Monmouth's Ask the Doctor January-February 2020

Monmouth County’s Ask The DOCTOR THE HEALTH &WELLNESS MAGAZINE F R YOU ANDYOUR FAMILY WINTER ISSUE JANUARY/FEBRUARY 2020

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Leading Interventional Pain Specialist Dr. Jagjeet Singh Joins Altair Health at New Freehold Office Healthcare system devoted to comprehensive spine care grows bench of pain management experts

With the addition of interventional pain specialist Jagjeet Singh, MD and the opening of its new office in Freehold, Altair Health – one of the nation’s first physician-managed healthcare systems devoted to compre- hensive spine care – continues to expand as it revolutionizes spine care for patients in New Jersey. Dual Board-certified in interventional pain medicine and anesthesiol- ogy, Dr. Singh specializes in treating all types of chronic pain, complex regional pain syndrome and failed back surgery syndrome. He is a key opinion leader in neuromodulation, including spinal cord stimulation and neuromodulation for diabetic neuropathy and chemotherapy-in- duced neuropathy. Dr. Singh is seeing patients at Altair Health Freehold, located next to CentraState Medical Center in the Ambulatory Care Center at 901 West Main Street, Suite 240 in Freehold. It is the healthcare system’s second office in Monmouth County and 10th location in New Jersey, which also includes a state-of-the-art spine center in Morristown and a surgery center in Florham Park.

“Back and neck pain can be completely debilitating, and being able to alleviate that pain – which some patients battle for far too long – is in- credibly rewarding,” says Dr. Singh. “What’s more, pain management can be even more effective for patients when it’s part of a comprehensive, coordinated approach to care. That’s exactly what Altair Health delivers.” Dr. Singh joins a distinguished group of pain management experts at Altair Health who collaborate with the healthcare system’s full team of spine specialists – including neurosurgeons, physical therapists, clinical psycholo- gists, physiatrists, wellness specialists and more – to manage each patient’s care from start to finish. “We’re proud to have some of the most progressive physicians specializing in spine care at Altair Health,” says Dr. Chris Valerian, COO of Altair Health. “Not only is Dr. Singh on the cutting edge of interventional pain manage- ment, he puts his patients at the center of everything he does, making him a natural fit as we deliver a convenient, patient-centric experience from end to end.” Prior to joining Altair Health, Dr. Singh spent 10 years practicing pain management at a private practice in New Jersey. Altair Health is one of the nation’s first physician-managed healthcare systems devoted to comprehensive spine care. Headquartered in Morristown, NJ, a team of spine specialists – including neurosurgeons, physical therapists, pain management specialists, physiatrists, wellness specialists and more – collaborate and leverage the power of integrated, evidence-based care for improved outcomes. Learn more at AltairHealth.com. Dr. Jagjeet Singh

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The History of Quinine By Pam Teel

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Until the 1940s, quinine was the go-to way to treat malaria infections. Its history is one tightly entangled with the history of European empires, and their quests for domination in the malar- ia-ridden areas of the world. The history of this drug, and the plant it derives from, stretches the globe, from the Andean jungles of South-America to the global network of British botanical gardens, from the colonial plantations of Southern-India, to the Indonesian island of Java. Quinine is extracted from the Cinchona tree that is native to the Andean regions of South America. It was used as a treatment to treat malaria infections. The disease seems to have been introduced into America by seafaring Europeans. By the time Europeans reached and colonized the Andes the indigenous population already used the bark of the Cinchona tree to treat malar- ia and other types of fever. Malaria had spread faster than the European colonizers could. (Note that at this stage the bark itself was used as a medicine, the chemical processes to extract the quinine from the bark were only invented later.) The European colonizers first sent the bark to Europe around the 17th century, probably by way of Jesuit missionaries. It provided a superior cure to a variety of fevers prevalent in Europe, particularly in its swampish regions. The bark was ground down into a powder and then mixed with wine to counter its bitter taste. Problems with dosage and classifying exactly which tree yielded the correct bark hampered its use as a medicine. In 1820, French scientists Pierre Pelletier and Joseph Caventou discovered the process to extract quinine from the Cinchona bark, which improved the potency of the medicine markedly. The discovery came just in time for European empires, as they were expanding into malaria-ridden parts of the world. They needed enough bark to supply their armed forces with quinine. Thus began an arms race for the precious bark among European powers. Several newly independent South-American republics, however, controlled supply of Cinchona. After their independence from Spain in the early 19th century, they inherited the monopoly on the exploitation of the Cinchona tree. The Republics of Peru, Ecuador, Colombia, and Bolivia jealously guarded their monopoly of the crucial Cinchona trees. They imposed strict export restrictions on seeds and plants, while gaining significant profits from exporting the bark. European powers, particularly France, Great Britain and the Netherlands, needed the bark and wanted to break the South-American monopoly. So they sent out several expeditions to procure seeds and plants, often by smuggling them out illegally so they could be replanted in colonial plantations. It was Charles Ledger, who with the help of a local, managed to procure seeds from the Peruvian/Bolivian border for a species of Cinchona whose bark contained up to 10% quinine (a significant improvement over other species). In 1865 these were sent to London, where the British government showed little interest in them. They were eventually sold to the Dutch who cultivat- ed and improved the species in their colony of Java (now Indonesia). This species was called Cinchona ledgeriana in honor of Charles Ledger, and formed the subsequent basis of much of the world’s supply of quinine. Sadly the local who helped Ledger steal the seeds was imprisoned, beaten, and later died from his wounds. In America, during the Civil War quinine was the closest thing to a miracle drug known to Civil War physicians. Malaria, yellow fever, and other tropical diseases had several symptoms in common, including fevers, chills, and nausea. In the early stages of these diseases, Southern Civil War physicians gauged the illness by the frequency of recurring fever, hence “intermit- tent,” “remittent,” “tertiary,” or “quotidian” fevers. Physicians of the time did not connect mosquitoes to malaria, but they did know quinine was a sure way to ease its symptoms. The problem was getting and administering the drug, especially getting it in quantity. Sadly, the South struggled through the war years with what quinine it could smuggle or capture. It was a different story for the North, which had excess quinine. Philadelphia-based Zeitler and Rosengarten had the foresight to hire French chemist, John Michael Maisch, who first isolated the alkaloid from cinchona bark and within three years of the discovery was selling quinine. They obtained cinchona in bulk at low cost and processed it to obtain the quinine, which was then extracted into sulfate. Maisch, working for the Union army, ensured the purity of the drug, developed standard doses, and oversaw the packaging and labeling of the drugs for distribution to the army medical depots. Today, quinine is rarely used for medicinal purposes. It's not used to prevent malaria, but rather to kill the organism respon- sible for the disease. When used to treat malaria, quinine is given in a pill form. It is still sold in the form of quinine water or tonic water, which is consumed around the world as a popular mixer with spirits such as gin and vodka. The FDA recently banned its use as a cure for leg cramps due to the negative side effects that can result from ingesting large amounts, such as headaches and fever. Some bad reactions to quinine have even been fatal, but don't let that stop you from or- dering a gin and tonic next time you're at the bar, because tonic water contains very low levels of quinine. A glass of tonic water holds roughly 20 mg of quinine, whereas a dose for the treatment of leg cramps would be in the 200 to 300 mg range.

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OUR DEPARTMENTS Doctor Advice ..........................................................5 Kids’ Health & Camp ........................................... 11 Information, news and expert advice to raising healthy children from pregnancy to 18 Diet and Excercise .............................................. 18 Healthy Mind & Soul ..........................................24 Inspirational stories and advice on achieving mental balance and clarity As We Age ...........................................................27 Articles and physician information just for seniors I Am Beautiful .....................................................37 Men’s Health ...................................................... 40 Doctor Profiles ...................................................... 42 Physician information, including credentials, to help you choose a doctor or find out more about a doctor that you go to now The Healthy Palate .............................................43 Recipes to enjoy and local dining options for eating out Healthy Home .....................................................47 Here you will find expert tips to make your home healthier, safe and fabulous Financial Health ................................................52 Information, resources and news related to the health and well-being of your financial future

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Murphy signs Dancer bill making prescription drugs more affordable by eliminating clawbacks and gag clauses

Under a new law signed by Gov. Phil Murphy and sponsored Assemblyman Ron Dancer, prescription drug costs will be more affordable and transparent by elimi- nating controversial practices known as clawbacks and gag clauses. The bill (S2690/A3993/A2214) prohibits pharmacy benefit managers, the mid- dleman that manage the prescription drug part of health insurance plans, from charging a copay that exceeds a drug's cash price and keeping the difference, a practice called clawbacks. It also removes gag clauses that prevented pharmacists from telling their customers about lower price options.

“Pharmacy benefit managers have been holding consumers and pharmacists hostage. This law will do away with the games,” said Dancer (R-Ocean). “Patients who need prescriptions for their health should not be subjected to profit-motivated deception.” One study found nearly one-quarter of all insurance copays exceeded the price the pharmacy had negotiated for the same drug by at least $2. An NBC News investigation found these clawback schemes often targeted a wide variety of generic drugs that treat diabetes, blood pressure, cholesterol, depression and anxiety. “The deck is stacked against prescription users who have no idea this is going on,” said Dancer. “The gag clause prohibits the pharmacists from informing their customers of this scheme. That’s not acceptable. Nobody should pay more for required drugs because they are insured.” Under the new law, pharmacists are now required to tell people how much their prescriptions cost, including cheaper options to purchase without insurance. It also directs the Division of Consumer Affairs to develop a public awareness campaign on pre- scription costs and consumer rights. New Jersey joins more than 30 states that have enacted laws prohibiting gag clauses and at least 20 others that outlaw copay clawbacks.

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Can Vaping Be Deadly? Your Questions Answered By Nirav N. Shah, DO, FACCP

D O C T O R A D V I C E Is it safer than smoking cigarettes? While initially vaping was marketed to consumers as a safer option than cigarettes, it does still deliver nicotine to the lungs and can cause lung inflammation. Vaping should not be used as a substitute for smoking. In fact, research shows that e-cigs encourage people to smoke, not help them quit. There is no solid evidence to suggest that vaping is safer than smoking cigarettes. What is THC? THC, or tetrahydrocannabinol, is a natural compound found in cannabis plants. It is the main psychoactive compound in marijuana. While THC can be accessed by smoking marijuana, the compound also is available in oil form, which can be used in vapes or e-cigarettes. The substance causes a chemical inflammatory reaction in the lungs. Most people who have experienced vaping-related illnesses used vap- ing liquid that contained THC oil. We aren’t sure why THC seems to affect the lungs more severely. How does flavored vaping liquids affect the lungs? The base of all vaping liquids is a combination of propylene glycol and vegetable glycerin. To this base, liquid manufacturers add flavors that while deemed safe for food, aren’t meant to be smoked and inhaled. We simply don’t have enough information about how the body reacts when flavoring chemicals are inhaled instead of ingested in smaller quantities in a food product as originally intended. What are the symptoms of a vaping-related illness? Vaping can cause a variety of health issues, including: • Coughing • Shortness of breath Some patients develop symptoms over a few days, while others notice symptoms over the course of several weeks. A lung infection does not appear to be the cause of these symptoms. How are these illnesses treated? Unfortunately, many of these cases are being misdiagnosed as pneumonia and patients are being prescribed antibiotics, which won’t help the condition. The recommended first course of treatment for a vaping-related illness is steroids, which suppress the immune reaction taking place in the lungs. If you vape and are having health issues, contact your primary care physician, who can determine if you need to see a specialist, such as a pulmonologist, for treatment. Your primary care physician also can refer you to smoking cessation services to help you quit. Are teens more at risk of developing a vaping-related illness? The brain keeps developing until about age 25. Using nicotine in adolescence can harm the areas of the brain that control learning, at- tention, mood, and impulse control. According to JUUL, an e-cig manufacturer, a single JUUL pod contains as much nicotine as 20 regular cigarettes. About 37 percent of high school seniors say that they vape, up from 28 percent in 2017. An estimated 3.6 million middle school and high school students reported using e-cigarettes in 2018. This is particularly troubling because the lungs and brains of adolescents are still ma- turing, meaning that nicotine and THC can affect brain and lung development. A secondary concern is that according to research, adolescents who use e-cigarettes may be more likely to smoke cigarettes in the future. As a parent, should I be concerned? Vaping is popular with adolescents because it’s easy for teens to buy vaping products. Vapes, particularly those that are marketed to teens like JUUL, look like USB cartridges, so they are small, easy to hide – and easy to use. Additionally, children have been poisoned by swallow- ing, breathing, or absorbing vaping liquid through their skin or eyes. I’ve seen about seven patients so far with vaping-induced lung disease. All of those patients were under age 30 and about half came into the emergency room without a parent. I advise parents to discuss these products with their children. Let them know that vaping can be addicting. And while we don’t know that vaping causes cancer, we don’t know for sure that it doesn’t. Until the U.S. Food and Drug Admin- istration rules on the safety of vaping, we need to get the word out to adolescents about the dangers before this trend becomes an epidemic. Nirav N. Shah, DO, FACCP, is board-certified in pulmonary medicine and critical care, and is on staff at CentraState Medical Center. He can be reached by calling 866-CENTRA7. • Chest pain • Nausea • Vomiting • Diarrhea • Fatigue • Fever • Abdominal pain What is vaping? Vaping is when a person uses a vape or e-cigarette to inhale nicotine. Vapes are battery-powered devices that heat a nicotine-containing liquid to produce an aerosol that is inhaled. The liquid is usually flavored with fruit or other sweet flavorings. Is vaping safe? No, vaping is not safe as it has been shown to cause inflammation of the lungs. In fact, as Oct. 1, 2019, 1,080 patients have sought treatment for vaping-induced illnesses in the United States. Nearly 20 people have died in 15 states, and in 80 percent of those deaths, the person was under the age of 35.

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Three Strategies to Successfully Stick to New Year Resolutions, and What to do if You Get Derailed By Ankur Desai, MD With a new year in full swing, it is often a perfect time for introspection on our lives, and we find ourselves motivated to make significant changes with the goal of making ourselves better, more successful people. These changes can vary widely, from changing our image physi- cally, to thinking about how to succeed in our careers or personal lives, to how we can make ourselves “better” people in regard to values, character, or personality. The bottom line is that although the motivation to make these impactful changes is admirable and comes from a positive space in our heart and minds, following through and maintaining substantial changes in lifestyle and personal character takes hard work, dedication, and discipline. To help improve your chances of making big resolutions stick, and stick for good, and to get back on track if you fall off course, I suggest these three simple strategies: 1. Keep it simple The chances of successfully making a change increase if you start with a smaller, realistic goals and establish bench- marks with associated rewards and validations along the way. The classic New Year resolution is getting in shape or losing weight. Depending on how much weight you are trying to lose, this goal can be overwhelming if you look at it all as one big number. For example, my brother wants to lose as much as his 4-year-old son weighs, which is 36 pounds. This is a significant amount of weight and I admire his drive and motivation. My proposed strategy is to break up the year into four quarters and divide up the total number of pounds you would like to lose by each quarter. For a 36-pound weight loss overall goal, strive to lose 9 pounds every three months. This is a more digestible, realistic goal. The good thing is if you implement successful strategies in the beginning of the year and you hit the goal after the first three months, you are well on your way to continuing to meet your goal for the next three months. What happens if you fall off track or don’t hit your goal? This is not a loss in any way, shape, or form. Focus on what went right and what worked, and what did not. Ask yourself if the goal is realistic or needs to be reevaluated? A goal needing to be re-adjusted is not a failure if there is a positive trend towards improvement or achieving the goal. You do have to go through the mental exercise of self-evaluation and determine what worked and what didn’t. Both are going to be equally important to know and understand for long-term success. 2. Be Visual and Objective Many people are focused on self-improvement, and the start of a new year is a great opportunity to set a goal for personal growth and development. An example is improving relationships with family and friends, or maintaining a more positive outlook towards daily life, or even practicing and effectively implementing strategies to manage anxiety and stress. These resolutions are difficult to measure. However, what I suggest is developing visual or objective aides and measures to help you remember your ultimate goal. Think about setting up specific deadlines to make connections with people that you want to reconnect with or improve your relationship. For example, write down the relationships you want to focus on, and on your calendar mark the deadline to contact those people. If making the change to have a more positive outlook is your goal, consider keeping a journal and writing down the times each week where you caught yourself thinking negatively or being doubtful, and how you were able to reframe your thinking into a more positive slant. The more you are able to visually track these instances, the more mindful you will become about thinking positively. After time, the more frequently you implement the change to positive thinking, it will become a natural, unconscious process. What happens if you don’t reach your goal? Again, don’t think of any shortcomings in the process as a loss. Focus on what you were able to do and stick to, and what ended up being too much to write down or practice. Once you understand what was above and beyond your scope, you can establish where to start in terms of positive progress. Re-adjust your goal to increase your chances of meeting your set dead- line and timeframes. Even small improvements can lead to significant changes in personal growth and development over time. Remember that a larger goal has to be broken down into smaller, measurable goals that can be set on a weekly or monthly basis. 3. Be Practical and Practice Assertiveness At the beginning of a new year, some of us have the opportunity to reflect on our ca- reers. Annual self-appraisals and performance reviews that are embedded into our work culture often train us to think about it. We often ask ourselves, “What’s the next step in advancing my career?” or “How do I work my way up and potentially earn a bigger paycheck?” The truth of the matter is, this goal may be too abstract or unachievable because of personal circumstances, including geographical constraints, limitations in experience and qualifications, or commitments to family and household responsibilities. I suggest thinking about the circumstances that limit you and develop a strategy to address each limitation. For example, if it’s experience and qualifications that you’re missing, create a specific plan to get them. Set deadlines for speaking with mentors and colleagues about career advancement. If family-related factors limit your career advancement, schedule time to have a heart-to-heart conversation with your partner. Finally, if the limiting factor is approaching the topic with your boss, schedule a meeting with him/her to discuss a promotion. Write down talking points that you want to discuss. Practice or “role play” what you would say in the meeting, including your strengths and abilities. What happens if you don’t obtain this goal? Perhaps you didn’t make the deadlines you set for yourself or the meeting with your spouse or boss didn’t go the way you intended. Keep in mind that this may have been the first time you approached these goals, but it doesn’t have to be the last. The more you get into the practice of thinking practically, setting timeframes and deadlines, and asserting yourself effectively with authority figures, the better you are going to get at doing it. Practice makes perfect.

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K I D S ’ H E A L T H & C A M P With ARFID, foods may be avoided based on physical characteristics such as texture, smell, and appearance, or based on past negative experiences like choking or vomiting. ARFID is a new addition to DSM-5, the official list of psychiatric diagnoses. Before this addition, it was classified under feeding disorder of infancy or early childhood, or eating disorder not otherwise specified. 2. ARFID CAN CAUSE SERIOUS HEALTH ISSUES. One of the most common results of ARFID is significant weight loss, or failure to gain weight and grow, for those who should be in a growth spurt. Significant levels of nutritional deficiency may require higher levels of care for medical stabi- lization. 3. ARFID PATIENTS ARE NOT CONCERNED WITH WEIGHT LOSS OR BODY IMAGE. Even though weight loss is a frequent sign of ARFID, it’s important to note that this isn’t the reason for avoiding food. The lack of a preoccupation with body image or a fear of gaining weight is one way that ARFID differentiates itself from other eating disorders, such as anorexia nervosa and bulimia nervosa. Despite this, the consequences of ARFID may be just as severe. 4. ARFID MAY OCCUR IN PEOPLE OF ALL AGES AND GENDERS. While ARFID is more often diagnosed in children and adolescents, it may occur in adults. This might include those who went untreated as children and have a long pattern of selective eating based on sensory concerns or feelings of disgust with new foods. While some eating disorders are more often found in females, ARFID is much closer to an even split or possibly even more common in males than females. 5. MANY PEOPLE WITH ARFID HAVE CO-OCCURRING CONDITIONS. It is common for people who are diagnosed with ARFID to have co-existing anxiety, mood disorder, or other condition, such as autism spectrum disorder. If a medical condition that impacts appetite or eating is present, the degree of food avoid- ance must go beyond what would be expected for the medical condition to be classified as ARFID. 6. ARFID HAS PSYCHOLOGICAL AND PHYSICAL WARNING SIGNS. More Than Picky Eating: 7 Things to Know about AFRID Most parents can attest to the difficulty of get ing kids to try new foods. Picky eating is nothing new, but what happens when it involves many foods, never goes away, or gets worse? Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder involving an extreme avoidance or low intake of food. Dr. Julie Lesser, MD, child and adolescent psychiatrist at Rogers–Minneapolis, shares seven facts that you should know about ARFID. 1. ARFID IS DIFFERENT THAN PICKY EATING. While picky eating and ARFID may have certain similarities, ARFID is differentiated by the level of physical and mental distress that eating causes. Someone with ARFID may have difficulty chewing or swallowing and can even gag or choke in response to eating something that gives them high levels of anxiety. The anxiety can also cause them to avoid any social eating situation, such as a school lunch or birthday party.

Psychological signs can include: • Fears of choking or vomiting

• Limiting food intake to particular textures • Complaints of upset stomach or feeling full around mealtimes

• Lack of interest in food or appetite • Picky eating that becomes worse Physical signs can include: • Stomach cramps and other gastrointestinal complaints • Cold intolerance

• Dizziness or fainting • Sleep-related issues • Fatigue

• Menstrual irregularities • Difficulty concentrating 7. TREATMENT FOR ARFID IS EFFECTIVE.

Despite ARFID being a recent addition to DSM-5, there are already effective treatment practices in place. One such treat- ment method, cognitive behavioral therapy with a specific focus on exposure and response prevention has been shown to help patients learn coping skills for long-term recovery. Julie K. Lesser, MD, is a board-certified child, adolescent and adult psychiatrist with the intensive outpatient and partial hospitalization programs at Rogers Behavioral Health–Minneapolis. Dr. Lesser is certified in family-based treatment for eating disorders and in the child and adolescent unified protocol for emotional disorders. In addition, she completed intensive training in interpersonal therapy, dialectical behavior therapy and cognitive behavioral therapy-enhanced for eating disorders. She has a special interest in treatment development for Avoidant/restrictive food intake disorder (ARFID).

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Fast Food Facts And Its Effect On Kids Regular Fast Food meals also contribute to Poor Academics. Fast food can lead to impaired academic performance because high sugar levels followed by sugar crashes and poor concentration levels make it difficult to accomplish tasks which need extended periods of focused attention. Blood sugar fluctuations can also result in mood swings and lack of alertness, lowering classroom participation.

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Drs. Segal, Shriver, Rho, Meirowitz, Osias and Bellows provide patients with timely, compassionate, high quality care for their digestive ailments. If you would like to arrange a consultation with one of our physicians, call us at 609-924-1422 Princeton Endoscopy Center provides services (colonoscopy, upper endoscopy) that can detect early signs of colorectal cancer and can help doctors diagnose unexplained changes in bowel habits, abdominal pain and bleeding and weight loss. Our goal is to

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15 Benefits of Breastfeeding for Mom and Baby By Lysanne Loucel, MBA, IBCLC You’ve probably heard that “breast is best.” In addition to being a catchy phrase, it’s true: there are a number of benefits for both mother 1. Breast milk contains live immunity. When a baby consumes breast milk, he or she receives both immediate and lifelong immunities. 2. Breast milk provides the specific nutrients that meet your baby’s needs. It’s pretty amazing: Your milk supply will fluctuate based on your baby’s demand. Your baby will communicate what she needs from your body, and your body will then produce the quality and quantity of milk to meet those requirements. 3. Breastfeeding can reduce your baby’s risk of sudden infant death syndrome (SIDS). While the American Academy of Pediatrics recommends that mothers breastfeed for at least one year, research shows that breastfeeding as little as two months cuts the risk of SIDS in half. 4. Breastfeeding allows babies to feel close to the “home base” that they’ve known while in the womb. Hearing your heartbeat and feeling your warm skin will help her transition from the inner world to the outer world. 5. Docosahexaenoic acid (DHA), a polyunsaturated fatty acid found in breast milk, helps support proper brain development. 6. Breastfeeding can reduce your baby’s risk of developing middle ear infections. 7. Breastfeeding can reduce your baby’s chances of developing allergies. 8. Breastfeeding can reduce your baby’s risk of developing diabetes, since breast milk contains no artificial sugar. Breastfeeding also can benefit mom: 1. Reducing her risk of developing osteoporosis 2. Reducing her breast cancer risk 3. Reducing her ovarian cancer risk 4. Producing oxytocin, which helps contract the uterus back to its pre-pregnancy size 5. Burning calories and using mom’s fat stores for her breast milk 6. Lowering her chance of developing postpartum depression, since breastfeeding enables pregnancy hormones to decrease slowly, instead of abruptly Breastfeeding isn’t always easy. It may take time for new moms – and new babies – to learn this skill. Many women of childbearing age weren’t exposed to breastfeeding, either because the women in their lives didn’t do it, so for many, it’s a new concept. And, sometimes difficulties will arise. You’re exhausted and sore from delivering, and your baby will likely want to eat several times a night in the middle of the night during the first few weeks. Your baby’s belly is about the size of a nickel. She needs small, frequent feedings during the first couple of weeks. In fact, a typical breastfed baby will eat eight to 12 times in a 24-hour period. It may feel like your baby isn’t getting enough milk, but a lactation consultant can provide you with the tools to determine how well your baby is feeding. You may think that you’re not producing enough milk, but you will. It’s important not to supplement breastfeeding with formula. I advise new moms not to use bottles, pacifiers, or pumps for the first four to six weeks, as these interventions will interrupt the supply and demand-driven process. Another time breastfeeding can be challenging is when your baby is not latching properly. A good latch means better milk transfer for her and less pain and discomfort for you. If you’re still experiencing nipple pain for more than two minutes into a feeding after two weeks and baby for those who choose to breastfeed. The Benefits of Breastfeeding for Baby 7. Saving money, since breastfeeding is free! Why Breastfeeding Can Be Challenging A partner who wants to be supportive can offer to take something off mom’s to-do list, like laundry or making sure mom has something to eat. There’s a great opportunity for bonding time for the other parent, like making bath time with baby your special time together. It’s important for the non-breastfeeding partner to also bond with the baby. What If I Don’t Breastfeed? We’re all entitled to our individual choices. A woman might choose not to breastfeed or is unable due to illness, medication usage, breast surgery or other personal reasons. Breastfeeding is a personal choice. It’s our job as medical professionals to support new moms through this journey, no matter what that is. If you’re unable to breastfeed or prefer not to, your body still will produce milk, but it should dry up quickly. A lactation consultant can help you understand this process. If you’ve decided breastfeeding is right for you and your family, a certified lactation consultant can provide the clinical guidance and support you need. A support group also may be helpful. CentraState Medical Center offers a free breastfeeding class every Friday. Any amount of breastfeeding is beneficial. Be patient and ask for help if you need it. It can be a lot of work in the beginning, but the benefits are worth it. Lysanne Loucel, MBA, IBCLC, is a board-certified lactation consultant on staff at CentraState Medical Center. She can be reached by calling 866-CENTRA 7. of feeding, contact a board-certified lactation consultant for help. How Can a Partner Support a Breastfeeding Mother?

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TENDER SMILES You have always been there for your mom, and now GoldenYears Care is here for you

We provide Adult Day Services For Special Needs Adults (21 years old +)

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Finally, a dentist your kids will be excited to go to! Call UsToday For ATour or Info! (732) 851-6640 www.GoldenYearsCareNJ.com • Medical AppointmentTransportation • Around-the-clock attention • Physical & OccupationalT erapy In Hou e • Free Door-to-DoorTransportation • Delicious Food Options (Spanish, Russian, Italian & more) • Onsite & Offsite Activities: (Ping Pong, Zumba, Shopping Excursions, Museums, Crafts,Trips to the Shore and much more) • Onsite Hairdr sser Serving Monmouth, Middlesex & Ocean Residents Conveniently off Rt 33 and NJTurnpike Exit 8 108Woodward Rd. Manalapan, New Jersey If your loved one needs care during the day, trust GoldenYears Care to put them in good hands! Dr. Max Sulla’s approach to creating a healthy smile is his commitment to educating parents and children of all ages on the importance of good dental hygiene. Dr. Max is proud to be on New Jersey’s referral list for Special Needs Dentistry www.TenderSmiles4Kids.com FREE Ortho Consultation $ 149 value FREE Infant Exam $ 99 value $ 160 New Patient Visit $ 399 value Bring in this ad for a FREE GIFT FREEHOLD 122ProfessionalViewDr. 732-625-8080 NO. BRUNSWICK 1330 How Lane 732-249-1010 EDISON 1656 Oak Tree Rd. 732-549-3773 ROSELLE 2209 N. Wood Ave 908-245-5556

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Dr. Steven Linker, OD

QUESTION: What is Optomap retinal imaging?

ANSWER:

The optomap ultra-widefield retinal image is a unique technology that captures more than 80% of your retina in one panoramic image while traditional imaging methods typically only show 15% of your retina at one time. Your retina (located in the back of your eye) is the only place in the body where blood vessels can be seen directly. This means that in addition to eye conditions, signs of other diseases (for example, stroke, heart disease, hypertension and diabetes) can also be seen in the retina. Early detection of life-threatening diseases like cancer, stroke, and cardiovascular disease. It also facilitates early protection from vision impairment or blindness Early signs of these conditions can show on your retina long before you notice any changes to your vision or feel pain. While eye exams include a look at the front of the eye to evaluate health and prescription changes, a thorough screening of the

free. It is suitable for every age, even children. The capture takes less than a second. Images are available immediately and you can see your own retina and exactly what your eye care practitioner sees in a 3D animation. Most importantly, early detection means successful treatments can be administered and reduces the risk to your sight and health.

Check out our website for more information MONMOUTHVISION.COM

Dr. Steven Linker, OD Monmouth Vision Associates 50 Rt 9 North Suite 206 Morganville, NJ, 07751 Tel: 732-617-1717

retina is critical to verify that your eye is healthy. Getting an optomap image is fast and pain-

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KNEE PAIN Dr. Scott Paris

QUESTION: What’s the best way to treat knee arthritis? Consider a non-surgical treatment that really works!

D I E T A N D E X E R C I S E number continues to grow. With knee arthritis, the cartilage breaks down and wears away, leaving the bones to rub together causing pain swelling stiffness and limited range of motion. As the cartilage breaks down, the knee loses its lubricating fluid. We found that by replacing this lubricating fluid with a natural substance called Hyalgan, the lubrication is restored and many patients experience amazing pain relief. O s teoarthritis of the knee is the #1 leading cause of disability in the U.S. Over 27 million people suffer with knee arthritis and that

DOES IT HURT? Many of our patients report that they feel little to no pain at all!We do everything possible to minimize any pain from the procedure, from pain relieving spray and a local anesthetic, to precision guidance that ensures we are always in the right spot. WILL MY INSURANCE COVER HYALGAN? This procedure is covered by most major insurance companies including Medicare. Our insurance department pre-verifies every patient. WHO WILL BE PERFORMING THE HYALGAN PROCEDURE? Dr. Scot Paris is the medical physician who performs the Hyalgan injection. Dr. Paris is trained as a general surgeon and has extensive experience with a variety of surgical procedures. With his conservative approach, he has excelled in the non-surgical treatment of knee pain with the use of fluoroscopy guided Hyalgan injections. SO HOW DO I KNOW IF YOUR KNEE PAIN TREATMENT PROGRAM WILL HELP ME? If you are tired of suffering with painful arthritis of the knee, and you want to see if the latest advances in non-surgical treatment can help, all you have to do is call 732-683-1800 to set up a risk free consultation. During the

WHAT IS HYALGAN AND HOW DOES IT WORK? Hyalgan is a natural lubricating fluid that acts as a lubricant and shock absorber inside the knee joint. The substance in Hyalgan is hyularonic acidwhich is normally found in high levels in healthy joints. Replacing the hyularonic acid with Hyalgan lubricates the joint and reduces pain. Hyalgan has been administered over 40 million times and has been proven to provide long-lasting relief of knee pain from osteoarthritis. WHAT IF YOU ALREADY TRIED KNEE INJECTIONS? If you have had injections like this in the past and experienced poor results, there is still hope! Many doctors in this area offer similar injections, but very few use precision fluoroscopy guidance. Fluoroscopy guidance ensures that the pain relieving Hyalgan reaches the knee capsule where it bonds with the joint fluid to create a lubricating and cushioning layer. Without fluoroscopy, it is estimated that doctors “miss” the capsule over 30%of the time resulting in poor results. We want each and every one of our patients to have the greatest chance of success, so every injection is done with precision fluoroscopy guidance to ensure that the Hyalgan gets into the capsule 100%of the time. Because of this, patientswho previously felt little to no relief with non-flouroscopy guided injection are now getting excellent results. The other “big difference” in our results is the multitude of other supportive care options that we have available to enhance the effectiveness of the Hyalgan procedure. These options include state of the art medical laser treatment, physical therapy, manipulation, corrective osteoarthritis bracing (takes pressure off the damaged section of the knee), and natural anti-inflammatory products. The combination of these treatments offers you what we feel is the most comprehensive non-surgical knee treatment program available.

consultation all of your questions will be answered in a warm and friendly environment. Knee replacement surgery is a very extreme measure to take without considering all of your other options first. Once it’s done there is no turning back. For that reason we encourage you to schedule an appointment to see if you are a candidate for Hyalgan treatment.

We are proud to offer our patients a comprehensive knee pain treatment program that includes the best non- surgical methods to relieve pain all under one roof. We look forward to having the opportunity to help you feel better. Take the first step in ending your knee pain and call to schedule an appointment today!

Dr. Scott Paris using precision fluoroscopy guidance to ensure the best results possible.

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CENTRAL JERSEY SPINE & WELLNESS 4251 Route 9 North, Bldg. 3, Suite B (Freehold Office Plaza) • 732-683-1800

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