Jupiter Medical Center Foundation Pinnacle Spring 2022 by Palm Beach Media Group

Pinnacle

SPRING 2022

WORLD-CLASS HEALTH CARE IN PALM BEACH COUNTY

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JUPITER OFFICE OPENING THIS SPRING We understand that dedication and commitment translate into long hours and demanding schedules for physicians. That’s why our advisors are on-call and available when you need us, whether it’s early in the morning, in the evening or on weekends.

Photo left to right: Douglas Parkey, Timothy Vickers, David Scaff, Dean Borland, Andres Salcedo, Paul Blatz FineMark National Bank & Trust, Jupiter, FL • 661 University Blvd, Suite 107 • Jupiter, FL 33458 www.finemarkbank.com • (561) 273-1570 • Member FDIC • Equal Housing Lender Trust and investment services are not FDIC insured, are not guaranteed by the bank and may lose value.

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CONTENTS

Features 26

Jupiter Medical Center is leading the way in heart valve replacement surgery By K.S. Meyer

Donors are doing their part to support world-class health care By Judy Martel

While their passions are rooted in racing, Johnny and Terry Gray are chasing a new checkered flag by giving back to JMC By Heather Graulich

A CUT ABOVE

How alternatives to IV chemotherapy are improving prognoses and quality of life By K.S. Meyer

What’s in store at Jupiter Medical Center’s new state-of-the-art $90 million Surgical Institute By Karen Feldman

Nicholas Mastroianni II is investing in Jupiter and the health of its families By Heather Graulich

WHEN LESS IS MORE

NEXT-GEN TREATMENT OF PERITONEAL CANCER

THE POWER OF PHILANTHROPY

REVVED UP TO GIVE BACK

LOVE THY NEIGHBOR

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South Florida’s Top Hospital for Safety At Jupiter Medical Center, we are honored to be the only hospital in South Florida to earn the “Top Hospital” designation from The Leapfrog Group as well as a seventh consecutive Leapfrog ‘A’ grade for patient safety. When choosing your medical care, choose the hospital with the highest commitment to quality, safety and exceptional patient care.

Jupiter Medical Center. Our commitment to your safety is world-class.

jupitermed.com WORLD-CLASS HEALTHCARE IS HERE.

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CONTENTS

50 Departments 10

WELCOME Greetings from Jupiter Medical Center

PULSE Ask the Expert | Well-Being | Prevention

PUTTING IN THE WORK Insight into the type of at-home exercises that are in store for patients recovering from common health issues

BADGE OF HONOR The faces of Jupiter Medical Center Foundation’s Honor a Caregiver initiative

20 ON THE COVER Illustration by Sebastian Kaulitzki, Science Photo Library, Getty Images

IN HIS WORDS Matt Perlman’s road to recovery at Jupiter Medical Center

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3/23/22 1:51 PM

Tansky Concierge Suites Now Open

Unique and elegant luxury accommodations • 7 luxury suites – 2 bed/2 bath or 2 bed/1 bath • Privacy, comfort and high-end amenities • Dedicated Concierge staff

• Personalized meals prepared by an Executive Chef

• Located on the 5th floor with stunning views and an abundance of natural light

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Scan here, or call 561-263-5885 for more information.

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1210 S. Old Dixie Highway Jupiter, Florida 33458 561.263.2234 jupitermed.com

Amit Rastogi, MD, MHCM President and Chief Executive Officer, Jupiter Medical Center Michael Morsberger Chief Philanthropy Officer and President, Jupiter Medical Center Foundation

JUPITER MEDICAL CENTER FOUNDATION, INC. TRUSTEES 2021-2022 Peter A. Lund, Chairman Donald H. McCree, Jr., Secretary Salvatore A. Tiano, Treasurer William C. Mattison, Jr. Jane F. Napier James E. Perrella Joseph M. Petri Katharine F. Plum M. Jude Reyes Burton M. Tansky Dennis K. Williams

Leonard Abramson Edward L. Babington Douglas S. Brown George H. Damman Neil S. Devlin Martin A. Dytrych Fred Lissauer John Healy Emeritus: Peter O. Crisp

JUPITER MEDICAL CENTER OFFICERS AND TRUSTEES 2021-2022 Martin A. Dytrych, CPA, Chairman Robert J. Stilley, Vice Chairman Jack Waterman, DO, Secretary Rosanne M. Duane, Esq., Treasurer

Mark L. Corry, MD Henri J. DesPlaines, CPA Michele D. Deverich Lee Fox, MD Harvey Golub

Philippe Jeck, Esq. Michael Leighton, MD Peter A. Lund Anthony P. Shaya, MD Andres Suarez, MD

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THE FRONT ROW at Scripps Research

CMY

Get Curious:

The Best Seat is Reserved for You From overcoming arthritis to harnessing the power of the microbiome, Scripps Research is excited to share the latest in the biomedical research being conducted by its world-class scientists. Each Front Row lecture is free and virtual, so you can join in from wherever you may be.

Visit frontrow.scripps.edu to register and watch past lectures.

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Jay Pandit, MD Assistant Professor, Molecular Medicine Director of Digital Medicine, Scripps Research Translational Institute

The Democratization of Vital Signs A practicing cardiologist, Jay Pandit is focused on accelerating the use of sensor technologies to capture rich, multi-layered, real-world patient data in care. Through this, Pandit seeks to change the paradigm of relying on limited “snapshots” of data from patients to make clinical decisions.

Special online events from Scripps Research We’re impossible to miss. If you can’t catch a Front Row lecture live, you can view all previous talks in full at frontrow.scripps.edu. To learn more about Scripps Research or join the conversation, contact (800) 788-4931 or philanthropy@scripps.edu

3/16/22 4:52 PM

Pinnacle

WORLD-CLASS HEALTH CARE IN PALM BEACH COUNTY Publisher Terry Duffy Associate Publisher Dina Turner Editorial Director Daphne Nikolopoulos Editor Mary Murray Creative Director Olga M. Gustine Senior Art Director Jenny Fernandez-Prieto CONTRIBUTING WRITERS Juliana Accioly, Karen Feldman, Heather Graulich, Sandra Gurvis, Judy Martel, K.S. Meyer, Michele Meyer, Seth Soffian, Lola Thélin CONTRIBUTING PHOTOGRAPHERS Steven Martine Photography, Jerry Rabinowitz DIGITAL IMAGING SPECIALIST Leonor Alvarez Maza ADVERTISING Publisher, Naples Kaleigh Grover Director of Sales Deidre Wade Account Manager Melissa Zolin Schwartz Advertising Services Coordinator Jordon Biton PRODUCTION Production Director Selene M. Ceballo Production Manager Kayla Earle Digital Pre-Press Specialist George Davis Digital Production Coordinator Brendan Everson Advertising Design Coordinators Anaely J. Perez Vargas, Jeffrey Rey OPERATIONS Chief Operating Officer Todd Schmidt Office Manager Andrea Berumen IT Manager Chris Thompson Marketing Manager Christopher Link Distribution Manager Judy Heflin Circulation Manager Marjorie Leiva Circulation Promotions Manager Marcus Alviar Circulation Assistant Elizabeth Gillespie Accounting Specialist Mary Beth Cook Accounts Receivable Specialist Ana Coronel

In Memoriam Ronald J. Woods (1935-2013) HOUR MEDIA, LLC CEO Stefan Wanczyk President John Balardo PUBLISHERS OF: Palm Beach Illustrated • Naples Illustrated • Fort Lauderdale Illustrated • Orlando Illustrated • Palm Beach Charity Register • Naples Charity Register Florida Design • Florida Design Naples • Florida Design Miami • Florida Design Sourcebook • Palm Beach Relocation Guide • Southwest Florida Relocation Guide Fifth Avenue South • The Jewel of Palm Beach: The Mar-a-Lago Club • Traditions: The Breakers • Palm Beach 100 • Naples 100 Art & Culture: Cultural Council for Palm Beach County • Pinnacle: Jupiter Medical Center Foundation • Waypoints: Naples Yacht Club Naples on the Gulf: Greater Naples Chamber • Jupiter • Stuart • Aventura • Vero Beach Magazine • Community Foundation of Collier County Community Report Advances: Tampa General Hospital • Fisher Island Club Magazine • Naples Realtor: Naples Area Board of REALTORS Published by Palm Beach Media Group North P.O. Box 3344, Palm Beach, FL 33480 Telephone: 561.659.0210 • Fax: 561.659.1736 www.palmbeachmedia.com Copyright 2022 Palm Beach Media Group North Inc. All rights reserved.

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Your heart could not be in better hands.

Ranked #1 for quality, safety and patient experience in Palm Beach County and the Treasure Coast, we offer a comprehensive array of services and advanced technology including:

The Robson Heart & Vascular Institute at Jupiter Medical Center provides the full spectrum of adult cardiac care from minimally invasive heart procedures to our openheart surgery program. Our dedicated team uses the latest techniques and technological advances to deliver the best patient outcomes.

• Cardiac Catheterization and Electrophysiology • Advanced AFib Treatments

• Structural Heart Program and Valve Clinic

• Vascular Surgery and Advanced Treatments • Cardiac Rehabilitation Center

• Joint Commission Chest Pain Certification

Visit jupitermed.com/cardiac for more information. WORLD’S BEST HOSPITALS 2021

WORLD-CLASS HEALTHCARE IS HERE.

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WELCOME

LILA PHOTO

IN THIS ISSUE

Andrea Clarke September 12, 1971 to January 4, 2022

Spring has sprung and with every spring comes new growth. Jupiter Medical Center is no exception. Committed to its strategic plan, the hospital continues to expand at a rapid pace, with new services and construction that serve as signs of this exciting growth. I am pleased to share that since the last issue our cardiac surgery and hepatobiliary oncology programs are breaking new ground. Our cardiac surgeons are now performing very advanced, minimally invasive procedures to treat complex valve issues of the heart with MitraClip and TAVR. On the surgical oncology front, JMC surgeons are performing cutting-edge procedures using the NanoKnife and robotic HIPEC to extend and improve quality of life for patients with cancers of the pancreas and liver. There is a great deal of optimism about these next-generation treatments that are truly on the leading edge of cancer care. One of the biggest recent developments at Jupiter Medical Center is the construction of our Surgical Institute. This 90,000-square-foot institute will pair “trailblazing, high-tech equipment with state-of-the-art facilities” to enhance the experience for both physicians and patients. With 16 operating rooms and two hybrid rooms, the hospital’s physical facilities will expand to match the technical capabilities of its highly skilled surgeons—resulting in better outcomes, less invasive procedures, and shorter stays. We are excited about 2022 as we continue to add advanced services to benefit our community and the region. In this issue, we also honor a special group of caregivers for their hard work, dedication, and outstanding care for our patients and their loved ones. Sadly, on January 4, 2022, we lost one of our honorees, Andrea Clarke. She is featured along with her fellow ICU nurses on page 55. “Andrea had an infectious smile and her heart welcomed everyone,” says Pam Canter, JMC’s chief nursing officer. “We were incredibly fortunate to have her as our first advanced practice nurse to join our intensivist team at Jupiter Medical Center.” Andrea touched many team members throughout JMC, whether attending to critical patients or just trying to help anyone in need. Her compassion and positive attitude left an indelible mark. To your health,

Amit Rastogi, MD, MHCM President and Chief Executive Officer Jupiter Medical Center

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PULSE Ask the Expert

Tips for combating a vitamin D deficiency The rise of antibiotic-resistant bacteria

Well-Being

The vital role laborists play in the delivery room and beyond Cardiac episodes among youth athletes

Prevention

Insight into the COVID vaccine and pregnancy How oral hygiene can impact heart health

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PULSE ASK THE EXPERT By Juliana Accioly

Follow the Sun Even in sunny South Florida, vitamin D deficiencies are prevalent among adults

Vitamin D is essential to good health, so much so that lowerthan-optimal levels can leave you feeling less than your best. Common symptoms of a vitamin D deficiency are fatigue, muscle cramps, bone and joint pain, and shifts in mood. Here, Dr. Peter Lyn, an internal medicine specialist at Jupiter Medical Center, discusses the importance of vitamin D, what can lead to its deficiency, and who’s most at risk. He also offers practical advice on sun exposure, a wholesome diet, and vitamin D supplementation. What is vitamin D and what role does it play in bodily functions? Vitamin D is the name of a group of compounds that are very important to many bodily functions. Vitamin D helps regulate the amount of calcium and phosphate in the body, nutrients we need to keep bones, teeth, and muscles healthy. Studies have shown that it also plays a role in heart health, immune health, and preventing certain cancers. Why is there a prevalence of vitamin D

deficiencies in the population, and why should we be concerned? Vitamin D deficiency is a very common problem in my practice. I have screened a lot of people who’ve had it, including youngsters and “gym rats.” Worldwide, about 40 percent of the population is lacking vitamin D. Its traditional main source is sunlight, which affects molecules on our skin and converts that into what we consider to be vitamin D. People drive cars everywhere now and don’t walk in the sunlight so much anymore. Many avoid the sun because of skin cancer or cover their skin with sunscreen, which shades the UVB rays responsible for the

conversion process. The elderly and those with darker skin (melanin blocks the UVB) are at higher risk of exhibiting an insufficiency, which could potentially increase health problems. How can we avoid vitamin D deficiency? It is difficult to say how much daily sunlight one needs, but it’s not a lot. Fair-skinned people don’t need as much as dark-skinned people. Ten minutes of exposure around 10 a.m. and 2 p.m. can usually do the trick. Diet is also an important factor. The main sources of edible vitamin D are fish, fish oil, mushrooms, and beef liver, along with milk, breakfast cereals, and orange juice that come fortified with vitamin D. How much supplemental vitamin D is recommended? If ingested in excess, vitamin D can cause toxicity in the body, causing symptoms such as confusion, abdominal pain, constipation, and kidney stones. The recommended daily intake is up to 1,000 IU per day as a supplement, but it’s important to check with your physician regarding how much you should supplement with. «

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PULSE ASK THE EXPERT By Seth Soffian

Ultimate Fighters Millennia-old bacteria are becoming resistant to modern antibiotics Antibiotics have been saving lives across the globe for decades, dating back to the discovery of penicillin in 1928 and its first widespread implementation in World War II. Today, however, the misuse and overuse of antibiotics has driven the rise of drug-resistant bacteria, widely acknowledged as a significant public health threat and a potentially looming global health crisis. Pinnacle recently connected with Dr. Daniel E. Peters, an infectious disease specialist at Jupiter Medical Center, to discuss what responsibilities providers have in addressing this problem and the role patients can play in helping to combat antibiotic resistance, a subset of a larger issue known as antimicrobial resistance, which also covers viruses, fungi, and parasites. According to the Centers for Disease Control and Prevention (CDC), at least 2.8 million Americans are infected every year from drug-resistant bacteria and more than 35,000 die as a result. How can individuals protect themselves and others? Do not take antibiotics outside the direction of a health care professional. This includes finishing your prescribed antibiotic course. Do not leave them in your medicine cabinet and take them again later when an illness arises. That can alter your diagnosis

if you are hospitalized, ultimately delaying proper treatment, prolonging your stay, adding to costs, and potentially exposing you to other drug-resistant germs. What is the provider obligation here? It all starts with the diagnosis. Some people’s perception of getting medical care is leaving with a medication or an antibiotic, whether it’s indicated or not. Others are using the shotgun approach to antibiotic prescription [employing an array of potential drugs, even if a diagnosis is unclear]. It’s not a good approach, for many reasons. Maintaining a relationship between patient and provider and providing follow-ups is very important. How is Jupiter Medical Center helping to lead improvements on this front? We’re in early discussions about establishing an antimicrobial stewardship program. A multidisciplinary team potentially would

include a clinical pharmacist, infectious disease practitioners, and others to monitor and guide the use of antimicrobials as an institution. Medical professionals and others have been sounding the alarm about drug-resistant bacteria and misuse and overuse of antibiotics for many years. How else can we communicate the message that we’re all in this together? I would point out something that’s always stuck with me. Microorganisms have been around for 3.5 billion years, as long as the world has been in existence. These microorganisms have learned and will continue to learn to live in the presence of anything we throw at them. It’s very important to start there, asking, as human beings, are we smarter than these microorganisms? As simple as their genetic makeup is, so far, I would say the answer is no. «

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Your First Choice for Cancer Care The Anderson Family Cancer Institute at Jupiter Medical Center sets the bar from South Florida to the Treasure Coast with a renowned multidisciplinary team of physician experts and support professionals. We provide patients with a full continuum of advanced cancer care using state-of-the-art diagnostic and treatment technologies all conveniently located under one roof.

The Anderson Family Cancer Institute at Jupiter Medical Center offers: • Advanced imaging, including 3T MRI & PET CT • CyberKnife M6TM, Varian TrueBeamTM Radiotherapy System

• Multidisciplinary Team of Medical, Surgical & Radiation Oncologists • Navigation Team

• Chemotherapy & Infusion

WORLD’S BEST HOSPITALS 2021

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PULSE WELL-BEING By Sandra Gurvis

The Importance of Laborists These ob-gyn hospitalists provide additional safety nets for women and their babies While childbirth is relatively safe in this country, problems do arise—a physician can get stuck in traffic, a baby can arrive early, or any number of other gynecological complications can occur at the most inconvenient times. Through its new laborist program, launching Spring 2022, Jupiter Medical Center plans to cover these and other contingencies. The idea of a laborist, an ob-gyn physician who specializes in inpatient care, is relatively new, having emerged in 2002 as an offshoot of the hospitalist movement of the 1990s. The American College of Obstetricians and Gynecologists (ACOG) defines hospitalists as “physicians whose primary professional focus is the general medical care of hospitalized patients” and officially refers to laborists as “ob-gyn hospitalists.” Highly trained and specialized, laborists not only help to mitigate potential complications and provide a chain of safe, consistent care to pregnant mothers and their newborns, but they also reduce the burden of 24-hour, on-call responsibilities that are common in many ob-gyn practices. Having an immediately available, well-rested physician can enhance patient safety and improve outcomes, according to ACOG. Along with helping to prevent physician exhaustion and burnout, laborists decrease the need for ob-gyns to have to reschedule appointments due to patients going into labor or requiring other unexpected care. “Laborists do the same things as the woman’s regular ob-gyn, from regular deliveries and C-sections, to admitting patients, to taking care of UTIs [urinary tract infections] and evaluating high-risk pregnancies,” explains Bernie Crosson, Jupiter Medical Center’s executive director of Women’s and Children’s Services. Having laborists on staff can eliminate potentially life-threatening delays in treatment while the patient waits for the on-call physician to arrive, as well as guarantee 24/7 continuity of care. “All our patients need to do is come to our OB emergency department any time of the day or night and they will see a board-certified OB physician,” says Crosson Within its program, JMC will employ four full-time laborists, including a medical director/team leader. JMC laborists will also provide treatment

to non-pregnant women who present to the emergency department with gynecological issues. After being assessed by an obstetrician certified by the American Board of Obstetrics and Gynecology (ABOG) and an obstetric registered nurse, “a plan of care will be developed for the mother and/ Jupiter Medical Center will soon have four or the baby, in collaboration with laborists (ob-gyn physithe patient’s primary OB physician, cians who specialize in whereby they will either be admitinpatient care) on staff. ted to the hospital or sent home with instructions and to make an appointment with their regular physician,” continues Crosson. Women who recently moved to the area or who don’t have an ob-gyn of record, “can also be seen, admitted if necessary, delivered, or given a referral to a JMC physician, if appropriate. One of the most important things for patients, especially those who are pregnant, is to find a physician or practice who can provide continuity of care.” Research has shown the efficacy of having a laborist program. A 2013 study led by Dr. Sindhu K. Srinivas of the University of Pennsylvania found it reduced the chance of having to induce labor and helped to prevent pre-term births. According to another study, “a dedicated ob-gyn hospitalist service was associated with a 27 percent reduction in the cesarean delivery rate as compared with the traditional model of care,” states ACOG. Allison Allen, a medical student at Oregon Health

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& Science University in Portland, and colleagues found that, when looking at a sample of 100,000 patients, “employing laborists was associated with 38 fewer intrapartum stillbirths (an 83 percent reduction), 25 fewer cases of major neurodevelopmental injury (a 17 percent reduction), and 15 fewer cases of neonatal death (a 13 percent reduction) per year,” reports MDedge ObGyn. Along with collaborating with the patient’s regular health care provider, laborists will also work with the staff “to develop policies and procedures and train nurses and other health care workers regarding best practices,” Crosson notes. More than 250 hospitals nationwide have laborist programs, “and that number is growing,” adds Crosson. JMC’s laborist program will be a “huge added benefit to women in the community.” «

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PULSE WELL-BEING By Lola Thélin

Cardiac Screenings Among Children For parents of youth athletes, being observant, communicative, and thorough are the best ways to prevent a cardiac episode The occurrence of sudden cardiac arrest in young people is a rare event, but the American Academy of Pediatrics still estimates that approximately 2,000 people younger than 25 die each year from sudden cardiac death (SCD). “Of these people we tend to see higher incidence rates in infancy and adolescence/early adulthood,” says Dr. David Drossner, who specializes in pediatric and fetal cardiology at Jupiter Medical Center. “Many of these cases are in asymptomatic individuals with no known prior cardiac history.” Sudden cardiac arrest (SCA) is a scary thought, and when the targeted population is children with no obvious risk factors, the scare factor intensifies. “People tend to think that obesity or poor lifestyle choices are risk factors for catastrophic events,” says Drossner. “This is not the case, as many times SCD affects young, healthy, athletic children with no apparent risk factors.” In addition, although SCA affects the heart, it is not a heart attack, which occurs when blood flow to a still-beating heart is blocked and is commonly preceded by chest pain. These cardiac episodes happen when the heart unexpectedly stops beating, resulting in a pause of blood flow exiting the heart. Hypertrophic cardiomyopathy (HCM) accounts for approximately 40 percent of SCA cases and is the No. 1 cause of SCD in school-age children. With this condition, the heart muscles become abnormally thick, making it harder for the heart to pump blood, which can cause dangerous arrhythmias. Precaution is the best line of defense for parents and their children. “It is estimated that nearly half of those with SCD experienced

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symptoms or warning signs,” says Drossner. It is crucial that parents schedule their children’s yearly physical and evaluation, where a pediatrician can screen them for signs, symptoms, or other risk factors that may suggest an underlying condition known to cause sudden cardiac arrest. Parents should communicate their family history and child’s symptoms to help the pediatrician identify children with underlying cardiac conditions. In addition, parents should bring their children to the doctor if they are experiencing unexplained fatigue, a significant decrease in physical stamina, exertional chest pain, palpitations, or passing out amid physical activity, after startle or scare, or without any warning signs. “Pre-participation physical exams and questionnaires focus on identifying these warning signs,” says Drossner. “An additional red flag worth noting is family history. Many of the etiologies for SCD have identifiable inheritance pat-

terns. For any symptoms we suggest discontinuing activity and seeking appropriate care.” Many children participate in highly physical activities, so it is difficult to pinpoint certain ones most likely to lead to cardiac arrest. Aside from the visit to the pediatrician and parents observing their children, Drossner says the next best course of action is to communicate with school coaches and athletic departments to ensure they are prepared for possible cardiac arrests on a sports field. This includes adult participants being certified for basic life support (BLS) such as CPR and automated external defibrillators (AED) training.

“Automated external defibrillators are a key link in the chain of survival for out-of-hospital cardiac arrest,” Drossner notes. “I would recommend parents ask schools and commissioners of local sports organizations how many of the coaches are certified in BLS, where are your AEDs, and do you participate in organized drills to prepare for the rare event of sudden cardiac arrest.” «

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PULSE PREVENTION By Sandra Gurvis

COVID-19 Vaccines and Pregnancy What to consider when you are expecting Dr. Anthony Shaya, an ob-gyn at Partners in Women’s Health in Jupiter, has seen this scenario play out too many times: “Even though I encourage my patients to do so, many of them still decline to get the COVID-19 vaccine,” says Shaya, who practices at Jupiter Medical Center. As a physician, he finds it especially distressing to see his patients and their families suffer, since “thanks to the vaccine, it’s mostly preventable.” While much still needs to be learned about the virus and the long-term effects of the vaccine itself—just like the now well-established shots for polio, the flu, and shingles—the Moderna, Pfizer-BioNTech, and Johnson & Johnson jabs, “have been held to the same rigorous safety and effectiveness standards as all other types of vaccines in the United States, with the same number of patients being studied,” notes Shaya. The only difference is that they were disseminated quicker, using emergency authorization, with approval from the Food and Drug Administration (FDA) following a few months later. With the Pfizer-BioNTech and Moderna vaccines, he says, “more than 30,000 pregnant women were studied, with no more side or adverse effects” than in the non-pregnant population. Additionally, Shaya continues, “while the vaccine is new, the science behind it is not.” The Women who opt to get vaccinated can add to the body of information through the vsafe pregnancy registry as well as the v-safe app, which provides personalized health check-ins after vaccination.

technologies for the Pfizer and Moderna messenger RNA (mRNA) vaccines and the Johnson & Johnson viral vector vaccine were developed in the 1970s. The mRNA technology was utilized to study flu, Zika, rabies, and cytomegalovirus (CMV) vaccines and, for cancer patients, to trigger the immune system to target specific cancer cells. The European Union approved a vaccine utilizing the viral vector technology for use against Ebola, with studies on pregnant women proving it to be safe and effective, according to information from the Centers for Disease Control and Prevention (CDC). When weighing whether or not to get a COVID-19 vaccine, mothers, mothers-to-be, and women thinking about getting pregnant should consider the following: There is an increased risk of severe illness for both mother and baby. The CDC states that “people who are pregnant or recently pregnant are at an increased risk for severe illness from COVID-19 when compared to people who are not pregnant.” Not only does pregnancy cause changes in the body that could make it easier to get very sick from respiratory viruses like COVID, but the changes can continue after pregnancy too. Adds Shaya: “Those who do come down with COVID-19 not only endanger

themselves but their babies as well.” Non-vaccinated pregnant mothers tend to get sicker and have longer hospital/ICU stays, according to a study from the Infectious Diseases Society of America. This can include intubation and “long COVID” health aftereffects. “Risk of moderate-to-severe or critical illness increased with the number of underlying medical or pregnancy-related conditions,” the study states. COVID-19 greatly increases chances for complications in pregnancy. A study of pregnant women in 18 countries found that COVID-19 patients had much higher rates of adverse outcomes, including maternal mortality, preeclampsia (dangerously high blood pressure), and preterm birth, according to the Journal of the American Medical Association (JAMA) Pediatrics. Another study of 240,000 births between July 2020 and January 2021 observed a 60 percent increased risk of “very preterm” birth (fewer than 32 weeks of gestation) and a 40 percent increased risk of preterm birth (fewer than 37 weeks) for those who contracted the coronavirus during pregnancy. Compared to uninfected women there is a greater chance for stillbirths, which increased four-fold after the Delta variant emerged,

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as evidenced in another study of more than 1.2 million deliveries, reports the CDC. Although stillbirth is relatively rare in the United States and the study called for additional refinement of data, numbers don’t lie: “0.98 percent of COVID-19–affected deliveries pre-Delta and 2.70 percent during the Delta period resulted in stillbirth,” the study found. Vaccine antibodies are transmitted from mother to baby via the placenta/umbilical cord and in breast milk, which means the baby is offered much protection before and after birth. A study of pregnant and lactating women receiving the mRNA vaccine found that robust immunity was conferred in both mother and child, although more data is needed to assess the level

of antibody protection in babies. Nevertheless “vaccine-induced immune responses were statistically significantly greater than the response to natural infection,” reports the American Journal of Obstetrics & Gynecology. Professional medical organizations such as the American Society of Reproductive Medicine (ASRM), American College of Obstetricians and Gynecologists (ACOG), and American Academy of Pediatrics (AAP) “emphasize that there is no evidence that COVID-19 vaccination causes a loss of fertility,” states the CDC. This applies to anyone of reproductive age, including adolescents and men. “These organizations also recommend COVID-19 vaccination for people who may consider getting pregnant in the future.”

It should be noted that, in December 2021, the CDC issued a recommendation that vaccines other than Johnson & Johnson’s should be preferred due to its link to a rare blood-clotting disorder. The risk was highest in women 30 to 49, although pregnancy was not a factor. As the pandemic drags on and variants emerge, it’s apparent that COVID is not going away any time soon. Additional boosters may be required, and medical professionals such as Shaya continue the battle against misinformation. “As physicians, the only skin we have in this game is to make sure our patients are safe and healthy,” he says. «

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PULSE PREVENTION By Seth Soffian

More than a Smile

The unseen health risks of poor dental hygiene

It’s universally understood how important good oral hygiene is to healthy teeth and gums. But there’s another reason people should take care of their mouths: the established link between oral hygiene and heart health. While a definitive cause and effect has

not been established, numerous studies have shown how people with poor oral hygiene are at greater risk—by as much as two to three times—of serious cardiovascular problems, such as heart attack and stroke. The connection largely centers around oral bacteria related to gum disease and tooth damage. Such bacteria enter the bloodstream and have been found to cause inflammation and infections in the heart, as well as in the brains of those who have had strokes, brain aneurysms, or blood clots in the leg. “There are various studies that correlate with similar findings,” says Dr. Steven Kessel, a cardiologist with Jupiter Medical Center and

the Palm Beach Cardiology Center. “People who have better dental care, better oral care, have less vascular disease: heart attacks, strokes, heart failure. People with worse oral hygiene generally have worse heart health.” Kessel notes, just as researchers have, that people who have better oral hygiene may simply have better overall health practices or access to health care, and that more research is needed. There’s also no proof that treating gum disease prevents cardiovascular disease or its complications. Still, the impact of harmful oral bacteria is enough that cardiologists, as a matter of practice, check the mouths of their patients, including those headed toward cardiac procedures, to reduce the risk of oral bacteria spreading to the heart. If necessary, they’ll order oral treatments and interventions. “The cardiothoracic surgeons will make sure patients have good dental health before they do any surgery on them,” Kessel says. “Once you place an artificial valve in a patient with poor oral health, the valve has the potential to become infected. That is a serious complication known as endocarditis in which the bacteria can damage the valve or cause blood clots and infection throughout the body.” Studies examining the link between oral health and heart health emphasize twice-daily toothbrushing for at least two minutes, along with regular flossing and twice-annual dental cleanings. The concern over excess or harmful bacteria spreading elsewhere in the body is enough that some dental insurers have begun recommending more frequent dental checkups for higher-risk patients, says Dr. Pamela Bell, owner of Maplewood Dental in Jupiter. “The insurance companies have decided it’s actually to their benefit to pay for more preventative treatment for people who have

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systemic issues, like cardiovascular disease, diabetes, and even pregnant women,” Bell explains. “These at-risk patients are given insurance benefits to get their teeth cleaned three or four times a year instead of just twice a year, which has been standard forever.” Bell notes, as other medical professionals have, that it’s common to have some bacteria in the bloodstream regardless of oral health. The Centers for Disease Control and Prevention (CDC) has found that nearly half of adults age 30 and older in the United States have some form of gum disease, while more than 70 percent of those age 65 and older have gum disease. “Most people introduce bacteria into their bloodstream every day from eating and brushing,” Bell says. “But when you have gum disease, you have much more bacteria in your mouth, which enters your bloodstream. And the type of bacteria can be more harmful.”

A study published in 2018 in the American Heart Association’s journal Hypertension found that gum disease was linked to higher blood pressure and could interfere with the effectiveness of medications to treat high blood pressure. Studies have also identified associations between harmful oral bacteria and greater risks for or impacts from other health problems, such as diabetes, rheumatoid arthritis, and pancreatic cancer. Medical professionals have said that the harmful effects of prolonged inflammation—the body’s natural immune response to chronic infection—are important in better understanding the role oral bacteria play in increased risk of

cardiovascular issues. Still, even without proof of causation, experts say it’s vital to understand the link between oral health and heart health. “If they already have an underlying heart condition, an infection will exacerbate it,” Kessel says. “Heart failure will worsen. Arrhythmias can occur. Atherosclerotic plaque that may exist in a coronary artery are prone to rupture and cause a heart attack, due to stress and inflammation from the infection.” «

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When LESS is MORE

Minimally invasive and transcatheter procedures represent a new frontier for critical heart surgeries By K.S. Meyer

I New alternatives to openheart surgery include minimally invasive procedures, MitraClip, and TAVR.

magine, for a moment, the many elements involved in the firing of a rocket engine: the propellant, the oxidizer, the preheat and intermix chambers, the networks of turbines, channels, and passive cooling coils shuttling everything toward a controlled combustion that propels the immense mass of the rocket into orbit. Now consider somehow stopping that rocket engine 30 seconds into flight, replacing a crucial component of its machinery, and then letting it continue on its trajectory without the launch failing. This, essentially, is what heart valve replacement surgery entails. The organ responsible for keeping all others in the body constantly supplied with blood does not stop and cannot be stopped for repairs without either dire consequences or mind-boggling measures of intervention.

Historically, this has meant openheart surgery. The very words have always taken patients and families aback, as these are among the most complex, invasive, and risky procedures performed—usually as life-saving last resorts, when all other options for treatment have failed. The sternum is cut in half. The heart’s motion is paused, and blood flow is directed out of the body through a heart-lung machine. The amount of anesthesia required is profound, as are recovery times and the list of possible complications. At least, that used to be the status quo. While the unpleasant realities of open-heart surgery are still a fact of life for the most severe and difficult cardiac valve replacement cases, several newer treatments—minimally invasive heart surgery, MitraClip, and TAVR, in particular—are giving patients hope for more complete recoveries in less time and with fewer side effects. “Minimally invasive surgery is sort of a bridge between transcatheter surgery and full, sternotomy, open surgery,” explains Dr. Arthur Katz, the medical

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In some patient populations, artificial heart valves (right) can now be placed using minimally invasive and transcatheter procedures.

director of cardiac surgery at Jupiter Medical Center. Instead of splitting the rib cage fully down the middle, as with open-heart, minimally invasive surgery utilizes “porthole” incisions either in the upper third of the sternum or on the side of the chest between the ribs. While this may seem limiting, for the right patient—typically those who only require work on a specific location within the heart—it can be quite advantageous. “With minimally invasive surgery, you don’t have access to the whole heart, so you do things in a different manner,” says Katz. “You put people on the heart-lung machine through the groin or through a small incision in the chest instead of opening the entire breastbone.” However, the pathology’s severity and geography within the heart limits the procedure to only a subset of patients. “It is good for people with isolated cardiac problems, but if you have multiple problems, you can’t really address them through a small porthole that only lets you look at one part of the heart,” notes Katz. Even less invasive than this, yet somehow more promising in its applications for valve treatment, is transcatheter surgery. The MitraClip device and a procedure known as transcatheter aortic valve replacement (TAVR) are two treatments at the forefront of this intervention. The MitraClip is used to treat a condition known as mitral valve insufficiency. “Mitral valve insufficiency is like a leaky pump,” explains Katz. “Every time you pump something forward, some of it comes back, and over time, you’re pumping the same blood over and over again, and the heart gets weaker.”

The mitral valve is positioned in the left side of the heart, above the chamber responsible for pumping blood to the rest of the body, and its dysfunction can have grave results. To fix this, the MitraClip device is placed—through a catheter inserted via the femoral vein in the upper leg and routed through the vena cava and into the heart—directly onto the leaflets of the mitral valve to help them close more completely. TAVR uses the femoral artery as a means of accessing the heart—through a very small cut in the upper leg rather than cutting through the chest—to replace the valve of the largest artery in the body, the aorta. Katz explains how this is done, referencing the analogy of replacing part of a firing rocket engine: “We put a temporary pacing wire in, to make the heart beat very quickly while we deploy the valve—it’s like pausing the launch. By pacing the heart very quickly, it keeps the heart from pushing blood out when we deploy the valve, so it doesn’t make the valve move away from where we want to position it.” The TAVR process has been in practice since 2011. When it originated, it was highly experimental, and there were far more complications and less optimistic outcomes associated with it due to its novelty. However, says Katz, “transcatheter aortic valve replacement has really come dramatically forward in the United States. In the beginning, the catheters were much bigger, so especially in small women we had trouble getting up the femoral artery because they could be tortuous, they could be small, and there were a lot of vascular complications related to that. Technology has advanced, making these catheters smaller and easier to pass. The catheters are slippery now—they used to sort of stick to tissues, but now they have a hydrophilic coating that allows them to slide in and out of blood vessels.” Katz also points out that the higher resolution imaging and hyperaccurate control of the navigational mechanisms involved in snaking the catheter through the blood vessels and heart chambers have greatly improved outcomes and reduced risks. “In 2011, when we first started doing them in the United States, you had to be inoperable. And it wasn’t just one surgeon who had to say you were inoperable—it was two surgeons, because there were a lot of complications and a lot of risks with it. Nowadays, it’s been shown that the younger and healthier you are, the better you do with a TAVR. So now, a TAVR is open to virtually all patients.” While all surgeries carry some risk of complication and level of discomfort, physicians and their patients are finding that the offerings of minimally invasive and TAVR surgeries significantly reduce these. Regarding minimally invasive heart surgery, says Katz, “there’s still some incisional discomfort, especially for the thoracotomies, because you’re spreading the muscle and the ribs. For the partial sternotomies,

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“More than one patient here [has] told me they didn’t realize how sick they were until after they had their TAVR.” —Dr. Arthur Katz they do a lot better because you don’t divide all the breastbone. It takes a good couple of months for your breastbone to heal, so if you only need to divide the upper third of the breastbone and the rest of it is intact—so as you’re coughing, you’re deep breathing—you’re not feeling pain there.” Likewise, for the MitraClip, “there’s no recovery—it’s a single groin puncture,” adds Katz. More importantly and impressively, though, is the degree of recovery most patients observe almost immediately after surgery. To gauge patient improvement, Katz references the New York Heart Classification for diagnosing heart failure, the most common presenting symptom of mitral valve insufficiency. “The stages are very specific: one is no symptoms, four is that you’re basically short of breath at rest and you are very limited in what you can do. Most patients are Class 3 heart failure—they get winded with minimal exertion. Class 2 heart failure is they get winded with normal exertion.”

Those who receive the MitraClip procedures, he notes, “feel better by one New York Heart Classification—at least one, the majority of them. Quite a few feel better by two stages.” TAVR operations also offer the benefit of no general anesthesia— utilizing conscious sedation instead—and only a small incision in the upper leg, along with the associated minimal recovery time and patient improvements that are even more remarkable. “Usually, they feel dramatically better right off the bat because they have all the benefits of a new valve that is working well and they don’t have to recover from surgery,” says Katz. “More than one patient here [has] told me they didn’t realize how sick they were until after they had their TAVR.” While minimally invasive surgeries have been available for decades, TAVR surgeries have been available only the last decade—MitraClip surgeries even more recently—and overwhelming progress has already been made in the screening for and implementation of these modalities in an increasing pool of candidates throughout South Florida. More importantly, the technology is ever evolving, concludes Katz. “There are newer and newer generations of devices that are already in the works that will address the things we found in the past and improve issues that we’ve already been working on. I think the future is bright and the outcomes are going to become better and better.” «

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Next-Gen Treatment

of Peritoneal Cancer

Technological advances for abdominal cancer surgery are extending survival and improving quality of life By K.S. Meyer

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n the last few decades, survival rates for most cancers have improved dramatically with the development of more sophisticated technologies and practices for earlier, more specified diagnoses as well as more intricate, personalized courses of treatment. Indeed, some cancers are becoming more comparable to manageable chronic conditions than the acute, life-threatening illnesses they have been since the dawn of time. However, one notable exception that remains among the most difficult cancers to treat are cancers that spread to the peritoneum, the tissue that lines the interior of the abdomen and covers and binds together the organs therein. This almost always occurs as a Stage 4 metastasis of a cancer originating in one of these organs, most often the colon, ovaries, or appendix, and by the time it is identified, the patient’s cancer has progressed so far that there are few, if any, treatment options available. For patients with this diagnosis, survival is often measured in months, not years. “The limitation with a diagnosis like this is very similar to pancreatic cancer,” explains Dr. Shanel Bhagwandin, medical director of gastrointestinal surgical oncology at Jupiter Medical Center. “I never use the word ‘cure’ when talking about a treatment like this. The way that I was taught it—understanding the biology of the disease, particularly when it carries such a poor prognosis—is that we’re almost resetting the clock. We know that there’s metastatic disease, Stage 4 disease, and when I have a patient in front of me, we know that their survival is likely going to be limited

by that diagnosis, so a lot of our conversation is geared toward, ‘How can we, taking into consideration quality of life, improve survival? How, although survival may be limited, can we improve it by years as opposed to months?’ That perspective and understanding are key. Many people are living longer as the result of advances in our treatments.” Because an aggressive, advanced cancer requires equally aggressive therapy, and because for patients with peritoneal cancer the question of end-stage disease typically is not one of “if” but of “when,” the factors concerning quality of life are particularly salient. Frequent, heavy rounds of intravenous (IV) chemotherapy have long been the course of action for treating cancers when they involve the peritoneum. With these come the host of well-known, widely feared side effects: nausea, vomiting, weight loss, weakness, fatigue, immunosuppression, and hair loss, to name a few. For these patients, the prospect of enduring such symptoms with so little time left can be unappealing, to say the least, but recent surgical advances (cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS/HIPEC), irreversible electroporation (IRE), microwave ablative surgery, and minimally invasive/ robotic-assisted surgeries, in particular) may be poised to change this outlook. With these operations, says Bhagwandin, “the accompanying survival benefits do offer the appropriate momentum that can carry a patient through their next set of treatment, but not only that. Although chemotherapy is integral, there is an opportunity here to move away from IV chemotherapy for a period of time, and that’s what I mean by ‘resetting the clock.’ There’s a high likelihood that this disease will come back, but it doesn’t have to be in a month or two months; it may be in a year or longer, [during which time] you have that break from chemotherapy, the fear of wondering whether it’s going to progress, and certainly all the challenges that come with the psychosocial understanding of an aggressive disease that usually carries with it that six-month prognosis.”

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“Many people are living longer as the result of advances in our treatments.” —Dr. Shanel Bhagwandin Cytoreductive surgery—the physical debulking of tumorous tissue inside the abdomen—has been utilized for the treatment of cancers since the mid-twentieth century, but it has only become more refined as the tools available to surgeons as well as the wealth of theory and literature behind the procedure have evolved. It wasn’t until closer to the twentyfirst century, on the other hand, that the benefits of HIPEC—the process of flushing the peritoneum with a heated chemotherapeutic agent—were first explored, and it has only been in very recent decades that the two procedures have been combined in order to compound each other’s efficacy. Bhagwandin describes how they are done in tandem, during a single visit to the operating room, and how they benefit the patient: “We start the procedure off with an operation in which all visible cancer cells are removed surgically. That can involve a number of procedures combined in one, in which we are removing organs or parts of organs. Once all visible tumors are removed, it’s inevitable that there are going to be microscopic cancer cells left behind, and if untreated, they will persist and cause a recurrence of the tumor. We can then deliver the hyperthermic chemotherapy to treat those microscopic cells at the same time of surgery in the one setting. The idea is that the chemotherapy will come into contact with those cells that can’t be seen with the naked eye and eradicate them.”

JMC takes a multidisciplinary approach to peritoneal cancers, convening doctors with various specialties to create a treatment plan.

The concept behind this compound procedure is ingenious, yet simple to understand, and requires the expertise of a board-certified surgical oncologist trained not only in correct patient selection but technical ability too. The heated chemotherapy penetrates deeper into the tissue, allowing it to absorb a far more concentrated dose without putting the patient at higher risk, effectively “cleaning up” whatever is left behind after the cytoreductive surgery. “We can give very high doses of chemotherapy during the operation that the patient otherwise normally wouldn’t be able to tolerate if given through IV,” says Bhagwandin. “That’s a benefit, that you can minimize the systemic side effects of chemotherapy because it stays in the abdomen. The thermodynamics have shown that the chemotherapy can penetrate the tissue a little bit deeper (when heated) without causing a significant amount of injury to the underlying structures.” Of course, the most effective way to treat peritoneal metastasis is to not allow it to develop in the first place. If it can be detected early, recognizing and removing the primary cancer from or within the organ it affects eliminates its opportunity to spread. Traditionally, this too is first attempted through IV chemotherapy, particularly when the tumor burden is too high or is close to a vital structure—a blood vessel, for example—and is deemed “unresectable,” meaning unable to be surgically removed. This, explains Bhagwandin, is a frequent occurrence. “While some aggressive liver, bile duct, and pancreatic cancers can be removed surgically, the majority in fact are inoperable, so we do have to find alternative means to treat them.” Irreversible electroporation (IRE) and microwave ablation are two such alternatives showing significant promise both in primary organ tumor treatment as well as metastatic disease. IRE involves the use of intense bursts of electricity, delivered by a device called a NanoKnife, to destroy cancer cells in situ rather than removing them. “It uses highvoltage direct current that doesn’t injure the surrounding noncancerous cells—blood vessels, etc.,” describes Bhagwandin. “Microwave ablation,” similarly, “is a surgical technique that uses microwave radiation to heat and treat tumors in the liver, particularly that are metastatic.”

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In addition to treating metastasis to the peritoneum and liver, Bhagwandin remains the only fellowship-trained surgical oncologist in the region performing the highest volume of surgery for esophagus, stomach, pancreas, liver, and bile duct cancers. Other novel submodalities for surgical treatment of abdominal cancers include minimally invasive and robotic-assisted surgeries, which aim to accomplish the same outcomes as traditional open procedures without the need for large incisions and with the enhanced capabilities for ultra-fine operations only a machine can provide. “We utilize robotic surgery to minimize incision pain, postoperative pain, things like that,” explains Bhagwandin. “It’s the same cancer operation, but it allows patients to return home faster and not deal with the quality-of-life issues—the big wound, potential for hernias, wound infection, etc.” Even more impressively, these benefits of minimally invasive and robotic-assisted surgery are now being integrated with the extraordinary results of CRS/HIPEC. “This past year, I was able to do the first robotic HIPEC procedure at Jupiter Medical Center,” says Bhagwandin. “That’s only been done a handful of times in the state, where a patient had a limited amount of disease, where you get a minimally invasive

approach to treat the cancer that has spread outside of the colon, remove it robotically, but then also deliver the chemotherapy through cannulas via the small incisions.” Despite these advances, the diagnosis of abdominal or peritoneal cancer remains a sobering one. While patients must still reconcile themselves with the fact that they will ultimately succumb to their illness, these novel treatments can now mean that their final months or years—as may increasingly be the case—need not be spent in constant pain or discomfort. “Looking at this philosophically,” says Bhagwandin, “this becomes the momentum that some patients need when they’ve been dealing with the diagnosis and the only treatment option that’s been offered is IV chemotherapy. If we can go to the operating room and come out of it and tell someone who was initially labeled as Stage 4 disease with a worse prognosis, ‘You have no cancer left inside,’ that’s powerful.” There is a great deal of optimism about the future of treatments for this type of cancer, considering the overwhelming progress that has been and continues to be made. It is reasonable to believe that someday, with regards to prognosis, “months” will become “years” and, eventually perhaps, “years” will become “decades.” «

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The Power

of Philanthropy With generous support from the community, donors advance the hospital’s mission and quality of care By Judy Martel

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Donors Peter and Missy Crisp

he easiest way to describe the community’s generosity toward Jupiter Medical Center would be to cite the numbers. As of March, donors have met the challenge, contributing more than $300 million and exceeding the goal of the Vision. Innovation. Impact. campaign to fund the hospital’s continued expansion in cardiac, cancer, and pediatric care, as well as its construction of the new Surgical Institute and the addition of both cuttingedge technology and a staff of top-tier physicians and nurses. But numbers don’t tell the whole story. Behind the charitable fiscal donations lies the compassion and devotion of hundreds of individuals whose actions are just as vital to maintaining JMC’s position within top hospital rankings nationwide. During the height of the COVID-19 pandemic, for example, not only did donors increase their contributions to assist with recovery efforts, but one donor also ordered and paid for a complete Thanksgiving dinner for

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workers on all three shifts. Another arranged to send an ice cream truck. “The heartfelt gifts touched us,” says Michael Morsberger, chief philanthropy officer and president of the Jupiter Medical Center Foundation. “These things go a long way toward saving patient lives and boosting staff morale at a critical time.” It’s no wonder Jupiter Medical Center Foundation is dedicated to ensuring donors feel valued in return, as it continues to expand while maintaining its standards of excellence. “We are the region’s only independent medical center and we are here for the sole purpose of serving the community in a world-class way,” says Dr. Amit Rastogi, president and CEO of Jupiter Medical Center. There’s a lot going on behind the scenes to back up that statement and ensure its future. “Demand for all our services continues to grow,” Rastogi notes. “Our women’s and children’s program broke all previous records for deliveries in 2021. In addition, our cancer treatment, orthopedics, and emergency care are all growing.” Since the launch of Jupiter Medical Center’s 2015 campaign, Vision. Innovation. Impact., donations have fueled several landmark projects. The 16-bed De George Level II Neonatal Intensive Care Unit offers advanced respiratory capabilities and monitoring to allow for babies born as early

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Donors Jayne and Timothy Donahue

“

These things go a long way toward saving patient lives and boosting staff morale at a critical time.” —Michael Morsberger as 32 weeks. The Robson Heart and Vascular Institute, the second phase in JMC’s Donahue Cardiac Surgery Program, includes a cardiovascular ICU and a vascular disease program. The Anderson Family Cancer Institute at the Crisp Cancer Campus boasts a 55,000-square-foot facility dedicated to cutting-edge cancer care. Money raised will continue to fund expansion efforts as well as state-of-the-art equipment and the recruitment of world-class physicians.

Michael Morsberger

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The latest project in the growth of the JMC campus, scheduled to open in 2023, is the 90,000-square-foot Surgical Institute, with 16 operating suites and two hybrid operating suites. So far, donors have contributed $24.5 million toward the $90 million goal. “The multipurpose Surgical Institute is our focus now,” says Rastogi. The facility will accommodate all the latest technology for minimally invasive surgery as well as larger procedures such as open-heart surgery. “The key elements of providing great care start with recruiting great physicians and giving them cuttingedge technology in a state-of-the-art facility,” he adds. Morsberger says the community has been so generous and engaged that he feels “the potential for JMC is almost unlimited.” But it still takes dedication to maintain and increase donations going

forward. “We’re a lean and mean, small operation compared with some of our peers,” he notes. “I want to ensure we have the staffing in place to serve our donors and form a true philanthropic partnership. Some of our donors have been with us for decades.” Developing new donor relationships is never relegated to the back burner, even as existing donors are nurtured. “I believe fundraising is a contact sport—the more contacts you make, the more money you raise,” says Morsberger. As the region’s population swells, especially with seasonal residents, JMC has had the opportunity to attract the right kind of attention from potential donors. “We’re a five-star, world-class facility right in their backyard. That doesn’t happen by accident. Our vision is to continue to enhance the brand.”

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“

We become emotionally invested in the hospital as well as in our fellow volunteers and, to a degree, with patients.” —Fred Lissauer

CALLED TO SERVE

To introduce potential donors and engage existing contributors, the foundation hosts a myriad of events and receptions, including an annual golf tournament. Foundation staff are also very involved in the community through various committees, councils, and sponsorships. They also host a number of engaging clinical lectures with JMC physicians. “These are all ways to get to know people,” Morsberger says. Morsberger is also quick to praise the dedication of the hospital’s 600 volunteers, who not only donate time and expertise in all areas of JMC’s operations and delivery of care, but also staff the largely volunteer-run gift shop and thrift store. “I don’t think capital is the only way to make an impact,” he says. “Our volunteers provide an extraordinary number of services to our patients and staff.” Although the future looks bright, Morsberger doesn’t forget the task at hand or the goal of the Jupiter Medical Center Foundation. “We are dedicated to maintaining our position as the preeminent health care provider in the area, so we can’t just sit on our hands,” he says. “I feel like we have an imperative to the community to keep this health system among the very best.” «

Their work might not always be visible, but the 600 volunteers who lend their talent and time are a vital asset in maintaining the high standards of care at Jupiter Medical Center. Most of them would say that for as much as they put into the calling, they get more in return. Although little is yet known about all the positive mental and physical benefits of volunteering, a study by Carnegie Mellon reports that the act alone can potentially reduce stress and lower blood pressure. To those giving their time, it hardly matters. “I don’t know about the physical benefits of volunteering, but it’s a wonderful feeling of satisfaction,” says Fred Lissauer, president-elect of the Jupiter Medical Center Auxiliary and a volunteer of eight years. “I can’t quantify it, but there’s an emotional tie with patients and team members at the hospital. It’s just a feel-good experience that’s mentally beneficial.” The hospital’s volunteers come from all walks of life— doctors to auto mechanics,

nurses to homemakers. The auxiliary offers them a chance to foster friendships, especially for those who are new to the area. “We become emotionally invested in the hospital as well as in our fellow volunteers and, to a degree, with patients, especially if we see them on a regular basis,” says Lissauer. In fact, many returning patients ask to see specific volunteers. Lissauer began volunteering after he moved to town from Baltimore and sought a way to put down roots in his new community. While living in Baltimore, he worked for the McCormick food company, spending 50 to 60 percent of his week traveling for business. With excess time in retirement, he approached JMC and began volunteering as a driver for Motor Aid, offering free rides to patients to and from their health appointments. As Lissauer notes, volunteering can help those find a sense of meaning during these secondact stages of life. “Most of our lives are spent working in our careers, but then you’re given a watch and walk out the door and say, ‘What’s the next chapter?’ Throughout my life, I’ve received kindness, and this gives me an opportunity to give back and receive something in return.”

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A CUT ABOVE

hen it opens in 2023, Jupiter Medical Center’s Surgical Institute will offer area residents a state-of-the-art complex designed to enhance the surgical experience for both patients and medical staff. With 16 advanced operating rooms and two fully equipped hybrid operating rooms, the 90,000-square-foot institute will bring the hospital’s physical facilities up to par

Jupiter Medical Center’s new $90 million Surgical Institute will pair trailblazing, high-tech equipment with creature comforts to enhance the experience for both patients and physicians By Karen Feldman

with the technical capabilities of its highly skilled surgeons. JMC physicians across a variety of specialties are excited about the prospect of this next generation in surgical care. The current surgical suites were built in 1995, and while that might seem like not that long ago, the medical advances that have occurred since then have been substantial. New technologies and techniques have resulted in less invasive methods and

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Artist’s rendering for illustrative purposes

surgeries, better outcomes, and shorter hospital stays. However, the use of robotics, video equipment, and other technology not previously available has led to crowding in operating rooms. The new suites will be larger and equipped to combine traditional surgery with image-guided interventional capabilities. Surgeons, radiologists, and other medical providers will team up to perform sophisticated procedures in real time. With an emphasis on enhancing collaboration, the Surgical Institute will also include anesthesia workrooms, multiple nurses’ stations, staff offices, and a physicians’ lounge within a short distance of the operating suites. For Dr. Arthur Katz, JMC’s medical director of cardiac surgery, the upgrades within the hybrid operating rooms mean the availability of more advanced equipment that will enable the heart team to do more minimally invasive The new Surgical Institute will span 90,000 square feet and boast the facilities and technology needed to treat more complex conditions.

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Some ORs will house the latest, most advanced Da Vinci Surgical System for robotic-assisted surgery.

“

We’ll be getting more minimally invasive and be able to apply it to more conditions in the future.” —Dr. Bassam Sayegh heart procedures, including those for atrial fibrillation (an irregular, rapid heart rate) and delicate heart valve interventions. “The new hybrid ORs will enable us to do structural heart (TAVR and MitraClip, Cardiac for example) and complex aortic vascular operating suite procedures,” he says. “This will enhance our capacity to continue doing state-ofthe-art procedures with the highest quality outcomes.” Dr. Bassam Sayegh, who performs general, vascular, and robotic surgery, believes the new institute will allow surgeons to refine an already excellent program. “We’re doing minimally invasive procedures now, but we’ll be getting more minimally invasive and be able

to apply it to more conditions in the future,” he says. Other procedures the physicians anticipate being able to complete more easily in the hybrid rooms include placing stents in carotid arteries through small incisions in the neck and, because of better imaging, salvaging legs that have contracted gangrene, thereby avoiding

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amputation. “Better imaging translates into more limb salvage,” explains Sayegh. “We’re so excited about it.” In the new Surgical Institute, JMC’s passion for perfection led it to design its operating rooms with an eye to the future, which carries an ever-changing need, as medical technology evolves quickly and JMC is committed to being on the cutting edge. With this timeless design, every single operating room will be spacious enough to easily and efficiently accommodate all needed equipment to perform the most complex and advanced surgeries. The expansive layout will allow for the placement of state-of-the-art tele-surgery equipment, which is going to bring unique medical capabilities to JMC, especially in robotic surgery. Any surgeon at JMC will be able to team up with a renowned surgeon from any major medical

center anywhere in the country or the globe to perform complex cases, giving patients in Palm Beach County access to world-class medical care right here at home. Dr. Matthew Stiebel, who specializes in sports and orthopedic medicine, is looking forward to the ultra-high-definition 4K monitoring system he will employ for arthroscopic procedures. “It will be a huge step up,” notes Stiebel, adding that robotics will play a bigger role in joint replacement as well. “I’m very excited,” says Dr. Christopher Boyes, a vascular surgeon. “For vascular surgery, the more important thing is going to be the hybrid operating rooms. As the surgical landscape changes, more technology allows for more minimally invasive techniques to be introduced as it relates to vascular surgery. The hybrid room allows for more advanced vascular procedures, so we can continue to remain at the forefront of progress for continued innovation.” Among those advances Boyes cites the ability to treat complex aortic aneurysms. The way they are done now involves the use of a mobile medical imaging device known as a C-arm. In the hybrid rooms, these will be built in. “As robotic surgery advances, more equipment is needed to keep up with technology and innovation,” he says. “Stuffing this in the current rooms leaves very little walkway. The much grander space certainly allows more room for equipment, machines for complex surgery, and will hopefully provide for continued expansion as innovation continues to grow.” Infection control will be yet another area of concentration, with built-in sterilization lighting, hands-free door operators, and advanced ventilation. And, because hybrid operating rooms are based

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The Surgical Institute will also dedicate more resources to sterlizing and managing surgical instruments.

around a variety of high-tech imaging equipment, the patient need not be moved during surgery to use it. Integrating advanced surgical imaging and information technology will allow for data collection from multiple locations, which surgeons can then access during procedures. Using robotics and telemetrics, the surgeons will also be able to connect to other major surgery centers for collaboration during complicated cases. Physicians and nurses who specialize in caring for surgical patients will be able to work together on pre- and postoperative care, and live video feeds will support two-way teaching. Furthermore, having more rooms means more surgeons can work there and surgical teams will

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Construction of the Surgical Institute as of March 2022

“

We are here for patient care, patient outcomes, and patient safety. That’s what drives the whole thing.” —Dr. Arthur Katz

have dedicated nurses for better continuity of care. “When we have our own teams, our own scrub nurses, you always get better outcomes because you don’t have to teach them procedures,” Stiebel says. He is especially happy that the Surgical Institute will have two hybrid rooms because “it showcases the forethought the administration has about its growth potential. As the population grows, to be able to have a second hybrid room ready to go is very important, rather than having to wait a year or two to build a second one” once there is sufficient demand. In addition to the operating rooms, the institute will have a large sterile processing department that will oversee the cleaning, assembly, and sterilization of surgical instruments; inventory management of surgical instruments and supplies; and vendor-provided implant and surgical instrument coordination. This department will also select the supplies for surgical case carts. Beyond all the high-tech equipment that will improve surgical outcomes, the new facility will have creature comforts too, including easier

access for patients, separate entrances for medical staff, and recovery areas right near the operating rooms so there won’t be a need to transport patients across the hospital in case of an emergency. “That’s pretty great,” Stiebel says. “Proximity is very important.” Private consultation rooms and other comfortable areas for pre- and postoperative meetings will enhance the patient experience as well as that of their family and friends. These individuals will also have access to an outdoor space with a terrace near the second-floor waiting room and a discharge area leading to parking for privacy and convenience. Another upgrade—for both visitors and staff—is the addition of more natural light. “Any time you can introduce natural light in a work environment, there’s a benefit in happiness, morale, even a benefit to surgery,” Stiebel notes. Yet another plus: a doctors’ lounge right near the operating rooms. “A lounge with a snack and coffee machine is worth its weight in gold,” Stiebel continues. “There are days when I don’t eat all day and have maybe 10 minutes between procedures and am searching for a cup of coffee. The lounges will be a big upgrade.” While there are many things that will change, some aspects of the JMC surgical experience will remain the same. “What makes Jupiter special is the hardworking, caring, and dedicated staff that gives every patient a personal touch,” says Katz. “Nobody is treated like a number. That’s what it’s all about. We are here for patient care, patient outcomes, and patient safety. That’s what drives the whole thing.” «

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DONOR PROFILE

Revved Up to

GIVE BACK Success in racing and business has enabled Johnny and Terry Gray to donate to causes close to their hearts By Heather Graulich | Photography by Jerry Rabinowitz

t’s a few days before Thanksgiving 2021, and Johnny and Terry Gray are feeling grateful for many things: plans to expand their Gray Motorsports museum in Jupiter to house an ever-growing vintage car collection; the recent celebration of their fiftieth wedding anniversary; and perhaps most special of all, the arrival a few weeks earlier of their first great-grandchild, a boy named Brogan. Life has been sweet for the couple, if not always as abundant as they are enjoying these days. Johnny and Terry share humble beginnings in Artesia, New Mexico, a town of fewer than 12,000 along the Pecos River, just 80 miles west of the Texas state line. They loved growing up there and were high school sweethearts, engaged by senior year. In their part of the country, “Friday Night Lights” is a big deal. Like many boys in town, Johnny played football, but he always dabbled in go-carts and tinkered with engines. By his teenage years, football was taking a back seat. “At 17 I started drag racing,” he says. “I raced a 1940 Willys pickup truck. I told my dad, ‘What I really want to do is work on cars and race them.’” He never looked back, racing whenever he could find the time while growing the family business into a powerhouse entity that included oil, farming, and machining interests. He eventually drove professionally on the National Hot Rod Association’s Pro Stock and Funny Car circuits until retiring about 10 years ago. Terry was always supportive of Johnny’s passion for the track and joined him in racing for a while, too, favoring the modified Porsche Cup cars. Their sons, Shane and Jonathan, also raced, and now grandsons

Tanner and Taylor drive professionally for David Gilliland Racing, a team Johnny partners in. “I’m just so lucky to have gotten to where I got. I’ve been blessed,” Johnny says. “I tell people, I can go anywhere in the world I want at any time, but what I want most of all is to watch my grandsons race.” While he continues to buy and restore some of the country’s most iconic vehicles and cheer on his family of speedsters, he and Terry are also aiming for a new checkered flag: giving back to their adopted hometown of Jupiter, where they moved in 2011 after visiting during nitro car testing at Palm Beach International Raceway. Since January 2021, the Grays have gifted Jupiter Medical Center a total of $7 million. The funds have enabled JMC to create a new Alzheimer’s and dementia program, purchase its third da Vinci Xi robotic surgical system to increase the hospital’s ability to perform precision surgery, and invest in its new $90 million Surgical Institute, slated to open in 2023. For the Grays, the donation is reflective of the family’s philanthropic goals, which include financing homeless shelters in their original hometown of Artesia and Operation 300, a Port Salerno–based charity that assists the children of fallen military service personnel. But the gift to Jupiter Medical Center is also deeply personal for Terry. Her father, Charlie Hammond, died of Alzheimer’s in 2020. She experienced the struggles family members face when they are caring for someone with an incurable disease that slowly robs them of their

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memories while also diminishing their physical health. Terry hopes JMC’s new program will help both family and professional caregivers learn how to support patients while also practicing self-care. “There’s so much heartache in that disease and people need to know what you go through and how to take care of your loved ones and yourself,” she says. Dr. Amit Rastogi, Jupiter Medical Center’s president and CEO, echoes Terry’s sentiments. “Alzheimer’s disease afflicts nearly 6 million Americans and is projected to affect 14 million Americans by 2060,” he explains. “Unfortunately, the disease often develops silently, decades prior to symptoms. The Grays’ gift is going to help us focus on the prevention and early detection of Alzheimer’s and other forms of dementia while serving as a much-needed resource for caregivers in our community. We expect to launch this new

program at Jupiter Medical Center in 2022.” Meanwhile, for all their successes in business and racing and their love for their new home in Jupiter, Johnny and Terry have never forgotten their racing roots. That very first drag pickup, the 1940 Willys, now sits fully restored in a central place of honor in their car museum. Flanking it are dozens of automobiles for enthusiasts to swoon over, including a 1930 F37 Bugatti, a bright red 1968 Yenko Camaro RS (one of only two believed to exist), and the grand dame, a cream-colored 1933 Duesenberg convertible once owned by silent film star Marie Dressler. They’re parked hood to fender, evidence of the need for a bigger home. “I’m terrible,” Johnny says, grinning as he sweeps his arm toward the gleaming vehicles filling the museum. “I just fall in love with all these cars and keep them.” «

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DONOR PROFILE

LOVE

Thy Neighbor With the goal of benefiting the Jupiter community, Nicholas Mastroianni II and his family have made comprehensive pediatric care an accessible reality at Jupiter Medical Center By Heather Graulich | Photography by Jerry Rabinowitz

hen Hurricane Dorian ripped across the Bahamas in 2019, it leveled much of Marsh Harbour and the surrounding Abaco Islands, shattering and leaving residents and their families displaced. As soon as the destructive winds passed, Nicholas “Nick” Mastroianni II and his family sprang into action. “I have been going there since the ’90s and we know a lot of local families,” says the Jupiter resident and developer of the Harbourside Place shopping and dining venue along the Intracoastal. “Right after Dorian we decided to form a 501(c)(3) and that resulted in 300 rescued people. With the help of volunteers and the Mastroianni Family Foundation the mission blossomed into this massive undertaking. We provided these rescued people complimentary accommodations at the Wyndham Grand at Harbourside until their visas expired and they had to go back. It is sadly still a disaster over there.” Mastroianni flew to the islands immediately after the storm and saw the firsthand impact of a focused effort to provide lifesaving aid and resources. The Mastroianni Family Foundation has continued to support the rebuilding efforts in the Bahamas as well as a variety of local causes important to both the family and the local community, particularly in health care. The foundation gifted $3 million to Jupiter Medical Center, allowing the hospital to establish the Mastroianni Family Pediatric Emergency Department, which opened in 2019. The facility provides much needed and specified pediatric treatment in a region that has grown popular with young families. The 6,300-square-foot facility is adjacent to the hospital’s current emergency room, however, it offers emergency services in a more

child-friendly environment. The unit features eight pediatric treatment rooms with child-sized exam and diagnostic equipment in addition to a dedicated family waiting area, pediatric triage rooms to reduce wait times, and indoor play areas to alleviate anxiety. There is always a pediatrician on-site, and patients have access to a team of pediatrictrained doctors and nurses. Patients can also receive pediatric specialist consults, as well as inpatient care through the De George Pediatric Inpatient Unit, when needed. As a grandfather of six—all of whom were born at Jupiter Medical Center—Nick Mastroianni understands just how vital it is to have world-class pediatric care available close to home. “I’ve been watching [Jupiter Medical Center’s] growth over the past 20 years, and they’re incredibly trusted within the community and have become an integral fiber of the community,” he says. “My son, Nicholas Mastroianni III, has been extensively involved with the foundation for many years, and we both believe strongly in the expansion of the hospital.” Community health care support has been an ongoing and personal mission of the Mastroianni family over many years. Nick Mastroianni tragically lost his mother, Audrey, to breast cancer at age 41—when he was just 19 years old. Cancer-fighting charities, including St. Jude and the family’s own Charities for Children with Cancer (a nonprofit managed by his sister, Stephanie) are main focuses of the Mastroianni family’s giving. Mastroianni grew up in New England and Long Island, where his father partnered with entertainment stars Burt Bacharach and his wife, Angie Dickinson, in the management of the famed steak house Rothmann’s (formerly known as Burt Bacharach’s). This sparked Mastroianni’s interest in hospitality and development and he began

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To learn more about the foundation please visit mastroiannifoundation.org or contact info@mastroiannifoundation.org

venturing in real estate finance and development projects in the Northeast. He eventually moved to North Palm Beach and formed Allied Capital and Development of South Florida in 2004. “Then we had the market crash,” he recalls. Rather than abandon his business goals, Mastroianni pivoted to a little-known U.S. visa program called EB-5, which allows foreign investors to qualify for American visas by providing capital for development projects. Mastroianni founded a new company, U.S. Immigration Fund (USIF), which has grown into one of the largest EB-5 regional centers in the country, facilitating more than 20 development projects totaling $3 billion in capital, including Jupiter’s own Harbourside Place. In 2015, Harbourside was named “Project of the Year” at the Vision Awards at Urban Land Institute’s Southeast U.S. and Caribbean awards ceremony in Miami. These days, the Mastroianni family operates both the Allied and USIF businesses as well as philanthropy projects, which include the Mastroianni Family Foundation. Nicholas Mastroianni III works alongside his father as president of USIF and executive director of the foundation, while his brother, Anthony, manages the family’s agricultural proper-

ties west of Jupiter. Sister Audrey—named for the late grandmother she was never able to meet—is active in the foundation and several charities in Palm Beach County and the surrounding areas. In their downtime, Mastroianni and his family love gathering for big Sunday dinners full of Italian favorites like ravioli and lasagna that he often cooks himself. They also enjoy watersports, fishing, and cruising aboard his favorite boat, a 41-foot Bahama sportfishing center console. “Jupiter is a great place to live, I wouldn’t live anywhere else,” he says. “The climate is amazing. The people are amazing. You can go boating, fishing, play golf—and it’s a great place to raise a family.” Mastroianni says keeping it local and staying family-focused is the heart that drives the future of the foundation’s giving. “We’ve highlighted Jupiter Medical Center as the largest recipient of our philanthropy and in March made the exciting decision to contribute another $6 million to the future Surgical Institute. You feel the most impact and you can actually see how your individual contributions and investments help your direct community when giving to local causes—and we’re not stopping any time soon.” «

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Putting in

the Work At-home exercise regimens are an important part of a patient’s recovery process and long-term health success By Lola Thélin

lthough the prospect of working out after suffering a health setback can be daunting, rehabilitative exercise led by a physical therapist can help patients heal sooner and move

plan, but the importance remains the same. “Once patients are discharged from therapy, I always say, ‘This is hopefully a springboard for you to make exercise a regular part

better. In addition to participating in a rehab program, patients

of your routine,’” says Catherine Frampton, an outpatient reha-

are encouraged to conduct at-home mini-workouts to further

bilitation physical therapist at Jupiter Medical Center. “Seeing the

promote their recovery. The frequency, movements, and exercises

patient use therapy to become more active in his or her life is one

heavily depend on the patient’s specific affliction and treatment

of my favorite parts of my job.”

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Here, we outline typical action plans for four common injuries, ailments, and surgeries.

parts of the body. “In rehab, we try to capitalize on the patient’s neuroplasticity,” says Trisha Cires, a certified stroke rehabilitation specialist, vestibular therapist, and senior physical therapist at

STROKES

Jupiter Medical Center. “Through early intervention, we can affect

Strokes are extremely individualized, and the patient’s damage

how the brain is recovering and facilitate restoration of movement.

can include sensory impairment, visual and spatial neglect, weak-

Repeated practice of these activity-specific exercise skills stimu-

ness of upper or lower extremities, or paralysis in one or more

lates those neurologic pathways.”

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Once at home, patients should continue exercises that engage mobility, balance, and meaningful, functional movement. To strengthen the lower extremities and core, a patient can do leg range of motion exercises against gravity and bridging while lying in bed as well as sit-to-stand movements from the edge of the bed or in a chair. For the upper body, a

Patients with stents typically have no precautions, according to Roca-

patient can do wrist curls, shoulder openers, or table circles. Cires sug-

fort, but their physical function depends on their previous exercise history

gests exercises—which patients can do with light weights and bands for

and if they have any limitations due to other orthopedic health reasons.

resistance—be done 20 minutes a day, three times a week. For cardiovascular conditioning, walking is ideal, beginning with five minutes and building up to 20 minutes. “Continued exercise and

FRACTURES “For most fractures, the mechanism of injury is a fall,” says Frampton,

wellness have to be part of the lifestyle, or development of additional

making the wrist and ankle bones the most common fractures. This is

comorbidities may put them at risk of having another stroke or event,”

due to misstepping and rolling the ankle or trying to break the fall with

adds Cires. “Exercising will set them up for success.”

a hand. Patients may want to get back to life as normal and as quickly as possible, but slow and easy is the name of the game. “In general, the

CARDIAC SURGERY

goal is to facilitate the healing process so we can start bearing weight

As a certified strength and conditioning specialist at Jupiter Medical

through that joint again,” she adds. “This is done by slowly progressing

Center who specializes in cardiac rehab, Bryan Rocafort analyzes pa-

their range of motion at the joint and then strengthening above and

tients who have had heart stents placed, experienced congestive heart

below the injured bone or joint.”

failure, or suffered a heart attack. “Three or four months after their procedures, these patients are like new people,” he says. “They don’t realize how bad they felt till afterward.”

Patients have simple exercises to do at home. Typically, the patient will start with isometrics to activate muscles without movement at the joint. Once pain and

Rocafort advises a gradual return to exercising to prevent fur-

swelling has gone

ther soreness and aches, and he also emphasizes the importance of

down, passive and

warming up and cooling down. At home, patients should be walking.

active range of mo-

Preference over distance versus time depends on the physician, but the

tion is gradually in-

goal is 2 miles a day or eight- to 10-minute bouts throughout the day.

troduced. To improve

Weights are allowed but only recommended for patients who have a

the ankle’s range of

history of using them.

motion, ankle pumps

Patients who had open-heart surgery yet are proficient with weights

and inversion and

should start at a very low weight. “It’s not their heart I’m worried about;

eversion in repeti-

it’s their incision in their chest and the nerves through their arms,” says

tions of 10 to 15 are

Rocafort. “Upper-body exercise will make them crazy sore. You can’t

ideal. This means

start people too easy, but you can start people too hard.”

moving the toes up

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“Seeing the patient use therapy to become more active in his or her life is one of my favorite parts of my job.” —Catherine Frampton

and down as far as possible and moving the foot in and out, respec-

and present with symptoms that are beyond the typical postoperative

tively. For the wrist, Frampton suggests active assisted range of motion

soreness,” says Frampton. “They are eager to get back to things they did

exercises that target the elbow and shoulders such as table slides,

prior to surgery but end up doing too much.”

where a towel is under the hand and the patient moves it forward and

An at-home exercise routine for a hip or knee replacement is al-

then back. “The key is to not put weight on the fracture while it is heal-

lowed if weight-bearing is possible, meaning they can get up and

ing, but still maintain range of motion and strength to avoid stiffness

walk. For the first week, patients should walk around with a walker and

and atrophy,” says Frampton.

get up from bed as often as they can tolerate. Gentle bed exercises include ankle pumps to prevent clotting, heel slides, and isometrics at

JOINT REPLACEMENTS

the quads. Once they graduate from bed exercises, patients can stand

After surgeries, those with hip, knee, and shoulder replacements

at the kitchen counter and march in place, move legs side to side, and

return home after a short stay in the hospital. Physical therapy for hip and knee surgeries begins the day of surgery, once patients are settled

perform knee flexion and extension. “We encourage mini-squats and sit-to-stands as well because they

in their hospital room. Following a hip or knee surgery, patients are

are functional movements,” says Frampton. “Think about how often

weight-bearing as tolerated. Therefore, a physical therapist will help get

we get up from a seated position throughout the day; keeping those

them out of bed to walk with a walker as soon as possible. Depending

muscles conditioned is very important as they are gradually gaining back

on surgeon preferences, patients may have therapy in their home be-

their function.”

fore going to outpatient physical therapy. On the other hand, shoulder

Over time, elastic bands can be added to a home program for strength-

replacement patients are kept in a sling with a pillow to hold their arm

ening. For shoulder replacements, most patients are cleared to begin

in a protective position for about six weeks before they begin therapy.

rehab therapy after six weeks. Frampton encourages patients to purchase

While minor exercises are recommended at home, many patients

a shoulder pulley system for their home. “They can put it over the back of

go too big too soon. “A patient will come in and tell me, ‘I overdid it,’

the door, and it facilitates gradually getting that motion back.” «

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Badge of Honor PHOTOGRAPHY BY STEVEN MARTINE PHOTOGRAPHY

Dr. Debra Brandt

Dr. Rogelio Choy

hrough the Jupiter Medical Center Foundation’s “Honor a Caregiver” program, grateful patients and their loved ones can make donations in recognition of caregivers who have gone above and beyond. This support aids the hospital in its mission to provide world-class care to the community and expand its footprint, facilities, and technology.

This year’s “Honor a Caregiver” recipients include: Gary Ackerman, MD Rahul Aggarwal, MD Kristine Allen, RN Robert Biscup, DO

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Daniel Bonanza, RN Janine Boylan Debra Brandt, DO Robert Briskin, MD Andrew Celigoj, MD Rogelio Choy, MD Krista Coquillette Mark Corry, MD Nichole Corry, MD Bruce Eisenberg, MD Rachel Ferguson, RN Juan Gomez, MD Jamie Granino, RN Nikola Jovanovic, MD Lewis Kaminester, MD David Lickstein, MD Gonzalo Loveday, MD Elisabeth McKeen, MD Jyoti Mohanty, MD James P. Mullen, MD Intensive Care Unit

Gary Pepper, MD Morgan Poncy, MD Raj Rajpara, MD John Randazzo, MD John Rimmer, MD Abraham Schwarzberg, MD Neerav Shah, MD Henry Shapiro, MD Nathan Tennyson, MD Jefferson Vaughan, MD Taylor Waronicki, RN Jack Waterman, DO Cardiac Rehabilitation Cath Lab COVID Vaccination Team Donor Relations Emergency Department Intensive Care Unit Nursing Staff Progressive Care Unit Nurses Security Department Donor Relations

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COVID Vaccination Team

Kristine Allen

Dr. Nikola Jovanovic

Emergency Department

Dr. Rahul Aggarwal

Dr. John Randazzo

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Rachel Ferguson

Dr. Gonzalo Loveday

Dr. Gary Ackerman

Pam Cantor (in recognition of the nursing staff)

Progressive Care Unit Nurses

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Emergency Department

Dr. Robert Briskin

Taylor Waronicki

Cardiac Rehabilitation

Dr. David Lickstein

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Cath Lab

Dr. Raj Rajpara

TRACEY BENSON

Dr. Henry Shapiro

Dr. Robert Biscup

COVID Vaccination Team

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Dr. Nathan Tennyson

Dr. Morgan Poncy

Dr. Neerav Shah

Krista Coquillette

Dr. Nichole Corry

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Security Department

Dr. Mark Corry

Dr. Juan Gomez

Janine Boylan

Daniel Bonanza

Dr. Jefferson Vaughan

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SETTING THE STANDARD

Palm Beach Media Group is a renowned publishing company with print publications representing a mix of proprietary titles and custom magazines, along with digital solutions, serving the entire state of Florida and more.

PALM B E AC H M E DI A. C OM

PUBLISHER OF: Naples Illustrated Orlando Illustrated Palm Beach Illustrated Naples Charity Register Palm Beach Charity Register Southwest Florida Relocation Guide Waypoints: Naples Yacht Club Palm Beach Relocation Guide Vero Beach Magazine The Jewel of Palm Beach: The Mar-a-Lago Club Jupiter Magazine South Florida Baby and Beyond Magazine Stuart Magazine Fort Lauderdale Illustrated Aventura Magazine Naples 100 5th Avenue South: 5th Avenue South Business Improvement District Palm Beach 100 Go561 Community Report: Community Foundation of Collier County Pinnacle: Jupiter Medical Center Foundation art&culture: Cultural Council for Palm Beach County Florida Design Florida Design Naples Edition Florida Design Miami Edition Florida Design Annual Sourcebook Naples on the Gulf: Greater Naples Chamber Time and Treasure: Guide to Better Giving Vero Beach Magazine: Vero Beach Handbook Advances: Tampa General Hospital Naples Realtor Magazine Fisher Island Magazine Club Braman Magazine

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3/10/22 9:39 AM

There’s a lot resting on our shoulders.

The Anderson Family Orthopedic & Spine Center of Excellence provides the most advanced care, innovative technologies and amenities including: At Jupiter Medical Center, we know you have a lot resting on the success of your orthopedic surgery. As the only hospital in Florida with both Blue Distinction Center Plus recognitions for Hip & Knee Replacement and Spine Surgery, and Joint Commission Certifications in Hip, Knee, Shoulder and Spine, Jupiter Medical Center has a proven track record of long-term success. With renowned physicians and advanced technology like The Mako™ Robotic-Arm Assisted Surgery System, you’ll be back to living your best life before you know it.

Visit jupitermed.com for more information or call 561-263-2200.

• The Mako™ Robotic-Arm Assisted Surgery System with CT scan technology, virtual preoperative implantation, and real-time alignment • Surgical Suites with advanced technology from minimally invasive surgery to total joint replacement and spine surgery • 30 private patient rooms and a state-of-the-art gym for pre and post-operative workouts

WORLD’S BEST HOSPITALS 2021

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IN HIS WORDS As told to Michele Meyer

MATT PERLMAN

JERRY RABINOWITZ

Building Hope “You’ve got Stage 4 lung cancer and eight to 14 months to live.” When an oncologist told me this in 2019, I felt grief and fear—but first, shock. I could not believe the news I was hearing. Then I cried. I’d dismissed recent shoulder discomfort as a reminder of a 1995 truck accident. Then a surgeon approached me in a cafeteria and said, “You look like you’re in lots of pain. What’s going on?” I heeded his advice and saw my longtime primary care physician. An MRI showed a tumor on my fifth rib and another on my upper spine. A more in-depth positron emission tomography (PET) scan revealed a large mass in the upper lobe of my left lung. I was just 53. My treatment started elsewhere with 10 rounds of radiation. After that, I shifted my care to Jupiter Medical Center, and I’m so glad I did. Throughout my stay at Jupiter, everyone smiled, cared, and really listened. The emergency doctor checked in daily, even though I wasn’t his patient. During immunochemotherapy, the nurses—angels— promptly took me to the emergency department when I couldn’t breathe and my blood pressure plummeted. While in the new and spacious ICU for eight days, the nurse treated me like I was the President. She’d say, “Look at you, Mr. President, in your big ICU room.” When I graduated to the progressive care unit, the nurses were so loving and got me anything I wanted— except high-sodium meals. They’d say, “Don’t be a bad boy or we’ll have to call your wife.” When my wife, Claudia, was there, which was often, they catered to her, too. When I returned to Westwood Gardens, my home of 17 years, I was in a bad way, yet the experience had been beautiful. I’ll never go to another hospital. Diagnosed with brain cancer six months later, I couldn’t stop crying. I thought I was through with cancer. I made a deal with God: If you help me beat cancer, I will dedicate my life to this community’s children. That’s what I’m doing as I build elaborate Lego amusement parks through my organization, Palm Brick Gardens. Surgery removed the brain mass, while traditional chemo and 15 rounds of radiation shrunk my tumors until they were almost gone. Each PET scan is better. And even though my headaches are back, my wife and I have faith I’ll be in remission soon. I’ve got Legos to build and children to entertain. I’m not stopping now.

64 | PINNACLE | jupitermed.com

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