Cirrhosis and Liver Cancer Rates on the Rise – What You Need to Know

Posted on by Michael Chananie

A recent study published in the British Medical Journal found that deaths from liver disease have increased significantly in the United States over the past two decades. Deaths related to cirrhosis (inflammation of the liver that leads to scarring and malfunction) have risen 65 percent since 1999, with the largest affected population being people ages 25 to 34. The study suggests that the disproportionate rise in cirrhosis among millennials may be the result of alcohol misuse and abuse.

“When my 40-year-old patients tell me they drink socially, it means a totally different thing from when my 20-something patients tell me they drink socially,” said Matthew Blaszka, MD, gastroenterologist, Englewood Health Physician Network.

According to Dr. Blaszka, the millennial generation suffers from a misunderstanding of what constitutes tempered, social drinking and what would be classified as binge drinking and alcohol abuse. The National Institute on Alcohol Abuse and Alcoholism defines binge drinking as five or more drinks for a man, and four or more drinks for a woman, in the span of two hours.

“Social drinking for my 40-year-old patients means two glasses of wine every other Saturday, while social drinking for my younger patients often means drinking to the point of intoxication or even blacking out,” said Dr. Blaszka.

A common misconception is that it takes decades of heavy, daily drinking to develop cirrhosis, when in reality it can take less than a decade and doesn’t require a daily drinking routine. Dr. Blaszka is convinced that this is why we need to begin educating children about alcohol much earlier.

“When does social alcohol use begin? In high school. So we have to intercept kids with alcohol education before they are presented with the opportunity to drink. We’ve done a good job of educating people on the dangers of smoking. We’ve got advertisements on TV and campaigns to stigmatize and end smoking – yet alcohol continues to be glorified,” said Dr. Blaszka.

However, Dr. Blaszka does not attribute the rise of liver disease to alcohol use alone. Factors like obesity and the presence of conditions like hepatitis C may also play a role.

“As the American population becomes heavier and obesity is on the rise,” said Dr. Blaszka, “so is something called fatty liver disease. Fatty liver disease, like other conditions involving liver inflammation, can eventually cause cirrhosis. Alone, this can take decades, but combined with heavy alcohol consumption, the process speeds up quite a bit.”

The cirrhosis that results from fatty liver disease or alcohol abuse can lead to liver cancer, which – no surprise – is also on the rise.

“What we’re also seeing, particularly among baby boomers,” said Dr. Blaszka, “is undiagnosed cases of hepatitis C, which is also associated with a higher risk of liver cancer.” The presence of hepatitis C among baby boomers, he added, is an issue that everyone should be made aware of, as there are antiviral medications that can treat hepatitis C and prevent cirrhosis.

According to the study, there was an “inflection point” in about 2009, when the rate of cirrhosis-related deaths began to increase 10.9 percent each year through 2016. The study suggests that the timing of this sudden increase might correlate with the economic crisis that began around the same time. The implication is that factors such as unemployment and financial strain may have turned many Americans to alcohol as a means of stress relief.

When it comes to this theory, however, Dr. Blaszka is not entirely convinced. “I’m hesitant to place all of the responsibility on the recession,” he said. “My feeling is that what we’re seeing is a lot of comorbid conditions such has fatty liver, untreated hepatitis C, and a lack of education about alcohol. Why none of this occurred before 2009 is unclear at this point.”

When asked how much alcohol intake is too much, Dr. Blaszka said there is no hard and fast rule. Everyone’s relationship and response to alcohol is different, based on a number of factors such as weight, gender, and individual biology. Dr. Blaszka typically tells his patients that if they think they might be drinking too much, they probably are.

“The good news is that cirrhosis caused by alcohol abuse is a reversible condition,” said Dr. Blaszka. “As soon as you stop drinking and stop introducing the insult to the body, your liver can quickly normalize. It is a uniquely regenerative organ – the scarring can reverse, and patients can go back to having a normal, healthy liver.”

Posted August 2, 2018

Wheelchairs Facilitate Accessibility for bergenPAC Patrons

Posted on by Michael Chananie
Wheelchairs for bergenPAC Patrons
Marc Farrand (far left), on behalf of bergenPAC accepts four donated wheelchairs from Englewood Health. Pictured from left to right, Marc Farrand, bergenPAC, Ernie Cantos and Richard Sposa, Englewood Health.

 
August 2, 2018 – Englewood Health recently donated four wheelchairs to the Bergen Performing Arts Center (bergenPAC), in Englewood, New Jersey to help ticketholders with physical limitations navigate the facility and provide them with necessary accommodations before, during, and after show times.

“When people come to see a show, we want them to enjoy the performance and leave the theater having had the best possible experience,” said bergenPAC president and CEO Dominic Roncace. “We thank the team at Englewood Health for once again ensuring that we have the tools and equipment to provide a safe, healthy environment for everyone who passes through our doors.”

New Artificial Heart Valve Offers Younger Patients More Options

Posted on by Keri Flaccomio

INSPIRIS RESILIA aortic valve - inside view
 
June 27, 2018 – Surgeons at Englewood Health performed the first INSPIRIS implant for aortic valve replacement in New Jersey, following U.S. Food and Drug Administration (FDA) approval for the valve, which is made by Edwards Lifesciences Corporation, a patient-focused medical innovator for structural heart disease. The artificial valve is made of pericardial tissue from cows and has two distinct advantages. First, early indicators show anti-calcification properties will make it more durable and longer lasting than existing valves. Second, the valve’s frame has built-in joints, making it expandable and facilitating any future re-replacement that may be necessary; through a minimally invasive or percutaneous procedure, a larger valve can be placed inside the deteriorating valve.

“In years past, aortic valve replacement typically substituted a mechanical valve for the damaged valve, requiring recipients to be on blood thinners for the rest of their lives,” says Adam Arnofsky, MD, cardiothoracic surgeon at Englewood Health who performed the first procedure in the state. “INSPIRIS has the potential to be a game changer for patients under the age of 70.”

“This is the perfect valve for a young patient who needs an aortic valve replacement and wants to avoid long-term anticoagulation,” he said. “You’re strategizing for life—better durability of the valve and the ability to place a large valve inside this one if it deteriorates over time. This can really set a younger patient up for lifelong aortic valve health while avoiding anticoagulation medication, which can lead to bleeding and clotting complications.”

Englewood Health’s first patient to receive the implant was a physically fit 53-year-old male who, aside from having a damaged aortic valve, was otherwise healthy. Englewood Health’s cardiothoracic surgery team, a leader in cardiac outcomes, clinical research and early adopters of the most beneficial treatment options for heart patients, is subsequently incorporating the INSPIRIS valve into its decision-making process when evaluating patients preoperatively.

Dr. Arnofsky says this innovation is just one of many new and exciting cardiovascular advancements underway at Englewood Health.

For more information, visit englewoodhealth.org/heart.

Comprehensive Joint Replacement Program Reports Excellent Results

Posted on by Michael Chananie

For the majority of patients, general musculoskeletal injuries take about six to eight weeks to heal. But proper pre- and post-operative orthopedic care can significantly expedite the healing process. Over the past five years, Englewood Health has taken significant steps to improve quality of life, minimize pain, and maximize mobility for patients needing a hip or knee replacement or spinal surgery. To achieve these goals, the health system, comprising Englewood Hospital and the Englewood Physician Health Network, has committed to an interdisciplinary approach.

In 2016, Englewood Health launched the Comprehensive Joint Replacement Program, a Medicare-initiated care model that supports better and more efficient care for patients undergoing hip and knee replacements, the most common inpatient surgeries for Medicare beneficiaries. Bringing together representatives from 15 disciplines, the model encourages hospitals, physicians, and post-acute care providers to work together to improve the quality, safety, and coordination of care from pre-surgical assessments to hospitalization and through recovery.

“Within 18 months of the program’s inception, the number of patients discharged from the hospital directly to their homes increased from 15 percent to 56 percent,” said Stephen Brunnquell, MD, president of Englewood Health Physician Network. “In the second year of the program, our complication rate was zero percent.”

The Joint Commission Gold SealIn the same year, Englewood Health earned recertification by The Joint Commission for total hip and total knee replacement, and became the only hospital in New Jersey to be Joint Commission-certified in spinal fusion. Englewood Hospital also expanded its main operating room with four new state-of-the-art operating rooms dedicated to orthopedic and neurological surgery. The rooms include advanced imaging tools, digital technology, and other features to support patient safety and high-quality care.

Asit Shah, MD, PhD, chief of orthopedics at Englewood Health, said his team is constantly following the latest improvements in engineering. “Robotics are making their way into orthopedic surgery more and more,” he said. “And technology is constantly enhancing in-office optics and diagnostics. We can now insert an 18-gauge needle into the knee and do an arthroscopy in the office—without anesthesia—instead of going into the operating room. There are also new materials being introduced. Components like bond materials and artificial cartilage are definitely enhancing.”

In addition, Englewood Health is focusing on minimizing the use of medication for pain management by incorporating services such as acupuncture, therapeutic massage, and yoga into the patient recovery process through its Graf Center for Integrative Medicine.

Posted July 9, 2018

2018 Healthgrades Patient Safety Excellence Award Recipient

Posted on by Michael Chananie

May 15, 2018 – Englewood Hospital and Medical Center has received the Healthgrades 2018 Patient Safety Excellence Award™, a designation that recognizes superior performance of hospitals that have prevented the occurrence of serious, potentially avoidable complications for patients during hospital stays. The distinction places Englewood Hospital among the top 5 percent of all short-term acute care hospitals in the nation reporting patient safety data for its excellent performance as evaluated by Healthgrades, the leading online resource for comprehensive information about physicians and hospitals. Englewood Hospital is the only hospital in Bergen County, New Jersey, in the top 5 percent of Patient Safety Excellence Award recipients.

During the 2014 to 2016 study period, Healthgrades found that patients treated in hospitals receiving the Patient Safety Excellence Award were, on average:

  • 55.6 percent less likely to experience an accidental cut, puncture, perforation or hemorrhage during medical care, than patients treated at non-recipient hospitals
  • 52.4 percent less likely to experience a collapsed lung due to a procedure or surgery in or around the chest, than patients treated at non-recipient hospitals
  • 62.8 percent less likely to experience catheter-related bloodstream infections acquired at the hospital, than patients treated at non-recipient hospitals
  • 54.3 percent less likely to experience pressure sores or bed sores acquired in the hospital, than patients treated at non-recipient hospitals1

During the study period (2014 to 2016), Healthgrades 2018 Patient Safety Excellence Award recipient hospitals demonstrated excellent performance in safety provided for patients in the Medicare population, as measured by objective outcomes (risk-adjusted patient safety indicator rates) for 13 patient safety indicators defined by the Agency for Healthcare Research and Quality (AHRQ).

If all hospitals achieved the average performance of award recipients for each of the 13 Patient Safety Indicators evaluated, during the 2014 to 2016 study period, 126,342 patient safety events could have been avoided.

“As the healthcare industry continues to put more deserved attention on quality and value, our efforts to improve patient safety are unwavering,” said Warren Geller, president and CEO of Englewood Hospital and Medical Center. “Earning the Patient Safety Excellence Award from Healthgrades is a testament to the tireless efforts of our entire staff that work to ensure that our patients receive the best, and safest, medical care.”

“We applaud the hospitals who have received the Healthgrades 2018 Patient Safety Excellence Award,” said Brad Bowman, MD, Chief Medical Officer, Healthgrades. “Their dedication and commitment to providing safe care creates tangible results for patients.”

View Healthgrades hospital quality methodologies.

Access the recently released Patient Sentiment Report from Healthgrades and MGMA, which analyzed nearly 7 million online patient reviews and reveals what patients say about their physicians.

1Statistics are based on Healthgrades Patient Safety Ratings and Excellence Award methodology, which is primarily constructed using AHRQ Technical Specifications version 5E applied to MedPAR data for years 2014 through 2016 and represent three-year estimates for Medicare patients only.

Englewood Hospital is Stigma Free

Posted on by Michael Chananie
Stigma Free 2018
Physicians and staff from Englewood Hospital and the Englewood Department of Health during the designation of the hospital as a stigma-free zone. Pictured from left to right, Phyllis Brown-Edwards, Deborah Baldwin (Englewood Department of Health), Lauren Menkes, Dr. Hillary Cohen, Dr. Stephen Bischoff, Dr. Steven Samuels, Jo-Ann Venezia, and Linda Leighton.

 
May 7, 2018 – Englewood Hospital has been designated a stigma-free zone after demonstrating a dedicated effort to educating the community and offering resources to help combat discrimination and negative perceptions toward individuals with mental illness.

“With the number of cases of mental illness on the rise, it is imperative that patients feel safe and comfortable seeking care,” explained Dr. Hillary Cohen, Vice President of Medical Affairs at Englewood Hospital. “At Englewood Hospital, we have always and will always treat those with mental illness in the same way we would treat anyone, with any condition – and that’s with compassion, diligence, and a patient-first approach. Being designated as a stigma-free zone is a wonderful recognition of those efforts and a signal to the community that we are doing all that we can to help break down barriers and provide a judgment-free space to seek care.”

Englewood Hospital hopes to raise awareness of mental illness, provide an effective way to reduce stigma against those who suffer from it, and encourage individuals with mental illness to seek services and feel supported. The designation of stigma-free will raise awareness of Englewood Hospital’s mental health resources, so no patient or community member need feel hopeless or alone. The elimination of stigma will enable people to ask for help when they need it, so they can start on the road to recovery, have hope for their future, and be spared avoidable tragedy.

The resolution was made during the City of Englewood’s third annual town hall meeting organized by the Englewood Municipal Alliance and Stigma-Free Task Force, on Tuesday, May 1 at Englewood Hospital.

Meditation: The Art of Leaving Things Alone

Posted on by Michael Chananie

The Graf Center for Integrative Medicine was featured in an article discussing meditation. The author interviewed Mark Van Buren, a mindful-living trainer affiliated with the Graf Center, who encourages people to look at meditation as the “cultivating the art of leaving things alone.”

 
Read full article from Vue Magazine

East Asian Tick Found in Second Location in NJ – Cause for Concern?

Posted on by Michael Chananie

April 26, 2018 – Last November, a rare East Asian tick, the Haemaphysalis longicornis—also known as the Longhorned tick or bush tick—was found on a farm in Hunterdon County, New Jersey.

Until this time, the Longhorned tick, which has been suspected to cause illnesses and diseases in livestock and humans, was never known to exist in the U.S. and how it ended up in the Garden State continues to be a mystery.

On Wednesday, April 25, the New Jersey Department of Agriculture confirmed that the tick has also been found at the Watchung Reservation in Union County, 40 miles away from the initial site in Hunterdon County. The tick was originally collected from the reservation in May of 2017 during an ongoing tick study, but had not been identified until just recently.

“Various local, state, and federal animal health officials, as well as Rutgers University are working together to identify the range of the ticks and develop a plan to eliminate this pest from the area in Union County,” the New Jersey Department of Agriculture said in a press release.

The press release did not say whether the ticks found in Union County survived the winter, as was the case in the first sighting in the Hunterdon County.

On April 17th the National Veterinary Services (NVS) confirmed that the initial outbreak of ticks, found primarily on the face and feet of a 12-year-old Icelandic sheep, had survived the winter and become established in our state.

On Tuesday, the NVS Laboratory confirmed that the Longhorned tick had also been found on a white-tailed deer near the farm where the sheep resided. This marks the first recording of the tick feeding on local wildlife.

“The fact that, despite the freezing temperatures that occurred over the winter, the tick survived—this means it’s here to stay. Does that mean the Longhorned tick is going to cause us any real harm? That has yet to be seen,” Dr. Ashwin Jathavadem said.

Dr. Jathavadem is Chief of Infectious Disease at Englewood Hospital and Medical Center and he believes, like many specialists in the field of disease, that it is too soon to panic about the Longhorned tick.

“It’s not clear whether the tick is going to transmit infections to the general population. If we begin to see unusual cases or symptoms that match the infection the Longhorned is linked to, that will be a different story,” Dr. Jathavadem said.

The infection in question that is associated with the Longhorned tick is an outbreak of severe fever with thrombocytopenia syndrome (STFS) in China. STFS has been described by the Center for Disease Control and Prevention as “an emerging hemorrhagic fever.”

“The only real concern regarding the Longhorn is the outbreak in China and even in that case, the virus was mainly restricted to people who had contact with farm animals,” Dr. Jathavadem said.

According to Dr. Jathavadem, it will be “very difficult” to spot the Longhorned tick visually, as it is roughly the size of a pea when fully engorged, can be as small as a speck of dirt and often is mistaken for a common spider.

Longhorned tick (Photo courtesy New Jersey Department of Agriculture)

“Use the same precautions this summer that you would use any other summer. Mainly keep yourself covered and do full body checks if you go hiking or in the woods,” Dr. Jathavadem said.

If you do happen to find a tick on your body this summer, treat it the way you would normally treat any tick bite. Remove the bugger as quickly as possible, save it in a sterile bag or jar and monitor yourself for symptoms over the following days and weeks. If you begin to experience rash, fever or any other unusual symptoms, bring yourself and the tick to the doctor’s office to get examined and tested.

So is the Longhorned tick cause for the concern? According to Dr. Jathavadem the answer is, “not just yet.”

“Anytime there is a new potential vector for infections, we just don’t know how it is going to behave. A lot of questions have to be answered before we hit the panic button,” Dr. Jathavadem said.

By no means should you let the presence of the Longhorned tick get in the way of your summer hiking, biking and camping plans. Simply take the necessary precautions to protect yourself against ticks of every sort, especially when walking in tall grass. Do regular body checks on yourself, your children and your pets, watch out for strange symptoms and perhaps be a little cautious when interacting with livestock this summer.

Englewood Hospital and Medical Center, Jewish Home Family host Parkinson’s research updates from Michael J. Fox Foundation

Posted on by Michael Chananie
Parkinsons Event Group
Dr. Jamuna Rajasingham, Dr. Harvey Gross, Dr. Samantha Hutten, Carol Silver Elliott, Dr. Rikki Racela, and Dr. Lauren DeNiro come together for a community update on Parkinson’s research. Dr. Rajasingham, Dr. Racela, and Dr. DeNiro practice together at Bergen Neurology in Englewood. Dr. Gross is the medical director of the Jewish Home Family and chief of the department of family practice at Englewood Hospital and Medical Center. Dr. Hutten is senior associate director of research programs for the Michael J. Fox Foundation. And Ms. Elliott is the president and CEO of the Jewish Family Home.

 
April 26, 2018 – In recognition of Parkinson’s Awareness Month and growing concern about treatment and quality-of-life options for those with Parkinson’s disease, Englewood Hospital and Medical Center and the Jewish Home Family partnered with The Michael J. Fox Foundation to present the latest updates in Parkinson’s research.

With one in 100 people over age 60 living with Parkinson’s disease, 60,000 new cases to be diagnosed this year, and an estimated 14 million projected for 2040, Parkinson’s is the most common neurodegenerative disorder next to Alzheimer’s.

Samantha J. Hutten, PhD, senior associate director of research programs for The Michael J. Fox Foundation, discussed clinical breakthroughs; the latest research in therapeutics, medications, and biomarkers for diagnosis; and the relationship between genetics and environment, including risk factors.

As the largest nonprofit funder of Parkinson’s research, The Michael J. Fox Foundation is focused on understanding the biology of the disease to develop new therapies and treatments for those it serves.

Due to the highly variable nature of the disease, no two people with Parkinson’s are the same. There is currently no objective test for the disease, so diagnosis is often the result a clinical exam. But many patients see their family physicians—rather than a neurologist or movement disorder specialist—and often have their symptoms confused with those indicative of other chronic conditions.

A combination of environmental, genetic, and lifestyle factors increase a person’s risk of developing Parkinson’s. Genetic mutations can make us more susceptible to the disease with exposure, explained Dr. Hutten. For this reason, the foundation has been exploring ways to treat the source of the problem.

Since the 1960s, the “gold standard” in Parkinson’s treatment has been levodopa, a drug the brain converts to dopamine, replacing what’s lost with damaged brain cells. While it works well, levodopa only treats certain symptoms, can cause dyskinesia (involuntary motor movement), and can wear off between doses, making patients feel “off.”

Recently approved treatments, including medications delivered orally and by direct infusion to the small intestine, aim to keep levodopa levels consistent, thereby controlling symptoms more consistently and avoiding side effects. Other new therapies work as “add-ons” to levodopa, helping avoid the natural breakdown of dopamine so it can function longer and alleviating dyskinesia.

Other treatment options are currently under review by the FDA. These include an levodopa inhaler and a thin under-the tongue strip of another drug (apomorphine) to quickly alleviate symptoms during “off” periods, and botulinum toxin for decreased saliva production to prevent drooling in Parkinson’s.

Equally important, Dr. Hutten noted, are various non-motor symptoms: cognitive impairment and dementia, urinary problems and constipation, depression and anxiety, vision disturbances, speech and swallowing problems, smell loss, fatigue, hallucinations and delusions, low blood pressure, pain, and sleep disorders. Walking and balance problems also are difficult to treat with available therapies.

Advancements in treatment of these symptoms include cognitive behavioral therapy for depression and anxiety in Parkinson’s; retinal studies tracking eye movement for vision problems that affect gait and balance; transcranial magnetic stimulation for pain; swallowing, breathing, and voice exercises to increase clarity and volume; the use of cocoa extract for fatigue; and a fiber supplement for delivering proper bacteria to the gut.

Additional treatments are being repurposed from other fields. Drugs approved for diabetes, cancer, high blood pressure and inflammatory diseases are currently being explored for use in Parkinson’s.

“Everything that we’ve talked about to date, with motor symptoms and non-motor symptoms, is still only addressing the symptoms,” said Dr. Hutten. “It’s not addressing the cause. So, what we consider our holy grail is finding a cure for Parkinson’s disease. What that would mean is finding something that could halt the disease in its tracks, or even a treatment that could be administered to people that were identified as being at risk to develop Parkinson’s disease. So this would really be what we call a disease-modifying therapy—therapy that actually changes the course of Parkinson’s disease.”

Through its Parkinson’s Progression Markers Initiative study, The Michael J. Fox Foundation collects clinical and biological data, specimens, and important information—from those with and without genetic mutations linked to Parkinson’s—to investigate biology and develop new tests to diagnose and track the disease.

Dr. Hutten explained the significance of such objective tests of Parkinson’s disease—called biomarkers—which ultimately could transform clinical care and fuel clinical trials. Scientists are looking for differences in body fluid and tissue, imaging changes in the brain, and wearable device data to diagnose and track Parkinson’s.

Following the presentation, Dr. Rikki Racela of Bergen Neurology and Dr. Harvey Gross, medical director of the Jewish Home Family and chief of the department of family practice at Englewood Hospital and Medical Center, joined Dr. Hutten on a panel to answer questions from physicians, medical professionals, and members of the community.

Strong themes included the impact of exercise on prevention and slowed progression of Parkinson’s; the importance of an expert care team and family support system; and the benefit of getting involved with the Parkinson’s community, research opportunities, and clinical trials.

“Exercise, not just for general health, is good, but in Parkinson’s it is absolutely essential,” said Dr. Racela. “It is more powerful and better than any sort of drug we can give you, or any technology. And, actually, it’s the only thing that has shown evidence where it actually modifies the disease.”

To learn more and watch the presentation recording, visit facebook.com/englewoodhealth.