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President’s Message November is National Epilepsy Awareness Month, and being aware of the signs of epilepsy can be difficult, as epileptic seizures are not always obviously noticeable. Each year, 150,000 children and adolescents in the United States will have a newly occurring single seizure and 30,000 are diagnosed with epilepsy after subsequent seizures occur. Epilepsy can emerge as early as the first year of a child’s life, which is why new parents can often miss or misinterpret physical symptoms. Some seizures can be very short, but frequent, and many times the seizure sufferer doesn’t recognize he or she experienced an epileptic episode, while those around them may not have perceived the signs of the seizure.

Community Voices Dear Mr. Gribbin, I was recently an emergency admission for an unknown brain tumor (thankfully benign). I cannot express how impressed I was with your state-of-the-art facility! Everyone was wonderful – the OR staff, the ICU staff, the NPs, and PAs, the 4 East Staff, the transporters, X-ray techs, lab techs and PT. I was assigned the finest physicians there were—the Princeton Brain & Spine group.

I was very impressed with the knowledge, confidence, professional manner and rapid response I received! No one was impatient or uncaring, preferring to meet my needs. I had constant feedback for my questions, and was asked if I had any other questions. When I had One thing that always holds true in health care is that Dear Mr. Gribbin, an emergency event, they were right there. I felt are consistently concerned if their child is Prevention, failure to According to theparents Centers for Disease Control and I just completed 33 radiation treatments for breast developing properly. It doesn’t matter if it’s your first child cancer under the guidance of a superb group of and protected during this vulnerable time. safe recognize seizures early not receiving proper increases the risk or your sixth,and their growth progress is always going totreatment be your staff members. Dr. Soffen [Edward Soffen, MD, foremost in your mind. and decreased health-related quality of life. Chaplin services, patient representatives, and for additional seizures, disability, board-certified radiation oncologist with Princeton As a father and now a grandfather, I know what it’s like trying to find top medical Radiation Oncology and chair of the Radiation social workers were all available. I even received Epilepsy can not only affect a child’s health, but can also have a major social care for your children. Finding the right pediatrician that you connect with can be Oncology Department at a call from Betty on 4 East post-discharge asking more difficult than you isolation would think. This is the person whom you’re entrusting CentraState Medical Center] impact, causing and loss oftoself-esteem. If you suspect that your your child’s health, so you have to feel comfortable with them and make sure that was the kindest, most downif all was well. child may experienced even one seizure, contact your pediatrician they’re goinghave to deliver the care that you expect. to-earth physician I have ever met! He was knowledgeable immediately for anaevaluation. Take notes about the Whether you’re expecting baby or need to find a new pediatrician for your child,duration and symptoms and experienced, and made me CentraState’s many advanced health care services for children—from our team Theme technology was amazing. You should be your child exhibited and share this with your doctor. feel empowered by giving of esteemed pediatricians to our Pediatric Emergency Department to our on-staff options of treatment.very He made proud of the staff you have—they know pediatric hospitalists—are available to ensure that your child receives the very me feel as though he came to best care. what to do at all times. I cannot say enough work just to care for me. CentraState is proud to provide specialized epilepsy treatment programs Edward Soffen, MD, One of our outstanding pediatricians on staff is Vatsala Bhaskar, MD, boardboard-certified radiation Your therapists: Susan, good things about them! Everyone washed their exclusively for infants andinchildren at Thepediatric Comprehensive Epilepsy Center at certified pediatrician, who is featured this issue discussing behavior oncologist Nathalie, Stephanie, Jennifer and development. As Dr. Bhaskar explains, well visits for your child are important hands CentraState, which features state-of-the-art technology and a staff of R. and Gloria went above and after each contact, observing universal to keeping track of their overall health, which makes finding the right pediatrician beyond any call of duty to make my treatments a precautions. I was impressed. The facility was all the more significant. Read more of Dr. Bhaskar’s insights into this topic on registered nurses, and experienced pediatric epileptologists, neurologists, pleasant experience. They always greeted me with page 10. clean a smile and kindneurologist words. They worked together as a and comfortable. technologists. Directed by Megdad Zaatreh, MD, a board-certified When mothers do choose CentraState to deliver their child and select one of our team to make sure that my treatment went perfectly specializing in epilepsy, Epilepsy provides a full spectrum of care pediatricians to care for their child’sthe health, they tend toCenter return for subsequent smoothly. I will genuinely missto seeing them every deliveries. Such is the case with Erika Vargo-Dill, a mother of three who delivered morning! They were the sunshine in my day. I felt compelled to write you to express my infants, children, adolescents and adults living with epilepsy and is part of all of her children at CentraState and has had nothing but positive experiences Nurses Carol, Jennifer S. and Jennifer B., with their and gratitude. You have a medical center thanks time. The story of Erika’s charming family can be foundmultidisciplinary on page 8. oureach larger neurosciences program. Our approach offers expertise, made me feel confident and reassured If you’re interested in learning more about CentraState’s maternity and pediatric to be proud of. My best wishes for continued that I was going to be fine. Cheryl, who took care complete care and ongoing support to epilepsy patients and their families, services, the perfect opportunity would be our Spring Baby Fair on April 25, to of my simulator needs, put me at ease with her growth. I cannot say enough good things about with theat goal of improving the Ambulatory quality of life and accessibility ofand care for be held CentraState’s Star and Barry Tobias Campus. More details knowledge care. Cassie at the front desk about the Baby Fair can be found on page 15. We hope to see you there, and greeted me each morning with kind wordsyou, and and will tell everyone I know about this anyone coping with seizures. hope to see your child or children as part of our healthcare system for many reassurance. astounding experience. years to come. Having cancer is a very scary experience, but due to your fine staff, I felt confident each day that I was ToYours learn more about pediatric epilepsy, read Aaron’s story on page 6. in Good Health, getting the best care possible! Thank you! Respectfully, Sincerely, Christine Jones Linda Howard New Egypt John T. Gribbin, FACHE Manalapan President and CEO Common symptoms of a child’s epileptic seizure include: • A staring spell • Uncontrollable jerking movements of the arms and legs • Lack of response to verbal stimulation s Message… Community Voices… • Shaking, falling President’ or smacking of the lips

Healthy Directions is produced by CentraState Healthcare System, Freehold, New Jersey.

Healthy Directions is produced by Editorial Advisors William J. Setaro, EdD CentraState Healthcare System, Chair, Board of Trustees Freehold, New Jersey. John T. Gribbin, FACHE Spring 2013

President and CEO

Daniel J. Messina, PhD, FACHE, LNHA Senior Vice President and Chief Operating Officer

Editorial Advisors William J. Setaro, EdD Chair, Board of Trustees John T. Gribbin, FACHE President and CEO

Jack H. Dworkin, MD, FACC Vice President and Chief Medical Officer

Linda W. Geisler, RN, MNEd, NEA-BC, FACHE Vice President, Patient Care Services Kim A. Kelly, RN, MS, NEA-BC, FACHE Vice President, Clinical Services Roman N. Lucky, CFRE Vice President, Development Rich Mackesy Vice President, Strategic Planning & Business Development Jay Solomon, MPA, LNHA Vice President, Senior Services Abbey M. Luterick Director, Public Relations and Communications

Editor–CentraState Brian Johnson Managing Editor–True North Mike Legault Writers Jane DeTullio Stephanie Duncan

Please note that physicians on staff are private practitioners and not employed by CentraState. We hope you enjoy this issue of Healthy Directions. Comments about the publication can be directed to the Public Relations and Marketing Department, CentraState Healthcare System, 901 West Main Street, Freehold, NJ, 07728. (732) 294-7080.

Daniel J. Messina, PhD, FACHE, LNHA Roman N. Lucky, CFRE Senior Vice President and Healthy Directions is published by CentraState Healthcare System toVice provide general health information. President, It is not intended to provide personal medical advice, which should be obtained directly from a Development Chief Operating Officer health care provider. Photographers Peter Chollick Rich Mackesy David KellyH. Crow Jack Dworkin, MD, FACC Rich Schaub Vice President, Strategic Planning & Business Development Vice President and Chief Medical Officer Designer Sherri Thornton Jay Solomon, MPA, LNHA Linda W. Geisler, RN, MNEd, NEA-BC, FACHE Vice President, Senior Services Vice President, Patient Care Services Abbey M. Luterick Kim A. Kelly, RN, MS, NEA-BC, FACHE Director, Public Relations and Communications Vice President, Clinical Services

CentraState Medical Center is a Magnet hospital. ®

2 CentraState Healthy Directions | Holiday 2013

Editor Brian Johnson Writers Jane DeTullio Stephanie Duncan Chris N. Johnson Jeannine Johnson Photographers Peter Chollick Rich Schaub Kevin Birch David Kelly Crow


The Hazards of Immobility:

Pulmonary Emboli

Frank Castro (center) is back on his feet after recovery from a pulmonary embolism thanks to the efforts of Peter Hynes, MD, (left) and Robert Kayser, MD (right).

For the past 20 years, 71-year-old Frank Castro and his wife, Pura, have spent two months a year in Spain, a place of heritage and lasting memories for them. The memories they have from this summer’s trip, however, are of a different order. Frank is lucky to have lived through this trip. He had noticed a shortness of breath while in Spain but chose not to worry his wife. The night of their return, Frank felt unusually exhausted and retired early, figuring that it was just from the trip. But by 1 a.m., Frank was struggling to breathe, and by early morning, Pura and Frank headed for CentraState’s emergency department, a decision that ultimately saved Frank’s life. Frank was found to have a massive blood clot, or pulmonary embolism, in the main artery to the lungs, most likely the result of his lengthy plane trip to and from Spain. Extended immobility is one of the main risk factors for blood clots, and Frank had not moved for most of the journey. While 95 percent of emboli, or blood clots, originate in the legs, they can break off and travel to the lungs, causing a blockage to the heart. Frank’s had done just that. To relieve this life-threatening condition, Robert Kayser, MD, board-certified interventional cardiologist with Change of Heart Cardiology and on staff at CentraState, consecutively threaded two types of catheters into Frank’s pulmonary artery. The suction catheter flushed the emboli with a clot-busting drug and suctioned particles out, but some remained. The newer infusion catheter, reserved for the most difficult cases, contains an ultrasound wire that dissolves the clot further and allows medication to penetrate more deeply into the clot than more traditional methods. The infusion catheter worked, and Frank’s lung pressure returned to normal. Subsequently, Peter Hynes, MD, boardcertified cardiologist and Dr. Kayser’s partner, located the

original clot in Frank’s leg and dissolved it as well, leading to Frank’s full recovery. Dr. Kayser remarks that “CentraState now has the capability to provide a level of care that is commensurate with or higher than any of the hospitals in the area and any academic center. Even though we are a community hospital, we have the latest and greatest of endovascular therapies available. There’s really almost nothing being done in the world of endovascular services that we don’t do at CentraState.” Dr. Kayser recommends that to avoid blood clots, people should attempt to be as mobile as possible, walking intermittently during long journeys or extended periods of sitting, such as in an office or in front of a television. CentraState inpatients are provided voluntary or mechanical methods of stimulating the muscles, such as leg compression devices, expressly to avoid clotting. Frank remains grateful for the services of his physicians and “the wonderful people at CentraState” and is looking forward to his next summer in Spain. For more information about CentraState’s endovascular services, visit www.centrastate.com/endovascular or call 866-CENTRA7 (866-236-8727).

Risk Factors for Pulmonary Emboli A genetic abnormality of the clotting system Prolonged immobility (from bed rest, long journeys, extended television viewing) Surgery Dehydration Trauma to the blood vessels Smoking Centrastate.com 3


Battling Three Types of Cancer Robert DeFeo (second from right) has beaten cancer three times thanks to the care and support of (left to right) Paul Rossos, MD, Amit Kharod, MD, Sharon Lorfing, APN-C, and Bhavesh Balar, MD.

Robert DeFeo loves to show off the photo book his daughter made for him as he began cancer treatment. Titled “Health is Our Greatest Gift,” the book is a collection of family pictures and inspirational captions.

Rossos removed a lesion from his larynx (voice box). A biopsy determined it was cancer, but fortunately it was detected early. “If you catch this type of cancer early, the cure rates are in the 90 percent range,” Dr. Rossos says.

There’s a photo with his wife, two grown daughters and two grandchildren with the caption, “We love you daddy.” Another photo bears one of the motivational phrases he turned to during his darkest days, “Bring it on treatment, I’m stronger than you think.”

During the course of treatment for laryngeal cancer, Robert had what might be considered a stroke of “luck,” under the circumstances. A CT scan showed a lesion in his lung that turned out to be lung cancer. Although Robert was a longtime smoker, he had no symptoms.

Without the love of his family, and the care and support of his team of doctors, nurses and specialists at CentraState Healthcare System, Robert says he doesn’t know how he would have survived his remarkable battle with cancer. In a span of less than 18 months, the 70-year-old was diagnosed with and treated for three separate types of cancer – undergoing multiple surgical procedures, three rounds of radiation treatments and a course of chemotherapy. “I’m beating throat cancer, lung cancer and thyroid cancer,” says Robert, a retired carpenter who moved to Monroe Township from Brooklyn in 2010. “It wasn’t easy, but I’m feeling really good right now.”

Cancer Identified

After experiencing hoarseness for several weeks in January 2012, Robert went to see Paul Rossos, MD, a board-certified ear, nose and throat specialist on staff at CentraState. Dr. 4 CentraState Healthy Directions | HOliday 2013

Robert Caccavale, MD, board-certified thoracic surgeon

“Lung cancer typically does not produce a cough or other symptoms during its earlier stages,” says Robert Caccavale, MD, a board-certified thoracic surgeon on staff at CentraState. “Yet, when we detect lung cancer before symptoms arise, patients very often have better outcomes.”

It’s Cancer, Again

Robert’s workup at CentraState included positron emission tomography, or PET, a diagnostic imaging exam to detect cancer cells in the body. The test showed possible cancer in his thyroid, which was later confirmed with a biopsy. “It’s not uncommon to have laryngeal cancer and lung cancer, but the thyroid cancer was just a rare happenstance,” says Edward Soffen, MD, a board-certified radiation oncologist on


“A lot of patients don’t realize you can get all of these services without going out of Monmouth County.” – Amit Kharod, MD

staff at CentraState, who performed Robert’s radiation treatments on the referral of Dr. Rossos. “It was really quite unusual to have all three cancers and have them all present in a very narrow time frame.” Robert’s doctors had to not only attack each type of cancer, but they had to work collaboratively on his care. “It was challenging, because treatment is different for each cancer,” says Bhavesh Balar, MD, a board-certified hematologist/oncologist who chairs the Cancer Committee at CentraState. “We constantly had to keep in mind whether treatment for one type of cancer would complicate treatment for the second or third.”

Sophisticated Cancer Care

Because of the complicated nature of his case, Robert benefited from many of the comprehensive services and coordinated care available at The Cancer Center at CentraState. • For his radiation treatments with Dr. Soffen, he underwent intensitymodulated radiation therapy (IMRT), a state-of-the-art technology that precisely targets and destroys cancer cells.

Caccavale involved an advanced, minimally invasive surgical procedure known as video-assisted thoracic surgery, or VATS. • Before Robert underwent chemotherapy for lung cancer, Dr. Balar checked his molecular markers to determine the best, most targeted treatment. • His thyroid was removed by Amit Kharod, MD, a board-certified general surgeon on staff at CentraState, using a method that helps ensure nerves of the throat are not injured during surgery. “A lot of patients don’t realize you can get all of these services without going out of Monmouth County,” Dr. Kharod says. “In a community hospital setting, we’re able to effectively communicate and coordinate care relatively quickly for patients.”

Emotional Support

Robert also credits the guiding hand of Sharon Lorfing, APN-C, a surgical oncology nurse practitioner and cancer navigator at CentraState. Sharon is available to help cancer patients deal with practical issues— from making appointments to finding transportation—and is there to provide education and emotional support.

• His lung cancer surgery with Dr.

“I try to give patients as much information as I can when they are first diagnosed with cancer,” she says. “We want patients and family members to be empowered to take Edward Soffen, MD, control of their care board-certified radiation oncologist and to also know they are not alone when they get that diagnosis.” With his cancers in remission, Robert has regained his strength, his weight and most of his old voice. He hopes to be back out on the golf course soon. While he doesn’t know what the future holds, he believes he can get through anything with the support of his family and his wife, Maryanne, who, remarkably, is a lung cancer survivor herself. “When I was feeling down and low, she would tell me not to worry and that everything was going to be all right,” he says. “She was right. I was treated wonderfully at CentraState. The way they treat you, it’s unbelievable.” For more information about CentraState’s cancer services, call 855-411-CANCER (855-411-2262) or visit www.centrastatecancercenter.com.

Free Lung Cancer Screenings The Lung Center at CentraState Medical Center, in conjunction with Freehold Radiology Group, is now offering free, low-dose CT screenings, using a 64-slice CT scan, for those individuals considered at high risk for developing lung cancer. Participants will be screened once a year for three years. To receive the free CT scans, participants must: • Be a current or former smoker age 55 to 74 • Have smoked for 30 pack years or more (e.g., 1 pack a day for 30 years, 2 packs a day for 15 years) • Still be smoking or have quit in the past 15 years • Not have existing nodules

For more information, and to determine your eligibility, please contact CentraState’s nurse navigator at 732-637-6365. Centrastate.com 5


Tom, Marie, and Aaron Lucia have peace of mind now that Aaron is receiving treatment for his epilepsy at CentraState.

A Feverish Discovery:

The Association of Language Delay and Pediatric Epilepsy

I

t was just another day in the Lucia household in Toms River during the summer of 2012. Aaron, 2 ½ at the time, had been engaged in speech therapy because his language development was lagging far behind that of his two older siblings, yet he appeared to be making little progress. Aaron still only uttered “Ma.” Frustration was building for both Aaron and his parents. That day, Aaron had a slight fever, suggesting a possible ear infection. Returning from the doctor’s office where the ear infection had been confirmed, Marie Lucia glanced in the rearview mirror to see Aaron convulsing in his car seat. Terrified, Marie rushed him to the closest hospital. A spike in Aaron’s temperature had set off a seizure, called a febrile seizure, a frightening but somewhat common occurrence in children. In isolation, a febrile seizure may not raise an alarm or require treatment. However, when coupled with a language or other developmental delay, further exploration is essential, 6 CentraState Healthy Directions | HOLIDAY 2013

states Megdad Zaatreh, MD, board-certified neurologist specializing in epilepsy and on staff at CentraState Medical Center. Dr. Zaatreh set Aaron up for a three-day electroencephalography (a.k.a., prolonged EEG), which showed that Aaron was having six to seven, visibly undetectable seizures per hour, a stunning finding for the Lucias. Seizures act like electric shocks to the brain, disrupting learning and memory storage and retrieval. Although Aaron’s seizures were lasting only four to five seconds per seizure, their frequency was disrupting his language development. The Lucias were proactive and chose to administer, over time, increasing doses of medication to Aaron, while Dr. Zaatreh monitored two parameters: Aaron’s speech and his seizure activity through repeat EEGs. To her relief, Marie found that “every time Dr. Zaatreh upped Aaron’s medication, his speech got better. He’s talking in sentences now. If we hadn’t found Dr.


Zaatreh, we could still be thinking that Aaron just had a speech delay.”

Seizures and Childhood Development

Public perception is that seizures involve convulsions and a loss of consciousness, as in grand mal seizures. A much more common type is the complex partial seizure, where a child or adult loses awareness for one or two minutes. The child may stare into space, have glassy eyes, and stop talking. Moments later, he or she is fine. Complex partial seizures are often undetected until something more dramatic occurs, as in Aaron’s febrile seizure. Meanwhile, precious developmental time is lost. The seizures will most likely disappear as the child ages; however, the child’s speech, behavior and school performance can all be affected if no treatment is provided. The repercussions of these learning deficits could last a lifetime. “Aaron was very, very shy before he was speaking. I think that had a lot to do with not being able to communicate with people,” Marie observes. The prolonged EEG picks up abnormalities occurring during different activity levels as well as times of day. Sometimes, the brain abnormalities occur only at night, a time when the brain stores information learned during the day. With nighttime seizures, the storage doesn’t happen. Dr. Zaatreh identifies two populations that would benefit from prolonged EEGs: children with speech delays for no apparent reason and children with autism. One child in three with autism experiences complex partial seizures, which can worsen the child’s speech, behavior or academic performance. “The unique thing about these two populations is that their seizures are usually treatable,” Dr. Zaatreh says. “If someone has speech problems because of recurrent seizures, treating the seizures should give the brain the chance to start learning. Sometimes, the response is dramatic with medication.” On the other hand, warns Dr. Zaatreh, “sometimes we catch these children later, when the critical period of learning has passed. The trick is finding these patients and finding them early, not treating them. There are 25 seizure medications to pick from. Treatment is not the issue.” Tom Lucia urges parents “to be more proactive than reactive, if there is a speech or developmental issue.” He adds, “Thankfully, Aaron had the febrile seizure or we would never have known about his seizure disorder.”

The Value of Prolonged EEGs

Megdad Zaatreh, MD, board-certified neurologist

Routine electroencephalographies (EEGs) last 20-30 minutes. If the patient doesn’t experience a seizure within that time frame, the result can be negative or inconclusive, as the brain appears normal in between seizures. Prolonged EEGs, on the other hand, are minimally 48 hours long and detect abnormalities that may occur while the patient is sleeping, waking, active, sedentary, or responding to stimuli. Neurologists undergo special training to administer and interpret prolonged EEGs.

For this reason, hospital intensive care units have found the prolonged EEG to be of tremendous value with unconscious or brain-injured patients. Seizure activity is one of the causes for an unconscious state; yet, the seizures are often visibly undetectable. As long as a patient is seizing, he or she will not wake up. Evaluation and subsequent treatment of the seizure disorder provides the brain a chance to emerge from the unconscious state, providing a faster recovery for the patient. “It’s amazing what we are finding with the prolonged EEG, such as patients who have seizures they’re not aware of, or abnormalities that were never detected before,” Dr. Zaatreh says. “For most, seizure activity is a treatable condition.” The Neuroscience Center of Central Jersey at CentraState offers comprehensive care for brain, spine and nervous system conditions. Our neuroscience experts understand that the most powerful, effective treatments address all of your needs—body, mind and spirit. From epilepsy treatment, to brain tumor surgery, to spine rehabilitation and pain management, to customized wellness programs—at CentraState you’ll always find the support and inspiration you need to reach new milestones and live life well. For a complete list of programs and services, call 866-CENTRA7 or visit www.centrastate.com/neuroscience.

Further evaluation is recommended:

Dr. Zaatreh is confident that Aaron’s abnormal brain activity will significantly improve or go away entirely, and medication will no longer be necessary. “Aaron will eventually catch up, speechwise,” Dr. Zaatreh says. “My prognosis is that he will do very, very well.”

• If a child is less than 8 months old and has a febrile seizure, especially if the seizure lasts more than a few minutes

For more information about The Comprehensive Epilepsy Center at CentraState, call 866-CENTRA7 (866-236-8727) or visit www.centrastate.com/epilepsy.

• If a child has been diagnosed with autism, especially if accompanied by staring events; behavior arrest (stopping for a few seconds, then resuming activities); muscle twitching; visual phenomena (older children); or language regression (had talked and now doesn’t)

• If a child has more than one febrile seizure • If a child has a febrile seizure on one side only • If a child has a speech delay for no apparent reason

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Pediatric sleep disorders

can jeopardize normal childhood development By Samuel Krachman, DO

Sleep behaviors are one of the most common concerns parents of young children discuss with their pediatricians. In infancy and early childhood, the developing brain requires more time asleep than it does awake. As a result, sleep quality is extremely important in the overall well-being of a child. Children suffering from lack of quality sleep or sleep-related disorders can jeopardize their cognitive, emotional and physical development. Pediatric sleep problems don’t just affect the child—they often have a negative impact on the quality of sleep for other siblings and the entire family dynamic. Sleep disturbances are diagnosed in 25 to 30 percent of infants and children. Causes can include an inconsistent bedtime routine, sleepwalking, sleep apnea, narcolepsy and epilepsy. Not surprisingly, pediatric sleep disorders are often overlooked because presenting symptoms—negative behavior, moodiness, irritability, lack of motivation, inability to focus, lethargy—are misdiagnosed as behavioral or emotional problems, not a physical, medical condition. Severe or chronic sleep disorders can even cause adverse cardiovascular and metabolic effects as well as failure to thrive.

Common pediatric symptoms

Symptoms of sleep disorders in children can be obvious or subtle and often present with one or more of these symptoms on a regular basis: • Ongoing bedtime resistance • Nightly awakenings • Sleepwalking • Nightmares • Bedwetting • Insomnia • Chronic snoring / breathing difficulties

How to proceed if you suspect a sleep disorder

First, consult with your pediatrician to rule out any acute or chronic 8 CentraState Healthy Directions | Holiday 2013

medical conditions. Once medically cleared, it may be helpful to clinically observe and monitor your child in a sleep center that offers pediatric diagnosis and treatment services. These centers offer comfortable bedroom-like settings where sleep patterns are evaluated and diagnosed during an overnight stay. A parent accompanies the child during the stay to provide comfort and alleviate anxiety. A sleep technologist applies small painless sensors designed to monitor your child’s brainwaves, muscle activity, heart rhythms, respiratory activity and oxygen saturation levels throughout the night. The results are then analyzed by a pediatric sleep medicine physician, who will determine a diagnosis and recommend the most appropriate treatment for your child, if necessary. Once properly diagnosed, this and other sleep-related medical conditions can be successfully treated to restore the child’s normal development process. If you suspect your child may have a sleep issue, see your pediatrician and discuss a sleep study evaluation. The Center for Sleep Disorders at CentraState Medical Center is one of only a few hospital-based sleep centers in the area. It is accredited by the American Academy of Sleep Medicine (AASM) and offers the latest diagnostic sleep disorder technology set in a comfortable, home-like atmosphere. Specially trained pediatric and adult specialists offer sleep study evaluations and EEGs (electroencephalograms) conducted in child-friendly bedroom settings. Parents stay with their children throughout the on-site sleep evaluation. To learn more about the Center for Sleep Disorders, call 877-NJSLEEP (877-657-5337) or visit www.centrastate.com/sleep. Samuel Krachman, DO, is a board-certified physician specializing in sleep medicine, pulmonary care and internal medicine and director of the Center for Sleep Disorders at CentraState Medical Center in Freehold. He can be reached by calling 732-303-5070.


The Changing Face of Health Care Traditionally, the doctor/patient relationship is pretty straightforward: Patient gets sick, visits doctor, eventually feels better. But impending changes in how health care operates in this country, accelerated by the Affordable Care Act (Obamacare) mean potential changes in some doctor/patient relationships, such as putting their primary focus more on preventative medicine, so patients don’t get sick as often or they better manage their chronic diseases. One model some doctors are starting to follow is the patientcentered medical home (PCMH). Despite its name, a PCMH is not a physical building but a health care model based on comprehensive, coordinated care, providing primary health care that is relationshipbased with an orientation toward the whole person. PCMHs deliver accessible services with shorter waiting times for urgent needs, enhanced in-person hours, and around-the-clock telephone or electronic access to a member of the care team. In short, it’s about giving patients proper guidance so they can take charge of their own health and have a better quality of life. Family Practice of CentraState (with offices at CentraState’s Star and Barry Tobias Ambulatory Campus, Freehold Boro, Colts Neck, Hightstown and Monroe) is currently participating in a PCMH program with Horizon Healthcare Innovations, and other physicians on staff are a part of similar programs in an effort to further enhance their quality of patient care. The practice is recognized by the National Committee for Quality Assurance as a level 3 patientcentered medical home, their highest certification. “Patient-centered medical homes are a program where doctors try to keep our patients healthy and prevent them from getting sick,” says Marc Feingold, MD, a board-certified family medicine physician on staff at CentraState, who runs an operation similar to a PCMH in Manalapan. “I think patient-centered medical homes are the way the health care industry is going to go in the future.” In his practice, Dr. Feingold goes over all treatment options with his patients so they have a full understanding of how to take care of themselves. “Patients feel more empowered, realize what must be done to improve their health, and take their medications more effectively,” Dr. Feingold says. “They feel better, and we feel better.”

Digital Doctoring

One of the keys of providing patientcentered care is implementing technology such as electronic medical records. When coupled with updated technology, one thing that the PCMH model brings to the table is an increase

Marc Feingold, MD, board-certified family medicine physician, is focused on preventative medicine.

in evidence-based medicine, which determines the best course of treatment through analysis of patient records, made easier by using electronic medical records (EMR). “Through technology, we can improve patient/provider communication,” says Howard Stein, DO, president of CentraState Medical Associates. “Technology is a conduit to capture data and organize it in a way for physicians to meaningfully use it in a PCMH. Family Practice of CentraState, was one of the first in the region to embrace EMR technology.” Dr. Feingold’s practice also uses electronic medical records, which allow him to quickly retrieve a patient’s medical history and easily share it with any other practice involved in the patient’s care, and an online patient portal, through which patients can submit questions about their care that are answered in a timely fashion by Dr. Feingold. “I think electronic medical records have made me a better doctor and a better communicator, and it frees up my staff to do their jobs more efficiently,” Dr. Feingold says. In addition, Dr. Feingold’s office is equipped with a generic medicine dispenser, which is used to give patients a 30-day supply of medication right away instead of having to make a trip to a pharmacy—something some patients aren’t able to do for days. Dr. Feingold feels that being able to show patients their medication while in the office increases their compliance to take them properly when they get home. “I can open the medication up and put the pill right in the patient’s hands so they’re not scared of it,” Dr. Feingold says. “The dispenser integrates with my electronic medical records, so it can check for drug interactions automatically.” With the combination of state-of-the-art technology and focus on patient responsibility, Dr. Feingold’s practice has elevated patient care from the traditional, standard way of practicing medicine to a guidance tool for overall health. “I like to think of myself as a health coach more than a doctor,” Dr. Feingold says. To find a physician at CentraState, call 866-CENTRA7 (866-2368727) or visit www.centrastate.com/physicians. Centrastate.com 9


Healthy Holiday Eating Everyone loves the holiday season, but all of that tasty holiday food can do some damage to your waistline. So instead of deep-frying your stuffing and smothering your turkey in mayonnaise, try serving up these healthy alternatives with a dash of holiday cheer instead:

Turkey

Stuffing

Green Beans w/ Caramelized Shallots

Directions: Spray a pan with nonstick cooking spray. Sauté celery and onions 3-4 minutes. Remove from pan. Remove sausage from casing and sauté in same pan until cooked through and broken into small pieces. Gently mix bread, onion, celery and sausage in a casserole dish. Add apple sauce and broth and fold together. Bake at 350 degrees for 30 minutes. Cover for softer stuffing.

Directions: Cook green beans in boiling, salted water until tender, about 6 minutes. Drain and plunge into a bowl of ice water to cool. Drain again.

Another healthy alternative: Instead of sweet potato casserole, bake sweet potatoes and lightly drizzle with honey and cinnamon.

Instead of buying the whole bird, try just buying individual turkey breasts, which are all white meat and lower in calories than dark meat. But if you must have that whole turkey to enjoy, avoid the trend of deep frying and stick to roasting. It may take longer, but the results in taste and health are worth it.

2 pounds green beans, trimmed 1 pound medium shallots 2 tablespoons butter 2 tablespoons olive oil 1/2 teaspoon fresh thyme, chopped Salt & pepper, to taste

Cut off and discard ends from the shallots. Cut shallots lengthwise in half and remove peel. Melt butter with oil in a large skillet over medium-high heat. Add shallots and sauté for 1 minute. Reduce heat to medium-low; sauté until shallots are browned and tender, about 20 minutes. Sprinkle with thyme, salt and pepper. Add cooked green beans to the shallots and stir over medium-high heat until heated through. Season to taste with additional salt and pepper. Serve warm.

1 12-oz package of cubed herb-seasoned stuffing 2 cups of fat-free, low-sodium chicken broth 1-1 1/2 cups applesauce 1 cup chopped celery 1 cup chopped onion 2 links of sweet turkey sausage

Lessons from the Kitchen: Cancer-Fighting Kitchen Cooking Demonstration Join us as we gather around the table to laugh, learn and share ideas on food, health, and lifestyle. Our cooking demos are facilitated by a master’s-prepared registered dietitian who will discuss and demonstrate healthy cooking techniques, exploring how making simple changes in your kitchen can be the first step toward a healthy lifestyle. Topics change monthly, and groups are small, so register early so you won’t miss out. Registration is required, as space is limited. To register, please go to centrastate.com and click on Class and Events or call the Health Awareness Center, Monday-Friday, 8:30 a.m.- 4 p.m. at 732-308-0570. Class Date: Tuesday, December 10, 7-8:30 p.m. Location: CentraState Medical Center, Star and Barry Tobias Ambulatory Campus, Health Awareness Center, Suite 100, 901 West Main Street, Freehold, NJ 07728 Cost: $10

10 CentraState Healthy Directions | Holiday 2013


“With the upcoming holidays we are often visiting older relatives that we may have not seen for quite some time,” says Maria Ciminelli, MD, program director of the CentraState Family Medicine Residency Program. “During these visits it may become apparent that their physical and/or mental health has declined significantly, and it’s time to begin thinking about the resources offered through assisted living.”

Making the Decision

“An important factor to remember is that your parent isn’t likely to admit that they need to move into an assisted living facility when someone first suggests it,” Dr. Ciminelli says. “You and other key family members may come to that determination after careful discussion and observation of your parent’s state of living. One strategy that may help your parent realize that an assisted living Maria Ciminelli, MD facility would improve their quality of life and their overall safety is to actually involve your parent’s primary care doctor in the discussion.” The following are some red flags that your parent shouldn’t be living on his or her own anymore.

Is Your Parent Ready for Assisted Living? It’s inevitable for virtually everyone—as we age, the tasks of everyday life become more and more difficult. We have a hard time remembering where we put things, wondering if we took our medication, getting in and out of the shower, cooking, cleaning the house, etc., and these complexities are usually exacerbated if we’re living alone. Some senior citizens can cope just fine doing these things on their own, but others, typically those with health problems, just find them too difficult to overcome without assistance. Naturally, you want to be there for your parents and help them as much as you can, but sometimes that’s just not a possibility. You have your own life you lead, and the more care your parents need, the less equipped you’ll be to personally help them. If you do find yourself in this situation, it may be time to consider the option of placing your parent in an assisted living facility. It’s a difficult choice to make, and one that your parent might not readily accept, but it may be the right choice for everyone.

Has your parent: 1. Experienced significant weight loss? 2. Let his or her grooming habits slide? 3. Isolated from friends and family? 4. Hidden bruises from falls or other household injuries? 5. Stopped paying bills? But finding the right residential setting for your parent isn’t just about their quality of life, it’s also about the effect it will have on your life. The following are some signs that you may be ready for your parent to make the change to assisted living.

By taking care of your parent, have you: 1. Become sleep deprived? 2. Missed key duties or functions at work and/or home? 3. Found yourself struggling to pay bills as a result of spending

money on your parent’s care? 4. Neglected your own health? 5. Felt concerned that your parent would not be able to properly respond to an emergency in their house?

Such a drastic change in lifestyle will undoubtedly be challenging and emotional for your whole family. The transition may not be easy, but sitting down with your parent and going over all of the reasons why he or she should move and showing them how their quality of life will improve will help them accept the change and the reasoning behind it, so you both can live your lives with more peace of mind. For more information about CentraState’s senior services, visit www.centrastate.com/senior-services.

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CentraState Medical Center 901 W Main St Freehold, NJ 07728

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CentraState Briefs Briefs CentraState

The ManorNamed Health aand Center Earns DOH Recognition CentraState TopRehabilitation Hospital in New Jersey • Top Hospitals for the Treatment of Strokes: No. 2

The April issue Healthcare of The Star Ledger’s JerseyHealth magazine CentraState System’s Inside The Manor and Rehafeatures its Castle listingJersey of New Jersey’s bilitation CenterConnolly recently Medical receivedLtd. the’s New Department TopofHospitals in 2013,Standard and CentraState Medical Centerofhas risen Health Advisory of Care—a recognition excellence near the top. Our facility was rated the No. 2 hospital in the state and one of the top honors the state can bestow on a senior care among hospitals with 350 or fewer beds. facility. According to the Department of Health (DOH), licensing CentraState wasNew alsoJersey ranked highlyhomes in the following categories standards for nursing include both mandatory (350 or fewer which beds): facilities must meet, and advisory standards, standards,

which are standards of excellence are optional • Top Hospitals for the Treatment that of Breast Cancer:and No.voluntary. 2 • Top Hospitals for the Treatment of Prostate Cancer: No. 2 • Top Hospitals for Hip and Knee Repair: No. 2 • Top Hospitals for the Treatment of Congestive Heart Failure: No. 3

The Manor with advisory No. standards in the • Topachieved Hospitalscompliance for High-Risk Pregnancy: 2 • Top Hospitals for the Treatment of Neurological areas of: Disorders: • Access to care No. 2 • Registered Nurses Always Communicated Well: • Resident activities No. 2 (tied) • Administration • Licensed Resident assessment and care plan physicians throughout the state provided for their top hospitals, which were then compiled • rankings Communication the third-party • by Dental services firm, Castle Connolly. • Congratulations Dietary services to all of the physicians, employees and • volunteers Nurse staffing at CentraState who deserve this well-earned • recognition! Pharmacy • Quality assessment and medical records

CentraState Earns Joint Commission Accreditation for Wound Program CentraState NursingCenter Excellence The Central JerseyHonors Wound Treatment at CentraState Medical has recently received The Joint Commission’s AwardCenter Winners Disease-Specific Care honored Certification. the CentraState recently sevenCentraState RNs with itsearned 11th annual two-year certification by demonstrating compliance with the Nursing Excellence Awards for demonstrating exceptional Commission’s national standards health care quality and clinical skill and leadership in the for hospital and in the safety in wound care. The Central Jersey Wound Treatment community. Center at CentraState a multidisciplinary ® recognition apSince 2005, CentraState provides has held Magnet proach to the diagnosis and treatment of non-healing status from the American Nurses Credentialing Center, (chronic) wounds, using the most advanced technology which is considered the “gold standard” for measuring and procedures, including excellence in nursing hyperbaric and patienttherapy. care. Nurses who win the Nursing Excellence Awards must demonstrate Magnet

The 2013 award winners are (from left to right): Karen Goglia, RN, AD, Critical Care/

Award;online Eileen Ammon, RN, BSN, CNOR, and Helen Bueti, RN, BSN, ReadEmergency HealthyServices Directions at www.centrastate.com/publications CGRN, Perioperative Services Award; Renie Ebreo, RN-BC, BSN, MSN, Mental Health

Servicesto Award; RNC, Maternal/Childby Health Services Award; Vickie Moon, Subscribe our Mary freeFoster, health e-newsletter visiting RN-BC, Medical Surgical Services Award; and (not pictured) Judy Howley, RN, BSN, CDP, www.centrastate.com/enews Long-Term Care Services Award.

program ideals, including leadership, scholarship and clinical Joint Commission recognition was earned only after CentraState excellence.a rigorous on-site review by the Commission’s exunderwent pert surveyor and assessment of compliance with national Healthy Directions online at standards of care, Read including program and clinical information www.centrastate.com/publications. management, optimization of care, and collection and analysis of performance datato toour drive future improvement Subscribe free health activities. Achieving Joint Commission certification means e-newsletter by scanning the QR that CentraState code has demonstrated a commitment with your smartphone or to the highest level of care for its and is a major step toward visitingpatients, www.centrastate.com/enews. maintaining excellence and continually improving the care it provides.


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