suffering from a seasonal allergy, close the windows, turn on the AC, vacuum your rugs and carpets, and consider running a humidifier or non-ionic air purifier. Kids with bad allergies should also shower after playing outside, so as not to transfer pollen to pillows, where it will irritate them all night long.


Good News on Concussions If you happen to be a hockey fan, you know that NHL superstar Sidney Crosby nearly lost his entire season to a concussion. What finally helped him get back on the ice was the diagnosis and treatment of a soft-tissue neck injury that accompanied the concussion. This was no surprise to the doctors at the MMTR Health Clinic in Guelph, Ontario, which has been treating hockey concussions for years. They have found that many symptoms attributed to the lingering effects of a concussion actually correspond to specific neck muscles damaged at the time of the original injury. Once treatment is individualized and the muscles repaired, patients experience speedy postconcussive recoveries.


 The Skinny on Modeling Role models play a key part in the world of eating disorders, with skinny fashion icons ranking among the major culprits. In Israel, a law passed recently dictates that models appearing in advertising must have a Body Mass Index (BMI) of 18.5 or more. A media storm ensued, with critics of the law saying the government should aim its efforts on health as opposed to weight. Indeed, some models now disqualified are naturally skinny and completely healthy. Should they be prevented from earning a living without knowing whether they are actually unhealthy in some way? The Israeli government points to statistics that show 1 in 50 teenage girls suffers from an eating disorder, and stands by its position.


Is There an Autism Epidemic? A March study released by the Centers for Disease Control and Prevention estimates that 1 in 88 children born in the U.S. suffers from a disorder on the autism spectrum. The last study estimated the ratio to be 1 in 110 and one done in 2002 suggests that the number of autistic children has doubled since then to around one million. Does this mean there is an “epidemic” of autism? Most doctors and researchers believe this is not the case. Instead, the numbers reflect better diagnostic screening tools and earlier detection. There is no “test” for autism, such as a blood test; it is detected through observing behavior of children typically around the age of eight. “One thing the data tells us with certainty,” says CDC Director Dr. Thomas Frieden, “is there are many children and families who need help.”

Pituitary Case

It may be pea-sized, but they don’t call it the Master Gland for nothing.

Irv Brechner joins daughter Stephanie and wife Nadine in the stands to root for his beloved Giants.

 Talk to Irving Brechner sometime. He will tell you small does not mean insignificant. The tiny pituitary gland, located at the base of the skull between the optic nerves, controls hormonal functions that include thyroid activity, early growth, estrogen and testosterone production, and even body temperature. Brechner was struggling with several temperature issues—specifically feeling cold most of the time, but also having hot flashes. After initial consultations with his own doctor had yielded no definitive diagnosis, he turned in February 2011 to Trinitas doctors William McHugh (the hospital’s Medical Director) and Ari Eckman (Chief of the Endocrinology, Diabetes and Metabolism Division).

Under their thoughtful examination, a diagnosis was finally forthcoming. Although pituitary tumors may be present in as much as 20% of the population, they are usually so slow-growing and typically benign that they often go unnoticed. Not the case for Brechner. Initially, he underwent a progression of tests and bloodwork, which indicated certain hormone and vitamin deficiencies that were immediately addressed, but without the hoped-for improvement. Dr. Eckman described their evolving conclusion as “the results just didn’t fit right with normal pituitary functioning.” At that point, the doctors felt the situation warranted the next step in testing hierarchy—an MRI, which revealed a large mass that was interfering with proper hormonal production. Both doctors concurred that this growth was responsible for Brechner’s non-specific symptoms and discomfort.

Dr. Eckman referred to the results as “bittersweet…unfortunate that the tumor was there, but grateful that it was benign and surgically treatable.” Dr. McHugh and Dr. Eckman provided referrals to surgeons who were expert in this area. Brechner underwent successful surgery this past December. He was in-hospital for three days, after which he returned home and was able to resume his home-office responsibilities almost immediately. Brechner was unreserved in expressing his gratitude and admiration, and how impressed he was with the skill, the thoroughness, and the personal attention he had received at Trinitas from his two dedicated doctors. In fact, he summed up everything as “a wholly wonderful experience.” Especially since his accurate diagnosis and speedy recovery enabled him to attend the Giants’ victories over the Dallas Cowboys and Atlanta Falcons as they began their amazing run to the Super Bowl. Go Big Blue!

He Said: She Said

What’s the Smart Way to Deal with Menopause? 

Trinitas psychologists Dr. Rodger Goddard and Patricia Neary-Ludmer discuss strategies for coping with the ‘change of life.’  

Goddard: The topic of menopause is often taboo in our society. It is not the subject of lively dinner conversations or casual talk. It is not something that people automatically flip to in a magazine (or program into your DVR). We are more likely to hear about menopause as the punchline in a joke on TV or in the movies—tossed out to explain a woman’s frustration, unusual actions or bizarre behavior. It is unusual to encounter a frank, positive discussion between health professionals on this issue. In our society, youth and beauty are valued, worshipped and cherished. Aging and the intricacies of body changes and emotional states as we age are often pushed aside and shunned. Women undergoing menopause often take on our society’s view that something negative and bad is happening to them. Menopause can be made worse when it is viewed through the lens and prism of the media and the taboo assigned to it.

Neary-Ludmer: Then there is the additional stress of day-today life. A menopausal woman may very likely be working full-time, managing growing children, caring for her home and helping with the needs of senior parents—all while dragging around bone tired in a brain fog. Also, many of the symptoms of menopause, such as anger, mood swings and lack of sexual desire, can impact the marriage and family. If so, supportive psycho-educational counseling can be very helpful. This is an important phase of life. If we believe what we see and hear in the media, it can turn into something shameful or humiliating.

Goddard: Although it is accompanied by many difficult and potentially painful physical and bodily discomforts, the time of menopause can be embraced as a time of introspection, discovery, growth and valuing of the mysteries of life. It can be a time of bringing together the wisdom of a woman’s life and sharing that wisdom with others. It can be a time of creativity and connection to what is sacred and meaningful in life. The physical discomforts and pain of menopause can be dealt with and overcome. It is said that women are better at dealing with pain and discomfort than men. Menopause necessitates a woman coping not only with physical discomforts and pain, but also with the negative thoughts and emotions that our society assigns to it. Understanding menopause and finding positive, productive and creative ways to deal with it can make an incredible difference in a woman’s second half of life. Just as George Bernard Shaw said that “youth is wasted on the young,” it can also be said that aging is wasted on those who are unable to appreciate its special, new and sacred ways of experiencing life. One problem encountered by many women going through menopause is the tension that can occur between husband and wife. A husband may be insensitive, fearful of, or not able to understand menopause. Wives may feel inadequate, uncared for and less lovable. Communication and sensitivity are essential during this time.

Neary-Ludmer: Although the average age for menopause is 52, each woman has her own unique journey with this stage of her life. Each woman’s hormonal profile can differ in terms of estrogen, progesterone, and testosterone. Early menopause can be brought on, at any age, by medical conditions such as cancer treatments or hysterectomy. About 25 percent of women begin menopause this way. Scientists have also found that if there is a family history of early menopause, the woman is 60 percent more likely to enter menopause early. Strictly speaking, menopause means no menstruation for at least 12 months. Symptoms include sweats, hot spells, hot flashes, fatigue, mood swings, craving sweetness and carbohydrates, difficulty sleeping, joint pain, concentration and memory difficulties, thinning hair, increased facial hair and dry skin and eyes. It is important to understand that women may also experience perimenopausal symptoms. Perimenopause refers to the time period where menstruation is still taking place but the female hormone levels are beginning to shift. Symptoms can be subtle to severe. Perimenopause can last months…or as long as a decade.

Goddard: It is important to be on the lookout for menopause problems that may be excessive and beyond what is expected. Women should not hesitate to see a doctor on a regular basis during menopause. Keep in mind the frequency, duration and intensity test: If your symptoms seem to occur more frequently, last with greater duration or have much greater intensity than what you would expect, see a doctor. Menopause brings with it many confusing and difficult decisions concerning whether to use Hormone Replacement Therapy and/or other special medication, herbal, supplement or dietary remedies. For example, Dr. Andrew Weil, a pioneer in integrative medicine, suggests that menopausal women should increase their intake of omega-3 fats, as they help to lessen the hot flashes and depression that may occur with menopause. The key is to be diligent, stay in control, investigate and determine what is right for you based on sound research. When is comes to any health issue or medical problem, the more information we have, the easier it is to make a decision. In fact, research shows that, in general, the more active a stance we take and the more we exert conscious decision-making and control over a medical issue, the more positive the outcome.

Neary-Ludmer: The most important active step you can take during menopause is to find a trusted doctor to perform a thorough medical evaluation and guide you through this time. In addition to Hormone Replacement Therapy, there are several options to consider. They range from low-dose birth control pills to help with mood swings to getting into a regular yoga or exercise routine to adjusting your diet and sleep patterns. Beyond the physical, of course, are the emotional issues.

Goddard: Think body mind-heart-soul. Taking care of our bodies involves eating health foods and controlling our stress levels. Menopause often necessitates a change in diet and renewed efforts to control our stress. Menopause can bring with it tension and anxiety. It is good to strengthen our ability to reduce tension, anxiety and stress. This can be done by learning how to calm ourselves throughout the day, doing a daily yoga routine and using deep mindful breathing throughout the day to calm ourselves down. Regular exercise has also been found to help decrease the negative effects of menopause. Taking care of the mind involves identifying and solving problems, as well as clarifying what is most important to us and taking the actions necessary to achieve those most cherished goals. It also involves using productive and tough thinking to fight against our negative emotions and thoughts. Taking care of the heart involves getting support from others and dealing with our emotions in productive ways. Women should find ways to have open discussions with husbands, boyfriends or partners during this time period. Taking care of the soul involves nurturing ourselves and treating ourselves with extra care. Being creative, pursuing your passions, communing with nature, taking time to meditate and connecting with the beautiful and sacred things in your life is important.

Neary-Ludmer: At the same time, it’s also important not to minimize or underplay the impact of menopause. This can be a 10-year process, and a chapter of a woman’s life that is often accompanied by insults to her self-image, feelings of increased vulnerability and insecurity. Women need support and encouragement to negotiate the body changes and emotional ups and downs. Lastly, they need to be reminded that post-menopause can be an exciting chapter of their lives. They will feel renewed and empowered.

Editor’s Note: Dr. Rodger Goddard is Chief Psychologist at Trinitas and Director of the hospital’s wellness program which provides companies, agencies and schools with onsite programs to improve health and productivity. Dr. Patricia Neary-Ludmer manages the Family Resource Center in Cranford, which is affiliated with Trinitas’s Department of Behavioral Health and Psychiatry.

What’s Up, Doc?

Why is There an Adderall Shortage? A shortage of the stimulant Adderall has parents of children with Attention Deficit Hyperactivity Disorder (ADHD) scrambling in the new year. The problem stems from DEA policies aimed at preventing the stockpiling of controlled substances, which are often diverted for inappropriate use. In the case of Adderall, it has become popular with students hoping to improve test scores. The DEA determines how much of the stimulant is released to drug manufacturers based on what it considers to be legitimate use. The agency has fired back at drug companies, which it claims have elected to manufacture more expensive brand-name pills instead of generics, which in turn contributes to supply-and-demand problems. “I am very concerned about the future,” Ruth Hughes told Reuters in January. Hughes runs Children and Adults with Attention Deficit Hyperactivity Disorder. “No one seems to have much inventory to get us through the months ahead.” As many as 20 million prescriptions for Adderall were written in 2011.

Inside the New HIV/AIDS Numbers You may have heard some encouraging news over the holidays about the fight against HIV/AIDS. The United Nations announced that both AIDS-related deaths and new HIV infections have dropped to their lowest levels since the peak of the epidemic in the 1990s. Worldwide, new infections have dropped 21% since 1997 and deaths were down 21% since 2005. Researchers credit a combination of things for the dramatic improvements, including scientific breakthroughs, access to treatment, better political leadership and social change. The UN report also noted that HIV-infected individuals are also living longer.

Wait a While…and It Won’t Go Away  A recent news story about a 44-year-old hospital worker who waited too long to address symptoms of severe abdominal cramping underscores the importance of catching colon cancer in its early stages. This individual, who was literally surrounded by doctors every day, put off a visit to his GP until the condition became unbearable. When he finally had it checked out, he was diagnosed with metastatic inoperable carcinoma of the colon. Colon cancer is the third leading cause of cancer-related death for both men and women. Yet it is 95 percent curable if diagnosed before symptoms arise. Most colorectal cancer begins as a non-cancerous (benign) adenoma or polyp (abnormal growth) that develops on the lining of the colon or rectum. Polyps can be removed to significantly reduce the risk of cancer.

Colonoscopy plays an important role in colorectal cancer prevention because precancerous polyps can be detected and removed during the same exam. The American Cancer Society suggests a colonoscopy after the age of 50 for both men and women. “A normal colon means you will not need another colonoscopy for another ten years,” says Dr. Samiappan Muthusamy of the Center for Digestive Diseases. “If you have a family history of colon cancer, especially a close family member who was diagnosed before the age of 60, then a colonoscopy is recommended at the age of 40.” According to Dr. Muthusamy—Clinical Assistant Professor at Seton Hall University and past Chief of Gastroenterology/Endoscopy at Trinitas RMC—colorectal cancer screening tests are covered by Medicare and, under a new Affordable Care Act provision, private insurers are now required to cover the entire cost of screening colonoscopy.

E-Shoppers Under the Influence  One of the most unusual trends to emerge this past holiday season was a sharp rise in “drunk shopping.” Drunk shopping is exactly what it sounds like. People have a couple of drinks, go online, and start buying things they normally wouldn’t. E-tailers know this is happening. They can tell when someone orders 10 of something instead of one—they have impatiently clicked the BUY button too many times. Another sign is when shoppers botch selections from a drop-down menu, such as which state they live in.

Online giant eBay saw a huge spike in shopping between the hours of 6:30 and 10:00 on weeknights, and has gone on record that alcohol is absolutely a factor. The home-shopping channels saw a big bump in impulse purchases of makeup and accessories by its core customer in the evening hours, too. “You can probably come to your own conclusion as to what’s motivating her,” said a QVC rep. Online retailers added fuel to the fire in December by holding their most enticing promotional emails until after 9:00 p.m. Shoppers who’d had a drink or two were more likely to drop an item into a make-believe shopping cart and follow through with a purchase of something they didn’t necessarily want or need.

Underactive Thyroid at Center of Pregnancy Debate  For a good decade now, it has been widely accepted that an underactive thyroid can raise a woman’s risk of miscarriage, underweight birth, or diminished IQ for her baby. Doctors know to treat severe cases with hormone medication, but there is a growing debate about how to handle milder “gray-area” cases. Roughly a quarter of pregnant women receive a thyroid blood test whether they have symptoms or not. Testing lab Quest Diagnostics recently reported that about 15% of the expectant mothers it tested showed signs of an underactive thyroid, which surprised many. An underactive thyroid (aka hypothyroidism) slows body functions, causing such problems as fatigue, weight gain and depression.

The obvious question is, are the three-quarters of women who are not getting tested being put at risk? As many in the field have pointed out, the effects of mild hypothyroidism on pregnancy—and the correct treatment—are unclear. “There are studies on both sides of the fence,” points out Dr. Dena Goffman of Montefiore Medical Center in New York, which tests only women it considers to be at high risk. “If you don’t know what to do with the results, you probably shouldn’t order the test.” The American College of Obstetricians and Gynecologists recommends testing only pregnant women who have thyroid symptoms, have had previous thyroid problems, or have similar auto-immune diseases. The American Thyroid Association suggests testing all pregnant women age 30 and older, and those with enlarged thyroids, previous pregnancy problems or who are obese.

Diet & Exercise Lower Breast Cancer Risk  Women need not feel powerless against breast cancer. Scientific evidence shows that women do have the power to protect themselves by staying slim and active, focusing on healthful, natural foods, and avoiding the disease-causing foods common in the standard American diet. According to Dr. Joel Fuhrman, author of Super Immunity, the keys to a cancer-resisting diet include getting your folic acid from green vegetables (as opposed to the synthetic type contained in multivitamins and prenatal vitamins); taking a daily dose of ground flaxseed (which contains estrogen-blocking lignans); eating your GOMBBS (greens, onions, mushrooms, beans, berries and seeds); minimizing the consumption of meat, fish and dairy products, and avoiding white flour and sugars.

Obesity is a strong risk factor for breast cancer, Furhman says, adding that a higher body mass index (BMI) is associated with higher estrogen levels, a risk factor for breast cancer. Besides a smart diet, exercise is critical. An analysis of 73 different studies recently concluded that women with high levels of physical activity reduced their risk of breast cancer by 25%.

Body of Work

Two years in the making, Generation Fit opens at the Newark Museum.

If you are the parent of a school-age child, then you are undoubtedly aware of the fact that 1) there isn’t much around here in the way of interactive museums once you’ve done the Liberty Science Center, and 2) left to their own devices, kids will almost always make the most atrocious food choices imaginable. (My own still insist Sour Patch Kids count as a serving of fruit). These seemingly unrelated facts are suddenly relevant thanks to the Newark Museum, which is opening an intriguing new exhibit for young people on November 26 entitled Generation Fit: Steps to a Healthier Lifestyle. The name may not be as spine-tingling as a ride at Great Adventure, but rest assured that it’s worth the trip. As the final touches were being put on the colorful and inviting 2,000 square feet of space, Ismael Calderon, Ed. D—the museum’s Director of Science and curator of Generation Fit—gave EDGE a tantalizing sneak peek. Calderon calls it an exploratory space, and that it is. But here’s the clever part—as kids explore the interactive exhibits, lessons of healthy eating, the benefits of exercise and a profound awareness of their own bodies start to sink in.

By the time children have worked their way around Generation Fit, they are likely to be a little smarter about the choices they make. According to Calderon, that’s a big step on the path to a healthier lifestyle. “Remember that we have been hard-wired to eat dating back to our days as hunter-gatherers,” he points out. “Today, we do less work to get our food, and much of the food that is available has little nutritional value.” One of the core messages of Generation Fit is that a healthy body is not measured so much by its outward appearance, but rather according to a person’s heart rate, determined by age.

The exhibit focuses on themes related to nutrition and exercise that are designed for families of all shapes and sizes—encouraging conversation in an inviting and non-judgmental environment. Different body types displayed at the entrance convey this message. Incidentally, by the time you reach this point, you’ve already been outfitted with a pedometer and raced up a flight of stairs. No elevators, please! Inside Generation Fit are a series of interrelated sections that engage kids and help simplify complex ideas through interactive displays. In the What is a Calorie? section, kids work the Calorie Crank, which provides a hard lesson in the amount of activity required to burn off a cheeseburger and fries. (Parents will merely appreciate that they don’t have to explain to their children what a calorie is.) One of the coolest teaching tools is the Body Scan. Kids roll a computer screen over a full-sized representation of a human body and it uses the different types of scans doctors employ for an “inside look” at diseases related to being overweight or obese.

You’ll be prying your children away from Body Scan, probably so you can play with it yourself. The My Plate section addresses nutrition and portions in a clever way. An array of foods representing various cultures is set upon a dining table, along with plates ready to be filled. After kids make their picks, an interactive display provides feedback on whether the selected meal is sufficiently balanced. It also provides alternative food choices. As you work your way around the exhibit hall, you’ll encounter the Label Decoder, Sugar Detective, Dollars and Scents, Know Your BMI, Exertainment and FIT Center (FIT is an acronym for frequency, intensity & time). You can probably make an educated guess at what each offers, and you’d be right. The key thing here is that Calderon (left) has seen to it that each section over-delivers. Two good things to know about Generation Fit. First, to avoid the chaos and disorder that sometimes diminish other interactive children’s exhibits, the Newark Museum will probably be time-ticketing the exhibit. This is a great idea. Call ahead to get details on this. Second, the crowded times for Generation Fit will probably be between noon and 2:00 pm. Plan accordingly.

Editor’s Note: The museum is located at 49 Washington Street in the Downtown Arts District, a couple of minutes away from NJPAC, and is open Wednesday thru Sunday from noon to 5:00 pm. Generation Fit uses research data from the Robert Wood Johnson Foundation and Center for Disease Prevention, the national Let’s Move! Initiative, National Institute of Health and scholarly journals.

He Said: She Said

Addiction is an issue that impacts everyone in some way. To overcome addiction—whether it is your own, a friend’s or a loved one’s—it is crucial to understand what addiction is, how it works, and why it is so easy to fall back into unhealthy habits. Trinitas psychologists Dr. Rodger Goddard and Dr. Patricia Neary-Ludmer discuss the role that “triggers” play in addictive behavior…

Goddard: There are many definitions of addiction including those that are used in a clinical psychiatric setting and those that are used in everyday language and everyday settings. A broad definition of addiction involves things that we consume or do compulsively, that are injurious to our health or happiness, and are very difficult to give up. These can be referred to as health-compromising habits. Health compromising habits may include compulsive shopping, unhealthy eating, overuse of computers or video games, self-doubt, negative emotional states, and so on.

Neary-Ludmer: Another important aspect of addictions— whether we are referring to eating disorders, substance abuse, compulsive behavior or tobacco use—is that they can be viewed as unhealthy coping behaviors. Boredom, anxiety, depression, trauma and failure are just a few of the triggers that might be antecedents to these addictive behaviors. When the unhealthy behavior leads to a reduction in the unwanted feelings, the behavior is reinforced. For example, a high-school student feeling rejected by peers may restrict eating or purge as a way of feeling more in control. Self- destructive cutting behavior also can lead to a reduction in emotional pain. And of course numbing emotional pain through the use of alcohol and drugs is a common pathway to addiction. Problems disappear for the moment, but are still there once the drugs and alcohol wear off.

Goddard: Triggers are the actions, events, people and things that initiate the addictive action. Triggers may become almost as rewarding as the addiction itself—they elicit brain chemistry changes similar to the actual addictive substance or behavior. They trap and lock us into the addiction. For alcoholics, the sound of ice jiggling in a glass, a bottle being opened, or the pouring of wine, beer or gin can heighten the urge for relief from stress by having a drink at the end (or beginning!) of our day.

Neary-Ludmer: How does one avoid or control these triggers? Support groups and therapists will warn the individual to stay away from the people, places and things that may trigger by association a need to drink, use drugs, gamble, smoke, cut or engage in eating disorder behaviors. They must build new friendships, interests and places to go. Obviously, drug addicts can be triggered by being with old buddies they got high with in the past. But they even need to avoid their old haunts, which serve as a reminder of the good times and put them at greater risk to use again.

Goddard: Substituting a new social network can be an important trigger-stopper. This is why Alcoholics Anonymous is so successful at helping alcoholics to overcome their addiction. An alcoholic can now socialize with people who are not popping corks and bottles.

Neary-Ludmer: Also, there may be a stimulus or an event that is so threatening that an addict feels the need to return to unhealthy behaviors. At this point you need someone to call to support you. In AA or Narcotics Anonymous, you have a sponsor to call and meeting you can attend. This is also a good time to have a therapist in place, to help see you through tough times.

Goddard: The greater our ability to identify a trigger, the stronger we become at overcoming an addiction. Trigger awareness can help us to substitute a behavior that does not injure our health or quality of life. When we can identify our triggers it is possible to stop the negative action before it takes us over. Writing down triggers can be a first step in overcoming addictions. Sometimes we are able to overcome an addiction on our own, but sometimes it is critical to get help from a therapist, clinic or professionals that specialize in addiction.

Neary-Ludmer: Unfortunately, all triggers are not avoidable. This is why it’s so important for an individual to make that plan…and manage those triggers that simply can’t be predicted or avoided.

Editor’s Note: Dr. Rodger Goddard is Chief Psychologist at Trinitas and Director of the hospital’s wellness program which provides companies, agencies and schools with onsite programs to improve health and productivity. Dr. Patricia Neary-Ludmer manages the Family Resource Center in Cranford, which is affiliated with Trinitas’s Department of Behavioral Health and Psychiatry.

What’s Up, Doc?

What’s Up, Doc?

Aye, Robot

Bariatric Surgeons are the Latest to Get a (Mechanical) Hand in the OR

To the layperson, the melding of humans and machines sometimes seems like the stuff of science fiction. For Trinitas surgeons working with the da Vinci Surgical System, it’s just another day at the office. Now Trinitas can claim the NY Metro area’s first Robotic Bariatric Surgery program. “This program establishes Trinitas as a Center of Excellence for Robotic Surgery,” says Gary S. Horan, President/CEO of Trinitas Regional Medical Center. “It will draw patients from all over the region, as well as many from outside the region. Trinitas also becomes the place where bariatric surgeons will come to do their training.”

Who benefits from robotic bariatric surgery? Both surgeon and patient. According to Dr. Forrester, robotic bariatric surgery may open the path to good health to patients who in the past might have been rejected as a bariatric surgical candidate. Higher-weight patients are more challenging to operate on because their body structure places limitations on conventional laparoscopic instruments. The da Vinci diminishes the problem by giving the surgeon greater control and maneuverability. The da Vinci is also good for revisional surgeries, where a bariatric patient needs a procedure redone, or must switch from a band to a bypass. Where will robotics take bariatric surgeons in the future? Anywhere they want. Indeed, seated inside the da Vinci pod and controlling the camera, a surgeon at Trinitas could theoretically perform a bypass on anyone, anywhere. This could have interesting implications for remote parts of our own country, where obesity is epidemic and trained surgeons are few.

The da Vinci system that is utilized for bariatric procedures is already on-site. It’s the techniques and training that are new to Trinitas. A team of surgeons from the hospital has completed the rigorous training involved in mastering the da Vinci robot, which is already used for minimally invasive surgeries in a number of specialties. For some of its training, the team had to fly to Maine. Of the three types of bariatric surgeries—gastric bypass, sleeve gastrectomy and gastric banding—that can be performed robotically, the bypass lends itself especially well to the da Vinci system, explains Glenn Forrester, MD, FACS, Director of Bariatric Surgery at Trinitas. The bypass requires the most fine suturing and the da Vinci allows for the exact placement of the sutures, he says. “Another significant advantage,” adds Dr. Forrester, “is that the surgeon controls the camera throughout the operation. During a normal laparoscopic procedure, an assistant handles the camera. This gives surgeons more control over where their eyes are trained. Imagine wanting to look at something and having someone else controlling your eyes.” In a robotic procedure, the surgeon is removed from the side of the operating table. The standard operating team is around the patient. Above the patient cart is the robotic arm. There is one surgical assistant on hand to perform tasks like retracting and stapling.

The surgeon operates remotely — with fingers manipulating ultra-responsive individual controls and feet working pedals that focus the camera and control energy to the devices. The surgeon views the procedure through a high-definition 3-D monitor. To perform robotic bariatric procedures, surgeons must receive training from da Vinci and training from Trinitas. It typically requires four days of training and observing procedures, and between 5 and 15 supervised procedures before a surgeon gets the green light to fly solo. On top of that, additional annual training is required, as the procedures and technology evolve. Is there a fear factor among patients when they hear that a robot will have a hand in the surgery? “Patients understand that it’s not a robot doing the surgery,” Dr. Forrester smiles. “The surgery is robotic-assisted. The da Vinci is only a tool.” Soon, he says, this will be viewed as just another instrument in the operating room. “Robotic bariatric procedures are safe and effective without altering the outcomes.” Any trepidation on the part of bariatric surgeons? “No,” says Dr. Forrester. “Surgeons have a technological side and the da Vinci lets us take our ability to help patients to a whole new level.”

Seeing Is Believing

Trinitas Is First in New Jersey to Offer New Image-Guided Breast Cancer Technology

The term “guesswork” is not a particularly comforting one for early-stage breast cancer patients. Once a lumpectomy has been performed, the diagnosis confirmed and radiotherapy initiated, women want to know that radiation is going to the right place. Now they can check the doctor’s work for themselves. In June, Trinitas Regional Medical Center became the first cancer treatment facility in the state to offer breast cancer patients a radiotherapy technology called AccuBoost. Developed by Nucletron, a company headquartered in the Netherlands, AccuBoost enables doctors and patients to actually see the area receiving radiation treatment as it receives it. In other words, no guesswork. The system images the site where cancer was removed so that the surrounding breast tissue can be treated more accurately with boost-dose targeting. “AccuBoost utilizes real-time mammography to localize the treatment,” says Clarissa Henson, MD, Chair of Radiation Oncology at Trinitas (above). “This technology is far superior to the current standard of care treatment. On average, only 51 percent of the treatment area receives 90 percent of the dose when using the current standard of care. With AccuBoost, targeting is improved and a more effective dose of radiation is delivered to the tumor site.” With AccuBoost, a technician can position the applicator so that it delivers the therapeutic dose accurately and reliably, with limited radiation exposure to the skin. The dose is uniform over the portion of the breast that is being irradiated, which reduces unnecessary exposure of healthy tissue to radiation and enables patients to retain more undamaged tissue.


“The diagnosis of breast cancer is one of the most traumatic for any woman,” says Dr. Henson. “Being able to see treatment as it is delivered through this new technology helps patients be informed and involved in their care.” “Trinitas was the first cancer treatment center in New Jersey to offer Rapid Arc radiotherapy technology and now we are the first with AccuBoost,” adds TRMC President and CEO Gary S. Horan (right). “It’s another clear example of why Trinitas Comprehensive Cancer Center is a regional leader in cancer care.”