Vitality Spring 2010

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

researchers battle breast cancer

tired of snoring?

introducing the cohen children’s medical center of new york

VITALITY

northshoreliJ.com spring 2010

sinus relief

2 Vitality + Spr ing 2010

3 commitment to QualityAn award from the National Quality Forum commends the North Shore-LIJ Health System’s high-quality, transparent, patient-centered care.

4 sinus reliefBalloon sinuplasty alleviates chronic sinusitis.

6 no more tossing and turningThe North Shore-LIJ Sleep Disorders Center studies can find and fix the cause of many sleep problems.

8 neurosurgeryA school psychologist thrives after a 17-hour surgery removes her skull tumor.

Deep brain stimulation helps a teen with Tourette’s syndrome.

12 pediatric and adolescent gynecology

A multidisciplinary team handles complex conditions affecting the reproductive systems of young girls.

14 saving lives A Long Island baby with a totally blocked airway receives lifesaving surgery while his placenta is still attached to his mother.

A Bay Shore teenager celebrates his recovery thanks to the Steven and Alexandra Cohen Children’s Medical Center of New York.

18 leading researchClinical trials have dramatically changed the outlook for breast cancer patients.

Scientists partner with physicians to disarm a mysterious killer.

22 hospital newsThe North Shore-LIJ Health System renames its children’s hospital in honor of Steven and Alexandra Cohen.

The Comprehensive Wound Care Center provides hyperbaric oxygen therapy to treat hard-to-heal wounds.

26 health bytesTips for a healthier lifestyle.

27 lighten up!Bronzed Mushrooms, Portobello Pizza, Mushroom-Barley Soup

spring 2010: in this issue

don’t-miss tVWatch Medical Update with Dr. Frank Field, north shore-liJ’s award-winning series at 11 a.m. and 2:30 p.m. Monday through friday on Verizon fios channel 1, and at 12:30 p.m. sunday, 7:30 p.m. tuesday and 1 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

commitment to Quality

The National Quality Forum (NQF) has designated the North Shore-LIJ Health

System as its 2010 National Quality Health-care Award recipient. The award — the first given to a healthcare organization in the New York area — recognizes the health system’s ongoing commitment to providing high-quali-ty, transparent, patient-centered healthcare.

“North Shore-LIJ is a clear leader in striving to make high-quality care central to its culture,” said Janet Corrigan, NQF president and chief executive officer (CEO). “We are at the precipice of change in healthcare in America, which will affect every healthcare facility in every community. North Shore-LIJ is ahead of the curve and firmly understands that quality measures, reporting of results and ongoing education and improvement are the cornerstones of increasing the quality of care, reducing costs, coordinating more effectively,

reducing errors and improving safety.”In announcing the award, the NQF noted

that North Shore-LIJ Health System’s commitment to quality and transparency has improved patient outcomes. For instance, after implementing a process of weekly postdischarge phone calls to heart failure patients, the health system reduced readmis-sion rates at one North Shore-LIJ hospital from 32 percent to 9 percent. Also, North Shore-LIJ’s new video-monitoring program displays hand-washing compliance statistics to patients and hospital staff — increasing hand-washing compliance by 81 percent.

“Quality improvement and accountability are familiar buzzwords within the health-care field,” said Michael Dowling, North Shore-LIJ’s president and CEO. “To succeed as a healthcare organization and strengthen public trust, we recognized long ago that

quality must be a top priority for all employees, regardless of their role.”

The NQF selects the recipient of its National Quality Healthcare Award through a blinded review by a panel of national healthcare experts who represent purchasers, government, health systems and consumers. The panel scores applica-tions on:

< effective prioritization of performance- improvement goals;

< well-designed and deployed “dashboard” to measure and manage system performance;

< commitment to transparency; < data-driven improvement of national

quality priorities with an emphasis on care coordination and disparity reduction; and

< demonstrated results on publicly reported performance measures. n

north shore-liJ receives Prestigious Quality award

north shore-liJ health system risk-adjusted Mortality index: overall Mortality

Data Source: Premier Clinical Advisor. Data as of January 7, 2010.Lives Saved = (observed mortality rate – expected mortality rate)* (total number of discharges)*Expected mortality rate is calculated using Premier’s Risk Adjustment Algorithm (based on APR-DRG)

overall Mortality

livessaved

2008

2009

920

1085

north shore-liJ goes Mobilea mobile version of the north shore-liJ health system’s Web site is now available. it 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, direc-tions and maps to north shore-liJ’s hospitals and facilities, as well as phone numbers and addresses for thousands of doctors affiliated with the health system.

Michael Dowling, right, president and CEO of the North Shore-LIJ Health System, recently accepted the National Quality Forum Award from Daniel Wolterman, president and CEO of Memorial Hermann Healthcare System in Houston, at the forum’s policy conference in Baltimore. North Shore-LIJ was the first New York-area healthcare provider recognized by the National Quality Forum for its quality-driven care.


sinus relief

Sitting and speaking with Diana Maffei at her dining room table, it becomes

rapidly clear that she is an extraordinary young woman. She is extremely articulate, certainly wise beyond her 23 years. Ms. Maffei speaks with purpose and empathy and exudes optimism about the bright future that lies in front of her as a second-year student at the New York College of Osteopathic Medicine. Her life has been an interesting yet challenging journey, greatly influenced by the field of medicine.

At age 11, Ms. Maffei was diagnosed with cystic fibrosis, an inherited condition in which the secretory glands produce abnormally thick and sticky mucus in the lungs, causing chronic respiratory and digestive problems. Treatments for cystic fibrosis are aimed at relieving its symptoms. For Ms. Maffei, the most debilitating complication associated with her cystic fibrosis is chronic sinusitis.

“I lived with constant headaches, facial pressure and coughing,” explained Ms. Maffei. “I could never breathe properly out of my nose. And when I was first diagnosed, polyps were literally growing out of my nose. It was very difficult to breathe and sleep, since I breathed solely through my mouth for a long time.”

Ms. Maffei was referred by the Cystic Fibrosis Center at the Steven and Alexandra Cohen Children’s Medical Center of New York to Mark Shikowitz, MD, vice chairman of otolaryngology and communicative disorders and director of the Zucker Nasal and Sinus Center at Long Island Jewish (LIJ) Medical Center.

“Chronic sinus disease can pose a significant threat to patients with cystic fibrosis,” explained Dr. Shikowitz. “It’s been imperative for us to keep Ms. Maffei’s nasal passages clear since mucus can harbor bacteria and viruses and any postnasal drip can potentially infect the lungs.”

nothing to sneeze atSinusitis affects many more than cystic fibrosis patients. In fact, it strikes more than 37 million Americans, making it more common than arthritis or high blood pressure. Moreover, $7.8 billion is spent annually on the direct and indirect costs related to sinusitis in the United States. Many factors can make people more prone to sinusitis, according to Dr. Shikowitz.

An anatomical problem such as a deviated septum or nasal polyps can make people more susceptible. There is also a direct link with smoking, which irritates the lining of

the sinuses, and certain systemic or chronic diseases, including cystic fibrosis and diabetes, that compromise the immune system. Congenital defects, enlarged adenoids and pediatric gastroesophageal reflux disease have been connected with sinusitis as well.

Sinusitis occurs when the cavities around the nasal passages (sinuses) become inflamed and swollen, which can impede drainage and cause mucus build-up. In addition to making it difficult to breathe through the nose, sinusitis can make the area around the eyes and face feel swollen, causing throbbing facial pain or a headache. While most people have one or two sinus infections at some point (known as acute sinusitis), chronic sinusitis is sinusitis that lasts more than eight weeks or keeps coming back.

Over the past 12 years, Ms. Maffei has undergone 14 surgeries to make her sinuses functional in order to protect her lungs, which one could say makes her a living barometer for the technological progress of sinus surgery. “My first surgery was a very traumatic experience for an 11-year-old girl,” said Ms. Maffei. “It was a major surgery, requiring an overnight stay in the hospital. I had packing in my nose, with a lot of bleeding. It took two weeks for me to fully recover and be able to return to school. And then I had my second surgery three months later and missed another week and a half of school. Being absent from school that long was very hard.”

the good inflationThis past November, however, Dr. Shikow-itz used a special and relatively new surgical technology called balloon sinuplasty to alleviate Ms. Maffei’s sinusitis, and the differences in recovery were astonishing. Balloon sinuplasty is an endoscopic, catheter-based system that uses a small flexible balloon catheter to open blocked sinus passages, very similar to how angioplasty uses

balloon sinuplasty brings new Meaning to “breathing easy”

What Are Sinuses?the sinuses are air spaces behind the bones of the upper face, between the eyes and behind the forehead, nose and cheeks. each sinus has an opening, called the ostium, which allows mucus to drain, and drainage is essential for keeping the sinuses working well and healthy. anything that blocks the normal drainage and flow pattern — such as a deviated septum, nasal polyps, facial trauma, congenital narrowing, common colds or allergies — can result in a backup of mucus in the sinuses. if the fluid remains in the sinuses instead of draining, the sinuses become warm, dark and wet, a perfect place for germs or bacteria to grow, causing infection.


balloons to open blocked coronary arteries. Using a guide wire, Dr. Shikowitz navigates the balloon into the nose to reach the sinuses. He then inflates it to gently restructure and dilate the passageway, restoring normal sinus drainage and function without incisions to the sinus lining. There is little bleeding, and many patients can return to normal activities within 24 hours.

“I had surgery on Tuesday, November 24, and was able to eat Thanksgiving dinner only two days later with no pain medicine, no bleeding and looking a lot like myself,” said Ms. Maffei. “Some of the people at

dinner didn’t even realize I had surgery.”“Even though previous endoscopic sinus

surgeries were less invasive than the open procedures we performed 20 years ago, they still entailed a lot of cutting and removing of tissue, changing the anatomy of the nasal passageway to facilitate drainage,” explained Dr. Shikowitz. “The balloon used in this new technique is so strong, when posi-tioned and inflated, we can expand the bone and unclog the blockage in the main drainage area of the sinuses.”

In addition to Dr. Shikowitz, LIJ Medical Center and North Shore University Hospital have numerous other physicians who

perform balloon sinuplasty, including Moshe Ephrat, MD, Gurston Nyquist, MD, Philip Perlman, MD, Angelo Reppucci, MD, B. Todd Schaeffer, MD, Michael Ditkoff, MD, Michael Setzen, MD, Josh Werber, MD, and Gerald Zahtz, MD.

“Balloon sinuplasty offers a real step forward in sinus surgery,” said Dr. Perlman, a community-based otolaryngologist with privileges at North Shore University Hospital. “It gives patients and their doctors a surgical option that definitely improves access to previously difficult-to-reach sinuses while minimizing discomfort and recovery time.”

Added Dr. Shikowitz, “The efficacy and safety have gone up significantly because we can visually confirm with the guide wire that the balloon is placed in the precise location of the blockage. The risk of postsurgery bleeding has greatly decreased as well. Patients are experiencing shorter recoveries and getting back to work or school sooner.”

ballooning ambitionsThis surgery gave a boost to Ms. Maffei’s

aspirations of entering the field of medicine. For Ms. Maffei, cystic fibrosis is accompa-nied by growths (polyps) in the nasal passages that often regrow every 12 to 16 months. “Since this is a chronic disease for me, it’s encouraging to know that my recovery now will be so much faster, and the bleeding and pain will be better and more manageable,” said Ms. Maffei. “I feel confident that my cystic fibrosis and sinusitis are not going to hamper my life or the things I want to accomplish and enjoy. It’s a lot more controllable.” n

Minimally invasive treatment for a chronic condition helped free Diana Maffei to pursue her dreams of a career in medicine.

+Breathe easy with specialized sinus treatment. to find an

otolaryngologist, call 1-888/321-docs.


no more tossing and turning

in search of a few good Z’s

E veryone can attest to the repercussions of a bad night’s sleep. The following day we feel like we’re moving in slow motion

— our concentration is impaired, and our emotions can go from one extreme to the other. Most people view sleep, or the lack thereof, as a quality-of-life issue, and sufferers, as well as their bedmates, resign to live with it.

In the case of Donovan Samuels, a maintenance technician for a North Shore-LIJ Health System office building, it took the insistence of his wife for him to finally address his daytime sleepiness. She had spent one too many nights on the living room couch, unable to sleep in her own bed because of her husband’s heavy snoring.

workplace wellnessFortunately, Mr. Samuels didn’t need to go any further than a few steps from his workplace to appease his wife and receive consulta-tion. He works in the same location as the North Shore-LIJ Sleep Disorders Center, a state-of-the-art, fully accredited diagnostic and treatment facility, where physicians, psychologists and technologists are dedicated to sleep disorder medicine. This multispecialty center assesses the neurological, psychological, respiratory and cardiovascu-lar aspects of abnormal sleep, including severe daytime sleepiness, insomnia, sleep apnea and snoring, abnormal behaviors and movement disorders during sleep.

“When patients come in for the first time, they can expect a comprehensive consultation,” said Harly Greenberg, MD, medical director of the North Shore-LIJ Sleep Disorders Center in Great Neck. “We evaluate complaints or concerns about their sleep and relate the information to their full medical history. Frequently, we conduct tests to help determine whether the patient has a sleep disorder. From there, we develop a therapeutic design for treatment.”

As part of his evaluation, Mr. Samuels underwent a sleep study, also called polysomnogra-phy, the most precise way to determine the cause of many sleep complaints. The sleep study usually requires staying overnight at the sleep center where brain waves, breathing patterns, heart activity and body movement are monitored and recorded.

“It was a good experience,” said Mr. Samuels. “They hooked me up to the monitoring equipment. I watched TV for a while and then fell asleep for the night.”

“The center offers the highest quality of care and provides the patient with a warm and friendly environment,” said Stacy Glickman, adminis-

trative director of pulmonary, critical care and sleep medicine for the North Shore-LIJ Health System. “Scheduling a study is convenient for those who work, since the center is open seven days a week.”

heart of the problemAfter analyzing the data gathered from the sleep study, the center diagnosed Mr. Samuels with sleep apnea, a serious yet easily treated sleep disorder that affects more than 18 million American adults. Sleep apnea occurs when breathing is briefly and repeatedly interrupted during sleep, causing fragmented sleep and low blood oxygen levels. If left untreated, the combination of disturbed sleep and oxygen starvation can lead to mood and memory problems, hypertension and heart disease.

“Mounting evidence shows untreated sleep apnea is life threatening,” said Dr. Greenberg. “Sleep apnea is linked with adverse cardiovascular events and diseases, such as high blood pressure, heart attacks and strokes. It is important to recognize the signs and symptoms of sleep apnea because effective diagnosis and treatment are available.”

For Mr. Samuels, Dr. Greenberg prescribed continuous positive airway pressure (CPAP), the leading therapy for sleep apnea. Patients wear a face or nasal mask during sleep that is connected to a pump filled with water. The device provides a positive flow of air

Mounting evidence shows untreated sleep apnea is life threatening.

Therapy for his sleep disorder made a big difference for Donovan Samuels.

continued on page 7


The Sleep Heart Health Study is a landmark multicenter cohort study being implemented

by the National Institutes of Health’s National Heart, Lung and Blood Institute to investigate the cardiovascular consequences of sleep-disor-dered breathing. In 2007, data released from the study indicated that people with obstructive sleep apnea are at increased risk for cardiovas-cular disease, especially congestive heart failure.

The study has been following more than 6,000 men and women, and its most recent findings show that moderate to severe sleep apnea is asso-ciated with an increased risk of death from any cause in middle-aged adults, especially men.

Specifically, after an average of eight years, patients who had severe sleep apnea at enroll-ment were 1.5 times more likely to die, regard-less of age, gender, race or weight, or whether they were a current or former smoker or had other medical conditions, such as high blood pressure, heart disease or diabetes.

The North Shore-LIJ Health System seeks adult volunteers with primary insomnia to participate in a research study involving treatment. Qualified volunteers can participate in the study at no cost. For more information, call Harly Greenberg, MD, at 516/465-3899. n

the sleep heart health study Weight and Sleep Apneaexperts know that excess weight may cause obstructive sleep apnea. extra fat, especially in the neck and upper body, can block airflow and disrupt sleep. fortunately, losing weight can help treat the problem.

but people with sleep apnea disorder often have trouble losing weight, possibly because the disorder makes them too tired during the day to exercise and burn calories.

in addition, there may be a biological link. studies have shown that overweight people with obstructive sleep apnea are likelier to gain more weight than are heavy people without sleep problems. some researchers think that’s because obstructive sleep apnea may be linked to abnor-mal nerve function. this could affect the body’s resistance to a key protein called leptin, which, in turn, is linked to weight control.

if you have sleep apnea, a weight-loss plan involving exercise and diet will help you reduce symptoms. try to exercise 20 to 30 minutes a day, but preferably not within five to six hours of bedtime.

Your doctor may also be able to help you form a plan to lessen your sleep apnea and help you sleep easier.

to make an appointment for a sleep medicine consultation, call 877/sleep md (877/753-3763) or 516/465-3899.

into the nasal passages to keep the airways open. Most insurance companies pay for sleep testing and for CPAP treatment.

“I’ve been on CPAP therapy for close to a year,” said Mr. Samuels. “At night, I put water in it, put on my mask and then turn it on. It’s very easy to sleep with it. I love it. It’s my new best friend.”

It goes without saying that Ms. Samuels is reaping the benefits of her husband’s CPAP treatment, too. n

+Could you have sleep apnea? select physicians with privileges at

north shore university hospital and liJ Medical center offer help with sleep disorders. ask your primary care physi-cian for a referral. to make an appoint-ment for a consultation with the North Shore-LIJ Sleep Disorders Center, call 877/sleep md (877/753-3763) or 516/465-3899.

continued from page 6


neurosurgery

A local school psychologist and avid hiker, 49-year-old Patty went to her

primary care physician with a horrible headache in November 2006. “Not the usual kind,” she said. “It felt like someone was stabbing me with an ice pick.”

After reviewing the film of the magnetic resonance image (MRI) he had requested, Patty’s doctor told her to go straight to the emergency department — “and don’t drive yourself there,” she remembered him saying. The doctors in the emergency department (ED) gasped when they saw the film, and with good reason: Patty had a tumor at the base of her skull large enough to be pushing her brain out of the way.

The tumor’s size was staggering in its own right, but it was even more surprising because Patty had walked into the ED unaided. To relieve her pain and prevent further complications, however, the tumor would have to be removed.

One of the physicians told her, “I know just the doctor who should perform this surgery.” His recommendation? Mark Eisenberg, MD, a skull base surgeon in the Harvey Cushing Institutes of Neuroscience and chief of neurosurgery at Long Island Jewish Medical Center. Dr. Eisenberg, the only fellowship-trained skull base surgeon in Nassau and Suffolk counties, has extensive experience with all types of skull base tumors. Still, Patty’s would be one of the largest he’d ever removed.

the right doctor for the taskDr. Eisenberg explained that pain is often an obvious symptom of a skull base tumor. Patty agreed, saying the headache was by far her most distressing symptom, but it was not the first.

Patient thrives after 17-hour skull tumor surgery

Patty is enjoying the outdoors again after undergoing surgery to remove a painful tumor.


Two years earlier, Patty’s primary care physician had given her a rudimentary neurological screening by asking her to close her eyes and touch her nose. He did not detect any problems or refer her to a neurologist. Patty also had some minor balance issues, but nothing alarming. “I wanted to hear good things, so I accepted the diagnosis,” she added.

Once she saw the MRI and the tumor became reality for her, though, Patty was grateful she had Dr. Eisenberg in her corner. “He is absolutely brilliant, and at the same time, very friendly. You don’t always find that combination,” she said. “He answered all my questions — and as a school psychologist, I ask a lot of them! I can’t say enough good things about him.”

a ‘gigantic’ tumor’s remoVal“Skull base tumors that originate where Patty’s did most often arise either from the inner lining of the skull or in the outer layer of one of the skull’s main nerves. Patty’s turned out to be the latter kind. Fortunately, these tumors are benign, or noncancerous. They may grow, but they do not spread or invade other body parts. The reason some people develop them is unknown,” explained Dr. Eisenberg.

Removing skull base tumors is a delicate proposition. The task requires patience, skill and teamwork. First, to prepare Patty for surgery and reduce the risk of dangerous blood loss, Avi Setton, MD, chief of interven-tional neuroradiology at North Shore Univer-sity Hospital (NSUH), blocked some of the blood supply feeding the tumor. Next, Dr. Eisenberg cleared his schedule for an entire day, knowing Patty’s surgery would be a long one.

Dr. Eisenberg combined two incisions, one in the front and one in the side of the head, to access the tumor. Once much of the right side of Patty’s head cavity was open and the tumor was exposed, he started carefully removing the tumor under the operating microscope. The goal was to leave nerve tissue intact so that Patty would not experience any lasting disability.

The surgery started around 9 a.m. on November 13, 2006, and ended at 2 a.m. the next day. “I asked him how he stayed focused on surgery for 17 hours like that. He said you just get in the zone. I still don’t know how he did it,” Patty said. But she’s glad he did.

a serious situation inspiresPatty said she was scared, but she focused on the tumor as a problem to be solved. The seriousness of her situation really didn’t sink in until she had time to reflect on her 15-year-old daughter, Camille, and husband, Clifford, waiting during her 17-hour operation.

After a lengthy hospital stay and occupa-tional, physical and speech therapy to regain her voice and strength, you wouldn’t know Patty had experienced a tumor of this magni-tude. She’s working full-time and enjoying hikes near the family’s country home in the Catskills. She has no obvious scars, and the tumor has not grown back. “She has done remarkably well,” Dr. Eisenberg said.

Assisting her mom with therapy exercises has inspired Camille to major in speech therapy in college. After having a breathing tube inserted during her operation, Patty developed a fungal infection in her throat and experienced difficulty talking. She was very thirsty and wanted water to soothe her throat. “Using American Sign Language, I signed ‘I need water.’ I taught Camille sign language when she was little, so she translated for the nurses.”

Patty credits her family, Dr. Eisenberg and the team in NSUH’s Intensive Care Unit (ICU) with her survival and recovery. “The ICU team was superior. They stayed on top of all my functions and anticipated every problem that might occur,” she said. “If you have to be sick, North Shore University Hospital is a great place to do it.” n

+Get expert care with one of the specialists at the

Harvey Cushing Institutes of Neuroscience. for more information, call 866/690-2008.

Healthy Aging Guideto help older adults and their families access the many resources available, the north shore-liJ health system offers healthyagingguide.com. Visitors will find links to all north shore-liJ and govern-ment facilities, medical services, home care agencies and many other elder-care services. the site also provides answers to frequently asked questions about issues of concern to seniors and their loved ones.

New Urology Center Opens the robert s. Waldbaum center at the smith institute for urology recently opened in Manhasset. named in honor of north shore university hospital’s chairman emeritus of urology who has practiced in Manhasset for more than 30 years, the center offers a full spectrum of urologic care. besides general urology, specialists at the center offer treatment for all urologic malignancies, kidney stones, enlarged prostate, ureteral obstruction, men’s and women’s voiding dysfunction and incontinence.

located on the first floor of 1554 northern boulevard in Manhasset, the center is staffed by dr. Waldbaum and farzeen firoozi, Md, lee richstone Md, Michael schwartz, Md, and Joph steckel, Md. to make an appointment, call 516/627-5348 or 516/734-8500.


neurosurgery

When Shaun Ryan was 8 years old, his mother, Rose, noticed him making a

few facial gestures she hadn’t seen before. He would squeeze his eyes shut repeatedly or grimace at odd moments.

She didn’t think much of it until his irregular movements grew markedly worse during a family vacation. Something was wrong. The Ryan family cancelled the rest of their holiday and embarked on what would become a six-year struggle to find help. They found the answer at North Shore University Hospital (NSUH).

trapped by tourette’sShaun had Tourette’s syndrome — a neurological disorder in which irregular brain signals cause involuntary movements, or tics. Symptoms can be mild or, as in Shaun’s case, very severe.

Shaun’s symptoms quickly progressed. He experienced constant tics and could no longer sit still. Sometimes he spun in circles. His arms jerked outward unexpectedly. He grunted loudly. His eyes rolled back for an hour at a time. Shaun even began involun-tarily swearing — a rare symptom of Tourette’s.

“He knew what was happening, but couldn’t stop it,” explained Ms. Ryan. “The only time Shaun was free from his tics was when he slept.”

hope of reliefShaun saw countless neurologists through-out his childhood. He also tried numerous treatments, including medication, Botox injections into his vocal cords and behavioral therapy.

“Some therapies worked for a short time, but never lasted,” said Ms. Ryan. “After we had exhausted every possible option, our neurologist suggested we meet with experts at North Shore University Hospital.”

Shaun’s neurologist had heard NSUH neurologists deliver a lecture on deep brain stimulation (DBS) for patients with Tourette’s. understanding deep brain stimulationAlthough it’s not fully understood how DBS works, it can be thought of as something like a pacemaker for the brain, resetting abnormal rhythms to get brain circuitry working in a more normal manner. A generator implanted under the collarbone sends signals to electrodes placed in the brain; a medical specialist can adjust the electrodes.

Using DBS to treat Tourette’s syndrome is still very rare. The therapy is FDA-approved only for Parkinson’s disease, tremors and dystonia. However, research shows that DBS can offer excellent outcomes for some Tourette’s patients.

Alon Mogilner, MD, PhD, chief of functional and restorative neurosurgery, and Michael Pourfar, MD, movement disorder specialist of North Shore-LIJ’s Harvey

Cushing Institutes of Neuroscience, collaborate to provide DBS therapy to patients. In the past seven years, they have treated hundreds of adults using DBS.

“DBS isn’t appropriate for the majority of children with Tourette’s syndrome because many do not have severe enough symptoms to warrant brain surgery or they gain adequate control with oral medications. In addition, many may outgrow the disorder on their own,” said Dr. Mogilner.

Until meeting Shaun, Drs. Mogilner and Pourfar had not offered DBS to a child with Tourette’s for these reasons. However, after

rare therapy hits “reset” for teen

Shaun Ryan’s six-year search for help ended at North Shore University Hospital.

Research shows that DBS can offer excellent outcomes for some Tourette’s patients.

continued on page 11


bone marrow transplantation

Thomas Judge of Levittown has always been grateful to be part of a large,

close-knit family — he is one of a dozen children. But he could never have predicted that one of his siblings would donate bone marrow for a life-saving procedure after he was diagnosed with full-blown leukemia. Last June, after visiting a hospital for abdomi-nal pain, the 53-year-old husband and father of three received some worrying test results: His white blood cell count was low. Follow-ing a bone marrow biopsy, he was referred to oncologist Jonathan Kolitz, MD, at the Monter Cancer Center in Lake Success.

Typical treatment options for adult leukemia are chemotherapy and bone marrow/stem cell transplantation, but finding a donor involves matching tissue types with the patient. Ideal donors are siblings who

have certain genes identical to the patient’s, but the chance of a match is just one in four. Thankfully, Mr. Judge’s 11 siblings were willing to be tested for compatibility.

His sister, Karen Manolis, RN, a case manager at North Shore University Hospital (NSUH), was a perfect match. “I grew up taking care of many siblings,” said Ms. Manolis. “I could feel my mother telling me this was the time to be there. I feel so honored to have given him help that contributed to saving his life.”

Before the transplant, Mr. Judge under-went four rounds of chemotherapy and many months in the hospital. “Through it all, he barely complained,” said Laura Judge, Mr. Judge’s wife and a secretary also employed at NSUH. No one lost hope — friends held fund-raisers to contribute toward his care, and his kids, brothers and sisters visited from as far as Texas, and they all kept their faith. Between three family members who work at the hospital, not a day passed without a visit. “When they told us he was in remission, it took a while to sink in,” said Ms. Judge. “It was a real miracle.”

Ruthee-Lu Bayer, MD, chief of bone marrow/stem cell transplantation at the Don Monti Division of Hematology/Oncology at NSUH, performed Mr. Judge’s procedure. On January 26, Mr. Judge returned home for the remainder of his recovery.

“I kept thinking, ‘Wow, my doctors are good,’” said Mr. Judge. “Plus the positive attitudes of the staff really got us through each day. When I felt sick, Dr. Bayer acted like my mom used to: She sat down next to me, rubbed my back and told me that it would be all right.” He is deeply grateful for the personalized, compassionate and skilled care he and his family received.

“The best care was right here in our backyard,” added Ms. Manolis. “My brother needed all of us in this long process, and it just wouldn’t have been the same anywhere else.” n

family ties: how one family beat leukemiaby Kristen longo

carefully evaluating Shaun for six months, they concluded that it might be his only hope for a normal life given the severity of his symptoms and the number of medica-tions and treatments he had already tried.

a life reclaimedDr. Mogilner performed the complex surgery to implant the devices. Dr. Pourfar worked closely to adjust the signals sent to the brain.

“There are thousands of different ways to

program this technology,” explained Dr. Pourfar. “It’s as much an art as it is a science. That’s why a team with strong experience in DBS is so important.”

Shaun’s surgery was one year ago. Today, he’s a different person.

“People who meet Shaun for the first time can’t tell he even has Tourette’s. It’s amaz-ing,” said Ms. Ryan. “His tics are virtually gone. He now has his driver’s license and

goes to school full-time. He’s even an emergency medical service volunteer and junior firefighter volunteer. Shaun never let the syndrome stop him. Drs. Mogilner and Pourfar gave him his life back.” n

+Get expert care with one of the specialists at the Harvey

Cushing Institutes of Neuroscience. for information, call 866/690-2008.

continued from page 10

Diane Egglinger, RN, right, supervisor of North Shore University Hospital’s Lab/Blood Bank, and Jim Martone, left, director of clinical lab operations, assisted Karen Manolis, RN, center, when she donated bone marrow to help her brother, Thomas Judge, overcome leukemia.

Thomas Judge at home with his wife, Laura.


obstetrics and gynecology

Two years ago, Brittany, then 15, had excruciating, intense

pain in her lower right side; she was diagnosed with a large ovarian cyst. Her parents were extremely concerned. Doris, Brittany’s mother, contacted Jonathan Trager, MD, an adoles-cent medicine specialist in Williston Park, who immediately sent her to Heather Appelbaum, MD, director of Long Island Jewish (LIJ) Medical Center’s new Division of Pediatric and Adolescent Gynecology.

“Brittany was definitely nervous. We all were,” explained Doris. “When Brittany was 5, her doctor told us that she only had one ovary. Now, here I was meeting Dr. Appelbaum for the first time, and the next thing I knew, my daughter was being rushed to the hospital for surgery. But as nervous as I was, I knew Brittany was in

good hands because Dr. Appel-baum put us at ease. She was professional and nurturing at the same time. And most importantly, she made Brittany feel safe in a very frightening situation.”

After her examination, Brittany was rushed into surgery to remove a large hemorrhagic cyst that was bleeding into her right ovary. Dr. Appelbaum was concerned that the cyst might be twisting, which could cut off the blood supply to Brittany’s ovary, essentially killing it. Losing her only ovary would result in permanent infertility and premature menopause at age 15.

sensitiVity and skill“We have a very special approach for the children and families who seek help from us,” said Dr. Appelbaum. “Young girls are usually very anxious about seeing

a gynecologist. They worry about the exam and fear potential complications with their reproductive organs. Often the girls do not fully understand their symptoms or the implication of their diagnoses. And, of course, parents may also be concerned about how their daughters will tolerate the evaluation and how their diagnoses will affect future fertility and childbearing.”

Dr. Appelbaum leads a multidisciplinary team devoted to providing the highest quality care for conditions affecting the pediatric and adolescent female reproductive system. Conditions they address include vaginal infections, menstrual irregularities, abnormal bleeding, endometriosis, polycystic ovary syndrome, genital trauma, birth defects and disorders of sexual development.

For Brittany, Dr. Appelbaum performed minimally invasive laparoscopic surgery to remove the cyst. While doing so, she located Brittany’s second ovary. Not only was Brittany relieved of her pain, but she was also relieved of worry about potential compromise to her future fertility.

“The anatomy, physiology and pathology of a developing girl are dramatically different from those of an adult woman,” said Dr. Appelbaum. “We evaluate each child to determine how it will affect her future.”

disorders of sexual deVelopmentSpecialists in LIJ’s Division of Pediatric and Adolescent Gynecol-ogy are skilled in pelvic recon-structive surgery for congenital

anomalies of the reproductive system. Working collaboratively with colleagues at the Steven and Alexandra Cohen Children’s Medical Center of New York, the division is the New York area’s only place that specializes in treatment of sexual development disorders. A team of physicians, which includes pediatric gynecolo-gists, pediatric urologists, pediatric endocrinologists, pediatric psychiatrists and medical geneticists, works together to provide a continuum of care for girls born with incomplete or malformed reproductive organs. Dr. Appelbaum is one of the few doctors in this country who specializes in current techniques for vaginal agenesis, a congenital disorder that occurs when the vagina stops developing. “What used to take up to six months can now be accomplished in 10 days,” said Dr. Appelbaum. The minimally invasive procedure is commonly performed in late adolescence.

“LIJ established the Division of Pediatric and Adolescent Gynecology to address the complex medical needs of these patients,” said Ron Sliwinski, senior administrative director of the Department of Obstetrics and Gynecology at LIJ and North Shore University Hospital. “We assembled a superior group of specialists so patients can get the best, most comprehensive care.” n

+For more information on pediatric and

adolescent gynecology, call 866/690-2008.

Pediatric/adolescent gynecology specialists address unique needs

The multidisciplinary team at LIJ’s Division of Pediatric and Adolescent Gynecology eased Brittany through a scary time.


At one time or another, you’ve probably undertaken the task of outlining your

own, or a family member’s, medical history to a nurse or doctor in an emergency department — sometimes more than once during a single visit. For a patient with a high-risk pregnancy, this not only becomes a dreaded ritual that can happen many times in a week, but is also frustrating and extremely stressful when what’s at stake is a long-awaited baby.

A new $7 million grant helps the Depart-ment of Obstetrics and Gynecology at North Shore University Hospital (NSUH) and Long Island Jewish (LIJ) Medical Center care for those mothers-to-be. The grant from the Healthcare Efficiency and Affordability Law for New Yorkers Capital Grant Program, commonly known as HEAL NY, helped develop and establish interoperable electron-ic health record (EHR) systems to coordinate the complex, long-term treatment of high-risk obstetrical patients.

A pregnancy may be diagnosed as high risk because of a chronic condition of the mother’s that can be adversely affected by the pregnancy or can jeopardize the well-being of the developing fetus, such as diabetes, high blood pressure, lupus, heart disease and cystic fibrosis. A birth defect that has been detected prenatally will also influence a high-risk diagnosis.

positiVely affecting safe care“For these patients, a number of specialists are consulted, and often in urgent care situations, because of serious complications related to the pregnancy,” said Adiel Fleischer, MD, chairman of obstetrics and gynecology at NSUH and LIJ Medical Center. “Our ability to literally be on the same page with the entire treatment team and to access the entire history of treatment swiftly and seamlessly makes a significant difference in the safe, effective care of mother and child.”

Through this initiative, the medical records and test results that originate from different

settings — such as doctors’ offices, hospitals, radiology centers and laboratories — are electronically linked, giving every healthcare provider immediate access to a patient’s entire clinical history. For a high-risk pregnancy patient, this may include a cardiologist, endocrinologist, pulmonologist, hematologist, perinatologist and/or medical geneticist. Once the baby is delivered, the mother’s obstetrician/gynecologist will also have access to the hospital information, as will the child’s pediatrician and specialists.

“As mother and baby move through the continuum of care, from the obstetrician’s office to labor and delivery to postpartum

recovery and perhaps on to a pediatric specialist, the most current information from each provider and environment of care continues to flow and be shared,” said Michael Oppenheim, MD, North Shore-LIJ’s chief medical information officer. “This will eliminate the time spent waiting for vital information that can hold up time-sensitive decisions and vastly improve communica-tion within a patient’s team of caregivers.” The new ob/gyn system complements the EHR system that North Shore-LIJ is implementing for community-based and staff physicians. n

electronic records ease Path through high-risk Pregnancy

Obstetrician/gynecologist Susan Alkasab, MD, helps a high-risk patient using an electronically linked medical record, seen in the back.


saVing liVes

the difference between doing something and nothing Is Life

Patrick Carroll, 46, and his fiancée, Liz Bell, had just returned from a family

vacation in Montauk. The vacation was an opportunity to spend time with Liz’s children — Garrett, 19, and Alison, 20 — who were going away to college in September.

Upon picking up Mr. Carroll from the train station after one of his first days back at work, Ms. Bell casually asked how his day was. “I don’t feel myself today. I’m kind of out of it,” answered Mr. Carroll, chalking it up as a difficult transition from vacation mode to the rigors of his job as a personal trainer at a gym in Manhattan.

life turns on a dimeLess than two hours later, Mr. Carroll went into sudden cardiac arrest, and while the next 72 hours are a complete blur to him, this critical time span has left an indelible mark on Ms. Bell. “I thought he fainted. That was my first reaction,” explained Ms. Bell. “But as seconds passed, I realized he wasn’t breathing and had no pulse. I had not been in a CPR [cardiopulmonary resuscitation] class since 1985, so my knowledge of CPR was outdated. But I went into survival mode, accessing my past training.”

Ms. Bell instructed her daughter, Alison,

to call 911. Alison conveyed instructions from the 911 operator to do 30 chest compressions and one breath, while the Smithtown Fire Department was alerted and dispatched. Ms. Bell continued until the emergency medical technicians (EMTs) arrived and took over.

“I just kept at it and did the best I could. I began chest compressions, not certain if I might injure him, but I had to do some-thing,” said Ms. Bell.

Sudden cardiac arrest claims hundreds of lives each year. According to the American Heart Association (AHA), less than one-third of sudden cardiac arrest victims receive bystander CPR — often because bystanders do nothing to help at the moment of collapse since they fear they might do something wrong or make things worse.

cpr saVes liVesFew attempts at resuscitation are successful unless CPR and defibrillation are per-formed within minutes of cardiac arrest. When the heart stops, the absence of oxygenated blood can cause death within eight to 10 minutes. CPR can keep oxygenated blood flowing to the brain and other vital organs until more effective medical treatment can restore a normal heart rhythm. If provided immediately, CPR can improve chances of survival by as much as three times.

Ideally, CPR involves two elements: chest compressions combined with mouth-to-mouth rescue breathing. Last year, the AHA released a scientific statement explaining that chest compressions alone, or hands-only CPR — even performed by an untrained person — can help an adult who suddenly collapses. This can be done by pushing hard and fast in the middle of the victim’s chest without stopping until EMT responders arrive. Moreover, the AHA

Patrick Carroll, right, was kept alive by CPR from Liz Bell, left, and subsequent cardiac intervention at North Shore University Hospital.


ALong Island boy born with a totally blocked airway — one of only 50

reported cases in the past 20 years — re-cently went home after four months in the Steven and Alexandra Cohen Children’s Medical Center of New York’s (CCMC) Neonatal Intensive Care Unit.

Justin Olivares recently greeted the world at a news conference accompanied by his parents, Derly and Julian. The family thanked dozens of physicians and nurses who assisted in his dramatic delivery at Long Island Jewish (LIJ) Medical Center.

While he was still in his mother’s womb, clinicians detected Justin’s condition — known as congenital high airway obstruction syndrome (CHAOS) — during a prenatal exam at LIJ. Somewhere between six and eight weeks of gestation, Justin’s airway failed to develop. Without surgical interven-tion, he wouldn’t be able to breathe once he was born. Besides cutting off oxygen, CHAOS causes fluid produced in the lungs to accumulate, dangerously enlarging the lungs. This leads to abnormal development and function of the lungs and diaphragm.

“The extreme challenge of CHAOS called for the close coordination of teams of

physicians and nurses from numerous pediatric subspecialties at CCMC with maternal/fetal medicine specialists from LIJ and North Shore University Hospital,” said Dennis Davidson, MD, chief of neonatology at CCMC. During Justin’s delivery, the clinical team established an airway while he was still supported by the placenta. This ensured that the baby received enough oxygen during the procedure so that he would not suffer severe brain damage — or death.

The procedure was Justin’s only option and was a major risk to his mother. The clinical team decided to deliver the baby at 36 weeks, before Ms. Olivares went into labor, so physicians could control the complicated process of performing a tracheostomy (insertion of a breathing tube) while the baby was still attached to the placenta. In Justin’s case, the obstruction was surgically bypassed while he and his mother were still attached by the placenta. When Justin was delivered, he received oxy-gen through mechanical ventilation.

In addition to the blocked airway, it was discovered in utero that Justin would be born with ventricular septal defect — a hole in the wall between his heart’s two major pumping chambers. Fortunately, doctors

report that the hole is beginning to close on its own, so cardiac surgery may prove unnecessary.

After treatment in the Neonatal Intensive Care Unit, Justin is breathing on his own, has developed normally, and is ready to live at home with his parents and 8-year-old brother, Jason, who is very happy to be a big brother to this miracle baby. n

dozens collaborate to save baby from chaos by Michelle Pinto

The Olivares family thanked dozens of clinicians who assisted in Justin’s lifesaving care.

the difference between doing something and nothing Is Lifereported that the chance that a person in cardiac arrest will survive increases when rescuers doing CPR spend more time giving chest compressions.

EMTs brought Mr. Carroll to a nearby hospital, where he was intubated and, upon the physician’s recommendation, prepped for transport to North Shore University Hospital (NSUH). Cardiac catheterization performed at NSUH revealed severe mitral valve insufficiency. After stabilization, surgery repaired Mr. Carroll’s mitral valve.

beating the odds“It’s important to know CPR, because getting help within a few minutes is the key to survival. Without a doubt, it resuscitates people, saving lives,” said Gustave Pogo, MD, the cardiothoracic surgeon at NSUH who operated on Mr. Carroll.

“Liz absolutely saved my life, and it is surreal because I have no knowledge of anything that transpired before I awoke in a hospital bed,” said Mr. Carroll. “Because of my job as a personal

trainer, I am certified in CPR, but I obviously could do nothing for myself. If anyone finds themselves in this situation and wonders whether they should attempt to do chest compressions, do it. That’s always going to be better than doing nothing.” n

+Learn CPR! the north shore-liJ department of Public health

education offers cPr instruction. to learn more, call 516/465-2500.


saVing liVes

After six grueling months of uncertainty, 16-year-old Eric Zapata of Bay Shore

can finally smile, thanks to a talented team of doctors and surgeons.

In a news conference at the Steven and Alexandra Cohen Children’s Medical Center of New York (CCMC), where he was literally brought back to life last fall, Eric and his family thanked the medical staff who refused to give up on him. They were especially grateful to David Zeltsman, MD, chief of thoracic surgery at Long Island Jewish (LIJ) Medical Center, who performed the surgeries that saved Eric’s life, and Michelle Ramirez, MD, a pediatric intensiv-ist who first cared for Eric upon his arrival at CCMC.

Last August, the Bay Shore teen com-plained to his mother, Iris Rivera, of back pains, trouble walking and fever. He was brought to a hospital near his home and soon placed on a respirator. A bump on his leg from an infected mosquito bite was discov-ered. Tests revealed that methicillin-sensitive staphylococcus aureus (MSSA) bacteria, the most common cause of staph infection, was running rampant through his bloodstream.

One month later, sepsis (a systemic blood infection that often becomes fatal) set in and Eric’s vital organs began to shut down. Both lungs collapsed, and he was put into a medically induced coma for 28 days. During that time, he developed infections in his left lung and necrotizing pneumonia in both lungs — a severe complication of community-ac-quired pneumonia that kills the lung tissue. Eric needed 17 tubes to help remove fluid buildup and inflate his lungs, a tracheotomy to help him breathe and feeding tubes. Despite the intervention, Eric’s high fever returned and he needed a ventilator to breathe. His weight dropped from 150 pounds to a skeletal 106.

frightening deVelopmentsLast September, Eric was transferred to CCMC, and on September 27, his heart

stopped. He was brought back to life with resuscitation. Though doctors promised they would treat him aggressively, they told Eric’s family to prepare for the worst: His lungs were like Swiss cheese from the necrotizing pneumonia and were literally falling apart. According to Dr. Ramirez, “Eric’s lungs were in very bad shape. He was as sick as anyone could be.”

That’s when Dr. Zeltsman was brought in. Called “Eric’s angel” by Ms. Rivera, Dr. Zeltsman informed the family of a surgical option — he referred to it as “the last resort” — that was extremely risky. Because of Eric’s condition, Dr. Zeltsman needed to operate immediately. Without the surgery, both lungs would continue to decompose and Eric would die. The surgeon performed two

operations in early October to clean out the diseased lung tissue; during each surgery, he removed one third of the lower lung.

the next chapterEric’s condition stabilized, and he slowly began to improve. He left CCMC last December and was sent to another hospital near his home in Suffolk County for one month of inpatient rehabilitation. In January, Eric returned to CCMC to have his breathing tube removed and he was allowed to go home to continue his recuperation. He has put on weight and recently celebrated his 16th birthday. Asked about his ordeal, Eric said simply, “Never take anything for granted. Life is a miracle.” n

gravely ill teen brought back to lifeby Michelle Pinto

Eric Zapata, second from left, celebrated his recovery with, from left: his older brother, Carlos Zapata Jr.; David Zeltsman, MD, chief of thoracic surgery at LIJ Medical Center; mother Iris Rivera; Michelle Ramirez, MD, a pediatric intensive care physician at CCMC; and Arthur Klein, MD, senior vice president of children’s services for the North Shore-LIJ Health System and executive director and chief of staff at CCMC.


leading research

Adevastating diagnosis — that would describe HER2-positive breast cancer

only a few years ago. Cells in HER2-positive tumors have excess human epidermal growth receptor 2 proteins on their surfaces, which makes the cancer more aggressive. HER2-positive cancers account for up to 25 percent of all breast cancer cases.

Today, however, there is a lot of excite-ment in HER2-positive breast cancer research, according to Daniel Budman, MD, associate director of oncology at the Monter Cancer Center. “Once a virtually untreatable disease, now it is very responsive to treatment. Two drugs, trastuzumab (Herceptin) and lapatinib (Tykerb), have markedly improved management of this dis-ease,” he said. “In addition, there are numerous agents in development that may possibly be even more efficacious. Research has dramatically changed the outlook for these patients. We are fortunate to have research protocols reviewed by the FDA incorporating these agents to offer to our patients with HER2-positive disease.”

Trastuzumab — recognized for revolu-tionizing the treatment of HER2-positive tumors — and lapatinib are “entirely different molecules,” said Dr. Budman. Trastuzumab is a large molecule — an antibody that may work through an immunological mechanism. Lapatinib is a

small molecule that has demonstrated beneficial effects in patients who no longer respond to trastuzumab and was approved by the FDA on that basis. adVancing researchWithin the North Shore-LIJ Health System, three of the nearly 80 clinical trials investi-gating treatments for various forms of cancer are focusing on HER2-positive breast cancer. A clinical trial is vital for advancing research into a disease or condition not cured or fully understood; worldwide, there are as many as 41,000 registered clinical trials being conducted. Among the hun-dreds of thousands of people who take part in clinical trials worldwide, a compelling reason is to receive an experimental treatment not available elsewhere that might be more efficacious. Patients who partici-pate in clinical trials also receive extra medical attention: more visits to the doctor, more monitoring, more testing and measurement — all at no extra cost. Qualified participants are provided the study drug and all the study procedures that are not part of their regular medical care at no cost. And although it may not be the primary motivator, there can be an element of altruism.

In the case of the trials offered by the Monter Cancer Center, the standard treatment is being compared to new versions. One international research trial, ALTTO (Adjuvant Lapatinib and/or Trastu-zumab Treatment Optimization), has the potential to “break new ground,” according to Dr. Budman. Medical centers in 48 countries are taking part in this study, with the goal of enrolling 8,000 women. In the United States, the National Cancer Institute oversees the study with the trial operations office at the Mayo Clinic. ALTTO is designed for women who had their breast surgery for localized cancer, have a HER2-positive tumor and are candidates for adjuvant chemotherapy, which is given after the operation. The participants then are randomized (choice of treatment

determined by chance) to the standard treatment with trastuzumab, a treatment with lapatinib, a treatment with both drugs given together or a treatment with both drugs given in sequence. “The human data, which is very scant at present, is insufficient to guide the physician on which drug or what combination will result in the best outcome, hence the large study,” Dr. Budman said.

Another clinical research trial under way at the Monter Cancer Center is known as EMILIA; the full name is “A Randomized, Multicenter Phase III Open-Label Study of the Efficacy and Safety of Trastuzumab-MCC-DM1 (T-DM1) vs. Capacitabine Plus Lapatinib in Patients with HER2-Positive Locally Advanced or Metastatic Breast Cancer Who Have Received Prior Trastuzumab-Based Therapy.” This international, multi-center research study seeks to enroll 580 women with metastatic breast cancer who have progressed through Herceptin (trastu-zumab) treatment. “T-DM1, which has been called ‘super-Herceptin,’ is a very promising therapy,” Dr. Budman said. T-DM1 is an antibody connected to a chemotherapy drug with the hope of making the chemotherapy drug more specific for the tumor.

In a cancer trial, it is unethical to provide no treatment, according to Lori Usak, RN, research nurse at the Monter Cancer Center. Still, the possibility exists that the treatment the study participant receives may be no more efficacious or even less efficacious than the standard treatment against which it is being measured. Before giving his or her consent, every participant in a cancer research trial is carefully informed of this possibility and of the risks associated with the study. n

+Participants needed. the north shore-liJ health system

is actively seeking participants in altto and eMilia, the two open Phase iii research trials mentioned in this article. to find out more, please call Ms. usak at 516/734-8835.

north shore-liJ battles aggressive breast cancer by thea Welch


It’s a disease that kills 225,000 Americans a year, yet most people don’t know its name. But when it comes to sepsis, The

Feinstein Institute for Medical Research devotes nearly a third of its research and development budget to advancing new treat-ments and diagnostics.

Dozens of Feinstein scientists work to discover why and how the human body wages an overblown immune response against an infection that causes organs to shut down. Sepsis is a condition that shows the very worst that the body’s immune system can do: send out an army of immune system soldiers to destroy its own land.

A sepsis diagnosis means a patient is very sick from an infection. However, it is not the infection itself but the body’s reaction to it that leads to deadly consequences. Sepsis can occur at any age, but mortality climbs as the decades advance. On average, 35 percent of sepsis patients will not survive. There are no highly effective treatments for sepsis despite a continued effort to identify potential substances that target the immune system.

Scientists at the Feinstein recently began partnering with physicians throughout the North Shore-LIJ Health System to identify patients in the earliest stages of sepsis and to collect blood samples for research in a collaboration to understand the condition and to discover ways to save lives, said Kenneth Abrams, MD, senior vice president of clinical operations at the health system. Dr. Abrams is spearheading the initiative with Kevin Tracey, MD, the Feinstein’s director and chief executive officer.

“Identifying sepsis patients early and following them over time will provide an important window into the disease process and help us determine the best way to use the findings in the lab to reduce the impact of sepsis on our patients,” said Dr. Abrams.

the feinstein to host international symposiumDr. Abrams and Dr. Tracey will host an international meeting on September 30 and October 1 as part of the Feinstein’s annual Merinoff Symposium. Scientists from all over the world will join a select group of elected officials, federal health regulators and health professionals who deal with sepsis daily to share research and figure

out a course for the coming decades. Merinoff Symposium attendees will also work to build consensus for a definition of sepsis that can be used worldwide to describe its symptoms and course. Right now, the definition varies from place to place, but in general terms the signs of sepsis include a list of garden-variety immune responses — high fever and abnormal white blood cell counts.

wrestling a rogue responseThe real key to unraveling sepsis is to figure out exactly what goes on behind the scenes of the body’s rogue immune response, said Dr. Tracey, one of the world’s leading sepsis scientists. Work conducted in his laboratory led to the discovery that the brain talks to the immune system through the vagus nerve, a long, thin nerve that snakes from the base of the brain down into the stomach. Stimulating the vagus nerve can alter the body’s immune response and suggests a novel way of quieting down a dangerously abnormal immune reaction.

“If we are going to reduce the risk for death and improve quality of life after sepsis, we have to know how the immune system is working under these very different conditions,” said Dr. Tracey. “What makes one person severely septic in response to an infection while another person mounts the appropriate immune response and gets better? We are just beginning to find out.” n

feinstein scientists target little-Known Killerby Jamie talan

Sepsis shows the very worst that the body’s immune system can do.

The immune system communicates with the brain through the vagus nerve, which may be key to identifying ways to protect against sepsis.


leading research

a “high” Way to a brain Wreck by Jamie talan

Stephen Dewey, PhD, may be decades older than the kids in the high school

auditorium, but he speaks the language of adolescence: pot, alcohol, cocaine, meth-amphetamine and heroin. Street drugs that many users see as a mere high, Dr. Dewey sees as a highway to a brain wreck.

On one recent evening, as at most of the presentations he gives at high schools and middle schools across Long Island and Queens, he stands on a stage clad in jeans and a matching shirt. He fixes his computer to fire image after image on a screen. This is your brain on drugs: big chunks of missing activity. Blue compared with an active red. Blunted activity in brains exposed to pot, alcohol, cocaine and other drugs. And the brain scans tell a frightening story: It doesn’t take much to alter the human brain — permanently.

“This is a young girl, 12, who found methamphetamine in her own home, swallowed it and is now in advanced stages of Parkinson’s disease,” Dr. Dewey told a stunned audience during a recent presentation. “She can’t move. Her face has

lost all expression. And her younger sister, 6, also swallowed some, and she is in a similar state.”

Dr. Dewey finds himself on the school lecture circuit when technology is available to show what the brain on drugs looks like — far more real than images like the public service television spots showing an egg in a frying pan. And the images aren’t pretty.

Dr. Dewey has spent his 25-year career researching the effects of drugs on the brain. In graduate school at the University of Iowa, he focused his research on the effects of fetal alcohol syndrome on brain plasticity. He found that even in the absence of a “nor-mal” appearing brain, traumatic brain injury produced profoundly different effects in the fetal alcohol syndrome brain compared with the normal brain. He did most of his research at Brookhaven National Laboratory and recently joined The Feinstein Institute for Medical Research, where he continues to study the effects of drugs on the brain and develop medicines to protect the brain or stop the addictive process.

During his tenure at Brookhaven, Dr. Dewey brought volunteers who abuse the most common drugs into the laboratory and connected them to a positron emission tomography (PET) scanner. The hope was to take snapshots of the brain on drugs and investigate interactions between functionally linked neurotransmitters.

He demonstrated that dopamine, acetylcholine and an inhibitory neurotrans-mitter called GABA modulated one another in the brain’s motor regions. He found that GABA inhibits dopamine release in both human and nonhuman primate brains. Dopamine is the primary neurotransmitter involved in substance abuse.

After studying brain images of hundreds of drug users, Dr. Dewey began looking for molecules that would block these circuits and stop the rewarding properties that led people to continue searching for and using more drugs. He scanned pharmaceutical libraries for medicines that worked on the reward centers and found one that seemed to have an impressive record of hitting just

the right spots to stop animals from seeking drugs. Now he is working with colleagues at the New York University (NYU) School of Medicine to test the effectiveness of the medicine — an epilepsy drug called vigabatrin — in reducing a person’s craving for cocaine. About 30 million people in the United States have used cocaine, and about one to three million would be considered addicted, experts say. There are no medi-cines approved for cocaine addiction.

Dr. Dewey works with NYU’s Jonathan D. Brodie, MD, PhD, and others to design a study to test vigabatrin in parolees in Mexico who were addicted to cocaine. The volunteers signed on to a double-blind, placebo-controlled study to test whether the epilepsy drug could reduce their cocaine use. In the end, 14 of the 50 parolees who were taking vigabatrin spent the final three weeks of the study with no signs of cocaine use on twice-weekly urine tests, compared with four of 53 who took a placebo. They were also less likely to drink during this same period.

The study was published in the November 2009 issue of the American Journal of Psychiatry.

Drs. Dewey and Brodie have spent more than a decade working on animal models, and now drug abusers, following their initial findings that vigabatrin blocks important reinforcement regions of the brain tied to addiction. The scientists recently received a $1.2 million grant from the US Department of Defense to continue their work in treating human addictions.

“In animal models, vigabatrin works to reduce the use of virtually every addictive substance,” said Dr. Dewey, who works closely with Wynne K. Schiffer, PhD, who also moved to the Feinstein from Brookhaven. The addiction research was conducted at Brookhaven, where Dr. Dewey worked from 1986 until moving his laboratory to the Feinstein last year. In 1998, when he discovered that the epilepsy drug, which had been approved for use in Europe but not in the United States, showed potential to end cocaine addiction.

Dr. Dewey is headlining the speaking circuit at schools across the region — and grabbing kids’ attention by showing scans of how the brain looks on drugs.


A year later, it was used for smoking cessation and then to treat methamphet-amine addiction. The drug was even used to see if it could reduce cravings for high-sugar, high-fat food.

Drs. Dewey and Brodie teamed with a biotech company — Catalyst Pharmaceuti-cal Partners — which has licensed use of the drug for treating cocaine addiction. There is a long way to go before vigabatrin can be used to treat addictions: Much larger studies need to determine dosages and whether it is appropriate for long-term use. In the current study, the only side effect was fatigue.

Dr. Dewey’s research on the addicted brain has led him into local schools to educate young people, parents and teachers on the dangers of drug abuse and its effects on the brain. His lectures and town hall meetings have become so popular that he was asked last fall to speak to the Welfare to Work Commission of the Suffolk County Legisla-ture during a public meeting on a growing network of “sober homes.”

His advocacy has won him the Brookhaven Award for Distinguished Effort in Community Service and the Officer John Jantzen Memorial Award for Prevention from the Suffolk County Coalition to Prevent Alcohol and Drug Dependencies, Inc.

These days, as soon as he’s finished in the lab, he heads to a school to talk to groups of students, parents and just about anyone who will listen. His passion to protect the brain is evident. His slides are damning. “I just hope it helps kids realize that drugs take a serious toll on the human brain, altering the way you think, feel and behave,” he said. “Kids are making decisions to use drugs without knowing — without seeing — the effect on their brain. When they see it in living color, they begin to understand. Then, they begin to talk about their experience. And talking makes them think. And maybe, just maybe, my science will alter the trajectory of their lives. Maybe they won’t have to ever know that ‘this is their brain on drugs.’” n

Images of a normal brain (top) and the brain of a cocaine abuser. Blue indicates missing activity from the brain.

Event Benefits Research, Honors Scientiststhe thomas hartman founda-tion for Parkinson’s research’s seventh annual cure for sure dinner will recognize the achievements of 2009 research grant recipients on June 22 at the crest hollow country club. among the scientists honored: david eidelberg, Md, chief of neurosciences at the feinstein institute for Medical research and the foundation’s executive scientific advisor, and andrew feigin, Md, chief of neurology at the feinstein. emmy award-winning actress susan lucci of All My Children will be the guest of honor. learn more at 631/277-9655 or hartmanfoundation.org.

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 new 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 demographic information or health history. scientists can extract dna from a saliva sample and use it anonymously in research.

More than 3,200 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


hospital news

The North Shore-LIJ Health System recently announced that the Steven A.

and Alexandra M. Cohen Foundation has pledged $50 million for pediatric care pro-vided at the campuses of Long Island Jewish (LIJ) Medical Center and North Shore University Hospital.

North Shore-LIJ’s pediatric hospital, formerly known as Schneider Children’s Hospital, has been renamed the Steven and Alexandra Cohen Children’s Medical Center of New York, in recognition of one of the largest single gifts ever received by the North Shore-LIJ Health System. The contribution by the Cohen Foundation will enable North Shore-LIJ to move ahead with plans to construct a 100,000-square-foot pavilion in front of the existing children’s hospital in New Hyde Park on the border of Nassau and Queens. The nearly $120 million project has been on hold since

December 2008 because of the eco-nomic downturn. Construction is scheduled to begin this spring and be completed in 2013.

The new pavilion will feature: < a Pediatric Emergency Center — the

region’s first dedicated, stand-alone pediatric emergency department;

< a 24-bed Pediatric Intensive Care Unit;

< a 25-bed Medical-Surgical Unit; and

< a state-of-the-art surgery center that will include six operating rooms solely dedicated to children.

Steven and Alexandra Cohen have had a 14-year relationship with North Shore-LIJ. Previously, the Cohen Foundation donated $7 million to North Shore-LIJ to build the new

children’s hospital renamed in honor of steven and alexandra cohen

Alexandra and Steven Cohen have a 14-year relationship with the North Shore-LIJ Health System.

The Cohens’ generosity will allow construction of a new pavilion, shown at left in this architect’s rendering, to move forward.


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.

Pediatric Ambulatory Chemotherapy Unit and establish an endowment called the Philip Lanzkowsky, MD, Professorship in Pediatrics.

“Pediatric healthcare is an issue that is near and dear to our hearts and one that we have supported for many years,” said the Cohens. “The hospital is one of America’s top children’s hospitals and impacts the lives of countless children and families. We hope that our gift will enable the hospital to continue its important work.”

“Earning the Cohens’ confidence and support is a testament to the progress we have made in advancing pediatric medi-cine and the reputation of our children’s hospital in the New York metropolitan area and nationally,” said Michael Dowling, the North Shore-LIJ Health System’s president and chief executive officer. “We are extremely thankful for the Cohens’ extraordinary generosity.”

North Shore-LIJ Chairman Saul Katz expressed his appreciation for the Schneider family’s more than 25-year com-mitment to the hospital and looked for-ward to deepening the health system’s existing relationship with the Cohens. “We’re delighted by the Cohens’ extraordi-

nary devotion to furthering our mission of providing the highest quality pediatric care to our patients. Their donation is a major development and represents one of the largest gifts ever made for pediat-ric care in the United States.”

Arthur Klein, MD, executive director and chief of staff of CCMC and senior vice president for children’s services for the North Shore-LIJ Health System, added, “We’re deeply touched and hon-ored by Steve and Alex Cohen’s support of the hospital. As someone who has known the Cohens for many years, I’ve seen firsthand their deep love of children and family. The new construction made possible by this gift will enable us to develop what will truly be a world-class children’s hospital unmatched in the New York area.”

For three consecutive years, US News & World Report magazine has ranked the children’s hospital as one of the best in the country. Opened in 1983 and known as Schneider Children’s Hospital until March 2010, the facility has nearly 600 affiliated pediatricians, including 120 full-time staff physicians and a total workforce of 1,330, including about 400 nurses. n

Caring for Today, Planning for Tomorrow

if you are age 55 or older, you can receive a fixed income for the rest of your life by making a gift to any north shore-liJ health system hospital or program. a gift of $10,000 or more in cash or stock will provide steady income, part of which is tax-free. for example, if you are 72 years old and donate $10,000 cash, you can lock into a fixed rate of 6.4 percent, and receive $640 of guaranteed annual income, $430 of which is tax-free for about 15 years. You would also be eligible for a charitable income tax deduction of about $3,700 the year you make the gift.

Sample Percentage Rates*one-life rates two-life ratesage % rate ages % rate55 5.3 55/55 4.660 5.5 60/60 5.165 5.8 65/65 5.470 6.2 70/70 5.775 6.8 75/75 6.180 7.6 80/80 6.690 10.0 90/90 8.3*rates are subject to change.

Get a Tax Deduction — and Save for Retirement

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].


hospital news

Patients with chronic wounds can find relief at the North Shore-LIJ Health System’s

new hyperbaric oxygen therapy facility in the Comprehensive Wound Care Center.

The Wound Care Center provides comprehensive, multidisciplinary treatment not only to heal wounds but also to preserve limbs and prevent wound recur-rence. The center is an outpatient program of the Department of Surgery of North Shore University Hospital and Long Island Jewish Medical Center. Among the most advanced in the region, the center offers individualized treatment plans. Specialists on the wound care team include: vascular, general, plastic and podiatric surgeons; certified wound care nurse practitioners; registered nurses; and physical therapists.

Most cuts, scrapes or minor injuries heal on their own and do not require medical attention. However, some people develop

wounds, infections or pressure ulcers that refuse to heal — even after many weeks and months — causing severe pain and disability. Often, these patients are suffering from complications of diabetes, vascular disease, tissue damage from radiation therapy or nonhealing traumatic wounds and need specialized treatment.

“Hyperbaric oxygen therapy offers a high-tech solution to the complex problem of healing chronic wounds,” said Gene Coppa, MD, senior vice president of surgical services of the North Shore-LIJ Health System. “Working closely with referring physicians, the wound care/hyperbaric medicine team develops a customized treatment plan to get patients back to their highest level of functioning.”

Hyperbaric oxygen therapy works by allowing patients to breathe 100 percent oxygen at two to three times greater-than-

normal atmospheric pressure within a monitored, pressurized chamber. This increases the amount of oxygen delivered to the body’s tissues by the blood. The increased blood flow to the wound site improves the body’s response to infection and supports tissue growth and healing. Many wound-healing problems require 30 to 40 hyperbaric oxygen treatments.

The facility is equipped with two hyperbaric chambers and TVs to help patients relax during treatments. An entrance in the underground parking garage at 1999 Marcus Avenue minimizes walking for patients with mobility issues. n

+Chronic wounds can be healed with hyperbaric oxygen therapy

at the Wound care center. to learn more, please call 866/690-2008.

hard-to-heal Wounds Meet their Match by betty olt

ballpark hit

The North Shore-LIJ Health System and the New York Mets cut the ribbon on a new health and wellness information center at Citi Field — the first of its kind in Major League Baseball. Among those participating in the opening of the Health Informa-tion Team (HIT) were members of the Ridgewood/Glendale/Middle Village/Maspeth Little League team and from left, back row: Mets pitcher Johan San-tana; Mets manager Jerry Manuel; Neeta Shah, MD, vice president of women’s health services at North Shore-LIJ; Iris and Saul Katz, president of the Mets and chairman of the North Shore-LIJ Health System; Stacey Rosen, MD, chief of cardiology at LIJ Medical Center; Queens Borough President Helen Marshall; City Councilwoman Julissa Ferreras; and North Shore-LIJ President and CEO Michael Dowling.


More advanced eye surgery techniques and tools will be

available soon at the Lions Eye Bank for Long Island at North Shore University Hospital (NSUH). A recent grant from the Lions Club Interna-tional Foundation matches the $75,000 already raised by local Lions chapters, providing a total of $150,000 toward new equipment for high-tech cornea transplant surgeries.

NSUH helped to revitalize the Lions Eye Bank in 2009 by increas-ing its funding. The Lions Clubs of Brooklyn and Queens (District 20-K1), Nassau (20-K2) and Suffolk (20-S) rose to the occasion by raising the money to purchase much-needed equipment for the eye bank when it relocates to larger quarters at 1554 Northern Boulevard in Manhasset. The new Lions Eye Bank will provide more advanced eye treatments, raise awareness and reach more potential

eye and tissue donors. Construc-tion begins later this year.

The eye bank’s network of more than 100 Lions volunteers assists in bringing corneas to the facility for evaluation and eventually delivering suitable corneas to Long Island hospitals.

“With our new facility, we’ll better serve the community because we can offer more advanced surgical techniques and better access to corneas and tissues,” said Kenneth Manger, director of the Lions Eye Bank for Long Island at NSUH. He said the grant is integral to growing the program, which currently brings in only about 30 percent of the tissues it uses from local donors. “This will put us on the map and help us raise more local awareness of the need for eye, tissue and organ donation.” n

Ken Manger, director of the Lions Eye Bank for Long Island at NSUH, shows a donated cornea to, from left: Al Brandel, chairperson of Lions Club International Foundation; Alvin Brereton, governor of Lions District 20-K1 (Brooklyn and Queens); Samuel Packer, MD, executive chairman of the Lions Eye Bank for Long Island at NSUH; and John Pinnella, chairman of the Lions Eye Bank for Long Island Board of Directors.

lions eye bank to expand by Kristen longo

North Shore University Hospital patients are enjoying the convenience

and service of a new retail pharmacy that recently opened in the hospital’s main lobby.

VivoHealth Pharmacy, the first drug store owned by the North Shore-LIJ Health System, offers prescription and over-the-counter medication and health and wellness supplies at competitive prices. The 1,100-square-foot store offers vitamins, supple-ments, smoking-cessation aids, medical equipment and more. Its computer kiosk allows consumers to order larger items like motorized wheelchairs, and a consultation room lets patients discuss issues with pharmacists privately if they desire.

“Patients leaving the hospital

often have several prescriptions to fill,” said Michael Dowling, North Shore-LIJ Health System’s president and chief executive officer. “The on-site retail pharmacy offers a convenient option. It’s also a natural extension of the continuum of care we provide.”

The VivoHealth Pharmacy is open Monday through Saturday, 7 a.m. to 11 p.m. For more information, call 516/562-VIVO (8486) or visit VivoHealth.com/pharmacy. reVamped gift shopVivoHealth Marketplace, North Shore University Hospital’s renovated and renamed gift store, offers a quick respite and a convenient place to shop. It stocks

more than 1,000 items, including jewelry, flowers, health-related books, gifts for new mothers, developmental toys, health and body care products, mineral-based cosmet-ics, men’s products, tote bags, aromatherapy and seasonal gifts and gourmet snacks. Sales proceeds benefit the hospital. VivoHealth Marketplace is open daily from 9 a.m. to 7:45 p.m. For information, call 516/562-4MKT (4658) or click VivoHealth.com/marketplace. n

nsuh opens Pharmacy, revamps gift shop by betty olt

free e-neWsletterVivoHealth News delivers wellness information and events to your e-mail inbox. sign up at vivohealth.com/news.

+Learn about the lions eye bank at lionsclubs.org or lebli.org.


Colon cancer is a silent killer: It usually doesn’t cause symptoms until the disease is advanced. But early

detection and intervention can reduce mortality by up to 90 percent. Some studies show that colon cancer in the United States has decreased since the adoption of more aggressive screening guidelines.

Colon cancer most commonly strikes after age 50. Generally, gastroenterologists recommend a colonoscopy every 10 years beginning at age 50;

African-Americans, who are more susceptible to colon cancer, should start screening at age 45. For

those with a family history of colorectal cancer, testing should begin at age 40 or 10 years younger than the age

of the youngest affected relative, whichever is earliest.When colon cancer does cause symptoms, it can lead to vague

abdominal pain, constipation, bloating or cramps and fatigue. See your doctor if you experience any symptoms.

know your risk for colon cancer

according to a study in the Journal of the National Cancer Institute, men and women who favor red and processed meat have a higher risk for colorectal cancer. this includes all types of beef, veal, pork and lamb, as well as sausages, bacon and cold cuts.

health bytes

So-called “detox” or “cleansing” plans make a lot of promises: quick weight loss, glowing skin, fewer headaches, a feeling of lightness — even a cure for cancer. “Detox/cleanse” proponents claim that poisons in food, per-sonal care products and the environment get stuck in your organs and hinder their proper functioning. “Detoxes” involve:• severe restriction of food and drink;• herbal supplements; and• colon “cleansing.”

But no scientific evidence shows that such plans work, and diets without variety lack important nutrients. Furthermore, their effects

can even mask symptoms of illness: Reports of euphoria during a “detox/cleanse” belie deficient nutrition that can lead to fatigue, fainting and gallstones. And “detox/cleanse” supplements can cause harmful side effects or interactions with medication.

Rather than a quick fix that’s no fix at all, follow a balanced food plan that incorporates fresh produce, whole grains and low-fat protein every day. And, of course, quit all tobacco. That way, you’ll support the function of your built-in detoxifiers — your liver, kidneys and lungs — the natural way.

Though colon cancer is the fourth most common cancer in adults, you can lower your risk just by exercising, according to the British Journal of Cancer. When research-ers reviewed 52 studies on exercise and colon cancer, they found that the more people ex-ercised, the less likely they were to have colon cancer. The most active folks — people who exercised five to six hours each week — lowered their risk by 24 percent. For overall good health, it’s recom-mended adults get 30 minutes of exercise at least five days a week.

“detox”: detrimental to your health

decrease colon

cancer risk

with exercise


lighten up!

8 oz. crimini mushrooms1 tsp. olive oil1 tsp. butter1 tbsp. low-sodium soy sauce1 tbsp. fresh savory1 tbsp. sherry (optional)

1. Brush mushrooms to remove any soil that may be clinging to them.

2. Trim stems and cut mushrooms in half. Then slice the mushroom halves.

3. Heat oil and butter in a saucepan. Add mushrooms and cook, stirring until they brown.

4. Add soy sauce, savory and sherry. Stir well and cook over medium heat until mushrooms look bronzed.

For a variation, add a tablespoon or two of reduced-fat sour cream. Mushrooms can be served over toast or pasta. Yield: two servings (as a side dish)Each serving provides 111 calories, 8 g fat, 15 mg cholesterol, 275 mg sodium, 7 g carbohydrate, 2 g fiber and 4 g protein.

Bronzed Mushrooms

4 whole portobello caps, approximately 6 oz.

1/2 cup tomato sauce5 oz. mozzarella cheese

1. Preheat the oven to 350 degrees.2. Wipe the caps clean of any dirt and brush

lightly with olive oil. Place them on a baking dish, smooth side down.

3. Fill the portobello caps with sauce and top with cheese.

4. Place in the oven and bake for six to eight minutes or until the cheese melts. Serve immediately.

Yield: four servings Each serving provides 124 calories, 7 g fat, 6 g carbohydrates and 9 g protein.

Portobello PizzaPortobello pizza is a variation of baked stuffed mushrooms.

Mushroom Barley Soup

3 cups fresh mushrooms, any variety1 tsp. olive oil1 tsp. light margarine1 cup chopped onion1 cup quick-cooking pearled barley4 cups vegetable broth2 cups water1 14.5-oz. can petite diced tomatoes1 carrot1/4 cup chopped fresh parsley or

other herb

1. Brush mushrooms to remove any soil that may be clinging to them.

2. Trim stems and cut into bite-sized pieces, remembering that mushrooms shrink when cooked.

3. Heat olive oil and margarine in a large soup pot. Add onion and mushrooms. Stir until onions are wilted and mush-rooms give up their moisture.

4. Add barley, broth, water and tomatoes. Sim-mer for 15 minutes or until barley is tender.

5. Turn off heat. Use a vegetable peeler to put thin strips of carrot into soup. Add parsley. Serve immediately.

Yield: eight servingsEach serving provides 120 calories, 1 g fat, 0 g cholesterol, 199 mg sodium, 25 g carbohydrate, 4 g fiber and 4 g protein.

Mushrooms are “a hidden treasure of nutrition,” according to the American Dietetic Association.

Maximize their flavor, versatility and health benefits with these recipes.

Retail Therapy Helps You and the Community

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

ALI

TY

NORTH SHORE-LIJ HEALTH SYSTEM HOSPITALSNORTH 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 • 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.

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!

do something nice for yourself and your community — just by shopping. during May, stores and restaurants participating in the every woman matters — a partnership for better health campaign will donate a portion of every qualifying purchase to support the north shore-liJ health system’s new Katz institute for Women’s health and Katz Women’s hospital. Vendors include:

• café continental • delicacies gourmet • hermés • invite Me • Kron chocolatier • lonnys • loro Piana • Michael Kors • on three restaurant • ooh la shoppe • Pearl east • Plumm shoppes • syosset travel

the every Woman Matters campaign will continue through october. Visit support.northshorelij.com/shop for regular updates on participating vendors.

so visit an old favorite or try a new place just for fun. together we will change the face of women’s healthcare forever..because women are worth it.

Documents

Vitality Spring 2010