With each 9-1-1 call, two award-winning Trinitas teams spring into action.

Terror. Pain. Confusion. A swirl of sounds and people. The fear that this might be a one-way trip. This is the part of a cardiac emergency you don’t see on TV medical dramas. Yet it is in these first moments when help arrives that difference-making action begins. The target window of time during which an individual in this situation needs to receive emergency care is 90 minutes—so says the American Heart Association. Which is why the right call is a 9-1-1 call. Indeed, according to Gerard “Rod” Muench, Trinitas Regional Medical Center Administrative Director of the Emergency and Emergency Medical Services Departments, a good chunk of that critical window can be wasted by driving that individual to the hospital in a personal vehicle. Dialing 9-1-1 initiates a System of Care that makes the most of those precious minutes.

Trinitas has been the recipient of Mission: Lifeline awards from the American Heart Association in each of the last four years. The departments receiving this honor are under the director- ship of Muench and Kathleen Azzarello, head of Cardiovascular Services—two professionals who excel at administering critical emergency-treatment response. Muench’s team is focused on saving the lives of severely distressed cardiac (and other) patients by streamlining the trip of EMS personnel from point of contact to the Emergency Department at Trinitas. Azzarello’s team, which includes the cardiac catheterization lab, is at the receiving end when the ambulance arrives with patients in cardiac distress.

Muench and his team deliver approximately 1,000 patients each year to Azzarello and her staff. On average, their coordinated care probably saves 50 patients a year—about one a week—whose extreme coronary distress would have resulted in death under almost any other scenario.

The Three C’s

The common goal of emergency System of Care protocols can be defined by three important C’s: Cooperation, Collaboration and Communication. The goal of the EMS team is to administer treatment at the very first moment that the EMTs make contact with the patient. Trinitas pre-hospital personnel is trained in procedures such as administering CPR, providing medication, inserting an IV, and transmitting an EKG to the hospital prior to the patient’s arrival. Once delivered to the Emergency Department, no time is wasted in turning over those in need of immediate cardiac care to the Cardiovascular Services Department.

The overall success of response to cardiac emergencies starts with expediting what used to be called “door-to-needle” time. The clock starts ticking at the point of first medical contact—in the home, in the car, at work, or on the phone with a 911 dispatcher—and doesn’t stop until a patient is transported by an emergency vehicle to the catheterization lab or cardiovascular department, where life-saving treatment can be initiated before time runs out. At Trinitas, first contact typically goes through the hospital’s Mobile Intensive Care Unit. The MICU operates in coordination with the Elizabeth Fire Department, which initiates on-site stabilization and treatment.

Everyone trained and supervised by Rod Muench appreciates that every minute matters when it comes to coronary patient outcomes, making the MICU an “Emergency Dept. on wheels.” He has been at Trinitas for 11 years, previously served as ED/EMS Administrator, and is often described as a paramedic educator. He has developed and implemented a thorough regimen for the hospital’s staff of EMTs, including a first-contact philosophy.

“Learning how to communicate with the patient is key,” Muench explains. “Good people skills are essential to a good emergency medical technician.”

The need to combine empathy with speed and accuracy is echoed by Kathleen Azzarello and her team, which deals with extreme pressure situations on a round-the-clock basis. In assembling that team, she looks for individuals who are “a bit of an adrenaline junkie,” adding that they need to stay calm under fire and also appreciate the ultimate rewards of being a critical caregiver. What is her reward?

“It’s an amazing privilege to watch a cardiac patient go from near death upon arrival to wanting to leave the hospital as soon as treatment has been administered.”

Needless to say, COVID-19 has complicated the work of everyone involved in emergency care. It has also created a growing number of post-COVID coronary infections, a story that was under-reported in 2020. Given the added stress of the pandemic, Azzarello and Muench are understandably proud of the Mission: Lifeline recognition their teams received in 2020—the Gold Plus award to the ED/EMS departments and the Gold Mission: Lifeline for ST Elevation Myocardial Infarction (STEMI) Receiving Department. Neither, however, is quick to take personal credit.

STEMI

According to the CDC, even in the pandemic year of 2020, heart disease was the number-one cause of death in the United States. A quarter-million people fall victim to the most fatal type of heart attack—ST Elevation Myocardial Infarction, or STEMI—which blocks blood flow to the heart. These extreme cases are prime examples of the difference that a 9-1-1 call to Trinitas can make.

“I am only doing so well,” Muench points out, “because my staff at Trinitas is a unique breed of highly skilled and motivated people who make my job easier.”

“I am supported by a staff of passionate, humble and unspoiled individuals from diverse backgrounds,” adds Azzarello. “We have become a family that is willing to walk that extra mile to help a patient in need.”

If your urologist seems busier than usual, well, there’s a reason for that…actually, there are three reasons

Urologists tend to fly under the radar. As a rule, their patients are not keen on discussing the problems and procedures with which they are involved in social situations. And, let’s face it: you don’t see a urologist unless you have to. Indeed, most people receive their AARP card before scheduling their first urological visit. So it’s worth paying attention when the profession pushes its way into the news—as it has in the last year or so.

Recent breakthroughs—and controversies—promise to alter the way urology practices interact with patients and conduct their business. Although these are topics that we don’t like to discuss, from prostate cancer to bladder cancer, there is actually quite a bit to talk about.

Prostate Screening

The Prostate-Specific Antigen (PSA) blood test measures the presence of an enzyme which is present in small quantities of men with healthy prostates, but is often elevated in men with prostate cancer or other prostate problems. The test has been in general use since the late-1980s. Around a third of patients who have high PSA turn out to have prostate cancer. The American Urological Association (AUA) in Maryland recommends the test for men 55 to 70. However, the American Cancer Society and some in the U.S. Preventative Services Task Force (USPSTF)—an independent panel of experts in prevention and evidence-based medicine—are recommending against using the PSA test for screening.

“Almost all urologists agree that PSA testing benefits far more people than it hurts,” says Andrew Bernstein, MD, adding that the AUA and USPSTF will eventually meet somewhere in the middle. “It is just a blood test. Doctors and patients together make the decision on what to do about the results. In years prior, it was a reflex to proceed with further biopsy work, surgery, or aggressive treatment. We know that is not necessarily mandatory now, but the cost of a blood test is far less than the cost of treating a disease after it has spread.”

“At this time, since there are no other commercially available blood tests, PSA coupled with a Digital Rectal Exam (DRE) are still recognized as a good screening method for prostate cancer,” Alan Krieger, MD, Division Chief of Urology at Trinitas, points out. He believes the USPSTF “got it wrong”—using the PSA test, early detection of prostate cancer has decreased cancer-specific death by approximately 30 percent.

Because an elevated PSA does not necessarily mean a man has prostate cancer, urologists are careful to track the rise in a patient’s PSA value (aka PSA velocity) over time, which can also indicate the possible presence of prostate cancer that is not always detected on a DRE.

Cancer Treatment Strategies

Not all prostate cancers are alike. Urologists use the Gleason Grading System to evaluate tissue removed through a biopsy and assign a score that measures how aggressive the cancer is. Gleason scores range from 2 to 10. Scores of 6 and under are associated with less-aggressive cancers. Patients falling into this range—particularly those over age 65—are now being advised to take an “active surveillance” approach to slow-growing tumors rather than immediately going under the knife.

According to Dr. Krieger, it’s not always that simple. Two men may have the same Gleason 6 score, but the biology of their individual tumors may behave differently. “New biologic genome testing has been developed and when used in the proper circumstances, men who may benefit from active surveillance can be identified and placed on protocols which involve sequential PSA testing and repeating prostate biopsies to see if the amount/volume or aggressiveness of a given tumor has changed,” he says.

“Every case is tailored to the patient’s cancer, as well as his personal opinion on whether he wants to be aggressive or not,” adds Dr. Bernstein. “Certainly, elderly patients with low-grade cancer can be followed with surveillance. This is also true of younger patients with a small volume of disease—as long as they are willing to be followed closely and undergo repeat biopsies.”

Bladder Cancer Breakthrough

Bladder cancer is among the 10 most common cancers in the U.S. and, by some estimates, ranks fourth among males. A study conducted at the Stanford University School of Medicine recently identified a single type of cell in the lining of the bladder for most cases of invasive bladder cancer. Not only does this research suggest that most bladder cancers arise from one specific (and common) kind of cell, it also may explain why bladder cancer often recurs after successful therapy.

The study holds great promise for understanding and treating the roughly 30 percent of bladder cancers that occur in the muscles around the bladder. This cancer can be very aggressive compared to the more typical kind, which is confined to the bladder lining. It is also extremely difficult and expensive to treat.

Editors Note: Dr. Bernstein and Dr. Krieger are both affiliated with Trinitas Regional Medical Center. Dr. Bernstein is a member of the Premier Urology Group in Pompton Plains. Dr. Krieger is a member of the Urology Group of New Jersey, which has a dozen locations in Central New Jersey.

A new Ambulatory Surgery Center keeps Trinitas ahead of the curve.

The calculus of running a hospital like Trinitas Regional Medical Center seems to get more complicated with each passing year. That being said, some decisions come down to a simple set of metrics. In the case of TRMC’s new Thomas and Yoshiko Hackett Ambulatory Surgery Center, the stars align perfectly. Patients desire speed and convenience, insurance companies want to avoid overnight stays, and surgical techniques and technologies have been evolving at light speed. All of these trends have converged in the$5.2 million, 9,500-square-foot facility, located in the Andrew H. Campbell Pavilion on Williamson Street.

The Center features state of the art operating rooms offering comprehensive outpatient surgical procedures including plastic surgery, laparoscopic gynecological procedures, gallbladder surgery, hernia repair, orthopedic, vascular, podiatric, and pain management surgeries as well as cutting edge hemorrhoid surgery. Andrea Zimmern, MD, Colorectal Surgeon at Trinitas, is the first surgeon in Union County to carry out Transanal Hemorrhoidal Dearterialization (THD) procedures at the Center. “The groundbreaking THD procedure is virtually painless,” Dr. Zimmern says. “We tie off all the blood vessels that feed the hemorrhoid, and work in an area of the anal canal that has no pain sensory innervation. It’s a drastic, positive change from traditional surgery—patients are back to normal activities usually in less than a week. THD changes the game because we’ve removed the painful discomfort while minimizing recovery time. That’s an amazing advancement when you consider what hemorrhoid surgery used to mean.”

The Center opened for business in March and will help Trinitas handle a growing demand for same-day surgery. From 2012 to 2013, the hospital experienced a rise of more than 15 percent in these types of procedures, and expects 10 to 15 percent growth in this category to remain steady for several years. About 45 percent of the surgeries performed at Trinitas are already of the outpatient variety.

This is consistent with a nationwide trend among hospitals, which now perform close to 60 percent of outpatient surgeries (as opposed to free-standing surgical centers). Not surprisingly, a major reason people opt for hospital-based ambulatory surgery facilities is the proximity to the greater resources of a hospital.

“In our case, it’s added assurance for patients who come for same-day surgeries,” says Trinitas President and CEO Gary S. Horan. “And by providing a new facility, we will support the work of our current medical staff, strengthen our ability to recruit new physicians, and assure patients of a superior patient experience.”

Given changes in the marketplace triggered by the Affordable Care Act, the opening of the Thomas and Yoshiko Hackett Ambulatory Surgery Center at Trinitas could not have been timed any better. Free-standing surgery clinics—for many years operating on an out-of-network basis—have been moving toward in-network status under pressure from insurance companies. Rather than responding to competition after the fact, Trinitas has stayed ahead of the curve with the opening of its new center.

Editor’s Note: Numerous organizations, foundations, and individual donors contributed $2 million for the construction of the new facility. For more information on the Thomas and Yoshiko Hackett Ambulatory Surgery Center, log onto njambulatorysurgery.com.

News, views and insights on maintaining a healthy edge.

Happy Days

A recent study out of University College in London has shed some light on why everyday physical activities are more difficult for some seniors than it is for others. Happiness may make the difference. People over 60 who considered themselves to be unhappy or dissatisfied with life were 80 percent more likely to have problems preparing food, bathing and dressing. The study followed more than 3,000 people over an eight-year period. Only about 4 percent of the people who said they enjoy life had problems with basic tasks.

Patient, Heal Thyself

The goal of employing stem cells to grow new organs for transplant has hit a number of snags, most notably that it requires either harvesting of cells from embryos, or manipulating DNA. Scientists in Japan may be on to a clever shortcut that does not involve either of these methods. Researchers at RIKEN, the nation’s largest research institution, found that soaking normal blood cells in a mild acid bath caused them to “revert” back to pluripotent stem cells. These new cells were injected into mice brains, hearts and other organs and proved adept at transforming themselves into regular cells. This surprising “shortcut” suggests that patients could one day produce their own stem cells on an as-needed basis.

Crisp Reminder

Americans consume a billion-and-a-half pounds of bacon each year. “You may be surprised to learn that in the healthcare setting, bacon is a favorite menu item,” reports

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

Michelle Ali, RD, Director of Food and Nutrition at Trinitas. “Bacon is not just a favorite of our patients, but also of our staff—so much so that bacon is in the Top 10 foods purchased on a regular basis for Trinitas.” That probably wouldn’t come as a surprise to those who were part of Bacon Week, a festival held at the Tropicana Casino in Atlantic City this past February, just one of about two dozen similar events scheduled to be held around the country in 2014. Among the highlights (aka lowlights) were bacon beer, bacon vodka, bacon milkshakes, bacon cupcakes, bacon cologne, bacon toothpaste, and bacon floss. Ali explains that bacon enjoys high marks for two reasons: fat and salt. “Fat is integral to the flavor and texture of bacon. The role of salt is as a preservative added during the brining process, otherwise known as curing.” When you combine these factors—high saturated fat and high sodium content—Ali recommends that it’s best to eat bacon in moderation. In other words, remember to eat healthy and don’t pig out.

Where There’s Smoke…

If you “use” cigarettes but don’t consider yourself a “smoker,” guess what? A) You’re not alone and, B) you’re not doing yourself any favors. A recent article in Tobacco Control cited a recent study in California that looked at two groups of “non-identifying” smokers—people who smoke at least once a month, but don’t think of themselves as smokers. One group consisted of older adults who quit smoking in the past, but still indulge in the occasional cigarette. The other group was made up primarily of people in their 20s and 30s who smoke “socially” but do not believe they are addicted to nicotine. Incredibly, 22 percent of non-identifying smokers actually admitted they smoke at least once a day. Researchers are drawing some troubling conclusions. For example, the number of people who do not identify themselves as smokers in health-related surveys may throw off the data. Also, smokers who don’t think of themselves as such are unlikely to avail themselves of quitting strategies, and thus run the risk of getting hooked on cigarettes. Why is the number of non-identifying smokers so much greater than previous estimates? As smokers become more marginalized, they don’t want to admit they are part of a socially unacceptable group. The Surgeon General recently added diabetes, colorectal cancer, liver cancer, and erectile dysfunction to the long list of smoking’s list of diseases and health problems.

The Wrong Kind of Tweeting

Late last year, an Illinois man was arrested for keeping nearly 500 birds—both alive and dead—in his suburban Chicago townhouse. Besides being arrested for animal cruelty, the man was also ordered to undergo therapy for hoarding. He admitted that he had become obsessed with acquiring birds after rescuing a parakeet in 2006. Between new bird purchases and their geometric breeding practices, the situation got out of hand within a few years and he felt powerless to address it. The creepy thing was that there were more than 100 dead birds that he couldn’t bring himself to throw away. Hoarding is a debilitating mental health condition that does not always respond to psychological treatments that are effective on other obsessive-compulsive disorders—and it’s a lot more common than you’d think. According to psychologist David Tolin, author of Buried Treasures, between 2%and 5% of Americans may meet the criteria for hoarding, and rarely do their homes show outward signs of the occupant’s disorder.

Patricia Neary-Ludmer, PhD
Director, Trinitas Family Resource Center
908.276.2244

Patricia Neary-Ludmer, PhD, Director of the Trinitas Family Resource Center in Cranford, concurs. “While the outside of their homes may appear normal, the inside, in many cases, has been reduced to mere pathways,” she explains. “The individuals are paying high rents or mortgages but their living space has been reduced by upwards of 80-90% in some cases.” These circumstances are compounded by their inability to address the issue, Dr. Neary-Ludmer notes. “Making decisions on what should stay or go is very painful; when meaningful or frustrated relatives clear the possessions of hoarders, the possessions are often replenished.”

Going Deep

Deep brain stimulation has been utilized with great effectiveness to treat the motor symptoms of Parkinson’s disease. Now this type of treatment is showing promise for individuals suffering from severe depression, who have not responded to antidepressant drugs or psychotherapy. According to neurologist Helen Mayberg of the Emory University School of Medicine, this treatment involves inserting electrodes to targeted areas of the brain, which are connected to a device that sends high-frequency electrical stimulation at regular intervals. The device is implanted in a patient’s chest. Ninety percent of the participants in an ongoing experiment have had positive results two years after the implantation surgery. “What we have found with patients is their psychic pain is gone with the treatment,” says Dr. Mayberg. “The constant brain stimulation takes away the profound mental suffering which allows the patient to re-train to do things they haven’t done in years.” This is far from a simple solution, she cautions, requiring a skilled team of brain-imaging specialists, neurologists, neurosurgeons, psychiatrists and psychotherapists.

News, views and insights on maintaining a healthy edge.

In the Blink of an Eye

High-powered blue handheld lasers—which some parents purchased for their children this past holiday season—are anything but toys. So powerful is the light from these devices that the normal blink reflex isn’t quick enough to prevent damage when they hit the human eye. Blue laser pointers resemble lower-wattage red and green laser pointers, but can cause much more severe retinal damage in just a fraction of a second—including hemorrhaging in multiple retinal layers, macular pucker and a retinal cavity. Ouch! A recent study in Ophthalmology stated that the lack of public knowledge about blue handheld lasers could lead to an “epidemic of ocular injuries” and called for government intervention.

Eating Away the Blues

While newspapers and magazines are full of stories about “holiday blues,” you don’t hear much about the sadness and mild depression that can kick in after the wind-down of endless parties and presents. In many cases, the problem is related to extra pounds we pack on in December and January. The good news is that healthy eating in February and March can not only help you shed that weight, it can also improve your mental well-being. For example, study after study has shown that adding foods rich in Omega-3 fatty acids can be effective in staving off depression. These foods include salmon and tuna, dark leafy vegetables, nuts and flaxseed. Fish (along with low-fat dairy foods) can also boost your mood by boosting your B12 levels. There is also growing evidence that a diet high in selenium can improve mild depression. Fish, nuts, lean meats, beans and whole grains are rich in selenium. Some other rules for avoiding diet-related moods swings include eating a healthy breakfast every day, drinking plenty of water and consuming a healthy snack or small meal every four hours or so for sustained energy.

16 Going on 17

How much exercise is too much exercise? For teenagers, this question almost seems superfluous. Study after study shows that kids simply aren’t active enough. According to sports medicine authority Dr. Michele Gilsenan, by mid-teens, when participation should be high, the opposite occurs and sedentary living becomes the norm for many teenagers. As reported in the Archives of Disease in Childhood, seven hours a week is the recommended “dosage” of sports for most teens; for kids on teams, an average 14 hours delivers the maximum benefit in terms of fitness and proficiency in a sport. However, 17 hours is the tipping point at which strenuous activity becomes detrimental for athletic teenagers. Once that 17 hour maximum is reached, the benefits of sports participation, including improved self-esteem and mental acuity and the reduced risk of depression, appear to diminish. In fact, researchers from the Institute of Social and Preventive Medicine in Switzerland found the risk of depression, irritability and anxiety actually starts to increase. “As young athletes frequently choose a single sport that they play year-round, overuse of the same muscles occurs,”

Michele Gilsenan, DO
Member, Family Medicine Department 732.388.7300

Dr.Gilsenan observes. “In general, early burnout from the sport or physical activity occurs. As a result, we’re seeing a type of injury in younger athletes that was once reserved for those older. Also, with too much sports activity, there is the possibility of reduced concentration, which can lead to potential injuries, too.”

Nuts to You

A study published in the New England Journal of Medicine this winter reached the startling conclusion that people who eat a handful of nuts every day have a lower mortality rate by 20 percent compared to those who do not eat nuts at all. That statistic covers death from all causes, but the study pointed specifically to significant differences in death due to heart diseases, cancer and respiratory illnesses. This news is exciting because it involves a relatively simple, un-dramatic lifestyle change. “Nuts contain unsaturated fatty acids, the good fatty acids. They help lower bad cholesterol, the low density lipoprotein (LDL), which is linked to the hardening of coronary arteries that can lead to heart attacks,” asserts

Fayez Shamoon, MD Director, Cardiovascular Services 973.877.5160

Fayez Shamoon, MD, Director of Cardiovascular Services at Trinitas. “Nuts, especially walnuts, hazelnuts, almonds, and peanuts, as recently shown, are also rich in fiber and are an extremely beneficial part of a heart-healthy diet as suggested in a July 2003 Food and Drug Administration (FDA) statement.” The New England Journal reporting further found that nut-eaters were more likely to consume fruits and vegetables, be non-smokers, and get a decent amount of exercise. These links may have something to do with the fact that nuts quell hunger pangs between meals compared to less nutritious snack foods. In a nutshell, Dr. Shamoon adds that eating one to two ounces of nuts daily is highly recommended.

Vacation Souvenir

The growing popularity of “nip-and-tuck tourism”—the blending of a tropical vacation with lower-cost cosmetic surgery procedures—is not without risk. In Boston this past fall, hospitals reported several cases of Mycobacterium abscessus infection, involving bacteria that are particularly stubborn when it comes to antibiotics. When doctors looked for a common vector, they found that the patients had undergone cosmetic surgery while vacationing in the Dominican Republic over the summer. Soon, they found that hospitals in New York, Connecticut and other states were reporting similar cases. Mycobacterium abscessus is spread by contaminated medical equipment and supplies, and bad surgical technique, but doesn’t show up until many weeks later. Fortunately, the infection is not contagious. A word to the wise from Board Certified plastic surgeon

Joseph D. Alkon, MD Chief, Plastic Surgery 908.583.5630

Joseph D. Alkon, Chief of Plastic Surgery at Trinitas: “When considering aesthetic plastic surgery, or any type of plastic surgery for that matter, it is important to seek out a board-certified plastic surgeon who is trained and experienced in your desired procedure. Verify the training and credentials of the physician who will be performing your surgery and the certification of the facility where your surgery will be performed. An excellent resource for this is the American Board of Plastic Surgery’s website, www.abplsurg.org. If your physician is not listed here, yet claims to be ‘board-certified,’ then that should serve as a warning and prompt you to ask specific questions about their credentials and training, and their ability to perform your plastic surgery safely.”

Autism Breakthrough at Yale

Research published in late 2013 by the Yale Child Study Center shows promise for oxytocin (OT)—aka the “love hormone”—in the treatment of autism. Areas of the brain governing social functions such as empathy and reward had greater activity after subjects were given an inhaler spray of oxytocin. The effects were temporary and the number of subjects (17) in the study small, but the really encouraging news may be that the brain regions involved in autism may not be irrevocably damaged. Another interesting finding in the Yale study was that children whose saliva had higher levels of oxytocin exhibited more activity in the amygdala, the part of the brain that plays an important role in the processing of emotions. “This encouraging study at Yale challenges what we know about treatment being effective in children only when given by three years of age,” asserts

Romulo Aromin, Jr., MD
Medical Director, Child/Adolescent Partial Hospital Programs 908.994.7028

Romulo Aromin, Jr., MD, Medical Director of Child/Adolescent Partial Hospital Programs at Trinitas.  “Children and adolescents with Autism Spectrum Disorders may still be responsive to medication and may still be malleable more than what we thought. Currently, Applied Behavioral Analysis (ABA) has been the evidence-based treatment recommended during this window period. Without such treatment, prognosis will be adversely affected. This study opens utilizing occupational therapy and Applied Behavioral Analysis as intervention arms.”

After five-plus years at Trinitas, the da Vinci Robotic System continues to surprise and impress

By Erik Slagle

If there’s a certain level of art that goes along with the science of surgery, the wave of advances taking place in robotics-assisted procedures could be considered its Minimalist movement. Less cutting. Less blood loss. Less pain. Less recovery time.

Less is usually more when it comes to surgery, and the procedures made possible by innovations such as the Single-Site da Vinci System are bringing surgeons and their patients to the cutting edge—which in many cases means a lot less cutting than in years past. Nowhere around New Jersey is that more evident than at Trinitas, where robotic equipment has transformed the concept of surgery in fields such as gynecology, colon and rectal, and gallbladder removal. The surgeons carrying out these operations often turn to robotics for maneuverability and visibility—consistently leading to more positive outcomes and faster recoveries for their patients.

“The ability to carry out robotic surgeries at Trinitas enables us to be more aggressive in how we treat, while giving us almost unlimited access within the surgical field,” says

Labib E. Riachi, MD, FACOG Chairman, OB/GYN
Director, Robotics 908.282.2000

Dr. Labib Riachi, Chairman of Trinitas’ OB/GYN Department and Director of Robotics. Dr. Riachi has carried out more than 700 procedures since 2009 on the da Vinci System. While at a console, a surgeon can manipulate the “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, fibroids, bleeding, lysis of adhesions and endometriosis, and now trains other surgeons to do the same.

The benefits are easy to see—literally. “This technique provides us with ten times the magnification that we’d have with conventional open and laparoscopic surgeries,” Dr. Riachi says. “When treating endometriosis, for example, we have unparalleled precision in identifying, lifting and excising the lesions. At the consoles, we can manipulate surgical equipment with 360-degree rotation—superior even to laparoscopy. We can hold, dissect, and clean at better angles, and bring in a second surgeon if necessary without having to scrub out—that doctor can sit down at the adjacent console and see exactly what we’re seeing.”

A recent patient of Dr. Riachi’s, only in her 30s, had consulted with nearly a dozen doctors over a 15-year period to treat endometriosis that threatened to claim her ovaries. Still hoping for the opportunity to one day become pregnant, the young woman was desperate to avoid losing her reproductive organs, but appeared to be running out of options. Through the da Vinci method, however, Dr. Riachi was able to clean and correct all of her adhesions and excise all the endometriotic lesions in a single surgery, saving her entire reproductive system in the process.

“For 15 years, this patient had lived with chronic pelvic pain,” Dr. Riachi says. “But thanks to robotics, in cases like hers we no longer have to take out an ovary. We can clean and clear the reproductive system instead. At a follow-up appointment, she said she hadn’t felt this good in years.”

Preserving organs and saving body functions are primary goals of systems such as the da Vinci. Even in cases where Single-Site isn’t an option, surgeons are finding that introducing other types of robotics into the process can yield great results.

Andrea S. Zimmern, MD, FACS Colorectal Surgeon 908.994.8449

For Dr. Andrea Zimmern, colon and rectal surgeries can be carried out using a combination of laparoscopy or open surgery along with a robotic “helping hand” to gain the most favorable outcomes. In Dr. Zimmern’s field, robotic precision can help surgeons carry out procedures that might otherwise prove impossible.

“The visualization [using robotic equipment] is far beyond anything we’ve had previously,” Dr. Zimmern says. “With robotics, we can perform surgeries that used to be impossible even via laparoscopy. We recently treated a patient who came to us with an abdominal tumor that took up his entire pelvis. The patient was also suffering from obesity, which made his case especially complicated. Even with laparoscopy, we wouldn’t have been able to remove the cancer without giving the patient a permanent colostomy. But the precision of our robotic equipment allowed us to do just that. So we’re learning there are particular instances and cases where the ability to carry out robotics-assisted surgery isn’t just advantageous—it’s really the ideal.”

The use of robotics in surgery is quickly becoming common across a range of fields including cardiology, endocrinology, and general surgery. Robots are now key players in helping surgeons tackle aggressive cancers of the bladder, uterus, prostate, throat and more. With skilled, talented, trained surgeons at the controls, the robots at work in the operating theaters at Trinitas are driving modern medicine into a future that used to exist only in the realm of science fiction. Like its namesake, the da Vinci System is redefining an art form: the art of complex, life-changing and life-savings surgeries.

Rodolfo Colaco, MD, FACS, FICS Chairman, Surgery
908.353.4177

Pioneering surgeon Rodolfo Colaco, MD, underwent specialized training and performed the region’s first robotic single site procedure at Trinitas in 2013. The patient’s gallbladder was removed through one tiny incision in the belly button, making the procedure virtually scarless.

Reaction Time

Allergies are the result of a reaction that starts in the immune system. An allergy to eggs, for instance, means your immune system identifies a protein found in eggs as an allergen. Your immune system reacts by producing antibodies called Immunoglobulin E (IgE). These antibodies attach to cells in your skin, lungs and gastrointestinal (GI) tract. If you come in contact with the allergen again, the cells release chemicals including histamine, which cause food allergy symptoms such as itching, hives, swelling, diarrhea, wheezing and a potentially life-threatening reaction called anaphylaxis. Without immediate treatment—an injection of epinephrine and expert care in a hospital—anaphylaxis can be fatal.

www.istockphoto.com

How do I identify anaphylaxis as opposed to an allergic reaction?   

An allergic reaction is responsible for affecting one organ, as is the case with common dermatological manifestations like urticaria (hives) and pruritis (itching). The signs of an allergic reaction can begin with something as simple as a rash to something more severe, such as shortness of breath and difficulty breathing. Anaphylaxis involves the skin and additional organs. On the spectrum of allergic responses, anaphylaxis is a profound reaction.

When does an allergic reaction demand a visit to the ER?

When you suspect anaphylaxis. Symptoms may include difficulty breathing, dizziness or loss of consciousness. If you experience any of these symptoms in the context of eating, immediately call 911. If you have known food allergies and have been prescribed auto-injectable epinephrine, use it and then call 911. In either case, don’t wait to see if your symptoms go away or get better on their own.

What are the typical causes of profound allergic reactions?

In 2014, an article in the Journal of Allergy Clinical Immunology found that anaphylaxis in adult patients was triggered 34% of the time by medications, 31% by food, 20% by insect stings and environmental allergens, 2.6% by latex, 1.2% by exercise, and 11% by unknown factors. When you factor in children, food allergy has become the most common cause of anaphylaxis overall in the United States.

Safety Steps

A good day for me and my staff is a day when we don’t have to treat an anaphylaxis case. There are some basic steps you can take to help make that happen…

• Always ask about ingredients when eating at restaurants or when eating foods prepared by family or friends.
• Carefully read food labels. The United States and many other countries require that major food allergens (milk, egg, fish, shellfish, tree nuts, wheat, peanuts and soybeans) be listed in easy-to-understand language.
• If applicable, carry with you—and know how to use auto-injectable epinephrine and antihistamines to treat emergency reactions.
• Teach family members and other people close to you how to use auto-injectable epinephrine and consider wearing an ID bracelet that describes your allergy.
• If a reaction occurs, have someone take you to the emergency room, even if symptoms subside. Afterwards, get follow-up care from your allergist.

What percentage of children have food allergies?

Generally, food allergy in children has an estimated prevalence of 8% in the United States, with approximately 150 deaths per year. Common food allergens include eggs, milk, soy, peanuts, tree nuts and shellfish. Tree nuts and peanuts are responsible for a large proportion of anaphylactic reactions. All patients with food allergies should avoid contact with these products, including contact with areas where these foods are prepared.

Can kids “outgrow” an allergic reaction to a food, ingredient or spice?

Most children outgrow their allergies to cow’s milk, egg, soy and wheat, even if they have a history of a severe reaction. However, shellfish allergy tends to persist through adulthood. Repeat allergy testing with your allergist can help you learn if you or your child’s food allergies are resolving with time.

I’m lactose intolerant. Does that mean I’m allergic to milk?

There is a difference between food allergy and food intolerance. A food allergy involves the immune system while food intolerance—and lactose intolerance is a good example—does not. Food intolerance typically involves the GI tract, causing uncomfortable symptoms like abdominal pain, nausea, vomiting and diarrhea. But there is no risk of anaphylaxis.

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Can stress trigger allergies?

When you’re all stressed out, your body releases hormones and other chemical— including histamine, that powerful chemical that leads to allergy symptoms. While stress doesn’t actually cause allergies, it can make an allergic reaction worse by increasing the amount of histamine in your bloodstream.

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.

An award-winning patient has transformed the culture of the Linden Dialysis Center.

For nearly four decades, Angela Taggart has successfully managed her renal failure through regular dialysis sessions, adherence to her doctors’ orders, and the support of her family. Even so, nothing has impacted her success as profoundly as her faith and her outlook—an outlook so inspiring that she was recently honored with the Patient Engagement Award from a major national renal disease network.  

Photos by Kathryn Salamone

Angela’s sessions at the 5-star CMS-rated Linden Dialysis Center begin with a ritual Hello to each of her fellow patients. Ruby Codjoe, RN, is the Unit Manager of the facility, which is a satellite operation of Trinitas Regional Medical Center. She has known Angela as a patient for the last 20 years. Ruby strategically seats new patients, who are sometimes depressed and upset at their own conditions, next to Angela so she can spread her own life lessons, share her insights, and offer encouragement that renal disease doesn’t have to take over a person’s life

“It is amazing to witness,” Ruby says. “What begins with a simple introduction to a new patient who may be sad and depressed results in a more hopeful patient, thanks to Angela fostering a positive outlook in them.”

When it was time to nominate a patient for the annual Patient Engagement Award presented by Quality Insights Renal Network 3 (QIRN3), Ruby immediately submitted Angela’s name.  “George Elliot once said, ‘It’s never too late to be who you might have been.’ It’s a perfect way to describe how Angela lives her life.”

Angela Taggart is an inspiration to all dialysis patients, according to Joan Wickizer, Patient Services Director at QIRN3.  “The thing that struck us about Angela’s story was how she serves as a cheerleader for other patients,” she says. “And how, for more than 30 years. she’s maintained such a full, engaged life.”

For the record, it’s 38 years. Angela started dialysis at just 20 years old. She has made a point of trying to live every day as if it could be her last. In the early days of her treatment—following a failed kidney transplant that led to life-threatening complications—she was befriended by an elderly fellow patient who passed along life-changing advice: learn.  

“He told me to take charge of my situation,” Angela remembers, “and learn what the machines do. Get involved in your treatment.  Ask questions. By staying engaged, you take back your independence.  I’ve been ‘in school’ for 38 years, and I never stop learning.”

In that spirit, Angela set a goal of returning to school and, in 1996, almost 20 years after being diagnosed with renal failure, she graduated from Kean University with a degree in Business Management and a teaching certificate for Special Education.  A stint with AmeriCorps followed, and she went on to teach preschool at Rahway’s Destiny After School Haven, as well as substitute teaching for the Elizabeth and Rahway school systems.  

The Patient Engagement Award notwithstanding, Angela doesn’t see herself as an example. In fact, when she was told she would be receiving the honor, she thought it was a practical joke.  

“I think that sometimes I’m a complainer,” Angela laughs. “I’m constantly asking questions, wanting to know how things work or why they’re being done, advocating on behalf of the other patients.”

Indeed, she advises and inspires others grappling with their illness and treatment. Playing that role means staying in constant, persistent communication with the staff at the Linden Dialysis Center. Angela pays attention to the small details that can make dialysis a more positive experience, from better Wi-Fi service to the comfort of the chairs.  She helps the center staff understand what it means to be a dialysis patient, including “bad days” when a patient might prefer simply to be left alone with the machine and a television.

Angela reminds her fellow patients to never stop asking questions or learning about their own treatments. She encourages them to pay attention to their bodies and listen for cues, reminding them that nurses and doctors can only do so much; it’s up to the patients to communicate how they’re feeling and responding. 

Angela says her strength is based in faith, and in her belief that prayer can work miracles.  She is a leader in her Church community, and never stops looking for ways to transfer that faith and grace to her fellow patients.  By initiating activities like a Birthday Card Campaign for patients who have left the center and the ‘Encourage Your Nurse’ project, she has turned the dialysis center into a real community, with a network of love and support.

Angela’s always seeking new ways to encourage other patients and the staff, and remains in Ruby’s words “tenacious, resilient, and ambitious.”  Naturally, whenever the center gets a new machine or other equipment, she asks for the manual and reads it during treatment.

Angela is engaged…the recognition from QIRN3 confirms it.

She exemplifies the life of someone who truly cares for others and will do everything in her power…for everyone she comes in contact with reads the nomination submitted by Ruby Codjoe and other members of the Linden team. She is the example of beating the odds no matter the obstacles that come her way

A pair of recent breakthroughs hold promise for type 1 and type 2 sufferers

Americans may be living longer, but they’re also living sicker. Chronic and acute illnesses are on the rise, most notably diabetes. According to the American Diabetes Association (ADA), diabetes causes more deaths per year than breast cancer and AIDS combined. Diabetes affects 25.8 million Americans, about 8.3% of the population; it is the seventh leading cause of death in the U.S. and sixth in our state.

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Not surprisingly, doctors have become hyper-vigilant when it comes to certain factors related to diabetic or pre-diabetic conditions. Nor should it come as a surprise that medical researchers and scientists around the world are working hard to find ways to prevent, manage and even cure this disease. In the last half of 2015 alone, several significant breakthroughs were reported. They ranged from new medical procedures to behavioral and dietary tweaks. Although a long-term magic-bullet cure is unlikely, the past year has produced some eye-opening results.

BioHub Breakthrough

A Texas woman named Wendy Peacock was introduced this summer as the first transplant recipient of a BioHub that mimics the pancreas. Peacock, who is in her 40s, was diagnosed with type 1 diabetes as a teenager and suffers from severe hypoglycemia unawareness—a dangerous drop in blood sugar that could cause her to faint without warning, or even slip into a coma while she’s asleep. With the implanted bio-engineered “mini-organ” she now has normal glucose levels and no longer needs to inject herself with supplemental insulin.

You Can Manage Your Diabetes!

If you’ve just been diagnosed, or if you’ve been living with diabetes, quality medical care, encouragement and education can make a difference in your daily life.

As an American Diabetes Association fully-accredited diabetes center, the Diabetes Management Center at Trinitas Regional Medical Center is a center you can trust to help you effectively manage your diabetes.

Ari Eckman, MD

Director, Trinitas Diabetes Management Center

Graduate of Johns-Hopkins University School of Medicine in Baltimore Specialist in Diabetes, Endocrinology & Metabolism committed to patient care and education

A respected staff of certified diabetes nurses, educators and nutritionists offer classes and one-on-one counseling

Quality medical care and attentive nursing support designed with you in mind to make diabetes a manageable part of your life

TRINITAS DIABETES MANAGEMENT CENTER

Medical Office Building, Suite 202  | 240 Williamson Street  | Elizabeth, NJ  | 908.994.5490THE HIGH COST OF HELPING

Statistics released by the ADA in 2013 on the cost of managing America’s diabetes problem were staggering:

• $245 billion: Total costs of diagnosed diabetes
• $176 billion for direct medical costs
• $69 billion in reduced productivity

A further breakdown of statistical evidence regarding diabetic-related expenses reveals:

• Inpatient hospital care (43%)
• Prescription medications to treat complications (18%)
• Anti-diabetic agents and diabetic supplies (12%)
• Physician office visits (9%)
• Nursing/residential facility stays (8%)

“As any type 1 knows, you live on a very structured schedule,” she said during a September press conference at the University of Miami Miller School of Medicine. “I do a mental checklist every day in my head: glucose tabs, food, glucometer, et cetera… Then I stop and say, ‘Wow! I don’t have to plan that anymore.’ Laying down at night and going to sleep and not having to worry about lows is something that is so foreign to me. It’s surreal to me. I’m still processing the fact that I’m not taking insulin anymore.”

The BioHub, which contains islet cells that restore natural insulin production, promises to be “a game-changer for millions of people,” according to Dr. Camillo Ricordi, who directed the project. Islet transplantation is not a new approach, but it has only been used in the liver until now.

The minimally invasive procedure required only three incisions, and doctors said they expected to perform 20 or 30 more at Miller School of Medicine in the coming year. And other diabetes centers will almost certainly join the BioHub trial.

Meanwhile, Peacock has no restrictions other than the diet and lifestyle a physician would recommend to any non-diabetic patient. “I feel like a great weight has been lifted,” she said, “I can breathe again.”

Type 1 diabetes is often referred to as Juvenile Diabetes, as it typically affects children and young adults. About one in every 600 children in the United States develops Type 1 diabetes, making it one of the most common chronic diseases in children. Symptoms usually occur during puberty, but it’s on the rise among younger children, some under the age of 5. Type 2 is often diet-related. It used to occur mainly in adults who were overweight and older than 40, however as childhood obesity rates rise, type 2 is on the rise among young people aged 10 and over. Per a 2012 CDC report, more than one-third of children and adolescents were overweight or obese. Childhood obesity has more than doubled in children and quadrupled in adolescents. Type 2 is not as life-threatening or dramatic as Type 1 at the time of diagnosis, but it can trigger serious long-term complications such as blindness, kidney disease, heart disease and limb amputation if left untreated.

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THAT WOULD BE FALSE

According to the International Diabetes Federation, misconceptions about diabetes persist despite volumes of scientific and statistical evidence to the contrary:

1. Diabetes only affects old people!

FALSE! Diabetes affects all age groups.

2. Diabetes is not a killer disease!

FALSE! Diabetes is a global killer that is responsible for more than 4 million deaths a year. In fact, someone dies from diabetes-related complications about every 7 seconds.

3. Diabetes predominantly affects men!

FALSE! Diabetes affects both men and women. In fact, diabetes today is on the rise among women along with a dramatic increase in Juvenile Diabetes.

4. Diabetes cannot be prevented!

FALSE!Up to 80% of Type 2 diabetes is preventable by making healthy diet changes, increasing physical activity, and improving general lifestyle choices.

5. Diabetes only affects prosperous societies!FALSE! Diabetes is a rising threat to all socio-economic groups, both in the US and globally.

Structure Settlement

Researchers looking at type 2 diabetes have begun to explore the way everyday foods are made. A study in England looked at what happens when the natural structure of dietary fiber is preserved during food production. The study’s findings, published in Diabetes Week, suggest that doing so slows the rise in blood sugar level following a meal. If this is indeed the case, it could lead to food products that look, feel and taste the same as existing products—but with an enzyme-resistant structure surrounding the starch, which would enable these foods to be digested more slowly.

The way starch is metabolized is relevant to a number of weight-related conditions, including type 2 diabetes.

The dietary fiber of grains forms a “protective” network of cell walls around starch. However, milling grains to produce different types of flour damages these cell walls, which enables the body to digest starch more quickly.

Study subjects were given a wheat porridge made of the identical ingredients, with one made of coarser particles and one finely milled. The people consuming the porridge with the larger particles showed 33 percent lower blood sugar levels after the meal, and insulin responses that were 43 percent lower. They also experienced less of a sugar crash.

The results strongly suggest that milling techniques that maintain the microstructure of grains such as wheat might be the key to a new wave of diabetic-friendly white bread, breakfast cereals and pasta.

Diabetes-related costs in the U.S. rose from $174 billion in 2007 to $245 billion in 2012—a 41 percent jump over 5 years. Medical expenses for diabetics, on average, are 2.3 times higher than for non-diabetics. Indirect costs such as absenteeism, reduced productivity, and disability claims cost untold additional billions. Within the scientific and medical communities, the disease is generally acknowledged as having reached pandemic proportions.

The hope is that a multinational, multifaceted approach to the problem will help turn those numbers around in the near future. Lifestyle modifications encouraging healthy eating habits and promoting physical activity can help lower risk of becoming of becoming obese and contracting related diseases. Ironically, the greatest challenge may not be the scientific hurdles, but instead the cultural ones. Humans are consuming more and exercising less. There may never be a cure for that.

Editor’s Note: Special thanks to Yelena Samofalov, MD of the Trinitas Pediatric Health Center for her input on this story. See page 66 for more from Dr. Samofalov on TRMC’s Eat Right Today! Program.

On October 27th, mental health advocate  Zak Williams shares the virtual stage with Jack Ford at the Trinitas Health Foundation’s Peace of Mind Event. The son of actor and comedian Robin Williams, Zak has focused his entrepreneurial skills on mental health advocacy. He will be sharing his personal story to address the challenges and stigma associated with mental health issues. He is the former Chief Operating Officer of Crossing Minds and Director of Business Development for Condé Nast, and a graduate of Columbia Business School.     

EDGE: How would you characterize your approach to mental health advocacy? 

ZW: My approach is primarily systems-based— how we think about making a difference across a collection of avenues to ultimately provide a better, more comprehensive approach for individuals and communities. 

EDGE: Is that more dependent on top-down or bottom-up strategies as a catalyst for good things to happen? 

ZW: It involves taking both a bottom-up and top- down approach. It requires grassroots initiatives—people understanding the needs of people—as well  as top-down policy considerations, organizational considerations and considerations in the private sector. Also cultural considerations, which involve both bottom-up and top-down strategies.  

EDGE: What does a systems-based approach to advocacy in this space look like? 

ZW: I break things down into five categories where change can happen: Programming, which involves development of curricula and potential applications; Experience, which involves mental health awareness and campaigns focused on, for example, reducing stigma; Research, which is done by institutions nationally and abroad; Advocacy, involving strategic thinking and how organizations and different constituents communicate and coordinate around making change; and then there’s Policy, which occurs mainly in the public sector and includes educating policymakers to make pragmatic and thoughtful decisions about crafting policy that ultimately impact their constituents for the best. 

EDGE: I hear the entrepreneur in you talking. What strengths do you bring from that realm to this one? 

ZW: My role as an advocate bleeds into what I do in the private sector. In terms of how I operate as a business executive, as I said I’m very much a systems-based advocate. I rely upon metrics and data to make decisions. But for me it’s very much about establishing belief systems that impact society, culture and people for the better. You can take an advocacy approach whether you’re in the private sector or the not-for-profit world. It’s just a particular style of management and organization and leadership

EDGE: When you speak at events like the one for Trinitas, is it similar to giving a presentation in front of a group of potential investors? 

ZW: It’s exactly like giving a presentation in front of  a group of investors. The key thing is tying storytelling to impact and data. If you can tell a story with the numbers, it’s extremely compelling because, at the  end of the day, the human element of mental health support and advocacy is absolutely  critical. The numbers element helps tell a story at scale. So tying the  two together is critical for sustained investment into  the category.   

EDGE: Because of its proximity to both urban and suburban populations, Trinitas extends its mental health service to a very wide and diverse audience. Is that type of “parity” the focus of most advocacy organizations? 

ZW: Yes it is, especially on a policy basis. From a technical standpoint, it can be boiled down to something pretty straightforward, which is providing a foundation for mandating that insurers provide equal coverage around mental health programs. That is extremely important when it comes to providing quality of care. So organizations that take a leadership role within the space of mental health parity are on the vanguard of what mental health support will look like. 

EDGE: And what will it look like? 

ZW: Expanded services and high-quality care for all constituencies that need it. We’re getting there. Slowly. The California state legislature recently passed a mental health parity law that ultimately mandates that insurers take an egalitarian approach to providing services. People deserve high-quality care across the board, regardless of whether they come from means or they don’t. The more we can think about how to implement that on a systems level, the more people will have access to preventative care, just as they have access to chronic and crisis-oriented care. 

EDGE: What role do you think technology will play in moving this forward

ZW: I’m taking Dr. Ronald Kessler’s lens here in  terms of how he talks about technology. He’s an epidemiologist and policy expert at Harvard Medical School. He says there are “tech extenders” and “people extenders.” Tech extenders are telehealth platforms that enable care to be extended to places that might not have in-person, offline resources that would enable people to have the quality of care that they need. People extenders would include providing behavioral coaching services and additional social services, whatever they may be, training people to create higher-quality coverage in areas and regions that might not have, say, the level of psychiatrists needed across an entire population. So that might look like behavioral coaches or students or residents that can provide preventative-level care before it becomes a chronic or crisis issue requiring psychiatric interventions. You want to match people to the level of care that’s needed.  

Prepare for Takeoff  

In 2020, Zak Williams launched a new company, PYM Health. PYM stands for Prepare Your Mind. According to Williams,  it is focused on “providing lightweight to middleweight solutions for stress and anxiety,” he says. “Our first product is a chew that contains primarily natural amino acid compounds that provide stress/anxiety support.”   

Original Mood Chews are available online through the company’s website and other ecommerce channels. “Ultimately, we hope to be available in stores throughout the nation,” Williams says.

EDGE: What other goals do you have in the area of mental health advocacy? 

ZW: The privilege of being able to do the work I do is something that I hope other people will explore. Within the communities that I’m a part of, we hope to empower others to advocate for causes associated with mental health. Ultimately, I hope to support people along their journey and create more communities of advocates that will create change on a systems level. The fact that we’re able to have this conversation, I’m very grateful.  

EDGE: Going from “son of…” to “father of…” status is a turning point for a lot of people, whether your dad is a celebrity, as yours was, or not. In what ways has fatherhood changed your perspective?  

ZW: When it comes to raising my son, to parenting, it’s caused me to prioritize empathy and openness and understanding. It has certainly changed my perspective in how I think about mental health advocacy and advocating for change. My son is 15 months old. He doesn’t think about mental health, but I am very heartened by how young people think about mental health and the stigma associated with it. I’m 37, which I guess makes me a late-stage Millennial. Generations younger than myself tend to have an openness and orientation toward thinking about mental health as being essential to a balanced and healthy lifestyle. I want to take the long view here, that future generations have an opportunity to remove the stigma and biases associated with mental health and ultimately create a more tolerant society and world. 

Photo courtesy of Zak Williams

Zak is on the board of Bring Change to Mind (bringchange2mind.org), a nonprofit founded by Glenn Close, that works to end the stigma and discrimination surrounding mental illness. He’s an advisor for Inseparable (inseparable.us), a national organization focused on creating pragmatic mental health policy.

Trinitas helps get Tony Testa back on his feet. 

By Erik Slagle 

Tony Testa’s life has always been about giving it his all for the fans. As the original guitarist for the beloved doo-wop group The Duprees—and now their leader and frontman—Testa’s charisma and give-and-take with the audience make every show dynamic and unforgettable. The band  formed in the early 1960s in Jersey City and shot to fame with hits like “You Belong to Me,” “It’s No Sin” and the classic “Have You Heard.”  

Extensive touring and physical wear and tear on Testa over the years resulted in a hip condition that took him off his feet earlier this year. A born performer, Testa knew he couldn’t take chances with anything other than the best care and technology when it came to receiving an artificial hip—a critical joint for someone who needs to command the stage for a living. After researching hip replacement procedures, Testa decided to seek out a facility that uses the Hana Orthopedic Table (right) in its OR. The Hana Table has transformed how hip replacement surgeries are carried out: patient positioning via the table means the surgery can be minimally invasive, less painful, and with much faster recovery time. It all adds up to a vastly improved experience compared to hip replacements of even the recent past.  A friend who had recently undergone surgery of his own recommended that Testa—who lives in Jackson Township—look into the work being done at Trinitas, which uses the Hana Table in its OR.  After speaking to another friend, Nadine Brechner,  Chief Development Officer and Vice President of the Trinitas Health Foundation, Testa chose Trinitas even though Elizabeth is 50-plus miles north of his home. 

“I’ve known Nadine Brechner for some time now, and she told me about the facilities and staff there who could perform my hip replacement,” Testa says. “I made the decision that Trinitas, even though it was a little far, would be the best place to have this surgery.” 

Then, however, came COVID-19. The pandemic caused many to rethink the decision to undergo elective surgeries. Testa, though, says he never seriously considered postponing his operation: “I was reasonably sure it would be safe. Hospitals are always ensuring of a healthy and clean environment, and given the crisis, I was especially confident every precaution would be taken.”  

For Testa, who like other entertainers had his touring schedule postponed, the timing was ideal, as he would have plenty of time to recover and recuperate. Live concerts for The Duprees—and special events like Holland America’s Malt Shop Cruise, which features the group in its all-star lineup—are set to resume sometime in 2021.  

The effort to get Testa back into the spotlight co-starred orthopedic surgeon Dr. Mark Ghobrial, anesthesiologist (and Chair of the Department of Anesthesiology) Dr. Leon Pirak and the Trinitas nursing team—all of whom Testa describes as “nothing short of incredible

As New Jersey flattened its curve and hospitalizations began slowing in the spring, Testa’s procedure was carried out as planned. In fact, with extra safety measures and disinfection procedures in place, hospitals soon became some of the safest places to be in terms of potential COVID-19 exposure. Trinitas, of course, was no exception. 

The Duprees

“The whole staff was extremely attentive to health and safety protocols,” Testa says. “They made sure everyone had masks, were always taking people’s temperatures  and wiping everything down. As a patient, I never felt unsafe or like corners were being cut. Dr. Ghobrial was terrific. Dr. Pirak? Top-notch. And the nurses, I can’t say enough about them. I would recommend Trinitas to everyone. I had the surgery on a Tuesday and was out of the hospital by Thursday morning. I was walking again almost immediately

According to Testa, he could have been back on stage by September. Whenever that happens, for fans of the Duprees, it won’t be a moment too soon.

When New Jersey desperately needed more nurses,  Trinitas grads answered the call…in record numbers.

By Erik Slagle 

Unprecedented. Among the myriad adjectives we’ll be using to capture the magnitude of 2020 in the years to come, unprecedented might not be as vivid as devastating or frightening or horrifying, but it captures the positive along with the negative—and that makes it a word we should embrace. For instance, the dedication and courage of healthcare professionals in the face of a tsunami of unknowns brought about by COVID-19 was truly unprecedented, although hardly surprising. At Trinitas and other hospitals around the state, workers put their lives on the line every day because, well, that’s what they do, isn’t it? 

Also unprecedented in 2020 was the surge in interest among young New Jerseyans in entering the healthcare field—specifically nursing—at a time when there was no small amount of risk accompanying that decision.  

The 2020 graduating class of the Trinitas School of Nursing was the largest ever, with nearly 190 graduates immediately entering the workforce when their communities needed them most—a new generation of frontline heroes joined the fight against the pandemic.  

“COVID-19 actually affirmed, for me, that I made the right decision in starting a nursing career,” says Patience Opaola, who graduated from the School of Nursing in January and now works at Trinitas as a registered nurse (RN). After graduating from Linden High School in 2016, she started her RN education at 18, unsure of where she should go next in life. Opaola admits it wasn’t an easy adjustment moving later from the classroom to the front lines, but says she was met with a great deal of support. 

“I wanted to quit so many times,” she says of her early days on the Medical-Surgical floor. “But I’m glad I saw it through. You learn how to ask for help…everyone’s ready to lend a hand.” 

“These nurses and students are amazing individuals who want to work with patients that are very, very sick,” says Dr. Roseminda Santee, Dean of the Trinitas School of Nursing. “Our students want to serve their communities and take on the challenge of the COVID-19 battle.” 

Between January and May, a record 188 graduates earned their credentials at Trinitas, and Dr. Santee says that, during the worst months of the pandemic, the school continued to see extraordinarily high numbers of applicants. Most were new to the healthcare field, while some were Certified Nurse Aides or Licensed Practical Nurses, completing their education to become RNs. The cohort overall was a diverse mix of ethnic and cultural backgrounds, and included a number of male candidates, as well—more so than usual, according to Dr. Santee. 

The coronavirus outbreak, of course, forced the physical closure of schools at all levels, and the School of Nursing had to quickly pivot toward online instruction. Faculty and students alike stepped up and made the transition a smooth one. Looking ahead toward 2021, challenges are likely to continue until an effective vaccine is made widely available, as social-distancing measures limit the number of seats permitted in each class. However, says Dr. Santee, the school is up to the task. 

“I wish I could take every single one of our applicants,” she says, noting that some will have to be waitlisted. “It’s a balancing act, meeting the New Jersey Board of Nursing demand for more licensed nurses while adhering to state-mandated health protocols in our classrooms. We also have to bear in mind the guidelines required by the New Jersey Office of the Secretary of Higher Education.” 

The school’s ability to master that balancing act helped garner its fourth designation as a Center of Excellence in Nursing Education by the National League for Nursing—one of only 17 institutions across the country to receive the recognition for another four years. The relationship between Trinitas and Union County College is a key to the School of Nursing’s ongoing success. 

“Trinitas has been such an open and helpful partner,” she adds. “It’s a collaborative effort between the hospital and college to ensure we’re meeting the standards of nursing education and graduating enough nurses to meet the hiring needs of our healthcare facilities.” 

To help meet demand, the New Jersey Board of Nursing has approved “temp” new graduate nurse hiring, meaning candidates receive temporary work permits while waiting to take the licensing examination. These exams were also impacted by COVID-19 because of the social-distancing requirement for examinees. 

For more than a decade, the Trinitas School of Nursing has enjoyed a reputation for rigorous curricula, an outstanding teaching staff, and an admissions policy ensuring that only the best students—representative  of the community served by the school—are admitted as future healthcare professionals. Based on recent applicants, enrollees and graduates, the school will maintain its status as one of New Jersey’s top destinations for students looking to lead the fight for our nation’s health for years to come. 

“Getting into the hospital after finishing school may be a bit of a shock,” says Opaola, reflecting on her advice to others thinking of following her path. “You might feel small in the beginning, but you’ll have a lot of support. And that support starts with your faculty and classmates at the School of Nursing.” 

DID YOU KNOW? 

The World Health Organization  Designated 2020 as the International Year of the Nurse and Midwife in honor of the 200th “birthday” of Florence Nightingale.

Kids…They Swallow the Darndest Things

Few moments are more frightening to a parent than the realization that their child may be choking on, or have swallowed, a foreign object. Sadly, every five days a child in the U.S. dies in a choking incident, almost always involving food, toys or coins. Choking is especially common in children 4 years old and younger. Thankfully, the vast majority of incidents are resolved by vigilant parents and quick-thinking doctors and nurses. As an ER physician, you never know what you’ll find when you ask a young patient to “open wide.”

Sir Isaac Newton is famous for saying, “What goes up, must come down.” Is the opposite true? 

Although I make no claim to being a world-famous physicist, I can tell you with some authority that, no, the opposite is rarely true. Once something goes down a kid’s throat, it may require a visit to your local ER.

Is coughing and wheezing in a baby or toddler usually an upper respiratory issue—such as a cold or asthma—or should parents pay closer attention?

You should pay closer attention, because the problem could be the result of an ingested foreign body. Just because a child isn’t choking per se, it doesn’t mean something’s not stuck down there. For example, one morning, a father rushed his 18-month-old son into our ER coughing and wheezing. I took the child from the dad’s arms and attempted to lay him flat on a stretcher. The child refused to lay flat. He would only sit upright. I tried again.

The child began to choke and cough. The dad said, “See that? He is coughing and wheezing again.” A quick examination of the child’s eyes, ears and nose was normal.

So what was the issue?

While a nurse held the child’s head steady, I depressed his tongue and there it was: a tiny gold-colored, rectangular object lodged in his airway. We sat the child upright and I used alligator-forceps to extract the item. It was a SIM card from his father’s cell phone. Only then did the father put it all together—he realized that his son had been teething and sucking on his cell phone and had accidentally ingested the SIM card. What the father had heard was actually not wheezing. It was stridor, which is an upper-airway obstruction at or above the level of the vocal cords.

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What other objects do you see fairly regularly in the ER?

Ingested foreign bodies come in many different shapes and sizes. Some of the most common include coins, button batteries, regular batteries, small toys that contain magnets, plastic hair beads, crayons, safety pins, paper clips and hairpins. The ingestion of button batteries, which are often lithium batteries, is a true emergency and could be fatal. Button batteries can be found in common items such as watches, small toys, cameras and children’s sound storybooks, among other things.

What’s the procedure involved in dislodging a button battery?

Once a patient has presented to the ER with this type of ingestion, the ER doctor must take an x-ray to make certain that it is not in the esophagus. The caustic within the button battery can erode the esophageal wall and cause a severe, life-threatening infection within the thoracic (chest) cavity. The treatment is emergent retrieval of the button battery via an endoscopy, performed by a Gastroenterologist. The main point here is if you think your child has ingested a button battery, do not wait. Bring your child to the ER immediately for evaluation.

What happens when a child actually swallows a small object and it passes through the esophagus and into the stomach?

The response depends on the object. An 8-year-old girl presented to the ER one evening on the night of her First Holy Communion. She had gone to bed and then, a half-hour later, ran to her mother in fear stating, “I don’t want you to yell at me, but I think I lost my St. Elizabeth metal that Uncle Joe gave me today for my Communion! I have the chain, but I can’t find the medal.” After a thorough search of the bed and room, her parents grew suspicious and feared that she had in fact swallowed the medal by accident, but she was afraid to admit the truth.

Was that the case?

It was. After an x-ray of the child’s chest and abdomen, I discovered that the medal had already passed through the esophagus and into the stomach.

Did she confess—no pun intended?

Yes, in private, I again asked the child what had happened. She spilled the beans: “I was hanging upside down off the side of my bed, flipping the medal in and out of my mouth with my tongue…and then it came off of the chain! I got scared and accidentally swallowed it when I tried to get back up onto my bed. Please don’t tell Mama!”

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Did it pass through her system?

Yes. In general, once coins, medallions, etc., have moved beyond the esophagus, they will pass freely through the bowels. If a child has no symptoms after such an incident, a follow-up x-ray 2-3 days later can show us whether or not the coin has passed through the bowels. If a child experiences vomiting or abdominal pain, however, a repeat examination is needed, complete with x-ray. If the object is stuck, then it may have to be removed.

ALSO…

People with specific medical needs should have a wristband that would alert doctors and nurses of that special need. It might even save a life.

—Rita B.

We use different color-coded wristbands for certain (but not all) patients, Rita. It’s actually part of the Critical Care Committee’s playbook at Trinitas. Expanding this to include a wider range of conditions is something we are always looking at.

—John D’Angelo, DO

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.

Do you have a hot topic for Dr. D’Angelo and his Trinitas ER team? Submit your questions to AskDrD@edgemagonline.com

News, views and insights on maintaining a healthy edge.

Where There’s Vapor…

The science on e-cigarettes is sketchy at best, and because they currently do not fall under the FDA’s purview, manufacturers are not compelled to list product ingredients. “When e-cigarettes started to become available, I thought it could be a good thing as it could satisfy both chemical craving associated with cigarette smoking by administering nicotine and psychological craving associated with the act of smoking,” recalls

Vipin Garg, MD
Director, Trinitas Comprehensive Sleep Disorders Center 908.994.8880

Vipin Garg, MD, of Trinitas who is board certified in pulmonology, critical care medicine, internal medicine, and sleep medicine. “I had patients who reported early success.

However, as the market for e-cigarettes exploded, I soon realized that e-cigarettes are essentially vaporizing systems and any known chemical could be administered—and it often varies manufacturer to manufacturer. They open the door for more dangerous and potent chemicals/drugs being inhaled.”

There has been a proliferation in California of shops selling e-cigarettes and, according to the journal Pediatrics, e-cigarette marketing to minors has tripled in recent years. More than 5,000 Californians signed a petition this year urging the Food and Drug Administration to regulate e-cigarettes. Senator Barbara Boxer delivered to the petition FDA commissioner Margaret Hamburg. Not surprisingly, e-cigarette use by children under 18 has risen dramatically, not just in the Golden State, but across America.  A 2014 national study showed that more teens are using e-cigarettes than regular cigarettes, which on the surface may not be a bad thing. The fear, of course, is that e-cigarettes—which most teens consider to be “safe”—will lead young people into cigarettes and other tobacco products.

“As a pulmonologist,” says Dr. Garg, “I know anything other than air at ambient temperature administered to lungs can cause damage to pneumocytes, which are the breathing units of the lungs.  Noxious particles, heated vapors, varying degrees of humidity associated with these products have the potential of causing Reactive Airway Disease. Glorifying e-cigarettes—especially to minors—will be a big mistake. I support a complete ban of e-cigarettes.”

In Sickness and In Health

Americans may want to rethink their marriage vows. Iowa State University released a study in March tracking 2,700 couples in the U.S. from 1992 to 2010. It found that divorce rates increase when the wife becomes seriously ill. This was not true when husbands had long-term illnesses. The results suggest that American men are ill-equipped to function as caregivers to a seriously ill spouse. Overall, 32 percent of the couples divorced during the 18 years they were tracked; that figure rose to 38 percent when a wife fell ill.  During his years as an oncologist,

Barry Levison, MD
Medical Director, Trinitas Comprehensive Cancer Center 908.994.8772

Barry Levinson, MD, Medical Director of the Trinitas Comprehensive Cancer Center, has observed spousal caregiving first hand. “When taken on a case-by-case basis, there are many men who are superb caregivers. On the whole, however, I think in our society, the traditional role of women as caregivers still predominates. As these societal roles change, and men become more involved in caring for family, I think the data will change, as well.”

The Skinny On Oxytocin

Is it your imagination, or do people in love seem skinnier? It’s not your imagination. According to new research out of Massachusetts General Hospital, the hormone oxytocin—aka The Love Hormone, which surges when couples hug or kiss—also appears to be an appetite suppressant. A group of men (half of whom were overweight) inhaled oxytocin spray an hour prior to breakfast and consumed 122 fewer calories and 9 fewer grams of fat than men given a placebo spray. The men who inhaled the oxytocin also burned fat slightly faster and handled insulin better. The study results were presented at the 2015 meeting of the Endocrine Society in San Diego.

Kids and Air Pollution

A study of schoolchildren in Barcelona, Spain suggests that air pollution impacts brain development. Students ages 7 to 10 in schools located in neighborhoods with heavy vehicle traffic showed reduced cognitive development compared to kids in less-congested areas.

Kevin Lukenda, DO
Chairman, Family Medicine Department
908.925.9309

Dr. Kevin Lukenda, DO, Chair of the Family Medicine Department at Trinitas, says that it is a well-known fact that “fuel exhaust competes with oxygen in our body. By breathing in excessive fuel exhaust, we compromise the amount of oxygen that is much needed by our brains. With lower levels of oxygen in our brain, our cognition is then compromised.” Among the conclusions drawn from the Barcelona data were that school buses in Spain (which run on unleaded fuel) should be fitted with particle filters, and classrooms facing busy streets should always keep their windows closed.  Dr. Lukenda sums up: “In this era of technology, we must do whatever it takes to prevent noxious chemicals from entering our bodies. Whether it be through a filtering process or other mechanical barriers, the less fuel exhaust and more oxygen we breathe the greater the ability we have to process cognitive information.”

No Ordinary Joe

The latest research on coffee swings the pendulum back toward America’s favorite hot beverage. Scientists in South Korea exploring the link between coffee consumption and the level of calcium in arteries determined that drinking up to five cups a day may reduce the risk of heart attacks. Their study of 25,000 men and women found the lowest levels of calcium among those who drank 3 to 5 cups of coffee a day. Calcium in the arteries is an early indicator of cardiovascular disease. So should we drink even more? Not so fast. The same study found the highest levels of calcium in subjects who drank over 5 cups a day.

Playing with Matches

Does love at first sight translate into successful long-term relationships? Study after study says No. Couples that marry due primarily to physical attraction have a higher rate of divorce than other couples. Rutgers University anthropologist Helen Fisher points out that our bodies actually develop a tolerance to the chemicals that trigger initial feelings of love—just as they build up tolerances to other chemicals. Add to this the fact that “looks fade,” and eventually all you’re left with is conversation and common interests. Physical attraction is important, of course, but in the balance it is not a good predictor of long-term compatibility. Full disclosure: Dr. Fisher is also the chief scientific advisor for the dating web site Match.com.

Skin In the Game

Mexican scientists believe they have found a skin test that may predict Alzheimer’s and other degenerative brain diseases. Minimally invasive skin biopsies on Alzheimer’s and Parkinson’s patients turned up significantly elevated levels of Alpha-Synuclein and Tau, proteins linked to decline in brain function. Brain and skin tissue share the same embryonic origin, which suggests that definitive tests for Alzheimer’s and related problems could be performed long before obvious symptoms arise. Early detection, in turn, could be the key to managing or even curing brain disease.

Science and technology are paving the way for a mind-altering experience.

What lies within our heads, protected by the bony shell of the skull, is a collection of soft nerve tissue that weighs only about 3 pounds on average—less than most other human organs. The brain is 75% water and consists of 100 billion neurons (equal to the number of stars in the Milky Way). Stretched out, these neurons would reach 600 miles.

At the mere mention of diseases of the brain, many of us might think first of tumors. According to the American Cancer Society, about 22,000 Americans are diagnosed with brain tumors annually.  The most common variety is the primary brain tumor, which includes more than 125 different types according to cells of origin. When a tumor grows within the bony confines of the skull, it can press on and damage the brain itself. Other tumors can migrate from elsewhere in the body and are therefore labeled metastatic. A variety of symptoms can present with a tumor: headaches, vomiting, blurred vision, seizures, memory and/or speech impairment, motor and/or sensory problems, personality changes and failing vision.

Specific treatment for a brain tumor is dependent on a variety of personal factors:

• Age and general health conditions
• Type and location of tumor (from low-grade I and II tumors through the more aggressive Grades III and IV)
• Drug, irradiation and/or procedure tolerance

Recommended treatment options include:

• Surgery
• Irradiation
• Chemotherapy
• Antiseizure/Antiepileptic Drugs (AEDs)
• Steroids

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What’s new in brain surgery?

The biggest challenge in brain tumor surgery cited by most neurosurgeons is how to remove all of the cancer while preserving the greatest possible brain tissue. Certain advanced procedures are already in place and available:

• Awake Surgery is the preferred approach when a tumor is situated close to those areas of the brain that control motor activity and speech. Awake surgery allows the surgeon to communicate at certain intervals with the patient to confirm normal conversation and movement capabilities have not been affected.
• Computer Assisted Surgery (CAS) is cutting-edge technology that allows the surgeon to view a detailed image of the patient’s brain while on the operating table to achieve more complete tumor removal.
• Robotic Surgery is a type of CAS through which the physician’s personal skills are enhanced by the precision, control and accuracy of a computerized robotic arm. An advanced minimalist surgical approach of this type is the da Vinci Surgical System, which has been available for more than five years at the Trinitas Regional Medical Center.
• Radiosurgery uses radiation to destroy precisely targeted tumorous tissue without affecting surrounding healthy tissue. This procedure, referred to as the Gamma or Cyber Knife (although not a knife in the true sense at all), was invented in Sweden in 1968 and introduced in the US in 1987.

And what about aging and the brain?

As the Boomer generation is approaching retirement, public and scientific attention has centered on other neurodegenerative brain challenges, for instance, dementias such as Alzheimer’s Disease. The National Institute on Aging (NIA) defines dementia as a disease that affects communication skills and the ability to perform “activities of daily living (ADLs).” Alzheimer’s dementia results in impaired thought processing, forgetfulness, loss of recent-term memory, and language difficulties. All currently acceptable descriptions refer to symptoms and not causes of these diseases, and for good reason. The causes continue to elude the investigators. Sadly, the diagnosis of Alzheimer’s disease often can only be confirmed by autopsy.

Statistics justify the growing concern in neuroscientific communities and in private lives about dementia. More than 5 million people in the US have been diagnosed with Alzheimer’s, accounting for 50-70% of all dementia cases per CDC research.  And this number is projected to reach 13.5 million by 2050. The total costs involved are equally mindboggling, at $226 billion per year.

As the focus, particularly on Alzheimer’s, intensifies, so does the level of personal concern as life expectancy continues to increase in the US. A critical if somewhat oversimplified question that often arises is: When is forgetfulness a normal part of aging and when does it become a cause for concern?…a very good question with no easy answer. Instead, a continuum of  stages is applied to generically categorize the disease in terms of the varying degrees of impairment ranging from Stage 1 (no impairment) to Stage 7 (very severe decline).

Good news for early Alzheimer’s diagnosis

As a testament to our growing interest (to put it mildly) in Alzheimer’s, we have only to revisit the 2015 Best Actress Oscar going to Julianne Moore for her poignant portrayal of an Alzheimer’s victim in Still Alice. Although conclusive diagnostic capabilities to identify the onset of Alzheimer’s are still undergoing intensive testing and theorizing, great strides recently have been made.

• Genetic risk profiling can identify certain markers that are red flags to inherited risk factors.
• Insulin resistance and reduced glucose uptake testing is often performed since diabetes indicators are often present in Alzheimer’s patients.
• Cerebrospinal fluid testing (aka a spinal tap) can isolate proteins that may form abnormal brain deposits.
• Living brain imaging through MRIs, CT (computerized tomography) and PET scans are valuable in providing assistance in identifying cortical thinning that is frequently found among Alzheimer patients.
• Advanced lab testing procedures have identified certain blood proteins that may be presymptomatic of Alzheimer’s Disease.
• Direct observation to assess Mild Cognitive Impairment (MCI) through diminishing sensory and motor capabilities continues to be an important diagnostic component.

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If Alzheimer’s, what can be done?

When any or all of the above diagnostic testing indicate the possible presence of early or later stage Alzheimer’s, the next proactive step is how best to slow down the progression of the disease, since there currently are no proven cures. The Mayo Clinic has been in the vanguard of institutions that are researching and evaluating possible treatment alternatives. Although positive results have been documented, most recommended treatments remain in the process of being evaluated. There are no  guaranteed cures…at least not yet. The emphasis today is always on may help not will help. Some of the most promising and popular regimens are:

• Drugs classified as acetylcholinesterase inhibitors have produced positive results in slowing the onset in 30-50% of patients with mild to moderate symptoms.
• Estrogen replacement therapy seems to have some potential impact on the risk of developing Alzheimer’s, but there is no conclusive evidence that this has had any measurable success in treating the disease post diagnosis.
• NSAIDs and corticosteroids (e.g., ibuprofen and prednisone) are prescribed for their anti-inflammatory properties that may help to reduce brain inflammation often associated with Alzheimer’s.
• Antioxidants (e.g., vitamin E) are often recommended to potentially help prevent brain cell damage of Alzheimer’s.
• Ginkgo Biloba, a supplemental herb, has also been the subject of much investigation for its potential contributions to improving quality of life.

What lies ahead?

Promising studies on new advances are being conducted to get a head start on conquering brain disease. A sampling of current ongoing research indicates the extent, variety and potential for adding to our knowledge basis when it comes to analyzing what’s inside all of our heads.

A nasal spray vaccine has been shown to reduce brain plaque in lab mice (an Alzheimer’s disease change). This research is ongoing to assess the possibility of nasal delivery in humans. Such a breakthrough would be dramatic, however, one of the critical challenges is how to direct drugs introduced nasally to the relevant locations in the brain.

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Today, an interoperative MRI allows the neurosurgeon to take an MRI post-resectioning, but while the patient is still on the operating table. This enables the surgeon to assess successful cancerous tissue removal on the spot and to react accordingly.

Neurogenetics is a flourishing field of scientific research, which promises to refine genetic markers so that they will be able to predict the possibility of brain disease even before any symptoms appear. Advanced genetic marking may allow the physician to design an early and highly personalized preventative program that could avoid more radical post-diagnosis alternatives.

Stanford University has seen many advances in the Cyber or Gamma Knife technology over the past two decades. Most impressively, this has resulted in expanding its potential surgical applications from removing brain tumors to addressing other brain-related issues such as depression, Obsessive Compulsive Disorder, and chronic neurological pain.

Over the past decade, the work of many researchers has indicated a strong relationship between the brain and the gastrointestinal system, often referred to as the Gut-Brain Connection. According to researchers at the Harvard Medical School, this connection apparently works both ways in that GI disorders can be the cause or the result of stress and emotional upset. Much remains to be done to fully understand the close interaction between the brain and the digestive system.

Finally, there has been much research focusing on the ability of the brain to remodel itself.  This phenomenon is called neuroplasticity. A recent patient who was born without a cerebellum has been studied in-depth by Dr. Jeremy Schmahmann, a neurology professor at Harvard Medical School. Through hard work and dedication, other parts of the patient’s brain apparently have taken over as the patient has learned how to work around his limitations. Exactly how this has happened remains to be further explored, but it does offer great promise to those suffering from brain damage.

It’s the mind that matters

Medical and research professionals alike remain enthusiastic, committed and hopeful about the future. Their goal is to one day find new and better ways to treat the many devastating brain-related diseases, which includes the debilitating downward spiral of dementia, and even schizophrenia and autism.

Certainly harnessing the power of the human brain remains as intriguing a possibility as it has been through the centuries. The quest to fully understand the brain goes on. In the meantime, we can improve our own mental well-being by indulging in pleasurable and brain healthy pursuits, such as listening to soothing music, socializing, or simply completing the latest New York Times crossword puzzle. The evidence may not yet be scientifically supportable, but the positive effect on our state of mind is incontrovertible.

Editor’s Note: Special thanks to Anwar Ghali, MD Chairman of Psychiatry, Trinitas Regional Medical Center, and Rodger Goddard, PhD, Chief Psychologist and Director of Wellness Management Services at Trinitas. for their input on this story.

May I Take Your Order?

For many of us, the path to a healthier diet begins with those first timid forays into new ethnic dishes. In this regard, few if any states can match New Jersey for the number of dynamic ethnic populations, density of population, and number of restaurants. Which ethnic foods are the healthiest? In most lists created by nutritionists, the “winning” countries are Greece, Viet Nam, Japan and India. Greek food makes wonderful use of dark, leafy vegetables and other heart-healthy, cancer-fighting ingredients. However, a helping of spanakopita—which is something of a national dish—is only slightly healthier than a Wendy’s Baconator. Vietnamese food gets high marks for its use of water and broth for cooking instead of oil. Many of the basic ingredients in this cuisine have been used in alternative medicine for centuries. Japanese dishes (we’re not including sushi here) are also prepared in a healthy manner, including steaming and rapid wok frying. Their fruits and vegetables are remarkably high in antioxidants, vitamins and minerals. White rice and soy sauce are problematic staples for some. The aromatic spices commonly used in Indian cuisine—including cardamom, coriander, cinnamon, turmeric, ginger, cumin and various chilies—not only produce a distinctive palate, some have been shown to ward off cancer and possibly Alzheimer’s. Skip the fried appetizers on most Indian menus. Italian cuisine (which is practically its own level on the New Jersey food pyramid!) also gets high marks for its liberal use of tomatoes, olive oil, garlic, basil, oregano and parsley. Not so much for the cheese. No matter which region’s cuisine appeals to you, there is a simple way to get through the maze of food options out there, according to

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

Michelle Ali, RD, Director of Food and Nutrition at Trinitas. “Healthier eating and a healthier lifestyle go together like peas and carrots,” she points out. “Healthy eating means watching what you eat—especially foods that may be higher in sugar, sodium or fats.” Make it a priority to reduce portions and try to limit those foods to special occasions, she suggests, and consider walking or doing an extra 15 minutes on the treadmill to offset your dietary decisions.”

Exercise in a Wrapper

The good folks at global food giant Nestle have been working for the better part of a decade on what one might be tempted to call “exercise in a wrapper.” According to an article in Chemistry & Biology, scientists in the company’s Swiss labs are beginning to understand how a compound called C13 can stimulate an enzyme in charge of regulating metabolism. It’s an important step in developing a way to mimic the fat-burning effect of exercise. The next step would be finding plants or fruits that contain C13, which might then lead to the creation of nutritional products that could actually help consumers drop weight by eating. This type of breakthrough could be a game-changer in the packaged food industry, which has come under fire for making the flavors of less-than-healthy snacks increasingly irresistible. It also sheds light on the increasingly fine line that separates the food and pharma industries. The companies that solve riddles such as this one not only will gobble up big shares of the snack food market. They will also enable people who are immobile due to obesity, diabetes or old age to enjoy the chemical benefits of exercise.

Ari Eckman, MD
Chief of Endocrinology and Metabolism 908.994.5187

Dr. Ari Eckman, Chief of Endocrinology and Metabolism and Director, Trinitas Diabetes Management Center, concurs. “However, it is obviously too premature to know if the compound C13 can indeed be the secret to more exercise,” he says. “We look forward to learning more about this possibility in the future.” In the meantime, no one should be waiting around for a miracle food. In this generation of a more sedentary lifestyle, Dr. Eckman points out, anything that encourages and promotes exercise will be extremely beneficial to help with weight loss and prevent conditions such as diabetes and heart disease.

Down and Dirty

More and more people are realizing that almost everything humans need is contained in the Earth. Now that also seems to be true of antibiotics. Researchers at Rockefeller University have concluded testing on soil samples from 185 different sources worldwide and discovered valuable compounds that could help create new drugs and improve existing ones. For instance, a sample from Brazil contained genes that offered a new version of the cancer-fighting bleomycin. A sample from New Mexico yielded epoxamicin, a molecule used in other cancer-fighting drugs. Another soil sample, from a southwestern state, appears to contain compounds similar to rifamycin, which helps treat tuberculosis. Only a small fraction of microbes can be grown in a lab environment; most need soil to do their thing. The idea of valuable microbes coming from the ground is hardly a new one; there are more microbes in a handful of soil than there are humans on earth. And lest we forget, penicillin and other important antibiotics started as uncultured bacteria in the dirt. Meanwhile, at Northeastern University, researchers have been building “soil hotels” to culture bacteria, and this effort has produced more than two dozen promising antibiotics. This is a huge step in battling the growing problem of antibiotic-resistant microbes. The last time a new antibiotic actually made it into the marketplace was more than 25 years ago.

Going Green

In a recent survey, 90 percent of Americans said they believed that certain foods—the kind that help stave off aging or disease—offered health benefits beyond basic nutrition. Whether this 90 percent was looking past advertising claims and correctly identifying which foods offer these benefits is certainly a topic for debate. However, there is no question that science is working hard to identify foods that deliver on this promise. One you are likely to be hearing a lot about in 2015 is microalgae. Foods containing this ingredient (a uni-cellular plant species found in freshwater and marine systems) have just begun to show up on store shelves. “It’s a well-known fact that micro-organisms in our body have a positive effect on our metabolism and proper physiologic function of our body,” explains

Kevin Lukenda, DO
Chairman, Family Medicine Department 908.925.9309

Dr. Kevin Lukenda, Chairman of Family Medicine at Trinitas. “The human gut is filled with bacteria and other micro-organisms that help keep the gastrointestinal tract functioning at its highest level. When this micro-organism environment is disrupted, normal body function is often compromised. Probiotics—algae in a pill—offer obvious benefits to our gastrointestinal tract as they help support the microalgae diet.” Microalgae can be used in certain high-fat foods not only to reduce cholesterol and saturated fat, but also to add antioxidants and protein. Proponents of omega-3 fatty acids already know about microalgae; fish don’t actually produce omega-3—they get it from.

Is Paleo Diet Hard to Swallow?

The most talked-about diet of 2014 was probably the Paleo Diet, which was outlined by author Loren Cordain several years ago in a best-selling book. Cordain’s basic premise is that nature determined what our bodies needed long before agricultural societies took root, and that eating food made of grains (and livestock raised on grains) is fundamentally unnatural and unhealthy. The Paleo Diet focuses on the consumption of fruits, vegetables, nuts, seeds, plant-based oils and meat from grass-fed animals. Grains, legumes, potatoes, salt, refined sugar and dairy are off the menu. In a Washington Post story published earlier this year, several experts lined up against this concept. For example, Harvard professor Daniel Lieberman points out that we didn’t evolve as a species because of our health so much as our reproductive fitness. Also, many Stone Age humans were consuming grains and dairy products (and we have since developed the genetic mutation to metabolize milk). Marlene Zuk, an evolutionary biologist at the University of Minnesota, believes the Paleo Diet concept is based more on some misplaced nostalgia than actual facts. Evolution is full of inexplicable twists and turns, she says, pointing out that bipedalism came with back pain, that didn’t send early hominids scrambling back into the trees. It’s worth noting that none of the experts cited by the Post claims the Paleo Diet is unhealthy—obviously, we consume far too much sugar and empty calories compared to our 300-x great-grandparents. They only question whether it is scientifically better than other ways of eating.

What’s With the Measles Outbreak?

One of the big healthcare headlines this past winter concerned the outbreak of measles in the United States. Worldwide, an estimated 20 million people each year become infected with measles annually and nearly 150,000 die. Yet, back in 2000, we had been told the virus had been eradicated in America. The recent cases in California, Ohio and New York were traced to travelers returning from endemic countries who subsequently came into contact with people in the U.S. who had not been vaccinated.

How do I not get measles?

Experience has shown that vaccines are highly effective in preventing the disease. The bottom line is that the best treatment for measles is prevention.

But there has been a lot of discussion in the media about the safety and effectiveness of vaccinations. Where do you stand on the measles vaccine?

The Centers for Disease Control (CDC) is recommending that anyone traveling outside of the United States should receive a measles vaccine if they haven’t already. After an initial dose, follow-up blood work should reveal immunity. If the blood lacks evidence of immunity, then a second MMR vaccine should be administered at least 28 days after the initial dose. The repeat dose increases immunity to nearly 97 percent. Scheduled pediatric dosing remains the same.

How do I know if I am already immune?

Several methods show evidence of measles immunity, including laboratory evidence and vaccination records from your physician.

What is Community or “Herd” Immunity?

When a critical portion of a community is immunized against a contagious disease, most members of the community are protected against that disease because there is little opportunity for an outbreak…thanks to “herd” immunity. Even those who are not eligible for certain vaccines—such as infants, pregnant women, or immuno-compromised individuals—have some degree of protection, because the spread of contagious disease is contained.

What are the signs of measles and when is a patient considered contagious?

Measles is a viral infection from the Rubeola (Paramyxoviridae) family. Clinicians look for fever and the disease’s characteristic rash. The fever occurs rapidly, sometimes as high as 104 degrees. As a viral exanthema—from Latin for eruption—measles starts on the head, typically behind the ears and the face, and then spreads to the trunk and lower extremities. The measles rash is accompanied by the three C’s: Conjunctivitis (reddish color of the whites of the eyes), Coryza (a runny nose) and Cough. Often there is a rash in the mouth, which appears as lesions on the fleshy portion of the inner cheek. As a highly contagious disease, the transmission rate of measles from person to person approaches 90 percent. It is spread via respiratory droplets, such as sneezing or coughing, and also by direct contact. The patient is contagious four days prior to experiencing fever. They are also contagious four days after the rash disappears.

What are some complications of measles?

The disease can cause ear infections, pneumonia, diarrhea and, in rare cases, encephalitis (inflammation of the brain). People at high risk for severe illness and complications from measles include infants and children aged less than 5 years  and people with compromised immune systems. One or two out of every 1,000 children who become infected with measles die from respiratory and neurologic complications.

If my child begins to show symptoms, should I go to the ER right away?

I think it’s best to call your child’s pediatrician. Explain your concerns and ask your pediatrician to recommend your next step.

How do you treat measles?

The cornerstone of therapy for measles is isolation and quarantine. Post-exposure Prophylaxis, or PEP, is a treatment that consists of administering the MMR vaccine within 72 hours of exposure. Immunoglobulin (IG) and Vitamin A can be given to a specific subset of patients, but do not reduce transmission or infection.

What happens if I, or my child, gets the virus?

The first step is to take universal airborne precautions by isolating the suspected case and giving you or your child a mask. We recommend an N95 respirator. A determination is then made about the degree of severity of the illness. Does it require hospitalization or can the case be managed on an outpatient basis? After stabilization, public health professionals will ask questions about your particular case and begin contact tracing. The CDC or local public health departments will then reach out to individuals who were exposed to you or your child. They will recommend vaccination and self-monitoring precautions in order to mitigate the further spread of the disease.

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.

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

Submit your questions to AskDrD@edgemagonline.com

Does your pain need an intervention?

Aside from cold, flu and upper respiratory conditions, the most common reason people see a doctor is due to neck and lower back pain. The causes of neck and back pain can vary greatly. Some are attributable to repetitive injuries, but more commonly the pain is traceable to a single event, such as bending or lifting, or something more direct, for example a fall. Sports injuries are also a very common source of neck or back pain, as are impacts from motor vehicle accidents.

Most neck and back muscle sprains will resolve spontaneously, or with conservative treatments. Patients whose pain persists may seek out stronger pain medication from their primary physicians, and go for various therapies such as massage, physical therapy, chiropractic treatment or acupuncture. These injuries typically resolve within several months of the accident.

But what if they don’t?

If the condition persists despite several months of conservative therapy, then interventional pain management is the logical next step. The goal of interventional pain management is to diagnose and treat the condition with the simplest and least number of treatments possible. Of the patients I see, over 95 percent will improve from these interventions; only a handful will ever need conventional surgery.

Your first visit to an interventional pain management practice involves the taking of a comprehensive history and an in-depth physical examination. Most patients I see have already had an MRI done, which I will review. If it turns out you have not undergone appropriate conservative treatment, then that will be recommended. The focus of the initial visit is aimed toward forming an accurate diagnosis, and from there a discussion of the most likely causes of the condition and the best treatment options.

Tools of the Trade

The mainstay of treatments that interventional pain physicians perform is diagnostic and therapeutic nerve blocks or epidural injections. Once I’ve formed a diagnostic impression, I utilize these interventional therapies to confirm it and treat the condition. Pain physicians use the term “the pain generator” to describe the structure that ultimately is determined to be the origin of the pain. Sometimes it is obvious, but other times it is not. These “tools”—the diagnostic nerve blocks—can help determine if any particular structure is producing the condition.

After the nerve block injection, the patient returns a week later to report on any progress or changes. I instruct patients to keep a diary on how they felt on Day 1, Day 2 and so on. If they report that they felt very little or no pain for a time after the nerve block, then it is very likely that structure is the source of what’s causing the pain. Basic interventions, such as nerve blocks or epidural injections, are the first line of therapy. Once the cause of the condition has been identified, if necessary, more definitive treatments can be performed such as nerve ablation or percutaneous disk decompression procedures. Some patients will be cured outright, and most will achieve sustained pain relief for an extended period of time.

MRIs are an important part of the evaluation, but they often don’t tell the whole story. In many cases, the patients that interventional pain practices see have already been to multiple doctors and received multiple opinions on causes and treatments. More times than not, the actual origin of the pain is not immediately obvious. A phrase I say a lot is that it’s normal to be abnormal—meaning that most patients will not have a MRI study that is completely normal. Most people exhibit some degree of disk degeneration, disk bulging or other abnormalities on their MRIs, because frankly disk degeneration begins at around 30 years of age for everyone. This is true even if they have never had any back pain. So I can’t automatically assume that abnormalities on the MRI are a true indication of what’s causing the pain.

I’m In Agony…What Now?

The most common neck and back injuries are sprains and strains—in other words, some type of muscle injury. Most initial injuries are treated similarly: rest, ice application (within the first 24 to 48 hours) and anti-inflammatory medications (NSAIDS). More severe neck and back injuries can involve the disks in the neck and back, nerves, joints and even bones (fractures).

The severity of an injury dictates whether or not you need to seek immediate medical attention. If the injury causes a significant limitation in function (standing, bending, walking, etc.), then it is advisable to be seen by a doctor ASAP.

A Feel for Pain

There are two main components of being a good interventional pain specialist. The first is being a good diagnostician (this is the art part), and the second is being a good injectionist. The latter involves the precision and technique required to perform the nerve block, or whatever treatment is being done. Treatment is an ongoing, dynamic situation. My over 16 years of experience has certainly improved both aspects of my care. Evaluating the results of one treatment, and from there forming a treatment plan leading to permanent relief, is paramount to being a good interventional pain management physician.

Patients usually ask me how many treatments they will need. Most patients only need a few treatments. I would say that 25 to 30 percent who undergo a single treatment return reporting so much relief from their pain that they are basically cured. Most of the remaining patients require two or three treatments to achieve benefit; unfortunately, there is no way to predict when someone walks through the door how many treatments he or she will require. Then, of course, you have those stubborn conditions, which require a more aggressive level of interventional care. What I say to most patients is that it’s not whether they are going to get better, just a matter of how many treatments and what level of therapy they will require.

There are, of course, conditions we see where we know right away that a cure is not possible. One such condition is when there is permanent nerve injury. In such cases, the goal is palliative care, to relieve as much of the pain and improve as much of the function as possible, using various interventional techniques and other modalities.

Lastly, there are of course some patients whose condition is beyond what interventional treatment can offer and do need surgery. Even so, undergoing a good “pain workup” can improve surgical outcomes because, at the point where someone is referred for surgery, we have already ruled out a good number of possible causes—and most times determined the precise condition that needs surgical intervention.

A need has always existed for a focused discipline that can monitor, diagnose and treat patients with pain-producing conditions. Pain is one of the most common reasons people visit their doctor, and at some point many of those patients will find themselves in need of a specialist who can manage and direct them to the most appropriate course of treatment. The field of interventional pain management actually originated as a subspecialty of anesthesiology. It makes sense if you think about it—anesthesiologists, after all, are doctors who specialize in rendering patients pain-free during surgery and childbirth. The field has grown substantially over the last two-plus decades, and physicians now enter from other fields, including physical medicine, rehabilitation and neurology.

My MRI shows a disk herniation, do I need surgery?

The take home message here is to always go from a conservative to a more aggressive course of treatment.

If you haven’t gone through a course of physical therapy, you must. Medications such as anti-inflammatories and muscle relaxants can also be beneficial. If symptoms persist, you need to get a comprehensive physical examination. Remember that MRI findings do not tell the whole story. While the most common type of spine injuries involve disk herniations, injuries can also involve the joints and other supportive structures which make up the spine.

If the disk herniation is shown to be the cause of the condition, you may be a candidate for a type of minimally invasive pain interventional therapy, which have fewer possible complications and a shorter recovery time.

When is it time to seek out professional help?

Listen to your body. If you have suffered an injury, you should not do things that exacerbate the pain. Some rest (but not too much) is important—ignoring the pain can sometimes lead to permanent and devastating disability. If the pain has not resolved quickly, seek medical care so that you can be evaluated and begin a course of conservative therapy.

Also, know that—when conservative treatment strategies don’t solve the problem—there are doctors who specialize in getting to the bottom of the pain. Again and again, I see patients who have waited months (or even years) before seeking interventional pain treatment. What I have learned from them is that, unfortunately, the longer a condition has persisted, the more difficult it can be to treat. Interventional pain management is not for everyone, of course, but the benefits greatly outweigh the risks in most cases. At the very least, any patient who is still experiencing pain after several months of conservative therapy—and is not improving—should be evaluated for the appropriateness of interventional therapy. The most important rule of thumb is to begin treatment with conservative therapies, and work your way up from there.

Editor’s Note: Dr. Todd Koppel is a board-certified pain specialist and
anesthesiologist, and Division Chief of Pain Management at Trinitas
Regional Medical Center. The variety of conditions he treats and the
techniques he utilizes can be found on his website, gspmweb.com. His practice, Garden State Pain Management, has offices in Clifton, Elizabeth and other New Jersey locations. Dr. Koppel can be reached at (973) 473-5752.

Issues with the Affordable Care Act include big changes in the way hospitals do business

No one wants to be a “repeat customer” when it comes to hospital care. However, many individuals who spent time in hospitals before the implementation of the Affordable Care Act (ACA)—also known as “Obamacare“—are likely to notice some interesting changes should they need to be hospitalized again.

Gary S. Horan, FACHE, President & Chief Executive Officer of Trinitas

U.S. health care expenditures prior to the ACA had crept north of $2 trillion. The projected goal of Obamacare (besides making coverage available to more people) was to lop a half-billion off that number, with a sharp focus on controlling reimbursement rates to hospitals and insurance plans—primarily in Medicare—by encouraging efficiency and productivity. Hospitals account for more than a third of total healthcare spending in the U.S., more than any other sector. The next largest is physician care (e.g. visits to the family doctor) and clinical work (e.g. blood tests), which combined make up roughly a quarter of health care costs. The changes mandated by the ACA mostly affect these sectors.

One area of significant savings projected by the ACA is the reduction of uncompensated care in hospitals. In theory, as more individuals find affordable coverage, the number of people who use hospital ER’s for non-emergency situations is declining. In practice, however, hospitals serving charity and Medicaid patients are seeing just the opposite.

“We’re already seeing a change with regard to patients moving from Charity Care to Medicaid,” Gary S. Horan, FACHE, President & CEO of Trinitas, told NJBIZ during a recent interview. “Since they now have ‘coverage’ through Medicaid, we’re experiencing a pent-up demand for health services from these patients. Unfortunately, physicians receive very low reimbursement from Medicaid—the lowest in the country—resulting in many physicians not accepting the Medicaid insurance product. This results in a double- whammy for hospitals, as more of these patients are directed to the Emergency Room, where Medicaid reimbursement for hospitals is only about 70 percent of actual costs. Make that a triple whammy—the ACA charges a tax on the hospital industry to help pay for coverage. This comes right off the bottom line and in our case results in a charge of about $250,000.”

Reimbursement was reduced for providers anticipating that they would receive a higher number of patients with insurance but, according to Horan, “As of now it is not quite working out that way.”

One byproduct of the ACA will almost certainly be a shift from the traditional hospital campus to standalone clinics and ambulatory care facilities. Will this spur a radical change in the way new hospitals are designed? Perhaps. The more immediate changes will likely take the form of additions like the $5.2 million Ambulatory Surgery Center that opened at Trinitas last year. Another result of the ACA that will be apparent to consumers is an uptick in acquisitions and mergers of hospitals and even whole hospital systems. In some cases, this may be the fastest way to create the efficiencies demanded by the new reforms and regulations.

One of the more interesting reforms introduced by the ACA is in the way medical services are delivered. For decades, health insurers reimbursed hospitals in a complex and often convoluted manner. Although this pay-per-fee system did not reduce the quality of care, in some cases it de-incentivized coordination of care. Hospitals that took care of their patients with greater efficiency often were not paid for going the extra mile.

To correct this problem, the ACA is phasing in initiatives aimed at reimbursing hospitals and doctors per “episode.” In other words, they get paid X dollars for an appendectomy or knee replacement—which rewards them for quality of care and reduction of wasteful spending. Hospitals with a high rate of readmission for certain cases (ranging from pneumonia to heart attacks) will be penalized, further incentivizing the completeness and quality of care. Interestingly, this could create more opportunities in the nursing field, as hospitals will almost certainly step up their “after-care game“ to visit discharged patients and make sure they are following recovery instructions.

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New Rules for Insurers

The Affordable Care Act has already begun to change the way insurance companies approach the marketplace. For instance, they can now base their premiums for a family on the number of children in that family. Prior to the ACA, they were compelled to offer a flat rate regardless of the number of kids a couple had. However, families with more than three children cannot be charged for more than three, so in this case the flat rate remains in effect. Insurers can also adjust premiums based on the age of the adults covered, but not on gender.

Dozens of services that had been excluded from health plans in the past are now covered as part of “Obamacare” in most states. These services range from autism screenings to shingles shots to prenatal supplements. That’s the good news. The bad news is that insurers will find ways to cover these added benefits in the form of higher deductibles and co-pays.

Some changes brought about by the ACA won’t impact New Jerseyans. Tobacco users can be charged 50 percent more than non-users now, but not in New Jersey, which prohibits this type of surcharge. Another change mandated by the ACA which does not affect New Jersey is the rule that says insurance companies must spend at least 80 percent of premiums on medical reimbursements or medical education. The Garden State already has a similar regulation in place.

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Another ACA initiative involves the reduction of infections. This has been an industry priority for a long time, but in 2015, hospitals that are still behind the curve in infection reduction will see their reimbursement cut by one percent.

Of course, not all of these changes are hitting all hospitals at the same time. In some cases, pilot programs have begun. In others, training for the ACA changes is underway. There are invariably some hiccups whenever new procedures are introduced into the health care field, so the ACA has devoted $10 billion to track the success of its initiatives and, presumably, tweak them as necessary. What might be a great fit for one hospital may present unanticipated hurdles for another.

The goal is to optimize the hospital experience for each patient, from the moment they come through the door to the day they leave, and for weeks after, while enabling a hospital to run its business successfully and efficiently.

Role of Ambulatory Surgery becomes more vital as Covid-19 subsides

By Yolanda Navarra Fleming

The numbers are tricky to pin down as Covid-19 cases rise and fall from coast to coast, but it appears that at least a third of Americans put off needed healthcare in the first four months of the pandemic. That figure covers everything from scheduled tests and screenings to minor procedures to actual emergency room visits. Caution is never a bad thing, but fear—especially fear fueled by a lack of accurate information (or sometimes way too much of it)—can exert a powerful influence on our decision-making. Often to our own detriment.

As Trinitas worked to stay a step ahead of the coronavirus this past spring and deliver a high level of healthcare to those who needed to be admitted, another part of the hospital—the Ambulatory Surgery Center (ASC)—was closed and waiting to safely reopen, and is now firing on all cylinders. “Ambulatory” in the case of the ASC reflects its Latin root (abulatore: to walk).  The ASC is an outpatient facility that allows our clients to have same-day procedures. Although there is always some risk in any type of surgery, the layer-upon-layer of Covid-19 precautions that have been adopted, as Trinitas doctors learn more about the virus, has minimized the risk of contracting and spreading the virus in the main hospital as well.

“Our Ambulatory Surgery Center provides an optimal environment for our patients and their families, as we do not treat Covid-19 patients in this facility,” says Donna Leonard, Peri-Operative Managing Director. “The atmosphere there is warm, calm, and peaceful. The ASC staff is professional, knowledgeable, and empathetic, in addition, our equipment is state-of-the-art. An important consideration when choosing an ASC site is knowing that we are a hospital-based facility, and all of the resources of Trinitas Regional Medical Center are at our disposal at any time, for any reason.”

The doctors, nurses, and technicians at the Ambulatory Surgery Center are skilled and experienced in a wide range of specialties and outpatient procedures. The ASC Operating Room handles:

• General Surgery
• Laparoscopic Surgery
• Vascular Surgery
• Plastic Surgery
• Gynecological Surgery
• Ear/Nose/Throat Surgery
• Pain Management
• Orthopedic Surgery

More complex procedures are performed in the Main Operating Room at Trinitas, where the same rigorous cleaning and sanitizing procedures take place.  These procedures include all of the above in addition to the following:

• Robotic Surgery
• Total Joint Replacement Surgery
• Genito-Urinary Surgery
• Ophthalmic Surgery
• Complex ENT Surgeries

Both OR areas are staffed by Board Certified Anesthesiologists, all nursing personnel are certified in Basic Life Support (BLS), they also have or are working towards becoming Advanced Cardio Life Support (ACLS) certified. Many Trinitas RNs are bi-lingual and multi-lingual. Most Registered Nurses have their Bachelor’s degree or are currently in a program working towards obtaining a BSN. We have several RN’s with BSN’s who are now Master’s degree holders in Nursing, and several more currently pursuing this highly regarded professional degree.

The $5.2 million 9,500 square-foot Ambulatory Surgery Center opened in 2014. Since then, more than 10,000 patients have been treated there.

“It’s only natural to have a little fear where medical care is concerned, especially given the current environment,” says Leonard. “The medical community has expressed concern that necessary testing and procedures have been delayed due to the fear of being exposed to the virus if they choose to come to the hospital. The ASC center has taken and continually updates all precautions to keep our patients and staff safe. We confidently state that we are offering a safe environment for the return of patients to our facility.”

Editor’s Note: The Thomas and Yoshiko Hackett Ambulatory Surgery Center at Trinitas is part of the hospital’s main campus at 225 Williamson Street in Elizabeth. For more information, visit njambulatorysurgery.com.