When Covid-19 hit, Trinitas hit back…with a true team effort.

By Yolanda Navarra Fleming

You don’t have to be in healthcare to comprehend the gravity of the COVID-19 pandemic. Gary S. Horan, President & CEO of Trinitas Regional Medical Center, says it’s been unlike anything he has experienced in his many years in healthcare administration. As he details, Trinitas staff members met the challenges of the patient surge in the spirit of skill, compassion, and innovative teamwork.

EDGE:  How has Trinitas Regional Medical Center adapted to the “new normal” conditions created by the COVID-19 pandemic?

GH: It was a challenge we didn’t expect but were prepared for, partly because Trinitas is no stranger to innovation. Innovation is the key in responding to something as novel as the COVID-19 pandemic.  We had to get creative about a lot of things, including making additional space for COVID patients during the surge. We have taken every precaution to keep our population safe, including patients, staff members, and the outside community.

EDGE: How did the staff handle the surge?

GH: Well, prior to the surge, we activated our Emergency Command Center, which is staffed by senior administration, safety personnel, and infection-prevention personnel.  Meetings and institution-wide conference calls were held every day to address the many issues that we knew were coming up. It was and still is a very volatile time, but saving lives is our business. We have such a dedicated, well-rounded, and fearless staff, who are not focusing on the negatives. But they needed help. As part of the Heroes Helping Heroes initiative, we were fortunate enough to have 20 registered nurses from Centura Health in Colorado come to Trinitas to assist in our efforts. They were extremely helpful in our Emergency Department and the Medical/Surgical units for more than four weeks.

EDGE: With a decline in the number of cases, do you expect another surge?

GH: There is certainly the possibility of another surge, but it drastically depends on how people behave in the upcoming weeks, and whether or not they observe the safety precautions. If people choose not to wear masks, use proper hand hygiene, follow the guidelines of social distancing, and avoid crowds, I’d say another surge is likely. If it comes to that, we are prepared and will do our best to carry out the Trinitas mission, just as we did the first time around.

EDGE: In the meantime, what do you say to people who may be staying away from the hospital because they’re afraid to return?

GH: The fear is understandable, but unwarranted. We use advanced technology as part of many steps to disinfect the entire hospital.  We were an early user of the Surfacide Disinfection UV-C system. This technology uses ultraviolet light to sterilize surfaces after they’ve already been wiped down with bleach. We’re asking our community to not neglect their health by putting off elective procedures and diagnostic testing because they think it might be unsafe to come to the hospital. It’s actually one of the safest places to be at the moment because of this technology and our attention to the matter.

EDGE:  How has the pandemic affected your organization as a whole? Is there such a thing as a “silver lining” in this environment?

GH: I think so. The fact that Trinitas is a Catholic teaching hospital means that we possess a strong sense of faith as an institution. In spite of the challenges we’re facing, we are grateful for the ways we had to rise to the occasion. So, I would say a silver lining is seeing a great team spirit to fight and win against this pandemic.

News, views and insights on maintaining a healthy edge.

Be Kind to Your Roomba       

One day, perhaps sooner than you think, robots will be playing important roles in our everyday lives. In anticipation of that day, researchers at Japan’s Toyohashi University of Technology initiated a study of how we are likely to interact with humanoid robots. What they found for the first time is neurophysiological evidence that humans are capable of empathizing with robots. When the study group watched humans and robots experiencing pain, they empathized with both in similar ways…only not as deeply with the robots. Researchers accounted for the difference by speculating that humans are unable to see things from a robot’s perspective. The study will help develop human-friendly robots for which we’ll feel more sympathy and be more comfortable with. Rodger Goddard, PhD, Chief Psychologist and Director of Wellness Services at Trinitas

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

, is not surprised that people feel concern and care for robots. “Many of us already have a personal relationship to our cars, computers and other precious possessions,” he says. “We feel the pain when our car gets dented, bruised, or is in an accident. Our children are comforted by, and connected to, their teddy bears, toys and action figures. And movies already show us how we can sympathize with the feelings of an R2D2 robot.” Besides, such connections are hardwired in the human psyche, Dr. Goddard explains. Primitive people have always ascribed human emotion and intelligence to the things in their surrounding world.  We now talk to Siri, OK Google, Amazon Echo and our car’s GPS—proof that our gadgets are very responsive to our questions and needs. Meanwhile, Facebook sharing has already replaced much of what would have been face-to-face interactions. “People who lived 50 to 100 years ago would not have been able to imagine the technologically connected world we live in today,” he continues. ““We also cannot imagine how our world will look—and how much more we will be connected to our machines—50 to 100 years from now.”

An 80% Jump in Autism Rates? 

If you look only at the recently released statistics from the CDC and National Center for Health Statistics (NCHS), you’d think that a tidal wave of autism hit the United States in 2014. Indeed, the prevalence of autism in children 3–17 jumped 80 percent in one year. The story behind the numbers? According to epidemiologist Benjamin Zablotsky of the NCHS, in previous years many parents of children diagnosed with autism spectrum disorder reported it as a developmental disability instead of (or in addition to) autism because “developmental disability” was listed first. The 2014 questionnaire flipped the two categories. The silver lining of this story, of course, is that more children will receive help earlier. And the earlier they have access to care, services and treatment, the more likely they are to progress.

Carole Soricelli, MS, OTR
Director, Trinitas Children’s Therapy Services
973.218.6394

Carole Soricelli, Director of Trinitas Children’s Therapy Services (TCTS) in Springfield, can attest to that. “Our occupational, physical and speech-language therapists work with many children diagnosed with Autism Spectrum Disorder (ASD) in schools and in our Therapy Center,” she says. “In recent years, more and more self-contained classrooms accommodate the many individualized needs of the ASD population by providing smaller adult-to-student ratios, classroom environments that facilitate optimal learning for students that have a variety of sensory processing considerations, and related services support. Most curriculums have moved toward a Universal Design for Learning (UDL) model to improve and optimize teaching and learning for all people, based on scientific insights into how humans learn. The result is a learning environment characterized by flexible goals, methods, materials, and assessments that empower educators to meet the varied needs of all students.”

Happy Results from SAD Study     

A recent study published in the American Journal of Psychiatry has cast a shadow on the long-held belief that the best way to fight the winter blues is with light. Light therapy used to treat seasonal affective disorder (SAD) has proved to be effective, especially in acute cases. However, a new type of cognitive behavioral therapy designed for SAD sufferers was found in the study to be significantly better when it came to preventing relapses. Forty-six percent of subjects receiving light therapy experienced a recurrence of depression two winters later as compared to 27 percent who received the cognitive behavioral therapy. The depressive symptoms were also more severe in the light therapy group. About 14 million Americans suffer from SAD. 

Walk This Way

Older adults who make an effort to exercise daily stand an excellent chance of delaying cognitive decline and prolonging their independence. A study at Boston University, published in the Journal of the International Neuropsychological Society, compared a group of young adults and older adults who engaged in rigorous physical activity and then took memory, planning and problem-solving tests. The study found that members of the older group (ages 55–82) who took  more steps (and more vigorous steps) performed better on these tests—particularly one that involved recalling which name went with a person’s face. This result is exciting because it suggests that physical activity will extend long-term memory, which is the type of memory that is negatively impacted by aging.

Jim Dunleavy, PT DPT MS
Director, Rehabilitation Services
908.994.5406

Jim Dunleavy, PT DPT MS, Doctor of Physical Therapy and Director, Rehabilitation Services, notes that, “while rigorous activity is the level cited in this study, we have seen improvement in patients even with sub-maximal exercise/activity. If a person is sedentary, just starting a walking program can make big changes in physical and mental wellbeing.” 

Can You Hear Me Now? 

Can hearing loss make you dumber? No, not exactly. However, people with a hearing impairment who choose not to wear a hearing aid, may be devoting way too much of their cognitive resources in order to figure out what others are saying. A report issued by the University of Texas at El Paso (UTEP) maintains that untreated hearing loss can lead to serious emotional and social issues, reduced job performance and a diminished quality of life. And also interfere with cognitive abilities. This is particularly important for the 10 million Americans between the ages of 46 and 64 suffering from hearing loss—80 percent of whom do not use a hearing aid. The UTEP study looked at subjects in their 50s and 60s who had never worn hearing aids. After only two weeks of use, they did better recalling words in working memory and selective attention tests, and improved the processing speed at which they responded.

Is There Really A ‘Fat’ Gene? 

According to the National Institutes of Health, there is. NIH researchers announced this fall that they believe a single variation in the gene for brain-derived neurotropic factor (BDNF) may influence obesity, both in adults and children. Dr. Jack A. Yanovski, an investigator at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development, notes that this less-common version may predispose people to obesity by producing lower levels of BDNF protein, which is a regulator of appetite. “The BDNF gene has previously been linked to obesity, and scientists have been working for several years to understand how changes in this particular gene may predispose people to obesity,” says Yanovski. Rather than being a rare mutation, the less common variation of BDNF actually occurs in the general population and that’s an important fact.  So, is there any way we can increase BDNF level in the body?

Yelena Samofalov, MD Trinitas Pediatric Health Center 908.994.5750

Dr. Yelena Samofalov, Trinitas Pediatric Center, believes so.  “Previously, it was thought that only vigorous exercise could stimulate production of this less-common version of BDNF,” she explains. “However, recent research shows that simple walking or doing light housework or yardwork can present benefits of not only staying fit, but increasing synthesis of BDNF in the brain.”  Dr. Samofalov and Dr. Yanovski concur that boosting BDNF protein levels could offer help to people with the gene variation—which tends to occur with greater frequency in Hispanics and African Americans than in Caucasians.  

New Advance in  Artificial Intelligence      

University of Chicago bioengineers have developed a mathematical algorithm that can sense what the human body “wants” to do in everyday situations. They believe it is that help people overcome obstacles and disturbances—from cars that steer out of icy skids to prosthetics that help stroke patients complete simple tasks smoothly. “If you know how someone is moving and what the disturbance is, you can tell the underlying intent,” explains Justin Horowitz, who authored the study, who adds that machines programmed with these algorithms could react and correct in a fraction of the time it takes average humans—who sometime freeze and don’t react at all.

The Big Chill

The human body possesses an amazing ability to maintain thermoregulation at a temperature not too hot or not too cold. It’s almost like there’s a thermostat that balances heat production and heat loss. Hypothermia occurs when extreme cold sends the body’s temperature below 95° F. However, hypothermia can occur at any temperature lower than normal body temperature. Factors including body fat, age, alcohol consumption and, especially, wetness can affect how long hypothermia takes to strike. So you don’t always see hypothermia coming—which is why we often use the term accidental hypothermia.    

What are some of the early warning signs of accidental hypothermia?    

Warning signs include uncontrolled shivering, memory loss, disorientation, incoherence, slurred speech, drowsiness and obvious exhaustion. 

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Who’s most at-risk?

The elderly and the very young. The next time you visit your parents or grandparents, notice how thin their skin appears. As we age, we lose the insulating protection of muscle, soft tissue and fat under our skin. Children, on the other hand, have a higher metabolic demand, requiring more heat production. 

Besides freezing cold, do other elements come into play?

Yes. Wind and water also play a pivotal role in temperature control. Both elements can precipitously cool the body to perilous temperatures in rapid order.

How is it that some people—like the ones on reality television shows set in Alaska—can tolerate extremely frigid temperatures?

It’s called the “hunting response.” In most of us, cold leads to vasoconstriction, which is narrowing of the blood vessels.  Repeated exposure to the cold, however, causes an adaptive physiology to occur. Those in Arctic climates possess the ability to vasodilate blood vessels in a cyclical pattern. When the extremities and skin begin to lose heat, the body shunts warmed blood to the skin, effectively warming the extremities. This occurs in a repetitive pattern to maintain thermoregulation.

Is shivering a bad thing?

On the contrary, shivering is essential to thermoregulation. In colder temperatures, you shiver to produce heat in your muscles. Small children will shiver after a bath in an attempt to raise their temperature immediately. Shivering is a very effective way to produce heat. It’s nature’s way of keeping our temperature from falling below 98.6° F.

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What can you do to treat accidental hypothermia?

Passive re-warming methods should be carried out for most mild hypothermia patients. A person should be removed from the cold environment. Moist, wet clothing should be removed. The body should be examined for signs of cold-related injuries. Warm clothing in layers should be applied. Passive re-warming methods typically raise the temperature by 0.5° C to 2° C per hour.

What about using warm water to raise body temperature?

I have my reservations. Immersing a foot or a hand is very effective at warming an extremity. However, my trepidation resides with the possibility of incurring a thermal burn during the process. Even simple heating packs or pads can lead to burns.

Does alcohol warm the blood?

No. Alcohol dilates blood vessels, leading to heat loss. Also, alcohol impairs judgment, which could potentiate cold-related injuries.  

How Do I Know if I Have Frostbite?

Warning signs of frostbite include numbness and lack of color. Fingers, toes, ear lobes, and the tip of the nose are the areas most susceptible to cold-related injuries. At or below 0° C, blood vessels close to the skin constrict and shunt blood away from the extremities.

This “life vs. limb” response is designed to protect vital organs such as the brain and the heart.
Typically, in our region, we see frostnip and chilblains. These are less severe cold-related extremity injuries in which the tissue never completely freezes. Burning and itching occur, followed by red and yellow patches. Transient numbness can occur but the damage is not permanent.

Is It True You Should Hold Your Breath in an Avalanche?

Avalanche victims typically die either through direct trauma or asphyxia. The snow becomes packed in the mouth, leading to suffocation. Avalanche survivors have better outcomes when they are recovered with their mouth closed. Assuming you survive the trauma of an avalanche, then hopefully you’ll find an air pocket to breathe. 

Of course, you’re not out of the woods at that point. Hypothermia sets in rapidly, slowing the metabolism down until your heart stops beating.  If a rescue team can get to the victim relatively quickly, people have survived at body temperatures as low as 64° F. Thirty-five minutes seems to be the magic number associated with favorable outcomes.

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

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

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

By Erik Slagle

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

By Christine Gibbs

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

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

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

THE BIG THREE

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

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

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

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NEW YEAR, NEW BREAKTHROUGHS

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

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

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

BREAKTHROUGH: FEMALE INCONTINENCE

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

BREAKTHROUGH: PACS

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

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

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

ON THE HORIZON

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

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

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

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

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

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

Schizophrenia Game-Changer? 

A team of researchers from Broad Institute, Harvard Medical School and Boston Children’s Hospital has identified a molecular process in the brain that helps to trigger schizophrenia. It may reveal what goes wrong in a young person diagnosed with the disease. “Research has identified several genes associated with schizophrenia,” says

Mona Ismail, MD
Medical Director Child Partial Hospital Program 908.994.7028

Mona S. Ismail, MD, Medical Director of Trinitas’s Child Partial Hospital Program. “But, until this study, we needed to know their mechanism of action that leads to the manifestation in young adults.” The landmark discovery, published in the February edition of Nature, could be a game-changer, given the emphasis on early detection and new treatments for schizophrenia. Dr. Steven Hyman of MIT, a former director of the National Institute of Mental Health (NIMH) says he is “almost giddy about these findings.” The process identified in the study shows that the risk of schizophrenia is dramatically increased if a young person has inherited variants of a gene important to synaptic pruning, the healthy reduction during adolescence of brain-cell connections that are no longer needed. What neurologists find especially exciting is that this discovery helps makes sense of a lot of other observations about the disease, which affects more than 25 million people around the world. “The question now is, ‘How can we use this information to alter this disease process?’” Dr. Ismail adds. “If we can interrupt it, then we might be looking at a possible cure rather than a lifetime of prescriptions for symptom management, at best. I think with the advancements of genetic and molecular science we are getting there.”

The Health Benefits of Equal Pay 

Researchers across the river at Columbia University recently looked at data on 22,000 working adults between the ages of 30 and 65 hoping to understand why women are more likely to suffer from depression and anxiety than men. What they found was that women who make less than men with similar levels of education and experience were four times more likely to develop an anxiety disorder, and 2.5 times more likely to suffer from depression. Those gaps all but disappeared, however, among women who made the same or more money than their male counterparts. The gender wage gap—when added to the added responsibility for childcare and housework—produces feelings of inequality, unfairness and insecurity that seem to account for the prevalence of anxiety and depression. “Primary care physicians don’t typically discuss wages or income with patients,” says

Vasyl Pidkaminetskiy, MD Trinitas Physicians Practice 732.499.9160

Vasyl Pidkaminetskiy, MD, of Trinitas Physicians Practice in Rahway. “They may touch on general job and family stress, and focus on symptoms and family history as part of making a diagnosis of depression. Since this study points to inequality in pay as it contributes to the rates of depression among women, that is something we as primary care physicians should include in our conversations with patients in the future.”

Screen Strain: It’s a Thing 

Multi-taskers be warned: The Vision Council released a report in January after surveying 10,000 people who spend a large portion of their day in front of a computer screen. The survey revealed that people who use multiple devices (e.g. tablet, e-reader, smart phone, smart watch) at the same time experience eye strain, and neck, back and shoulder pain more than users of one device. People in their 20s are most at risk, as they are the most likely to use multiple devices. More than 70 percent of the people in the survey reported these symptoms. Overall, about 60 percent of us use electronic devices for five or more hours a day. The good news is that digital eye strain is almost always a temporary problem. It is caused by the tiny muscles in the eye being overworked focusing on objects close to the face, or adjusting to differing levels of illumination.

Small Wonder 

One of the major obstacles in treating lung disease has been getting medicine to tough-to-reach parts of the respiratory system. A joint project between Malaysian scientists and Harvard University School of Public Health researchers is seeking a safe and effective way to overcome this obstacle through the development of “smart” nanoparticles that are even smaller than the particles produced by the fine sprays and mists used by lung cancer and COPD patients today. Nanotechnology is the manipulation of matter at a molecular scale, up to 100 nanometers. A nanometer is one billionth of a meter.

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

Dr. Vipin Garg, a board-certified physician in pulmonology at Trinitas, is intrigued by this idea. “Those of us who treat patients with obstructive airway diseases like COPD and asthma increasingly realize the important role that smaller airways play in these diseases,” he says. “Our experience shows that newer inhalers with particles reaching the smaller airways have improved management of these diseases.” Currently about 10 percent of deaths are caused by irreversible obstruction of the airway.

What You Don’t Know Can Hurt You 

Urinary Tract Infections (UTIs) account for more than 8 million doctor visits a year in the U.S., generating $1.6 billion in health costs. They are also the second-greatest reason why doctors prescribe antibiotics to women. Yet as two recent studies show, women know surprisingly little about UTIs. For example, only 13 percent of women 18 to 45 knew that sexual activity is a primary cause of bladder infection, and were unaware of the basic precautions that can prevent it. Thirty-nine percent of women assumed that UTIs go away if they do nothing. The fact is that if UTIs are left untreated they can lead to kidney infections, kidney stones or even kidney failure. 

Gene-Editing Breakthrough 

A team of scientists at the University of Texas Southwestern Medical Center has used a new gene-editing technique to halt the progression of Duchenne muscular dystrophy in mice. Duchenne is a rare disorder caused by a mutation in the protein dystrophin. It results in muscle degeneration and premature death. The mutation is carried on the X chromosome. It can be carried by males and females, but strikes boys, usually around age 2 or 3. If the technique is successfully scaled up, it will be the first to eliminate the cause of the disease as opposed to just diminishing its effects. The UT team published its findings in Science.

Mind & Body Connection 

You learn something new every day. For centuries it had been widely accepted in medicine that the brain did not have a direct connection to the immune system. An NIH-funded study completed by University of Virginia researchers in 2015 proved otherwise, as malfunctions in these vessels were shown to contribute to certain neurological diseases, including Alzheimer’s and autism. Abnormal immune activity had been associated with psychiatric conditions in the past, but the UVA study showed evidence of direct links.

No matter the variables, treating patients like family is part of the Trinitas equation. 

By Erik Slagle

When Martin Mintz went into cardiac arrest on September 30th, 2015, he was far from home and the hospitals he was familiar with. A 95-year-old resident of Brooklyn, Martin was visiting family in Elizabeth when the heart attack occurred. The responding paramedics administered the “Code Frosty” protocol—induced hypothermia that preserves brain function in patients following cardiac arrest—and rushed him to Trinitas. There, says his daughter Selena, he experienced a level of care and compassion that met or exceeded that of the most prestigious New York medical centers, making his stay in an unfamiliar hospital a little easier.

Martin, a Holocaust survivor, spent five years in a concentration camp in Poland. The Jewish faith is an indomitable trait of the Mintz family, and at a time of crisis they were able to find some solace in the hospital’s Bikur Cholim Room. Bikur Cholim is the Hebrew phrase for “visiting the sick,” and Martin’s family was impressed that Trinitas, a Catholic hospital, makes this accommodation available for Jewish families in need of support and a place to come together in prayer.

Beyond the spiritual support, Selena says the medical care her father received was equally outstanding.  “The doctors were thorough, attentive and caring,” she says. “The nursing staff was very helpful and calm as they went about their work. They made sure all the patients were comfortable. One of the nurses even offered to work with my father on her day off because she was so concerned about him.  Our family was so very impressed with the whole staff.”

Several of her father’s doctors, adds Selena, stand out for reasons that went beyond just their medical expertise. Dr. Maria Khazai of the Nephrology Department told her, “I’m taking care of him like that is my father in the bed.”  Selena appreciated the candor of cardiovascular specialist Dr. Mehrewan Joshi in assessing Martin’s condition. Along with Drs. Arthur Millman, Clark Scherer, Ying Tao, and Michael Chen—and ICU Director Dr. Michael Brescia—they formed

a team of constant support. Selena also singles out Dr. Leon Pirak for the attention and assistance he provided during Martin’s care.

“Dr. Pirak was simply unbelievable,” she says. “He oversaw everything and ensured that our family always got answers to our questions, and were always fully aware of what was happening.  We were able to discuss everything with him and make sure all aspects of my father’s care were being addressed. Everyone here is an advocate for family members—they constantly check to see how they are doing, if there’s anything they need, down to little details like a cup of coffee to pick someone up. Everyone we came into contact with at Trinitas was simply wonderful.”

Martin passed away later that autumn, but Selena says it was a comfort knowing he was so well cared for in his final days. The doctors, nurses and staff at Trinitas made every effort to give care—“beyond what we had seen when my father was admitted to other hospitals in Brooklyn and New York City.” 

“My father was treated with great dignity and humanity,” she says. “We’re very grateful to Trinitas for the way he was tended to and the care he was given.” 

Spring initiative highlights organ donation.

By Caleb MacLean

On any given day, more than 120,000 people in America are waiting for an organ transplant. On average, 22 people a day die for lack of a donated organ. There are currently more than 5,000 New Jerseyans on various transplant lists. How this precious material gets from donors to recipients is a mystery to most people. That is where groups like NJ Sharing Network come in.   

NJ Sharing Network is a non-profit, federally designated organ procurement organization. It was formed three decades ago at about the same time the government passed legislation that required hospitals to present the option of donation to families of potential donors. Since then, organ donation has quadrupled in New Jersey, saving, extending or restoring countless thousands of lives. NJ Sharing Network coordinates the efforts of hospitals, transplant centers, medical examiners and funeral directors, as well as increasing public awareness through education and media outreach. The organization will be particularly busy this April, during National Donate Life Month. Schools, community groups, businesses, elected officials and, of course, hospitals around the country will be demonstrating their support of organ and tissue donation, and encouraging people to start talking about what they would do if a family member becomes a candidate for donation.

“Everyone needs to have the conversation with their family members about what they would do if they could give the gift of life,” says Jackie Lue Raia, Assistant Director of Resource Development for NJ Sharing Network. “The idea behind National Donate Life Month is to get the community talking about organ and tissue donation.”

In New Jersey, most people are exposed to the concept of donation through the Motor Vehicles donor registry; 34 percent say yes to donation on their driver’s licenses. However, at bedside, that number soars to more than 60 percent, which means there is room for immediate improvement. The need for greater participation is magnified by the fact that less than 1 percent of deaths can actually give the gift of life. A person must be in a hospital, on a ventilator—typically as the result of a stroke, heart attack, aneurysm or auto accident with a traumatic brain injury. 

Last year, NJ Sharing Network facilitated 531 transplants. According to Lue Raia, that made it the “best year ever.”

NJ Sharing Network operates a fully accredited, state-of-the-art transplant lab, which performs compatibility testing between donors and recipients, and also pre- and post-transplant evaluations—a critical component in assuring the success of transplants for hard-to-treat individuals. The lab handles compatibility determination for a number of regional hospitals, including Trinitas. The organization also has a Family Services division for donor families. 

According to Mary McTigue, RN, the VP of Patient Care Services at Trinitas, as well as Chief Nursing Officer, the professional relationship between the hospital and the Sharing Network is very strong. “Both staffs always work in close collaboration to ensure a caring and compassionate approach towards potential donors and their families,” she says. “The skill and expertise of the staff recognizes the sensitive needs of a potential donor family, as well as the drive for a successful outcome for the potential organ recipient.”

The engine that powers NJ Sharing Network is its robust corps of volunteers (above). They handle the outreach initiatives that educate the public about donation and transplantation by participating in events or civic groups, businesses, community centers and houses of worship. 

“If the community is more open to talking and being proactive, we would be able to save more lives,” says Lue Raia. “Particularly in the area of tissue donation, which encompasses procedures including bone grafts, ACL and rotator cuff repairs and breast reconstruction. Volunteers can speak at pubic events, facilitate programs at worksites, or work at hospitals. Each is highly trained and vetted, with a thorough background check. Anywhere we send our ambassadors, you’re getting the best of the best.”

What do NJ Sharing Network volunteers have in common?Most have a personal connection to the organization. Jackie Lue Raia herself was a “donor daughter.” Six years ago, she was driving back from Newark Liberty Airport with her mother and son when a tractor-trailer slammed into their car on the New Jersey Turnpike. Her mother suffered fatal injuries in the crash. Her organs and tissues ended up going to 43 people. Two years later, Lue Raia decided to meet the two kidney recipients (right). One was the same age as she was, the other the same age as her mom. Soon after, she noticed a job opening at NJ Sharing Network. Needless to say, her experience with organ and tissue donation has proved invaluable.

“In part because my mother had not made the decision to be an organ donor,” she explains. “We’d never had that conversation. The clock was running out and the siblings had to make a decision. That was my first encounter with NJ Sharing Network. A volunteer met with us and convinced us that this was something my mother would want to do.”  

Editor’s Note: On June 5 in New Providence, NJ Sharing Network is sponsoring a USATF certified 5K race. For more information on this event call (908) 514–1761. For info on NJ Sharing Network itself, log onto njsharingnetwork.org or call (800) 742–7365. Promotional materials and kits for National Donate Life Month can be downloaded from the web site.

Tales from the front lines of New Jersey’s heroin epidemic.

By Mark Stewart 

Welcome to Heroin Town. That eye-catching headline ran last December on the NJ.com web site. The story posited that, if one were to take all of New Jersey’s heroin addicts and put them in one place, the population would work out to about 128,000 people—making it the fourth-largest city in the state. The scope of the heroin problem in New Jersey has grown over the last decade, claiming 5,000 victims and ruining the lives of countless hundreds of thousands since the mid-2000s. The optics of heroin addiction have changed, as well. It’s now someone you know, someone you work with. Maybe it’s someone teaching your kids. Or maybe it is your kid.  

Or, possibly, it’s you.

Michele Eichorn, Addiction Therapist

According to Michele Eichorn (left), an addiction therapist who runs the Hospitalwide Screening for Substance Use Disorders project for Trinitas Regional Medical Center, the Hollywood version of the zonked-out junkie in an abandoned building or trash-strewn alleyway is not what heroin addiction looks like anymore. 

“The face of addiction has changed,” she says. “Now everybody knows someone with a heroin problem. Chances are, you have a neighbor or a friend or a co-worker or a family member with a drug addiction. It could be that sweet cheerleader who was a friend of your daughter’s 15 years ago. Now she’s hooked on painkillers, or worse. More than ever, this is a problem that’s in people’s backyards.”

Eichorn offers the example of a woman she calls Jane. Jane is a 40-something well-adjusted woman with a college degree, solid work history and a family. Jane was in a motor vehicle accident and had terrible pain. She was put on pain medication, which affected her performance at work. Eventually, she was laid off from her job, lost her insurance and could no longer afford the medication. So she started using heroin because it was the only thing she could afford that made the pain bearable. 

“That’s actually a case that happened here and it was heartbreaking,” Eichorn says.

www.istockphoto.com

IT ALL BEGINS WITH PAIN

Heroin addiction stretches across the full socioeconomic spectrum. It’s a problem in the inner city, to be sure, but its impact is felt in small working-class towns and sprawling suburbs, too. Addiction doesn’t discriminate, it’s not particularly picky and it almost always begins with physical pain. A twist, a tear, a sprain, a strain. An operation. A work accident. A car accident. A prescription for 30 Oxycontin—enough to help manage the discomfort, enough to get a patient over the hump. 

However, when the little orange container runs out and reality sets in, we really miss those pills. Some of us a lot more than others. How one deals with that need can alter the course of a life, a family, a career. 

The first call is typically to the doctor to renew the prescription. Most physicians have become hyper-aware of the addiction risks, and also that they are at the fulcrum of a growing problem. A Los Angeles doctor was recently convicted of murder and sentenced to 30 years after three of her patients overdosed. No physician wants to swap a lab coat for an orange jumpsuit. So they prudently move patients to a less-addictive option. Alas, the warm, fuzzy high isn’t there and sometimes those patients look for pills in other places. On the street, of course, there’s no copay plan. Each pill costs $25 or more. For someone accustomed to gobbling a half-dozen a day, that works out to thousands a month. Some stick with that model until their bank accounts and 401k’s are drained. Or until the shut-off notices start piling up. Others sell their possesions, however and wherever they can. In the end, though, addiction usually boils down to a matter of dollars and cents: How can I achieve my next high for as little as possible? It’s all about today. Tomorrow matters less and less the deeper a person tumbles into addiction.

This is where heroin typically enters the picture. Oxycontin and other prescription opioids are basically pharmaceutical spins on heroin. Heroin may not be as neat or as clean or as “safe” as pills, but with heroin an addict can stay afloat all day for the same cost as a single street-purchased Oxy. And heroin is available everywhere. Take a look at your local police blotter and see where the arrests are taking place. In office buildings. At shopping malls. Outside convenience stores and fast-food joints. The places you already go every day.

A VORACIOUS ANIMAL

Sadly, people overdose and die from painkillers every day. It is a growing problem. Heroin, however, is an entirely different animal, and lately it’s been voracious. According to the Centers for Disease Control and Prevention, since 2010 overdose deaths among heroin users have tripled in the United States. About 1 in 50 addicts will die of an overdose. In New Jersey, the problem is far worse—at least three times worse, in fact. This year, heroin overdoses will kill more New Jerseyans than automobile accidents, homicide, suicide or AIDS. What that number will be—700, 800, 1,000, more—is anyone’s guess. But it will be a big number.

Michele Eichorn, Addiction Therapist

What is being done about this problem? First off, it’s not really a law enforcement issue. Heroin is so widely available in New Jersey that arresting dealers is like playing a carnival Whack-a-Mole game. Smash one down and another pops up immediately. Doctors have become more vigilant about over-prescribing and monitoring their patients’ use/abuse of painkillers, which certainly can stop a problem before it starts. However, there is some thought that closing down pill mills and, in general, being more judicious about refilling prescriptions simply drives more people underground for their drugs, and ultimately into the arms of a heroin dealer. Also, in terms of the overdose epidemic, the availability of the life-saving drug Naloxone may actually embolden heroin users, who regard it as a sort of get-out-of-jail-free card, often with deadly results.

So we are left to deal with addiction in emergency rooms, in rehabilitation facilities, in jails and in the morgue. 

ON THE FRONT LINES

Trinitas has been a leader in the field of treating addiction, initially with its Substance Abuse Services Department and, beginning in 2014, with its Hospitalwide Screening for Substance Use Disorders project. Now every adult patient who is medically admitted to the hospital—regardless of how they present—sits down with a nurse and has a conversation about alcohol and drug use, during which an Alcohol Use Disorders Identification Test (AUDIT) is administered and scored on a scale of 1 to 10. Some of these patients arrive at Trinitas through the ER with drug- or alcohol-related injuries, while others come to the hospital for scheduled procedures, such as removal of a gall bladder or foot surgery. Regardless of what brings them to Trinitas, when patients score an 8, 9 or 10, Michele Eichorn’s team is called in.

“At that point, we do a brief intervention using a technique called motivational interviewing,” she explains. “We have an honest conversation with the patient and really listen. If the person is agreeable, we’ll refer them to treatment and come up with a plan quickly, usually within a matter of hours, or at most a couple of days. It’s a very short window. And in order to ensure that people really are getting to treatment, we have a team of people—an addiction specialist who encourages them, a case manager who conducts outreach and helps people get into programs, and a therapist who is available to work with the individuals.”

Eichorn, who holds a masters degree in Social Work from Columbia University, initially became interested in the field of substance abuse while serving in the Army. She worked with veterans’ drug and alcohol issues and later did an internship at the National Institute of Addiction and Substance Abuse. Eichorn’s research showed that substance abuse as a whole was growing. She saw a challenge and wanted to be on the front lines. When she first arrived at Trinitas, she ran a program for drug-addicted mothers and pregnant women.

During the two short years the Hospitalwide Screening for Substance Use Disorders project has been up and running, between seven and 14 patients a month have been plucked out of the patient population and placed into drug or alcohol treatment. In the years prior, less than two percent of the patients for whom Trinitas counselors recommended treatment actually went. The project has already established itself as a difference-maker, Eichorn believes. 

50–50

On the drug-addiction front, perhaps the most eye-opening number to come out of the Trinitas project is the breakout of alcoholism referrals vs. drug referrals: “What we noticed immediately was that, among the patients our team saw, there was a 50-50 split between chronic alcoholism and serious drug addiction,” Eichorn says. “That includes heroin and other opioids, medications like Xanax, and so-called club drugs. A number of people fell into both groups.”

While the Hospitalwide Screening for Substance Use Disorders project can help heroin users get into the in-patient rehab programs they need, the lack of detox beds available can mean addicts may have to wait two months to start. That delay often has tragic consequences.

“The demand for treatment has increased so much that now folks are literally dying on the waiting list,” Eichorn confirms. “The problem we face is related to the availability of heroin. People are overdosing while they are waiting to get into programs. We know we may only have one shot to engage these people and get them into treatment.”

What stands out the most among the heroin users she sees?

“I’m a therapist so that’s what I can talk about,” Eichorn says. “What I will say is that many patients report that they have trauma in their background. And they have never been part of what we think of as ‘heroin culture’—communities where people are just hanging out and drugs are rampant. A lot of the individuals we see just don’t fit that profile at all. Something unfortunate happened and suddenly they are in this terrible, heartbreaking situation.”  EDGE

Editor’s Note: The Hospitalwide Screening for Substance Use Disorders project is funded by Medicaid’s Delivery System Reform Incentive Payment (DSRIP) program. Michele Eichorn LCSW, LCADC was a recipient of the 2015 Lester Z. Lieberman Award for Humanism in Healthcare from the Healthcare Foundation of New Jersey. She says if she could change two things about the current substance-abuse landscape it would be to make therapy services more readily available to a larger percentage of people, and to reduce the stigma attached to seeking help for substance abuse. “Rather than dealing with people in desperate situations, we could be dealing with them much earlier.”

Raw Milk: Coming Soon to NJ? 

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

Kevin Lukenda, DO
Chairman, Family Medicine Department 908.925.9309

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

Almond Joy 

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

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

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

Big Bang 

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

Connection Between Autism  and Early Death     

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

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

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

Zika Update

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

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

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

Fish Warning For Mothers-To-Be 

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

Yelena Samofalov, MD Trinitas Pediatric Health Center 908.994.5750

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

Going Gray 

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

Fussy Babies 

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

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

Yelena Samofalov, MD Trinitas Pediatric Health Center 908.994.5750

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

Parkinson’s Breakthrough 

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

Stem-Cell Scams? 

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

Nice Pick 

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

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

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

Bagpipe Lung: It’s a Thing 

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

Cancer Study to Assess Gene-Editing Technology

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

Benefits of Unsaturated Fats 

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

Mark Preston joins the robotic team at Trinitas.

By Yolanda Navarra Fleming

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

By Yolanda Navarra Fleming

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Alzheimer’s Breakthrough 

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

No Blind Mice 

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

Large, But In Charge 

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

Do Opiods Ease Pain?

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

Waist-Reducing Carbs? 

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

Abu Alam joins the Trinitas OB/GYN team.

By Erik Slagle

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

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

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

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

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

Return to His Roots

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

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

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

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

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

Productive Partnership

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

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

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

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

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

Presbyopia…Don’t have it? Just wait.

By Mark Stewart

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

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

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

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

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

www.istockphoto.com

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

TREATMENT OPTIONS

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

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

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

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

www.istockphoto.com

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

EDGE: What led you to specialize in ER medicine?

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

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

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

By Christine Gibbs

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

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

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

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

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

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

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

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

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

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

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

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

What can we expect from Phase III?

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

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

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

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

When Phase III is done, how will you feel?

Dr. Li: Proud!

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

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

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

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

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

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

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

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

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

Doctors are catching abdominal aortic aneurysms before they can kill.

By Erik Slagle

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

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

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

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

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

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

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

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

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

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

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

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

Adrian Velasquez agrees. 

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

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

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

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

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

’Tis the Season

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

How many bones are in the human body? 

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

What’s the difference between ligaments and tendons?

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

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

Are sprained ankles the most common sports injury you see?

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

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

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

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

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

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

How do strains differ from sprains?

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

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

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

Can I treat minor injuries effectively myself?

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

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

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

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

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

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

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

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

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

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