John T. Gribbin, MBA, FACHE ... specific programs that address risk factors, we can help ... Our programs address specif
SUMMER 2017
Back on Her Feet after Spine Surgery page 13
Also in this issue:
When a Physician Needs Knee Surgery page 5
Robotic Surgery Provides New Options for Cancer Treatment page 9
Regaining Balance with Specialized Treatment page 10
A New Treatment for Advanced Reflux Disease page 11
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PRESIDENT’S MESSAGE John T. Gribbin, MBA, FACHE President and CEO The health care landscape is continually changing and evolving. In recent years, the abundance of health information online and the use of social media have made patients increasingly sophisticated consumers of health care. Health care providers are managing diseases more effectively with advanced technology and treatments. Concurrently, patients and providers are more focused on quality, convenience, cost, and efficiency than ever before. This evolution is leading to a new way of looking at the role of a hospital. At CentraState, we feel that our responsibility goes far beyond treating injuries and illnesses. We are at the forefront of efforts to prevent disease with the same passion we have for treating acute and chronic health conditions. In fact, we are working toward keeping people out of the hospital altogether by helping them lead healthier lives.
As part of our LIVE LIFE WELL initiative, we engage physicians and facilitate direct links to the tools that help patients prevent chronic diseases—in essence, we help create an overall “wellness script” for patients. Our programs address specific health goals and coach patients through the process, while providing feedback to physicians to promote progress in each patient’s health management plan. SM
These ideals are exemplified by our LIVE LIFE WELL SM initiative, which focuses on strategies that foster health and wellness across the population, particularly among those at risk for certain diseases. By working with physicians to coordinate care and directing people to health coaches and specific programs that address risk factors, we can help prevent or delay the onset of a chronic disease. The LIVE LIFE WELL SM initiative also gives patients with existing conditions— from numerous cancers to multiple sclerosis and Parkinson’s disease—the tools to live their lives to the fullest.
In addition to various health screenings, LIVE LIFE WELL SM components include:
As we advance this type of care coordination that is so integral to the future of health care, we are pairing this approach with an intense focus on quality and the pioneering treatments and technologies that improve care delivery and patient outcomes. As you’ll see throughout these pages, these efforts are making a vital difference to many people throughout our region.
Eat Well
Programs on healthier eating, from “Plant-Powered Nutrition” and “The Mediterranean Diet” to nutritionist consultations, cooking workshops, and virtual grocery shopping trips
MOVE Well
Tai chi, yoga, balance, and fitness classes, and wellness retreats
RELAX Well
Meditation and stress relief programs, with topics ranging from music-based healing to aromatherapy
MANAGE WELL
Hypertension, prediabetes, diabetes, and brain health programs, along with a smoking cessation program and presurgery bariatric education
For more information about these programs, visit www.livelifewellnj.com or call 866-CENTRA7 (866-236-8727). Healthy Directions is produced by CentraState Healthcare System, Freehold, New Jersey. EDITORIAL ADVISORS
Editor
Stephen G. Perrella, Esq. Chair, Board of Trustees
Thomas W. Scott, MHA, FACHE, FABC Senior Vice President and Chief Operating Officer
Jack H. Dworkin, MD, MBA, FACC Vice President and Chief Medical Officer
Kim A. Kelly, RN, MS, NEA-BC, FACHE Vice President, Clinical Services
John T. Gribbin, MBA, FACHE President and CEO
Vincent L. D’Elia, MA, MPS Vice President, Marketing & Public/Government Relations
Linda W. Geisler, DBA, RN, MNEd, NEA-BC, FACHE Vice President, Patient Services
Abbey M. Luterick Director, Public Relations and Communications
Please note that physicians on staff are private practitioners and not employed by CentraState. We hope you enjoy this issue of Healthy Directions. Comments about the publication can be directed to the Public Relations and Marketing Department, CentraState Healthcare System, 901 West Main Street, Freehold, NJ, 07728. (732) 294-7080. Healthy Directions is published by CentraState Healthcare System to provide general health information. It is not intended to provide personal medical advice, which should be obtained directly from a health care provider. CentraState Healthcare System complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. CentraState Healthcare System does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. For more information, please visit our website at www.centrastate.com/non-discrimination.
SUMMER 2017
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Brian Johnson
Read Healthy Directions online at www.centrastate.com/publications. Subscribe to our free health e-newsletter at www.centrastate.com/enews.
Gaining Control with Wellness Strategies Alex Kushnir significantly lowered his blood pressure thanks to CentraState’s Managing Hypertension program.
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hen Alex Kushnir of Manalapan was diagnosed with high blood pressure at age 44, he had never been on medication in his life—and he didn’t want to start. His board-certified family medicine physician, Marc Feingold, MD, connected him to the hypertension services at CentraState. With the help of Elaine Dymyd, RN, BSN, health coach and community outreach program coordinator at CentraState’s Star and Barry Tobias Health Awareness Center, Alex completed a six-week Managing Hypertension program as part of the LIVE LIFE WELL SM initiative. Dymyd and registered dietitian Caryn Alter, MS, RD, helped Alex set goals and supported him along the way, providing personalized advice to help him take a more active role in his health. By taking steps like reducing sodium in his diet and incorporating regular exercise, his blood pressure went down significantly within a few months.
“The results were amazing... I put in the work, but I had great guides to lead the way.”
“The results were amazing, thanks to the collaboration of Dr. Feingold, the CentraState team, and my own efforts,” Alex says. “I put in the work, but I had great guides to lead the way.” Based on his measurable blood pressure reduction and a noticeable difference in the way he feels, Alex has been inspired to continue his progress by following the recommendations he learned in the program and seeing Dr. Feingold for regular checkups.
— Alex Kushnir
“Because patients are typically in a physician office for only a short amount of time, I rely on CentraState as a key extension of my health care team,” Dr. Feingold explains. “Education and prevention strategies for conditions like heart disease and diabetes are just as important as the medicine I prescribe. I can even link patients to these CentraState services with the simple click of a smartphone app. It’s all about helping patients prevent disease before we have to treat it.”
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Managing Hypertension is a free, six-week program in which health coaches work with patients to help them manage their high blood pressure. During the first session, patients meet with a registered nurse health coach to discuss their health history and medications. Together, they identify individual strategies and goals, with motivation and assistance provided from the health coach throughout the course of the program. To learn more, visit www.livelifewellnj.com/hypertension-program, or call 732-308-0570.
3 SUMMER 2017
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Double Knee Replacement is Cause for Celebration A few weeks after undergoing double knee replacement surgery, Michael Connolly was dancing an Irish jig in his orthopedic surgeon’s office to demonstrate his progress—and to celebrate finally being pain free.
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or nearly 40 years, the 61-year-old Old Bridge resident had suffered from knee pain that first began after a lacrosse injury in college. His career didn’t help matters; he worked for 36 years as a motion picture, theatrical, and television teamster, driving a truck to move stage sets and jumping into and out of the back while carrying heavy equipment. In recent years, Michael’s knee pain progressively worsened. Not only did he have to sit at the bottom of the mountain while his wife hiked the Adirondack trails they used to enjoy together, but walking and even rolling over in bed had become unbearable.
Ready for Surgery “After having several surgical procedures in the past few years that helped my knee pain temporarily, I finally said enough was enough,” Michael explains. “I was ready for knee replacement surgery, and I wanted to have them both done at once.” He consulted Michael J. Greller, MD, a board-certified and fellowship-trained orthopedic surgeon on staff at CentraState, who determined that Michael had arthritis in both knees and boneon-bone erosion. When Dr. Greller confirmed that he was a candidate for bilateral surgery, Michael began preparing. He researched the procedure online, lost 27 pounds, took a joint replacement patient education class at CentraState, and prepared an extra bedroom at home to accommodate space for physical therapy exercises. Michael underwent the procedure in late February, and he was up and walking the same day with the help of his care team, including CentraState physical therapists. That same week, he was back at home.
“At the three-week mark, Michael’s progress was like that of most patients at 12 weeks,” Dr. Greller says. “Not everyone is a candidate to have both knees replaced at once, but Michael worked hard and came in physically and mentally ready. That type of motivation—along with a team approach to recovery—makes a difference in healing.” Within three months, Michael and his wife were back to enjoying some of the smaller hiking trails in the Adirondacks together. “I’ve already told about 15 or 20 friends with achy knees about CentraState and Dr. Greller,” Michael says. “There’s no need to travel anywhere else. Both the team and the hospital environment were fantastic.” Dr. Greller adds, “In addition to a great outcome, Michael’s whole outlook changed after the surgery. He’s no longer worried about the pain that came with simple tasks like walking. Even better, he is now able to enjoy his retirement and his life again.”
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For more information about CentraState’s orthopedic surgical services:
4 SUMMER 2017
Preparation Pays Off
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When the Doctor Becomes the Patient On any given day, you might find William Kohlberg, MD, a board-certified urologist on staff at CentraState, in the operating room (OR) at the hospital. However, last September there was one distinct break in OR routine: Dr. Kohlberg was undergoing surgery rather than performing it.
A Solution for Worsening Knee Pain For decades, Dr. Kohlberg had exercised regularly on a treadmill so he could stay fit for weekly tennis matches and annual ski trips with fellow CentraState physicians. But over the past year, worsening pain in his right knee prevented him from enjoying the sports he loved. Eventually, the pain became severe enough to wake him up at night. As a physician, Dr. Kohlberg diligently researched his options and first pursued conservative approaches like weight loss, steroid injections, and a knee brace. He soon knew, however, that the next step was surgery—and that the right place was CentraState. “I trained in New York City and could have gone anywhere, but I know CentraState and I know the OR,” Dr. Kohlberg says. “I wasn’t going to get better care anywhere else.”
Partial Knee Replacement Surgery In September, Dr. Kohlberg underwent a right unicompartmental knee surgery, or “uni,” with Alan Nasar, MD, and Gregg Berkowitz, MD, both board-certified and fellowship-trained orthopedic surgeons on staff at CentraState. In accord with his passion for learning, Dr. Kohlberg requested local anesthesia so he could watch the entire procedure on a monitor. “About one in five patients needing knee surgery is a candidate for a unicompartmental procedure, which is a partial knee replacement most suitable for active patients who do not have arthritis throughout the knee,” Dr. Berkowitz explains. “It’s less invasive than a total knee replacement, and sizing, alignment, and precision are critical for success.”
Dr. Nasar adds, “We’ve been performing unicompartmental procedures for more than a decade, yet we still bring improvements to our practice every day. We accomplish this by examining outcomes, staying current on the latest research findings, and making improvements in areas ranging from surgical nuances to medication management. For me, it’s part of what makes surgery so interesting and gratifying—and it’s also reflected in patient results.” Dr. Kohlberg returned home the same day as his surgery and began physical therapy. In about three weeks, he was back at work, and also building strength and range of motion with the aid of team members at CentraState’s OceanFirst Rehabilitation Center. “It’s been smooth sailing, and my tennis game is improving,” adds Dr. Kohlberg, who joined fellow physicians on the annual ski trip to Colorado in January and even navigated the more challenging slopes. “I couldn’t ask for a better outcome or a better team.”
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866-CENTRA7 (866-236-8727) www.centrastate.com/orthopedics
5 SUMMER 2017
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Renewed Hope for Heart Disease and Cholesterol Disorders By Spencer Kroll, MD, PhD, FNLA
H
eart disease remains the No. 1 cause of death in the United States—and one of the most important risk factors for developing coronary heart disease is an elevated level of “bad” cholesterol. The large number of patients who have both cholesterol and blood sugar problems necessitates testing and treatment that address the connection between these issues when it comes to heart disease. As a result, more sufficient measures are being introduced.
Carbs—An Overlooked Contributor For patients with cholesterol problems, it’s not so much their fat intake that matters— it’s the fat consumed in combination with carbohydrates. An increased LDL level, which is linked in part to saturated fat intake, is only one type of cholesterol problem. Eating sugar and other carbohydrates also raises triglycerides, lowers HDL, and has negative effects on LDL molecules. The overconsumption of carbohydrates, and the insulin resistance that results from this, is the direct cause of LDL particle problems.
A New Family of Medications
Advanced Lipid Profiles First, there’s a growing recognition that the basic lipid profile performed when assessing cholesterol doesn’t tell a complete enough story to best predict impending heart disease. Standard cholesterol measurement reveals your total cholesterol level broken down by LDL (bad cholesterol), HDL (good cholesterol), and triglycerides. For every one percent increase in LDL, there’s a one percent increase in the likelihood of developing heart disease over a 10-year course. For every one percent decrease in HDL, there’s a two percent increase in your chances of developing heart disease over the same time span. While we do need to measure LDL levels, we also need to take a more precise approach and assess LDL particles—a different measure than blood LDL levels. LDL particles carry varying amounts of cholesterol. From the more accurate breakdown of LDL and HDL into concentrations and particles, we can now better predict outcomes and treat heart disease with more defined medications and approaches.
For the past 25 years, statins have been viewed as the best available drugs for reducing cholesterol, but there is a limitation to how much statins can lower your heart disease risk. In addition, statins can cause such side effects as muscle aches, liver problems, and some reports of cognitive troubles. Fortunately, we now have a new class of drugs that interferes with the processing of cholesterol. They work by blocking a protein that breaks down LDL receptors that pull cholesterol out of the bloodstream. These new medications seem to be more effective than statins for LDL reduction, and are effective in improving heart health when added to statin therapy.
Not a One-Size-Fits-All Approach Since cholesterol problems are a modifiable risk factor for heart disease, many people tend to believe in a one-size-fitsall approach—thinking that a low-fat diet and a statin will fix everything. I work with people on an individual basis to help them lower cholesterol based upon their unique lifestyles and personal health care needs. Each patient’s blood work, medical history, age, and overall health determine the best treatment for lowering cardiovascular disease risk.
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Dr. Spencer Kroll is a board-certified and fellowship-trained physician specializing in internal medicine. He is also a board-certified lipidologist and a fellow of the National Lipid Association. For more information, call 866-CENTRA7 (866-236-8727) or visit Dr. Kroll’s Physician Finder page at www.centrastate.com/SpencerKroll.
6 SUMMER 2017
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Robotic Fibroid Surgery Can Restore Quality of Life
M
elissa Vella says her symptoms caused by uterine fibroids became so bad last fall that she constantly felt as if she were several months pregnant.
“I was always tired, I had to urinate frequently, and even my abdomen was sticking out like I was pregnant,” says Melissa, a 46-year-old mother of three from Jackson. “I was extremely uncomfortable most of the time, and it was impacting my daily life.” After consulting with Steven Goldstein, MD, a board-certified OB/GYN on staff at CentraState Medical Center, Melissa decided to put an end to her recurrent, fibroid-related symptoms by undergoing a minimally invasive procedure: robotic hysterectomy with the da Vinci® Surgical System.
A Common Problem Roughly half of women develop fibroids—noncancerous tumors within the wall of the uterus— at some point in their lives, according to the National Institutes of Health. Most, however, never experience any symptoms and treatment is only necessary to relieve symptoms such as pelvic pressure, pain, and heavy menstrual bleeding. Melissa’s fibroids were detected more than a decade ago and caused periodic symptoms. Dr. Goldstein monitored her condition over the years until fibroids had caused her uterus to grow uncomfortably large—more than a pound in weight and about the size of a small melon. For women like Melissa who no longer want to have children, removal of the uterus is the definitive treatment for fibroids. Robotic hysterectomy takes advantage of tiny instruments and a 3D high-definition vision system to allow the uterus to be removed through small incisions, which is a much less invasive approach than traditional surgery. “Because of the size of her uterus, and her history of cesarean section deliveries, this would have been a challenging procedure to perform with traditional minimally invasive techniques,” Dr. Goldstein says. “The robotic platform was really valuable here; otherwise, she might have needed a surgery with a large incision and a longer recovery.”
I feel amazing, and I’m very happy that I had the surgery. To have the peace of mind of not worrying when and where these symptoms would pop up—I feel like I made the decision for all the right reasons.” — Melissa Vella
A Speedy Recovery Melissa went home the morning after her January 2017 procedure and required little pain medication. Within a month, she was back to all normal activities, including light exercise. She says surgery was a difficult choice, but she felt comforted by Dr. Goldstein and the robotic surgical approach, which left her with only minimal scarring.
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For more information about CentraState’s gynecological surgical services, www.centrastate.com/robotic-fibroid-surgery. visit
To find a CentraState OB/GYN, call 866-CENTRA7 (866-236-8727).
7 SUMMER 2017
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Gina Barnett overcame chronic pelvic floor pain thanks to the customized treatment of the Pelvic Floor Program at CentraState’s OceanFirst Rehabilitation Center.
Freedom
to Live
CentraState’s Pelvic Floor Program offers relief from chronic pain.
O
ne year ago, Gina Barnett was living in extreme pain. Her pelvic area felt so heavy that she could barely walk, forcing the 52-year-old Freehold resident to give up exercise, singing, and just about every other activity she loved.
“I was constantly uncomfortable,” says Gina, describing unbearable pressure and pain that extended from her pelvis all the way down her legs, along with mild incontinence and other disabling symptoms. “I didn’t want to socialize or even leave the house.” Gina sought help from many specialists, including her urologist, who found no signs of disease or infection. While tests revealed that nothing was wrong, Gina’s body told her otherwise. Those instincts prompted a referral to the Pelvic Floor Program at CentraState’s OceanFirst Rehabilitation Center, where she finally found the answers—and relief—that changed her life. Much to her surprise, Gina was diagnosed with pelvic floor dysfunction, which occurs when the pelvic muscles, ligaments, and connective tissue don’t work properly. Pelvic floor disorders affect one in five Americans. “The pelvic floor is a muscle group that stretches from the pubic bone to the tail bone, acting as a sling or hammock to hold up the pelvic organs,” explains Molly O’Brien, PT, DPT, CLT, one of CentraState’s three physical therapists who specialize in pelvic floor dysfunction. “You need to work those muscles just like any others. If they become weak, the pelvic organs drop and cause incontinence; if they get too tight, they cause pain.” Gina’s pelvic floor was so taut that the muscles were spasming, causing severe, radiating pain that was exacerbated by stress. Dr. O’Brien planned Gina’s pelvic floor therapy to include stretching and strengthening exercises, deep breathing, relaxation techniques, and yoga. Her symptoms improved within a few sessions, and she is currently pain free.
CentraState’s Pelvic Floor Program The Pelvic Floor Program at CentraState’s OceanFirst Rehabilitation Center employs specially trained therapists who evaluate and treat pelvic floor disorders with gentle interventions, which typically improve symptoms after a few short visits. This approach may include: • Pelvic floor exercises to strengthen pelvic muscles and improve control • Biofeedback/surface EMG to help you know that you’re contracting the right muscles • Real-time ultrasound that allows you to view the actual muscles while they are contracting • Education on lifestyle changes that decrease bladder irritability • Maintaining a bladder diary to aid in retraining • Relaxation and breathing techniques
Gina now looks forward to resuming her love of singing, and in sharing her story, she hopes to raise awareness about pelvic floor dysfunction so others don’t suffer in silence. “I’m so grateful to Molly and her team for helping me understand my symptoms and live without pain,” Gina says. “Listen to your body, and don’t be afraid to get help. To live your life with the ability to walk out the door and be who you are—it’s an amazing thing.”
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For more information about the Pelvic Floor Program, call 866-CENTRA7 (866-236-8727) www.centrastate.com/pelvic-floor-rehab. or visit
8 SUMMER 2017
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Robotic Surgery Provides New Options for Cancer Treatment After working for 47 years as a lineman with a power company, Gary Balon is enjoying retirement this summer by working part time as a golf course ranger and spending time with his family, including two grandchildren.
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Robotic surgery is the greatest thing. I had never heard about it until I talked to Dr. Rizkala. Now, I would recommend it to anyone.”— Gary Balon (right),
If you saw him on the course, it would be hard to tell that less than a year ago, he was facing the health challenge of his lifetime—a diagnosis of kidney cancer that required a complex, robot-assisted surgery at CentraState Medical Center.
pictured with Dr. Rizkala (left).
“It came as a total surprise because there is no history of cancer in my family,” says Gary, a 65-year-old South Amboy resident. “I was depressed, but I wanted to do everything I could to fight it.” Gary’s kidney cancer was diagnosed after blood in his urine and pain and swelling in his ankles sent him to the hospital last July. He was referred to Emad Rizkala, MD, a board-certified and fellowship-trained urologist who is part of CentraState’s team of surgeons performing robotic procedures with the da Vinci® Surgical System.
Surgical Precision To treat his cancer, Dr. Rizkala removed Gary’s left kidney and ureter, the narrow tube that connects the kidney to the bladder. Traditionally, they had to be removed in two steps, with separate incisions that often included a large incision in the abdomen. With robotic surgery, the surgeon has exceptional control, range of motion, and visibility, allowing the procedure to be done in a single step with fewer, smaller incisions. “Performing this procedure robotically reduces the risk of bleeding and other complications, and can shorten a patient’s hospital stay and overall recovery time,” Dr. Rizkala says. “CentraState was one of the first hospitals in the region to offer this single-step procedure for kidney cancer, and Gary’s surgery went very smoothly.” Gary had his procedure on a Thursday and was home by Saturday night with, as he says, “just four little cuts” where the surgery was performed. Because the cancer had moved from the lining into the body of his kidney, he also had to undergo a round of chemotherapy during the winter to protect against the possibility that microscopic cancer cells had spread. Follow-up tests have not shown any cancer recurrence and his remaining kidney is healthy, Dr. Rizkala says. “I feel good,” Gary says. “I talked to someone who had a kidney removed with a large incision, and the recovery was much longer. Robotic surgery is the greatest thing. I had never heard about it until I talked to Dr. Rizkala. Now, I would recommend it to anyone.”
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For more information about CentraState’s robotic kidney surgical services, visit www.centrastate.com/robotic-kidney-surgery. To learn more about the cancer services provided at CentraState, call www.centrastatecancercenter.com. (855-411-2262) or visit
855-411-CANCER
9 SUMMER 2017
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A Matter of
Balance
CentraState’s Balance and Dizziness Program restores stability and independence.
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ife has been compared to a carousel—sometimes up, sometimes down, and sometimes round and round. No one understands that better than Mary Jean Sehnal, who suffered from vertigo (the sensation of spinning), weakness, and other problems that impaired her balance for the past 10 years. “I woke up dizzy every morning, like I was on a merry-go-round,” says the 78-year-old Monroe resident. “Two separate bouts of vertigo were so bad that they left me incapacitated for more than a week.” Mary Jean was also wobbly on her feet, often swaying to the left side. She found it hard to look both ways before crossing the street, and she was afraid to drive. But the real wake-up call came last summer, when Mary Jean fell twice over the course of two weeks. On one occasion, she found herself sprawled across a busy parking lot. Shortly after the incident, Mary Jean’s primary care physician, Christopher Wong, MD, referred her to the Balance and Dizziness Program at CentraState’s Health Pavilion at East Windsor. A satellite location for the hospital’s OceanFirst Rehabilitation Center, the facility offers balance testing and training, among other services, to individuals with balance disorders.
Determining the Cause of a Balance Problem According to physical therapist Patricia Guttormsen, DPT, OCS, FAAOMPT, balance problems can strike anyone, although they’re especially common among the elderly. In most cases, they are related to inner ear issues, head injuries, infections, muscle or joint weakness, certain medications, or simply the process of aging. After a thorough assessment, Dr. Guttormsen determined that Mary Jean’s balance was compromised by muscle weakness and inner ear problems. She partnered with Heather Murray-Miller, PT, DPT, a CentraState physical therapist specializing in vertigo, to develop a comprehensive treatment plan that combined musclestrengthening physical therapy in the East Windsor facility with a few sessions of vestibular rehabilitation (exercises and movement techniques to treat vertigo) at CentraState. Two months later, Mary Jean was back on solid ground, no longer experiencing vertigo, dizziness, or falls. “I’m walking with confidence,” Mary Jean says. “I feel better than I have in years!”
“Balance, and ultimately movement, can be affected by many body systems, including the muscular, skeletal, visual, and central nervous systems. Physical therapists figure out which systems are contributing to the impairments, and then resolve symptoms through customized exercises and other therapies.” — Patricia Guttormsen, DPT, OCS, FAAOMPT Pictured above: Mary Jean Sehnal (left) has regained control of her balance thanks to the efforts of Dr. Patricia Guttormsen (right) and the physical therapy team at CentraState’s OceanFirst Rehabilitation Center.
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For more information about CentraState’s Balance and Dizziness Program, or to schedule a complimentary www.centrastate.com/balance-and-dizziness balance screening at one of our rehabilitation centers, visit 866-CENTRA7 (866-236-8727). or call
10 SUMMER 2017
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A New Treatment for Advanced Reflux Disease By Amy Tilara, MD
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any of us experience occasional heartburn related to eating a particularly heavy or spicy meal. Yet for an estimated 20 percent of Americans, heartburn happens multiple times a week due to gastroesophageal reflux disease (GERD). GERD occurs when the muscle that serves as a valve between the esophagus and stomach doesn’t work correctly and acid flows back up into the esophagus. While GERD is often uncomfortable, it can also be dangerous. Long-term exposure to stomach acid can cause a change in the lining of the esophagus called Barrett’s esophagus. Normal esophageal cells change into tissue that’s similar to the tissue lining the intestinal tract.
Talk to a doctor about screening for GERD and Barrett’s esophagus if you regularly experience any of these symptoms:
• A burning sensation in the chest or throat, sometimes with a sour taste in your mouth
• Trouble swallowing or a chronic sore throat
In some people, Barrett’s can trigger a precancerous condition in esophageal tissue called dysplasia. Dysplasia puts you at high risk for developing esophageal cancer, the fastestgrowing cancer in the United States based on the number of new cases.
• A feeling of a lump in
Preventing Esophageal Cancer
• Dry cough
To help prevent esophageal cancer in Barrett’s patients, CentraState recently began offering an advanced, nonsurgical procedure called Barrx™ radiofrequency ablation. Barrx uses heat energy to destroy (ablate) diseased Barrett’s tissue in the lining of the esophagus. The treatment has been shown to be more than 90 percent effective in removing precancerous tissue. Barrx is an outpatient procedure done under sedation. A thin, flexible tube called an endoscope is inserted into the esophagus, allowing the physician to view and measure the abnormal tissue. The Barrx ablation device is then inserted to precisely deliver heat energy to only the diseased tissue. The tissue is destroyed and healthy tissue eventually grows back as it heals.
your throat
See a doctor immediately if you experience “red flag” symptoms such as blood in your vomit or stool or severe chest pain.
The procedure takes about 20 minutes, and patients go home the same day and return to most normal activities within 24 hours. Barrx is repeated every three months until the lining of the esophagus returns to normal. Most patients require three or four treatments. Additional follow-up endoscopies monitor whether any Barrett’s tissue has returned.
Are You at Risk for Barrett’s? Not everyone with GERD has symptoms. For certain patients, including those with a family history of esophageal cancer, an endoscopy to screen for Barrett’s esophagus may be recommended, whether or not you have GERD symptoms. The average age of diagnosis for Barrett's esophagus is 50, and it is more commonly seen in Caucasian men. If you are concerned about GERD or Barrett’s esophagus, your doctor can help you decide whether screening is appropriate.
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Dr. Amy Tilara is a board-certified and fellowship-trained gastroenterologist at Advanced Gastroenterology Associates. For more information, call 866-CENTRA7 (866-236-8727) or visit Dr. Tilara’s Physician Finder www.centrastate.com/AmyTilara. page at
11 SUMMER 2017
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CentraState
News CEO Cancer Gold Standard Reaccreditation CentraState Medical Center has once again received CEO Cancer Gold Standard™ reaccreditation by the CEO Roundtable on Cancer, a nonprofit organization of cancer-fighting CEOs in collaboration with the National Cancer Institute, many of its designated cancer centers, and leading health nonprofit organizations and professionals. CentraState was recognized for its extraordinary commitment to the health and well-being of its employees and their families.
New Vice President of Quality and Patient Safety CentraState is pleased to announce that Karen Freeman, MSA, has been appointed vice president of quality and patient safety. Karen has 25 years of senior-level leadership experience in both community and academic medical centers in areas of quality, performance improvement, risk management, regulatory affairs, accreditation, medical staff credentialing, and operational leadership for various clinical and ancillary departments.
Dr. Jack Dworkin Testifies on Angioplasty Bill Jack Dworkin, MD, MBA, FACC, board-certified cardiologist and vice president of medical affairs and chief medical officer at CentraState, recently gave testimony to the New Jersey Senate Health Committee on the critical need for angioplasty to treat cardiac patients. New Jersey is one of only a handful of states that require a certificate of need for emergent and elective angioplasty, which can hinder proper cardiac treatment. Dr. Dworkin urged the committee to make safe elective and primary angioplasty available to any hospital in New Jersey that can demonstrate the ability to offer a high-quality program for the provision of such services.
Heart failure patients now have one more way to connect with a health care expert: the Nurse Advice Line. An initiative of CentraState’s progressive care unit, this dedicated telephone line enables heart failure patients to call in with questions about their medications, diet, exercise, or any other nonemergent issues. Managed by cardiac coordinator Kelly Collazo, RN, this free service is available Monday through Friday, from 8 a.m. to 4 p.m. Any heart failure patient can call the Nurse Advice Line; however, nurses can best answer questions from CentraState patients based on medical records access. Questions that require physician input are referred to the patient’s primary care physician. Call 732-294-2675 with your nonemergent heart failure questions.
CentraState Wins Three Aster Awards
STAFF NEWS
CentraState Healthcare System’s marketing department was recently honored with three Aster Awards, recognizing excellence in health care marketing and advertising. The Aster Awards, one of the largest national competitions of its kind, received nearly 3,000 entries in 2017 from across the United States as well as several foreign countries. All entries were reviewed by a panel of industry experts and scored on multiple criteria, including creativity, layout and design, functionality, message effectiveness, production quality, and overall appeal.
CentraState’s entries competed against similar-sized organizations in their specific groups and categories. Awards were issued for entries that received top marks from judges, placing them in the top 16 percent of the nation for advertising excellence. CentraState’s projects that earned an Aster Award included: • Fall Baby Fair Direct Mail Piece—Gold Award • Three “Health” Foods E-newsletter—Bronze Award • Live Life WellSM Winter 2017 Newsletter—Bronze Award
Read Healthy Directions online at www.centrastate.com/publications. Subscribe to our free health e-newsletter at www.centrastate.com/enews.
12 SUMMER 2017
New Nurse Advice Line
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“I’m Back to Doing Everything I Want to Do” Spine surgery helps student resume her studies, and her life.
L
ast summer, Lindsay Peters was preparing to enter the final year of her doctorate of physical therapy program at Stony Brook University when she was stricken with severe back pain.
The pain was in the same area where she had surgery for a herniated disc in early 2015, but it was much worse—radiating down her right leg and causing numbness in her toes. It became so bad that she had difficulty walking and even needed to lie down during her classes. “I had friends from my physical therapy classes try everything we had learned, but the pain kept getting worse,” says Lindsay, a 26-year-old Point Pleasant resident. “It was clear at that point I would need surgery again.”
A Minimally Invasive Approach A herniated or “slipped” disc occurs when one of the soft discs that allows the spine to bend and twist bulges out between two vertebrae and presses on nerves. They are generally caused by wear and tear over time, and Lindsay believes her condition was the result of training to run road races.
Looking to the Future
Surgery is necessary when relief is not found with more conservative treatments, such as pain medication, steroid injections, and physical therapy. At CentraState Medical Center, spine surgeons are now offering disc procedures using state-of-the-art, minimally invasive endoscopic techniques.
Following the October 2016 procedure, Lindsay had immediate relief from the pain of her injured disc. She went home the next day, and she was back in class in less than two weeks. By early spring, she was looking forward to graduation.
In Lindsay’s case, the injured disc was removed and replaced with a plastic spacer, and the two adjacent vertebrae were fused together with screws—all through a few small incisions. The procedure limits injury to back muscles and creates much less scar tissue, greatly reducing recovery time, says Grigory Goldberg, MD, the board-certified and fellowship-trained spine surgeon who performed Lindsay’s procedure.
“My recovery has been excellent,” she says. “I’m still young and it was important to me to have no limitations at work and in my daily life. I’m back to doing everything I want to do.”
“Minimally invasive spine surgery allows patients to get back to their normal lives much faster,” Dr. Goldberg says. “Whether someone is young like Lindsay or older, they want to get back on their feet after surgery as soon as possible.”
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For more information about CentraState’s orthopedic services, visit www.centrastate.com/spine 866-CENTRA7 (866-236-8727). or call
With her medical training, Lindsay was not only impressed by the surgery itself, but also with the personal care she received, including Dr. Goldberg’s efforts to speak with her nervous parents during the five-hour procedure.
13 SUMMER 2017
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A Nonsurgical Option for Skin Cancer Treatment By Edward Soffen, MD, FACP
F
irst introduced at CentraState Medical Center last fall, skin brachytherapy is proving to be a highly effective option for patients who don’t want to undergo surgery or are concerned about permanent scarring.
Are You a Candidate?
How Brachytherapy Works During skin brachytherapy, a specially designed circular applicator is placed over the area being treated. The applicator is connected via a tube to a machine that precisely delivers a tailored radiation dose directly to the tumor.
Skin cancer is, by far, the most common type of cancer. According to the American Academy of Dermatology, nearly 9,500 people in the United States are diagnosed with skin cancer every day.
State-of-the-art imaging and computer-based planning are used to help ensure that radiation destroys cancer cells while minimizing exposure and potential damage to surrounding, healthy tissues. The procedure should cause no pain.
The good news is the two most common types of skin cancer— basal cell carcinoma and squamous cell carcinoma—are generally localized and highly treatable. However, they frequently occur on areas of the body that get a lot of sun exposure, including the face, nose, and lips.
Each treatment lasts about five to 10 minutes, and patients generally undergo seven treatments in a little over two weeks. In the weeks following the treatments, dead skin from the lesion gradually flakes off, leaving healthy skin with almost no likelihood of scarring and a very low likelihood of cancer returning.
Traditional treatments, including surgical removal and cryotherapy (freezing), can leave unsightly scars in highly visible areas. Brachytherapy is potentially a good alternative for patients who:
In fact, the procedure is so quick and convenient, we have successfully treated hospital employees who were able to receive treatments during their lunch break. I have also seen many patients who had multiple lesions surgically removed in the past. They were thrilled to have a less-invasive option that is as effective as surgery.
• Have small (2 cm or less), early-stage basal cell or squamous cell lesions on the surface of the skin
• Are worried about the cosmetic outcome of having cancer surgically removed
• Are worried about the functional outcome of having cancer surgically removed from areas such as the eyelids and tear ducts
• Are not good candidates for surgery because of other health conditions
The procedure is not recommended for larger lesions or those that have grown deep under the skin. It is also not a treatment for melanoma, the most serious type of skin cancer.
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Dr. Edward Soffen is a board-certified radiation oncologist and medical director of the Radiation Oncology Department at CentraState Medical Center. For more information, call 866-CENTRA7 (866-236-8727) or visit Dr. Soffen’s Physician Finder page www.centrastate.com/EdwardSoffen. at
A Comprehensive Cancer Program Skin brachytherapy is one of the many state-of-the-art treatments available through the Statesir Cancer Center at CentraState. With a talented team of cancer specialists, and an approach that emphasizes personal caring, the center gives patients the kinds of choices found in the most respected medical centers throughout the country.
14 SUMMER 2017
For more information about skin brachytherapy for the treatment of skin cancer and all other treatment options 855-411-CANCER (855-411-2262) or offered at the Statesir Cancer Center at CentraState, call visit www.centrastate.com/skinbrachytherapy.
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locationS: Unless otherwise indicated, all screenings, classes, and programs are held at The Star and Barry Tobias Ambulatory Campus Health Awareness Center • Suite 100 • 901 West Main Street • Freehold, NJ, 07728 Registration is required for all screenings. To register for these or other CentraState screenings, classes, and programs, visit www.centrastate.com/healthprograms or call the Star and Barry Tobias Health Awareness Center, Monday - Friday, 8:30 a.m. – 4 p.m. at 732-308-0570.
SCREENINGS
Summer
CENTRASTATE HEALTH CALENDAR
MEMORY SCREENINGS
SKIN AND THYROID CANCER SCREENING
By appointment Cost: $5
Wed., Sept. 13, 6 – 7:15 p.m. Statesir Cancer Center Donna O’Donnell, RN Medical Arts Building
FREE GLUCOSE & BLOOD PRESSURE SCREENING Every Monday from 10 a.m. – 4:30 p.m. (except holidays) Are you at risk for diabetes? Come join us for a free glucose and blood pressure screening at the Star and Barry Tobias Health Awareness Center.
SKIN SCREENING Wed., Aug. 16, 6 p.m. Statesir Cancer Center Donna O’Donnell, RN Medical Arts Building
As part of this screening, patients complete a questionnaire and have a blood test for a thyroid stimulating hormone. A physician meets with each patient to review risk factors and examine the thyroid. Within 1-2 weeks, the lab results and patient charts are reviewed by the physician for any further recommendations, after which patients receive their results and recommendations by mail.
MOBILE FOR LIFE Wed., Sept. 13, 6 – 7 p.m. Learn how mobility and activity are predictive of your functioning in future years, and strategies to improve your mobility. Confidential frailty screenings to establish your baseline will be available.
CLASSES
PROGRAMS
MINDS IN MOTION: MASTER YOUR MEMORY
MANAGING HYPERTENSION
4 sessions: CentraState Medical Office at Monroe: Sept. 6, 13, 20, 27 CentraState Health Pavilion at East Windsor: Oct. 3, 10, 17, 24 Cost: $40
By appointment Work with RN health coaches to help set goals and get support with managing your blood pressure.
Participants will learn how memory works and why we forget, plus simple and effective strategies for improving information retention. This class is designed for those with mild cognitive changes or for those who wish to stave off any future cognitive decline. Classes will run for 90 minutes, and will include take-home materials for added learning. For upcoming dates and locations, visit www.livelifewellnj.com/memory.
‘A TIME TO QUIT’ SMOKING CESSATION PROGRAM
Is Weight-Loss Surgery Right for You? Upcoming sessions: Aug. 2, Sept. 6, Oct. 4 Are you wondering if you are a candidate for bariatric surgery? Learn about the process, surgical options, benefits and risks, and life after bariatric surgery.
Mon., Sept. 11 (free orientation) Six scheduled meetings starting Mon., Oct. 9, 6:30 – 7:30 p.m. Cost: $129 “A Time to Quit” is a seven-week, evidence-based smoking cessation program that offers support and professional guidance for anyone who is thinking of quitting or is ready to quit.
Educate yourself on weight-loss surgery options (such as gastric bypass, Lap-Band, and gastric sleeve), how they work, and the risks and benefits.
15 SUMMER 2017
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NONPROFIT ORGANIZATION U.S. POSTAGE
PAID
CentraState Medical Center 901 W Main St. Freehold, NJ 07728
CENTRASTATE HEALTHCARE SYSTEM
Coming this Fall:
CentraState Health Pavilion at Marlboro CentraState Health Pavilion at Marlboro Marlboro Medical Arts Building 479 Newman Springs Road Marlboro, NJ 07746 www.centrastate.com/marlboro 866-CENTRA7 (866-236-8727)
T
o make it more convenient for area residents to meet their health care needs, CentraState will open the CentraState Health Pavilion at Marlboro in September. Designed with today’s busy lifestyles in mind, this new facility will provide quality care and easily accessible services in one location, featuring:
• Family Practice of CentraState—board-certified physicians who provide health and wellness care for the entire family
• Physical, occupational, and speech therapy • Laboratory services • Immediate Care Medical Walk-In—an urgent care center open seven days a week
The Marlboro site is CentraState’s second Health Pavilion location; the first opened in East Windsor last summer and features the same convenient health care services. Both facilities have partnered with Immediate Care Medical Walk-In, which offers medical services overseen by board-certified emergency physicians affiliated with CentraState.
CentraState Healthcare System The full circle of health and wellness dedicated to excellence.
