What’s Up, Doc?

News, views and insights on maintaining a healthy edge.

 

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

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

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

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

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

 

Doubling Up with da Vinci

Enters a New Dimension

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

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

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

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

He Said: She Said

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What’s Up, Doc?

What’s Up, Doc?

News, views and insights on maintaining a healthy edge. 

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

 

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

 

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

 

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

 

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

Pituitary Case

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

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

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

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

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

He Said: She Said

What’s the Smart Way to Deal with Menopause? 

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

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

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

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

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

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

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

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

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

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

What’s Up, Doc?

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

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

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

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

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

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

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

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

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

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

Body of Work

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

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

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

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

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

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

He Said: She Said

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

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

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

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

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

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

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

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

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

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

What’s Up, Doc?

What’s Up, Doc?

Aye, Robot

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

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

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

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

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

Seeing Is Believing

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

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

 

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

 

Mind Field

 

Photo credit: iStockphoto/Thinkstock

Well, and limit your exposure to toxins like cigarettes and alcohol. But maintaining mental fitness is often off our radar. We go to medical doctors for checkups and tests, but we’re often reluctant to make time to review and change elements in our lives to maintain our mental health. “The mind is a miraculous and delicate thing,” says Rodger Goddard, Ph.D., chief psychologist at Trinitas Regional Medical Center. “It needs our care, protection and nurturance to continue growing throughout our lives.” Fortunately, preserving and enhancing your mental health requires only a few key lifestyle changes and simple strategies. At the top of the list? Managing stress. Stress causes surges in hormones that can damage your body— and your mind. “Stress increases the cortisol level in our brains, causing the destruction of neurons,” says Patricia Neary-Ludmer, Ph.D., a psychologist and director of Trinitas Regional Medical Center’s Family Resource Center in Cranford.

 

The fight-or-flight surge of adrenaline that occurs when you’re stressed can cause other damage to your brain, too. “When the lower reptilian brain is aroused by excessive stress or anger, higher brain functions tend to decrease or shut down,” Goddard points out. “Stress, anxiety and depression have been shown to decrease intelligence and cognitive skills.” There are a number of lifestyle tweaks that can improve mental acuity and fight off stress, depression and other mental-health issues. Here are some of the most effective:

Eat Smart You already know a healthy diet is essential for improving your overall physical health—but eating the right foods can improve your mental health, too. Fatty foods, especially those with saturated fats, can clog arteries and inhibit blood flow to your brain, explains Neary-Ludmer. To boost your brainpower, “eat foods like fish and nuts, which are commonly referred to as brain foods.” To further boost your brainpower, consider supplementing your diet with antioxidants and vitamins. “Studies show that diets rich in antioxidants—vitamins C, E, B and beta carotene—can help us to maintain good memory and thinking skills,” Goddard says.

Challenge Your Brain Just as your body needs regular strength and cardio training to keep it in optimal shape, your brain needs a good workout to preserve its prowess. Puzzles, animated discussions and memorization exercises can help improve your mental acuity. Goddard suggests asking yourself questions to strengthen your mind. “In particular trying to discover the causes of events and asking ourselves ‘why’ questions can strengthen our mental muscle.” Neary-Ludmer recommends challenging your brain by learning a new language, or even simply trying to write with your non-dominant hand. The payoff in mental prowess will be rich. “The more we exercise our brain and keep it active, the sharper our minds will be,” Goddard says. “Mental dullness and passivity can erode mental sharpness.”

Photo credit: iStockphoto/Thinkstock

Get a Good Workout Exercise isn’t just good for building muscles—it helps build mental acuity, too. “Exercise will increase blood flow to the brain, carrying oxygen and nutrients,” Neary-Ludmer says. A good workout plays a key role in ensuring good mental health. “Physical exercise has been shown to increase brain chemicals that improve memory, reaction speed and creativity,” Goddard adds.

Meditate You don’t have to do a full-on “just say ohm” yoga retreat—but taking a few minutes each day to clear your mind, breathe deeply and relax can have benefits beyond simple stress relief. “Meditation has been shown to increase mental focus, awareness and some thinking skills,” Goddard says.

See the Glass as Half Full Look for ways to increase the amount of fun in your life—whether it’s listening to upbeat music, limiting the amount of time you spend with negative people, or adjusting your own attitude to accentuate the positive. “Studies have shown that thinking positive, loving and caring thoughts can improve neural connections in the brain,” Goddard says.

Get a Good Night’s Sleep You’ve likely heard (and heard again) that a good night’s sleep—about eight hours a night—is essential for good physical health. But it’s also important for keeping your brain at peak performance. “Good sleep habits have been shown to improve brain functioning and mental agility,” Goddard says. Do your best to ensure you get the right amount of rest every night.

Photo credit: iStockphoto/Thinkstock

Be Wary of Multi-tasking It may feel like your brain’s firing on all cylinders—and that you’re accomplishing more—by multi-tasking, but the jury’s still out as to whether multitasking is harmful or helpful to your mental health. “It is still unclear whether the multi-tasking demands of our modern world enhance or deteriorate mental sharpness,” Goddard says. “At least for some people, excessive multi-tasking may lead to being more scattered, unfocused and having decreased concentration and memorization skills.” If it seems like your ability to focus has diminished, consider trying to limit the amount of multi-tasking you do.

Break Out of Your Routine “It is easy for all of us to fall into ruts and experience our stress and problems as unchangeable,” Goddard says. But thinking outside the box—and moving outside your comfort zone—gives your brain the kind of kick-start you need to stay sharp. “Traveling, journaling and using personal or spiritual retreats can help us to reflect on our lives and chart new goals.” A quick getaway or a new class can be all you need to break out of the rut—and get on the road to a sharper mind. EDGE

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

What’s Up, Doc?

Pancreatic Cancer May Not Be A Death Sentence When we hear the words Pancreatic Cancer we shudder. And rightfully so. By the time the first symptoms develop—unexplained abdominal pain, weight loss, poor appetite, jaundice—and the tumor is picked up by a CT scan or MRI, the disease is uniformly fatal. According to Dr. Dan Ramasamy, a gastroenterologist at the Center for Digestive Diseases in Union, Pancreatic Cancer actually can be cured—when caught in its earliest stages. Early stage diagnosis is accomplished through Endoscopic Ultrasound (EUS). A special ultrasound device installed on the tip of the endoscope enables examination from the stomach through to the pancreas. With EUS, the pancreas can be visualized with high-quality ultrasound images, detecting tumors as small as a few millimeters, which can be missed by a CT Scan or MRI. According to Dr. Ramasamy, who performs this procedure, a biopsy can be taken through the stomach wall with fine needle aspiration (FNA) and sent for evaluation. If still in its earliest stage, the cancer is curable by surgery.

Smart Kids & Stupid Decisions Two recent studies, one in the U.S. and one in England, reveal that “very bright” kids are more likely than children of average intelligence to be heavy drinkers when they grow up. The studies—National Longitudinal Study of Adolescent Health (US) and National Child Development Study (UK)—took into account religion, sex, race, ethnicity, marital status, number of children, education, earnings, satisfaction with life, frequency of socialization with friends, depression, number of recent sex partners, childhood social class, mother’s education, and father’s education—and still came up with the same results. Satoshi Kanazawa, an evolutionary psychologist and author of Why Beautiful People Have More Daughters, offered one interesting theory for this phenomenon. Intelligent people aremore likely to be “early adopters,” so it makes sense they would adopt beer, wine and distilled spirits—which are acquired tastes as opposed to evolutionary staples.

Smoking, Obesity Increase CRC Risk in Women With so much attention focused on urging men to get checked out for colorectal cancer (CRC), people sometimes forget that this is the third most common cause of cancer in women. Adding to the threat is the fact that screening guidelines are not “one-size-fits-all” for men and women. Indeed, according to a May article in Women’s Health, myriad factors contribute to determining the right screening intervals for female patients. The article also cited recent studies that have shown smoking and obesity increase the risk of CRC in women. Screening for CRC increases the chances for early detection of cancer and premalignant polyps, and also decreases morbidity from this disease.

Stamping Out Alzheimer’s The effort to understand, treat and perhaps ultimately prevent Alzheimer’s Disease depends on raising funds and awareness. In May, these goals got some help from Maryland Senator Barbara Mikulski, who introduced a resolution in the House of Representatives urging the U.S. Postal Service to issue a special stamp to help raise money for Alzheimer’s research. Mikulski’s own father was one of an estimated 5.4million Americans diagnosed with the disease. By voluntarily paying more than the normal postage rate for the Alzheimer’s stamp, people would contribute directly to the search for a new treatment or a cure.

Do Not Enter

The fast-food Drive-Thru has transformed our lives. Well, that’s one way of looking at it.

Fast food giant Taco Bell recently became embroiled in a high-profile lawsuit, during which it was compelled to respond to allegations that its “beef filling”

contained— what’s the delicate way of putting this? —twice as much “filling” as “beef.” The media seized on this story, as did the late-night comics. Unfortunately, everyone missed the point: The crime is what’s in fast food, not what isn’t. “Fast food poses a huge threat to the American public’s health, along with smoking and substance abuse,” says Ari Eckman, MD, chief of the Division of Endocrinology, Diabetes & Metabolism and director of The Diabetes Management Center at Trinitas Regional Medical Center. “Fast food meals are high in fat, sugar, salt, starch and calories, and very low in fiber and nutrients.” Indeed, the convenience of grab-and-go meals is far outweighed by the dangers that await us after we make that final hard left to the pickup window. Study after study is showing that reliance on heavily processed foods could be costing us our health. In a 2005 report published in The Lancet, healthy young adults who consumed fast food more than twice each week gained 10 more pounds and had twice as great an increase in insulin resistance—a precursor to type-2 diabetes—as their healthier eating counterparts. Fast foods are rich in trans fats, those manmade fats that have been shown to wreak havoc on the human heart. “Trans fats are terrible for one’s cholesterol,” Dr. Eckman says. “It’s dangerous to eat these foods if you have high blood pressure

e or high cholesterol.” Fast food isn’t just a nutritional nightmare. With the constant push to supersize, fast food portions are warping our sense of when to say when. “People are not at all in touch with the reality of how much they’re eating,” Dr. Eckman says. “The portion sizes are encouraging people to eat more. Burgers 50 years ago were only one ounce, and now they’re six ounces. You buy a 64-ounce soda, which is a half-gallon— and contains 48 teaspoons of sugar.” As a result, Dr. Eckman maintains, our society is becoming supersized. “Over 60 percent of our population is overweight, and 30 percent is obese,” he says. “And the children’s statistics are even more mind-boggling—nine million American kids were considered obese, a rate that has nearly doubled in the last 20 years. It’s getting out of control at an epidemic rate.” Fortunately, there are measures you can take to fight back—even if you have to eat fast:

  • Check the labels. Most fast-food restaurants offer nutritional information on their websites or on pamphlets, which enables you to make a more informed decision about what you order. “Try to stay away from the foods that are highest in cholesterol, saturated fats, sugar and salt,” Dr. Eckman says. “Choose low-fat options, if they’re available.” Keep in mind that that healthy salad may come with a not so – healthy dressing, so resist the temptation to squeeze the entire packet onto your greens.
  •  Cut down on your portions. Avoid the push to supersize your meal—those value menus may be a better dealfinancially, but could cost you your health. “To help spread out the calories, consider eating half of it and giving the other half to your partner or taking it home for another meal,” Dr. Eckman advises.
  • Turn your kids into educated eaters. The fast-food commercials—and those little plastic toys—may entice your kids into clamoring for a drive-thru run, but you can fight back. “Making a healthy dinner at home can be a fun activity you do with your kids, that can help encourage them to eat healthier,” Dr. Eckman suggests. “You can also talk with your kids about the problem of obesity and some of its long-term effects on health, so they can become educated and make healthier choices on their own.”
  • Moderation. Dr. Eckman suggests limiting fast food to only one meal per week, at the most. “Enjoy it once in a while, but this really shouldn’t be a weekly or biweekly event,” he says. “You don’t want to sacrifice your health for convenience.” EDGE

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

What’s Up, Doc?

What’s Up, Doc?

Going with the Flow

Cold feet. Heavy legs. Cramping. As the years pile up, we deal with life’s extra little discomforts every day. They can be a real pain in the you-know what. Dealing with them, however, does not mean ignoring them. If annoyances such as these persist, it may be prudent to speak with a vascular surgeon. The fact of the matter is that each of the aforementioned symptoms (including, yes, buttock pain) could point to something more serious. “We’re not talking about spider veins here,” says Salvador Cuadra, MD. “Vascular system disorders such as Peripheral Artery Disease (PAD) and Carotid Artery Disease—including Transient Ischemic Attacks (TIAs)—can begin with relatively mild symptoms. The earlier we catch these problems, the more likely a patient is going to have a favorable outcome.” As a vascular surgeon, Dr. Cuadra is a specialist who treats diseases of the major blood vessels. A member of the Cardiovascular Care Group (with offices at Trinitas and in Westfield, Springfield and Belleville), he treats problems with the carotid arteries in the neck, as well as the veins and arteries in the abdomen, arms and lower extremities. One of Dr. Cuadra’s specialties is called a carotid endarterectomy. In lay terms, this is a surgical procedure that addresses blockages in the artery feeding the brain. Plaque can build up and potentially cause a stroke. The surgery literally “shells out,” or removes, the plaque through a small neck incision. Although the condition is extremely serious, the surgical prognosis is excellent and recovery time is relatively short. Typically, it involves only an overnight hospital stay. Within the past decade, there have been other advances in the development of less invasive treatments for vascular system disorders. Most of these involve the use of stents, which are applied through a catheter inserted through the groin area. The less invasive nature of this procedure certainly makes it more attractive to patients. Vascular surgeons routinely perform angioplasty to repair arteries that are blocked or narrowed. There has been much recent research and discussion about the relative efficacy of stents compared to surgery. The much-publicized CREST Trial has indicated that stents have no statistical advantage over surgery and, in certain cases, might even run a higher risk of subsequent stroke. However, Dr. Cuadra is uniquely qualified to perform either angioplasty or surgery. He has found that some patients have better results with angioplasty and stents, while others benefit more from surgery. Another problem that can be addressed by inserting a stent is an aneurysm. In such a case, an artery develops a bulge (widening) rather than a blockage. Over time, this can cause a weakening in the arterial wall. A vascular surgeon will perform a procedure to insert a specialized stent that allows blood to pass through it removing the pressure on the arterial wall (the aneurysm) thereby reducing the risk of rupture. At present, dialysis patients constitute approximately 50% of Dr. Cuadra’s group practice. In cases of kidney failure— which requires hemodialysis to remove toxic waste and excess fluid from the bloodstream—surgery is done to establish the necessary connection between an artery and a vein thereby allowing for dialysis to be performed. Of the remaining 50%, different people land in his office in a number of different ways. Many patients come via their PCP referral already suffering from obesity and/or diabetes; their doctor may have found an abnormality through physical examination or through an ultrasound, or some other procedure such as a CT scan. Others come because of physical symptoms such as loss of circulation to the legs causing pain, ulcerations, and even gangrene in the extremity. Although Dr. Cuadra says he enjoys working with patients to prevent the onset of vascular disease, he embraces the myriad challenges he faces every day. Being a surgeon suits him, he says. “I like using my hands to solve relatively serious patient problems. Surgery is more rewarding to me than some other specialties. I can see a problem, diagnose it and fix it in a relatively short time period.” EDGE  

Editor’s Note: Dr. Salvador Cuadra attended Cornell University as an undergrad and received his medical degree—and became Chief Resident in surgery—at the State University of New York at Stony Brook. He has authored a number of vascular surgery treatises, receiving awards for several of his publications.

In One Year and Out the Other

Why resolutions fail (and how yours can succeed). 

 If you’re planning to make 2011 the year you lose weight and get fit, join the club: Studies show these are the most common resolutions people make come January 1st. Good luck to you; the grim reality is that most of the people who start the year off wanting to slim down don’t end up succeeding. The same goes for other popular New Year’s vows—stop smoking, get out of debt, help others, etc., etc. etc. The bottom line is that we just aren’t wired to break habits overnight that we’ve developed over 10, 20 or 30 years. As individuals, human beings tend to value their individuality. As a species, we’re just plain stubborn. Some great minds have weighed in on this subject. The controversial author Anaïs Nin insisted she made no resolutions to curb her habits, because “the habit of making plans, of criticizing, sanctioning and molding my life, is too much of a daily event for me.” Sculptor Henry Moore preferred to “think in terms of the day’s resolutions, not the year’s.” Writer Oscar Wilde, whose list of questionable habits was practically endless, characterized resolutions as “checks that men draw on a bank where they have no account.” Comic Joey Adams’s favorite party toast was “May all your troubles last as long as your New Year’s resolutions.” Mark Twain evaluated New Year’s resolutions with a single word: Humbug. Given this overwhelming preponderance of intellectual evidence, what chance do we mere mortals have to drop a few pounds and elevate our fitness? According to Michelle Ali, a registered dietician at Trinitas Regional Medical Center, there are 10 things we can do to improve the odds: 

1 Don’t Go Overboard There’s a real temptation to sprint out of the gate and make drastic changes to your diet and workout routines. But being gung-ho from the get-go can lead to burnout and failure down the line. “Unrealistic goals hurt us more than we realize,” says Ali. “Weight loss should be slow, about a pound a week.” She advises skipping a full-scale renovation in favor of making slow and subtle changes that can become a permanent part of your life. “Make one food change each month and stick to it. That’ll make weight loss happen—and make it permanent.”

2 Monitor Portion Size Those supersized portions of food you often see at restaurants are rarely the right amount of food to keep you at a healthy size. “Far too often we are unaware of what a serving of a particular food is,” Ali says. “For example, for protein foods such as chicken or beef, a serving is considered to be 3 ounces, or the size of a deck of cards. Most Americans consumes more than twice the amount of protein that is needed by their bodies.”

3 Don’t Skip Meals It may seem like a smart idea to avoid eating those extra calories, but studies show that this method can backfire, especially if it’s breakfast that you skip. “Breakfast really sets the mood for the rest of the day,” Ali says. “Skipping breakfast slows down your metabolism and causes you to overeat at other times.”

4 Create a Food Diary Keep track of what you’re eating and when. Studies have shown that writing down your daily diet can help you consume fewer calories and be more thoughtful about the choices you make. If you don’t want to use a pad of paper, consider signing up for an online weight-loss tool like SparkPeople.com, where you can record your daily diet and track calories, protein, fat and more.

5 Be Salad Savvy You may feel very virtuous with that plate of greens in front of you, but the dreamy dressing you choose could turn that salad into a caloric nightmare. “One frequent mistake that people make is that they load up on salads and use far too much salad dressing,” Ali says. “Regular salad dressings are loaded with calories, which comes mainly from fat and, when use in abundance, defeat the purpose.” Stick with vinaigrettes in lieu of the creamier mayonnaise-based dressings, or make a simple (and delicious) one at home with olive oil, lemon juice and vinegar.

6 Read the Label You might be surprised to find that that can of soup or container of ice cream that claims to be healthier for you actually comes with a pretty hefty calorie count. “You will be surprised at what you’ll find when you compare one product to another—especially when we compare things like fat, sugar and sodium,” Ali says. “Be sure to look at some dietetic foods that may claim to be low in sugar and or fat—you may find that the regular product is lower in total calories.”

7 Avoid Fad Diets There’s always a new trendy diet to try—high-protein, low-carb, no-fat, the infamous cabbage soup diet—but even if you start off your fad diet peeling off the pounds, odds are the effects won’t last. “Crash diets never lead to permanent weight loss,” Ali says. “To succeed, you must commit to a healthy lifestyle for a lifetime.”

8 Exercise Cutting back on your food intake is only one piece of the puzzle. For consistent weight loss success, you’re going to have to work up a sweat. “When we lose weight we lose both fat and muscle, but exercise can preserve lean body mass,” Ali says. “Exercise speeds up our metabolism and helps us to burn more calories—and toned muscles also make us look better in our clothes.”

9 Make It Fun “If jogging’s not your thing, find an activity you enjoy doing,” Ali says. That way, exercise doesn’t become a chore—it’s an enjoyable part of your day.

10 Don’t Give Up Even if you had a bad day (and a Snickers bar or two), it isn’t the end of the world—or even the end of your diet. Remember that tomorrow is another day. Vow to do better. EDGE