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Saturday January 21, 2017

Caring for World Trade Center Responders

Caring for World Trade Center Responders

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Fifteen years after 9/11, the World Trade Center Health Program at Rutgers continues to monitor and treat heroic responders and participate in research on their health problems

The World Trade Center Health Program at Rutgers, one of five Centers for Disease Control's Clinical Centers of Excellence, has monitored 8,800 9/11 responders and treated 2,659 of them.

'The expertise that they have pulled together to work with our very individualized diseases goes far beyond what normal general practitioners deal with. That’s what saves us and gives us a shot at being healthy again.'
 
 – Dave Howley
 

The day after Sept. 11, 2001, New York Police Detective Herb Fonseca was reassigned from the department’s Staten Island warrant squad to oversee the search operation at Fresh Kills Landfill, where a steady stream of debris from the World Trade Center collapse was arriving by the truckload.

There for the next year, he helped direct the debris-sifting operation at the landfill to turn up whatever items could be retrieved from the ashes in the aftermath of the attacks that claimed nearly 3,000 lives.

“We went through everything,” said Fonseca, who retired from the NYPD after 20 years in 2003. “I knew a couple of guys who got sick from the get-go, but I went 10 years without getting sick.”

Fonseca found his way to the World Trade Center Health Program at Rutgers University Environmental and Occupational Health Sciences Institute (EOHSI), where exams turned up gastroesophageal reflux disease and, later, prostate cancer.

Since 2003, the World Trade Center Health Program at Rutgers – one of five Centers for Disease Control’s Clinical Centers of Excellence – has monitored 8,800 responders who rushed to the site on Sept. 11, 2001, and worked there in the days, weeks and months afterward, and treated 2,659 patients assigned to its clinic on Busch Campus. 

The center currently cares for 1,340 patients experiencing a variety of health problems related to their work at the site, including respiratory and gastrointestinal ailments, sleep apnea, post-traumatic stress disorder and cancer.

World Trade Center Health Program
Photo: Nick Romanenko/Rutgers University
The clinic staff has tripled since it opened, and medical director Iris Udasin, center, has been there from the start. At left is Linda Christiansen, staff nurse. Bonnie Gordic, right, is the clinic's mental health director.
More than 200  patients are being treated for various cancers, which were added to the list of illnesses covered by the Zadroga Act, which funds WTC workers’ health care and was extended by Congress in December for 75 years. When patients need more care than the center can offer, patients are referred to specialists at nearby Robert Wood Johnson University Hospital and the Cancer Institute of New Jersey.

“We are very comfortable treating our patients with asthma and garden-variety pulmonary problems. But some of our patients have really complicated asthmas, some have pulmonary fibrosis and sarcoidosis, some have really bad sleep apnea – so we always work very closely with our medical and cancer institute colleagues,” said Iris Udasin, medical director of the clinical center and a professor within EOHSI at Rutgers School of Public Health. Udasin has testified twice before Congress to help make the case for continued funding for the health programs. She keeps in touch with many patients, past and present, between visits, and they love her for it.

“I have gotten a ton of support from Iris and everyone at the clinic,” said Dave Howley, a retired New York Police Department officer who developed sinus problems after working at the WTC site and was diagnosed with head and neck cancer in 2006. “The expertise that they have pulled together to work with our very individualized diseases goes far beyond what normal general practitioners deal with. That’s what saves us and gives us a shot at being healthy again.”

When the clinic first opened, Udasin worked with a part-time doctor, a few nurses and medical residents who pitched in to monitor patients. The staff has since tripled to include Udasin and fellow doctors Connie Chuang, Barbara Marroccoli, Joseph Romano and Roy Carman, several nurses, psychologists, social workers and support staff who help with benefits, counseling, record-keeping and outreach.

Patient Care and Research

“We do thorough medical examinations and histories and keep track of patient info, including spirometry and breathing tests, in a shared database,” Udasin said. The data is used in research conducted at Rutgers and in other government-approved WTC health studies. “We’ve been able to do patient care and take part in evidence-based research.”

For example, when Udasin and Marroccoli noticed many of their patients were experiencing sleep apnea but were not overweight – obesity is a risk factor for the sleep disorder -- Robert Wood Johnson Medical School’s Jag Sunderram, a pulmonology specialist, pursued the connection. He collaborated with the center, New York University School of Medicine, the Icahn School of Medicine at Mount Sinai and RWJMS colleagues to study the relationship between obstructive sleep apnea and nasal resistance from dust exposure among WTC workers.

“We continue to see a high prevalence of sleep apnea in 70 to 80 percent of our patients,” said Kathy Black, a Rutgers Robert Wood Johnson Medical School senior research associate.  Sleep apnea can lead to serious health problems, including diabetes and severe cardiovascular complications, she noted. The Rutgers WTC Health Program continues to help with an ongoing trial to determine how the different modes CPAP (continuous positive airway pressure) machines improve sleep apnea symptoms.

Led by Rutgers’ Robert Laumbach, another ongoing study is determining how WTC dust caused persistent breathing problems among responders – specifically, how persistent respiratory disorders among patients are associated with changes in DNA. Laumbach also is a professor in the School of Public Health.

Among wider studies the Rutgers clinic has participated in is a look at the prevalence of prostate cancer among WTC responders. The study found a link between WTC exposure and prostate cancer aggressiveness, and that it occurs at a younger age in WTC responders than in the general population.

Fonseca, who also was treated for sleep apnea and received counseling from Bonnie Gordic, a psychologist and the clinic’s mental health director, continues treatment for complications from radiation treatments for his prostate cancer. Along the way, he said he’s received top-notch referrals from Udasin and the clinic team.

“I’m grateful to all of the people who are affiliated with the WTC program,” he said. “They are the real deal.”


Media contact: Dory Devlin, dory.devlin@rutgers.edu or 973-972-7276

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