Shall we play a game?

By Rena Sandberg

Bad news. The federal government has just received viable intelligence that insurance, healthcare, utility and communications systems are minutes away from a cataclysmic cyber attack. Urban areas on the East Coast are in its crosshairs. Within minutes, the Trinitas Emergency Department will be dealing with an influx of patients that promises to grow in size and complexity as the drama unfolds.

Fortunately (this time) the crisis is purely conceptual. It was created in order for Trinitas to identify and assess vulnerabilities with an eye toward determining how it can improve its state of preparation for the unthinkable. Over a four-day period beginning November 25, 2018, Trinitas put Operation Community Peril into action. The full-scale exercise involved all of the hospital’s campuses, buildings and business occupancies.

Operation Community Peril was developed to assess the response capabilities of the Trinitas Incident Command System during a number of threat scenarios, including a cybersecurity failure, information technology (IT) breach, and communications blackout. Response objectives were set by an exercise planning team. Phil Solomon, Safety Officer and Emergency Preparedness Coordinator at Trinitas, who was in charge of the exercise, says that operations of this nature make Trinitas and the surrounding communities better prepared in the event of catastrophic events.

“We want to make sure that we have the highest level of preparedness for our customers, community and patients,” he adds.

Coordination between Trinitas, the Elizabeth Police Department and the community prepares everyone so they know how to respond if a situation arises in the future. Deputy Chief Alexander Sofianakos agrees: “It’s very important to give the community an idea of how their role would play out [in the event of a catastrophe], how they would help themselves and how they can assist us.”

The object of the “game” was to gauge response, initiation, incident command, and the testing of communication capabilities. Trinitas personnel worked with subject-matter professionals to create a path toward full preparation in the event of an actual disaster. According to Solomon, the exercise objectives were clearly defined and successfully accomplished.

www.istockphoto.com

“They took it very seriously,” says Solomon, adding that there was an outstanding level of participation from hospital personnel during more than 70 hours of real-time flow scenarios.

“Trinitas is up-to-date and very well prepared for a disaster,” says Deputy Chief Sofianakos. “They are doing a great job.”

Orchestrating Operation Community Peril’s complex scenarios required strategic planning and a diversity of live simulation drills, evacuations, lockdown events and departmental huddles. By all accounts, the collaboration of the participants exceeded expectations. Just as importantly, the large-scale exercises played a fundamental role in community preparedness by testing their ability to communicate and cooperate.

All Hands On Deck

Participants in Operation Community Peril included the Incident Report Team, Trinitas leadership, the hospital’s Emergency Preparedness Committee and external agencies including the City of Elizabeth, County Emergency Management and the Tri-County Radio Association. Training activities also took place outside of the Elizabeth area— such as the Bayonne Community Mental Health Center, Cranford Campus and ED triage. In addition, a groundbreaking activity occurred at the first-ever evacuation of residents from the Brother Bonaventure Care Center on Jersey Street in Elizabeth, as a large number of patients were moved from one wing of the facility to another. This drill was very well received by the residents. The “horizontal evacuation” was attended by the Elizabeth Fire Department and County Office of Emergency Management, who also gave the team a big thumbs-up.

My mother. My hero. My problem?

By Ashleigh Owens

In the summer of 2017, my mother lost her life to pulmonary fibrosis, the puzzling disease that takes your life by literally taking your breath. The illness plagued her through a 16-year-long battle that began in her 30s. She never saw it coming. She was at the height of her success when the disease crept into her life, robbing her of her dreams, her mobility and, ultimately, her time. I witnessed her excruciating decline and her diminished quality of life starting when I was in grade school. During those years, I wrestled with some difficult questions about the origin of the disease, its management and, of course, whether I too might be gasping for air one day.

“Am I next?” I often wondered.

You may be familiar with my mother’s work. Her name was Tracey Smith-Owens and she conducted celebrity interviews (as Tracey Smith) for EDGE until her passing. She had a knack for engaging people—including Louis Gossett, Chazz Palminteri and Frank Vincent—in thoughtful conversation, and often carried those conversations past the magazine’s pages into civilian life.

Her own words held great weight, too. Of her fight with pulmonary fibrosis, she once wrote: My freedom is limited and my assailant is a fifty-foot tube that lingers around my ankles and is connected to a concentrator to provide me with the oxygen necessary to live. My mother often spoke about the way this culprit, which had weakened her lungs, sliced into her life with no regard for the innocent people it impacted. We shared that fear and anxiety.

My mother was in the hospital for over a month until peacefully departing in her sleep. I never saw it coming; pulmonary fibrosis is full of surprises. My mother and her lungs were true fighters, the doctors told me. Her ability to survive and in many ways thrive for more than a decade-and-a-half astounded them.

Throughout my mother’s illness, she constantly warned me to keep myself healthy. She was unable to identify a connection or source of her disease—and indeed, pulmonary fibrosis is very much a mystery. Her greatest fear was that it was genetic, that there might be some chance of me inheriting it. Although this was always in the back of my mind, I was primarily focused on being my mother’s protector during her trials and tribulations. The life I had known as an only child with a single mother, who was devoted to watching over me, was suddenly juxtaposed: I became a shield for her.

Seeing how pulmonary fibrosis affected my mother physically, mentally and emotionally could be overwhelming, especially when I was a teenager. We felt a distance from family and friends, who lacked an understanding of her condition. My mother knew she could rely on me to listen. She could count on me to be her cheerleader, to root her through her at-home medical therapies and doctor visits, to remind her of maintenance with lung exercises, and to step in for her on day-to-day tasks, as her pace and strength weakened over time. Our bond strengthened as two became one to fight against this illness.

www.istockphoto.com

My mother left me a recording of a February 2017 doctor visit, which included a conversation regarding her eligibility for a lung transplant. To get on the list involves meeting certain criteria, in her case to demonstrate how her lungs and heart coincide. This recording drove home for me the monumental medical obstacles she faced and her commitment to explore any options that would enable her to stay on this earth longer with me. The doctors in the recording seemed amazed as she described her journey, and her will to keep ongoing. They said my mother would make a great spokesperson for the Pulmonary Fibrosis Foundation. Hearing these words validated for me that my mother was the ultimate heroine in the fight against this life-crippling disease.

Following the loss of my mother, the fear that I might be next weighed heavily on me. It forced a certain growth. We were guardians for each other; now she wasn’t there to guard me. However, fighting alongside her all those years prompted me to explore ways I could live a healthy life that might diminish the chances of my getting this disease—and to take the initiative and see a pulmonologist early on to determine the state of my lung function. I went through a series of tests and x-rays, both of which came back with satisfactory results.

The severe (or idiopathic) pulmonary fibrosis that eventually claimed my mother usually affects people in their 50s or 60s. She was diagnosed with the disease in her 30s. She lived a decade longer than average. She was a fighter. I am in my 20s.

Fortunately, idiopathic pulmonary fibrosis rarely occurs in more than one family member. But because its causes are not completely understood, no one can say with certainty that it is not hereditary. There does in fact appear to be a genetic link in certain cases where it runs in families: Two genes, TERT and TERC, are found to be mutated in about 15 percent of idiopathic pulmonary fibrosis sufferers. However, not everyone who develops these mutations develops the disease. Needless to say, a lot more research needs to be done.

So am I next?

When I asked my doctor, he said where pulmonary fibrosis is concerned there is never really any guarantee, but emphasized that the disease doesn’t “have” to be hereditary. He said to live healthily and be proactive by monitoring the state of my lungs, and that everyone should be as curious and vigilant about their health as I am. You can choose to be oblivious to the inevitable, he added, but you do so at your own risk.

National Heart Lung and Blood Institute

Pulmonary Fibrosis: The Hard Facts

Individuals suffering from pulmonary fibrosis must struggle for every breath. Thick, scarred tissue becomes progressively stiffer until the lungs can no longer function properly, preventing oxygen from entering the bloodstream. The damage is irreparable and the cause often is unknown. In some cases, pulmonary fibrosis can be attributed to long-term exposure to environmental toxins—including airborne asbestos, metals or silica particles—or an adverse reaction to certain medicines or medical procedures, such as radiation therapy. Pulmonary fibrosis has also been linked to other conditions, including rheumatoid arthritis, lupus, connective tissue disease and even pneumonia.

Medication (including steroids and antibiotics) and various therapies can ease symptoms, but only for a while. Depending on the severity of the disease, pulmonary fibrosis can progress very quickly or linger for a decade or more. Over time, it can trigger pulmonary hypertension, heart failure and respiratory failure. For some pulmonary fibrosis patients, a lung transplant is a possibility. About half of the lung transplants performed in the U.S. each year are for pulmonary fibrosis sufferers. Not all patients are good candidates for a transplant; many who are don’t live long enough to receive a suitable pair of lungs.

For many women, finding the right post-operative compression garment is still a mystery.

By Caleb MacLean

Follow-up is everything after a hospital stay. For women returning home from surgery, childbirth or certain other medical procedures, part of that follow-up process involves an after-surgery garment of some kind. Typically, a doctor will mention a particular type of garment or possibly even a specific brand as patients are preparing to be discharged. However, most women have no concept of what to do next.

For instance, many women benefit from postpartum compression abdominal garments. In some cases, they are worn to help restore that pre-pregnancy figure. Jessica Alba (a former EDGE cover girl) famously wore a double corset 24/7 for 12 weeks after giving birth to her daughter and was back on the red carpet in no time. Other celebrities have fessed up about their use of compression garments in recent years, creating a mini-boom in the business. For mothers who have delivered via caesarian section, the support of a compression garment is less a choice than a must. It speeds recovery and healing of the abdominal muscles. Typically, an abdominal binder is worn for six to eight weeks after a c-section.

Prairie Wear

Post-operative compression garments often must be “staged.” For example, in a tumescent liposuction procedure, the surgical fluid used to loosen fat cells is not completely expelled. Patients begin with a “first stage” compression garment that helps with draining and also protects bruised and swollen areas. After a week or two, liposuction patients will switch to a less-confining “second stage” garment that allows the body to return to normal lymphatic functioning. After a month or more, when healing is complete, many patients opt for a “third stage” or everyday compression garment, which helps maintain the new body shape.

Trinitas patients often find their way to The Pink Room in Elizabeth, or its sister store in Union. The company is primarily known for its “shapewear”—waist cinchers, butt lifters, tummy-control garments and full-body shapers. In recent years, however, The Pink Room has become a go-to resource for after-surgery garments, with more than 20,000 items in stock and a sales staff meticulously trained by owner Maria Sparacio to ask the right questions and provide the right answers.

“Patients are referred to us by surgeons,” explains Sparacio, “but frequently they just tell them to go get a compression garment. For the women who come to us, it’s kind of a mystery. We spend 30 to 40 minutes on average consulting with new customers to find the garment that best matches their needs and is perfectly comfortable. We get it right 99 percent of the time—it’s very unusual when someone needs to come back.”

Wherever a woman goes for a compression garment, customization is crucial. There is no such thing as one-size-fits-all; the size and type of garment can vary dramatically depending on the type of surgery, the amount of swelling, the type of support needed, a patient’s sensitivity to compression and the length of time a garment is needed—from a couple of weeks to a couple of months or more.

As for Sparacio, she got into the business in a roundabout way. A native of Colombia, she was working her way through law school as a bank manager in the Pacific coast city of Cali when she came to the United States on a student visa. The plan was to improve her proficiency in English, but it didn’t take long for her to realize that she had a head for figures—the financial kind, as well as the humankind—and that these dual talents would serve her well as an entrepreneur.

“I noticed how many women wore clothing that was either the wrong size or the wrong style for their body types,” Sparacio recalls. “It was obvious to me that they were not getting the help they needed in stores. I watched how they did business and always thought that people wanted more help. I thought, ‘I can do this better. I can be more professional. I can help people.’”

Yoga Compression Garments

Sparacio opened The Pink Room, on Morris Avenue in Elizabeth in 2008, just as the economy was hurtling off a cliff. However, her knack for individualizing service and solving problems for a multitude of body types enabled the store to build up a loyal walk-in and online clientele. She was able to open a second store, in Union, a few years ago.

The quest for the ideal garment often takes consumers to a website rather than a store. It might be a matter of convenience, or a reluctance to allow others to see the physical aftermath of childbirth or surgery. Online shoppers should have the same goal as store visitors: finding a compression garment that closely mimics the wearer’s movements while staying flush to the skin. No creases, no bunching, no extra space. Most internet sellers have liberal return policies, and build that into their pricing. They also carry thousands of sizes. Many women start in a store and then order online from that store (or a competitor) going forward. Bargain shopping isn’t really an option, however. In the compression business, you generally get what you pay for.

www.istockphoto.com

Sports Compression: A Placebo?

Compression garments have been around for many decades, of course, and are perhaps more familiar to athletes than surgical patients. The last 20 years have seen a boom in performance-enhancing compression garments. In fact, many products originally designed for medical purposes, such as calf sleeves, have seen sales skyrocket among athletes. Whether compression garments actually increase performance is debatable; it could simply be a case of athletes believing they do. Most medical experts agree, however, that where they are most helpful is in the recovery phase of sports—for much the same reason they work post-surgery.

EDITOR’S NOTE: Not all post-surgery garments require a consultation or fitting. Maria Sparacio estimates that 60 percent of her customers buy online while 40 percent visit her stores.

Easing the Stigma of Mental Illness and Addiction

By Yolanda Navarra Fleming

If anyone can speak with authentic candor to a ballroom full of people about behavioral health and addiction, and make them simultaneously laugh out loud and nod in empathy, it’s Patrick J. Kennedy II, the former U.S. Congressman, mental health advocate and author of the New York Times Bestselling book titled A Common Struggle: A Personal Journey Through the Past and Future of Mental Illness and Addiction (Blue Rider Press, New York, 2016).

In October 2018, the Trinitas Health Foundation launched their Peace of Mind Campaign with an informative evening with Journalist Jack Ford moderating a conversation with Kennedy on “Easing the Stigma about Behavioral Health” at The Park Savoy Estate, Florham Park.

The event raised $235,000 toward the $4 million renovation project to update Trinitas’ Behavioral Health facility, one of the most comprehensive departments of behavioral health and psychiatry in New Jersey. They offer specialized services for adults, children and their families, as well as services for those with various addictions, and a 98-bed inpatient facility. The hospital welcomes nearly 200,000 behavioral health visits per year. The multi-disciplinary and bi-lingual staff includes psychiatrists, psychologists, social workers, nurses, creative arts therapists, substance abuse counselors and mental health workers, offering such services as psychiatric, emergency response/screening center, inpatient, outpatient, partial hospital programs and addiction services.

Trinitas provides treatment for patients like Kennedy, who was diagnosed with asthma as a child, and went on to suffer through a lifetime of depression, bipolar disorder and substance use, which included many failed attempts at sobriety until he arrived at the right balance of medication and alternative therapies.

Patrick Kennedy, son of the late Senator Edward “Ted” Kennedy and Joan Kennedy, has fully embraced his DNA. He has worked tirelessly to shed new light on the struggle with mental illness and addiction that hang—now in plain view—on numerous branches of his family tree. In true Kennedy fashion, he is in the public eye working to right certain wrongs, more specifically, to get the world on board with the fact that the brain is part of the body and requires (and deserves) proper medical attention just like any other part. But unlike the Kennedys before him, he practices a sort of transparency that he recognizes as his destiny, which he fully owns both in spite of his DNA and because of it. In his book, he admits to the mistakes he has been hardwired to make and since then, has made easing the stigma of behavioral health his sole mission.

His passion was contagious when he and journalist Jack Ford discussed Patrick’s position as the nation’s leading political voice on mental illness, addiction, and other brain diseases. Ford’s focus on the subject stems from the fact that his father died from alcoholism at age 49.

Kennedy’s efforts to create stronger advocacy for all types of mental health and substance use disorders, have manifested in, among other things, lead sponsorship of the Mental Health Parity and Addictions Equity Act of 2008, as well as the creation of two nonprofit organizations—The Kennedy Forum and One Mind, which aim to provide and encourage groups that would normally compete for research dollars and support in other forms, to join forces.

The Kennedy Forum leads a national dialogue on transforming mental health and addiction care delivery by uniting mental health advocates, business leaders, and government agencies around a common set of principles. One Mind pushes for greater global investment in brain research, which Kennedy has called “the next great frontier in medicine,” and is pioneering a worldwide approach to make scientific research, results, and data available to researchers everywhere.

Progress has been made, but Kennedy says there is much more that can be done to encourage acceptance that brain illnesses should be treated with the same level of concern and respect as other diseases of the body such diabetes, cancer, heart disease, etc.

Here is a large portion of their conversation.

Jack Ford: You have clearly become one of the champions in the area of mental health and addiction. …You have been very open and candid in your book talking about your own life and your own struggles. There has always been a spotlight on the Kennedy family, and it’s something you cannot run and hide from. But what made you decide to step into that spotlight to talk about this in your own personal journey?

Patrick Kennedy: …I didn’t ask to be here as the advocate for mental health and addiction. I never wanted to be here at a podium being asked about this part of my life… and living in a family that also suffered from mental health and addiction. You got me by default. I became the leader of mental health and addiction policy in this country because I put my name on a bill that said the brain was part of the body. I never expected to be the first name on the bill. I thought because in my father’s case it took him 50 years in the US Senate before he got sponsored whatever he wanted because he was in the Senate longer than almost anyone else and he was chair of the big committees. So it was odd that as the youngest member of Congress, at 27, from the smallest state in the country and in the minority party, and as the lowest guy on the totem pole I got the chance to put my name number one. I got to be the sponsor. How in the world does that happen? Because no one else wanted to have to go in front of the cameras and have Jack ask them the same question he just asked me. That is the honest-to-God truth. No politician wanted to get up there and say they’re a champion of mental health, knowing that all of us are affected by it, and then have a press person ask about our own family situations. Because if we said anything, well, that yarn just spools right out and where do you reign it back in? And so you’re in trouble. If you say you’ve never been to treatment yourself, then you’re a one-termer. You say it’s happened to anyone in your family and you’re in the dog house with them, and you might be affecting their mental health by outing them involuntarily. So, there is no good minefield to walk through on this. And if you say no, they’ll think you’re a liar. So that’s why no one else wanted to put their name first.

I put my name first, not because…I keep reminding my Republican colleague Jim Ramstad, who I co-sponsored this with, he goes…if your uncle were alive he’d put you in a chapter in his book Profiles in Courage, but I have to tell everyone…the only reason I came out was because the guy I was in drug treatment with sold his story about being in drug treatment with me to the National Inquirer, which meant my face was on the cover (with the headline), “Patrick Kennedy: Cocaine Addict.” When I got up one morning, I was a second-term member of the State Legislature, and that was on every check-out counter in my district. I thought I was all done, as you would expect. I represented a very conservative neighborhood in Providence, RI, in the State House. The good thing is that my neighborhood was predominately Italian-American. Even though no one liked a drug addict, they really didn’t like someone who ratted on a drug addict. My posse…we started a re-election bid on “We’re not for the Rat Bastards; we’re for Patrick Kennedy.” That was my campaign slogan.

JF: That sounds like a skit from Saturday Night Live.

PK: Life is often like that.

JF: You’re right. So you became the lead sponsor with a bi-partisan backing, signed into law in 2008 by President George W. Bush. The title of the act is the Mental Health Parity and Addiction Equity Act. Why did you feel there was a need for the Federal Government to pass this act and what were you hoping it would provide?

Jill Sawers, Campaign Co-Chair & Trinitas Health Foundation Trustee Chair

PK: I was incredibly blessed because everything I was exposed to in life kind of set me up for this. If I look back on my life now, I could never have orchestrated the way it turned out, in a better way for me. My Aunt Eunice started Special Olympics with my grandmother. My family was steeped especially in the Disability Rights Movement, my father worked on the Americans with Disabilities Act. I was very sensitized to people who were treated as “the other,” particularly if they had a brain illness of some kind. My Aunt Rosemary, frankly, had a lobotomy because of her psychiatric disorder. Most people don’t know that. She had a mild form of intellectual disability. And yet, like many people, a certain percentage of those with intellectual disability also have psychiatric disorders. Everything I’ve read and learned about my Aunt Rosemary, leads me to conclude she had a psychiatric disorder, which really unnerved my grandfather, as it would any parent. At that time, lobotomy was the standard form of therapy. When that didn’t go well, she was banished from my family, and was sent to Wisconsin and wasn’t seen again by any member of my family, until after my grandfather had a stroke. My grandfather never saw her again after the lobotomy. That shame was so deep in my family that it transmitted itself through my father’s generation. When I think about my father’s inability to address what’s right in front of him, …he had learned and become very good at denial. It allowed him to survive things that…no one could survive what my father survived.

Deborah Q. Belfatto, Campaign Co-Chair & Trinitas Health Foundation Trustee

I was sensitized to that and to growing up with my mother being vilified because of her alcoholism. She would walk through the house inebriated in the middle of the day. My dad would have all of our nation’s leaders come to our house, people you would recognize and know of, and none of them would look up when my mother walked through the hallway. As a kid, I totally got the message to get her back in the room and shut the door. My brother, sister and I spent our childhoods doing all we could to hide our mother so she wouldn’t embarrass anybody. That was on family vacations, in our house and everywhere we went. I never got to connect with my mother on an emotional level because she was so debilitated by her illnesses, both alcoholism and severe depression, but I felt the need to defend her. Throughout my life, that’s what I took on.

I really feel blessed that I was able to support this bill and that, ironically, the House version of the bill covered alcoholism and depression and the Senate version of the bill did not. I could not get any agreement between the House and the Senate versions. But when my dad got brain cancer and he was home and nearing the end of his life, I asked him to help get the House version passed. He told me to call Chris Dodd, his best friend. …four days later, the market collapsed and the banks in this country went belly-up, and all of a sudden, Chris Dodd became somebody. He was Chairman of the Banking Committee and all of a sudden he was the most important man in Washington, D.C. That was four days after I asked for his help to get HR1424, the Mental Health Parity and Addiction Equity Act passed.

He called me back and said, “Patrick, we have to pass this bail-out of our nation’s banks. It’s going to cost the taxpayers between $700 and 800 billion dollars. None of us wants to vote for it, but we know if we don’t, our country could end up in another Great Depression. That was the feeling on Wall Street and around the country at that time. He said, “I have an idea.” I said, “What’s that?” He said, “How about I write the whole Toxic Acid relief program into your bill, the Mental Health Parity and Addiction Equity Act.” And I said, “You can do that?” And he said, “Yes, I’m Chairman of the Banking committee.” And that’s exactly what he did. And because of that, we got the whole DSM (Diagnostic Statistical Manual for all mental illnesses) covered in the Parity law, which we never would have gotten if it was on its own. Just to give you a quick flash of what a Conference Committee is, it’s when the Senate sponsors meet with the House sponsors. Pete Domenici said to me, “I’ll be damned if I let those addicts sink our bill.” And frankly, he was right. If we had added addiction, there was no way the Congress of the U.S. would have passed that. There would be no way we could pass that bill today for the same reasons.

There is no advocacy out there in this country. None! Facing addiction… You could fill this whole house with the members nationwide. Faces and Voices probably would fit in the room back here. NAMI (National Alliance on Mental Illness) does a great job, but they’re a fraction of what they really represent in terms of the populations affected by these illnesses. Bottom line, the reason we don’t get anywhere on these illnesses, is the stigma is so great that no one is willing to come up like HIV-AIDS, who knows. If they could do it, we should be able to do it. But frankly, I think the stigma is even greater than even cancer. That’s the big problem.

JF: Why do you think that is? I had a conversation with someone recently on my PBS show about this. They said something to me, and I hadn’t thought of this. So much of it has to do with words. For instance, if you’re talking about someone who has “substance abuse,” what does that say as opposed to “substance disorder?” I thought about it. I realized, and I make my living with words, the words you use can be extraordinarily impactful. What do you think it is that drives this notion of the stigma that attaches to mental illness and addiction?

PK: …It cuts to the heart of it, and that is who we are as people. We’re talking about our agency, our ability to be considered of right mind. Who amongst us wants to be saddled with the label that somehow we’re not “all there,” that we’re not in full possession of our mental faculties. That, my friends, is why there’s stigma because there’s no one out there who wants to be seen in a way that’s pitiful. …There is nobody who can get past the fact that if you admit that you have one of these illnesses people are going to not only look at you different, but you’re going to have an immediate liability in dealing with them and other people for the rest of your life. They’re always going to look at you in that prism. Are they all right today? Are they on their meds? People make judgments. It’s very disconcerting.

JF: How can we combat that? Like you said, it gets to the core of who we are in the notion of your defense mechanisms and how you want to view yourself. As an aside, I interviewed an Iraq War veteran who lost both legs and part of an arm and suffered a head injury. The first day after his surgery, he was ready to get up and start his rehab, but he wouldn’t talk about his brain injury. When I asked him, he echoed what you said. He said, I can lose my arms and I can lose my legs and I can still function and remember that I was a soldier. But I can’t look my comrades in the eye if they think there’s something missing. So how do we deal with that?

Susan Head, Campaign Co-Chair & Trinitas Health Foundation Trustee

PK: …We have to deal with each other based upon a sense of compassion and not judgment, in that respect. The way we’re all conditioned is to give people value based on all of these other characteristics besides who they are as human beings, and what matters most is how you connect with someone. Mental illness and addiction do not need to impair the human connection, even while it can impair the way communication takes place because of the impairments from these illnesses. But people can show human warmth and love, and that has to be the essential element. I’m a real believer these days in seeing the spark of divinity in every person because every person has his own set of gifts. It may be more difficult to see to find those gifts in some people than in others, but if you spend time because you know we’re all children of God, and they’re going to teach you something you didn’t know before and they’re going to add to your life in some other way…that, I think, is the revolutionary change. That leads to a whole different paradigm in the way people relate to each other. That’s the paradigm that’s going to heal this stigma. It has to be a spiritual solution.

Nine mind-blowing 2018 medical breakthroughs.

By Mark Stewart

Was 2018 a banner year for medical breakthroughs? Only time will tell, of course. That being said, there were a number of wow-factor stories that found their way into the mainstream media, as well as some that flew a bit under the radar. Each of the following news items, in its own way, heralds a game-changing health discovery that is likely to have a near-term impact—perhaps on your life or the life of a friend or family member.

LET THERE BE LIGHT

During flu season, every countertop, door handle, and armrest is a potential vector for illnesses that sicken millions—and can be deadly to those with compromised immune systems. A study published in Scientific Reports earlier this year showed that far-ultraviolet C light—aka. Far-UVC—can kill flu viruses. The beauty of Far-UVC.(besides its cost-effectiveness as a virus-killer) is that it is not harmful to human cells. Conventional ultraviolet light kills viruses but causes skin damage with too much exposure. This breakthrough could have a dramatic impact on the spread of microbial diseases—not just on public surfaces, but in the air, including influenza and even tuberculosis. Don’t be surprised to see Far-UVC fixtures in airports, schools, and hospitals in the years to come.

A SLUG’S LIFE

For all the medical advances made over the course of human history, wound and incision closure hasn’t progressed all that much. Stitches and, later, staples have been the basic method for keeping our insides in and the outside out. Last year, inspired by the sticky defensive slime secreted by the European slug (Arion subfuscous), scientists at Harvard’s Wyss Institute for Biologically Inspired Engineering created a new adhesive material that sticks to wet surfaces. In 2018, scientists took things a step further and unveiled a new surgical “superglue” that shows great promise as an alternative to stitches and staples. The advanced hydrogel is made of biomaterials that mimic the slug mucus, which adheres to surfaces in three different ways. The ick factor notwithstanding, it is non-toxic, flexible and able to stick to any surface—even surfaces covered in blood. Next up? A biodegradable version that will dissolve when a wound fully heals.

QUICK AND PAINLESS

We are officially one step closer to Star Trek sickbay thanks to Portal Instruments, a company working with MIT to develop a needle-less shot. The result of their work is PRIME, an injection device that introduces a high-pressure stream of medicine through the skin and into the blood without the sharp stick that none of us particularly likes. PRIME ejects doses of medication at Mach 0.7, or about the cruising speed of a Boeing 707. For people with an intense fear or phobia of needles—who often avoid much-needed doctor visits—the needle-free injection is a game-changer.

EARLY ONSET DEMENTIA BREAKTHROUGH

A few years ago, the acronym CRISPR began popping up in medical stories. It stands for Clustered Regularly Interspaced Short Palindromic Repeats and refers to a type of DNA sequence in bacteria and single-celled microorganisms. In 2018, scientists at the Salk Institute used CRISPR gene editing to target the RNA of diseased cells related to frontotemporal dementia, which is second to Alzheimer’s in early-onset dementia cases. In the Salk experiment, the RNA targeting effectively restored healthy levels of protein to the neurons affected by the disease. RNA-targeted use of CRISPR has been tried before, but in terms of accuracy, this type of gene-editing represents a significant breakthrough.

NEW WEAPON AGAINST SUPER BUGS

The battle against drug-resistant bacteria took an interesting turn this year when researchers at the University of Lincoln in England synthesized an antibiotic called teixobactin—and used it successfully to treat infections in mice. Teixobactin is a key weapon in fighting bacterial strains such as MRSA, which are difficult to kill and possess the potential to trigger epidemics. Teixobactin was originally discovered using a new method of culturing bacteria in soil and has been shown to kill Staphylococcus and Mycobacterium tuberculosis. The ability to synthesize teixobactin on a commercial level will take many years but should provide an important level of protection against staph and tuberculosis sometime in the 2020s.

MOSAIC VACCINE

A large human trial on a new HIV vaccine began in sub- Saharan Africa this year. The new “mosaic” vaccine addresses an obstacle that has thwarted the development of this type of vaccine for decades: The virus has multiple strains and tends to mutate rapidly. Initial trials on healthy, low-risk individuals in the U.S., Asia, and Africa produced a significant anti-HIV immune response. Tests of the vaccine on rhesus monkeys protected two-thirds from HIV. “One of the great challenges for development of HIV vaccine is viral diversity,” says Dan Barouch, Director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center in Boston. “The mosaic strategy is one way to attempt to deal with the global virus diversity.”

SLOWING ALZHEIMER’S

An 18-month trial completed earlier this year by Biogen (a U.S. biotech company) and Eisai (a Japanese pharmaceutical firm) has confirmed that the experimental drug BAN-2401 slows the progress of Alzheimer’s disease. BAN-2401 is an antibody that removes amyloid, the protein that interferes with nerve-cell function in the brain. The study was conducted on 856 individuals with mild cognitive impairment or signs of early-stage Alzheimer’s, all of whom showed amyloid build-up. Other drugs have been effective on amyloid levels, but BAN- 2401 reduced the development of new amyloid clusters and—most notably—slowed the decline in planning and reasoning skills by up to 30 percent. More work needs to be done, but this marks the first time a significant clinical trial has identified a drug that actually slowed Alzheimer’s disease.

SPECIAL K

Ketamine has a long and varied history. It was used as an IV anesthetic during Vietnam and is still used in field. hospitals and ERs. It is prevalent in veterinary medicine

(though not as a “horse tranquilizer” as some have referred to it) and is sometimes used to treat chronic pain in humans. Ketamine has also enjoyed some popularity as a high-powered party drug. In 2018, building off a decade’s worth of clinical studies, researchers at the University of Illinois at Chicago College of Medicine concluded that Ketamine is able to lift treatment-resistant depression in a few hours—which has profound implications within the psychiatric community.  Indeed, it’s the first drug in more than two generations that has demonstrated an ability to affect various neurological pathways to alleviate depression. The Chicago study, published in the June edition of Molecular Psychiatry, was one of several on Ketamine released during 2018. Unfortunately, the antidepressant effect rarely lasts longer than a week or so, and it is unclear whether repeat infusions are effective or even safe. The discovery has triggered research into similar drugs that last longer and come with fewer side effects, so expect more news to come in 2019 and beyond.

EXPLOSIVE DEVELOPMENT

When you see the letters TNT, you probably think dynamite. When scientists in the field of regenerative medicine talk “TNT,” they are likely referring to Tissue Nanotransfection, an emerging technology that involves a stamp-sized chip that reprograms skin cells to help repair organs and blood vessels. The implanted chip is used to send an electrical current into the body that delivers genetic codes to the skin cells, essentially changing their function to rescue failing body functions.  In a series of 2017 lab tests at the Ohio State University College of Medicine, researchers applied the chip to the legs of mice that vascular scans showed had little or no blood flow. The TNT chip reprogrammed their cells to become vascular cells and within a week the transformation began. By the second week, active blood vessels had formed. By the third week, the legs of mice were saved (with no other treatment). Human trials of this technology began this year.

New technologies have changed the landscape for pulmonologists.

By Mark Stewart

A lot of people joke that you can’t tell doctors anything. Don’t tell that to Dr. Carlos Remolina. And know that, when it comes to early detection of lung cancer, it’s no joking matter. On a Monday evening back in December, the Chief of the Pulmonary Division addressed the assembled Department of Medicine at Trinitas on how and when to employ the dramatic technological advances in his area of medicine. Much of his time was devoted to reviewing the fine points of Bronchial Navigation, a new way to detect the minute, shadowy nodules that could be the beginning of lung cancer.

“I presented several cases we have encountered here at Trinitas, one in which the nodule was as small as nine-by eleven millimeters,” says Dr. Remolina. “We were able to identify the nodule and use Navigational Bronchostomy to reach it and do a biopsy. The patient did have lung cancer, but because we detected the disease in its earliest stage, we were able to perform a resection and save that patient’s life.”

Where lung cancer is concerned, it is all about early detection. The 10-year survival rate for patients diagnosed in Stage 1 or 2 is 88 percent; in Stage 3 and 4, the five-year survival rate is just 17 percent. In his presentation, Dr. Remolina encouraged his fellow doctors to be more proactive when it comes to using the new technology. Medicare actually covers lung screening for “30-pack smokers” ages 55 and over, and Trinitas has a superb Lung Screening Program that employs a low-dose CT scan.

“Our program is not used as aggressively as it should be,” says Dr. Remolina, who adds that lung screening needs to become more ingrained in the medical community. Not only is it potentially a matter of life and death, he points out, it could soon be a matter of liability. When a woman goes to a doctor and that doctor doesn’t order a mammogram, the doctor could be liable if she develops breast cancer. The same could be true for a doctor who fails to refer an older ex-smoker for screening and a full workup if, years later the diagnosis is Stage 4 lung cancer.

HOW IT WORKS

Navigational Bronchostomy employs electromagnetic fields that create “GPS” to tumors when they are very small, so they can be reached and biopsied. A computer program generates a 3-D map that pinpoints the location of the tiniest tumors, and shows the twists and turns along the way. Prior to this technology, the diagnostic options faced by patients at risk for lung cancer were limited. They included traditional bronchoscopy, which often could not reach the area of concern or an invasive surgical procedure. Needle biopsies sometimes didn’t get to the target and came with a significant risk of pneumothorax, more commonly known as a collapsed lung.

“Another option was watching and waiting,” Dr. Remolina recalls. “When a nodule got big enough, you’d go after it. By that point, of course, the tumor had grown.” 

The new technology, he adds, reduced the risk of lung collapse from a range of 18 to 30 percent to just 2 or 3 percent. What are some of the first signs that suggest someone should get a screening?

“An unexplained cough, especially one that brings up a small amount of blood, would be a major area of concern,” Dr. Remolina says. “Unexplained weight loss is something to watch for, too.”

These symptoms are much more likely to occur in smokers, but lung cancer can also affect people who never smoked a cigarette in their lives. Unfortunately, those individuals don’t meet the criteria for low-dose CT scans at the moment. 

Another procedure that has come online in recent years is Endobronchial Ultrasound, or EBUS, which Dr. Remolina also says is a game-changer: “Before EBUS, you had to send a patient to a thoracic surgeon for a procedure on a lymph node. Now it can be done as an outpatient procedure.”

Dr. Remolina maintains that advances such as Navigational Bronchostomy and Endobronchial Ultrasound have changed the landscape of pulmonology. His goal is to encourage more physicians to embrace these procedures. It’s a matter of smart medicine and, potentially, life and death.

LOW DOSE/BIG RESULTS

The Trinitas lung screening program has been up and running for 18 months and, in that time, has already demonstrated its life-saving potential. The low-dose, non-invasive CT scan—which takes less than a minute—has detected tiny, early-stage tumors in dozens of patients, dramatically altering outcomes for those individuals. Lung cancer kills more people in this country than breast, colon and prostate cancer. Combined. The Trinitas screenings involve only a quarter of the radiation of traditional CT scans. For more information on the Lung Screening Program at Trinitas call (908) 994-5051.

Carlos Remolina, MD, FCCP, PA

Chief/Pulmonary Division,

Trinitas Regional Medical Center

Director, Care One LTACH

908.241.2030

The Connie Dwyer Breast Center opens at Trinitas.

By Yolanda Navarra Fleming

Connie Dwyer, a breast cancer survivor from Summit, was not shocked by her breast cancer diagnosis back in 1999. In fact, she almost expected it, in spite of the fact that her parents lived long, cancer-free lives and she was not considered high-risk. But there were other factors that came into play. For instance, her father smoked cigars. She grew up in Niagara Falls, NY near chemical plants. Connie even smoked for a short time when she was in college. Perhaps the most interesting fact of all was her older brother’s breast cancer diagnosis five years prior to her own. He lived for 17 years without traditional therapies until it spread to his lungs and eventually his brain, before he died.

Photos courtesy of Grace Photography

“Early screening is the most important thing,” she said. “I have friends who don’t like doctors and don’t go to the doctors. But I always felt that I was going to get breast cancer. I had a dear friend when I was in my early 30s, who was 10 years older, who passed from breast cancer and because of that, it was always on my mind. So I always went for my mammograms. And then when my brother was diagnosed, I would get a mammogram, see a breast surgeon and my gynecologist, so I was seeing someone four times a year because I just had a feeling.” 

The year she was diagnosed, it had only been 11 months since her previous mammogram, which meant it would not be covered by insurance. She paid for it and that’s when it was discovered. “Had I waited and we went away for the summer like we usually did, it would have been another four months. My instincts were good

She had a double mastectomy and chemotherapy, and shortly after being released from the hospital, her oldest daughter learned that she had a lump that needed to be removed. It was benign and she has been fine ever since

Her experience inspired her to go to the next level

 “During my chemo, there was a young girl who took a bus to get her chemo. She was a single mother with two children who took two buses to get to work after chemotherapy. I thought to myself, if you don’t have family around to help you, can you imagine how much harder it would be? That’s what inspired me to do what I do. And what I do could not be done without the board I have. I couldn’t do this on my own. It’s everyone who works with us that makes the outcome possible

Connie and a dedicated group of friends began a grassroots effort, where she worked tirelessly to create awareness and raise funds. By 2005, the doors of the first Connie Dwyer Breast Center had opened at St. Michael’s Medical Center in Newark. However, when St. Michael’s was purchased by a for-profit, Connie began looking for another non-profit hospital for a new center

“What inspired us to partner with Trinitas Regional Medical Center is that our missions are so similar—to serve the poor and vulnerable women in the community. When I walked into Trinitas, not only was it one of the cleanest hospitals I’ve been in, everyone was happy. That in itself made us want to be there.”

Just in time for Breast Cancer Awareness Month, the $3.4 million Connie Dwyer Breast Center opened at Trinitas on October 1 with a ribbon-cutting ceremony featuring Connie Dwyer, the Trinitas leadership, local officials such as Elizabeth Mayor Christian Bollwage, and a special guest appearance by Grammy award-winning singer Gloria Gaynor (left, with Connie), who sang “I Will Survive

Trinitas has partnered with The Connie Dwyer Breast Cancer Foundation to bring a highly empathic approach to screening, diagnosis, treatment, and community outreach and education to all women, regardless of financial status, in a brand new facility that evokes comfort and a sense of well-being

The Breast Center, staffed with board-certified bilingual specialists, offers the most up-to-date equipment and services available, such as 3D imaging, which allows radiologists to view the breast tissue in several layers. This breakthrough technology can detect 41 percent more invasive breast cancers and can reduce false positive results by up to 40 percent. 

The American Cancer Society recommends that all women over the age of 40 have regular breast exams and mammograms. Most women who undergo screening will be healthy and not require further services until their next scheduled screening. However, patients who require continued care will meet with a Breast Navigator, a highly trained guide who answers questions and assists through the process of diagnosis and treatment. 

Gary S. Horan, FACHE, President and CEO of Trinitas, says, “With the generosity of Connie Dwyer, the new Connie Dwyer Breast Center at TRMC is a beautiful, calming and comprehensive center for women in our community to have everything from their yearly screening mammograms to the latest diagnostic studies. In addition, it is a one-stop shop where care can be coordinated for the patient among our dedicated, compassionate multidisciplinary care team.” 

In November 2017, Connie was diagnosed again with breast cancer. 

“That was shocking to me, almost more shocking than the first time,” she says. “It had been 18 and a half years. I was still going every six months to the oncologist. I was very sad. I felt badly for my girls, my husband, and my 12 grandchildren. But they were very inspirational to me. They talk about how strong I am and it makes me want to be strong.”  

Her strength, at 75, is remarkable, in spite of cancer. “I’m still here. On many days I feel good. I might have to nap in the afternoon. I do complain, but in the big picture, how lucky am I? Within us there’s a strong drive to stay alive and be happy. I am really lucky to have so many good people around me. It’s amazing how good people can be. It makes me hopeful for the future. 

My unlikely encounter with a silent epidemic.

By Dree Andrea

Twenty-five years had passed since my last visit to a doctor’s office. Which is why, in 2016, finding myself in a constant state of fear and paranoia, the thought of doing so never even crossed my mind. It happened practically overnight. I grew increasingly afraid of leaving my house. My dreams were so vivid that I started to confuse nightmares with reality. In order to (literally) save the day, my subconscious ordered the insomnia that followed. After five days without sleep, however, I became terrified of my fellow human beings. I had always considered myself a grounded, healthy, joyous person who met all the responsibilities that come with living life. I did my best to remain calm and logical, but I was also aware that my emotions were on the verge of total collapse, and would get the better of me sooner rather than later.

A traumatic experience with the medical community early on in my life in Amsterdam (where I was born and raised) had motivated me to study a variety of holistic healing modalities after I came to America. When health issues arose that I could not address myself, I had worked successfully with a chiropractor and an acupuncturist, but never a traditional GP. Once, while experiencing severe pain after being clipped by a hit-and-run driver, a colleague convinced me to take an aspirin. It made me so sick that I decided to never touch over-the-counter medication again. Arnica gel for sprained ankles and Old Indian Wild Cherry bark for severe coughs were as far as I would go, no matter how grave the situation. I was a happy, healthy artist and documentary filmmaker living in the States for over 20 years when I began to “lose my mind.”

Of course, my American friends had long questioned my sanity, albeit jokingly.

www.istockphoto.com

My belief that diet is the key to physical, emotional and mental health has made me an object of curiosity. On occasion, I have been called stubborn or even stupid for living my holistic lifestyle. I ate solely organic food and avoided sugar, coffee, and alcohol. I also exercised and practiced yoga and mindfulness. I learned through my own success—and as a graduate of the Natural Gourmet Institute in New York—that staying healthy (and doctor-free) takes a lot of time and attention, willpower and discipline. Eventually, I started coaching others—acquainting each client with the tools and techniques necessary to discover the lifestyle that worked best. In some cases, I imparted knowledge I had acquired in other areas, like Reiki, a form of hands-on healing developed in Japan. I also believed the key to balance and happiness was connecting to your creative self, whether through journaling, painting, cooking, or some other passion. I held art and cooking classes, as well as dream workshops. I was a Jack-of-all-trades with a stack of certificates, but no conventional degree. Even so, as the years went by, with a track record of positive reactions and referrals, I was satisfied that my degree in Life Experience was an acceptable alternative.

On paper, I was the last person who should have been swept away by this tsunami of negative energy. Over the previous seven years, I had dealt successfully with a series of unexpected stressful events, including a separation, the passing of a few dear friends, and working with a psychotic life-coaching client who turned out to be far more dangerous than I had been willing to admit while working with him. Also, I had recently made a major quality-of-life decision that I considered to be very positive. After two decades in a New York rental apartment, I had initiated a project that opened up the opportunity to purchase a fairytale weekend home in New Jersey, the perfect place to one day create a coaching practice and writer’s den. I knew the city eventually would become too demanding for the sensitive soul that—at age 50—I recognize that I am.

Most of my life I had been told to “not be so sensitive” and to “get over myself.” In 2010, however, I learned from one of the professionals with whom I worked that I am indeed an unusually (physically and emotionally) sensitive individual. Which is to say that I need a little less stimulus and a little more nature than the average person. So the location of the house—in a national historic district, with unpaved roads winding up and around a hillside overlooking the ocean, an absence of streetlights, friendly neighbors and lots of wildlife—was a dream come true. As technology has rushed forward, time has barely moved there. I saw it as a new phase in life. I hoped to find the community I missed in New York and I intended to practice what I preached, in order to eventually obtain my “Master’s” in Life Experience. Even if the unsettling experience with the aforementioned coaching client had taken place in this house, when my emotions started to unravel, I still felt peaceful there, protected by nature, thankful for this safe haven.

One day in November 2016, I entered my home and something seemed terribly wrong. Panic struck me like a bolt of lightning. I ran outside, finding myself standing under a full moon, in freezing weather, without a coat. The chill I felt was not from the cold. The house was haunted. The hill was haunted. “You’re going crazy,” I said out loud, trying to compose myself. “No one knows about it yet. And you better make sure they don’t find out!” Hearing my own words grounded me. I would rather die than get locked away in a psych ward. Thinking of the birds, crickets and squirrels with whom I cohabitate in this magical place, I took off my shoes and connected with Mother Earth. I had trained with shamans in Peru a decade earlier; Patcha Mama would come to my rescue, I just knew it. I had never felt so grateful in my life. “I’m no lunatic,” I declared, looking up to the huge, bright full moon.

www.istockphoto.com

However, in the ensuing months, I grew more and more tired. I started to lose my ability to concentrate or focus. I had completely lost my grip. I reacted to everything like a deer in the headlights. My self-confidence crumbled. It was like living outside of a box made of unbreakable, soundproof, see-through glass looking in, but at the same time being locked up inside that very same box, reaching out to myself for help. Neither of us could find a door to even knock on. I was a documentary filmmaker trapped in a horror movie.

Deep down inside, I sensed that I had just lost my way. I never lost my identity. Yet it was hard to continue to believe in myself as more and more people who had known me for a long time, when confronted with my personality change, seemed to be looking to create a little distance. I kept hearing that I appeared pretty healthy and, therefore, it could not really be that bad. Some suggested antidepressants, others that I get a dog. In my world, those were not solutions. I just wanted people to be part of my life again; I was desperately looking for support from humans, not animals. A caring neighbor who had attended and appreciated my dream workshops—and who was familiar with my diet— offered up another idea. She is all about finding balance, but seeks it in different places, in different ways than I do.

Dree AndreaShe suggested I might have a vitamin deficiency. The one thing I had not considered or tested were the levels of my vitamins, minerals, and hormones.

So it came to pass that I found myself in an examination room for the first time since the early 1990s. I was terrified of how an M.D. might approach whatever the outcome of the lab work would be but fortunately managed to find a doctor who was open to holistic modalities. It turned out that I did indeed have severe vitamin deficiencies—caused by long-term stress, which had taken its toll on both my sleep as well as my digestive system. Due to malabsorption, she said, I was dangerously low in B-12.

Dree Andrea

It turns out B-12 is a really big deal. It is one of the essential vitamins affecting various systems of the body. Neurologic, hematologic, gastrointestinal, as well as psychiatric symptoms, arise in cases of deficiency. The reason? Neurotransmitters communicate information throughout the brain and body, relaying signals between neurons. The brain uses neurotransmitters to let your heart know to keep beating, your lungs to inhale and exhale, and your stomach to digest. A lack of B-12 can also affect mood, sleep, concentration, and weight. Vitamin B-12 helps increase brain serotonin and dopamine levels because it is a cofactor in the synthesis of these neurotransmitters, as well as in norepinephrine and gamma-Aminobutyric acid (aka GABA)—the chief inhibitory neurotransmitter in the central nervous system. In humans, GABA also regulates muscle tone.

As I read up on B-12 deficiency, it was like reading my own story: Although not common, psychiatric symptoms may precede the physical ones, including fatigue, forgetfulness, loss of muscle strength, a feeling of pins-and-needles and change in vision. And wouldn’t you know it? The agitation, irritability, negativism, confusion, disorientation, amnesia, impaired concentration and attention and insomnia that a B-12 deficiency can also cause is often misdiagnosed as depression, bipolar or panic disorder, psychosis, phobias, or even dementia.

My doctor administered my first B-12 shot that very day. She warned me that it would take quite some time to start feeling better—up to six months. Me being me, I rushed home to do more research and discovered an alarming number of stories about people who had taken years to recover. A few had to get B- 12 shots for the rest of their lives.

As of December 2017, I had completed my fourth month of replenishing. From onset to diagnosis, almost a year had passed. I am glad to know that I am not going out of my mind.

During those months of self-doubt and uncertainty, a friend convinced me, quite forcefully, to see a therapist who, in turn, referred me to a trauma therapist. Those sessions actually left me questioning whether I would rise out of the ashes ever again. Therapy is not for everyone, and I sensed that this, at least for me, was not the right path. I continued exploring other options to find answers. Looking back, what now seems “crazy” to me is that going down the therapy path might very likely have resulted in a prescription for mood-altering psychotropic medication before my levels of vitamins, minerals, and hormones had been checked out first

And it is dawning on me that B-12 deficiency may be a silent epidemic. According to some studies, four in ten Americans, for example, are not getting enough B-12, while 60 percent of vegetarians and 90 percent (!) of vegans apparently are deficient. A growing number of medical professionals and therapists have also begun talking about a vulnerable third “high-risk” group: highly sensitive people, to which I belong. We perceive emotions, thoughts, and moods, energies, in such an intense way that we are often physically affected or even depleted by other people or situations, or by stimuli such as lights, sounds, or wifi radiation. In my case, adding a B-12 deficiency to an often confusing energy mix could have led to my personal short-circuit. Honestly, I felt I was blowing an emotional fuse. Had I wavered from the belief that I was not mentally ill, I could easily have ended up misdiagnosed with a mental disorder, on lithium or some other antidepressant.

In fact, I looped back to my physician after noticing my mood sink a few days after each B-12 injection—and then rise again while taking the sublingual (under-the tongue) B-12 in between shots. After a little more research, a new gameplan was formulated with the help of an orthomolecular practitioner, which involved no injections and a combination of two different types of sublingual B-12, 3000 mcg methylcobalamine and 3000 mcg adenosylcobalamine. Each one includes folic acid and is held under the tongue for a half-hour for optimal absorption.

Long story short, B-12 deficiency can be a complicated and highly personal journey. And because it is not part of the standard ordered lab work, it requires asking your doctor to test for B-12 if you suspect you have symptoms.

While my viewpoints on health and wellness have not significantly changed, I understand that the mind-body connection is not for everyone. I remain firm in my belief that physical problems arise as a result of something emotionally off-balance in life. During this whole ordeal, I knew that the path back to my old joyous and energetic self would require continuous truthful self-exploration, a combination of the right foods and supplements, and most of all patience. I am still not a huge fan of doctors, but I do recognize the value of a second opinion. 

READ THE LABEL

www.istockphoto.com

My blood work revealed a number of vitamin and mineral deficiencies, for which I took various supplements to replenish. It was suggested that I try melatonin to help me sleep. That first night I woke up more often, feeling more severe disorientation and terror than ever before, so I immediately stopped taking it. A few weeks prior to this writing, I suddenly recalled that in my shamanic education we were told to take melatonin in combination with B-6 to enhance practicing lucid dreaming and astral travel. I myself had chosen not to take the supplements at the time. I decided to check the label on the bottle I bought a year ago. Sure enough, on the front in huge letters it said MELATONIN, but in examining the small print I found that the capsules contained a whopping 10 mg of B-6—500% of the daily recommended value!—in addition to the 1 mg of melatonin in each pill. I was shocked to find, returning to the health food store, what other ingredients are added to many vitamin supplements without a clear indication. Turns out we have to start reading those labels as carefully as we read the ones on our food.

HUNTER GATHERER

During my ordeal, a number of my friends brought up the fact that I do not eat meat, which is a good source of B-12. The suggestion I think is that my wounds, on some level, were self-inflicted. It is true that vegans and vegetarians are more likely to be confronted with this problem. Having been a vegan myself for about a year in 2005 during my education as a chef, I respect their choice, even if it means committing to a regimen of B- 12 injections to avoid killing animals. I have opted for eating fish and organic eggs again, thanking the fish and chickens for their offerings. And I have upped my intake of sardines and salmon, which are two of the best B-12 sources, making peace with the fact that I am, like many other animals, a hunter, and gatherer.

Editor’s Note: Dree Andrea is an international award-winning filmmaker, artist, and energy coach working in New York and New Jersey. Her B-12 journey has taken her in some fascinating directions and led her to some eye-opening studies on B-12 deficiency. There is research that suggests that her hypersensitivity may have been further amplified by the fact that her mother carried twins, but that her sibling died in the womb. She is currently enrolled in the only training that specializes in coaching highly sensitive people and empaths. Dree is working on her second book, The Empath and the Psychopath, and on the documentary Losing Your Marbles; A B-12 Side Effect. Dree can be found at dreeinthebigcity.com.

A trinity of benefactors advances nursing education.

By Kathryn C. Salamone

Haiti… where natural disasters like the 2010 earthquake and Hurricane Matthew in 2016 exacerbate already unforgiving conditions for its 10 million-plus people who live in abject poverty; where more than half of the population is undernourished and 800,000 people experience food insecurity every day, and where nearly 10,000 people have died of cholera since an outbreak in 2010, the first in a century.

Despite being the poorest country in the Western Hemisphere, despite the existence of an ill-equipped and under-staffed healthcare system—25 physicians and 11 nurses serve 100,000 people—Haiti can now look forward to better health among its people.

Thanks to the combined efforts of the Trinitas School of Nursing (TSON), the College of Saint Elizabeth (CSE), and the Sisters of Charity of Saint Elizabeth (SC), healthcare leaders in New Jersey form a virtual league of healthcare “Avengers.”

As the program began to take shape, The Haiti Student Nurse Project soon became known as Global Connections in Nursing Education: Haiti and the USA – a name that aptly communicates its essence: assuring that Haitian nurses have access to learning the best practices used in the US that they can then apply in responding to the needs of their fellow Haitians. Since 2014, the program has educated student nurses enrolled at Université de Notre Dame in Jacmel, Haiti, located about 100 miles south of Port au Prince. Its goal: to improve healthcare by strengthening the competence of its nurses. The student nurses have flown to New Jersey to undergo total immersion in US nursing practices and procedures, making the program one of the very few, if not the only one of its kind, to bring students to the United States for their learning experience.

Sister Janet Lehmann, SC, a past chair of the Nursing Program at the College of Saint Elizabeth, envisioned an innovative collaboration with the TSON and CSE. As the current Dean at the Jacmel campus of the Université de Notre Dame, Sister Janet knew that a partnership between the two New Jersey learning institutions could be invaluable to a nation so desperately in need of improved healthcare.

She called TSON and CSE to propose a bold, lasting and beneficial venture. “I asked for faculty and curriculum support plus the opportunity for 12 of my junior nursing students to gain bedside patient care,” Sr. Janet explains. “In Haiti, nursing education relies heavily on memorization which can limit a nurse’s ability to retain the knowledge needed to respond quickly, efficiently. It’s a constant challenge to call to mind what’s needed for competent patient care. From the planning stages, we realized the education program should concentrate on teaching
‘hands-on’ care.”

During the two-week immersion programs in 2014 and again in 2016 at the TSON’s Simulation Lab located in the Elizabeth I. Kellogg Building at the Union County College Elizabeth campus, the student nurses cared for computer-controlled “sim patients.” Sister Janet added, “The student nurses could perform their nursing care in different scenarios with greater confidence as they improved their critical thinking skills.”

Seasoned nursing professionals at TSON and CSE bought into the partnership without hesitation: Mary Beth Kelley, recently retired Dean of TSON, who served more than 40 years in that role, and Professor Eileen Specchio of the CSE Nursing Program who herself has 30 years
behind her.

Dean Kelley notes, “From the beginning, we took great care in developing the in-depth curriculum. Creolespeaking faculty members of TSON translated in both Creole and French and CSE Nursing program graduate students and alumni were heavily involved. Experienced clinical specialists from Trinitas Regional Medical Center and Saint Clare’s Hospital in Denville, another SC sponsored hospital, and those like SC who provided administrative support became a team of ‘super heroes’ who helped bring our vision to reality.”

The program received support from a trinity of benefactors. In addition to the use of the TSON lab, the Trinitas Health Foundation approved a grant that funded the purchase of the simulation equipment specifically designed for countries like Haiti. CSE offered its dorms for the students during their stay.

“We created a challenging environment to educate Haitian nurses so they could gain greater competence and confidence in patient care,” says Dr. Specchio. “Our vision of a global outreach to initiate real change in nursing care in Haiti, our experience with the students, the results we’ve seen in Haiti, all show that we’ve succeeded.”

FOCAL POINTS

Global Connections in Nursing Education: Haiti and the USA has lived up to its goal of answering global health needs that the World Health Organization and the International Council of Nurses have identified: to design education programs to promote better health, reduce disease burdens, and lower risk factors.

Here’s what the Trinitas program has concentrated on:

• Hygiene, sanitation/waste control
• Infectious disease, asepsis, and wound care
• Maternal emergencies: hemorrhage, eclampsia, and dystocia
• Women’s health: STD’s, HIV, condom use, self-breast exam, breastfeeding
• Cardiac disease: hypertension, stroke prevention, congestive heart failure
• hydration/dehydration fluid management
• First aid and disaster management: infant, child and adult CPR, choking
• Mental health: communication/active listening, empathy, learned helplessness, domestic violence, parenting principles
• Children issues: malnutrition, assessment, diarrhea prevention and management, and choking

To learn more about the Trinitas School of Nursing, visit:
www.trinitasrmc.org/school_of_nursing.htm

Cryotherapy is coming to a health club near you. Is that a good thing?

By Mike Cohen

In the classic sci-fi film Logan’s Run, set in the year 2274, citizens of a certain age entered a special chamber called the Carousel, where they were “renewed.” It turned out that was future-speak for being vaporized. Renewal has a different look in 2018, although in the case of cryotherapy, it still has a futuristic feel. Across the country, citizens of a certain age are discovering the renewing benefits of the cryosuana chambers that have started to pop up in gyms, health clubs and spas. You may have seen one; it’s an insulated standalone chamber that you stand in, with protection for your hands, feet and private parts, and your head exposed at the top.

Cryotherapy is an ergonomic modality used to address a wide range of aches, pains and medical conditions. It also has benefits for athletes looking to improve their performance. The ancient Greeks and Romans used cryotherapy (immersion in chilly seawater) to treat inflamed wounds. In the 19th century, European medicine rediscovered this technique. A couple of generations ago, cryotherapy looked a lot different: a bag of ice wrapped around a knee or shoulder, a chilled whirlpool bath. In the 1970s, Japanese researcher Dr. Toshiba Yamauchi pioneered the concept of whole-body cryotherapy to treat rheumatoid arthritis and, in doing so, began to notice its therapeutic side effects for subjects who suffered from injuries and chronic inflammation. Since then, there has been a huge amount of medical information coming out about this technology and how it can benefit the human body in myriad ways.

Back to the cryosauna chamber. Liquid nitrogen gas is expelled at –200⁰C and blown around your body in the chamber, escaping from the top. It’s all over in three minutes. You’re shivering, yes, but you quickly warm up and experience a particular euphoric feeling, which keeps a lot of folks coming back. “Regulars” often schedule sessions every one to two weeks.

What exactly is going on with this cold air and your inflammation/injury? The cold blast hits the skin and the blood vessels constrict. The skin doesn’t “like” the cold and shunts blood to the center of the body, the core, to keep it warm. The autonomic nervous system—which controls automatic stuff like breathing and heart rate— begins to take over. It is composed of the sympathetic (fight or flight responses) and the parasympathetic, which conserves energy and relaxes things. The body begins to shiver, contracting muscles to stay warm, and increases the metabolic rate. This is the sympathetic part. The chemical mediators that started this process are basically put into hibernation and the tissues’ response is one of slow motion. The blood slows down in the extremities and, in turn, slows down what is called oxidative stress to the tissues (aka free radical formation).

Another part of the autonomic nervous system, the parasympathetic system, when exposed to cryotherapy, begins its magic with releasing noradrenaline from the nervous system. This helps to alleviate pain along with several other actions. Increased parasympathetic activity has been linked to exercise recovery and a reduction in cardiovascular risk for stroke or heart attack

Medicine can be so boring, right? So let’s skip to the good stuff. Why would cryotherapy be something of interest to you? Well, there are many medical issues where this type of treatment has been tested and the results are pretty eye-opening. For example, studies have shown remarkable improvement in low back pain with as little as 10 sessions of three minutes duration each.

Another area where cryotherapy has proved to be effective is sleep. A study of elite basketball players from Europe showed a 15% improvement in the quality of their sleep with as little as one session. The maximal effect was demonstrated after 10 sessions.

Currently, the main customers for cryotherapy are seeking relief and recovery from the pains and strains of physical exercise. When we exercise strenuously, we release inflammatory compounds like CRP (C Reactive Protein), and inflammatory cytokines—including Tumor   Factor, Interleukin and Interleukin 6—into the circulatory system. Not good. Pain, swelling, stiffness, loss of motion all come with “overdoing it.” Free radicals are also part of the picture, generated during exercise. These free radicals attack cell walls, especially the lipid (fatty) parts, which causes cells and blood vessels to leak. With cryotherapy there is a dramatic reduction in these factors by virtue of cryo’s ability to generate an Interleukin inhibitory factor, and by releasing an anti-inflammatory cytokine called Interluekin 10.

I know. It can be a little confusing. But here is the takeaway: Even after a single three-minute exposure, there is medical proof that the inflammatory chemicals begin to reduce in concentration in the blood. Strength can actually increase after cryo treatment. Power also can improve after as little as one to three sessions. And, for all those runners/rowers out there, the body’s VO2 Max is increased after as little as three exposures. Athletes having been “cooling it” before competing and noting an increase in performance. The NBA Dallas Mavericks and the NFL Dallas Cowboys are among the pro teams that have these machines.

There is also evidence that cryotherapy can benefit individuals experiencing depression and anxiety, as pain can be the underlying issue in both cases. By exposing the body to cryotherapy, it increases the metabolic rate —as detailed above—which brings with it an increase of catecholamines, such asepinephrine, norepinephrine and dopamine. Also cortisol, ACTH and endorphins are increased as a result. These are all ingredients for improving one’s mood and attitude. In the brain there is a system called the Opioid Peptide System, which regulates motivation, emotion, responses to stress, and control of food intake. You can see how this is part of the depression and anxiety issue. With cryotherapy, this Opioid Peptide System is stimulated to release these chemicals into the brain. Indeed, medical studies have shown significant improvement after only five sessions.

One final aspect of cryotherapy that is worth noting is that its benefits are cumulative. The more you do it, the better things tend to get. That sounds like a good business model, doesn’t it? It’s another reason you may be seeing cryosuana units coming to a location near you. 

What Exactly Is Inflammation?

We have all seen inflamed joints, tendons, and extremities. Hot, sometimes swollen and painful limbs, spine and joints all tell us that we have either done too much in the gym or have been subjected to injury. Inflammation and injury start with the vascular system. Small arteries and veins are part of the capillary system, where they are renamed arterioles and venules. These are called the endothelium. With trauma or overuse, the endothelium becomes sticky and attracts platelets and leukocytes (white blood cells) that clump together at the site of injury and begin to decompose. Doctors call this degranulation. Once this happens, there are all sorts of chemical compounds released by these cells to create a pulling-back of the endothelium, creating gaps inside the walls of vessels. These compounds have nasty names like tumor necrosis factor and interleukin 1. Additionally, free radicals, histamine and serotonin are generated and all swim in the same pool of liquid inside the vessel. With the gaps created, the liquid inside the vessel, lets call it plasma, leaks out into the surrounding tissues, joints and muscles and creates swelling and irritation. This liquid has a higher protein content than inside the vessel, and therefore more liquid from inside the vessel tries to dilute the protein outside the vessel. Then the body attempts to heal itself with more cells “coming to the rescue”—namely macrophages, which are human waste disposals. They grind up and eat the damaged tissue so that new tissue can be laid down. However, this process is not fun. It hurts. It’s the body’s way of saying, “I need some time off to heal this problem.”

CRYOTHERAPY AND DISEASE

Rhuematoid Arthritis

This is a disease where the body is essentially destroying itself, eating away at soft tissue and bones. Studies have shown that some of the chemical factors involved in this disease are Interleukin and Tumor Necrosis Factor. With cryotherapy—and from here on I am talking about the cryosauna unit—exposure does remarkable things to the blood work of rheumatoids. With 10 exposures of three minutes. there is a significant drop in these chemical markers, which in turn decreases pain, inflammation, and degradation.

Fibromyalgia

A difficult diagnosis to deal with, as this is a diagnosis often arrived at after loads of negative testing results. The anguish of chronic pain, often from a neurological basis, is distracting to patients. Cryotherapy has shown that, with as little as 15 treatments of 30 seconds in duration, there is a dramatic effect on reducing pain.

Multiple Sclerosis

MS is a debilitating disease of the muscles and nerves.

Fatigue was the overwhelming issue in most MS patients when questioned about their disease. With 10 three-minute exposures, there is a significant reduction in fatigue of the skeletal muscles.

EDITOR’S NOTE: Although thousands of athletes, including LeBron James, swear by whole body cryotherapy, the FDA has not approved any WBC devices. It’s a good idea to discuss cryotherapy with your doctor, especially if you plan to replace more traditional treatment options for medical conditions.

While other charitable groups are devoted to raising money, HFNJ focuses on how best to spend it.

By Yolanda Navarra Fleming

The Healthcare Foundation of New Jersey (HFNJ) has been a nurturing force in the greater Newark, NJ area and the Jewish community of MetroWest since 1996, when it was formed from the sale of Newark Beth Israel Medical Center to the Saint Barnabas Corporation. As a champion donor to Trinitas, the HFNJ’s extreme generosity to the hospital dates back to 2000, totaling 21 grants to the rather significant tune of $3,374,132.

According to Marsha I. Atkind, Executive Director/CEO, the HFNJ functions a bit differently than one might expect. Rather than working to raise funds, the board plays an active role in making decisions about applicants’ proposals and projects.

Kathleen Shevlin, Director of Resource Development;
Nadine Brechner, Vice President of the Trinitas
Foundation; Gary Horan, Trinitas President/CEO; Dr. Beth
Levithan, HFNJ Chair; Marsha Atkind, Executive
Director/CEO of HFNJ; and Dr. John D’Angelo of Trinitas
take part in the ribbon cutting of The Healthcare
Foundation of NJ Geriatric Unit.

“We have a strong endowment,” says Atkind, a University of Pennsylvania graduate, who studied at Columbia University Law School. “(The late) Lester Lieberman, our founding chairman, was the chair at Newark Beth Israel when the sale took place. He made that sale happen and his vision made the HFNJ happen. We owe everything to him.”

At one time a stay-home mother, Atkind got involved in women’s issues and became President of the National Council of Jewish Women in 2002. When her term was up, she was hired by the Jewish Federation of MetroWest to start a women’s foundation. In 2008, she was recruited to the HFNJ.

“In our 21-year history, we’ve given away about $135 million dollars, the lion share in greater Newark,” remarks Atkind. “We fund everything from major pieces of equipment, as we’ve done for Trinitas in the Emergency Department, to programs at grassroots agencies that help people improve their health and wellness.”

As needs arise, Nadine Brechner, Vice President/Chief Development Officer at Trinitas, remains grateful that the HFNJ’s generosity doesn’t begin and end with money. Trustees and staff spend their time working closely with applicants to get to know the challenges of their goals and how to best meet them, which sometimes means reshaping and improving proposals.

“Marsha, her staff and trustees are all fantastic,” says Brechner, who works closely with them on projects from start to finish. “They have taken an active interest in our patients and visit frequently. Whenever I’ve gone to them with our needs—both big and small—they’ve always found a way to help. They also question our proposals. And they follow up because they want to know that they have truly helped. They are true partners.”

An example is the new Gary S. Horan Emergency Department at Trinitas, a 24,000-square-foot renovation that nearly doubled the amount of beds and created separate treatment areas for the consideration of seniors, families and behavioral health patients.

“Their gifts have literally touched almost every aspect of care at Trinitas, which is why the HFNJ will be honored at the 2018 Peace of Mind Gala this year,” says Brechner.

By definition, the HFNJ’s mission is to improve the health and well-being of vulnerable, underserved populations in greater Newark and the Jewish Community of MetroWest NJ, to elevate the quality of community healthcare, reduce disparities in access, and promote the infusion of compassion and humanism into our healthcare system. Dr. Beth Levithan, chair of the HFNJ, who joined the board in 1997, is most proud of the HFNJ’s commitment to humanism.

Geriatric Unit

“There is a focus on humanism in every grant we fund and everything we do,” says Levithan, the former adjunct professor at the Rutgers School of Social Work in New Brunswick, and senior researcher/evaluator at the Research Center at John Jay College of Criminal Justice in New York.

“Les was passionate about inspiring our Board with that mission. He always emphasized treating people, not their diseases, as the key to successful healing and wellness. The Healthcare Foundation of NJ Center for Humanism and Medicine, which was founded and funded by HFNJ at Rutgers New Jersey Medical School in 2004, is only one example of this emphasis.”

Nadine Brechner, Vice President/Trinitas Health
Foundation and Marsha Atkind, Executive Director/CEO
of HFNJ shake hands during the CORE Building
dedication.

Arnold and Sandra Gold of the Arnold P. Gold Foundation were a pivotal influence on Lieberman and the HFNJ. “The most wonderful evening of the year for HFNJ is when we give out the Lester Z. Lieberman Humanism in Healthcare Awards to individuals nominated by our grantees as excellent examples of humanistic caregivers,” she adds. “Les and Arnold Gold are now deceased, but they would be so pleased to know their work will continue at HFNJ reaching the most vulnerable populations they both wanted to serve.”

The HFNJ was one of the early champions of HIV-AIDS programs and has prioritized projects aimed at early development, disabilities, and parenting. One of HFNJ’s biggest successes is Mom2Mom, a telephone peer support program run by Rutgers University Behavioral Health designed to have mothers of children with disabilities answer questions posed by other mothers with similar issues. Mom2Mom began locally and has now grown to serve mothers throughout the US.

“Some of the work we’ve done has been to help mothers bond with their infants and be the best parents they can be,” says Atkind. “We feel so strongly that if children start off on the right foot, a lot of the problems later in life could be alleviated or possibly eliminated. We know how hard it is to raise children, especially in today’s world with all the responsibilities and issues brought on by poverty, racial and cultural disparities, and technology. Programs that support mothers and teachers are crucial to the health of our country moving forward.”

Women, in general, can be grateful for the HFNJ’s most recent pledge for the new Connie Dwyer Breast Center to pay for the Hologic Selenia 3D Mammography System, the latest technology for detecting invasive cancers.

“HFNJ initially helped us update our technology when we went from film to digital imaging,” says Brechner. “They care about our moms and have been caring for them fora long time.”

THE HEALTHCARE FOUNDATION OF NEW JERSEY HAS SUPPORTED TRINITAS WITH THE FOLLOWING GRANTS:

Connie Dwyer Breast Center

Most recently, a $348,467 grant will cover the balance needed for a Hologic Selenia 3D Mammography System for the New Connie Dwyer Breast Center. This system will be the centerpiece of the new Center. Now the industry standard, 3D mammography technology, can detect 41% more invasive cancers than older methods while reducing false positives by 40%. With this grant, Trinitas will be able to provide the highest quality, potentially lifesaving diagnostic care to the underserved women of the region.

Emergency Department

These are among the latest and largest gifts they have given to Trinitas. In all, HFNJ gave $1.75 million to the Proud Past, Promising Future Campaign with the following components:

• The Healthcare Foundation of New Jersey Transitional Care Unit: $1,000,000 (10/2016). Through this grant, HFNJ funded the construction costs for the Transitional Care Unit. This unit was created as a designated space to safely stabilize, diagnose and provide medical clearance to patients who are experiencing a psychiatric and/or substance abuse emergency. The HFNJ Transitional Care Unit served 6,544 patients in 2017— more than triple our initial projection of 2,000 patients per year.
• The Healthcare Foundation of New Jersey Geriatric Unit: $500,000 (December 2015). The purpose of this project was to create a model for urban safety-net hospitals that ensures that seniors receive the safest, most comfortable and clinically sound care in an environment that respects their privacy and dignity. This five-bed unit was on track to serve 5,700 patients in its first full year of operation.
• Emergency Department Diagnostic Unit CT Scan: $250,000 (August 2014). HFNJ gave a $250,000 grant for the 128 slice CT Scan, which is the centerpiece of the ED Diagnostic Unit. Hospital-Acquired Delirium HFNJ took a leadership role through its initiative aimed at tackling Hospital Acquired Delirium (HAD) across New Jersey. Two grants totaling $242,048 provided salary support and supplies to establish a hospital-acquired delirium program, devoted primarily to aiding seniors on our inpatient units. The foundation also provided an additional grant to ensure that the program would be fully established over the long-term.

Ambulatory Surgery Center

A $149,134 grant in 2014 helped purchase two pieces of equipment for the Ambulatory Surgery Center. HFNJ also gave grants for the Behavioral Health EMR Project ($148,500), Surgical Equipment ($150,000), the first Digital Mammography Suite ($100,000) and other projects.

News, views, and insights on maintaining a healthy edge.

Back to the Future

Drug-resistant bacteria is responsible 

for more than 20,000 deaths a year in the United States, and the CDC warns that this number is unlikely to go down until a new antibiotic comes on the scene. Is Octapepin the answer? If so, it’s a case of “back to the future,” as this drug was developed in the 1970s…and then dropped.

According to the journal Cell Chemical Biology, researchers at the University of Queensland in Australia noticed that Octapepin is similar in structure to Colistin, which is currently used as the last resort drug against antibiotic-resistant bacteria. The toughest bacteria to fight have an extra membrane to penetrate, which is camouflaged from drugs, as well as the human immune system. Because Colistin is effective against this additional layer, the hope is that Octapepin will be, too.

If so, it should replace Colistin, which can wreak havoc with the kidneys and other internal organs. Octapepin was shelved in the 1970s and’80s because so many other powerful antibiotics were hitting the market during this time.

New Blood Test Detects 8 Forms of Cancer

Scientists at Johns Hopkins recently announced a universal blood test that detects eight of the most common types of cancer. The test looks for trace amounts of mutated DNA and proteins that are released into the bloodstream by tumors. By identifying each type of cancer before it has time to spread, the test promises to have a major impact on the mortality rate from the disease. The most recent trial showed a 70 percent success rate in detecting cancer among study subjects. Ovarian cancer was the easiest to detect, followed by liver, stomach, esophageal, colorectal, lung and breast cancer. Although current blood tests can detect cancer, none have been able to pinpoint the type of cancer with significant accuracy.

Researchers were quick to point out that most of the cancers detected were advanced stage two or stage three, but there is hope that the test can be refined to catch the disease in its pre-symptomatic stages.

Breakthrough for Central Sleep Apnea Sufferers

Sleep apnea, a breathing disorder that affects an estimated 1 in 15 Americans, has been getting a lot of attention lately. Even if you are one of the 14 that doesn’t suffer from this disorder, you may have noticed an increase in ads for CPAP devices, as well as louder debates about whether sleep-deprived sleep apnea sufferers should be allowed to operate trains, planes and automobiles. Sleep apnea comes in two varieties, obstructive and central. Obstructive sleep apnea, which is caused by an upper-airway blockage, is the most common and controllable. Central sleep apnea is far more dangerous. It happens when the brain and diaphragm don’t communicate, resulting in lapses in breathing. Some lapses can last a minute or more. Late last year, the FDA approved an implanted device for central sleep apnea patients that should be available sometime in 2018. Marketed under the name Remede, the neuromodulation system activates a nerve that sends signals to the diaphragm to stimulate breathing. It is one of several new products on the horizon for sleep apnea sufferers—an estimated 40 percent of whom refuse to wear a  CPAP device.

“Perfect Storm” Flu Season

So what did we learn from the recent, and particularly bad, flu season? Stay at home. The relative ineffectiveness of this year’s vaccine (estimates range from 10 to 22 percent effectiveness)—combined with regional shortages of Tamiflu and a robust employment picture—created a perfect storm for transmission. Although most flu sufferers followed the basic medical advice to stay in bed, drink fluids and take fever reducers, many went back to work (or school) too soon. Most doctors recommend staying home an additional 24 hours after you “feel fine.” Although healthy adults and children will recover from the influenza virus, it can be deadly for those with weakened immune systems, as the virus can lead to pneumonia. The World Health Organization links between 290,000 and 650,000 fatalities each year to flu epidemics. Four in five flu deaths worldwide occur among people 65 and older.

New Benchmark for Gene Therapy

For the 1,000-plus individuals in the U.S. with a rare, inherited retinal disorder caused by a defective gene called RPE65, 2018 holds incredible promise. The rest of the medical profession is also excited, because the FDA’s approval of Luxturna marks the first time it has OK’d a “true” gene therapy treatment to reach the market. Gene therapy involves the delivery of a healthy copy of a gene to make up for one that is unhealthy. The RPE65 gene is responsible for a protein that makes light receptors in the eye. Patients that inherit a defective version of the gene suffer from retinitis pigmentosa and eventually go blind. Luxturna is injected into each eye with a single dose that uses a benign virus to deliver healthy copies of the RPE65 to the retina. Though not a cure, it has been shown to improve eyesight substantially. The bigger picture surrounding FDA approval of gene therapy is intriguing, to say the least. Because many cancers begin with a DNA defect, gene therapy (which has been under development for two-plus decades) could become a major weapon in the fight against the disease.

Warming Up to Saunas

There are now more than a million saunas in the United States, including home units and those in health clubs, spas and resorts. Those who swear by saunas got some good news recently when a study out of Finland pinpointed a specific benefit for middle-aged adults at risk for heart disease. Researchers found that a 30-minute session at 160 degrees decreased blood pressure by seven points and increased arterial elasticity. Heat exposure can widen blood vessels and promote better blood flow, easing the workload for the heart. Study subjects had at least one of the three conditions: obesity, high blood pressure or high cholesterol. Saunas gained an initial foothold among Americans in the 1950s, after the Helsinki Olympics. Finnish athletes attributed their medal-winning performances to the incorporation of saunas into their training routines.

Booze News Not Good for Heavy Drinkers

A new study from the University of Toronto has drawn some alarming conclusions about the long-term effects of heavy drinking. Researchers looked at the medical histories of a million individuals diagnosed with dementia over a five-year period and found that the strongest predictor for this condition was a previous hospitalization for issues related to alcohol consumption. More than half of early-onset dementia cases were linked to alcohol-related brain damage. Of the 5.5 million cases of Alzheimer’s dementia in the U.S., about 200,000 are considered early-onset. One in 10 Americans over the age of 65 has some form of dementia. Heavy drinking is defined as four or more drinks per day for men and three a day for women.

The Hidden Cost of Climate Change

Does climate change impact health? The devastating aftermath of the 2017 hurricanes in the Gulf of Mexico and the Caribbean has focused much attention on this relationship. While the response to each disaster teaches us something new about how to deliver healthcare to stricken areas, each disaster also demonstrates how natural disasters can undermine healthcare in vulnerable parts of the world. In many places, the disasters are actually the source of public health crises. This, maintains the World Health Organization, which is the “hidden” cost of climate change. The situation is exacerbated by bureaucratic tinkering with post-disaster statistics. For instance, only 64 deaths in Puerto Rico were officially attributed to Hurricane Maria. The apocalyptic images that we saw suggest a different story. And indeed, the deaths related to a “disruption in healthcare” on the island surged well past 1,000 in the weeks that followed.

Dry Eye Syndrome is a growing problem in the United States. And no, there’s nothing fun about it.

By Caleb MacLean

What is it about tears that make them such fertile territory for songwriters? Think, for instance, about how many times you’ve heard the words Don’t Cry as song lyrics: The Four Seasons (“Big Girls Don’t Cry”), Melissa Manchester (“Don’t Cry Out Loud”), Guns n Roses (“Don’t Cry”) and of course the signature song from Evita (“Don’t Cry for Me, Argentina”). The irony is that the inability to produce healthy tears can be a sign of a serious medical situation. Indeed, keratoconjunctivitis sicca—better known as Dry Eye Syndrome—affects millions of people each year. Based on data derived from the 2013 National Health & Wellness Survey, the percentage of Americans with dry eye could be as high as 6.8 percent—and the number of cases promises to increase steadily in the near future.

Dry eye syndrome can cause a number of symptoms, including but not limited to foreign body sensation (or a “sandy” feeling in the eyes), excessive tearing, burning, and redness. Blurred vision and eye fatigue can also be worsened with dry eye syndrome.

“The eyes can become dry when the quality or quantity of the tears fails to lubricate the eyes adequately,” explains Dr. Erica O’Lenick, an optometry specialist at the Santamaria Eye Center in Edison. “The tear film has three layers, all of which contribute to keeping the ocular surface healthy. With any disruption of a layer, the inflammation cycle that causes dry eye will begin in a chronic manner.”

Symptoms can be exacerbated by smoking, contact lens wear, heating, and air conditioning, and environmental or hormonal changes. The risk for dry eye syndrome increases with age, and is most prevalent in middle-aged women, adds Dr. O’Lenick.

According to Dr. Joel Confino of The Eye Care and Surgery Center in Westfield, until relatively recently dry eye syndrome was typically treated with artificial teardrops, often of the over-the-counter variety. “Now it’s become a more evolved specialty, with more high-tech solutions available, such as tiny ‘plugs’ to be gently inserted to prevent excessive drainage of much-needed tears,” he says.

Even more advanced solutions are on the horizon, Dr. Confino adds—one being the TrueTear, which was approved by the FDA about a year ago. The device is battery-operated and consists of two tips that are inserted into the upper nose to stimulate tear production. TrueTear will likely be used in conjunction with other treatment options to provide the most comprehensive relief.

Both doctors have noted a steady increase in dry eye cases over the past several years. One explanation is screen time. “Computer overuse is the most common cause of dry eye in young patients today,” says Dr. O’Lenick. “With changes in technology, many people are using their computers for approximately 10 hours or more daily. While on the computer, we often forget simple measures like blinking to continuously keep the eyes lubricated. Decreasing screen time and remembering to take breaks often to blink may help in preventing dry eye discomfort while working.”

Dry eye causes can be traced not only to the tear glands themselves but also to the oil glands in the eye. 

“In fact,” says Dr. Confino, “there are two types of tear glands—those that produce regular tears and those that are responsible to produce the tears that are a reaction to irritation, allergies, or emotions. Paradoxically, at times the dry eye condition will actually stimulate the overproduction of the latter type of tears.”

He says that issues where the oil glands become blocked can also be a factor since healthy eyes need a mix of sufficient tears and oil. This is called evaporative dry eye and it is often found with meibomian gland dysfunction (MGD)—which occurs when the glands that produce the oils for the tear film become clogged and no longer provide the necessary help for the tears to stick to the ocular surface.

When this occurs, the tears evaporate more quickly, causing the eyes to become dry. This is the most common kind of dry eye, points out Dr. O’Lenick, but not the only kind—which is why it is important to see an eye care physician to determine the type of dry eye that you may have.

Other types of dry eye syndrome include aqueous deficient dry eye, which occurs when the body does not produce enough tears. This can be the result of autoimmune diseases such as Sjogren’s syndrome, lupus, or rheumatoid arthritis. Taking certain medications like antihistamines or blood pressure medications may cause a decrease in tear production, too. Systemic diseases, such as diabetes or hypertension, may contribute to dry eye syndrome, as well.

According to Dr. O’Lenick, the treatments for dry eye depends on the cause and type of dryness. Warm compresses and eyelid scrubs are a conservative treatment that may allow the oil glands to better function with evaporative dry eye and MGD. Mild dry eye symptoms may be relieved with the aforementioned over-the-counter artificial tears and ointments. For moderate to severe symptoms, your physician may recommend a prescription eye drop or anti-inflammatory medication.

Patients may also benefit from the use of omega 3 fish oil vitamins to help decrease the inflammation that causes dry eye.

What’s the secret to good eye health? Dr. Confino recommends balancing good nutrition with getting enough rest and also treating the eye as if it were a muscle—“that is, exercising it and caring for it with the same respect as any large muscle in the body.” 

When is it time to see the doctor if you suspect you have some form of dry eye syndrome? As a rule, when symptoms such as tiredness, scratchiness, itchiness, and burning—often accompanied by redness, blurred vision, and sometimes even uncontrollable watering—becomes uncomfortable, but before they reach the point of being unbearable.

“Early detection and management of dry eye is key in preventing symptoms,” Dr. O’Lenick says

Joel Confino’s specialty is cataract surgery. He is a graduate of the Albert Einstein College of Medicine and completed his Ophthalmology residency at Mount Sinai School of Medicine. 

Erica O’Lenick is a graduate of the Pennsylvania College of Optometry. She has experience in pediatric, binocular vision care, ocular disease, and anterior segment care.

Editor’s Note: According to the National Eye Institute, left untreated, dry eye can lead to scarring of the cornea. Some studies have suggested that around 70% of the elderly may suffer from dry eye at one time or another. The condition is especially prevalent in China, where a 2014 article in the Journal of Ophthalmology noted that 17% percent of the population exhibits symptoms.

Trinitas puts the science of “shut-eye” in play.

By Christine Gibbs

Can you recall the moment when you first heard the term sleep hygiene? For those of us who suffer from some form of sleep disorder, the concept couldn’t have come soon enough. From insomnia to sleep apnea, from snoring problems to nodding off at work (or behind the wheel!), the dream of a good night’s sleep is just that—a dream—for upwards of 50 million Americans. Indeed, so much attention has been placed on getting enough sleep in our stress-filled lives that Sleep Medicine is now a recognized medical specialty devoted to the diagnosis and therapy of sleep disorders. For the record, “sleep hygiene” refers to those practices, habits and routines that contribute to a sound sleep.

According to the American Sleep Association (ASA), nearly one in 10 adults in this country suffers from sleep apnea. Around half have a snoring problem. Two in five adults fall asleep during the day when they should be awake, with an alarmingly high 5% reporting that they do so while driving at least once a month. The ASA also attributes between 3% and 5% of obesity to sleep deprivation. Not surprisingly, insomnia tops the chart of sleep issues.

This would explain the growth of the Comprehensive Sleep Disorders Center at Trinitas, which began with a single bed in a single room. It has now expanded six-fold, with four in-hospital beds at the Elizabeth campus and two more located remotely at the Homewood Suites by Hilton in Cranford. The center is accredited by the American Academy of Sleep Medicine.

Dr. Vipin Garg, who has been the program’s director since 2004, focuses on ensuring that everything in the Trinitas Center is as conducive to comfort, personalization, and privacy as possible. This includes ensuite bathrooms, temperature control, TVs, books, and even “get acquainted” visits prior to the first session. He adds that some patients prefer the hotel ambiance to that of the hospital, finding it to be more relaxing and sleep-inducing, adding “we try to make the center less like a hospital and more like a hotel.” Regardless of the venue, the key for all patients, he says, is to relax beforehand.

SERIOUS BUSINESS

Dr. Garg emphasizes the potential seriousness of many underlying causes of sleep problems. “Some disorders such as sleep apnea and insomnia have high mortality rates,” he says. “Even individuals who go to bed late and get up late have a 10% higher mortality rate than average. And of course, sleep deprivation can have disastrous results in the workplace due to diminished cognition and judgment.”

Some of the issues treatable at the center include sleep apnea, insomnia, restless leg syndrome, snoring, and narcolepsy. No issue goes untreated, however, even the non-life threatening ones, such as oversleeping or teeth grinding.

“We are open 24–7, day and night,” he says. “In fact, sometimes we are as much a ‘wake-up’ center as a sleep center.”

Indeed, at times, the Comprehensive Sleep Disorders Center is so successful at inducing sleep that it becomes the only place where patients believe they can get a good night’s rest. In such cases, the patient has to be weaned off dependence on sessions at the center by analyzing the reasons for the preference and recommending reasonable changes to the home environment to make it more sleep-friendly.

The Sleep Disorders Center is equipped with all state-of-the-art diagnostic equipment to monitor heart, breathing and muscle activity, as well as specialized equipment such as the BiPAP machine, a non-invasive form of therapy for patients suffering from sleep apnea. Videos are an important tool in sleep analysis and are regularly reviewed with patients to help them understand the source of their sleeplessness.

Currently, a staff of 16 mans the Comprehensive Sleep Disorders Center, a 2:1 staff-to-patient ratio. Some are respiratory therapists and others are board-certified polysomnographers. One-on-one supervision is provided to accommodate special needs. On average, 30 patients are seen each week. Males with sleep apnea problems account for the majority; insomniacs are predominantly female. Annually, the center treats about 1,200 patients.

According to Nancy Gonzalez, Chief Technologist, the Comprehensive Sleep Disorders Center is especially proud of its care and support of young sleep-deprived patients. Pediatricians from the surrounding counties frequently refer patients to Trinitas for diagnosis and treatment. Children ranging in age from six months to their teens often present with physical disorders, such as enlarged tonsils/adenoids or sleep apnea. Patients with Down’s syndrome and ADHD have also been treated. In fact, in contrast to most adults, the center’s clinical case studies have revealed that children who are not getting enough sleep at night typically become overactive and agitated during the day, with the unfortunate result that many are misdiagnosed with ADHD.

Along with the very young, many seniors seek solutions at the center for their age-related sleep issues. In general, all patients at the center respond positively to the nurturing staff and comfortable environment. Perhaps the best testament to its reputation is that patients who were treated 10 or 15 years ago, but who suffer a relapse, have confidence enough to return for retreatment.

DOCTOR’S ORDERS 

“Sleep disorders of all kinds and of varying degrees are very curable and reversible,” Dr. Garg states. In fact, this positive prognosis was what attracted him to sleep medicine more than 15 years ago. He sums up the center’s treatment protocol as comparable to the recommendations of most healthy diet and exercise programs. Sleep aids are always reserved as a last resort—he indicates that many of the newest drugs are non-addictive and of significant therapeutic value when carefully prescribed and monitored by a physician. As to specific bedtime rituals and requisites, Dr. Garg offers the following suggestions:

• Leave enough time for 7 to 9 hours of sleep.
• Go to bed at the same hour each night.
• Avoid all caffeine or alcohol.
• Keep the room dark and noise-free without distractions such as TV, computer, etc.
• Be sure to visit the bathroom before going to bed.
• Try some deep breathing exercises (but no aerobic exertion for four hours prior to bedtime).

The goal for all patients is to analyze their sleep behavior in order to develop natural and restorative sleep patterns that will improve overall health and add quality to their personal lives.

HOW MUCH IS ENOUGH?

The American Sleep Association has issued the following guidelines for a healthy night’s sleep…

Adult • 7 to 9 hours

Teenager • 8 to 10 hours

Child (6 – 12) • 9 to 12 hours

Child (3 – 5) • 10 to 13 hours*

Child (1 – 2) • 11 to 14 hours*

Infant • 12 to 16 hours*

What’s the right amount of sleep for seniors? It all depends. 

* including nap

SENIOR SLEEPERS

Sleep recommendations for seniors are more difficult to generalize since aging often brings on more physical issues, such as restless leg syndrome, acid reflux, and bladder problems that can affect sleep patterns. It is a common misconception that seniors require less sleep; rather, ideal sleep needs remain relatively constant throughout adulthood (with some person-to-person adjustments). Older adults on the whole often have a harder time with their personal sleep architecture—i.e., falling asleep and/or staying asleep. The recommended amount of sleep for seniors, however, remains the same as for most adults: 7 to 9 hours, even when interrupted.

THESE DREAMS

Do dreams come into play in the analysis of sleep disorders? From a scientific perspective, dream content does not determine the quality of sleep —although it can affect the patient’s condition upon waking. Narcoleptics are among the most frequent “day dreamers.” Whether the dreams are sweet or nightmarish, the physical aspects of the sleep event are no different, even though the acting out behavior upon awakening can be dramatically different (for example when based on traumatic real-life events as with many PTSD cases).

Vipin Garg, MD

Director, Trinitas Comprehensive Sleep Disorders Center

908.994.8880

Trinitas branches out to offer convenience and continuity of care.

By Caleb MacLean

If you’ve ever needed to get a simple referral for a special test or treatment, you know that often there is nothing simple about it. Much of the frustration one experiences as a patient in a typical medical practice stems from a lack of communication. In that regard, there is nothing “typical” about the Trinitas Medical Group, where communication, service, and follow-through define the patient experience.

The offices, located in Elizabeth and Clark, are owned by Trinitas, and the physicians and staff are employed by the medical center. In addition to primary care physicians, the Trinitas Medical Group encompasses a wide range of specialty care practices. For the consumer, that translates into a level of convenience that is difficult to find at traditional practices.

“Our primary care patients receive one-on-one personalized treatment and care,” says Nancy DiLiegro, VP of Clinical Operations and Physician Services. “You’re not a number here. Everyone knows you.”

“The sharing of information internally between the practices enables us to interface with the hospital and other services and care providers,” adds Frank Andreola, Director of the Trinitas Medical Group. “So all the paperwork is handled within the practices. If you need one of the ancillary services, we’ll make the call for you and arrange everything. Our staff will make all your appointments for whatever you need.”

Two doctors who have been an integral part of the Trinitas Physicians Practice team are Dr. Vasyl Pidkaminetskiy and Dr. Sergio Baerga. Both appreciate the value of expanding Trinitas’s healthcare services and network of medical professionals beyond the bounds of the flagship hospital in Elizabeth into local communities within Union County. Dr. Pidkaminetskiy (Dr. P to his patients and staff) has worked almost three years in the offices located in Clark, and he is pleased with this unique opportunity to be part of what he calls “a very special group of physicians.”

Dr. Pidkaminetskiy is especially impressed with the community-oriented approach of the practice, as well as the convenience of close contact with his colleagues to expedite immediate consultations and sharing of vital patient information. Patients similarly appreciate the wide range of medical services and treatments provided by Trinitas and the ease with which care can be both delivered and accessed at the various practice offices.

Everyone in the practice network, he adds, is focused on delivering the best possible care and inspiring the utmost patient confidence.

Dr. Baerga, a surgeon in the Clark office, echoed Dr. P’s sentiments, adding that “the wide variety of clients keeps me on my toes, keeps me thinking and keeps me challenged.”

Ask him how his patients feel about the practice and you’ll get a smile. “I hope they feel okay,” he says. “I think I would hear about it from them if they weren’t pleased about coming here!”

Dr. Baerga also says that he enjoys taking his time and not rushing his patients—something that is emphasized throughout the Medical Group: “I like to get to know them and to learn what’s happening in their lives.”

Jazmyn Thomas (pictured right), a current patient of the Medical Group, appreciated Dr. Baerga’s kindness before, during, and after having minor surgery. “He was very supportive,” said the Elizabeth resident. “I called him with questions every day, sometimes more than once, and he never made me feel like I was a bother. Even when he wasn’t in the office, he managed to get back to me right away. He made me feel a lot better about everything, especially because I had never had surgery before.”

According to Dr. Baerga, as a satellite to the main Trinitas campus, the location of the office in Clark offers the opportunity to meet other professionals in other communities, and to treat a wide variety of clientele— including many of whom speak Spanish. “In fact,” he says, “some days I get to practice so much of my Spanish that I have to remind myself to speak English when I get home.”

Dr. Sergio Baerga

The list of services includes general surgery, endocrinology, and hematology-oncology and surgery, gastroenterology, ear-nose-throat, breast health, medical oncology, hematology, and radiation oncology, OBGYN and urology.

The availability of doctors for appointments both in Clark and Elizabeth—as well as the availability of specialists— is something that surprises the group’s new patients.

“If your primary care physician wants you to go for a test or be evaluated by a specialist, we can get you in within a week, if not sooner,” says DiLiegro, who adds that another advantage that the Trinitas Medical Group offers is that it accepts any insurance the hospital does, and vice-versa.

“This is a jewel,” says DiLiegro. “We have quality, boardcertified physicians and a multilingual staff providing efficient and timely care in a very difficult landscape where, frankly, a lot of people with good insurance still can’t get to see a practitioner.” 

A TEAM EFFORT

The Trinitas Medical Group offers a large and growing staff of physicians and providers, including…

Dr. Nazima Abarova, OB/GYN

Dr. Abu Alam, OB/GYN

Traci Alves, NP

Dr. Sergio Baerga, General Surgery

Dr. Gerardo Capo, Oncology/Hematology

Symptom Management

Dr. Michelle A. Cholankeril, Medical Hematology/Oncology

Dr. Ari S. Eckman, Chief, Division of Endocrinology, Diabetes & Metabolism

Dr. Clarissa Febles Henson, Chair, Radiation Oncology

Dr. Clyde T. Jacob, OB/GYN

Dr. Eddy Joseph, OB/GYN

Dr. Rachel Kaye, Otolaryngology/Surgery

Dr. Barry Levinson, Hematology/Oncology

Dr. Prakriti Merchant, Gastroenterology

Dr. Boris Pashkover, Otolaryngology/Surgery

Dr. Jack Perrone, OB/GYN

Dr. Vasyl Pidkaminetskiy, Internal Medicine

Dr. Mark Preston, OB/GYN

Dr. Vincent Salerno, Hematology/Oncology

Dr. Adriana Suarez-Ligon, General Surgery

Dr. Richard Tai, OB/GYN

Dr. Oscar Verzosa, Internal Medicine

Dr. Michael Viksjo, Gastroenterology

Midwives:

Carol Rose Trzaska, CNM

Shirley McDuffie, CNM

Chantal Berry, CNM

MaryBeth Weimer, CNM

Editor’s Note: For more information on the Trinitas Medical Group, visit TrinitasMedical.Group or call (732) 499-9160. The Clark Office is located at 67 Westfield Avenue.

The FDA is wary of Vaping. Should you be, too?

By Erik Slagle

Would you knowingly inhale the chemical used to de-ice airplane wings? Or boil antifreeze and breathe in the vapors? Probably not. Yet that’s exactly what people are doing when they “vape.” To healthcare professionals, the greatest danger is the fact that a significant majority of vapers believe they have found a clean, healthy alternative to smoking cigarettes.

Can you blame them? As flavors go, Crème Brulée, Peach and Fruit Medley are infinitely more appealing than, say, nicotine, tar, and filters. That’s one-way makers of e-cigarettes and other electronic nicotine delivery systems (aka ENDSs) are trying to convince the public that vaping is safe. Another is by omitting some key information, which could mislead the public and potentially create new smokers from people who would have never considered developing the habit in the first place—including millions of kids.

www.istockphoto.com

“When you pick up one of these devices, you need to be aware of what you’re inhaling into your lungs,” says Dr. Adam Rowen, a Pulmonary Medicine specialist and President of the Trinitas Medical Staff. “It’s an attractive flavoring, yes. But it’s also a combination of substances like nicotine and propylene glycol. We don’t yet know what might be the long-term effects of inhaling them.”

Dr. Rowen points to a recent report from the National Asthma Resource Center showing that vaping can introduce unsafe levels of lead, chromium, manganese, and nickel into the lungs due to the heating of a metal coil, which warms and helps aerosolize the liquid. In addition to the many detrimental health effects—including damage to the liver, immune systems, cardiovascular system, and even the brain—there may be a risk of developing cancer due to repeated exposure.

“Manufacturers may want us to believe that ENDSs don’t contain the volume of carcinogens that tobacco smoke produces,” he says. “But studies like the one by the Asthma Resource Center show these devices still introduce irritants into the airways, which causes coughing and many other bronchial issues.”

There are quite a few “known unknowns” in play here. Propylene glycol, for example, is safe to eat, according to the Food and Drug Administration. It is used as an additive in ice cream and frozen desserts and can be found in small amounts in liquid sweeteners, soda, and whipped dairy products. However, it’s also the primary ingredient in automobile antifreeze and the de-icing foam used on airplanes. Vapers pull atomized propylene glycol into their lungs with each puff.

The FDA has also weighed in on the marketing of e-cigarettes, Juuls, and similar devices as cigarette alternatives: They are not approved smoking cessation products. In point of fact, many ENDSs actually are categorized as tobacco products by the FDA. Patches, gums, and lozenges are still the only approved products that don’t require prescriptions.

For the uninitiated, Juul is just one brand of vaping device, while other brands are sometimes manufactured to look like everyday items, such as flash drives, lipstick tubes, and even flasks. They are easy to conceal and can be charged in a computer’s USB port.

THIN BLUE LINE

In several Union County towns, vaping has become a matter for the police. Detective Michael Dubitsky and Detective Sergeant Matthew Nazzaro of the Cranford Police Department’s Juvenile Bureau have made vaping a primary focus of their education and action initiatives. They host regular presentations for children and parents about the dangers of vaping and have immersed themselves in learning as much about the products and devices as possible. “A Juul starter pack,” Dubitsky explains, “including the device and liquid pods, contains the equivalent of 200 cigarette puffs per pod. That’s more than enough to form an addiction just from the starter pack.”

Dr. Rowen agrees: “These devices can act as gateway drugs to smoking actual tobacco products.” This ease of concealment and operation, combined with enticing flavors (and marketing tactics straight out of the 1950s and ‘60s tobacco-industry playbook), is creating what Nazzaro calls a shifting dynamic on what kids choose to put into their bodies.

“Vaping isn’t a fad,” he insists. “It’s creating a generation of kids addicted to another substance. We thought we were raising the generation that could end smoking, but vaping has created a whole other problem we need to combat.”

A recent study by MonitoringTheFuture.org shows that, while the rate of 8th graders who admitted to smoking cigarettes has dropped from 4.5% in 2014 to less than 2% today, 6.6% of today’s respondents say they’ve vaped. That number rises to 13% among high school sophomores, and one out of every six seniors says they’ve vaped at least once

Zack Martini, a recent high-school graduate from Springfield, saw it firsthand:

“My freshman year, few if any people had vaped. Over the last two to three years, though, I noticed a huge increase at my school. I don’t think people are doing it to be ‘cool’ either. Rather, they’ve become addicted to the high levels of nicotine.”

Detective Sergeant Nazzaro concurs.

“When kids are caught in school before three o’clock with a vape, it’s almost as if they can’t get from one period to another without vaping,” he says. “Nicotine is an addictive stimulant. At a certain point, kids start having heart palpitations because they’ve been vaping, and that’s a real danger.

www.istockphoto.com

LIKE BUTTER

Ever heard of Popcorn Lung? Sounds like something you get at the movies, right? It’s actually the nickname for bronchial obliterans, a condition that damages the smaller airways in the lungs and creates shortness of breath. One of the causes is exposure to diacetyl, a chemical used to give microwave popcorn its rich, buttery flavor. It was once thought to be perfectly safe, but not anymore. The condition was first identified in workers at a microwave popcorn factory. Diacetyl is one of the chemicals to which vapers are exposed.

Adam Rowen, MD

Pulmonary Medicine Specialist

Trinitas Regional Medical Center

(908) 289-7600

Editor’s Note: For more information on vaping, visit fda.gov/tobaccoproducts.

At Trinitas Regional Medical Center, you don’t have to. She’s already there.

By Yolanda Navarra Fleming

Belinda DeJesus, a Kenilworth resident who lost her private insurance and went on Medicaid before becoming pregnant, arrived at Trinitas in labor hoping for the best. Which, she says, is exactly what she got.

“I had no idea about the midwives until I got there,” she admits. “But I was very blessed to have such humble, down-to-earth, hardworking, kind, and caring midwives that made my delivery such a pleasant experience that I can’t imagine going elsewhere. It has become such a wondrous memory.”

Lekha Sreekumar, WHNP-C and Chantal Berry, CNM,
WHNP-C enjoy a moment with a newborn.

In the modern world, isn’t giving birth about making memories? If your goal is to experience childbirth with minimum medical invasion, and you’re healthy and free of any medical issues that would require a physician’s attention, the Trinitas team of seven midwives can help make that happen. The hospital is home to the second-longest running midwifery program in New Jersey. Each woman can experience her pregnancy and childbirth in a modern maternity unit with private labor/delivery/recovery rooms, and the most advanced medical technology available. A midwife is in charge of a mother-to-be’s care and labor management.

“On every shift, we have a doctor, a nurse/anesthetist, neonatologist or pediatrician, a resident and a midwife, and we work as a team,” says Carol Rose-Trzaska, OB/Gyn Certified Nurse Midwife, who began her training at Trinitas in 1991 and graduated the State University at Downstate in Brooklyn in 1992. “We have strong midwives here who have more years of healthcare experience than some of the doctors.”

After earning a Bachelor of Science in Nursing with a specialized graduate degree in Nurse Midwifery, midwives finish training with enough experience to deliver babies, and provide mothers with newborn care, breastfeeding guidance, and routine gynecological care. Shirley McDuffie, who has been a midwife for 25 years, was a Labor and Delivery nurse in 1981 before going back to school to become a Certified Nurse Midwife. Although she had just had her own baby—and new mothers were not considered good returning-student candidates—she defied the odds. Becoming a midwife was that important to her.

“It was that old way of thinking, that you can’t work and go to school and also be a mother,” she recalls. “I cried every day because I had to leave my son, but I finished school and don’t regret it.”

McDuffie’s story is a testament to the common thread of passion for the work of Trinitas midwives, as well as compassion and empathy for their patients. Shanaya Recalde, MSN, RN, CNM, began her career in 2009 and came to Trinitas this past January. It turned out to be an ideal career move.

“I have worked in other hospitals and I think there’s something special happening at Trinitas,” she explains. “The midwives here possess a wealth of knowledge and have been more than happy and willing to share their experiences with me. They have treated me like family. They are constantly seeking new opportunities to learn and grow. They are supportive of patients’ rights and encourage patient autonomy with birth plans and expectations. They are also a driving force behind the mission to help moms successfully breastfeed. There’s tremendous respect for the midwifery services here.”

Shanaya Recalde, CNM, WHNP-C with new mom and infant.

At the root of the team’s success is good communication, not just midwife-to-midwife but midwife-to-mom, too. A variety of languages are spoken in the Trinitas Labor & Delivery Unit. For instance, in addition to her 31 years of experience, Chantal Berry, CNM, WHNP-C—who began at Trinitas in 2013—is fluent in both Haitian Creole and English. Upwards of 40,000 Haitians reside in New Jersey, with the majority living within a half-hour of the hospital. Lekha Sreekumar, WHNP-C, an adjunct faculty member of the Trinitas School of Nursing since 2010 (and a nurse practitioner since 2013), brings 30 years of experience to her job, including the ability to speak Malayalam, Tamil and Arabic. Mothers for whom Polish is the first language can connect with Iwona Lewinski, CNM MS, who recently joined the midwifery team. Like Sreekumar, she has a healthcare résumé three decades long. Spanish translators are also available to patients at all times.

In all likelihood, expectant mothers will get to know more than one midwife from the team, particularly if they visit the Women’s Health Center at 65 Jefferson Avenue or in the OB/GYN office at 240 Williamson St. in Room 503, both in Elizabeth. There the midwives see patients from the beginning of their pregnancies through delivery, and into post-partum care.

“Midwives can prescribe medication, order treatments and tests for the well woman or pregnant patients,” says Rose-Trzaska, who blazed a trail with the first and only independent midwifery practice on Staten Island before coming to Trinitas in 2014. “When it comes to dealing with higher risk patients, we consult with the doctor.”

Dr. Jack Perrone, OB/GYN at Trinitas, counts on the midwives for their expertise and the collaborative efforts among all staff members of the Labor and Delivery Unit of the hospital.

“The midwives have for a long time collaborated with the OB/Gyn physicians to provide outstanding care for our patients,” he says. “The midwives provide our low-risk obstetrical care while the physicians concentrate on higher-risk patients. During a low-risk labor, the midwife will both manage and deliver the baby with the physician present as back-up if the need arises.”

That need occasionally involves the decision for a Caesarean section. Having a C-section is not typically part of a woman’s birthing plan, but sometimes it can’t be avoided. That being said, Trinitas was recently singled out for its low C-section rate (16.9%) by the New Jersey Department of Health and New Jersey Hospital Association. That recognition came as part of a statewide initiative to reduce unnecessary Caesarean sections for the well being of mothers and babies.

Once again, Dr. Perrone points out, it all comes down to communication—in this case, between the doctor and midwife.

“Which carries over to the patient, in avoiding a C-section birth unless medically necessary,” he says.

“Because our Midwifery Services are firmly in place, and have been for decades, our commitment to the natural birthing process is solid. There’s no question that a woman in labor will be able to honor her body’s own timetable and have every opportunity to enjoy her baby’s birth as a family event…without ever being rushed to the finish line for our convenience.” 

ONE MOTHER’S LAMENT

www.istockphoto.com

I still vividly remember becoming part of my couch while watching back-to-back birthing shows on TLC hoping to live vicariously through another pregnant woman who would accomplish my dream of a completely natural (aka no medical intervention) childbirth. Although I’d heard the pain involved would be like nothing else (meaning worse than) I’d ever experienced, I was more afraid of needles. According to the shows I watched, epidurals seemed par for the course, and I’d just have to wait the full nine months to test my own strength. It didn’t matter that the nurses at my hospital repeatedly offered anesthesia; I avoided it anyway—twice in fact, the second time occurring 22 months later with my second child. Still, I regret not having the guidance and nurturing of a midwife.

—Y.N.F.

Shirley McDuffie, CNM with newborn.

WHAT DOES IT TAKE TO BE A MIDWIFE?

The Certified Nurse Midwife is a professional care provider—a Registered Nurse (RN) who has graduated from one of more than 30 advanced education programs accredited by the American College of Nurse-Midwives (ACNM). In addition, Certified Nurse Midwifes must pass a national certification examination and meet strict requirements set by state health agencies. Each of the Certified Nurse Midwifes at Trinitas meets and exceeds these requirements. Shirley McDuffie, CNM with newborn.

www.istockphoto.com

WHO’S IN THE ROOM?

Obstetricians and neonatologists are present at all times in the Trinitas Labor & Delivery Unit. The scope of collaboration is determined by a mutually agreed upon plan between the midwife and obstetrician. Even if a physician must assume a lead role in the care of a mother-to-be, the midwife may continue to participate in her physical care, guidance, teaching and support.

THE TEAM

Chantal Berry, CNM, WHNP-C

Shirley McDuffie, CNM

Shanaya Recalde, CNM, WHNP-C

Carol Rose Trzaska, CNM.MS

Lekha Sreekumar, WHNP-C

Marybeth Weimer, CNM

Iwona Lewinski, CNM MS

They provide:

• Comprehensive gynecologic care, including annual well-woman physical and pelvic exams
• Education and counseling in nutrition, exercise, physiological and emotional changes, and sexuality
• Breastfeeding assistance and encouragement
• Assistance in developing a personalized birth plan
• Prenatal care
• Labor support and management

Editor’s Note: To set up an initial screening appointment, call either of the following locations:

Trinitas Physician Practice, OB/GYN

240 Williamson Street

Suite 503

Elizabeth, New Jersey

Monday thru Friday (9 to 4:30)

(908) 282–2000

Women’s Health Center

65 Jefferson Avenue

Elizabeth, New Jersey

Monday thru Thursday (9 to 5)

(908) 994-5500

News, views and insights on maintaining a healthy edge.

Crunch Time 

Do loud eaters make you crazy? Then you may be suffering from Misophonia. A small percentage of people experience a strong fight-or-flight response when they hear lip-smacking, chip-crunching or liquid-gulping sounds. A recent study published in Current Biology looked at 42 individuals—20 of whom were misophonic and 22 of whom were not—who listened to noises ranging from neutral to annoying while they were in an MRI machine. Researchers observed that the 20 misophonics had significant activity in the insular cortex, which links senses and emotions. In most cases, the result was a strong feeling of anger as opposed to disgust, which is how most people respond to eating noises. Fortunately, misophonia is fairly rare, according to Dr. Rodger Goddard, Chief Psychologist at Trinitas. “It’s a problem that usually occurs between the ages of 9 and 13 and is more common in girls, and is believed to involve brain functions and not one’s ears,” he says. There is a Misophonia Foundation, which can provide guidance for people suffering from this difficulty. 

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

Dr. Goddard adds that getting upset, stressed, anxious or annoyed at a variety of things is common for many of us.  We need to always look at the frequency, duration and intensity of any problem. If we have an emotional difficulty that occurs on a regular basis, lasts for a significant amount of time when it occurs, or is intense in its effect on us, then it is probably time to take action and seek professional help from a doctor or therapist.   

Into the Woods 

Have you planned your annual spring camping adventure yet? If not, perhaps you should. A study conducted at the University of Colorado in Boulder suggests that a weekend in the great outdoors can reset the body clock—a boon to those of us who have trouble waking up in the morning or shaking the wintertime blues. More time spent outside in bright light, and less time exposed to artificial light at night, improved alertness, mood and even strength in a group of volunteers who went on weeklong camping expeditions. The results were almost as good for campers who spent just two days in the great outdoors. This type of activity can be a great boost to one’s health, confirms

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

Dr. Rodger Goddard, Chief Psychologist for Trinitas. “Paradoxically, there is a psychiatric disorder called SAD, or Seasonal Affective Disorder,” he adds. “Some people, when sunlight is decreased or restricted, become depressed.” Indeed, light—particularly sunlight—plays an important role in our health. In addition to increased exposure to sunlight, the silence, oxygen, social connection and vacation from the technology overload can do wonders for mental health.

Cervical Cancer’s “Racial Divide” 

Since reaching an all-time high in 1991, the number of cancer deaths in the U.S. has come down steadily and is now 25 percent lower than it was a quarter-century ago. That includes cervical cancer deaths, which are now largely preventable with proper screening and regular monitoring. Yet, according to a study by the Bloomberg School of Public Health at Johns Hopkins, the death rate from cervical cancer is higher than previously estimated. Much of the disparity is attributable to high rates among African-American women, who are as likely to die from the disease as someone in a developing country. Their mortality rate from cervical cancer is more than double that of white women. The study did not get into the reason for this disparity, but an article in Gynecologic Oncology suggested that the relationship between income and access is the likely cause. 

But Is It An Organ? 

Gray’s Anatomy (the book, not the TV series) lists 78 organs in the human body. Is there a 79th? According to scientists at the University of Limerick in Ireland, the tissue that connects the intestines to the abdominal wall—known as the mesentery—should be considered an organ because it performs a specific body function. Namely, the tissue works as one entity to prevent the intestines from jigging around. Which means you couldn’t survive without it. There is an actual “advantage” to being classified as an organ. It means that medical researchers are likely to pay much more attention to it. In the case of the mesentery, that could translate into progress in the understanding and treatment of abdominal disorders such as Crohn’s disease.

Real-Time Concussion Detector 

With football increasingly in the crosshairs of the medical community, it was only a matter of time before equipment measuring concussions in real-time started finding its way onto the field. A new “smart” mouthguard should be available to players nationwide by 2018. The device, manufactured by Prevent Biometrics, calculates a player’s risk of concussion after a hard hit. That information is sent instantly to coaches, team doctors and parents, who can pull a player out of the game if need be. This is a critical decision—study after study has shown that players who stay on the field after a concussive hit take twice as long to recover compared to those who leave immediately. The mouthguard was developed with the help of the famed Cleveland Clinic. Dr. Kevin Lukenda of Linden Family Medical Associates thinks a computerized Bluetooth mouthguard could be a valuable tool to objectively gauge whether a player is injured and to what degree he may be concussed. “Right now, we depend on referees, coaches, parents, teachers, school physicians and even the student-athletes themselves in the diagnosis of concussions,” Dr. Lukenda points out.

Kevin Lukenda, DO
Chairman, Family Medicine Department
908.925.9309

“Many times these voices go unheard because of the consequence of limiting the student athlete’s ability to play—despite jeopardizing their health. Though there are objective measures to determine a concussion, often times the decision becomes very subjective.”

Early Detection for Autism 

Roughly one in every 100 babies born in the U.S. ends up diagnosed on the autism spectrum between the ages of two and four. According to a study published earlier this year in Nature, brain scans can now detect the origins of autism in the first year of life. Researchers at the University of North Carolina did brain scans on a group of children at high risk of autism (their older siblings were autistic) at 6, 12 and 24 months. The scans showed early differences in the cerebral cortex—which is responsible for high-level functions— in the children who went on to be diagnosed with autism. The study should lead to new tests for autism and, hopefully, opportunities for early behavioral therapies. It also provides a compelling argument against claims that autism is caused by the MMR (measles-mumps-rubella) vaccine, which is typically given after 12 months of age.

Lucile Esralew, PhD, NADD-CC, CDP
Clinical Administrator for Trinitas CARES and S-COPE
908.966.3033

“The idea that autism is caused by vaccination has been disproved,” conforms Lucille Esralew, PhD, NADD-CC, CDP, the Clinical Administrator for Trinitas’s CARES and S-COPE outreach programs. “There is no credible scientific evidence that link the two.” Until such time as brain scans are widely available, pediatricians can detect signs of autism using the Modified Checklist for Autism in Toddlers-Revised (MCHAT-R) as early as 18 months, while psychologists use the Autism Diagnostic Observation Schedule—the gold standard for assessment with children beginning as young as age three. “The Autism Diagnostic Inventory (ADI-R),  a comprehensive review of a child’s early social, communication, behavioral and adaptive skills history is also utilized in assessment.” April, adds Dr. Ersalew, has been designated as Autism Awareness Month. 

Jack Perrone comes home to New Jersey.

By Ghilianie Soto 

There is something humbling about Dr. Jack Perrone. He exudes a calming energy that allows patients to open up and share concerns they may have pertaining to their health. It could be that Trinitas Regional Medical Center’s newest obstetrical surgeon is from the Midwest and brings a friendly demeanor and charm to the workplace. One thing’s for sure: His passion for women’s health has made him an asset in the community.      

Though born and raised in Minnesota, Dr. Perrone is no stranger to the Garden State. He made his first New Jersey connection in college, graduating from Rutgers and receiving his medical degree from the University of Medicine and Dentistry of New Jersey (UMDNJ). He completed his residency at the Mayo Clinic School of Graduate Medical Education and has been practicing obstetrical gynecology for 21 years. He led his own private practice in Rochester, Minnesota as part of Olmstead Medical Center, a not-for-profit organization serving southern Minnesota. 

“I wanted to come back to the East Coast for the second phase of my career,” says Dr. Perrone. “Once I met the delightful people at Trinitas and saw the potential for growth here, there was no question this is where I belong.”

At Trinitas Regional Medical Center, the birthing facilities offer a modern maternity unit with private accommodations. The labor, delivery and recovery rooms Trinitas participated in the American Heart Association’s Little Hats, Big Hearts program to empower new moms to live heart-healthy while raising awareness of congenital heart defects.

Trinitas participated in the American Heart Association’s Little Hats, Big Hearts program to empower new moms to live heart-healthy while raising awareness of congenital heart defects.

are decorated to approximate a homelike atmosphere, and allowing mothers to remain in one room throughout the birthing process. State-of-the-art facilities and skilled staff of experienced obstetricians, anesthesiologists, neonatologists, midwives, and nurses are available in-house, 24 hours a day, and ensure the best possible care for mother and child.

Dr. Perrone enjoys delivering babies and taking care of women through pregnancy, childbirth, and the postpartum period. Trinitas’s maternity services include Labor & Delivery, an Intermediate Care Nursery, and a Mother-Baby Unit. A Level II Nursery offers sophisticated technology and treatment for ill and high-risk infants who require concentrated care and attention. Trinitas also offers TOLAC (trial of labor after cesarean) for women who desire vaginal delivery after a prior cesarean section.

“One of the best things about being part of the Trinitas network is working so closely with my medical and nursing colleagues to help educate our patients and the community,” he says. “Being a resource is an important piece of what makes the work I do so meaningful.”  

www.istockphoto.com

Trinitas has worked to advance care by eliminating the element of the unknown and offering a variety of courses in preparing for parenthood, including “Labor, Delivery & Recovery,” “Breast Feeding” and “Caring for Your Baby.” New to their services is a partnership with The Baby Box Company. Through this special initiative, parents who complete the learning module on “safe sleeping” for their newborn receive a box filled with premium products and information on safe sleeping habits. Partnerships like these furnish parents with education and resources to give their babies a safe start in life. 

With two daughters of his own, Dr. Perrone understands the importance of making sure parent and child receive the necessary resources and tools to lead healthy and happy lives.  

Working together to make a good idea great.

By Yolanda Navarra Fleming

In 2001, the ink was barely dry on the merger that created Trinitas Regional Medical Center. The new hospital’s CEO, a respected executive, had retired, the country was coming off a contested presidential election, and Elizabeth—along with the rest of the nation—would soon be dealing with the “new normal” of the September 11th terror attacks. It was a time of profound uncertainty—probably not an ideal time to look for a “star-quality” CEO. Indeed, Trinitas is unique in terms of sponsorship and governance. The hospital is officially sponsored by the Sisters of Charity of Saint Elizabeth in partnership with Elizabethtown Healthcare Foundation, which is the former parent of Elizabeth General. The new CEO needed to be a team-builder from Day One, creating chemistry from the goals and objectives of two separate entities. Fast-forward 16-plus years. Board chair Vic Richel and CEO Gary Horan sat with EDGE Business Editor Yolanda Navarra Fleming to talk about that transformative moment in the hospital’s history, and all that followed. 

VR: We did a national search and there were a lot of really qualified candidates, but what we really needed was a personality with the tremendous ability to grow a business, to effectively create a new atmosphere from the three prior individual hospitals. Gary instantly stood out. His personality is magnanimous. His background was spectacular. He had run other hospitals, but the most important ingredient Gary had was his ability to quickly create a team and a style that would enable us to flourish.

GH: I was in my 11th year as a CEO at Our Lady of Mercy in the Bronx. Trinitas was a challenge—and I always look for a challenge. I was at an age where, if I was going to make a change, I had to make it, and I was in the prime of my administrative background. I was very impressed with the committee evaluating the candidates, and the Board of Trustees, I had an opportunity to meet the administrative staff and I was impressed with the organization and the merger. However, I knew there were challenges in the culture of one hospital against another hospital. Looking back, we have done things that frankly, in my own mind, I didn’t think we’d be able to accomplish. One of the biggest difficulties was becoming financially stable as a newly merged institution, which can create a lot of chaos. We had to reduce the staff and evaluate the organizational leadership as to whether the chemistry was right between all the different executives. I’m pleased that the changes we made have been long-standing. Most of the people I’ve brought in have been here with me almost as long as I have.

VR: Gary has worked beautifully with the Board of Trustees, with the city of Elizabeth, the mayor, and the elected officials of the community, all of whom are great supporters of the hospital. We couldn’t be more proud of where we are. I should add that the Sisters of Charity is enormously supportive of our mission. We are unusual in that every two years the chairs change. The Sisters of Charity representative becomes chair and I become vice-chair. It’s a wonderful combination. Sister Rosemary has been a terrific vice-chair and in January she becomes chair.

GH: My chemistry with the board has been superb. The mutual trust is there. I don’t think there’s ever been a vote that was not 100 percent unanimous. I think that’s due to Vic’s leadership. We’ve developed a very strong relationship of confidence and trust. I am always honest with the board. I tell them the good, the bad and the ugly, and they appreciate that. They don’t always like the ugly—and there is some ugly sometimes—but they need to know and address those issues accordingly. They also know the positives, and there is an incredible amount of positives.

VR: There are. We’re really well positioned heading into the future. We are fiscally sound. We invest well and we are profitable. The biggest challenge we have is managing through the government oversight and the difficulty with dealing with various changes in rules and regulations at the federal and state levels. Gary and his staff are very skilled at working through those processes.

GH: It’s not a one-person show. We have a solid executive staff, plus the management staff. The mid-level staff is fantastic and our employee staff is excellent, and we have great employee relations. We have a very good, solid chief financial officer who keeps me in check, and we work very well together as a team. People are not afraid to speak up at our meetings and say what they like and what they don’t like, and we discuss it. We have taken Trinitas from Trinitas Hospital to Trinitas Regional Medical Center. We have grown programs and facilities. We’re financially sound and we’re independent.  What that means for us is that we govern ourselves and we have an independent board. We have clinical affiliations where it is most appropriate for Trinitas, and also where we can help other organizations. The longevity of our staff is tremendous. And in terms of my relationship with Vic, the confidence and trust has been there from the beginning and it’s a terrific partnership.

VR: It really is. We work beautifully together. Gary always tells it just as it is. One of his biggest strengths is his ability to plan effectively. He anticipates the negative and plans around it. I have the same kind of style and we work very effectively together. Gary far exceeded our expectations. We are now one of the major independent hospitals in New Jersey. We have centers of excellence that are outstanding and Gary has put together a wonderful staff. EDGE

Editor’s Note: Can’t get enough of Vic and Gary? Go to EdgeMagOnline.com to read more of their conversation.