Trauma, Shorten Recovery Time
Acid Reflux Sufferers Benefit
The latest in laparoscopic surgery is performed at Trinitas Hospital, Elizabeth. Pictured, surgeon Muhammad S. Feteiha, M.D., (second from right) performs a laparoscopic repair of acid reflux syndrome. He is assisted by James Frost, M.D., (second from left), anesthesiologist Scott Saffran, M.D., (left) and Operating Room Nurse Olga Mcgruder, LPN (right). The surgical team is viewing the procedure on one of two monitors positioned above the patient.Over 40 million Americans suffer from the chronic, painful heartburn associated with acid reflux disease - a condition in which the valve that separates the esophagus from the stomach doesn't close properly, permitting acid to reflux into the esophagus. Until recently, treatment options were limited to either medication or surgery requiring a seven-day hospital stay and six-week recovery.
Now, another option exists at Trinitas Hospital, thanks to the area's only surgeon to undergo advanced laparoscopic training, Muhammad S. Feteiha, M.D. of the Elizabeth Surgical Group. Using specialized equipment purchased by Trinitas Hospital, Dr. Feteiha is able to perform surgery to laparscopically repair acid reflux disease. Following the 90-minute procedure patients remain overnight at the hospital and return to work in as early as one week. Laporascopic surgery replaces the 8-inch incision of traditional "open" surgery with five small punctures that allow a camera and small grasping and cutting instruments into the abdominal cavity. Viewing the surgery on one of two television monitors, Dr. Feteiha immobilizes the top part of the stomach, wraps it around the gastro-esophageal junction and recreates a valve that prevents acid from escaping into the esophagus. Relief from the surgery is immediate, and the long-term success rate is above 90 percent, according to Dr. Feteiha.
"I am very pleased that we are starting to do this procedure laparoscopically, thanks to Dr. Feteiha," stated Benjamin Zamora, M.D., Chairman of the Department of Surgery at Trinitas Hospital. "Acid reflux is a common problem, and this new procedure will bring relief to a great number of individuals who did not want to go through the typical 'open' surgical procedure."
"There are several anatomical reasons that could cause reflux," Dr. Feteiha explained. "The esophageal valve may not be long enough. The patient could also have a hiatal hernia, where part of the stomach protrudes through the diaphragm. Sometimes, the esophageal valve is in the chest and not the abdomen where it should be. The negative pressure in the chest can keep the valve open." One of the theories of the cause of reflux may be overeating which distends the stomach and keeps the valve from closing. "The resulting acid can injure the valve so that even if you don't overeat you can still get acid reflux into the esophagus," he said.
Not everyone is a candidate for surgery, according to Dr. Feteiha. "Acid reflux can be temporary, as when people eat too much during the holidays and experience heartburn only on those occasions. If acid reflux occurs over a prolonged period, however, the lining of the esophagus can become inflamed, putting the patient at a higher risk for esophageal cancer."
"The typical acid reflux sufferer can experience relief from medication, but if the sufferer has constant heartburn and taking medication is an everyday occurrence, then perhaps surgery is indicated," he said.
According to Dr. Feteiha, studies have shown that among chronic sufferers, the surgery pays for itself within two years. "These new medications are very expensive. In fact, some insurance companies pay for certain heartburn medications for just a limited period," he stated.
Olga Mcgruder, LPN, (left), Muhammad S. Feteiha, M.D. (center) and James Frost, M.D. ready instruments for a laparoscopic procedure.The traditional "open" method of performing the surgery was first performed in the 1940's. "There really has been no change in the procedure until the advent of laporoscopic surgery," Dr. Feteiha explained, adding that today a full range of surgical procedures can be performed laporoscopically. "The removal of diseased gallbladders, spleens, adrenals and even kidneys can be done this way. It's pretty much limitless, given a good set of instruments and a proper skill base on the part of the surgeon" he said. One of a number of laparoscopic procedures performed at Trinitas by Dr. Feteiha is a colostomy reversal. "Sometimes, people need to have a colostomy, which is a procedure where a section of the colon is removed and waste exits the body through an ostomy that is created in the abdominal wall. Reversing this procedure typically requires a midline incision, but with laparoscopic surgery a small incision is made in the area of the ostomy - you don't make any other big incisions. The typical recovery from the procedure is shortened from about 5 weeks to 2 weeks."
Following a five-year general surgery residency, Dr. Feteiha underwent a one-year fellowship dedicated to advanced laparoscopic surgery at Columbia University. His general residency took place at the University of New Mexico, Albequerque, where one of the fathers of laparoscopic surgery, Carl Zucker, M.D., practiced.
For these advanced procedures Trinitas Hospital purchased the latest in laparoscopic equipment. These include a variety of tools, including retractors, retractor holders, graspers, dissecting and cutting instruments, light sources and smaller caliber cameras. "Most of the instruments out there are 10 millimeter instruments, but I'm trying to move to all 5 millimeter instruments - which reduces the size of the incision from a half to a quarter inch," Dr. Feteiha explained. Included in this arsenal is the Harmonic scalpel, which cuts and coagulates at the same time. "The Harmonic scalpel uses ultrasound energy to liquefy and seal the smaller vessels during surgery. Without such an instrument we would have to isolate each vessel and put clips on them separately. The Harmonic scalpel saves about an hour of operating time," he added.
Trinitas Hospital is one of a small number of hospitals in the state currently examining this procedure.
"We know that if cancer has spread to the lymph nodes, it will arrive first in the sentinel node," explained Benjamin Zamora, M.D., Chairman of the Department of Surgery at Trinitas Hospital. "The sentinel node is the guardian. If cancer is present anywhere in the local lymphatic system, it will be there in that first node. But during surgery, the sentinel node is difficult to identify, so surgeons typically remove up to 40 lymph nodes in a standard dissection." Lymph node surgery is typically performed immediately following the removal of a tumor that has been found to contain cancerous cells.
"Now, thanks to the use of radioisotopes, doctors can pinpoint the sentinel node before surgery, saving the patient the trauma of a more extensive surgical dissection," he explained.
"Removing one lymph node takes just a fraction of the time, and saves the patient a great deal of unnecessary surgery," explained surgeon Jung Sai Tsai, M.D., who described the technique as "extremely exciting - the patient experiences less trauma, less time recovering from surgery, and less chance of surgical side effects." Dr. Tsai is one of several Trinitas surgeons who are actively exploring the use of this surgery.
"I expect that Trinitas Hospital will be able to offer this option to the general public in the very near future," Dr. Zamora said.
Emergency Department Upgrades
Emergency Treatment Space Will Double
Psychiatric Emergency Service, For Adults & Children
(formerly located at the Jersey Street Campus (former Elizabeth General Medical Center).
If you are in doubt about any emergency - please go to the Williamson Street Campus Emergency Department!
Trinitas Hospital is nearing the completion of a comprehensive construction program that will increase the number of emergency treatment beds to 27 at the Williamson Street Campus, and add a 6-bed "urgent care" center to the New Point Campus. ,br>
According to Hospital President & Chief Executive Officer Gary S. Horan FACHE, "Those needing emergency medical treatment in Elizabeth and Eastern Union County can rest assured that there is a top-quality emergency treatment facility at Trinitas Hospital."
Elizabeth Mayor J. Christian Bollwage concurred. "In terms of bioterrorism, this emergency department will be able to serve the needs of Elizabeth and the surrounding community if God forbid there is a major catastrophe in our area."
Main Emergency Facility
The main acute emergency facility is located at the Williamson Street Campus (former St. Elizabeth Hospital) 225 Williamson Street, where there will soon be 15 acute-care beds, a 6-bedded observation area, a 6-bedded "fast track" area for patients with minor illnesses and injuries, two triage rooms and a decontamination shower facility.
"The purpose of a "fast track" area is to allow for the efficient and timely treatment of patients with non-serious conditions," explained Michelle Weisberger, RN, Director, Emergency Services. "Since there will be 'fast track' staff dedicated to facilitating quick assessment and treatment, these non-serious emergency patients will not have to wait behind more seriously ill patients for care," she added.
Children needing emergency treatment will receive care in an area dedicated exclusively to the care of young patients. Children will benefit from the availability of specialized equipment, and the Hospital's inhouse pediatric physician will be available on a 24-hour basis to consult on children's emergencies.
The 6-bedded observation area will be used for those occasions when a patient needs to await the results of tests that will allow for a diagnosis. "This allows a comfortable area where the patient can be closely observed while tests are being run. By not having these patients wait in a treatment room we can free up resources and move everyone along more quickly," Weisberger explained.
Two radiology rooms located within the Emergency Department will also assist in the prompt diagnosis and treatment of emergency patients. One of the x-ray suites features digital imaging, allowing near instant viewing of test results.
The Hospital's New Point Campus (former Alexian Brothers Hospital) 655 East Jersey Street, features a new, walk-in "Urgi-Center" for minor illnesses and injuries. The facility provides 6 treatment rooms, on-site laboratory and radiology services, and the ability to stabilize and transfer patients who require a higher level of care.
"Easier Access" To Emergency Care
Prior to the establishment of Trinitas Hospital there were emergency departments in place at both Elizabeth General Medical Center and St. Elizabeth Hospital. "Knowing that the Elizabeth General facility would eventually close, we worked long and hard to arrive at a plan that would enhance emergency services and place them where they are most needed. This multiple site system achieves our goals, and furnishes easier access to the most appropriate level of care," explained Paul Jordan, M.D., Chairman of Emergency Medicine at Trinitas Hospital.
Responding to the Call Members of the Trinitas Hospital Mobile Intensive Care Unit (pictured, left to right: Rafael Jimenez, Clinical Coordinator, Mobile ICU; Art Kharonov, Paramedic; Rich Tomshaw, Paramedic; and David Schmid, Director, Mobile ICU) pause outside their headquarters on Morris Avenue, Elizabeth. The Mobile ICU essentially brings the Emergency Department out to emergency situations in the community. Paramedics are trained to perform a wide variety of services such as physical assessment, cardiac monitoring, intravenous therapy, advanced airway management and cardiac pacing. In 2001, Trinitas Paramedic units responded to 6,377 emergencies. Members of the Mobile ICU are also involved in a wide variety of training programs for all levels of healthcare professionals and the community.
A New Setting For Psychiatric Emergency Care
The adult and child/adolescent psychiatric emergency service is now located at the New Point Campus. "This service, which had been located at the former Elizabeth General Medical Center, provides emergency screening, treatment, crisis intervention and stabilization to adults and children experiencing mental illness," explained James Lape, Vice President/Behavioral Health & Psychiatry at Trinitas. Six evaluation beds are available for medication monitoring, observation and crisis resolution. This emergency element serves as the State designated screening service for involuntary hospitalization for Union County residents.
The new psychiatric emergency location offers separate entrances and treatment areas for adults and children/adolescents. It is located at the front of the building, to the right of the main lobby. The Emergency hotline number is (908) 351-6684.
The Department of Behavioral Health & Psychiatry is a regional provider of a full range of inpatient and outpatient care for seniors, adults, adolescents and children. The staff provides expertise in the areas of individual, group and family psychiatry, psychological assessment and testing, and creative arts therapies. The intensity of treatment ranges from acute inpatient care to outpatient services. For more information please call (908) 994-7452.
Department of Defense Bioterror Training
Trinitas Hospital was the first hospital in New Jersey to undergo an intensive two-day bio-terrorism training by the US Department of Defense Casualty Care Research Center. The hands-on training program, entitled: "Responding to Weapons of Mass Destruction for Healthcare Facilities," was designed to prepare hospital staff and facilities for a large-scale event involving biological or chemical weapons.
According to Gary S. Horan FACHE, President and CEO of Trinitas Hospital, "Most hospitals are equipped to handle a small number of bioterror casualties that may arrive in their emergency department. Given our metropolitan location we had to ask ourselves, 'what would happen if 50 or 100 victims arrived at our Hospital?'" He explained, "Our goal is to work closely with City, County and State emergency management personnel so that we are prepared for any type of possible bioterror attack. As the only hospital in Elizabeth and Eastern Union County, we feel especially compelled to be ready for a large number of casualties if the worst should come."
A total of 50 individuals participated in the training. These included Hospital staff such as emergency and infectious disease physicians, registered nurses, and staff from such areas as the Emergency Department, Pharmacy, Laboratory and Security Departments. Also participating were representatives of the Elizabeth Fire Department.
The training covered such areas as: Protecting Your Facility; Preparing Your Facility; Medical Aspects of Biological/Chemical Agents; Personal Protective Equipment; Decontamination Issues, and Skill Stations. In addition, the Department of Defense team evaluated the Hospital's policies and procedures, and will make recommendations on additional equipment and supplies to have on-hand.
The training was part of a comprehensive Bioterrorism Task Force that was established at the Hospital to enhance preparedness throughout the facility, and to coordinate with City and State emergency management officials.
Trinitas Hospital has enhanced its bioterrorism preparedness through a number of recent developments, including the unveiling of the first phase of its emergency department construction/renovation project. Included in the new facilities is a large new decontamination shower room. When completed early next year the emergency department will have double the treatment capacity of the former facility. Mr. Horan explained, "In addition, we have six Board Certified infectious disease specialists on staff at Trinitas - a very good number for a hospital this size. They are extremely well-trained and they are helping all of our staff get to the peak of readiness," he added.
Form County-Wide Grief Counseling Network
Trinitas Hospital lead an area-wide approach to help meet the heavy demand for grief and anxiety counseling in Union County following the World Trade Center disaster, announced Gary S. Horan, President and Chief Executive Officer.
"Through our Department of Behavioral Health & Psychiatry we worked closely with the County Mental Health administrator, Jim Eddleton, to put in place a response that includes coordinating the outreach efforts of all the major mental health agencies in the County," Horan said. James Lape, Vice President/Behavioral Health & Psychiatry at Trinitas Hospital, explained, "Our aim was to be able to meet the needs of people in Union County for grief counseling by quickly identifying and prioritizing those affected." Lape said that the effort also involved developing a pool of professionals available to go out to locations such as schools and worksites on short notice.
"We know from recent tragedies like the Oklahoma City bombing that the expression of grief and anxiety takes several phases and extends for many weeks and months," Lape said, indicating that the effort is addressing both the short and long-term psychological effects of the disaster.
The Hospital's Family Resource Center can be reached at (908) 276-2244, ext. 14. Callers may also use the Trinitas Crisis Hotline (908) 351-6684.
William Farrer, MD (center), Academic Chief of Infectious Diseases and Associate Program Director of the Residency Program at Trinitas, was a featured speaker at a community forum held at Schering-Plough recently. The program, entitled, "Public Health Issues & Concerns in the Aftermath of September 11th" also featured Dr. George DiFerdinando (right) Acting Commissioner, New Jersey Department of Health and Senior Services, and Dr. Allan Rosenfield, Dean, Mailman School of Public Health, Columbia University.