Monthly Archives: July 2015

Daniel Madigan with a yellowfin tuna. Photo by Maile Madigan

When Daniel Madigan is out working, he sometimes has no access to a computer, an iPhone or email and that’s just fine by him. Instead of searching for parking spaces, waiting for traffic lights and standing in line at a grocery store, he rocks back and forth on the ocean, seeking answers to questions deep below the surface.

An NSF postdoctoral fellow at the School of Marine and Atmospheric Sciences at Stony Brook University, Madigan said the typical month he has spent over the last four years on the Pacific Ocean has given him a “sense that this is where I want to be. You see something you’ve never seen before, every time.”

He’s watched a killer whale feeding on tuna and has witnessed a school of yellowtail jack beating with their tails on a blue shark. Fin whales, killer whales and blue whales have dotted the landscape on his research trips.

Recently, Madigan completed work on a study of tuna. Knowing that the bluefin tuna has a metabolism that enables it to remain warmer in colder waters than the albacore and yellowfin tuna, Madigan explored whether the bluefin’s greater range gave it a more varied diet.

It turns out that the bluefin is more selective than its more temperature-limited tuna cousins. “We expected a broader habitat use would lead to more access to more food,” Madigan said. “That would be a straightforward benefit to the expansion they get” from being warm-bodied.

In a way, this finding also “makes sense,” he said, because fish that can “access more space can also pick the best thing to specialize in.” The bluefin can not only dive deeper but it can also travel further north to colder waters.

Bluefin tuna face considerable competition for sardines, a primary food source. Humans also consume this fish, and it is a staple of aquaculture-raised fish. Competition for sardines leads to questions about ecosystem-based management.

“When people form policies, they want to know things like, ‘If we limit the sardines in the ocean, how many metric tons of bluefin tuna will that save us?” Madigan asked. “If you can’t give those answers, it becomes more difficult to make concrete estimates.”

At this point, Madigan and other scientists are still in the recognition rather than the implementation stage, which means researchers are developing a greater awareness of the dynamic between the preferred foods for bluefin and measures such as the fish’s fertility and growth rates.

To be sure, Madigan said the population of these warmer-bodied tuna were unlikely to go into deep decline amid a drop in the number of sardines because the bluefin can feed on whatever is abundant to survive.

Still, understanding the life history of these fish with different habitat ranges can enable scientists and policy makers to recognize the complexity of interactions in the marine ecosystem, as well as any possible effect of fisheries policies.

Sardines, anchovy and herring are considered forage fish, which are used in aquaculture and are also popular with sharks, seabirds and marine mammals.

To track the fish in the study, Madigan and his colleagues collected all three types of tuna, put tags on them, sent them back in the ocean and retrieved and downloaded the information from the tags.

Heidi Dewar, a fisheries research biologist at NOAA’s Southwest Fisheries Science Center in California who has worked with Madigan for six years, described her colleague as an “innovator.” She praised Madigan’s work with chemical tracers to understand large-scale migrations. Madigan has used the nuclear accident in Fukushima, Japan, to quantify the migration of bluefin tuna from west to east. His work can have a “long-term application,” she added.

Dewar agreed that working on and in the ocean provides opportunities to make new discoveries. “There is nothing like getting up close and personal with sharks, giant bluefin tuna, manta rays or opah,” Dewar described. “Unlocking the mysteries of their various adaptations either using electronic tags or by examining their physiology and morphology makes me feel like an early explorer mapping new territory.”

Madigan, who grew up in Garden City, lives in Port Jefferson with his wife Maile, who is a school administrator for a charter school in Riverhead.

Madigan said the broader goal for his research is that “these animals will still be here in 100, 200 years” and will be in “even greater numbers and surviving to even greater sizes.”

Red ribbons are one way North Shore residents are remembering the fatal crash victims. Photo from Smithtown Historical Society

One week has passed, but no amount of time can ever truly heal the wounds endured by the greater North Shore community since four of its own were killed in a horrific limousine crash.

Anyone driving through the streets of Smithtown and its surrounding communities this week could notice the red ribbons wrapped around trees in memory of Smithtown’s Brittney Schulman, 23, and Lauren Baruch, 24, as well as Stephanie Belli, 23, of Kings Park, and Amy Grabina, 23, of Commack. The four girls were killed when Steven Romeo, 55, T-boned their limousine with his pickup truck in Cutchogue last Saturday, injuring Romeo, along with limo driver Carlos Pino, 58, of Bethpage, Joelle Dimonte, 25, of Elwood, Melissa Angela Crai, 23, of Scarsdale, Alicia Arundel, 24, of Setauket, and Olga Lipets, 24, of Brooklyn.

After the crash, Romeo was arraigned at Eastern Long Island Hospital and charged with driving while intoxicated. He was initially ordered held in lieu of $500,000 cash bail, or $1 million bond, but that bail was reduced to $50,000 cash or $100,000 bond last Thursday, according to Suffolk County District Attorney Tom Spota. At a press conference on Friday, Spota said Romeo had recorded a blood alcohol content of .066 percent when he was tested roughly one hour after the crash. The DWI charge, however, was not dropped despite his BAC coming in below the legal limit of .08, Spota said. No additional charges were filed against Romeo as the investigation continued.

Romeo’s court date, which was originally set for last week, was adjourned to Sept. 18.

The past week saw the funerals of all four of the victims, while those injured were released from hospital care by the middle of this week. The North Shore community planned to take one of its first steps toward closure on Wednesday night at Smithtown High School West, where residents, elected officials and members of Mothers Against Drunk Driving were scheduled to meet. The event was borne out of a Facebook page titled “Candlelight Vigil for Our Girls,” which was put into action in the days following the tragedy. By Wednesday, the page had collected more than 6,000 names to its roster and countless photos of mourning and support for the victims’ families.

Marianne Howard, executive director with the Smithtown Historical Society, was one of the several Smithtown residents to tie red ribbons around trees in front of the society’s property. She said various businesses throughout town, including Towers Flowers of Nesconset and James Cress Florist of Smithtown, helped donate the ribbons to the cause.

“We mourn the loss of four beautiful souls who were taken too early from our community,” she said. “We send our deepest condolences to their families and friends. May they rest in peace.”

Chabad at Stony Brook also signed onto the cause of finding good in a tragic situation, launching its own Facebook event page, “responding to dark, with light,” in memory of the four girls and challenging residents to commit 400 random acts of goodness and kindness in their honor.

Chaya Klein Grossbaum of Chabad at Stony Brook said once the goal was reached, the group would print a book detailing each singular act.

Beyond-Words-Jacket-wThe Bates House, 1 Bates Road, Setauket, will host a reading and book signing by Carl Safina on Thursday, Aug. 6, at 7 p.m. Named one of 100 Notable Conservationists of the 20th Century, Safina has authored seven books including “Song for the Blue Ocean,” which was a New York Times Notable Book of the Year, “Eye of the Albatross,” “Voyage of the Turtle” and “The View from Lazy Point.”

Safina is founding president of The Safina Center at Stony Brook University, where he also co-chairs the university’s Alan Alda Center for Communicating Science. Winner of the 2012 Orion Award and a MacArthur Prize, his work has been featured in National Geographic, The New York Times, CNN.com, The Huffington Post and Times Beacon Record Newspapers.

On Aug. 6, Safina will speak about and sign copies of his latest nonfiction landmark book, “Beyond Words: What Animals Think and Feel,” sharing some astonishing new discoveries about the similarities between humans and animals. There will also be a Q-and-A.

Carl Safina. File photo from SBU
Carl Safina. File photo from SBU

Discover Magazine said the book is “a beautifully written, provocative case for seeing animals through their eyes,” and Elizabeth Marshall Thomas, author of “The Hidden Life of Dogs” said “‘Beyond Words’ is a must-read. Animals think, mourn, dream, make plans, and communicate complex messages in much the same way that we do. Readers who knew this already will rejoice, others will learn the truth and the more of us who capture the message, the sooner we will change the world.”

Don’t miss this special event. For more information, please call 631-632-3763 or visit www.carlsafina.org.

by -
0 1293

By Nancy Burner, ESQ.

For most of us, if a time comes when we need assistance, the preferred option would be to remain at home and receive whatever care services we needed in our familiar setting surrounded by family. For many, the Community-Based Long-Term Care Program, commonly referred to as Community Medicaid, makes that an affordable and therefore viable option.

Oftentimes we meet with families who are under the impression that they will not qualify for these services through the Medicaid program due to their income and assets. In most cases, that is not the case. Although an applicant for Community Medicaid must meet the necessary income and assets levels, oftentimes with planning we are able to assist in making an individual eligible with little wait.

An individual who is applying for homecare Medicaid may have no more than $14,850 in nonretirement liquid assets. Retirement assets will not be counted as a resource as long as the applicant is receiving monthly distributions from the account. An irrevocable prepaid burial fund is also permitted as an exempt resource. The primary residence is an exempt asset during the lifetime of the Medicaid recipient. However, when the applicant owns a home, it is advisable to consider additional estate planning to ensure that the home will be protected once the Medicaid recipient passes away. 

Although the home is considered an exempt resource as long as the Medicaid recipient is living in it, once the applicant passes, Medicaid can assert a lien on the home if it passes through the probate estate. One way to avoid this is to ensure that at the time of the death of the applicant no assets pass through the probate estate; this can be achieved by transferring the home to a trust. Once this is done, the home will pass to the intended beneficiaries without a probate proceeding and without an opportunity for Medicaid to seek recovery against the home. 

With respect to income, an applicant for Medicaid is permitted to keep $825 per month in income plus a $20 disregard. However, where the applicant has income that exceeds that $845 threshold, a Pooled Income Trust can be established to preserve the applicant’s excess income and direct it to a fund where it can be used to pay his or her household bills.  It is important to note that there is no “look back” for Community Medicaid. This means that for most people, with minimal planning, both the income and asset requirements can be met with a minimal waiting period allowing families to mitigate the cost of caring for their loved ones at home, in many cases making aging in place an option.   

Individuals looking for coverage for the cost of a home health aide must be able to show that they require assistance with their activities of daily living. Some examples of activities of daily living include dressing, bathing, toileting, ambulating and feeding.

Community Medicaid will not provide care services where the only need is supervisory; therefore, it is important to establish an assistive need with the tasks listed above. Once this need is established, the amount of hours awarded will depend upon the frequency with which assistance with the tasks are necessary. 

For example, an individual who only needs help dressing and bathing may receive minimal coverage during the scheduled times, maybe two hours in the morning and two hours in the evening. Contrast that with an individual who requires assistance with ambulating and toileting. Because these tasks are considered “unscheduled,” the hours awarded will be maximized.

In fact, where the need is established, the Medicaid program can provide care for up to 24 hours per day, seven days per week. Once approved, the individual may be enrolled in a managed long-term care company. The MLTC may also cover adult day health care programs, transportation to and from nonemergency medical appointments and medical supplies such as diapers, pull-ups, chux and durable medical equipment.

The Community-Based Medicaid Program is invaluable for many seniors who wish to age in place but are unable to do so without some level of assistance.

Nancy Burner, Esq. has practiced elder law and estate planning for 25 years.

Brookhaven’s Youth Bureau is collecting school supplies. File photo

The start of school is right around the corner, and the Brookhaven Town Youth Bureau is making sure no student goes back empty-handed.

Through Aug. 24, the bureau is collecting back-to-school supplies at locations throughout the town, including Town Hall in Farmingville, the Highway Department in Coram, the Rose Caracappa Senior Center in Mount Sinai and all Astoria Bank branch locations.

Pens, calculators, backpacks, notebooks, lunch boxes, folders, glue and binders are among the items needed and that will be distributed to needy families. Last year, the bureau collected enough supplies to help more than 1,500 children, according to a press release from the town.

For more information or to find additional collection bin locations, visit www.brookhaven.org or call 631-451-8014.

Annual Asharoken swim to benefit Alzheimer's disease research raises more than $6,000

By Talia Amorosano

On Tuesday morning, more than 20 kayakers and swimmers gathered for the 12th Annual Distant Memories Swim, an event created and organized by Bryan Proctor, a Harborfields physical education teacher, to raise awareness for Alzheimer’s disease, the most common form of dementia. Participants traveled two nautical miles from Asharoken Beach in Northport to Knollwood Beach in Huntington and were cheered on by family members and supporters who waited and watched the event from shore. This year’s event has raised more than $6,000 for the Alzheimer’s Disease Resource Center so far, and over the course of its existence, has raised over $100,000. Organizers hope that the money will eventually help researchers find a cure for this increasingly prevalent disease.

An aggressive crocodile was found in an open cardboard box in a Melville parking lot and handed over to officials at the Suffolk County Society for the Prevention of Cruelty to Animals on Tuesday, officials said.

The three-foot-long croc, discovered at 25 Melville Park Rd., was “very aggressive and its mouth had to be taped shut,” according to a statement from the Society for the Prevention of Cruelty to Animals. Chief Roy Gross said that Jerry Mosca, the director of the Huntington Town Animal Shelter, and another animal control officer, responded to an anonymous call about the crocodile. Mosca didn’t immediately return a call seeking comment on Tuesday afternoon.

The New York State Department of Environmental Conservation Police and Suffolk County SPCA investigators will team up to get to the bottom of who left the crocodile in the parking lot, according to the statement.

Anyone with information is asked to contact the Suffolk County SPCA at (631) 382-7722. All calls will be kept confidential.

Chad Morizsan pleads guilty to charges

Suffolk County Police Officer Nicholas Guerrero is released from Stony Brook University Hospital and transported to a rehab center. File photo by Barbara Donlon

A Northport man has been sentenced to 25 years in prison after pleading guilty to running down two Suffolk County police officers last year and critically injuring one of them.

Suffolk County District Attorney Tom Spota said that Chad Morizsan, who was sentenced on Thursday, July 23, waived his right to appeal and pleaded guilty to assault in the first degree, assault on a police officer, leaving the scene, grand larceny, criminal possession of stolen property, robbery in the second degree and forgery.

Last September, Morizsan sped off in a stolen SUV after being pulled over by officers Nicholas Guerrero and Heriberto Lugo at a traffic stop. He struck both officers as he fled the scene, critically injuring Guerrero.

Chad Morizsan. Photo from SCPD
Chad Morizsan. Photo from SCPD

Bob Clifford, a spokesman for Spota, said Guerrero was in the courtroom at Morizsan’s sentencing.

Guerrero was hospitalized for more than three weeks with a severe head injury at Stony Brook University Hospital. He underwent surgery and a regimen of physical therapy during his recovery.

He has been with the police department for four years. His partner, Lugo, was treated and released.

Once Morizsan fled the scene, along with his co-defendant and passenger Nicholas Franzone of Northport, police said they carjacked a Ford Explorer, stole the credit cards of the 87-year-old owner of the Explorer in her Commack driveway and stole gas from a gas station in the area.

The two were arrested at a Central Islip store hours later when police said they attempted to purchase a television with the woman’s stolen credit card.

Attorney Ian Fitzgerald, who is representing Franzone, has said that Franzone had nothing to do with the hit-and-run.

“He was in the back seat of the car,” Fitzgerald said in a previous interview. “He had nothing to do with Mr. Morizsan fleeing and injuring the officer … he had no control over the vehicle.”

Franzone is set to return to court on Aug. 4, charged with unauthorized use of a motor vehicle for his alleged role in the carjacking incident, police said.

Daniel Guttmann, who is listed in online court records as Morizsan’s attorney, didn’t immediately return calls seeking comment on Tuesday.

Kara Hahn, center, officially opens Forsythe Meadow Count Park/Nora Bredes Preserve’s new walking trail during ribbon cutting ceremony Monday. Photo by Giselle Barkley

The sun appeared just in time for Suffolk County Legislator Kara Hahn’s (D-Setauket) ribbon cutting ceremony that marked the official opening of Forsythe Meadow County Park/Nora Bredes Preserve’s walking trail.

The ceremony took place Monday afternoon at 52 Hollow Rd. in Stony Brook. More than 50 people were in attendance including Hahn; former legislator Vivian Viloria-Fisher; Cynthia Barnes, president of the Board of Trustees Three Village; and Louise Harrison. Barnes and Harrison were both co-chairs of the Coalition for the Future of Stony Brook Village.

Once Hahn cut the ribbon, those who attended the ceremony were invited to hike the trail.

Coalition members wore pink ribbons, which the group selected upon their  outrage that developers wanted to turn the property into a 40-house subdivision.

For these members, the trail is a symbol of success in an effort to preserve this approximate 36-acre property. But according to Jeffrey Weissman, scoutmaster of Troop 377 for the Three Village Boy Scouts, the trail will not be the last improvement made to the property. Weissman wants to have more benches in the area among other improvements.

Hahn, as well as Viloria-Fisher, Barnes, Harrison and Councilwoman Valerie Cartright (D-Port Jefferson Station) thanked the individuals who helped create the trail. They also thanked those who attended the ribbon cutting ceremony for their support and effort to save “Stony Brook’s last forest.”

“It is this group standing here today that saved this forest,” Harrison said. “Someday we’ll have access from the village center.”

by -
0 1132

High cholesterol is a problem that affects a countless number of people in the United States. One of the challenges is that it has no noticeable symptoms but may result in an increased risk of cardiovascular disease, including heart attacks and strokes. So what do we do about it?

Currently, the standard medical treatments for high cholesterol are statins. Statins include rosuvastatin (Crestor), atorvastatin (Lipitor), simvastatin (Zocor) and pravastatin (Pravachol). But now a new drug has been approved by the FDA, and it is the first drug in a new class, proprotein convertase subtilisin/kexin type 9 inhibitors or, more affectionately and easier to say, PCSK9 inhibitors.

The first medication approved in this class was Praluent (alirocumab) on Friday, July 24, 2015 (1). PCSK9 inhibitors are monoclonal antibodies that turn off specific proteins in the liver, reducing the levels of LDL, the “bad” cholesterol (2). Right behind, Repatha (evolocumab), another PCSK9 inhibitor, was just recommended by the FDA advisory board. Usually the FDA follows advisory board recommendations.

Therefore, we will likely have two drugs from this class approved and on the market.

Will PCSK9 inhibitors take the place of statins?
Hardly, at this point. The FDA has taken a conservative and narrow approach when it comes to indications for alirocumab (1). Patients who have either heterozygous familial hypercholesterolemia (FH), a genetic disease that affects about 1 in 500 Americans, or those who have atherosclerotic cardiovascular disease (ASCVD), meaning they have had heart attacks, strokes or chest pain due to plaque buildup in the arteries, are presently candidates for treatment. And then, only if both lifestyle modifications and the highest tolerated dose of statins are not sufficient to produce the desired effects. Then, PCSK9 inhibitors may be added to lower LDL further. Patients who are intolerant of statins and who do not have cardiovascular disease are not currently candidates. This may change, but not at the moment.

Class effectiveness of alirocumab and PCSK9
These drugs have been shown to significantly reduce the LDL levels. In five randomized controlled trials, the gold standard of studies, alirocumab was shown to reduce LDL levels by between 36 and 59 percent over placebo (3).

Ironically, though it lowers the LDL considerably, 10-year risk assessment calculator for cardiovascular disease based on the Framingham Heart Study does not include LDL as a consideration (4).

Caveats for this new drug class
There are two significant limitations. One is the outcomes data, and one is the cost. Oh yeah, and I forgot to mention that you need to inject the drug every two weeks.

While this class has shown impressive results in reducing LDL levels, especially compared to statins, it is still in trials to determine whether the reduction in bad cholesterol actually translates into a reduction in cardiovascular events. Trials are not expected to be finished until 2018 (5). This may be one reason for the FDA’s limited treatment population.

Already, drug costs seem to be soaring. Just when we thought they were getting better for statins, since most of them now are generic, here comes a new class of cholesterol-lowering drugs with an even higher price tag. The annual cost for treatment is expected to be around $14,600 (3). This does not help. According to Sanofi and Regeneron Pharmaceuticals, the companies involved, this is a low price for the type of drug, monoclonal antibodies, and the savings from preventing cardiovascular events will be worth the price.

Ironically, the drugs have yet to demonstrate this outcome.

The side effect profile
Unfortunately, with just about every medication there is the dreaded side effect profile. Presently, it seems that alirocumab has a mild side effect profile. These include itchiness, bruising, swelling and pain in the site of injection, flu symptoms and nasopharyngitis (inflammation of the mucous membranes of the nasal passages and pharynx) (3). There were also some allergic reactions that involved hospitalization. As a class, monoclonal antibodies are known to potentially precipitate significant infection. We will have to wait and see whether or not this is the case with PCSK9 inhibitors. Remember, it took a number of years before we knew some of statins’ adverse reactions and the extent of their side effects.

The role of statins
With the recent ACC/AHA guidelines for statin use, published in 2013, these drugs continue to be prescribed for a broader audience of patients. They recommend that those who have LDL levels between 70 and 189 mg/dL and at least a 7.5 percent risk of a cardiovascular event over 10 years are candidates for statins for primary prevention, and this is cost-effective (6). That does not mean these patients necessarily need to have elevated total cholesterol nor elevated bad cholesterol.

In an even broader recommendation, a recent study suggested that people between the ages of 75 and 94 could be on a generic statin for primary prevention of a heart attack or death as a result of coronary heart disease (7). These results were based on using two studies and then forecasting from those results. The authors suggested that this may be both clinically and financially effective. However, they did acknowledge that this would exclude those with adverse reactions to statins.

Have we gone too far with this recommendation? According to an editorial in the same journal, harm from modest side effects would most likely limit the use of these drugs in this population (8).

Impending triglycerides
In two trials, results show that patients who have acute coronary syndrome (ACS) and who are treated with statins have a 50 to 61 percent increased risk of a cardiovascular event in the short term and long term if their triglyceride levels are mildly elevated, either greater than 175 or 195 mg/dL depending on which of the two studies is considered (9). ACS is defined as reduced blood flow to the heart resulting in unstable angina (chest pain), heart attack or cardiac arrest. In one of the two trials, the long-term effects of high triglycerides >175 mg/dL were compared to triglycerides <80 mg/dL. Almost all of the patients were on statins and had LDL levels that were near optimal (<70 mg/dL) with a mean of 73 mg/dL. By the way, “normal” triglycerides, according to most labs, are <150 mg/dL.

Move over bones — vitamin D for healthy cholesterol
In a non-drug-related study, it turns out that high vitamin D levels in children are associated with lower total cholesterol levels, non-HDL “bad” cholesterol levels and triglyceride levels overall (10). The authors note that higher non-HDL levels in children may result in a greater risk of cardiovascular disease in later life.

Though it is exciting to have more options in the arsenal for medical treatment, the moral of the story is that those who do not fit the FDA’s criteria for usage should most likely watch and wait to see how longer term side effects and outcomes play out. Statins are beneficial, as we know, but we may be overreaching in terms of the patient population for treatment. In my clinical experience, lifestyle changes including diet and exercise are important for reducing triglycerides to normal levels. And finally, it is never too early to start mild prevention for cardiovascular disease, such as by managing vitamin D levels.

References:
(1) FDA.gov. (2) health.harvard.edu. (3) medpagetoday.com. (4) cvdrisk.nhlbi.nih.gov. (5) J Am Coll Cardiol. 2015:23;65(24):2638-2651. (6) JAMA 2015; 314:134-141. (7) Ann Intern Med 2015; 162:533-541. (8) Ann Intern Med 2015; 162:590-591. (9) J Am Coll Cardiol 2015; 65:2267-2275. (10) PLoS One. 2015 Jul 15;10(7):e0131938.

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 www.medicalcompassmd.com or consult your personal physician.