Miracle Workers

The top medical breakthroughs of 2015…and 2016…and beyond.

By Christine Gibbs

In the field of medicine, today’s science fact can sound a lot like yesterday’s science fiction. In 2015, we read about back-to-front face transplants, mind-controlled bionic hands and smart antibiotics—all of which are here and happening. We also heard about cancer-killing nano-robots and head transplants, which are, as they say, “still in the works.” In addition to these headline-grabbing advances, researchers are building on earlier breakthroughs to improve the length and quality of human life

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Consider, for instance, the Human Genome Project, which was completed in 2003 and which was covered in these pages in the spring of 2013. In the three years since, there have been a number of important advances in the treatment and cure of chronic and life-threatening diseases and disabilities. In the 2015 calendar year alone, scientists created the first roadmap of the epigenome (which consists of chemical compounds that modify the genome and tell it what to do), discovered genomic information on how skin changes with aging and sun exposure, and learned how to use known genetic associations to improve the development success rates of new drugs. Scientists also reverse-engineered the complex genetics of infertility, which in turn triggered research that holds promise for up to half the people who experience reproductive difficulty. 

Other recent breakthroughs that have a profound and ongoing impact on our lives range from targeted cancer therapies to stem cell research to laparoscopic surgical techniques. According to the National Cancer Institute, radiation and chemo may soon be replaced by treatments developed to hit molecular targets produced by the patient’s tumor itself. Cloned human stem cells, meanwhile, hold special promise for treating diseases of the heart and eye. And more than 2 million minimally invasive surgeries are done laparascopically in the U.S. each year, saving patients a lot of discomfort and saving the healthcare system countless billions. Recent advances in the treatment of migraines and Hepatitis C, as well as the development of a smarter pregnancy test, have also changed our lives for the better.

THE BIG THREE

My picks for the top three breakthroughs of 2015, as mentioned in the opening paragraph, are (in no particular order) the face transplant, bionic limb and antibiotic stories. Back in 2001, volunteer firefighter Pat Hardison lost almost all of his facial features—including his hair and ears—battling a mobile home blaze. In 2015, he received the most comprehensive face transplant ever attempted, from a BMX biker who was killed in an accident. The 26-hour procedure was performed by a team of more than 100 doctors, nurses and technicians, led by Dr. Eduardo Rodriguez of NYU Medical Center. They grafted both the front and back of the donor’s head to Hardison’s. 

In Austria, three patients received robotic hands that can be manipulated directly by the brain. The bionic hands have sensors that respond to electrical impulses from muscles that were transplanted from their legs to their arms. A few years ago, people who lost hands in traumatic accidents had to make do with mechanical prosthetics. The three Austrian men are able to button their shirts and pour water—tasks that were all but impossible with the old technology.

Perhaps the most important breakthrough of 2015 emerged from the battleground with drug-resistant super bugs—with emphasis on ground. Bacteriologists at Northwestern University discovered teixobactin while studying soil bacteria. The drug safely killed even the toughest infections it encountered in trials with mice, and human trials may not be far away.

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NEW YEAR, NEW BREAKTHROUGHS

What kinds of breakthroughs will we be writing about a year from now? That’s impossible to say. So much work is being done outside what we consider the mainstream that one never knows where the next big story will come from. However, we do know what’s in the pipeline. According to the Cleveland Clinic, the Top 10 medical innovations for 2016 are likely to be:

  • A seriously promising Ebola vaccine may be licensed for use on humans this year.
  • CRISPR, a genome-editing tool, is presenting a possible way to eliminate genetic diseases by identifying and removing bad genes from a DNA strand—and it could cost as little as $30.
  • Cell-free fetal DNA testing for Down’s and Edwards syndrome that is far more accurate than standard blood or ultrasound tests may soon be available.
  • In 2016, a new biomarker technology that focuses on changes in the structure of certain blood proteins will offer more accurate cancer screenings and earlier detection. Advances in the technology of breath analysis are also offering promise for even earlier non-invasive detection.
  • Swedish scientists have developed the first mind-controlled prosthetic arm.
  • Cleveland researchers have developed an under-the-skin system of wires and electrodes that recently restored the sense of touch to two amputees.
  • Biosensors are being developed to monitor glucose and other vital statistics. Another remote device is a bandage that can diagnose pregnancy, hypertension or hydration from sweat molecules.
  • A tiny device called a neurovascular stent retriever can entrap and remove deadly clots. It will be available in many hospitals this year.
  • A study found that resveratrol—a compound found in red grapes, red wine and dark chocolate—may help treat Alzheimer’s disease.
  • An “artificial pancreas” is under development that provides a sensor and insulin pump to automatically check blood sugar levels in Type 1 diabetics.

All of this potential in the various fields of medicine is exciting and exhilarating, Yet at the same time, it raises some crucial questions. Where will medical technology and advances in treatment take us as a society with regard to certain moral and ethical issues—such as unbridled longevity, genetic manipulation, and enhanced intelligence? And how will all these medical miracles impact us economically, politically and socially?  Big questions for big breakthroughs.  

BREAKTHROUGH: FEMALE INCONTINENCE

Trinitas OB/GYN Chairman Dr. Labib E. Riachi, is dedicated to neutralizing the taboo regarding female urinary incontinence. Recent advances in technology have reduced a previous 2–3 day post-surgery stay in hospital to a 5–10 minute, same-day outpatient visit. In lay terms, he summarizes the operation as employing a piece of polypropylene mesh, which he calls “Scotch tape,” that works 90% of the time to reduce 90% of any incontinence issue. “The tape is getting smaller and the surgery even shorter,” says Dr. Riachi, whose subspecialty is female pelvic and reconstructive surgery. He is committed to educating physicians and their female patients to eliminate any embarrassment about a problem that can now be corrected quickly, safely and easily, “yet can change a woman’s life 180 degrees.”

BREAKTHROUGH: PACS

In the field of Radiology, says Dr. Eugene Kennedy, Chairman of the Trinitas Radiology Department, significant advances tend to build off of breakthroughs “that happened a while ago, but just continue to expand and develop,” such as:

  • Multi-detector Spiral CT, which has revolutionized not only how to perform a CT scan, but also what can be imaged, revolutionizing “how we image the body from head to toe.”
  • Positron Emission Tomography (PET-CT), which advanced cancer imaging from solely anatomic to functional physiologic imaging.
  • Magnetic Resonance Imaging (MRI), which as a technology has continued to expand in all areas of imaging, including neuroradiology, musculoskeletal radiology, women’s imaging and body imaging.

Pressed to choose one recent breakthrough, Dr. Kennedy says that the Picture Archiving and Communication System (PACS)—which he uses in his private practice—helps him to supply the best possible patient care. One of its sweeping innovations, he explains, is that “PACS images can be viewed simultaneously by numerous different individuals in diverse places.” This makes possible real-time consultations between radiologists and other MDs. 

ON THE HORIZON

A decade from now, we will be celebrating these five medical breakthroughs:

1 Vision Quest: Microchip implants will help the blind to see.

2 Organs to Go: Tissue engineering or regenerative medicine that will let scientists “grow” new organs. 

3 Rewired: Microchip technology, along with a matrix of fiber optic wires, will bridge damaged areas of the brain to cure a multitude of neurological conditions…and possibly even expand human brainpower.

4 Uplifting: Nanotechnology will be applied to a variety of age-reversing procedures.  

5 Heart Beats: Stem cells extracted from bone marrow will help new vessels grow to increase blood flow to the heart.

The Smart Approach

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

By Erik Slagle

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

A Day at the Beach

No matter the challenges, Holly Charleton loves everything about emergency medicine.

Dr. Holly Charleton, a specialist in Emergency Medicine, is part of the Trinitas ER’s late shift. When Dr. Charlton is not dedicating her thoughts and energy to the patients who walk through the door of the Emergency Department, she’s likely to be thinking about the doctors and nurses she teams with on her annual trips to Jamaica.     

EDGE: When did you become affiliated with the American West Indian Medical Association?

HC: While I was in training at the Brooklyn Hospital Center. After my residency, I volunteered to participate. Jamaica needs help. Diabetes and high blood pressure are rampant.

There is no Medicaid and there are few private insurance programs to cover healthcare needs. 

EDGE: How are they able to afford basic medical care?

HC: Some of the patients I see have saved up for years just to pay for an ultrasound. Others opt to feed their children instead of buying their meds. I remember one female patient who came in with severe knee pain from her years of field work. When I removed the dirty ace bandage wrapped around the injury, I saw that it was covered with repulsive beige paste and pink sprinkles. Upon closer examination, I realized that the paste was made up of mashed fruit and the sprinkles were mashed up pain pills she had been prescribed. That taught me how much education the Jamaican population needs today and tomorrow.

EDGE: What appeals to you most about emergency medicine, both in Jamaica and here at Trinitas?

HC: That’s easy…saving lives. People come in who are at the brink of a life-or-death situation. It feels good to bring someone back from that brink. I recently had the pleasure to see a cardiac arrest patient I had saved who was back in with a minor injury. He thanked me all over again. It’s rewarding to see a patient leave and live.

EDGE: How have you personally fared through all of Phase I expansion activity?

HC: I’ve been through worse. The construction team was really good at minimizing our inconvenience. We actually managed to function relatively normally throughout.

EDGE: What are some of the logistical and technical components of a top-notch Emergency Room?

HC: Design is really important when you’re dealing with critical patients. They need to be readily visible at all times. All tech equipment should be state-of-the-art, accurate and functioning—especially when it relates to patients’ vital signs.  

EDGE: What led you to specialize in ER medicine?

HC: My mother was a pediatric nurse. She often took me to work with her, so I was always interested in medicine, but the Emergency Room appealed to me even before I went to med school. In the ER, you face a variety of medical challenges involving all possible bodily parts on a daily—or, in my case, nightly—basis. As a result, an ER practitioner needs to develop acuity in order to respond to all those challenges that come up fast and furiously. 

Editor’s Note: Dr. Charleton spoke with editor Chris Gibbs. She told Chris that ER doctors need to know how to decompress during their time off. Dr. Charleton loves to travel and does so often. At home, she hangs out with family and friends. The key is to achieve a complete break from the work environment: “Everyone on staff at Trinitas knows that when you’re off, you’re off-limits.”

 

Blurred Lines

Presbyopia…Don’t have it? Just wait.

By Mark Stewart

Evolution and genetics have blessed a little more than half of our population with excellent distance and reading vision. Unfortunately, the human eye is not built for the long haul. As we age, our lenses get a little harder and the muscles that help us focus on near objects become a bit less dependable. Around 40 years old, even people with “perfect” vision (or surgically corrected vision) begin to notice that they don’t see up-close as well as they used to.      

Welcome to the world of presbyopia…the only affliction that affects every eyeball on earth.

“For people who’ve always had good vision, presbyopia kind of comes as a shock and disappointment,” says Dr. Joel Confino, co-founder of The Eye Care & Surgery Center, a three-office practice in Central New Jersey. “Their eyes have always performed. They don’t think it’s going to happen to them. Now they need more light or have to hold things further away. They come into the office and say, ‘My eyes have gone bad!’ I’m still surprised by how many people are surprised by it.”

According to Dr. Confino, who was the first in the area to offer laser surgery back in 1995—and whose practice treats the entire range of eye diseases—presbyopia also affects people who wear contact lenses, and people who underwent LASIK surgery in their 20s or 30s.  

To the layperson, presbyopia sounds a lot more serious than it actually is. Where does the term come from?  

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“It’s actually derived from the Greek word for older person, presbys, and ops, the word for sight,” explains Dr. Jaime Santamaria of the Santamaria Eye Center in Edison. “So it translates roughly to ‘the way an older person sees.’ Interestingly, the word Presbyterian shares the same root. A presbyter was a name for an older minister in the Greek Orthodox Church.”   

TREATMENT OPTIONS

The simple fix for people with otherwise good vision is a pair of reading glasses. For current glasses-wearers, the solution is often a pair of bifocals. Often, there is a natural resistance to both, Dr. Santamaria points out. 

If you’ve never worn glasses, the thought of being tethered to a cheap pair of CVS readers may be unacceptable. If glasses are already a part of your life, the idea of switching to bifocals may be your personal line in the sand where aging is concerned. And that’s totally understandable. Ben Franklin, the man who invented them, took his off to pose for the $100 bill. 

Refractive surgery has been a viable option to correct presbyopia for more than two decades, and has gone through significant improvement over that time. In most cases it is a better option than LASIK, especially for patients over 40. Refractive procedures replace the eye’s crystalline lens with an intraocular lens, similar to what happens in a cataract operation. In some cases, patients who undergo these surgeries see better than they ever did. Unfortunately, this type of procedure is not typically covered by insurance.

A relatively recent option for people who have never experienced vision problems, or who have undergone Lasik, is the KAMRA inlay, which was approved by the FDA about a year ago. It restores the eye’s ability to read without detracting from distance vision. 

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“It is an implant in the cornea,” Dr. Confino explains, “smaller and thinner than a contact lens. It restores reading power by creating a ‘pinhole effect’ that gives great depth of focus in one eye—much the way a camera’s aperture does, or what happens when you squint to see something more clearly.”

Although new in the U.S., the procedure has been used in Europe and Asia for a decade. During that time, both the device and the surgical procedure used to implant it have improved and, in the year it has been available here, both have continued to evolve, says Dr. Confino, who offers KAMRA in his practice. He says the quality and results are consistent with the other procedures his group does.

Joel Confino, MD
The Eye Care & Surgery Center Westfield / Warren / Iselin newjerseyvision.com

Jaime Santamaria, MD, FACS Santamaria Eye Center
104 Market Street
Perth Amboy, NJ 08861 santamariaeyecenter.com

Both Dr. Santamaria and Dr. Confino stress that presbyopia is not a disease, and therefore there should be no fear on the part of patients in being diagnosed. 

Editor’s Note: Dr. Confino is a Yale University graduate who studied medicine at the Albert Einstein School of Medicine in New York. Dr. Santamaria trained at Columbia Medical School and is on the faculty of Columbia’s Harkness Eye Institute. 

 

Stand and Deliver

Abu Alam joins the Trinitas OB/GYN team.

By Erik Slagle

Dr. Abu Alam, MD, PA is contemplative, looking back on his distinguished career as he sits in the waiting room of his office, which was once the parlor of a private home that is more than 140 years old. He’s looking ahead to the upcoming wedding in Chicago of his youngest daughter, thinking of Ramadan and also settling into his new role as Interim Chairman of Obstetrics/Gynecology at Trinitas Regional Medical Center in Elizabeth. Trinitas welcomed Dr. Alam to its team in April, and he quickly made an impression on both the faculty and the hospital’s patients.

Elizabeth’s considerable Haitian population gives Dr. Alam the opportunity to relate stories from his work serving in Haitian clinics where there is often no electricity and procedures are sometimes performed by flashlight. He dedicates several weeks each year to volunteering in Milot, Haiti as part of his commitment to charitable work in the impoverished island nation.

A doctor who has given much of his free time to charitable pursuits in underserved communities around the world, Dr. Alam is entering the next phase of his career, where he can serve as a teacher and mentor to the next generation of practitioners at the hospital while still working with OB/GYN patients and bringing new lives into the world.

“I believe I’m destined to do certain things in life,” Dr. Alam

says as he looks out the window onto Springfield Avenue. “I’ve delivered more than eight thousand babies, sometimes close to three hundred a year. When I go to bed at night, I know that I’ve given my patients the best care I can, whether that’s here in New Jersey, or in Haiti. My first priority has always been to my patients. Money was never the goal.”

Return to His Roots

Dr. Alam has also made it his mission to provide medical services to residents of his home country, Bangladesh. His work in Haiti inspired him to gather a team of like-minded medical professionals and open Nandina General Hospital, the only medical care for miles around its village. The village is about four hours by car from where Dr. Alam was born.

“I know that in many parts of Bangladesh malnutrition and childbirth are areas where not enough attention can be paid by the limited number of doctors available,” he says. “The patients who we treat at Nandina General Hospital might otherwise not have any treatment options available to them. We work with equipment donated by New Jersey medical centers to bring current, modern medical practices to people who truly need them.”

For his philanthropy and service, Dr. Alam was awarded the Ellis Island Medal of Honor in 2006; presented annually to immigrants who have made significant contributions to America’s heritage. Dr. Alam also serves as Chairman of the Teddy Bear Foundation, which provides support for patients stricken with achondroplasia—commonly known as dwarfism—for the past 20 years. These children often require multiple surgeries and painful recovery periods to help alleviate the condition, and the Teddy Bear Foundation raises funds to help provide the treatment and after-care needed. 

Vanessa Loeffler, who is a long-time member of the staff at Dr. Alam’s Summit office, established the Teddy Bear Foundation more than 20 years ago after her daughter Theodora was born with the condition. Loeffler credits Dr. Alam with playing a key role in helping further the Foundation’s mission.

“Dr. Alam has been instrumental in helping us grow the Teddy Bear Foundation,” she says. “His work on behalf of children like Theodora has made such an incredible impact on our ability to help families who are caring for people with this condition.”

Productive Partnership

Throughout his life, Dr. Alam has believed fate has led him to his accomplishments on professional and personal planes. As he sets out on his next professional endeavor as a member of the Trinitas team, the communities the medical center serves are fortunate to be coming under his care and compassion.

“For many years I’ve heard about Trinitas’ reputation for outstanding outcomes and patient satisfaction,” Dr. Alam says. “I look forward to being a part of this wonderful team and to working closely with the residents and students. I expect I can learn as much from them as they may hopefully learn from me.”

It is one thing to have practiced medicine for almost five decades without losing your ardor and drive to serve patients. It’s another to give so selflessly of your time and energy to help those in need around the world. To be able to balance both of those while also raising four children—and maintaining a perspective on the things in life that are truly important—is something else altogether. It’s a rare amalgam to find in a person who has seen and done as much as Dr. Alam. 

And it’s a great victory for Trinitas Regional Medical Center to welcome him to their team. 

Abu Alam, MD, PA
240 Williamson St., Suite #304 Elizabeth, NJ
908.282.2000
128 S. Euclid Avenue Westfield, NJ
908.928.1234

What’s Up, Doc?

Alzheimer’s Breakthrough 

Doctors know that the main culprit in the onset of Alzheimer’s Disease is a sticky protein called beta amyloid, which accumulates in the brain as synapse-destroying plaque. How it collects there was something of a mystery until Harvard Medical researchers found evidence that this substance forms as protection against pathogens that cross the blood-brain barrier, forming a “cage” around them. The problem seems to be that the beta amyloid stays in the brain after the invading bacteria has been eliminated. The Harvard team believes that further research could reveal ways to treat or even prevent Alzheimer’s.

No Blind Mice 

Whoever wrote the song “Three Blind Mice” probably never imagined that, one day, they would regain their sight. Last month, the journal Nature Neuroscience reported that Stanford University scientists reactivated the optic nerve cables of a blind mouse, reestablishing the link between eye and brain. In a functioning eye, photoreceptors in the back of the retina send information to the brain through axons, whic act like electrical wires. When axons in the brain are damaged- from injury or disease- it had been assumed that they don’t regenerate. The Stanford project proved otherwise. Researchers were able to reactivate the retinal pathway with a combination of high-contrast visual stimulation and biochemical manipulation.

Large, But In Charge 

Many obese mothers-to-be are resigned to producing overweight children. A new study, funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, shows that there is something expecting moms can do during pregnancy to tilt the odds in their favor. Researchers found that adequate maternal folate appears to mitigate the effects of a mother’s obesity on her child’s health. An essential B vitamin, folate is known to reduce a fetus’s risk for malformations affecting the brain, spine and spinal cord. In this study, children of obese mothers with adequate folate levels had a 43% lower risk of obesity than children of obese moms whose folate levels were considered too low.  

Do Opiods Ease Pain?

The short answer is Yes. However, the longer-term impact of painkillers such as Oxycontin and Vicodin is less clear. Neuroscientists at the University of Colorado conducted a lab study in mice that suggests that painkillers may actually prolong pain. It took mice treated with morphine up to 12 weeks to recover from chronic nerve pain, while untreated mice recovered in an average of five weeks. The researchers suspect that opioids reshape the nervous system in ways that amplify pain signals long after an injury (or illness) heals, prolonging discomfort. 

Waist-Reducing Carbs? 

“Pasta doesn’t make you fat,” celebrity chef Giada de Laurentiis likes to say. “How much pasta you eat makes you fat.” Well, now she’s got some science to back her up. Researchers from the Mediterranean Neurological Institute studied more than 20,000 people throughout Italy, comparing their pasta intake, body measurements and other criteria. They concluded that consuming pasta in moderation (traditionally Italians eat a small serving as an opening course) appears to contribute to a healthier body mass index and better waist-to-hip ratio. The results of the study do not prove that pasta helps you lose weight—only that the carbs it contains are not unhealthy. It probably doesn’t hurt that many in the study ate foods associated with a Mediterranean diet. They are, after all, Mediterranean.

 

Comfort Zone

Dr. Adriana Suarez walks the walk…and talks the talk. 

By Yolanda Navarra Fleming

When a doctor and a patient literally don’t speak the same language, building a relationship based on trust and under-standing poses a challenge that, at times, can be impossible to overcome. As a native Spanish speaker, Dr. Adriana I. Suarez-Ligon offers patients of Trinitas Regional Medical Center the most current and accurate breast health care in two languages.     

“There is a large language barrier that exists between the Latino community and the healthcare system,” says Dr. Suarez, who recently joined the Surgical Department at Trinitas as a breast surgeon—and is also an Instructor of Surgery at Rutgers University–New Jersey Medical School in the Division of Surgical Oncology. “Enough is lost in translation when doctors do speak the same language as their patients. I am excited to bridge the gap between the Dr. Adriana Suarez-Ligon (left) pictured with Veronica Vasquez (right), MHA, CN-BA, Breast Patient Navigator, within the Trinitas Comprehensive Cancer Center. local Hispanic community and the healthcare system.”

Born in the Bronx to Cuban parents, Dr. Suarez received her Doctor of Medicine from the University of Medicine & Dentistry of New Jersey–New Jersey Medical School in 2009, and completed her general surgery residency at Rutgers in 2015. 

Dr. Adriana Suarez-Ligon (left) pictured with Veronica Vasquez (right), MHA, CN-BA, Breast Patient Navigator, within the Trinitas Comprehensive Cancer Center.

“Medicine and surgery are complicated,” she says. “Breast cancer is complicated. Even speaking the same language, medical terminology is a language on its own. Just think, we doctors go to medical school for four years before we even complete a specialty training program, which is oftenup to a decade of training before we go out into practice our given specialty. We have all that time to understand the disease processes that we treat and the treatments we offer. Patients generally don’t have that background and now we have to explain their disease to them in an office visit that may not last more than one hour. At least doing so in their native language is a start.”

Dr. Suarez, who doesn’t remember a time that she didn’t want to be a doctor, has followed in the footsteps of her father and aunt, both OBGYNs. However, medical school intrigued her with the prospect of not only being able to care for patients, but also to remove their disease. 

“I really loved the idea of being able to care for female patients with the perspective of being female myself,” she says. “As a breast surgeon, I am able to take care of the female patient with a surgeon’s hands.”

With every new patient a partnership is formed, Dr. Suarez explains. The human being is her top priority, not just the case.  She interacts with mothers and fathers, daughters and sons, wives and husbands and oftentimes, she says, she sees herself in a patient. 

“Each patient is different and at different stages in their lives,” Dr. Suarez explains. “They’ve had vastly different life experiences that make them the unique people they are. These unique experiences also shape how they respond to their diagnosis, whether benign or malignant, and how they approach the treatment plan. I very strongly believe in giving patients all the information they need to make informed decisions for themselves. That said, not all patients want all the information [these patients are rare, she maintains] and want me to make the decision for them; I am okay with this, too.”

And just as no two patients are alike, no two breast cancers are created equal. Indeed, Dr. Suarez takes a special interest in breast cancer disparities, especially among Hispanic women, young breast cancer patients, and high-risk patients. 

“Each breast cancer is as unique as the patient that has the disease,” she explains. “It is very important for doctors to approach each patient with breast cancer on a very individual basis. Similarly, patients need to acknowledge that the stories that they hear and the information that they read may not apply to them. With the accessibility of the internet, there is a lot of information floating around that is not all validated. Be careful and ask a lot of questions.” 

As comfortable as Dr. Suarez is interacting with patients and their families, it is in the operating room where it all comes together. The OR, she says, is a place of Zen and extreme concentration. 

“Operating on my patients is a privilege,” she explains. “One I am very grateful to have. In the OR, my patients relinquish control over their body and trust me to provide them with the highest level of care. I leave everything behind when I enter the OR with a patient and focus solely on them.” 

“I truly believe that my patients and I are partners in their healthcare process. I am the one trained to provide them with their surgical care, but together we make the decisions”

Adriana I. Suarez-Ligon, MD Breast Surgery
Trinitas Regional Medical Center (908) 994-8230

Editor’s Note: Dr. Adriana I. Suarez-Ligon is a frequent lecturer on a wide variety of topics related to breast cancer. She is trained in the spectrum of benign and malignant breast diseases, and is an expert in the vast spectrum of breast pathology. For benign disease, she performs excisional breast biopsies. For malignant disease, she offers breast conservation surgery, oncoplastics, skin and nipple sparing mastectomies, as well as axillary staging procedures. Earlier in 2016, Dr. Suarez completed a Society for Surgical Oncology Accredited Breast Surgical Oncology Fellowship at Emory University School of Medicine in Atlanta. She and her husband, a coach for Nike, have two children.

 

Doctor, Fix it

Mark Preston joins the robotic team at Trinitas.

By Yolanda Navarra Fleming

Mark Preston didn’t grow up with the dream of becoming a doctor. In fact, he says, the first time he had any inkling of entering the field of medicine was during his senior year in college, when he was digging out a particularly deep splinter in his hand. At the time, he was at Dartmouth College majoring in government. A year later, in a remote part of China, he got sick and spent a day as a patient in an open ward of a hospital.      

“As I witnessed the nurses and doctors caring for much sicker patients, I was impressed and moved by the caring manner of the staff and also taken by the vulnerability one has while being a patient,” he recalls. “That really left an impression.”

A rare moment when the da Vinci surgical robot at Trinitas is not in use.

Upon returning home to his career in finance, he became an EMT, which further opened his eyes to a career in medicine: “Finance wasn’t going to satisfy me…I succumbed to my calling and went back to school to become a doctor.”

Fast-forward to 2016. Dr. Preston—one of the first doctors in the U.S. to become board certified in Female Pelvic Medicine and Reconstructive Surgery (more commonly known as urogynecology)—is now on staff at Trinitas Regional Medical Center, which is among the busiest robotic surgery centers in New Jersey. As director of the Women’s Center for Incontinence and Pelvic Surgery in Waterbury, CT, Dr. Preston relied on robotic surgery as an important part of his practice for the past five years. He brings to Trinitas his expertise in robotic sacrocolpopexy, a surgical technique for repairing pelvic organ prolapse (dropped pelvic organs).

“The problems that I deal with—urinary incontinence, other bladder issues and prolapse—impact so many women,” he says. “These conditions are treatable. You don’t have to live with them. I am very excited about the fact that Trinitas has such an established and highly esteemed robotic surgery program. It’s a real bonus to be able to walk into an already established program of such high quality.”

Known for his relaxed, easygoing personality—and unflappable demeanor in the OR—Dr. Preston spends at least 45 minutes to an hour talking to patients upon first meeting. The key, he says, is to listen to the patient and make sure you are addressing her desires and concerns. 

“It’s really important that patients feel I understand them and that they are comfortable with me,” Dr. Preston explains. “I’ve kept that primary care attitude that I had when I first started in medicine: I love getting to know patients and building a relationship with each person. I spend a lot of time listening, finding out what their goals are, and explaining their problems, the options available, and then ultimately what to expect from the treatment we decide on.”

After his first year of clinical rotations at Columbia University College of Physicians and Surgeons, when it came time to choose a specialty, Dr. Preston gravitated to primary care because, he says, “it’s where one gets to know patients over many years and builds a relationship with them. Intellectually, I liked physiology and internal medicine—figuring out how things work or are going wrong. But what I really liked doing was surgery.”

OB/GYN, he concluded, was the only specialty that would combine his favorite aspects of doctoring.

“Within the gynecologic surgical specialties, I found I had a knack for visualizing where things ought to be that have fallen out of place and how to put them back, and I enjoyed the creativity needed to do that,” he says.

“For instance, I see a bulge in the anterior vaginal wall,” says Dr. Preston, “and then try to figure out what’s causing the bulge—is it a weakening or tear in the middle of the vaginal wall or at the top or at the sides, or has the uterus dropped, pulling the wall with it? I have a larger-than-average surgical toolbox, which means I can tailor a surgery to the specific needs of the patient. Rather than having one surgical technique to deal with cystocele, I have four that I can use. I was fortunate to have the opportunity to complete fellowships both in pelvic reconstructive surgery and minimally invasive gynecologic surgery.“

All too often, Dr. Preston sees a patient after an unsuccessful surgical outcome. As a member of the American Urogynecologic Society’s Quality Outcomes Committee, he helps to develop national quality guidelines and measures in Female Pelvic Medicine and Reconstructive Surgery. The organization maintains surgical outcomes registries, works with national quality groups and the federal government on quality measures, and monitors the regulatory environment as it pertains to the specialty.

Although the experience of performing surgery is different for every doctor, what remains the same is the intensity and the importance of remaining laser-focused. What Dr. Preston believes sets him apart is the way he responds to the pressure. When he is on a case, there are no distractions. 

“I am one hundred percent focused on the surgery,” he says. “It’s almost as if time stands still. Fatigue, pains, and other worries…they all disappear when I am in the OR.” EDGE

Mark R. Preston, MD Urogynecologist
Trinitas Regional Medical Center (908) 282-2000

Editor’s Note: Dr. Mark R. Preston did his post-graduate urogynecology training at St. Luke’s-Roosevelt Hospital, Emory University Medical School and the Center for Women’s Health and Female Continence in Salinas, CA.

 

What’s Up, Doc?

Fussy Babies 

A recent study out of the University of Buffalo suggests that babies who are fussier and take longer to calm down may be at higher risk for future obesity. Infants were taught to push a button for a reward in the study. Researchers found a correlation between babies who were willing to work for a non-food reward (such as bubbles) and the ability to recover quickly from crying or distress. Likewise, there was a correlation between babies who worked for a food reward and who took longer to stop crying.

Other studies, published by the Federation of American Societies for Experimental Biology (FASEB), have explored how feeding can be used as a strategy to calm or pacify infants. Association with increased carbohydrate intake and practice to calm down infants was found. Analysis indicated that fussier babies were twice as likely to be fed solids and non-milk liquids at 3 month of age. “Those infants were also more likely to be given cereal in the bottle,” points out

Yelena Samofalov, MD Trinitas Pediatric Health Center 908.994.5750

Yelena Samofalov, MD of the Trinitas Pediatric Center, “which is not consistent with current feeding recommendations. These feeding practices also can lead to infants being overweight. We suggest to our patients to follow your doctor’s advice regarding feeding your infant…and not to use food as a pacifier for a fussy baby.”

Parkinson’s Breakthrough 

Parkinson’s researchers have long been searching for a way to get out in front of the disease before its symptoms develop. Scientists at University College in London may have made a breakthrough in this effort with a non-invasive eye test. They observed that rats exhibited changes in the back of the eye before visible symptoms occurred and before brain cells had been significantly damaged. Parkinson’s is the second-most common neurodegenerative disease worldwide and currently there are no blood tests or brain scans that can render a definitive early diagnosis. Identifying an early biomarker would be a game-changer. 

Stem-Cell Scams? 

Stem cell therapies hold profound promise for a wide range of diseases, with public awareness at an all-time high. Yet only one stem-cell product has actually been approved for sale by the FDA: Hemacord, which is used for blood disorders. None of the other 300-plus therapies advertised around the country have been deemed safe or effective. They include treatments for Alzheimer’s and Parkinson’s disease, arthritis, multiple sclerosis and even autism.  Many of the companies offering these therapies do not even have a stem-cell expert on staff. 

Nice Pick 

So it was under our noses all along? Well, technically, in our noses. German scientists announced the discovery of bacteria in the human nose that produces an antibiotic that holds great promise in the fight against super bugs. The human body isn’t typically fertile ground for antibiotics—most come from the soil. However Lugdunin, which is made naturally by a microbe that lives in nose hair bedding, works in ways that researchers don’t yet fully understand. “Although preliminary, this report is very exciting,” says

William Farrer, MD
Chief of Infectious Diseases
Trinitas Regional Medical Center
908.994.5455

William Farrer, MD, the Academic Chief of Infectious Disease at Trinitas. “We are running out of antibiotics as bacteria mutate to become ‘superbugs,’ resistant to most if not all antibiotics. Research on the human microbiome and its role in health and disease has exploded in recent years. This discovery may lead researchers to find other potential antibiotics made by the bugs living in and on us.” 

Bagpipe Lung: It’s a Thing 

It may be time to reach out to the trumpeter in your life. Doctors in England recently diagnosed a fatal case of what they are calling “bagpipe lung”—a deadly reaction to mold and fungus that can live in the moist interior of many wind instruments. In this case, the 61-year-old victim was a bagpipe player, but scientists warn that the same conditions could exist in saxophones, trumpets and other instruments. They suggest that owners do regular cleanings to prevent the build-up of harmful pathogens, and that musicians who develop a lingering cough get themselves checked out in order to prevent permanent lung damage. 

Cancer Study to Assess Gene-Editing Technology

You may be hearing about something called CRISPR–Cas9 over the next couple of years. And that would be a good thing. It’s a promising new therapy being tested against cancer at the Universities of Pennsylvania, Texas and California-San Francisco with the blessing of the National Institutes of Health. CRISPR–Cas9 involves a gene-editing technology used to alter a patient’s T cells so that they do a better job recognizing and attacking tumors. The FDA hasn’t approved CRISPR–Cas9, so the initial goal of the study is to determine whether it’s safe. The study is being funded by tech billionaire Sean Parker, and will be tested on a handful of patients who have melanoma, sarcoma and myeloma. 

Benefits of Unsaturated Fats 

Is the key to staying slim eating more fat? University of Minnesota researchers analyzed 56 different studies on diet and chronic disease and noticed something interesting: People who consume unsaturated fats (such as avocados, nuts and fatty fish) along with fruits, veggies and whole grains are 29% less likely to develop heart disease or suffer strokes, 30% less likely to develop type 2 diabetes, and at a 57% reduction in the risk for breast cancer. Carbs and processed sugar are the real bad guys, the study suggests, adding that when it comes to monounsaturated fats like olive oil, for most people there is no such thing as “too much.”

What’s Up, Doc?

Raw Milk: Coming Soon to NJ? 

A recent study out of Munich, Germany confirms the fact that children who consume unprocessed cow’s milk are less likely to develop asthma. The research, which was published in The Journal of Allergy and Clinical Immunology concludes that “raw” milk’s higher level of omega-3 fatty acids is a contributing factor. Omega-3 fatty acids are critical to human health, but cannot be created in a lab; they must come from dietary sources. The study’s authors stop short of recommending raw milk, however, because it may contain pathogenic microorganisms. “It is a well known fact that the processing of our foods in this country takes away some vital nutrients, vitamins and minerals,” says

Kevin Lukenda, DO
Chairman, Family Medicine Department 908.925.9309

Dr. Kevin Lukenda, Chairman of the Trinitas Family Medicine Department. “It’s a Catch-22 situation, as the processing of our foods makes them safer from an infectious point of view but takes away many of the health and nutritional benefits.” The sale of raw milk is illegal in New Jersey, however a bill introduced in the legislature this winter may change its status. If so, it will be available to consumers only at the dairies where it is produced, not in stores.

Almond Joy 

A study published in the Journal of Nutrition Research suggests that a handful of almonds a day may be enough to keep the doctor away. A group of 28 child-parent groupings were instructed to consume almonds (or almond butter) each day for three weeks—the adults 1.5 ounces and the kids a half-ounce. University of Florida researchers measured the participants’ Healthy Eating Index—a measure of diet quality based on USDA guidelines—before and after the three-week period. Both parents and children showed exactly the same improvement in their scores (roughly 14 percent), which was attributed in part to decreasing their intake of empty calories. Kids will be kids, however: Researchers noted that many of the children said they didn’t like the taste of almonds or were tired of eating them every day. “This study showed that changing just one component of a diet can have a positive effect,” says

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

Michelle Ali, Director of Food and Nutrition Services for Trinitas. “Eating the same foods each day can becomes monotonous and boring, especially for children. I’d add in a handful of almonds to salads, add almond butter to apple slices, and even to your milkshakes. You’ll improve your nutrition and ease boredom.”   

Big Bang 

While the health risks of e-cigarettes (both to the smoker and others) are still being hotly debated, the overheating dangers of the device itself have been drawing attention of late. Every year, a handful of “vapers” report that their e-cigs have exploded—often causing devastating injuries. The culprit appears to be the lithium batteries that power the devices. The industry has grown to $2 billion-plus annually, with roughly 4 percent of the U.S. population using e-cigarettes regularly. Industry advocates point out that accidents are rare, and that they typically involve extreme conditions or damaged batteries, which can produce shorts. Last December, Daniel Pickett was driving through his hometown in Central Washington when he heard a static-y sound a half-second before his e-cigarette exploded, burning his hand and arm, and leading to skin grafts and five surgeries. Daniel won’t be vaping again. “I just think that if people really knew this could explode in your face, they would consider twice putting a device like this to their mouth,” Pickett says.

Connection Between Autism  and Early Death     

The effort to understand, treat and possibly prevent autism has acquired new urgency after findings by Sweden’s Karolinska Institute published in the March issue of The British Journal of Psychiatry. Individuals on the autism spectrum tend to die significantly younger than other adults—on average 18 years younger. The culprit is not cancer or heart disease, as is the case in a great many premature adult deaths. It’s suicide. “The inequality in outcomes for autistic people shown in this data is shameful,” says Jon Spiers, who heads the British charity Autistica. “We cannot accept a situation where many autistic people will never see their 40th birthday.” The Swedish study tracked 27,000 people with autism and 2.5 million people who were not diagnosed with the social communication disorder. The age at death also changed relative to a person’s cognitive ability. Those considered “high-functioning” with strong language skills lived longer, but still were twice as likely to die young as the general population. “This research really helps characterize the magnitude of health problems faced by people with social communication disorders in Western countries,” says Trinitas psychiatrist

Salvatore Savatta, MD
Deputy Chairman
Dept. of Behavioral Health & Psychiatry
908.994.7281

Dr. Salvatore Savatta. “More research is required on how to engage and retain these at-risk individuals in mental health treatment and related services.”

Zika Update

The Zika scare may come uncomfortably close to home this summer, thanks to the Olympic Games. Although host country Brazil is working to mitigate the Aedis aegypti mosquito—and August is “winter” in Brazil—if the disease comes back to the U.S. through one of the 50,000-plus Americans who reportedly plan to travel to the games, it will arrive during one of our warmest months. That has infectious disease physicians concerned, and has already launched a debate about the best way to attack Zika if it gains a foothold in North America. One plan involves genetically modifying the male mosquito to produce offspring that die in the larval stage. “It is likely that cases will be transmitted here in New Jersey this summer,” says

William Farrer, MD
Chief of Infectious Diseases Trinitas Regional Medical Center

Dr. William Farrer, a member of the Infectious Disease Division of the Trinitas Medicine Department. “It is important that people take steps to reduce mosquito habitats, such as removing standing water from their yards. It is also important to employ methods to reduce your chances of mosquito bites, such as wearing long sleeved clothing and applying insect repellent when outdoors. The CDC website [cdc.gov/zika] has many helpful suggestions and is frequently updated.”

Fish Warning For Mothers-To-Be 

The health benefits of fish have been touted for decades, but because of possible exposure to organic pollutants, most doctors are now suggesting people limit their consumption. According to a recent article in JAMA Pediatrics that advice is especially important for pregnant women. Those pollutants appear to have endocrine-disrupting properties that contribute to rapid growth in infancy and the development of childhood obesity. The study cited looked at more than 28,000 pregnant women in Europe and the U.S. and tracked the progress of their children to age 6. Women who had more than three servings of fish per week gave birth to children with higher body mass indexes at ages 2, 4 and 6. “The latest FDA and EPA recommendations suggest that pregnant women eat 8 to 12 ounces per week, in two or three servings,” says

Yelena Samofalov, MD Trinitas Pediatric Health Center 908.994.5750

Dr. Yelena Samofalov of the Trinitas Pediatric Health Center. “It’s also important to remember that not all types of fish accumulate the same amount of pollutants.” Indeed, while researchers accounted for different fish types, they were unable to drill down on cooking procedures or the quality/type of water fish came from—which may influence the data. Fish associated with higher amount of mercury—which is especially dangerous for the developing brain of neonates—should be avoided during pregnancy and while breastfeeding, Dr. Samofalov adds. Preferences should be given to salmon, pollock, shrimp, tilapia, canned tuna, catfish and cod. 

Going Gray 

Who among us does not rue the day when we go gray?For some, the process is gradual; for others, not. Age and stress are the prime culprits but, according to researchers from University College in London, for about 30 percent of people of European descent, gray hair is a genetic inevitability. The IRF4 gene, which appears to cause people to gray prematurely, is linked to the production of melanin, which regulates eye, skin and hair color. This discovery should be of particular interest to hair care companies which might be able to develop products that delay or reverse graying as hair grows.

Expanding Horizons

Phases II and III of the hospital’s ER project are driven by emergency care…and emergency caring.

By Christine Gibbs

By this time next year, the ambitious $18.7 million expansion project for the Emergency Department at Trinitas Regional Medical Center will be long done. Phase I began in July of 2015 and ended in May of this year. Phase II is already nearing completion and the third and final phase is targeted for early 2017. Unlike most suburban hospitals, Trinitas is “land-locked” so there was not much real estate available for expansion. Even so, the architects and general contractor still managed to add 24,000 square feet, which will house 45 private spaces designed to accommodate emergency patients as soon as possible after coming through the front door.    

The expansion itself was an absolute necessity. In the last few years, the number of patients seen annually in the Emergency Department was double the 35,000 it was originally designed for. 

The Phase I improvements have already made a huge difference. They include three new treatment areas that provide 27 beds. The Fast Track area now has seven newly constructed treatment bays, the Behavioral Health area has six, and the Geriatric Unit has five new private rooms. There will also be an ICU accommodation comprised of three new rooms, as well as one renovated room. Once expansion is completed, 18 more treatment spaces will be added to the current 27 beds, which get the final number up to the aforementioned 45 spaces.

As with all projects of this nature, there have been some tweaks along the way. For example, the original plans for Phase II called for a two-story atrium waiting lounge. However, it was decided that the space would be more efficiently utilized by creating a second floor for the department’s administrative offices. The waiting room is now a single story, but with an entire wall of glass to bring some of the outside in. Additional improvements include a Radiology Suite, an Ultrasound Suite, and an Emergency Services Lounge for the staff.

What do the people who run the Emergency Department have to say about its progress? We sat down with Dr. John D’Angelo, Chairman of Emergency Medicine, Dr. Abie Li, Assistant Medical Director of Emergency Medicine and Mercy Mallari, RN, MSN  ER Director…

What is the most valuable resource added as a result of the expansion program?

Dr. Li: The new CT scanner, for sure, since it benefits doctors and patients alike. 

Dr. D’Angelo: I agree about the value of the scanner. Of course, the most valuable ER resource is the dedicated staff—those strong people who work to save lives every day are our most precious resource.

Were there any issues that gave you some sleepless nights during Phase I?

Dr. D’Angelo: Absolutely none [laughs]. The main issue during construction has revolved around spatial challenges—that is, how to keep the patient flow unhampered despite ongoing major construction activities.

Nurse Mallari: The ER never shuts down…the show must always go on!

Dr. D’Angelo: We actually experienced volume growth during Phase I, yet the “walk-out” rate went down. It was amazing that we were able to maintain the same level of performance and deliver the same quality of services despite some unavoidable inconveniences.

What can we expect from Phase III?

Nurse Mallari: Phase III will provide an ambitious “face lift” for all existing spaces with the goal of transforming the entire ER into a harmonious and homogenous environment. 

Dr. D’Angelo: The effort to achieve this has involved careful planning and execution to make the ER as comfortable, healthy, and safe as possible for patients and visitors alike. This requires the full-blown expertise of both the design consultant firm we hired for the entire project, Ewing Cole, as well as the main construction company, Barr & Barr.

Once everything is done, how will Trinitas rate as an ER facility?

Dr. D’Angelo: To be fair, we should compare our ER with similar sized facilities in comparable urban areas that process at least 70,000 patients per year. In this group, Trinitas’ ER is ranked among the best. Our metrics—from time of arrival, to point of contact with provider, to final discharge—place us at the top of the industry. We also have a very low rate of patients who leave without being seen [see “Trinitas by the Numbers”]. Of course, the greater the volume, the greater the challenge to service all patients. I am determined as the Emergency Medicine Chairman to right-size the department so that we can handle the daily projected volume of patients. 

When Phase III is done, how will you feel?

Dr. Li: Proud!

Nurse Mallari: Excited to serve the community…to show them that we are here to serve them.

Dr. D’Angelo: I feel especially proud of the geriatric area, which is becoming more important with the aging of the Baby Boomers. Geriatric care is a very resource-intense operation. Specific treatment is dependent upon the complexity of care needed by an older patient. Also, a lot of consideration must be given to proper aftercare. The majority of elderly patients are going to need to take advantage of our advanced technology, such as our new CT scanner and hand-held point-of-care bloodwork equipment that delivers lab results in 20 minutes, instead of 90. All architectural and construction planning for the project will reflect the latest advances to assure the physical safety of geriatrics while in our care. With the growing number of memory care patients, training will be given to staff on up-to-date testing procedures to assess levels of Alzheimer’s and dementia impairment in order to recommend the best final disposition of each patient from the ER.

Why did each of you choose Emergency Medicine as your specialty?

Dr. Li: I wanted to help as many of the sick as possible. The ER provides a “Spice of Life” environment with a constant flow of a wide variety of people who are in need of all kinds of help. I promised my parents I would try to help as many people as possible. In the ER, I can do that.

Nurse Mallari: Nursing has a wide array of specialties. During the rotation phase of my career, I felt an immediate calling during the ER training. The adrenaline surge from seeing a gunshot wound being treated right before my eyes to save a life was amazing.  I felt, “This is home!”

Dr. D’Angelo: My reason for selecting Emergency Medicine has evolved over time. Somehow, I relate to how frenetic the energy in the Emergency Department can be. It takes a special breed of ER providers to be able to react quickly enough to resuscitate and save a sick child, or a parent, or a grandparent. We’re glad to be here and we’re looking forward to building an even stronger relationship with the entire community. We care for those who often times are marginalized in society and have no choice about where and who should provide them with healthcare. We are here for them. Our doors are always open. 

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

Abie Li, MD
Assistant Medical Director, Emergency Medicine
Trinitas Regional Medical Center

Mercy Mallari, RN, MSN ER Director
Trinitas Regional Medical Center

 

AAA-Rated

Doctors are catching abdominal aortic aneurysms before they can kill.

By Erik Slagle

Adrian Velasquez was fortunate. During a routine physical in early 2015, doctors discovered a silent killer developing in his abdomen—an aneurysm had formed in the aorta, the largest artery in the body, which runs from the heart and supplies blood to every organ in the body. It was an abdominal aortic aneurysm (AAA), a condition that often goes unnoticed until it ruptures. When that happens, 85 percent of patients do not survive.  

Adrian was doubly fortunate in that his doctors had caught his condition early, and that he would soon come under the care of the Vascular Surgical Team at Trinitas Regional Medical Center. A 78-year-old resident of Roselle Park, Adrian was referred to the team of vascular and endovascular surgeons on faculty at Rutgers-New Jersey Medical School (NJMS).  

Dr. Michael Curi, chief of Vascular Surgery at NJMS and Trinitas, explained he would operate to repair the aneurysm—not through invasive open surgery, but through a minimally invasive endovascular procedure known as a Stent Graft. Dr. Curi enlisted his partner, Dr. Timothy Wu, an expert in percutaneous techniques, so they could perform the entire procedure using just two needle punctures without creating an incision.

“We recruited Dr. Wu to the faculty at Rutgers because of his vast experience with minimally invasive techniques such as these for treating all forms of vascular disease,” Dr. Curi explains, “and so we could also make these advanced techniques available at Trinitas. These techniques are game-changers for patients who would otherwise not do well with the more invasive, traditional therapies for treating AAA.”

“I was very thankful for Dr. Wu’s recommendation and approach,” Adrian says. “Given my age and weight (210 pounds), this was the most appropriate option for me.  The fact that it was non-invasive was a great relief to me and my family.”

Surgery to correct these types of aneurysms before they rupture has traditionally been aggressive and invasive, requiring major incisions and an extended hospital stay. Recovery is typically lengthy and uncomfortable. But the endovascular technique has changed that.

“Elective repair, as was performed on Mr. Velasquez, can be greatly beneficial to patients who have this condition,”

Dr. Wu says. “Once an abdominal aortic aneurysm ruptures, the loss of blood is extremely damaging. When one is discovered early, the majority of cases can be treated with stents in a fashion similar to Mr. Velasquez’s. This is preferable, as the open approach to these aneurysms introduces a high level of trauma to a patient’s body. The percutaneous method significantly cuts down on that trauma and greatly eases recovery.”

Adrian’s age, Dr. Wu adds, made him an excellent candidate for the minimally invasive method. Correcting an AAA through endovascular surgery saves up to two hours of anesthesia time for a patient, and hospital stays can be cut from 5 to 7 days down to just 1 or 2. Adrian spent less than two days in the hospital following his December 10th procedure, giving him plenty of time to spend the holidays with his grandchildren.

“I was able to come home to my family much more quickly thanks to Dr. Wu’s method,” he says. “I had very little discomfort…no pain that was out of the ordinary at all.”

www.istockphoto.com

As screenings for abdominal aortic aneurysms become more routine, doctors are confident more of these issues can be caught, monitored, and repaired before they become a serious threat to a patient’s life. The SAAAVE (Screening Abdominal Aortic Aneurysms Very Efficiently) Act of early 2006 encourages screenings, providing as part of Medicare coverage a one-time ultrasound exam for individuals considered to be at risk (males between 65 and 75 who have ever been a smoker) or anyone with a family history of AAA.

“We do believe that the SAAAVE Act has contributed significantly to the number of AAAs that have been found, and operated on, before they can rupture,” Dr. Wu says. “These types of aneurysms are known as ‘silent killers’ in the medical field, because patients often don’t know they have one until they’re in severe pain, or until it bursts. I encourage anyone with certain risk factors, especially those with family members who have had an AAA, to talk to their doctor about screening options.”

Adrian Velasquez agrees. 

“I’m happy to talk about what happened to me, because I want other people to know about the risk for abdominal aortic aneurysms,” he says. “People should be aware of the importance of getting checked, and that this non-invasive procedure could be available to them.”

Adrian recalls that when surgery for the AAA needed to be scheduled, he was given the option of having it performed at a hospital in Newark, or at Trinitas in Elizabeth. He picked Trinitas because of its proximity to his Roselle Park home. He says it was a good choice.

“I came away with a very good opinion of Trinitas,” he says. “Everyone there—the doctors, the nurses, the whole staff—were professional and kind to me. If someone needs to have a procedure, and Trinitas Regional Medical Center is an option, I definitely recommend it.” 

Michael Curi, MD
Associate Professor and
Chief of Vascular Surgery
Rutgers New Jersey Medical School Attending Physician
Trinitas Regional Medical Center 973.972.9371

Timothy Wu, MD
Assistant Professor
Rutgers New Jersey Medical School Attending Physician
Trinitas Regional Medical Center 973.972.9371

Ask Dr. D’Angelo

’Tis the Season

Springtime heralds a new season of outdoor activities—hiking, biking, jogging, team sports—and after a long winter you are ready to take them on…or so you think. The musculoskeletal system of the body is a complex network of bones, ligaments, muscles and tendons, and at this time of year we see an uptick in sprains, strains and fractures in the Emergency Department. 

How many bones are in the human body? 

We are born with 270 bones. As adults, we have 206 because some of those bones fuse as the body matures. 

What’s the difference between ligaments and tendons?

Ligaments are fibrous tissue that connect bone to bone. Tendons are fibrous tissue that connect muscles to bone.

A joint is defined as two or more bones that join together to create motion.   

Are sprained ankles the most common sports injury you see?

Yes. A sprain refers to ligamentous injury. Athletes and weekend warriors often turn the ankle over while running, jumping or pivoting on the ankle joint. Typically, the patient will hear a “pop” or report a tearing sensation. The ankle will swell and walking becomes painful.  As clinicians, we are taught several degrees of sprains—first, second and third. The degree of sprain can lead to very important patient discharge instructions. If a patient has a third-degree tear of the ankle ligament, the recovery period is significantly longer.  

Why do ligament injuries often take longer than broken bones to heal?

There are several reasons for this. Ligaments that are completely torn lead to joint instability. Ligaments have poor blood supply, which leads to a protracted recovery. Also, the articulating bones are left to move freely and unrestricted. This can lead to the non-union of bones, which—left unrecognized—can progress to chronic pain, swelling and arthritis. 

Thankfully, most sprains are first- and second- degree injuries. They heal well with PRICE therapy: Protection, Rest, Ice, Compression and Elevation. Sprains that do not improve over a one- to two-week timeframe may require a repeat evaluation by a physician.

Are these types of injuries less serious in children than adults?

No. On the contrary, children are not “little adults.” A limping child, no matter the circumstance, needs to be evaluated by a medical professional. Also, swelling over a joint, as well as persistent pain and swelling over a bone, requires a medical evaluation. In addition, persistent back pain in a child or an adolescent necessitates a medical evaluation.  

How do strains differ from sprains?

A strain refers to an injury to the muscle-tendon complex. Strains are commonly seen in patients who have overstressed muscle groups or who have tried to generate excessive force in a non-conditioned muscle. The generation of tremendous contraction forces coupled with excessive forcible stretching results in a severe strain. Patients typically present a day or two after the injury, because of increasing pain and spasm. The majority of back pain will resolve on its own with rest, analgesia and time.  After approximately two weeks, 50 percent of back strains resolve and nearly 80 percent resolve after about six weeks. 

What’s the best way to avoid sprains and strains when I begin my springtime outdoor activities?

Proper stretching and mobility exercises are the key to an injury-free spring and summer. Shedding winter weight is another way to assure healthy activity.  A five- to ten-pound weight gain can place undue stress on the back and joints. 

Can I treat minor injuries effectively myself?

Yes. If you do find yourself injured after a day on the golf course or in the yard with the kids, there are some home remedies that might speed your recovery, including ice and heat. Ice works very effectively as a natural anti-inflammatory and a pain reliever. About 20 minutes every hour for the first three days is prudent. Heat is for muscles, chronic pain and stress. Heat relaxes muscles that are in spasm and calms trigger points of pain. Some more advanced sports medicine clinicians recommend a combination of both hot and cold therapy, which can act like a therapeutic stretch. The cold contracts the tissue and the heat relaxes the tissue. In either case, don’t forget to protect your skin with some kind of barrier to avoid scalding or frost injuries. 

What about “getting back on the horse” after a day or two of rest?

Joints are designed to stay in motion. If you injure a knee, ankle, back, shoulder or wrist, you want to avoid prolonged immobilization. Our bodies are meant to  stay in motion—the longer we restrict our mobility the longer our recovery may be. However, aggressive early immobilization is smart. Then, if you can move the joint after a day or so of immobilization, introduce the joint to its original fluidity, but reduce its workload. Be very cautious. Slow and steady wins the race.  Listen to your body as it permits you to heal. Over-ambitious weekend warriors often find themselves reinjured when they don’t exercise patience with an injury.  

When does a back strain warrant a trip to the ER?

In general, if you can’t explain the mechanism that led to the back pain, then an evaluation is warranted. Also, certain historical symptoms and signs would demand an urgent Emergency Department visit, including:

  • Sudden onset of back pain without a coinciding mechanism
  • Sudden loss of urine or inability to control bowel or bladder
  • Fever or chills associated with back pain
  • Abdominal pain accompanying back pain
  • Age greater than 65 years of age
  • Weakness in an extremity
  • Intravenous drug users
  • Blood in the urine
  • Mid-line back pain
  • A cancer patient
  • COPD patients

How can I tell if my child has a growth plate injury?

These injuries can be insidious. When a child or adolescent presents to the Emergency Department with tenderness and swelling over a joint, we assume there might be a growth plate injury. Growth plate fractures occur in areas where the ligaments are stronger than the developing bone. Most growth plates are closed between the ages of 12 to 16 years old. If a fracture is seen in an x-ray, we can formulate a treatment plan. But sometimes these injuries are occult fractures, which aren’t detected by x-rays until much later. This is referred to as a Salter Harris Type1 injury. The clinician will explain to the parent or guardian that we do not see a fracture, but we cannot completely rule out a growth plate injury, so a reexamination is scheduled in 7 to 10 days. X-rays taken at that point may show no change, which suggest a sprain, or reveal a growth plate fracture. The growth plate attempts to lay down new bone to heal, which appears as a scar or increased density within the growth plate—which wasn’t there on the initial x-ray. A growth plate fracture requires four to six additional weeks of immobilization.

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

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

 

Prepared for the Worst

Shall we play a game?

By Rena Sandberg

Bad news. The federal government has just received viable intelligence that insurance, healthcare, utility and communications systems are minutes away from a cataclysmic cyber attack. Urban areas on the East Coast are in its crosshairs. Within minutes, the Trinitas Emergency Department will be dealing with an influx of patients that promises to grow in size and complexity as the drama unfolds.

Fortunately (this time) the crisis is purely conceptual. It was created in order for Trinitas to identify and assess vulnerabilities with an eye toward determining how it can improve its state of preparation for the unthinkable. Over a four-day period beginning November 25, 2018, Trinitas put Operation Community Peril into action. The full-scale exercise involved all of the hospital’s campuses, buildings and business occupancies.

Operation Community Peril was developed to assess the response capabilities of the Trinitas Incident Command System during a number of threat scenarios, including a cybersecurity failure, information technology (IT) breach, and communications blackout. Response objectives were set by an exercise planning team. Phil Solomon, Safety Officer and Emergency Preparedness Coordinator at Trinitas, who was in charge of the exercise, says that operations of this nature make Trinitas and the surrounding communities better prepared in the event of catastrophic events.

“We want to make sure that we have the highest level of preparedness for our customers, community and patients,” he adds.

Coordination between Trinitas, the Elizabeth Police Department and the community prepares everyone so they know how to respond if a situation arises in the future. Deputy Chief Alexander Sofianakos agrees: “It’s very important to give the community an idea of how their role would play out [in the event of a catastrophe], how they would help themselves and how they can assist us.”

The object of the “game” was to gauge response, initiation, incident command, and the testing of communication capabilities. Trinitas personnel worked with subject-matter professionals to create a path toward full preparation in the event of an actual disaster. According to Solomon, the exercise objectives were clearly defined and successfully accomplished.

www.istockphoto.com

“They took it very seriously,” says Solomon, adding that there was an outstanding level of participation from hospital personnel during more than 70 hours of real-time flow scenarios.

“Trinitas is up-to-date and very well prepared for a disaster,” says Deputy Chief Sofianakos. “They are doing a great job.”

Orchestrating Operation Community Peril’s complex scenarios required strategic planning and a diversity of live simulation drills, evacuations, lockdown events and departmental huddles. By all accounts, the collaboration of the participants exceeded expectations. Just as importantly, the large-scale exercises played a fundamental role in community preparedness by testing their ability to communicate and cooperate.

All Hands On Deck

Participants in Operation Community Peril included the Incident Report Team, Trinitas leadership, the hospital’s Emergency Preparedness Committee and external agencies including the City of Elizabeth, County Emergency Management and the Tri-County Radio Association. Training activities also took place outside of the Elizabeth area— such as the Bayonne Community Mental Health Center, Cranford Campus and ED triage. In addition, a groundbreaking activity occurred at the first-ever evacuation of residents from the Brother Bonaventure Care Center on Jersey Street in Elizabeth, as a large number of patients were moved from one wing of the facility to another. This drill was very well received by the residents. The “horizontal evacuation” was attended by the Elizabeth Fire Department and County Office of Emergency Management, who also gave the team a big thumbs-up.

Mom Genes

My mother. My hero. My problem?

By Ashleigh Owens

In the summer of 2017, my mother lost her life to pulmonary fibrosis, the puzzling disease that takes your life by literally taking your breath. The illness plagued her through a 16-year-long battle that began in her 30s. She never saw it coming. She was at the height of her success when the disease crept into her life, robbing her of her dreams, her mobility and, ultimately, her time. I witnessed her excruciating decline and her diminished quality of life starting when I was in grade school. During those years, I wrestled with some difficult questions about the origin of the disease, its management and, of course, whether I too might be gasping for air one day.

“Am I next?” I often wondered.

You may be familiar with my mother’s work. Her name was Tracey Smith-Owens and she conducted celebrity interviews (as Tracey Smith) for EDGE until her passing. She had a knack for engaging people—including Louis Gossett, Chazz Palminteri and Frank Vincent—in thoughtful conversation, and often carried those conversations past the magazine’s pages into civilian life.

Her own words held great weight, too. Of her fight with pulmonary fibrosis, she once wrote: My freedom is limited and my assailant is a fifty-foot tube that lingers around my ankles and is connected to a concentrator to provide me with the oxygen necessary to live. My mother often spoke about the way this culprit, which had weakened her lungs, sliced into her life with no regard for the innocent people it impacted. We shared that fear and anxiety.

My mother was in the hospital for over a month until peacefully departing in her sleep. I never saw it coming; pulmonary fibrosis is full of surprises. My mother and her lungs were true fighters, the doctors told me. Her ability to survive and in many ways thrive for more than a decade-and-a-half astounded them.

Throughout my mother’s illness, she constantly warned me to keep myself healthy. She was unable to identify a connection or source of her disease—and indeed, pulmonary fibrosis is very much a mystery. Her greatest fear was that it was genetic, that there might be some chance of me inheriting it. Although this was always in the back of my mind, I was primarily focused on being my mother’s protector during her trials and tribulations. The life I had known as an only child with a single mother, who was devoted to watching over me, was suddenly juxtaposed: I became a shield for her.

Seeing how pulmonary fibrosis affected my mother physically, mentally and emotionally could be overwhelming, especially when I was a teenager. We felt a distance from family and friends, who lacked an understanding of her condition. My mother knew she could rely on me to listen. She could count on me to be her cheerleader, to root her through her at-home medical therapies and doctor visits, to remind her of maintenance with lung exercises, and to step in for her on day-to-day tasks, as her pace and strength weakened over time. Our bond strengthened as two became one to fight against this illness.

www.istockphoto.com

My mother left me a recording of a February 2017 doctor visit, which included a conversation regarding her eligibility for a lung transplant. To get on the list involves meeting certain criteria, in her case to demonstrate how her lungs and heart coincide. This recording drove home for me the monumental medical obstacles she faced and her commitment to explore any options that would enable her to stay on this earth longer with me. The doctors in the recording seemed amazed as she described her journey, and her will to keep ongoing. They said my mother would make a great spokesperson for the Pulmonary Fibrosis Foundation. Hearing these words validated for me that my mother was the ultimate heroine in the fight against this life-crippling disease.

Following the loss of my mother, the fear that I might be next weighed heavily on me. It forced a certain growth. We were guardians for each other; now she wasn’t there to guard me. However, fighting alongside her all those years prompted me to explore ways I could live a healthy life that might diminish the chances of my getting this disease—and to take the initiative and see a pulmonologist early on to determine the state of my lung function. I went through a series of tests and x-rays, both of which came back with satisfactory results.

The severe (or idiopathic) pulmonary fibrosis that eventually claimed my mother usually affects people in their 50s or 60s. She was diagnosed with the disease in her 30s. She lived a decade longer than average. She was a fighter. I am in my 20s.

Fortunately, idiopathic pulmonary fibrosis rarely occurs in more than one family member. But because its causes are not completely understood, no one can say with certainty that it is not hereditary. There does in fact appear to be a genetic link in certain cases where it runs in families: Two genes, TERT and TERC, are found to be mutated in about 15 percent of idiopathic pulmonary fibrosis sufferers. However, not everyone who develops these mutations develops the disease. Needless to say, a lot more research needs to be done.

So am I next?

When I asked my doctor, he said where pulmonary fibrosis is concerned there is never really any guarantee, but emphasized that the disease doesn’t “have” to be hereditary. He said to live healthily and be proactive by monitoring the state of my lungs, and that everyone should be as curious and vigilant about their health as I am. You can choose to be oblivious to the inevitable, he added, but you do so at your own risk.

National Heart Lung and Blood Institute

Pulmonary Fibrosis: The Hard Facts

Individuals suffering from pulmonary fibrosis must struggle for every breath. Thick, scarred tissue becomes progressively stiffer until the lungs can no longer function properly, preventing oxygen from entering the bloodstream. The damage is irreparable and the cause often is unknown. In some cases, pulmonary fibrosis can be attributed to long-term exposure to environmental toxins—including airborne asbestos, metals or silica particles—or an adverse reaction to certain medicines or medical procedures, such as radiation therapy. Pulmonary fibrosis has also been linked to other conditions, including rheumatoid arthritis, lupus, connective tissue disease and even pneumonia.

Medication (including steroids and antibiotics) and various therapies can ease symptoms, but only for a while. Depending on the severity of the disease, pulmonary fibrosis can progress very quickly or linger for a decade or more. Over time, it can trigger pulmonary hypertension, heart failure and respiratory failure. For some pulmonary fibrosis patients, a lung transplant is a possibility. About half of the lung transplants performed in the U.S. each year are for pulmonary fibrosis sufferers. Not all patients are good candidates for a transplant; many who are don’t live long enough to receive a suitable pair of lungs.

The Big Squeeze

For many women, finding the right post-operative compression garment is still a mystery.

By Caleb MacLean

Follow-up is everything after a hospital stay. For women returning home from surgery, childbirth or certain other medical procedures, part of that follow-up process involves an after-surgery garment of some kind. Typically, a doctor will mention a particular type of garment or possibly even a specific brand as patients are preparing to be discharged. However, most women have no concept of what to do next.

For instance, many women benefit from postpartum compression abdominal garments. In some cases, they are worn to help restore that pre-pregnancy figure. Jessica Alba (a former EDGE cover girl) famously wore a double corset 24/7 for 12 weeks after giving birth to her daughter and was back on the red carpet in no time. Other celebrities have fessed up about their use of compression garments in recent years, creating a mini-boom in the business. For mothers who have delivered via caesarian section, the support of a compression garment is less a choice than a must. It speeds recovery and healing of the abdominal muscles. Typically, an abdominal binder is worn for six to eight weeks after a c-section.

Prairie Wear

Post-operative compression garments often must be “staged.” For example, in a tumescent liposuction procedure, the surgical fluid used to loosen fat cells is not completely expelled. Patients begin with a “first stage” compression garment that helps with draining and also protects bruised and swollen areas. After a week or two, liposuction patients will switch to a less-confining “second stage” garment that allows the body to return to normal lymphatic functioning. After a month or more, when healing is complete, many patients opt for a “third stage” or everyday compression garment, which helps maintain the new body shape.

Trinitas patients often find their way to The Pink Room in Elizabeth, or its sister store in Union. The company is primarily known for its “shapewear”—waist cinchers, butt lifters, tummy-control garments and full-body shapers. In recent years, however, The Pink Room has become a go-to resource for after-surgery garments, with more than 20,000 items in stock and a sales staff meticulously trained by owner Maria Sparacio to ask the right questions and provide the right answers.

“Patients are referred to us by surgeons,” explains Sparacio, “but frequently they just tell them to go get a compression garment. For the women who come to us, it’s kind of a mystery. We spend 30 to 40 minutes on average consulting with new customers to find the garment that best matches their needs and is perfectly comfortable. We get it right 99 percent of the time—it’s very unusual when someone needs to come back.”

Wherever a woman goes for a compression garment, customization is crucial. There is no such thing as one-size-fits-all; the size and type of garment can vary dramatically depending on the type of surgery, the amount of swelling, the type of support needed, a patient’s sensitivity to compression and the length of time a garment is needed—from a couple of weeks to a couple of months or more.

As for Sparacio, she got into the business in a roundabout way. A native of Colombia, she was working her way through law school as a bank manager in the Pacific coast city of Cali when she came to the United States on a student visa. The plan was to improve her proficiency in English, but it didn’t take long for her to realize that she had a head for figures—the financial kind, as well as the humankind—and that these dual talents would serve her well as an entrepreneur.

“I noticed how many women wore clothing that was either the wrong size or the wrong style for their body types,” Sparacio recalls. “It was obvious to me that they were not getting the help they needed in stores. I watched how they did business and always thought that people wanted more help. I thought, ‘I can do this better. I can be more professional. I can help people.’”

Yoga Compression Garments

Sparacio opened The Pink Room, on Morris Avenue in Elizabeth in 2008, just as the economy was hurtling off a cliff. However, her knack for individualizing service and solving problems for a multitude of body types enabled the store to build up a loyal walk-in and online clientele. She was able to open a second store, in Union, a few years ago.

The quest for the ideal garment often takes consumers to a website rather than a store. It might be a matter of convenience, or a reluctance to allow others to see the physical aftermath of childbirth or surgery. Online shoppers should have the same goal as store visitors: finding a compression garment that closely mimics the wearer’s movements while staying flush to the skin. No creases, no bunching, no extra space. Most internet sellers have liberal return policies, and build that into their pricing. They also carry thousands of sizes. Many women start in a store and then order online from that store (or a competitor) going forward. Bargain shopping isn’t really an option, however. In the compression business, you generally get what you pay for.

www.istockphoto.com

Sports Compression: A Placebo?

Compression garments have been around for many decades, of course, and are perhaps more familiar to athletes than surgical patients. The last 20 years have seen a boom in performance-enhancing compression garments. In fact, many products originally designed for medical purposes, such as calf sleeves, have seen sales skyrocket among athletes. Whether compression garments actually increase performance is debatable; it could simply be a case of athletes believing they do. Most medical experts agree, however, that where they are most helpful is in the recovery phase of sports—for much the same reason they work post-surgery.

EDITOR’S NOTE: Not all post-surgery garments require a consultation or fitting. Maria Sparacio estimates that 60 percent of her customers buy online while 40 percent visit her stores.

 

Patrick Kennedy & Jack Ford

Easing the Stigma of Mental Illness and Addiction

By Yolanda Navarra Fleming

If anyone can speak with authentic candor to a ballroom full of people about behavioral health and addiction, and make them simultaneously laugh out loud and nod in empathy, it’s Patrick J. Kennedy II, the former U.S. Congressman, mental health advocate and author of the New York Times Bestselling book titled A Common Struggle: A Personal Journey Through the Past and Future of Mental Illness and Addiction (Blue Rider Press, New York, 2016).

In October 2018, the Trinitas Health Foundation launched their Peace of Mind Campaign with an informative evening with Journalist Jack Ford moderating a conversation with Kennedy on “Easing the Stigma about Behavioral Health” at The Park Savoy Estate, Florham Park.

The event raised $235,000 toward the $4 million renovation project to update Trinitas’ Behavioral Health facility, one of the most comprehensive departments of behavioral health and psychiatry in New Jersey. They offer specialized services for adults, children and their families, as well as services for those with various addictions, and a 98-bed inpatient facility. The hospital welcomes nearly 200,000 behavioral health visits per year. The multi-disciplinary and bi-lingual staff includes psychiatrists, psychologists, social workers, nurses, creative arts therapists, substance abuse counselors and mental health workers, offering such services as psychiatric, emergency response/screening center, inpatient, outpatient, partial hospital programs and addiction services.

Trinitas provides treatment for patients like Kennedy, who was diagnosed with asthma as a child, and went on to suffer through a lifetime of depression, bipolar disorder and substance use, which included many failed attempts at sobriety until he arrived at the right balance of medication and alternative therapies.

Patrick Kennedy, son of the late Senator Edward “Ted” Kennedy and Joan Kennedy, has fully embraced his DNA. He has worked tirelessly to shed new light on the struggle with mental illness and addiction that hang—now in plain view—on numerous branches of his family tree. In true Kennedy fashion, he is in the public eye working to right certain wrongs, more specifically, to get the world on board with the fact that the brain is part of the body and requires (and deserves) proper medical attention just like any other part. But unlike the Kennedys before him, he practices a sort of transparency that he recognizes as his destiny, which he fully owns both in spite of his DNA and because of it. In his book, he admits to the mistakes he has been hardwired to make and since then, has made easing the stigma of behavioral health his sole mission.

His passion was contagious when he and journalist Jack Ford discussed Patrick’s position as the nation’s leading political voice on mental illness, addiction, and other brain diseases. Ford’s focus on the subject stems from the fact that his father died from alcoholism at age 49.

Kennedy’s efforts to create stronger advocacy for all types of mental health and substance use disorders, have manifested in, among other things, lead sponsorship of the Mental Health Parity and Addictions Equity Act of 2008, as well as the creation of two nonprofit organizations—The Kennedy Forum and One Mind, which aim to provide and encourage groups that would normally compete for research dollars and support in other forms, to join forces.

The Kennedy Forum leads a national dialogue on transforming mental health and addiction care delivery by uniting mental health advocates, business leaders, and government agencies around a common set of principles. One Mind pushes for greater global investment in brain research, which Kennedy has called “the next great frontier in medicine,” and is pioneering a worldwide approach to make scientific research, results, and data available to researchers everywhere.

Progress has been made, but Kennedy says there is much more that can be done to encourage acceptance that brain illnesses should be treated with the same level of concern and respect as other diseases of the body such diabetes, cancer, heart disease, etc.

Here is a large portion of their conversation.

Jack Ford: You have clearly become one of the champions in the area of mental health and addiction. …You have been very open and candid in your book talking about your own life and your own struggles. There has always been a spotlight on the Kennedy family, and it’s something you cannot run and hide from. But what made you decide to step into that spotlight to talk about this in your own personal journey?

Patrick Kennedy: …I didn’t ask to be here as the advocate for mental health and addiction. I never wanted to be here at a podium being asked about this part of my life… and living in a family that also suffered from mental health and addiction. You got me by default. I became the leader of mental health and addiction policy in this country because I put my name on a bill that said the brain was part of the body. I never expected to be the first name on the bill. I thought because in my father’s case it took him 50 years in the US Senate before he got sponsored whatever he wanted because he was in the Senate longer than almost anyone else and he was chair of the big committees. So it was odd that as the youngest member of Congress, at 27, from the smallest state in the country and in the minority party, and as the lowest guy on the totem pole I got the chance to put my name number one. I got to be the sponsor. How in the world does that happen? Because no one else wanted to have to go in front of the cameras and have Jack ask them the same question he just asked me. That is the honest-to-God truth. No politician wanted to get up there and say they’re a champion of mental health, knowing that all of us are affected by it, and then have a press person ask about our own family situations. Because if we said anything, well, that yarn just spools right out and where do you reign it back in? And so you’re in trouble. If you say you’ve never been to treatment yourself, then you’re a one-termer. You say it’s happened to anyone in your family and you’re in the dog house with them, and you might be affecting their mental health by outing them involuntarily. So, there is no good minefield to walk through on this. And if you say no, they’ll think you’re a liar. So that’s why no one else wanted to put their name first.

I put my name first, not because…I keep reminding my Republican colleague Jim Ramstad, who I co-sponsored this with, he goes…if your uncle were alive he’d put you in a chapter in his book Profiles in Courage, but I have to tell everyone…the only reason I came out was because the guy I was in drug treatment with sold his story about being in drug treatment with me to the National Inquirer, which meant my face was on the cover (with the headline), “Patrick Kennedy: Cocaine Addict.” When I got up one morning, I was a second-term member of the State Legislature, and that was on every check-out counter in my district. I thought I was all done, as you would expect. I represented a very conservative neighborhood in Providence, RI, in the State House. The good thing is that my neighborhood was predominately Italian-American. Even though no one liked a drug addict, they really didn’t like someone who ratted on a drug addict. My posse…we started a re-election bid on “We’re not for the Rat Bastards; we’re for Patrick Kennedy.” That was my campaign slogan.

JF: That sounds like a skit from Saturday Night Live.

PK: Life is often like that.

JF: You’re right. So you became the lead sponsor with a bi-partisan backing, signed into law in 2008 by President George W. Bush. The title of the act is the Mental Health Parity and Addiction Equity Act. Why did you feel there was a need for the Federal Government to pass this act and what were you hoping it would provide?

Jill Sawers, Campaign Co-Chair & Trinitas Health Foundation Trustee Chair

PK: I was incredibly blessed because everything I was exposed to in life kind of set me up for this. If I look back on my life now, I could never have orchestrated the way it turned out, in a better way for me. My Aunt Eunice started Special Olympics with my grandmother. My family was steeped especially in the Disability Rights Movement, my father worked on the Americans with Disabilities Act. I was very sensitized to people who were treated as “the other,” particularly if they had a brain illness of some kind. My Aunt Rosemary, frankly, had a lobotomy because of her psychiatric disorder. Most people don’t know that. She had a mild form of intellectual disability. And yet, like many people, a certain percentage of those with intellectual disability also have psychiatric disorders. Everything I’ve read and learned about my Aunt Rosemary, leads me to conclude she had a psychiatric disorder, which really unnerved my grandfather, as it would any parent. At that time, lobotomy was the standard form of therapy. When that didn’t go well, she was banished from my family, and was sent to Wisconsin and wasn’t seen again by any member of my family, until after my grandfather had a stroke. My grandfather never saw her again after the lobotomy. That shame was so deep in my family that it transmitted itself through my father’s generation. When I think about my father’s inability to address what’s right in front of him, …he had learned and become very good at denial. It allowed him to survive things that…no one could survive what my father survived.

Deborah Q. Belfatto, Campaign Co-Chair & Trinitas Health Foundation Trustee

I was sensitized to that and to growing up with my mother being vilified because of her alcoholism. She would walk through the house inebriated in the middle of the day. My dad would have all of our nation’s leaders come to our house, people you would recognize and know of, and none of them would look up when my mother walked through the hallway. As a kid, I totally got the message to get her back in the room and shut the door. My brother, sister and I spent our childhoods doing all we could to hide our mother so she wouldn’t embarrass anybody. That was on family vacations, in our house and everywhere we went. I never got to connect with my mother on an emotional level because she was so debilitated by her illnesses, both alcoholism and severe depression, but I felt the need to defend her. Throughout my life, that’s what I took on.

I really feel blessed that I was able to support this bill and that, ironically, the House version of the bill covered alcoholism and depression and the Senate version of the bill did not. I could not get any agreement between the House and the Senate versions. But when my dad got brain cancer and he was home and nearing the end of his life, I asked him to help get the House version passed. He told me to call Chris Dodd, his best friend. …four days later, the market collapsed and the banks in this country went belly-up, and all of a sudden, Chris Dodd became somebody. He was Chairman of the Banking Committee and all of a sudden he was the most important man in Washington, D.C. That was four days after I asked for his help to get HR1424, the Mental Health Parity and Addiction Equity Act passed.

He called me back and said, “Patrick, we have to pass this bail-out of our nation’s banks. It’s going to cost the taxpayers between $700 and 800 billion dollars. None of us wants to vote for it, but we know if we don’t, our country could end up in another Great Depression. That was the feeling on Wall Street and around the country at that time. He said, “I have an idea.” I said, “What’s that?” He said, “How about I write the whole Toxic Acid relief program into your bill, the Mental Health Parity and Addiction Equity Act.” And I said, “You can do that?” And he said, “Yes, I’m Chairman of the Banking committee.” And that’s exactly what he did. And because of that, we got the whole DSM (Diagnostic Statistical Manual for all mental illnesses) covered in the Parity law, which we never would have gotten if it was on its own. Just to give you a quick flash of what a Conference Committee is, it’s when the Senate sponsors meet with the House sponsors. Pete Domenici said to me, “I’ll be damned if I let those addicts sink our bill.” And frankly, he was right. If we had added addiction, there was no way the Congress of the U.S. would have passed that. There would be no way we could pass that bill today for the same reasons.

There is no advocacy out there in this country. None! Facing addiction… You could fill this whole house with the members nationwide. Faces and Voices probably would fit in the room back here. NAMI (National Alliance on Mental Illness) does a great job, but they’re a fraction of what they really represent in terms of the populations affected by these illnesses. Bottom line, the reason we don’t get anywhere on these illnesses, is the stigma is so great that no one is willing to come up like HIV-AIDS, who knows. If they could do it, we should be able to do it. But frankly, I think the stigma is even greater than even cancer. That’s the big problem.

JF: Why do you think that is? I had a conversation with someone recently on my PBS show about this. They said something to me, and I hadn’t thought of this. So much of it has to do with words. For instance, if you’re talking about someone who has “substance abuse,” what does that say as opposed to “substance disorder?” I thought about it. I realized, and I make my living with words, the words you use can be extraordinarily impactful. What do you think it is that drives this notion of the stigma that attaches to mental illness and addiction?

PK: …It cuts to the heart of it, and that is who we are as people. We’re talking about our agency, our ability to be considered of right mind. Who amongst us wants to be saddled with the label that somehow we’re not “all there,” that we’re not in full possession of our mental faculties. That, my friends, is why there’s stigma because there’s no one out there who wants to be seen in a way that’s pitiful. …There is nobody who can get past the fact that if you admit that you have one of these illnesses people are going to not only look at you different, but you’re going to have an immediate liability in dealing with them and other people for the rest of your life. They’re always going to look at you in that prism. Are they all right today? Are they on their meds? People make judgments. It’s very disconcerting.

JF: How can we combat that? Like you said, it gets to the core of who we are in the notion of your defense mechanisms and how you want to view yourself. As an aside, I interviewed an Iraq War veteran who lost both legs and part of an arm and suffered a head injury. The first day after his surgery, he was ready to get up and start his rehab, but he wouldn’t talk about his brain injury. When I asked him, he echoed what you said. He said, I can lose my arms and I can lose my legs and I can still function and remember that I was a soldier. But I can’t look my comrades in the eye if they think there’s something missing. So how do we deal with that?

Susan Head, Campaign Co-Chair & Trinitas Health Foundation Trustee

PK: …We have to deal with each other based upon a sense of compassion and not judgment, in that respect. The way we’re all conditioned is to give people value based on all of these other characteristics besides who they are as human beings, and what matters most is how you connect with someone. Mental illness and addiction do not need to impair the human connection, even while it can impair the way communication takes place because of the impairments from these illnesses. But people can show human warmth and love, and that has to be the essential element. I’m a real believer these days in seeing the spark of divinity in every person because every person has his own set of gifts. It may be more difficult to see to find those gifts in some people than in others, but if you spend time because you know we’re all children of God, and they’re going to teach you something you didn’t know before and they’re going to add to your life in some other way…that, I think, is the revolutionary change. That leads to a whole different paradigm in the way people relate to each other. That’s the paradigm that’s going to heal this stigma. It has to be a spiritual solution.

Did That Just Happen?

Nine mind-blowing 2018 medical breakthroughs.

By Mark Stewart

Was 2018 a banner year for medical breakthroughs? Only time will tell, of course. That being said, there were a number of wow-factor stories that found their way into the mainstream media, as well as some that flew a bit under the radar. Each of the following news items, in its own way, heralds a game-changing health discovery that is likely to have a near-term impact—perhaps on your life or the life of a friend or family member.

LET THERE BE LIGHT

During flu season, every countertop, door handle, and armrest is a potential vector for illnesses that sicken millions—and can be deadly to those with compromised immune systems. A study published in Scientific Reports earlier this year showed that far-ultraviolet C light—aka. Far-UVC—can kill flu viruses. The beauty of Far-UVC.(besides its cost-effectiveness as a virus-killer) is that it is not harmful to human cells. Conventional ultraviolet light kills viruses but causes skin damage with too much exposure. This breakthrough could have a dramatic impact on the spread of microbial diseases—not just on public surfaces, but in the air, including influenza and even tuberculosis. Don’t be surprised to see Far-UVC fixtures in airports, schools, and hospitals in the years to come.

A SLUG’S LIFE

For all the medical advances made over the course of human history, wound and incision closure hasn’t progressed all that much. Stitches and, later, staples have been the basic method for keeping our insides in and the outside out. Last year, inspired by the sticky defensive slime secreted by the European slug (Arion subfuscous), scientists at Harvard’s Wyss Institute for Biologically Inspired Engineering created a new adhesive material that sticks to wet surfaces. In 2018, scientists took things a step further and unveiled a new surgical “superglue” that shows great promise as an alternative to stitches and staples. The advanced hydrogel is made of biomaterials that mimic the slug mucus, which adheres to surfaces in three different ways. The ick factor notwithstanding, it is non-toxic, flexible and able to stick to any surface—even surfaces covered in blood. Next up? A biodegradable version that will dissolve when a wound fully heals.

QUICK AND PAINLESS

We are officially one step closer to Star Trek sickbay thanks to Portal Instruments, a company working with MIT to develop a needle-less shot. The result of their work is PRIME, an injection device that introduces a high-pressure stream of medicine through the skin and into the blood without the sharp stick that none of us particularly likes. PRIME ejects doses of medication at Mach 0.7, or about the cruising speed of a Boeing 707. For people with an intense fear or phobia of needles—who often avoid much-needed doctor visits—the needle-free injection is a game-changer.

EARLY ONSET DEMENTIA BREAKTHROUGH

A few years ago, the acronym CRISPR began popping up in medical stories. It stands for Clustered Regularly Interspaced Short Palindromic Repeats and refers to a type of DNA sequence in bacteria and single-celled microorganisms. In 2018, scientists at the Salk Institute used CRISPR gene editing to target the RNA of diseased cells related to frontotemporal dementia, which is second to Alzheimer’s in early-onset dementia cases. In the Salk experiment, the RNA targeting effectively restored healthy levels of protein to the neurons affected by the disease. RNA-targeted use of CRISPR has been tried before, but in terms of accuracy, this type of gene-editing represents a significant breakthrough.

NEW WEAPON AGAINST SUPER BUGS

The battle against drug-resistant bacteria took an interesting turn this year when researchers at the University of Lincoln in England synthesized an antibiotic called teixobactin—and used it successfully to treat infections in mice. Teixobactin is a key weapon in fighting bacterial strains such as MRSA, which are difficult to kill and possess the potential to trigger epidemics. Teixobactin was originally discovered using a new method of culturing bacteria in soil and has been shown to kill Staphylococcus and Mycobacterium tuberculosis. The ability to synthesize teixobactin on a commercial level will take many years but should provide an important level of protection against staph and tuberculosis sometime in the 2020s.

MOSAIC VACCINE

A large human trial on a new HIV vaccine began in sub- Saharan Africa this year. The new “mosaic” vaccine addresses an obstacle that has thwarted the development of this type of vaccine for decades: The virus has multiple strains and tends to mutate rapidly. Initial trials on healthy, low-risk individuals in the U.S., Asia, and Africa produced a significant anti-HIV immune response. Tests of the vaccine on rhesus monkeys protected two-thirds from HIV. “One of the great challenges for development of HIV vaccine is viral diversity,” says Dan Barouch, Director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center in Boston. “The mosaic strategy is one way to attempt to deal with the global virus diversity.”

SLOWING ALZHEIMER’S

An 18-month trial completed earlier this year by Biogen (a U.S. biotech company) and Eisai (a Japanese pharmaceutical firm) has confirmed that the experimental drug BAN-2401 slows the progress of Alzheimer’s disease. BAN-2401 is an antibody that removes amyloid, the protein that interferes with nerve-cell function in the brain. The study was conducted on 856 individuals with mild cognitive impairment or signs of early-stage Alzheimer’s, all of whom showed amyloid build-up. Other drugs have been effective on amyloid levels, but BAN- 2401 reduced the development of new amyloid clusters and—most notably—slowed the decline in planning and reasoning skills by up to 30 percent. More work needs to be done, but this marks the first time a significant clinical trial has identified a drug that actually slowed Alzheimer’s disease.

SPECIAL K

Ketamine has a long and varied history. It was used as an IV anesthetic during Vietnam and is still used in field. hospitals and ERs. It is prevalent in veterinary medicine

(though not as a “horse tranquilizer” as some have referred to it) and is sometimes used to treat chronic pain in humans. Ketamine has also enjoyed some popularity as a high-powered party drug. In 2018, building off a decade’s worth of clinical studies, researchers at the University of Illinois at Chicago College of Medicine concluded that Ketamine is able to lift treatment-resistant depression in a few hours—which has profound implications within the psychiatric community.  Indeed, it’s the first drug in more than two generations that has demonstrated an ability to affect various neurological pathways to alleviate depression. The Chicago study, published in the June edition of Molecular Psychiatry, was one of several on Ketamine released during 2018. Unfortunately, the antidepressant effect rarely lasts longer than a week or so, and it is unclear whether repeat infusions are effective or even safe. The discovery has triggered research into similar drugs that last longer and come with fewer side effects, so expect more news to come in 2019 and beyond.

EXPLOSIVE DEVELOPMENT

When you see the letters TNT, you probably think dynamite. When scientists in the field of regenerative medicine talk “TNT,” they are likely referring to Tissue Nanotransfection, an emerging technology that involves a stamp-sized chip that reprograms skin cells to help repair organs and blood vessels. The implanted chip is used to send an electrical current into the body that delivers genetic codes to the skin cells, essentially changing their function to rescue failing body functions.  In a series of 2017 lab tests at the Ohio State University College of Medicine, researchers applied the chip to the legs of mice that vascular scans showed had little or no blood flow. The TNT chip reprogrammed their cells to become vascular cells and within a week the transformation began. By the second week, active blood vessels had formed. By the third week, the legs of mice were saved (with no other treatment). Human trials of this technology began this year.

Breathing Easier

New technologies have changed the landscape for pulmonologists.

By Mark Stewart

A lot of people joke that you can’t tell doctors anything. Don’t tell that to Dr. Carlos Remolina. And know that, when it comes to early detection of lung cancer, it’s no joking matter. On a Monday evening back in December, the Chief of the Pulmonary Division addressed the assembled Department of Medicine at Trinitas on how and when to employ the dramatic technological advances in his area of medicine. Much of his time was devoted to reviewing the fine points of Bronchial Navigation, a new way to detect the minute, shadowy nodules that could be the beginning of lung cancer.

“I presented several cases we have encountered here at Trinitas, one in which the nodule was as small as nine-by eleven millimeters,” says Dr. Remolina. “We were able to identify the nodule and use Navigational Bronchostomy to reach it and do a biopsy. The patient did have lung cancer, but because we detected the disease in its earliest stage, we were able to perform a resection and save that patient’s life.”

Where lung cancer is concerned, it is all about early detection. The 10-year survival rate for patients diagnosed in Stage 1 or 2 is 88 percent; in Stage 3 and 4, the five-year survival rate is just 17 percent. In his presentation, Dr. Remolina encouraged his fellow doctors to be more proactive when it comes to using the new technology. Medicare actually covers lung screening for “30-pack smokers” ages 55 and over, and Trinitas has a superb Lung Screening Program that employs a low-dose CT scan.

“Our program is not used as aggressively as it should be,” says Dr. Remolina, who adds that lung screening needs to become more ingrained in the medical community. Not only is it potentially a matter of life and death, he points out, it could soon be a matter of liability. When a woman goes to a doctor and that doctor doesn’t order a mammogram, the doctor could be liable if she develops breast cancer. The same could be true for a doctor who fails to refer an older ex-smoker for screening and a full workup if, years later the diagnosis is Stage 4 lung cancer.

HOW IT WORKS

Navigational Bronchostomy employs electromagnetic fields that create “GPS” to tumors when they are very small, so they can be reached and biopsied. A computer program generates a 3-D map that pinpoints the location of the tiniest tumors, and shows the twists and turns along the way. Prior to this technology, the diagnostic options faced by patients at risk for lung cancer were limited. They included traditional bronchoscopy, which often could not reach the area of concern or an invasive surgical procedure. Needle biopsies sometimes didn’t get to the target and came with a significant risk of pneumothorax, more commonly known as a collapsed lung.

“Another option was watching and waiting,” Dr. Remolina recalls. “When a nodule got big enough, you’d go after it. By that point, of course, the tumor had grown.” 

The new technology, he adds, reduced the risk of lung collapse from a range of 18 to 30 percent to just 2 or 3 percent. What are some of the first signs that suggest someone should get a screening?

“An unexplained cough, especially one that brings up a small amount of blood, would be a major area of concern,” Dr. Remolina says. “Unexplained weight loss is something to watch for, too.”

These symptoms are much more likely to occur in smokers, but lung cancer can also affect people who never smoked a cigarette in their lives. Unfortunately, those individuals don’t meet the criteria for low-dose CT scans at the moment. 

Another procedure that has come online in recent years is Endobronchial Ultrasound, or EBUS, which Dr. Remolina also says is a game-changer: “Before EBUS, you had to send a patient to a thoracic surgeon for a procedure on a lymph node. Now it can be done as an outpatient procedure.”

Dr. Remolina maintains that advances such as Navigational Bronchostomy and Endobronchial Ultrasound have changed the landscape of pulmonology. His goal is to encourage more physicians to embrace these procedures. It’s a matter of smart medicine and, potentially, life and death.

LOW DOSE/BIG RESULTS

The Trinitas lung screening program has been up and running for 18 months and, in that time, has already demonstrated its life-saving potential. The low-dose, non-invasive CT scan—which takes less than a minute—has detected tiny, early-stage tumors in dozens of patients, dramatically altering outcomes for those individuals. Lung cancer kills more people in this country than breast, colon and prostate cancer. Combined. The Trinitas screenings involve only a quarter of the radiation of traditional CT scans. For more information on the Lung Screening Program at Trinitas call (908) 994-5051.

 

Carlos Remolina, MD, FCCP, PA

Chief/Pulmonary Division,

Trinitas Regional Medical Center

Director, Care One LTACH

908.241.2030

 

In the Pink

The Connie Dwyer Breast Center opens at Trinitas.

By Yolanda Navarra Fleming

Connie Dwyer, a breast cancer survivor from Summit, was not shocked by her breast cancer diagnosis back in 1999. In fact, she almost expected it, in spite of the fact that her parents lived long, cancer-free lives and she was not considered high-risk. But there were other factors that came into play. For instance, her father smoked cigars. She grew up in Niagara Falls, NY near chemical plants. Connie even smoked for a short time when she was in college. Perhaps the most interesting fact of all was her older brother’s breast cancer diagnosis five years prior to her own. He lived for 17 years without traditional therapies until it spread to his lungs and eventually his brain, before he died.

Photos courtesy of Grace Photography

“Early screening is the most important thing,” she said. “I have friends who don’t like doctors and don’t go to the doctors. But I always felt that I was going to get breast cancer. I had a dear friend when I was in my early 30s, who was 10 years older, who passed from breast cancer and because of that, it was always on my mind. So I always went for my mammograms. And then when my brother was diagnosed, I would get a mammogram, see a breast surgeon and my gynecologist, so I was seeing someone four times a year because I just had a feeling.” 

The year she was diagnosed, it had only been 11 months since her previous mammogram, which meant it would not be covered by insurance. She paid for it and that’s when it was discovered. “Had I waited and we went away for the summer like we usually did, it would have been another four months. My instincts were good

She had a double mastectomy and chemotherapy, and shortly after being released from the hospital, her oldest daughter learned that she had a lump that needed to be removed. It was benign and she has been fine ever since

Her experience inspired her to go to the next level

 “During my chemo, there was a young girl who took a bus to get her chemo. She was a single mother with two children who took two buses to get to work after chemotherapy. I thought to myself, if you don’t have family around to help you, can you imagine how much harder it would be? That’s what inspired me to do what I do. And what I do could not be done without the board I have. I couldn’t do this on my own. It’s everyone who works with us that makes the outcome possible

Connie and a dedicated group of friends began a grassroots effort, where she worked tirelessly to create awareness and raise funds. By 2005, the doors of the first Connie Dwyer Breast Center had opened at St. Michael’s Medical Center in Newark. However, when St. Michael’s was purchased by a for-profit, Connie began looking for another non-profit hospital for a new center

“What inspired us to partner with Trinitas Regional Medical Center is that our missions are so similar—to serve the poor and vulnerable women in the community. When I walked into Trinitas, not only was it one of the cleanest hospitals I’ve been in, everyone was happy. That in itself made us want to be there.”

Just in time for Breast Cancer Awareness Month, the $3.4 million Connie Dwyer Breast Center opened at Trinitas on October 1 with a ribbon-cutting ceremony featuring Connie Dwyer, the Trinitas leadership, local officials such as Elizabeth Mayor Christian Bollwage, and a special guest appearance by Grammy award-winning singer Gloria Gaynor (left, with Connie), who sang “I Will Survive

Trinitas has partnered with The Connie Dwyer Breast Cancer Foundation to bring a highly empathic approach to screening, diagnosis, treatment, and community outreach and education to all women, regardless of financial status, in a brand new facility that evokes comfort and a sense of well-being

The Breast Center, staffed with board-certified bilingual specialists, offers the most up-to-date equipment and services available, such as 3D imaging, which allows radiologists to view the breast tissue in several layers. This breakthrough technology can detect 41 percent more invasive breast cancers and can reduce false positive results by up to 40 percent. 

The American Cancer Society recommends that all women over the age of 40 have regular breast exams and mammograms. Most women who undergo screening will be healthy and not require further services until their next scheduled screening. However, patients who require continued care will meet with a Breast Navigator, a highly trained guide who answers questions and assists through the process of diagnosis and treatment. 

Gary S. Horan, FACHE, President and CEO of Trinitas, says, “With the generosity of Connie Dwyer, the new Connie Dwyer Breast Center at TRMC is a beautiful, calming and comprehensive center for women in our community to have everything from their yearly screening mammograms to the latest diagnostic studies. In addition, it is a one-stop shop where care can be coordinated for the patient among our dedicated, compassionate multidisciplinary care team.” 

In November 2017, Connie was diagnosed again with breast cancer. 

“That was shocking to me, almost more shocking than the first time,” she says. “It had been 18 and a half years. I was still going every six months to the oncologist. I was very sad. I felt badly for my girls, my husband, and my 12 grandchildren. But they were very inspirational to me. They talk about how strong I am and it makes me want to be strong.”  

Her strength, at 75, is remarkable, in spite of cancer. “I’m still here. On many days I feel good. I might have to nap in the afternoon. I do complain, but in the big picture, how lucky am I? Within us there’s a strong drive to stay alive and be happy. I am really lucky to have so many good people around me. It’s amazing how good people can be. It makes me hopeful for the future.