Ingredients

• 1 stick (1/2 cup) trans fat – free margarine
• 4 oz fine-quality dark chocolate, chopped
• 1/2 cup granulated sugar
• 3 egg whites
• 1 Tbsp canola oil
• 1 tsp vanilla extract
• 1/2 cup unsweetened cocoa powder
• 1 Tbsp confectioners sugar, for sprinkling

Preparation

Preheat oven to 375° and lightly coat an 8-inch round baking pan with nonstick cooking spray.

Line bottom with a round of wax paper or parchment paper.

In a microwave-safe bowl, microwave margarine and chocolate on high for 20 seconds, stir, and continue to microwave at 20- second intervals until melted.

Remove from microwave and whisk mixture until smooth.

Whisk granulated sugar into chocolate mixture.

Add egg whites, oil and vanilla and whisk well.

Sift cocoa powder over chocolate mixture and whisk until just combined.

Pour batter into pan and bake in middle of oven for 20 to 25 minutes, or until top has formed a thin
crust.

Cool cake in pan on a rack for 5 minutes.

Turn onto a serving plate.

Dust cake with confectioners sugar.

Nutrition Information

Calories: 162
Fat: 11g
Saturated Fat: 4g
Cholesterol: 1mg
Sodium: 81mg
Carbohydrates: 17g
Fiber: 1g
Protein: 2g

Kidney and ureteral stones are among the most painful conditions that send people to the doctor or hospital. Most of the time, people don’t know they have a stone until it moves into the urinary tract and blocks the flow of urine. Each year, almost 3 million Americans seek medical treatment and another half million end up in the emergency room because of kidney and ureteral stone problems.

According to the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), the number of Americans with kidney stones has increased significantly over the past 30 years, yet medical researchers do not know why. The NKUDIC predicts that about 5 percent of the adult population will experience a kidney stone at some point.

Stones can form in the kidney, ureter and bladder. Stones occur more frequently in men than women, yet more women are getting them now than ever before. Men are most susceptible starting in their early 40s and the risk continues to increase well into their 70s. Women are at most risk in their 50s.

Causes of Stones Are Still Unknown

“We do know that eating certain foods is not the cause of kidney and ureteral stones,” said Allen D. Seftel, MD, FACS, Head of Urology at Cooper University Hospital. “Urinary tract infections, kidney disorders such as cystic kidney disease, and certain metabolic disorders such as hyperparathyroidism, can be linked to stone formation, but unless a person is susceptible, food is not the culprit.”

It is important to note that although, in general, foods are not a known cause of kidney and ureteral stones, people who have a history of stones may need to be very careful with their diet to prevent additional stones from forming. What foods to consume or avoid depends upon the type of stone. Foods that may help prevent one type of stone may actually cause another type of stone to form. For example, citrus drinks (orange juice, lemonade) are recommended to help avoid the formation of calcium oxalate stones, the most common stone, yet these drinks can be harmful and should be avoided when a person has calcium phosphate stones.

“Is is very important for people who have a history of stones to ask their doctor which foods are best,” explained Dr. Seftel. “Stone sufferers should also drink plenty of water every day. Water flushes chemicals from the body and can help prevent all kinds of stones.”

How Stones Form

The kidneys are bean-shaped organs on each side of the body. They remove extra water and wastes from the blood, producing urine. They help the body keep a stable balance of salts and other substances in the blood and also produce hormones that help build strong bones and form red blood cells.

Kidney and ureteral stones are a mass that develops from crystals that separate from the urine in the urinary tract. Chemicals in the urine usually prevent these crystals from forming. In some people, however, these inhibitors do not work. Medical researchers do not know why one person is more likely to develop stones than another. They do know, however, that once a person has more than one stone, there is a greater chance they will continue to develop more stones in the future.

Small kidney and ureteral stones often pass through the body without a person experiencing any pain or discomfort. When the stone is large enough to cause a blockage, the result is extreme pain. Also, stones can sometimes cause nausea, vomiting, or pain in the abdomen, back or groin. Blood in the urine is another sign a stone may be present.

 Cooper Urologic Institute Offers the Latest Treatment for Stones

Many stones do not require an invasive surgical procedure. Extracorporeal shock wave lithotripsy (ESWL) treats kidney and ureteral stones from outside the body and is performed without requiring the surgeon to cut into the body. This treatment is now the most frequently used procedure in the United States for the treatment of kidney and ureteral stones.

 Shock Waves Crush Stones

Cooper’s urologists perform ESWL for the treatment of all types of kidney and ureteral stones. ESWL is a non-invasive approach that breaks down stones by directing up to 3,000 waves of ultrasonic energy directly onto and into the stone, which then breaks into fragments small enough to pass via normal voiding.

“Cooper’s technology provides optimal access to stones of any size,” Dr. Seftel said. “The energy focus required to crush a stone can be perfectly matched with the size of the stone.”

ESWL is performed on an out-patient basis and takes approximately one hour. More than one treatment may be required in some cases. General anesthesia, intravenous sedation or regional anesthesia is used depending on the patient’s health and co-morbidities. Most patients can return to normal activities within a few days.

 Multiple Treatment Options Available

Cooper urologists work closely with each patient and each patient’s nephrologist to identify the best treatment option. In addition to ESWL, Cooper urologists perform minimally invasive ureteroscopy (URS) – an outpatient procedure in which the surgeon passes a small scope through the urethra, through the bladder and then snares the stone with the scope and crushes it. They also perform percutaneous nephrolithotomy (PNL) for very large stones that can’t be treated with ESWL. The PNL procedure requires the surgeon to make an incision in the back and into the kidney. The surgeon then uses a nephroscope to break up and extract the stones. In extremely rare cases, traditional open surgery is required to remove stones. All procedures require some form of anesthesia, and recovery times vary for each procedure. Most major health insurance plans are accepted, including Medicare and Medicaid.

To request an appointment with  Allen D. Seftel, MD, FACS  

This recipe is diabetes-friendly and heart-healthy.

Ingredients

Yield: 12 servings

• 1 lb pasteurized lump crab meat
• 1/4 cup + 2 Tbsp olive oil
• 3 Tbsp fresh lemon juice
• 3 Tbsp capers, drained
• 3 Tbsp diced shallots or red onion
• 1/4 cup chopped fresh parsley
• 1/8 tsp salt
• Black pepper to taste
• 1 whole wheat baguette (about 12 inches long), cut into 24 (1/2-inch) slices

In a large bowl, combine crab meat, 1/4 cup of the olive oil, lemon juice, capers, shallots, parsley, salt and black pepper.

Mix gently. Cover and chill for at least 1 hour.

Crab mixture will keep, refrigerated, for up to 2 days.

When ready to serve:

Heat grill to high.

Brush bread slices with remaining 2 tablespoons olive oil and grill on both sides until toasted lightly.

Arrange bread on a serving platter and top with crab mixture.

Serve hot.

Nutrition Information

Calories: 137
Fat: 8g
Saturated Fat: 1g
Cholesterol: 30mg
Sodium: 271mg
Carbohydrates: 10g
Fiber: 1g
Protein: 9g

Pediatric Emergency Medicine, Cooper University Hospital

Over the past several weeks, we have been overwhelmed by the news reports detailing abuse committed on children. To wit: the Penn State scandal, the Syracuse Basketball headlines, the reports of abuse by clergy and, most recently, the child molestation allegations against Philadelphia sports writer Bill Conlin, purported to have happened 40 years ago.

The headlines are sensational. How can one believe these things could happen in such hallowed institutions? Yet, the allegations have become all too familiar.

Each day when I go to work, I listen to children’s stories, stories that detail experiences that no child should have to endure: sexual abuse, physical abuse, emotional abuse and neglect. Sadly, these experiences are shared by thousands of other vulnerable people in our communities, but without the national headlines. Most stories are told by children who are much like our own. They attend local schools and have parents who are ‘regular, every-day’ people. The perpetrators of the abuse most often are people who are trusted by the children and their families—a relative, a close friend, a neighbor. These violations against children occur in secrecy and often have been perpetrated for weeks, months or years. Most children tell of their experiences long after the onset of abuse.

All too often, once allegations are made, people in the community and even members of the family question the truth of what the children relate. The accusations often seem to be beyond belief. We ask ourselves, “How could this happen?”  “How did I not know?” The accusations seem too fantastic, too surreal,  too difficult to accept.

How do we stop this? How do we stop child abuse? I don’t have the answers. Even though I have spoken to hundreds of children, I cannot understand the prevalence, frequency, or inhumanity of humans against those most in need of care and protection.

What I do know is that each and every one of us must be willing to call attention to the plight of the children in our lives—our own children; our neighbors’ children; our children’s school mates and team mates; the children we see on the street, at the store or mall, or on the playground. If we suspect that a child is in harm’s way or is in any way unsafe, we must report our concern to the N.J. Division of Youth and Family Services by calling the Child Abuse/Neglect hotline, at 1-877-NJ ABUSE.  Callers do not need proof to report an allegation of child abuse, and they can make the report anonymously. (Every state has a similar statewide hotline.)

If we witness aggression against a child, we must, morally and ethically, intervene on that child’s behalf. We must listen and believe children, no matter how difficult it may be. The worst thing we can do is ignore a child’s plea for help as we do when we ignore or dismiss a child’s disclosure.

Furthermore, we must provide them with the opportunity to tell their story to professionals who have the skills to support them. And, finally, we must provide the resources to treat children if they have experienced abuse so that they may begin to heal.

Remember, if you are in New Jersey and concerned for a child’s safety or well-being, MAKE THE CALL: 1-877-NJ ABUSE.  If the child is in immediate danger, call 9-1-1 as well.

To learn more about how and when to report child abuse/neglect, visit: www.nj.gov/dcf/abuse/how/

Who is the “cosmetic surgery” patient? In our office the most common reason that a patient seeks advice is that the image they see in the mirror does not reflect the youth and vitality they feel. The old image of the cosmetic patient as the privileged wealthy or Hollywood star is outmoded. Even the term “cosmetic surgery” doesn’t truly reflect the wide range of non-surgical procedures that are available for rejuvenation. And while the “extreme makeovers” we see on reality TV are compelling, they do not accurately depict the day-to-day services provided in cosmetic practices throughout the country. Here are some of the biggest myths about cosmetic procedures:

Myth #1: People who have cosmetic surgery look fake. Only poorly done and/or excessive cosmetic procedures look artificial. Well-planned and carefully chosen procedures restore your natural appearance and make you look fresher, rested and yes, a little younger. Make sure your doctor listens to what you are trying to achieve. Everyone has a different bone and soft tissue structure. Everyone ages differently. Trying to restore a more youthful appearance or making modest changes is usually achievable. Trying to completely change your features or look like a model in a magazine can lead to an artificial appearance.

Myth #2: Botox makes your face look frozen. Only poorly done or excessive injections of botulinum toxin look unnatural. When done correctly, facial movement is fluid and natural and only the undesirable movement (such as frowning) is softened.

Myth #3: Injectible fillers are not worth doing as the results are too short-lived. Many of the fillers such as hyauluronic acids (best known – Restylane and Juvederm) and others stimulate the body to lay down collagen and over time can give a natural filling that requires fewer products, less often.

Myth #4: Liposuction is for people who want an alternative to diet and exercise. Liposuction is a reshaping procedure that works best in people that have a figure problem that is resistant to diet and exercise. An example would be the outer thigh or “saddle bag” area in women which corrects nicely with liposuction.

If you do decide to go to your dermatologist for a cosmetic evaluation, make sure that you get a full face analysis taking into account your face shape, bone structure and fat distribution. You should be given clear pricing for everything discussed. Finally, no cosmetic procedure is emergent. Don’t feel pressured if you are not comfortable.

This recipe is Diabetes Friendly and Heart Healthy

Ingredients

Yield: 8 servings

• 8 – 4 ounce chicken breasts, boneless and skinless
• 1 cup flour, seasoned with pepper
• 1 cup buttermilk
• 1 cup walnut pieces, finely ground

Preheat oven to 350 degrees.

Coat chicken with flour and then dip each breast in buttermilk.

Coat each chicken breast with walnuts.

Heat non-stick pan on medium and spray it with vegetable oil.

Place chicken in pan and cook on each side for 2 to 3 minutes, regulating the heat to avoid burning walnut crust.

Press index finger onto chicken to test doneness. Chicken is cooked when firm to the touch.

Transfer chicken to oven to bake thoroughly, approximately 10 to 12 minutes.

Remove from pan when cooked. Slice each chicken breast diagonally into 4 pieces.

Serve hot.

Nutrition Information

Calories: 341
Fat: 17g
Saturated Fat: 2g
Cholesterol: 67mg
Sodium: 107mg
Carbohydrates: 16g
Fiber: 2g
Protein: 32g

Head of the Division of Emergency Medical Services and Disaster Medicine at Cooper

It can be very stressful when an emergency medical event occurs that requires activation of the 9-1-1 system. It is even more stressful when you don’t know what to expect once that phone call is made. Understanding how 9-1-1 works, and what you need to do during and after that phone call, can go a long way in lessening the tension of an already stressful situation.

How 9-1-1 Works

All 9-1-1 calls are answered by trained emergency medical dispatchers who will ask a series of questions based on the reason for the call. The dispatchers will have access to state-approved guidecards that will guide the dispatcher through the call to obtain specific information and to provide basic instructions to the caller. While on the call, the dispatcher will deploy emergency medical personnel to the scene.

The New Jersey Emergency Medical Services system, called EMS, provides two levels of response depending on the call. The first level:  Basic Life Support (BLS) services, which are performed by certified Emergency Medical Technicians, or EMTs, who generally are responsible for ground transport via ambulances. The second level: Advanced Life Support (ALS) services, whose providers are certified paramedics or licensed Mobile Intensive Care Registered Nurses who are dispatched to potentially life-threatening incidents to offer the highest level of pre-hospital care.

What to Do When You Call 9-1-1

Please follow these recommendations:

1.  Provide accurate information to the 9-1-1 dispatcher.

The dispatcher will send an ambulance with EMTs to provide BLS services and to transport the patient to the hospital. Based on the information received, the dispatcher will determine whether ALS services are needed. ALS services can later be requested or recalled by the EMTs after their assessment of the situation, but immediate accurate information can assist the dispatcher in getting the appropriate resources to the patient as soon as possible.

2.  Be involved in the pre-hospital care.

Although sometimes difficult in emergency situations, patients should always understand the care that is being provided. EMS providers are patient advocates, and patients should work collaboratively with them for optimal care. Patients need to ask questions and to express any concerns to the EMS providers. Patients also should have available pertinent information that may affect their care (e.g., names of treating physicians and hospital affiliations, medications/medication list, advance directives, medical records, lab results, radiology reports). EMS providers will take the patient to the closest, most appropriate facility unless patients request transport to a particular hospital. Reasons to transport to a particular hospital include previous hospitalizations there, physician affiliations, and specialty care. However, EMS providers may not transport based on patient preference if the decision may negatively affect the patient’s health.

3.  Trust in the EMS providers’ ability to provide care.

Both ALS and BLS providers are specifically trained to provide emergency care outside of the hospital setting. They must go through an initial certification and routine recertification processes approved by the New Jersey Office of Emergency Medical Services to function as EMS providers. These processes involve required and elective classes in various topics that are encountered in the pre-hospital setting.

For more information, contact your local EMS agency or access the New Jersey Office of Emergency Medical Services website at www.state.nj.us/health/ems.

In a typical scenario, I run into an old friend in the supermarket. Inevitably, the question comes up, “So tell me, what is it that you do again?”

“I am a Palliative Care Specialist,” I proudly respond.

I have come to expect the response. It is accompanied by a bit of unease, “And what exactly is that?”

There are so many things to say about the new field of Palliative Medicine that it seems difficult to sum up in a sentence or two.

Palliative care is the relatively new specialty of medicine that involves the comprehensive treatment of the discomfort, symptoms, and stress of serious illness. Palliative Care treatment plans begin with a comprehensive pain and symptom assessment, and utilize a multidisciplinary team approach to alleviate patient discomfort and patient and family anxieties.

Palliative Care puts the patient and family at the center of attention and identifies issues that have an impact on a person’s quality of life and eliminates or minimizes these problems. Often these issues can include pain, fatigue, nausea, depression, anxiety and the list goes on and on. Palliative care is delivered in conjunction with current therapies for severe illnesses such as chemotherapy, or surgery. In fact, it has been found that the presence of such intense management of symptoms alone by a qualified palliative care team will not only improve one’s quality of life, but also can extend the length of life in severe disease.

Palliative care recognizes the importance of the mind-body connection and addresses psychological, social and spiritual concerns – all to achieve the best quality of life possible for each patient.

“Hmm, sounds like difficult work,” my old friend replies.

While I acknowledge the emotional and sometimes technical challenges of the field, I often respond that this is probably the most rewarding work a physician can do. As a Palliative Care specialist, when I walk out of a room, people have clarity of their treatment plan moving forward, they have a partner to walk with them through their journey with their illness, and I get to make an impact on their lives at sometimes a very critical nexus.

Meeting people where they are with their values, goals, and lifestyle to make a positive impact on their lives and that of their families are what happens every day in the world of palliative care.

I smile as I complete the encounter with my friend thinking, “Educated one more.”

Flu season is here and the best way to protect against flu is to get a flu vaccine. Annual flu vaccination is recommended for everyone 6 months of age or older.

What is flu?

Flu, also known as influenza, is a contagious illness caused by the influenza virus which infects the nose, throat, and lungs. Symptoms include fever, chills, cough, sore throat, runny or stuffy nose, headache, muscle aches, and fatigue. Flu also can cause pneumonia.  Other illnesses can have similar symptoms and be mistaken for flu. If flu is suspected, your doctor may be able to order a test that can detect the flu virus in the nose or throat.

Can flu cause serious illness?

Yes!  Flu can lead to very serious complications, including pneumonia, and even death. For example, from 2009 to 2010 in the United States, 275,000 hospitalizations and 12,500 deaths were estimated to have occurred due to flu. While serious complications from flu are more common among certain people–children younger than 5 years of age, adults age 50 or older, pregnant women, and people with certain chronic medical conditions, complications also can occur in otherwise healthy individuals of any age.

How do I protect myself and my family from flu?

The most important step in protecting against flu is to get a flu vaccine every year. Getting a flu vaccine may also protect your family and others around you. How? If you don’t get vaccinated and become infected with flu, you can spread the virus to others who may be at high risk for serious illness or death from flu, such as a baby, a child, a pregnant woman, grandparents, or a friend. Also helpful in preventing the spread of flu is washing your hands frequently, or using an alcohol-based hand rub, as well as covering your nose and mouth with a tissue when you cough or sneeze.

Is the flu vaccine safe?

Yes! The most commonly administered flu vaccine is the “flu shot.” It is made of killed virus, so you cannot get the flu from it. The most common side effect from the flu shot is soreness where the shot was given, which typically lasts only one or two days. The risk of serious problems from the flu shot, such as a severe allergic reaction, is extremely small. Of course, even if you get the flu shot, you still can catch a non-flu virus or bacteria that may cause symptoms that mimic flu.

Where can I get the flu vaccine and how long does it take to develop immunity?

See your doctor or go to other locations where the flu vaccine is being offered. It typically takes about two weeks for your body to develop an immune response after getting the flu vaccine, so get vaccinated now to protect yourself and your family. Remember, flu activity in the United States usually peaks in January or February and can continue to occur as late as May.

Ingredients

Yield: 24 cookies
Portion size: 1 cookie

• 4 egg whites
• 1/2 cup granulated sugar
• 1/2 cup powdered sugar

Preheat oven to 200°.

Beat egg whites with a hand mixer until frothy. Mix in sugars until stiff peaks start to form. Do not overmix.

Tint with food coloring for a festive look or add nuts, dark chocolate chips or cocoa for some variety.

Drop mounds of meringue onto baking sheet, using two spoons. Bake in oven for two hours. Turn off oven, but do not remove cookies.
Leave in oven overnight or at least 2 hours. Store in an airtight container.

Nutrition Information

Calories: 29
Fat: 0g
Saturated Fat: 0g
Cholesterol: 0mg
Sodium: 9mg
Carbohydrates: 7g
Fiber: 0g
Protein: 1g