vitality summer 2010

A PUBLICATION OF NORTH SHORE UNIVERSITY HOSPITAL AND LONG ISLAND JEWISH MEDICAL CENTER

paralyzed athlete walks again

New MoM OvercOmes strOke

suppOrt after pregNaNcy loss

VITALITY

NorthshorelIJ.coM suMMer 2010

refreshINg recipes

2 Vitality + Summer 2010

3 Manhattan expansionLenox Hill Hospital joins the North Shore-LIJ Health System.

4 stroke rescueA new mom from Massapequa Park receives lifesaving care through the Stroke Rescue Program at North Shore University Hospital.

6 healing for pregnancy lossThe Recurrent Pregnancy Loss Program supports women who have suffered multiple pregnancy losses.

7 circle of careA new program personalizes the medical services necessary for senior adults to maintain health and independence at home.

8 cancer careA routine screening saves lives.

LIJ Medical Center gets an Outstanding Achievement Award for excellent care of cancer patients.

Patients at the new Center for Head and Neck Cancer receive comprehensive care from a team of specialists.

A new cancer treatment delivery system produces faster images with lower radiation doses.

16 NeuroscienceTransitions® of Long Island helps patients recover from traumatic brain injuries through neurorehab ilitation.

A professional cricket player receives life-altering spinal cord surgery at North Shore University Hospital.

20 seeing clearlyCustom LASIK gives patients clearer, sharper vision than conventional LASIK.

22 lupus researchPositive results of a drug study give hope to lupus patients.

25 health system NewsThe Hofstra School of Medicine in partnership with North Shore-LIJ has earned accreditation. Richard Goldstein elected as the new North Shore-LIJ Health System chairman.

Clinicians learn new skills without risk at the Patient Safety Institute.

29 health BytesTips for a healthier lifestyle.

30 lighten upRefreshing recipes.

summer 2010: in this issue

Medical Update to enter season 8Medical Update will return from its summer break on saturday, October 9. watch north shore-liJ Health system’s award-winning tv series on saturdays at 11 a.m. on wlnY-tv (channel 10 on cablevision and verizon fiOs and channel 55 on time warner cable in new York city), plus Directv and Dishtv. see reruns at 11 a.m. and 2:30 p.m. monday through friday on verizon fiOs channel 1, and at 12:30 p.m. sunday, 8:30 p.m. tuesday and 3 p.m. friday on great neck public access tv (channel 20 on cablevision and channel 37 on verizon fiOs) and any time at NorthshorelIJ.com.

coNteNts

northshorelij .com 3

welcoMe

Lenox Hill Hospital, a 652-bed facility on Manhattan’s Upper East Side, recently

joined the North Shore-LIJ Health System. The new partnership opens an exciting chapter in Lenox Hill Hospital’s 153-year history, preserving a rich legacy of providing exceptional care to more than 325,000 patients annually. For North Shore-LIJ, the addition of Lenox Hill establishes its first hospital in Manhattan and its 15th overall, expanding its reach in the metropolitan New York area.

“When Lenox Hill Hospital began the process of seeking a partner, North Shore-LIJ was identified as desirable since both organizations have similar cultures with core missions of providing high-quality clinical care supported by medical educa-tion and research,” said William Hiltz, chairman of the Lenox Hill Hospital Board of Trustees.

“The decision was also based on North Shore-LIJ’s reputation as a highly respected organization that has successfully integrated independent hospitals into its system,” said Gladys George, president and chief executive officer of Lenox Hill Hospital.

“We are confident that our patients will benefit from North Shore-LIJ’s nationally recognized quality initiatives, depth of clinical services and new medical school being developed with Hofstra University.”

“This is an unprecedented opportunity to build upon Lenox Hill Hospital’s legacy of medical excellence,” said Saul Katz, former chairman of the North Shore-LIJ Health System’s Board of Trustees. “Utilizing North Shore-LIJ’s infrastructure and resources will

further strengthen Lenox Hill Hospital’s ability to provide its physicians with access to the full continuum of care for their patients. The board is confident that this new partnership will bring great value to both Lenox Hill and the North Shore-LIJ Health System.”

“North Shore-LIJ will provide the necessary support to help Lenox Hill Hospital enhance its clinical services, which have a well-deserved reputation for excellence in cardiac care, digestive disorders, maternal/child health and orthopedics,” said Michael Dowling, president and chief executive

officer of the health system. “By making clinical investments at Lenox Hill and providing other resources and support that will enhance quality and reduce expenses, we’re confident we can build on the hospital’s unique operating niche as a physician- and patient-friendly facility that attracts clinical talent and patients from throughout the metropolitan area,” he said. “Among Lenox Hill’s attributes is its large core of loyal physicians in key clinical areas who are critical in attracting patients and expanding programs.” n

north shore-liJ expands into manhattan

nOrtH sHOre-liJ gOes mObile

Lenox Hill Hospital, on Manhattan’s Upper East Side, recently joined the North Shore-LIJ Health System.

a mobile version of the north shore-liJ Health system’s web site is accessible via NorthshorelIJ.com on any smartphone, blackberry, iphone or palm and delivers a greatly improved experience for mobile web site visitors. You can quickly retrieve address information, phone numbers, directions and maps to north shore-liJ’s hospitals and facilities.

The loss of a pregnancy in the first or second trimester, also known as miscarriage, is one

of the most devastating and emotionally draining experiences a woman and her family can endure. When a woman suffers from two or more miscarriages in a row, it is nothing short of a life crisis, fraught with sorrow, anger and grief. The Recurrent Pregnancy Loss Program at North Shore-LIJ’s Center for Human Reproduction provides patients with tools to handle the trauma and treatment to help prevent future miscarriages.

“When I see patients who have had a second or third miscarriage, they are just destroyed,” said Eileen Mitchell, a psycho-therapist who counsels couples in the Recurrent Pregnancy Loss Program. “With each subsequent loss, it becomes more and more difficult.”

The recently established program provides comprehensive support, evaluation and treatment to those who have suffered from multiple pregnancy losses. It helps pinpoint why the miscarriages occurred and determine treatment options to improve the likelihood of a viable, successful pregnancy.

a loNely trauMaAlthough approximately 25 percent of all recognized pregnancies result in miscarriage, less than five percent of women experience two consecutive miscarriages and only one percent experience three or more, according to the American Society of Reproductive Medicine.

“Women who suffer from multiple miscarriages experience feelings of inadequacy and isolation. It is extremely difficult to be around family, friends or neighbors who are pregnant and/or have children. Holidays can be heartbreaking because family gatherings are painful reminders of the children they don’t have,” said Ms. Mitchell. “Friends and family often don’t fully understand or appreciate the severity of this ordeal.”

“Patients in this emotionally trying situation often don’t know where to turn after suffering repetitive pregnancy losses,”

said David Rosenfeld, MD, chief of human reproduction for North Shore-LIJ Health System. “This program helps our patients navigate through this complex and baffling medical trauma, offering comprehensive and clinically proven testing and treatment in a compassionate and encouraging environment.”

fINdINg solutIoNsRecurrent Pregnancy Loss Program partici-pants are guided through examinations that help determine the causes for their miscar-riages, which can be anatomic, genetic, hormonal or immunologic in nature.

Developmentally or genetically flawed embryos or fetuses account for the vast majority of miscarriages. While most miscarriages result from a random chromo-somal abnormality, some inherited chromo-somal abnormalities can be identified by analyzing the parents’ blood. The most common of these disorders is translocation.

“Each embryo has a certain number of chromosomes, and while it might have the right number, the chromosomes may not be paired up properly,” explained reproductive endocrinologist Micheline Chu, MD, director of the Recurrent Pregnancy Loss Program. “The genetic material that biological parents pass on to a fetus can split unevenly in translocation, which can cause miscarriage. Pre-implantation genetic diagnosis, a procedure that checks the genes of embryos created through in vitro fertilization, can help parents carrying translocations or other chromosome defects.”

Deformation of the uterine cavity affects approximately 10 to 15 percent of women with multiple miscarriages, according to Dr. Chu. “Outpatient surgery can address any uterine abnormalities,” she said.

Specialists evaluate hormone levels and metabolic abnormalities to determine if a related condition is the culprit. Antiphos-pholipid syndrome, a blood vessel disorder, causes between three and 15 percent of recurrent miscarriages.

a BeaM of hope“Once we identify the origin of the problem, we methodically try to treat it,” said Dr. Rosenfeld. “But sometimes there is no identifiable reason for miscarriages. Even in these instances, the likelihood of conceiving and carrying a child to term is still good.”

Studies show that a woman with no identifiable cause for recurrent miscarriages has a very good chance of having a successful pregnancy when standard treat-ments are used. “If we follow women very closely through early pregnancy, we can help improve the outcome,” added Dr. Chu. n

+The Recurrent Pregnancy Loss Program provides comprehen-

sive support, evaluation and treatment to those who have suffered from multiple pregnancy losses. for more information or to make an appoint-ment, please call 516-562-2229.


ceNter for huMaN reproductIoN

somewhere to turn after recurrent pregnancy loss


hoMe care servIces

As we age and the risk of developing health problems that require complex care increases, it can be confusing knowing

how to get the services and assistance we need. This is especially true for elderly people who live on their own. Coordinating appointments with multiple doctors, wading through insurance questions or even driving to appointments can be difficult. That’s why the North Shore-LIJ Health System created Circle of Care, a new geriatric care management program.

“Circle of Care helps senior adults navigate the healthcare system, offering a complete array of home care services,” explained Merryl Siegel, executive director of the North Shore-LIJ Home Care Network. “Our program is unique because most of the services are available in our own healthcare system [North Shore-LIJ], providing patients integrated, seamless care.”

coordINatINg IN-hoMe care servIcesCircle of Care is supported by a broad spectrum of home care services offered through the North Shore-LIJ Home Care Network. These services can address short-term health issues, such as recovery from surgery, to longer-term, chronic care management of such conditions as congestive heart failure, stroke or diabetes. The many in-home clinical services available include:

< geriatric care management; < nursing care; < physician house calls; < wound and skin care; < physical therapy; < occupational therapy; < speech/language pathology; < social work; and < infusion services.

Through the array of home health services available, the Circle of Care program helps seniors access the combination of clinical services they may need. A geriatric care manager, who is a licensed social worker, works with clients to personalize the medical and care services necessary to maintain their health and independence at home. The geriatric care manager then coordinates and schedules the services for each patient.

“This program helps fill the gap in caring for the geriatric population,” said Ms. Siegel. “Services are often available for people with chronic health needs, but it can be difficult knowing what services you’re entitled to and how to access them. Circle of Care takes the confusion out of the process.”

goINg the extra MIleCare for each individual is personalized, and often extends beyond

the scope of the medical programs typically offered by home care providers. For example, if a patient needs home bathroom renova-tion to accommodate a wheelchair, the geriatric care manager can help get the process started. Furthermore, geriatric care managers often facilitate finding an eldercare attorney or financial planner. They can also travel with clients to doctor appointments when necessary — not only providing transportation, but also taking notes and asking questions as the patient’s advocate.

“Anything a patient needs, we can provide,” explained Ms. Siegel. “We do all we can to support a patient’s choice to live at home by providing access to care and services.”

partNerINg wIth faMIly MeMBers If desired, the Circle of Care program also closely coordinates with patients’ family members. This can be especially helpful for loved ones who don’t live nearby. Geriatric care managers keep concerned family members informed of services, care and progress through regular e-mails and phone calls.

“Many patients do best in their home environment,” said Ms. Siegel. “We offer patients the help they need to stay there.” n

+Circle of Care offers a complete array of home care services. for a free assessment or more information,

call 866-651-4200.

Older patients maintain independence with personalized program


oNcology

noon, he can enjoy a round of golf, go for a long walk outside or hop on the treadmill in his basement. He was understandably stunned when his routine colonoscopy revealed that not only did he have a large polyp in his colon, but also that it was cancerous.

June Kim, a 60-year-old man from Syosset, is vigilant about taking care of

his health, and it shows. Most days, Mr. Kim rises at 5 a.m. and begins his daily routine. The owner of a plumbing and heating supply business, Mr. Kim heads to work early, so that by 2 or 3 in the after-

“This was a shock. I consider myself a very healthy man and never had any serious health problems in the past,” explained Mr. Kim. “My screening was a miracle. I would never have known I had cancer if I hadn’t checked it.”

“When I met Mr. Kim, I was surprised by his age because he looks no older than 40.

colorectal cancer screening: an Ordinary miracle

June Kim is back to work at his plumbing and heating supply company after being treated for Stage II colon cancer.


He is that visibly fit,” said Marc Greenwald, MD, chief of colorectal clinical services at North Shore University Hospital (NSUH). “But Mr. Kim is also typical of many colorectal cancer patients because he had no symptoms of being sick, let alone having Stage II colon cancer.”

Virtually all colorectal cancer cases start as a polyp, an abnormal growth of tissue found on the wall of the colon or rectum. Most often, these polyps are asymptomatic and therefore don’t cause pain or bleeding, and often go undetected on blood tests. For this reason, people who have no identified

risk factors — other than age — should begin regular colorectal cancer screening at age 50, when the incidence of polyps substantially increases.

“I like to explain to my patients that a polyp is like a little seed,” said James Sullivan, MD, associate chairman of surgery in the Division of Surgical Oncology at NSUH. “We know that not every seed grows up to become a tree. But every tree was once a seed. Every case of colorectal cancer was at one time a polyp. This is why when polyps are detected, they should be removed at the pre-malignant state to prevent the development of colon cancer.”

cases oN the rIseThere are nearly 150,000 new cases of colorectal cancer in the United States each year, making it the third most common cancer diagnosed in both men and women excluding skin cancers, according to American Cancer Society estimates. More concerning, colorectal cancer is the second leading cause of cancer-related deaths in the United States when both sexes are com-bined and was estimated to cause nearly 50,000 deaths during 2009. Last year in New York State, more women died of colorectal cancer than of breast cancer.

“It is widely known that mammograms detect cancer at an early stage. But as crucial as it is for women to get mammograms, they actually don’t prevent breast cancer,” said Dr. Sullivan. He added that colorectal cancer is preventable through regular screening. A colonoscopy can either find benign polyps before they develop into cancers or find the cancer in its earlier stages when the disease is easier to cure.

The colonoscopy procedure allows the physician to view the entire length of the large intestine by inserting a colonoscope (a long, flexible, lighted tube) through the rectum up into the colon. The physician examines the lining of the colon to identify and remove any abnormal growths, such as polyps, for further examination.

John Procaccino, MD, is chief of colon and rectal surgery at NSUH and director of the Center for Colon and Rectal Diseases, a state-of-the-art facility that administers colonoscopies in a convenient ambulatory setting.

“One of the reasons I wanted to build a center for colon and rectal diseases was to make it patient friendly,” said Dr. Procaccino. “We have a certified colonoscopy suite in our center that meets very stringent criteria set by the New York State Department of Health so patients can undergo the procedure outside the hospital. A colonoscopy takes between 15 and 30 minutes. If no polyps are found, the patient doesn’t need another screening for another five to 10 years. If polyps are found, they can be removed then and sent to our lab for analysis.”

the earlIer, the BetterColorectal cancer is very curable if it is diagnosed at an early stage. The treatment of colon and rectal cancer almost always necessitates surgery, which entails removing the diseased tissue and then resecting, or splicing, the healthy sections together. Chemotherapy and radiation therapy may also be used depending on the case and stage.

“Removing the segment of the colon that has cancer does not have long-term effects on patients’ bowel patterns, eating habits or physical activities. There is so much redundancy to the colon, which is actually five feet long. If you take one foot out, the remaining four feet will more than compensate for what was removed,” said Dr. Procaccino.

There have been many surgical advances in the treatment of colorectal cancer within the last 10 years, including minimally invasive, laparoscopic-assisted colorectal surgery, which is done extensively at NSUH. Laparoscopy requires very small incisions on the abdomen, and reduces how long patients stay in the hospital and the severity of pain during recovery. Dr. Sullivan uses a robot in surgery for some cases.

continued on page 10

Colorectal cancer is very curable if it is diagnosed at an early stage.


oNcology

“Robotic surgery gives us a minimally invasive approach with the best articula-tion,” explained Dr. Sullivan. “The instru-mentation is so advanced, we can do things with the robot that we couldn’t do before.”

For rectal cancer, many patients receive radiation therapy or chemotherapy to shrink the cancerous tumor before surgery. This course of treatment prevents the need for colostomies, which are rarely necessary today.

The treatments of Stage III and IV colorectal cancer also have undergone major breakthroughs. More advanced and aggressive treatments of liver metastasis, the most advanced stage of colorectal cancer, including new surgeries and radiofrequency ablation, have increased survival rates in these further advanced stages.

work BecoMes persoNalFor Ivy Algazy, her June 12, 2009, colonoscopy marked the day her professional and personal lives collided. She has been the director of communications for women’s health services for North Shore-LIJ Health System for nearly two years. In February, Ms. Algazy completed her last course of chemotherapy treatment for Stage III colon cancer.

“My job for the health system is to promote the message of prevention and wellness and taking care of ourselves, for women. If we don’t take care of ourselves, we won’t be able to take care of our families,” said Ms. Algazy. “These words could not have become truer for me than on the day of my colonoscopy. If I did not take charge of my health and get my colonoscopy, I would never have caught the cancer early enough to get treatment and save my life. Moreover, one of the best things that came out of this ordeal is that my three children will begin to get their screenings at age 35 to ensure early detection.” n

+Colorectal cancer is a very curable disease if it is diagnosed

at an early stage. to find a colorectal surgeon, call 888-321-docs or go to NorthshorelIJ.com and click on “find a physician.”

colorectal cancer screening continued from page 9

Ivy Algazy is enjoying her summer plans after recently completing treatment for Stage III colon cancer.


The Commission on Cancer (CoC) recently honored Long Island Jewish (LIJ) Medical

Center with an Outstanding Achievement Award for the hospital’s excellent program-matic care of cancer patients.

“This exceptional designation is reserved for only a few programs,” said Richard Gralla, MD, vice president of cancer services for North Shore-LIJ Health System and chief of hematology/oncology at the Monter Cancer Center in Lake Success. “Based on the daily dedication and expertise of our physicians and staff, we are very pleased that a presti-gious group such as the American College of Surgeons, which established the CoC, has recognized our achievement.”

Eligibility and accreditation for the CoC’s Outstanding Achievement Award are reserved for facilities that commit to providing the best cancer care and comply with CoC standards. Each program undergoes a rigorous evalua-tion and review of its performance and compliance with CoC standards and on-site evaluation every three years.

“To be among the few institutions chosen from around the country to receive the Outstanding Achievement Award shows our deep commitment to providing the highest quality of care to our cancer patients,” said Kanti Rai, MD, chief of hematology/oncology at LIJ Medical Center. “Our Cancer Registry staff members maintain excellence in each aspect of their work, while Cancer Committee colleagues pursue new areas in cancer research as well as community outreach. This is an occasion to take pride in our work and rededicate ourselves to maintaining our high level of care,” he added.

To receive the CoC’s Outstanding Achieve-ment Award, a facility must demonstrate a commendation level of compliance with six standards that represent the full scope of the cancer program within activities that encom-pass cancer committee leadership, cancer data management, research, community outreach and quality improvement. The commendation follows an on-site evaluation by a physician

surveyor. Furthermore, each facility receives a compliance rating for an additional 30 standards. Only 82 programs received the award following the 2009 surveys — 18 percent of the 432 participating programs.

There are more than 1,480 CoC accred-ited cancer programs across the country. These accredited hospitals and treatment

centers diagnose and treat 80 percent of newly diagnosed cancer patients annually. Participating programs focus on continuum of cancer care, prevention and early detection, pretreatment evaluation, staging, optimal treatment, rehabilitation, surveil-lance for recurrent disease, support services, end-of-life and lifelong follow-up care. n

liJ cancer care is “Outstanding”by elaine wohl

Standing from left: Adrienne Thomas, tumor registry supervisor; Kanti Rai, MD, LIJ’s chief of hematology/oncology; Mary Paul, RN, nurse manager, ambulatory chemotherapy and treatment (ACT); and Meg McCormick, RN, ACT, with patient Mel Ilberman, seated.


oNcology

Head and neck cancers are challenging to diagnose and treat. Determining the

location and extent of each patient’s cancer can be difficult, and greatly affects the approach to treatment. Preservation of day-to-day abilities such as eating and speaking as well as physical appearance must also be factored into the course of care. To accomplish this best, head and neck cancers must be treated by a team of specialists — head and neck surgeons, radiation oncologists, medical oncologists, diagnostic radiologists, plastic and recon-structive surgeons, dentists, oral and maxillofacial surgeons, and speech and swallowing therapists — who collaborate to develop the best plan and improve the patient’s quality of life.

The Head and Neck Cancer Center, located in the Naymark Hearing and Speech Building on Long Island Jewish (LIJ) Medical Center’s campus in New Hyde Park, gives patients one convenient place for evaluation and treatment by a team of dedicated specialists. After initial screening, patients return within a week for a highly coordi-nated evaluation by all specialists involved in their care.

“In other settings, developing a course of treatment can often drag out over several weeks because it takes that long for patients to see each specialist involved in their care individually,” said Douglas Frank, MD, the hospital’s chief of head and neck surgery, Department of Otolaryngology, and codirec-tor of the center. “In our center, patients see a head and neck surgeon, a radiation oncolo-gist and possibly a medical oncologist all in the same location. In most cases, a speech pathologist performs a swallowing evalua-tion. After these examinations are completed, the team comes to a consensus on the stage of the cancer and tumor volume, and works out a tentative treatment plan — all in one visit. We are truly coordinating patients’ care at the time of examination. This reduces treatment delays — ultimately enhancing patient safety.”

William Nardella of Islip Terrace was diagnosed with tongue cancer in October 2008. The following January, Dr. Frank

removed one-third of Mr. Nardella’s tongue to eradicate the cancerous tumor, as well as Mr. Nardella’s wisdom teeth, and then

new multidisciplinary Head and neck cancer center gives patients coordinated, comprehensive and convenient care

William Nardella says “Everything is great” after undergoing complex treatment at the Head and Neck Cancer Center.


reconstructed his tongue using an artery and vein taken from Mr. Nardella’s left arm during a 12-hour surgery at LIJ Medical Center. After recovery from surgery, Mr. Nardella received courses of radiation therapy and chemotherapy.

“I was very surprised by the complexity of my treatment and the number of physicians who were involved in my care,” said Mr. Nardella, who completed his treatment nearly a year ago. “But now the rest is history. I am able to eat, my speech has improved through speech therapy and I have full use of my arm. Everything is great.”

“The Center offers patients one of the most cohesive and sophisticated treatment experiences for head and neck cancer in the country,” said David Schwartz, MD, vice chairman of radiation medicine at North Shore-LIJ Health System, and codirector of the center. “Patients facing the stress and anxiety of their diagnosis can meet with experts and quickly receive a plan for their treatment from their team. Patients will know right away if they are eligible for one or more of our clinical trials or specialized techniques. The idea is to make the process understandable and reassuring, and to make treatment as individualized and effective as possible.” n

+The new Center for Head and Neck Cancer gives patients one

convenient place for evaluation and treatment by a team of specialists dedicated to treating head and neck cancer. to make an appointment, please call 866-690-2008.

Be Part of the Conversationfollow North shore-lIJ on facebook and twitter

get up-to-the-minute healthcare information when you follow the north shore-liJ Health system on facebook and twitter. You’ll get the latest health news, press releases, free health screening information and community education events, plus a host of wellness and other important information. in addition, you’ll be able to lend your voice to the healthcare conversation by asking questions and offering insights. On facebook, search for North shore-lIJ health system. and find us on twitter.com/NorthshorelIJ. be part of the conversation!

North Shore-LIJ Health System charitable gift annuity rates are increasing. If you are age 55 or older, you can receive a fixed income for the rest of your life by making a gift of $10,000 or more.

SAMPLE RATES as of July 1, 2010*

One-Life Rates Two-Life Rates

Age Rate Ages Rate

55 5.5 percent 55/55 5.1 percent60 5.7 percent 60/60 5.4 percent65 6.0 percent 65/65 5.6 percent70 6.3 percent 70/70 5.9 percent75 6.9 percent 75/75 6.2 percent80 7.7 percent 80/80 6.8 percent

90 10 percent 90/90 8 percent*Rates may change.

charitable gift rates are up

+ For more information and a no-obligation personalized

illustration of benefits, contact alexandra brovey, senior director of gift planning, at 516-465-2610 or [email protected].

You will receive a steady income, part of which is tax-free. The amount of the gift that remains is used to benefit North Shore-LIJ. For example, if you are 72 years old and donate $10,000 cash, you can lock into a fixed rate of 6.5 percent and receive $650 of guaranteed annual income, $440 of which is tax-free for about 14 years. You would also be eligible to claim a charitable income tax deduction about $3,560.


oNcology

new cancer-fighting technology Delivers faster treatment

In a promising development for cancer patients in the New York metropolitan area, Long Island Jewish (LIJ) Medical Center’s

Department of Radiation Medicine has acquired an innovative new system called TrueBeam that offers a radically different approach to treating cancer with image-guided radiotherapy.

The TrueBeam system, produced by Varian Medical Systems, was engineered to deliver more powerful cancer treatments with pinpoint accuracy and precision. It uniquely integrates new imaging and motion management technologies within a sophisticated new architecture that makes it possible to deliver treatments more quickly while monitoring and compensating for tumor motion. The technology opens the door to new possibilities for the treatment of lung, breast, prostate, head, neck and other cancers that are treatable with radiotherapy.

“TrueBeam is a real game changer that will enable us to treat even the most challenging cases with unprecedented speed and precision,” said Louis Potters, MD, chairman of radiation medicine at LIJ Medical Center and North Shore University Hospital. “With a broad spectrum of new capabilities, TrueBeam breaks the mold in just about every dimension, making it possible for us to offer faster, more targeted treatments to tumors even as they move and change over time.”

treatMeNt tIMe reducedWith dose delivery rates that are 40 to 140 percent higher than earlier generations of linear accelerator technology, the TrueBeam system can complete a treatment commensurately faster. This makes it possible to offer greater patient comfort by shortening treatments and to improve precision by leaving less time for tumor motion during dose delivery. “Intelligent” automation further speeds treatments with an up to fivefold reduction in the number of steps needed for image guidance and dose delivery.

Simple treatments that once took 15 minutes or more can be completed in less than two minutes, once the patient is in position. “These are significant reductions in treatment time,” said Dr. Potters. “Patients will spend a whole lot less time lying still, immobilized on a hard surface.”

eNhaNced QualIty aNd precIsIoNBeing an early adopter of this technology requires rigorous monitor-ing and quality assurance testing. The North Shore-LIJ Department of Radiation Medicine is putting this machine through its paces to ensure a smooth integration of treatment planning and delivery with the greatest of accuracy, Dr. Potters said. “This tool offers us capabilities never before considered,” he explained, “but along with that potential comes the responsibility to prove the clinical benefits of this technology.”

The precision of the TrueBeam system is measured in increments of less than a millimeter. This accuracy is made possible by the system’s sophisticated architecture, which synchronizes imaging, patient positioning, motion management, beam shaping and dose delivery, performing accuracy checks every 10 milliseconds throughout the entire treatment. More than 100,000 data points are measured every 10 seconds as a treatment progresses, ensuring that the system maintains a true isocenter, or focal point, of treatment.

For lung and other tumors subject to respiratory motion, TrueBeam offers gated RapidArc radiotherapy, which makes it possible to monitor patient breathing and compensate for tumor motion, while quickly delivering the appropriate dose during a continuous rotation around the patient. “During the past decade, lung cancer became the leading cause of cancer death for both men and women in the United States,” said Dr. Potters. “With TrueBeam, we can treat a moving lung tumor as if it were standing still. We expect this to make a meaningful difference for lung cancer patients in the area.”

faster IMagINg at lower dosesTrueBeam imaging technology can produce the 3-D images used to fine-tune tumor targeting in 60 percent less time. Additional functionality makes it possible to create images using 25 percent fewer X-ray doses. “Imaging is an essential part of modern-day targeted radiotherapy,” explained Dr. Potters. “This unit allows us to choose an imaging mode that minimizes the number of X-rays needed to generate an image — and that’s good for our patients.”

TrueBeam can be used for radiotherapy treatments, including image-guided radiotherapy and radiosurgery, intensity-modulated radiotherapy, RapidArc radiotherapy and gated RapidArc.

“With TrueBeam, we can select the optimal treatment for every type of cancer,” said Dr. Potters. “This is a breakthrough that lets us bring a wider spectrum of advanced radiotherapy treatment options to many more patients. It represents a quantum leap in our ability to help people fight cancer.” n

+Get quicker results fighting cancer. to learn more, call 866-690-2008.

The TrueBeam’s precision is measured in increments of less than a millimeter. The

system measures more than 100,000 data points every 10

seconds as a treatment progresses.

For more than 20 years, Andrew Mongiardo lived with the some-times fatal disease called hepatitis C, which affects over 3.9

million Americans and 170 million people worldwide. Over the past two decades he participated in many clinical trials, not knowing what the outcome would be, always trying to maintain a positive attitude. Recently, he was offered an opportunity to take part in yet another new clinical trial — and it changed his life.

“This was the most difficult clinical trial by far, as it took a toll on me physically, mentally and emotionally,” said Mr. Mongiardo, a Long Island resident. “It was a very rough trial therapy, with many side effects lasting for a year. After waiting six months for the results, it was worth all of the pain and suffering, as I was told that my viral count was so low that it was undetected and I was virtually cured, a word I thought I would never hear. I am now hepatitis C-free.”

North Shore University Hospital was one of only 53 hospitals worldwide invited to take part in a clinical trial study designed to treat patients with hepatitis C, genotype 1 (the type of hepatitis most prevalent in the United States) who had failed previous treatments.

“These two studies of triple drug therapies, recently published in the New England Journal of Medicine, have recently been shown to be more effective in obtaining a sustained viral response. These medications were pegylated interferon, ribavirin and a new agent called a protease inhibitor,” said David Bernstein, MD, chief of the Digestive Disease Institute at North Shore University Hospital and LIJ Medical Center, and principal investigator of the study.

The currently accepted two-drug (dual) therapy, a combination of weekly alpha interferon injections and twice-daily oral ribavirin, has so many difficult side effects that many people drop out of the therapy that lasts from 24 to 48 weeks, depending upon the patient’s type of hepatitis C. The overall sustained viral response rates for people who failed initial treatments and are retreated with the same regimen are less than 15 percent and the side effects are considerable, including flu-like symptoms, anemia and depression.

“The new three-drug regimen was well-tolerated by patients,” said Dr. Bernstein. “This combination led to a greater than 50 percent sustained viral response rate in previous nonresponders like Mr. Mongiardo — a dramatic improvement over the previous response rates of around 10 to 15 percent with the previous therapies.”

Many patients show no obvious symptoms or warning signs of

the disease. Hepatitis C, one of five known hepatitis viruses that affect humans, and the one with the highest rates of progression to chronic disease, can cause scarring of the liver, cirrhosis and liver cancer. It is transmitted by blood and patients may have contracted the disease from blood or blood product transfusions they received prior to 1992 when there was no reliable, standard prescreening of blood, or from injected or intranasal recreational drug use.

The new therapies are targeted for approval in the United States by the end of 2011. Dr. Bernstein emphasizes that the use of these products, when approved by the Federal Drug Administration, will require significant experience by physicians and their staffs. Until then, he recommends that patients practice a liver-safe way of life by avoiding alcohol and marijuana, maintaining a healthy diet and exercising. Patients with cirrhosis need to be screened every six months for liver cancer.

Mr. Mongiardo credits North Shore’s Liver Support Group, Dr. Bernstein, the department’s nurses and staff, and the American Liver Foundation for helping him and others get through their ordeal. “Without their constant encouragement and care, I may not have had the perseverance to continue with the trial which proved to be so critically important to my life. I still go to my support group, hoping to encourage others,” said Mr. Mongiardo. n

+Participate in the promise. to enroll in the study, call 516-562-4281.

Hepatitis c: a light at the end of the tunnel by elaine wohl

“I was virtually cured, a word I thought I would never hear. I am now hepatitis C-free.”

hepatItIs c trIal


Illustration of the hepatitis C virus in the bloodstream.


Neurology

In 1995, a two-ton truck traveling 50 miles per hour rear-ended Deborah Schneider’s

station wagon. Unknown to her then, she sustained a traumatic brain injury (TBI) so severe that it reduced her level of function-ing to that of a 5-year-old. A wife and mother of two young children, Ms. Schneider recalls headaches so painful that she could not get out of bed. She suffered from vertigo, memory loss, sensitivity to light, inability to form sentences or recall words and chronic pain that made her life feel burdensome.

A few months later, Ms. Schneider visited a neuropsychologist whose tests were “frustrating” because she was unable to complete them. “I couldn’t understand why he was asking me to do things I couldn’t do,” she said. The neuropsychologist recognized that she needed full-time rehabilitation, so in January 1996, Ms. Schneider began her journey at Transitions® of Long Island, a neurorehabilitation program tailored for the complex needs of people with acquired brain injuries.

Part of North Shore-LIJ Health System, Transitions has provided specialized services

since 1988. Its therapies primarily focus on giving clients practical strategies that will provide new, lifelong coping mechanisms, said Jean Elbaum, PhD, director of clinical services. “Learning and using new strategies — which could be as simple as making lists, highlighting written material to help with memory or keeping a journal — are invaluable to our clients, who struggle constantly to reclaim their place at home, at work and in their community.

“Our greatest achievement is to help people reinvent themselves after sustaining life-altering trauma and returning a sense of meaning and purpose to their lives,” added Deborah Benson, PhD, chief of rehabilita-tion psychology at Transitions. BegINNINg the JourNeyFor her first few months of neurorehabilita-tion, Ms. Schneider attended the program five days a week, then scaled back to four days. Her neurocognitive team worked with her in such key areas as speech and occupational therapy. “For example,” said Ms. Schneider, “the injury left me unable to concentrate. My therapists helped me

learn new strategies for paying attention, such as filtering out unwanted background noise. I also learned new ways to solve problems since so much had to be relearned. And a big focus was on learning to remember things.

“I truly believe that these new strategies are what got me back to real life,” she concluded. “Even years later, what I learned at Transitions continues to help me keep it all together.” full spectruM of careAlong with physical and occupational therapy, Transitions offers speech/language therapy, neuropsychological evaluations, individual and group counseling, family education and support and prevocational training.

Transitions remains pivotal for clients because treatment continues even after discharge, said Dr. Elbaum. “We welcome our clients to remain connected to us,” she said. Both Dr. Elbaum and Dr. Benson maintain regular contact with Ms. Schneider and many other Transitions alumni. “We encourage our clients to take advantage of our Post-Rehab Extension Program [PREP],

people with traumatic brain injuries transition to a better lifeby michelle pinto

community members over age 18 can get involved in genetic research through the genotype and phenotype (gap) registry. thanks to a $2.2 million federal grant, the gap registry is now expanding to become a national resource to scientists.

the program is enrolling healthy volunteers who provide a Dna sample in addition to a limited health

history. collection of a Dna sample and health history allows for the selection of control subjects on the basis of genotype, as well as demo-graphic information or health history. scientists can extract Dna from a saliva sample and use it anonymously in research.

more than 3,600 volunteers have already enrolled; the long-term goal

is to attract 10,000. those in the long island/metro new York area community are encouraged to participate. volunteers may be contacted about voluntary participation in additional studies.

for more information, visit gapregistry.org or call 516-562-1175 and ask about the gap registry.

Harnessing the Power of Genetics


which reinforces the skills learned in therapy sessions and provides continued structure and stimulation. Also, we have an active alumni group, where our clients can come back to visit and socialize every month.” the Next chapterWhen Ms. Schneider began treatment, she had one thought: “I can remember being here almost 15 years ago and vowing that one day I would write a book about all this,” she said. “I decided that I wanted to help people understand TBI’s and how to deal with the reality of their new life. Most of all, I wanted to let people know that there is life after a serious brain injury. My motto is, ‘The sky’s the limit. I did it — it can be done.’”

Today, Ms. Schneider is the coordinator for the Family Advocacy, Counseling, Training and Services Program of the Brain Injury Association of New York State, where she advocates for TBI survivors and their families; she was even the keynote speaker at North Shore University Hospital’s 2010 Brain Injury Symposium. She also published her memoir, Wind Dancing: The Gift of Healing Traumatic Brain Injury. Along with her devout faith and spirituality, Ms. Schneider credits the staff at Transitions for her miraculous recovery. “When I come here, I know I’m not alone. These are people who care,” she said. n

+Along with physical and occupational therapy, transitions

offers speech/language therapy, neuropsychological evaluations, individual and group counseling, family education and support and prevocational training. to learn more, call 866-690-2008.

the north shore-liJ Health system foundation’s web site features an attractive, user-friendly design. NorthshorelIJ.com/foundation offers:

< a variety of opportunities to support building projects or individual hospitals, or to make a gift in honor of a loved one and more;

< campaign pages with news about exciting changes throughout the health system;

< expanded coverage of foundation and health system events, including the opportunity to purchase event and raffle tickets online; and

< photo albums featuring our supporters.

Caring for Today, Planning for Tomorrow

Deborah Schneider recently visited Transitions to showcase her continuing progress to Dr. Elbaum.


Neurology

Roopnarine Ramlall, 25, a professional cricket player, was paralyzed from the chest down in a car crash last December

in his native country of Guyana. When his car was rear-ended, Mr. Ramlall was thrown from the vehicle, leaving him unconscious and with a fractured spine.

At Guyana Hospital, he was evaluated for a spinal cord injury; however, there are no neurosurgeons in the country. Mr. Ramlall remained unconscious in the hospital for 15 days. When his doctors predicted that he had a 50 percent chance of survival, his uncle in Queens arranged to have him transported to North Shore University Hospital (NSUH).

To prepare Mr. Ramlall for the seven-hour flight to New York City, Guyana doctors immobilized his head, neck and chest in a cast. The athlete’s family brought him to the Emergency Department at NSUH, where orthopedic surgeons cut away his cast and trauma surgeons and neurosurgeons evaluated him.

A specialist in spinal cord injury medicine, Adam Stein, MD, assessed Mr. Ramlall’s neurological function. “Although Mr. Ramlall was partially paralyzed in his hands and completely paralyzed in his trunk and legs, he could correctly discriminate between sharp and dull sensation in his lower body,” said Dr. Stein, chairman of physical medicine and rehabilitation for the North Shore-LIJ Health System. “This indicated a good prognosis because the nerve fibers that carry sharp/dull sensations are adjacent to nerves that control movement.”

Soon after Dr. Stein’s evaluation, Peter Hollis, MD, a specialist in neurosurgery and the spine, performed spinal fusion surgery on Mr. Ramlall at NSUH. Dr. Hollis stabilized the C-6 and C-7 vertebrae in Mr. Ramlall’s lower cervical spine. “If he did not have this surgery, he wouldn’t have been able to recover,” said Dr. Hollis. “Mr. Ramlall is a young, accomplished athlete and that’s in his favor,

but his situation is unique in that his family went to extraordinary lengths to bring him to us.”

After surgery, Mr. Ramlall could move his feet and toes and had sensation in his hands. “These new abilities gave me confidence that I would improve and eventually learn to walk again,” he said.

Upon discharge from NSUH, Mr. Ramlall was transferred to Glen Cove Hospital’s Wunsch Center for Rehabilitative Therapies for intensive rehabilitation. Mr. Ramlall had worked out at a gym regularly, lifting weights and performing cardiovascular exercise. “At first, therapists were surprised to see how well I did, given my injury. I couldn’t wait to get to rehab; every minute, every second, I was working for improvement,” said Mr. Ramlall.

After 28 days in rehab at Glen Cove Hospital, Mr. Ramlall used a walker at his time of discharge. Three months after the car accident, he no longer needed a walker at home and aimed to take a two-block walk every afternoon with his wife, Padmini. “I hope my husband will soon be chasing after our little girl, Mia,” said Ms. Ramlall.

In addition to rehab at Glen Cove, Mr. Ramlall received physical therapy at home and is now an outpatient at Transitions® of Long Island in Manhasset. “For now, the main thing is to keep doing exercise, keep my body and muscles moving and stay focused on my recovery,” said Mr. Ramlall. Looking forward to starting a position as a computer technician, he added, “I can’t thank the doctors and nurses at North Shore and the therapists at Glen Cove enough for helping me start my new life.” n

+Get expert care with one of the specialists at the Harvey Cushing Institutes of Neuroscience.

for information, call 516-562-3822.

paralyzed athlete walks again, takes new path in life by betty Olt

Online cOst estimatOr

a new online service from north shore-liJ Health system can help estimate medical costs. accessible via the financial Help section on NorthshorelIJ.com/financialhelp, the cost estimator also helps consumers understand hospital bills; determine their eligibility for financial assistance; establish affordable, interest-free payment plans; and arrange for convenient online pay-ments. for concerns with an existing account, contact a payment specialist with our online contact form in the “understand Your bill” section or by calling 888-214-4065.


Mr. Ramlall, right, stays active and looks forward to a new computer career. His physical therapist, Daniel Madrazo, left, worked with him for a month to help restore mobility.

Could Your Aching Neck Signal Some-thing Serious?

“what a pain in the neck!” for many people, that’s more than just a cliché — it’s a bone-crunching daily misery. neck pain is one of the most common reasons to visit a doctor. unfortunately, one of its common causes is something you can’t do much about: aging.

Degeneration of the spine is a normal consequence of growing older. aging is a risk factor for many of the degenerative disorders that can cause neck pain, including osteoarthritis, spinal stenosis and cervical spondylosis.

those are big words to describe small changes in the spine that get worse over time. all of these conditions can put pressure on the spinal cord. the result: chronic pain which, left untreated, can severely impact daily life.

symptoms that may signal a degenerative spinal disorder include:

< neck pain that worsens when you bend or turn your neck or when you cough, sneeze or laugh;

< pain, weakness, numbness or tingling in shoulders, arms, hands or legs;

< difficulty in using fingers for precise tasks such as writing, fastening buttons or opening cans;

< legs that feel stiff, weak or jerky, making walking difficult; and

< bowel or bladder control problems.

if you have any of these symptoms, see your doctor.


vIsIoN care

While conventional LASIK revolution-ized vision correction — obviating the

need for corrective lenses for millions of patients — the newest generation of vision correction, Custom LASIK, advances the innovation further. Custom LASIK gives patients clearer, sharper vision than available from conventional LASIK.

“Studies show that Custom LASIK may improve not only what you see but also how well you see it,” said Carolyn Shih, MD, codi-rector of the North Shore-LIJ LASIK Center in Great Neck. “In fact, clinical studies have shown that Custom LASIK treatments help reduce possible higher-order aberrations that create glare and halos during night driving.”

solvINg More proBleMsPreviously, conventional LASIK could measure and treat only such eye imperfec-tions as nearsightedness, farsightedness and astigmatism, said Jodi Luchs, MD, a community-based ophthalmologist with privileges at North Shore University Hospital and Long Island Jewish (LIJ) Medical Center, adding that other vision flaws, like glare and halos, went unad-dressed. “Now, Custom LASIK can custom-ize treatment of such problems that previously couldn’t be treated adequately with glasses, contacts or conventional LASIK,” he added.

With Custom LASIK, a wavefront analyzer measures how light travels through patients’ individual eyes. This state-of-the-art tool creates customized 3-D maps that detail the unique characteristics of each eye, providing additional, crucial data about the patient’s vision that allows further custom-ization of vision correction.

laser vision correction evolves with custom lasik by maria conforti

Like most LASIK patients, Ms. Feaser recovered fully in a couple of days. She said her biggest thrill is not needing to wear glasses to see her alarm clock in the morning.


she caN see clearly NowLaura Feaser, MSW, a senior social worker at the Orzac Center for Extended Care and Rehabilitation, recently underwent Custom LASIK performed by Dr. Shih. She utilized IntraLase blade-free technology to create an optimal corneal surface for Ms. Feaser’s outpatient procedure. Like most LASIK patients, Ms. Feaser recovered fully in a couple of days.

IntraLase performs the initial step of the LASIK procedure — creat-ing a corneal flap — with a laser (previously, doctors performed this step with a handheld oscillating blade). Clinical analysis reveals that the IntraLase laser prepares an optimal corneal surface below the flap, providing for superior visual outcomes, especially among Custom LASIK patients.

“I cannot believe how simple the Custom LASIK procedure was and how well I did afterward,” Ms. Feaser said. “Dr. Shih is profes-sional and delightful. I appreciate the conscientious follow up, and I wake up each morning surprised that I can see without glasses.” n

+See the world more clearly. select physicians with privileges at north shore university Hospital and

long island Jewish medical center offer custom lasik expertise. ask your primary care physician for a referral. to make an appointment for a free evaluation at the north shore-liJ lasik center, call 866-690-2008.

using computers won’t harm your eyes, according to the american academy of Ophthal-mology. but it can cause temporary discomfort. Your eyes may feel heavy or tired. Or your vision may seem less sharp after you’ve been surfing the internet for some time.

Here’s how to prevent these problems: < place your computer’s monitor so that it is about 20 to 25 inches from you. if you can,

raise or lower the chair or monitor so the screen is just below your eye level. < get rid of glare. try closing blinds or lowering the light in the room. putting a

glare filter on your screen also can help. < take frequent rest breaks. Do something else and blink your eyes several times. if

your eyes feel dry, try using artificial tears.

while computers may not be a threat to your eyesight, other things can pose problems as you get older. remember to get your eyes checked every one to two years. an ophthalmologist or optometrist can check for early signs of eye diseases. see an eye professional sooner if: your vision gets worse; you have eye pain, redness or swelling; you see flashes of light; or you have fluid leaking from your eye.

Tailor Your Visionclinical studies show custom lasik can provide: a greater chance of having 20/20 vision; the potential for better vision than possible with contacts or glasses; less glare and halos; and better overall vision — even at night.

Computer Users: Give Your Eyes a Break


leadINg research

scientists collaborate to unravel lupusby Jamie talan

Kathleen Nolan, RN, was diagnosed with systemic lupus erythematosus (SLE) when she was 26. Two years ago, her

rheumatologist handed her the bad news: There was nothing else they could do for her. She took 12 pills in the morning and two at night, and an injection of another medicine once a week. Her symptoms — joint pain, ulcers, fatigue and constant fever — were unrelenting despite her medication regimen. The doctor’s proverbial black bag was empty.

A colleague gave Ms. Nolan a copy of Focus on Research, published by The Feinstein Institute for Medical Research, which detailed an extensive lupus research program and a number of experimental drug studies at the institute. There hasn’t been a new lupus drug in more than 50 years. Most of the medicines now used were designed for other conditions.

Ms. Nolan enrolled in a Phase III study of Benlysta, which showed promise in laboratory models of lupus and in early studies in humans. Last summer, after spending a year in the trial not knowing whether she got the real drug or a placebo dose, Ms. Nolan — and the rest of the lupus world — learned about the results of a similar multicentered study of Benlysta being conducted outside the United States. It seemed to be working. Patients on the drug fared better than those in the placebo group. After one year, patients were all put on one of two doses of the study drug.

progress for patIeNts “This is a major step forward,” said Cynthia Aranow, MD, a rheumatologist at the Feinstein who was an investigator in the study. Dr. Aranow said there are about 10 other lupus clinical drug trials under way in the Feinstein’s Center for Autoimmune and Musculoskeletal Disorders and a number of other studies to figure out why the disease starts and progresses. Benlysta, which is the brand name for belimumab, is a monoclonal antibody against BAFF, which is a B lymphocyte stimulator. BAFF is an immune system cytokine that is important for B cell activation and B cell survival. Lupus patients make too much BAFF and this drug blocks BAFF.

“This is the first time in decades that a lupus drug study had positive results,” added Meggan Mackay, MD, codirector with Dr. Aranow of the center’s Clinical Research Unit. The unit works through the General Clinical Research Center.

The Feinstein Institute for Medical Research is one of the leading centers in the world exploring SLE. Led by Betty Diamond, MD, director of the Center for Autoimmune and Musculoskeletal Disorders, Feinstein scientists are committed to unraveling the puzzle of this abnormal immune response to identify pathways to stop this rogue process. Lupus is an autoimmune disease.

To understand autoimmune disease, scientists turn to the inner workings of the B cell repertoire. In producing antibodies against things that are foreign to itself, the body on more than a rare

occasion wages war against its own tissues. About eight percent of the population has an autoimmune disease.

The body produces millions of antibodies that protect against infection. In general, it is an efficient system. But every once in a while, the immune system sees the self as foreign and wages an attack. This process is the underlying problem at work in scores of autoimmune diseases, including common ones like diabetes, rheumatoid arthritis, lupus and multiple sclerosis.

geNetIc aNd eNvIroNMeNtal trIggersLupus is characterized by a high serum of auto-antibodies — spe-cifically antibodies to double-stranded DNA. Lupus is unusual (and therefore a good model) in that it can affect so many different

A trial of a medication for systemic lupus erythematosus is giving study participant Kathleen Nolan, RN — and others like her — new hope.


organs of the body. Dr. Diamond’s interest in understanding the induction of anti-DNA antibodies and how these antibodies become toxic to that environment is at the heart of the research. In demystifying this process, the Diamond team has discovered that the condition has both genetic roots and environmental triggers. For instance, scientists on Dr. Diamond’s team are fascinated by a finding that sex hormones can trigger SLE. Lupus is far more common in women, which is why they are now focusing on estrogen. They are exposing B cells to sex hormones to see how the hormones change B cell receptor signaling and B cell maturation. They are also studying whether genes regulated by hormones alter the response of the immune system.

Dr. Diamond’s team has identified foreign antigens (microbes from the environment) that cross-react with the anti-DNA antibod-ies that they believe play a major role in lupus. What is the normal way to regulate or prevent this cross-reactive system? How does the immune system make this mistake? These are some of the questions the team is answering.

Her team is also working to discover how this cross-reactivity alters a very important population of glutamate receptors called NMDA receptors. These receptors are all over the brain and regulate a lot of excitatory synaptic activity. Dr. Diamond has shown that a subset of anti-DNA antibodies cross-react with NMDA receptors and contribute to neuropsychiatric lupus. It has become clear in recent years that many lupus patients have a long list of cognitive and mood complaints that until now were ignored or not linked to the underlying pathological lupus process. As part of the effort, Dr. Diamond’s colleagues, Drs. Mackay and Aranow, are working cross-

institute with David Eidelberg, MD, head of the Susan and Leonard Feinstein Center for Neurosciences, to image the brains of lupus patients to figure out whether there are observable brain changes and whether more changes occur with advancing illness. They are using magnetic resonance imaging and positron emission tomography scans to identify the functional and structural problems that underlie these brain symptoms. n

+To learn more about ongoing lupus studies, call 866-690-2008.

Scientists at The Feinstein Institute for Medical Research work to discover how B cells alter the response of the immune system.

Sisters Helping Sistersscientists at the feinstein institute for medical research have embarked on a national search for sisters. the sissle (sisters of women with systemic lupus erythematosus) research study is looking for sisters: one with a diagnosis of lupus, an autoimmune disease, and one (or more) who does not have lupus. betty Diamond, mD, and peter gregersen, mD, designed the study to understand how individuals may progress to lupus. by following a sister or sisters of a lupus patient, the scientists hope to identify the disease in its earliest, presymp-tomatic stage and track its progression over time.

the feinstein will enroll 400 sisters over a two-year period. scientists will be able to identify auto-antibodies that play a role in lupus and study other changes in blood serum that may help predict disease. studies show that 15 to 20 percent of sisters with these auto-antibodies will not get lupus. figuring out who those people are and why they are protected will help design treatment options for those who do go on to develop lupus. women who were diagnosed with lupus between the ages of 10 and 35 are welcome to join the study if they have a sister or sisters (also between the ages of 10 and 35) with no signs of illness. Half-sisters are welcome to joint the sissle study as well.

for more information about the study, call a research nurse at 877-698-9467, e-mail [email protected] or visit sissle.org.

tHese telltale signs maY signal lupus

lupus is a disorder that causes the immune system to attack the body’s own organs and tissues. and if you’re a woman of childbearing age, you’re in the biggest risk group for lupus.

One symptom of lupus is a distinc-tive “butterfly rash,” in which the skin across your nose and cheeks turns red. Other possible signs include the following:

< painful, swollen joints — most often in the knees, wrists and hands;

< extreme tiredness; < achy muscles; < low-grade fever; and < sensitivity to the sun.if you have any of these symptoms,

talk with your doctor. left unchecked, lupus can damage the kidneys, brain and other organs. but treatment can help control symptoms and manage the disease.

The north shore-liJ Health system board of trustees has elected richard

goldstein as chairman. mr. goldstein was formally named to the post at the board’s annual meeting.

He succeeds saul katz, who conclud-ed four years as chairman after previ-ously serving as the north shore-liJ Health system’s first chairman from 1997 to 2000.

mr. goldstein, an attorney, joined the board of trustees in 1995, after serving for three years as an associate trustee.

He has served as the board’s vice chairman for the past four years.

“i am honored to serve as the north shore-liJ Health system’s fourth chair-man,” said mr. goldstein. “it’s an enormous challenge that brings with it enormous responsibilities, but i have the benefit of being able to rely on the knowledge and experience of my predecessors, most notably saul katz, who leaves an incredible legacy of unparalleled leadership, energy, dedica-tion and devotion to our health system.”

mr. goldstein is chairman and chief executive officer of aep capital llc, a specialized invest-ment/merchant banking firm located in new York. He is also a senior managing director of alpine equity partners lp.

richard goldstein elected chairman of north shore-liJ Health system


health systeM News

new school to change medicine on long island and beyond

Hofstra University’s and North Shore-LIJ Health System’s School of Medicine is officially open for business. It is the first new

allopathic medical school to open in New York State since 1963.The medical school has received preliminary accreditation from

the Liaison Committee on Medical Education (LCME), as well as final approval of its education program from the New York State Education Department’s Professional Education Division. The approvals have allowed the medical school to begin to recruit its first class of 40 students, who will begin studies next summer.

“Having our own medical school will transform both North Shore-LIJ and Hofstra University, elevating us to an unprecedented level of prominence,” said Michael Dowling, the health system’s president and CEO. “It will put the health system on par with some

of the nation’s most prestigious healthcare organizations.”The school’s curriculum will change the face of medical education

in this country by putting students in patient care settings from Day One, including the ambulances operated by North Shore-LIJ’s Center for Emergency Medical Services. The health system’s Patient Safety Institute, Feinstein Institute for Medical Research and hospitals will all serve as training sites, ensuring students will graduate as highly prepared young doctors five years from now. n

+Learn about the region’s most exciting development in higher education. visit http://medicine.hofstra.edu,

call 516-463-7516 or e-mail [email protected].

Richard Goldstein


health systeM News

us senator kirsten gillibrand recently toured north shore-liJ’s patient safety institute to learn about the health system’s work in providing simulation training to medical residents, nurses and other clinicians from throughout the region. north shore-liJ’s chief learning Officer kathy gallo, rn, phD, right, showed senator gillibrand plans for expanding the health system’s patient safety institute and center for learning and innovation — the nation’s largest corporate university.

At a ceremony to dedicate the Mitchell A. Goldman, MD, Diagnostic Imaging Center, from left: Dennis Dowling, North Shore-LIJ’s regional executive director for physician and ambulatory network services; Barbara Goldman, Dr. Goldman’s wife; Michael Dowling, president and CEO of North Shore-LIJ; Laura Chasin, Dr. Goldman’s sister, and his father, Leo Goldman.

Diagnostic imaging center renamed to Honor mitchell a. goldman, mD

North Shore-LIJ Health System has renamed its Diagnostic Imaging Center in Lake Success as a tribute to the late Mitchell

A. Goldman, MD, former chairman of radiology at North Shore University Hospital and Long Island Jewish Medical Center. The facility was recently dedicated as the Mitchell A. Goldman, MD, Diagnostic Imaging Center in appreciation of his many contributions to the health system over the past 34 years.

Dr. Goldman, who passed away February 16 after a long illness, served as chairman of radiology for the past 12 years. He was a gifted radiologist, specializing in ultrasound, and a beloved physician and clinical leader known for his engaging personality and kind nature. His career at North Shore-LIJ dates back to 1976, when he joined the North Shore University Hospital Radiology Department. n

Health and wellness meet the metsnext time you attend a mets home game at citi field, check out the Health and wellness information center, located on the field level in the right field corner. the first of its kind in major league baseball, the 400-square-foot center, called the Health information team, or Hit, is staffed by a team of healthcare professionals who can answer questions on such health-related topics as sports safety, exercise, heart health and nutrition. Hit is the brainchild of mets co-owner saul katz, chairman of the board of north shore-liJ Health system from 2006 until this summer and previously from 1997 to 2000.

for more information about the health and wellness Information center at citi field, visit NorthshorelIJ.com/hIt.

Sen. Gillibrand Tours Simulation Center


the north shore-liJ Health system will open three multispecialty locations this fall, providing high-quality outpatient care and specialized services to residents of Queens and nassau counties.

Healthcare practitioners in a variety of disciplines will staff the new facilities to provide community-based care, said Donna moravick, np, north shore-liJ’s vice presi-dent for cardiovascular services. “each location — two in Queens and one in nassau — will offer expert specialized care,

educational programs and state-of-the-art imaging services to help diagnose and treat disease,” she said. “the new locations represent a significant investment by north shore-liJ and are a continuation of our commitment to the communities we serve.

“these new locations provide conve-nience and quality under one roof, complementing our inpatient programs and services in Queens and nassau,” ms. moravick said. “responsiveness to patient needs will be paramount and supported

by our ambulatory care management team.”

the locations and services are: < 1001 franklin avenue, garden city

— internal medicine, cardiology; < 150-55 14th avenue, whitestone

— internal medicine, cardiology, pulmonary medicine; and

<Queens crossing, 136-20 38th avenue, flushing — internal medicine, cardiology, thoracic surgery, urology.

making striDes fOr wOmen’s HealtHcareby marisa fedele

Four thousand community members donned sneakers and traversed the

Jones beach boardwalk recently as partici-pants in every woman matters: a walk for women and their families. the event benefited the north shore-liJ Health system’s new katz institute for women’s Health and katz women’s Hospital.

One of the most rousing sights was the sea of white hats bearing the prudential Douglas elliman real estate logo. inspired by the president and ceO Dottie Herman, hundreds of new York-area prudential Douglas elliman employees formed an impressive three dozen walk teams and raised significant funds in a variety of creative ways.

“several years ago, i was contacted by saul katz, who shared his vision for the first women’s hospital in new York state,” said ms. Herman. “i feel this is one of the most important things i can do in my lifetime.” after learning of the health system’s plans to hold a walk for this cause so close to her heart, ms. Herman made a generous gift for prudential Douglas elliman real estate to become the event’s title sponsor.

the walk raised more than $500,000 for the katz institute for women’s Health and

katz women’s Hospital, thanks to dozens of corporate and individual sponsors, thou-sands of people who walked or supported other walkers, and the dedication of the commerce and industry council (cic), a group of professionals and philanthropists who cohosted the walk with north shore-liJ.

“cic got involved with this walk to celebrate women’s health and wellness and to support a cause that promises to transform women’s healthcare,” said arthur

sanders, who cochaired the walk with fellow cic members teresa breen and cheryl vanek. “it was incredibly rewarding to be on the boardwalk and see so many families bonding as they walked in honor or memory of the women they love.”

+To learn more or make a gift to the katz institute

for women’s Health and katz women’s Hospital, visit support.northshorelij.com/women.

Staff members from the event’s corporate sponsor, Prudential Douglas Elliman Real Estate, formed 36 walk teams, contributing significantly toward the more than half a million dollars raised for the Katz Institute for Women’s Health and Katz Women’s Hospital.

cOming tHis fall: 3 new Outpatient locationsby brian mulligan


health systeM News

The North Shore-LIJ Center for Learning and Innovation recently tripled its size to 45,000 square feet — and nearly half of the space is

dedicated to patient safety. The newly expanded Patient Safety Institute (PSI), a major hub for high-tech medical simulation training, allows clinicians to sharpen their skills without risk to patients.

PSI features cutting-edge simulated hospital settings such as an operating room, a procedure room, a labor and delivery suite, and eight critical care rooms where physicians and nurses hone their clinical and communication skills. The facility includes computer-ized patient mannequins that mimic high-risk medical scenarios like respiratory failure and cardiac arrest in a variety of clinical settings. All training simulations are video-recorded and reviewed during post-scenario debriefings.

In 14 new patient-room settings, actors test physicians’ diagnostic skills by portraying patients with various illnesses. The institute also houses an endovascular simulation lab where physicians practice cardiac, vascular and neurosurgical procedures.

“The Patient Safety Institute is a major asset and we must continually invest in the development of our physicians and nurses to practice life-saving skills for real-life situations,” said Michael Dowling, president and chief executive officer of the North Shore-LIJ Health System. “The expanded facility greatly expands our ability to train clinicians in a state-of-the-art learning environ-ment and improve quality and safety for our patients.”

Medical simulations will train approximately 7,000 clinicians at PSI this year. The North Shore-LIJ Patient Safety Institute’s comprehensive and innovative programs align with the health system’s goal of zero tolerance for medical errors and hospital-acquired infections. Borrow-ing lessons learned from the aviation industry, where pilots learn with simulator technology to improve performance, North Shore-LIJ is helping its nurses and doctors improve clinical and decision-making skills — and avoid serious medical errors in the hospital.

“Healthcare is a team sport,” said Kathleen Gallo, PhD, the health system’s chief learning officer. “At the Patient Safety Institute, we

emphasize that those who work in teams, train in teams so communication and skills are learned in realistic, fast-paced hospital simulations, and responding to rare medical events becomes second nature.”

PSI will also be used as a key clinical training site for medical students at the Hofstra University School of Medicine in partnership with the North Shore-LIJ Health System.

“Medical simulation lets us put new doctors into critical situations that you would never allow them to get involved in with real patients,” said Lawrence Smith, MD, North Shore-LIJ’s chief medical officer and dean of the medical school. “Learning doesn’t happen without being emotionally engaged, and the life-like mannequins replicate stressful medical scenarios, so the simulated setting is as real as it gets.”

The debriefing sessions are equally important because that is when healthcare teams can critique their own performance, Dr. Smith said. “The power of simulation is to recreate rare medical events that you’d never be proficient in, in real practice,” he added. “The litmus test of a medical student is whether you can put knowledge into action in real time under the most stressful situations.” n

clinicians enhance patient safety via simulation training by betty Olt

Pediatric critical care nurses Jacqueline Colombraro, RN, left, and Ronit Schwartz, NP, of the Cohen Children’s Medical Center of New York, insert a breathing tube and check airways on a computerized infant mannequin during a simulated medical emergency at North Shore-LIJ’s newly expanded Patient Safety Institute.


health Bytes

A high triglyceride level is a risk factor for heart disease. To find out how common the condition is, researchers looked at data from a health survey of 5,600 US adults ages 20 and older. Based on blood test results, 33 percent had borderline high (150 to 199 mg/dL) or higher (200+ mg/dL) levels. But only one percent used medi-cine for the condition. This may be because experts suggest adopting a healthy lifestyle as the first step in treatment. If lifestyle changes don’t work out, however, medicine may be an option for those with high triglyceride levels.

watch out for high triglycerides

girls ages 8 to 13 who ate three or more daily servings of fruits and vegetables had stronger bones than girls who ate fewer servings. Other studies have shown that adult bones benefit from eating lots of produce, too.

an exercise-free diet

could rob your Bones

food & fitness

Vitamin C is found in citrus fruits and juices and green peppers.

Whole grains and nuts are high in vitamin E.

High-zinc foods include poultry, fish and dairy products.

Carrots, kale and spinach are good sources of beta-carotene.

Vitamins C and E, zinc and beta-carotene may cut the risk for age-related macular degeneration.

Losing weight is more complicated than “calories in and energy out.” How you lose matters to your bones. People who simply dieted for one year lost bone density in the lower spine and hip. In contrast, dieters who exercised maintained their bone density.


lIghteN up!

1 gallon skim milk4 cups nonfat instant dry milkup to 3/4 cup sugar to taste1 cup plain yogurt with live culturesfood thermometer

1. Mix the dry milk and sugar and blend into skim milk. Heat in a saucepan to just near boiling (185 degrees). Remove from heat and let cool to 110 degrees.

2. Warm to 110 degrees. Slowly stir the warm yogurt into milk mixture.

3. Put liquid in the oven and keep at 110 degrees until a custardlike texture develops — about three to six hours.

4. Pour yogurt into containers that have been sterilized with boiling water. Refrigerate and keep for two to three weeks at most. If desired, add fresh or drained canned fruit before eating.

Make Your Own Yogurt

1 15-oz. can of tropical fruit salad in fruit juices, no sugar added (or about 1 3/4 cups of your favorite chopped fresh fruit)

1 cup low-fat vanilla ice cream or frozen yogurt, softened but not melted

strainersmall mixing bowlmeasuring cuplarge spoon2 containers

1. Open the can of fruit and drain the juices in the strainer over a small bowl. You can save the drained juices for drinking later if you want.

2. Pour the drained fruit into a small mixing bowl. Spoon in the softened ice cream.

3. Mix the fruit and ice cream together with a large spoon.

4. Divide the Fruity Freeze into two containers, cover and freeze for at least two hours. When ready, serve and enjoy!

Fruity FreezeChillin’ Out Pasta Salad2 cups (8 oz.) spiral or shell pasta1 cup (8 oz.) plain nonfat yogurt2 tbsp. spicy brown mustard2 tbsp. salt-free herb seasoning1 cup chopped celery 1 cup sliced green onion1 lb cooked small shrimp3 cups (about 3 large) coarsely

chopped tomatoes

1. Cook pasta according to directions — but do not add salt to water. Drain and cool.

2. In large bowl, stir together yogurt, mustard and herb seasoning.

3. Add pasta, celery and green onion. Mix well.

4. Chill for at least two hours.5. Just before serving, carefully stir in

shrimp and tomatoes.

Chill out with these refreshing summer dishes.


Salt, or sodium chloride, is a staple of the diet. Derived in crystalline form from the

sea or from salt deposits on land, it is added to food as a flavor enhancer and preservative and sprinkled on at the dining table. Ten percent of salt is found naturally in our food supply, taken up from the soil as crops grow or as part of the diet of livestock and fish.

Believe it or not, it’s mostly a very good thing. Besides being tasty, salt is critical in maintaining the body’s balance of fluids, regulating blood pressure and blood volume and contributing to the functioning of muscles and nerves through the activities of electrolytes (dissolved sodium) that regulate cell activity.

But in large quantities, salt becomes dangerous. It contributes to high blood pressure in people who are sensitive to sodium,

and it can also lead to a serious buildup of fluid for those with congestive heart failure, liver cirrhosis or kidney disease. People diagnosed with these conditions are directed to limit salt intake to 1,500 mg or less daily. For the rest of us, the current FDA recommendation is 2,300 mg of sodium daily — less than a teaspoon of table salt. But nearly all Americans consume well above that without realizing it. The typical male ages 20 to 39 takes in close to 4,500 mg, most of it consumed in processed food, like canned goods, cold cuts, frozen entrées, sauces, condiments, chips, cereal — and soft drinks. Even healthy food can add to the salt load: An eight-ounce cup of low-fat milk has about 107 mg of sodium!

What’s the solution? Be a savvy consumer. Read labels carefully, being sure to take the

number of servings into account. Choose food that has less than five percent of daily sodium values. Cut back on canned, frozen and otherwise processed and preserved food in favor of fresh produce and meat. Steer clear of bottled salad dressings and condi-ments. Enhance food with herbs, spices, lemon juice, garlic, onions and other natural flavors instead. And select salt substitutes wisely. Many contain potassium chloride, which can interfere with medica-tion, or have so little flavor that you end up doubling the amount and use as much table salt as you set out to avoid. n

+For an excellent guide to lowering salt intake and healthy

eating, see dashdiet.org.

salt: friend or foe?

Non-Profit Org U.S. Postage

PAID NSLIJHS

Michael DowlingPresident and CEO, North Shore-LIJ Health System

Dennis DowlingRegional Executive Director

Susan SomervilleExecutive Director, North Shore University Hospital

Chantal Weinhold Executive Director, Long Island Jewish Medical Center

Terry LynamVice President, Public Relations

Maria ConfortiManaging Editor

Vitality is published by the Public Relations Department of the North Shore-LIJ Health System (516-465-2600). The information within this publication is intended to educate readers about subjects pertinent to their

health and is not meant to be a substitute for consultation with a personal physician. Produced by StayWell Custom Communications, Evanston, IL. © 2010. Printed in USA

NORTH SHORE-LONG ISLAND JEWISH HEALTH SYSTEM, INC.300 Community DriveManhasset, NY 11030

VIT

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North shore-lIJ health systeM hospItals: nOrtH sHOre universitY HOspital • lOng islanD JewisH meDical center • cOHen cHilDren’s meDical center Of new YOrk • Zucker HillsiDe • franklin • glen cOve • sYOsset • plainview • sOutHsiDe • HuntingtOn •

fOrest Hills • staten islanD universitY HOspital • lenOX Hill HOspital • affiliate: nassau universitY meDical center

NEED TO FIND A DOCTOR? 888-321-DOCS • NORTH SHORE-LIJ HEALTH SYSTEM

Hope lives here.SM

northshorelij.comneed to find a doctor? call 888-321-docs

940MPlease recycle this magazine.

North shore university hospital

allergy & ImmunologySharon Markovics, MD Marc Sicklick, MD

gynecologic oncologyJohn Lovecchio, MD

hematologySteven Allen, MD

Maternal & fetal MedicineVictor Klein, MD

NeurologyRoger Kula, MD

obstetrics & gynecologyMichael Nimaroff, MD

otolaryngologyMichael Setzen, MD

plastic surgeryLyle Leipziger, MD

rheumatologyRichard Furie, MD

lIJ hospital

gastroenterologyMaurice Cerulli, MD

ophthalmologyIra Udell, MD

orthopaedic surgeryDavid Dines, MD

pathologyLeonard Kahn, MD

plastic surgeryAlex Keller, MD

pulmonary diseaseHarly Greenberg, MD Mark Rosen, MD

thoracic surgeryL. Michael Graver, MD

urologyLouis Kavoussi, MD Michael Ziegelbaum, MD

ccMc

adolescent MedicineMartha Arden, MDMartin Fisher, MD

child and adolescent psychiatryCarmel Foley, MD

NeurologyJoseph Maytal, MD

clinical geneticsMartin Bialer, MD, PhD

pediatricsAndrew Adesman, MDEric Gould, MD

allergy and ImmunologyVincent Bonagura, MD

cardiologyFredrick Bierman, MDRubin Cooper, MD

endocrinologyDennis Carey, MDPhyllis Speiser, MD

gastroenterologyJeremiah Levine, MDJames Markowitz, MD

hematology/oncologyJeffrey Lipton, MD, PhD

Infectious diseaseLorry Rubin, MD

NephrologyHoward Trachtman, MD

rheumatologyBeth Gottlieb, MD

surgeryStephen Dolgin, MD

the zucker hillside hospital

child and adolescent psychiatryVictor Fornari, MD

New York magazine recently published its 2010 list of top doctors in the metropolitan new York area. physicians from long island Jewish (liJ) medical center (which incorporates liJ Hospital, the cohen children’s medical center (ccmc) of new York and the Zucker Hillside Hospital) and north shore university Hospital were among the honorees.

north shore and liJ physicians among New York’s “best” Caregivers’ Conferencecaring for children? your parents? Both? equip yourself at the many faces of caregiving: practical strategies and solutions. francine russo, author of They’re Your Parents, Too, will keynote the conference.

tuesday, October 26, 8 a.m. to 3 p.m.immaculate conception center, 7200 Douglaston parkway, Douglaston

for information and reservations, call north shore-liJ Health system’s Department of public Health education at 516-465-2500.

vitality summer 2010

Documents

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