Health

Bertha Madras will be the keynote speaker at Stony Brook University's 9th annual Meeting of the Minds symposium

By Ernest J. Baptiste

Ernest J, Baptiste

Not a week goes by without a news story referencing the misuse of, addiction to, treatment of and deaths caused by opioids. And it’s no wonder. While the United States accounts for 4.4 percent of the world’s population (per U.S. Census Bureau figures), we consume 30 percent of prescribed opioids worldwide, according to the International Narcotics Control Board. 

Sadly, within New York State, Suffolk County bears the brunt of this notoriety. Based on information from the NYS Department of Health, between 2009 and 2013, the county reported 337 heroin-related deaths — more than any other county in our state. 

As Suffolk County’s only academic medical center, Stony Brook Medicine has the clinical, research and educational expertise to lead our community in the battle against addiction. We have a duty and an obligation to do so. For years we have worked closely with both Stony Brook Southampton Hospital and Eastern Long Island Hospital to help those affected by the opioid crisis. 

In 2017, we took our commitment a step further by launching an Addiction Psychiatry Division. Our team of experts evaluates, diagnoses and treats people who suffer from one or more disorders related to addiction. They also conduct research into the causes and effective interventions for addiction and train our health are professionals in how to better identify and treat addiction.

In addition to treating those affected by the opioid epidemic, it’s also important to have a forum where the physicians and nurse practitioners, who have the authority to dispense prescriptions for pain medication, can explore, and develop, with input from the public, the future of pain management medicine.

This was the premise for a recent conference panel discussion held in August at Stony Brook University Hospital titled, Changing Perceptions About Pain Management and Opioid Use Across the Continuum of Care. During the panel discussion, Stony Brook experts explored current issues in the practice of managing chronic and acute pain. The event was part of our Ethical Decision Making Series and attracted over 100 clinicians and members of the community. 

This month, Stony Brook has two more opioid epidemic-related events planned. 

On Thursday, Oct. 18, Stony Brook Southampton Hospital will present its 5th annual Addiction Medicine Symposium at Stony Brook Southampton University, Avram Theatre, 39 Tuckahoe Road, from 8 a.m. to 5 p.m. The goal is to help increase knowledge and improve performance of medical staff members, residents, nurses and other health care professionals when working with patients who suffer from addiction. To learn more, visit http://cme.stonybrookmedicine.edu.

The following day, Friday, Oct. 19, the opioid epidemic will be the focus when the Stony Brook University Neurosciences Institute hosts its 9th annual Meeting of the Minds symposium at Stony Brook University’s Charles B. Wang Center, 100 Nicolls Road, Stony Brook from 8 a.m. to 1 p.m. The free event is open to physicians and other health care professionals, researchers, students and anyone with an interest in the opioid epidemic.

Experts from Stony Brook Medicine will present, discuss and explore the clinical implications of their scholarly research findings and discuss translational and informatics approaches to the opioid epidemic. This year’s keynote speaker will be Bertha Madras, a prominent psychobiologist, public policy maker and member of the President’s Commission on Combating Drug Addiction and the Opioid Crisis. Breakfast will be provided and a discussion and Q&A will follow each presentation. To learn more, visit www.neuro.stonybrookmedicine.edu/motm. 

Let’s fight the opioid epidemic together as a community so that our children and future generations of Long Islanders won’t have to.

Ernest J. Baptiste is chief executive officer of Stony Brook University Hospital.

 

Girl Scouts, Girl Scout alumnae and volunteers will once again help out at the event. Image courtesy of Jenn Intravaia Photography

By Ernestine Franco

I never need a reason to eat pancakes. In case you do, head over to the 4th annual Butterfly Breakfast for a Cure at Applebee’s, 355 Route 25A in Miller Place on Saturday, Oct. 13 at 8 a.m. and eat pancakes to help find a cure for the worst disease you’ve probably never heard of: epidermolysis bullosa. Young people who suffer from this disease are called “butterfly children” because their skin is so fragile it blisters or tears from friction or trauma. This rare genetic disease affects 1 out of every 20,000 births in the United States. Currently, there is no treatment or cure.

Proceeds from this fundraiser will support DEBRA of America, an organization that provides assistance and education to families with children born with this genetic condition.

Rocky Point resident Donna McCauley is often associated with this event, but it is her daughter, Kelly, who is the driving force for this fundraiser. “It all started when I was a junior in High School with this out of the world idea to host a fundraiser and create more awareness for the disease that affects both my mom and my uncle. Doing this event every year is just a small act that I can do to repay my mom for showing me what being strong is like, and not letting ANYTHING bring you down,” said Kelly.

 As in the past, former and current members of Donna McCauley’s Girl Scout troop will volunteer their time as servers for the breakfast. In addition to a breakfast of pancakes, sausage, scrambled eggs and a beverage (coffee, tea, juice or soda), there will be a raffle auction with fantastic prizes. So come and “enjoy a short stack for a tall cause.”

Tickets are $10 for adults and $7 for children 10 and under. Tickets can be purchased online at www.debra.org/butterflybreakfast. To pay by check, email Donna at donnamc1230@gmail.com. For more information, please call 631-821-6740.

Feds recommend trio of changes in staffing, hiring and overtime management to facility’s new leadership

Northport VA Medical Center. File photo

A federal investigation into Northport Veterans Affairs Medical Center’s four community living centers has shown a troubling trend of chronic nursing staff shortages and excessive overtime, issues that could have placed patients “at a higher risk for adverse events.”

In one case, federal investigators found a nurse’s assistant worked double shifts for six straight days — more than 96 hours in a single week – while expected to diligently oversee a patient requiring one-on-one care.

As the Northport facility is the only VA Medical Center on Long Island it serves more than 31,000 patients per year and oversees several outpatient clinical sites. Its four nursing homes are located in two buildings, with an approximate capacity of 170 beds.

The Office of Inspector General, a division of U.S. Department of Health & Human Services, charged with independent oversight of Department of Veterans Affairs programs, received several anonymous complaints about the quality of care received at Northport VAMC in 2017 following the deaths of two patients.

In September 2017, the OIG launched a year-long investigation into staffing shortages after receiving two further emails: the first from an employee at Northport VAMC, the second from a liaison to the House Committee on Veterans’ Affairs. The investigation produced a Sept. 18 report (click here to read the full report) that found Northport VAMC’s leadership knew about the staff shortages, forced administrative level nurses to care for patients, and yet still continued to accept new patients despite knowing they wouldn’t have the staff needed to provide the expected level of care.

Federal investigators recognized in August 2017 there was significant turnover in the leadership at the Northport VAMC, affecting key positions such as its director, acting chief of staff and acting nurse executive, who were cited “as catalysts for this change.” Staff members’ remarks indicated it’s given them hope for a better future.

The agency recommended a series of changes for the Northport VAMC pertaining to the nursing staff currently being enacted, and the facility says is bringing immediate tangible results.

Two patient deaths

Anonymous complaints about two patient deaths at the Northport VAMC in 2017 started the series of federal investigations into the facility.

The first death was a male patient in his late 60s who died as a result of choking on his food. Federal inspectors found insufficient evidence the man’s death was due to a lack of nurse oversight, as alleged in the complaints, but did conclude Northport VAMC had ongoing challenges in maintaining basic necessary staffing levels.

“Conditions such as staffing shortages could create an environment where the increased workload assigned to each staff member was such that it became more difficult to remain vigilant,” the report reads.

A forum was held for the Northport VA nursing homes staff to voice their concerns with the facility and its operation while an investigation of the first patient’s death was ongoing.

“Many [staff members] shared a concern about staffing levels being too low,” the report reads.

A second death raised claims of poor quality of care in the Northport vets nursing homes, after a patient in his mid-60s slipped, fell and fractured his hip. He underwent surgery and six days later stopped breathing. Allegations included the VA staff failed to protect the patient from falling and failed to properly provide
one-on-one observation post surgery, neither of which was substantiated by federal investigators.

The investigation into the second death showed the nurse’s assistant caring for him was on her sixth consecutive day of double shifts — 16 hours at a stretch. Investigators again cited “concern that working extra hours with double shifts could lead to staff becoming tired and less vigilant.”

A staff member working double shifts was not common practice, according to Northport VAMC spokesman Levi Spellman, who said union workers are contractually required to have 10 to 12 hours off between nursing shifts.

Closer look at staffing numbers

Records pulled by the federal investigators showed Northport VAMC has been chronically short of nursing staff dating back to at least 2016. Allegations were made that understaffing could lead to a higher rate of “nurse-sensitive outcomes,” such as surgical wounds getting infected, urinary tract infections, ulcers and pneumonia.

Northport’s four nursing homes were found to be short approximately 6.3 full-time employees in 2016 needed to meet VA’s recommended number of nursing hours spent with patients per day. By 2017, the facility’s staffing shortage had more than doubled, with 15.3 additional full-time employees needed. Northport VAMC’s nursing homes were only staffed at 60 to 80 percent of recommended levels over the two years, according to federal investigators.

Northport VAMC’s leadership attempted to tackle the short staffing issue by using “floating” shifts and overtime — sometimes mandatory, according to the federal report. Floating shifts meant staff from other areas of the VAMC were brought in to assist with patients in the nursing homes.

In 2016, Northport VAMC’s nursing home employees put in a  total of 19,991 hours of overtime. It nearly doubled by the end of 2017 as only 107.9 of the facility’s authorized 128 full-time positions were filled, according to Spellman, causing the facility’s overtime costs to skyrocket to nearly $1.5 million.

“Nurse managers had no mechanism to alert them if one of their unit nursing personnel worked excessive OT,” the report reads.

Federal investigators found part of the nursing homes’ staffing issues were due to an inability to hire and retain the members of its nursing staff. Northport VAMC got approval to hire 10 additional registered nurses and 10 nurse assistants as intermittent staff in November 2016, though the team wasn’t assembled until August 2017.

Often the process of hiring new nursing staff was delayed. In one instance, Northport’s leadership said two applicants interviewed and hired in January 2017 were told they would not start working until July.

“This delay in hiring often resulted in the loss of selected applicants who took other jobs,” the report reads.

The leadership of Northport VAMC said the high cost of living on Long Island has also made finding and maintaining a full-time staff difficult.

“Not only does this affect our ability to retain talent, but to recruit it as well,” spokesman Spellman said.

Steps to improvement

The federal investigators made three recommendations to Northport VAMC in order to  ensure it has adequate nursing care for its patients and improve quality of care for residents.

First, that the VAMC’s acting director, Dr. Cathy Cruise, completes a review of the nursing homes to ensure staffing levels align with the needs of its current residents. More staff should be recruited and hired to fill the current vacancies “until optimal staffing is attained,” reads the report.

Spellman said leadership of Northport VAMC, including Cruise, have already started taking action, implementing changes to improve the quality of care and working conditions.

A registered nurse clinical coordination position has been added in order to streamline nursing staff’s efficiency, according to Spellman. At the beginning of 2018, the facility was given approval to hire 2.6 more full-time employees and another 10 staff members were recently approved to bring the total nursing staff to the equivalent 140.6 positions.

“A staffing methodology is in the process of being completed, with additional staff expected,” Spellman said.

The Northport VA has received approval to directly hire its nursing staff and is giving new employees immediate start dates, according to him. It also had plans to expand its nursing floating pool, and to cross train other VAMC nurses in long-term care to continue to grow the available number of staff who can provide residents with care.

Third, Northport’s leadership was also told to improve its management of staff’s overtime hours and make sure of future responsible use of financial resources, citing the $1.5 million in 2017 overtime.

“Federal employees are expected to be good stewards of government funds,” the report reads. “The OIG found a lack of accountability for managing OT expenditures.

Spellman said the nursing homes staff had a total weekly average of 437.3 hours of overtime for the 2018 fiscal year, which ended Sept. 30. This indicates a significant drop from last year, where the total weekly average of overtime exceeded 750 hours.

“All of this is to say that, while the OIG has helped Northport identify areas in which we can improve, we have implemented measures to make those improvements — and we are already seeing results,” Spellman said.

Recent research focuses on modest lifestyle changes

By David Dunaief, M.D.

Dr. David Dunaief

Parkinson’s disease has burst into the public consciousness in recent years. It is a neurodegenerative (the breakdown of brain neurons) disease with the resultant effect of a movement disorder. 

Most notably, patients with the disease suffer from a collection of symptoms known by the mnemonic TRAP: tremors while resting, rigidity, akinesia/bradykinesia (inability/difficulty to move or slow movements) and postural instability or balance issues. It can also result in a masked face, one that has become expressionless, and potentially dementia, depending on the subtype. There are several different subtypes; the diffuse/malignant phenotype has the highest propensity toward cognitive decline (1).

The part of the brain most affected is the basal ganglia, and the prime culprit is dopamine deficiency that occurs in this brain region (2). Why not add back dopamine? Actually, this is the mainstay of medical treatment, but eventually the neurons themselves break down, and the medication becomes less effective.

Risk factors may include head trauma, reduced vitamin D, milk intake, well water, being overweight, high levels of dietary iron and migraine with aura in middle age.

Is there hope? Yes, in the form of medications and deep brain stimulatory surgery, but also with lifestyle modifications. Lifestyle factors include iron, vitamin D and CoQ10. The research, unfortunately, is not conclusive, though it is intriguing.

Let’s look at the research.

The role of iron

This heavy metal is potentially harmful for neurodegenerative diseases such as Alzheimer’s disease, macular degeneration, multiple sclerosis and, yes, Parkinson’s disease. The problem is that this heavy metal can cause oxidative damage.

In a small, yet well-designed, randomized controlled trial (RCT), researchers used a chelator to remove iron from the substantia nigra, a specific part of the brain where iron breakdown may be dysfunctional. An iron chelator is a drug that removes the iron. Here, deferiprone (DFP) was used at a modest dose of 30 mg/kg/d (3). This drug was mostly well tolerated.

The chelator reduced the risk of disease progression significantly on the Unified Parkinson Disease Rating Scale (UPDRS). 

Participants who were treated sooner had lower levels of iron compared to a group that used the chelator six months later. A specialized MRI was used to measure levels of iron in the brain. This trial was 12 months in duration.

The iron chelator does not affect, nor should it affect, systemic levels of iron, only those in the brain specifically focused on the substantia nigra region. The chelator may work by preventing degradation of the dopamine-containing neurons. It also may be recommended to consume foods that contain less iron.

CoQ10

When we typically think of using CoQ10, a coenzyme found in over-the-counter supplements, it is to compensate for depletion from statin drugs or due to heart failure. Doses range from 100 to 300 mg. However, there is evidence that CoQ10 may be beneficial in Parkinson’s at much higher doses. 

In an RCT, results showed that those given 1,200 mg of CoQ10 daily reduced the progression of the disease significantly based on UPDRS changes, compared to the placebo group (4). Other doses of 300 and 600 mg showed trends toward benefit but were not significant. This was a 16-month trial in a small population of 80 patients. Though the results for other CoQ10 studies have been mixed, these results are encouraging. Plus, CoQ10 was well tolerated at even the highest dose. Thus, there may be no downside to trying CoQ10 in those with Parkinson’s disease.

Vitamin D: Good or bad?

In a prospective (forward-looking) study, results show that vitamin D levels measured in the highest quartile reduced the risk of developing Parkinson’s disease by 65 percent, compared to the lowest quartile (5). This is quite impressive, especially since the highest quartile patients had vitamin D levels that were what we would qualify as insufficient, with blood levels of 20 ng/ml, while those in the lowest quartile had deficient blood levels of 10 ng/ml or less. There were over 3,000 patients involved in this study with an age range of 50 to 79.

When we think of vitamin D, we wonder whether it is the chicken or the egg. Let me explain. Many times we are deficient in vitamin D and have a disease, but replacing the vitamin does nothing to help the disease. Well, in this case it does. It turns out that vitamin D may play dual roles of both reducing the risk of Parkinson’s disease and slowing its progression.

In an RCT, results showed that 1,200 IU of vitamin D taken daily may have reduced the progression of Parkinson’s disease significantly on the UPDRS compared to a placebo over a 12-month duration (6). Also, this amount of vitamin D increased the blood levels by two times from 22.5 to 41.7 ng/ml. There were 121 patients involved in this study with a mean age of 72.

So, what have we learned? Though medication with dopamine agonists is the gold standard for the treatment of Parkinson’s disease, lifestyle modifications can have a significant impact on both prevention and treatment of this disease. Each lifestyle change in isolation may have modest effects, but cumulatively they might pack quite a wallop. The most exciting part is that lifestyle modifications have the potential to slow the progression of the disease and thus have a protective effect. Iron chelators specific to the brain may also be very important in disease modification. This also brings vitamin D back into the fold as a potential disease modifier.

References:

(1) JAMA Neurol. 2015;72:863-873. (2) uptodate.com. (3) Antioxid Redox Signal. 2014;10;21(2):195-210. (4) Arch Neurol. 2002;59(10):1541-1550. (5) Arch Neurol. 2010;67(7):808-811. (6) Am J Clin Nutr. 2013;97(5):1004-1013.

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.

Many businesses in the Village of Port Jefferson and Port Jefferson Station will be ‘dressed in pink’ throughout the month of October.

Pink pumpkins, chocolate nights and yoga classes will be part of this year’s Paint Port Pink, Mather Hospital’s month-long October breast cancer awareness community outreach in Port Jefferson and Port Jefferson Station. The event was created in 2015 to raise awareness about the disease, share information and education and foster solidarity in the community.

Employees at Mather Hospital will celebrate Wear Pink Day on Oct. 9.

New this year are Pink Your Pumpkin and Pink Your Windows contests and chocolate-making classes. It Takes a Village Wellness will offer yoga classes with a portion of the registration fees going to the Fortunato Breast Health Center’s Fund for Uninsured and Underinsured. 

Paint Port Pink begins on Oct. 1 with Turn Your Pink Lights On!, when local merchants and residents will be asked to light up Port Jefferson and Port Jefferson Station. On Wear Pink Day, Oct. 9, Mather employees and community residents will be encouraged to dress in pink and to post their photos on Facebook and Instagram using #paintportpink. 

Local residents and merchants can Pink Their Pumpkins and Pink Their Windows in contests designed to raise awareness about breast cancer. Month-long promotions by local businesses will raise funds for the Fund for Uninsured and Underinsured. Mather has teamed up with about 120 local community partners — businesses and professional offices — to help spread the word about the importance of breast health.

Mammograms can help save lives

The American Cancer Society reports that the chance of a woman having invasive breast cancer in her life is about one in eight. That is why increased awareness, education and early detection are important parts of breast health care.

Fortunato Breast Health Center co-medical directors Dr. Michele Price and Dr. Joseph Carrucciu.

A mammogram can reveal a tumor as much as two years before you or your health care professional can feel it. Following the American College of Radiology guidelines, the Fortunato Breast Health Center recommends that you get annual mammography screening starting at age 40. In some higher risk situations, earlier mammography screening or additional breast imaging studies, such as ultrasound, may be recommended. To make an appointment, call 631-476-2771, ext. 1.

If you are uninsured or underinsured, you may be eligible for no cost or discounted screenings through the center’s Fund for Uninsured and Underinsured. If you have been diagnosed with breast cancer and need financial assistance, contact Pink Aid at www.pinkaid.org.

Women receiving their annual mammograms will now have even more accurate screenings thanks to two new state-of-the-art 3-D mammography units at the Fortunato Breast Health Center. Advances in imaging technology deliver highly detailed images that enhance a radiologist’s ability to provide accurate diagnoses. Improvements in ergonomic design allow for improved patient comfort and relaxation. The units also protect patients by delivering the lowest radiation dose of all FDA approved 3-D mammography systems.

“The mammographic images are very clear and detailed, which helps us to identify abnormalities at the smallest possible size,” says Dr. Michelle Price, co-medical director of the breast center. 

Above, one of the new 3-D mamography units at Mather Hospital

The new devices allow for improved detection rates and diagnostic accuracy over older mammography technology through the addition of tomosynthesis, also known as three-dimensional (3-D) mammography. This allows radiologists to see more than what is shown on a standard digital mammogram. “A traditional mammogram offers a top-down picture from compression of the breast tissue. With tomosynthesis, the ‘3-D’ portion of the exam, we get thin cross-sectional images so we can see what it looks like at different angles — in that respect, it is almost like a CAT scan,” said Price.

Having your mammogram done by the same center year after year allows your doctor to compare prior images and look for subtle changes or abnormalities. This can allow for early detection of breast cancer, which in turn can lead to life-saving treatment. “Being able to look back at a history of breast images and compare with prior films is critical for being able to interpret studies correctly. That’s a major advantage of coming to a place where you have established your medical records,” said Price. “It improves the accuracy of the reading.” 

Special community events

Paint Port Pink will offer several events throughout the month of October hosted by Mather’s community partners. Register for events at www.paintportpink.org.

Monday, Oct. 1: Turn Your Pink Lights On!

Thursday, Oct. 4, 6 to 8 p.m.: Chocolate Making Class, Chocolate Works, Stony Brook. Join them for some sweet fun molding and decorating your own chocolate creations! Registration is required.

Tuesday, Oct. 9, Noon: Wear Pink Day, Mather Hospital, Port Jefferson. Get dressed up in your best pink outfit, take a photo and post using #paintportpink

Wednesday, Oct. 10: Pink Sale, Mather Hospital, Port Jefferson. Come and find some pink treasures at the Mather Hospital Thrift and Gift Shop lobby sale. 

Saturday, Oct. 14, Noon & 1 p.m.: Community Reiki Circle, It Takes a Village Wellness, Port Jefferson with two chances to participate in and learn about the power of reiki. Registration is required.

Friday, Oct. 19, 6 to 7 p.m.: Meditation Session, It Takes a Village Wellness, Port Jefferson. Attend a meditation session to enhance your health and tune in to mindfulness. Registration is required. 

Friday, Oct. 19, 7 to 9 p.m.: Chocolate Making Class, Chocolate Works, Stony Brook. Join them for some sweet fun molding and decorating your own chocolate creations! Registration is required. 

Monday, Oct. 22, 6:30 to 7:30 p.m.: Yoga for Health class, Mather Hospital, Port Jefferson offered through It Takes a Village Wellness in Mather Hospital’s conference room B. Registration is required.

Friday, Oct. 26, 12 to 2 p.m.: Wellness Luncheon, Nantucket’s, Port Jefferson. Hosted by It Takes a Village Wellness, attend their “whole health” wellness luncheon and learn about staying healthy naturally. Registration is required. 

Saturday, Oct. 27, 9 a.m to 1:30 p.m.: HealthyU, Mather Hospital, Port Jefferson, a seminar series and health fair focused on physical, emotional and financial well-being. Registration is required. Call 631-686-7879.

Wednesday, Oct. 31: Winners of the Pink Your Pumpkin and Pink Your Window contests will be announced. 

* Proceeds from all events benefit the Fortunato Breast Health Center Fund for Uninsured and Underinsured.

Month-Long Promotions

Chick-fil-A, Port Jefferson Station: $1 from all milk shake sales during the month of October will benefit the Fund for Uninsured.

LI Pour House, Port Jefferson Station: Hosting Wine Down Wednesdays. Every Wednesday during the month of October a glass of wine will be $4 with 10 percent of your purchase benefiting the Fund for Uninsured.

East Main & Main, Port Jefferson: $1 from all pink donut sales during the month of October to benefit the Fund for Uninsured.

Amazing Olive, Port Jefferson: $1 from all extra virgin olive oil sales during the month of October to benefit the Fund for Uninsured.

Luck Soap, Port Jefferson: 40 percent of all Luck Soap Pink Ribbon soap sales (available for sale at Amazing Olive, Port Jefferson and Patchogue locations) during the month of October to benefit the Fund for Uninsured.

The Soap Box, Port Jefferson: 20 percent off Pink Sugar Kiss items during the month of October.

Yogo Delish, Port Jefferson: Donate $1 with your purchase during the month of October and get a $1 off coupon for your next visit.

Tapestry Salon, Mount Sinai: A portion of all pink hair extension sales during the month of October will benefit the Fund for Uninsured.

Cutting Hut, Port Jefferson Station: 10 percent of all pink hair extension sales during the month of October will benefit the Fund for Uninsured.

The Pie, Port Jefferson: Give a donation during the month of October and receive a free Pink Lemonade.

MAC Hair Salon, Mt. Sinai: Pink hair strands for $15 or $10 per pink foil during October with 50 percent of the proceeds to benefit the Fund for Uninsured.

Theatre Three, Port Jefferson: Receive a 20 percent discount on the purchase of your tickets in October when you mention Paint Port Pink.

For more information, please visit www.paintportpink.org.

All photos courtesy of John T. Mather Memorial Hospital

Above, Mikala Egeblad works with graduate student Emilis Bružas in the Watson School of Biological Sciences. Photo from Pershing Square Soon Cancer Research Alliance

By Daniel Dunaief

For some people, cancer goes into remission and remains inactive. For others, the cancer that’s in remission returns. While doctors can look for risk factors or genetic mutations, they don’t know why a cancer may come back at the individual level.

In a mouse model of breast and prostate cancers, Mikala Egeblad, an associate professor at Cold Spring Harbor Laboratory, has found an important driver of cancer activation and metastasis: inflammation. When mice with cancer also have inflammation, their cancer is likely to become more active. Those who don’t have inflammation, or whose inflammation is treated quickly, can keep the dreaded disease in check. Cancer cells “may be dormant or hibernating and not doing any harm at all,” she said. “We speculated what might be driving them from harmless to overt metastasis.”

Egeblad cautioned that this research, which was recently published in the journal Science, is on mice and that humans may have different processes and mechanisms.

CSHL’s Mikala Egeblad. Photo from Pershing Square Soon Cancer Research Alliance

“It is critical to verify whether the process happens in humans,” Egeblad suggested in an email, which she will address in her ongoing research. Still, the results offer a window into the way cancer can become active and then spread from the lungs. She believes this is because the lungs are exposed to so many external stimuli. She is also looking into the relevance for bone, liver and brain metastases. The results of this research have made waves in the scientific community.

“This study is fantastic,” declared Zena Werb, a professor of anatomy and associate director for basic science at the Helen Diller Family Comprehensive Cancer Center at the University of California in San Francisco. “When [Egeblad] first presented it at a meeting six months ago, the audience was agog. It was clearly the best presentation of the meeting!”

Werb, who oversaw Egeblad’s research when Egeblad was a postdoctoral scientist, suggested in an email that this is the first significant mechanism that could explain how cancer cells awaken and will “change the way the field thinks.”

Egeblad credits a team of researchers in her lab for contributing to this effort, including first author Jean Albrengues, who is a postdoctoral fellow. This group showed that there’s a tipping point for mice — mice with inflammation that lasts six days develop metastasis.

Egeblad has been studying a part of the immune system called neutrophil extracellular traps, which trap and kill bacteria and yeast. Egeblad and other researchers have shown that some cancers trick these NETs to aid the cancer in metastasizing.

In the new study, inflammation causes cancer cells that are not aggressive to develop NETs, which leads to metastasis. The traps and enzymes on it “change the scaffold that signals that cancer should divide and proliferate instead of sitting there dormant,” Egeblad said.

To test out her theory about the role of enzymes and the NETs, Egeblad blocked the cascade in six different ways, including obstructing the altered tissue scaffold with antibodies. When mice have the antibody, their ability to activate cancer cells after inflammation is prevented or greatly reduced, she explained.

The numbers from her lab are striking: in 100 mice with inflammation, 94 developed metastatic cancer. When she treated these mice with any of the approaches to block the inflammation pathway, 60 percent of them survived, while the remaining 40 percent had a reduced metastatic cancer burden in the lungs.

If inflammation is a key part of determining the cancer prognosis, it would help cancer patients to know, and potentially treat, inflammation even when they don’t show any clinical signs of such a reaction.

In mice, these NETs spill into the blood. Egeblad is testing whether these altered NETs are also detectable in humans. She could envision this becoming a critical marker for inflammation to track in cancer survivors.

The epidemiological data for humans is not as clear cut as the mouse results in Egeblad’s lab. Some of these epidemiological studies, however, may not have identified the correct factor.

Egeblad thinks she needs to look specifically at NETs and not inflammation in general to find out if these altered structures play a role for humans. “We would like to measure levels of NETs and other inflammatory markers in the blood over time and determine if there is a correlation between high levels and risk of recurrence,” she explained, adding that she is starting a study with the University of Kansas.

Werb suggested that inflammation can be pro-tumor or anti-tumor, possibly in the same individual, which could make the net effect difficult to determine.

“By pulling the different mechanisms apart, highly significant effects may be there,” Werb wrote in an email. Other factors including mutation and chromosomal instability and other aspects of the microenvironment interact with inflammation in a “vicious cycle.”

In humans, inflammation may be a part of the cancer dynamic, which may involve other molecular signals or pathways, Egeblad said.

She has been discussing a collaboration with Cold Spring Harbor Laboratory’s Doug Fearon, whose lab is close to hers.

Fearon has been exploring how T-cells could keep metastasis under control. Combining their approaches, she said, cancer might need a go signal, which could come from inflammation, while it also might need the ability to alter the ability of T-cells from stopping metastasis.

In her ongoing efforts to understand the process of metastasis, Egeblad is also looking at creating an antibody that works in humans and plans to continue to build on these results. “We now have a model for how inflammation might cause cancer recurrence,” she said. 

“We are working very actively on multiple different avenues to understand the human implications, and how best to target NETs to prevent cancer metastasis.”

In recent studies, the Mediterranean-type diet decreased mortality significantly. Stock photo
Many Americans are malnourished

By David Dunaief, M.D.

Dr. David Dunaief

It may come as a surprise, but most of us are malnourished. How could that be, when approximately 70 percent of the U.S. population is overweight or obese? When we think of malnourishment, developing countries come to mind. However, malnourishment is not directly correlated with hunger; it is common at all levels of the socioeconomic scale. The definition of malnourished is insufficient nutrition, which in the U.S. results from low levels of much needed nutrients.

Over the last 30 years, the pace of increase in life expectancy has slowed substantially. In fact, a New England Journal of Medicine article noted that life expectancy may actually decline in the near future (1). 

According to the American Medical Association, almost half of Americans have at least one chronic disease, with 13 percent having more than three (2). The projection is that 157 million Americans will have more than one chronic disease by 2020. Most chronic diseases, including common killers, such as heart disease, stroke, diabetes and some cancers, can potentially be prevented, modified and even reversed with a focus on nutrients, according to the Centers for Disease Control and Prevention (CDC). 

I regularly test patients’ carotenoid levels. Carotenoids are nutrients that are incredibly important for tissue and organ health. They are measurable and give the practitioner a sense of whether the patient may lack potentially disease-fighting nutrients. Testing is often covered if the patient is diagnosed with moderate malnutrition. Because the standard American diet is very low in nutrients, classifying a patient with moderate malnutrition can be appropriate. A high nutrient intake approach can rectify the situation and increase, among others, carotenoid levels.

What is a high nutrient intake and why is it so important?

A high nutrient intake is an approach that focuses on micronutrients, which literally means small nutrients, including antioxidants and phytochemicals — plant nutrients. Micronutrients are bioactive compounds found mostly in foods and some supplements. While fiber is not considered a micronutrient, it also has significant disease modifying effects. Micronutrients interact with each other in synergistic ways, meaning the sum is greater than the parts. Diets that are plant rich raise the levels of micronutrients considerably in patients.

Let’s look at some examples.

A study showed olive oil reduces the risk of stroke by 41 percent (3). The authors attribute this effect at least partially to oleic acid, a bioactive compound found in olive oil. While olive oil is important, I recommend limiting olive oil to one tablespoon a day. There are 120 calories per tablespoon of olive oil, all of them fat. If you eat too much, even of good fat, it defeats the purpose. The authors commented that the Mediterranean-type diet had only recently been used in trials with neurologic diseases and results suggest benefits in several disorders, such as Alzheimer’s. 

In a case-control (compare those with and without disease) study, high intake of antioxidants from food is associated with a significant decrease in the risk of early age-related macular degeneration (AMD), even when participants had a genetic predisposition for the disease (4). AMD is the leading cause of blindness in those 55 years or older. There were 2,167 people enrolled in the study with several different genetic variations that made them high risk for AMD. Those with a highest nutrient intake, including B-carotene, zinc, lutein, zeaxanthin, EPA and DHA, substances found in fish, had an inverse relationship with risk of early AMD. Nutrients, thus, may play a role in modifying gene expression. 

What can we do to improve life expectancy?

In the Greek EPIC trial, a large prospective (forward-looking) cohort study, the Mediterranean-type diet decreased mortality significantly — the better the compliance, the greater the effect (5). 

The most powerful dietary components were the fruits, vegetables, nuts, olive oil, legumes and moderate alcohol intake. Low consumption of meat also contributed to the beneficial effects. Dairy and cereals had a neutral or minimal effect.

Though many Americans are malnourished, nutrients that are effective and available can alter this predicament or epidemic. Hopefully, with a focus on a high nutrient intake, we can re-ignite the pace of increased life expectancy and improve quality of life for the foreseeable future.

References:

(1) N Engl J Med 2005; 352:1138-1145. (2) www.ama-assn.org. (3) Neurology June 15, 2011. (4) Arch Ophthalmol. 2011;129(6):758-766. (5) BMJ. 2009;338:b2337.

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.

Being a hospital patient for any length of time is not likely an experience that engenders tranquility or inner peace for most, but local artists and hospital staff are doing their best to change that.

The 3 North Patient Care Unit at Port Jefferson’s John T. Mather Memorial Hospital, a newly constructed intermediate care unit on the third floor, is now furnished with paintings from artists who donated their work to be displayed for and enjoyed by patients and staff.

The hospital hosted a reception to thank the artists, including Irene Ruddock, president of Setauket Artists, who played a leadership role in getting the idea off the ground.

“The art installation endeavor was the inspiration of Dr. Shug-Hong Young, a cardiologist at Mather Hospital, who purchased one of my paintings which he donated to the hospital’s newest wing,” Ruddock said.

She said Young then took the idea to Mather president, Kenneth Roberts, who liked the concept and requested works featuring Long Island waterways and boats be displayed.

“This is actually a wonderful opportunity and a wonderful meeting of community members and artists with their local community hospital resource,” Roberts said. “We put a brand new wing on with private rooms with computers in the rooms so we don’t have all of the [computers on wheels] or [workstations on wheels] out in the hallways, so nothing is crowded. So we have this brand new nursing station with beautiful finishes, but the one thing we didn’t have was artwork.”

Ruddock was tasked with selecting paintings from her group’s members that fit the bill.

“I chose art that would add to the beauty of the already beautiful space, create a peaceful, serene environment that might provide a sense of spiritual healing,” she said. “I wanted paintings that touch people’s hearts and souls — ones that were memorable and draw you right into the painting.”

Young explained why he donated Ruddock’s initial painting, and why he thought it would brighten up the wing.

“It came to me that if we could bring all of these local artists [works] to the hospital, because many of the artworks reflect local scenes — the beach, the port, the pond — that would make patients feel they are not isolated, they are still connected to the beautiful environment,” he said.

Emily Emma, nurse manager for 3 North who recently transferred to the position, said she asked colleagues in her unit if there was anything she could do to elevate their work and the care they provide to patients, and a common theme emerged in the answers.

“Most of them had said, ‘We would really like some artwork on the walls,’” Emma said. “Patients can’t get enough of them. It’s really a nice peaceful journey to get through their progression of health.”

Jim Molloy, a Miller Place-based artist, was among those who donated a piece to the hospital that he called “Turning Tides.”

“I think that’s what art is about — it’s about brightening up someone’s day,” Molloy said. “If somebody can look at a piece of art and kind of escape for a while, then that makes me feel good, it makes them feel good — it’s perfect.”

Ruddock thanked Roberts, Young and Emma for their efforts in bringing the idea to fruition, as well as Mather employees Nancy Uzo, vice president of public affairs, and Laura Juliano, director of annual giving. Juliano said artist Renée Caine also provided invaluable help during the planning and installation phases of the idea. Caine donated one of her own works.

“By far, the most rewarding aspect of the project was the reaction of the patients, caregivers and staff to the paintings,” Ruddock said. “One staff member said of Michael Kutzing’s painting of a sailing vessel, ‘I mentally take a ride on the boat every day on the Long Island Sound to breathe in the air.’”

Placing one foot in front of the other can lead to impressive mental and physical benefits. Stock photo
Benefits are seen with modest exercise

By Dr. David Dunaief

Dr. David Dunaief

There is great emphasis on exercise. We have heard it is good for us ever since we were children in gym class striving for the presidential fitness award. 

The average reaction, unfortunately, is an aversion to exercise. As kids, many of us tried to get out of gym class, and as adults, we “want” to exercise, but we “don’t have time.” The result of this is a nation of couch potatoes. I once heard that the couch is the worst deep-fried food. It perpetuates inactivity, especially when watching TV. Even sleeping burns more calories.

I think part of the problem is that we don’t know what type of exercise is best and how long and frequently to do it. 

Well, guess what? There is an easy way to get tremendous benefit with very little time involved. You don’t need expensive equipment, and you don’t have to join a gym. You can sharpen your wits with your feet.

Jane Brody has written in The New York Times’ Science Times about Esther Tuttle. Esther was 99 years old, sharp as a tack and was independently mobile, with no aids needed. She continued to stay active by walking in the morning for 30 minutes and then walking again in the afternoon. The skeptic might say that this is a nice story, but its value is anecdotal at best. 

Well, evidence-based medicine backs up her claim that walking is a rudimentary and simple way to get exercise that shows incredible benefits. One mile of walking a day will help keep the doctor away. 

Walking has a powerful effect on preserving brain function and even growing certain areas of the brain (1). Walking between six and nine miles a week, or just one mile a day, reduced the risk of cognitive impairment over 13 years and actually increased the amount of gray matter tissue in the brain over nine years.

Those participants who had an increase in brain tissue volume had a substantially reduced risk of developing cognitive impairment. Interestingly, the parts of the brain that grew included the hippocampus, involved with memory, and the frontal cortex, involved with short-term memory and executive decision making. There were 299 participants who had a mean age of 78 and were dementia free at the start of the trial. Imagine if you started earlier? 

In yet another study, moderate exercise reduced the risk of mild cognitive impairment with exercise begun in mid-to-late life (2). 

Even better news is that, if you’re pressed for time or if you’re building up your stamina, you can split a mile into two half-mile increments. How long does it take you to walk a half-mile? You’ll be surprised at how much better you will  feel — and how much sharper your thinking is.

If you ratchet up the exercise to running, a study showed that mood improves, mollifying anger (3). The act of running actually increases your serotonin levels, a hormone that, when low, can make people agitated or angry. So exercise may actually help you get your aggressions out.

Walking has other benefits as well. We’ve all heard about the importance of doing weight-bearing exercise to prevent osteoporosis and osteoporotic fractures. The movie “WALL-E” even did a spoof on this, projecting a future where people lived in their movable recliners. The result was a human skeletal structure that had receded over the generations from lack of use. Although it was tongue in cheek, it wasn’t too far from the truth; if you don’t use them, bones weaken and break. Walking is a weight-bearing exercise that helps strengthen your joints, bones and muscles. 

So remember, use your feet to keep your mind sharp. Activities like walking will help you keep a positive attitude, preserve your bones and help increase the plasticity of your brain.

References: 

(1) Neurology Oct 2010, 75 (16) 1415-1422. (2) Arch Neurol. 2010;67(1):80-86. (3) J Sport Exerc Psychol. 2010 Apr;32(2):253-261.

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.

Choppy conditions in Port Jefferson Harbor forced the cancellation of the race portion of the 2018 Village Cup Regatta Sept. 8,  but the annual fundraiser was a success anyway.

For the ninth year, the Port Jefferson Yacht Club and the Port Jefferson Village Center were the home for the event, which features a parade past the village-owned pier at Harborfront Park, a race out in the open water between sailboats representing the village and John T. Mather Memorial Hospital, and a banquet to conclude the festivities. This year, conditions weren’t conducive to holding the race, but the event still raised about $70,000 for two worthy causes, according to Mather’s Facebook page.

Funds raised by the regatta will be split between Mather Hospital’s Palliative Medicine Program and the Lustgarten Foundation for Pancreatic Cancer Research.

For the sixth year,  actor/director and local resident Ralph Macchio served as community ambassador for the event. Macchio helps to publicize the important work of the two programs funded by the regatta. His wife, Phyllis, is a nurse practitioner in Mather’s Palliative Medicine Program.

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