Columns

Pedometers can be the first step to helping those with mild COPD. Stock photo
Lifestyle changes can reduce COPD exacerbations

By David Dunaief, M.D.

Dr. David Dunaief

COPD, or chronic obstructive pulmonary disease, is the third leading cause of mortality in the United States (1), although it’s not highlighted much in the layman’s press.

COPD is an umbrella term that includes emphysema, chronic bronchitis of more than three months for two consecutive years and/or chronic obstructive asthma. It is an obstructive lung disease that limits airflow. The three most common symptoms of the disease involve shortness of breath, especially on exertion, production of sputum and cough. This disease affects 6.7 percent of the U.S. population (2).

It tends to be progressive, meaning more frequent and severe exacerbations over time. Since it is a devastating and debilitating chronic disease with no cure, anything that can identify and prevent COPD exacerbations, as well as comorbidities (associated diseases), is critically important.

What are the traditional ways to reduce the risk of and treat COPD exacerbations? The most important step is to stop smoking, since 80 percent of COPD is related to smoking. Supplemental oxygen therapy and medications, such as corticosteroids, bronchodilators (beta-adrenergic agonists and anticholinergics) and antibiotics help to alleviate symptoms (3).

One of the underlying components of COPD may be chronic inflammation (4). Therefore, reducing inflammation may help to stem COPD exacerbations. There are several inflammatory biomarkers that could potentially help predict exacerbations and mortality associated with this disease, such as interleukin-6 (IL-6), C-reactive protein (CRP), leukocyte (white blood cell) count and fibrinogen (a clotting factor of the blood).

How do we reduce inflammation, which may contribute to exacerbations of this disease? Some drugs, such as statins, work partially by reducing inflammation. They may have a role in COPD. Lifestyle changes that include a high-nutrient, anti-inflammatory diet and exercise may also be beneficial. Let’s look at the evidence.

Biomarkers for inflammation

In a recent population-based study with over 60,000 participants, results show that as three biomarkers (CRP, leukocyte count and fibrinogen) were elevated, the risk of COPD exacerbation increased in a linear manner (5). In other words, the risk of frequent exacerbation increased 20, 70 and 270 percent within the first year as the number of elevated biomarkers increased from one to three, compared to patients who did not have biomarker elevations.

As time progressed beyond the first year of follow-up, risk exacerbation continued to stay high. Patients with all three biomarkers elevated for longer periods had a 150 percent increased risk of frequent exacerbations. These predictions were applicable to patients with stable and with mild COPD.

In an observational study, results showed that when the biomarker IL-6 was elevated at the start of the trial in stable COPD patients, the risk of mortality increased almost 2.7-fold (6). Also, after three years, IL-6 increased significantly. Elevated IL-6 was associated with a worsening of six-minute walking distance, a parameter tied to poor physical performance in COPD patients. However, unlike the previous study, CRP did not show correlation with increased COPD exacerbation risk. This was a small trial, only involving 53 patients. Therefore, the results are preliminary.

These biomarker trials are exciting for their potential to shape treatments based on level of exacerbation risk and mortality, creating more individualized therapies. Their results need to be confirmed in a randomized controlled trial (RCT). Many of these biomarkers mentioned in the two trials are identifiable with simple blood tests at major labs.

Statin effect

Statins have been maligned for their side effects, but their efficacy has been their strong suit. An observational trial showed that statins led to at least a 30 percent reduction in the risk of COPD exacerbations, with the effect based on a dose-dependent curve (7). In other words, as the dose increased, so did the benefit.

Interestingly, even those who had taken the statin previously saw a significant reduction in COPD exacerbation risk. The duration of statin use was not important; a short use of statins, whether presently or previously, had substantial benefit. 

However, the greatest benefit was seen in those who had been on a medium to high dose or were on the drug currently. The researchers believe that the mechanism of action for statins in this setting has to do with their anti-inflammatory and immune-modulating effects. This was a retrospective (backward-looking) study with over 14,000 participants. We will need a prospective (forward-looking) study and an RCT to confirm the results.

Exercise

Pedometers can be the first step to helping those with mild COPD. Stock photo

Exercise is beneficial for almost every circumstance, and COPD is no exception. But did you know that a pedometer might improve results? In a three-month study, those with mild COPD were much more successful at achieving exercise goals and reducing exacerbations and symptoms when they used pedometers, compared to the group given advice alone (8). Pedometers gave patients objective feedback on their level of physical activity, which helped motivate them to achieve the goal of walking 9,000 steps daily. This is a relatively easy way to achieve exercise goals and reduce the risk of COPD exacerbations.

When exercising, we are told to vary our exercise routines on a regular basis. One study demonstrates that this may be especially important for COPD patients (9). Results show that nonlinear periodization exercise (NLPE) training is better than traditional routines of endurance and resistance training in severe COPD patients. The goal of NLPE is to alter the time spent working out, the number of sets, the number of repetitions and the intensity of the workout on a regular basis.

This study was randomized, involved 110 patients and was three months in duration. Significantly more severe COPD patients achieved their exercise goals using NLPE rather than the traditional approach. The group that used NLPE also had an improved quality of life response. The researchers believe that compliance with an NLPE-type program is mostly likely going to be greater because patients seem to enjoy it more.

Chronic inflammation may play a central role in COPD exacerbation. Nonspecific inflammatory biomarkers are potentially valuable for providing a more personalized approach to therapy. Drugs that can control inflammation, such as statins, show promise. But don’t forget the importance of lifestyle changes, such as quitting smoking and committing to an exercise regimen that is varied and/or involves the use of a pedometer. And potentially a high-nutrient, anti-inflammatory diet will also contribute positively to reducing the frequency and severity of COPD exacerbations.

References:

(1) Natl Vital Stat Rep. 2011 Dec.;59(10):1-126. (2) cdc.gov. (3) N Engl J Med. 2002;346:988-994. (4) www.goldcopd.org. (5) JAMA. 2013;309:2353-2361. (6) Respiratory Research. 2013;14:24. (7) Am J Med. 2013 Jul;126:598-606. (8) ATS 2013 International Conference: Abstract A1360. (9) Am J Respir Crit Care Med. 2013; online Feb. 28.

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.

friend recently told me she’s pregnant with her first child. She sounded thrilled and anxious. She is, as I’ve known for years, incredibly organized and efficient. She has been a standout in her job for several years.

“What’s the concern?” I asked.

“Everything,” she giggled.

As my children take one standardized test after another, I thought perhaps I would share a test-format version of what to expect when you’re expecting. No. 2 pencils ready? OK, let’s begin:

Question 1: Before the baby is born, you should:

a. Panic buy everything, including a crib and six months worth of food and clothing. You never know if you’ll be trapped in your house without access to the outside world.

b. Sleep as much as you can because the days of sleeping at your leisure are over.

c. Read everything you can about parenting and the delivery, and then realize that every process, including childbirth, can go off script.

d. Don’t tell anyone because people will write about you.

Question 2: When people give you advice, you should:

a. Write everything down because friends, family and strangers always know better and will enlighten you with wisdom that far exceeds that which you’d get on a fortune cookie.

b. Nod politely, say, “That’s a great idea,” and wonder what to eat for dinner.

c. Pretend your phone is ringing.

d. Ask them how many Nobel prizes their children have won.

Question 3: Taking Lamaze classes can be helpful because:

a. It allows you to meet parents who are older than you.

b. It allows you to practice breathing together because sometimes parents forget to breathe.

c. It’s so relaxing that you can doze off without punishment.

d. It gives you a sense of control that you’re unlikely to have in the actual moment.

Question 4: People generally love other people’s children unless:

a. They are sitting on a plane near them.

b. They have to do something for them.

c. The children are crying constantly and they don’t know why.

d. The children have dropped or broken something.

Question 5: Parents can be so tired in the early stage that they forget:

a. To take pictures of everything.

b. To feed themselves.

c. To go to the bathroom when they need to.

d. To revel in a new baby smell that will change into something much more challenging to the nose within a year.

Question 6: When you have a baby, it’s a great idea to:

a. Change jobs.

b. Move to a new city.

c. Start attending a new and rigorous educational course.

d. All of the above, because you’ll never have a chance to juggle more challenges at the same time than when a baby is born.

Question 7: The families of the father and mother are likely to:

a. Always agree on everything you should do for the child.

b. Never agree on anything you should do for a child.

c. See evidence of their family’s genes in the child.

d. Put small differences aside and enjoy the moment when they share a new relative.

Question 8: Once you have a child, you will:

a. Be thrilled when young children come over to play with your child.

b. Be worried that the young children who come over are sniffling.

c. Want everyone to bathe in Purell sanitizer before coming near your child.

d. Not be like me and will relax when people sneeze across the room.

Question 9: You know you’ve had a great day with your child when:

a. You keep replaying something he or she said or did as you’re preparing to sleep.

b. You actually go to sleep instead of passing out with Oreo cookie crumbs in your mouth.

c. You and your spouse are laughing, quietly, for hours before you go to sleep.

d. You can’t wait to start the next day.

Question 10: Parenting is:

a. Awesome.

b. Terrifying.

c. Exhausting.

d. All of the above.

By Bob Lipinski

Bob Lipinski

I love reading quotes, especially funny, historical, inspirational or those from well-known individuals. With that in mind I’d like to share 20 of my favorite wine quotes that may stimulate you to reach for a bottle of wine.

1. “Life is too short to drink bad wine.” (Author unknown)

2. “A meal without wine is like a day without sunshine.” (Jean Anthelme Brillat-Savarin, 1755–1826, French politician and writer)

3. “The fine wine leaves you with something pleasant. The ordinary wine just leaves.” (Maynard A. Amerine, 1911–1998, professor emeritus, University of California, Davis)

4. “Wine is one of the agreeable and essential ingredients of life.” (Julia Child, 1912–2004, American master chef)

5. “Wine is the intellectual part of a meal. Meats are merely the material part.” (Alexander Dumas, 1802–1870, French novelist)

6. “Where there is no wine, there is no love.” (Euripides 480–406 B.C., Greek playwright)

7. “If food is the body of good living, wine is its soul.” (Clifton Fadiman, 1904–1999, American writer and editor)

8. “I love everything that’s old: old friends, old times, old manners, old books, old wines.” (Oliver Goldsmith, 1728–1774, novelist; “She Stoops to Conquer,” 1773)

9. “Wine is a substance that is wonderfully appropriate to man, in health as well as in sickness, if it be administered at the right time, and in proper quantities, according to the individual constitution.” (Hippocrates, 460–377 B.C., Greek physician)

10. “Wine is like sex in that few men will admit not knowing all about it.” (Hugh Johnson, 1939–, British author)

11. “What is better than to sit at the end of the day and drink wine with friends, or substitutes for friends?” (James Joyce, 1882–1941, Irish novelist and poet)

12. “When it comes to wine, I tell people to throw away the vintage charts and to invest in a corkscrew. The best way to learn about wine is in the drinking.” (Alexis Lichine, 1913–1989, wine writer and winery owner)

13. “I feast on wine and bread, and feasts they are.” (Michelangelo, 1475–1564, Italian sculptor, painter, architect and poet)

14. “The metamorphosis of grape juice to wine is a natural process, but the creation of truly fine wines requires balanced contributions of tradition, expertise, and innovation.” (Angelo Papagni, Papagni Vineyards, Madera, California)

15. “Wine can be considered with good reason as the most healthful and most hygienic of all beverages.” (Louis Pasteur, 1822–1895, biologist and chemist)

16. “There are two reasons for drinking wine: one is when you are thirsty, to cure it; the other is when you are not thirsty, to prevent it. Prevention is always better than cure.” (Thomas Love Peacock, 1785–1866, English novelist and poet; “Melincourt,” 1817)

17. “Wine makes every meal an occasion, every table more elegant, every day more civilized.” (André L. Simon, 1877–1970, French wine writer)

18. “You Americans have the loveliest wines in the world, you know, but you don’t realize it. You call them ‘domestic’ and that’s enough to start trouble anywhere.” (H.G. Wells, 1866–1946, British novelist, historian and social reformer)

19. “Our Italian winery workers were full of red wine and garlic. They never caught anything. The germs couldn’t get close enough to them.” (Karl L. Wente, Wente Vineyards, California)

20. ‘Wine is sunlight, held together by water.’ (Galileo Galilei)

Bob Lipinski, a local author, has written 10 books, including “101: Everything You Need to Know About Gin, Vodka, Rum & Tequila” and “Italian Wine & Cheese Made Simple” (available on Amazon.com). He conducts training seminars on wine, spirits and food and is available for speaking engagements. He can be reached at www.boblipinski.com OR bkjm@hotmail.com.

Photo courtesy of Kent Animal Shelter

MEET SIMBA!

Say hello to Simba! Open your heart to this sweet 3-year-old couch potato and you will have a friend for life. Currently waiting for adoption at Kent Animal Shelter, this adorable guy loves human companionship and is a huge lap cat. Some of his favorite things are scratch pads, watching birds and squirrels out the window and sitting on your lap while you watch TV or read. He is a little shy at first but very quick to warm up. Simba comes neutered, microchipped and is up to date on all his vaccines. 

Kent Animal Shelter is located at 2259 River Road in Calverton. The adoption center is open from 10 a.m. to 4 p.m. every day. For more information on Simba and other adoptable pets at Kent, visit www.kentanimalshelter.com or call 631-727-5731. 

 

By Heidi Sutton

If you’re like me, you are just chomping at the bit to get your garden started. 

After a winter plagued with one snowstorm or nor’easter after another, it’s hard to believe that spring has finally arrived. Avid gardeners hibernating in their homes for what seemed like months have been keeping their spirits high by perusing the gardening catalogs for the latest plants and products, all the while patiently waiting for the ground to thaw.

In perfect timing, All-America Selections recently announced National Winners for 2018 — new varieties of flowers, fruits and vegetables that will do well in any climate throughout the United States and Canada. With fun names like Sweet American Dream, Super Hero Spry, Queeny Lime Orange, Valentine and South Pacific Orange, these cultivars are the best of the best, beating out thousands for the ultimate title.

Since 1932, this nonprofit organization has annually tested new varieties of flowers and vegetables in various locations throughout the United States and Canada. Judges look for improved qualities such as disease tolerance, early bloom or harvest dates, taste, unique colors and flavors, higher yield, length of flowering or harvest and overall performance.

Here’s what the judges had to say about some of the award winners:

1. Zinnia Queeny Lime Orange: A “WOW” color in an easy-to-grow zinnia is what this flowering annual brings to the garden. Sporting lovely, large, dahlia-like blooms on a sturdy, compact plant, this variety provides cut-flower gardeners and growers with a wonderful hue for today’s floral trends. The unique color evolves from dark coral/peach/orange to a light peach with a dark center as the flowers age and each uniform plant produces prolific deeply fluted blooms that last about 3 weeks without preservatives or feed.

2. Canna South Pacific Orange F1: This variety is more vigorous, more uniform and has more basal branching than comparison cannas. It offers an outstanding bloom color in an attractive, vivid bright orange that contrasts nicely with the bright green foliage. Pollinator gardens will love this addition of an attractive canna that sports uniformly colored flowers over a long blooming period. Bonus: This canna is grown from seed, not tuber, meaning less chance of succumbing to disease.

3. Marigold Super Hero Spry: Super Hero Spry is a lovely compact (10 to 12 inches) French marigold with dark maroon lower petals and golden yellow upper petals perched on top of the dark green foliage. The list of winning attributes includes a more uniform and stable color pattern, earlier to bloom and no deadheading required. These stunning blooms make any garden fit for a Super Hero!

4. Tomato Valentine F1: Hands down, the judges agreed this was the most appealing grape tomato they trialed. With an appetizing deep-red color, it has a very sweet taste and will hold longer on the vine without cracking or losing the excellent eating quality. The plant is quite prolific and will mature early (55 days from transplant). Gardeners should plan on staking the indeterminate vines for best results. Tomato lovers will appreciate the sweet, firm flesh that is meaty enough to resemble a Roma tomato but in a smaller, grape-type fruit. These easy-to-harvest tomatoes can take the summer heat and keep on producing.

5. Corn, Sweet American Dream: With its excellent germination, very tender, super sweet kernels, this newbie will make a great addition to the home garden. American Dream matures slightly earlier than the comparisons and produces vigorous, healthy plants with cobs that have good tip fill of bicolored kernels. Plants grow 6 to 7 feet tall and mature in 77 days after planting the seed. Perfect fresh, roasted, grilled, canned or frozen.

For a complete list of the new plants chosen by the AAS, as well as other information about the organization, visit its website at www.all-americaselections.org

Maurizio Del Poeta. File photo from SBU

By Daniel Dunaief

Sometimes, fixing one problem creates another.

People with multiple sclerosis have been taking a medication called fingolimod for a few years. The medicine calms immune systems that attack the myelin around nerve cells. Fingolimid decreases the lymphocyte number in the bloodstream by trapping them in the lymph nodes.

In a few cases, however, the drug can reduce the immune system enough that it allows opportunistic infections to develop. Cryptococcosis, which is a fungal infection often spread through the inhalation of bird droppings or from specific trees such as eucalyptus, is one of these infections, and it can be fatal if it’s not caught or treated properly, especially for people who have weakened immune systems.

Swiss pharmaceutical giant Novartis contacted Stony Brook University fungal expert Maurizio Del Poeta, a professor in the Department of Molecular Genetics & Microbiology, to understand how this drug opens the door to this opportunistic and problematic infection. He is also exploring other forms of this drug to determine if tweaking it can allow the benefits without opening the door to problematic infections.

Most of the human population has been exposed to this fungus. In a study in the Bronx, over 75 percent of children older than 2 years of age had developed an antibody against Cryptococcus neoformans, which means they have been exposed to it. It is unknown whether these people harbor the fungus or if they have just mounted an immune reaction. Exposure may be continuous, but infections may only occur if a person is immunocompromised.

Fingolimid “inhibits a type of immunity” that involves the movement of lymphocytes from organs into the bloodstream,” Del Poeta said. “Because of this, there are certain infections that can develop.”

Through a spokeswoman, Novartis explained that the company was “happy to have started a scientific collaboration” with Del Poeta to understand the role of a specific pathway in cryptococcus infections.

Cryptococcal meningitis is one of several infections that can develop. Others include herpes meningitis and disseminated varicella zoster. Before starting fingolimid, patients need to receive immunization for varicella zoster virus. At this point, doctors do not have a vaccine for cryptococcosis.

To study the way this drug and its derivatives work, Del Poeta recently received a $2.5 million grant over a five-year period from the National Institutes of Health.

Yusuf Hannun, the director of the Cancer Center at SBU, was confident Del Poeta would continue to be successful in his ongoing research.

Del Poeta “does very important and innovative work on fungal pathogenesis and he is a leader in the field,” Hannun wrote in an email. “His work will enhance our understanding of the molecular mechanisms.”

Fingolimid mimics a natural lipid. Years ago, Del Poeta showed that this sphingolipid, which is on the external surface of the membrane, is important to contain cryptococcosis in the lung. If its level decreases, the fungus can move from the lung to the brain.

While people with multiple sclerosis have developed signs of this infection, it is also prevalent in areas like sub-Saharan Africa, where people with AIDS battle cryptococcosis. About 40 percent of this HIV population develops this fungal infection, Del Poeta said. About 500,000 people die of cryptococcosis every year.

In certain areas of the United States, such as the Pacific Northwest, this fungus is also endemic. On Vancouver Island, about 19 people died from Cryptococcus gattii infections between 1999 and 2007. Most of those patients were immunocompromised.

When the fungus migrates from the lung to the brain, it is “very difficult, if not impossible in most cases, to eradicate,” Del Poeta explained in an email. If the diagnosis is made early enough before the infection spreads to the brain, the recovery rate is high, he suggested. In people whose immune systems are not compromised by drugs or disease, “death is rare.” 

Del Poeta plans to study the interaction between the drug and the fungal infection through a mouse model of the disease. The mouse model mimics the human disease and will provide insights on how to control the infection, particularly when the fungus reaches the brain.

Some of the derivatives Novartis has developed do not cause a fungal infection. Del Poeta is working with Novartis to study other forms of fingolimid that do not reactivate cryptococcosis. Del Poeta said Novartis is currently in Phase III clinical trials for another drug for multiple sclerosis. The new drug acts on a different receptor.

“We think the reason the fingolimid reactivates cryptococcosis is that it is blocking one receptor, which is important for the containment” of the fungus. The other drug doesn’t allow the disease-bearing agent to escape.

“This is a hypothesis,” Del Poeta said. He is waiting to corroborate the cell culture data in animal models.

Del Poeta has been working with Novartis for over three years. The Stony Brook scientist used some preliminary studies on the way fingolimid analogs behave as part of the research grant application to the NIH that led to the current grant.

Del Poeta said he is excited about the possibility of contributing to this area.

“Not only will this work contribute to the field of MS, but it will also have a contribution to the field of cryptococcosis,” he said. “This will have important implications for MS patients [and] for the entire HIV population.” He said he believes patients may have some other defect. If he is able to discover what that is, he may be able to protect them from a cryptococcosis infection.

Ultimately, Del Poeta hopes this work leads to a broader understanding of fungal infections that could apply to other pathogens as well.

Mycobacterium tuberculosis causes a granuloma very similar to the one caused by the cryptococcosis and we could potentially study whether the same molecular mechanisms involved in the control of the infection in the lung are similar between the two infections,” he explained in an email.

HOPE ‘SPRINGS’ ETERNAL

Alyssa Cutler took this photo of a forsythia branch in Port Jefferson on April 2. She writes,  ‘[This was taken] right after the snow stopped on April 2. This is what Long Islanders are about. Strong backs to weather storms, eternally hopeful and rejoicing in the beauty around us. Also, we smile a lot more in the spring and summer!’

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

By Nomi Dayan

Nomi Dayan

Whaling was a risky business, physically and financially. Life at sea was hazardous. Fortunes were made or lost. Whale hunts were perilous, as was the processing of the whale. Injuries were rampant and death was common, sometimes on nearly every voyage. In some instances, the deceased was none other than the captain.

Captain Sluman Lothrop Gray met his untimely end on a whaleship. Born in 1813, very little is known of his past, his family or his early experiences at sea. In 1838, he married Sarah A. Frisbie of Pennsylvania in the rural town of Columbia, Connecticut. His whaling and navigational skills must have been precocious, because in 1842, in his late 20s, Gray became a whaling captain — and a highly successful one. 

His wife Sarah joined him in his achievements, living with him at sea for 20 years. Three of their eight children were born during global whaling voyages. Gray commanded a string of vessels: the Jefferson and Hannibal of New London, Connecticut, to the Indian and North Pacific oceans; the Mercury and Newburyport of Stonington, Connecticut, to the South Atlantic, Chile, and Northwest Pacific oceans; and the Montreal of New Bedford, Massachusetts, to the North Pacific Ocean.  

While financially successful, Gray’s crew felt his harsh personality left much to be desired. Some of his blasphemies were recorded by a cabin boy on the Hannibal in 1843. Gray did not hesitate to flog crew members for minor mistakes. Unsurprisingly, when Sarah once reported her husband had taken ill, the crew rejoiced. To their chagrin, he recovered.

As Gray aged, he attempted to retire from maritime living and shift into the life of a country gentleman. He bought 10 acres of land in Lebanon, Connecticut, and lived there for seven years, where his house still stands. 

This bucolic life did not last, and Gray returned to whaling. With his wife and three children — 16-year-old Katie, 10-year-old Sluman Jr. and 2-year-old Nellie, he sailed out of New Bedford on June 1, 1864, on the James Maury. Built in Boston in 1825 and sold to New Bedford owners in 1845, the James Maury was a hefty ship at 394 tons. Gray steered the course toward hunting grounds in the South Pacific. 

Unexpectedly, after nine months at sea in March 1865, he suddenly became ill. The closest land was Guam, 400 miles away. Sarah described his sickness as an “inflammation of the bowels.” After two days, Gray was dead. The first mate reported in the ship’s logbook: “Light winds and pleasant weather. At 2 p.m. our Captain expired after an illness of two days.”  He was 51 years old.

Sarah had endured death five times before this, having to bury five of her children who sadly died in infancy. She could not bear to bury her husband at sea. Considering how typical grand-scale mourning was in Victorian times, a burial at sea was anything but romantic. It was not unheard of for a whaling wife to attempt to preserve her husband’s body for a home burial. But how would Sarah embalm the body?

Two things aboard the whaleship helped: a barrel and alcohol. Sarah asked the ship’s cooper, or barrel maker, to fashion a cask for the captain. He did so, and Gray was placed inside. The cask was  filled with “spirits,” likely rum. The log for that day records: “Light winds from the Eastward and pleasant weather; made a cask and put the Capt. in with spirits.”

The voyage continued on to the Bering Sea in the Arctic; death and a marinating body did not stop the intentions of the crew from missing out on the summer hunting season. 

However, there was another unexpected surprise that June: the ship was attacked by the feared and ruthless Confederate raider Shenandoah, who prowled the ocean burning Union vessels, especially whalers (with crews taken as prisoners). The captain, James Waddell, had not heard — or refused to believe —that the South had already surrendered. 

When the first mate of the Shenandoah, Lt. Chew, came aboard the James Maury, he found Sarah panic stricken. The James Maury was spared because of the presence of her and her children — and presumably the presence of her barreled husband. Waddell assured her that the “men of the South did not make war on women and children.” Instead, he considered them prisoners and ransomed the ship. Before the ship was sent to Honolulu, he dumped 222 other Union prisoners on board. One can imagine how cramped this voyage was since whaleships were known for anything but free space.

A year after the captain’s death, the remaining Gray family made it home in March 1866. The preserved captain himself was shipped home from New Bedford for $11. 

Captain Gray was finally buried in Liberty Hill Cemetery in Connecticut. His resting place has a tall marker with an anchor and two inscriptions: “My Husband” and “Captain S. L. Gray died on board ship James Maury near the island of Guam, March 24, 1865.” Sarah died 20 years later and was buried next to her husband.

It is unknown if Gray was buried “as is” or in a casket. There are no records of Sarah purchasing a coffin. Legend has it that he was buried barrel and all.

Nomi Dayan is the executive director at The Whaling Museum & Education Center of Cold Spring Harbor.

The final budget left spousal refusal intact. Stock photo

By Nancy Burner, ESQ.

Nancy Burner, Esq.

On March 31, the New York State Legislature and Gov. Andrew Cuomo (D) finalized the budget for the 2019 fiscal year. In January, the governor’s office set forth a budget proposal. Using that as a jumping-off point, the Legislature and the executive started a negotiation process that resulted in the budget beginning the fiscal year on April 1, 2018.

Elder law attorneys across the state watch the budget proposal and negotiations closely to see what, if any, impact there will be on the Medicaid program. Many elderly and disabled individuals in the state rely on the Medicaid program to cover their costs of long-term care. The budget proposals often suggest changes to eligibility as well as to the methods by which care is provided.

One item that was in the governor’s original proposal, but eventually left out of the final budget, was the elimination of spousal refusal. Spousal refusal is the method by which a spouse in need of care can enroll in the Medicaid program while the healthy spouse can maintain assets in their own name to support their own needs. The final budget left spousal refusal intact. This is a tremendous benefit to the spouses of Medicaid recipients.

The budget did include a change in the way the Medicaid program will be administered to long-term nursing facility residents. Until the budget was enacted, long-term patients in a nursing facility were enrolled in a managed long-term care plan. These plans receive a flat rate from the state for each enrollee regardless of whether the enrollee is receiving a small amount of in-home care, round-the-clock care in the home or nursing facility services. 

The new rule is that a patient that has been in a nursing facility for three months will be disenrolled from the managed long-term care plan and their services will be paid directly to the facility from the Medicaid program. The stated purpose for this change is to eliminate any duplication of care coordination services. The concern from the governor’s office was that both the facility and the plan were providing this same service.

Another change to the Medicaid program will impact managed long-term care plan participants who want to switch plans. Prior to the new budget, there were no restrictions on such changes. The new budget states that a plan participant can change plans within the first 90 days after enrollment without cause. However, after the first 90 days, the participant can only change plans once in every 12-month period. Any additional changes after the first 90 days must be for cause. Good cause is listed to include, but is not limited to, issues relating to quality of care and access to providers.

The managed long-term care plans will also be affected by the budget provision that will limit the number of licensed home care agencies with whom a plan can have a contract. As stated above, each plan receives a set rate from the state for each enrollee. That plan then has to contract with an agency to provide the aide in the home for a Community Medicaid recipient. 

Until now, a plan was not limited on the number of agencies with which it could hold a contract. As of Oct. 1, 2018, a plan can only hold a contract with one agency for every 75 members it enrolls, and on Oct. 1, 2019, it will be one contract per 100 members.

These budget provisions adjust the ever-changing landscape of the long-term care Medicaid program. The direct impact of these changes on consumers is not yet known. The stated purpose of the managed long-term care program is to streamline the care provided to the aging and disabled population of New York state. Advocates in this area continue to work with the governor and Legislature to make Medicaid long-term care benefits available to all New York residents who require such assistance. Stay tuned.      

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

By Barbara Beltrami

I don’t know about you, but it seems to me that often dishes that start out cast in supporting roles end up being the stars of a meal. I’m thinking of things like potatoes au gratin or pasta with a creamy lemon sauce or polenta with green chilies. A dry overdone piece of meat or poultry doesn’t stand a chance next to a savory side dish; a piece of overdone or (worse) underdone fish pales next to such tasty accompaniments. And so, before you know it, a side dish becomes a main dish and, served up with a veggie or salad, takes on a life of its own. As with so many simple recipes, this is where you get to be creative and dream up your own versions and variations with additions or even deletions.

Angel Hair Pasta with Creamy Lemon Sauce and Prosciutto

YIELD: Makes 2 to 4 servings

INGREDIENTS: 

¾ pound angel hair pasta (capellini)

1 tablespoon unsalted butter

1 tablespoon extra virgin olive oil

4 slices prosciutto, chopped

1 large shallot, minced

¼ cup minced fresh flat-leaf parsley

Juice and grated zest of two lemons

1 cup heavy cream

Sea salt and black pepper, to taste

DIRECTIONS: 

Cook pasta according to package directions. Set aside to keep warm. Meanwhile, in a large skillet, heat the butter and oil and sauté the prosciutto and shallot for 3 to 5 minutes. Add the parsley, lemon zest and cream and cook over medium heat, stirring frequently, until mixture comes to a boil. Add cooked pasta to skillet, toss to coat, then add lemon juice, a little at a time until desired tartness is achieved and cook over medium heat until all liquid is absorbed by pasta. Serve hot or warm with fresh asparagus, peas or a light green salad.

 Potatoes au Gratin

YIELD: Makes 6 servings

INGREDIENTS: 

Nonstick cooking spray

6 medium potatoes, very thinly sliced

4 tablespoons unsalted butter

½ cup minced onion

3 tablespoons flour

Salt and freshly ground pepper, to taste

2 cups milk

½ cup half and half

1 cup shredded cheddar cheese

½ cup unflavored breadcrumbs

DIRECTIONS: 

Preheat oven to 350 F. Coat bottom and sides of 2-quart casserole with nonstick cooking spray. Arrange potato slices evenly in dish. In medium saucepan or skillet, melt three tablespoons of the butter; add onions and cook, stirring frequently, until they are soft. Stirring constantly, add flour, salt and pepper; continue cooking until mixture is bubbly; remove from heat.  

Add milk and half and half, return to heat and cook, stirring constantly, until mixture comes to a boil, then boil and stir for one minute, until it thickens. Add cheese and stir until it melts. Pour mixture over potatoes; sprinkle with breadcrumbs. Dot with remaining tablespoon butter. Cover with aluminum foil and bake 30 minutes; remove foil and bake another hour, until liquid is absorbed by potatoes and top is golden brown. Remove from oven; let sit 10 minutes, then serve immediately with a crisp mixed green salad.

Polenta with Green Chili Peppers, Tomatoes and Manchego Cheese

YIELD: Makes 4 servings

INGREDIENTS:

Nonstick cooking spray

2 cups milk

1 cup water

¾ cup yellow cornmeal

3 garlic cloves, minced

¾ cup chopped fresh cilantro

Salt and freshly ground pepper, to taste

17-ounce can whole green chilies, drained and diced

1 cup diced fresh tomatoes

½ cup grated Parmesan cheese

2 cups grated manchego cheese

½ cup melted unsalted butter

DIRECTIONS: 

Preheat oven to 400 F. Coat a 9-inch square baking dish with nonstick cooking spray. In a heavy medium saucepan, combine the milk, water, cornmeal, garlic, cilantro, salt and pepper. Stirring constantly with a wire whisk, bring to a simmer over medium heat and continue to cook and stir until mixture thickens, about 10 to 12 minutes. 

With a rubber spatula, scrape half the mixture into the baking dish; sprinkle half the chilies, half the tomatoes, half the grated Parmesan and half the manchego. Drizzle half the melted butter over top. Starting with remaining polenta, repeat procedure and finish with remaining melted butter. Bake about 30 minutes until golden brown. Serve hot, warm or at room temperature with a spinach and mushroom salad.

Social

0FansLike
1,065FollowersFollow
33SubscribersSubscribe