Monthly Archives: January 2014

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They often refuse to stop, go away, or even shut down for long. That’s what makes them such powerful killers. Cancer has an ability to work around temporary solutions doctors and scientists discover, going with backup plans to take over cells and damage organs, systems and endanger lives.

Looking specifically to alter a group of receptors, which are like docking stations for cellular signals, Sabine Brouxhon, clinical associate professor of emergency medicine at Stony Brook, has found an antibody that doesn’t just knock out one route for the development and spread of cancer, but may disable several such options. At the same time, her approach causes cancer cells to die.

The antibody she’s working with targets a specific protein, called a shed protein, in the area around a tumor. The antibody causes growth factor receptors to become internalized in a cell, where they get degraded. “We have an antibody-based therapy that downregulates” these receptors, said Brouxhon.

The receptors she’s targeting are the ones that have become the site of several treatments approved by the Food and Drug Administration and are involved in breast cancer, colorectal cancer, pancreatic cancer and skin cancer.

Four of the receptors are called human epidermal growth factor receptor and are abbreviated HER1 through 4. Her antibody also works to downregulate another receptor tyrosine kinase called the insulin-like growth factor receptor.

With some of the treatments that knock out one specific HER receptor, cancers sometimes develop resistance to that therapy, using another receptor to continue in its destructive path.

“Since her therapy down-regulates many of the resistance pathways used by cancer cells, this treatment could be useful [with] certain drug resistant cancers,” said Sean Boykevisch, senior licensing associate in the Office of Technology Licensing and Industry Relations.

By attaching to this shed protein, the antibody has become effective at killing cancer in lab dishes and in preclinical mouse models of some human diseases.

The next step for Brouxhon is converting the antibody into a version that will work for humans. She estimates the timetable for this process at about two years.

Brouxhon has presented her promising results to several possible funding partners, including venture capital firms and pharmaceutical companies. Once she creates a human form of the antibody, Brouxhon will look for a specific group or patients for whom this treatment might be effective.

“We need to find that patient population that is amenable to this treatment,” she said. A possibility, she added, is a population of patients who develop resistance to cancer treatment.

Brouxhon has been at Stony Brook for five years. Previously, she had worked at the University of Rochester. She believes the support she received at Stony Brook has enabled her to advance her research. “There’s a lot of interest” in her research and she “couldn’t ask to be so lucky,” she said.

Some of Brouxhon’s colleagues praised her work and her approach. She is “charting new ground with her recent discoveries,” said Boykevisch, whose office is working with her to find a partner to take this innovation to the marketplace. She said her pursuit of a treatment for cancers is professional and personal. Her grandfather died of pancreatic cancer and that “hit home” with her.

When she was growing up, Brouxhon traveled all over the world with her family, living in New Guinea, Belgium, Australia, South Africa and Brazil, as her father worked for the United Nations and as an independent consultant. She used to hate all of the travel, but when she grew up, she realized her father “gave me a lot. I got to see a lot of different cultures. That made me stronger.”

Brouxhon and her husband, Stephanos Kyrkanides, the chair of the Department of Orthodontics and Pediatric Dentistry at Stony Brook, live in East Setauket with their 15-year-old son, James, and their 12-year-old daughter, Nicole.

They met in Rochester when she was working for Dave Felten and Kyrkanides was working for Felten’s wife, Susan. Kyrkanides had asked Brouxhon for help with an experiment.

Brouxhon puts many hours into her work. Boykevisch described her as “one of the most driven people I know.

As a scientist and medical doctor, she is eager to see her discoveries help the lives of those afflicted with cancer.”

The work “requires a lot of time,” she said. “I really want to see this go forward.”

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Soy may exacerbate hypothyroidism

It seems like everyone has heard of hypothyroidism. But do we really know what it is and why it is important? The thyroid is a butterfly-shaped organ responsible for maintaining our metabolism. It sits at the base of the neck, just below the laryngeal prominence or Adam’s apple. The prefix “hypo,” derived from Greek, means “under” (1). Therefore, hypothyroidism indicates an underactive thyroid and results in slowing of the metabolism. Many people get hypo- and hyperthyroidism confused, but they are complete opposites.

Blood tests determine if a person has hypothyroidism; they include thyroid stimulating hormone, which is usually increased, thyroxine (free T4), and triiodothyronine (free T3 or T3 uptake), which may both be suppressed (2).

There are two types of primary hypothyroidism: subclinical and overt. In the overt (more obvious) type, classic symptoms include weight gain, fatigue, thinning hair, cold intolerance, dry skin, and depression, as well as the changes in all three thyroid hormones on blood tests mentioned above. In the subclinical, there are may be less obvious or vague symptoms and only changes in the TSH. The subclinical can progress to the overt stage rapidly in some cases (3).  Subclinical is substantially more common than overt; its prevalence may be as high as 10 percent of the U.S. population (4).

What are potential causes or risk factors for hypothyroidism? There numerous factors, such as medications, including lithium; autoimmune diseases, whether personal or in the family history; pregnancy, though it tends to be transient; and treatments for hyperthyroidism (overactive thyroid), including surgery and radiation.

The most common type of hypothyroidism is Hashimoto’s thyroiditis (5). This is where antibodies attack thyroid gland tissues. Several blood tests are useful to determine if a patient has Hashimoto’s: thyroid peroxidase antibodies and antithyroglobulin antibodies.

Synopsis

I would like to separate the myths from the realities with hypothyroidism. Does treating hypothyroidism help with weight loss? Not necessarily. Is soy potentially bad for the thyroid? Yes. Does coffee affect thyroid medication? Maybe. Does subclinical hypothyroidism negatively impact cholesterol? There are studies that suggest this. And finally, do vegetables, specifically cruciferous vegetables, negatively impact the thyroid? Probably not. Let’s look at the evidence.

Treatments: medications and supplements

When it comes to hypothyroidism, there are two main medications: levothyroxine and Armour Thyroid. The difference is that Armour Thyroid converts T4 into T3, while levothyroxine does not. Therefore, one medication may be more appropriate than the other, depending on the circumstance. However, T3 can be given with levothyroxine, which is similar to using Armour Thyroid.

What about supplements? A recent study tested 10 different thyroid support supplements; the results were downright disappointing, if not a bit scary (6). Of the supplements tested, 90 percent contained actual medication, some to levels higher than what are found in prescription medications. This means that the supplements could cause toxic effects on the thyroid, called thyrotoxicosis. Supplements are not FDA-regulated, therefore they are not held to the same standards as medications. There is a narrow therapeutic window when it comes to the appropriate medication dosage for treating hypothyroidism, and it is sensitive. Therefore, if you are going to consider using supplements, check with your doctor and tread very lightly.

Soy impact

What role does soy play with the thyroid? In a randomized controlled trial, the gold standard of studies, the treatment group that received higher amounts of soy supplementation had a threefold greater risk of conversion from subclinical hypothyroidism to overt hypothyroidism than those who received considerably less supplementation (7). Thus, it seems that in this small yet well-designed study, soy has a negative impact on the thyroid. Therefore, those with hypothyroidism may want to minimize or avoid soy. Interestingly, those who received more soy supplementation did see improvements in blood pressure and inflammation and a reduction in insulin resistance but, ultimately, a negative impact on the thyroid.

The reason that soy may have this negative impact was illustrated in study involving rat thyrocytes (thyroid cells) (8). Researchers found that soy isoflavones, especially genistein, which are usually beneficial, may contribute to autoimmune thyroid disease, such as Hashimoto’s thyroiditis. They also found that soy may inhibit the absorption of iodide in the thyroid.

Weight loss

Since being overweight and obese is a growing epidemic, wouldn’t it be nice if the silver lining of hypothyroidism is that, with medication to treat the disease, we were guaranteed to lose weight? In a recent retrospective (looking in the past) study, results showed that only about half of those treated with medication for hypothyroidism lost weight (9). This has to be disappointing to patients. However, this was a small study, and we need a large randomized controlled trial to test it further.

WARNING: The FDA has a black box warning on thyroid medications — they should never be used as weight loss drugs (FDA.gov). They could put a patients in a hyperthyroid state and worse, have potentially catastrophic results.

Coffee

I am not allowed to take away my wife’s coffee; she draws the line here with lifestyle modifications. So I don’t even attempt to with my patients, since coffee may have some beneficial effects. But when it comes to hypothyroidism, taking levothyroxine and coffee together may decrease the absorption of levothyroxine significantly (10). It did not seem to matter whether they were taken together or an hour apart. This was a very small study involving only eight patients. Still, I recommend avoiding coffee for several hours after taking the medication. This should be okay, since the medication must be taken on an empty stomach.

Vegetables

There is a theory that vegetables, specifically cruciferous ones, may exacerbate hypothyroidism. In one animal study, results suggested that very high intake of these vegetables does reduce thyroid functioning (11). This study was done over 30 years ago, and it has not been had replicated.

Importantly, this may not be the case in humans. In the recently published Adventist Health Study-2, results showed that those who had a vegan-based diet were less likely to develop hypothyroidism than those who ate an omnivore diet (12). And those who added lactose and eggs to the vegan diet also had a small increased risk of developing hypothyroidism. However, this trial did not focus on raw cruciferous vegetables, which is much needed.

There are two take-home points: try to avoid soy products and don’t think that supplements that claim to be thyroid support are good for you or harmless because they are over the counter and “natural.” In my experience, an anti-inflammatory diet helps improve quality of life issues, especially fatigue and weight, for those with Hashimoto’s thyroiditis.

References:

(1) dictionary.com. (2) nlm.nih.gov. (3) Endocr Pract. 2005;11:115-119. (4) Arch Intern Med. 2000;160:526-534. (5) mayoclinic.org. (6) Thyroid. 2013;23:1233-1237. (7) J Clin Endocrinol Metab. 2011 May;96:1442-1449. (8) Exp Biol Med (Maywood). 2013;238:623-630. (9) American Thyroid Association. 2013;Abstract 185. (10) Thyroid. 2008;18:293-301. (11) Crit Rev Food Sci Nutr. 1983;18:123-201. (12) Nutrients. 2013 Nov. 20;5:4642-4652.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management.  For further information, go to the website medicalcompassmd.com and/or consult your personal physician.

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Stonyfield Organic's O'Soy yogurt tries to fill the void left by WholeSoy's absence.

Stonyfield Organic O'Soy yogurt at Wild By Nature is one option to fill the hole left by WholeSoy.

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A man walked into the emergency room at Stony Brook recently with chest pain. At first, the doctors thought he might have a pulmonary embolism, or a blockage of the main artery in the lungs. It could also have been heart disease.

Unsure of the diagnosis from his symptoms, the doctors performed a procedure called coronary computed tomography angiography. Quickly, they realized the man had 90 percent obstruction of the coronary artery.
“He had a stent put in and he was fixed,” said Mark Henry, a professor and chairman of the Emergency Medicine Department at Stony Brook.

The CCTA test allowed the doctors to perform a procedure that likely kept him from having a heat attack that might have killed him.

Michael Poon, a professor of radiology, medicine and emergency medicine and director of advanced cardiovascular imaging at Stony Brook, helps make this test available seven days a week at the school.

“Dr. Poon deserves a lot of credit,” Henry said. “We’re really happy to be able to offer that to our population.”
Henry estimates that Stony Brook does more CCTAs than any other hospital in the country. Poon advanced the state of the art at the school in terms of imaging, Henry said, while also reducing the amount of radiation exposure to “the lowest possible level.”

Poon published a paper in 2013 showing that this technique saves money and cuts down on time in the emergency room.

“Nine out of 10 times, [chest pain] is a false alarm,” Poon said. “We didn’t have an accurate test to screen out that one out of 10. We ended up admitting everybody because we can’t afford to miss one.”

This test cuts down the length of stay in the ER dramatically, Poon said. Once patients get a clear diagnosis, they don’t tend to return with the same uncertainty to the ER with the same symptoms, Poon said.

Poon’s paper on this method recently won a Minnies award for Scientific Paper of the Year. The Minnies awards provide a way for radiology experts to recognize the contributions of their peers in medical imaging. Poon said he was honored to receive the recognition.

In 2002, Poon became intrigued by the possibilities of this imaging technique when he was at Mount Sinai Hospital. He was involved with research into noninvasive imaging of the coronary artery, the tube that supplies blood to the heart.

“When I saw the early images from Germany using CCTA, I said ‘I have to learn this,’” Poon recalled. He invited the University of Munich team to spend a year with him, during which he learned about the procedure.

The beauty of this test, Poon said, is that it gives a clear diagnosis with the highest negative predictive value among all noninvasive tests. This method is also a way of detecting plaque in the heart, which can be an early indication of heart disease.

In addition to conducting research, Poon sees patients three days a week. “I’m constantly looking for newer and better ways of doing things,” Poon said.

One of the areas he’s currently working on is called enhanced external counter pulsation. He calls the system “exercising without exercising.” It makes it easier to pump blood through the body at the same time that it sends blood back to the heart while it’s resting. “It’s all done automatically,” he said. “You lay there on the bed and the machine does all the work for you.”

This treatment is approved for angina and heart failure, but Poon believes it could improve the health of people who aren’t in cardiac stress. He uses it himself once or twice a week.

Poon suggests that this system enables blood to flow to other areas farther from the heart more easily.
Poon, who maintains an active lifestyle that includes snowboarding, lives in Harrington Park, N.J., with his wife, Mei. The couple have four children, who range in age from 16 to 27. Poon spends four days a week at university housing.

Poon said he believes a combination of early diagnosis, with tools like CCTA, and early intervention is the best way to help his patients.

“Making early diagnosis without offering some help is not that useful,” he said. “Using pills isn’t ideal, either. The best way is lifestyle modification. We can use really good science to do it.”

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By Linda M. Toga, Esq.

We all know that time flies by and that important things are sometimes put on the back burner as we rush around taking care of our day to day responsibilities. We have also all heard heartbreaking stories about people who had every intention of revising their estate plans but, failed to take the necessary steps while they were able to do so. The end result of not having an up-to-date estate plan that reflects their wishes and addresses all of the relevant issues facing their loved ones is sometimes devastating.

To avoid the stress, expense and emotional turmoil that their loved ones could face if they unexpectedly died without revising their estate plans to reflect changed circumstances, I urge my clients to periodically review their estate planning documents. Questions they should ask themselves include whether their named beneficiaries are, in fact, the people they want to inherit their assets. Relationships change, people die, marry and/or divorce, and fortunes come and go. Any one of these events could be the basis for making changes to an estate plan.

For example, if a client’s married son died prematurely without having children of his own, the client may want that son’s share of her estate to pass to her other children. However, if the client was very fond of the son’s wife, she may want her son’s inheritance to pass to the son’s widow. Unless she addressed this contingency when she initially had her Will prepared, the son’s wife will not be in line inherit anything from the client’s estate. Clearly, the death of a child is the sort of life changing event that should prompt a client to review her estate plan. A review and revision may also be appropriate upon the death or incapacity of the individuals who are named as executors, guardians and/or trustees in estate planning documents.

In addition to considering the factors named above, clients should ask themselves the following questions. Are any of their beneficiaries currently receiving government benefits that may be adversely impacted by an inheritance? Since signing their Wills, have any of their beneficiaries died leaving minor issue who may not be responsible enough to handle an inheritance? Do any of their beneficiaries currently have problems with drugs, alcohol or gambling? Have the tax laws changed in such a way that they should consider estate tax avoidance strategies? If the answer to any of these questions is “yes,” I recommend that my clients revise their estate plans to reflect the new reality.

Fortunately, there are ways to protect the inheritance of beneficiaries who are minors, as well as beneficiaries who suffer from disabilities, have drug or alcohol problems or who have creditors knocking on their doors. In addition, provisions can be included in Wills that create trusts designed to insure that the estate is not faced with unnecessary estate taxes and that beneficiaries do not suffer adverse effects from an inheritance. If warranted, planning can also insure a stream of income for a beneficiary who may not be in a position to handle his own finances or provide a mechanism through which a beneficiary may enjoy the exclusive use of an asset without the tax liability that may be associated with its ownership.

Even though revising an estate plan may be as simple as naming a new executor in a Will, certain formalities must be observed for the revisions to be effective and enforceable. Courts generally will not give effect to handwritten changes made to a Will and in some cases, such changes may actually result in the court refusing to admit the Will to probate. Since the result of not having an estate plan that is up-to-date, or having documents that have been improperly altered may be devastating to loved ones, revisions to an estate plan should only be made with the assistance of an experienced estate planning attorney.

Linda M. Toga, Esq. provides legal services in the areas of litigation, estate planning and real estate from her East Setauket office.

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There may be a spectrum of gluten sensitivity

Gluten has been gaining in notoriety over the last several years. When we hear someone mention a gluten-free diet, several things tend to come to mind. One may be that this is a healthy diet. Along the same lines, we may think gluten is bad for us. However, gluten-free is not necessarily synonymous with healthy. There are many beneficial products containing gluten.

We might think that gluten-free diets are a fad, like low-fat or low-carb diets. Still, we keep hearing how more people feel better without gluten. Could this be a placebo effect? What is myth and what is reality in terms of gluten? In this article I will try to distill what we know about gluten and gluten-free diets, who may benefit and who may not.

But first, what is gluten? Most people I ask don’t know the answer, which is OK; it is part of the reason I am writing the article. Gluten is a plant protein found mainly in wheat, rye and barley.

Now to answer the question of whether going gluten-free is a fad. The answer is resounding “No,” since we know that patients who suffer from celiac disease, an autoimmune disease, benefit tremendously when gluten is removed.(1) In fact, it is the main treatment.

But what about people who don’t have celiac disease? There seems to be a spectrum of physiological reaction to gluten, from intolerance to gluten (sensitivity) to gluten tolerance (insensitivity). Obviously, celiac disease is the extreme of intolerance, but even these patients may be asymptomatic. Then, there is nonceliac gluten sensitivity, referring to those in the middle portion of the spectrum.(2) The prevalence of NCGS is half that of celiac disease, according to the NHANES data from 2009-2010.(3) However, many disagree with this assessment, indicating that it is much more prevalent and that its incidence is likely to rise.(4) The term was not even coined until 2011.

What is the difference between full-blown celiac disease and gluten sensitivity? They both may have intestinal symptoms, such as bloating, gas, cramping and diarrhea, as well as extraintestinal (outside the gut) symptoms, including gait ataxia (gait disturbance), malaise, fatigue and attention deficit disorder.(5) Surprisingly, they both may have the same results with serological (blood) tests, which may be positive or negative. The first line of testing includes antigliadin antibodies and tissue transglutaminase. These measure a reaction to gluten; however, they don’t have to be positive to have reaction to gluten. HLA–DQ phenotype testing is the second line of testing and tends to be more specific for celiac disease.

What is unique to celiac disease is a histological change in the small intestine, with atrophy of the villi (small fingerlike projections) contributing to gut permeability, what might be called “leaky gut.” Biopsy of the small intestine is the most definitive way to diagnose celiac disease.

Though the research has mainly focused on celiac disease, there is some evidence that shows NCGS has potential validity, especially in irritable bowel syndrome.

Before we look at the studies, what does it mean when a food says it’s “gluten-free”? Well, the FDA has recently weighed in by passing regulation that requires all gluten-free foods to have no more than 20 parts per million of gluten.(6) The agency has given food manufacturers a year to comply with the new standards. Now, let’s look at the evidence.

Irritable bowel syndrome

Irritable bowel syndrome (IBS) is a nebulous disease diagnosed through exclusion, and the treatments are not obvious. That is why the results from a randomized controlled trial, the gold standard of studies, showing that a gluten-free diet significantly improved symptoms in IBS patients, is so important.(7) Patients were given a muffin and bread on a daily basis.

Of course, one group was given gluten-free products and the other given products with gluten, though the texture and taste were identical. In six weeks, many of those who were gluten-free saw the pain associated with bloating and gas mostly resolve; significant improvement in stool composition, such that they were not suffering from diarrhea; and their fatigue diminished. In fact, in one week, those in the gluten group were in substantially more discomfort than those in the gluten-free group. There were 34 patients involved in this study.

As part of a well-written March 4, 2013 editorial in Medscape, by David Johnson, M.D., a professor of gastroenterology at Eastern Virginia Medical School, he questions whether this beneficial effect from the IBS trial was due to gluten withdrawal or to withdrawal of fermentable sugars because of the elimination of some grains, themselves.(8) In other words, gluten may be just one part of the picture. He believes that nonceliac gluten sensitivity is a valid concern.

Autism

Autism is a very difficult disease to quantify, diagnose and treat. Some have suggested gluten may play a role. Unfortunately, in a study with children who had autism spectrum disorder and who were undergoing intensive behavioral therapy, removing both gluten and casein, a protein found in dairy, had no positive impact on activity or sleep patterns.(9) These results were disappointing. However, this was a very small study involving 22 preschool children. Removing gluten may not be a panacea for all ailments.

Antibiotics

The microbiome in the gut may play a pivotal role as to whether a person develops celiac disease. In an observational study using data from the Swedish Prescribed Drug Register, results indicate that those who were given antibiotics within the last year had a 40 percent greater chance of developing celiac disease and a 90 percent greater risk of developing inflammation in the gut.(10) The researchers believe that this has to do with dysbyosis, a misbalance in the microbiota, or flora, of the gastrointestinal tract. It is interesting that celiac disease may be propagated by change in bacteria in the gut from the use of antibiotics.

Not everyone will benefit from a gluten-free diet. In fact, most of us will not. Ultimately, people who may benefit from this type of diet are those patients who have celiac disease and those who have symptomatic gluten sensitivity. Also patients who have positive serological tests, including tissue transglutaminase or antigliadin antibodies are good candidates for gluten-free diets.

There is a downside to a gluten-free diet: potential development of macronutrient and micronutrient deficiencies. Therefore, it would be wise to ask your doctor before starting gluten withdrawal. The research in patients with gluten sensitivity is relatively recent, and most gluten research has to do with celiac disease. Hopefully, we will see intriguing studies in the near future, since gluten-free products have grown to a $4 billion industry that the FDA now has begun to regulate.

References:

(1) Am J Gastroenterol. 2013;108:656-676. (2) Gut 2013;62:43–52. (3) Scand J Gastroenterol. (4) Neurogastroenterol Motil. 2013 Nov;25(11):864-71. (5) medscape.com. (6) fda.gov. (7) Am J Gastroenterol. 2011; 106(3):508-14. (8) medscape.com. (9) 9th annual AIM for Autism Research 2010; abstract 140.007. (10) BMC Gastroenterol. 2013:13(109).

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, go to the website medicalcompassmd.com or consult your personal physician.

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28-year-old skeleton racer will go to Sochi, Russia

John Daly competes in the World Cup in Lake Placid in December. Photo by Pat Hendrick

By Daniel Dunaief

Four years ago, he was just happy to be there. Weeks before the world turned its attention to Vancouver for the 2010 Winter Olympics, Smithtown’s John Daly had no idea whether he’d be watching the games from home or representing the country in the high-speed sport of skeleton racing.

Now, Daly, 28, is preparing for his second winter games in Sochi, Russia. He finished 17th in Vancouver and is approaching the competition, which is scheduled for Feb. 14 and 15, with a different attitude.

“I’m confident, I think I could do really well,” Daly said via Skype while in St. Moritz, Switzerland for one of the pre-Olympic qualifying races. “In the last game, I was a long shot. In this one, I’m truly prepared. If ever there was a race to win, it’s this one coming up.”

Daly competes in skeleton racing, where he digs his spiked shoes into an ice track, extends his arm and dives headfirst onto the sled. He races at speeds of more than 80 miles per hour, his chin inches above the frozen track. He steers by shifting his weight slightly, as spectators hear something akin to a freight train seconds before he becomes a bullet blazing down the bluff.

Daly said the four years of training and living have helped him maintain his focus in a race where the difference between a medal and fourth place is measured in hundredths of a second.

Thoughts about the action, the crowd and “how crazy would it be if I medal” may have hurt him in Vancouver.

“That’s when you start to put yourself days and hours ahead. I’m staying in the moment. I will take it one day at a time, one curve at a time.”

Tuffy Latour, the coach of the men’s and women’s skeleton team for the United States, suggested that the focus shouldn’t be on winning medals. Instead, his team needs to have “good starts and good drives” while “believing in themselves.”

As the number of days dwindle until he takes those last deep breaths before diving down the mountain, Daly and his family are preparing for a trip that’s more than 5,200 miles from their home.

His mother, Bennarda, a nurse at St. Catherine of Siena Medical Center in Smithtown, is thinking about “all the silly little things,” including making sure her husband, James, son, James, daughter, Kristen and sister, Sabina Rezza of Kew Gardens, make their flights.

The designers of the Sochi track originally wanted to make the course among the fastest in the world. A fatal accident in Vancouver, however, caused them to redesign their course, which now includes uphill sections that cut down on a slider’s speed.

“They wanted [the racers] to go to 100 miles per hour,” Daly said. “But they slowed it down to 83 miles per hour.” It makes the track especially unforgiving of any mistakes.

“With those uphill sections, you can’t mess up, or it’ll mess up the race,” Daly said. ‘You don’t want to teach perfection, but you need to be pretty close.”

Still, Daly has a short, but encouraging, history with this track. He placed fourth last February in a test run, a mere seven hundredths of a second behind third place. He also finished ahead of Latvian Tomass Dukurs, one of the two brothers who have been the dominant force in skeleton racing.

This year, Daly said, everyone on Team USA, including his friends Matt Antoine and Kyle Tress, has beaten at least one of the powerful tandem.

“It shows they are human,” Daly said. “It’s anyone’s game.”

Latour is encouraged by the way his competitors have performed.

“The Dukurs are beatable,” he said through an emailed statement. “Our team has had some fantastic races despite some small mistakes. If we’re going to beat those guys, we have to be at our best. I think we can get there.”

Daly said the only one of his entourage who might want a medal more than he does is his father James, a retired EMS worker for the FDNY.

The elder Daly said he’s so eager to see his son succeed because “when his dreams come true, so do mine.”
In addition to safety, Bennarda Daly has another goal for her son.

“If he knows he did his best, that’s all that matters,” she said.

James Daly said the agony of standing near the track, watching his son prepare for a race, is almost unbearable.

“You almost don’t know how to act,” he said. “There’s so much I want to do. Clapping my hands is all I can do.”

Daly’s mom plans to bring a cowbell to the other side of the world. Lining the track like pieces of metal drawn to a magnet, spectators shout encouragement and clang their cowbells, amplifying their sound and warming up their arms on mountains where icy winds seem intent on defeating wool sweaters, socks and hats.

Daly’s family and friends have been instrumental in getting him to Sochi, he said. When he needed money or he had to change a plane ticket, no matter what the hour, his father would get it done. Daly said he hopes he’s as helpful to his children some day.

James Daly said he learned how to support his family from his father, the late Joe Daly, a police officer in New York City.

As for what Daly will do after the Olympics, he’s considering a career in advertising.

“That’ll be my first actual job,” he said.

The trail from frozen tracks all over the world to the white-hot lights of the Winter Olympics has included its share of financial, physical and emotional sacrifices. He said he still has unaffordable college loans from Plattsburgh State University, where he was an All-American in the decathlon in 2007.

He has also bumped into walls during competitions and finished the races with bruises or blood dripping down his ankle.

Each year, he missed important personal events, including his mother’s birthday early in January, Thanksgiving and weddings. He couldn’t attend seven weddings in recent years.

Still, the opportunity to race down a mountain and represent the country is worth the trade-off.

“I get to be a kid and ride a sleigh,” he said. “How many other 28-year-olds can say that?”

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While wines are his passion, it was the martinis that changed James Muckerman’s life. Ten years ago, the senior chemist at Brookhaven National Laboratory attended a memorial symposium for the former chairman in his department, Richard Dodson.

Muckerman was at a table with Cal Tech’s Harry Gray, who was the keynote speaker. The waiters had mixed up some of the water pitchers with the martinis, a favorite drink of the late chemistry chairman. As Muckerman described it, a “well-lubricated (Gray) explained the plan to sell the Bush administration on the importance of solar energy.” Gray suggested that everyone in the scientific community ought to get behind this effort.

“By the time he was finished,” Muckerman recalled, “I was ready to sign on the dotted line.”

Muckerman said he didn’t want to continue to burn hydrocarbon reserves, adding to the increase of carbon dioxide in the atmosphere. A goal of artificial photosynthesis that appealed to him was that it recycles the greenhouse gas.

Muckerman and his colleagues investigate new basic photo- and electrochemistry for carrying out the various steps in artificial photosynthesis, which include light absorption, charge separation, water oxidation, hydrogen production and carbon dioxide reduction.

The change in career direction had its risks. Muckerman had become an expert in his field and already had a regular stream of funding for his studies. It was as if he had a long-running show on television and he had to go back to the pilot stage, waiting to see if the early results merited more money.

Fortunately, following his passion and interest in this new area worked out for Muckerman, who dedicates his professional energy to working on artificial photosynthesis as a theoretical chemist.

That means he uses quantum chemistry to figure out the critical but often unknown intermediate steps in between the beginning and end of a chemical reaction.

He works in close collaboration with others in the department who do hands-on laboratory research, including Etsuko Fujita, who is the leader of the artificial photosynthesis group.

The connection between the theoretical and the practical chemistry has “a history of using basic understanding of how chemistry processes work to design better molecules for artificial photosynthesis,” said Alex Harris, the chairman of the chemistry department.

Muckerman and Fujita aren’t just scientific collaborators, but are also partners in life.

Harris said Muckerman and Fujita have an “extremely productive collaboration.” Muckerman developed theories to help explain her results, while also predicting ways to improve her performance. He also was able to learn a new field by working closely with an established experimentalist, Harris added.

Wei-Fu Chen, a research associate at BNL who has worked with both of them, described the team as “solid and highly united and has become the most pioneering in the field of artificial photosynthesis.” On top of that, Chen felt the tandem served as “wonderful supervisors and friends.”

The couple, who live in Port Jefferson, have been together since 1985. Each of them have children from previous marriages, which means all the children “regard us as their parents,” he said. Muckerman said the two of them have an unofficial game of chicken, where the first to leave the lab has to cook dinner.

“I always lose,” Muckerman laughed, although Fujita does the cooking on the weekends.

Muckerman said the couple, whose work travels have allowed them to pursue their shared interest in wine tasting (his favorite is a red burgundy, while she expressed a preference for champagne and Japanese sake), complement each other’s professional interests.

Muckerman praised Fujita’s work ethic. That incredible focus enabled Fujita to earn her doctorate from Georgia Tech in an astoundingly quick two-year period.

In addition to contributing his theoretical chemistry and weekday culinary skills to their partnership, Muckerman also offers editing advice to Fujita and the rest of the artificial intelligence group. “I’ve been correcting the same mistakes in (Fujita’s) English for 30 years,” he said.

Fujita and Muckerman realize what’s at stake in the work they’re doing. Alternative energy, including the use of artificial photosynthesis, is an area that has to succeed, Muckerman said.

“The energy problem,” offered Fujita, who has worked on artificial photosynthesis for 25 years, “is the most important issue in this century.”

Muckerman shared similar sentiments. “I firmly believe that our survival depends on developing new ways to harness clean energy,” he said, “but it’s not going to be easy.”

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Losing weight may decrease AFib episode frequency and duration

Atrial fibrillation is the most common arrhythmia, an abnormal or irregular heartbeat, found in the U.S. Unfortunately, it is very complicated to treat. Though there are several options, including medications and invasive procedures, it mostly boils down to symptomatic treatment, rather than treating or reversing underlying causes.

What is AFib? It is an electrical malfunction that affects the atria, the two upper chambers of the heart, causing them to beat “irregularly irregular,” or with no set pattern affecting the rhythm and potentially causing a rapid rate. The result of this may be insufficient blood supply throughout the body.

Complications that may occur can be severely debilitating, such as stroke or even death. Its prevalence is expected to more than double in the next 16 years (1). Risk factors include age (the older we get, the higher the probability), obesity, high blood pressure, premature atrial contractions and diabetes.

AFib is not always symptomatic; however, when it is symptoms include shortness of breath, chest discomfort, light-headedness, fatigue and confusion. This arrhythmia can be diagnosed by electrocardiogram, but more likely with a 24-hour halter monitor. The difficulty in diagnosing AFib sometimes is because it can be intermittent.

There may be a better way to diagnose AFib. In a recent study, the Zio patch, worn for 14 days, was more likely to show arrhythmia than a 24-hour halter monitor (2). The Zio patch is a waterproof adhesive patch on the chest, worn like a Band-Aid, with one ECG lead.  While 50 percent of patients found the halter monitor to be unobtrusive, almost all patients found the Zio patch comfortable.

There are two main types of AFib, paroxysmal and persistent. Paroxysmal is acute, or sudden, and lasts for less than seven days, usually less than 24 hours. It tends to occur with greater frequency over time, but comes and goes. Persistent AFib is when a patient has AFib that continues past seven days (3). AFib is a progressive disease, meaning it only gets worse especially without treatment.

Medications are meant to treat either the rate or rhythm or prevent strokes from occurring. Medications that treat rate include beta blockers, like metoprolol, and calcium channel blockers, such as diltiazem (Cardizem). Examples of medications that treat rhythm are amiodarone and sotalol. Then there are anticoagulants that are meant to prevent stroke, such as warfarin and some newer medications, dabigatran (Pradaxa), rivaroxaban (Xarelto) and apixaban (Eliquis). The newer anticoagulants are easier to administer, but may have higher bleeding risks in some circumstances with no antidote.

There is also an invasive procedure, ablation, that requires threading a catheter through an artery, usually the femoral artery located in the groin, to reach the heart. In one type of ablation, the inappropriate nodes firing in the walls of the atria are ablated, or destroyed, using radiofrequency. This procedure causes scarring of the tissue in the atria. When successful, patients may no longer need medication. Let’s look at the evidence.

Premature atrial contractions

Premature atrial contractions, abnormal extra beats that occur in the atrium, may be a predictor of atrial fibrillation. In a recent study, PACs alone, when compared to the Framingham AF risk algorithm (a conglomeration of risk factors that excludes PACs) resulted in higher risk of AFib (4). When there were greater than 32 abnormal beats/hour, there was a significantly greater risk of AFib after 15 years of PACs. When taken together, PACs and the Framingham model were able to predict AFib risk better at 10 years out as well. Also, overall when the number of PACs doubled in patients, there was a 17 percent increased risk of AFib.

The role of obesity

There is good news and bad news with obesity in regards to AFib. Let’s first talk about the bad news. In studies, those who are obese are at significantly increased risk. In the Framingham Heart Study, the risk of developing AFib was 52 percent greater in men who were obese and 46 percent greater in women who were obese when compared to those of normal weight (5). Obesity was a BMI >30 kg/m2, and normal weight was a BMI <25 kg/m2. There were over 5,000 participants in this study with a follow-up of 13 years.

The Danish Diet, Cancer and Health Study reinforces these results by showing that obese men were at a greater than twofold increased risk of developing AFib, and obese women were at a twofold increased risk (6).

Now the good news: weight loss may help reduce the frequency of AFib episodes. That’s right, weight loss could be a simple treatment for this very dangerous arrhythmia. In a recent randomized controlled trial, the gold standard of studies, those in the intervention group lost significantly more weight, 14 kg (32 pounds) versus 3.6 kg (eight pounds), and saw a significant reduction in atrial fibrillation severity score compared to those in the control group (7). There were 150 patients involved in the study.

AFSS includes duration, severity and frequency of atrial fibrillation. All three components in the AFSS were reduced in the intervention group compared to the control group. There was a 692-minute decrease in the time spent in AFib over 12 months in the intervention arm, whereas there was 419-minute increase in the time in AFib in the control group. These results are potentially very powerful; this is the first study to demonstrate that managing risk factors may actually help manage the disease.

Caffeine

According to a recent meta-analysis (a group of six population-based studies) done in China, caffeine does not increase, and may even decrease, the risk of AFib (8). The study did not reach statistical significance. The authors surmised that drinking coffee on a regular basis may be beneficial because caffeine has antifibrosis properties. Fibrosis is the occurrence of excess fibrous tissue, in this case, in the atria, which most likely have deleterious effects. Atrial fibrosis could be a preliminary contributing step to AFib. Since these were population-based studies, only an association can be made with this discovery, rather than a hard and fast link. Still this is a surprising result.

However, in those who already have AFib, it seems that caffeine may exacerbate the frequency of symptomatic occurrences, at least anecdotally. With my patients, when we reduce or discontinue substances that have caffeine, such as coffee, tea and chocolate, the number of episodes of AFib seems to decline. I have also heard similar stories from my colleagues and their patients. So think twice before running out and getting a cup of caffeinated coffee if you have AFib.  What we really need are RCT studies done in patients with AFib, comparing people who consume caffeine regularly to those who have decreased or discontinued the substance.

The bottom line is this: if there were ever a reason needed for obese patients to lose weight, treating atrial fibrillation should be on the top of the list, especially since it is such a dangerous disease with potentially severe complications.

References:

(1) Am J Cardiol. 2013 Oct. 15;112:1142-1147. (2) Am J Med. 2014 Jan.;127:95.e11-7. (3) Uptodate.com. (4) Ann Intern Med. 2013;159:721-728. (5) JAMA. 2004;292:2471-2477. (6) Am J Med. 2005;118:489-495. (7) JAMA. 2013;310:2050-2060. (8) Canadian J Cardiol online. 2014 Jan. 6.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, go to the website medicalcompassmd.com and/or consult your personal physician.

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The Russian Orthodox Monastery of the Holy Cross on Main Street. File photo by Rachel Shapiro

By Mallika Mitra

A Boy Scout at Ward Melville High School has completed an Eagle service project that beautifies and benefits the Russian Orthodox Monastery of the Holy Cross on Main Street in East Setauket. Justin Russo, 15, got a gazebo donated by John T. Mather Memorial Hospital installed at the church.

Justin said he was on his way home from searching for possible projects when he decided to see if the church could find something for him to work on. Father John, a priest at the Brotherhood of the Holy Cross, explained to Justin that the church used to baptize under a tree that was destroyed by Hurricane Sandy, and that they were looking for a gazebo for baptisms.

The 10th-grade Boy Scout of Troop 117 began searching for a gazebo for the church.

When he called Gera Gardens in Mount Sinai, he was told that they had sold a gazebo to the hospital and that the hospital was now getting rid of it. With the help of his father, the assistant Scoutmaster of the troop who knew a Mather Hospital board member, Justin was able to get the gazebo donated to the church.

They hired East Setauket-based Hurricane Tree Experts Inc. to remove the stump of the tree that had been there since the tree was destroyed during Hurricane Sandy and a local roofing company to restore the gazebo’s roofing.

Justin was able to raise money by collecting donations from friends and family.

“Thankfully I had a lot of support,” he said.

He worked after school and on the weekends doing paperwork and completing business transactions for the service project, with the help of his father.

At the end of November, the Boy Scout organized younger members of his troop to help put in and power wash the gazebo, and put in new banisters and railings, which were destroyed when they got the gazebo from Mather Hospital.

“To teach, you’ve got to be a good leader,” Justin said about organizing the younger Scouts to help him with his project, and added that working with the younger boys was a great experience.

The original plan was to stain the gazebo as well, but they ended up not doing so because “The people at the church said it was perfect the way it was,” Justin said.

Now that the project is completed, Justin, who has been a Boy Scout for about six years, still keeps in touch with Father John at the Brotherhood of the Holy Cross. He said that because he still has some funds left over from the project, he will be able to help Father John with future projects related to the gazebo, if they come up.

The Boy Scout still has a few tasks to finish before he officially becomes an Eagle Scout, but his service project is now complete.

“It was a really good experience,” he said. “I’ve never been involved in anything like it.”

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