Protecting a Weak Heart with an ICD

Posted on by Michael Chananie

Englewood Health’s David Feigenblum, MD, PhD, a cardiac electrophysiologist (specialist in abnormalities of the heart’s electrical system), diagnoses and treats a range of heart rhythm disorders. Ventricular arrhythmias, which occur in the heart’s two lower chambers, or ventricles, can put patients at risk of sudden cardiac arrest and death.

When abnormal electrical signals in the ventricles cause the heart to beat too rapidly (tachycardia) or just quiver (fibrillation), an implantable cardioverter defibrillator (ICD) can save a person’s life.   

To help us understand ICDs, Dr. Feigenblum explains…

ICDs and S-ICDs

Patients at risk of developing ventricular arrhythmias typically have a weak heart muscle due to:

  • coronary artery disease
  • prior heart attack
  • heart infection

Others risk factors are a previous cardiac arrest, as well as certain genetic factors.

An ICD is an internal device that is implanted in the chest. When it detects a dangerously fast heartbeat, it delivers a small (or sometimes large) electrical shock to restore the normal heart rhythm. Its purpose is to prevent sudden cardiac death.

The two main types of ICDs are:

  • Transvenous ICD—implanted with wire leads through the vascular system to the heart, it continuously monitors the heart’s rhythm and acts as both a pacemaker and a defibrillator.
  • Subcutaneous ICD (S-ICD)—for patients with no condition requiring transvenous leads, this device uses an electrode near the heart to detect arrhythmias and deliver therapy. An S-ICD is often a good option for younger patients, such as those with a genetic heart condition, as it minimizes hardware and saves vascular space for any future interventions that may be needed.

Both types of ICDs are implanted through a minor surgical procedure in Englewood Health’s Electrophysiology Lab. Patients stay overnight in the hospital and go home the next day.

Quantity and Quality of Life

In electrophysiology, the focus is on quality, as well as quantity, of life. Generally, there are two things that patients want to know:

  1. Is it going to improve my quality of life?
  2. Is it going to extend my life?

For most patients, their biggest fear is how one lives life with a defibrillator. Their main questions concern what happens if the defibrillator detects that the heart needs to be “shocked” back into rhythm. Modern ICDs, which serve as both pacemaker and ICD, have two functions:

  • Pacing therapy—this therapy is painless; the patient generally doesn’t feel anything.
  • Shock therapy—the electrical shock, if needed to restore the heart’s rhythm, may last only a second. The shock, which can feel like a strong jolt, provides immediate therapy to treat a life-threatening arrhythmia. For patients who are awake when it occurs, it can be emotionally overwhelming, and our team is available to provide support.

Advances in Defibrillator Therapy

A study published in 2015 demonstrated the effectiveness of a new algorithm that has changed how electrophysiologists manage ICDs. In the past, patients were sometimes shocked unnecessarily. Today, the way we program the devices has significantly reduced unnecessary shocks to the heart; hence, when a patient is shocked, it is usually needed.

Few Restrictions for Patients with ICDs

We focus on quality of life for our patients. Essentially, patients have no restrictions after the initial recovery period.  Patients often want to know if they can travel and might ask, “What if I am in Timbuktu?” I reassure them that the purpose of the defibrillator is to allow them to live a normal life, and I offer this analogy: It is as if you are walking around with your own ambulance crew. The device allows you to go about your life with the assurance that you are protected. 

Remote Monitoring

We follow our patients through remote monitoring of their device. If a patient experiences a cardiac event, the system transmits the information from the defibrillator over a phone line. The data from their device goes to the “cloud,” and our team can log in to a secure site and see what is going on without the patient’s having to come in to the hospital’s emergency department. Since the device works globally, they can go to Timbuktu and still have continuity of care. We can follow them wherever they go.

Beyond Cardiac ICDs

At Englewood Health, we have a full-service and highly experienced electrophysiology team. In addition to pacemakers and ICDs, my partners and I implant resynchronization devices (also known as biventricular pacing) in advanced heart failure patients, to improve quality of life. We also routinely perform ablation procedures to treat atrial fibrillation and ventricular tachycardia, as well as a range of other cardiac EP tests and procedures.

Dr. Feigenblum’s Philosophy

As a physician, I see my role as that of an educator—educating my patients on their condition and options, and on how I, as an electrophysiologist, can help them have a better quality of life. I explain treatment options, so my patients, along with their family, can make their own decision. I try to treat every patient as a family member. I ask myself, if this were my mother, whom I love dearly, how would I treat this condition?

David Y. Feigenblum, MD, PhD, is medical director of the implantable cardioverter defibrillator (ICD) center at Englewood Health, and a member of the Englewood Health Physician Network. He practices at North Jersey Electrophysiology Associates and Northvale Cardiology. In addition to English, he is fluent in Hebrew.

Posted January 2019

Ask the Doctor: Dr. Ashwin Jathavedam

Posted on by Michael Chananie

Ashwin Jathavedam, MD, is chief of infectious disease at Englewood Health, and a member of the Englewood Health Physician Network.

All across northern, central, and southern New Jersey, rates of the flu are hitting a fever pitch uncharacteristic of mid-January—a byproduct of the flu beginning to circulate a few weeks early this year. According to the NJ Department of Health, H1N1 (perhaps the most well-known of the flu strains) is the source of the largest number of flu cases seen in minute clinics, doctors’ offices, and hospitals throughout the state. The Centers for Disease Control and Prevention reported that 80,000 Americans—including 150 children—died during last year’s flu season. The threat remains high for this season. New Jersey has already seen its first pediatric death—a child from Central Jersey who died in late December. With flu rates expected to peak at the end of this month, Dr. Jathavedam discusses what we can do to protect ourselves for the duration of the season.

Why do rates of the flu (and other illnesses) skyrocket during late fall/early winter?

Dr. Jathavedam: Data has shown that cold weather enhances transmission rates. Also, in the fall and winter, people are inside more often than not. It’s an epidemiologic phenomenon—viruses spread much more easily when we are in closer proximity and indoors with each other.

When is the optimal time for a flu shot? Is it too late for this season?

Dr. Jathavedam: The best time for a flu shot is around mid-October. This gives you enough time to develop immunity before the season starts, and it’s late enough to keep you protected through most of the season. But it’s not too late to get a flu shot this year. The flu will be a threat until March, so, there’s still time to get immunized and be protected for the rest of the flu season.

How is it that some people get their flu shot and still manage to get sick?

Dr. Jathavedam: The flu shot is not always an exact match for the viral infection circulating at any given time. Often there are multiple strains of the flu going around, some of which your particular flu shot may not offer protection from. Also, everyone’s body reacts differently to the shot. Some people may produce more antibodies in reaction to the shot while others produce less.

If we do get sick, what symptoms might differentiate the flu from other viruses floating around?

Dr. Jathavedam: The flu is almost always accompanied by a high fever. If you don’t have a fever, it’s a safe bet that you don’t have the flu. The flu also causes body aches and severe headaches. The common cold is more often associated with sinus and chest congestion, rather than body aches and headaches.

What would you say is the most common misconception about the flu?

Dr. Jathavedam: That the flu shot doesn’t work. Decades of evidence shows the shot does work and that it decreases the number of flu-related deaths each year. Another fallacy is that the flu shot gives you the flu. I think this misconception arises every year because lots of other viruses are out there during flu season. So if a patient gets sick with a cold one or two weeks after they get their flu shot, they associate it with the shot. In truth, there are no live viruses in the flu shot, so it’s impossible to get the flu from the shot.

Posted January 2019

New Procedure for Carotid Artery Disease at Englewood Health

Posted on by Michael Chananie

January 14, 2019 — Englewood is among the first hospitals in New Jersey to offer new minimally invasive procedure to help prevent stroke.

Englewood Health is one of the first hospitals in New Jersey to offer a new, minimally invasive procedure to treat severe carotid artery disease, a condition in which plaque builds up inside the arteries and can lead to a stroke. The procedure, called transcarotid artery revascularization (TCAR), is unique in that blood flow is temporarily reversed during the procedure so that any small bits of plaque that may break off in the artery are diverted away from the brain, which helps prevent a stroke. A stent is then placed inside the artery to stabilize the plaque, minimizing the risk of a future stroke.

Up until to now, the main treatment options for severe carotid artery disease were an open surgical procedure called carotid endarterectomy, which while safe and effective, may not be appropriate for high-risk patients, and stenting from the groin, which has a greater risk of complications.

“TCAR is an important new option for the treatment of severe carotid disease,” says Dr. Thomas Bernik, chief of vascular surgery at Englewood Health. “The procedure is particularly suited for patients who are at higher risk of complications from carotid surgery due to age, anatomy, or other medical conditions. This safer, minimally invasive approach can lead to better outcomes and a faster recovery.”

Englewood Health Appoints Two New Executives to its Leadership Ranks

Posted on by Michael Chananie

January 10, 2019 — Englewood Health has appointed two new executives to its leadership ranks, expanding the team dedicated to patient-centered care, quality, and safety. Vicki Hoffman has joined Englewood Health as vice president of operations and Jamie Ketas has been appointed vice president of quality.

Vicki Hoffman

As vice president of operations, Hoffman will have responsibility for many of Englewood Health’s ancillary and outpatient services, including The Lefcourt Family Cancer Treatment and Wellness Center, laboratory, pharmacy, rehabilitation services, and respiratory care.

“We are very excited to have Vicki join the team,” says Helene Wolk, senior vice president of operations at Englewood Health. “She is a seasoned healthcare leader, who I am confident will make an immediate contribution to Englewood Health and to the communities we serve.” She added, “Vicki’s natural talent at constructing highly effective teams and building consensus across a variety of stakeholders, combined with her deep experience in healthcare operations, will enable both the hospital and the physician practices to continue to flourish as we evolve to meet the needs of our communities.”

Hoffman has over 25 years of experience in healthcare operations and has worked at some of the region’s top institutions including Hospital for Special Surgery and the University of Pittsburgh Medical Center. She joins Englewood Health from Stamford Health, where she was service line director for over 10 years, overseeing a variety of clinical services including orthopedics, neurosciences, women’s health, and pediatrics.

After receiving her BA in organizational behavior and communications from New York University, Hoffman went on to achieve an MPA with a certificate in non-profit management from Villanova University. She also holds a certificate in ministry from Princeton Theological Seminary and is a fellow of The Advisory Board Company.

Jamie Ketas

As vice president of quality, Ketas will provide executive oversight of all inpatient and ambulatory quality efforts, business intelligence, patient engagement, care transition teams, and research operations. A key part of her role will be to partner with physician leaders and administrators to coordinate system-wide activities to improve and enhance performance, quality patient care, and customer service.

“Jamie has proven herself an effective leader and a champion in the relentless pursuit of quality,” says Kathleen Kaminsky, senior vice president patient care services and chief nursing officer at Englewood Health. “We are delighted to promote her to this important role and know that with her keen clinical and business acumen, we’ll be able to leverage data, research, and best practices to ensure that the highest quality care is available for our community. We will also be able to continue improving population health locally.”

Ketas has been a member of the team at Englewood Health for nearly eight years, most recently serving as senior director of research and care transitions, responsible for all research initiatives as well as population health. Prior to that she was director of the hospital’s Clinical Research Center and Institutional Review Board. Ketas previously held a variety of progressive positions focused on clinical research at Weill Cornell Medicine, Memorial Sloan Kettering Cancer Center, and the Aaron Diamond AIDS Research Center. After receiving her BS in biology from the University of Notre Dame, she earned an MS in management with a graduate certificate in clinical trials management from Thomas Edison State University. She is also a fellow of The Advisory Board Company.

Keith Wilhemson — Schoolteacher, DJ, Family Man — Chooses Englewood for Rectal Cancer Treatment

Posted on by Cody
Keith Wilhemson

“Initially I thought my stomach pains were a result of stress — my job can be pretty straining sometimes. Then around April 2018, I started noticing a change in my system. I was having to run to the bathroom more than is normal for me,” Keith Wilhemson says.

He visited a doctor for his stomach issues and was told it was likely a bacterial infection.

“I was really lucky because before my doctor prescribed me the medicine, he decided to do a colonoscopy just in case. That’s when they found the tumor,” Wilhemson said.

He was diagnosed with locally advanced rectal cancer.

Three kids under the age of nine, a loving wife, a fulfilling career as a Paterson schoolteacher, and a side gig as a DJ were all more than enough reasons to keep Keith fighting through cancer treatment.

“My wife and I did our due diligence. We spoke to people at different hospitals, including one where we have some family friends working. Ultimately, we just felt very comfortable at Englewood Health. With them, everything was on the table. They were extremely open with us and that really gained our trust,” Wilhemson says.

Wilhemson underwent nearly six weeks of radiation and chemotherapy. In September, Anna Serur, MD, chief of colorectal surgery, removed the tumor from his colon. He will soon undergo additional chemotherapy, the last portion of his treatment plan.

Wilhemson has healed well from surgery. The last couple months have been spent at home with his 8-year-old twin boys and his 2-year-old daughter. Wilhemson says this time has given him a renewed appreciation for all the stay-at-home parents out there.

“My experience with treatment has been really positive. When I went in for my infusions, I always messed around and joked with the team. They gave me a funny certificate when I finished my infusions. Now they’re actually planning their Christmas party and are having it at the restaurant where I DJ on the weekends. I think I’ve made some friends that will last beyond treatment,” Wilhemson says.

His surgeon, Dr. Serur, says, “We worked together with Keith and his family to provide the best long-term outcome and not to disrupt his life. Most importantly, we wanted Keith to continue smiling and doing what he loves best. We tailored his treatment without compromising his quality of life. He and his family went to Ireland in between his treatment and surgery, he took his kids to Disney World, and he celebrated his children’s birthday parties with a bash.”

Posted January 4, 2019

Wanda and Terri Faulk, Sisters and Breast Cancer Survivors

Posted on by Cody
Wanda and Terri Faulk

For Wanda Faulk, the hardest part of cancer treatment came on the day she went to her salon to get her hair done for a wedding she was attending the following afternoon. During the appointment, her beautician suddenly emptied out the salon — telling everyone else to go get some food — then pulled Faulk aside and told her that her hair was falling out in chunks. This was a devastating blow to Faulk, who, before treatment, got her medium-length hair done almost every week.

“My mother and sister came to the salon. We cried together for a while, but then I told my beautician to just cut it and we went to Paterson to get a wig. The next day at the wedding, no one was the wiser,” Faulk says.

Faulk had had leakage in her breast and was referred to V. Merle McIntosh, MD, chief of breast surgery. “Upon further screening, she determined I did in fact have breast cancer,” she says.

Faulk underwent chemotherapy and a mastectomy. On the day of her surgery, Dr. McIntosh walked with her to the operating room — a gesture that she remembers and appreciates to this day.

It’s been several years since she finished cancer treatment at Englewood Health. As a long-time breast cancer survivor, she is the person to whom the women in her life turn when they are faced with the same diagnosis. She offers them the understanding that only a fellow woman who has contended with breast cancer can provide. Faulk imparts everything she learned during treatment, and in the years since.

“My treatment was exemplary. Everyone treated me well, from the ER nurses to the cafeteria staff. I refer everyone I know to Dr. McIntosh. My sister received treatment from Dr. McIntosh and so is my friend who was just diagnosed three months ago,” Faulk says.

When Wanda Faulk’s sister, Terri Faulk, was diagnosed just after her 50th birthday, she was shocked and frightened and experienced all the emotions one might expect — but she also had the benefit of having witnessed her sister go through it and survive.

“I’d like to think I was a good example of how not to fall apart. Terri had six-plus weeks of radiation done and, like was the case with me, the team at Englewood treated her extremely well. She made many friends there. They even played Marvin Gaye for her during treatment.”

As for herself, Wanda Faulk has chosen not to grow out her hair since treatment. She keeps it short because, as she explains, she is a changed woman and isn’t going back to who she was before.

Posted January 4, 2019

Lawrence D’Ercole Undergoes Pioneering Treatment for Lung Cancer

Posted on by Cody
Lawrence and Janet D'Ercole

“I’ve been married to my sweetheart, Janet, for 59 years. We have three sons, three daughters-in-law, and nine grandchildren — all I can say is I’m so happy to still be here to see them,” says Lawrence D’Ercole. He made history for being the first patient in New Jersey and one of the first in the country to undergo a new kind of radiation therapy for lung cancer following its FDA approval in April 2018.

The initial symptoms were mild enough — a little weight loss and a cough. So, when he was diagnosed with stage I lung cancer, it came as all the more of a shock to him and his family. “They did a CAT scan and found a nodule on my upper left lung. The patient coordinator at Englewood Health recommended I see Dr. Dubin,” D’Ercole says.

Unbeknownst to D’Ercole, David Dubin, MD, chief of radiation oncology, and Michael Speiser, PhD, chief physicist, had just finished establishing stereotactic body radiation therapy (SBRT) with Varian Calypso® Anchored Beacon® transponders at The Lefcourt Family Cancer Treatment and Wellness Center.

Treating lung cancer with radiation therapy presents challenges. Ideal radiation treatment would target only the exact area of the tumor and no surrounding healthy tissue, but tumors in the lungs are constantly shifting position as the patient breathes. This motion typically requires larger treatment areas to ensure the moving tumor receives the full treatment. SBRT with Varian Calypso allows physicians to insert transponders — which act like a tiny GPS — around the tumor and track its whereabouts during radiation therapy 25 times a second. This makes the process much more precise and simultaneously spares the healthy tissue around the tumor.

“Mr. D’Ercole was a great candidate for this therapy,” says Dr. Dubin. “Not only was his tumor location appropriate, but he happened to be great at holding and controlling his breath, taking in the same amount of air with each inhale. Like any treatment, this won’t be appropriate in every case. Where the tumor is, the size of the patient, and the patient’s lung capacity all play a role. But this treatment should be the standard, in my opinion, simply because of how accurate it is,” Dr. Dubin says.

Two months after finishing radiation therapy, D’Ercole has started to feel better and has been spending a lot of time with his family. “I feel really lucky to have gotten to Englewood Health when I did. I’ve been there for other procedures and everyone is always great. I wouldn’t go anywhere else for treatment,” D’Ercole says.

Posted January 4, 2019

Englewood Health Awarded Advanced Certification for Primary Stroke Centers

Posted on by Michael Chananie

December 27, 2018 — After a rigorous on-site review, Englewood Health has earned The Joint Commission’s Gold Seal of Approval® for Advanced Certification for Primary Stroke Centers for the fifth consecutive time since 2009. With this certification, Englewood Health joins an elite group of health care organizations focused on stroke care.

“Earning re-certification of The Joint Commission’s Gold Seal of Approval for Advanced Certification for Primary Stroke Centers is a strong testament to our ongoing efforts to bring the safest, highest-quality, and most technologically advanced care to our community,” said Warren Geller, president and CEO of Englewood Health. “We thank our doctors, nurses, and other staff for their tireless efforts to make us who we are and congratulate them on this recognition of excellence by The Joint Commission.”

Established in 2003, Advanced Certification for Primary Stroke Centers is awarded for a two-year period to Joint Commission-accredited acute care hospitals.

“Englewood Health has thoroughly demonstrated the greatest level of commitment to the care of stroke patients through its Advanced Certification for Primary Stroke Centers,” said Patrick Phelan, executive director, Hospital Business Development, The Joint Commission. “We commend Englewood Health for becoming a leader in stroke care, potentially providing a higher standard of service for stroke patients in its community.”

Ask the Doctors: Dr. Diane Schwartz, Dr. Alexandra Gottdiener, Dr. Samuel Suede, Dr. Jeffrey Cohen

Posted on by Michael Chananie

Coughing, sneezing, feasting, treating, tripping, falling—it’s that time of year. Trying to make it through the winter months without putting your health at risk can seem near impossible. But there are some steps you can take to protect yourself, and they might be easier than you think.
The weather might be frightful, but your health doesn’t have to be. Diane Schwartz, MD, Alexandra Gottdiener, MD, Samuel Suede, MD, and Jeffrey Cohen, DPM shared some of their best advice for staying well over the next few months.

Everyone around me is getting sick. What can I do to avoid the winter bug?

Diane Schwartz, MD

Dr. Schwartz: First and foremost, make sure you’re getting enough sleep. Lack of sleep compromises the immune system, and that’s the biggest reason we get sick. Clean surfaces in your home or office that many people touch—refrigerators doors, microwave and faucet handles, and water fountain and vending machine buttons. Never touch your eyes, nose, mouth, or face after touching handrails, doorknobs, or shopping carts in public places. The nose and mouth are the main portals of entry into our bodies for bacteria and viruses.

I think I’m having flu symptoms, but I’m not sure if it’s just a cold. How can I tell?

Alexandra Gottdiener, MD

Dr. Gottdiener: The flu comes on suddenly, typically with a fever, cough, sore throat, muscle or body aches, runny nose, and headaches. A cold comes on gradually and symptoms are not as severe. If you think you have the flu, call your doctor as soon as possible. Medication can help you recover more quickly but is only effective if started within 48 hours of symptom onset.

I’m trying to be more conscious of heart health this year. Where should I start?

Sam Suede, MD

Dr. Suede: There are some pretty simple lifestyle changes you can make to be more heart healthy. Limit your alcohol intake to one drink per day. Prepare food with little or no salt—cut back a little at a time. If you smoke, even casually, make this the time to QUIT. And keep the sweets in your love life, not in your food: Read labels and minimize the amount of sugar you consume in beverages and prepared foods.

I’ve been prone to falls in the winter before. Is there anything I can do to protect myself?

Jeffrey Cohen, DPM

Dr. Cohen: Invest in a good pair of all-weather boots to prepare for rain, snow, and ice. Look for a waterproof exterior and a comfortable, breathable interior. Boots are better than high-quality sneakers because they usually have a high upper portion to properly stabilize your ankle and tendons on unstable terrain. If you’re wearing dress shoes, carry them in a bag and change later, or consider wearing shoe covers with rubber gripping on the soles that you can slip over what you’re already wearing.

Posted December 2018

Do you have a question for a doctor?

From your head to your toes, and everywhere in between, the Englewood Health Physician Network has you covered. Ask a question about your health. Selected questions will be answered in this column.

Ask the Doctor: Dr. Maria Paschalidis

Posted on by Michael Chananie

Maria Paschalidis, DO, a family medicine physician, has started seeing patients on Kennedy Boulevard in Union City. Part of the Englewood Health Physician Network, Dr. Paschalidis is fluent in Greek and Spanish.

What is family medicine?

Dr. Paschalidis: A doctor who works in family medicine is able to care for all members of a family, at all ages —the kids, the parents and the grandparents. I was drawn to this field during medical school because I found I was able to get to know my patients much more closely. As a family doctor, you know everything about a family and they get to know you as well. I find my patients are more inclined to trust me and act on my advice if they know who I am and that I’m coming from a good place.

Is it important to see a doctor even if I don’t feel sick?

Dr. Paschalidis: Most of the diseases I see in my practice (prediabetes, diabetes and hypertension) do not cause physical symptoms that would typically prompt a patient to seek medical attention. For instance, a person who feels great on a day-to-day basis and falls within in a normal weight range, may actually be prediabetic, have high cholesterol or be hypertensive. Regular wellness visits allow us to detect an otherwise invisible illness or disease before it becomes a much larger issue down the road.

This is called preventive medicine, right?

Dr. Paschalidis: Right. Preventive medicine is all about getting checked out by a physician before you’ve developed a disease that can only be treated by medication, or other intervention. I encourage people of all ages to come in and get an evaluation so that, if there is a sign of something developing, we can manage it before the long-term consequences of the disease begin to manifest; whether that be a heart attack or stroke.

What advice do you give your patients with prediabetes?

Dr. Paschalidis: Lifestyle changes are hugely important. A regimen of diet and exercise can change everything for someone with prediabetes. I go into great detail with my patients about the specific changes they can make—providing handouts so that patients can refer back to the information after they leave my office. If we find we are unable to get their numbers under control through basic lifestyle changes, there are medicines available that can help prevent the development of diabetes.

How do you typically treat someone with high blood pressure?

Dr. Paschalidis: High blood pressure, or hypertension, is caused by a combination of stress, diet and genetic factors.Early treatment is similar to that for prediabetes—diet and exercise modifications. With hypertension there is the added element of stress, so I encourage patients to do whatever they can to lower their stress levels. In addition to lifestyle changes, most patients will require medication to control their blood pressure.

Posted December 2018

Do you have a question for a doctor?

From your head to your toes, and everywhere in between, the Englewood Health Physician Network has you covered. Ask a question about your health. Selected questions will be answered in this column.