Spanish2 · hobbies, gathering with friends, shopping, dining, ... storm Sandy and 9/11, increased mental health and substance use issues followed. But many people were reluctant

Mirror ImageIdentical twin sisters face the exact same breast cancer diagnosis just months apart.

At First SightA mom meets her newborn son for the first time after a month of fighting COVID-19.

Second ChanceThanks to an early diagnosis, one patient successfully battles lung cancer.

Fall 2020

Para leer esta revista en

español, visite HMHforU.org/

Spanish2.

Regular screenings can find breast, cervical, prostate, lung, skin and colorectal cancers early, when treatment is more likely to be effective. Find out who should be screened and when.

04 Hi. Welcome to this issue of HealthU A message from Robert C. Garrett, FACHE, CEO of Hackensack Meridian Health.BETTER U ■ TIPS AND RESOURCES TO HELP YOU LIVE YOUR HEALTHIEST LIFE

05 Support for Your Physical and Mental Health This Fall Mood-boosting foods ■ Answers to your health questions ■ Weighted blankets ■ Recipe for kale and sweet potato salad06 Adjusting to a Stressful COVID-19 World Uncertainties created by the pandemic bring heightened levels of anxiety, stress, depression and substance use disorder.SPECIAL SECTION ■ CANCER SCREENING

10 Screen Time Regular screenings can find cancer early, when treatment is more likely to be effective. Here is what you should know. 14 Mirror Image Identical twins Meagan McCallum and Courtney Werner got the same breast cancer diagnosis just months apart.SPOTLIGHT ON U ■ YOUR STORIES OF HEALING AND TRIUMPH

17 Collaborative Care by Design Interior designer Colleen Rosar was diagnosed with breast cancer at age 40 after her first mammogram.20 Second Chance After catching and treating lung cancer early, Diana Robertson Fidanzato feels better than ever.22 Change of Plans Dena Kibel’s birth plan for her fifth child took a major turn. Looking back, she wouldn’t have it any other way.24 At First Sight Maria Acevedo delivered her son after complications from COVID-19. A month later, she was able to see him in person.26 A New Game Plan Vinny Placanica was ready to celebrate Super Bowl Sunday with family when he began coughing up blood. 28 Body Positive Since a successful vertical sleeve gastrectomy two years ago, Jaclyn Tucker has lost more than 150 pounds.30 Step by Step After battling COVID-19, Ernesto Averia suffered a nerve compression injury in his right thigh. Thanks to extensive

rehabilitation, he is slowly returning to normalcy.

33 A Life of Service $12,000 has been donated in memory of Martin Seidenstein, M.D., to support team members fighting COVID-19.SCHEDULE ■ EVENT AND CLASS LISTINGS

34 Your Calendar for Fall 2020 Live and virtual events and classes you won’t want to miss.TEAM PLAYERS ■ EMPLOYEES WHO GO ABOVE AND BEYOND FOR THEIR PATIENTS

38 When Duty Calls Nurse Caitlyn Sutter didn’t hesitate to volunteer to serve at a hot spot of the COVID-19 outbreak.BY THE NUMBERS ■ A SNAPSHOT VIEW OF AN IMPORTANT HEALTH ISSUE

39 Bright and Early The impact of early screening for breast, prostate, lung, skin and colorectal cancers.CEO Robert C. Garrett, FACHE COO Mark Stauder Medical Advisors Elliot Frank, M.D., and William Oser, M.D. Production Team Michael McCauley, Marisa Tranchina, Jacki Kronstedt, Joe Colón

This free magazine is prepared by the Marketing and Communications Team of Hackensack Meridian Health. Inquiries or ideas can be addressed to healthu@ hackensackmeridian.org.

© 2020 Hackensack Meridian Health ■■

The material provided in this magazine is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.

02 Health Fall 2020U 03HackensackMeridianHealth.org

ContentsC

ONLINE EXCLUSIVES

MORE FOR YOU Visit HMHforU.org for these and other great health care stories, and to subscribe to the HealthU e-newsletter.

Fall ■■ 2020

ONLINE EXCLUSIVES

17

20

28

24

30

Is your shoulder killing you, but you can’t think of anything you did to make it hurt? Visit HMHforU.org/Shoulder for possible causes.

Find out what you should know about the risks of secondhand vaping at HMHforU.org/SecondHand.

Tune in to our HealthU podcast! For more details, visit HMHforU.org/Podcast.

Typically, we photograph every patient appearing in HealthU. Because this issue was planned during the COVID-19 pandemic, in-person contact would have been too risky. Instead, our team took a creative approach and replaced photo shoots with illustrated portraits of patients.

04 Health Fall 2020U

UBettertips & resources to help you live your healthiest life

Hi. welcome to this issue of HealthU

05

Screening Saves Lives

Bob Garrett demonstrates some of the safety protocols in place for in-person appointments, including universal masking and temperature checks.

Regular cancer screenings are incredible tools for detecting cancer at its earliest and most treatable stages. By identifying cancer early through regular screenings, we greatly improve our ability to treat it. Unfortunately, fear of contracting COVID-19 has caused many people to delay otherwise routine appointments, such as mammograms, colonoscopies and lung cancer screenings.

While some people may feel that it’s safer to stay away from the doctor, even when they are experiencing concerning symptoms, it can be extremely dangerous and may have long-term effects on your health. The data is alarming:

} Epic, an electronic medical records vendor, showed screenings for breast, cervical and colon cancer have been down between 86 percent and 94 percent nationwide since March.

} In June, the National Cancer Institute predicted that the decrease in mammograms and colonoscopies in recent months could lead to an excess of 10,000 more breast and colorectal cancer deaths over the next decade.It’s clear that you should not skip cancer

screenings, particularly if you notice any symptoms. It’s even more important to continue your cancer treatment regimen if you’ve already been diagnosed. Rest assured that we’ve made it safer than ever to receive treatment or return for necessary screenings like mammograms, prostate exams, Pap smears, lung cancer screenings and colonoscopies. We are following strict safety protocols, including cleaning, universal masking, social distancing and checking patients for COVID-19 symptoms before appointments to make care and screenings as safe as possible.

We encourage you to make it a priority to schedule important cancer screenings. Turn to page 10 to better understand which screenings are right for you. If you aren’t up-to-date on your screening schedule, find a location near you at HMHforU.org/CancerScreening.

Finding cancer early offers the best chance for a positive outcome. We are with you every step of the way—from screening to diagnosis to treatment—all while keeping your safety our top priority.

Robert C. Garrett, FACHE, CEOHackensack Meridian Health

Since March, we’ve all worked together to take extra precautions to stay safe amidst the COVID-19 crisis. Right now, staying healthy is an important part of staying safe.

Learn more about available cancer screenings or find a screening location near you at HMHforU.org/CancerScreening.

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Mood-boosting Foods

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Eat Well a balanced approach to nutrition

Dark Chocolate

Not only is this sweet

treat packed with

antioxidants, but it can

improve the brain’s

cognitive function.

When consumed in

moderation, chocolate

made of 70 percent

cocoa or more releases

flavonoids that can

help us relax.

As we head into fall, the days are becoming shorter and the weather is turning cooler. When seasons change, our moods can swing with them—bringing feelings of fatigue, sadness and even depression. While we can’t control how long the sun hangs in the sky, we can determine which foods to eat that

can give us a great source of energy. Stock up on these foods to give your mood a boost.

Find more recipes and tips for healthy eating at HMHforU.org/HealthyEating.

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Nuts and Seeds

Packed with protein,

healthy oils and fiber,

almonds, sunflower

seeds, pumpkin seeds,

walnuts and peanuts

all have zinc and mag-

nesium that can boost

the immune system.

Dark Leafy Greens

From kale and Swiss

chard to spinach and

collards, leafy greens

are rich in iron and

magnesium that can

increase serotonin

levels, decrease

anxiety and increase

energy levels.

Fatty Fish Salmon is rich with omega-3 fatty acids, which are helpful to brain and nervous system function. Albacore tuna, sardines, trout and anchovies are great alternatives that provide the same nutrients.

Sweet Potatoes Rich in Vitamin B6, sweet potatoes help the pro-duction of serotonin, the “feel good” chemical in our brains. An antioxidant known as carotenoid can also help keep depression at bay.

Green Tea Not only is green tea full of antioxidants that can improve brain function and metabolism, but it can (unlike coffee) increase the amount of dopamine sent to your brain—giving a happy, less jittery feeling.

INSIDE THIS SECTION6 Adjusting to a stressful COVID-19 world8 Answers to your health-related questions9 Can weighted blankets help you sleep?9 Recipe for kale and sweet potato salad

06 07Health Fall 2020 HackensackMeridianHealth.orgU

betterU

Adjusting to a Stressful COVID-19 World

When COVID-19 first hit New Jersey, many of our fears were focused on staying safe from the virus and adjusting to challenges associated with family care, job loss and financial instability.

Now, we are more than seven months into the pandemic, and for most of us, those fears and isolation remain, compounded by the lack of normalcy in many aspects of our lives. Personal hobbies, gathering with friends, shopping, dining, going to the gym and other activities that help reduce stress are either unavailable or have to be done with extreme caution.

All of this creates a heightened level of anxiety, stress and depression, and an increased possibility of substance abuse or self-medicating. If you are experiencing any of this, you aren’t alone, and help is readily available.

“The behavioral health challenges associated with COVID-19 are a marathon, not a sprint,” says Ramon Solhkhah, M.D., co-chair of the Department of Psychiatry at Hackensack Meridian Health. “We each need to focus on our mental health, so that we can then focus on

our physical health, work and families. Think of the airplane analogy: In the case of an emergency, put on your mask first before helping others.”

What History Tells UsAfter natural disasters and mass-casualty events like Super-storm Sandy and 9/11, increased mental

health and substance use issues followed. But many people were reluctant to seek behavioral health care following these events. Some may have ignored red flags, thinking the feelings would go away on their own, while others may have delayed seeking care because of other priorities or concerns about cost and access to care.

“We’re seeing similar trends with COVID-19, where people are struggling but may not be seeking care at the moment,” Dr. Solhkhah

says. “Tragic events like Superstorm Sandy or 9/11 spanned a day or a few days—although, of course, we dealt with the consequences for a long time. With COVID-19, it has gone on for months with no sign of letting up. So this is a behavioral health crisis like no other in our lifetime.”

Barriers to Stress ReliefIn this unique time, we often can’t rely on typical coping mechanisms like getting together with friends and family and having a clear separation of work and home.

“This health crisis has tremendous ramifica-tions on every person’s overall well-being,” says Juliet Caldwell, M.D., director of Addiction Medicine at Hackensack Meridian Health. “We are being confronted daily with fear of getting sick, fear of close physical contact with those we care about and fear of losing loved ones to this devastating disease. Many are experiencing eco-nomic uncertainty, unemployment, and possibly the loss of a home or difficulty getting essential items like food—enormous stressors that cannot be overstated. At a time when we want and need to reach out to those we love to provide and obtain support, we are held back by very real fears. These uniquely challenging circumstances provide fertile ground for increasing self-medication with over-the-counter or illicit drugs, and it is the perfect environment for those already in recovery to suffer a full-blown relapse.”

Dr. Caldwell points out that people may struggle with substance use disorder and mental health challenges that are influenced by both genetics and the environment. The current circumstances with the pandemic create challenges for everyone. “When a person’s envi-ronment becomes stressful or unstable, those with genetic tendencies will be more susceptible to addiction, depression or anxiety,” she says.

“However, this pandemic and prolonged isolation have a negative impact on almost everyone’s overall psychological health.”

Your First Line of DefenseIf you have feelings of anxiety, stress, isola-tion, depression, changes in mood, appetite or sleep—or if you are struggling with alcohol

or drug use—a first, trusted source of guidance can be your primary care doctor.

John Gumina, M.D., a primary care doctor at Hackensack Meridian Medical Group who has prac-ticed for 44 years, has seen an increase in patients experiencing these behavioral health challenges over the past few months. “As a primary care doctor, I’m not just concerned about my patients’ physical health—their diabetes or hypertension, for example,” he says. “I also care about their emotional and mental well-being—their family dynamics or whether someone has lost their job.”

During appointments, he asks general ques-tions to assess patients’ mental and emotional health, such as: How are you feeling with every-thing going on? Are you feeling extra anxious

“Making a commitment to change can seem overwhelming, and many people avoid the topic or would prefer to delay treatment until ‘a better time.’ So we suggest exploring types of treatment to get a better understanding of the process and what a personalized recovery plan would look like,” Dr. Caldwell says.

She adds that if you aren’t emotionally ready for that, and don’t have an imminent need for medical attention, peer-recovery groups are a good start-ing point. “You can get the recovery ball rolling simply by hearing from people who struggle from the same disease as you,” she says. “For many people, being understood and accepted is an important step on the road to treating the medical condition of substance use disorder.”

She points to peer-recovery groups such as Alcoholics Anonymous (AA.org) and Narcotics Anonymous (NA.org) as good resources.

More Support Than Ever BeforeSupport for behavioral health challenges is often misunderstood or misperceived. It doesn’t have to include checking into an inpatient center. A full range of treatments and services is available to provide relief and manage these medical conditions, from telehealth video visits with physicians, to outpatient services and programs, to integrative health and medicine therapies and urgent care centers with behav-ioral health services.

“Many highly effective medications have been proven to dramatically decrease overall mortality and relapse if used appropriately, particularly for those who suffer from opioid use disorder,” Dr. Caldwell says. “Reaching out to an addiction- trained doctor who can discuss these options with you can be crucial to your chance of recovery.”

In addition, many behavioral health services are available by telehealth, so people can get treatment in their own home. Peer recovery groups like AA and NA are meeting virtually. “For-tunately, many of the barriers to care have been removed, and there is increased availability and accessibility like never before,” Dr. Solhkhah says.

Adds Dr. Caldwell: “You are not alone, though you likely feel alone. There is help available on so many levels, and supportive, nonjudgmental, exceptional care is available close to home. Mak-ing the decision to discuss your feelings may be the hardest part of getting better. You will feel better, day by day, if you do.”

Emotional Harmony supporting your emotional and mental health

Juliet Caldwell, M.D.

Board certified in addiction medicine, emergency medicine and internal medicine

800-822-8905

Hackensack

John Gumina, M.D.

Board certified in family medicine

800-822-8905

Sea Girt and Freehold

Ramon Solhkhah, M.D.

Board certified in addiction medicine, child and adolescent psychiatry, addiction psychiatry and psychiatry

800-822-8905

Neptune

Learn about the comprehensive behavioral health services available at Hackensack Meridian Health at HMHforU.org/GetHelp. Find a primary care doctor near you at HMHforU.org/FindADoc.

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about anything specific? “I keep my questions open-ended, so patients can feel comfortable bringing up concerns or questions, and I can

provide support,” Dr. Gumina says. If you don’t have a primary care doctor, he

suggests asking friends or family members for a recommendation. Or find a doctor near you at HMHforU.org/FindADoc.

When starting a conversation with your primary care doctor, Dr. Solhkhah recommends coming prepared with a list of mental health or addiction issues you’re having. “That way, you don’t forget your feelings or experiences when you speak with your doctor,” he says.

For substance use disorders specifically, Dr. Caldwell suggests it’s best to seek profes-sional help to determine how much care you need and understand available care options.

You Are Not AloneMental Illness

47.6million adults in the U.S.

had a mental illness in 2018. That’s more than

19% of all adults.

Among those with a mental illness,

1 in 4had a serious mental illness.

60%of adults with a mental illness did not receive mental health services

in the previous year.

9.2 million adults

had both a mental illness and a substance

use disorder.

57.8 million adults in the U.S.

had either a mental illness or a substance

use disorder.

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for M

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SAM

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2018

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Substance Use Disorder

19.3million adults in the U.S.

had a substance use disorder in 2018. That’s

almost 8% of all adults.

Among those with a substance use disorder:

struggled with alcohol usestruggled with illicit drugs

12.9% struggled with both

Only 1 in 10patients with an addiction

get treatment.

74.5%

38.3%

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Depression and Addiction: Understanding the Connection Webinar Join Caitlin Simpson, DSW, director of Retreat & Recovery at Ramapo Valley, on October 28 at 11 a.m. as she discusses how mental health and substance use often have a connection, tips for talking about these sensitive issues, how and when to seek care, what types of care and treatment are available, and what the care experience looks like. Visit HackensackMeridianHealth.org/Events to register.

We’re headed into flu season again—only this year, we have to worry about COVID-19 on top of seasonal flu. What can I do to protect my family?

—Angie V.

Aysha Seeni, M.D.

Board certified in internal medicine

800-822-8905

Monroe Township

Until there is a vaccine created or we have achieved herd immunity, COVID-19 must remain top of mind when it comes to you and your family’s health and well-being. As it gets colder outside, it’s important to be mindful of symptoms of both COVID-19 and seasonal flu: fever, cough, body aches, fatigue, congestion or runny nose, and sometimes vomiting and diarrhea. Call your primary care doctor immediately if you or a family member experience these symptoms. You can protect your family by making sure everyone has their flu shot, washes their hands regularly for at least 20 seconds, practices social distancing and wears a mask when around others. Finally, as we head into holiday season, when parties and gatherings are typically more common, remember that we’re still dealing with a highly infectious virus. This year, keep gatherings virtual when possible, and make sure in-person ones are smaller, socially distanced and with masks worn.

This school year, my 13-year-old’s grades are significantly below what they were last year, and he seems much more withdrawn and argumentative. How can I help him?

—Sean L.Given the unprecedented year we’ve all experienced since March, your son may be experiencing a delayed emotional response to everything that’s been going on. In fact, your son may not even recognize the change in his behavior or understand the underlying fear, frustration or anger that is causing the observed behavior change. Approach him in a way that is loving and understanding, being careful not to demean or belittle him.

Ask him questions such as: }Did you forget to complete an assignment? }Do you miss being around friends? }Do you need extra support with your studies? }How are you feeling, and what do you think would be most helpful?These types of questions show concern rather

than anger and give your son an opportunity to express what is truly bothering him. If he doesn’t feel comfortable sharing, seeking help from a professional might be the best next step.

Steven Miller, D.O., FAAP

Board certified in pediatrics

800-822-8905

Tinton Falls

“ We are grateful for our valued partnership with the Count Basie Center for the Arts,” says Robert C. Garrett, CEO of Hackensack Meridian Health. “Research suggests that experiencing music and the arts can reduce stress, relieve pain, create energy and boost moods. We’ll get through this challenge together, as a community.”

08 09Health Fall 2020 HackensackMeridianHealth.orgU 09HackensackMeridianHealth.org

healthy recipes in five steps or lessWell Fed

betterU

Wilted Kale and Sweet Potato Salad

Serves 2 (4 as a side dish)

Ingredients2 medium sweet potatoes1 small sweet onion,

thinly sliced4 garlic cloves, crushed4 cups kale leaves, chopped

(stems removed)½ cup golden, seedless raisins

Dressing1 tablespoon balsamic vinegar2 tablespoons extra virgin

olive oil½ tablespoon honey½ tablespoon port or other

dessert wine¼ teaspoon toasted

sesame oil

Seasoned CookIf you’re not a fan of kale, use Swiss chard or hardy spinach instead.

Nutritional InformationPer serving220 calories, 3g protein, 38g carbohydrate (4g fiber), 7g fat (1g sat, 6g mono/poly), 35mg sodium

Steps➊ Heat oven to 400° F. Peel

and chop potatoes into 1-inch cubes and roast for 20 minutes until tender and just barely brown.

➋ In a lightly oiled skillet over medium heat, sauté onions and garlic. Cook until onions are softened and garlic is fragrant, about 5 minutes.

➌ Turn heat to low and add all dressing ingredients to the pan. Heat and stir until honey liquefies.

➍ Add kale to skillet, and lightly sauté until kale starts to wilt, about 1–2 minutes.

➎ In a large bowl, combine contents of skillet and sweet potatoes. Toss, top with raisins and serve warm.

Can Weighted Blankets Help You Sleep Tight? For many of us, getting a good night’s sleep proves to be challeng-ing these days. With a never-ending news cycle and our “normal” schedules taking a complete 180-degree turn, our minds are often running several miles a minute.

Being swaddled in a heavy blanket may seem trivial, but it could help ease your mind and body. While science hasn’t proven the ability of weighted blankets to solve sleep issues, a small number of studies have demonstrated their impact. According to one small study, 63 percent of subjects experienced lower anxiety after using a weighted blanket, while 78 percent believed the blanket to be a calming agent.

What Is a Weighted Blanket? A weighted blanket is a heavy blanket, weighing 10–30 pounds, stuffed with plastic pellets and intended to give the feeling of a warm hug. This theory, also known as deep pressure therapy, is believed to cause a shift in your nervous system and create a calming, soothing sensation throughout the body. “Weighted blan-kets are a popular sleep aid because they help your body produce endorphins or ‘happy hormones’ that allow you to feel comfortable and safe,” says Adrian Pristas, M.D., corporate medical director, Centers for Sleep Medicine at Hackensack Meridian Health. “Addi-tionally, the chemicals melatonin and serotonin are increased and provide a sense of calm and peace while sleeping.”

How to Choose a Weighted Blanket }Choose a weight that is comfortable for your body size (7–12 percent of your body weight, but no more than 35 pounds). }Consider the size of your bed when selecting a blanket. }Select a material that provides the level of temperature you like (i.e., cotton vs. polyester). } Find a blanket that matches your budget. Prices vary, but blan-kets are becoming more widely available at all types of retailers.If you have a circulatory condition such as diabetes or high blood

pressure, talk with your doctor before using a weighted blanket.

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Find more recipes and tips for healthy eating at HMHforU.org/HealthyEating.

BODY+MIND+SPIRIT

Learn how Hackensack Meridian Integrative Health & Medicine focuses on the health and well-being of the whole person—body, mind and soul—at HMHforU.org/IntegrativeHealth.

U•Ask you have questions; we have answers


Innovation transforming medical research into treatments

11HackensackMeridianHealth.orgHealth Fall 2020U

CANCER WHAT WHY WHO HOW OFTEN

Breast

In traditional 2D mammog-raphy, the most common screening tool, the breast is compressed between two plates, and X-rays are used to take a picture of the breast tissue. The procedure for 3D mammography, which more effectively finds tumors in women with dense breasts, is similar but acquires images from different angles. This method can find additional cancers not visible on 2D mammography.

Since 1990, mammography has helped reduce breast cancer mortality in the U.S. by nearly 40 percent. Some women think they don’t need a mammogram because they have no family history or risk factors. But the fact is most people who get breast cancer have no risk factors. That is why no woman should put off a mammogram.

Women at average risk for breast cancer should start screening at age 40. “Women at higher risk should be screened 10 years before the age of their first-degree relative when they were diagnosed, or by age 40 if the relative was older when they were diagnosed,” says Margaret H. Hager, M.D., a family practitioner in Forked River, New Jersey. Risk factors include:

}Mother, daughter, sister or multiple relatives with breast cancer }Previous personal history of breast cancer }Previous treatment involving radiation to the chest area } Inherited gene mutations, such as BRCA1 and BRCA2

The National Comprehensive Cancer Network, Society of Breast Imaging, American Society of Breast Surgeons and American College of Radiology all recommend that women begin annual mammography screening at age 40. “In high-risk patients, there must be a discussion between the doctor and patient about the frequency and type of screening,” Dr. Kayastha adds.

The choices we make about diet, exercise and other habits can influence not just our overall health, but also our risk for cancer. In many cases, another tool exists for reducing cancer risk: early screening. “Identifying cancers early, through regular screenings, results in improvements in treatment and progno-sis for many types of cancer,” says Jonathan Shammash, M.D., FACP, primary care provider in Hackensack, New Jersey.

Unfortunately, the COVID-19 pandemic has led to a signifi-cant reduction in the number of regular screenings conducted. Recent data from Epic, an electronic medical records vendor, shows screenings for breast, cervical and colon cancer in the U.S. have been down 86–94 percent since March.

“We encourage people to come in for routine screenings, particularly if they are falling more than six months behind schedule,” Dr. Shammash says. “We are following care-ful protocols: cleaning, social distancing and screening of patients before appointments to make the cancer screening process very safe.”

Shital Kayastha, D.O., a family medicine practitioner in Edison, New Jersey, adds, “A patient should never hesitate to discuss the timing of screenings with their doctor, then personalize the screening schedule to fit their needs.”

Here is what you should know about recommended cancer screenings for your age, sex and lifestyle.

Regular screenings can find breast, cervical, prostate, lung, skin and colorectal cancers early, when treatment is more likely to be effective. Here is what you should know about who should be screened and when.

TimeScreen

Innovation transforming medical research into treatments

Special Section | cancer screening

Breast Cancer Lung CancerCervical Cancer Skin CancerProstate Cancer Colorectal Cancer

10


Innovation

13HackensackMeridianHealth.orgHealth Fall 2020

Innovation


CANCER WHAT WHY WHO HOW OFTEN

Cervical

Cervical cancer screening is typically part of a woman’s health checkup. There are two types of tests: the Pap test and the HPV test. “During a Pap test, the doctor will collect samples of cervical and vaginal cells during an internal vaginal exam,” Dr. Kayastha says.

“HPV testing occurs when the doctor collects cells from the endo-cervix using a cervical brush, places them in an HPV test medium and sends it to a lab for analysis of HPV strains.”

Cervical cancer was once one of the most common causes of cancer death for American women, but the cervical cancer death rate dropped significantly with the increased use of the Pap test for screening. “Cervical cancer is not as common as breast cancer, but I often tell patients it is equally important to get screened, as it is still a type of cancer that occurs in women,” Dr. Kayastha says.

“Cervical cancer screening should begin at age 21 and continue until age 65,” Dr. Hager says. Women no longer need screening if they have a hysterectomy, but high-risk women may need to continue screening after age 65. Women at higher risk include:

}Those who are immunocompromised }Those infected with a high-risk strain of HPV }Those with prior abnormal screening results }Those with a history of inadequate screening for cervical cancer

According to the American College of Obstetri-cians and Gynecologists, average-risk women ages 21–29 should have a Pap test every three years. Average-risk women ages 30–65 should have a Pap test and an HPV test every five years. “It’s also acceptable for them to have a Pap test alone every three years,” says Dr. Kayastha. “For higher-risk women, the screen-ing strategy chosen may differ depending on why the patient is at higher risk, so it’s best to follow up with your gynecologist for counseling.”

Prostate

Screening tests for prostate cancer include a prostate-specific antigen (PSA) blood test and a digital rectal exam (DRE). The PSA test measures the level of PSA in the blood; PSA levels can be higher in men who have prostate cancer. During a DRE, the doctor looks for any bumps or hard areas that could signify prostate cancer.

The biggest benefit for prostate cancer screening is for men ages 55–69, and the decision to screen should be shared between the patient and doctor.

“It’s important for men to talk to their doctor about personal risk factors and learn about possible benefits versus risks of screening, diagnosis and treatment,” Dr. Shammash says.

Dr. Shammash encourages average-risk patients to begin conversations about prostate cancer and screening with their doctor around age 55. Men at higher risk should start those conversations earlier, around age 40 or 45. Those at higher risk include:

}African American men }Those with a family history of prostate cancer }Those with a BRCA gene mutation

Depending on risk level, doctors may recommend prostate cancer screening every one to two years for men ages 55–69. But Dr. Shammash emphasizes that it should be an individualized decision, as discussed with your physician, to start or continue screening.

Lung

Low-dose computed tomography (LDCT), which is sometimes called a low-dose CT scan, has increased lung cancer survival rates in the United States by 20 percent. The test is noninvasive and quite simple: You position your body in a scan machine and a low dose of radiation is used to create a highly detailed image of your lungs. There is no blood work or dyes associated with this screening.

People rarely know they have lung cancer when it’s in the earliest stages and is most curable. In fact, only 15 percent of lung cancers are diagnosed early. Without screening, lung cancer is often diagnosed at a late stage, when it’s more difficult to treat.

Those referred for lung cancer screening generally meet all of these requirements (nonsmokers typically are not referred for screening):

}Current smoker or have quit smoking in the past 15 years }Age 55–80 }Generally in good health otherwise }A 30-pack-year smoking history

“In terms of pack years, that could be someone who smokes a pack a day for 30 years or smokes two packs a day for 15 years,” Dr. Shammash says. “After 15 years of quitting smoking, a person’s risk for lung cancer decreases significantly.”

Frequency of screening depends on the results of the imaging, Dr. Shammash says. “Generally, annual screening is recommended, although that doesn’t need to be continued indefinitely,” he says. “It also varies based on whether you have a series of negative CT scans and what happens with your smoking history.”

Skin

Skin cancer screening generally begins with a total skin exam. “A doctor will examine a patient from head to toe, looking at areas of the skin for irregular moles or concerning areas,” Dr. Shammash says. “If the doctor sees something irregular, they may use a tool called dermoscopy [in which the doctor uses a brightly lit, hand-held magnifier called a dermatoscope to reveal signs of cancer]. After that, a biopsy may need to be taken.”

For people who are at increased risk of skin cancer, screening helps find cancer at its earliest stage, when the chances for successfully treating it are greatest.

People most likely to benefit from skin cancer screening include those who have:

} Fairer complexions }A significant history of sun exposure and sunburns }A family history of skin cancer and melanoma

Those at higher risk of skin cancer should get a full-body screening exam every year. Regardless of risk level, everyone should be familiar with their own skin to notice changes. If you have a suspicious skin area, a sore that doesn’t heal or a change in a mole or freckle, talk with your doctor.

Colorectal

Several tests are available to screen for colorectal cancer. In a colo-noscopy, the doctor inserts a long, thin lighted tube into the rectum to check for polyps or cancer inside the rectum or the entire colon. Fecal immunochemical tests use antibodies to test for blood in stool. For this noninvasive test, your doctor will provide an at-home test kit, which is returned to the doctor or a lab. The Cologuard test is another at-home stool test. A lab checks for abnormal DNA from colorectal polyps or cancer, as well as hemoglobin, which may be bleeding from a polyp or cancer. If either stool test is positive, you will need a colonoscopy to examine the entire colon.

A colorectal cancer screening looks for cancer before symptoms start, so it can find colorectal cancer early, when it’s small and possibly easier to treat. “Colorectal cancer screenings have been shown to be effective at reducing colorectal cancer-related mortality,” Dr. Shammash says.

The average-risk population should start colorectal cancer screening at age 50. Those at higher risk should begin screening in their 20s, Dr. Shammash says. Colorectal cancer risk factors include:

}Obesity }Smoking }Heavy alcohol use }Personal history of colorectal polyps }Personal history of inflammatory bowel disease } Family history of colorectal cancer } Inherited syndrome like Lynch syndrome

For the average-risk population, colonosco-pies should be conducted every 10 years. If polyps are found, or if someone is considered high risk, frequency will be increased. Fecal immunochemical tests need to be performed annually, while flexible sigmoidoscopies may need to be performed every five years.

Are you up-to-date on your cancer screenings? Learn more, and find a screening location near you, at HMHforU.org/CancerScreening.

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Shital Kayastha, D.O.

Board certified in family practice

800-822-8905

Edison

Margaret Hager, M.D.


800-822-8905

Forked River

Jonathan Shammash, M.D., FACP

Board certified in internal medicine

800-822-8905

Hackensack

12

Identical twins have a lot in common, but Meagan McCallum and Courtney Werner never dreamed they’d get the same diagnosis within months of each other.Identical twins Meagan McCallum and Courtney Werner have always had a unique bond. As kids, they shared their own private language. When Meagan was pregnant with her first daughter, Courtney awoke at 5 a.m. one day with an inexplicable urge to call her sister. When she did, Meagan answered from her bathtub, where her water had broken, and she was debating whether to call Courtney.

Courtney, who lives in Manahawkin, New Jersey, is older than Meagan, who lives in Waretown, New Jersey, by two minutes. She was often the first to try new things, such as field hockey, which Meagan would later join. That trend changed last year.“I’m usually the trailblazer, but she beat me for the first time

in our lives,” Courtney says. “She got cancer first.”

Unpleasant SurprisesMeagan had a routine mammogram in October 2019. Her results came back clear, but because she has dense breast

Meagan’s ABVS ultrasound revealed an abnormality, so she made an appointment at Ocean Medical Center with breast surgeon Yolanda Tammaro, M.D., who recom-mended a biopsy to confirm if the abnormality was cancer-ous. Because of her age (42), and the fact that she had no family history of breast can-cer, had three pregnancies and breastfed all her children, it was very unlikely that any-thing was amiss.

But on January 15, 2020, Meagan got the unbeliev-able news that she had breast cancer.“I didn’t even tell my

sister until several days after the biopsy,” Meagan says. “I was so shocked, I just couldn’t say it. We tell each other everything, but I didn’t want her to worry.”

After learning of Meagan’s diagnosis, Courtney’s mind went back to the mammogram she had put off over the holidays. She made the next available appointment in March, but prior to that, she did a self-examination and found a lump. In disbelief, she told herself it was a sympathy lump. What she didn’t know was that Meagan’s lump was in the exact same spot.

Dr. Tammaro removed Meagan’s lump in February,

sparing her breast. When Courtney visited Meagan the day after the surgery, she kept quiet about the lump she had found. She didn’t want to upset Meagan, especially without knowing what it was. But when Meagan showed her the location of her incision, Courtney couldn’t hide her shock. “She went pale as a ghost,” Meagan recalls.

tissue, she also received an automated breast volume scanner (ABVS) ultrasound.“In younger patients, breast cancers are more difficult to

find if the patient has dense breasts,” says Southern Ocean Medical Center radiation oncologist Joseph Lattanzi, M.D. He estimates about 10 percent of patients with dense breast

tissue have underlying lesions, and about half of women under age 40 have dense breast tissue. Computer-assisted screen-ing tools used by Hackensack Meridian Health providers give a precise breast density reading, which determines a patient’s risk of cancer being missed on their mammogram, adds Thomas Yu, M.D., radiologist at Health Village Imaging.

ImageMirrorMeagan McCallum (depicted on the right) completed radiation May 5, and her twin sister, Courtney Werner (depicted on the left), began hers June 24.



Twin DiagnosesThe following week, Courtney told Meagan about her strangely similar mass. Meagan implored Courtney to ask for the ABVS ultrasound at her upcoming mammogram. “I told her, ‘Tell them what happened to me,’” Meagan says, “because if I hadn’t gotten that done, I would have cancer now and not know it.”

When Courtney’s ABVS results came back, they showed the sus-picious mass, and like her sister, a biopsy confirmed that she, too, had breast cancer.

By the time Courtney received her diagnosis, Meagan had already finished the first part of her three-step treatment plan—surgery—and was onto the next—radiation. She gave Courtney the names of each of her doctors, and Courtney requested the exact same lineup.“Having all of her doctors was such

a huge help,” Courtney says. “She did so beautifully that I had no doubt in my mind that I would do the same. She told me, ‘Everyone is going to be super nice to you,’ and everybody was. I never once felt like they were treating me like I was my sister. I was my own individual.”

Courtney met Dr. Tammaro first. Her biopsy was scheduled in the thick of New Jersey’s COVID-19 outbreak, which meant she had to go to visits alone or schedule virtual visits when appropriate. Southern Ocean oncolo-gist Tricia Morino, D.O., prescribed tamoxifen, an estrogen-modulating drug, to treat the breast cancer while Courtney waited for her lumpectomy.

Prior to the sisters’ surgeries, Dr. Tammaro ordered genetic testing to determine whether a lumpectomy (which removes just the tumor) or a mastec-tomy (which removes the whole breast) would be the best treatment. Then Dr. Morino ordered Oncotype testing, which determines whether chemotherapy will be an effective treatment.

Although their tumors fell into the intermediate risk category based

on the Oncotype test, their age and cancer-free family history helped their doctors decide that chemo was unnecessary.

On the Road to RemissionMeagan completed radiation on May 5, and Courtney began hers on June 24. As Meagan recovered, her progress was a preview of the road ahead for Courtney. “I kept telling her, ‘You’re going to feel like yourself again soon,’” Meagan says.

Looking back on the whirlwind they have faced, both women say the hardest part was watching the other go through it. “I didn’t even have a chance to process that I had cancer before we scheduled my surgery,” Meagan says.

“I was 10,000 times more afraid for my sister. My experience was over and done with, but I had to watch her go through it.”

Courtney echoes, “I was more scared and nervous for Meagan when she was going through her cancer diag-nosis, waiting for all of her test results and surgery. It felt like it took a lifetime, and time almost stood still for me. But when living through it myself, I felt like it all went so fast. I feel like I blinked my eyes; my tests, surgery and radia-tion were over; and I was on my way to full recovery.”

The sisters had testing to determine if they carry a genetic mutation linked to their cancers, and both tested negative. Now they are onto step three, hor-monal therapy, and they will keep up a rigorous surveillance program with each of their doctors to catch any sign of recurrence.“They are my patients for life now,

and I’m happy to say that because they’re beautiful women, inside and out,” Dr. Tammaro says. “They share the same spirit.”

Tricia Morino, D.O.

Board certified in medical oncology, hematology and internal medicine

800-822-8905

Manahawkin

Thomas Yu, M.D.

Board certified in diagnostic and interventional radiology

Manahawkin

Yolanda Tammaro, M.D.

Board certified in surgery

800-822-8905

Brick and Manahawkin

Joseph Lattanzi, M.D.

Board certified in radiation oncology

800-822-8905

Toms River and Manahawkin

In the GenesA number of factors can make a woman a candidate for genetic testing for breast cancer:

}Family or personal history of breast cancer, ovarian cancer or multiple cancers }Family history of BRCA1 or BRCA2 gene mutations }Ashkenazi Jewish descent

Learn more about who should get genetic screening for breast cancer at HMHforU.org/Genetics.

Hackensack Meridian Health offers the largest breast cancer and imaging program in New Jersey. Learn more at HMHforU.org/BreastCancer.

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Diagnosed with breast cancer at age 40 after her first mammogram, interior designer Colleen Rosar found a care team that helped her fight back.

Design

Colleen Rosar is the owner of a successful interior design business. At the time of her breast cancer diagnosis, she had just opened a second location and retail space.

Care

16 Health Fall 2020U

Spotlight on Uyour stories of healing and triumph

17HackensackMeridianHealth.org


Feeling Whole AgainColleen went straight from her mastectomy sur-gery to breast reconstruction with plastic surgeon Peter T. Hetzler, M.D., FACS, chair of the Plastic Surgery Division at Riverview. For Dr. Hetzler, treating breast cancer patients is personal. He lost his mother to it, and his wife and sister both are breast cancer survivors. His life’s work has been dedicated to helping his patients heal in more ways than one.“What women tell me is that it makes them

whole again to have their reconstructions done as realistically as possible,” Dr. Hetzler says. “I think reconstruction really helps patients cope with the loss of their breasts. Of course, they’re always reminded that they’ve had mastectomies, but the advanced techniques that we’ve developed over the years have made these reconstructions so much more lifelike and realistic.”

For Colleen, Dr. Hetzler performed reconstruction using soft tissue expanders, placed immediately after her mastectomy. A few months later, after the skin over the breast area had stretched enough, the expanders were removed and replaced with silicone implants.“I actually looked forward to going into his office

every week when they would put fluid in my expanders. It just felt so comforting to be there,” Colleen says.

Because of the type of mastectomy Colleen had, her nipples were removed. “That was actu-ally the toughest thing I had to deal with—when I found out I couldn’t keep my nipples,” she says.

“For some reason, having the mastectomy wasn’t upsetting to me, but that sent me into a tizzy. I couldn’t even wrap my head around it.”

This has left Colleen with another decision to make: to have surgically attached, reconstructed nipples or have them tattooed on. Colleen is leaning toward the tattoos. “I know the doctors want me to feel good and normal. But I don’t want anything attached to me, and I don’t want to lose any time doing something that’s not for my health,” she says.

Dr. Hetzler says the tattoos are becoming more popular and have come a long way. “These days, you can do what’s known as ‘trompe l’oeil,’ which when translated means ‘fools the eye.’ They actu-ally look 3D,” he says.

A Steadfast Spirit“Because everything happened so quickly, I almost don’t even remember it,” Colleen says of her

procedures. “I didn’t have a tough time physically with it. But emotionally, it’s been tough. It’s a lot to process. It has taken me a while to do that.”

Colleen leaned on her support system, including friends who came from all over the country to nurse her back to health. “I was back in the shop six weeks [after the first surgery],” she says. “My business is my whole life. It did really well because I have the best co-designer and studio manager. If I didn’t have her, I wouldn’t have been able to keep it going.”

Since her procedures, she has hiked part of the Appalachian Trail and hopped on a plane to Puerto Rico to go horseback riding. “Colleen was quite the trooper through all of this.

She was amazing,” Dr. Hetzler says. “The most remarkable thing was her spirit throughout the entire process. She’s kept such a positive focus, which helps the healing process.”

When Colleen Rosar went in for her very first mammogram at age 40, she thought she was just checking something off her to-do list. “I didn’t think anything of it. I thought of it like I was getting my teeth cleaned,” she says.

But by the end of that Friday in August 2019, Col-leen had already had a mammogram, an ultrasound and a biopsy of her breast. The following Monday, she received the call from her doctor. “She said that I had cancer,” Colleen says. “I

don’t really remember what she said after that. It was kind of a blur.”

A Swift DecisionColleen, founder and owner of a successful interior design business, had just opened a second location and a retail space in Bay Head, New Jersey, when she figured it was time for a mammogram. A friend of hers worked at the Women’s Center at Riverview Medical Center and helped coordinate her appointment with Bokran Won, M.D., a fellowship-trained breast radiologist and medical director of the Women’s Center.

Given that Colleen was young and had no other risk factors, cancer wasn’t a thought in her mind. According to the American Cancer Society, inci-dence of breast cancer in average-risk women in their 40s is only 1 in 65, while lifetime risk of breast cancer is 1 in 8.

But Colleen’s mammogram showed a small, distorted area that required a closer look. “When women have their baseline mammograms, it’s not unusual to have additional imaging studies,” Dr. Won says. An ultrasound confirmed that there was cause for concern.

Dr. Won performed a needle biopsy on the same day at the Women’s Center, which revealed that Colleen had invasive ductal carcinoma. Col-leen scheduled a consultation appointment with Riverview breast surgeon Catherine Campo, D.O., FACOS.“Colleen’s MRI showed extensive disease in the

right breast,” Dr. Campo says. “In Colleen’s case, mastectomy leads to a lower risk of recurrence than lumpectomy because the span of the tumor was very large and in more than one quadrant of the breast.”

Within weeks of her initial diagnosis, Colleen had her bilateral mastectomy. “I didn’t even have time to think about it,” she says. “It was like a train. It went so fast. One minute I was in the doctor’s office, and the next minute I was waking up from surgery.”

Bokran Won, M.D.

Board certified in radiology

800-822-8905

Red Bank and Holmdel

Catherine Campo, D.O., FACOS

Board certified in general surgery

800-822-8905

Tinton Falls and Holmdel

Peter T. Hetzler, M.D., FACS

Board certified in plastic surgery

800-822-8905

Little Silver

Are Mammograms Painful?Mammograms are a key step in keeping women and their breasts healthy. But if you haven’t had a mammogram before, knowing what to expect can help alleviate fears you might have about discomfort.

What to Expect from a MammogramA mammogram is a type of X-ray that produces images of breast tissue. Radiologists examine the images to determine if there are abnormal areas in the breast tissue that could be indicators of cancer. The breast rests on a plate, and a curved flexible paddle will compress the breast against the plate to spread out and immobilize the tissue. This allows for a clearer image and the lowest possible radiation dose. The results of your mammogram are typically avail-able the same or next day. How to Make Mammograms More ComfortableMammograms are quick and noninvasive. Some women may have minor discomfort, but it is brief and most women find it to be tolerable.

The timing of your mammogram can help reduce the chance of pain. Try not to schedule your mammogram for the week before or during your period, as breasts can be swollen or tender during this time. In addition, for some women, caffeine can contribute to fibro-cystic changes and breast pain. So cutting back on caffeine may help.

Keep in mind that the value of the test outweighs any soreness it may cause, says Bokran Won, M.D. “Mammography is the only screening tool that has been proven to reduce mortality from breast cancer,” she adds. “There are additional screening tools, such as breast ultrasound and breast MRI with contrast, that can improve cancer detection rates, especially in women with dense breasts.”

Check out what you should know if you are scheduling your first mammogram at HMHforU.org/MammogramFacts

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Find out more about the Women’s Center at Riverview Medical Center at HMHforU.org/RiverviewWomen.

Despite seemingly insurmountable obstacles—which, on top of her breast cancer diagnosis, included a burst pipe in her store and temporary closure due to COVID-19—she presses on and has a new perspective. “Certain things at work are stressful, but it doesn’t carry the same weight anymore,” she says. “It’s all just stuff.”

Colleen is proof that a woman is never too young for a cancer diagnosis, and that early detection and fast action make all the difference.

“Screening mammograms detect breast cancer before it becomes palpable, which leads to more treatment options and improved survival,” Dr. Campo says.

Colleen’s advice for young women? “Don’t be afraid to get a mammogram. Had I waited, this whole experience would have been even more emotionally difficult for me.” iSt

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Mammogram Results

Mammography X-Ray Machine


Spotlight on U

After catching and treating lung cancer early, Diana Robertson Fidanzato feels better than ever.It was by chance that Diana Robertson Fidanzato had a chest X-ray in December 2017. After falling and hitting her head in the middle of the night, she ended up in the Emergency Department, where a chest X-ray was taken as part of flu sea-son protocol. That was how doctors first discovered a small nodule in the upper right lobe of her lung—just two weeks before her daughter’s wedding.

Diana, 59, a resident of Brick, New Jersey, followed up with her primary care doctor, Kelly G. Ussery-Kronhaus, M.D., for another chest X-ray and low-dose computerized tomography

change. Dr. Ussery-Kronhaus referred her to thoracic surgeon Thomas Bauer, M.D., FACS, MBA, chair of the Department of Surgery and medical director of thoracic surgery at Jersey Shore University Medical Center. Jersey Shore is the first in New Jersey to earn The Joint Commission’s Gold Seal of Approval® for Lung Cancer Certification, an accreditation for excellence in lung cancer treatment. After consulting with Dr. Bauer in January, Diana had surgery to remove the nodule on February 13, 2020.

Catching Lung Cancer EarlyDiana, who lost a close friend to lung cancer a few years ago, feels fortunate that her cancer was caught at stage 1 and that she was able to have surgery right away. “Because my friend wasn’t having any symptoms right away, she wasn’t diagnosed until stage 4, which was when she started feeling ill and went to the doctor. What I’ve learned from my whole experience is you often don’t have symptoms until later stages [of lung cancer], and there’s not as much they can do to treat you then,” she says.

Echoes Dr. Bauer: “The earlier you catch lung cancer with screening, the greater the probability is of a good outcome. I ask my patients, ‘If you’re

going to be unfortunate enough to get lung cancer, do you want an 80 percent chance of a cure if you participate in the lung cancer screening program or a 23 percent chance of a cure if you don’t?’ That difference is so profound that it’s a pretty easy answer.”

Dr. Bauer notes that Diana’s screening journey in particular shows the importance of careful follow-up and monitoring.

“If we operated on everything we found on a CT scan, we would be doing a lot of unnecessary surgery,” he says.

“Carefully monitoring the finding over time, then being able to discern when to operate, is an important part of making sure you’re not harming patients.”

Compassionate CareLooking back, Diana says the care she received at Jersey Shore was nothing short of incredible. “Everyone on Dr. Bauer’s team was amazing. They are truly compassionate people,” she says. “You can call any one of them and get immediate feedback.”

Specifically, Diana recalls getting cold feet a few days

before her scheduled surgery, and someone on the care team spoke with her on the phone for about 20 minutes to reassure her that she was doing the right thing. “She explained everything to me again and talked about all the benefits of having the surgery now versus later,” Diana says. “It really helped me.”

One of the most heartwarming parts of Diana’s entire experience is the story behind the cough pillow she received from Dr. Bauer just before her surgery. Meant as a little something to hold and squeeze to reduce pain when coughing post-surgery, Diana’s cough pillow—navy blue with stars all over—was handmade by Dr. Bauer’s daughter. “That meant a lot to me,” she says.

Diana also was impressed with the care she received in the hospital after surgery. “My nurse was amazing,” she says. “He took me down when I got discharged and stayed with me so my sister could get the car. He spent a lot of time in my room, made me feel comfortable, answered all of my questions and told me I was doing a great job. I really felt like I was treated like an individual, not just another post-op patient.”

The Road AheadNow a few months post-surgery, Diana says she feels even better than she did before her surgery. “Living in this area, I love everything about shore life: the beach and the ocean,” she says. “That’s where I get my energy.”

Every day, Diana embraces the ocean air and takes 3- to 4-mile walks with her hearing-impaired dog with posttraumatic stress disorder, Savannah, whom she rescued in December 2019. “I wear hearing aids because I can’t function without them. So when I was looking to adopt a dog and found out there was one en route from South Carolina who was hearing impaired, I knew I had to meet her,” she says.

With her first two grand-children born this summer, Diana has plenty to look forward to in addition to her daily walks. “I feel like I’m being given a second chance, and I want to make the most of it,” she says.

(CT) scan shortly thereafter. Diana was a former smoker, but because of the small size of the nodule, they decided to simply monitor it. She had a repeat CT scan in December 2018 that showed little change.

So the mom of four adult children continued to lead a normal life, working as a quality analyst for a large insurance provider, and volunteering once a week at a local nonprofit that supports women being treated for cancer. “I love to help people,” Diana says. “As an empty nester, I was looking for something to do. I heard about this organization and thought it was an awesome concept—that women with cancer could go there free of charge to relax and heal. I love helping them with anything they need and being there to listen.”

In December 2019, another CT scan showed the nodule on Diana’s lung had grown. She found herself in need of help for a

How Do Lung Cancer Screenings Work?Screening for lung cancer is quick, painless and low risk. It also finds cancer at its earliest stages, when it’s most curable. Learn more about how lung cancer screenings work and who should get one at HMHforU.org/ScreeningFacts.Thomas Bauer, M.D.,

FACS, MBA

Board certified in thoracic surgery

800-822-8905

Neptune

Kelly G. Ussery-Kronhaus, M.D.


800-822-8905

Brick

Should you be screened for lung cancer? Take a five-minute online lung cancer risk assessment to see if you qualify and find a screening location near you: HMHforU.org/CancerScreening.

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SecondChance

A few months after successful lung cancer surgery, Diana Robertson Fidanzato enjoys daily walks along the shore with her dog, Savannah.


Spotlight on U your stories of healing and triumph

Dena and Yaakov felt comfortable with the doctors in New York with whom they’d built a relationship. “That night when I went into labor, I fully believed

I was on my way to New York City to give birth. That was the plan—and I’m a very organized, plan-things-out type of person,” Dena says. “I’m not a spur-of-the-moment person at all.”

Dena, a learning disability teacher/consultant for the Toms River Regional Board of Education, and Yaakov, a licensed clinical social worker, were in the car by 1:45 a.m. en route to the city. As her labor pains intensified, and her contractions grew closer by the minute, Dena remembers being in intense pain. It became obvious they needed a backup plan.

Panicking and unsure of what to do, Yaakov remembered the Labor and Delivery team at Ocean Medical Center in Brick Township, New Jersey. They plugged the hospital into the GPS and went straight to the Emergency Department.“We literally came running in through the front

door,” Dena says.

Ready for the UnexpectedThe time was 2:05 a.m. A nurse rushed from behind the desk to help her. “She was so completely reassuring and attentive,” says Dena, adding that the team was respectful of her family’s Orthodox Jewish culture. “I felt like I was in good hands.”

Dena still didn’t quite believe she would give birth at Ocean. “I was in a bit of denial. I thought I’d get checked out and then move on to some-where else,” she says. “This wasn’t part of my plan, and it was pretty terrifying to imagine having my baby, given his condition, with an entirely new team of people.”

But when Jeffrey Schlogl, M.D., the Emergency Department doctor on duty that night, realized that Dena was ready to push immediately, he whisked her onto a gurney, through the hallway and into the elevator to the Labor and Delivery unit. “It was like something out of a movie,” Dena says. “Dr. Schlogl got me up there so fast, it was record time, and we all joked that he just didn’t want to deliver a baby that night!”

Adds Dr. Schlogl, “We’re trained to handle anything that comes through the Emergency Department door; full term and ready to deliver is included in that. But we’re also incredibly fortunate to have an OB Hospitalist Group in-house.”

Founded on the commitment that every expect-ant mother presenting to Labor and Delivery would receive consistent, unconditional, quality medical

care from an experienced physician, this group of highly trained doctors are available 24/7 for women who find themselves in unplanned scenarios.

Once they were in the Labor and Delivery unit, Dr. Schlogl transferred Dena’s care to Susan Passarella, D.O., part of the OB Hospitalist Group. “We’re there and ready for the unexpected

for women who find themselves in emergency situations,” Dr. Passarella says. “The truth is, you don’t necessarily need nine months to build a rela-tionship with a patient. You can establish a good rapport and confidence with a patient in minutes if you have to.”

That’s just what Dr. Passarella did. “Even though I wasn’t delivering with my original doctor, I felt so comfortable and reassured by Dr. Passarella and her team,” Dena says. “She was confident, calm and competent. I was beyond grateful to have her by my side.”

Dena planned on an epidural like she’d done with her other pregnancies. “But that wasn’t happening,” Dr. Passarella says. “There wasn’t enough time.” “I hadn’t done any of the breathing or preparation

for a natural birth,” Dena says. “But Dr. Passarella and her team got me through it.”

Best YetAt 2:15 a.m., her baby, Yehoshua—Hebrew for Joshua—was born.

“The care I received from the entire team was just phenomenal. All the nurses, doctors and everyone there went out of the way to make us feel comfort-able,” Dena says.

That goes for pediatric cardiologist Mitchel Alpert, M.D., who serves as director of Pediatric Cardiology at K. Hovnanian Children’s Hospital at Jersey Shore University Medical Center. Dr. Alpert arrived first thing in the morning to evaluate Yehoshua’s PAC, tracked down his medical records from New York City and ran a battery of tests. “He was extremely careful to do everything right. And he assured us that we could go home without any concerns,” Dena says.

The Kibels were discharged after a regular-length stay. “As far as having a baby is concerned—and I’ve had five—my experience at Ocean was my best hospital experience ever,” Dena says. “It wasn’t my plan, but it worked out for the best in the end. And I realized it’s always good to have an emergency backup plan.”

Susan Passarella, D.O.

Board certified in obstetrics and gynecology

800-822-8905

Brick

Jeffrey Schlogl, M.D.

Board certified in emergency medicine

800-822-8905

Brick

Mitchel Alpert, M.D.

Board certified in pediatric cardiology

800-822-8905

Brick and Red Bank

Dena Kibel’s birth plan for her fifth child took a major turn. But looking back, she wouldn’t have it any other way.

Change of Plans

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Learn more about Ocean Medical Center’s family-centered maternity care at HMHforU.org/OceanOB.

Discover the most common heart conditions in infants, and what parents should expect from each if found, at HMHforU.org/BabyHeart.

As the old saying goes, the best laid plans often go awry. Sometimes that’s unfortunate; other times it’s serendipitous. Thankfully for Dena and Yaakov Kibel, it was the latter.

It was a cold winter’s night in February 2020. Dena, 36 years old and 38.5 weeks pregnant with her fifth child, woke in the middle of the night in full-on labor. Her plan had been to give birth at a hospital in New York City, 55 miles from her home in Lakewood, New Jersey. At 30 weeks in utero, her baby was diagnosed during an ultrasound with premature atrial contractions (PAC)—premature heartbeats in the upper chambers of the heart—and

Dena and Yaakov Kibel planned to deliver their son, Yehoshua, at a New York City hospital. When their plans had to change in the middle of the night, they were grateful for top-notch care close to home.

Ocean Medical Center and Jersey Shore University Medical Center were named two of the Best Maternity Hospitals in the U.S. in 2020 by Newsweek.



Pamela Schultz, M.D., FACOG, and Noelle Aikman, M.D., consulted with maternal and fetal medicine specialist Sheveta Jain, M.D., and critical care intensivist Eric Costanzo, D.O. They decided that, in order to give Maria the lifesaving treatment she needed, they would conduct an emergency C-section immediately after she was intubated and placed on a ventilator.

Fortunately, Maria remained stable long enough to administer steroids to accelerate fetal lung development and magnesium for neuroprotection. Maria got some final words of encourage-ment over video chat with her husband, Alexian Acevedo, her mother and her grandparents, who could not accompany her due to COVID-19 restrictions. “A month before that date, my grandfather had passed away,” Maria says. “They just told me, ‘He’s watching you and watching over the baby. He won’t let anything bad happen to you.’”

Uncharted WatersDrs. Schultz and Aikman made their own preparations. They reviewed new protocols and guidelines from hospitals in New York and northern New Jersey, which at the time were seeing a much higher number of COVID-19 cases than southern New Jersey. The worldwide lack of information on how to treat pregnant women with the virus meant they would be blazing new trails. Maria would be the first COVID-19- positive C-section at Jersey Shore.“Nothing about Maria’s case felt

routine,” Dr. Schultz recalls. “We knew that once a COVID-19 patient was on a ventilator, the virus could be aerosolized, so we were taking extra precautions with full personal protective equipment,

double masking, plastic shields and minimizing staff in the operating room.”

Maria’s surgery was a success. Alexian Acevedo Jr. was due to make his debut in the world on June 18. Instead, he arrived March 27, almost three months early and at just 2 pounds. “The entire case was a shining example of a multidisciplinary

approach to medicine,” Dr. Schultz says. “Without each team from various departments collaborating and relying on one another, the care of Maria and her baby—and all COVID-19

Maria and Alexian Acev-edo’s son, Alexian Jr., was born more than two months early on March 27. On June 4, the family was finally able to take their baby home.

patients—would be impossible.”

Maria recovered quickly. After three days on the ventilator, her vitals returned to normal. “Likely, part of the reason Maria recovered so well was that the ICU team could resume their care plan and that her body was able to focus on supporting itself,” Dr. Schultz says.

Her condition improved, but Maria was still COVID-19- positive. So the closest she could be to Alexian Jr. were the pho-tos of him that staff put up around her room. Alexian Jr. tested negative for the virus, but he had to spend nearly 10 weeks in the neonatal intensive care unit (NICU) at K. Hovnanian Children’s Hospital at Jersey Shore University Medical Center, so he could grow and recover from some infections. “Feeding was also a challenge because he had multiple epi-

sodes of abdominal distension,” says Carmelita Mabanta, M.D., neonatologist at Jersey Shore and the Children’s Hospital. A biopsy confirmed Alexian Jr. had Hirschsprung disease, a condition that affects 1 in 5,000 newborns and causes an absence of nerve cells in a segment of the large intestine.

“He underwent surgery without any complications and toler-ated feedings thereafter,” Dr. Mabanta adds.

Joyous ReunionFor the first three weeks that their son was in the NICU, the Acevedos could only watch him on a webcam. Although they had both recovered from the virus, they continued to test positive week after week. Finally, on April 25, they were able to meet Alexian Jr. in person.“When we got [to the NICU], all the nurses and doctors were

clapping for us,” Maria recalls. “They recorded a video of us meeting our son. They really did everything they could to help us, especially to help us see our baby. They really fought for us.”

Maria and Alexian brought their son home on June 4, and they say life has been sleepless but happy. “We can’t put him down because we’re making up for lost time,” Maria says.

“You never think this could happen to you. The best moment of this year was taking Alexian Jr. home and getting our lives started.”

When Maria Acevedo opened her eyes on March 31, 2020, she was in a hospital bed, surrounded by baby photos taped to the walls. So much had changed in the four days she had been asleep.

The last time she was awake, Maria, who lives in Fords, New Jersey, was 28 weeks pregnant and struggling to breathe. She began feeling sick on March 18 and was admit-ted to Raritan Bay Medical Center-Perth Amboy six days later, just as New Jersey was making a steep upward climb in COVID-19 cases. Though the results of her COVID-19 test

wouldn’t confirm she was positive for another three days, a chest X-ray and negative influenza test highly suggested that she had contracted the virus.

Within hours, she was transferred to the intensive care unit (ICU) at Jersey Shore University Medical Center, where her condition worsened. Two treatment options—positioning Maria prone on her stomach and putting her on a ventilator—had not yet been studied in pregnant women, but the rate of her decline demanded quick action. Obstetricians

Learn more about the most advanced obstetrics and gynecology care in the region at HMHforU.org/JerseyShoreMaternity. Learn more about K. Hovnanian Children’s Hospital’s specialized neonatal care for high-risk pregnancies and congenital conditions at HMHforU.org/KHovNICU.

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COVID-19 and PregnancyFor the foreseeable future, pregnancy will look a bit different for expectant parents. Whether you’re planning to start a family or are pregnant and seeking prenatal care, get answers to your questions about maternity and COVID-19, as well as advice on how to keep your newborn safe during the pandemic.

Visit HMHforU.org/COVIDPregnancy.

Pamela S. Schultz, M.D., FACOG

Board certified in obstetrics and gynecology

800-822-8905

Oakhurst

Carmelita Mabanta, M.D.

Board certified in pediatrics

800-822-8905

Neptune

At

Maria Acevedo delivered her son at 28 weeks after complications from COVID-19. A month later, she fully recovered

from the virus and was finally able to see him in person.

FirstSight Jersey Shore University Medical Center and Ocean Medical Center were named two of the Best Maternity Hospitals in the U.S. in 2020 by Newsweek.



A New Game Plan

That’s when doctors brought in Dr. Doss, who specializes in interventional radiology using minimally invasive, image-guided procedures to diagnose and treat diseases in nearly every organ system. An overarching goal of this specialized care is to avoid major sur-gery—no scars or larger incisions and a quicker, easier recovery. “I’m able to use imaging in real time to

help guide tiny catheters or needles into areas we want to treat,” Dr. Doss says.

“Instead of having patients undergo open surgery, we can achieve successful outcomes through tiny little pinpricks inside blood vessels or inside basically any solid organ.”

For Vinny, interventional radiology was twofold: finding exactly where the bleeding was and stopping it. To do so, Dr. Doss performed an angiogram. He inserted a small catheter into the groin, then used an X-ray machine and dye injections. Through this procedure, he was able to move the catheter to the aorta in the chest to inject more dye and see where the bleeding was coming from.

He ultimately found that bleeding was coming from the bronchial arteries in the lung where Vinny had a recent biopsy. (The bronchial arteries supply blood and help support the structure of the lung.) “With all that information, I decided to close down those arteries temporarily,” Dr. Doss says. Using a similar procedure, he injected embolic material to temporar-ily block the arteries. The goal was to give the body a chance to heal itself, stop the bleeding and stabilize Vinny. “Within 36 hours, he went from being in a life-threatening

situation to being healthy,” Dr. Doss says.

Back to NormalVinny’s situation was as serious as it gets, Dr. Doss says. Without interventional radiology, the only other option would have been to remove a third of Vinny’s lung. That surgery would have been invasive and required a longer recovery and drastic changes to his quality of life—shortness of breath and little ability to be active.

That’s not to say the interventional radiology procedure was without risk. The embolic material that’s used to shut down the artery can sometimes go to unintended places, such as a tiny artery that can supply the spinal cord. “You have to be careful with your technique, carefully and methodically con-trolling where that embolic material is going,” Dr. Doss says.

“If embolic material gets into that tiny spinal artery, and blood flow to the spinal cord is interrupted, the patient can become permanently paralyzed.”

Vinny, fortunately, had no complications and was up and talking just two days after the Super Bowl. “All the nurses

and doctors were great. They took great care of me and were always there for whatever I needed,” Vinny says.

Being able to provide Vinny with a definitive treatment that was relatively minimally invasive with no scars is a gratifying part of Dr. Doss’ job, he says. “These are the kinds of procedures that often take place

in major hospitals in big cities,” Dr. Doss says. “It’s not as common to see these procedures take place in community hospitals like Bayshore. It’s nice to be able to treat some-one locally with the same level of care that they would get in big cities.”

Today, Vinny is back to his life in Morganville with his wife, daughter, grandchild and extended family—and back to root-ing for the Patriots.

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Peter Doss, M.D.

Board certified in diagnostic and vascular/interventional radiology

800-822-8905

Toms River and Avenel

Learn more about the Emergency Department—and the new Dr. Robert H. Harris Emergency Care Center that is currently being built, set for completion by 2021—at Bayshore Medical Center. Discover how our team is equipped to handle everything from minor situations to the most pressing life-or-death moments at HMHforU.org/BayshoreED.

Vinny Placanica was ready to celebrate Super Bowl Sunday with family when he began coughing up blood. Two days later, he was back in good health thanks to the interventional radiology team at Bayshore Medical Center. Super Bowl Sunday was supposed to be simple enough for Vinny Placanica, from Morganville, New Jersey. “I planned to go to my sister-in-law’s house to have all the traditional bad-for-you food and beer and watch the game,” he says. Even though the New England Patriots, his favorite team, weren’t playing in the championship, he was excited nonetheless.

But around 4 a.m., Vinny, who beat lung cancer in 2015, started coughing up blood. His wife brought him to the Emergency Department at Bayshore Medical Center. Vinny doesn’t remember much else until he woke up two days later.

In that time, his life was placed in the hands of Peter Doss, M.D., an interventional radiology specialist at Bayshore.

“Before I even saw him, the situation had become dire, his life threatened because of the volume that he was bleeding,” Dr. Doss says.

When Less Is MoreThe first obstacle for doctors: figuring out what was causing the bleeding. “When you’re basically vomiting a large amount of blood, you’re putting your airway at risk,” Dr. Doss says.

“You could essentially drown in your own blood.”Vinny’s situation is like a garden hose that’s spraying uncon-

trollably. Doctors have to find the valve—the source of the bleeding—and shut it off temporarily, Dr. Doss says.

Frequently, sources of such bleeding arise from the stom-ach or the esophagus. However, gastrointestinal doctors performed an endoscopy (where the physician inserts a long, flexible tube with a tiny camera down the throat) and found those areas looked normal. After performing more tests, including a CAT scan of the chest, doctors discovered abnor-malities in the right upper lobe of Vinny’s lungs. iSt

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When Vinny Placanica—a lung cancer survivor—starting coughing up significant amounts of blood, Peter Doss, M.D., discovered that the source was the bronchial arteries in his lung where he recently had a biopsy.

Just How Bad Is Coughing Up Blood?Even if the volume is small, coughing up blood could signal a much more serious underlying condition, such as lung cancer. If you start coughing up blood, seek medical attention right away.

Learn more at HMHforU.org/CoughingBlood.

Note: Super Bowl and New England Patriots are registered trademarks of the National Football League.26 27Health Fall 2020 HackensackMeridianHealth.orgU


Body PositiveSince a successful vertical sleeve gastrectomy two years ago,

Jaclyn Tucker has lost more than 150 pounds and created new opportunities for her and her 10-year-old son.

compromise because of my weight.” Although she had no other medical conditions, Jaclyn knew obesity could cause health problems like diabetes and high blood pressure in the future.

“Heart attacks run in my family, and I wanted to prevent anything like that from happening,” she says.

Seeking HelpBecause her mother had experienced severe com-plications from a gastric bypass procedure when Jaclyn was 16, she grew up wary of bariatric sur-gery. However, one of her friends had a lap band procedure at JFK University Medical Center, and Jaclyn has gone to JFK for all of her medical needs, including when she gave birth to her son. After talking to her friend and researching current bariatric procedures, Jaclyn knew she would be in good hands.

Her surgeon, Aram Jawed, M.D., FACS, FASMBS, recommended a vertical sleeve gastrectomy (VSG) due to Jaclyn’s age, the amount of weight she needed to lose and the fact that she had no preex-isting conditions. “There are three major bariatric procedures:

laparoscopic gastric bypass, vertical sleeve gastrec-tomy and the lap band,” Dr. Jawed says. Jaclyn’s profile fit VSG because she wanted the metabolic benefits that a restrictive procedure like the lap band does not provide.

VSG addresses hunger hormones and the metabolic aspects of obesity. The stretchy portion of the stomach is removed, along with the hunger hormone called ghrelin, so the capacity of the stomach changes and the desire to eat is reduced.

While Jaclyn was confident in the procedure, Gabriel was concerned about whether she would have complications and require hospitalization—or worse. Knowing how important it was for both mother and son to feel confident about surgery, Dr. Jawed made sure Gabriel was part of the discussion.“I explained to him that his mother was prohibited by her

weight, and it was preventing her from being the mother she

wanted to be for him,” Dr. Jawed says. “I also told him that bariatric surgery is less risky and has a lower morbidity and mortality profile than any other general surgery, and it’s minimally invasive.”

Adds Jaclyn, “Dr. Jawed sat down with [Gabriel] to answer all of his questions and made him feel so much better. I was so impressed that he did that.”

A Bright FutureJaclyn’s surgery was successfully performed on September 18, 2018. Almost two years later, she has lost an impressive 153 pounds and main-tains a healthy lifestyle. She follows her bariatric meal guidelines and works out three to four days a week.

Dr. Jawed’s patients, including Jaclyn, also have a regular follow-up schedule with him:

}Two weeks after surgery }Four weeks after surgery }Three months after surgery }Six months after surgery }One year after surgery }AnnuallyJaclyn recently saw Dr. Jawed for her two-year

annual follow-up, and she knows that if she has questions about her meals, weight or any other concerns in the meantime, she can call him for help. “I feel 100 percent supported,” she says.

Dr. Jawed adds, “We like to see patients for life. We never leave you.”

Jaclyn is also using the knowledge she gained through this experience to help her son make healthy choices. They stay active together through activities like biking, walking and playing an exercise video game, and she is teaching him about nutrition.“It’s never too early or too late to make a change,” she says.

“Even small changes add up and make a huge difference.”

What Is Vertical Sleeve Gastrectomy?Vertical sleeve gastrectomy (VSG) is a surgical weight-loss procedure where about 75 percent of the stomach is removed, leaving the stomach the size and shape of a banana. VSG is usually performed laparoscopically, also known as minimally invasively, which involves inserting small instruments through multiple small keyhole incisions in the upper abdomen. Limiting the size of the stomach helps people consume less food, as well as prompts hormonal changes that assist with feeling full more quickly and reducing appetite for optimal weight loss.

Bariatric surgery shouldn’t be considered a last resort. Learn more about the importance of bariatric surgery for people who can’t lose weight on their own at HMHforU.org/Destigmatize. Plus, find out how obesity affects those with COVID-19 at HMHforU.org/COVIDObesity.

Aram Jawed, M.D., FACS, FASMBS

Board certified in surgery

800-822-8905

Edison

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To learn more about bariatric surgery at Hackensack Meridian Health, visit HMHforU.org/WeightLoss.

Jaclyn Tucker has always been a body-positive person. Having been overweight since about age 10, the now 38-year-old never really saw her weight as a problem that needed to be solved. She tried fad diets and exercise programs alongside her mother, but “I didn’t feel OK doing them,” says the Belleville, New Jersey, resident. “People looked at weight loss as a vanity issue, so I never took it seriously because I didn’t feel fat or like my weight hindered me in any way.”

Several years ago, Jaclyn decided to think more seriously about weight loss when her weight got in the way of everyday life with her son, Gabriel. She took Gabriel, now 10, to a birth-day party where the kids were riding go-karts. Parents were required to sit in the go-karts with their children, but Jaclyn couldn’t fit into the seat and got stuck trying to climb out.“My son said, ‘That’s OK, I didn’t want to go anyway.’ But I

knew he did,” she recalls. “I didn’t want to keep making him

Jaclyn Tucker decided to think more seriously about weight loss wh

Spanish2 · hobbies, gathering with friends, shopping, dining, ... storm Sandy and 9/11, increased mental health and substance use issues followed. But many people were reluctant

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