Arts & Entertainment

Apple-Honey Loaf Cake

By Barbara Beltrami

Like so many holidays, Rosh Hashana, which begins the Jewish New Year on the evening of Sept. 9, features an assortment of traditional foods. Among them are carrots, pomegranates, fish and, last but not least, bread, apples and honey. Each of these has a symbolic association with the idea of plenty, prosperity, newness, beauty and sweetness — all very happy and positive bodings for the new year. I would love to go into what each means, but my editor would have a conniption if I wrote all that. Anyway, below are recipes that feature three of those very important elements of the Rosh Hashana table … apples and honey for a sweet and happy new year and challah for a prosperous one.

Apple-Honey Loaf Cake

Apple-Honey Loaf Cake

 

YIELD: Makes two 9×5×3-inch loaves.

INGREDIENTS:

1 cup sugar

1 cup vegetable oil

2 eggs

1 cup honey

1 teaspoon vanilla extract

2½ cups flour

1 teaspoon baking powder

1 teaspoon baking soda

1 teaspoon salt

1 teaspoon cinnamon

3 apples peeled, cored and shredded 

DIRECTIONS:

Preheat oven to 325 F. Grease and flour loaf pans. In a large bowl combine sugar and oil; add eggs and beat until mixture is pale yellow. Stir in ¾ cup of the honey and vanilla. In another large bowl, combine the flour, baking powder, baking soda, salt and cinnamon. Stir into egg mixture just until moistened. Fold in apples. Pour batter into loaf pans; bake 45 minutes or until cake tester inserted in middle comes out clean. Heat remaining quarter cup of honey until warm. Let cake cool 15 minutes, then invert onto plate, prick with a fork and drizzle warm honey over top. Serve with dessert wine, coffee or tea.

Holiday Challah

Holiday Challah

YIELD: Makes 2 large loaves.

INGREDIENTS:

Four ¼-ounce packages quick-rise yeast

4 cups warm (105–115 F) water

2 tablespoons salt

¾ cup sugar

1 cup vegetable shortening, melted

4 eggs

10 to 12 cups bread flour (approximate)

1 egg

¼ cup poppy seeds

DIRECTIONS:

In large bowl, sprinkle yeast over water; stir to moisten. Stir in salt, sugar, shortening and the 4 eggs. Gradually mix in flour, one cupful at a time until dough becomes slightly sticky but not wet. (You may not need all the flour.) Turn the dough onto a floured surface and knead about 10 minutes, until smooth and elastic. Grease two baking sheets and set aside. Cut dough into two equal pieces, then divide each of those pieces into 3 equal pieces. On a floured surface, roll each of the smaller pieces into a 12-inch rope about the thickness of a thumb, but thicker in the middle and thinner toward each end. For each loaf, braid the 3 ropes, pinch together and tuck under at ends. Gently pat each loaf into a circular shape and lift onto baking sheet. Cover with a damp towel let rise in a warm place until double in size, 60 to 90 minutes. Preheat oven to 350 F. Beat remaining egg with ½ teaspoon water and brush top of each loaf with mixture. Sprinkle with poppy seeds. Bake until tops are shiny and golden, about 30 minutes. Let cool before slicing.

From left, Major Benjamin Tallmadge (Art Billadello) and Abraham Woodhull (Beverly C. Tyler) read a copy of The Royal Gazette dated July 21, 1780 on the grounds of the Sherwood-Jayne Farm in East Setauket as Big Bill the Tory, aka William Jayne II (David Burt), looks on. Billadello is wearing a dragoon coat from the AMC television series ‘TURN’ that will be auctioned off at Gallery North’s Studio during Culper Spy Day. Photo by Heidi Sutton

 ‘Lucky is the child who listens to a story from an elder and treasures it for years.’

Barbara Russell, Town of Brookhaven Historian 

By Heidi Sutton

Margo Arceri first heard about George Washington’s Setauket spies from her Strong’s Neck neighbor and local historian, Kate W. Strong, in the early 1970s. Arceri lights up when talking about her favorite spy, Anna Smith Strong. 

“Kate W. Strong, Anna Smith Strong’s great-great-granddaughter, originally told me about the Culper Spy Ring when I used to visit her with my neighbor and Strong descendant Raymond Brewster Strong III. One of her stories was about Nancy (Anna Smith Strong’s nickname) and her magic clothesline. My love of history grew from there,” she said.

Five years ago Arceri approached the Three Village Historical Society’s President Steve Hintze and the board about conducting walking, biking and kayaking tours while sharing her knowledge of George Washington’s Long Island intelligence during the American Revolution.

Today, Arceri runs Tri-Spy Tours in the Three Village area, which follows in the actual footsteps of the Culper Spy Ring. “I wanted to target that 20- to 60-year-old active person,” she said.  “I have to thank AMC’s miniseries “TURN” because 80 percent of the people who sign up for the tour do so because of that show,” she laughs. 

It was during one of those tours that Arceri came up with the idea of having a Culper Spy Day, a day to honor the members of Long Island’s brave Patriot spy ring who helped change the course of history and helped Washington win the Revolutionary War.

The Brewster House, considered to be the oldest house in the Town of Brookhaven, will be open for tours on Culper Spy Day.

“Visiting places like the Brewster House, which is owned by The Ward Melville Heritage Organization, the grave site of genre artist William Sidney Mount at the Setauket Presbyterian Church cemetery (whose paintings are at The Long Island Museum) and the Country House, which every one of the spies visited,” Arceri thought “there has to be a day designated to celebrating all these organizations in the Three Village and surrounding areas; where each of us can give our little piece of the story and that’s how Culper Spy Day developed.”

After a successful three-year run, the fourth annual Culper Spy Day will be held on Saturday, Sept. 15 from 9 a.m. to 4 p.m. offering self-guided tours of 24 locations including eight new spots for the ultimate Culper Spy Day experience. “The more the merrier,” laughs Arceri.

One new event you won’t want to miss is an interactive tour at the Sherwood-Jayne Farm in East Setauket where you’ll experience a different spin on George Washington’s Culper Spy Ring. Maintained by Preservation Long Island, the property boasts a 1700s saltbox home, apple orchard, barn, an ice house, corn crib, a pasture and nature trail.

According to Darren St. George, education and public programs director at Preservation Long Island, the farm was originally owned by the Jayne family.

“The property was purchased by Mathias Jayne in 1730 [who built a lean-to saltbox dwelling] which is eventually passed down to William Jayne II in 1768 who expands the house after his second marriage,” he said, continuing, “[William] was involved with local government, he was a constable, so he had some stature and clout in the community and it was nice to have a more substantial home.”

However, when the Revolutionary War broke out, Jayne chose to remain a Loyalist and a steadfast supporter of the crown.

Meet Big Bill the Tory at the Sherwood-Jayne Farm in East Setauket on Culper Spy Day and learn the TRUTH about George Washington’s pesky band of renegade spies! Photo by Darren St. George, Preservation Long Island

“William Jayne II was a known Tory in the neighborhood,” said St. George. “Long Island was occupied by many Tories, many people still supported the king and didn’t want to upset the status quo, but as the war concluded, most Torys moved to Canada or Connecticut or they turned their back on the king entirely, but Jayne doesn’t. He still stays a Tory, he has his reputation and still thrives in the community,” eventually acquiring the nickname Big Bill the Tory.

When Jayne passed away, the home remained in the family until it was sold in 1908 to Preservation Long Island’s founder, Howard C. Sherwood, who used the home to showcase his many antiques. It was placed on the National Register of Historic Places in 2009.

During Culper Spy Day, ticketholders will be able to take part in a 20-minute guided tour of the first floor of the home, specifically the Jayne Parlor (which was added after the Revolutionary War), the Sherwood Living Room (which was the original 1730 home) and the Tap Room (kitchen/dining room).

One of the more interesting features of the home are the original late-18th-century hand-painted floral wall frescoes on the walls of the Jayne Parlor. Commissioned by William Jayne II, they were rediscovered underneath wallpaper by Sherwood in 1916 who had them restored by well-known artist Emil Gruppé. “One small panel was left untouched so that you can see how it’s weathered through the years,” St. George pointed out during a recent tour.

The home contains artifacts that specifically relate to the American Revolution, including paneling on the fireplace wall and shutters on a bar in the Tap Room that came from the Tallmadge House of Setauket, believed to be the birthplace of Colonel Benjamin Tallmadge, a founding member of the spy ring who would become George Washington’s chief intelligence officer.

As a special treat, Big Bill the Tory, portrayed by David Burt, will make a guest  appearance during each tour and share his views on the Culper Spy Ring and the noble intentions of King George III. “He’ll explain what life has been like for him as a Loyalist — the other side of the story that we’re really not hearing too much of,” explained St. George.

Parking will be in the field next to the property and visitors are asked to line up at the back door for the tour, which will be ongoing from 9 a.m. to 4 p.m. Apple cider and donuts will be available for purchase.

Arceri’s favorite part of the day is “seeing all these different organizations coming together as a whole. It really is our Revolutionary story,” she said. “Everywhere you turn in the Three Villages you are looking at an artifact, and as the historical society believes, the community is our museum and that I would really love to put on the forefront of people’s minds.”

Admission is $25 adults, $5 children ages 6 to 12 and may be purchased in advance at the Three Village Historical Society (TVHS), 93 North Country Road, Setauket, by calling 631-751-3730 or by visiting www.tvhs.org. Veterans and children under the age of 6 are free. 

Tickets may be picked up at the TVHS from Sept. 11 to 15. At that time, participants will receive a bracelet and a copy of the Culper Spy Day map with all event listings and include access to 24 Culper Spy Ring locations. If available, tickets on the day of the event may be purchased at the historical society.

Participating organizations: 

The fourth annual Culper Spy Day is presented by Tri-Spy Tours, the Three Village Historical Society, the Long Island Museum and The Ward Melville Heritage Organization in collaboration with the Benjamin Tallmadge District of the Boy Scouts; Campus Bicycle; Caroline Church of Brookhaven; Country House Restaurant; Custom House; Discover Long Island; Drowned Meadow Cottage Museum; East Hampton Library, Long Island Collection; Emma S. Clark Memorial Library; Fairfield Historical Society, Fairfield Museum & History Center; Frank Melville Memorial Park; Fraunces Tavern® Museum; Gallery North; History Close at Hand; Huntington Historical Society; Huntington Militia; Joseph Lloyd Manor House; Ketcham Inn Foundation; Northport Historical Society; Old Methodist Church; Paumanok Tours; Port Jefferson Chamber of Commerce; Port Jefferson Free Library; Preservation Long Island; Raynham Hall Museum; Rock Hall Museum; Setauket Elementary School; Setauket Harbor Task Force; Setauket Neighborhood House; Setauket Presbyterian Church; Sherwood-Jayne Farm; Stirring Up History; Stony Brook University Libraries, Special Collections; Stony Brookside Bed and Bike Inn; Three Village Community Trust; The Three Village Inn; Times Beacon Record News Media; and the Underhill Society of America Inc. 

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Rabbi Paul D. Sidlofsky. Photo by Donna Newman

By Donna Newman

A Canadian-born rabbi with an extensive background in religious education and youth outreach is the new spiritual leader at Temple Isaiah, the Reform Jewish congregation in Stony Brook. Paul D. Sidlofsky comes to Long Island from Temple of Israel in Wilmington, North Carolina, the oldest Jewish congregation in that state. His worldview has been enhanced by the experience of residing in Canada, England, Israel and the United States.

Rabbi Sidlofsky says he found his calling early in life while attending a summer camp affiliated with the North American Reform movement. He said he met rabbis there “who led services, taught Hebrew and talked about being Jewish, but they also wore sneakers, played sports and told jokes. They were not only people to be admired, but role models to whom I could relate.”

Following graduation with honors from the University of Toronto, Sidlofsky pursued graduate studies at the Hebrew University in Jerusalem as part of his rabbinical course. He was ordained in 1988 after completing training at Leo Baeck College in London and received a master’s in Jewish education from the Hebrew Union College Jewish Institute of Religion (HUC-JIR) in Los Angeles. Subsequently he earned a master’s in educational administration and a doctor of religious Jewish education.

“To me, a major role of the rabbi is to be a teacher,” Sidlofsky said. “This is central to my work and affects all aspects of it. I encourage congregants to pursue lifelong Jewish education. Informal interactions, counseling and sermons all provide teaching and learning opportunities.” As the “Rappin’ Rabbi” he likes to make his teaching fun, creating raps that give a unique spin to holy days, B’nai Mitzvah, and even the Torah. 

In his prior position in Wilmington, as well as in previous congregations, the rabbi was an active participant in community and interfaith events, and he looks forward to those interactions on Long Island. One community outreach event he instituted, an Invite Your Neighbor service to welcome and inform non-Jewish members of the community about the temple and Judaism, was a success he hopes to replicate at Temple Isaiah.

Teamwork between clergy in a synagogue is crucial to creating a welcoming vibe. Rabbi and cantor must work together closely.

“Often,” said Cantor Marcey Wagner, “I spend more time with my rabbinic partner than with my spouse! That’s why I am so pleased with the choice of Rabbi Sidlofsky. He’s the kind of person I can partner with in a meaningful way. Together we’ll create the community environment here at Temple Isaiah that the congregation is thirsting for,” adding that she likes that he is open to new ideas, yet has a healthy respect for tradition as well. “When the rabbi/cantor relationship thrives, the congregation can feel it and the institution becomes stronger and healthier for it.” 

Temple President Phyllis Sterne concurs that Temple Isaiah is on the right path with its new clergy team. “I look forward to growing our congregation and having it see good times and good health in the years ahead. I’m confident that Rabbi Sidlofsky will lead us into a bright future. We welcome not only the rabbi to our Temple family, but also his lovely and talented wife, Wendy, and caring and enthusiastic teenage son, Ben. Both will add immeasurably to our community.”

For information about Temple Isaiah, located at 1404 Stony Brook Road in Stony Brook, call the temple office at 631-751-8518 or visit www.tisbny.org

Reviewed by Rita J. Egan

Author Thomas M. Cassidy

Setauket resident Thomas M. Cassidy has taken his real-life experiences as an investigator and turned them into a detective thriller that will keep readers on the edge of their seats. The book “Damage Control,” set in the early 1980s, travels back to a time when detectives solved crimes without the help of modern technology and had to rely solely on their instincts and wit. Using New York City as a backdrop and an array of characters, Cassidy takes readers on an interesting trip behind the scenes to see how crimes were once solved.

Recently, Cassidy took time out to answer a few questions about writing his first mystery novel.

You were a former senior investigator with the New York State Attorney General’s Office. How did you become interested in writing?

As a reader of crime fiction and a frontline investigator, I challenged myself 25 years ago to take the leap and write a book. I was amazed at how fast I was able to complete my goal. It took me two weeks to write my book. But, it was only 12 pages long! OK, it was a short book, but it changed my life forever. 

I started buying books on how to write novels and get published. Then I read in The Village Times Herald that a professor at Stony Brook University, the late Deborah Hecht, offered a free workshop called Coffee and Conversations for aspiring writers on the third Friday of each month. This program, which is no longer available, included a presentation by an author, publisher or journalist as well as time to interact with other would-be writers. I listened, learned and read. I kept adding pages to my book.

How long did it take you to write this book?

It took me more than 25 years to reach the finish line for “Damage Control.” I thought I had finished it in 1999, 2001 and 2004, but each update resulted in numerous rejection letters from literary agents and publishers. As I continued adding pages to my novel, I felt a big piece of my mystery puzzle was missing: I needed a mentor with hands-on experience in the New York City Police Department. 

I gave my father, Hugh “Joe” Cassidy, a retired NYPD detective commander, my draft manuscript. He rolled up his sleeves at once, and he spent many months working and sharing his expertise with me on every phase of my book until his death in 2011 at age 85. Plus, by this time I was an experienced author of several nonfiction books.

How many books have you written? 

My writing life took a surprising turn when friends and family members started asking me for elder care help because of my experience as a health fraud and patient abuse investigator. I then began writing books about growing old in America, including “Elder Care/What to Look For/What to Look Out For!” from New Horizon Press, “How to Choose Retirement Housing,” from the American Institute for Economic Research, and co-editor of a college textbook, “Multidisciplinary Perspectives on Aging” from Springer Publishing Company.

Is ‘Damage Control’ your first fiction novel?

Yes. I never gave up on my detective mystery. I believed that I chanced upon many fascinating detectives, investigators, FBI agents and investigations in my career, and I wanted to share my experiences in a novel.

 

The cover of Tom Cassidy’s latest book.

How would you describe the book to someone who hasn’t read it?

On September 10, 1981, Lieutenant John Patrick Donnellan, Manhattan South Homicide, is in a routine meeting with the medical examiner when he gets an urgent call about a high-profile murder in midtown Manhattan that will change his life forever. In one of the deadliest years in New York City history, this murder stands out among the rest, and with only weeks before the mayoral election, all eyes are on the city’s response.

Donnellan, well known in police, political and media circles as a straight talker with a cynical wit, is warned by the most powerful politician in the city to keep a lid on media leaks — and himself — or he will be off the case. Vintage Donnellan sarcasm, scorn and mockery have to be bottled up. But with all the buffoons, phonies and opportunists mixed up in this case, keeping his big mouth shut may be his most difficult task as he navigates through uncharted emotional media, organized crime and romantic networks in pursuit of the killer.

Tell me more about the main character, Lieutenant John Patrick Donnellan.

John Patrick Donnellan joined the New York Police Department, excelled as an investigator and swiftly rose through the detective ranks. He becomes the youngest lieutenant ever appointed commander of Manhattan South Homicide, the most prestigious command in the NYPD.

Are any of the events or characters based on real-life experiences or people in your life?

Yes, many of the events, characters and investigations mentioned in “Damage Control” are loosely based on real-life experiences, while others are a product of my imagination. In addition, all of the New York City police procedures were provided by myfather, a thirty-year veteran of the NYPD.

How close to reality are the investigations in this novel?

“Damage Control” is set in 1981, which was one of the most violent years in New York City history. The investigations in this book are close to reality because back then there was no internet or smartphones, so investigators relied on street smarts.

Do you feel your experiences as an investigator helped you when writing this book? 

Yes, being an investigator definitely helped me write this book. I knew firsthand that many cases have unexpected twists and turns that could never be anticipated when the first wave of detectives arrive at a crime scene. I was able to call upon my own experiences, as well as those of other detectives I worked with or met along the way, as I wrote “Damage Control.”

Do you have a favorite character in the book?

That’s a tough question. I have many favorites including Donnellan, the chief, who is the first female chief of detectives, the mystery woman and many others. But at my current age, I have more in common with Dugan, the oldest detective in the police department.

What is your favorite scene in the book?

I’m nostalgic for the Windows on the World restaurant at the Twin Towers. I had to include that location in the book as a reminder of life before Sept. 11.

What was it like to work with your dad on a detective mystery?

It was truly a blessing for me to share the last years of his life working together on this project. The first time I held my book in my hands, I felt his spirit with me and saw his fingerprints on every page of “Damage Control.”

Tom Cassidy with his father, Hugh “Joe” Cassidy

What do you think your dad would have thought of the finished product?

I don’t want to give away the ending, but he would have laughed so hard at one critical breakthrough uncovered by Donnellan that I would have had to help him get up off the floor. I’m also very confident that he would have written a five-star review of the book on Amazon, like he did for my book on elder care, that he would be the first person to take “Damage Control” out of the library, and he would be helping me write the sequel, “Grave Danger.”

What advice would you give to first-time fiction writers?

Believe that you have an attention-grabbing story to tell, trust yourself, take the first step and start writing. Recognize that fiction readers select from a wide range of genres, so be selective about sharing your manuscript with people who are not in your niche market. Most importantly, avoid negative people, they can be energy vampires!

When is your next book signing event?

On Sept. 7, I’ll be doing a book signing to support Old Field Farm’s free Summer Film event. The week’s movie is one of my favorites, “Casablanca.” My late brother Hugh was the former owner of Old Field Farm, and I am grateful for the opportunity to honor his legacy.

“Damage Control” is available online at www.seattlebookcompany.com and www.amazon.com. For more information about the Old Field Farm Summer Film event, call 631-246-8983. Gates open at 6 p.m. and the farm is located at 92 West Meadow Road in Setauket.

Ralph Macchio returns as community ambassador

From left, Port Jefferson Yacht Club’s Chuck Chiaramonte, actor Ralph Macchio and PJYC’s Karl Janhsen at a reception following last year’s race. Photo from Mather Hospital

Sailboats decorated to the nines will congregate in Port Jefferson Harbor for the 9th annual Village Cup Regatta on Saturday, Sept. 8. A  friendly competition between Mather Hospital and the Village of Port Jefferson, the race raises funds for Mather’s Palliative Medicine Program and The Lustgarten Foundation, which funds pancreatic cancer research. The event has raised more than $442,000 for the two organizations. 

Boats take part in a parade before last year’s race. Photo by Alex Petroski

The boat race was initiated by the Port Jefferson Yacht Club (formerly Setauket Yacht Club) primarily to call attention to and to support efforts to combat pancreatic cancer, which has claimed the lives of two of its members in recent years. The event also promotes a closer relationship between the club and the village in the wonderful maritime setting they share.

Actor/director and local resident Ralph Macchio will again act as community ambassador for the event. This is the sixth year Macchio has helped to publicize the important work of the two programs funded by the regatta. Macchio’s wife, Phyllis, is a nurse practitioner in Mather’s Palliative Medicine Program.

The regatta consists of yacht club-skippered sailboats divided into two teams representing Mather Hospital and the Village of Port Jefferson. Employees from the hospital and village help crew the boats, which race in one of three classes based on boat size. 

The festivities begin at Harborfront Park, 101 East Broadway, at 10 a.m. Regatta T-shirts designed by a local artist and signed by Macchio will be available for purchase along with the event’s commemorative T-shirts, hats and nautical bags. The Memorial Parade of Boats begins at 11 a.m. at the Port Jefferson Village dock. All sailboats participating in the regatta will pass by the park dressed in banners and nautical flags. 

Following the regatta, a celebratory Skipper’s Reception and presentation of the Village Cup will take place in a restored 1917 shipyard building that now serves as the Port Jefferson Village Center.

The cup is currently held by Mather Hospital, which has won the race three times. The Village of Port Jefferson has earned the cup four times, and bad weather forced the cancellation of the 2012 race. 

Businesses, organizations and individuals can support the regatta and the programs it funds by making a donation or purchasing tickets to attend the Skipper’s Reception or view the regatta on a spectator boat. Sponsorships also are available. For more information, visit www.portjeffersonyachtclub.com.

There are serious side effects of NSAIDs and Tylenol

Dr. David Dunaief

Most of us keep a few key items in our medicine cabinets. In addition to aspirin, among these are usually NSAIDs (non-steroidal anti-inflammatory drugs) and acetaminophen (Tylenol). We often use them for relief of pain, fever or inflammation. Familiar NSAIDs include ibuprofen (Advil, Motrin) and naproxen sodium (Aleve). It is estimated that more than 17 million people use NSAIDs on a daily basis. According to a poll of these regular users of over-the-counter (OTC) NSAIDs, a substantial number — 60 percent — were unaware of their dangerous side effects (1).

Acetaminophen is used frequently, as well. On a weekly basis, one quarter of Americans take it. 

We think of these drugs as relatively benign. In fact, I find that unless I specifically ask about their use, most patients don’t include them on a list of their medications on a patient registration form. 

NSAIDs: The statistics

Unfortunately, NSAIDs, according to the Centers for Disease Control and Prevention, are responsible for 7,600 deaths annually and 10 times that number in hospitalizations (2). These are not medications that should be taken lightly. NSAIDs increase the risk of several maladies, including erectile dysfunction, heart attacks, gastrointestinal bleeds, exacerbation of diverticular disease and chronic arrhythmias (abnormal heartbeats). In some instances, the cardiovascular effects can be fatal. 

NSAIDs: Studies demonstrating adverse side effects

In a case control (epidemiologic, retrospective) study using the UK Primary Care Database, chronic users of NSAIDs have a significantly increased risk of a serious arrhythmia (abnormal heartbeat) called atrial fibrillation (3). Patients were between 40 and 89 years of age. 

Interestingly, chronic users were defined as patients who took NSAIDs for more than 30 days. Those patients who used NSAIDs more than 30 days had a 57 percent increased risk of atrial fibrillation. A Danish study reinforces these results after the first month of use (4). This is not very long to have such a substantial risk. For patients who used NSAIDs longer than one year, the risk increased to 80 percent. Caution should be used when prescribing NSAIDs or when taking them OTC. Atrial fibrillation is not an easy disease to treat.

NSAIDs also increase the risk of mortality in chronic users. Older patients who have heart disease or hypertension (high blood pressure) and are chronic NSAIDs users are at increased risk of death, according to an observational study (5). Compared to those who never or infrequently used them over about 2.5 years, chronic users had a greater than twofold increase in death due to cardiovascular causes. High blood pressure was not a factor, since the chronic users actually had lower blood pressure. Yet I have seen with my patients that NSAIDs can increase blood pressure. 

Is acetaminophen the answer?

Acetaminophen does not cause gastrointestinal bleeds, arrhythmias and deaths due to cardiovascular events that NSAIDs can. However, the Food & Drug Administration announced in 2011 that acetaminophen should not exceed 325 mg every four to six hours when used as a prescription combination pain reliever (6). The goal is to reduce and avoid severe injury to the liver, which can potentially cause liver failure. 

There is an intriguing paradox with acetaminophen: Hospitals typically dispense regular-strength 325-mg doses of the drug, whereas OTC doses frequently are found in extra-strength 500-mg tablets, and often the suggested dose is two tablets, or 1 gram. Patients should not take more than 4 grams a day to lower their risk of liver damage. The 4-gram amount sounds like a significant quantity, but it translates into two pills of extra-strength Tylenol every six hours.

I have patients who have taken three pills at one time thinking that, since it is OTC, exceeding the dose is okay. Unfortunately, this is not true. 

The FDA’s recommendations for limiting the dose result from a conglomeration of data. For instance, one study that showed acute liver failure was due primarily to unintentional overdoses of acetaminophen (7). Accidental overdosing is more likely to occur when taking acetaminophen at the same time as a combination sinus, cough or cold remedy that also contains acetaminophen. Over-the-counter cold medications can contain acetaminophen. 

In order to be aware of potentially adverse events, you have to be your own best advocate and read labels. Remember to tell your physician if you are taking OTC medications. If you are a chronic user of NSAIDs because of underlying inflammation, you may find an anti-inflammatory diet, which is usually plant-based, is an effective alternative.

References: 

(1) J Rheumatol. 2005;32;2218-2224. (2) Annals of Internal Medicine, 1997;127:429-438. (3) Arch Intern Med. 2010;170(16):1450-1455. (4) BMJ 2011;343:d3450. (5) Am J Med. 2011 Jul;124(7):614-620. (6) FDA.gov. (7) Am J Gastroenterol. 2007;102:2459-2463. 

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, visit www.medicalcompassmd.com or consult your personal physician.

٭We invite you to check out our new weekly Medical Compass MD Health Videos on Times Beacon Record News Media’s website, www.tbrnewsmedia.com.٭

Aaron Sasson. Photo courtesy of Stony Brook Medicine

By Daniel Dunaief

Thanks to the efforts of Stony Brook University School of Medicine’s Chief of Surgical Oncology Aaron Sasson and numerous doctors and researchers at Stony Brook, Long Island has its first National Pancreas Foundation Center.

A nonprofit organization, the National Pancreas Foundation goes through an extensive screening process to designate such centers around the country, recognizing those that focus on multidisciplinary treatment of pancreatic cancer. The NPF offers this distinction to those institutions that treat the whole patient and that offer some of the best outcomes and improved quality of life for people suffering with a disease who have an 8 percent survival rate five years after diagnosis.

Sasson appreciates the team effort at the medical school. “As opposed to one person leading this, there are many people here who are required to have an interest in pancreatic cancer,” he said. “We are not only looking to build a great infrastructure for the treatment of pancreatic cancer, but we’re also looking to build a team for research on pancreatic cancer.”

Sasson highlighted the research efforts led by Yusuf Hannun, the director of the Cancer Center at SBU, who has helped attract a “tremendous number of scientists” to engage in research into this disease.

The recognition by the NPF helps the university recruit physicians who are clinically interested in developing ways to improve the outcome for patients.

Pancreatic cancer presents particular challenges complicated by its biological aggressiveness, its difficulty to detect and by the many subtypes of this disease. “It’s similar to lung and breast cancer,” Sasson said. “There are many facets of those cancers. You can’t lump them all together.”

Researchers and clinicians are still trying to understand pancreatic cancer in greater detail. Once they have done that, they can advance to treating the possible subtypes.

Numerous researchers at SBU have developed collaborations with scientists at Cold Spring Harbor Laboratory. David Tuveson, the director of the National Cancer Institute-designated Cancer Center, has engaged in collaborations with SBU scientists in his work on organoids, which are model human organs grown in a lab. Scientists use organoids to test drugs and molecular pathways involved in pancreatic cancer.

Members of the Long Island community can take comfort in the continuing dedication of the numerous staff members committed to finding a cure. “Residents of Suffolk County and Long Island should be proud of what Stony Brook has been able to accomplish,” Sasson said.

Stony Brook University has been involved in several clinical efforts. The university developed a drug called CPI-613, for which Rafael Pharmaceuticals is in the early stage of clinical trials in combination with other drugs.

In early stages, the treatment increases the vulnerability of cancer cells to numerous other drugs. Newark, New Jersey-based Rafael Pharmaceuticals is testing this treatment in pancreatic cancer and in acute myeloid leukemia.

At SBU facilities, Sasson explained that researchers and clinicians are taking a multidisciplinary approach in their work. One study, he said, is exploring the effects of a kind of radiation therapy for a subpopulation of pancreatic cancer that combines expertise in radiology, gastroenterology, pathology and medical and surgical oncology.

Sasson himself is interested in screening and biomarkers. At least half of his work is related to pancreatic cancer. When he thinks about people who have battled pancreatic cancer, several patients come to mind. He had a patient who was about 80 at the time of his diagnosis. His primary doctor told him to get his affairs in order.

“We operated on him and he lived another six or seven years,” Sasson recalls. “He was grateful to see his grandchildren graduate and to see his great-grandbabies being born.”

While every patient is unlikely to have the same outcome, Sasson said surrendering to the disease and preparing for the inevitable may not be the only option, as there may be other courses of action.

Another patient had advanced pancreatic cancer for 18 months before Sasson met her. She had received no treatment and yet the cancer didn’t progress, which is “almost unheard of and unbelievable.” In fact, the case defied medical expectations so dramatically that the doctors conducted two more biopsies to confirm that she had pancreatic cancer. “She did well for many years despite having advanced pancreatic cancer.”

In another case, a patient was receiving surveillance for lung cancer every three months. In between those visits, he had developed metastatic pancreatic cancer. This patient example and the previous one show the range of cancer progression.

The value of having an integrated clinical and research program is that scientists can look for subtle clues and signals amid the reality of cancer with a wide range of outcomes. Indeed, scientists attend the weekly tumor board meeting, so they can learn about the clinical aspects of the disease. Doctors also attend research collaborations so they can hear about developments in the lab.

Rather than dictating how researchers and clinicians should collaborate, Sasson hopes to facilitate an environment that sparks these partnerships.

Sasson joined Stony Brook Medical School almost three years ago. He said he is “impressed with the caliber of physicians.” It took time to get the critical mass and organization for pancreatic cancer to match the number of basic science investigators.

“I’m hopeful for the progress we’ll be able to make to treat this terrible disease,” he said.

TAKING A REST ON A HOT DAY

Bill Pollack of East Setauket took this lovely photo of a cabbage white butterfly sitting on a cucumber leaf in his garden on Aug. 12  with a Samsung Galaxy S7. He writes, ‘I followed it for several minutes while it was deciding which leaf to land on.’

Send your Photo of the Week to leisure@tbrnewspapers.com.

District Attorney Tim Sini (D) has announced a new initiative to combat the drug epidemic ravaging Suffolk County. File photo by Victoria Espinoza

By Fr. Francis Pizzarelli

Father Frank Pizzarelli

Recently District Attorney Tim Sini (D) announced a new initiative to combat the drug epidemic ravaging Suffolk County. The Comprehensive Addiction Recovery and Education Program, or CARE Program, allows nonviolent defendants with substance abuse disorders a full dismissal of chargers if the person successfully completes a 90-day treatment program. It was designed by prosecutors, defense attorneys and court officials.

This initiative is definitely a positive step in the right direction. As someone who has provided outpatient and residential treatment for addictions for more than 25 years, I am deeply concerned that this effort lacks substance and appropriate resources for those struggling with substance abuse and mental health issues.

Many of our judges have already been open to alternative sentencing for nonviolent drug offenders. 

There are some important facts that seem to always get buried when this important issue is raised. These are facts that the public should know. 

First and foremost, we do not have nearly enough detox and/or residential treatment beds.

And insurance no longer covers a full 28-day stay in a residential treatment program. At best, most will only cover 7 to 11 days. That is unconscionable. More tragically, many insurance companies tell those battling chronic addiction “try outpatient treatment first — fail at this then we will pay for residential care.”

A growing number of young men and women are trying outpatient treatment first and are failing in record numbers. They are dying! What is very disturbing is that few to no voices are crying out about this horrific human atrocity.

Evidence-based treatment grounded in competent research states that the chronic opioid and heroin addict needs long-term residential treatment if long-term recovery is the hope for outcome.

Presently in Suffolk County we have two programs that provide more than three months of care. Only one program is not insurance based.

So the CARE initiative is a great step forward. Let’s not set those struggling with addictions within the criminal justice system up for failure because we lack the comprehensive and competent resources to make the CARE Program an effective tool on one’s road to recovery and wellness.

Unfortunately, outpatient programs have very limited success with chronic drug abusers. Do some enter and sustain health recovery? Yes, but a growing number fail.

As one local religious leader, I have presided at way too many funerals for young people who have died senselessly around addiction. In the past three weeks, I have had three young adults with tremendous potential lose their lives because of overdosing on heroin. I have talked with many of my colleagues in religion who are burying a record number of young people within their own faith traditions. 

Actions speak louder than words. The violence of our silence is contributing to this national health crisis. Change and transformation is possible. I live among these miracles everyday.

Fr. Pizzarelli, SMM, LCSW-R, ACSW, DCSW, is the director of Hope House Ministries in Port Jefferson.

The first question that must be answered is whether you are determined a resident of New York. Stock photo

By Nancy Burner, Esq.

Nancy Burner, Esq.

We have seen many clients considered “snowbirds,” those who maintain a residence in New York but travel down south during our harsh winters. For our snowbird clients who want to create estate planning documents and plan for possible care needed in the future, it is important to determine if you should see an attorney in New York or elsewhere. 

The first question that must be answered is whether you are determined a resident of New York or of the other state you are visiting. Some factors to determine residency include the amount of time spent in each state, your mailing address, which state your driver’s license is held, where your car is registered, where you are registered to vote and where you file your income taxes.

Once you determine which state is your primary residence, there are other considerations to be examined regarding your estate plan. Snowbirds should consider where they plan on living in the future and where they think they will likely receive care. There may be a possibility that you move down south upon retirement but you plan to move back to New York to be with family members when you are in need of assistance. Since most clients do not have a plan set in stone, they should have estate planning documents, which may include Medicaid asset protection, that would cover them in either state.

Because the laws governing estate planning and Medicaid benefits differ from state to state, it is advisable that you have your documents reviewed by an attorney in both states to ensure that they comply with the laws in both places. For example, there is an additional signature required on a last will and testament in Florida that is not required in New York. Complying with Florida law when executing a last will and testament will not invalidate the document if it is probated in New York. This will avoid any issues or delay in administration if your will is probated in Florida. 

Additional examples of differences in the law are for powers of attorney and advance directives, including health care proxy and living will documents. Since these are state-specific laws, they often have different terminology that can be confusing when moving between locations. 

For a health care proxy in New York the person named to make your medical decisions is called your “agent.” In Florida the term for the agent acting as your health care proxy is a “surrogate.” In Florida the term used under the law to name the default agent appointed is “proxy.” This could cause unnecessary confusion and should be addressed by your estate planning attorney. 

The language and powers listed in your power of attorney will also differ by state. This becomes especially important when your agent is assisting in long-term care planning. You should make sure that your power of attorney includes all of the possible powers your agent may need should you need long-term care whether it is by privately paying or applying for Medicaid to cover your care costs. This may include: the power to prepare, sign and amend a trust agreement; allow for transfers of assets to your agent; and enter into contracts for caregivers or home health care services. 

For our snowbird clients it is important to consider where you are likely to receive care in the future. We recommend that you have your estate planning documents reviewed by an elder law and estate planning attorney in New York and your warm winter destination. 

Nancy Burner, Esq. practices elder law and estate planning from her East Setauket office.

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