How has the Human Genome Project changed the way we look at life?

By Christine Gibbs

The human body consists of more than 100 million million cells. Each contains a complete set of blueprints that determines who and what we are. Reading those blueprints was the goal of the Human Genome Project. By analyzing the sequence of the cellular gene pairs that make up that incredible macromolecule—our DNA—scientists hoped to unlock secrets that would lead to the prediction and prevention of future health issues, as well as designing treatments for all manner of diseases. The first significant results of the Human Genome Project were released to the public in 2003. Since then, an international army of biotech researchers has been using this information to explore the genetic differences that increase the risk for certain common diseases, such as diabetes and cancer, in order to develop effective cures and treatments.

When the Human Genome Project began, it laid out a set of ground rules for its participants:

• Identify all the genes in human DNA
• Sequence the chemical base pairs that make up human DNA
• Store this information in databases
• Improve the tools used to analyze this data
• Address the ethical, legal and social issues that are likely to arise and
• Transfer technologies to the private sector

Wait. What? That last item caught a lot of people off guard. Why would government-funded research centers in the US, UK, Japan, France, Germany and Spain simply hand over their breakthroughs to pharmaceutical companies and biotech firms? The directive to share technology with the private sector was originally intended to encourage friendly cooperation for the good of humankind. Needless to say, it actually generated some not-so-friendly competition—and, at times, near open warfare. Ironically, it was this rivalry that spurred some of the most productive research, and resulted in impressive scientific advances.

THE GREAT RACE

A case in point is J. Craig Venter, recognized as one of the most successful entrepreneurs in the genomics arena (he was included in 2008 on Time magazine’s list of the 100 most influential people in the world). Venter launched his career in bioscience with the Human Genome Project as a colleague of Dr. Francis Collins, who headed the National Human Genome Research Institute, which was formed under the National Institutes of Health. In his autobiography, A Life Decoded, Venter said he became frustrated with the slow pace of progress with the project, prompting him to fund his own company. To do so, he turned to Wallace Steinberg, a lifelong New Jersey resident and entrepreneurial visionary in the private sector. Steinberg was famously quoted in a 1992 New York Times article as saying, “I have this theory that death is a genetic disease.”

Photo credit: iStockphoto/Thinkstock

Together, Venter and Steinberg formed a non-profit research center, The Institute for Genomic Research (affectionately called TIGRE). The collaboration was nothing short of remarkable.

Venter’s corporate goal was to sequence the human genome and release it into the public domain faster and cheaper than the Human Genome Project itself. The pressure TIGRE put on the public program led to a redoubling of its efforts. In 2001, the Human Genome Project managed to publish its initial findings for the scientific community one day before Venter’s publication—three years before the project’s original target date. Yet the greater victory may belong to Venter. His “shotgun” approach to sequencing has become the de facto standard still used today. In truth, we are all the winners in this great race. Since then, the scientific advances from both the project and the private sector in deciphering the human genetic code have led to a wide range of improvements.

Topping the list of advances that have come from genetic research are those made in personalizing medical diagnosis, prognosis and treatment. Human genome mapping will soon become more available and popular as the cost (currently about $8,000) is reduced to a more affordable $1,000. That’s less than an MRI, which is mind-boggling when you consider that it cost the Human Genome Project about $400 million to sequence the first genome of a cancer cell. Already we are learning why certain cancer treatments are more effective than others—and that some patients may not be getting the best treatment at all.

Indeed, on a recent CBS This Morning segment, Dr. Sanjay Gupta reported that as much as one-third of current cancer patients are getting the “wrong” treatment for their particular type of cancer. Dr. Gupta explained that genomic mapping research should help reduce this percentage by pinpointing the best possible treatment regimens according to personal genetic markers.

A deeper understanding of the inner workings of DNA has led to breakthroughs that extend far beyond our own bodies. For instance, analyzing the genome structure of non-human species has resulted in raising hardier, healthier, and safer crops and animals. Through that pesky government requirement to share genome technology with the private sector there have been major improvements in the “greening” of many industries, resulting in cleaner and more efficient processing of chemicals, textiles, food products, fuels, and more. In the area of environmental biotechnology, genome technology has led to producing biodegradable products, finding new energy resources, and initiating hazardous site cleanup. And recently we learned that five major mental illnesses share a common genetic root—the result of the largest-ever genetic study of psychiatric disorders.

TOO MUCH INFORMATION

If you’re like most Americans, the greatest impact the Human Genome Project has had on your daily life is the TV crime show. You can’t turn the channel without finding an episode that hinges on the breathlessly awaited results

from the “DNA lab.” A whole new vocabulary has crept into our daily lives, as well as a whole new set of expectations. We are all experts, it would seem, in solving cases with technology developed during the Human Genome Project. In fact, cagey lawyers have made this awareness a part of criminal defense cases, elevating the burden of proof to the molecular level. “Where’s the DNA evidence?” they ask…and juries nod in agreement. Like most things on TV, it really doesn’t work that way. Most crime scenes produce no usable or relevant DNA.

That being said, criminology has benefited. Suspects in certain crimes can be ruled out, leaving police more time to focus on their investigations. And the guilty can be brought to justice where traditional evidence might prove inconclusive. Perhaps most important, the wrongfully imprisoned have been exonerated in significant numbers thanks to analysis of DNA evidence. In addition, anthropology has benefited. Paternity claims have been resolved through simple DNA smears. DNA can be used to match organ donors. And even national security has been impacted by improvements in detecting and resisting harmful biological warfare agents.

At what point, however, do we cross the line into the realm of too much information? How much about ourselves do we really want to know? The classic question is: “If your genome mapping raises the possibility of a serious disease lurking somewhere in your future—especially one for which there is currently no known treatment or cure, such as Alzheimer’s—would you want to know?” Regardless of the answer, the next question is: “Who else might find out?”

This raises the serious issue of privacy. The possible consequences are real. Insurance premiums might rise after the insurer is notified of a predisposition to a life-threatening illness. An employer might be less motivated to hire someone with a less than perfect genome profile. Colleges may reject students on the same basis. Once your genetic information has been published, the genie is out of the bottle, so to speak. The possibility exists that you could become a victim of genetic discrimination through unauthorized access to personal health records.

The primary weapon against such violations of privacy is HIPAA, the Health Insurance Portability and Accountability Act of 1996, which spells out your rights regarding personal health information, and limiting who may access and use that information. Yet medical identity theft can and does occur. According to a report released from the Ponemon Institute, a privacy and security research firm, it is a $30 billion a year crime in the United States.

While other American industries have been constricted by the recent recession, the genomics business has been fairly booming. Building off the Human Genome Project, researchers are breaking new ground every day. Even with recent budget cutbacks, as a nascent industry, genomics is building an impressive track record. Ernst & Young in 2011 reported that there were 1,870 public and private biotech companies in the U.S. alone, with annual revenues totaling $58.8 billion. A striking success story is Human Genome Sciences (HGS) which, with the backing of Goldman Sachs in 2009, raised more than $800 million through stock offerings. Competition is fierce. R&D is expensive. But potential profit can be irresistible.

Despite serious concerns such as medical identity theft and genetic engineering, the value added by the Human Genome Project to the quality of our lives is undeniable. Among its proponents is none other than Dr. Mehmet Oz, who encourages everyone to become familiar with their own genetic architecture. As he noted in a recent issue of O Magazine, “Our one-size-fits-all approach to medicine will soon be a thing of the past.” Of course, Dr. Oz tempers his enthusiasm with a not-unexpected caveat: Always work closely with your doctor.

Genomics 101

Let’s flex our left brain with some basic scientific vocabulary. Besides being a mouthful, the term Deoxyribonucleic Acid (or the more familiar short form DNA) is the chemical name for a macromolecule that encodes essential genetic instructions. These instructions determine the development of not only every single known organism, but many hazardous viruses, too.

Moving up the vocabulary ladder, a gene is the basic unit of inheritance passed on to us from each parent. Genes determine diverse personal traits, ranging from how we look to how we metabolize, how we fight infection and even how we behave. Individual genes (approximately 20,000 of them) reside on “packages” of DNA called chromosomes within a cell’s nucleus. Humans have 23 pairs of chromosomes, contributed by both parents, one of which determines sex—the X and Y chromosome.

The operative word in the Human Genome Project—a genome—is an aggregate of all of the aforementioned genetic information. The human genome is made up of the macromolecule DNA, which is the main component of our genes and chromosomes. The genome is simply “everything.”

Surf’s Up! What’s your Beach IQ?

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

How much sun is too much sun?

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

How often is often?

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

What other precautions should I take?

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

How about kids?

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

How dangerous is the water along the Atlantic Coast?

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

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

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

In a potential drowning emergency, what do I do?

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

Wait, I have to learn CPR?

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

Isn’t that the lifeguard’s job?

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

What are some common water safety mistakes boaters make?

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

RED MENACE

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

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

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

Did You Know?

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

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

Westfield native leaves California in quest of advanced surgery at Trinitas.

When Sena O’Connor-McLellan embarks on her regular daily run along the trails of the Diablo Mountains of California’s Bay Area, she is doing something her West Coast doctors said would never happen: regaining the physically active lifestyle she enjoyed before uterine prolapse began slowing her down. A native of Westfield and an avid runner, O’Connor-McLellan initially consulted with her California physicians, who recommended a radical solution.

“They said I’d have to have my cervix removed and give up running,” she recalls. “That didn’t feel right to me. That’s when I called Dr. Riachi.”

Dr. Labib Riachi, Chairman, OB/GYN, and Director of Robotics at Trinitas Regional Medical Center, had treated O’Connor-McLellan for a separate condition in 2009, using a robotics-assisted procedure that she says resulted in a smoother-than-anticipated recuperation. The surgical scars were practically unnoticeable, and the discomfort was minimal. After a phone call to Dr. Riachi, she boarded a plane back to New Jersey, consulted with him at his office, and was scheduled for surgery the next day. Once again, the robotics-assisted procedure delivered results.

“Four small incisions—that’s all it took,” says O’Connor-McLellan, a mother of four sons ages 15 to 20. “So unobtrusive, so simple. It wasn’t painful to roll over and I could pull myself up to get out of bed. Within a week, I was on a plane back to California. By two weeks, I was completely back to being myself.”

The procedure, which is performed using the daVinci Surgical System, is called a robotic cervicosacropexy. It involves the insertion of an abdominal mesh to relieve the prolapse and in most cases is a permanent solution with few if any lingering effects. After six weeks, as Dr. Riachi promised, O’Connor-McLellan was able to restart her trail work with a slow jog. “It is very rewarding to see people such as Sena benefit from this minimally invasive technology,” he says. “The daVinci system enables us to perform delicate surgeries in a faster and more secure way. It allows us to be more aggressive in how we treat, while giving us almost unlimited access within the surgical field.”

Labib Riachi, MD
Chairman, OB/GYN, and Director of Robotics
at Trinitas Regional Medical Center
908.282.2000

The daVinci system allows a surgeon working at a console to manipulate four robotic “arms” that maneuver a camera and carry out cutting, holding and coagulating all through a single or multi-port precise abdominal incision. Dr. Riachi has used the system to perform corrective surgeries for conditions such as prolapse, bleeding, fibroids, uterine cancer, and endometriosis. He now trains other surgeons to do the same. In all, he has carried out more than 800 robotic procedures since 2009.

“I call him the rock star,” O’Connor-McLellan says. “I would still go back to New Jersey if I needed another procedure, and I recommend anyone else to make that trip as well. I wouldn’t trust anyone else; I wouldn’t put my health in anyone else’s hands. I feel that strongly about what he can do, and about robotics in surgery. People shouldn’t be afraid of it. The healing is incredible.”

NO COMPARISON

In 2007, Sena O’Connor-McLellan (below and on page 46) underwent a non-robotic laparoscopic procedure to treat Crohn’s Disease. “The recuperation was longer, more painful, and generally much worse,” she reports, adding that she hopes that her experience will lead other women to explore the benefits of robotics-assisted surgery. “Women put off things like [prolapse correction] because they think they can’t get it done and get back to life. You think the only option is surgery that will put you on your back for two weeks. But the robotics option gets you back on your way in a few days. The flu will put you down for longer!”

Editor’s Note: Sena O’Connor-McLellan is back to enjoying the lifestyle she loves, hitting the trails every day for a running routine which, less than a year ago, she was advised to give up. Every mile she covers is a testament to the difference Dr. Riachi and the daVinci system can make. Next up for O’Connor-McLellan is the Rock & Roll Half-Marathon for the Crohn’s and Colitis Foundation of America in November on the Las

New diagnostic devices are taking gastroenterologists on a fantastic voyage

Imagine possessing the ability to enter the body to conduct reconnaissance, diagnose and perhaps save a life without traditional invasive measures. In 1966, sci-fi authors imagined—and Hollywood created—that exciting scenario. In Fantastic Voyage, a CIA agent, a surgeon and three others are charged with removing a life-threatening blood clot from the brain of a comatose Soviet scientist, who barely survived an assassination attempt while defecting to the West.

You probably know the story. The CIA shrinks the crew and its submarine down to one micrometer and inserts the vessel into the scientist’s body. It’s a race against time, as the effects of miniaturizing begin wearing off after an hour.

Pretty exciting stuff back then—not to mention a field day for the special effects team.

Miniaturization took a more humorous turn in the 1987 film Innerspace, when an experimental craft piloted by a naval aviator is miniaturized and—through a series of unlikely events—injected into a hypochondriacal grocery clerk, played by Martin Short. For the record, both Fantastic Voyage and Innerspace won Oscars for Best Visual Effects.

Fast-forward a few decades. People, submarines and aircraft aren’t miniaturized, but medical devices complete with cameras and data retrieval capabilities are.

In 2006, MIT Technology Review reported on a then recently-FDA-approved diagnostic device the size of a vitamin pill, which could be ingested. Once inside the body, the device for diagnosis of gastroenterological conditions could gather information along its way through the digestive system. The sensor could then transmit information to an external receiver, about the size of a cell phone, worn by the patient. Once its data gathering was complete, the diagnostic device was excreted through normal bodily functions. The patient could then return to the gastroenterologist’s office with the external receiver for data analysis.

While being interviewed for this article, Dr. Neil Kheterpal described the intricacies of the PillCam SB 3 to writer Kathryn Salamone.

At that time, such a device gave gastroenterologists information on digestive disorders that could not be easily obtained through previous methods. Before the advent of this type of diagnostic sensor, taking a look at the twists and turns of the intestines was both invasive and unpleasant for the patient. In less than a decade, these devices have become a valuable tool for gastroenterologists in diagnosing digestive disorders. They make exploring the 25 feet of the small and large intestines almost as easy as using a GPS device.

Dr. Neil Kheterpal, gastroenterologist at Trinitas Regional Medical Center, has been using the PillCam line of medical diagnostic devices—developed and manufactured by Israel-based Given Imaging—since 2007. He is confident that the latest generation, the PillCam SB 3, will be of great benefit to the diagnostic procedures he performs on his patients at Trinitas.

“This technology has played a major role in our better understanding of the small intestines,” Dr. Kheterpal explains.  “The mobility of the device has made viewing the intestines much easier and has improved our diagnostic capabilities as a result.  I have found it to be an exceptionally valuable tool in my role as a diagnostician.”

Equipped with a sophisticated camera and sensors, the latest generation offers diagnosticians two new benefits, notes Dr. Kheterpal.  “I have used the two earlier generations of the PillCam in the past seven years.  They offered images of excellent quality.  But, this latest version exceeds that level with images of even higher resolution, a 30 percent improvement over the PillCam SB 2.”

Also, the device now has the capability of capturing images at varying rates of speed through an adaptive frame rate technology.  In other words, while traveling through the intestinal track, sensors will respond when the capsule is moving slowly or quickly. Slow movement will allow the camera to capture images at two frames per second, while faster movement will capture up to six images per second.

In his years of using the earlier generations of PillCam, Dr. Kheterpal has recognized the high standards of the device. He considers the PillCam “the pioneer” in diagnostic devices for gastroenterologists. “What started out as a promising concept and purpose has shown its worth in successive generations as these refinements demonstrate,” he observes.

Neil Kheterpal, DO Gastroenterologist, TRMC 908.282.0500

However, Dr. Kheterpal stresses that the PillCam SB 3 or any future generations of this device will not replace tradi-tional colonoscopies. “The PillCam SB 3 and its predecessors have given us a view of the intestinal track that we didn’t have before. It’s just one of the tools that we have in the arsenal of disease diagnosis that ultimately helps in diagnosis and in recommending potential disease treatment, helping to contribute to the best possible outcomes for patients. Treatment will continue to be the domain of other more invasive procedures. Diagnosis is the one thing that this device is designed for and it does it exceptionally well.”

WATCH WHAT YOU EAT

As in the case of many chronic conditions, diet can play an important role relieving the impact of various digestive disorders. According to the U.S. National Library of Medicine, these strategies can help ease symptoms…

• Eating small amounts of food throughout the day.
• Drinking lots of water (drink small amounts often throughout the day).
• Avoiding high-fiber foods (bran, beans, nuts, seeds, and popcorn).
• Avoiding fatty, greasy or fried foods and sauces (butter, margarine, and heavy cream).
• Limiting dairy products if you have problems digesting dairy fats.

Try low-lactose cheeses, such as Swiss and cheddar, and an enzyme product, such as Lactaid, to help break down lactose.

• Avoiding foods that you know cause gas, such as beans.

Also, ask your doctor about extra vitamins and minerals you may need, such as iron supplements (if you are anemic), calcium and vitamin D supplements to help keep your bones strong, and vitamin B12 to prevent anemia.

News, views and insights on maintaining a healthy edge.

Brown Bagging It

Is your child’s packed lunch getting the job done? A recent report by the Boston Nutrition Obesity Research Center and the National Institutes of Health suggests that it may not. Only 27 percent of lunches brought to school by the 3rd and 4th graders in the study satisfy minimum standards of one ounce of protein, a half-cup of fruit or vegetables, a half-cup of grains and a cup of milk. What’s interesting about these numbers is that the study focused primarily on upper-income families with college-educated parents. In this case, poor food choices are not a function of affluence or education. Among the suggestions nutrition experts offer are packing the lunch the night before, when there is less of a time crunch, and a dedicated section of your fridge for school lunch ingredients.

Is Obesity the New Normal?

With all the talk of stemming America’s childhood obesity epidemic, one crucial component has actually gone underreported: the failure of parents to recognize that their child has a weight problem. A 2014 study published in Pediatrics revealed that the percentage of parents who believe their child is “about the right weight” has risen considerably compared to the previous generation—despite irrefutable evidence to the contrary. Parents of girls in a n earlier study (1988 to 1994) said their kids were about the right weight, as opposed to 78 percent of current parents. The increase was not as dramatic for boys (78 percent to 83 percent). However, 37 percent of parents of obese boys said their weight was about right. These numbers worry researchers because children are less likely to lose weight if their parents don’t see a problem. One contributing factor may be that the percentage of obese adults is double the number of obese children.

Deep 6 BPA

Despite the fact the FDA has declared Biphenol A (BPA) to be safe, mounting concern about its long-term effects on the brains and behavior of young children has many parents opting to be safe rather than sorry. “Technology has given us many advances in the food and beverage industry,” says Dr. Kevin Lukenda of Trinitas Regional Medical Center. “Responsible parents need to stay on top of—and be aware of—the possible downside of these conveniences. We need to always remind ourselves that certain products may make our lives easier…but need to know which of these advances can be a risk to our health.”

BPA is an industrial chemical used to create rigid plastic products—including food and beverage containers, as well as some dental sealants and register receipts.  A number of studies are under way, but until their results are in, here are some basic precautions parents can take:

• Never microwave in plastic containers.
• Get rid of any container marked with a #7 or marked PC.
• Store food in glass, ceramic or steel containers instead of plastic.
• Cut down on processed food purchases at the grocery store—most come in plastic packaging.
• Bring your own bags to the store. California recently banned plastic ones. New Jersey should, too.

E-Lim-I-Nate the Negative

A recent study conducted at Carnegie Mellon University found that too many negative social interactions can trigger bouts of inflammation that overwhelm a person’s adaptive system and lead to hypertension in older adults. The study (which focused on subjects 50 and older) defined these interactions as involving excessive demands, criticism, disappointment, or other unpleasantness with partners, children, family members, and friends. The effects appear to be more serious among individuals between 51 and 64, and among women in general. One way to manage these situations—besides avoiding them, if possible—is to practice stress-management techniques, including paced breathing and meditation. “The research coming from Carnegie Mellon indicating that unpleasant or demanding interpersonal encounters increase hypertension risk among older adults should come as no surprise to any of us,” points out Rodger Goddard, PhD, Chief Psychologist and Director of Wellness Management Services at Trinitas. Dr. Goddard adds that controlling stress should be very high on one’s priority list. “We cannot become monks and live in a cave in the mountains, so we need to deal productively with what is in our lives,” he says. Stress management involves using both passive and active tools and skills.  Passive skills involve improving the capacity to calm our body and muscles down all throughout the day, and involve deep-breathing, stretching, muscle softening and self-calming thoughts all day long. Active skills involves using:

• Tough Thinking to fight against and banish our negative worries and emotions
• PIPS (Problem Identification Problem Solving) to dwell on the solutions to our difficulties and not on the problems
• Radical Self-Support to build social skills, avoid the negative interactions cited in the study, nurture ourselves, resolve conflict and get our need for love and support filled

Your Germs, My Germs

The next time you check into a hotel or motel and start thinking about all the icky-sticky bacteria you’re being exposed to, consider this: Within 24 hours of check-in, that room will be microbiologically identical to your home. According to the recently released Home Microbiome Study by the Argonne National Lab in Chicago, the bacteria you carry with you does a remarkable job wiping out whatever the previous occupant left behind. “Those who travel regularly, or even just occasionally, tend to be very suspicious of their environment when they check into a hotel, whether it’s in Des Moines or Dubai,” observes Michelle Gillis-Harry, RN, MPH, CIC, Director of Infection Prevention and Control at Trinitas. “By using a sanitizing spray or a disinfectant wipe that kills germs, you create a line of defense against germs that others leave behind. But, based on the findings of this study, as you close the hotel door behind you, you’re leaving your own unique microbial imprint. Simply put, we all leave our mark on the places we live, visit, work or play. It’s part of being human and living within the complex environment we call the Earth.” The true potential of the Chicago study (and others in the works) may be in forensics, since microbiological evidence left by humans may be more useful than fingerprints.

Trinitas Joins Elite Group of Palliative Care Programs

Earlier this year, Trinitas received the Joint Commission’s Advanced Certification status for its Palliative Care Program, becoming just the fifth medical center in New Jersey to attain this distinction. TRMC’s multidisciplinary team—which includes medical specialists, nurses, pain management specialists, chaplains, social workers respiratory/physical/speech therapists and nutritionists—was singled out for having demonstrated exceptional patient- and family-centered care, optimizing the quality of life for patients with serious illness. Gary S. Horan, President and Chief Executive Officer, praised the work of the team, noting that their commitment to achieving the Advanced Palliative Care Certification was “a tribute to their dedication to these patients and families who need this highly specialized compassionate care. ”According to Valerie Ramsberger, RN, MSN, ACHP—who initiated, developed and directed the Palliative Care Program—in recent years, palliative care has become a specialty that melds the unique skills of a broad spectrum of healthcare professionals dedicated to relieving pain and other symptoms in the most challenging of circumstances. Ramsberger (at center, above), who recently retired as Director of Palliative Care at Trinitas, began the qualifying process more than three years ago by participating in collaborative activities with the Greater New York Hospital Association (GNYHA), Institute for Healthcare Improvement (IHI), and the New Jersey Hospital Association. Geraldine “Magie” Cruz, RN, MSN, CCRN—an ICU staff

FLU SEASON

It’s that time of the year again. Winter is around the corner and flu season—which can stretch from October to May—is already well under way. As Benjamin Franklin once stated, “ An ounce of prevention is worth a pound of cure.” The key to avoiding the flu is prevention. The cornerstones of flu management are based on a three-pronged approach: getting vaccinated, washing hands well and often, and protecting others by staying at home if infected. Once you’ve contracted the influenza virus, the best cure is time. The virus will typically last from 7 to 10 days. It’s important to manage a fever with acetaminophen or ibuprofen and to keep well-hydrated. Antiviral therapy (for example, Tamiflu) started within two days of symptom onset has been reported to decrease the length of the flu by one or two days. However, there is much debate within the medical community as to whether or not antivirals play any role at all. Consult your healthcare provider to determine the appropriate plan of action in your scenario. But first things first…

Who should get vaccinated?

If you are reading this, the answer is almost certainly You. The exceptions would be babies under 6 months, people with allergies and active asthma—need to discuss their options with their physician to determine an appropriate plan of action (i.e., those with an egg allergy)—and those with weakened immune systems, who might be best served to receive the Inactivated Influenza Vaccine (IAV) as opposed to the Live Attenuated Influenza Vaccine (LAIV).

So there are more than one kind of flu shot available?

Yes. You will need to discuss the most appropriate option for yourself with your physician, taking your age and medical history into account. The most common options are:

1. Standard Dose Trivalent Shot (Contains Killed Viruses). This shot is approved for people ages 6 months and older.
2. High-Dose Trivalent Shot (Contains Killed Viruses). This shot is approved for people ages 65 and older. As we age, our immune system becomes less robust. The aging immune system can lack the necessary immune response to combat the flu. The high dose flu-shot contains three times the exposure (antigen) to the virus resulting in a more immunogenic response to the flu.
3. Trivalent Shot (Standard) contains 2 Influenza A strains and 1 Influenza B strain
4. Quadrivalent Shot contains 2 Influenza A strains and Influenza B strains
5. Nasal Spray Flu Vaccine (Contains Live Viruses). The CDC recommends this as an option for healthy children from ages 2 through 8 years old, as studies have shown that nasal sprays are more efficacious than the flu shot in children in this age group.

Do I need to get vaccinated every year?

Yes, you do. Researchers isolate the top three flu viruses that will be most prevalent each season and create one flu vaccine. Therefore, you need to get a new flu shot every year to make sure that you are protected. Ninety percent of deaths related to the flu occur in people 65 years of age or older, so it is especially important for this group to get annual vaccinations.

How does the flu actually spread?

The flu virus is contained in droplets. The flu is spread when an infected person with the flu sneezes, coughs or talks. As with most viruses, it spreads from our hands to our nasal and oral cavities.

What’s the best way to avoid getting the flu?

If you are sick, stay home from work, school or daycare. It is imperative to practice excellent hand-washing hygiene in order to prevent the spread of the flu. A helpful tip is to wash your hands with soap and water for approximately 15 seconds—the same time it takes to sing the Happy Birthday song. You can also use an alcohol-based hand rub.

What are the common symptoms that tell me I’ve got the flu?

Cough, runny nose, stuffy nose, sore throat, fever, fatigue, muscle aches, vomiting and diarrhea.

How do I know when to seek medical attention?

If you are at the extremes of age, pregnant or have multiple co-morbid conditions such as diabetes, COPD, asthma—or if you are immuno-compromised—get to the doctor the instant you suspect you have the flu.

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

EV-D68

Enterovirus-D68 was first detected in California in 1962. It occurs less frequently than other types of Enteroviruses (EV), which can be difficult to distinguish from any of the viruses that cause the common cold.

The viruses are called “Entero” because they enter the body through the stomach or intestinal tract. There are over 100 types of EV, which affect 10-15 million people each year in the U.S. The strain in question was identified as D68 in August by the CDC. More than 40 states have confirmed respiratory cases caused by EV-D68. In the state of NJ, there are a total of nine laboratory-confirmed cases as of October 3. The counties affected included are: Sussex, Essex. Passaic, Middlesex, Mercer, Morris, Camden and Burlington counties. EV-D68 was detected in specimens from four patients who have died and had samples submitted.

What are symptoms of EV-D68 infection and how is it spread?

Symptoms are nearly indistinguishable from the common cold—cough runny nose, sneezing, body aches and sometimes fever. Severe symptoms include difficulty breathing, wheezing and worsening of asthma. Enteroviruses can be found in secretions from the nose, mouth and through the entire gastrointestinal tract. The virus spreads from person to person via fecal oral contamination, coughing, sneezing or by touching your hands to your face after touching infected surfaces.

Are children at particular risk?

They are. Little ones get their hands in everything. Children are in close contact with one another. Whereas most adults have been exposed to the many types of Enterovirus—and over time, our immunity strengthens and we are able to combat the assailant—infants, children and adolescents lack the immunity necessary to fight the virus. Children with reactive airway disease are particularly susceptible to EV-D68. Parents of children with asthma should use particular vigilance. If their child becomes ill or has increase in his/her work of breathing they should consult their healthcare provider. Adults can contract the virus, of course, but are less likely to become very ill. Even so, EV-D68 can masquerade as the flu or any other “cold-like” illness. Medical professionals view EV-D68 as a possible cause of severe respiratory illness. If you, a member of your family or community experience a new onset of difficulty breathing or shortness of breath, please seek medical attention.

Can it be treated with antibiotics?

No. Antibiotics treat bacteria, not viruses. A patient will be treated by supportive care—namely medications for breathing, fever control and hydration. Practicing proper hand hygiene is paramount to protecting yourself and others. Wash with soap and water for 20 seconds, especially after changing diapers. Hand sanitizers are not effective against Enterovirus. Avoid contacting your eyes, nose, and mouth with unwashed hands. Cough or sneeze into a tissue or an elbow as opposed to an uncovered space. Keep your children or yourself at home if you are not feeling well. Disinfect high-traffic household items such as bathroom surfaces, countertops and toys with bleach-based household cleaners. EV is resistant to alcohol disinfectants. Look for products that list “Alkyl dimethyl benzyl ammonium chloride” as the active ingredient on the label. The product should state that it kills norovirus and rhinovirus.

Should my child stay home from school if I suspect EV?

Parents should never send a sick child to school. And they should not return to school until they are symptom-free and fever-free, meaning a temperature less than 100 degrees for 24 hours without fever-reducing medications.

Breast cancer ‘co-pilots’ help to steer the ship through treatment and recovery. 

Too often, cancer treatment is complex and the added stress of making one’s way through myriad mazes of treatment options, insurance forms, doctors’ appointments, and various medical procedures can sap a person’s energy that would be better spent on fighting the disease. Several years ago, Trinitas Comprehensive Cancer Center recognized that many women with breast cancer were in need of a “navigator service” that would help them cut through the red tape surrounding their treatment.  Breast cancer patients, Trinitas administrators surmised, would be able to best articulate their concerns and challenges to compassionate healthcare professionals, who could then direct them toward resources designed to help manage the disease. An innovative program was initiated, which showed promising results. Two years ago, the program was revamped to sharpen its focus, resulting in the Breast Cancer Patient Navigator program.

Veronica C. Vasquez, MHA, CN-BA, (left) heads the Breast Cancer Patient Navigator program at Trinitas and works to provide seamless care coordination while considering the unique needs of each patient. “The program helps facilitate patients’ access to doctors’ appointments, deal with insurance claims, and directs them to complimentary transportation and other supportive services,” she says. “Finally, a breast cancer patient navigator offers much-needed emotional support to patients at all phases of breast cancer treatment.”

One of the most frustrating parts of any medical treatment is getting answers to questions in a prompt manner. The Breast Cancer Patient Navigator program helps patients obtain answers to their queries regarding screening, diagnosis, treatment, insurance claims, follow-up visits, clinical trial participation, referrals, transportation, supportive services, and any other concern that may arise. It also assists patients in finding information on self-education resources, and with accessing community resources and cancer management services.

“We also direct patients to support groups that have been shown to help boost emotional well-being while providing coping mechanisms from others who have gone through cancer treatment,” adds Vasquez.

Breast Cancer Navigator, Veronica Vasquez, brings thoughtful caring and support to patients, as shown in the photo on page 44. From her office that overlooks the City of Elizabeth, she manages each patient’s case during their treatment at Trinitas.

Breast Cancer Navigator, Veronica Vasquez, brings thoughtful caring and support to patients, as shown in the photo on page 44. From her office that overlooks the City of Elizabeth, she manages each patient’s case during their treatment at Trinitas.

Dacia Gaillard, 43, who was diagnosed with breast cancer this past August, calls the Navigator program “a godsend.” Referred to the program by her physician, she gave it high marks and said it has enabled her to cope with a potentially overwhelming and stressful situation.  “I am amazed by the amount of compassion I receive,” she says. “I feel reassured that I am not just a name or a number.”

In addition to helping navigate her way through doctors’ visits and insurance queries, Gaillard explains that she can count on Vasquez to “hold her hand” throughout the often long, and arduous, process. Vasquez had her first personal encounter with breast cancer in 2011, when a beloved aunt was diagnosed with Stage III IBC (inflammatory breast cancer). “Not only was it a life altering moment for her but for the entire family, as she was the first member of the family to receive a cancer diagnosis,” she recalls. “She passed away in 2012, but her legacy lives within all those she encountered, forever.”

At the time, Vasquez—who earned her master’s degree in health care administration from Seton Hall—never dreamed that she would have the position that she holds today. “Having had a close family member diagnosed with breast cancer, I hold the work I do to help these women in high regard,” she says. “I dedicate the work I do in loving memory of my aunt, who I miss greatly.”

There’s no time to spare when responding to a stroke.

You’re having a normal day, going about everything as usual, not giving much thought to what might possibly create issues. You are convinced you have everything under control. You certainly don’t give any thought to the fact that you might become a statistic: Every 40 seconds, someone in the United States experiences a stroke; every 4 minutes, someone dies from one.

Let’s get back to your day. First, you start to feel your face drooping. Next, there is a weakness in your arm. You speak but your words don’t make sense. Don’t wait a moment longer. Time is critical. Call 911 for help.

Bernard Schanzer, MD, Chairman of the Division of Neurology, and Debbie Milkosky, RN, Coordinator of the Trinitas Primary Stroke Center, review a CT scan that reveals the presence of a stroke. With decades of experience, Dr. Schanzer serves as the primary neurological consultant for stroke cases at Trinitas, while Debbie seamlessly brings together a team of medical and nursing professionals to address the treatment and care of stroke patients throughout the medical center.

The American Stroke Association has summed up these symptoms in the acronym FAST to encourage a greater awareness of stroke (also know as brain attack). Those who suffer stroke notice a drooping in their Face (F), followed by Arm (A) weakness, and then Speech (S) abnormalities. These symptoms—and others, such as loss of balance or severe headache—mean it’s Time (T) to to call 911.

The person who is symptomatic (experiencing some or all of these symptoms) may be taken so off guard that an observer is often better able to act quickly and place that call. Whatever the case, stroke leaves little time for hesitation. In fact, the longer the delay, the greater the chance for brain damage; approximately 2,000,000 brain cells (neurons) die every minute a stroke goes without treatment.

This past October 29th was World Stroke Day. Now in its ninth year of international observance, it calls attention to what can be a life-altering or fatal health emergency. Statistics bear this out. The Centers for Disease Control and Prevention (CDC) report that one of every 19 deaths is caused by stroke—taking the lives of nearly 130,000 Americans each year. The disability that results from stroke costs the nation $38.6 billion annually; that’s a hefty price tag that includes health care services, medication and lost productivity. Although the American Stroke Association emphasizes that 80 percent of all strokes are preventable, uncontrollable risks such as heredity, age, gender and ethnicity remain key factors that can lead to stroke.

Root Causes

Strokes occur when a blood clot blocks the blood supply to the brain or when a blood vessel within the brain bursts. Medical conditions such as high blood pressure, high cholesterol, heart disease, diabetes, being overweight or obese, and previous “mini strokes” (transient ischemic attacks, TIAs), can all exert negative influences and cause someone to be a candidate for stroke. Of the 795,000 people who suffer stroke each year, 610,000 are first or new strokes; 185,000 are recurrent strokes.

That being said, positive lifestyle choices—such as avoiding smoking and excessive alcohol, eating a balanced diet, and getting regular exercise—can all make a difference in reducing the risk of stroke.

Neuro is called,” she says, “an Emergency Room physician evaluates the patient within 10 minutes of arrival. Within the next five minutes, a neurological consult takes place to determine the likelihood of stroke. Based on the neurologist’s recommendation, a patient may be given a clot-busting medication. At 25 minutes after arrival, a CT scan is done. The results are then interpreted within 45 minutes of the patient’s arrival. All of this happens so rapidly because every minute counts in reducing brain damage.”

Education = Prevention

Trinitas’s targeted education plays a pivotal role in pointing out the dangers of stroke and, ultimately, in lessening the frequency of Code Neuros. Trinitas has conducted community outreach that shares information with an average of 700 people each year. With the assistance of the Rotary Club of Elizabeth and a grant from the Rotary District 7510 of Central Jersey, Trinitas created educational resources for family members and friends who may be caregivers to a stroke patient.

In addition, Milkosky and a team of healthcare professionals wrote and produced a video that drives home the important points about acting FAST in the stroke situation. The video follows a patient from the moment he begins to experience initial stroke symptoms through his arrival at the emergency room, to his treatment, and, ultimately his discharge in the care of loving family members. “We’ve put a face on stroke that makes it real for viewers,” she explains.

Milkosky realizes that little can be done to reduce the likelihood of stroke based on genetics, age, gender and ethnicity. However, a better-informed community has a greater chance of striking a blow against stroke. “We conduct cholesterol and glucose lab testing, blood pressure and pulse checks, and offer stroke-related counseling to encourage a better understanding and awareness of stroke.”

She stresses being pro-active to reduce the risk of stroke by eating better, exercising regularly, and avoiding tobacco and alcohol. “In the case of stroke, long-term commitments to healthier living can sometimes help avoid a devastating health crisis that can literally happen in an instant.”

Growing Pains?

Maybe not. A look at the cost of LBP in kids.

What is the leading cause of disability in the world today? The answer, according to the World Health Organization’s 2010 Global Burden of Disease study, is low back pain (LBP). LBP is defined as pain in the area on the posterior aspect of the body, from the lower margin of the twelfth ribs to the lower gluteal folds, with or without pain referred into one or both lower limbs that lasts for at least one day. The common image of an LBP sufferer is a hard-laboring adult, or a senior citizen, but the fact is that low back pain in children and adolescents is a significant health problem, too.

As Dr. Naomi Betesh points out, in children and teens, back pain increases with age. And because LBP in adolescents leads to increased risk of recurrence in adulthood, physicians are realizing the importance of early detection and treatment in the pediatric population.

“Patients, whether adult or pediatric, have the best outcomes with a multidisciplinary treatment approach,” explains Dr. Betesh, a pain management and rehabilitation specialist at Union County Orthopedic Group in Linden and Clark. “Treatment strategies include core strengthening, postural training, proper biomechanics education, medication management and minimally invasive procedures.”

The 2010 WHO study, which was released in March 2014, concluded that LBP causes more global disability than any other condition. With the planet’s aging population, the report stated, “there is an urgent need for further research to better understand LBP across different settings.”

LBP: DID YOU KNOW?

• The annual bill for chronic pain in America, which includes healthcare costs plus lost productivity, is more than $600 billion.
• More than 15% of that cost is related to lower back pain.
• In 2014, 1 in 34 Americans will lose two weeks or more in productivity to LBP.
• Only one-third of the annual cost of LBP in America is related to healthcare; lost wages and diminished productivity accounts for the remaining two-thirds.

Editor’s Note: The above statistics were part of a 2013 study that included information sourced from the CDC, the Center for Medicare & Medicaid Services and the U.S. Bureau of Labor Statistics.

The last line of defense at the Super Bowl is not what you think. 

By Alison Hemstitch

You wouldn’t believe the things a “house doctor” sees at a football game. So says Dr. Kevin Lukenda, Chairman of the Family Medicine Department at TRMC. Dr. Lukenda has been working two to three events a month at the Meadowlands Sports Complex for a dozen years.

Photo credit: iStockphoto/Thinkstock

MetLife stadium holds 85,000 people including employees. When the stadium sells out a football game, concert or soccer match, it is essentially a small city with the same potential for 911 calls and problems that a city would encounter on any given day. The Meadowlands Sports Complex has its own EMS, Fire, Safety Services and Maintenance Departments, among others. The physician on duty for an event handles everyone’s medical problems—from colds to falls to life threatening situations such as heart attacks, strokes and diabetic emergencies. The staff also sees its share of stadium-exclusive issues, like moths dive bombing into the ear canals of guests sitting in the upper level near the lights.

So what does Dr. Lukenda consider a normal day at a New Jersey sporting event?

“Respiratory and cardiac issues are the normal fare,” he says. “Essentially our fans bring a full complement of their chronic illnesses with them to events at the Sports Complex, some of which are exacerbated by the weather, walking a distance into the buildings, or the food and beverage they consume at the tailgate parties they attend. Tailgate parties can be quite elaborate, fully catered affairs.”

The Meadowlands Sports Complex, which is owned by the state and managed by the New Jersey Sports and Exhibition Authority, is the only sports venue in the state that has its own Medical Team of physicians, nurses, EMTs and ambulances that are managed by a Medical Director, EMS Director and EMS Coordinator, who plans the EMS coverage for all the events.

For the Super Bowl, Dr. Lukenda was one of eight physicians stationed in various medical rooms throughout the stadium. This job required the physicians and staff to have in-service training prior to each NFL game this season to prepare them for anything that might be thrown at them come the Super Bowl game.

Normally, Dr. Lukenda’s job is to administer to fans and employees, but after rock concerts, he is occasionally called upon to treat a performer. “Some of those guys leave it all out on the stage and come back to their dressing room spent or dehydrated,” he says (but won’t say who). “These acts go on tour and depending on how long they have been touring, they start to get ill from the long hours and the demands of the road. We are their on-the-road, so to speak, physicians. What a rush when you first get to treat a celebrity.”

Kevin Lukenda, DO Chairman, Family Medicine Department, TRMC 908.925.9309

Dr. Lukenda says, “I love working at the Sports Complex. It is a totally different feeling than the office and hospital. You get a bit of an adrenalin rush being so close to the action.”

News, views and insights on maintaining a healthy edge.

Bariatric Surgery: A “Miracle Moment”

A recent study of diet and nutrition disorders looked at attitudes of the morbidly obese toward obesity and obesity treatment. Researchers found that the majority of study subjects thought of obesity as an unalterable hereditary trait. Although they recognized that personal eating behavior contributes to and exacerbates their condition, they feel that altering this behavior is difficult to change or control. The same study also showed that food is often used as a coping strategy, which makes following a healthier diet plan a “huge sacrifice.” The findings support the idea that, for the morbidly obese, bariatric surgery represents a “miracle moment” that will change their lives without requiring an active role or participation. Researchers concluded that it is important to empower patients before and after bariatric surgery, and to promote a new awareness of the weight-loss process.

Heads Up On Facial Fractures

With all the publicity about the long-term damage associated with concussions, the medical community has become hyper-vigilant when it comes to the diagnosis and treatment of major head injuries. A new study out of Victoria Hospital in Canada suggests that doctors may be overlooking one type of injury—facial fractures. Patients suffering this type of injury show evidence of minor brain injury. Unlike a typical concussion, where the brain is “sloshed” by heavy force, facial fractures appear to injure the brain because impact forces are transmitted through the head. The same dynamic can also cause neck problems. The study, conducted by craniofacial surgeons, showed that facial fractures cause major brain injury 29% of the time—but in the remaining 71% of cases, more than half showed evidence of minor brain injury, which can easily go unnoticed and untreated.

Crazy Time for Cannabis

On the heels of news that marijuana use has been legalized in Washington State, recent research has added to the growing amount of data that suggests that heavy cannabis exposure during adolescence increases the future risk of developing schizophrenia. In addition, legalization for medical use elsewhere in the country exposes an entirely new group of users to pot, many of whom may have other types of psychosis risks. Many healthcare professionals and scientists are now urging for a test that might help predict the risk for developing cannabis psychosis—something that doctors, for instance, could administer before prescribing marijuana to a patient. Genetic researchers at the King’s College London’s Institute of Psychiatry recently carried out a case control study to investigate variation in the AKT1 gene and cannabis use in increasing the risk of psychosis. AKT1 is involved in dopamine signaling, which is known to be abnormal in psychosis. The study found that cannabis users who carry a particular variant in the AKT1 gene have a two-fold increased probability of a psychotic disorder; this increases up to seven-fold if they smoked or ingested marijuana daily. The results are not conclusive in and of themselves that AKT1 is the key to a genetic test, but according to Dr. John Krystal, Editor of Biological Psychiatry, it “does show that this source of psychosis risk has a genetic underpinning.”

Link Between Sleep Disorders and Cancer Deaths

Sleep apnea sufferers have one more bit of bad news to add to their growing list. A study conducted in 2012 suggest that sleep-disorder breathing is associated with an increased risk of cancer mortality. This on top of increased risk of hypertension, cardiovascular disease and depression. Patients with severe sleep apnea had an incidence of cancer deaths five times higher than those without serious sleep-disorder breathing. “We are a long way from proving that sleep apnea causes cancer or contributes to its growth,” says Dr. F. Javier Nieto of the Wisconsin School of Medicine and Public Health—the lead scientist on the study and a sleep epidemiology expert. “But animal studies have shown that the intermittent hypoxia [an inadequate supply of oxygen] that characterizes sleep apnea promotes angiogenesis-increased vascular growth-and tumor growth. Our results suggest that SDB is also associated with an increased risk of cancer mortality in humans.”

Environmental Factors Trigger Allergies in Newborns

The idea that smoking while pregnant—or significant exposure to second-hand smoke—can trigger any number of problems in a newborn is widely accepted. In the case of allergies, now we know why. Two Iranian scientists from the Helmholtz Centre for Environmental Research recently released findings that show smoking affects the development of peripheral allergy-relevant stem cells in the blood. Their report, published in Clinical & Experimental Allergy, shows that one-year-olds with skin problems, such as dermatitis or cradle cap, had elevated levels of eosinophil progenitors in their blood. This establishes a relationship between the genetic predisposition for a disease and environmental influences. The conclusion the scientists drew is that, just because allergies run in a family, it doesn’t mean a child will suffer from those same allergies. The stem-cell findings prove that environmental and lifestyle factors actually determine whether a genetic predisposition is in fact realized or not.

Holiday Baking: Shoulda Woulda Coulda

Don’t you love it when you hear how unhealthy holiday eating can be? Hopefully, your guilt has worn off and you’ve dropped an unwanted pound or two.  But just in case, Utah State University has some tips for healthier baking. 1) Lower fat content by using plain yogurt instead of shortening or butter. 2) Replace icing with sifted confectioner’s sugar. 3) Add fiber to recipes by using a 50-50 mix of hard white wheat flour with regular flour. 4) Cut the amount of salt called for in baking by a third or half—it’s important from a taste and chemistry standpoint, so you can’t leave it out entirely. 5) Cut the sugar in recipes by 25%—you’ll barely notice the difference. Don’t think of these tips as “too little, too late.” Think of them as a recipe for success in 2013, and implement one every other month. By next December, you will be happier, healthier and guilt-free when the baked goods start rolling out of your oven.

New Findings on Gluten-Free Foods

Back in December, the good folks at Guinness added a new entry in their Book of World Records: the largest gluten-free pizza. It covered more than a third of an acre and weighed more that 50,000 pounds. Given the recent proliferation of gluten-free foods on supermarket shelves, some have questioned whether there is actually a need for this type of product, or whether it’s just some new dietary fad. After all, fewer than 1% of people in the U.S. suffer from Celiac Disease, an autoimmune disorder of the small intestine triggered by exposure to gliadin, a protein found in wheat. So is wheat sensitivity among non-Celiac individuals real or imagined? A recent study published in the American Journal of Gastroenterology confirms what many in the field long suspected: non-Celiac wheat sensitivity not only exists as a distinct clinical condition, it shows up in people who already exhibit food hypersensitivity, as well as those who do not. “These findings are very important, and I hope to see more research in this area,” says Dr. Samiappan Muthusamy of the Center for Digestive Diseases. “For our patients with non-Celaic sprue gluten sensitivity disorder, we suggest they continue a gluten-free diet.”

Raisin D’Etre

New data presented at the last American College of Cardiology scientific session suggest that a handful of raisins (not an apple) a day could keep the doctor away for those with mildly increased blood pressure or hypertension. Raisins contain a high amount of potassium—which is known to lower blood pressure—and are a good source of antioxidants, which have been shown to have a good effect on blood vessels. The study may lead to more ambitious trials on the positive impact of raisins on blood pressure. Until then, researchers suggest consuming 60 a day (about a handful). P.S. If you have a dog, please no sharing; vets haven’t figured out exactly why yet, but raisins (and grapes) appear to be toxic to canines.

What’s the ‘real’ cost of obesity?

By Lisa Milbrand

The line between social acceptance and social unacceptability can be a surprisingly fine one. Consider the smoker, once ubiquitous, who now encounters hostility whenever he or she lights up.

It’s one thing, after all, to ruin your own health. But as soon as the collateral damage of secondhand smoke was recognized—to our lungs and our pocketbooks—smokers were dead ducks.

Photo credit: iStockphoto/Thinkstock

Are the overweight next?

Laboring through the day with an extra 50 pounds is a chore. Absorbing the glances of pity or disgust each time a French fry crosses the lips is no fun, either. But what happens when the “real” costs of obesity are made clear to the American public?

There’s no question that obesity is on the rise here in the U.S. Currently, 60 percent of American adults are considered overweight. “And 30 percent are considered obese, where it causes a real medical problem,” adds Jim Dunleavy, PT, the Administrative Director of the Trinitas Health & Fitness Center. It’s not just our problem—the World Health Organization recently proclaimed that it now considers obesity a greater threat to humankind than hunger.

Photo credit: iStockphoto/Thinkstock

Furthermore, the impact of obesity goes beyond the health issues with which we are all too familiar, including skyrocketing rates of type-2 diabetes, coronary problems and other chronic and fatal diseases. Experts outside the world of medicine are now beginning to assess the cost of obesity in ways that impact everyone’s bottom line. Everything is on the table, from loss of productivity and increased risk of going on permanent disability, to the need to retrofit hospitals and build trains, planes and automobiles with wider seats, to an entirely new level of wheelchair accessibility in public and private spaces.

IT’S PUBLIC

Many inside the world of medicine feel that this is a discussion that needs to happen, if for no other reason than to create a more sophisticated level of public awareness.

“They’ve done a good job of showing the dangers of smoking, but obesity has to be the next thing they tackle,” says Gregory Charko, MD, an orthopedic surgeon at Orthopedic Physicians and Surgeons, P.C., in Union. “Everybody pays the cost for this; all health insurance premiums go up to cover the sickest people in the population. There’s a huge cost to the whole society when obese people are disabled prematurely and can’t participate in society, pay taxes and contribute.”

Some researchers have actually tried to put a number on the cost of obesity. They’re finding that about 20 percent of our annual health-care spending—or about$190 billion each year—goes toward treating obesity-related medical conditions. Yet that may be the tip of the iceberg. There are subtler ways we all pay—for instance, in our plane tickets, as airlines’ fuel costs have increased to account for the millions of gallons of extra fuel needed to transport the extra weight, and through governmental or hospital spending to retrofit public transportation and hospitals to accommodate the obese with extra-large seats, toilets that can withstand the excess weight and other accommodations.

We may also have to work harder as a result. “Obese people miss work more, so they cost employers more,” points out Penny Cappuccino, a registered dietitian at Trinitas. Some researchers peg that annual cost to employers at up to $30 billion per year.

IT’S PRIVATE

No one should be surprised if the public cost of obesity finds its way into the headlines more and more over the next few years. Hopefully, that won’t obscure the highest cost of America’s weight problem: the personal one. Almost every study shows that obese people shed years off their lives, and have much poorer health in their later lives than people with normal weight.

Much of this relates to the damage that excess weight can create on every system of the body, from the lungs to the legs. “Obese people are at very high risk of obstructive sleep apnea syndrome, as their throat narrows during sleep, causing oxygen levels to drop,” says Vipin Garg, MD, the Medical Director of Trinitas Sleep Disorders Center. “Low oxygen levels to the brain mean a person cannot get to deep sleep, and it affects all the other organs as well. It makes them more susceptible to heart disease, strokes, seizures and things of that nature.

Photo credit: iStockphoto/Thinkstock

And abdominal obesity moves the diaphragm up and stiffens the chest wall with fat around the ribcage, so the lungs aren’t able to fill with air as they would if the person wasn’t obese—that can lead to shortness of breath.”

“Obesity is also the top cause of knee replacement,” says Dr. Charko. “The force across your knee is three to five times your body weight, and if you’re morbidly obese, it just wears that joint down. If you’re over 300 pounds, you’re just carrying too much load for your skeleton, and it’s wearing out because of that increased load. Also, obese people are more prone to lower back degeneration, because of poor abdominal muscle tone.”

Chronic health conditions such as these can actually contribute to further weight gain and impairment of your health. “It’s a vicious cycle,” says Dr. Garg. “Once you’re obese, the one thing you’re supposed to do is exercise, and if you get short of breath with exertion, or have pain, you’ll exercise less—and you’ll get even more obese.”

Because of these chronic health conditions, many obese people become disabled and leave the workforce early. “They spend more of their lives disabled, their quality of life is diminished,” Dr. Charko says, “and they won’t be able to afford to do the things they want to do.”

IT’S PERSONAL

Beyond the social and financial costs of obesity are the ones that are sometimes hardest of all to fix—the psychological ones. “Obese kids may be ridiculed and bullied, and studies show that obese people may have fewer job opportunities and may be less likely to be given jobs,” says Cappuccino. Indeed, John Cawley, a heath economist at Cornell University, found that obese individuals are regularly paid less than their healthy-weight counterparts—to the tune of about 11 percent of their annual income.

Photo credit: iStockphoto/Thinkstock

No matter how you look at it, we’re all losing due to society’s weight gain.

“We’re losing in terms of their health and the quality of life, but we’re losing in terms of how productive that person is and the number of working years they have,” says Dr. Garg. “It’s a big cost to society, when people are spending more time dependent than they are working.”

b When Lisa Milbrand’s not writing about health and wellness for EDGE, she is sharing advice on everything from wedding planning to child rearing as a magazine writer and blogger. If you know a couple haggling over baby names, send them to her In Name Only blog on parents.com.

News, views and insights on maintaining a healthy edge.

Good News for Popeye

In the world of healthy eating, spinach and other salad greens are the heroes. In the world of food poisoning, they have often played the role of villains. Over the last decade, no fewer than 18 nationwide food-poisoning outbreaks have been traced back to leafy greens. In 99% of the cases, the problem originates in the way they were washed, which sometimes fails to eliminate bacteria such as E. coli.

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

Dr. William Farrer, Chief of Infectious Diseases at Trinitas, points out that an outbreak in Europe in 2011 with a toxin-producing E. coli strain linked to sprouts sickened 852 people and killed 32. In the US, the Centers for Disease Control and Prevention estimates that 48 million Americans fall ill to food-related illnesses each year and about 3,000 people die each year from food poisoning. “Our modern food distribution system means that outbreaks linked to leafy vegetables can involve people in multiple states,” observes Dr. Farrer. The good news is that, at the last meeting of the American Chemical Society in Boston, a group of scientists presented a new, simple-to-implement parallel-plate flow chamber system that keeps bacteria from attaching to the outer layer of leaves. This method helps disinfecting rinses get to all parts of leaf surfaces equally; only 85% percent of surfaces on average get properly cleaned now. The USDA has already started funding the project.  Dr. Farrer is encouraged by the government response: “Any process that can improve the washing of vegetables can potentially decrease the likelihood of these infections and make our food supply safer.”

I Can’t Believe It’s Not Healthy

Distressing news for all of us raised on the eat-margarine-not-butter ethos: That thinking may be dead wrong. A survey of 1 million people in 50 recent studies by McMaster University in Canada has concluded that saturated fats from animal products do not appear to increase the risk of death from heart disease, diabetes or stroke.

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

Michelle Ali, Director of Food and Nutrition at Trinitas, explains that “the carbon chain of saturated fats consists of fatty acid ‘saturated’ with hydrogen. Trans fats are created by an industrial process that adds hydrogen to liquid vegetable oils. This addition of hydrogen makes these fats more solid at room temperature and gives them qualities that are similar to shortening or lard. Given that change in consistency, we’ve known for some time that trans fat has been linked to heart disease.” The Canadian researchers concluded that commercially produced trans fats found in snack foods, packaged baked goods and, yes, margarine, raised the risk of premature death by more than 30 percent. The research team was quick to add that this does not mean people should increase their intake of animal fats, which can lead to unhealthy weight gain. We should focus more on eating healthy including more whole grains, fruits, vegetables and lean meats, Ali suggests. “In general, we should reduce our intake of saturated fat and, of course, avoid foods that are known to contain trans fat.”

Nickel for Your Thoughts

If you had a nickel for every time you developed a weird skin rash…Well, in some instances, dietary nickel could actually be the culprit. Perhaps counter-intuitively, it’s a common cause of contact dermatitis. If a rash develops on your hands or elbows—or elsewhere after coming into contact with a zipper, belt buckle or other nickel-containing object—you may be mildly allergic to nickel. And the origin of that allergy could be foods such as wheat, rye, nuts, seeds and even chocolate, which are high in nickel. Other causes of nickel allergies can include medical devices containing the metal, including dental and orthopedic implants.

Mouth to Mouth

Anthropologists don’t often make their way into the pages of What’s Up, Doc?, but a study by a joint team from Indiana University and the University of Nevada caught our attention. The anthropologists looked at attitudes toward kissing around the world. Although affectionate pecks on the cheek are common across most cultures, especially for babies and children, in most parts of the world romantic kissing kind of creeps people out. Indeed, in the 168 societies studied, only 46 percent see erotic value in the locking of lips. In fact, among cultures in the Amazon, New Guinea and sub-Saharan Africa, romantic kissing is practically unknown. According to

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

Dr. Rodger Goddard, Chief Psychologist at Trinitas and Director of Wellness Management Services, kissing spans the spectrum from a dangerous, unhygienic transmission of disease to the most intimate and caring exchange of love. And there are health benefits to kissing, too. Dr. Goddard notes that intimacy and positive relationships—whether sealed by a kiss or an old-fashioned hug—have been shown to improve one’s health and longevity. “Theories about the origins and reasons for kissing are varied, including evaluation of another’s most intimate biological, hormonal information to a reinforcement of trust, intimacy, closeness and sexual attraction to another,” he says, adding that, in a recent article by Dr. Noam Shpancer, men and women were found to differ on their views of kissing. “Half of men say they would have sex with a partner without the need for kissing, while only 14% of women would. Women were found to heavily weigh the overall quality of a kiss in their decision for commitment to someone.”  Some Pacific island cultures practice a “kiss” where a couple’s lips pass a couple of centimeters apart without actually touching. Is the swapping of saliva such a health risk in these places that kissing never evolved? The Nevada study author couldn’t say. However, he did offer an alternative hypothesis: In many of these non-kissing cultures, people don’t brush their teeth.

Now You See Me

The concept of a bionic eye has intrigued us since The Six Million Dollar Man, but until recently the gulf between concept and execution seemed unbridgeable. That looks to be changing. Over the summer, a Florida woman who had been blind for 16 years (as a result of retinitis pigmentosa) held a press conference to announce that she has regained much of her sight thanks to the Argus II Retinal Prosthesis System, which she had implanted about a year ago. Carmen Torres was the 70th person in the world to receive the Argus II, which is currently the only FDA-approved system of its kind. Needless to say, the procedure is far from simple. More than 30 professionals were involved—from initial evaluation to implantation to post-operative training. The system features a photosensitive array of electrodes that is implanted directly on the retina, and eyeglasses that contain a tiny camera that transmits video to a pocket-sized computer. The computer then sends the signal to the implant, which emits pulses of electricity that bypass damaged photoreceptors in the eye and stimulate the retina’s remaining cells. Very cool.

Weighty Issues

A study published recently on the website of The Journal of Pediatrics found that hospitals could do a much better job in the fight against childhood obesity. Of 300 clinically overweight/obese children admitted to Primary Children’s Hospital in Utah, only 4 percent had their condition directly addressed by physicians (or their medical student trainees).

Yelena Samofalov, MD Trinitas Pediatric Health Center 908.994.5750

Dr. Yelena Samofalov, MD, of the Trinitas Pediatric Health Center, explains why this may occur:  “Discussing a child’s weight issues with parents can be challenging. The health care provider should express concern and also offer a plan of action. This is especially important since health problems such as diabetes, high blood pressure, sleep disturbances, and joint pain, have their roots in early childhood.” In the Utah study, Body Mass Index calculations of children were seldom performed and weight issues rarely included in discharge diagnoses. The study authors pointed out that this is true for most—but not all—US hospitals. Trinitas, for example, is proactive in fighting childhood obesity. “We take every opportunity to discuss healthy nutrition with our little patients and their parents,” says Dr. Samofalov. “We launched Eat Right Today!, a bilingual interactive educational program for parents and their children, to help them make healthy nutritional choices. Thanks to the program, kids and parents have shown great interest in the benefits of developing healthy eating habits.”

Red Hot News on Chili Peppers

Can eating spicy foods help you live longer? An international team of researchers led by the Chinese Academy of Medical Sciences says Yes. A five-year study involving nearly half a million participants aged 30 to 79 found that people who ate spicy meals once or twice a week had a 10% reduced risk of death compared to people consuming non-spicy diets. Individuals eating spicy food 3 to 7 times a week saw that risk drop to 14%. The correlation between spicy food and a reduction in cancer and heart and respiratory disease was greater for women, and also among those who did not consume alcohol. Fried and dried chili peppers were the most common ingredient in the spicy meals; they contain Capsaicin, vitamin C and other nutrients. Those who consumed fresh chilies also appeared to have a lower occurrence of diabetes. However, researchers stopped short of saying there is a direct link between capsaicin specifically and a lower risk of disease and death.

Problem-solving by the numbers

By Dr. Rodger Goddard

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

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

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

The four types of problems that you may face are:

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

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

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

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

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

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

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

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

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

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

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

By Caleb MacLean

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

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

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

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

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

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

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

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

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

Colon cancer rates drop as screenings increase.

By Christine Gibbs

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

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

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

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

UNDERSTANDING THE BASICS

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

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Genetics

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

Staging

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

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

Treatment

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

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

THE IMPORTANCE OF SCREENING

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

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

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

Andrea S. Zimmern, MD, FACS

Colorectal Surgeon

908.994.8449

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

When should I call 911?

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

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

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

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

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

What should I bring to the ER?

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

Who answers my 911 call?

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

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

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

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

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

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

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

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

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

COLOR ME READY

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

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

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

Submit your questions to AskDrD@edgemagonline.com

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

News, views and insights on maintaining a healthy edge.

Experimental Drug Looks Good vs. MRSA

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

William Farrer, MD Chief of Infectious Disease 908.994.5455

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

A Blunt Assessment of Marijuana

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

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

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

Obesity and the Brain

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

Ari Eckman, MD
Chief of Endocrinology and Metabolism 908.994.5187

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

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

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

There is a silver lining in this dark cloud.

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

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

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

Redefining the Evidence Base

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

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

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

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

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

Quicker, Stronger

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

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

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

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

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

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

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

Trinitas welcomes a familiar face to the nursing staff.

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

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

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

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

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

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

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

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

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

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

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

DID YOU KNOW? 

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