The WATCHMAN FLX™ Left Atrial Appendage Closure Device, which has been used at Valley Health, is FDA approved for use in nonvalvular atrial fibrillation patients who are eligible for anticoagulation therapy. The device improves procedural performance and safety while also expanding the treatable patient population.

Healthcare

Caring for Chronic Conditions

Advanced medical treatments can help those with chronic diseases, but lifestyle choices are also key in preventing and reducing symptoms.

By George N. Saliba, Contributing Writer On Dec 7, 2023

Approximately six in 10 adults in the United States suffer from a chronic disease, and four in 10 adults have two or more chronic diseases, according to the Centers for Disease Control and Prevention (CDC). Major lifestyle risks include tobacco use, poor nutrition, physical inactivity, and excessive alcohol use, although genetic predispositions and other factors may mean that chronic diseases are unavoidable for some patients.

On the following pages, New Jersey Business Magazine highlights select chronic diseases, modalities for treating them, and lifestyle advice that may help prevent these diseases and/or ameliorate their symptoms following onset.

Alzheimer’s and Dementia

The author of several books, including The New York Times best-seller “The Memory Bible,” Hackensack Meridian Health’s Behavioral-Health-Physician-in-Chief Gary Small, M.D., has been studying dementia for decades. He recalls the first treatments for Alzheimer’s-type dementia in the 1990s, which were merely symptomatic treatments and not actually disease-modifying. Flash-forward to today: Modifying-treatment medicines can be now infused into patients’ veins every few weeks to reduce amyloid plaque in the brain.

“The challenge with [all of] these medicines is that the effects are relatively modest, and there are side effects, particularly with the anti-amyloid medicines,” Small explains. “[The medicines] are also very expensive.”

Pharmaceuticals are not the only tools available: Many brain-protecting lifestyle changes can be leveraged before damage even occurs; these techniques can even mitigate certain symptoms once people have dementia. Regular physical exercise, not smoking cigarettes, stress management, and obtaining Omega-3 fatty acids from fish and nuts via a Mediterranean diet can all reduce brain inflammation and, in turn, improve brain health. Separately, special memory techniques can help patients with symptoms.

Small explains, “The further [patients are along] with dementia, the less of an impact [these approaches] are going to have, but it is something I will help people adjust to depending on their level of cognitive decline.”

The future of dementia care is not entirely clear, although Small believes there will be increasingly efficacious drugs with fewer side effects. He’s also hopeful for other approaches: A Hackensack Meridian Health study, for example, is using a medical device to jumpstart neural circuits in patients with mild dementia.

Regarding lifestyle-changes research, Small says: “We [already] have a lot of data there. The challenge is to develop [patient] programs that are cost effective and to incentivize people to change.”

Type II Diabetes

Lifestyles changes can also help control Type II diabetes, a condition which can be identified through simple blood tests, and – according to the Centers for Disease Control and Prevention – impacts some 37.3 million Americans.

Improving one’s diet and engaging in physical activity may be all that’s necessary to control Type II diabetes, says Steven Kaufman, M.D., division head, endocrinology, diabetes and metabolism, and medical director, Urban Health Institute at South Jersey-based Cooper University Health

Care. Eliminating chronic sleep deprivation from, say, sleep apnea, can also help control elevated glucose levels.

American Diabetes Association-recognized self-management education programs can additionally play a significant role in helping people manage their diabetes by promoting lifestyle changes that positively impact glucose levels.

If diet and exercise modifications are inefficacious, oral agents such as Metformin can be administered, and non-insulin injectables are also sometimes prescribed. While insulin is occasionally used early on in some patients, diabetes tends to progress, so many people will require it over time, Kaufman says.

Chronic Cardiac Conditions

Since cardiovascular disease is often linked to obesity as well as sleep apnea, diabetes, and high blood pressure, Ridgewood-based Valley Health System takes a multi-pronged approach to its patients’ cardiac health. This can include upstream interventions in which primary care doctors educate patients on lifestyle habits that can help avoid cardiac care problems in first place. It can also include providing patients with access to nutritionists and health coaches. Supervised exercise programs including formalized cardiac rehabilitation for patients with congestive heart failure, for example, are also available.

Suneet Mittal, M.D., associate chair of cardiovascular services at Valley Medical Group, explains, “We believe lifestyle changes are a core pillar of the management of atrial fibrillation [for example], and, in fact, in almost every visit that we have with a patient who has a disease like atrial fibrillation, we address: What are they doing about lifestyle choices to give us an opportunity for intervention?”

While state-of-the-art pharmaceuticals are ever-evolving, patients are also more actively participating in their chronic cardiac care. By leveraging high-quality smartphone apps, smart watches and other sensors to help monitor their heart rates, heart rhythms, blood glucose levels and sleep patterns, patients can gain immediate insights into their chronic cardiac conditions.

“The provider [and the patient] are equipped with physiologic data that is constantly streaming [information], potentially to [obtain] indices of rhythm and heart failure, so if there is something suddenly trending out of range, [the patient is notified right away], and we can start intervening before a major decompensation occurs,” Mittal explains.

Cancer Care

With more than 200 types of cancer, there often are no easy answers in combating the illness. However, vast cancer research is occurring worldwide. Memorial Sloan Kettering Cancer Center’s (MSKCC’s) Ciara Kelly, MBBCh BAO, is a medical oncologist conducting cutting-edge research by using both liquid and solid tumor biopsies to identify biomarkers that can personalize cancer treatments for patients with sarcomas.

“Ideally, you would have a biomarker that can help you identify who is most likely going to benefit from a treatment, or a biomarker that you can follow to understand if a treatment is helping somebody,” Kelly explains. Her research is specifically examining pathways for targets within the immune system for novel immunotherapy-based drugs.

It’s part of MSKCC’s wide-ranging research and treatment capabilities, of which Kelly says more broadly: “It’s been shown in the literature time and again … that outcomes tend to be better for patients who go to these centers with larger [patient] volumes because [the centers are] more used to managing that. They offer people the best care that’s out there.” Among other services, MSKCC provides associated integrative medicine and social workers for its patients at its multiple New York locations, as well as New Jersey locations in Basking Ridge, Montvale and Middletown.

Cancer prevention/early cancer detection is also on Kelly’s radar. She notes that reducing alcohol intake, not smoking, exercising, consuming a quality diet, using sunscreen and undergoing cancer screenings, such as colonoscopies, are all important.

Mental Illness

Mental illness is a wheelhouse of complexities, and preventing it may not be simple, since its underlying causes can be wide-ranging. Nonetheless, if somebody is mentally ill, S. Tyler Veterano, D.O., M.B.A., ECT medical director at Virtua Health, strives to educate the patient about sleep hygiene/optimizing their sleep, and he additionally inquires about the use of illicit drugs, alcohol, and marijuana.

“If [a patient] is drinking heavily and is excessively depressed, that may be contributing to [their condition],” Veterano explains.

But clean living may not be enough: Patients with various psychiatric diagnoses can require antidepressants, mood stabilizers or antipsychotics on an outpatient basis, in addition to psychotherapy and/or interventional psychiatry. The latter attempts to directly impact a patient’s biology or neurology to improve outcomes such as through electroconvulsive therapy or transcranial magnetic stimulation.

Inpatient psychiatric care is required when patients pose a threat to themselves or others, or when they don’t appropriately manage activities of daily living such as eating and bathing/showering, and therefore pose a threat to themselves in those ways. These patients often undergo medication management in addition to individual or group therapy.

Many people never require inpatient care. Virtua Health’s Veterano says primary care physicians are on the front lines of encountering mental illness in the United States and “they are going to see mental illness before anybody else does.” These physicians may escalate patients to licensed clinical social workers for limited therapy or send them to psychiatrists for medication management.

Balance Disorders

Many Americans also face balance disorder conditions. When the sensation that “the room is spinning” or the “person is spinning” does not stem from cardiac conditions or strokes, it may, in some cases, be caused by vestibular system (inner ear) issues. Patients may also have various medical issues creating disequilibrium and “feel like they are on a boat” or they are “off balance.”

Balance testing and physical therapy can address these symptoms in many cases, according to Todd Rowan, M.D., medical director of the balance center at Vineland-based Inspira Health and a partner at Advanced ENT & Allergy, the latter with 10 locations in South Jersey.

He says, “There’s no reason why you should walk around dizzy or have a fall risk. About 15 years ago, the government essentially made a plea for us to do more balance testing to prevent falls, because people were fracturing hips and had other injuries. A lot of falls can be prevented.”

Certain types of dizziness can sometimes be treated with methods such as asking a patient to hold two playing cards in their hands and look back and forth between the two cards. Rowan says: “If you do that 25 times, you are going to get a little bit dizzy. But if you do that every day, and you practice it, your brain is pretty adaptive; it will get used to it; it will strengthen [and you won’t be dizzy].”

Balance issues are complex, however, and may be caused by blood pressure medications or occur for other reasons, which is why it is crucial for patients to undergo complete evaluations. Whatever the etiology, Rowan recommends that patients eliminate loose carpets in their homes, take everything off the floor that they could trip on, remain hydrated so that their blood pressure does not drop when they stand up, and place grab-handles in various areas of the home, including in the shower.

COPD

Chronic obstructive pulmonary disease (COPD) features injury to the lungs arising from environmental exposures via cigarette smoking, working in mines, working with chemicals, and – typically for people in the developing world – exposure to crude wood-burning stoves and biofuels including oils. Genetic predispositions also play a role.

Amar Bukhari, MD, chief of the division of pulmonary, critical care and sleep medicine, and associate chair, department of medicine, at Saint Peter’s University Hospital in New Brunswick, says, “Early recognition of the disease is very important, and early intervention, especially stopping smoking, is very important.” He adds that seeking care from a specialist is key because they are familiar with various treatment modalities.

Those can include long-acting and short-acting bronchodilator medications, oxygen care, steroids, antibiotics, PDE4 inhibitors, consuming more protein-based foods, as well as lung-volume reduction surgery that can, in effect, remove unhealthy areas of the lung so that healthy lung areas can expand. Endobronchial valve placements, where pulmonologists install valves in areas of the lung that are not especially active, can prevent air that enters those areas from becoming trapped. Lung transplantation is another option. Also: Since COPD patients are at increased risk for developing infections, vaccinations for COVID, influenza and RSV are important.

“[Patients] do have what are called exacerbations of their COPD,” Bukhari says. “The best way to describe this is in terms of not being able to breathe.” He explains that patients may need to be hospitalized and given antibiotics and additional oxygen therapy;hey also may need intravenous steroids or oral steroid therapy as well as frequent bronchodilators by nebulizer.

Chronic Renal Disease (Kidney Disease)

There are many lifestyle techniques that can help renal disease (nephrology), but avoiding nonsteroidal anti-inflammatory drugs (NSAIDS) is important, as is staying hydrated to avoid a pre-renal or “dehydrated” state.

“Blood pressure control is our primary area of focus,” says Marc Zelkowitz, M.D., chief of nephrology, Englewood Health. “We make sure patients are on the appropriate blood pressure medications and [we] counsel them about lifestyle modifications such as a low salt diet, weight loss, and exercise, to help them lower their blood pressure.”

Zelkowitz explains that the “gold standard” for renal replacement therapy (needed when the kidneys are no longer functioning well enough on their own) is a kidney transplant. He says it is not an option for everyone, since some people may not qualify due to medical comorbidities, while others may be interested in a transplant, but do not have a living donor and must remain on a waiting list.

Those patients leverage different forms of dialysis while waiting, and Englewood Health focuses on managing these patients with home-based therapies as opposed to having them visit a dialysis center three times per week.

Zelkowitz explains, “One of our focuses as nephrologists is education both in terms of what chronic kidney disease is, how to slow down its progression and avoiding what we call ‘crash starts of dialysis.’ Crash starts of dialysis refer to patients who [present] at emergency rooms

severely ill with renal failure and [who] have not had appropriate care and counseling for their renal disease as it has progressively gotten worse. We offer chronic kidney disease counseling through a variety of programs that help prevent such cases.” Also, newer medications that offer renal protection may slow down the disease.

Conclusion

Chronic diseases are often preventable in today’s world, where an array of cutting-edge education and research is available via trusted online sources and through highly trained physicians and other experts. For those actually afflicted with a chronic illness, it’s never been a better time to be alive: Medical treatments are continuously advancing in tandem with related technology and are available at leading healthcare institutions.

To access more business news, visit NJB News Now.