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Dr. Shah points to better pain management,more resources, less time in the hospital andimmediate physical therapy as improvementsin joint replacement.Dr. Hartzband adds that “surgeons have

minimized incisions, and prostheses havebeen modified. For example, knees nowcome in two widths, as women’s knees arenarrower.” Moreover, research is ongoing toperfect prostheses to minimize discomfort.Dr. Shah is working on an all-polymer knee,which is currently in clinical trials. “This willfeel much more natural than the metallicknees.”Dr. Anthony Scillia, an orthopedic surgeon

specializing in sports medicine, at AtlanticSports Health and Chilton Medical Center,sees many athletes at all levels — includingyouth and recreational sports. Once surgeryhas been decided upon, he considers “thealgorithm of different surgical procedures. Ifpossible, I will consider something minimally

invasive like a partial kneereplacement orshoulder resurfacing.”The prep

process for sur-gery is part of thereason for its suc-cess. At Chilton,there is a “totaljoint class” toeducate patientson the entire pro-cess. Regardlessof where they have the surgery, all patientsare educated pre-operatively. They may begiven medication pre-surgery to reduce theneed for narcotics post-operatively. Pre-sur-gery clearance is, of course, also needed by a patient’s medical doctor and any specialiststhey see.Post-surgery, patients can expect to

receive physical therapy the same day. In general, joint replacement patients can

expect to spend one to three days in the hospital; a shoulder or hip replacement wouldnormally require one day, and a knee wouldrequire two to three, although individualhealth concerns could change this. Oncehome, patients can expect two weeks ofphysical therapy. Both a nurse and physicaltherapist will be sent to a patient’s home fivetimes a week. After the first two weeks, thepatient will return to the surgeon’s office, andwill then participate in outpatient therapythree times a week for eight to twelve weeks.A return to activities depends upon the

patient. Dr. Hartzband has had patients whogo to work or drive the next day. He notes,“It depends upon how fit or how independentyou are.” However, those patients areexceptions. Dr. Shah finds his patients areusually back to driving in three to four weeksand back at a desk job in three weeks.Dr. Hartzband has treated tri-athletes and

a nationally ranked skier who have been ableto return to their sports. However, Dr. Scillianotes that “the more impact you put on a

joint, the quicker it wears out. Cycling and swimming have a lot less impact thanrunning. I urge patients to modify the impactupon their joints. The younger you are whenyou get a joint replacement and the moreactive you are, the more likely that you willeventually need another surgery.”So, how long do joint replacements last?

Dr. Shah explains, “The older generation last-ed 15 to 20 years. The latest generation havenot been in bodies that long, so we cannotstate definitively, but they could last 20 to 30 years.” Once again, like so many partsof the joint replacement process, this is goingto vary widely from individual to individual.All three doctors agreed that patient

education, pain management, improve-ments in surgical techniques, and intensivephysical therapy have all contributed to theper-fection of joint replacement surgery. If it becomes necessary, after the exhaustionof non-surgical methods, joint replacementcan greatly improve the quality of life forpatients.

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Dr. Anthony Scillia

Joint Replacement: Improved Procedures and Results

Quality Breast CancerCare Close to Home

Skilled Physicians Devoted to PatientsBy KATHLEEN MATHIEUSpecial to Health Quarterly

Teamwork, expertise, state-of-the-arttechnology, research, and exceptionaldiagnostic and treatment services are hallmarks of breast cancer care

at Valley Health System and HackensackMeridian Health Hackensack UniversityMedical Center. Oncoplastic surgeon LauraA. Klein, MD, and breast medical oncologistDeena Mary Atieh Graham, MD, are twophysicians providing quality care to local residents, as well as individuals who travelfrom other locations.

QUALITY IS PARAMOUNTSelect a program that offers comprehen-

sive cancer services when it comes to breastcare, said Dr. Graham, on staff at JohnTheurer Cancer Center at Hackensack. “We offer comprehensive care along thespectrum of breast care and breast cancercare, from screening to diagnosis, to treat-ment and survivorship. “Our screening services are state-of-

the-art,” said the doctor, citing exceptional technology and specialized radiologists who interpret breast images exclusively. In addi-

tion, Dr. Graham, who devotes the vast major-ity of her time to breast patients, is one ofthree breast medical oncologists on Hackensack’scancer team. All technologists are certified in breast imaging, and coordinators workwith patients to obtain precertification.

HIGHLY QUALIFIED CAREGIVERS, SPECIALIZED CARE

“Quality care for breast cancer includesexcellent, fellowship-trained physicians inevery aspect of care,” said Dr. Klein, medicaldirector of The Valley Hospital Breast Center.“We have fellowship-trained specialists, andmuch of that training has been with topexperts in the world,” said the physician, whohas been part of oncoplastic surgery sinceher early years as a surgeon when her men-tor was the world-renowned breast surgeonMelvin Silverstein, MD. Valley’s oncoplasticsurgeons combine the latest plastic surgerytechniques with breast-conserving surgery.Oncoplastic surgery offers options with

superior results, said Dr. Klein. For example,in one type of oncoplastic surgery, physiciansremove “larger tumors with an excellent cosmetic result and balancing.” Somepatients even find both breasts to be moreattractive after surgery, said the doctor. Also,

“oncoplastics can decrease the need for mastectomy.” Surgical procedures at Valley include

nipple-sparing mastectomy, immediate con-struction following mastectomy and breastpreserving lumpectomy, among others. “The goals of our surgical services are to treat cancer and make patients feel wholeand beautiful again,” said Dr. Klein.Valley’s cohesive breast cancer team

includes a wide range of highly qualified professionals. A breast navigator, one of the first team members patients encounter, facilitates a streamlined process that guidesand comforts patients even before a diagno-sis. If cancer is detected, patients are assistedthroughout treatment and follow-up on aone-on-one basis.

Laura Klein, M.D., (center) medical director of The Valley Hospital Breast Center, with Tihesha Wilson, M.D., (right) assistant medical director.

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LLEY H

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See BREAST CANCER, Page 15N

PERSONALIZED CAREWhether a patient needs

chemotherapy, hormonal therapy or targeted anticancerdrugs, Hackensack’s medicaloncologists collaborate withother team members to choosethe most appropriate medi-cations for an individual’s typeand stage of breast cancer.One size does not fit all in cancer treatment. For example,the activity of a patient’s genes is studied through Oncotypetesting, which helps determine if chemotherapy is required,and if so, which course of treatment is most appropriate. Hackensack also participates

in clinical trials, which providephysicians access to new careoptions as they contribute tobreast cancer research at the same time. Participating inclinical trials is one way she and her colleagues are “keepingtheir fingers on the pulse of cancer care,” said Dr. Graham.“Clinical trials provide access to new treatments, technologyand innovations for patients.” Panel testing, in which multiple genes are examined, is

used in genetic counseling and testing to determine anindividual’s risk for certain cancers. Knowledgeable special-ists interpret sophisticated findings and provide key informa-tion to patients, helping them make decisions about cancerprevention, among other crucial issues for high-risk patients.

STATE-OF-THE-ART RADIATION ONCOLOGYState-of-the-art equipment applied by a top-notch medical

team is the basis for superior radiation oncology, one inwhich therapy is delivered with exceptional precision. Valleyhas numerous hi-tech modalities, such as TrueBeam high-precision radiotherapy treatment, accelerated (hypofraction-ated) radiation therapy and heart-protecting radiation treatment techniques, such as prone treatment and deepinspiratory breath hold. Breast intraoperative radiation therapy, an option for

early-stage breast cancer, delivers an entire course of radia-tion therapy in the operating room following a lumpectomy,eliminating the need for what is typically weeks of post-surgery radiation.

THE MIND-BODY-SPIRIT CONNECTIONExperts agree—patients should avail themselves of all

appropriate therapies, not just chemotherapy, surgery andradiation. Dr. Klein recommends a holistic approach to breastcancer care. “I believe, as the ancient Greeks did, that we have to have a strong mind and body,” said the doctor.Holistic care promotes more than emotional or spiritual well-being, she noted. For example, “there is evidence to supportthat survivors who participate in yoga have better clinicaloutcomes.” Groups such as Valley’s Young Women’s BreastCancer Support Group have numerous benefits.

QUALITY CARE CONTINUESQuality care includes services that continue after

treatment, said Dr. Graham. Hackensack provides diverseeducational, counseling and support opportunities, includingthe Breast Cancer Survivorship Program, which has beendesigned with input from cancer team physicians and willsoon launch at Hackensack’s wellness and fitness center in Maywood. Keep connected with your care team, especially your

physician, said Dr. Graham. Maintaining this relationship has unique benefits. “There is nothing like sitting down with a patient.”

HEALTH QUARTERLY / ADVERTISING SECTION

Breast Cancer Care: Personalized to Patients

Deena Mary AtiehGraham, M.D.: BreastMedical Oncologist at The John Theurer CancerCenter at HackensackMeridian HealthHackensack UniversityMedical Center.

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