Performance Anxiety

Planning to step up your game after the holidays? Worried that you’re not up to the challenge? Listen to your body (and your doctor) and you’ll avoid the sprains, trains and stress that send others to the bench.  

Three cheers for medical science. Although staying fit still takes hard work and commitment, remaining injury-free is easier than ever. Whether you’re a weekend warrior training for your first triathlon or you live on the tennis courts, you have two missions when you’re pushing the performance envelope: Do your best… and make it home in one piece. The key to success (or survival, depending on your sport) is recognizing that there are three important components where your body is concerned: BEFORE, DURING, and AFTER. Understanding the basics of each not only gets you on the court or field or road—it’s what ultimately will keep you there.


The right preparation can save you a world of hurt, but often people skip this step. Here’s how to ensure you’re ready to take on all comers:

  • Check yourself out. Most people know it’s wise to consult your doctor before starting a new exercise routine, but there’s another professional who might be just as key. “I’m a strong advocate of having a person trained in physical therapy take a look at the muscular-skeletal system,” says Jim Dunleavy, PT, MS, Administrative Director of Rehabilitation Services for Trinitas Regional Medical Center. “We all come with little quirks that we may not know we have. For instance, if someone has resisted motion in their hip, that could cause a knee or ankle problem. After the assessment, they can make sure that their exercise program attends to those potential issues.”
  • Ditch the heels. Women who wear heels put themselves at risk for injuries in sports. “If you wear heels during the day, your calf is shortened all day long, and you won’t have the flexibility and the strength to participate in your activity without hurting,” Dunleavy says. You’ll need to engage in some extensive stretching of your lower legs before and during your activity to help minimize the chances of injury.
  • Be sure you’re balanced. You may be working hard to get your muscles in shape for your particular sport, but you can’t ignore the rest of your muscular system. “You need to pay a little attention to your core muscles, to A Special Health & Wellness Section from Trinitas Regional Medical Center balance things,” says Dr. Richard Mackessy, Chairman of the Orthopedics Department at Trinitas. “If you overdevelop one area, like your chest, but haven’t done anything to the back, you’ve created an imbalance in your shoulders that makes it so they’re pulled forward constantly, and creates a risk of pain.”


While you may be concentrating on squaring up to the ball or keeping your marathon pace, there are other things to keep in mind before you shift into high gear:

  • Warm up. There’s been so much debate on how to get rolling—just stretching, stretching and warm-up, or full speed ahead—but most experts agree that a warmup is essential. “You don’t want to just walk onto the field and play the toughest match without doing anything,” Dr. Mackessy says. “We recommend going through a period of warming up, where you’re going at half the pace. If you’re playing tennis, you might hit balls at a very relaxed pace for a few minutes, then stop and do some stretches before you really start playing.”
  • Don’t go crazy. Weekend warriors may be all gung-ho about doing the activities they love when they have the time, but it’s best to work up to an all-day round-robin. “If you’re working 9 to 5, your body is not built up to withstand the constant stress that’s placed on the body with a prolonged sports activity,” Dunleavy says. “Your body can only take so much—overuse can result in inflammation, making it very difficult to use that area without pain.”
  • Stop if you have pain. Forget that old No pain, no gain adage—if you’re hurting, take a break. “If you have pain, you need to stop playing,” Dr. Mackessy insists. “You don’t need to hurt yourself and be laid up for six weeks.”


When you’re ready to pack it in for the day, there are a few tricks you can use to help ensure you’ll be ready to achieve peak performance the next time out:

  • Stretch it out. After a brief cool-down (like the warmup, you’re going at a more relaxed pace), be sure to give your muscles a well-deserved stretch to keep them limber. “Hit all the common stretches—legs, arms, shoulders,” Dr. Mackessy suggests.
  • Nurse your wounds. If you do have pain and inflammation—the most common results of overuse injuries—there are a number of steps you can take to decrease the swelling, either at home or under a doctor’s care. “Swelling is going to retard the healing process, so you need to cool down the tendon with ice,” Dunleavy suggests. “We can also try to stimulate the healing process by increasing blood supply with electricity, heat and ultrasound, or by injecting medications, like cortisone or steroids. We can even load medication into an electrode and use electricity to drive medication into an area.”
  • Assess your performance. Play Monday morning quarterback and see what you can improve at your next sporting event. “John MacEnroe once said that he learns more from losing than from winning,” says Dr. Rodger Goddard, Chief Psychologist and Director of Wellness Management Services for Trinitas Regional Medical Center. “Being able to look back at what was disappointing in our performance and devise a plan to improve our technique, execution and strategy in these areas is an important skill.”


Editor’s Note: Lisa Milbrand is a New Jersey-based writer whose articles on health and relationships appear in Parents, Arthritis Today and Modern Bride. Her blog celebrates the life of a working mother.


State Your Case

Shiny hair and teeth, longer legs, firmer abs, cooler apartments, faster cars—the list of differences between TV docs and the real-life ones is practically endless. Yet from a practical standpoint, the difference that matters the most to real-life patients is this: Can you help me? That’s when the TV docs disappear and the true problem-solvers hit their mark.  

Let’s face it. Who doesn’t love a good medical drama? When some “Doc Hollywood” sinks his teeth into a perplexing patient, we are transfixed. These television characters will crack the case—we know it and, on some level, we know they know it, too. The medical dramas that play out on hospital floors every day present the same challenges and demand the same out-of-the-box thinking. However, when a patient stares desperately into a doctor’s eyes, that’s not acting. It’s the real deal. We asked a trio of the top docs at Trinitas to “state their case”—the one that intrigued or challenged them, surprised or gratified them, the kind that makes real-life doctoring far better than doctoring As Seen On TV.

A HELPING HAND For Dr. Richard Mackessy, the chairman of Trinitas’ orthopedics department and a specialist in hand surgery, the toughest patients are often the youngest. He’s spent the past 20 years donating his surgical expertise to Healing the Children, a nonprofit that helps children from around the world come to the U.S. to receive treatment. “Most of the kids have congenital problems with their legs that keep them from getting around,” he says. “We usually have to amputate and give them a prosthesis, but the results are amazing—it allows them to be up and walking around, independent and functional.” Healing the Children sponsored two of Dr. Mackessy’s most memorable patients—a pair of children from Russian orphanages who had severe hand deformities. The first, a boy, was missing a thumb due to a congenital condition. Dr. Mackessy was able to utilize the index finger to create a thumb for the little boy. “You situate the index finger in a different way, attach different muscles, and take one of the bones out of it, and you’ve created a thumb.” The surgery helped the child gain use of his hand. Another, a little girl, was missing most of her left arm below the elbow, and the fingers on the right hand were fused together. Dr. Mackessy was able to separate the thumb and fingers on the right hand, and perform surgery to make her left arm more useable. Both kids not only regained the use of their hands, they gained something else—while they were in America for their surgeries, they were adopted by U.S. families. Dr. Mackessy says he constantly sees the power of medicine. “[This work] makes you see life differently—it shows you what medicine can do for people.”

THE HEART OF THE MATTER For Dr. Arthur Millman, head of Trinitas’ cardiology center, mending broken hearts is all in a day’s work. One of his most interesting patients was a 70-something lady who wanted to skydive. “She wanted to get a letter from us that said that she could go, but she was in severe heart failure, with a leak in the mitral valve,” he recalls. After she was stabilized, Dr. Millman was able to surgically repair her valve. “While you can replace the valve, doing so damages the heart muscle and creates illness in the patient,” he says. “If you are able to fix the valve instead, it’s still you, not some piece of plastic or something that came from a cow or a pig.” With this valve repair, he was able to give the patient a whole new lease on life. “She can take care of herself now, go shopping—things she couldn’t do beforehand. I still tell her that skydiving isn’t a good idea, though.”

SOLVING A MEDICAL MYSTERY When a young diabetic patient came to Dr. Paul Vaiana early in his medical career complaining of numbness in his hands and feet, the now-president of Trinitas Regional Medical Center’s Medical and Dental Staff, might have assumed that the problem stemmed from a failure to take his medications. But Dr. Vaiana noticed something that concerned him. “He had no motor strength, and that made me think that something else was happening.” A spinal tap revealed the cause—Guillain-Barré syndrome, a disorder in which the nervous system comes under attack by the body’s immune system. At the time, not much was understood about the disease, but Dr. Vaiana knew his patient was running out of time. “I knew it needed to be addressed quickly with a very specialized treatment,” he recalls. “If you aren’t able to wash the patient’s blood, they became ventilator-dependent quickly.” Dr. Vaiana and the hospital were able to locate a plasmapheresis machine within 24 hours to cleanse the patient’s blood and get him on the road to recovery. “Everyone worked together on this young man and in three days he was out of the woods,” he remembers. “We were so aggressive in treating it, and now that is the standard care of this disease.” Three decades later, that young man is still Dr. Vaiana’s patient. “I love practicing medicine and having a relationship with my patients,” Dr. Vaiana says. “It’s not the money driving care here—I’m glad to be part of a team who really goes out of their way to help people in their time of need.”

Editor’s Note: Lisa Milbrand is a New Jersey-based writer whose articles on health and relationships appear in Parents, Arthritis Today and Modern Bride. Her blog celebrates the life of a working mother.

Trinitas Regional Medical Center Children’s Therapy Services
Made In The Shade

Clean living. Prudent diet. Sunscreen savvy. All vital to healthy skin. And all easier said than done.

People spend billions of dollars a year on products that promise to make their skin firmer, fresher and younger. But doctors who focus on caring for the skin insist that the body’s largest organ needs more than over-the-counter potions to maintain its health and radiance—and to do what it was designed to do. “Skin is the protector of our body and the first line of defense,” says Dr. Kamran Khazaei, head of Nouvelle Confidence, the Center for Cosmetic Laser & Rejuvenation. “The first thing that’s affected when you come in contact with pollutants, bacteria and other toxins is the skin—that’s why you have to continually do maintenance on the skin, to allow it to work its best.” Everything we eat, breathe, and do affects our skin, and the results aren’t always pretty—especially when people neglect the basics of skin health.

Here’s how to ensure you protect the skin that protects you. SKIN RAVAGERS While genetics can play a role in how easily you burn or scar, whether you freckle and how soon you show signs of aging, experts say that lifestyle choices have the biggest impact on your skin’s health. Smoking, eating an unhealthy diet, exposure to pollutants and even a lack of sleep and exercise can cause premature aging and other skin problems. “Smoking and a poor diet absolutely damage the skin,” says Dr. Khazaei. “Any type of toxin in the body affects the whole body, including the skin.” But when it comes down to it, sun exposure continues to have the most punishing effects on a person’s skin. “The worst enemy of the skin is the sun,” says Dr. Khazaei. “Everyone thinks they look healthier by tanning themselves under the sun, but that’s the worst thing to do for skin health.” It’s hard to avoid news reports on the dangers of sun exposure, but surprisingly it hasn’t had a huge effect on people’s behavior.

Recent CDC studies have shown that 40 percent of adults don’t use sunscreen, and 70 percent of those who use sunscreen don’t bother to reapply when it’s recommended. It’s the ultraviolet radiation that causes most of the trouble—particularly UVA rays. “UV radiation is a known carcinogen, and is associated with both an increased risk of skin cancer and an increase in skin aging,” says Dr. Joseph Alkon, a plastic and reconstructive surgeon at Trinitas Regional Medical Center, who specializes in treating skin cancers. Unfortunately, many people have taken their desire for darker skin straight to a more dangerous spot—the tanning bed—where UVA rays are three times more potent than in natural sunlight. “There has been a rise in the number of people using tanning salons, including teens and younger patients,” says Dr. Alkon. “More than one million people use tanning salons on a typical day in this country—70 percent of whom are females in their late teens to late 20s.” Tanning bed use, he adds, may put you at even more risk of cancer and other damage.

SAVING YOUR HIDE You may think you’re a lost cause after decades of sunscreen-free sunning at the shore, but there’s still plenty to be done to improve the health—and look—of your skin. Dr. Khazaei uses laser and microdermabrasion treatments to help combat the signs of skin damage. “Laser treatments help regenerate collagen formation to rejuvenate the skin, and can be used to treat freckles and age spots,” he says. “Microdermabrasion removes dead skin cells that are produced by the sun, exposing the younger, healthier skin beneath.” Customized skin care products—like Dr. Khazaei’s own line—can help clear away dead cells and revitalize the skin beneath. But the best protection is prevention—and that means stopping smoking, getting more sleep, eating better, and most importantly, using sunscreen regularly. “Even on a cloudy day, you need sunblock to protect the skin—the rays that cause the most damage can still pass through the clouds,” Dr. Khazaei warns. “If you take care of your skin, it naturally stays younger and lasts longer.”

Editor’s Note: Lisa Milbrand is a New Jersey-based writer whose articles on health and relationships appear in Parents, Arthritis Today and Modern Bride. Her blog themamahood. com celebrates the life of a working mother.


Smooth Move

While the skincare industry touts its latest, greatest miracle-working scientific formulations, actual science increasingly links healthy skin to what you put IN your body, not ON it.

Skin is the largest organ of the body. It’s the only one that is instantly visible. And it is vulnerable to all sorts of attacks, including dryness, excess oil, wrinkles, sunburn, acne, dermatitis, rosacea, eczema, psoriasis, seborrhea, and various forms of cancer. Millions of consumers shell out billions of dollars on topical skincare products each year in an effort to improve the look and feel of their skin. All the while, they may be missing a more obvious, cheaper, and better way to reach their goal. Food.

In their book Beauty Basics for Teens, Dianne York-Goldman and Mitchel P. Goldman, M.D., urge a balanced diet that includes carbohydrates, protein, nutrients and fiber, but is low in saturated fats and empty calories. They also advise drinking at least eight 8-ounce glasses of water each day for proper hydration. The goal is to eat foods rich in vitamins, minerals, antioxidants, and healthy fats. Melody L. Meyer of Albert’s Organics, a California-based natural products distributor, suggests leafy green vegetables for iron and calcium, sweet juicy fruits (especially at breakfast), a variety of whole grains, and easy-to-digest proteins like legume soups, paneer (cheese made from boiling milk, adding lemon and straining solids), and lassi (diluted yogurt and spice drinks).

Carotenoids, which are found in red and orange fruits as well as in yellow and dark green vegetables, are recommended by Sharrann Simmons of Cognis Nutrition & Health, an Illinois-based food technology company. She says that carotenoid lutein has been shown to protect skin against UV-damage, improve skin hydration, encourage elasticity and enhance beneficial lipid levels. For its “Beauty from Within” campaign, DSM Functional Food Marketing of New Jersey also enlists carotenoids, as well as antioxidant vitamins C and E, green tea extracts, omega-3 fatty acids (which can be found in fish and flaxseed), and polyphenols (derived from olives). Consumers seem to be getting the message. A recent study by the Mintel Group, a market research fi rm, notes that 2008 saw the debut of more than twice as many new beauty foods and beverage products as there were in 2007.

Dermatologist and author Nicholas Perricone urges a diet loaded with these essential proteins: fish, poultry and, occasionally, lean beef, pork or ham. He also suggests consumption of soy foods like tofu and tempeh, egg whites, low-fat cottage cheese, low-fat milk, and yogurt. For carbs, he favors squash, spinach, onions, green beans, asparagus, cabbage, cauliflower, eggplant, collard greens, escarole, green peppers, strawberries, raspberries, apples, blackberries, blueberries, cantaloupe, honeydew, and kiwi. Recommended fats include oils derived from olives, walnuts, safflower, soybeans, rapeseed (canola), and sunflowers, as well as nut butters and avocado.

Perricone also is high on the following ten “Superfoods”: Aτai (pronounced ah-sigh-ee), a high-energy berry that grows in the Amazon The allium family of foods, including garlic, onions, leeks, scallions, shallots, and chives, all of which are rich in flavonoids. Barley, which is not only low on the Glycemic Index, but high in both soluble and insoluble fiber. Green foods, which are derived from cereal grasses and blue-green algae. Buckwheat, also low on the glycemic scale, and which may be substituted for less healthful grains like rice, wheat, and corn. Beans and lentils, an alternative to fattier meat proteins. Hot peppers, which are high in heart-healthy, anti-inflammatory compounds. Nuts and seeds, which are a source of good fats. Sprouts for their enzyme content.

Yogurt and kefir, fermented dairy products that add digestion-aiding probiotics to the diet. J.T. Ryan is a licensed physical therapist and owner of Healing Touch in Howell. The company makes and markets handmade natural body-care products. She emphasizes the need for trace minerals and electrolytes, which she calls “a key to cellular regeneration.” For example, Ryan says, a deficiency in copper will lead to scar formation during the skin’s 40-day cycle period. Foods rich in copper include most nuts (especially Brazils and cashews), seeds (especially poppy and sunflower), chickpeas, liver and oysters. Are there foods that should be shunned if your goal is shiny, smooth skin? Most definitely. This is particularly true if you are worried about acne. Naturopath Alan C. Logan, who teamed with dermatologist Valori Treloar on the 2007 book The Clear Skin Diet, cautions against the foods most popular with American teenagers—pizza, hamburgers, cookies, crackers, fried potatoes, salty snacks and sweetened beverages.

Even milk consumption is “strongly associated with acne,” the authors claim. In place of these no-no’s, Logan argues for a diet that focuses on the omega-3 fatty acid eicosapentaenoic acid (EPA), found in fish like mackerel, sardines and salmon, tomato extract with the carotenoid lycopene, marine fish that are rich in collagen, and a high-flavanol cocoa extract. Logan explains that inflammation is at the core of acne, and that oxidative stress, a byproduct of the standard American diet, “fans the flames of inflammation.” Fish oil, he says, especially EPA, blocks the production of the inflammatory chemicals. This also is why antioxidant fruits and vegetables are so important. Does this mean you have to toss away all your lotions, creams and ointments? Of course not. They definitely serve a purpose. But keep in mind that if you really want a smooth, healthy complexion, a good nutritional foundation is where you should start.

Editor’s Note: New Jersey-based freelance writer Alan Richman is the former editor of Whole Foods Magazine.

Perchance to Dream

“Everyone knows someone who has lost their job… people have a lot on their minds.”Your house is worth a half-million less than it was last summer. Your portfolio is in freefall. That Christmas bonus was a little short. And you’ll be waiting a bit longer to retire. It’s enough to give you nightmares—if you could actually fall asleep. As stress rises, so does the risk of insomnia and other sleep disorders. In these trying times, more and more people will try anything to get some decent shuteye.

Unfortunately, chronic insomnia isn’t something you can make up for with a Starbucks run. Consistent sleep problems can take their toll on everything from your mood to your mortality. “There is no substitute for sleep,” says Vipin Garg, MD, Medical Director of the Comprehensive Sleep Disorders Center at Trinitas Regional Medical Center, who is board certified in pulmonary medicine and sleep medicine. “If you don’t get adequate sleep, you’re going to have consequences.” “People who have chronic sleep problems find it hard to concentrate and are often much more irritable,” adds Christopher Jagar, MD, a psychiatrist with the Department of Behavioral Health & Psychiatry at Trinitas Regional Medical Center. “It can affect performance on even the simplest tasks.”

It can lead to dozing off for milliseconds at a time, called microsleep. That can affect your ability to carry on a conversation, follow a meeting—or get behind the wheel safely. And sleeping disorders often go hand in hand with other serious health issues, which makes it doubly important to diagnose and treat them. Sleep apnea, a chronic interruption of a person’s breathing during sleep, has been linked to several life-threatening conditions, including heart attack, congestive heart failure, hypertension, obesity and diabetes. “Treating sleep apnea can not only affect the quality of your life, but also how many years you live,” Dr. Garg says. While disorders like sleep apnea have their roots in physical issues, many of us bring our nightly problems on ourselves. “Lifestyle is often a factor,” Dr. Garg says. “Using stimulants— caffeinated beverages, cigarettes, chocolate—can cause sleep problems. If the room isn’t dark enough, or if you leave a TV on, that can interfere with sleep. Engaging in some sort of stimulating activity, like an office conference, an argument or a workout, can make it hard to fall asleep.” Even something that’s often considered a sleep aid—we’re talking nightcap here—can backfire. “Alcohol may make you drowsy enough to fall asleep, but you’ll wake up again in a few hours,” explains Cheryl Krempa, RPh, MBA, Director of the Pharmacy at Trinitas.

Routine Tweaks

The upside? You may be able to cure your own insomnia with a few tweaks to your routine. Dr. Garg recommends keeping a diary of your daily activities, diet and sleep quality, to see if any patterns emerge—like a case of insomnia every time you knock down an order of crab-cakes. Or watch CNBC. Or talk to your mother. If stress is causing your sleep issues, try some common stress reducers—regular exercise early in the day, meditation, deep breathing—and take time to wind down before bed without bright lights or stimulating activities.

Even something as simple as a notebook by the bed could help you relax. “You can write down your thoughts in your diary before bed, so you’ve unloaded the problems that are keeping you up at night,” Dr. Garg suggests. If anxiety, depression or another issue is contributing to your insomnia, consult with a mental health professional. “Treating the underlying psychiatric problem usually solves the sleep issue as well,” says Dr. Jagar. Should lifestyle changes fail as a fi x, resist the temptation to load up on Tylenol PM or other sleep aids. “Over-the-counter sleep-inducing products use diphenhydramine hydrochloride, the active ingredient in Benadryl, to help you fall asleep,” Krempa says. “But they can make you feel drowsy the next day, so you’ll need more caffeine to be alert, and a vicious cycle begins.”

Instead, it may be time to see your doctor. “If you try all these techniques and they don’t work, you should see a physician to determine what could be causing it, so it can be dealt with correctly,” Dr. Garg recommends. Following diagnosis at an accredited sleep disorder center, apnea patients are often set up with positive airway pressure machines (CPAPs or BiPAPs), which keep the airways from becoming obstructed and enable a good night’s sleep. Other sleep problems may disappear after starting cognitive therapy or even light therapy, when you spend part of each morning lounging under a bright, sun-like light. Dr. Garg sometimes restricts the amount of sleep a patient gets each night to try to concentrate the sleep and avoid frequent night wakings. Still, stress-related sleep disorders can sometimes be even more difficult to overcome. “People have a lot going on right now—everyone knows someone who has lost their job. Things are dire,” says Dr. Jagar. “People who are under a lot of stress have a lot on their minds, and they often have a harder time falling asleep and staying asleep. They simply don’t feel rested.”

If the lifestyle changes and stress relievers don’t work, your doctor may be able to prescribe one of the newer medications that have fewer side effects and are less likely to cause next-day drowsiness. “There are numerous formulations out there, so it’s easier to tailor the prescription to your exact problem,” Krempa says. Some medications, like Sonata (zaleplon) and Ambien (zolpidem) wear off quickly, so they work best for people who just need help falling asleep; others, like Lunesta (eszopiclone) help you stay asleep. It may take a few tries to hit upon the solution to your sleep issues, but once you do, you’ll feel like a whole new person. “Sleep disorders affect every part of your life—you become more irritable and take it out on your loved ones, and you have a harder time enjoying the things you love when you’re fatigued all the time,” Dr. Jagar says. But after you’ve caught up on your rest, you’ll be ready to take on the world, with all of its worries.

Editor’s Note: For more on sleep and sleep disorders log onto or call (908) 994–8694.

Serious Shut-Eye

I’m so tired, I haven’t slept a wink… I’m so tired, my mind is on the blink.

Photo credit: iStockphoto/Thinkstock

Beatles aficionados will recognize these lyrics from the Let It Be album. Truth be told, the group’s weary words should resonate with anyone who has ever been sleep-deprived for more than a night or two. The fact is, we’ve all been there—from punching the snooze button for an extra five minutes, to skipping that 5:45 a.m. spin class in hope of additional Zs, to heading straight for the couch after a long workday. So why is feeling fatigued so common? Why is having a healthy sleep so important? And what would be the downside if we just let it be? Health and sleep are inherently intertwined. Sleeping is a regenerative process for both the mind and body. A sufficient amount of quality slumber helps to maintain a healthy heart, metabolism and endocrine system.

Since most of us spend one-third of our lives buried in a pillow, it is important to have healthy and consistent sleep on a regular nightly basis. For some, however, nights featuring the cardinal eight hours are few and far between. According to the National Heart, Lung and Blood Institute, about 70 m llion people in the U.S. have a sleep problem and 40 million of these are chronic problems. Maybe you are a habitual snorer; you wake in the night and have difficulty falling back asleep; you’ve gained a significant amount of weight in the past year; or you kick during sleep. All of these symptoms and more can be associated with sleep disorders, though they are often under-diagnosed. All are curable. If left untreated, however, they can lead to serious health issues. Insomnia (the inability to fall asleep or stay asleep), for example, results in loss of concentration, reduced productivity and poor alertness.

Over time, insufficient sleep creates chaos within metabolic hormones, which can lead to obesity and diabetes. Sleep Apnea (breathing stoppage and diminished oxygen levels) can affect one’s blood pressure, heart and brain. It can lead to serious cardiovascular complications, including hypertension and strokes. While sleep disorders are prevalent in adults, they are increasing for children. If untreated, children may experience emotional, behavioral and learning disorders. As with most diseases, the symptoms triggered by sleep disorders can escalate over time. That being said, not all sleep-related difficulties are actually classified as disorders. There are many modifications that can be performed to improve sleep habits, such as shortening naps, avoiding caffeine and alcohol, and fixing a bedtime and wake-up time.

SEEING A SPECIALST If making a few lifestyle changes doesn’t do the trick, the next move is seeing a sleep specialist and undergoing a sleep study, which can diagnose and ultimately cure the disorder. Unfortunately, many people shy away from submitting to this type of procedure. They picture themselves in a bleak hospital sub-basement, on an uncomfortable cot, with wires connecting them to a bank of machines. The reality is quite different. At the Trinitas Comprehensive Sleep Disorders Center, for example, homey bedrooms await the troubled sleeper. The state-of- the-art facility offers monitored diagnostic sleep studies that are designed to quickly reveal the disorder. Trained sleep specialists and technicians work together on each study and conduct follow-up appointments with a subject’s physician. All cases are reviewed by Dr. Vipin Garg, the center’s Medical Director. Dr. Garg is board- certified as a Sleep Specialist, as well as in Pulmonary Medicine, Critical Care and Internal Medicine.

One of the center’s goals is to make patients feel as comfortable as possible during their stay. The center on the TRMC campus consists of four bedrooms—each with a personal bathroom and television and other amenities. To fulfill the growth and demand for more space, the center expanded to the Homewood Suites by Hilton in Cranford early in 2010. There are now two fully equipped bedrooms at this property. Dr. Garg notes how important it is to feel comfortable and at ease during a sleep study in order to gather the most helpful results. “The psychological mind-state of sleeping in a center is not the same as being at home,” he explains. “We try to make it feel as if you are in a hotel, rather than a hospital. We have access to all resources from the hospital’s many departments, and facilities at the hotel are extended to patients, including breakfast and the gym.” Sleep studies and treatment provided at the center are personalized for each type of sleep disorder. The staff is certified and trained in many disciplines and an array of treatment options is available.

If the problem is neurological, a neurologist will meet with the patient. For breathing issues, a pulmonologist will be present. If significant weight-loss is deemed beneficial to a sleep apnea patient, dieticians and surgery options are at hand. All sleep disorders are curable and patients have the opportunity to choose from treatment types. For example, if diagnosed with sleep apnea, depending on the case, one can undergo surgery for tonsil removal or sleep with a CPAP machine, which delivers additional air through the nose.

ONE NIGHT ONLY Typically, a single night of monitoring can result in a lifetime of quality sleep. The process is simple. Patients are instructed to do what they would typically do before any night of sleep, to ensure regularity and comfort, such as reading or watching TV. Patients are hooked up to leads that measure eye and leg movement, heart rate, airflow measurements and more—all while specialists watch the sleep behavior on video monitors. After roughly one week, the patients are asked to come back, results are reported and treatment arrangements are made. For those who cannot (or will not) leave home to participate in a study, Dr. Garg proposes an alternative possibility: an at-home sleep study, using a new portable device that collects the same useful data. Success stories are hardly few and far between at Trinitas Comprehensive Sleep Disorders Center. On the contrary, the center conducted nearly 1,500 studies in 2012, including adults and children. One of Dr. Garg’s favorite stories concerns an eight-year-old boy, who was prescribed ADHD medication after meeting with a psychiatrist and pediatrician for hyperactivity and inattention in school.

The boy’s mother mentioned his nightly snoring to the pediatrician, who recommended a sleep study. Dr. Garg diagnosed a severe case of Obstructive Sleep Apnea. After addressing the apnea, the ADHD medications were no longer needed, the boy’s performance in school drastically improved, and he became more energetic after losing weight. “The importance of sleep is an issue that has been previously ignored,” Dr. Garg laments. “Many times an internist fails to realize sleep disorders may be the problem at hand, because different questions are asked during a physical than during a sleep study. The impact of a sleep study is huge. It is a very natural, non-invasive process with no known side effects. The technology is getting better day by day, and we have had a lot of success.” Healthy sleep is imperative for us as individuals. By diagnosing and treating a sleep disorder, future serious issues can be avoided. The Trinitas Comprehensive Sleep Disorders Center is one of many centers that can help in the journey of pursuing quality sleep habits. Don’t let it be. If you are experiencing sleep difficulties, talk to your physician or sleep specialist about a center near you, and get on the road to a dreamy recovery.

Editor’s Note: The Trinitas Comprehensive Sleep Disorder Center is accredited by the American Academy of Sleep Medicine. It is located at 210 Williamson St. in Elizabeth. For more information, call 908.994.8694 or log onto

For the Heart

Six Gifts that Keep on Giving

Getting your over-50 friends and family members into the exercise groove is tough, but what if you gifted a gadget that made the experience more engaging and fun? Here are a half-dozen innovative and practical gift ideas that can jump-start a new post-holiday fitness routine…

• The Striiv Pedometer not only counts your daily walking steps, it sets up challenges for your routine and lets you earn points for your achievements. The folks at Striiv design personalized challenges tailored to your activity levels, and turn 10,000 steps a day into playing a game, donating to charity and competing with friends.

• For practical health, Fitbit’s Aria Scale doesn’t just measure your weight (which, FYI, isn’t the truest measure of health)—it also measures body mass index and body fat (which are more revealing). The information is transmitted wirelessly to your computer and assists in making sure you are on-track to reach your goals.

• Tired? The adidas Energy Boost Running Shoe boasts micro cells embedded in the sole engineered to return energy with each step you take. Runners’ World magazine gave the shoe high marks.


• Creativity keeps things interesting with the Zombies, Run! smartphone app. As you run or walk, the narrator gives instructions to dodge zombies and other threats. Novelist Naomi Alderman provides the storyline here— the website promises “you will go on an epic adventure that motivates you to run further and faster than ever before.” Better than having your brains eaten, right?

• For a more serene app, try Pocket Yoga, which lets you follow yoga routines from anywhere. An extensive library demonstrates everything from downward-facing dog to warrior. The nice thing about the app is that it allows you to create your own yoga routine, rather than forcing you to adhere to an instructor’s “most liked” poses.

• Swimming is one of the best activities you can do for your body! It’s easy on the joints and involves nearly every muscle, all while working your heart and lungs. There’s also a meditative rhythm to swimming steady laps. The problem is that swimming can be a bore at times. FiNIS SwiMP3 Headphones transmit music through your cheekbones and are fully submersible. Long-distance swimmers can even listen to audiobooks and podcasts.

For many people 50 and over, exercising sporadically just isn’t cutting it in terms of helping to maintain a healthy body mass index, or a strong heart and lungs. These are what I like to call our 30 bonus years…let’s use technology to keep our bodies in sound working condition so we can rise to the physical challenges that potentially await us later in life.  


 Editor’s Note: Gerontologist Alexis Abramson, PhD appears frequently as an on-air expert for NBC’s Today show, and also on CNN, CBS and MSNBC. Her commitment to baby boomers and mature adults has been featured in TIME, Forbes, The Wall Street Journal, People and other national publications. To see more of her thoughts on aging gracefully (and intelligently), log onto


What’s Up, Doc?

News, views and insights on maintaining a healthy edge.

Flip-Flopping in the Classroom The back-to-school season always holds some surprises for educators, kids and parents. This year, many noticed a rise in foot pain among returning students. The popularity of cheap, stylish flip-flops has more than a little to do with this, according to the American College of Foot and Ankle Surgeons. Right into the mid-teens, kids have new bone growing in their heels. Flip-flops offer no support or cushioning for this part of the foot, and summer-long repetitive stress can manifest itself in pain and injuries once students switch back to traditional school footwear. If your child is experiencing pain, it’s important to explore an immediate remedy—stretching exercises, ice massage, anti-inflammatory medications, and custom or over-the-counter shoe inserts are certainly worth exploring. Obviously, if the pain worsens or persists, a visit to the podiatrist is called for.

Follow-Up on NYC Soda Ban  New York’s short-lived soda ban spurred a slew of studies on the actual impact of obesity-focused legislation. A recent article published in the American Journal of Agricultural Economics suggests that strategies such as taxing sugary beverages would not reduce obesity, because consumers would simply switch to un-taxed options. Public health advocates have posited that higher prices would deter unhealthy food purchases. But according to research economists, that simply isn’t the case. In New York, a court ruled that the Board of Health exceeded its authority in instituting the ban, which was pushed by Mayor Michael Bloomberg. Among the criticisms of an “obesity tax” is that it would target lower-income consumers who tend to buy more high-calorie foods and beverages, and thus would be a regressive tax. Even so, the search for a “social solution” will continue; more than a third of U.S. adults, and one in six children, are technically obese. The medical costs associated with obesity are between $125 and $150 billion a year.


Drug Wonder Downunder A pair of Australian medical researchers have been recognized for their breakthrough work with Duchenne Muscular Dystrophy, a condition caused by mutations in the dystrophin gene on the X chromosome—which means it mostly affects boys. DMD patients are wheelchair-dependent by age 12 and often don’t survive past their early 20s. The researchers have developed a drug that works by skipping over the faulty part of the gene, producing a functional version of the protein dystrophin. This protein stabilizes the muscle fiber during muscle contraction. Without dystrophin, muscle fibers are replaced by scar tissue. In clinical trials, boys on the drugs have been walking up hills, operating pedal cars and whistling after 90 weeks. “It is extremely exciting to see that genetic testing is finally coming to the forefront of clinical medicine,” says Dr. Kevin Lukenda, Chairman of TRMC’s Family Medicine Department. “For years, this information was limited to research and academia. With a simple swab of a patient’s saliva in my office, we can detect over 30 possible genetic mutations within an individual’s DNA. This is the future of early diagnoses and treatment in clinical medicine.”

 Kevin Lukenda, DO Chairman, Family Medicine 908.925.9309   


You Snooze, You Lose Don’t lose sleep over junk food purchases. Seriously, don’t. A new study shows that lack of sleep can lead people to buy more food—and more high-calorie items— when they shop. Researchers gave 14 normal-weight men a budget of $50 and instructed them to purchase as much as they could out of a possible 40 food items, which included 20 high-calorie and 20 low-calorie foods. They conducted this exercise after a night of sleep deprivation and again after a good night’s sleep. They bought 18 percent more food— and 9 percent more calories—after a night of sleep deprivation. “Another recent study showed that the pleasure centers of the brain were activated more when sleep-deprived people looked at pictures of junk food,” adds Dr. Vipin Garg, Director of the Trinitas Comprehensive Sleep Disorders Center. “Lack of sleep can prevent the brain from making an intelligent decision regarding healthy food choices. Getting enough quality sleep can help weight control by allowing people to make proper nutritional decisions and also provide energy to exercise to achieve better overall health.” There are plans in the works for follow-up studies to see how sleep deprivation affects other buying decisions.

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


Word of Mouth Unreliable Where Strokes are Concerned So what’s the deal with the “Crooked Tongue” story making the rounds on social media? According to countless emails and Facebook postings, a woman who was suffering from a stroke but didn’t exhibit the typical symptoms was diagnosed by an alert ER physician who asked her to stick out her tongue. When she did so, and her tongue presented to one side rather than straight out, he was able to correctly diagnose the stroke and save his patient’s life. Is the “crooked tongue” technique a reliable way to diagnose stroke? According to Dr. John D’Angelo, Chairman of Trinitas Regional Medical Center’s Emergency Department, the story has all the earmarks of an urban legend. “I can find no reference to this suggestion from any reliable source, such as the Heart and Stroke Foundation, the American Heart Association or the National Institute of Neurological Disorders and Stroke,” he says. “Lingual deviation can indicate a host of issues that are typically associated with a tumor or other type of lesion. So a crooked tongue is a sign that something is wrong, but it’s not a reliable sign you are having a stroke.” The T in the American Stroke Assoc

iation’s STR test—which stands for Smile, Talk & Raise both arms—may have erroneously morphed into tongue. “Cranial nerves 9 and 12, the glossopharyngeal and hypoglossal nerves respectively, are associated with the tongue,” Dr. D’Angelo explains. “CN IX receives sensory information from the 1/3 posterior portion of the tongue—the taste buds. CN XII controls the muscles of the tongue. In neuroa

natomy and neurology, we learn that the tongue points to the affected side of the brain. CN XII is located on either side of the medulla oblongata, which is not a typical locale for a stroke.”

John D’Angelo, DO Chariman, Emergency Medicine 908.994.5273    


New Hormone Promises Diabetes Breakthrough Harvard researchers have discovered a hormone called Betatrophin, which holds promise for a more effective treatment of Type 2 Diabetes, which currently affects more than 25 million Americans. In the Harvard study, Belatrophin caused mice to produce insulin-secreting pancreatic beta cells at up to 30 times the normal rate. The new cells produce insulin only when called upon by the body. This offers the potential for natural regulation of insulin, as well as a reduction in the complications associated with diabetes. There is hope that this treatment may also have an impact on juvenile diabetes. It could eventually mean that instead of taking insulin injections three times a day, you might take an injection of this hormone once a week or once a month or—in the best case—maybe even once a year, explains Doug Melton, one of the researchers. “This new hormone offers optimism for researchers lo

oking to discover a cure for diabetes,” says Dr. Ari Eckman, who heads up the Trinitas Division of Endocrinolo

gy, Diabetes & Metabolism. “It should be noted, however, that this hormone was seen in a mouse model—whether or not this translates to humans is yet to be determined. It is obviously way too early to speculate

if this will work in humans, but certainly this may one day be a novel approach to managing diabetes.”

Ari Eckman, MD Chief of Endocrinology and Metabolism 908.994.5187  


Be Mindful About Smoking Take a long, slow deep breath…close your eyes….relax…and get rid of that cigarette! According to the University of Oregon’s Department of Psychology, learning meditation techniques makes it easier for smokers to taper off. Mindful Meditation—a technique that encourages people to relax, focus on the current moment and “go with the flow” of thoughts and sensation—has already been shown to have a positive impact on cold and flu, hot flashes and irritable bowel syndrome. In the Oregon study, 60 people received five hours of either relaxation training or Mindful Meditation training. Among the smokers in the study, there was no difference in the amount the relaxation group smoked. However, the smokers in the meditation group had cut back by 60 percent. Researchers admit that the smoking findings are surprising, and caution that the study was very small. Also, the participants were all college students. On the other hand, none of the subjects were told they were taking part in a smoking study. And the Oregon study found that the brains of the smokers who learned meditation techniques were more active in an area linked to self-control. More work in this area is warranted.


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  News, views and insights on maintaining a healthy edge.


  Painkiller Overdoses Spiking Among Women A new report from the Centers for Disease Control offers some eye-opening facts on the abuse of painkillers among women. Since 1999, the number of women who have died from a painkiller overdose has increased by a factor of four. “Mothers, wives, sisters, and daughters are dying at rates that we have never seen before,” says Dr. Thomas Frieden, Director of the CDC. Among the more alarming aspects of the report are: 1) On average, 18 women die from painkiller overdoses in the U.S. every day; 2) More women die from prescription drug overdoses than from car accidents; 3) Some 50,000 women between the ages of 25 and 34 will be taken to U.S. emergency rooms as a result of painkiller overdoses this year. In its report, the CDC recommended that healthcare providers exercise greater caution when prescribing prescription medications—and suggested that states and the federal government could turn this trend around by doing a better job educating women on the dangers of prescription painkillers. “We are seeing an increase in the numbers of women and young people presenting in the emergency room with prescription pain and anxiety medications—many of whom have legitimate prescriptions for a physical or mental health disorder, and others who are accessing prescription meds from others or on the street,” Lisa Dressner confirms. Dressner is Program Director of TRMC’s Psychiatric Emergency Services. “Too often, alternatives to these highly addictive medications are not explored, and primary care or pain management doctors may not fully assess someone’s potential or history of substance abuse.” There is an urgent need, she adds, for more education to consumers around the potential for addiction to commonly prescribed pain meds, and medications for problems related to anxiety or sleep, so that risk for abuse of these medications, and increased depression, withdrawal and suicidality is minimized.

Lisa Dressner Program Director of TRMC’s Psychiatric Emergency Services 908.994.7152

 Good News on HPV Virus Michele Bachman can rest easy. The HPV vaccine does not make young women “mentally retarded.” In fact, according to a report released by the Centers for Disease Control in June, the prevalence of Human Papilloma Virus (HPV) infections has been cut in half since 2006. The Journal of Infectious Diseases reported that researchers were surprised by this result—not because of the vaccine’s effectiveness, but because the rate of vaccination in the U.S. lags far behind other developed countries. Only a third of American girls have been fully vaccinated; in other countries (including Rwanda!) the rate is closer to 80 percent. HPV causes 19,000 cases of cancer among women in the U.S. each year. It also accounts for 8,000 cases in men, a statistic brought to light by actor Michael Douglas, whose throat cancer was identified as being HPV-related. “The study showed that less than four years later the prevalence of the vaccine strains among young women aged 14–19 years had fallen by 56%,” points out Dr. William Farrer, Associate Program Director and Associate Professor of Medicine of the Seton Hall University School of Health and Medical Sciences at TRMC. “This was despite the fact that in 2010, only 32% of 13–17 year-olds had received the full 3-dose series of vaccine. Rates of HPV infection in older women had not fallen, probably reflecting the fact that they were not the target group for the vaccine.The researchers also reported that ‘Sexual behavior among females aged 14–19 years overall was similar in the two periods.’ This should reassure opponents of the HPV vaccine who expressed concern that somehow use of the vaccine would encourage promiscuity.”

 William Farrer, MD Department of Medicine, Infectious Diseases Division 908.994.5455 


 Air Pollution Linked to Sleep Disorders in Children While we watch the Arab Spring unfold in Egypt in dramatic fashion, some dramatic health news has come out of that country that is relevant right here in New Jersey. In July, University of Cairo researchers announced the results of sleep study on school-age children, which shows a link between air pollution and sleep disorders. The 276 children in the study exhibited significant disorders of initiating and maintaining sleep, and excessive somnolence when exposed to PM10 (particulate matter smaller than 10 micrometers) in the air. PM10 particles can settle in the lungs and cause health problems. Larger particles are typically filtered by the nose and throat. In treating the pediatric population at the Trinitas Comprehensive Sleep Disorders Center, Vipin Garg, MD, Director of the Center notes that, “Small particles or large particles of pollution can irritate the airways of children, especially those who have large adenoids. Children who have to breathe through their mouths because of enlarged adenoids bypass the normal filtering process of the nose and that can have an irritant effect on both the upper and lower airways. This may result in a significant sleep disturbance especially if sleep is already compromised. Also lower airway irritation can lead to asthma-like symptoms.”

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


 Walking the Walk While the medical profession has long promoted the benefits of daily exercise, a new study out of the Middle East pinpoints how short, brisk walks taken after meals are an effective way to diminish the risk of developing Type 2 diabetes. The results, published in the latest issue of Diabetes Care, focus on how post-meal strolls reduce blood sugar levels. “Blood sugar levels are the highest after meals and as we age our pancreas is less effective in releasing insulin, a hormone that helps lower blood sugar,” explains Dr. Mahmoud Ali Zirie, who ran the study out of Qatar. “This leads to higher blood sugar that can increase the risk of diabetes. A short walk two hours after meals can help normalize blood sugar levels. To achieve maximum health benefits walking should be moderate intensity. In other words, it needs to be faster than a stroll and brisk enough to raise your heart rate.” Those who are new to this type of exercise should begin slowly, stay hydrated and avoid excessive heat, and build toward a regular and rigorous regimen. Kathleen McCarthy, RN, a Certified Diabetes Educator at Trinitas, offers these tips: “Whether you have diabetes or you are trying to keep diabetes at arm’s length, you will benefit from a regular exercise regimen of 30 minutes a day, five days a week, or more. Short brisk walks, two hours after a meal, improve post-prandial (after meal) glucose readings. Walking also improves circulation, heart and lung function, and releases endorphins which help control of stress and pain. As you build muscle mass, your metabolism will increase which then gives you more energy and will lead to weight loss over time. The benefits of aerobic exercise last up to 12 hours after exercise. Exercise is a key ingredient to improve or maintain optimal health.”

 Kathleen McCarthy, RN Certified Diabetes Educator 908.994.5490


   Mild Depression and Alzheimer’s A recent aging study conducted by researchers in the U.S. and Asia has found that the onset of Alzheimer’s Disease appears to be accelerated by depression. The study suggested that individuals with depressive symptoms progressed from mild cognitive impairment to full-blown Alzheimer’s at a much faster rate than those who did not exhibit signs of depression. Indeed, depression doubled the risk of developing Alzheimer’s in this particular study. These findings have opened up a number of debates about what actually triggers the cognitive decline. However, it strongly suggests that decisive steps to intervene or mediate depression among people at risk for Alzheimer’s need to be taken. “Occasionally, depression in the elderly, even in the absence of dementia, has been known to result in impairment of cognitive functions,” adds Dr. Anwar Y. Ghali, Chairman of Psychiatry at Trinitas. “Especially the memory, in a condition referred to as ‘depressive pseudo dementia.’ Hence, one would expect that this might occur at a higher rate with patients already diagnosed with Alzheimer’s. Therefore, physicians should always evaluate Alzheimer’s patients for the possibility of a co-morbid depression. With adequate treatment of depression, patients should be relieved of suffering and also experience reduced possibility of suicide—a complication of depression that occurs at a higher rate with the elderly, especially in males and particularly for those suffering from an additional illness.”

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


 Landmark Diabetes Study Completed The recently completed Look AHEAD study by the University of Pittsburgh has brought into question the value of lifestyle intervention programs for overweight and obese Type 2 diabetes patients. The study covered more than 5,000 people at 16 clinical centers across the country, over more than a decade. One group in the study followed an aggressive program of weight management and increased physical activity. The other was only provided with health information and support related to diabetes. In terms of strokes and heart attacks, there was no significant difference between the two groups. The biggest difference between the groups was in the area of weight loss. The information and support group lost relatively little weight, while the intervention group lost 8.7 percent of their body weight and had excellent success keeping it off. A 5 percent weight loss is considered clinically significant, particularly in the controlling of cholesterol, blood pressure and blood sugar. “While the findings from the Look AHEAD study did not support that engagement in a weight-loss intervention was effective for reducing the onset of cardiovascular disease incidence or mortality, this does not mean that overweight adults with diabetes should not lose weight and become more physically active,” says John Jakicic of the Department of Health and Physical Activity in Pitt’s School of Education. Dr. Ari Eckman, Chief of Endocrinology and Metabolism at Trinitas, adds that there is an overwhelming amount of evidence from this study to date that has shown that weight loss and physical activity were associated with numerous other health benefits: “While weight loss alone was not shown to significantly decrease this incidence in the recent Look AHEAD study, there is strong support from numerous studies supporting the benefits of weight loss and physical activity for many other health benefits. Further studies are recommended to determine the full effect weight loss has on cardiovascular disease prevention. It is still strongly recommended for people with diabetes who are overweight or obese to lose weight and maintain a healthy lifestyle.”

Ari Eckman, MD Chief of Endocrinology and Metabolism 908.994.5187 

Defending Your Life

10 Ways to Live Longer (and Better)

You may be one of the 47% who “doesn’t pay taxes,” but that other inevitability—death—is a little harder to sidestep. Indeed, sooner or later the predator time catches us all. The trick, of course, is to push “later” as far forward as possible. We do this by eating well, exercising and not smoking. At least, that is what we are told to do. The reality is quite different. According to the CDC, one third of our population qualifies as obese, and a Duke University study projects a rise to 42% by 2030—adding $550 billion to national healthcare obligations. With obesity running rampant through America, some of us actually breathe a sigh of relief that we are merely “overweight.” Meanwhile, we spend billions on exercise equipment that gathers more dust than sweat, gym memberships that can’t be cancelled, and workout wardrobes that still have their tags on—more than $70 billion a year, according to the Sporting Goods Manufacturers Association. And although we have come a long way from idolizing the Marlboro Man and athletes sponsored by Virginia Slims, smoking is actually on the rise among women and teens. We all know what to do. So why aren’t we doing it? What is it that triggers yo-yo dieting, couch potato-ing, and closet smoking? We all want to live longer…so why are we so bad at it? In many cases, it turns out, the prospect of making major life changes is so daunting or dispiriting that folks unconsciously have given up before they even begin; one bump in the road and they revert back to bad habits. A successful outcome is far more likely if you take on small, achievable challenges and fold them into your current lifestyle. In that spirit, we’ve identified 10 smart ways to keep you going strong:

1 DRINK UP The Mayo Clinic has adjusted the longstanding “8 by 8” rule (eight 8-ounce glasses of water daily) to include any healthy fluids. And a Loma Linda University study indicates that as little as 5-8 ounces daily can be helpful.

2 SWEET SURRENDER According to a 15-year study conducted by Dutch researchers, eating about 4 grams of cocoa a day could cut your risk of heart disease. Dark chocolate with a high cocoa content is ideal.

3 LAUGHTER IS THE BEST MEDICINE According to a study by Dr. Michael Miller at the University of Maryland, laughter can reduce blood pressure, lower cholesterol and improve blood flow to the heart by as much as 50%. Start DVR-ing The Colbert Report!

4 ACID TEST The International Journal of Cardiology tells us that chronic heartburn can lead to a heart attack. A high acid level in the esophagus, when untreated, can decrease blood flow to the heart by 20%. According to a CNN report last year, if you suffer from heartburn you might try sleeping on your side to reduce acid reflux.

5 CATCH SOME Zs According to the CDC, 41 million Americans don’t get enough sleep, with consequences ranging from a higher risk of diabetes to depression to slower reaction time in emergencies. How much sleep is right for you? The next time you have a totally free weekend—or better yet, a vacation—go to bed when you’re tired and wake up when you want. If you get through the day without feeling tired, that’s probably your “sleep number.”

6 CURRY FLAVOR Rutgers University scientists have determined that combining curry with cruciferous vegetables (cabbage, bok choi, turnips, broccoli, cauliflower) appears to help ward off prostate cancer.

7 GO NUTS Loma Linda University researchers tracking the lifestyle habits of 34,000 Seventh-Day Adventists (a population famous for its longevity), discovered that those who munched on two ounces of nuts almost daily lived on average almost three years longer.

8 PERK UP Numerous studies have linked coffee drinking (often 2-3 cups per day) with a positive impact on diabetes, heart attacks and strokes—and even Parkinson’s and Alzheimer’s.

9 STAND UP FOR YOURSELF Whether in front of the TV, computer or anywhere, sitting for long periods at work or at home can be almost as risky as smoking or being obese, particularly for your heart. Dr. James Levine, a professor at the Mayo Clinic, suggests that even sitting for an hour straight is sitting too long.

10 THINK POSITIVE A Yale University study of older adults showed that those with a positive outlook on aging lived about seven years longer than those with less optimism.

Dr. Kevin Lukenda, who chairs the Family Medicine Department at Trinitas, also believes in keeping things simple. He advises his patients to live by the following 10 rules:

1 Reduce stress by not taking anything too seriously.

2 Set aside quality time with friends and family; share your feelings, thoughts and fears with them.

3 Do something selfish and productive for 15 minutes every day.

3a Do something selfish and productive for one hour once a week.

4 Read a book, magazine, newspaper—anything.

5 Do nothing to the extreme.

6 Keep your carbs to a minimum.

7 Get enough sleep!

8 Life is hard—be a strong person rather than asking for an easier life.

9 Take walks.

10 See your family doctor as needed. Regardless of which (or whose) nuggets of wisdom you follow, the good news is that you have a lot of interesting and attainable options. Still better news is that some of them you might even enjoy! The best news? All of these not only add up to living longer. They add up to living better.


Editor’s Note: Log onto for six more ambitious ways to improve and extend your life.

What’s Up, Doc?

News, views and insights on maintaining a healthy edge.      

Pumped Up Patches Drug delivery via patch works for some medicines but not for others. That could change very soon, thanks to a device pioneered at the Birck Nanotechnology Center at Purdue University. A micro-pump containing small amounts of yeast and sugar has been built into drug patches. The micro-pump is 1.5 centimeters long and uses water activated by body heat to begin a fermentation process that releases tiny amounts of carbon dioxide gas. The gas then powers the pump continually for several hours. The greatest impact of this device would probably be in powering micro-needle arrays used to deliver cancer and autoimmune drugs. These drugs involve molecules too large to be delivered through the skin with traditional patches. The new technology differs from other micro-pumps on the market because it does not use a battery.

Don’t Just Sit There! Thanks to a new study out of Australia, you can add one more thing to the list of long-term health no-no’s that includes smoking, drinking, lack of exercise and a high-fat diet: Sitting. Research by the Sax Institute of adults 45 and over found that those who sat for 11 or more hours a day had a 40% higher risk of dying within the next three years than people who sat less than four hours a day. The study adjusted for an array of other lifestyle and medical issues, but even for those who exercised regularly, the risk of death still rose with every additional hour spent in a chair.

New Road Map for Families of Teen Diabetics For many parents, coping day-to-day with their teenagers is the most difficult, aggravating and exhausting phase of the child-rearing process. For parents of teens with Type 1 Diabetes, managing the disease and the young man or woman can prove next to impossible. The Eunice Kennedy Shriver National Institute of Child Health and Human Development recently provided a road map that families should find helpful. Their findings suggest that kids between ages 12 and 15 with Type 1 Diabetes benefitted dramatically from a two-year program (of three to four meetings a year) with parents and a health advisor to discuss shared responsibilities, goals and strategies for solving diabetes management problems that arose. Meeting with a health advisor during regular diabetes clinic visits, researchers reported, helped families better manage the changes that occur as children take on more responsibility for their day-to-day diabetes care.

Impact of the NYC Soda Ban The announcement of an impending ban in New York City on large, sugary drinks has prompted many people—both inside and outside of the medical profession—to chime in on what, if any, effects this will have on overall health. Obviously, gulping down quarts of soda, energy drinks and sweetened teas a week is not a smart idea. But will shaving a few ounces off this total make a difference? The consensus thus far is that it will—but only a small difference. Obesity is a complex disease, involving a lot of variables. That being said, if the “soda ban” pushes forward the national discussion about the dangers of consuming too much sugar—and overeating in general—it could have a significant impact. Lifestyle changes are often triggered by cultural changes; if the culture of junk-food consumption is altered through publicity and awareness that begins in New York, we may look back on this law as a true game-changer.

Genetic Connection to Blindness More than 15 million people around the world suffer from blindness brought on by Primary Angle Closure Glaucoma (PACG). The problem is especially pronounced among Asian populations, which account for about 12 million of these cases. A collaborative international research effort launched in Singapore recently identified three previously unknown genes associated with PACG. The medical community has long suspected the disease to be strongly hereditary, but these findings—published in the journal Nature Genetics—confirm the fact. This opens the door to possibilities of novel treatments, as well as the potential of early identification of people at risk for PACG. “These data are the first critical steps toward a better understanding of the underlying molecular events responsible for this blinding disease,” explains Dr. Janey Wiggs, Professor of Ophthalmology at Harvard Medical School.

New Study on Job Stress When Johnny Paycheck recorded the country hit “Take This Job and Shove It” back in the 1970s, it turns out he was way ahead of his time. Doctors in England recently completed a study that shows workers who feel over-pressured yet powerless run a risk of coronary disease that is 23% greater than those who are content in their work environment. The study covered around 200,000 workers in a wide range of occupations, from civil servants to factory workers. Subjects were asked about the type of work they did, the workload, deadlines and freedom to make decisions.

EQ vs. IQ

Which Gray Matter Matters Most?

Photo credit: iStockphoto/Thinkstock

Think of the smartest person you know. Now ask yourself: Is that person successful? Is that person happy? Stop right there. The two are not necessarily the same thing. A robust IQ may look good on paper, but there is a new way of measuring abilities called the Emotional Quotient (EQ)—or, more specifically, Emotional Intelligence (EI)—which is proving to be a more accurate predictor of your potential for a happy and successful life. Emotional intelligence is best defined as a set of life skills. It’s the ability to handle challenging situations by managing your own emotions, and the emotions of those around you.

These skills can improve not only your personal life, but your work environment as well. On a corporate level, companies that have implemented emotional intelligence training have noticed an increase in production and profits. Schools that have incorporated emotional intelligence into their curricula have reported improvement in grades and test scores. A person with high emotional intelligence and an average IQ has a greater chance of flourishing—both personally and professionally—than a person who possesses a high IQ with low emotional intelligence. Emotional intelligence is a relatively new term. But it’s been around for as long as humankind has existed. In the 19th century, we called it “horse sense” and in the 20th century, “street smarts.” It was how we described individuals able to manage themselves in new or stressful situations, who demonstrated the kind of level-headedness that led to successful decision-making. It was all about understanding your own emotions as well as someone else’s, and governing yourself accordingly.

In the 1980s and 1990s, researchers began to look at emotional intelligence with a more scientific eye. Right away, there were some distinguishing characteristics. For instance, with IQ, there is a standardized test that measures your cognitive abilities. You either have a high IQ, or you don’t, and it’s going to be about the same at age 15 and age 50. Emotional intelligence, on the other hand, is a part of your reasoning capabilities, and these can be learned; you don’t necessarily have to have been born with a high EQ. Here’s another eye-opening tidbit. When your parents told you to stop watching TV and read a book—or go outside and play—to keep your brain from turning to mush, they actually were right. With use, the brain is forming and expanding. This is called neuroplasticity. Neuroplasticity describes the brain’s ability to change by forming new connective tissue. A single cell can grow 15,000 new connections. The area of the brain that deals with our emotions, the amygdala, expands when our EQ improves, by forming new axons (connections). The amygdala is the brain’s center for emotional memory, emotional reactivity, and helps us be resilient when dealing with emotional distress. Emotional intelligence requires effective communication between the emotional and the rational centers of the brain. So, the higher our EQ becomes, the more connective tissue is formed, giving us an improved brain. 

THERE’S A TEST FOR THAT Is there an emotional intelligence test? Yes, but only a handful have been proofed with extensive research and accepted by the Consortium for Research on Emotional Intelligence in Organizations (CREIO). Reuven Bar-On, Ph.D., a clinical psychologist and a leading pioneer in the field of emotional intelligence, developed the EQ-I (Emotional Quotient Inventory) test after 18 years of research. The test was published in 1997 and was the first accepted measurement of emotional intelligence. It has been distributed worldwide in 30 different languages, and covers five different scales of EQ:

  • Intrapersonal (self-awareness and self-expression)
  • Interpersonal (social awareness and interpersonal-relationship)
  • Stress Management (emotional management and regulation)
  • Adaptability (change management)
  • General Mood (self-motivation)

Another highly accepted test is the Mayer-Salovey- Caruso Emotional Intelligence Test (MSCEIT 2.0). This test went through a grueling evaluation process, with detractors expressing concern about the viability of standardizing what is a right or wrong response when dealing with emotions. After much point and counterpoint, the MSCEIT emerged as another highly valued and widely employed test. It measures the four branches of EI based on the John C. Mayer and Peter Salovey model:

  • Perceiving emotions
  • Using emotions to facilitate thought
  • Understanding emotions
  • Managing emotions

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EQ IN THE WORKPLACE Most EQ tests take anywhere from 30-45 minutes to complete. Because a higher EQ has been shown to not only increase your mental health by lowering stress (which can lead to anxiety, depression and physical problems), but also your relationships and performance in a complex work environment—the place you are most likely to encounter an EQ test is in the workplace, or at least when applying for a job. Indeed, many companies have now incorporated emotional intelligence training into their practices, with spectacular results. Typically, they report anywhere from 55% to 70% improvement in both individual and corporate production. Emotional intelligence has also become a key factor in differentiating a mediocre business leader or manager from a highly effective one. The ability to understand the moods and behavior of employees—coupled with the management of the leader’s own emotions when dealing with stressful situations—leads to better interactions with co-workers.

This results in a more approachable team leader who is more readily available, who can maintain emotional flexibility to positively direct the energies of others, and who creates a more conducive work environment. This translates into greater trust and respect for the leader. Conversely, the lack of emotional intelligence may help explain why really smart people do really dumb things that end up ruining their careers. In his paper Bringing Emotional Intelligence to the Workplace, Daniel Goleman, Ph.D., writes that unlike “the brilliant executive who does everything well except get along with other people, or the technically gifted manager who can’t handle stress and whose career falters,” leaders with good emotional intelligence tend to advance more successfully in their field and remain happier throughout the process. “The super salesperson whose ability to sense what is most important to the clients and to develop a trusting relationship with them, or the service employee who is excellent in dealing with irate customers by helping to calm, and diffuse the situation,” are two examples of how emotional intelligence is used in the work environment with positive results.

IQ may get you in the door, but EQ will help you manage the stress and emotions of the job. Indeed, what research is available on the subject suggests that the higher one advances in an organization, the more important EQ becomes—with EQ skills accounting for 90 percent of what separates good leaders from average ones. For the record, Goleman is probably the most famous of the emotional intelligence experts. He has published numerous books and papers on EI. The most popular book, Emotional Intelligence, was written in 1995 and sold over 5,000,000 copies worldwide in 40 different languages. His second book, Working with Emotional Intelligence, deals with EI in the business world. 

GIRLS RULE? In terms of basic skills for leading a happy and successful life, almost every test for EQ finds that women have an edge over men. However, Goleman warns, “It’s not that simple.” Keep in mind that these tests have a basic four-part scale: self-awareness, managing emotions, empathy, and social skills. In response to a blog posted in 2011, “Are women more emotionally intelligent than men?”, Goleman answered, “Yes, and yes and no.” Women, on average, are better at some forms of empathy, while men are better at managing distressing emotions. Yet, as Goleman points out, “There are two very different and distinct Bell Curves that lead to an overlap where it can switch.” He explains further, “There are three different kinds of empathy: cognitive empathy (being able to know how another person sees things); emotional empathy (feeling what the other person feels); and empathic concern or sympathy (being ready to help someone in need).” Goleman maintains that women tend to be better at emotional empathy, which fosters rapport and chemistry with others. For example, if another person is upset, a woman can stay with the feelings of distress for a longer period of time than a man.

A man will sense the feeling for a moment, then tune out the emotions and switch to an area of his brain that will try to solve the problem at hand. The part of the brain that registers empathy is called the insula. Neuroscientists tell us that, when we empathize with someone, our brain mimics what that person is feeling, and the insula reads that pattern and tells us what that feeling is. So, when a man’s brain clicks into tune-out mode, he’s no longer using the insula; he’s switched to another part of the brain. This helps him to stay calm while everyone else is in high emotional distress, enabling him to focus on finding a solution. Conversely, a woman’s tendency to stay in-tune with an emotionally upsetting situation helps her to nurture and support others. “So, one is not better than the other, just different,” Goleman concludes. Tune in, tune out—it’s a brain difference. Since women do tend to score higher than men on the empathy card, they have the edge when it comes to the work environment. However, as psychologist Ruth Malloy of the Haygroup Boston (which studies business leaders) says, “When it comes to top leaders in business, gender differences in emotional intelligence level out.” The men are as good as the women and the women are as good as the men.”

Editor‘s Note: J.M. Stewart’s other contribution to this issue—her interview with Sandra Oh—actually started with a discussion with the actress about the subject of EQ. Oh is not a big fan of media, but is passionate on this particular subject. You can read an extended version of EQ vs. IQ—including a look at how educators view the subject—at


Joint Decision

When Is Replacement Surgery the Right Call?

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According to the American Academy of Orthopedic Surgeons, over 500,000 total knee replacements are performed each year. In addition, close to 300,000 total hip replacements are performed annually. As a physical therapist, I am often asked about total joint replacements. Many individuals are not sure if they are candidates for a replacement; some are concerned about what they have to do in order to regain function after the operation, while others are a bit nervous about the operation itself—and the potential of pain and how it will impact their lives. My answer is that in the past 50 years, refined operative techniques, advancements in total joint component design and enhanced rehabilitative techniques have totally changed the game in rehabilitative medicine. We can get a person moving again without the arthritic pain that many people experience for years prior to their joint replacement.

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Decisions, Decisions As we age, everyone seems to have an ache or a pain someplace. Changes in the surfaces of our joints—with osteoarthritis being the most prevalent cause—are a major source of pain for many people. While some individuals can work through the pain and not have it affect their daily lives, others experience pain that limits everyday functions to a point where it is difficult for them to take care of themselves. Also, many of us—especially those of the baby boomer generation—want to continue very active lifestyles, which the arthritis in their joints makes difficult to do. When does the discussion about joint replacement begin? A family physician will typically conduct a physical exam, do blood tests and take x-rays to determine the cause of joint pain. Once it is established that the joint surfaces are the likely source of the pain, patients are referred to an orthopedist, who can determine whether or not total joint replacement is warranted. Surgery is not a foregone conclusion at this point. On the contrary, an orthopedist often will refer patients to physical therapy in order to determine if maximizing muscle function can decrease pain to a point where one can manage discomfort and lead an active life without undergoing an operation. Some do gain enough pain relief and are able to return to a level of function without a joint replacement. Others—even those in good shape, muscle function-wise—still find the pain and loss of movement at a level that leads them to explore the possibility of a total joint replacement. By the way, as a physical therapist, I believe all these patients are in a better place than they were before. For those who do decide to go down the path of joint replacement, they are in much better shape heading into the surgery than they would have been without this period of physical therapy.

Walking the Walk How long before a patient can go home after surgery? The national average for total joint replacement patients’ stay in the hospital is approximately four days, depending on the type of surgery, age of the patient and any other medical conditions a person may have. However, both total-hip and total-knee patients are up and walking immediately—in some cases starting the afternoon of their surgery!

From there, physical and occupational therapists provide the skills and encouragement necessary to achieve early, major gains in function. While patients experience normal postoperative discomfort, most notice that the pain they had before the operation is almost gone. The reason for this is simple—the source of that pain (the roughed surfaces of bone in the joint) is now gone. Pain reduction, new methods of non-narcotic pain control, early movement and function are all the hallmarks of today’s modern total joint replacement experience. We have indeed come a long way. After discharge from the hospital, whether one goes to a sub-acute rehab center or home with homecare, the real work begins. I have found that those patients who really push themselves in their rehab routine at home—and later, when they start their outpatient program—are the ones who achieve the greatest success. Unfortunately, our society still has a bit of a passive approach to healthcare; many still just want to swallow a pill and move on with their lives. Not so with total joint replacements. These patients are fully engaged in their own treatment and progress. Persons with total joint replacements find themselves doing more with each passing day, experiencing less pain than they ever thought possible.  

Editor’s Note: Jim Dunleavy is the Director of Physical Therapy and Rehabilitation for Trinitas Regional Medical Center.


What’s Up, Doc?

News, views and insights on maintaining a healthy edge.

A Shift in Workplace Health A meta-analysis of studies covering more than two million people shows that people who do shift work have a 23% greater risk of heart attack—and a 5% increase in risk of stroke—than those who work other types of jobs. The group that conducted the research at the Stroke Prevention and Atherosclerosis Research Centre in Ontario, Canada, believes their findings have profound implications for public policy and occupational medicine. Shift work disrupts the body clock (aka circadian rhythm) and is associated with an increased risk of high blood pressure, high cholesterol and diabetes. However, this is the first time its link to vascular disease has been established. Shift work is defined as evening shifts, irregular or unspecified shifts, mixed schedules, night shifts and rotating shifts; and workers who pull a “normal” 9 to 5 work day were used as the control group.


 The Ankle Bone’s Connected to the…What? That broken ankle may lead to bigger problems. So say researchers at Texas Tech, who recently established a link between ankle injuries and life-threatening complications, including deep vein thrombosis and pulmonary embolisms. The study suggested that treating physicians should assess patients with ankle fracture for their risk of developing a venous thromboembolic event on an individual basis, and also provide thromboprophylaxis (prevention of thrombosis) for those with an increased risk of developing such complications.


Let’s Do (it at) Lunch As a rule, people don’t mind paying the tab to achieve healthy, beautiful skin. Finding the time to make it happen is often the greater obstacle. According to plastic surgeon Dr. Joseph D. Alkon, there are a number of non-invasive, “lunchtime” treatments that can make your skin look and feel its best. “A chemical peel helps those with dry skin, uneven tone, acne, discoloration and/or mild wrinkles,” Dr. Alkon says. “This office-based procedure uses a special liquid to remove the harsh outer layers of skin, while leaving smoother and healthier layers intact. Peels vary from mild to aggressive depending on the skin being treated.” Microdermabrasion also works to remove unhealthy, dry, flaky outer skin, he adds. This procedure uses a gentle tool or wand to remove the outer layers of skin. This leaves behind fresh, healthy skin. Although commonly performed on the face, other body parts can benefit from both chemical peels and microdermabrasion. “A facial is another popular, relaxing and rejuvenating service,” Dr. Alkon says. “It’s often performed by a licensed esthetician, and includes a skin analysis followed by customized exfoliation, extraction, massage, and application of toners, moisturizers, and sunscreens customized to your skin type. A facial can leave the skin clean, clear, hydrated, and rejuvenated.”    

New Alzheimer’s Drug May Be on Horizon The medical profession has accepted the fact that there is no “cure” for Alzheimer’s. However, a trial just concluded found that patients who had injections every two weeks of the drug immunoglobulin—made from antibodies in human blood—showed no decline in cognition, memory, daily functioning or mood for a period of three years. Immunoglobulin is normally given to patients who suffer from an immune deficiency, and is extremely costly. If all goes well, however, the drug would be on the market within 10 years. “This is probably the most exciting drug we know about that is currently in the late stages of research,” says Clive Ballard, Director of Research at the Alzheimer’s Society. “We now know it is safe. But the real test will be whether these initial promising results can subsequently be replicated in larger groups.” As life spans increase, the likelihood that a person over the age of 65 will develop some form of dementia is about one in three. Currently, there are only three drugs for Alzheimer’s in the early to moderate stages, and they are effective in some patients but not in others.


Smile and Say “Aaaaaah” Do you experience nausea, bloating, heartburn, constipation, or a feeling of fullness? These may be symptoms of a motility disorder, such as gastroparesis and chronic constipation. Gastropathy is a common condition in long standing diabetic people, especially if not well controlled. People with gastropathy can suffer from postprandial indigestion, abdominal discomfort, nausea, and vomiting. Fortunately, the guesswork has been removed from diagnosis of these conditions thanks to the SmartPill, a wireless motility capsule procedure. “The SmartPill capsule travels through your GI tract, collects data, which is then recorded for your doctor to evaluate,” explains Samiappan Muthusamy M.D. of the Center for Digestive Diseases (, which offers this state-of-the art procedure. According to Dr. Muthusamy, the SmartPill can also diagnose Diffuse Colonic Dysfunction (aka lack of colon motility), an extremely serious condition that can present as constipation. Of course, causes such as a poor diet, lack of fluids, sluggish thyroid, colon cancer and constipating medications are ruled out first. “In modern medicine,” adds Dr. Muthusamy, “living with gastropathy and constipation is a thing of the past. They are treatable.”


UGNJ Strikes Gold The Urology Group of New Jersey (UGNJ) recently earned The Joint Commission’s Gold Seal of Approval for its continuous standards of healthcare quality and safety in ambulatory care. By receiving this accreditation award, UGNJ is now the only Urology physician practice in the nation to achieve this status. Recognition followed a rigorous unannounced on-site survey of all 12 UGNJ offices in March 2012 by a team of expert surveyors, who evaluated the group’s standards of care specific to the needs of patients—including prevention of infection, leadership and medication management. “Achieving accreditation from The Joint Commission is a team effort that will bring confidence to our patients and give us a framework to provide the best care possible,” says Dr. Alan Krieger, UGNJ’s President.


Mapping Menopause A study published in July by the Endocrine Society suggests that the primary barrier to women receiving hormone therapy to treat menopausal symptoms is patients’ fears about the risks, and their unwillingness to discuss the option. What is interesting about this study is that it was conducted with internal medicine, family practice and OB/GYN physicians—and not patients. “Nearly every physician participating in the survey said menopausal symptoms have a negative impact on quality of life,” says William F. Young, Jr., MD, president of The Endocrine Society. “It’s important for a woman to know what hormonal and non-hormonal treatment options may be best for them to provide symptom relief.” To that end, the Society has created what it calls the Menopause Map, an online interactive tool that guides a woman through the different options available to get relief from her symptoms. The map uses a series of prompting questions about those symptoms and her personal health history, and also has links to questionnaires that help assess current risk for breast cancer, heart disease, and stroke. The tool weighs hormonal and non-hormonal therapies against the risks based on individual symptoms and medical history. The url is


Regarding Henry

As one patient learned the hard way, time does not heal all wounds.

Henry Schroeding, a 66-year old Delaware resident, was one of the more than five million Americans who deal with chronic, non-healing wounds. He tried self-treating a leg injury he incurred in the summer of 2009, employing over-the counter remedies for about 6 months. But the infection only became worse. Schroeding then opted for professional help at two reputable wound care centers in Delaware, where he underwent various treatments, including a vascular closing and a skin graft—unfortunately without much permanent improvement. In fact, a trip to the beach the following summer resulted in the wound festering still further into a situation so serious that it could easily have become limb-threatening. Out of sheer frustration and in near panic, Schroeding resorted to doing his own research on the Internet and identified two out-of-state hospitals with highly renowned wound care centers: Johns Hopkins in Baltimore and Trinitas Regional Medical Center in Elizabeth. The Hopkins website cited a 60-70% heal rate, whereas Trinitas claimed more than 90% overall. That made the choice easy.

Within two days of his initial phone call (and much to his pleasant surprise), Schroeding had an appointment at The Center for Wound Healing & Hyperbaric Medicine at Trinitas. His attending physician was Dr. Morteza Khaladj, DPM, FACPPM, Chief of Podiatry and Director of the Podiatric Surgical Residency program at Trinitas since 2006. Dr. Khaladj assured Schroeding that the Wound Center, which opened in 1997, is acknowledged to be one of the finest in the country, having received the Robert Warriner III, MD, “Center of Excellence” award from Diversified Clinical Services (DCS) in recognition of its excellent clinical results and its record for successful healing outcomes and overall patient satisfaction.

Dr. Khaladj attributes the center’s high ranking to its ongoing research, its challenging residency program, and its internal product testing and evaluation system. “That’s what keeps Trinitas in the vanguard of healing centers,” he says. The Trinitas Wound Center specializes in treatment of very serious and chronic wounds, many of which have undergone failed treatments elsewhere. It offers therapeutic treatments using three of the latest wound technologies: • Hyperbaric Oxygen Therapy or HBOT: administered typically to patients presenting with non-healing wounds from conditions such as gangrene, carbon monoxide poisoning or unsuccessful skin grafts. This involves placing the patient in a special chamber that delivers a healing 100% oxygen-rich environment through the bloodstream to the wound. • Apligraf Living Skin Device: utilizes a biological dressing produced under laboratory conditions that was first used in New Jersey at Trinitas, bringing relief to many patients suffering from limb-threatening venous leg ulcers and other types of hard-to-heal wounds. • Vacuum Assisted Closure (VAC): exerts controlled negative pressure, which helps to remove infectious material and promotes the growth of new blood vessels in preparation for successful grafting. Each patient is different, of course, but when pressed for an average healing time statistic at the Trinitas Wound Center, Dr. Khaladj indicated it typically might range from 4-6 weeks up to 2-3 months.

He affirmed that any individual suffering with a wound that shows no improvement within two weeks should be examined by a medical professional. For individuals with serious chronic conditions such as diabetes, any significant wound should be examined at least by a general practitioner as soon as possible. If the wound persists despite medical attention, then a wound treatment center should be consulted to benefit from their expertise and technologically advanced treatment alternatives. In Schroeding’s case the VAC therapy was determined to be the best treatment. After initial testing and final diagnostic assessment, he was admitted to Trinitas for a surgical procedure that involved removal of some affected muscle tissue. He continued to undergo weekly VAC treatments for the next 2 months. He also underwent a second skin graft, which this time was a total success.

Throughout his treatment, Schroeding did experience some pain, but at a level that was manageable with daily doses of aspirin and sometimes a more serious pain killer. Finally, after a total of almost 10 months of treatment, his wound was no more. As an overall assessment of his experience at the Trinitas Wound Center, Schroeding says that it was “way over 10 on a scale of 1 to 10”—and that his stay was the best time he ever spent in a hospital. “When I hit the call button, someone actually came right away. Amazing!” In short, although Trinitas was approximately 160 miles away, Schroeding gladly made the weekly 300-mile roundtrip that totaled more than 14,000 miles over his more than nine months of treatment. Dr. Khaladj adds, “Through all of our ongoing research and successful patient treatments, we know what works and what doesn’t work.” That would account for the center’s heal rate of 98%…and Henry Schroeding’s response to the question How are you doing? “Terrific!”

EDGE Editor’s Note: Henry Schroeding was interviewed while undergoing his treatment. Both he and Dr. Khaladj can be seen on YouTube at watch?v=LfjrlDVbTwQ. For more information on the Trinitas Center for Wound Healing and Hyperbaric Medicine, call 908-994-5480 or

He Said: She Said

When relationships go from hopelessly devoted to just plain hopeless, it may be time to talk to a professional. Psychologists Dr. Rodger Goddard and Dr. Patricia Neary-Ludmer look at the ins and outs of Couples Therapy. 

Goddard: Marriage and long-term, committed relationships pose intense challenges. They are strained by drinking, infidelity, parenting differences, stress, overwork, house-chore inequality, unresolved fights, emotional wounds from one’s childhood, anger, abuse, financial stress, instigation from in-laws, drug use, grudges and many other problems. The divorce rate in the U.S. is extremely high—estimates range between 45 and 55 percent. If you were to factor in break-ups in other committed relationships, there would be no telling how high that number might climb.

Neary-Ludmer: In isolation—in other words, just the one-on-one aspect of a relationship—couples generally communicate and connect fairly well. Otherwise they would go their separate ways. However, once they commit to each other the challenge begins. I believe most couples know how to communicate. If there is a problem, it’s likely due to the external pressures of life.

Goddard: Good communication skills are definitely essential. Couples should strive to be each other’s best friend. They need to be able to talk things out, articulate their inner feelings, and share their stress, emotions and thoughts with each other. Too often the hyperactivity of modern life, work and responsibilities do not leave time for enjoying each other’s company. Laundry needs to be washed, dinners served, children chauffeured, floors cleaned, shopping done, homework finished and hundreds of other chores carried out before affection, intimacy, friendship and romance can take place.

Neary-Ludmer: A common error couples make is focusing on building a beautiful marriage and family life without securing and feeding the foundation. They characteristically will sacrifice themselves to make sure their children’s needs and wants are being met, often at the expense of their own relationship. They forget about the importance of balance. A child needs to have parents that are happy and healthy. Otherwise the family structure will begin to crumble.

Goddard: I call it BC and AD. BC (Before Children) a couple focuses on each other. AD (After Da Kids) presents new challenges. The connection between couples now becomes a triangle pointed downward with a focus on the children. The connection between the couple can suffer. A new and revitalized couple connection needs to be reestablished and strengthened.

Neary-Ludmer: In our practices we see challenges to marriage that are very difficult and often require clinical intervention. They include coping with infertility, raising children with special needs, various types of addictions, the loss of a child, mental illness, and caring for elderly or sick parents. All of these put incredible stress on a relationship. For instance, untreated substance abuse or mental illness can be very detrimental to a marriage and family. Often it leads to lies, disappointment, betrayals and financial ruin. It causes the healthy spouse—and the family—untold pain and suffering. If the impaired spouse is unwilling to address the problem it often leads to divorce.

Goddard: Couples therapy is often extremely useful. Infidelity is an issue that often necessitates couples therapy. I enjoy doing couples therapy because it can be very easy to get a couple to remember what they love about each other, and how to treat each other special. Couples therapy is extremely helpful because it can provide a referee who lays down the rules of the game. A good therapist calls fouls and levels the playing field into one that supports both parties. Job number one is establishing guidelines for good communication. Sports and life necessitate effective game rules (e.g., no hitting below the belt, no clips, bring-downs, take-downs, or offensive fouls). It is critical for couples to focus on the specific things that they want from each other in the present and future, and not on all those horrific things that the other person did to them five, ten and 15 years ago. Too often couples get into endless nobody-wins power struggles.

Neary-Ludmer: Arguing and shutting down creates a disconnect; communication breaks off and the relationship suffers. Reestablishing that connection opens communication back up. And that happens by showing compassion and love. I believe that time is key. Make time to connect, just as you might schedule a music or tutoring lesson for your child. And protect that time. I encourage “date night”—not to focus on problems, but rather to laugh and talk and rekindle. Words are not necessary. Go to the gym together, garden together. Communication will follow.

Goddard: Among the most common important relationship problems I find is that couples often hold onto resentments, grudges and irritations with an iron grip. Another is the frustration that people feel when their viewpoint or emotions are not recognized or affirmed. It seems incredibly easy for two grown-up people to figure out who should take out the garbage on what day. And yet they do not, because… “He just doesn’t understand all the things I do around here” or “She just doesn’t understand that I need to unwind when I get home” or “He doesn’t show me decent respect when he speaks to me” or “Everything is a criticism from her” or “He is never available” …and on and on. Of course, these things need to be resolved. But a critical ingredient involves the other person feeling that their emotions, thoughts or desires are being understood. It is almost a primary motivation of ours to feel understood. When this need is not satisfied, bad things tend to follow.

Neary-Ludmer: Building a life together in today’s times requires hard work and discipline. It becomes quite the challenge to find time and energy for each other. And that work should really begin before committing to a long-term partnership. Ask yourself if you are being realistic about your relationship and being in love. Are you addicted to, or searching for, those early-on “honeymoon” feelings. Remember that falling in love is generally based on excitement, sexual energy and a desire to become one— to fill our loneliness and secure a future. Ask yourself, “Is this love? Is this really sustainable?”

Goddard: For a marriage to work, couples need to be able to “fight clean.” All too often when conflict arises, a spouse is likely to fight dirty—criticize, blame, shame and name everything the other person ever did wrong. When arguing, try to first “feed back” what you think the other person feels and wants. Change from being defensive— trying to overpower the other person, getting on the witness stand and arguing your point—to listening better, accepting the other person’s viewpoint and admitting imperfections. Let the other person feel they have a right to their emotions and what they want.

Neary-Ludmer: Almost every long-term relationship goes off the tracks at one time or another. If you’ve been doing the work all along, it’s much easier to get things back on track. Some of the guidelines I think are helpful include: • Be comfortable in your relationship…but do not take your spouse for granted. • Voice concerns…don’t build resentments. • Focus on the positives of your spouse…substitute critical thoughts with positive attributes. Remember that nobody is perfect, and the grass always seems greener on the other side. • Try to preserve trust… surviving lies and infidelity is very difficult. • Avoid trying to control…search rather for satisfying solutions that are mutual. • Allow yourself to be vulnerable…wearing emotional armor keeps out hurt, but also keeps out love and connection!  

Editor’s Note: Dr. Rodger Goddard is Chief Psychologist at Trinitas and Director of the hospital’s wellness program, which provides companies, agencies and schools with on-site programs to improve health and productivity. Dr. Patricia Neary-Ludmer is the Director of the Family Resource Center in Cranford, an affiliate of the Trinitas Department of Behavioral Health and Psychiatry.  

What’s Up, Doc?

News, views and insights on maintaining a healthy edge.


Don’t Walk Sign Are you a sleepwalker? If so, you’re definitely not alone. New research by the Stanford University School of Medicine found that somnambulism is far more prevalent than previous studies suggested. About 3.6 percent of American adults are prone to nocturnal wandering. That translates to 8.4 million. The same research suggests that sleepwalking is linked to anxiety and depression. A subject of humor and silliness in popular culture, this disorder can actually have serious consequences. Sleepwalkers have been known to injure themselves and others. They are also prone to psychosocial disorders. The Trinitas Sleep Disorders Center deals with sleepwalking and other problems every day. For information call 908-994-8694.

Oh, Canada The never-ending legal debate over medical marijuana acquired an intriguing new wrinkle in May after a report in the Canadian Medical Association Journal on the results of a new study on patients with Multiple Sclerosis. A group of MS sufferers with muscle spasticity (hard-to-control muscles) who had not responded well to traditional treatment showed a 30% reduction in spasticity and a 50% reduction in pain after smoking marijuana over a threeday period. The side effects were hardly a surprise. Patients showed a drop in cognitive ability and experienced some dizziness and nausea. A few reported feeling “too high.” The study only looked at short-term effects on the MS patients, but results were encouraging enough to warrant more extensive research.

New Options for Hospice Care One of the greatest concerns in hospices is preventing sudden and deep depression. Standard antidepressant medications are only marginally successful in this setting, as they take time to achieve their desired effect—and time is something hospice patients don’t have. That explains the buzz at the recent annual meeting of the American Academy of Hospice and Palliative Medicine when it was reported that methylphenidate and oral ketamine are showing considerable promise as extremely rapid-acting, safe, and cost-effective treatments. Ketamine in particular is a drug already used in hospices to deal with pain. According to Dr. Scott Irwin, director of psychiatry programs at the Institute for Palliative Medicine at San Diego Hospice, more research is needed. Clinical trials are problematic in hospices because of the high death rate, as well as informed consent issues.

Answering the Call A college student who lives in New Jersey has filed a patent for a smaller, less invasive implantable cardioverter defibrillator—the battery powered device used to prevent sudden cardiac arrests in people who suffer from arrhythmia. Benjamin Strauss, a volunteer ambulance crew chief, came up with the idea after two calls to the same patient in Bergenfield in a span of two months. A biomedical engineering major at Cooper Union in New York, Strauss delivered the student commencement address this past May. The one-inch square defibrillator, which he dubbed iRescue, was created as his senior project. “I wanted to do something that would enable me, at some point, to actually contribute to making people’s lives better,” Strauss explains. “And I didn’t find anything that made this kind of treatment less invasive.”

Another Link Between TV & Obesity From the “Wait, Didn’t We Know that Already?” department comes the news that kids who watch a lot of TV have poorer overall diets than kids whose exposure to television is limited. “The more TV you watch, the less likely you were to eat fruits and vegetables every day, and the more likely you were to eat things like candy and soda, eat at a fast-food restaurant and even skip breakfast,” says study author Leah Lipsky of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The research doesn’t prove that TV watching influences what kids eat, but strongly suggests a link between TV, snacking and a lack of exercise. Add questionable parenting to the mix and you have yet another contributing factor to America’s epidemic of childhood obesity. The average age of the children in the study was 13.


He Said: She Said

Trinitas psychologists Dr. Patricia Neary-Ludmer and Dr. Rodger Goddard get to the bottom of getting steamed.

Goddard: Anger is a serious issue. Stories of road rage, shootings, domestic violence, workplace assault and bullying fill our airwaves. Movies and television shows are populated with dangerous, angry, vengeful, criminal characters. Anger, aggression and violence are ever-present in our lives. Anger fuels violent crimes, rapes, murder and war. The model of dealing with threat that we see in the media is one of threatening back, upping the ante and retaliation. We often ascribe to the Clint Eastwood, Dirty Harry Go ahead make my day school of conflict resolution.

Neary-Ludmer: We become angry when we—or someone we care about—is threatened, or when another person has wronged us or those we care about. Anger also can be the result of frustration when our needs, desires, goals are not being met, or when we feel a lack of control.

Goddard: We may experience anger in dealing with our husbands, wives, boyfriends, girlfriends, sons, daughters, mothers, fathers and work relationships. We experience anger in our bodies, thoughts, urges, heart and soul. Anger can express itself on a continuum of intensity ranging from annoyance, tension, dislike, frustration and resentment, to fury, rage, aggression and violence. Anger makes us do and say horrible things. Anger makes the heart pound and thoughts race. Anger infiltrates our daily lives in the form of stress, frustration, dissatisfaction, anxiety, argument, discomfort, illness and relationship problems. Anger is unhealthy. It takes a toll on the quality and quantity of our lives. Living with chronic states of anger injures our immune system and contributes to heart disease, stroke, ulcer, stomach problems, headaches and countless other illnesses. We hold anger in our bodies. It leads to subtle and sometimes intense muscle tightening that we may have for days, weeks or years. Many of us have favorite body areas for holding our anger. We may constrict the muscles of our lower back, forehead, neck, jaw, face or stomach. We can begin to reverse the negative effects of anger by first learning how to tell how tense our muscles are, and secondly, by learning how to release our muscles tension.

Neary-Ludmer: One of the ideas I try to convey to the people I see with anger issues is that anger does far more damage to them than to others. I try to explain that it’s okay to forgive—it doesn’t mean you have to forget. Just breath in, breathe out, and move on. Often I will use quotes to help people understand their anger. There are three in particular that are really effective. Buddha said that holding onto anger is like “grasping a hot coal with the intent of throwing it at someone else—you are the one who gets burned.” Gandhi observed that “an eye for an eye makes the whole world go blind.” And Ralph Waldo Emerson pointed out that for every minute you remain angry, “you give up 60 seconds of peace of mind.”

Goddard: Anger and frustration often come from not being in control—not getting something we want or not getting our way with others. Regaining control in our lives is an important key to overcoming chronic anger. Many people do not understand the difference between anger and aggression. Anger is an emotion. Emotions and anger are actually good. Emotions are a sixth sense. They tell us very important things about ourselves and others— what we want and what we need. Emotions, however, can be used, experienced or expressed in positive or negative/constructive or destructive ways. Aggression, on the other hand, is a negative action that is harmful, destructive, threatening and/or violates the rights of another. Anger can give us important messages and can be positive fuel which can provide us with the motivation and energy to make needed changes.

Neary-Ludmer: There are some basic steps involved in getting anger under control. First, a person with anger problems has to admit he/she has a problem. This is a fundamental step in addressing virtually all self-destructive behavioral issues. Next, a person needs to learn relaxation techniques that target the emotional and psychological components of anger; feelings of anger protect us from other more vulnerable feelings, such as hurt, insecurity, anxiety or fear. Part of anger control also involves learning to challenge the thinking that creates hostility and inflammation. Finally, a person with anger problems must develop the positive communication skills of assertiveness and conflict resolution.

Goddard: Two skills that I give to my clients and audiences concerning anger are the MAD skill and the SURF Method of Assertion. The MAD skill involves, M for Muscles Relax, A for Ask Nicely for What I Want and D for Do Not Insult or Drop It. SURF Assertion involves S for Specifics, U for Understanding, R for Repetition and F for Firmness or Find a Compromise.

Neary-Ludmer: Knowing how to deal with someone else’s anger is also a valuable skill. Rule number one is to remember that it takes two—do not take the bait! Do not respond to anger with anger in kind, or it could set off an escalation process that could turn violent and even deadly. Adopt a non-escalation policy by being the emotionally mature person. For instance, if a driver believes you slighted him by cutting him off, taking his parking space or looking at his girlfriend, defuse the situation. Apologize even if you don’t mean it. You never know whom you may be dealing with. Be the bigger person. Show empathy for their feelings.

Goddard: If someone you know has serious difficulty with managing anger, there is no quick or easy solution. Confronting this type of person can definitely be dangerous and is often not helpful. Chronic aggression or anger indicates a serious problem and needs to be dealt with by getting professional help.

Neary-Ludmer: Something that has definitely hit the Anger Management radar in recent years is the role technology plays. Rage-induced emails, texts and tweets require the mere tap of a Send button and they are on their way. Many a job, marriage and friendship have been lost over impulsiveness with this type of technology—not to mention the legal problems this communication can cause. If you are angry, don’t hit Send. Reread, rethink, reconsider, sleep on it. Chances are you won’t send it.

Goddard: The point is not to eliminate anger, but to understand and manage it. Anger is an important part of life. Anger is fuel, energy and power. Like any hot and powerful energy we need to learn how to handle and channel it. We can get a message from our anger, control it, embrace it and use it in positive ways. Or, we can let it control us, take us over and allow it to injure our health and relationships. Dealing productively with anger necessitates building self-calming, assertion and anger management skills. The next time you get angry try identifying exactly what you want and use the MAD skill or SURF Method of Assertion to calm down, relax your body tension and get what you need from yourself or others.

Neary-Ludmer: To deal successfully with anger, it’s also helpful to recognize a few of the myths about it. Anger isn’t inherited. The expression of anger is learned. That’s good news, because it means that appropriate ways of communication can be learned, too. Intense anger does not automatically trigger aggressive behaviors. One can develop skills to challenge hostile, negative or irrational feelings and beliefs. And contrary to earlier beliefs, “venting” anger in aggressive ways—such as screaming or punching a pillow—is not a good idea. It merely reinforces aggressive behavior.  

Editor’s Note: Dr. Rodger Goddard is Chief Psychologist at Trinitas and Director of the hospital’s wellness program which provides companies, agencies and schools with on-site programs to improve health and productivity. Dr. Patricia Neary-Ludmer manages the Family Resource Center in Cranford, an affiliate of the Trinitas Department of Behavioral Health and Psychiatry.

What’s Up, Doc?

What’s Up, Doc?

News, views and insights on maintaining a healthy edge. 

Smoking While Pregnant: Are Friends Actually Foes? Most people are aware that smoking and pregnancy don’t mix. Yet expectant mothers continue to puff away, or live in smoking environments. A recent study published in the journal Addictive Behaviors looked at some of the reasons this situation persists. It was no shock to find that nearly half of pregnant women who smoke had a partner who also smoked. It was a surprise, however, to find that women who had close friends that smoke were far more likely to smoke themselves. In fact, the influence of friends was actually higher than the influence of family members. The study, conducted by researchers at SUNY Buffalo from 2006 to 2011, will continue, and focus on generating data on the children of pregnant smokers.


 Cold or Allergies? One of the toughest calls for a parent to make is whether their runny-nosed child is fighting a spring cold or suffering from spring allergies. Both can involve sneezing and congestion, making that call even trickier. Knowing some basic differences can help parents decide how to proceed. For example, the severe part of a cold only lasts a few days; allergic symptoms tend to persist. Allergies are often accompanied by itchy eyes, while colds are not. According to the Children’s Hospital in Boston, if you suspect your child is suffering from a seasonal allergy, close the windows, turn on the AC, vacuum your rugs and carpets, and consider running a humidifier or non-ionic air purifier. Kids with bad allergies should also shower after playing outside, so as not to transfer pollen to pillows, where it will irritate them all night long.


Good News on Concussions If you happen to be a hockey fan, you know that NHL superstar Sidney Crosby nearly lost his entire season to a concussion. What finally helped him get back on the ice was the diagnosis and treatment of a soft-tissue neck injury that accompanied the concussion. This was no surprise to the doctors at the MMTR Health Clinic in Guelph, Ontario, which has been treating hockey concussions for years. They have found that many symptoms attributed to the lingering effects of a concussion actually correspond to specific neck muscles damaged at the time of the original injury. Once treatment is individualized and the muscles repaired, patients experience speedy postconcussive recoveries.


 The Skinny on Modeling Role models play a key part in the world of eating disorders, with skinny fashion icons ranking among the major culprits. In Israel, a law passed recently dictates that models appearing in advertising must have a Body Mass Index (BMI) of 18.5 or more. A media storm ensued, with critics of the law saying the government should aim its efforts on health as opposed to weight. Indeed, some models now disqualified are naturally skinny and completely healthy. Should they be prevented from earning a living without knowing whether they are actually unhealthy in some way? The Israeli government points to statistics that show 1 in 50 teenage girls suffers from an eating disorder, and stands by its position.


Is There an Autism Epidemic? A March study released by the Centers for Disease Control and Prevention estimates that 1 in 88 children born in the U.S. suffers from a disorder on the autism spectrum. The last study estimated the ratio to be 1 in 110 and one done in 2002 suggests that the number of autistic children has doubled since then to around one million. Does this mean there is an “epidemic” of autism? Most doctors and researchers believe this is not the case. Instead, the numbers reflect better diagnostic screening tools and earlier detection. There is no “test” for autism, such as a blood test; it is detected through observing behavior of children typically around the age of eight. “One thing the data tells us with certainty,” says CDC Director Dr. Thomas Frieden, “is there are many children and families who need help.”