Amy B. Mansue covers a lot of geography behind the wheel of her car as she crisscrosses large chunks of New Jersey daily for her demanding work as an executive in healthcare delivery for Monmouth, Ocean, Mercer, Middlesex, and Somerset counties. In March 2016, Mansue accepted the position of President of the Southern Region of RWJBarnabas Health, the parent organization formed by the 2016 merger of Barnabas Health and Robert Wood Johnson Health System. As a person who is passionate about learning, she uses her driving time to listen to audio books and think creatively about the healthcare challenges that affect the communities she serves.
Mansue is accustomed to traveling from place to place, since as a child her family would vacation for a week camping in Maine, then visit family in Massachusetts or Florida. She grew up in a house that her parents built on two acres of a spinach field in Plainsboro. She planted trees, examined worms, and took violin lessons. As an only child, she has a close relationship with her parents, who were both educators.
Her mother was enrolled in one of the first classes at Douglass College, which encouraged women to enter college after they had children. She did this when Mansue was four years of age and shared duties with her father who oversaw care for young Amy at night. There were visits to the candy store and visits to family members. “It took a village,” Mansue observes, a concept that forms her own people-centered approach as a leading healthcare executive.
Mansue sees her job at RWJBarnabas Health as a chance to develop relationships, see people in different ways and learn from them. She applies the same principles of the village running through daily life, “whether you pick up a cup, or help somebody in a grocery store or transform healthcare in multiple counties.” She believes that we each play a role in helping others and from the small to large scales of action, that we can do it better when we do it together.
Mansue was born and raised in Plainsboro and is now a Hightstown resident who also owns a condo in Bradley Beach. Though she went south for her college years at University of Alabama, Mansue is a true New Jerseyan who has along the way fallen in love with the Shore. She draws her considerable drive and inspiration from every town and community she visits, however, as they form the roots of her faith in positive outcomes.
“I think you have to be purposeful about finding the goodness in every day, because there’s so much getting thrown at us about what is wrong or what we don’t have or what we should be aspiring to, that I think we can lose sight of what we have, and most importantly what can be done.”
A favorite book that she likes to keep close is “The Power of Moments” by Chip Heath, Dan Heath. It teaches how to focus on how to make an ordinary moment memorable. Mansue ordered 15 of the books to give to co-workers, encouraging them to find those opportunities. She also has a favorite “business” book, Five Dysfunctions of a Team by Patrick Lencioni, which presents in narrative form insights about how to tackle management issues. She turns to music – from classical to country rock to Bruce – to provide comfort in her very busy and challenging life.
As a child growing up in a household with two educator-parents, Mansue was allowed to watch only the news with Walter Cronkite and one half-hour TV show daily. It’s entirely probable that her big smile and ready laugh were inspired by nightly doses of her show of choice, I Love Lucy. Thankfully for us, that enduring sense of humor, coupled with intelligence and a wicked work ethic have this Jersey Girl in good stead as she tackles complex healthcare – and other issues – on the frontlines in New Jersey.
Living In Monmouth thanks Amy Mansue for taking the time to chat with us about her important role in shaping the present and future of healthcare in New Jersey.
LIM: The merger of Barnabas Health and Robert Wood Johnson Health System happened in 2016. How difficult was the merger process for these two major institutions?
AM: Change is always a hard thing, so any merger is difficult. But I think for the most part we’ve had a really smooth transition. We’ve had a steady opportunity to hit our goals, and that’s the first key of any merger.
We knew there would be synergies arising from strategic alignment, and there certainly have been. The need to share best practices has been wonderful throughout the system. I watched how suddenly all these people who were fierce competitors back in the community hospital days had to sit down together and share. It was definitely a process.
LIM: What institutions fall under your purview?
AM: I am responsible for the system’s service areas from the Raritan River south, including RWJ Somerset, RWJ Hamilton, Community Medical Center, Monmouth Medical Center, Monmouth Medical Center Southern Campus, and Children’s Specialized Hospital. Beyond hospitals, I have responsibility for those outpatient sites and physician practice locations in this region that work together to provide accessible service to patients.
LIM: Can you describe your main strategy for accomplishing healthcare services goals?
AM: There are established collaboratives around each of our service lines that provide the opportunity to share best practices. Using Ob/Gyn as an example, every hospital that has a program can come together and say, these are the issues we’re working on. How did you solve something similar? We pilot things and test them. There’s such dynamic energy in these systems, and it’s been really exciting to see how people love coming together.
LIM: You were CEO and president of Children’s Specialized Hospital in Mountainside from 2003 to 2016. Can you talk a little about the legacy you established there?
AM: I was very excited to have been there and have a chance to work with the team to create really powerful things, such as the expansion of our services to 11 sites and the move of the inpatient hospital from Mountainside to the RWJUH academic campus in New Brunswick. We tried to serve as many kids as we possibly could, and so we invested in telemedicine and all sorts of other approaches to try to meet the need, because the need was so great. By the time I left, we were taking care of 28,000 kids, but we knew that the need was more like 300,000.
LIM: What was it like for you to leave?
AM: I don’t think anybody really leaves Children’s Specialized. I think your heart always stays there. But when the merger came, it was a wonderful opportunity to channel my skills into a whole different set of challenges.
LIM: What knowledge did you bring to your new job as President of the Southern Region of RWJBarnabas Health?
AM: The thing that I learned early on in my education in social work is that the experts are the patients and families who are on the forefront of what we do. These are the people in our communities receiving the services, living in poverty or struggling with some of the changes. They know how the system can better serve them. They know this much better than we do. And I think that’s really true for healthcare in general. I think that we’re still very driven by everyone’s needs but those of our customers. Medicare, the State, the Joint Commission have requirements for us, but we need to learn how you listen and how you respond to the people we care for as much as our regulatory structure.
LIM: What do you think is the most important metric in assessing health needs for the Southern Region?
AM: I think it’s really about the number of people we can touch. There are nine million people in the state of New Jersey, and five and a half million of them live in our service area. So, we have the chance to improve the lives of those people with our programs and our services. How we are going to help people live better lives today, and in the future, is the key issue for me.
LIM: Why are we seeing a growing number of partnerships and mergers between competing healthcare organizations?
AM: I’ll use Monmouth and Ocean counties as an example. Hackensack Meridian and RWJBarnabas, we’re well-matched competitors on the healthcare playing field. But there are places where we can and do come together around opioid addiction, health screenings, ways to improve access and quality of care that we must tackle together because the issues for people in New Jersey are too big to tackle alone.
LIM: What are some of the biggest challenges for healthcare in our area?
AM: We know that the opioid epidemic is just horrific. We go to too many funerals and see too much loss. There must be a marriage between behavioral health and physical health if we are ever going to address the most perplexing health issues of our time – such as this opioid epidemic. The drugs really are about filling holes and cravings, and we must figure out how to deal with those in a forward-thinking basis, like we would do if we found out you were diagnosed with cancer. There has to be that same understanding, and so much of it is still stuck in the stigma against raising your hand and saying I need help – and then being able to access care.
LIM: How can healthcare services help bridge this divide between behavioral and physical health?
AM: I feel like things are not where they need to be in reaching kids and families sooner, or younger. And also making it okay to say, I need to talk to somebody. Many of us were raised that you just tough those things out. Nobody would ever say to somebody with a cancer diagnosis, just “suck it up”, but for some reason you need to tough it out when you’re depressed, right? But that is still the message when there is a behavioral health issue. The challenge that I think we all have to overcome in the healthcare field is to figure out how to de-stigmatize a program, a set of services that is critical, not just for those people with mental illness, but those people who have chronic health conditions, because those chronic health conditions make you depressed. You need to be able to have the ability to move in and out of those systems and access that care. And we as a healthcare system need to make that easier.
LIM: Have you seen progress in access to care?
AM: A really important instance of a team approach to improving access is in Central Jersey, where The Robert Wood Johnson Foundation and Middlesex County funded the work that St. Peter’s University Hospital in New Brunswick and RWJ New Brunswick are doing together. We have these two super hospitals three blocks from each other, and through this partnership we’re seeing improved access to cancer screenings and behavioral health services, for example. We have been making great strides and are looking at those boots on the ground to figure out how to do that work better in Monmouth and other counties.
LIM: In January 2018, you were named chair of the Board of the New Jersey Hospital Association, the state’s oldest and largest hospital and healthcare advocacy organization. Do you feel this is a good fit for you?
AM: I am grateful for this opportunity to continue to improve wellness for both individuals and local communities. Our 2018 mission statement is to improve the health of the people across the state, and as Board Chair of NJHA I look forward to collaborating with other leaders and organizations to concentrate on the societal challenges that impact health in our communities throughout New Jersey.
LIM: Are you looking to community partners outside the healthcare arena?
AM: I’m seeing that RWJBarnabas has really moved outside of the traditional healthcare realm very successfully. We view ourselves broadly in the social service business, not solely in the healthcare business. Whether you’re talking about developing jobs and work opportunities or looking at food insecurity and safe housing, you know, you’re really looking at these holes that need to be plugged to really have total wellness for people in a community.
LIM: Can you give an example of a community-outreach initiative?
AM: One of our major initiatives in Ocean County was the partnership with the schools and the naming of the RWJBarnabas Health Arena, which is in Toms River. It’s right on the campus of the high school. The school uses it for all of its activities, and it’s also the center for the community.
A primary driver for that naming opportunity was partnering with families and educators and really looking at creating those healthy lifestyles right up front because, you know, the older we get, the harder it is to change our behaviors, right? We want to look at how to start those healthy behaviors early, and also identify this next generation of healthcare leaders.
We’ve also started aligning RWJBarnabas Health with Rutgers’ education, research and clinical activities, including those at the Rutgers Cancer Institute of New Jersey and Rutgers University Behavioral Health Care.
This summer we will mark the first Rutgers Robert Wood Johnson Medical School class that will begin at Monmouth Medical Center in Long Branch. We’re very excited about that opportunity.
LIM: Can you identify any major shifts in our healthcare services model?
AM: We know we’re moving from a fee for service, inpatient model to an outpatient model, a value- based model that really looks at health outcomes. A priority is making sure that we use our universities and our health professionals to help ensure that we’re protecting people as we move to that value- based model. That is going to be critical. LIM: You seem to take a boots-on-the-ground approach to community healthcare. Why?
AM: The responsibility of ensuring the public good is one that you don’t always understand until you’re inside of Federal and State government.
I could never tell you the hours and challenges and things that I saw from the DYFS worker who would go into the most difficult situations, to the individual who’s making, you know, just barely minimum wage caring for our most fragile elderly and children. Those are really important jobs and we need to make sure that there is talent to be able to do them. When you’ve been privileged to see that whole range of challenges people face, it forms who you are. When you see the dedication of people who are passionate about helping their neighbors, it’s humbling. What matters is what you’re doing on the ground every single day for each person. And I think that it’s easy in this time of great competition to lose sight of that.
LIM: Does healthcare advocacy necessarily involve politics?
AM: I’ve always been interested in how laws get made and in how they impact people on the frontline, but I don’t see healthcare as a partisan issue. At the end of the day, whether you’re a Democrat or Republican or Independent, you want to make sure that when a patient walks into a facility, they receive the highest quality of care, a relationship with the practitioner that is respectful, and the ability to make important decisions together.
LIM: You’ve had experience in the public sector at both the federal and state level. Can you give us some highlights?
AM I had two tours of duty in State government under Governor Florio and then again under Governor McGreevey. My most memorable experiences came from the dedicated staff, advocates and families I got to meet along the way. Caring for the most vulnerable among us is both a huge responsibility and a tremendous honor. We must strive to find the best in each other and the institutions that help us provide these critical services.
LIM: You served as Co-Chair of the Budget Transition Advisory Committee for current Governor Phil Murphy. Do you think his administration will be proactive on healthcare issues?
AM: The thing that I like most about Governor Murphy is that he’s not afraid to take on a tough issue. He has been very clear about his desire to address the major issues we have in New Jersey, and it doesn’t matter whether it’s healthcare or education or transportation. They are all important issues that are going to require critical partnerships. I think we’re in for a very dramatic time in New Jersey as one of the states that has been on the forefront of Medicaid expansion, ensuring that people have access to services. There is no calculation under any federal block grant proposal or any entitlement reform that doesn’t end up hurting New Jersey. I think Governor Murphy has a clear vision about that. He’s been out front in reference to the out-of-network legislation, saying that people should not have surprise medical bills. He looks for a partnership between the hospitals and the doctors to really address those issues.
LIM: Any chance you might run for public office yourself?
AM: I never say never, except I know I won’t ever run for office. I can say never to that! Mr. Ostrowsky [Barry H. Ostrowsky, President and Chief Executive Officer at RWJBarnabas Health] has given me more work than I could even imagine. I can’t be thinking about another job right now. I’ve got to do well with the one I have.
Making the “impossible” possible through Sedation Dentistry
BIO: Being both a dentist and board-certified anesthesiologist, Dr. Lichtenstein created and developed his sedation dentistry office in Holmdel, NJ to incorporate the facilities of a hospital operating room in a friendly, pleasant, private office setting. He and his highly trained staff offer general dentistry services as well as dental treatments that can be performed using sedation dentistry and general anesthesia techniques to make their patients’ experiences more pleasant and comfortable.
What sets your dental practice apart from others?
In addition to over 20 years experience, THE most important thing that sets me apart from all other dentists doing “sedation” is – I did a full hospital based residency program in anesthesiology. I am an anesthesiologist.
(I spent 80 – 90 hours per week in hospital, mainly OR, as as well as critical care areas (ICU, CCU, PICU, ER) and outpatient treatment sites.) Patients choose my practice because I have a full training background in anesthesiology, with state-of-the-art monitoring equipment that other dental offices may not have.
Are there different options available for sedation dentistry?
Sedation for dental procedures in our office provides several options and depends on what works best for each individual. It can be as simple as talking to a patient to reduce anxiety, and the use of nitrous oxide (“laughing gas”). The next level is the administration of Valium-like drugs orally. The next level is intravenous medication for moderate conscious sedation. General anesthesia is the deepest level on the continuum, its administration reserved for practitioners with the highest level of license. The use of general anesthesia is reserved for patients with the more difficult issues. The higher the level of sedation needed, the more training the dental professional needs to have.
What kind of patient benefits from sedation dentistry?
Really, any patient who wants to have a more relaxed and comfortable experience when they have dental work done can opt for some level of sedation. There are people who are afraid to have the needle for the Novocain local anesthetic, and those for whom the usual doses do not numb the mouth sufficiently to block the pain. Any patient who has anxiety, fears, or phobias that render them reluctant or unable to seek out the dental care they need can be helped by sedation dentistry. Little children often can’t understand what is happening at the dentist, so it’s hard for them to sit still and cooperate. There are also a whole range of people with other special needs who are able for the first time to access regular dental treatment at our office.
Are there other types of special needs do you accommodate?
We feel that no one should be forced to suffer poor dental health because of a disability or disorder. There are a wide range of conditions that we accommodate, including neurological disorders like Parkinson’s or epilepsy that can cause tremors or seizures. Individuals on the autism spectrum or those with Down’s Syndrome may not understand that the dentist is here to take care of them, so sedation helps to calm their fears and give them an easier and more comfortable experience. Similarly, with Alzheimer’s and dementia, decreased reasoning capacity can keep the patient from cooperating. When the patient is asleep, the dentist can do the work that the patient needs.
Can you talk about your practice philosophy?
The mainstay of my practice is restorative dentistry. I want to fix and save the natural teeth whenever possible. We do root canal therapy, whether conventional or surgical, oral and periodontal surgery, and place and restore implants with the least discomfort to the patient. Sedation allows for work to be done on multiple teeth at the same appointment, even for the patient who can’t sit in a dental chair or keep their mouth open for extended periods. Our objective is to maintain a healthy mouth and teeth, so that every patient is able to speak properly, eat without discomfort, and flash a winning smile.
Atlantic Eye – Providing a full continuum of care for your eyes
Our vision plays such a crucial role in everyday life, and that’s why the doctors at Atlantic Eye Physicians offer a full continuum of the most up-to-date procedures for restoring and maintaining eye health and function for their patients. They are dedicated to providing comprehensive, high-quality, personalized eye care, from routine eye examinations to cosmetic improvements to state-of-the-art eye surgery. The guiding principle of their team of physicians and nursing staff is always to provide the highest standards of patient care and service.
Their services include advanced custom cataract surgery, laser vision correction, corneal transplant surgery and DSEK, and they are also sought out for expertise in glaucoma evaluations, laser therapy, retinal care for diabetes and macular degeneration. They perform eyelid rejuvenation, Botox and Restylane procedures in the office, too. No matter what procedure you choose, the knowledgeable and friendly staff is committed to providing you with all of the information you need to feel comfortable with the process.
Atlantic Eye Physicians has four convenient locations in Monmouth County: Long Branch, Little Silver, Holmdel, and Manasquan. Each office is equipped with state-of-the-art diagnostic equipment: digital imaging, corneal topography, anterior & posterior segment OCT.
Many doctors now refer patients to ambulatory surgery centers because they know that ambulatory surgery is a quality, cost-effective alternative to hospitalization for many procedures. At Atlantic Eye Physicians, your surgery will be performed on an outpatient basis by your own doctor in the privacy of their comfortable Center. Their mission is to provide first-class surgical services in a safe, welcoming environment with compassionate care, integrity and the highest ethical standards, one in which they would be happy to treat their own families. Best of all, no overnight stay is necessary.
Atlantic Eye Physicians is also here to help you with any eye injuries and emergencies. They have the expertise, the experience and the facilities to take care of you and your family members should an eye-related emergency arise. In addition, they have an Optical center offering a wide selection of frames, and the newest lens technology for each specific prescription.
Visit www.atlanticeyephysicians.com to schedule a Free LASIK consultation or Custom Cataract consultation. At Atlantic Eye Physicians, taking good care of your eyes is their highest professional priority.
Sal Cannizzaro, CEO
SFC Enterprises, Inc.
Immediate Care Medical Walk-In
Marlboro Medical Arts Building
479 Route 520, Suite A103
Marlboro, NJ 07746 (732) 218.7550
OVERVIEW: The Immediate Care vision is to be the emblem for superior quality, patient centered care in the communities they serve. They are creating a new standard for urgent care services, one that combines a personalized, caring environment with a commitment to providing compassionate and convenient healthcare services.
With your background not originally being in the medical field, what made you want to move into urgent care centers in NJ?
My vision of building and opening a medical complex came from wanting a place where I myself could go for emergency services, X-rays, and lab work as well as my primary doctor. While plans for the Marlboro Medical Arts Building were on hold, I was introduced to the concept of urgent care centers, from which Immediate Care Medical Walk-In was started. We were finally able to break ground on this facility in August 2016.
How many medical facilities have you opened thus far?
The Marlboro Medical Arts Building houses the ninth urgent care center for Immediate Care Medical Walk-In.
What were the most important factors you considered when choosing the location for the Marlboro Medical Arts Building?
When looking for the ideal property for this facility, I considered the population of the community and surrounding towns, visibility and accessibility for patients. I also looked for a location that I could add to in the future.
Do you plan to expand the Marlboro Medical Arts Building? If so, what do you plan to include?
Yes, we have already begun plans for an additional 24,000 square foot, two-story building that will house a surgery center and medical offices for pain management and sports medicine.
What are some of the surprises or challenges you encountered when building your own medical arts building?
I initially started this project in 2005, but a huge challenge was the recession that the economy encountered shortly after plans were started. However, this challenge brought with it my discovery of the urgent care business from which Immediate Care Medical Walk-In developed.
What other practices are located on premises?
Within the facility is Immediate Care Medical Walk-In of Marlboro, CentraState Physical Therapy and Primary Care, Dr. Gostovich, Marlboro Medical Arts Pharmacy, and Dr. Sadek of Advanced Surgical and Bariatrics.
With so many projects and responsibilities, is it difficult to create a work/life balance?
I am very lucky to have a family that is so understanding and supportive of my work. I truly enjoy what I do, which makes them very happy for me. I also have the privilege of working with my son, Frank, who is the Vice President of Construction for SFC Enterprises Inc.
Can you tell us a bit about your involvement in the community?
We make every effort to be involved with all the communities that we are a part of whether that is sponsoring the local schools, participating in town events or hosting blood drives. We are in the business of helping people and that continues outside our urgent care centers.
What’s next for Immediate Care?
Immediate Care is always looking for a new way to make medical treatment more accessible, convenient and cost effective. We plan to continue to implement additional healthcare services and expand to new communities.
Mary Brighton, MS, RDN
Hackensack Meridian Health Integrative Health & Medicine (732) 263-7999
BIO: Mary Brighton is a Registered Dietitian and French trained Culinary Nutritionist. As an Integrative Nutritionist with Hackensack Meridian Integrative Health & Medicine, she works with the Integrative team on a Five Pillars of Health and Well-Being (Sleep, Activity, Purpose, Nutrition, and Resilience) approach, with the ‘food as medicine’ philosophy as the basis of her nutrition counseling and classes with patients and the community. Mary strives to see every person, young to less young, optimize their health and live a longer more productive life.
I’ve noticed that when I have a cold, food doesn’t taste as good. Can you tell me why?
Smell is the most important sense in how we perceive the flavor of the food we eat. When there is a physical problem with processing odors, the pleasure in relation to our diet is diminished. Taste is mostly odor detection, so if food has lost its flavor, the problem is usually a smell issue. Our taste sense, which is a sensory system, is similar to sight and audio senses. The tongue’s taste buds perceive chemical signals from the food we eat and work together with the aromas in food, our memory, temperature and even the texture of the food to bring the final ‘yum!’ picture to the person eating.
Are there any disorders that affect our sense of smell?
Smell disorders are a common problem with several million Americans suffering either temporarily or chronically from this condition. Half of all diabetic persons have a diminished sense of smell and taste and almost all those with Alzheimer’s disease have lowered smell capacity. Viral infections like colds and flu, certain medications, smoking, alcohol abuse and other brain related disorders are linked with smell disorders. As we age, over a quarter of persons over 55 years old and about two-thirds over 80 years old have a lowered sense of smell.
Why should health professionals know about the taste and smell sense?
Unlike our sense of sight and hearing, which are apparent to the health professional, our loss of smell sensitivity is not detected as well, and this problem can have devastating effects on a person’s lifestyle and food enjoyment. Appetite and food intake can go up or down, and because the flavor of foods is linked to emotion and memory, a person with a smell disorder can feel isolated and even depressed. Genes also play a role in taste perception and certain genetic variations can affect how we perceive flavor. This is why cilantro tastes delicious for some of us but tastes like soap to others! By knowing how important smell is to food pleasure, we can guide a person to the different options available, some of which are related to food preparation and nutrient availability.
If we have a smell disorder, what can we do to help food be more flavorful?
In the aging population we see people trying to make food ‘taste’ better by adding more salt to their meals. Rather than adding table salt, we emphasize textures and temperatures, spices and herbs that help the mouth taste food but don’t involve the olfactory sense.
How can we keep our sense of taste and smell as we get older?
There are certain trace mineral deficiencies that are related to taste and smell, in particular zinc. Good oral hygiene and nutritious diet with adequate zinc are important to support our sense of smell and food enjoyment. In our practice, I talk to people about the taste of food and look for any underlying factors on why their appetite for flavorful food is down.
The terms ‘aneurysm’ and ‘stroke’ are sometimes used interchangeably. Factors such as obesity, smoking, high blood pressure, cardiovascular disease, alcoholism, and diabetes can lead to aneurysm and stroke. Diagnosis includes a thorough medical exam as well as tests such as MRI and CAT scans. Additional diagnostic tools for stroke include carotid ultrasound, cerebral angiograms and echocardiograms.
Most Aneurysms Develop After Age 40
“An aneurysm occurs when the walls of an artery weaken and a bulge forms,” says Dr. Ciro G. Randazzo, a board-certified neurosurgeon and neuro-endovascular specialist. “If the aneurysm continues to grow, it can eventually burst, which can lead to severe and even fatal consequences (hemorrhagic stroke).”
Symptoms can vary depending on where the aneurysm is located, from pain and swelling in the abdomen to vision problems, slurred speech and severe headaches.
“Fortunately, state-of-the-art treatments exist that permanently seal the bulging blood vessel and redirect blood flow,” says Dr. Randazzo.
Stroke: A Leading Cause Of Long-Term Disability
“Stroke is the fifth leading cause of death in the US and a leading cause of disability,’ says Dr. Randazzo. “By understanding the risk factors and with proper diagnosis and treatment, most strokes can be avoided.”
Stroke, also known as a cerebrovascular accident (CVA), occurs when the blood supply to the brain is interrupted or reduced. Stroke is a medical emergency. Treatments include the blood clot buster tPA, thrombectomy, and angioplasty procedures. “Fortunately, by partnering with comprehensive stroke centers throughout New Jersey, skilled stroke teams at local hospitals are helping New Jersey residents survive the devastating effects of stroke,” concludes Dr. Randazzo.
Spinal Disc Degeneration
Degenerative disc disease (DDD) is a condition that results from aging and normal wear and tear on the spinal discs, which act as shock absorbers between the vertebrae. “With age, the discs lose fluid, making them less flexible and more compressed,” says Pinakin R. Jethwa, MD, a board-certified neurosurgeon. “The discs can also develop tiny tears, which cause pressure on the spinal cord and nerves. The most common symptoms of DDD are deep lower back pain or neck pain, and stiffness.”
Smoking, obesity, heavy lifting and hereditary factors also lead to disc degeneration.
Artificial Spinal Disc Replacement
“Conservative therapies such as over-the-counter medications, physical therapy and injections are the first course of treatment,” says Dr. Jethwa. “When these no longer bring relief, it may be time to consider surgical intervention.”
“Spinal fusion or replacing the disc with a metal cage or other stabilizing materials were the conventional approaches to degenerative disc disease,” says Dr. Jethwa. “The gamechanger today is using a device that allows normal motion of the spine – bending, pivoting – to continue. Disc replacement patients can return to normal routines, such as playing tennis and picking up grandchildren.”
Spinal surgery is not a procedure to be taken lightly. Take the time to consult with a skilled spinal surgeon experienced in newer procedures such as artificial disc replacement.
Ciro G. Randazzo, MD, MPH, FAANS
From performing regular exams to full-mouth reconstruction, your dentist plays a key role in maintaining your overall health. Good oral and dental hygiene can help prevent bad breath, tooth decay and gum disease, and can help you maintain or replace your teeth as you get older. Researchers have discovered that good oral health can help ward off serious medical disorders such as heart disease, stroke, diabetes and even preterm labor.
Establish an Oral Health Baseline
“Adults should have a dental exam and cleaning twice yearly,” says Dr. Joseph P. Prasad D.M.D., M.A.G.D. “It is very important to establish your oral health baseline,” he explains. “Your dentist should perform a complete oral examination, including an oral cancer screening, a periodontal evaluation, an analysis of
your bite, and a thorough examination of your teeth, their supporting structures, and of the oral anatomy.”
“Regular cleanings by a dental hygienist will help prevent new cavities, preserve teeth that have been restored, and manage periodontal disease,” says Dr. Prasad. “If you haven’t visited the dentist in a while,” he adds, “schedule an appointment soon.”
Technology-Driven Patient Care
Technology is contributing to more beautiful smiles for patients of all ages. “Orthodontic practice is embracing the future of technology in dentistry,” says orthodontist Dr. Patrick Cuozzo. “One great advance is using 3-D printing to create in minutes customized orthodontic models for clear aligners, precise surgical guides and more, which can be done right in the orthodontist’s office.”
After a digital impression has been made, the data is fed into a computer program and a 3-D printer produces a model on the spot. “State-of-the-art 3-D printing is just one of the technologies available to streamline patient care without sacrificing accuracy and precision,” says Dr. Cuozzo.
Accelerated Orthodontics: Faster Orthodontic Treatment with Less Discomfort
“For anyone considering orthodontic treatment, the first question is always ‘How long will treatment take?’” says Dr. Tara Gostovich.
“The goal of an emerging school of treatment called “Accelerated Orthodontics” is to shorten the time in orthodontic appliances and treat the patient with less discomfort,” says Dr. Gostovich. “Almost anyone is a candidate for accelerated treatment, but it is perfect for those who have a special event in mind, such as a wedding or the start of a new job.”
“Today’s surgical and non-surgical accelerated orthodontic treatment options painlessly stimulate the movement of teeth into proper alignment in less time,” says Dr. Gostovich. “These accelerated treatment options can be used in combination with current orthodontic treatments such as braces or clear aligners to reduce treatment time by as much as 50 percent.”
Prosthodontists: Architects of the Smile
Not all dental care is preventative. Some conditions require the advanced care of a prosthodontic specialist. Sometimes called the “architects of the smile,” prosthodontists are primarily concerned with the restoration and replacement of lost or damaged teeth with implants, dentures, bridges, crowns and other restorations.
After graduating from college and completing four years of dental school, prosthodontists receive an additional four years of advanced graduate training recognized by the American Dental Academy. These specialists are highly familiar with all the elements that go into a beautiful, functional and naturallooking smile—not just the teeth, but also the gums, lips, and facial features.
“Dental reconstruction because of trauma, disease and congenital disorders can sometimes require several steps, including bone grafts, implants and orthodontic therapy,” says prosthodontist Dr. James Courey. “The prosthodontist puts the plan together and sequences other dental specialists. By collaborating with dental professionals in other specialty areas, we can ensure the best possible outcomes for the patients we serve.”
Infertility is a condition that affects approximately 1 out of every 8 couples, according to the American Pregnancy Association. “When to seek help is really up to the couple,” says board-certified specialist in Reproductive Endocrinology and Infertility, Dr. William Ziegler, D.O., FACOG. Dr. Ziegler is Medical Director of the Reproductive Science Center of New Jersey.
“If a woman is feeling stressed about the length of time it is taking to conceive or is worried there is a problem, then they should seek help,” advises Dr. Ziegler. “By definition, a couple should seek help if they have failed to conceive after one year if the woman if under age 35, or within six months if the woman is older than age 35.” An infertility diagnosis is given to a couple that has been unsuccessful in efforts to conceive over the course of one full year.
Common Causes of Infertility
The most common causes of female infertility include problems with ovulation, damage to the fallopian tubes or uterus, or problems with the cervix. “Age can contribute to infertility because as a woman gets older, her fertility naturally tends to decrease,” says Dr. Ziegler.
Ovulation problems can be caused by:
• Hormone imbalance
• A tumor or cyst
• Eating disorders such as anorexia or bulimia
• Alcohol or drug use
• Thyroid gland problems
• Excess weight
• Intense exercise that causes a significant loss of body fat
• Extremely brief menstrual cycles
Female infertility factors contribute to approximately 50 percent of all infertility cases, and female infertility alone accounts for approximately one-third of infertility cases. Male infertility can be the result of low sperm production, abnormal sperm function or blockages that prevent the delivery of sperm, illnesses, injury, chronic health problems, and lifestyle choices.
“Overweight and underweight women have increased risk for infertility and less success with fertility treatments,” says Dr. Ziegler. “Consistent, moderate exercise and a healthy diet is good preconception care to help a woman maintain her reproductive health. “
Meeting Each Patient’s Special Needs
“There are many encouraging advances in fertility treatment, and every patient desiring to conceive should be treated individually, helping them to build a family in the best way specific to their needs and wishes” says Dr. Ziegler.
“A patient’s treatment is based on many variables,” says Dr. Ziegler. “This includes the cause for their infertility, other medical conditions, ovarian function, and results from prior fertility treatment.”
“Medications have evolved over the years, which helps us to fine tune a patient’s response so we can now decrease the risk of multiples and ovarian hyperstimulation,” adds Dr. Ziegler.
“For women that are older or if they are carrying a genetic abnormality, we are now able to test embryos for genetic issues prior to transferring them into a women’s uterus,” says Dr. Ziegler. “This has helped increase pregnancy rates in women with pregnancy losses and those at an increased risk for genetic issues.”
Cryopreservation is another exciting advance for women who may choose to delay pregnancy. A woman may choose to delay pregnancy for medical reasons such as cancer treatments including chemotherapy, radiation and surgery, which can speed up the natural decline in available eggs and increase the risk of infertility, or for personal reasons such as education, career, relationship and other social factors.
Cryopreservation is the freezing and storage of mature eggs or embryos for later use in assisted reproductive treatments. These treatment options help women address the disconnect between the readiness to have children and the biological limitations of aging eggs.
“At some point, maternal age becomes a factor in achieving the goal of parenthood” says Dr. Ziegler. “With egg and embryo cryopreservation, however, women can take a proactive role to protect their future fertility.”
Americans are information-hungry and, thanks to the Internet, there’s plenty of data to be found – especially when it comes to healthcare. According to the Pew Research Center, over 70 percent of people look for healthcare information on the web. Moreover, 77 percent of consumers admit they use the Internet at the outset of their search for a new healthcare provider.
The problem, of course, is that not everything we read online is factual. In fact, with the exception of mainstream media such as the The Wall Street Journal and The New York Times, information online is often skewed. It’s called “marketing,” and it’s often onesided and not 100 percent reliable.
A study completed by Invespro truly underscores the importance of reviews, as well as the impact negative reviews can have on a doctor or healthcare practice.
• Positive reviews make a practice seem more trustworthy, according to 72 percent of patients surveyed.
• If a local doctor has a five-star rating, they are going to earn more patients; 92 percent of people surveyed said that “stars” are a determining factor in choosing a physician.
• Before even trusting a healthcare professional, the vast majority of patients (who read reviews) said they read at least four online reviews.
It’s easy to understand why bogus reviews present a huge challenge for physicians, hospitals and healthcare practices around the country. It’s so easy for anyone to post a review, but there’s no way to know if it’s bogus, or unfair. Further, there are companies out there that permit people to “buy” reviews – good for themselves or bad for a competitor – which truly makes the entire concept of online reviews unpredictable and practically a waste of time.
Unfortunately, this isn’t stopping disgruntled patients from writing doctor reviews. In most cases, reviews posted on Healthgrades or Yelp, and other sites can’t even be responded to or refuted by the healthcare professional or practice (due to privacy laws.)
Bogus Complaints Send the Wrong Message
Consider a story about a woman who was very clearly addicted to pain medication. According to the director of a major New Jersey healthcare practice, she came to the office complaining of pain and requesting pain medication. “She was refused pain meds due to her obvious prescription abuse history,” he said. “However, she took the opportunity to write a review about our practice. She wrote that no one here cared about her pain. She clearly misrepresented the facts.”
Due to HIPAA laws, the practice is unable to respond to “bogus” complaints like that, leaving healthcare practices helpless to refute bad information. “People read these kinds of one-sided, unfair reviews and make a decision that the practice is not compassionate,” he added.
In another case, a patient showed up at a specialist’s office without a referral from his primary care physician. The paperwork snafu caused an extended stay in the waiting room which obviously angered the patient. He wrote a review of the practice complaining about the horrible wait time. A review like this is biased and unfair and is not truly representative of the practice.
According to a report printed in JAMA, the prestigious Journal of the American Medical Association, “commercial physicianrating websites have significant limitations.”
While the number of physician reviews online are increasing, the reviews observed by the study were not meaningful. “It is difficult for a prospective patient to find (for any given physician on any commercial physician-rating website) a quantity of reviews that would accurately relay the experience of care with that physician,” according to JAMA.
NJ Healthcare Practices Seriously Injured by Bogus Online Reviews
Moazam Gazi, administrator for University Urology Associates of NJ, says bogus online reviews are a problem faced by most, if not all, healthcare practices. Unless a practice is large enough to have a team of people monitoring social media and online review sites, doctors and healthcare practices face substantial risk to their public image, Mr. Gazi said.
“The conversations on these review boards are almost exclusively one-sided due to HIPAA laws. People feel that it’s a place to vent and discuss their personal care,” he explained. “But it doesn’t give a physician or practice the ability to respond in kind due ethical considerations. Additionally, practices are often very negatively affected by bogus reviews stemming from insurance issues like copays that have nothing to do with quality of medical care.
“Bottom line”, Gazi added, “people should be careful about where they go for their reviews.”
“Taking Reviews with a Grain of Salt”
Many people interviewed said they regularly look at reviews when considering a healthcare professional for their own, or their family’s, care. But suspicions abound.
“I read reviews but I take them with a grain of salt because of the bad experiences I’ve have with docs who were given rave reviews. I do admit, though, that I am more influenced by negative reviews compared to 100% glowing reviews.” — Sue M., Robbinsville
“I know the internet has trolls. It could be someone’s just posting negative comments to be mean. It could be the doc did make a medical mistake once, but is otherwise a great doc. It could be the doc aggravated the commenter in some realm other than medical, and the comment is a revenge posting.” — Jennie P., Hamilton
“I am usually suspect of every review and can’t help but wonder if they were planted. That’s just my suspicious nature. I do not to trust them nor do I base my choices on them.” — Nancy R., Howell
Many consumers look to friends and family for referrals when it comes to choosing a physician. Even so, they still admit to checking out online reviews before making a final decision about setting an appointment.
“I typically read online reviews after I’ve made my decision because I prefer to get a referral from someone I know,” said Jamie C. ff Allentown. “That being said, I know for a fact that people are much more likely to complain than they are to write a good review. So, one review – either way – I am suspect about who wrote it.”
Still others look to reviews for specific information. A negative review, in this case, could really impact a patient’s decision to see one physician over another.
“It’s difficult to ascertain the legitimacy of a review. It’s very subjective and there are so many factors that come into choosing a doctor. Bedside manner is important to me,” said Janis P. of Hopewell. “So if there was a review that said he doesn’t spend a lot of time or is gruff, couldn’t be bothered, that would definitely impact my decision.”
Bogus Reviews are Bad for Consumers and Bad for Business. Period.
“Bad online ratings can wreak havoc on doctors’ businesses, in extreme cases driving physicians to leave a particular state to practice elsewhere,” according to research published in The Wall Street Journal. “Ratings sites will take down reviews that use profanity, but they typically won’t edit or remove a review simply because a doctor (or any business) disputes what is in it.”
Further, while an electrician or an eatery can just close and change the business name and reopen, physicians can’t do that. Once their reputation is damaged, it’s a done deal.
In fact, “one negative review can cost you almost 30 new patients, and nearly 80 percent of patients will change their mind about a practice after reading a bad review,” according to the Invespro study.
“Unfortunately, it’s hard to find reliable, easy-to-understand information about specific doctors or practices,” Doris Peter, Ph.D., director of the said. “Sure, you can check out physician reviews on sites such as Yelp and Angie’s List, but do you really want to find a doctor the same way you do a restaurant or plumber? Probably not.”
So – What is the solution?
Patients should seek in-depth information regarding the physician, their practice and their philosophy. One site dedicated to bringing deeper information to consumers is HumanizeMD (www.humanizemd.com). Compatibility with your physician enhances communication, and good information flow between doctor and patient leads to better outcomes.
Hyper local, and focused initially in Central New Jersey, HumanizeMD is the first informational website that helps you get to know more about a doctor as a person before making one of your most important healthcare decisions.