Jack H. Dworkin, MD, MBA, FACC. Vice President ... At CentraState, we often say that value is a combination of quality o
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WHEN SCIENCE MEETS HOPE Two Leukemia Patients Benefit from Targeted Therapy page 4
Also in this issue:
Fighting Back Against Parkinson’s page 7
Consider Physical Therapy Before Opioids to Treat Pain page 9
Colorectal Surgery Proves Life-Changing for Manalapan Woman page 10
How to Prepare for Pregnancy—Well Before You’re Ready page 13
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John T. Gribbin, MBA, FACHE President and CEO Much has changed in the world of health care since CentraState first opened its doors 46 years ago. More than ever, patients are focused on quality, convenience, cost, and efficiency in seeking health care services. It’s a standard that CentraState has worked hard to live up to, as demonstrated in part through our high ratings from the Centers for Medicare & Medicaid Services and the Leapfrog Group, and our three-time Magnet designation for excellence in nursing care. These factors that have become so critical in today’s health care landscape all relate to value. At CentraState, we often say that value is a combination of quality of care, cost of services, and access to care. But there is no one-size-fits-all definition of health care value; people view it differently depending on their interests and needs. For example, some may consider value as the availability of groundbreaking technology. Others may see it as affordable care delivered by compassionate caregivers—or as convenient access to quality care close to home. We’re committed to viewing health care value through all of those lenses and exceeding expectations on all of those fronts. You will see examples of this commitment throughout this issue of Healthy Directions. We are providing targeted therapy for breast cancer and leukemia, because our patients value hope. We offer a comprehensive diabetes management program that meets very specific individual needs, helping patients who value empowerment. We are also using minimally invasive techniques to eradicate long-standing abdominal pain and other problems, as we know our patients value quality of life.
DEFINING VALUE THROUGH THE LENS OF THE PEOPLE WE SERVE is the most important
perspective we can have. We are focusing on the expertise, services, and care delivery that matter most to our community—and there is nothing more valuable than that.
Join CentraState’s ViewPoint Panel. Through your input, we gain invaluable insight into what you want and need from your health care system—helping us build a better health and wellness experience for you and everyone we serve. Visit www.centrastate.com/value to learn more and sign up today!
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.
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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.
The Power of Personalized Cancer Care By Bhavesh Balar, MD
C
ancer is an unpredictable disease—two people diagnosed with the same type of cancer may have completely different responses to the same treatment. That’s why cancer care continues to evolve from standardized treatment regimens to more personalized, targeted therapies. These newer treatments take advantage of individual differences at the cellular level and the body’s natural ability to fight disease.
The Evolution of Cancer Care Standard chemotherapy is still one of our most effective cancer treatments. It works by targeting and killing cells that grow and divide quickly. This approach kills cancer, but it can also harm healthy cells. The goal of personalized, targeted therapy is to precisely destroy cancer by taking advantage of particular traits of specific types of cancer, with little impact on healthy cells. Targeted therapies can be especially important for patients with advanced disease for which there are few other options. Depending on the patient, targeted treatments may be used alone or in combination with standard treatments—chemotherapy, radiation, and surgery. For each patient, the challenge of targeted therapy is to find the underlying process that’s driving his or her cancer and find ways to stop it.
Genomic Medicine Many cancers are caused by mutations in our DNA, the building block chemicals in the body that instruct cells on how to work. Mutations may cause cells to grow too quickly and harm nearby, healthy cells. By identifying these genetic mutations, researchers are developing new medications that reverse the DNA instructions that cause cancer cells to misbehave. These genomic medicines are all available at CentraState Medical Center’s Statesir Cancer Center.
Immunotherapy Cancer grows in the body unchecked because cancer cells develop a sort of shield to protect themselves from the immune system. Immunotherapy works to break down that shield, allowing the body to attack cancer in the same way it attacks an infectious disease.
Medicines known as checkpoint inhibitors are among the more promising new treatments. Checkpoints are proteins that keep the immune system from attacking normal cells. Some cancers also contain lots of these proteins, offering cancer cells similar protection from the immune system. Checkpoint inhibitors stop these proteins from doing their job, which allows the immune system to eliminate cancer cells.
Novel Therapies and Screening Other targeted therapies being used at CentraState include hormonal therapy for breast and prostate cancer, and monoclonal antibodies used in breast cancer, lymphomas, and colorectal cancers. These treatments kill cancer cells by starving them of compounds they need to grow. In addition to treatment, our growing knowledge of cancer genetics is helping us determine a person’s risk of developing certain types of cancer in the future. For example, the presence of inherited mutations of BRCA1 and BRCA2 genes greatly increases a woman’s chances of developing breast or ovarian cancer. This knowledge can ensure that a woman is closely followed over time with appropriate cancer screenings.
Dr. Bhavesh Balar is a board-certified and fellowship-trained hematologist and oncologist on staff at CentraState. His office can be reached at 855-411-CANCER (855-411-2262) or visit www.centrastate.com/BhaveshBalar.
For more information about CentraState’s cancer services, visit www.centrastatecancercenter.com.
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Two Leukemia Patients Find Common Ground During
TARGETED THERAPY
On a snowy day in February, 52-year-old Adam Fox and 23-year old Ashley Getta had no idea that an unusual diagnosis would later connect them. As Winter Storm Niko barreled across the Northeast on February 9, flights were cancelled and many schools and offices were closed. Suffering from what he thought was the flu, Adam Fox was awaiting blood work results from his primary care physician, Nivedita Sharma, MD. That snowy day, she called to advise the 52-yearold Jackson resident to go right to the CentraState Emergency Department for further testing. Meanwhile, in Howell, 23-year-old Ashley Getta was concerned about a bruise on her right forearm that seemed to appear out of nowhere. The walk-in clinic she had visited the day before called with her blood work results, and urged her to go straight to the Emergency Department as well.
My treatment team was on top of everything so I could focus on getting better.” —Ashley Getta
At the time, neither Adam nor Ashley had any idea that they were both about to be admitted for a full month of inpatient treatment for acute promyelocytic leukemia (APL), a relatively rare type of cancer of the white blood cells.
Skilled Pathology Team Facilitates Diagnosis Although Adam and Ashley arrived at CentraState’s Emergency Department at different times that day, each had blood work drawn and sent to the hospital’s pathology department for testing. In both cases, a skilled hematology technician knew something was not right. CentraState pathologists Paul J. Simon, DO, and Karabi Sinha, MD, carefully reviewed the specimens and recognized that the diagnosis in each case could be APL. “With many different types of acute leukemia, it would be extremely uncommon to see two cases of APL in one day,” Dr. Simon says. “But in the medical field, you always have to trust your instincts and training and be prepared for the unexpected.”
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Despite the treacherous weather conditions impacting normal courier schedules, Drs. Simon and Sinha were able to arrange for the blood work to be picked up by an off-site specialty reference lab for confirmation of the diagnosis. In the meantime, they consulted with Jeffrey Silberberg, MD, a board-certified and fellowship-trained hematologist/oncologist on staff at CentraState, to assess the situation and initiate APL treatment. “APL can interfere with the body’s coagulation processes, putting patients at risk for life-threatening blood clots or bleeding,” Dr. Sinha says. “If there’s a question of APL, it’s critical to expedite treatment protocols.”
One moment I thought I had a bad case of the flu, and the next I was in the hospital for the fight of my life.” —Adam Fox
While both patients experienced a few side effects of treatment— Ashley had swelling in her optic nerve and Adam was treated for a lung condition called differentiation syndrome—these issues were resolved and managed by other CentraState specialists so that they could continue with their APL protocols.
Brought Together by a Common Bond Several days after being admitted to the hospital, Ashley learned that she was not alone in her fight against APL. She crossed paths with Adam, who was right down the hall undergoing the exact same course of treatment. They began sending each other little gifts, like puzzles and word game books, and before long a friendship was established.
An Extended Course of Targeted Therapy As unexpected as the pathology results were, the confirmation of an APL diagnosis was even more shocking for Adam and Ashley. “It was the strangest feeling,” Adam recalls. “One moment I thought I had a bad case of the flu, and the next I was in the hospital for the fight of my life.” Dr. Silberberg started both patients on a six-week course of daily targeted therapy with the oral medication all-transretinoic acid (ATRA) plus an IV medication called arsenic trioxide. Together, these medications specifically target the leukemia cells, causing them to mature and die while the body makes healthy, new white blood cells. “If APL is caught early and bleeding is prevented, it’s very treatable and is curable in the vast majority of patients,” Dr. Silberberg says. “Targeted therapy with these two medications is a relatively recent advance that can be used in place of traditional chemotherapy. Treatment starts in the hospital with induction therapy, which eradicates most of the leukemia cells. The second step is consolidation therapy, usually as an outpatient, to target any remaining cells that might still be present in the bone marrow.”
“It’s so nice to have someone to talk to who’s going through a similar experience,” Ashley says. “Whenever I had a rough day, he would know exactly what to say to make me feel better. We’ve helped each other stay strong.” As they currently finish up intermittent courses of consolidation therapy as outpatients, Ashley and Adam keep in regular contact to support each other’s recovery. According to Dr. Silberberg, their prognosis is excellent. “I’m ready to go back to taking college classes and hopefully do great things,” Ashley says. “I’ve always loved the beach, so I plan to get my diving certification and perhaps one day be a marine biologist.” Adam is also ready to move on with life, thanks to the treatment he received. “I couldn’t have asked for better care,” says Adam, who works as a technology executive in New York City. “The teams at the hospital and in Dr. Silberberg’s office have been unbelievable. The nurses were so kind and comforting—it’s clear that the role of caregiver is a special calling for them. I’ve got a second chance at life now, and nothing is going to hold me back.”
For more information about CentraState’s cancer services, visit www.centrastatecancercenter.com or call call 855-411-CANCER (855-411-2262).
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Targeted Therapy Helps Howell Woman
BATTLE BREAST CANCER When Deborah Mozak was diagnosed with breast cancer last fall, it had already spread to the lymph nodes in her underarm and neck.
“She essentially had inoperable breast cancer when she was diagnosed,” says Bhavesh Balar, MD, a board-certified and fellowshiptrained hematologist and oncologist on staff at CentraState. “It was very locally advanced—no distant spread, but advanced to where it was inoperable.” Less than a decade ago, Deborah’s cancer would have been difficult to treat with traditional chemotherapy. Today, targeted therapies that block the ability of cancer cells to grow and spread are providing new options for patients with certain types of previously inoperable breast cancers. In Deborah’s case, these newer therapies have had remarkable results—from her original diagnosis of metastatic breast cancer to a very good possibility of a complete cure.
A Family History
Moving Forward
Deborah, a 62-year-old Howell resident, was diagnosed with breast cancer after noticing a mass in her neck, which turned out to be a cancerous lymph node. A half-marathoner in otherwise good health, the diagnosis was especially difficult as a close family member had been diagnosed with an operable form of breast cancer earlier in 2016.
For six weeks ending in September, Deborah underwent external beam radiation therapy with Neesha Rodrigues, MD, a board-certified radiation oncologist at CentraState.
“I know cancer runs in families, but this was just one thing after another,” Deborah says. “Thankfully, my family and friends offered a lot of support.”
“After a lumpectomy, radiation is the standard of care to target any microscopic cancer cells that may potentially remain,” Dr. Rodrigues says. “Radiation treatment significantly reduces the risk that cancer will come back in the breast and lymph nodes.”
In December, Deborah began chemotherapy and targeted therapy with medications that block her type of breast cancer, HER2-positive, from growing.
Deborah says that throughout her treatment she tried to keep a positive attitude, and she and her doctors are hopeful that she will achieve a complete cure.
“The cancer began to disappear in front of our eyes,” Dr. Balar says. “Cancer that was inoperable quickly became operable.”
“I was very pleased with everyone at CentraState—they were all so caring and understanding,” Deborah says. “I never doubted that I was getting anything but the very best treatment.”
In June, Deborah had lumpectomy surgery at CentraState to remove the cancerous mass from her right breast. The cancer that had spread to nearby lymph nodes was no longer detectable.
For more information about the Breast Cancer Program at CentraState, visit www.centrastate.com/breastcancer or call 855-411-CANCER (855-411-2262).
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Fighting Back Against
PARKINSON’S Rock Steady Boxing can help patients improve balance, strength, and agility.
K
en Springer goes to the gym twice every week to box his enemy. But he’s not fighting against any ordinary opponent—this one is a degenerative movement disorder that causes a deterioration of motor skills, balance, speech, and sensory function. It affects nearly one million people in the United States. To Ken, this is the disease that robs him of his ability to perform everyday tasks, such as carrying a cup of coffee without spilling it. The 74-year-old Freehold resident and U.S. Marine Corps veteran had always been active and strong, so being diagnosed with Parkinson’s disease two years ago came as a blow. Never before had he needed help doing anything, but the effects of Parkinson’s that impede his mobility, balance, and fine motor skills make even the most mundane tasks—such as putting on socks or screwing in a light bulb—incredibly difficult. Ken has a tremor that shakes his hand when he’s trying to use the computer mouse. “Sometimes it’s so bad that I throw the mouse across the room,” he admits. Ken recently discovered that he can release his anger by hitting a heavy bag through Rock Steady Boxing, a unique program that empowers people with Parkinson’s to literally fight back. The concept was founded on research that suggests intense “forced” exercise is most beneficial for reducing, reversing, and delaying Parkinson’s symptoms. Many of the elements that boxers train to condition, including agility, speed, muscular endurance, accuracy, balance, hand-eye coordination, footwork, and overall strength, are among the biggest struggles for patients with Parkinson’s.
The program originally began in Indianapolis and has affiliate sites across the country. It was brought to CentraState by two physical therapists who recognized the need for this type of long-term training program for Parkinson’s management. Amanda Mangulabnan, PTA (pictured left of Ken Springer), and Shannon Lenahan, PT, DPT (right), work with volunteer fitness trainers to help patients perform a variety of exercises designed to strengthen the legs, arms, back, and core. The rules are no contact to other people, so the only targets getting hit are the boxing bags. Ken has been attending classes since the program began in June, and he already feels that his balance has improved. But the benefits extend beyond the physical—he finally is getting relief from his anxieties and frustrations. “What I like about the program is that it’s a marriage of physical fitness and therapy, both of which push you to become better,” Ken says. “It helps me not only with balance, but also with building muscle and confidence.” Lenahan said the classes also create comradery among people who are dealing with all levels of Parkinson’s. “Rock Steady Boxing gives people with Parkinson’s the motivation to continue fighting,” she says. “At the same time, we’re working to improve their quality of life.”
For more information about the Rock Steady program, visit www.centrastate.com/rocksteady or call 866-CENTRA7 (866-236-8727).
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Outsmarting
DIABETES Manalapan resident manages disease through weight loss and nutrition.
F
ung-Ping Siniakin was struggling with severe allergies and fibromyalgia, a debilitating syndrome that impairs the muscles and joints, when she was also diagnosed with type 2 diabetes. “I felt completely overwhelmed,” the 57-year-old Manalapan resident says. “Not only was I fighting constant fatigue, pain, and immobility from the fibromyalgia, but now I had another health issue to manage.” Diabetes is a chronic disease that occurs when the body is unable to make enough insulin or use it properly, causing glucose, or sugar, to accumulate in the blood. “When you have type 2 diabetes, your body can’t handle the metabolism of glucose,” explains Saima Farghani, MD, a boardcertified and fellowship-trained endocrinologist on staff at CentraState. “While the disease is not curable, it is treatable.” At the time of diagnosis, Fung-Ping’s sugar levels were dangerously high—about three times higher than normal. As a result, the diabetes exacerbated her fibromyalgia symptoms, leaving Fung-Ping exhausted and disheartened.
Getting Back on Track Seeking help to manage her diabetes, Fung-Ping turned to CentraState’s Novo Nordisk Diabetes Center, where she met with a team of certified diabetes specialists, including a nurse and dietitian. They partnered with Dr. Farghani to develop a diabetes management program tailored to Fung-Ping’s unique needs. “They were wonderful—answering my questions, teaching me how to monitor my glucose, and providing emotional support,” Fung-Ping says. Fung-Ping’s treatment was especially challenging. Life-threatening allergies prevented her from using any oral diabetes medication and all but one type of insulin, which was initially administered through injection and later by an automated pump.
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“I had to get on the right path through nutrition, because my life could depend on it,” she says.
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Losing Weight, Gaining Control With guidance from Dr. Farghani and the Diabetes Center, Fung-Ping modified her diet and lost 50 pounds by counting calories and carbohydrates, curbing portion sizes, and making smart choices when dining out. Within months, she lowered her blood sugar to a normal range, eliminating the need to take insulin. She is still battling fibromyalgia, but is breathing easier with less joint pain, more energy, and greater peace of mind. “I feel healthier and in control of my diabetes,” Fung-Ping says. “If I can do this with all my health problems, others can, too!”
CENTRASTATE’S NOVO NORDISK DIABETES CENTER helps patients understand their diagnosis and develop management strategies. The program begins with a one-on-one assessment with a diabetes educator, and a team of certified diabetes specialists consults with the patient’s physician on a customized management program. The patient then takes part in a six-session group education program that includes:
• Diabetes survival skills • Nutrition education including customized meal plans
• Exercise advice and an
introduction to our medically supervised Fitness and Wellness Center
• Blood glucose monitoring • Stress management • Risk reduction techniques Visit www.centrastate.com/diabetes to learn more and to take an online risk assessment, or call 732-294-2574.
DIABETES FORUM Sweet Success—Preventing and Managing Diabetes Thursday, November 2, from 5 to 8 p.m This forum will include physician lectures, question-and-answer sessions, and a health fair offering diabetes information. For more information or to register, visit www.centrastate.com/events.
Consider Physical Therapy Before Opioids to Treat Pain By Brian Mason, PT, DPT
In my 30 years as a physical therapist, I have often seen how pain can lead to a vicious cycle of worsening physical and mental health, with loss of function. The downward spiral happens this way: A person experiences pain and limits activity for fear of causing more pain. However, limiting activity is actually detrimental in the long term for both the body and mind. By the time the person seeks medical help, he or she may be in severe pain and feel depressed about the loss of mobility and quality of life. At that point, powerful prescription opioid pain medications such as oxycodone and hydrocodone may seem like the best option for immediate pain relief, but they cannot restore function—that is up to the patient.
The Opioid Problem Opioids work by blocking pain signals to the brain, which reduces the sensation of pain but does nothing to address the underlying problem. These medications also can be highly addictive. Physical therapy treats pain through movement by:
• Identifying the source of pain and any loss of function • Stretching and strengthening related muscles • Encouraging production of natural pain-fighting chemicals in the body • Helping patients overcome the fear of movement In physical therapy, we help patients understand that some pain is normal and that being active is not going to harm them. We can adapt therapies to a patient’s condition and abilities, with options ranging from water therapy to antigravity treadmills. Our goal is to return patients to a normal level of functioning so they can enjoy a good quality of life.
PHYSICAL THERAPY AT CENTRASTATE The OceanFirst Rehabilitation Center at CentraState offers comprehensive services to aid in the recovery from injury, stroke, illness, surgery, and other physical setbacks. Physical therapists collaborate with physicians to develop a customized treatment plan and work with each patient using state-of-the-art equipment. In addition to our main center in Freehold, we offer physical therapy at offices in Monroe, Jackson, East Windsor, and coming soon in Marlboro.
When to Pursue Physical Therapy Physical therapy should be considered any time that pain causes a loss of mobility or the ability to perform normal activities. We can start work as soon as the patient’s doctor feels he or she is healthy enough for activity. When physical therapy is a first-line treatment for pain, we can provide relief in the vast majority of cases. Physical therapy also does not prohibit other treatments. Patients can still pursue other options with their doctor, including pain medication. Before starting a prescription for opioids, I urge patients to speak with their doctor and a physical therapist about the possibility of trying therapy first. The sooner active recovery is started, the better the chances at success.
Brian Mason, PT, DPT, is a board-certified physical therapist and clinical director of rehabilitation services at CentraState. To learn more about the OceanFirst Rehabilitation Center at CentraState, visit www.centrastate.com/rehabilitation or call 866-CENTRA7 (866-236-8727).
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REMARKABLE
Relief
Colorectal Surgery Proves Life-Changing for Manalapan Woman
For years, Margaret Sharkey suffered from on-and-off constipation and abdominal discomfort that made daily life a struggle. In May 2017, a bout of sharp pain led doctors to order a CT scan that found her colon was almost completely blocked.
“I was in bad shape—I was doubled over, rocking back and forth in pain,” says Margaret, a 53-year-old dental office manager from Manalapan. Margaret needed surgery to remove the blockage, but CentraState physicians first decided to perform colonic stenting—a minimally invasive, endoscopic procedure to reopen an obstructed section of the bowel. Stenting allows doctors to delay surgery in order to allow the bowel to empty. It also eliminates the need for a temporary colostomy, a procedure in which an opening is surgically created in the abdomen to drain fecal matter.
One Surgery Versus Two Colon cancer is usually the first suspected concern when a patient has a blockage, says Kunal Gupta, MD, MBA, a board-certified and fellowship-trained gastroenterologist and chief of gastroenterology at CentraState. Colon blockages are traditionally treated using two surgical procedures, three to six months apart—a colostomy, followed by a procedure to remove the diseased section of colon and reconnect two healthy sections to allow normal bowel movements. “In Margaret’s case, we were able to avoid that first surgery by inserting a self-expanding metal stent that reopened the colon and relieved the obstruction,” Dr. Gupta says. “She went home the following day and was able to schedule her colon surgery a few weeks later.”
A Positive Diagnosis At the time of Margaret’s stenting procedure, it didn’t appear that she had cancer, which was confirmed during her colon surgery by Thomas Kayal, MD, a board-certified and fellowship-trained colorectal surgeon on staff at CentraState. Her problem turned out to be diverticular disease, an abnormality of the colon that can cause bleeding, recurrent infections, or blockages.
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“This blockage contributed to some of the problems she had been having for years,” Dr. Kayal says. “We were able to remove the diseased section of her colon with the obstruction and reconnect her colon, allowing her to have normal bowel function again.” Margaret, a mother of two adult children, says the relief she experienced after the stenting and colon surgery was immediate and remarkable. She has more energy and she’s back to enjoying being active with her dogs, a Rottweiler named Monty, and Kiara, a Shiba Inu. “I eat, I go to the bathroom, I do everything like a normal person,” Margaret says. “It feels great to have my life back.”
For more information about CentraState’s colorectal surgical services, call www.centrastate.com/gastroenterology or visit 866-CENTRA7 (866-236-8727).
Providing Comprehensive Complex
DIGESTIVE CARE CentraState Medical Center offers some of the most advanced procedures available to diagnose, treat, and even prevent a wide range of conditions affecting the digestive tract. The hospital’s Interventional Gastroenterology (GI) Program takes advantage of nonsurgical endoscopic techniques to evaluate and treat conditions ranging from gastroesophageal reflux disease (GERD) and gallstones to cancers of the digestive tract. Under the direction of board-certified and fellowship-trained gastroenterologists Amy Tilara, MD, and Kunal Gupta, MD, MBA, the program provides complex GI care for residents throughout our region.
"These procedures can provide an improved quality of life for patients who are struggling with pain and other symptoms related to digestive tract diseases," says Dr. Tilara, who completed fellowship training in interventional endoscopy. "They are performed in CentraState’s state-of-art endoscopy suite, giving patients the peace of mind of having their procedure in a hospital setting."
Treating Problems Without Surgery Endoscopy uses a thin, flexible tube (endoscope) with a light and camera that allows our GI specialists to examine the upper or lower parts of the digestive tract. Interventional gastroenterology uses special endoscopy equipment to not only evaluate a condition, but also to provide therapy. At CentraState, some of the more common interventional GI procedures include:
• Endoscopic ultrasound (EUS) to view and biopsy abnormalities of
the pancreas and upper gastrointestinal tract and drain pancreatic pseudocysts
• Endoscopic retrograde cholangiopancreatography (ERCP) to treat blocked or narrowed bile and pancreatic ducts
• Stent placement, a procedure that uses a metal mesh or plastic tube to reopen a blocked section of the esophagus, biliary tree, or intestinal tract
“We have the training and experience to provide many advanced endoscopic procedures that often eliminate the need for traditional surgery,” says Dr. Gupta, who has advanced training in EUS and ERCP. “These endoscopic procedures are done under sedation, allowing patients to return home and resume most normal activities the same day.”
Preventing Cancer The hospital has long offered colonoscopy (lower endoscopy), which allows doctors to detect and remove precancerous colon polyps before they become malignant. Now, the Interventional Gastroenterology Program is offering a procedure called BarrxTM radiofrequency ablation, which has the potential to prevent cancer in patients with advanced GERD. Radiofrequency ablation uses heat energy to destroy (ablate) diseased tissue in the superficial lining of the esophagus caused by Barrett’s esophagus, a complication of GERD. The treatment has been shown to be more than 90 percent effective in removing precancerous tissue from the esophagus.
• Electrohydraulic lithotripsy (EHL) to break up large bile duct stones so they can be more easily removed
• Nerve blocks to treat pain in patients with advanced GI cancer For more information about CentraState’s Interventional Gastroenterology Program, visit www.centrastate.com/gastroenterology or call 866-CENTRA7 (866-236-8727).
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ADHD’S Gender Gap Attention-deficit/hyperactivity disorder (ADHD)—a brain disorder marked by inattentiveness and impulsivity—largely discriminates. Among school-age children, the incidence of ADHD is between 7 and 9 percent, and the ratio of boys to girls is 2.3 to 1, according to Ankur Desai, MD, a boardcertified and fellowship-trained child/adolescent psychiatrist on staff at CentraState Medical Center.
“Although hyperactivity is certainly a symptom of the disorder, the true hallmark of ADHD is inattentiveness,” Dr. Desai explains. “Symptoms such as hyperactivity and impulse-control problems are often recognized sooner by teachers and parents compared with inattentive symptoms, which can take a little bit longer to identify—especially if the child has a high level of intelligence. Such children may not get identified at a younger age, as it may take longer for them to have difficulties that adults can readily identify.” In effect, Dr. Desai says, girls with ADHD tend to be identified at a later age because they may not exhibit as many of the hyperactive, impulsive symptoms. Identification is key to ensuring that children with ADHD go on to lead full, happy lives. Without treatment, Dr. Desai explains, they may grow into adults who have difficulty maintaining jobs and relationships. Hyperactivity typically subsides, but lack of impulse control and poor organizational skills could persist into late adolescence and adulthood. Fortunately, ADHD is treatable with proper medication. “We have very strong evidence that medication can help ADHD—perhaps more so than many other behavioral health conditions,” Dr. Desai says. “Although medical professionals encourage a comprehensive treatment of psychotherapy and medication—especially if ADHD co-occurs with another behavioral health condition, such as oppositional defiant disorder or generalized anxiety disorder—medication is still the front-line treatment.” Early intervention is important in order to treat ADHD properly, so it’s critical for parents and teachers to keep an eye out for warning signs in young children. Even though the neurodevelopmental disorder is more common in males, females are not immune to ADHD—their symptoms may just be harder to spot.
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ADHD WARNING SIGNS The earliest indicators for ADHD are reports from teachers or other adults who are spending time regularly with the child in a group of similarly aged children and note a significant difference in that child's specific activity level, impulse control, or ability to stay on task, according to Dr. Desai. Examples of these indicators include: ››
Constantly being in motion
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Having a difficult time sitting still or staying in their seat
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Having difficulty waiting their turn
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Excessive talking
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Blurting responses out of turn or frequently interrupting others
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Forgetfulness or frequently losing possessions
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Having a difficult time finishing tasks to completion without frequent redirection
To find a CentraState physician, visit www.centrastate.com/physicians or call 866-CENTRA7 (866-236-8727).
How to Prepare for Pregnancy— Well Before You’re Ready By Borislava Burt-Libo, DO It is never too early for women to think about fertility as part of their overall health—whether they’re planning to start a family soon or perhaps sometime far in the future. A commitment to good health is critical once you become pregnant. Pregnancy is a major stressor on the body— it stresses the heart, the lungs, the vascular system, the kidneys, and potentially every single organ in the body. By taking care of yourself now, you can help ensure a healthier pregnancy whenever you’re ready.
Healthy Habits at All Ages AVOID EXPOSURE TO CHEMICALS. You want your lawn or garden to look great, but take caution when using pesticides and herbicides to kill weeds and bugs. Prolonged exposure may disrupt menstrual cycles and decrease fertility. TRAVEL WITH CAUTION. Women who are pregnant or thinking about becoming pregnant should avoid travel to areas known to have widespread cases of the mosquito-borne Zika virus. If you do travel to these areas, wait at least six months before trying to get pregnant. STOP SMOKING. Infertility rates among women who smoke are twice as high as nonsmokers, according to the American Society of Reproductive Medicine. Studies have also shown that women who smoke cigarettes daily experience menopause one to two years earlier on average. CONTROL YOUR WEIGHT. Obesity can lead to many problems for expectant moms, including infertility, diabetes, and hypertension. It also puts you at a greater risk for fetal problems. PRACTICE SAFE SEX. Sexually transmitted infections such as chlamydia are among the leading causes of infertility. Chlamydia can lead to the development of pelvic inflammatory disease, which can cause blockages of the fallopian tubes and related infertility.
When You’re Ready CentraState’s Star and Barry Tobias Health Awareness Center offers health and wellness programs to help future parents achieve optimal health prior to conception and beyond. Visit www.centrastate.com/healthprograms for a class listing or call 732-308-0570 for personalized program recommendations. For growing families, the First Impressions Maternity Center at CentraState provides special treatment for every mother, baby, and family. Staffed by boardcertified OB/GYNs, neonatologists, and anesthesiologists, the center offers private labor and delivery rooms and home-like postpartum rooms.
THINK VITAMINS. Taking the B vitamin folic acid before getting pregnant can prevent certain brain and spine defects in your baby. Women of childbearing age should take a multivitamin that contains folic acid every day. As with all aspects of health, the habits you develop now can make a lasting impact—in this case, on your future ability to start or expand your family.
Dr. Borislava Burt-Libo is a board-certified OB/GYN at Women’s Physicians and Surgeons and on staff at CentraState. For more information, call 866-CENTRA7 (866-236-8727) or visit www.centrastate.com/BorislavaBurtLibo.
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CentraState
NEWS
CENTRASTATE ACHIEVES MOST WIRED STATUS FOR 2017 For the eighth consecutive year, Hospitals & Health Networks, the journal of the American Hospital Association WINNER 2017 (AHA), has recognized CentraState Medical Center as one of the nation’s Most Wired health care organizations according to the results of the magazine’s annual survey. The prestigious distinction recognizes health care organizations that have successfully adopted information technology (IT) in four critical areas: infrastructure, business and administrative management, clinical quality and safety, and clinical integration. CentraState has invested nearly $55 million in health IT over the past 10 years as part of its ongoing commitment to enhance patient engagement and health data security. CentraState’s participation in the Most Wired process was a significant factor in being one of the first hospitals in the country to be recognized as a Meaningful User of Technology by the Centers for Medicare & Medicaid Services (CMS) in 2013.
OPEN ENROLLMENT FOR COMMUNITY CARE NETWORK HEALTH PLANS CentraState is committed to ensuring that our communities have access to quality health care at a reasonable cost. Through a partnership with seven other health systems throughout New Jersey, we have formed the Community Care Network (CCN) to offer small- to mid-size employers and their employees access to multiple group health plan options that are affordable and flexible while providing outstanding coverage. CentraState will hold a program on “Strategies Employers Need to Know About Health” on October 18 at 8 a.m., which will include information about CCN during our current open enrollment period. For details or to register, visit www.centrastate.com/ccn or call 732-294-7080.
AWARDS HEART FAILURE AWARD
BEACON OF EXCELLENCE AWARD
CentraState has received the Get With The Guidelines — Heart Failure Bronze Quality Achievement Award for implementing specific quality improvement measures outlined by the American Heart Association/American College of Cardiology Foundation’s secondary prevention guidelines for the treatment of patients with heart failure. ®
CentraState earned the award by meeting specific quality achievement measures for the diagnosis and treatment of heart failure patients at a set level for a designated period, including evaluation of patients, proper use of medications, and aggressive risk-reduction therapies.
In September, CentraState received the First Beacon of Excellence Award as the Major Business of the Year by the Monmouth Regional Chamber of Commerce. The award was accepted by John T. Gribbin, CentraState’s president and CEO.
CENTRASTATE HEALTH PAVILION AT MARLBORO OPENING SOON The CentraState Health Pavilion at Marlboro will be opening its doors soon, featuring primary and urgent care, physical therapy, and laboratory services. For more information, visit www.centrastate.com/marlboro.
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Read Healthy Directions online at www.centrastate.com/publications. Subscribe to our free health e-newsletter at www.centrastate.com/enews.
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
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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 to Friday, 8:30 a.m. to 4 p.m. at 732-308-0570.
CENTRASTATE HEALTH CALENDAR
SCREENINGS MEMORY SCREENINGS
BONE DENSITY SCREENINGS
By appointment Cost: $5
Every Monday from 10 a.m. – 4 p.m. (except holidays) Cost: $20 Know your osteoporosis risk score with a quick and simple test to evaluate bone density in the heel, which correlates with bone density of the hip and spine. This test can tell you if you have normal bone density, low bone density (osteopenia), or osteoporosis.
FREE GLUCOSE & BLOOD PRESSURE SCREENINGS Every Monday from 10 a.m. – 4 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.
FREE COLORECTAL LECTURE & SCREENING KIT Tue., Nov. 7, 6 – 7:30 p.m. The lecture will be followed by instructions for using a take-home collection kit as part of the colorectal screening. The kit should be returned to the CentraState Outpatient Lab within one week after the lecture.
PROGRAMS
CLASSES
MANAGING HYPERTENSION
MINDS IN MOTION: MASTER YOUR MEMORY
By appointment Work with RN health coaches to help set goals and get support with managing your blood pressure.
‘A TIME TO QUIT’ SMOKING CESSATION PROGRAM Mon., Dec. 18 (free orientation), 6:30 – 7:30 p.m. Six scheduled meetings starting Jan. 8, 6:30 – 7:30 p.m. Cost: $129 This seven-week, evidence-based smoking cessation program offers support and professional guidance for anyone who is thinking of quitting or is ready to quit.
EVENTS SWEET SUCCESS—PREVENTING AND MANAGING DIABETES Thurs., Nov. 2, 5 – 8 p.m. Hear lectures on diabetes management, insulin pumps, and finding the right balance of food, exercise, and relaxation. This informative event includes a health fair with vendors offering the latest devices and techniques to help you take
Four sessions: Nov. 6, 13, 20, 27 3:30 – 5 p.m. Cost: $40 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 additional dates and locations, visit www.livelifewellnj.com/memory.
IS WEIGHT-LOSS SURGERY RIGHT FOR YOU? Upcoming sessions: Nov. 1, Dec. 6, Jan. 17 7 – 8 p.m. Are you a candidate for bariatric surgery? Learn about the process, surgical options (such as gastric bypass, Lap-Band, and gastric sleeve), benefits and risks, and life after bariatric surgery.
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NONPROFIT ORGANIZATION U.S. POSTAGE
PAID
CentraState Medical Center 901 W Main St. Freehold, NJ 07728
CENTRASTATE HEALTHCARE SYSTEM
THE ROAD TO HEALTH: CentraState’s Live Life Well Mobile Van
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he mission of CentraState Healthcare System is to enhance the health and well-being of our community. CentraState’s Star and Barry Tobias Health Awareness Center—with its team of registered nurses, registered dietitians, certified health educators, certified diabetes educators, preventive specialists, and wellness coaches— is committed to providing education, disease management, and preventive services to help our community stay healthy. Our Live Life Well mobile van assists the Health Awareness Center and other hospital departments by conveniently bringing many of our health programs, screenings, and lectures directly to our community. The van features work stations, storage for supplies and educational materials, audiovisual equipment for educational programs, and a private area for HIPAA compliancy and the comfort of participants during the screenings and coaching sessions. SM
The mobile van benefits our entire community, including senior residences, schools, local companies, and members of the community who do not have access to transportation or need more convenient access to care. For more information about the Live Life Well mobile van, call the Star and Barry Tobias Health Awareness Center at 732-308-0570.
THE LIVE LIFE WELL MOBILE VAN WILL OFFER FREE GLUCOSE AND BLOOD PRESSURE SCREENINGS AT THE FOLLOWING LOCATIONS THIS FALL: JACKSON DAY October 28 11 a.m. – 8 p.m. Johnson Park 260 Kierych Memorial Dr. Jackson CENTRASTATE HEALTH PAVILION AT EAST WINDSOR October 31 1 – 3 p.m. 319 Route 130 N. East Windsor
CENTRASTATE MEDICAL OFFICE AT MONROE November 8 1 – 3 p.m. Renaissance Crossing 312 Applegarth Rd. Monroe CENTRASTATE HEALTH PAVILION AT MARLBORO November 10 12 – 2 p.m. Marlboro Medical Arts Building 479 Newman Springs Rd. Marlboro
CentraState Healthcare System The full circle of health and wellness dedicated to excellence.
