HealthW ks SUMMER 2018
BRINGING COMPLEX CARE CLOSER TO HOME PREVENTING DIABETES PAIN YOU SHOULDN’T IGNORE
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LETTER FROM THE PRESIDENT & CEO •••
Share Your Story!
To our community:
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s Nyack Hospital proudly assumes its new name “Montefiore Nyack Hospital,” this is an exciting time in the hospital’s extensive history because it reinforces our commitment to transforming the delivery of quality, patient-centered healthcare. Together with the Montefiore Health System, we are better positioned to create healthier communities and promote wellness in our region. Together, we will bring the best of academic medicine, education, research and community health expertise to create the most comprehensive health system in Rockland County. For our patients, this means greater and more convenient access to high-quality care, the development and expansion of advanced new services and more access to cutting-edge clinical trials.
DO YOU HAVE A MONTEFIORE NYACK HOSPITAL OR HIGHLAND MEDICAL, P.C., HEALTH SUCCESS STORY? IF SO, WE’D LOVE TO KNOW ABOUT IT! PLEASE EMAIL YOUR STORY TO: PUBLICRELATIONS@ MONTEFIORENYACK.ORG. WITH YOUR PERMISSION, IT MAY BE FEATURED IN A FUTURE ISSUE OF MONTEFIORE NYACK HOSPITAL’S HEALTH WORKS.
In this inaugural issue of Health Works, I invite you to read more about the hospital’s Transformation Project, which is advancing our progress toward a newer state-of-the-art facility. The pages that follow underscore our excellent patient-centered care and the exceptional services that we provide to the diverse communities we serve. Thank you for trusting Montefiore Nyack Hospital as your healthcare partner. We’re excited to become the healthcare provider of choice in the Hudson Valley, and we look forward to caring for you.
BEST REGARDS, MARK GELLER, MD PRESIDENT & CEO MONTEFIORE NYACK HOSPITAL
facebook.com/MontefioreNyack
@MontefioreNyack
EDITORIAL STAFF Lauren Malone, Director of Public Relations and Marketing Rose McAllister Croke, Marketing Manager Briana Puncar, Marketing Manager, Highland Medical, P.C.
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IN THIS ISSUE
summer 2018
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TRANSFORMING YOUR HEALTHCARE Coming soon: new state-of-the-art patient-care facilities. COLLABORATIVE SURGERY Bringing experts together to improve healthcare.
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PAIN YOU SHOULD ACT ON NOW If you have any of these symptoms, talk to your doctor about them. SUMMER SAFETY Stay healthy as you enjoy time outdoors this summer.
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PREVENTING DIABETES Take steps today to avoid this dangerous disease.
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THE MIDWIFERY DIFFERENCE Midwives celebrate 20 years of service, and nearly 20,000 babies delivered.
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Save the Date! BLOW AWAY BREAST CANCER 5K RUN/WALK DATE: Sunday, October 14, 2018 TIME: 9:00 a.m. PLACE: Montefiore Nyack Hospital 160 N. Midland Avenue, Nyack
The proceeds from the 28th annual Blow Away Breast Cancer 5K Run/Walk will support the programs, services and equipment needs of The Breast Center at Montefiore Nyack Hospital. For information and sponsorship opportunities, please call 845-348-2770 or email foundation@montefiorenyack.org. M O N T E F I O R E N YAC K .O R G
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TRANSFORMING YOUR HEALTHCARE
EXCITING CHANGES ARE UNDERWAY AT MONTEFIORE NYACK HOSPITAL, INCLUDING AN EXPANDED AND UPGRADED EMERGENCY DEPARTMENT AND A MEDICAL VILLAGE THAT WILL MAKE IT EASIER TO ACCESS THE CARE YOU NEED.
TO GET INVOLVED OR MAKE A DONATION, PLEASE CALL 845-353-3333 OR EMAIL FOUNDATION@MONTEFIORENYACK.ORG.
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ith nearly 60,000 visits annually, Montefiore Nyack Hospital’s Emergency Department is one of the most active in the lower Hudson Valley. The hospital’s Transformation Project, currently underway, will include a new and expanded Emergency Department and a Medical Village. The project’s goals: to help reduce hospitalizations, to improve access to disease-management programs and preventive services, and to encourage community involvement in health and wellness programs.
STATE-OF-THE-ART FACILITIES The Transformation Project includes a twostory addition that will add 16,300 square feet of space to the hospital’s campus. The ground floor of the addition will partially house the new Emergency Department, and the second floor will be home to the new Medical Village. The Transformation Project also includes the renovation and reconfiguration of 23,300 square feet of existing space, including the current Emergency Department, the hospital lobby and adjacent corridors. The new Emergency Department, which will be double the size of the existing
ED when the Transformation Project is complete, will include an adjacent Fast-Track Express Care Center where patients with non-emergency conditions will receive care and access to primary care providers.
ONE-STOP CARE The Medical Village will house physicians and providers in multiple specialties, strengthening the hospital’s ability to offer easier access to specialized healthcare services when needed. In addition, the Medical Village will link patients to community resources that can provide appropriate alternatives to hospitalization, enhancing the healthcare delivery system, making it more patientcentric and reducing costs. The Medical Village also will offer non-emergent transportation to and from appointments with providers and organizations in the Medical Village and other services offered at Montefiore Nyack Hospital. Construction on the Transformation Project is expected to be complete in 2020. For updates, information and realtime video of construction progress, visit montefiorenyack.org/transformation.
PROJECT HIGHLIGHTS EMERGENCY DEPARTMENT: • Private treatment rooms • New rapid assessment area • Larger trauma treatment bays • Dedicated digital imaging suites • Separate Fast-Track Express Care Center • Private behavioral assessment unit • Dedicated pediatric Emergency Department
FOR CONSTRUCTION UPDATES AND IMAGES, VISIT MONTEFIORENYACK.ORG/ TRANSFORMATION.
MEDICAL VILLAGE: • Multi-specialty outpatient service center • Primary and specialty care providers • Community-based support services • Non-emergent transportation assistance
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COLLABORATIVE SURGERY: BRINGING CARE CLOSER TO HOME
MONTEFIORE NYACK HOSPITAL’S COMMITMENT TO PUTTING PATIENTS FIRST ENABLED ADDOLORATA GRILLO TO HAVE A COMPLEX COLON-LIVER OPERATION LOCALLY, WITH FAMILY CLOSE AT HAND. 6
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PICTURED OPPOSITE PAGE: LEE FLEISCHER, MD, FACS, WITH HIS PATIENT ADDOLORATA GRILLO
“We’re working around the patient’s needs instead of the surgeon’s. It’s an evolving model of multidisciplinary and communitybased healthcare.” Milan M. Kinkhabwala, MD, FACS
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hen Addolorata Grillo was rushed into emergency surgery at Nyack Hospital (now Montefiore Nyack Hospital) in April 2017 for a perforated colon, her surgeon, Lee Fleischer, MD, FACS, discovered she had colon cancer that had spread to the liver. That meant she would need a complex series of treatments involving several surgical procedures and chemotherapy—and a team of physicians. Dr. Fleischer, Director of the Department of Surgery at Montefiore Nyack Hospital and surgeon with Highland Surgical Associates, Highland Medical, P.C., performed a partial colectomy and temporary colostomy, a surgical operation in which a piece of the colon is removed and the end is brought through an opening in the abdominal wall. Addolorata then underwent chemotherapy to shrink her liver tumor enough so that it could be removed. She needed two more operations: a reversal of the colostomy, and a liver resection, or removal of the diseased
portion of the liver. Dr. Fleischer intended to perform the colostomy reversal, but knew there was no liver surgeon available in Rockland County. His solution: to ask Milan M. Kinkhabwala, MD, FACS, Professor of Surgery and Director of the Hepatobiliary Section at the Montefiore Einstein Center for Cancer Care located in Bronx, NY, to come to Nyack to perform the surgery. “The alternatives were either for Addolorata to have two separate procedures—one at Montefiore Nyack Hospital and one at Montefiore Einstein Center—or to have both at Montefiore Einstein Center, which is more than 25 miles farther away from her home, and would make follow-up care more difficult,” says Dr. Fleischer.
PATIENT-CENTRIC CARE If Addolorata had both procedures done at Montefiore Einstein Center, she would have had a different colon surgeon. “I decided to have both surgeries in Nyack because I felt comfortable with Dr. Fleischer and the staff,” she explains. “I was taken care of after my first surgery there and wanted to feel comfortable for my second surgery.” Dr. Kinkhabwala agreed, and in January, the two procedures were done in the same operating room at Montefiore Nyack Hospital. Dr. Fleischer and his partner did part of the colostomy reversal, then Dr. Kinkhabwala and his partner stepped in to remove the tumor-containing portion of the liver. Dr. Fleischer then finished the colon procedure.
THE COMFORT OF FAMILY CLOSE BY Addolorata says it was easy for her family to stay at the hospital during her surgery: “Having my family there made me feel at ease and less nervous to have the procedures done.” She had an uneventful recovery, was up and around the next day, and went home four days after surgery. “Addolorata has recuperated, and is back to her normal life,” says Dr. Fleischer. She has been able to receive follow-up care at Montefiore Nyack Hospital’s Cancer Center, under the supervision of her medical oncologist Irina Rybalova, MD. Addolorata says she is very happy with her decision to have both procedures done at Montefiore Nyack Hospital. “Both surgeries went well, and both surgeons were very accommodating to each other and made me feel very comfortable,” she says. “In the past, we would have made the patient come to us. Now we have a more patient-centric approach. We’re working around the patient’s needs instead of the surgeon’s. It’s an evolving model of multidisciplinary and community-based healthcare,” says Dr. Kinkhabwala. “As our collaboration grows, we’ll have more opportunities to bring more complex surgery to Montefiore Nyack patients, without requiring them to come to Montefiore Medical Center.”
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FOR MORE INFORMATION ON HOW TO KEEP YOU AND YOUR FAMILY SAFE, VISIT MONTEFIORENYACK.ORG/ TRAUMA-ADDITIONALRESOURCES.
PAIN
YOU SHOULDN’T IGNORE THOUGH ACHES AND PAINS OFTEN RESOLVE THEMSELVES, HERE ARE FIVE TYPES OF PAIN TO HAVE CHECKED BY A PHYSICIAN AS SOON AS POSSIBLE. 8
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hen you feel a sudden pain, how do you know when to wait it out or to seek immediate medical attention? Jeffrey S. Rabrich, DO, FACEP, Medical Director for Emergency Medicine at Montefiore Nyack Hospital, says if the pain is bad enough to make you think about going to the hospital, you should go. “If you have pain and you’re not sure what’s going on, come to the Emergency Department and let us evaluate it,” he says. “We’d rather see someone and send them home after determining it’s indigestion than to have them sit at home with a heart attack or other serious problem.” The most common signs of pain that could signal a serious health problem include:
ABDOMINAL PAIN: Common causes of
CHEST PAIN: Heart-attack
HEADACHE: While most head-
pain can feel like pressure in the center of your chest, which may spread to the jaw, neck and arm. Other possible heart attack signs include pain that gets worse when you exert yourself, shortness of breath, nausea and sweatiness. At the hospital, a person with chest pain will get an electrocardiogram (EKG) to check for problems with the electrical activity of the heart.
aches are not a sign of a severe medical problem, there’s one exception: pain that comes on suddenly, particularly after exertion, and feels like the worst headache of your life. “This could be a sign of an aneurysm, or bleeding in the brain,” Dr. Rabrich explains. At the hospital, a person with a sudden, severe headache may have a CT scan or MRI.
LEG PAIN: If you have leg pain along with swelling of the leg, it could be a sign of a blood clot. The pain caused by a blood clot feels more like throbbing or aching. A blood clot is diagnosed with an ultrasound. “We want to identify and treat a blood clot as quickly as possible, because an untreated clot could get larger, break off and go to the lungs, where it can cause a lifethreatening problem,” he warns.
abdominal pain include appendicitis, gallstones (hardened deposits of digestive fluid that can form in your gallbladder), pancreatitis (an inflamed pancreas) and diverticulitis (when pouches in the wall of the colon get inflamed or infected). Appendicitis is associated with pain in the right lower section of the abdomen, and is often accompanied by fever, nausea and vomiting. Anyone with these symptoms should go directly to the ER, Dr. Rabrich advises. Gallstones cause pain in the right upper section of the abdomen, often after eating a fatty meal. The pain can be severe, and is often associated with nausea.
BACK PAIN: While most cases of back pain are caused by muscle strain, some types of back pain are a sign of a more serious problem. “Back pain associated with weakness and numbness in the arms and legs, or accompanied by fever, should be evaluated immediately,” Dr. Rabrich says. This type of back pain could be a sign of a spinal cord infection, which should be treated right away to reduce the risk of permanent damage to the spinal cord. Severe upper back pain, whether or not it’s accompanied by chest pain, could be a sign of a heart attack or aneurysm.
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SUMMER SAFETY STARTS BY THE POOL
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s summer gets into full swing, it’s time to start thinking about water safety measures that could save lives. According to the American Red Cross, 200 kids drown every year in backyard pools. Drowning is the leading cause of unintentional and injury-related death among children ages 1 to 4. “Drownings are a preventable cause of death and injury for children,” says Aleksandr Rakhlin, MD, FACS, of Highland Surgical Associates and Trauma Medical Director at Montefiore Nyack Hospital. “By practicing proven safety behaviors and implementing systems, you and your family will be much more secure in and around public and residential pools.” The best safety measures prevent accidents before they happen, like teaching your child to swim and using Coast Guard-approved life vests. Other
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safety tips to keep in mind are: • Teach your children basic water safety tips, including how to swim and have them wear a life jacket when they are on a boat. • Don’t let children out of your sight at beaches, pools and lakes. • If a child is missing, look for him or her in the pool or spa first. • Lifeguards aren’t babysitters. Make sure there is a designated parent or responsible adult who can swim to watch your child at all times. • Understand the basics of life-saving and CPR for both children and adults, so that you can assist in a pool emergency. • Remind your children to stay away from pool drains, pipes and other openings to avoid entrapments. • Install proper barriers, covers and alarms on and around your pool and spa.
• Have a portable telephone close by at all times when using a pool or spa. Smart safety rules for swimmers of all ages and levels: • Never swim alone. • Don’t dive into unknown bodies of water. • Don’t push or jump on others. • Be prepared for an emergency. • Create a Pool Safety Toolkit for your home pool or spa that includes: a first aid kit; a pair of scissors to cut hair, clothing or pool cover, if needed; a charged portable telephone to call 911; and a flotation device. “The best way to prevent drowning is by providing constant supervision by an adult who can swim,” says Dr. Rakhlin. “Being vigilant and limiting distractions will assure a safe and fun summer.” Have a safe and happy summer!
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TIPS FROM MONTEFIORE NYACK HOSPITAL
FIRST AID SUMMER SAFETY GUIDE STAY HYDRATED • Always keep a bottle of water handy. • Drink before you start to feel thirsty.
PACK A SUMMER FIRST AID KIT • Bug Spray • Sunscreen • Bottle of Water • Band-Aids, Gauze, and Tape • Instant Ice Packs • Tweezers • Sanitizing Wipes • Aloe Vera Gel • Thermometer • Hydrocortisone Cream • Tea Tree Oil • Antibiotic Ointment • Antiseptic Towelettes • Cotton Balls • Saline Solution
• Choose water over other sugary beverages to stay hydrated.
PROTECT YOUR SKIN FROM THE SUN • The sun’s rays can start to damage your skin in as little as 15 minutes. • Use sunscreen with SPF 30 or higher. • Apply sunscreen 20 minutes before sun exposure, and re-apply every two hours.
AVOID MOSQUITO BITES • Use insect repellent to help prevent mosquito bites. • Wear long sleeves and pants in areas with many mosquitoes. • Apply repellent only to exposed areas of skin.
IF YOU COME IN CONTACT WITH THESE PLANTS
POISON IVY
POISON OAK
POISON SUMAC
• Wash exposed area with soap and water for 5 to 10 minutes. • If a rash starts to break out, soak in a cool bath sprinkled with oatmeal or baking soda. • Wash clothes and sneakers to get rid of any oil.
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PREVENTING DIABETES
DO YOU HAVE PREDIABETES? FINDING OUT WILL HELP YOU AVOID DEVELOPING THE FULL-BLOWN DISEASE.
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rediabetes can lead to diabetes, which can cause serious complications, including heart disease, stroke, kidney disease, blindness and amputations. Though prediabetes is a serious condition, many people who have it don’t know because they don’t experience any symptoms. People with prediabetes and diabetes have a problem with the hormone insulin: Either their cells have become resistant to insulin or their pancreas doesn’t make enough of it. (In some patients, both conditions exist.) Insulin helps move glucose (sugar) from the bloodstream into the cells, where it’s needed for energy. When glucose can’t be processed the way it should be, it stays in the bloodstream. To prevent prediabetes from progressing to type 2 diabetes, it’s crucial to keep bloodsugar levels as close to normal as possible. Key ways to do this include exercise (30 to 60 minutes of moderate physical activity most days of the week) and a healthy diet (low in fat and high in fiber). Maintaining a healthy weight also is important, and patients who smoke should quit. If you have risk factors for prediabetes (see sidebar, “Are You at Risk?”), talk to your doctor about them. If needed, he or she can order a screening test to see whether you have prediabetes, and then recommend a plan to help you manage it and keep the disease from progressing.
ARE YOU AT RISK? You may have prediabetes if you: • Are 45 years of age or older • Are overweight • Have a family history of type 2 diabetes • Are physically active fewer than three times a week • Ever had gestational diabetes (pregnancy diabetes) or gave birth to a baby weighing more than 9 pounds
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MONTEFIORE NYACK DIABETES SUPPORT GROUPS
DIABETES:
HOW MUCH DO YOU KNOW? When it comes to diabetes, knowledge is power. Take our quiz to learn more. Mark each of these five statements about type 2 diabetes “true” or “false,” then check your responses against the correct answers printed below.
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Cardiovascular disease is the leading cause of death in people with diabetes. TRUE FALSE
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Blindness is a common complication of poorly controlled diabetes. TRUE FALSE
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A person at risk for diabetes should avoid eating nuts. TRUE FALSE
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Almost everyone with diabetes has some noticeable symptoms. TRUE FALSE A half hour a day of aerobic exercise, with moderate weight loss, can halve your risk of developing type 2 diabetes. TRUE FALSE
QUIZ ANSWERS
1. TRUE. Diabetes that is not properly controlled can result in high blood pressure and hardening of the arteries, which can lead to heart disease.
2. TRUE. Diabetic retinopathy, a degeneration of the blood vessels in the retina, is a leading cause of blindness in adults.
3. FALSE. In fact, several studies have linked a diet that’s rich in nuts to a lower risk of diabetes.
4. FALSE. Some 30 to 50 percent of individuals with type 2 diabetes have no noticeable symptoms.
5. TRUE. One study showed that 30 minutes a day of moderate physical activity, such as walking, along with a 5 to 10 percent reduction in body weight, reduced the risk of type 2 diabetes by 58 percent.
DIABETES SELF-MANAGEMENT TRAINING PROGRAM: Our Diabetes Self-Management Training program is accredited by the American Association of Diabetes Educators (AADE DEAP). For those who want to learn how to manage their diabetes, our Certified Diabetes Educators (CDEs) teach everything you need to know, including nutrition. DIABETES SUPPORT GROUPS: We have monthly daytime and evening programs, which are facilitated by a Certified Diabetes Educator. These groups are free of charge and open to the public. MAMAS MARAVILLOSAS: This Diabetes Prevention Program is targeted to Spanish-speaking Latina women who are overweight, obese or have other risk factors that put them at a higher risk for diabetes. Mamas Maravillosas supports them in losing weight by promoting increased physical activity, healthier food choices and breastfeeding for as long as possible through their baby’s first year. The program is hosted at a community center in Spring Valley, NY. For more information about our diabetes education programs, call the COMMUNITY AND PATIENT HEALTH EDUCATION DEPARTMENT OF MONTEFIORE NYACK HOSPITAL at 845-348-2004. For more information about MAMAS MARAVILLOSAS or for assistance in Spanish, call 845-348-3057.
28+
24%
84
million Americans have type 2 diabetes
of diabetics don’t know they have the disease
million Americans have prediabetes
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THE MIDWIFERY DIFFERENCE
TO SCHEDULE AN APPOINTMENT WITH A MIDWIFE, PLEASE CALL 845-353-5900 OR 845-353-1441. TO SCHEDULE A TOUR OF THE MATERNITY CENTER, CALL 845-348-2660. FOR FURTHER INFORMATION, VISIT MONTEFIORENYACK.ORG/MATERNITY.
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PICTURED FROM LEFT TO RIGHT: DANA MACDONALD, CNM; KAREN BERGSTEIN, CNM; JENIFER LUCIA, PA-C; AND STEFANIE FERRARO, CNM
ELISA B. AND SAMANTHA G.
“Some women hear the word ‘midwife’ and think only home birth, without pain management. That’s not true.” Karen Bergstein, CNM MONTEFIORE NYACK HOSPITAL’S MIDWIVES DELIVER BABIES AND PERSONALIZED CARE FOR WOMEN OF ALL AGES. THIS YEAR MARKS 20 YEARS OF SERVICE.
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or sisters Elisa B. and Samantha G., having their babies delivered by a midwife was an obvious choice. Before becoming pregnant, both had received healthcare from Karen Bergstein, a certified nurse midwife and Director of Midwifery Services at Montefiore Nyack Hospital. “I have always wanted to use a midwife for my care,” says Samantha. “I love their holistic approach while still incorporating modern medicine, and the compassion and care they provide to their patients. I never imagined anyone besides Karen delivering our baby.”
A SPECIAL BOND Elisa had worked at an OB-GYN practice, where she talked with many women about their birth experiences. “Seeing firsthand how these women bonded with their midwives, established a comfortable relationship and how the feeling of being a ‘patient’ was lost, was an experience that I wanted for my
future pregnancies,” she says. Midwives have delivered close to 20,000 babies at Montefiore Nyack Hospital over the past 20 years. They provide prenatal care and handle vaginal deliveries. “If a woman’s pregnancy becomes high-risk, we co-manage with a doctor, or a doctor takes over management,” says Bergstein, who has been with the program for its entire 20-year history. “But we still help with the delivery.” There is always a midwife at Montefiore Nyack Hospital to cover the labor room and work with mothers in labor and birthing. They also see new mothers in the postpartum unit to make sure they are ready to be discharged. “Some women hear the word ‘midwife’ and think only home birth, without pain management—that’s not true,” says Bergstein. “The experience of childbirth belongs to a woman and her family. If she knows she wants an
epidural as soon as possible, then we’ll abide by her wishes, as long as it’s safe for her and her baby.”
CARING FOR WOMEN OF ALL AGES The seven midwives at Montefiore Nyack Hospital don’t just focus on pregnancy, labor and delivery. Five days a week, our midwives see women for their annual well-woman exams. They prescribe birth control, and see women going through menopause. Six of the midwives, including Bergstein, are certified nurse midwives. They have a college degree in nursing and a master’s degree in nursemidwifery. CNMs are registered nurses (RNs). A seventh is a certified midwife. “Our focus is on women’s health, pregnancy and birth,” says Bergstein. “Pregnancy is a normal, natural part of a woman’s life cycle. We teach women to take care of their bodies before, during and after the birth of their baby.”
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160 North Midland Avenue Nyack, NY 10960
WE ARE NOW MONTEFIORE NYACK HOSPITAL. OUR EXCEPTIONAL SERVICES JUST GOT EVEN BETTER. As an affiliate of this premier academic medical center, Montefiore Nyack Hospital has increased access to Montefiore’s clinical expertise, cutting-edge research and clinical trials, as well as its specialized Centers of Excellence in cancer, cardiology, transplant, and pediatrics. OUR PATIENT-CENTERED PROGRAMS AND CENTERS INCLUDE: • Cancer Care • Orthopedic Surgery • Behavioral Health and Substance Use Disorder Services (including inpatient and outpatient services for adults and children) • New York State designated Area Trauma Center (the only Trauma Center in Rockland County) • New York State designated Level 2 Perinatal Center • New York State designated Stroke Center DISCOVER MORE AT MONTEFIORENYACK.ORG
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