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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.”

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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.

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.

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.

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.

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

Feel like strangling Santa? You’re not alone. And there’s probably nothing wrong with you, either.

Tradition tells us that this time of year is meant for “Decking the Halls.” But did you ever feel like decking a friend or family member instead? All kidding aside, the mini-bouts of depression and anger that sometimes accompany this season are very real. The holiday blues can grip even the happiest, most well-adjusted of us with little or no warning. Understanding where these feelings come from, as well as your options for addressing them, can go a long way toward making it to January with your sanity intact. According to Dr. Rodger Goddard, who has served as Chief Psychologist at Trinitas Regional Medical Center for more than two decades, stress is almost always the trigger. And holiday stress can come from many sources. “At the end of the year, during the holidays, we reflect on our lives,” he explains. “When we reflect, we can get nervous about many things. For instance, many of us now face intense financial stress due to the state of the economy. This kind of reflection often leads us to dwell on our shortcomings and what we don’t have, rather than our accomplishments and the miracle of just being alive.” Dealing with relatives can just compound the situation. Tension between different family members, dwelling on past hurts or injustices, rivalries and jealousies can bring old wounds back to the surface. In this environment, little things—such as where to eat, what to eat and who sits where—can become incredibly stressful and suck the joy out of what should be pleasant reconnections and reunions. “On top of this,” Dr. Goddard adds, “we often eat and drink too much. The result is body discomfort, which contributes to distressing emotions.” The media can play a leading role in feelings of depression and anger. Movies, music, television shows and commercials all make the holidays out to be a magical time of happiness and perfection. To feel otherwise just feels wrong. “We live in reality, not a movie,” says Dr. Goddard. “Holidays cramp our schedule—overloading us with shopping, socializing, preparations and party-going. The holiday season has become hyper-commercialized, giving us the message that love is shown through material gift-giving. Under these conditions, we can feel that what we give and what we get are being constantly evaluated—which leads to even more stress.”

Mind-Heart-Body-Soul So what’s a seasonal sour-puss to do? Creating a “radical support” plan for the holidays should alleviate a good deal of the stress. According to Dr. Goddard, your anti-stress strategy should look something like this:

MIND — Make a PIPS list (Problem Identification/Problem Solving); for each thing that worries you about the holidays, write down a reasonable solution.

HEART — Spell out the actions that you will take to protect yourself and nurture yourself emotionally—specifically, commit to do the things that you love doing, with the people that you love the most.

BODY — Formulate a plan to limit your intake of the things that are great in moderation, but make you feel lousy in excess: sugar, starch, desserts, alcohol, cholesterol—you know, all the good stuff. Also, write down a daily workout regimen and stick to it. Exercise and movement actually processes negative emotions out of the body.

SOUL — Spell out your life mission and purpose. List the good things you have achieved during the past year. Look toward the year ahead and identify what you will do to experience a deeper spiritual feeling—anything from connecting with nature to taking a Tai Chi class. “We all try very hard to make life work,” says Dr. Goddard. “Always remember that you deserve the best.” EDGE  

Editor’s Note: Dr. Goddard also directs Trinitas’s Wellness Management Services, which provides training, consultation and program development to companies and schools to improve employee, teacher and corporate health, effectiveness and success.

If that’s how dieting makes you feel, then it’s time for a new Rx

If sticking to a diet were literally to boil down to a life-ordeath choice, could you do it? Anyone who’s fought an unsuccessful battle of the bulge has, at one time or another, considered this extreme set of circumstances. The fact that we actually wonder about such things says a lot about our attitude toward dieting. It suggests that, for a great many of us, eating healthy and living healthy won’t start until we have a gun pressed to our heads. Or some other vital organ. In his practice at Trinitas Regional Medical Center, Dr. Ari S. Eckman, M.D., sees a steady stream of patients dealing with diabetes—a disease approaching epidemic proportions— and also hypothyroidism, another disorder that is growing, particularly among women. When asked if his high-risk patients were better dieters than most, the Chief of TRMC’s Division of Endocrinology, Diabetes & Metabolism said that yes, initially they are. “But many do lapse over time,” he admits. Apparently, risk alone is no guarantee of success. Dr. Eckman is quick to confirm this fact. He maintains that dieting is not so much about food as it is about lifestyle. The root of the word “diet” actually comes from the Greek word diaita, which means a “prescribed way of living.” Dieting, he insists, doesn’t have to mean depriving. That being said, he cautions, the whole point of dieting is to lose weight. “Make no mistake about that.” The Power of Positive Eating Google “diet” on your computer and the results are overwhelming. You’ll discover page after page of sites that are overflowing with imaginative menus and mouthwatering recipes. Whichever one you choose, says Dr. Eckman, you can increase the chance for success by following these ground rules: Spice Up Your Life Although salt can amp up flavor, there are a lot of other herbs and spices, both dried and fresh, that can compensate: pepper, oregano, basil, cumin, garlic, cilantro and the well-sung quartet of parsley, sage, rosemary, and thyme. Most Americans need to reduce their daily salt intake. This is doubly true for people trying to lose weight. Think Outside the Box Get creative in your kitchen. Take advantage of seasonal produce. Cook veggies several different ways (roast, steam, grill) for different taste and texture…and raw is always beautiful. Make fruit a part of your meal to stave off a major sugar craving. Dress Up Your Diet Visually feast, don’t just blindly eat! Set a pretty plate. Garnish your heart out. Color-coordinate healthy food choices. Use your best china. Sip water out of a crystal goblet. Presentation goes a long way—cater to all of your senses, not just your taste buds. Move Away from the Kitchen At home, dine someplace other than where the food is, namely the kitchen. You’ll have to get up for second helpings. The extra steps will make you take notice of how much you’re consuming. Work In a Workout A diet without exercise is a recipe for failure. Find 30 minutes each day to break a sweat with some cardio activity, and not necessarily all in a single interval. Park your car a little farther from the office or the supermarket. If you work at home, devote the commuting time saved to exercise. No buts to getting off your butt. Lead Yourself Not into Temptation Drive by the driveins. Clean out your cupboards. Eat five to six small meals a day rather than only two; your body seeks to metabolize— deny it by skipping a meal and you’ll overeat at the next. Monitor the Usual Suspects Forego the fad diets; better to identify your specific food weaknesses and just stay away from them. That way a minor slip-up won’t lead to a major binge! Among the same search-engine results that yield great recipes for different diets, you will also find lengthy dissertations on the challenges to success: temptation, boredom, stress, self-indulgence and the need for instant gratification. To that, says Dr. Eckman, you can add resentment. Nothing can sabotage a diet’s success more than hating the fact that you have to diet at all. Ultimately, he says, we will comfort ourselves by giving in to cravings. We’ll indulge ourselves with dangerous “treats.” We’ll eat, drink and yet we still won’t feel particularly merry. Denial is also a definite diet-killer, adds Dr. Eckman. “Too often I hear patients claim that they don’t eat much! The problem is how much is ‘much’ to them? And it may not even be how much they eat, but how wrong they eat,” he says. “If you can’t see the real you when you look in the mirror, then maybe you need to go out and buy a good scale…and then be sure to step on it.” The numbers won’t lie. EDGE  

Editor’s Note: Dr. Eckman completed a fellowship in Endocrinology and Metabolism at Johns Hopkins University. In addition to providing medical treatment for Diabetes and Thyroid conditions, his practice, Premier Diabetes & Endocrinology (tel: 908 994 5187), extends to a broad range of health conditions, including polycystic ovarian syndrome, osteoporosis and other calcium disorders, low testosterone levels and lipid abnormalities.

When it comes to picky eaters, the truth may not be that hard to swallow

We’ve all heard the stories—the child who completely shuns vegetables or refuses to consume anything but white foods. They’re funny if you aren’t the parent trying to get healthy food into a picky eater. If the kid is yours, however, it’s no joke. There are reasons for your child’s peculiar eating habits, and things you can do to broaden his or her culinary horizons. First off, you may be surprised to learn that it’s hardly ever a matter of taste. Picky eating is a natural part of toddlerhood, as children express their independence. What parents may believe is a fussy eater may not actually be that at all. “Children don’t tend to eat as much at meals as adults expect them to eat, and babies spit out their food, leading parents to believe that they don’t like it,” says Dr. Maria Padron, a pediatric and adolescent psychiatrist at Trinitas Regional Medical Center. “But babies taste food by spitting it out and licking it, and if parents believe their child doesn’t like it and don’t continue to introduce that food, it becomes a foreign food to them.” Well-meaning parents may try to cater to a picky eater, but experts say that that only backfires. “They create a monster,” Dr. Padron explains. “Unless there’s a medical contraindication, children should be ‘helped’ to eat everything that the family eats.” Easier said than done, right? Don’t give up until you’ve exhausted these strategies: Offer variety earlier. “Kids often become picky eaters because they haven’t been exposed to a lot of foods,” Dr. Padron says. “You should slowly expose children to different kinds of foods.” Hold your ground. Your child may decide to go on a hunger strike for a meal or two if you suddenly stop being a short order cook and insist that he eats what you’re eating, but he won’t hold out forever. “Kids may refuse to eat for a few meals, but as long as they’re healthy and still drinking liquids, it’s fine,” Dr. Padron says. “When he’s hungry, your child will eat.” Keep reintroducing the same food. “Parents need to be patient when they’re introducing new foods, and not get upset if kids aren’t jumping to eat broccoli right away,” Dr. Padron advises. Even if your children didn’t like asparagus the first few times, all it may take is the repetition (or a new way of serving it) to make them like it the 10th time around. You just need to insist on one bite each time you serve it— if they still don’t like it, don’t force it. Get your kids involved. Take your kids along to the grocery store and let them choose something new to try in the produce department—and if you have the time, let them get involved in preparing the dinner, too. By allowing your child to have a say in what they’re eating and an investment in the meal, you may find that they’re more willing to eat the fruit they picked out or the side dish they helped make. Minimize distractions at dinnertime. If there are other forms of entertainment beyond eating—a TV, books or toys—that can keep kids from attending to the task at hand. Instead, look for ways to make the meal itself more entertaining, with a colorful variety of vegetables or interesting presentations. Seek help. Get your pediatrician on board, especially if it’s been a long-standing issue, where your child’s eating habits may have become ingrained. For more severe cases, your pediatrician may recommend speaking to an expert, such as a counselor or a speech or occupational therapist. Indeed, in some instances, picky eating can be the sign of a more serious issue—a sensory disorder or a mechanical issue with feeding. So when is the right time to call in professional help? “In children with feeding issues, it could be a textural or tactile issue, often with mushy foods like bananas or yogurt,” says Kevin Nelson, occupational therapist and Manager of Trinitas Children’s Therapy Services. “Or it can be a mechanical issue, where they simply don’t have the musculature in their mouth to handle that food.” Whatever the cause of a child’s pickiness, in the end the key is to work slowly. Your kid won’t become an adventurous eater overnight, and if the issues are more sensory or mechanical in nature, you may need to follow a much gentler, slower path toward introducing these foods.

“Seeing a therapist is not the first step in a long and expensive process.”

“We slowly try to introduce the textures to them,” Nelson explains. “If they have an issue with mushy textures, we might start to do some play with finger paint or shaving cream to get them comfortable with that texture. Then we’ll have them sit at a table with the yogurt on the table, then put a dab on their finger, maybe have them smell it. Finally, we’ll put a dab on their tongue. We slowly try to get it closer to get them to tolerate it.” Depending on the severity of the issues, this process could take months. However, if you consistently work with children at home as well as in therapy, you may find that you’ll move faster toward turning your child into a well-rounded eater. Also, understand that seeing a therapist is not the first step in a long and expensive process. On the contrary, says Nelson. “You may need to see a therapist for an initial consultation, just to get started in the right direction and get trained on how to handle it.” “A lot of our job is educating parents on what’s appropriate,” he says, “and how to deal with different situations.” 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.

On October 26th, mental health advocate Jesse Close and journalist Jack Ford will discuss the importance of “Easing the Behavioral Health Stigma” at the Trinitas Health Foundation’s virtual Peace of Mind Event, with proceeds helping Trinitas expand its inpatient unit for adults dually diagnosed with intellectual/developmental disabilities and severe mental illness—New Jersey’s only inpatient facility that cares for these patients. Close, the younger sister of actress Glenn Close, is a writer, photographer and mental health advocate whose own battle with bipolar disorder illustrates the critical need for early diagnosis and treatment. She speaks with great passion and humor on a subject with which she is intimately familiar.

EDGE: Something that friends and family and co-workers have come to understand about people struggling with bipolar disorder is that it manifests a little differently for each individual, and also what works as a treatment now may not work as well a week or a month or a year from now. Has that been your experience?

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Jessie Close: Yes. Just recently, in fact, I have started getting off Lithium and onto another drug. It’s going to take a while. I’m still on my full dose of Lithium so I’m not sure how my psychiatrist is going to pull this off. I didn’t realize that Lithium can be quite dangerous if you “cold turkey” it. Luckily, I’m not doing that.

EDGE: You were diagnosed at 50, having gone more than two decades undiagnosed. How did that continue for so long?

JC: I remember as a teenager being sent to live with my older sister, Tina, while I was on a trip with my parents to Africa—I didn’t do well over there—I said to her, “I’d really like to talk to a psychiatrist.” She said, “Oh, we don’t do that in our family.”

EDGE: Was that a New England thing?

JC: Yeah, yeah. Stiff upper lip, you know. However, I knew there was something wrong. I was born in 1953 and the stories I’ve heard from that era are about people having lobotomies. We weren’t respected as people. We were “crazies.” I’m so happy that so many young people are now getting help sooner than later. Bipolar disorder can hit young men from around 17 years old up, while for women it usually hits us in our 20s, sometimes earlier. I don’t know why that is.

EDGE: Do you think the healthcare system in this country, as currently constructed, is adequately equipped to deal with mental illness?

JC: I would hope so. But we’ve had a running battle for years with our hospital here in Bozeman, Montana, trying to get them to create a mental health unit, and they’re just fighting it and fighting it. If you have Apple TV, you can watch a show Glenn and I did called The Me You Can’t See. It’s done really well. There is a sequence in that show where the hospital rep says, “We want it to be perfect.” My sister pipes up and asks, “How can it be perfect if you haven’t even started?”

EDGE: During the COVID-19 shutdown, a lot of the people who might have noticed someone with a bipolar disorder going off the rails no longer had regular face-to-face contact, where they could check in or intervene. Is that one of the under-told stories of the pandemic?

JC: I think the pandemic has caused a lot more mental illness. I was fortunate that Glenn lives nextdoor so we had each other, and my daughter and older son, Calen, were here. But back in March 2020, when we started to isolate, I found it very difficult to just be in my home.

EDGE: Calen is schizophrenic.

JC: Yes. My eldest son, Calen, was diagnosed with schizophrenia at age 18. He went off the rails at 17 and we didn’t know what was happening. We went to McLean Hospital in Belmont, Massachusetts and met with the Director of the Psychology Research Lab, Dr. Deborah Levy, who unfortunately has since passed away. She studied our family for four years, took blood and tissue samples, and ran the data through her colleagues at McLean. She was able to show how genetic mental illness really is. She described my mother as a “mosaic” because she had three children without mental illness and then she passed it to me. I had three children and passed it on to Calen in the form of schizophrenia. He went to McLean for two years. He was 19 when he went and 21 when he came home and early intervention helped him enormously. He’s an artist and writer now and he takes his meds—you would never suspect that he has schizophrenia.

EDGE: What event precipitated your finally seeking treatment?

JC: It was after a family gathering in Wyoming, where my parents had a house, and I was about to drive with my daughter back up to Montana and I knew I had to say something. I went to Glenn and said, “I cannot stop thinking about killing myself. It’s this constant, monstrous thing saying kill yourself kill yourself kill yourself.” A week later I was at Belmont.

EDGE: Had you had the benefit of an early intervention, how do you think that would have changed things?

JC: Well, I wouldn’t have had five husbands [laughs] that’s for sure! When I speak at events like Peace of Mind, I ask, “Who in this audience has been married five times?” So far no one has raised their hand.

EDGE: My mother was married five times…but I suspect it was because she was a narcissist. Anyway, going forward now, even if no one raises their hand, at least you can say you know someone!

JC: [laughs] Well, I so wish I had been diagnosed earlier because I know I wouldn’t have had five husbands. I was out of my mind most of the time. I haven’t been with a man since 2004 and I’m very happy about that. I’ve gotten so much done. I’ve had shows with my drawings, I’m getting ready to send a new novel to my agent, I have two photography projects going and I can help with my three grandchildren. I attribute all of that to being on the right medication. But, yeah, I do have very deep regret that I wasn’t diagnosed sooner. I’m pushing 70 for God’s sake.

EDGE: For individuals with a bipolar diagnosis, a common trigger is seeing their siblings have success or just having a good time. Was this something you experienced as Glenn’s entertainment career unfolded?

JC: It wasn’t much of a factor in my case. I saw how hard she works. She has to travel, remember lines—it’s a brutal career. She has done so well because she works her butt off. Glenn is six years older than me and has always been my big sister. I remember like it was yesterday how she would take me up to her room, where she had a blackboard. She taught me how to do the letter “i” and I loved the dot then and I love it now. She was very good to me and continues to be.

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EDGE: You wrote a book entitled Resilience. How do you define that word?

JC: I was resilient because I didn’t commit suicide. I’ve had three attempts; thank goodness they were all thwarted. There is a scene in the book when I was married to my last husband when we were living way out in the boonies in Montana. I’d made a mental note he’d left his handgun on the seat of his truck—he usually kept it locked up. I got drunk and went out and was about to open the door and thought to myself, All three of my children will hear the gun go off and come outside and see me. I just couldn’t do that to them. So my kids “saved” me. Later, in 2004, after that husband fled, I finally went to the hospital and got help. That’s when they started me on Lithium.

EDGE: Beyond getting the right medication, how did that experience change you?

JC: Being around other people with mental illness was so wonderful, because you all speak the same language. It was amazing.

EDGE: When you appear at events like Peace of Mind, what do you want the take-away to be for the audience?

JC: I want to open their eyes to the fact that those of us who are mentally ill are human. We have the same feelings as everybody else…they might just get exaggerated. I want them to laugh, I want them to realize in their gut that, if you treat people with mental illness with love and kindness—and understand that they can get help—that it’s quite amazing how medication gives our brains what they need and turns us around. And if there is someone in the audience who is concerned about a family member, I hope after listening to me they will do something about it. EDGE

Editor’s Note: For more information on Peace of Mind, visit trinitaspeace.givesmart.com. For tickets, call (908) 994–8249. Trinitas operates one of the most highly respected and comprehensive departments of Behavioral Health & Psychiatry in New Jersey. Services are offered along a full continuum of care, with specialized services available for adults, children, adolescents and their families, as well as services for those with various substance use disorders. In addition to operating a 98-bed inpatient facility, the medical center provides almost 200,000 outpatient behavioral health visits annually.

In the world of stroke prevention, the odds are in your favor.

If you found a way to increase your retirement nest egg by 80% with a few tweaks to your investment strategy, you’d drop everything and get on the phone to your broker, wouldn’t you? Or, if you knew that you had an 80% chance of avoiding a serious car accident by altering some of your driving habits, you’d make those changes, too, right? There are no guarantees in life, of course, but when it comes to your health, there are some powerful ways to swing the percentages in your favor.

The problem is that, until you experience these numbers personally—until it’s your life on the line and the changes are ones you have to make—odds and percentages are just numbers. Which means they are easy for busy people to ignore. For me, that changed the day, during a routine physical, that I learned high blood pressure was putting me at real risk for a stroke.
Yocasta Corona (above), a co-worker at Trinitas, is the Stroke Program Coordinator. She deals with life-and-death numbers all day and every one of them tells her something different. Is her favorite number 80? I’m beginning to believe that it is.

“Eighty percent of strokes,” she says, “can be prevented by actions that are 100% within our control. Those are amazingly good odds.”

Stroke awareness—specifically contributing factors such as being overweight, suffering from high blood pressure or having a family history of stroke—have come into sharp focus in recent years. Trinitas has played a critical role in the community education effort on how to recognize the signs of stroke and, perhaps more importantly, how to prevent them in the first place.
“Risk factors like age, sex and ethnicity are uncontrollable risk factors,” Corona points out. “And yet, as much as 80% of strokes can be prevented through lifestyle changes, including improved diet, increased exercise, smoking cessation, and less alcohol consumption.”

One in four people will suffer a stroke event in their lifetime, she adds, citing data from the American Stroke Association.

Blood pressure is the single most controllable contributor to strokes and is the fifth-leading cause of death in the U.S. each year. Managing blood pressure through diet, exercise, and, if necessary, medication can be especially critical for people who may not even realize they are at risk, like me!

After my high blood pressure reading, I decided to focus on supplementing for the vitamin B12 and D deficiencies that my bloodwork revealed. But it wasn’t long before my body sent me a less subtle warning sign: I was in my office and it was almost time to go home when I suddenly felt panicky for no apparent reason. Anxiety runs in my family, so I could have chosen to pass it off as a panic attack. But then, high blood pressure is also a trait many of my elders share. I wasn’t thinking about any of this. Instead, I began having a telepathic conversation with my husband, who was suddenly speaking rather loudly in my head, telling me to stop in to see the doctor before going home.

“I don’t feel well,” I reported to the RN in the employee health office. When she took my blood pressure, her eyes got wide: “Umm…it’s 200 over 95.”

Seconds later, she was marching me down the hall to see a doctor, who prescribed medication. Soon after that I saw a cardiologist and had a series of tests that cleared me of any immediate danger—so long as I take my medication, eat better and exercise.

I still wonder what might have happened had I assumed it was just a panic attack. What if I’d been driving and had a stroke?

Think Fast, Act F.A.S.T.

I think it is worth mentioning that the initial reason I had my BP checked was that another Trinitas staff member had suffered a stroke and I couldn’t stop thinking about her story of survival. Lemons, she insisted, may have made the difference between life and death.

She was washing lemons in her kitchen one afternoon and noticed she was having difficulty grasping them. Her son could tell something was wrong and when she tried to tell him she was fine—that he was overreacting—she was making only incoherent sounds. He wasted no time calling 9-1-1. By the time the paramedics arrived, her face had drooped on the right side, the same side as the hand that couldn’t grip the lemons. Their F.A.S.T. diagnosis confirmed it: She was having a stroke. She made it to the hospital in time, avoiding any serious long-term complications.
F.A.S.T. stands for Face, Arm, Speech, Time. When someone’s face droops, their arm weakens, and they start slurring their speech, it’s time to call 9-1-1.

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“Getting F.A.S.T. care can make the difference between recovery and disability,” Corona says. “Time is especially critical.”
Earlier this year, yet another staff member at Trinitas—in her early 50s with newly diagnosed hypertension —arrived at work with a bad headache. A co-worker noticed she was having difficulty speaking and knew right away something was off. She called for the Rapid Response Team to activate a Code Stroke. Quick care enabled the team to treat her effectively and aggressively, which led to a full recovery.

“She hadn’t had a chance to fill the prescription for blood pressure medication,” says Corona, noting that otherwise the stroke could have been averted. “In addition to her blood pressure, she was also a smoker with a family history of stroke. While that genetic component can’t be controlled, kicking the smoking habit, starting on medication, and taking steps like meditating to de-stress could have all dramatically decreased the odds that she’d be a stroke victim.”

Since my own hypertension diagnosis, I have worked to swing the odds in my favor by making important lifestyle changes. Although I never smoked and am not overweight, I recognize that I’m still at risk. I know my body, but I haven’t always listened carefully enough to what it was trying to tell me. Now I’m doubly conscientious about exercising and paying attention to the signals. I’m also doubly medicated, thanks to the 24-hour monitoring of my blood pressure that indicated numbers that were still too high, even with medication.
Do I consider myself a success story? Absolutely.

And I hope you start taking steps today to become one, too. EDGE

Editor’s Note: Trinitas is recognized as a Primary Stroke Center by the American Heart Association/ American Stroke Association.

Occasionally on the news you hear journalists call vaccine research a “cat-and-mouse” game. That’s only partially true. It misses the point that, if the cat doesn’t get its claws into the mouse, sometimes the mouse turns around and kills the cat. This game has been going on for most of recorded history and, as we have become better-educated about the nature of viruses and vaccines over the last 18 months, it’s safe to say that we have gained a greater respect for both the cat and the mouse.

Thankfully, in 2021, the cat seems to have gained the upper hand. Because, for most of human history, let’s face it: The mouse was winning. Until relatively recently, in fact, unchecked viruses, diseases, infections and a fundamental misunderstanding of how the body works doomed most people to an early grave.

Which explains why the idea that human beings might somehow create resistance or immunity to serious illness stretches back centuries—and how we arrived at the current state of vaccine technology. Long before scientists understood how epidemics spread, or even what they were, many cultures in Europe, Asia and Africa subscribed to the belief that exposure to a small amount of virus could boost immune response and prevent large-scale deaths. As the vaccines developed in late 2020 and early 2021 helped us turn the corner on COVID-19, it is worth a look back at how we got to where we are today.

The Scourge of Smallpox

The initial breakthrough dates back more than 1,000 years to China, where we find the first mention of variolation experiments. Variolation takes its name from the scientific name for smallpox, variola. Smallpox killed an estimated one-third of the individuals who contracted the disease, and left its survivors hideously scarred and often sterile or blind. A ship entering an ancient harbor with reports of smallpox aboard was often quarantined until the disease had run its course. The root of the word quarantine, with which we are now all too familiar, is quarantena. It originated with the policy in Venice during the bubonic plague of the 1300s and 1400s, when all ships arriving at the Italian port were compelled to anchor for 40 days before sailors could come ashore. For the record, the “quarantine” imposed on travelers during the coronavirus pandemic isn’t a quarantine at all; technically it is medical isolation.

Variolation involved various methods of introducing a small amount of biological material taken from an infected patient into an uninfected person. Among the ways this was accomplished was with a needle piercing a smallpox pustule and then being scraped across the skin of a healthy individual. Another was the collection of scabs from a smallpox victim, which were then ground up and rubbed into an incision in the skin—or blown up the healthy person’s nose. Sometimes a needle and thread that had been pulled through a smallpox pustule were pulled through a small scratch in the uninfected patient’s skin. The goal was to induce a very mild version of the infection, which (fingers-crossed) would subside in a few weeks and create a strong resistance to smallpox.
Early adopters of variolation did not include England, which considered itself the world leader in medical expertise, which it wasn’t. However, enough prominent physicians had used it effectively in the 1600s and early 1700s to finally convince the government to approve its use against smallpox in the early 1720s, with the full support of the Royal Family. Remember, at this point scientists had almost no understanding of how viruses and bacteria caused disease. Predictably, there was public outcry against variolation—the precursor to today’s anti-vaxers—not just in Great Britain, but in the American colonies, as well. To many, giving someone a dreaded disease they didn’t have seemed crazy and dangerous. In Boston, clergyman Cotton Mather was the target of a bomb for his advocation of variolation. The explosive hurled through his window contained a note that read You dog, dam [sic] you; I’ll inoculate you with this; with a pox to you.

Mather was a controversial public figure who had his hands in just about everything in the Massachusetts colony and was nothing if not a paradox. For example, he was devoted to importing Newtonian science to the American wilderness on the one hand while, on the other, he was the guy who set up the Salem Witch Trials. Mather learned of variolation not from Newton or other British scientists but from a Libyan slave he received in 1703 as a gift, who he rechristened Onesimus (his real name is lost to history). Curious about the scars on the man’s body, Mather listened as Onesimus explained how North African cultures dealt with smallpox. He then spearheaded a variolation campaign during an outbreak in Boston that yielded spectacular results. And took all the credit, of course.

Within a generation, our Founding Fathers had all hopped on the variolation stagecoach. Benjamin Franklin convinced English physician William Heberden to produce a pamphlet touting the success of smallpox inoculation (a word borrowed from horticulture, originally related to the grafting of plants) and distributed it free of charge throughout the 13 colonies. Two decades earlier, Franklin had lost a son at age four to smallpox. The pamphlet included do-it-yourself instruction for home inoculations—a forerunner of YouTube videos for DIYers. George Washington contracted smallpox as a young man, which some have theorized was responsible for his inability to produce offspring with Martha. True or not, it did make him immune to the smallpox outbreaks that would ravage military camps during the American Revolution. One of Washington’s lesser known edicts as commander of the Continental Army was that his soldiers had to be variolated. During Thomas Jefferson’s presidency, he personally conducted inoculation experiments on his slaves at Monticello, demonstrating both his enlightened approach to science and his unenlightened regard for human freedom and dignity.

Vaccines Arrive

There were worse jobs for young ladies in 18th century Europe than being a milkmaid, but like most occupations it came with its own set of risks. Repeated contact with a cow’s udder, especially by someone with broken or abrased skin common to farm work, was an invitation to contract cowpox, which produced pustules on the hands and forearms. The disease was considered an occupational hazard—rarely serious and, once a girl got it, she didn’t get it again. And, farmers began to notice, those girls didn’t contract smallpox, either—even after close contact with workers or family members who did. In 1774, smallpox began tearing through the county of Dorset in the south of England. A farmer named Benjamin Jesty used fluid from cowpox lesions to successfully inoculate his wife and children against smallpox. Over the next 20 years, similar stories caught the attention of scientists. Another piece of the puzzle was that British cavalry officers tended to dodge smallpox outbreaks, presumably from exposure to horsepox, a close relative of cowpox.

In 1796, English scientists Edward Jenner made the big breakthrough. He took a sample of pus from the lesion of a cowpox-infected milkmaid and injected it into an 8-year-old boy who had never had smallpox. Six weeks later he injected smallpox into the boy, who was the son of his gardener—which poses some uncomfortable questions about Jenner’s moral compass—but lo and behold, there was no reaction! Jenner called this process vaccination, from vacca, the Latin word for cow. Recent DNA research suggests that the disease Jenner was working with may have been transferred from horses to cow, possibly through farriers, whose farm duties often involved shoeing horses and milking cows. In which case you could say that we are all getting equivaccinations this year.

Vaccinations caught on quickly in the United States and, in 1813, President James Madison signed a bill creating the National Vaccine Agency. Part of that bill waived postage fees for vaccine material. England went one better, making vaccination of infants mandatory; if parents refused, they faced possible imprisonment. In 1863, little more than halfway through Abraham Lincoln’s first term as President, he contracted smallpox and was desperately ill for a month before recovering. His valet, William Henry Johnson, was not so lucky. He caught smallpox from Lincoln and was dead by the end of January. He had worked with Lincoln going back to his Springfield days. Some historians posit that the president contracted the disease around the time he delivered his Gettysburg Address, which in retrospect had all the earmarks of a textbook super-spreader event.

The next breakthrough in vaccines was discovered, somewhat accidentally, by Louis Pasteur in 1879. The French biologist was the first person to create a vaccine in a lab. An oversight by an assistant during an experiment with chicken cholera demonstrated that exposure to oxygen makes bacteria less deadly. This led the way to several more discoveries, including the rabies vaccine in 1885. By the turn of the century, researchers in the U.S. and Europe were beginning to get the upper hand on typhoid and cholera and, by World War I, the first vaccines for these diseases were becoming available.

At War with Disease

There were setbacks, of course, including a terrible story here in New Jersey, where nine children died from tainted smallpox vaccines. That incident led to the Biologics Control Act, which was passed in 1902. However, then as now, the increasing involvement of the government in public health was not always appreciated. In England and America, there was small but vocal opposition to vaccinations, mostly citing an infringement on personal freedom. Massachusetts was the first state to make smallpox vaccinations mandatory and the resulting lawsuit went all the way to the Supreme Court. In 1905, the court upheld the constitutionality of the program in Jacobson v. Massachusetts. In 1909, Americans learned the story of Mary Mallon, the woman dubbed “Typhoid Mary” by the press. She was what we now call an asymptomatic spreader of the disease, who worked as a cook for several wealthy families and, later, for hospitals, hotels and restaurants. Everywhere she worked (often gaining employment under a fake name) a typhoid outbreak soon followed. Mallon finally had to be quarantined on North Brother Island, near Riker’s Island in New York’s East River.

The need for further progress on the vaccine front was made particularly clear in the waning days of the First World War, when the Spanish Flu—which probably originated in a U.S. Army camp in Kansas—spread across the planet and killed tens of millions people. It was a particularly powerful version of the H1N1 influenza virus; it took a particularly high toll on young, healthy adults, who normally weathered the flu without incident. It spread fast, killed quickly and if a patient’s lungs filled with fluid, there was nothing doctors could do. If you got it, you went to bed and waited:
On the last day of that year, 1918, I went up to the shop with a bad cold. Influenza had been raging in [Norwood, MA], the hospital was crowded, and there were deaths almost daily. About two hours after going to work, I collapsed. It had got me. I was taken home, went to bed and a doctor was summoned. I was past 70, but he was the first doctor since my birth who had ever been called to treat me. He found me in great pain, temperature 104, but said my lungs were not affected. For several days as I lay in bed, I did a deal of thinking. I thought it was probable that I was near the end of the race, but I had no dread. I was comforted that I had been able to keep up the payments on my life insurance, and that my wife would have the use of it in her old age.
This patient, my great-grandfather George Stewart, survived to write this account before he died, in 1925. He was never the same, however. George was unable to walk more than a short distance or do anything that required strength, including ascending the flight of stairs leading to the second floor of his home. In his defense, I know those stairs. They are weirdly steep and are available if a movie company is interested in remaking the Hitchcock classic Vertigo. The point here is that the world became fixated on understanding how the influenza virus mutates and spreads, the long-term impact for survivors, and what could be done to give humans a fighting chance. A century has passed and we are still addressing these challenges.

How To Make a Vaccine

The first important step in creating an effective, mass-produced flu vaccine was to develop a process for growing (or culturing) viruses in large quantities. Scientists already knew how to culture bacteria—give them a comfy medium and they’re off to the races—which was the key to making vaccines for bacterial illnesses. However, viruses don’t reproduce on their own. A virus must first infect a cell before using the cell to make copies of itself, and at the time of the Spanish Flu there was no method for growing viruses outside of a living host. The breakthrough came in the mid-1930s, when two English researchers discovered separately that the flu virus could be grown on the membranes of fertilized hens’ eggs—and soon after isolated the first neutralized antibodies. One of the U.S. scientists working on the flu vaccine at this time was Dr. Jonas Salk, who used what he’d learned in the 1930s to tackle polio in the 1950s.

The U.S. President during this era was Franklin Roosevelt, who had been stricken with polio as a young man. His inability to walk or stand was the best-kept/worst-kept secret in America. During a 1938 radio broadcast, entertainer Eddie Cantor, whose program had an audience of millions, pitched the idea of sending dimes to the White House to help fund polio research. Listeners sent more than 2 million dimes to Washington, triggering a grassroots effort that involved several more national celebrities and eventually became known as The March of Dimes. A year after FDR passed away, his profile replaced the head of the winged liberty on the silver 10-cent piece, commonly known as the Mercury dime. Reach into your pocket and you’ll notice that this coin still bears his image.

Building on a wave of discoveries by virologists and epidemiologists, over the next three decades, life-saving vaccines came fast and furious, including increasingly effective flu vaccines, Diphtheria-Tetanus for infants, and measles and mumps vaccines. The crowning achievement of the post-war era was the creation of an effective injectable polio vaccine by Dr. Salk. Salk’s work followed several research breakthroughs dating back to the 1930s and was ready for testing in 1952, the same year polio cases in the U.S. surged over 50,000. Testing proceeded over the next two years, culminating in the Francis Field Trial, which involved more than 1.8 million schoolchildren. It was the largest medical experiment in history at that time and the results were extremely positive, despite a one-man anti-vax campaign waged by gossip columnist Walter Winchell. Winchell “uncovered” that several monkeys had died during initial testing and labeled the Salk vaccine a killer, likening it to a phony cancer cure—and adding that even if the vaccine were 99% effective, well, that wasn’t good enough. Winchell was what we would now call an “influencer”…more than 150,000 parents pulled their children out of the study.

Nevertheless, the Salk vaccine was licensed in 1955 and, thanks to an ingenious “rocking bottle” manufacturing method developed by a team led by Canadian biochemist Leone Farrell, went instantly into mass production. An interesting sidenote is that when Salk traveled to Toronto to meet with Farrell’s team, she was barred from the reception because it was held in a men’s-only club. Farrell was an astonishing figure in medicine who is largely forgotten today; she later devised a way to accelerate penicillin production.

Where We Are, Where We’re Going

Over the last 30 years, vaccines have successfully tackled countless health issues in the U.S. and around the world, including hepatitis, shingles, cervical cancer and the H5N1 avian flu. However, viruses are nimble and clever. When faced with obstacles, they do what we do: evolve and mutate in order to survive. That’s why we get flu shots every year and why sometimes they are only 50% effective. And that’s why scientists are still looking for ways to eradicate tuberculosis, malaria, Lyme disease and hepatitis C. And HIV. And the common cold.

Keep in mind, too, that it takes a billion or more dollars and a decade of research and testing to develop a viable vaccine, and even with government funding, often private industry and investment funds determine what’s “worth” the time, money, effort and risk…and what’s not.

The arrival of COVID-19 on American shores in the winter of 2019–20 and our less-than-stellar response to the virus (including the politicizing of mask-wearing) will leave a public-health and also a cultural legacy that is certain to be with us for a long time. What we will probably forget pretty quickly is how vaccines were going into arms within a year of the start of the pandemic. That is an insanely short period of time to develop a vaccine for a virus that seemed to have everyone baffled at first.

How did it happen so quickly? The short answer is computers. Once the COVID-19 genome was posted by Chinese researchers, the vaccine could essentially be created on a computer screen and then go right into manufacturing. Also, no one in the vaccine game starts from scratch or goes it alone. The COVID-19 vaccines out there now had a scientific running start, which was further accelerated by Operation Warp Speed. The running start in this case were the multiple safe and effective vaccine platforms created since Edward Jenner started tinkering with cowpox. COVID researchers looked at which ones were most likely to offer the highest level of immunity and produce the least side effects, and then got right into determining which proteins, or viral antigens, would generate an immune response that would protect people from the disease.

As it turned out, the quick-turnaround vaccines used mRNA and vector-based platforms. The vector-based strategy was developed in the fight against SARS. Since the viral enemy is technically SARS-CoV-2, that seems logical. The mRNA platform was utilized in treating Zika a few years ago. What both have in common is that they did not exist in the 20th century. They are relatively new but appear to be safe. What is still in question is how long vaccinations will last—like the flu vaccine, we may need a new one every year—and whether they will be effective against the variants that will almost certainly develop in the coming months.

So is 2021 the Year of the Cat? Did we catch and kill the mouse? It may be too early to claim total victory. The mouse undoubtedly has a few more tricks up its sleeve. Also, human behavior is nothing if not unpredictable; even when Americans are “fully vaccinated,” there will be outliers who refuse the needle. And finally, just because we are vaccinated, that doesn’t mean they are. And by they I mean a billion or more people in developing countries who are unlikely to be offered, or avail themselves of, a vaccine—or who fall prey to supply-chain problems, as happened in India this past spring.

This is where the mouse loves to play. Hopefully the cat is watching. EDGE

Medical breakthroughs you may have missed during the pandemic.

With the 2020–21 news cycle hyper-focused on COVID-19, these five advances in medicine went almost unnoticed…

Unforgettable

We may look back at 2020 as the year that we quietly turned the corner on Alzheimer’s, thanks to a couple of important breakthroughs in identifying biomarkers, as well as the development of a new drug. In the early days of the COVID-19 pandemic, the FDA approved Flortaucipir, a radioactive diagnostic agent used to image tau neurofibrillary tangles in the brain. In October, doctors began using the new PrecivityAD blood test to determine whether a patient is likely to have the presence (or absence) of amyloid plaques in the brain, which is a pathological hallmark of Alzheimer’s disease. In early November, the human monoclonal antibody Aducanumab—the first new drug in a generation to treat Alzheimer’s—moved an important step closer to final FDA approval. In addition to these news items, dozens of major non-drug studies on the effects of supplements, diet, exercise and sleep on cognitive decline continued to generate mounds of useful data for the prediction, diagnosis and treatment of the disease.

The Doctor Can See You Now

A couple of years ago, fewer than one in 500 doctor visits in the U.S. were virtual. Although the technology was in place, the impetus for patients, health providers and insurers just wasn’t. That all changed when we began masking up and hunkering down. Around one in 10 interactions fell under the Telehealth heading during the early months of the pandemic. While the healthcare industry is still sorting through the Mt. Everest of new data this shift generated, it is safe to say that Telehealth is no longer a solution looking for a problem to solve. At Trinitas, Telehealth has enabled the adult Dialectical Behavior Therapy (DBT) program to serve a larger audience at a critical time.
“Distance from our location does not have to be a barrier any more— explains Essie Larson, Ph.D., and co-director of the DBT Institute at the hospital. “The pandemic also allowed for large-scale research around the world to be conducted on the effectiveness of DBT in a virtual modality. The results are indicating not only great success, but also better attendance rates. While virtual services may not be a fit for everyone, having it as an option for either ongoing therapy or for occasional sessions—due to barriers such as bad weather, illness or car trouble, for example—is wonderful.”
It may have taken a pandemic to provide proof of concept, but Telehealth has become a tool ideally suited for a wide range of challenges to the traditional face-to-face, doctor-patient relationship, including continuity of care, triage and plain old capacity.

Game Changers

Last fall, the American Heart Association proclaimed SGLT2 inhibitors and GLP-1 receptor agonists—blood-sugar control medications that are prescribed primarily for Type 2 diabetes—as being game-changers for patients with higher risks for cardiovascular disease and chronic kidney disease. “There are many drugs available to treat diabetes that lower the patient’s blood sugar,” says Dr. Ari Eckman, an endocrinologist at Trinitas. “The class of drugs of SGL2 inhibitors and GLP-1 agonists not only lowers the patient’s blood sugar—which is important in managing their diabetes—but it has also been shown to decrease the risk of complications of heart disease and kidney disease. This is an additional benefit to using these excellent medications for patients with diabetes.”
The drugs have been around for over a decade but have not been widely prescribed for diabetics with these conditions. Clinical trials completed earlier in 2020 found that SGLT2 inhibitors and GLP-1 RAs can safely and significantly reduce the risk of cardiovascular events and death, reduce hospitalization and slow the progression of chronic to end-stage kidney disease.

Extra Cheese, Please

A large-scale Iowa State University study of the connection between specific foods and later-in-life cognitive acuity confirms what we all secretly suspected: that the benefits of wine and cheese keep paying dividends long after the wine and cheese party is over. Of all the foods evaluated, cheese was shown to be the most protective against age-related cognitive problems. And moderate regular consumption of red wine was associated with improvements in cognitive function. Other tidbits from the Iowa State results were that excessive salt intake is bad, particularly for individuals at risk for Alzheimer’s (we knew that already) and that, among the red meats, only lamb was shown to improve long-term cognitive ability (good news…unless you are a lamb).

Itching for a Solution

Any parent who has dealt with the nightmare of head lice will appreciate the FDA’s approval of Abametapir, a lotion applied to dry hair and rinsed out with water after 10 to 15 minutes. In clinical trials it was 80% effective at ridding the hair of children 6 months and older of the little buggers. Although virtual learning dramatically curtailed the number of cases in the U.S. of kids with head lice—which in some past school years touched 10 million—lice aren’t going anywhere. Indeed, many have started to develop a resistance to tried and true treatments.
“This new treatment,” says Dr. William Farrer, an infectious disease specialist at Trinitas, “requires a prescription, but does not require a second application, as older treatments often do. When it becomes available, it may be a significant improvement in the treatment of head lice.”

ECT is shedding Hollywood myths and restoring the rhythm of mental health.

John Lanier is the kind of healthcare professional who wears his life experience like a badge of honor. Having experienced Electroconvulsive Therapy (ECT) as a professional who helped patients prepare for and reorient after treatments—and then later as a patient himself—he offers an analogy to help people understand the fundamental aspects of ECT.
“Defibrillation shocks your heart to get it back into its proper rhythm,” he says. “It unscrambles and restarts everything. ECT does that for your brain. What we see on TV and in the movies—the flailing, the violent seizing—it doesn’t happen. There’s minimal seizing activity…more like muscle cramping. It isn’t a barbaric procedure at all.”

In 1973, at the age of 19, Lanier (left), now Program Coordinator for Nursing Performance Improvement at Trinitas Regional Medical Center, was treated for severe depression with ECT. Before that, he was a Psychiatric Technician at the Carrier Clinic in Belle Mead, helping patients prepare for ECT and then reorient afterwards. Lanier recalls waking up from the anesthesia after one of his own treatments with a breakfast tray in front of him. He had no pain or immediate memories of experiencing the treatment. And in the long run, he says, it worked.
Lanier’s childhood was worse than your typical unhappy childhood, but he made it through high school. However, after one year of college, too depressed to function, he quit.
“I had been going to therapy and taking medication for a month, but my depression wasn’t responding satisfactorily,” he says. “I felt like I might be schizophrenic, and was diagnosed as having depressive neurosis.”

Whenever he encountered problems, Lanier’s first reaction was I should kill myself. Then he attempted suicide.
“I remember my therapist telling my parents that, without a more aggressive treatment, there would be future attempts,” he says, “and eventually one could be successful.”
When Lanier decided to get a job, Carrier Clinic hired him as a Psych Tech. He understood the stigma surrounding ECT, which still exists, and appreciated the difficult choice his parents faced at the time. Back in those days, he points out, “you didn’t talk about depression, and you certainly couldn’t talk about shock treatments.”
After his ECT treatments nearly five decades ago, Lanier experienced incremental changes until eventually he noticed that suicide was no longer his go-to option. “It had fallen to maybe third or fourth on my list until finally it didn’t enter my mind at all. And in 1987, he began to notice an odd sensation that felt unfamiliar, but pleasant. He felt happy.
“My parents’ decision wasn’t an easy one, but it was the right one,” Lanier says.

The Facts About ECT

The words shock treatment conjure up scenes from One Flew Over the Cuckoo’s Nest and A Beautiful Mind, where Electroconvulsive Therapy is portrayed as punishment for bad behavior linked to mental illness. The reality is quite different: An ultra-brief pulse of electrical current is applied unilaterally (one side of the brain, as opposed to both sides). There are minor side effects, such as initial confusion and temporary memory loss.

“There are many misconceptions about today’s ECT,” confirms Dr. Salvatore Savatta, Chair of Psychiatry at Trinitas. “People believe what they’ve heard or seen on TV and in the movies. These over-dramatizations—applied against a patient’s will—have little to do with the real-life treatments. We need to remove the stigma surrounding ECT so more people can feel comfortable seeking out and receiving the treatment they need.”
Used in tandem with traditional psychiatric medications and evidence-based psychotherapies—such as dialectical behavioral therapy (DBT) or cognitive behavioral therapy (CBT)—ECT can help complete an integrated series of treatments that bring relief from the most challenging types of depression. When a patient isn’t finding relief through psychotherapy and traditional antidepressants, Dr. Savatta says, “ECT can provide substantial relief.”

The Road Ahead

Patients like John Lanier can be counted among therapy’s great long-term success stories. With proven results and an established history as a legitimate, humane medical treatment, tens of thousands of psychiatric patients now opt to have ECT each year. Lanier’s own success story took a remarkable turn when he went to work in Carrier Clinic’s Addiction Recovery Department, and a nurse manager urged him to go back to school for nursing.
“She told me I’d made history by working at a psychiatric facility after also receiving treatment myself,” he recalls. “The Director of Occupational Therapy, who worked with me during my illness, said that with my skills and my personable nature, I’d make a good clinician. So I went back to college, and this time—since I was thriving, not just surviving— I stuck with it.”
In the months and years that followed, Lanier became a Licensed Practical Nurse, then earned his Associate Degree in Nursing from Raritan Valley Community College before earning a bachelor’s degree from the University of Phoenix and finally a master’s degree from the University of Hawaii. He spent years working at Trinitas before retiring last August.
Or so he thought. Chief Nursing Officer Mary McTigue wanted Lanier’s skill set back on the job to assist with a COVID-related Department of Health project involving long-term care facilities. He returned on a per diem basis, then transitioned into a full-time role when a massive public outreach effort was organized around COVID vaccination distribution. Lanier was tasked with coordinating Trinitas’ vaccination administration centers, including Elizabeth High School, which at one point was administering more than 1,000 shots per day.
Over the course of Lanier’s entire career, including his recent return to Trinitas, he has touched tens of thousands of lives. The health of an entire community has been bolstered in part because he has been there time and again to answer the call. Without his decision to undergo ECT as a young adult, however, the community might have missed one of its most impactful members. His story is a testament to the value in ECT, and to the importance of setting the record straight when it comes to what Electroconvulsive Therapy is…and what it isn’t.
As the field continues to advance—at Trinitas and many other facilities across the state—Lanier’s story offers hope to individuals struggling to combat depression and other mental illnesses.
“I believe my experience can help other patients see the light at the end of the tunnel,” he says. “There’s an empathy I feel towards them, because I’ve been there. To anyone struggling, I can tell you that it gets better.”

Trinitas monitors slumber from afar.

Humans are good at a lot of things, but sleep isn’t always one of them. There are any number of non-medical reasons why we don’t get enough sleep—life stress, work stress, breastfeeding, bad dreams, noisy neighbors, a pet nesting on the covers or a partner hogging the sheets. Some issues you can address, others you can’t. Whatever the cause, losing sleep means you’re not rested or alert during the day, which can diminish focus, slow productivity and dangerously impair judgment.

If you are missing out on restorative sleep because of sleep apnea, however, that’s definitely a problem you can solve. Also, know that you’re not alone.

More than 23 million people in the United States have undiagnosed sleep apnea, which is kind of a staggering number given how simple testing has become. The Comprehensive Sleep Disorders Center at Trinitas, located at the Homewood Suites by Hilton, in Cranford, was seeing a steady stream of patients prior to the COVID-19 pandemic. While seeing patients and monitoring their sleep on-site became problematic in the spring of 2020, the center was able to shift gears and ramp up its home testing for sleep apnea thanks to a portable diagnostic device called the WatchPAT®, a small piece of equipment with three components. The PAT stands for Peripheral Arterial Tonometry, which measures arterial pulse volume changes to detect apnea events.

“It comfortably sticks to the chest with a small sensor, straps on your wrist like a watch, and slips onto your pointer finger,” says Dr. Vipin Garg, Director of the Comprehensive Sleep Disorders Center. “While you sleep, information is collected by the device and sent through the WatchPAT app to your doctor. Theoretically, if I was your doctor, I would be able to look at the results of your sleep test as soon as you woke up and hit send on the app from your phone.”

Sawing Wood

Nearly half of all adults snore occasionally. About a quarter snore regularly. Often, snoring is the result of a treatable condition, such as a sinus infection or a deviated septum. The culprit may also be bulky throat muscles or a soft palate or uvula. And, of course, in cases when loud snoring or gasps are interspersed with pauses in breathing—sometimes 20 or 30 an hour—sleep apnea is a strong possibility.

One more annoying thing about growing old is that we are more likely to snore as we age or go through physical changes. Middle-aged men and postmenopausal women are more likely to snore where they hadn’t in the past, and weight gain is connected to increased snoring.

Whatever the reason, the sleep deprivation that often goes hand-in-hand with snoring can come with its own health and wellness issues, and has been linked to obesity, heart disease and diabetes.

So who are these 23 million undiagnosed sleep apnea sufferers? If you snore, you may be one of them…and a candidate for a sleep apnea test. Snoring in and of itself is bad enough, even if it can be blamed on your anatomy, allergies, your sleep position or something else entirely. Snoring is unhealthy because when you stop breathing your oxygen level drops and makes it difficult for your brain and heart to function properly. With sleep apnea, you actually stop breathing—possibly several times per hour—which means interrupted sleep for you and anyone within earshot.

Dr. Garg says snoring “isn’t the only red flag to look out for.” There is also morning headaches, dry mouth, mood changes, pauses in breathing, snorting or gasping, insomnia, irritability and depression. Sleep apnea can lead to high blood pressure, stroke, cardiac problems, asthma, COPD and diabetes mellitus. It also causes a low oxygen level known as hypoxia, which creates a fight-or-flight response, meaning that your quickening heart beat also narrows your arteries. Undiagnosed sleep apnea also raises your risk of stroke by two or three times. You may also be at a higher risk of cardiac issues if you are older than 60, have 20 or more episodes of sleep apnea per hour and have an oxygen level of less than 78 percent while you sleep.

There are three types of sleep apnea that Dr. Garg and his sleep center staff look for when they test. Central Sleep Apnea means your brain isn’t signaling your muscles to breathe. Obstructive Sleep Apnea, which is most common, is a blockage in your airway. Complex Sleep Apnea syndrome is a combination of the two.

If you need to be treated for sleep apnea, the choice with which most people are familiar is the CPAP, short for Continuous Positive Airway Pressure. It’s a small, portable machine that keeps the upper airway open when you wear a small mask over the nose. A nasal mask is attached to the machine with tubing. It’s not as uncomfortable as it sounds and it’s most definitely the kind of thing one can get used to—and actually prefer to sleep with—to make breathing easier. The global CPAP market has been estimated at over $2 billion annually, with more than a quarter sold in the U.S.

There are some instances where surgery is the best option. For instance, removing the adenoids and tonsils—which is the most common treatment of Obstructive Sleep Apnea in children—nasal polyps or anything else blocking the airway can solve the problem. You may also be a candidate for an uvulopalatopharyngoplasty (UPPP) to remove the excess tissue from the back of the throat.

No matter what you and your doctor decide, the path to a better night’s sleep begins with testing. And testing begins at home.

Editor’s Note: The Comprehensive Sleep Disorders Center at Trinitas was the first hotel-based sleep center in New Jersey. For more information call Dr. Garg at (908) 994-8694.

Crazy 8

In a day and age when social media and family drama pulls us in so many directions, and the line between work and home is increasingly blurred, the idea we grew up with—“everyone needs eight hours of sleep”—would almost seem quaint if it didn’t sound so crazy. And while some people can truly thrive on five or six hours a night, sleep experts maintain that the traditional range of seven to nine hours a night is still a solid number. Seniors can get away with slightly less, while children actually need more for proper growth and development. So when your teenager is heading into his or her tenth hour of unconsciousness, don’t take it personally. It’s just nature doing its job.

If you sense that you’re not getting enough sleep, trust your instincts and talk to a doctor. Research shows that six hours or less can increase anxiety, affect your decision-making and create a general fog that is unpleasant and potentially dangerous. Sleep apnea is not a slam-dunk diagnosis. It may be that you play a lot of sports or have a labor-intensive job, or that you’re hitting the caffeine a little too hard. There may be a coexisting health issue.

An insider’s guide to taking your temperature.

The most-measured quantity on earth is time. That makes sense. However, did you know that the second most-measured quantity is temperature? Think of all the devices that monitor hot and cold in your life, from the ones that regulate your heating and cooling system and your car, to the ones in your kitchen appliances and your computer. And, of course, there is one of the most important pieces of medical equipment in your home—the clinical thermometer—which measures body temperature and is the subject of this story.

Interestingly, what all of the aforementioned measuring devices have in common is that they share a single ancestor, one that looked a lot like the old glass-and-mercury thermometer, which, not for nothing, should no longer be in your medicine cabinet (but probably still is). More on this in “Getting Rid of Mercury” on page 43.

Taking your temperature (or someone else’s) doesn’t involve much in the way of experience or artistry. However, there are a few hard and fast rules that are easy to forget if you’re not feeling well. For example, if you’re taking your temperature orally, wait a good 15 to 30 minutes after eating or drinking to get an accurate reading. If you’ve taken a medication designed to lower a fever, like Tylenol, wait six hours before using a thermometer to ensure your numbers are correct. And if you take your temp under the armpit, remember it must touch skin and not clothing (a surprisingly common mistake).

“Normal” temperatures for an adult range between 97 and 99 degrees. The range is slightly broader for children—95.9 to 99.5—while the normal range for infants is a tick higher at 97.9 to 100.4. According to Cheryl Meyer, RN, CEN, Assistant Director of the Trinitas Emergency Department, an infant with a temperature above 100.4 should be seen right away by a medical professional. The same goes for children with a fever above 102 and an adult with a temperature north of 103. A low-grade fever lasting more than a few days is also worth a call to your physician.

What does a fever mean? It means your body is fighting an illness (such as a virus) or infection of some kind. Fevers are often accompanied by other symptoms—typically chills, headaches and body aches, but also more severe symptoms, including vomiting, diarrhea and convulsions. COVID-19 symptoms, as we all know by now, are often characterized by a dry cough, exhaustion and breathing difficulty. There are ways to check for a fever without a thermometer, but they are unlikely to be accurate, especially if you are feeling your own forehead.

What does a high temperature reading tell you?

“It is usually indicative of infection and/or sepsis,” says Meyer. “However, a high temperature also could reflect an exposure to heat—such as when a child is left in a car…or if someone is left exposed to the heat for a long time, due to a medical emergency or accident, and they can’t seek shelter. Whatever the cause, you need to seek immediate medical attention.”

What can an unusually low temperature tell you? Meyer says that it can be the result of exposure to the environment—“such as our homeless population or someone who maybe was confused and got lost in and was exposed to the cold.” Be aware that it also can be caused by sepsis and/or infection, she adds.

Thermometer Basics

Thermometers take a patient’s temperature in five different ways, and each has a name: Oral/Sub-Lingual (under the tongue), Axillary (under the armpit), Rectal (in the rectum), Tympanic (in the ear) and Temporal (on the forehead). There are two essential parts to any medical thermometer, the sensor and the means of converting the result into something readable. For glass or plastic thermometers, the sensor is that little bulb located on the business end of the thermometer. For infrared thermometers, a pyrometric sensor gathers the data. Once a reading is complete, you get a number—either as a digital readout, or using those hashmarks on an old-school thermometer.

Okay, let’s get this part out of the way. The most accurate temperature reading is the rectal one. It is still the method of choice for infants. And also animals. Most people find oral temperature-taking boring or unpleasant, but for adults and children capable of keeping the thermometer under the tongue, this is the method of choice. If a person is unconscious or coughing heavily, sub-lingual may not be the answer, even with fast-reading digital models. In these cases, medical professionals choose between the ear and the armpit. An axillary reading can take five-plus minutes to be accurate and, even at that, many doctors mentally add a degree.

Getting Rid of Mercury

Do you have an old-school mercury and glass thermometer in your medicine cabinet? If so, be aware that it contains half a gram of elemental mercury. That’s not enough to kill you (or even seriously harm you) if you somehow swallowed it (the vapors from the mercury are actually far more harmful), but all the mercury adds up when people start throwing their old thermometers away by the tens of millions. To properly dispose of a mercury thermometer, place it inside a plastic container or glass jar, fill the container with something oil-absorbent (like cat litter or sand) and mark it “Contains Mercury” with a Sharpie. Your town or county will have a hazardous chemical drop-off site where you can dispose of it properly.

Temporal thermometers are simple to use and very accurate between 97 and 100. Which, if you’re curious, is how that random dude at the front of Trader Joe’s became, literally, a front-line worker last year. A similar device is now being used on wrists instead of foreheads. Recent studies have shown that it is 95% accurate in terms of fever-screening ability—the same or better than forehead readings. Wrist scanners work because the artery is very close to the surface of the skin.

The Road to 98.6

Most of us have been ingrained with the knowledge that the ideal human body temperature is 98.6 degrees. Did you ever wonder who decided this, and how? It was a German physician and psychiatrist named Carl Wunderlich in the 1860s. He averaged out over a million (mostly armpit) readings and determined that the temperature of healthy people fell between 97.3 and 99.5, with an average within that range of 98.6.

Medical professionals are quick to point out that your temperature is usually lower in the morning than in the afternoon, often by a degree or more, so there is no reason to be wed to 98.6, other than it has been drilled into our heads since childhood. Many believe the more accurate average number is between 97.5 and 97.9. Why the drop? In the century-plus since Wunderlich’s time, humans have gotten fatter and have lower metabolic rates. The less heat your body has to make to keep all its parts going, the lower your temperature will be.

While we’re on the topic of history, it’s worth noting that the basic principles behind the thermometer were known in ancient Greece more than 2,500 years ago. However, the first device you’d think of as approaching a “modern” thermometer was pioneered by Santorio Santorio (right) at the University of Padua in the early 1600s. Galileo, who was on a first-name basis with the professor, is believed to have had some input—as did other scientists who were exchanging ideas in Venice at the time. Temperature-taking was all the rage in 17th century Europe, it seems. Santorio’s invention used the expansion of water, not mercury, to show changes in temperature and was called a thermoscope. It became a thermometer after a standardized scale was added. The first scale measured only eight different “degrees.”

Over the next century, scientists tinkered with non-water liquids, including brandy. In 1701, Isaac Newton proposed that thermometers be standardized to measure the difference between the melting point of ice and the temperature of the human body, with 12 degrees separating the two measurements. In 1714, a Dutch inventor found mercury to be the most reliable and sensitive thermometer-filler. His name was Daniel Fahrenheit and he made a nice living manufacturing mercury thermometers. In 1742, a Swedish physicist proposed a new temperature scale, which used 100 to express the freezing point of water and 0 for the boiling point of water. His name was Anders Celsius (right), and his colleagues loved the idea…with one small tweak: They flipped the script, making 0 the cold end and 100 the hot end. Outside of the academic community, almost no one in America has the faintest idea how Celsius works, so don’t feel bad.

The first doctor who stuck a thermometer into a person as part of his patient practice was Herman Boerhaave (left), a Dutch chemist and physician who founded the first European teaching hospital at the University of Leiden in the early 1700s. His patients were none too thrilled about the idea—it took up to a half-hour to obtain an accurate reading, so no matter the input, the process was tedious and unpleasant. And if you think that’s a long time, consider that it took 150 more years to cut the temperature-taking times down to five minutes.

That breakthrough came after years of tinkering by a British scientist named (I swear I am not making this up) Thomas Allbutt (right). Just as thrilling was the fact that his clinical thermometer was only six inches long—half the (yikes) standard length during the early 1800s. Later in life, Allbutt was rewarded for his ingenuity by being appointed a Commissioner of Lunacy for England and Wales. Oh, and by the way, if you think wearing a mask and getting your forehead scanned is annoying, imagine waiting in line to get into Whole Foods only to encounter a 12-inch thermometer at the front door!

New Temp Tech

Thankfully, about 20 years ago, the temporal artery thermometer was unveiled by Exergen. A two-second forehead scan is all that’s needed to obtain an accurate temperature now. Dr. Frank Pompeii, who has a wall full of degrees from Harvard and MIT, developed this technology in the 1990s. Before forehead-scanning devices became affordable, you may recall that electronic ear thermometers—which measure blood temp with an infrared probe—were very popular. They came on the market in the late-1960s, courtesy of a German doctor named Theodor Benzinger, who emigrated to the U.S. after World War II and went to work for the Navy. He was actually experimenting with ways to measure brain temperature without the use of electrodes. Benzinger determined that the blood vessels coursing through the ear drum are shared with the hypothalamus, the part of the brain that regulates body temperature. The drawback to ear thermometers is that they can fail to detect a fever if a patient has significant wax build-up, or the probe records the temperature of the external ear canal and not the part containing the ear drum’s blood vessels.

In conclusion, and to underscore an earlier point, the newer, safer methods for temperature-taking have made the mercury-and-glass thermometer entirely obsolete. Starting around 20 years ago, states began banning their sale and the National Institute of Standards and Technology stopped calibrating mercury thermometers a decade ago.

Although mercury is arguably the most beautiful and captivating of the elements, it also happens to be a neurotoxin that is almost impossible to clean up once it escapes its container. It’s bad stuff, so please say goodbye to your mercury thermometer if you haven’t already. 

Editor’s Note: From the “Don’t Try This at Home” Department, the highest recorded human temperature was 115.7 degrees. Willie Jones of Atlanta set the record during a summer heat wave in 1980 and suffered no apparent ill effects. “Based on studies,” his doctor told reporters at a press conference, “Mr. Jones should not be sitting here next to me. He was as close to death as anyone gets.”

Seeing Red

Mercury isn’t the only substance used in thermometers. Think of all the souvenir and advertising thermometers you’ve seen in your life. Some people actually collect them. The red stuff they contain is dyed alcohol or ethanol. It’s not as accurate as mercury and is not dangerous if the thermometer breaks. The substance is accurate up to 172 degrees, so it’s really only good for measuring air and body temperature.

News, views and insights on maintaining a healthy edge.

Coughing Up More for Cigarettes

Getting adults to quit smoking sometimes seems like an uphill battle. But keeping kids from starting is a little easier. Study after study—many dozens, in fact—agree that the more cigarettes cost, the less likely young people are to start smoking. That is one of the main reasons the Centers for Disease Control is backing President Obama’s recent proposal to raise the federal tobacco tax by almost 100%.  CDC Director Tom Frieden estimates that this alone would result in 230,000 fewer people taking up the habit as teens. An additional benefit would be a reduction in heavy smokers. A 2012 study by Tobacco Control magazine found that people who smoke two packs a day were very likely to cut back with a steep rise in prices.

60 is the New…75?

We may be living longer than our ancestors, but are we healthier? A new study in the Netherlands suggests we are not. Researchers looked at the prevalence of risk factors for stroke, heart disease and diabetes—including obesity and high blood pressure—and found that today’s adults are “15 years older” than their parents and grandparents at the same stage of life. The reason we live longer is probably because fewer of us smoke, and treatments for common diseases are better. The study, published in the European Journal of Preventive Cardiology, followed 15,000 adults between 20 and 59 for a period of 16 years.

Breaking Up is Hard to Do

Who takes it harder when a relationship goes south? A study by Wake Forest University claims that young men do. Despite being portrayed as aloof and insensitive in romantic relationships, they appear to be more emotionally involved than their female counterparts. Researchers found that young women derived a greater benefit from being part of a couple. However, their male counterparts were more likely than women to be harmed emotionally when a relationship hit the rocks. “This finding makes a lot of sense and is extremely logical,” says Dr. Rodger Goddard, Director of Wellness Management Services at Trinitas. “Women are socialized to share and express their emotions and stress with others. When men get together, however, young and old, they tend to talk about sports, politics and other things that are external to them. They often save their emotions and intimacy for their love relationships. It therefore makes sense that, when they lose the person they love, they are more devastated emotionally than women are…because now they are without an outlet for their emotional side.”

The One Percent Solution

Every week it seems we hear about another initiative to get teens to eat healthier. And yet our eyes tell us that teens are eating more junk than ever. Well, our eyes don’t lie. The University of Oklahoma’s School of Public Health just released data from a five-year study that shows 4 in 5 teens are eating their way toward heart disease. Even worse, only 1 in 100 teens is eating an “ideal” diet from a heart-health perspective. The American Heart Association, which published the report, characterized the numbers as unacceptably high and called for broad social and cultural changes as the only way to avoid a national catastrophe by the time today’s teens reach middle age. “The apple doesn’t fall far from the tree,” observes

Kevin Lukenda, DO Chairman, Family Medicine

Kevin Lukenda, DO, Chairman of the Family Medicine Department at Trinitas. “Parents need to show their teens and ’tweens how to eat healthy, by example. Also, fewer video games and more outside activity will keep the heart healthy.”

Bipolar Breakthrough

In the last issue of EDGE, Chris Gibbs wrote about the advances in medicine triggered by the Human Genome Project. One of the newest advances may benefit people suffering from bipolar disorder. Researchers at University in College in London found that a small percentage of these patients had a mutation in a brain receptor gene that put them at greater risk for bipolar disorder. The findings, published in JAMA Psychology, suggest that these individuals can be effectively treated with existing drugs that are not currently used for bipolar disorder. Indeed, two drugs trialed for anxiety disorder and schizophrenia should be effective on 1.7% of bipolar patients. It’s not a huge number, of course, but to that 1.7% it could mean the world. While genetic research holds tremendous promise,

Anwar Y. Ghali, MD Chairman, Psychiatry

Dr. Anwar Y. Ghali, Chairman of Psychiatry at Trinitas, cautions that the medications approved by the FDA—including mood stabilizers and second-generation anti-psychotics—are still the most effective means of treating bipolar disorder. “In addition,” he says, “psychotherapy is indicated for better adjustment and coping with the disease, as well helping to reduce future relapses.”

News, views and insights on maintaining a healthy edge.

California Cool

Revenge is a dish best served cold. But if scientists at the University of Southern California are right, soon the target of that revenge might not feel it. That’s because neurobiology professor David McKemy and his team have isolated the sensory network of neurons in the skin that relays the sensation of cold to the brain. The USC researchers reported in the February Journal of Neuroscience that they have managed to control TRPM8 (pronounced tripemate)—the sensor of cold temperatures, and also menthol—to “turn off” cold receptors in the skin, without turning off the heat receptors. Their discovery has promising implications in the treatment of pain. “One of our goals,” says Dr. McKemy, “is to pave the way for medications that address the pain directly, in a way that does not leave patients completely numb.”

Drop-Dead Good, Y’all

Earlier this year, at the American Stroke Association’s international conference, research was presented confirming what everyone knows but we’re all too willing to ignore: A diet of Southern-style foods is directly linked to a higher risk of stroke. That diet—characterized by researchers as including fried chicken, fried fish, fried potatoes, bacon, ham, liver, gizzards and sugary drinks—explains why, statistically speaking, Southerners are 20 percent more likely to suffer a stroke than the rest of Americans. “We’ve got three major factors working together in the Southern-style diet to raise risks of cardiovascular disease,” explains lead researcher Dr. Suzanne Judd, a nutritional epidemiologist at the University of Alabama-Birmingham. “Fatty foods are high in cholesterol, sugary drinks are linked to diabetes and salty foods lead to high blood pressure.” This was the first large-scale study on the relationship between down-home cooking and stroke events.

Link Between Folic Acid and Autism

Obstetricians have been recommending folic acid for their patients for decades. Results of a Norwegian study published in the Journal of The American Medical Association provides expecting moms with one more good reason to listen to their baby doctors. Women who took folic acid supplements from four weeks before conception to eight weeks after had a 40 percent lower chance of having an autistic child. Researchers looked for correlations between other supplements and diets—and also explored the affect of folic acid on Asberger Syndrome—but did not find anything of statistical significance. Interestingly, pregnant women who took folic acid beyond the eighth week of pregnancy showed no marked improvement over those who took it for only the first eight weeks. “This vitamin is also known to decrease the risk of neural tube defects to the developing baby,” adds Dr. Orli Langermost, Director of Obstetrics and Perinatal Services at Trinitas. “The Norwegian study reports a lower risk of autism amongst mothers who took folic acid supplements before and during early pregnancy. Although more research is needed to investigate whether this association is causal, it is another great reason for obstetricians to promote prenatal folic acid supplementation to their pregnant patients.” The article was careful to point out that this study does not prove that folic acid supplements can prevent childhood autism. However, the findings are so apparent that they constitute a good argument for further exploration.

The Slim Jim Diet

No, you can’t lose weight eating Slim Jims. But the nitrite-packed meatsticks (that is meat, right?) aren’t as bad for you as you think. You might be surprised to know that fruits, vegetables and your own saliva also contain nitrites. So what gives? The idea that nitrites cause cancer stems from two reports (one in Nature and another in Science) issued in the 1970s, which created a media sensation and triggered a cascade of food-additive legislation. In 2012, Dr. Andrew Milkowski of the Food Research Institute at the University of Wisconsin-Madison, authored a study that attempted to put the threat of nitrites into better context. The Science article, he says, “was later found to be flawed—but that was not nearly as well-publicized.” Dr. Milkowski also points out that the human body makes 70 to 100 milligrams of nitrite per day. By contrast, a cooked hotdog, a side order of bacon or a Slim Jim has only a few milligrams of nitrite left in it (if that). In other words, you’d have to eat 30 or 40 Slim Jims to take in the same amount of nitrites you get swallowing your own spit every day. Bon appétit!

Oils Well that Ends Well?

Not all polyunsaturated vegetable oils are created equal. According to the results of the Sydney Diet Heart Study, which monitored 458 Australian men—aged 30 to 59—with a history of cardiovascular problems, oils containing Omega-6 fatty acid did not live up to their long-touted health benefits. On the contrary, the study found that participants who consumed vegetable oils rich in Omega-6 (in the form of safflower oil and safflower oil polyunsaturated margarine), actually had an elevated risk of death from all causes—including death due to coronary heart disease and cardiovascular disease. Some scientists are now saying that the American Heart Association’s recommendation that people get more Omega-6 fatty acid may need to be revisited. “People just ran with s the ball that polyunsaturates are good for you, so therefore each individual one must be good for you,” says Richard Bazinet, a nutrition professor at the University of Toronto. “That turns out not to be true.” Omega-6 oils include safflower and corn oil. Omega-3 oils, which lived up to their billing as “heart-healthy” in the Australian study, include canola oil, and oil from flaxseed, walnuts and fish such as salmon and trout. Soybean oil contains both Omega-3 and Omega-6. Michelle Ali, RD, Director of Food & Nutrition Services at Trinitas, points out that while this study finds that polyunsaturated fatty acid (PUFA) or specifically, safflower oil, was not as beneficial—and may be detrimental to those with heart disease—she doesn’t believe that the message presented by the American Heart Association (AHA) is completely wrong. “Since October 2000, the AHA has placed more emphasis on foods rather than on percentage of food components, such as fat, cholesterol, etc.,” she explains. “However, as the science evolves we will find that changes will have to be made and the public educated.”

Hidden from the Nazis as a boy, TRMC’s Neurology Chief honors the women who helped him survive

By Erik Slagle

When a neurology patient recovers from injury or trauma, there’s a bit of mystery to how the brain responds—even a bit of a miracle. Dr. Bernard Schanzer has been working those miracles for more than 40 years, first as a neurology resident at St. Elizabeth’s Hospital, and later as chair of the Trinitas Neurology Department, the position he holds today. His personal story, though, might be the most miraculous one of all.

Bernard and his twin brother, Henry, grew up in Belgium during the 1930s, unaware of the horrors that awaited Jewish families. In the spring of 1940, as the German Army rolled through their country, they fled with their parents and sister, Anna, to neighboring France. The children eventually found sanctuary with the Bonhomme family on a farm in Saint-Etienne, near Lyon.

Dr. Bernard Schanzer (l) of Trinitas and his brother Henry pose for a family picture with Camille Panchaut, great-great-granddaughter and great-grandniece of the women who sheltered the Schanzer brothers from Nazis in France during World War II.

Dr. Schanzer recounts his story without a drop of melodrama. However, one can hear the exuberance pouring out in every word when he talks about the Bonhomme women. “Adolphine Dorel and her daughter, Jeanne Bonhomme, were unbelievable individuals,” he says. “For someone in France, at that time, to have this grandeur of spirit was incredible. And in many ways, Adolphine Dorel was my grandmother. My Meme.”

Hidden from the occupying Nazis, the boys fashioned yarmulkes out of cloth and recited the only Jewish prayer they knew. One night, Adolphine overheard them and asked what the prayer meant. She asked to learn it, and prayed with them to help them feel safe. The Bonhomme family was sheltering the Schanzer children—the boys with Adolphine, Anna with Jeanne—at great risk to themselves, and yet they never felt unwelcome.

“If they had been caught, they could have been deported for what they were doing, yet we never felt anything but safe and secure when we were with them,” recalls Dr. Schanzer. He talks about them through a contagious smile—testament to the light, the courage and the love that surrounded him and his siblings during that horrific epoch.

Bernard and Henry survived the war, made their way to the United States, started families of their own and became the proud grandfathers of 39 grandchildren between them. Last year, members of the Schanzer clan had the opportunity to meet Camille Ponchaut, the teenage great-great-granddaughter of Adolphine Dorel (and great-grandniece of Jeanne Bonhomme), when she came to America for a three-month study abroad program. During her stay, a delegation led by Senator Raymond Lesniak held a ceremony at the Statehouse in Trenton honoring Adolphine and Jeanne in a Resolution for their bravery.

“I knew about the role my family had played in their lives,” says Camille, “but I had never heard a detailed story before I met them. I was indeed very proud to discover more about my ancestors—how they were able to hide children during the Holocaust.”

For Senator Lesniak, the presentation of the resolution to the Schanzers and to Camille was part of a very personal storyline: Dr. Schanzer had treated the Senator following his stroke last summer. “Dr. Schanzer’s approach is very understated, and as a patient, that really builds your confidence,” Lesniak says; then he laughs. “This is how understated he is—it was during a follow-up exam that Dr. Schanzer asked me if I would do him a favor and arrange a tour of the statehouse for Camille. I said, ‘You want me to do you a favor?’ I was absolutely honored. He is a giant in the field of neurology in New Jersey.”

Dr. Schanzer says his greatest professional joys are still teaching and working with his residents. He’s seen the medical center—and the city of Elizabeth—undergo far-reaching changes since he joined the staff in 1970. “I was in residency at Albert Einstein College of Medicine,” he recalls. “A friend there referred me to what was then Elizabeth General Hospital. At that time, there were no fully trained neurologists in the area.”

These days, he oversees a department full of them.

In a profession where positive outcomes are everything, one wonders how the course of countless lives and careers might have been altered had Dr. Schanzer’s path not crossed that of Camille Ponchaut’s ancestors. “When all the lights were out in Europe,” he says, “Jeanne and Adolphine were stars. They are true examples of how we should behave and respect other people. How many people today can say they would have the courage to do what they did?”