Health

Stock photo
Toenail fungus can have medical implications

By David Dunaief, M.D.

Dr. David Dunaief

Summer is almost here, and millions of Americans are beginning to expose their toes. Some are more self-conscious about it because of a disease called onychomycosis, better known as nail fungus.

Nail fungus usually affects toenails but can also affect fingernails. It turns the nails yellow, makes them potentially brittle, creates growth underneath the nail (thickening of the nails) and may cause pain.

Many consider getting treatment for cosmetic reasons, but there are also medical reasons to treat, including the chronic or acute pain caused by nail cutting or pressure from bedsheets and footwear. There is also an increased potential risk for infections, such as cellulitis, in those with compromised immune systems (1).

Onychomycosis is not easy to treat, although it affects approximately 8 percent of the population (2). The risk factors are unclear but may relate to family history, tinea pedis (athlete’s foot), older age, swimming, diabetes, psoriasis, suppression of the immune system and/or living with someone affected (3).

Many organisms can affect the nail. The most common class is dermatophytes, but others are yeast (Candida) and nondermatophytes. A KOH (potassium hydroxide) preparation can be used to differentiate them. This is important since some medications work better on one type than another. Also, yellow nails alone may not be caused by onychomycosis; they can be a sign of psoriasis.

When considering treatment, there are several important criteria, including effectiveness, length of treatment and potential adverse effects. The bad news is that none of the treatments are foolproof, and the highest “cure” rate is around two-thirds. Oral medications tend to be the most efficacious, but they also have the most side effects. The treatments can take from around three months to one year. Unfortunately, the recurrence rate of fungal infection is thought to be approximately 20 to 50 percent with patients who have experienced “cure” (4).

Oral antifungals

There are several oral antifungal options, including terbinafine (Lamisil), fluconazole (Diflucan) and itraconazole. These tend to have the greatest success rate, but the disadvantages are their side effects. In a small but randomized controlled trial (RCT), terbinafine was shown to work better in a head-to-head trial than fluconazole (5). Of those treated, 67 percent of patients experienced a clearing of toenail fungus with terbinafine, compared to 21 and 32 percent with fluconazole, depending on duration. Patients in the terbinafine group were treated with 250 mg of the drug for 12 weeks. Those in the fluconazole group were treated with 150 mg of the drug for either 12 or 24 weeks, with the 24-week group experiencing better results.

The disadvantage of terbinafine is the risk of potential hepatic (liver) damage and failure, though it’s an uncommon occurrence. Liver enzymes need to be checked while using terbinafine.

Another approach to reducing side effects is to give oral antifungals in a pulsed fashion. In an RCT, fluconazole 150 or 300 mg was shown to have significant benefit compared to the control arm when given on a weekly basis (6). However, efficacy was not as great as with terbinafine or itraconazole (7).

Topical medication

A commonly used topical medication is ciclopirox (Penlac). The advantage of this lacquer is that there are minor potential side effects. However, it takes approximately a year of daily use, and its efficacy is not as great as oral antifungals. In two randomized controlled trials, the use of ciclopirox showed a 7 percent “cure” rate in patients, compared to 0.4 percent in the placebo groups (8). There is also a significant rate of fungus recurrence. In one trial, ciclopirox had to be applied daily for 48 weeks in patients with mild to moderate levels of fungus.

Laser therapy

Of the treatments, laser therapy would seem to be the least innocuous. However, there are very few trials showing significant benefit with this approach. A study with one type of laser treatment (Nd:YAG 1064-nm laser) did not show a significant difference after five sessions (9). This was only one type of laser treatment, but it does not bode well. The advantage of laser treatment is the mild side effects. The disadvantages are the questionable efficacy and the cost. We need more research to determine if they are effective.

Alternative therapy

Vicks VapoRub may have a place in the treatment of onychomycosis. In a very small pilot trial with 18 patients, 27.8 percent or 5 of the patients experienced complete “cure” of their nail fungus (10). Partial improvement occurred in the toenails of 10 patients. The gel was applied daily for 48 weeks. The advantages are low risk of side effects and low cost. The disadvantages are a lack of larger studies for efficacy, the duration of use and a lower efficacy when compared to oral antifungals.

None of the treatments are perfect. Oral medications tend to be the most efficacious but also have the most side effects. If treatment is for medical reasons, then oral may be the way to go. If you have diabetes, then treatment may be of the utmost importance.

If you decide on this approach, discuss it with your doctor; and do appropriate precautionary tests on a regular basis, such as liver enzyme monitoring with terbinafine. However, if treatment is for cosmetic reasons, then topical medications or alternative approaches may be the better choice. No matter what, have patience. The process may take a while; nails, especially in toes, grow very slowly.

References:

(1) J Am Acad Dermatol. 1999 Aug.;41:189–196; Dermatology. 2004;209:301–307. (2) J Am Acad Dermatol. 2000;43:244–248. (3) J Eur Acad Dermatol Venereol. 2004;18:48–51. (4) Dermatology. 1998;197:162–166; uptodate.com. (5) Pharmacoeconomics. 2002;20:319–324. (6) J Am Acad Dermatol. 1998;38:S77. (7) Br J Dermatol. 2000;142:97–102; Pharmacoeconomics. 1998;13:243–256. (8) J Am Acad Dermatol. 2000;43(4 Suppl.):S70-S80. (9) J Am Acad Dermatol. 2013 Oct.;69:578–582. (10) J Am Board Fam Med. 2011;24:69–74.

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 active is the magic pill for a healthy life. Stock photo
Inactivity may increase mortality and disease risk

By David Dunaief, M.D.

Dr. David Dunaief

With the advent of summer weather, with its heat and humidity, who wants to think about exercise? Instead, it’s tempting to lounge by the pool or even inside with air conditioning.

First, let me delineate between exercise and inactivity; they are not complete opposites. When we consider exercise, studies tend to focus on moderate to intense activity. However, light activity and being sedentary, or inactive, tend to get clumped together. But there are differences between light activity and inactivity.

Light activity may involve cooking, writing and strolling (1). Inactivity involves sitting, as in watching TV or in front of a computer screen. Inactivity utilizes between 1 and 1.5 metabolic equivalent units — better known as METS — a way of measuring energy. Light activity, however, requires greater than 1.5 METS. Thus, in order to avoid inactivity, we don’t have to exercise in the dreaded heat. We need to increase our movement.

What are the potential costs of inactivity? According to the World Health Organization, over 3 million people die annually from inactivity. This ranks inactivity in the top five of potential underlying mortality causes (2).

How much time do we spend inactive? In an observational study of over 7,000 women with a mean age of 71 years old, 9.7 waking hours were spent inactive or sedentary. These women wore an accelerometer to measure movements. Interestingly, as body mass index and age increased, the amount of time spent sedentary also increased (3).

Inactivity may increase the risk of mortality and plays a role in increasing risks for diseases such as heart disease, diabetes and fibromyalgia. It can also increase the risk of disability in older adults.

Surprisingly, inactivity may be worse for us than smoking and obesity. For example, there can be a doubling of the risk for diabetes in those who sit for long periods of time, compared to those who sit the least (4).

Let’s look at the evidence.

Does exercise overcome inactivity?

We tend to think that exercise trumps all; if you exercise, you can eat what you want and, by definition, you’re not sedentary. Right? Not exactly. Diet is important, and you can still be sedentary, even if you exercise. In a meta-analysis — a group of 47 studies — results show that there is an increased risk of all-cause mortality with inactivity, even in those who exercised (5). In other words, even if you exercise, you can’t sit for the rest of the day. The risk for all-cause mortality was 24 percent overall.

However, those who exercised saw a blunted effect with all-cause mortality, making it significantly lower than those who were inactive and did very little exercise: 16 percent versus 46 percent increased risk of all-cause mortality. So, it isn’t that exercise is not important, it just may not be enough to reduce the risk of all-cause mortality if you are inactive for a significant part of the rest of the day.

Worse than obesity?

Obesity is a massive problem in this country; it has been declared a disease, itself, and it also contributes to other chronic diseases. But would you believe that inactivity has more of an impact than even obesity? In an observational study, using data from the EPIC trial, inactivity might be responsible for two times as many premature deaths as obesity (6). This was a study involving 330,000 men and women.

Interestingly, the researchers created an index that combined occupational activity with recreational activity. They found that the greatest reduction in premature deaths (in the range of 16 to 30 percent) was between two groups, the normal weight and moderately inactive group versus the normal weight and completely inactive group. The latter was defined as those having a desk job with no additional physical activity. To go from the completely inactive to moderately inactive, all it took, according to the study, was 20 minutes of brisk walking on a daily basis.

So what have we learned about inactivity? If you are inactive, increasing your activity to be moderately inactive by briskly walking for 20 minutes a day may reduce your risk of premature death significantly. Even if you exercise the recommended 150 minutes a week, but are inactive the rest of the day, you may still be at risk for cardiovascular disease. You can potentially further reduce your risk of cardiovascular disease by increasing your activity with small additions throughout the day.

The underlying message is that we need to consciously move throughout the day, whether at work with a walk during lunch or at home with recreational activity. Those with desk jobs need to be most attuned to opportunities to increase activity. Simply setting a timer and standing or walking every 30 to 45 minutes may increase your activity levels and possibly reduce your risk.

References:

(1) Exerc Sport Sci Rev. 2008;36(4):173-178. (2) WHO report: http://bit.ly/1z7TBAF. (3) JAMA. 2013;310(23):2562-2563. (4) Diabetologia 2012; 55:2895-2905. (5) Ann Intern Med. 2015;162:123-132, 146-147. (6) Am J Clin Nutr. online Jan. 24, 2015.

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.   

Photo from Stony Brook Medicine
Dr. Kenneth Kaushansky

When choosing a hospital, whether for yourself or a loved one, it pays to have the peace of mind in knowing that you or your loved one will receive the highest quality of care. One way to help ensure that peace of mind is to do your homework.

We recently received news that will give the residents of Suffolk County and beyond one more reason to feel confident about choosing Stony Brook University Hospital for their health care needs. Our hospital has been named one of America’s 100 Best Hospitals™ for 2019 by Healthgrades, the first organization in the country to rate hospitals entirely on the basis of the quality of clinical outcomes.

Recipients of the America’s 100 Best Hospitals Award are recognized for overall clinical excellence based on quality outcomes for 34 conditions and procedures for 4,500 hospitals nationwide. Healthgrades reviews three years of Medicare and other inpatient data, comparing actual to predicted performance for specific and common patient conditions. 

This impressive distinction was achieved by the entire Stony Brook University Hospital team working together to achieve one goal — to deliver on a commitment to provide every patient with exceptional care. We continuously put patient safety and quality of care first, while bringing cutting-edge services and evidence-based medicine to our community. 

As one of America’s 100 Best Hospitals, Stony Brook University Hospital is in the top 2 percent of hospitals nationwide and one of only four hospitals in New York State exhibiting exemplary clinical excellence over the most recent three-year evaluation.

Stony Brook was also named one of America’s 100 Best Hospitals for cardiac care, coronary intervention and stroke care. I’m proud to report that our hospital is the only one in the entire U.S. Northeast region, and one of only two hospitals in the nation, to achieve America’s 100 Best Hospitals in all four of these categories.

With so many choices, it helps to understand that the quality of care you receive varies from hospital to hospital. Whether you are planning an elective surgery or you are admitted to our hospital unexpectedly, it’s important to know that at Stony Brook University Hospital, you’ll be at one of the nation’s best.

Dr. Kenneth Kaushansky is senior vice president, Health Sciences, and dean, Renaissance School of Medicine at Stony Brook University.

Hypothyroidism is a condition in which the thyroid gland is not able to produce enough thyroid hormone. Stock photo
Treatment doesn’t always result in weight loss
Dr. David Dunaief

By David Dunaief, M.D.

Many refer to hypothyroidism as a potential cause for weight gain and low energy. But do we really know what it is and why it is important?

The thyroid is a butterfly-shaped organ responsible for maintaining our metabolism. It sits at the base of the neck, just below the laryngeal prominence, or Adam’s apple. The prefix “hypo,” derived from Greek, means “under” (1). Therefore, hypothyroidism indicates an underactive thyroid and results in slowing of the metabolism.

Blood tests determine if a person has hypothyroidism. Items that are tested include thyroid stimulating hormone (TSH), which is usually increased, thyroxine (free T4) and triiodothyronine (free T3 or T3 uptake). Both of these last two may be suppressed (2).

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

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

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

Myths versus realities

I would like to separate the myths from the realities with hypothyroidism. Does treating hypothyroidism help with weight loss? Not necessarily. Is soy potentially bad for the thyroid? Yes. Does coffee affect thyroid medication? Maybe. Let’s look at the evidence.

Medications

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

What about supplements?

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

Soy impact

In a randomized controlled trial, the treatment group that received higher amounts of soy supplementation had a threefold greater risk of conversion from subclinical hypothyroidism to overt hypothyroidism than those who received considerably less supplementation (7). According to this small, yet well-designed, study, soy has a negative impact on the thyroid. Therefore, those with hypothyroidism may want to minimize or avoid soy.

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

Weight loss

Wouldn’t it be nice if the silver lining of hypothyroidism is that, with medication to treat the disease, we were guaranteed to lose weight? In a retrospective study, results showed that only about half of those treated with medication for hypothyroidism lost weight (9). This was a small study, and we need a large randomized controlled trial to test it further.

WARNING: The FDA has a black box warning on thyroid medications — they should never be used as weight loss drugs (10). They could put a patient in a hyperthyroid state or worse, having potentially catastrophic results.

Coffee

Taking levothyroxine and coffee together may decrease the absorption of levothyroxine significantly, according to one study (11). It did not seem to matter whether they were taken together or an hour apart. This was a very small study involving only eight patients. Still, I recommend avoiding coffee for several hours after taking the medication.

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

References:

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

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 weekly Medical Compass MD Health Videos on Times Beacon Record News Media’s website, www.tbrnewsmedia.com.٭

KEEP MOVING A regular program of walking can reduce stiffness and inflammation. Stock photo
A 10-pound weight loss reduces pain by 50 percent

By David Dunaief, M.D.

Dr. David Dunaief

Over 27 million people in the U.S. suffer from osteoarthritis (OA) (1). Osteoarthritis is insidious, developing over a long period of time. By nature, it is chronic. It is also a top cause of disability (2). What can we do about it?

It turns out that OA is not just caused by friction or age-related mechanical breakdown, but rather by a multitude of factors. These include friction, but also local inflammation, genes and metabolic processes at the cellular level (3). This means that we may be able to prevent and treat it better than we thought by using exercise, diet, medication, injections and possibly even supplements. Let’s look at some of the research.

How can exercise be beneficial?

In an older study, results showed that even a small 10-pound weight loss could result in an impressive 50 percent reduction of symptomatic knee OA over a 10-year period (4).

Most of us either tolerate or actually enjoy walking. We have heard that walking can exacerbate OA symptoms; the pounding can be harsh on our joints, especially our knees. Well, maybe not. Walking actually may have benefits.

In the Multicenter Osteoarthritis Study (MOST), results showed that walking may indeed be useful to prevent functional decline (5). The patients in this study were a mean age of 67 and were obese, with a mean body mass index (BMI) of 31 kg/m2, and either had or were at risk for knee arthritis. In fact, the most interesting part of this study was that the researchers quantified the amount of walking needed to see a positive effect.

The least amount of walking to see a benefit was between 3,250 and 3,750 steps per day, measured by an ankle pedometer. The best results were seen in those walking more than 6,000 steps per day, a relatively modest amount. This was random, unstructured exercise. In addition, for every 1,000 extra steps per day, there was a 16 to 18 percent reduced risk of functional decline two years later.

Acetaminophen may not live up to its popularity

Acetaminophen (e.g., Tylenol) is a popular initial go-to drug for osteoarthritis treatment, but what does research tell us about its effectiveness?

Although acetaminophen doesn’t have anti-inflammatory properties, it does have analgesic properties. However, in a meta-analysis (involving 137 studies), acetaminophen did not reduce pain for OA patients (7).

In this study, all other oral treatments were significantly better than acetaminophen, including diclofenac, naproxen and ibuprofen, as well as intra-articular (in the joint) injectables, such as hyaluronic acid and corticosteroids. The exception was an oral Cox-2 inhibitor, celecoxib, which was only marginally better.

What about NSAIDs?

NSAIDs (nonsteroidal anti-inflammatory drugs) help to reduce inflammation, by definition. However, they have side effects that may include gastrointestinal bleed, and they have a black box warning for heart attacks. Risk tends to escalate with a rise in dose. Interestingly, a newer formulation of diclofenac (Zorvolex) uses submicron particles, which are roughly 20 times smaller than the older version. This allows it to dissolve faster, so it requires a lower dosage.

The approved dosage for OA treatment is 35 mg, three times a day. In a 602-patient, one-year duration, open-label randomized controlled trial (RCT), the newer formulation of diclofenac demonstrated improvement in pain, functionality and quality of life (7). The adverse effects, or side effects, were similar to the placebo. The only caveat is that there was a high dropout rate in the treatment group; only 40 percent completed the trial when they were dosed three times daily.

Don’t forget about glucosamine and chondroitin

Study results for this supplement combination or its individual components for the treatment of OA have been mixed. In a double-blind RCT, the combination supplement improved joint space, narrowing and reducing the pain of knee OA over two years. However, pain was reduced no more than was seen in the placebo group (8).

In a Cochrane meta-analysis review study of 43 RCTs, results showed that chondroitin, with or without glucosamine, reduced the symptom of pain modestly compared to placebo in short-term studies (9). Yet, the researchers stipulate that most of the studies were of low quality.

So, think twice before reaching for the Tylenol. If you are having symptomatic OA pain, NSAIDs such as diclofenac may be a better choice, especially with SoluMatrix fine-particle technology that uses a lower dose, hopefully meaning fewer side effects.

Even though results are mixed, there is no significant downside to giving glucosamine-chondroitin supplements a chance. However, if it does not work after 12 weeks, it is unlikely to have a significant effect. Also, try increasing your walking step count gradually; this could reduce your risk of functional decline. And above all else, if you need to lose weight and do, you will reduce your risk of OA significantly.

References:

(1) Arthritis Rheum. 2008;58:26-35. (2) Popul Health Metr. 2006;4:11. (3) Lancet. 1997;350(9076):503. (4) Ann Intern Med.1992;116:535-539. (5) Arthritis Care Res (Hoboken). 2014;66(9):1328-1336. (6) Ann Intern Med. 2015;162:46-54. (7) ACR 2014 Annual Meeting: Abstract 249. (8) Ann Rheum Dis. Online Jan 6, 2014. (9) Cochrane Database Syst Rev. 2015 Jan 28;1:CD005614.

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.   

Lisa Cooper embraces her son Dante Lombardo at a recent reunion. Photo from Lisa Cooper

Mental health, particularly among service members, often seems to be a forgotten topic. One man and his Northport High School friends want to change that by riding bicycles this June from New York to California to raise awareness about mental health concerns among those who have served our nation’s military. 

Dante Lombardo in uniform. Photo from Lombardo

Dante Lombardo is a former U.S. Marine who was medically discharged due to his mental health. The East Northport resident,  who graduated from Northport High School in 2015, served in the U.S. Marine Corps Reserve from 2015 to 2019. He was trained as a digital wideband transmission equipment operator and as a field radio operator. 

Throughout Lombardo’s time in the Marine Reserves, he struggled with depression and anxiety, and like many others in a similar position, tried to “tough it out,” because that’s what he said the current military culture dictates. “Nearly anybody who has served can tell you that it is highly frowned upon to seek out mental health care,” he explained.

These issues came to a head in April of last year for Lombardo, when he attempted to take his own life. Thankfully, he was connected with a local behavioral health service, giving access to the counseling and the psychiatric care he needed. 

“Had it not been for these services, I do not believe I would have ever begun the path to wellness that I am on today,” said Lombardo.

Unfortunately, many service members suffer from similar mental health issues but do not seek out the help provided by the military, Lombardo said, in fear of being separated from duty due to their issues.

The statistics are staggering.

“We see 20 veterans each day take their own lives,” said Barbara Van Dahlen, a clinical psychologist who created in 2005 a national network of professionals who provide free services to U.S. troops, veterans, their loved ones and their community. “People think that because the war is over, so are the challenges, but that’s not the case.” 

‘People think that because the war is over, so are the challenges, but that’s not the case.’

— Barbara Van Dahlen

As for Lombardo, he may no longer wear his Marine uniform, but he and his bike team are committed to fighting for their fellow service members. 

Lombardo, Brian Fabian and Anthony Rubin, all Northport High School graduates,  just earned their college degrees. Lombardo graduated from Clinton College, Fabian from SUNY Plattsburgh last weekend and Rubin from SUNY Buffalo. Now, they’re raising money in a GoFundMe campaign to pay for expenses that occur throughout the trip. Proceeds remaining will be donated to Give an Hour, which earns exceptional ratings as a charity on Guidestar. 

Give an Hour was chosen, the bike team stated, because it is an organization that is not affiliated with the Department of Defense and can provide mental health services to those in need, without running the risk of negative consequences from the service members chain of command. Lombardo said that the charity could provide service members the opportunity to get help and start healing before their issues become a crisis that demands the official attention of their command, or one that brings harm to themselves or others, while simultaneously defending them from the stigma of needing mental health care while serving.

“The need is huge,” Van Dahlen said in a phone interview. She is honored and grateful for Lombardo’s efforts to raise awareness and funds for the non-profit. 

Van Dahlen emphasizes the need for collaborative approach to address the issues. “We really can take care of the understandable mental health needs of those who serve and their families,” Van Dahlen said. “If we work together and coordinate services — we in the government, nonprofit and private sectors — our country can hopefully step up to serve those who have given so much.”

Northport residents Dante Lombardo, Brian Fabian and Anthony Rubin are riding bicycles cross-country to raise awareness about military mental health issues. Photo from Coast to Coast for Mental Health, Dante Lombardo’s supporters.

It’s a concept that Lombardo and his bike team understand. “This fight is not one person’s burden to bear, but instead one we face together.”

During the team’s travels cross-country, they plan to volunteer in soup kitchens, homeless shelters, elderly care homes and other places that offer opportunities to give back. Their journey aims to seek out and hear the testimonies of veterans nationwide so their stories may be heard. 

The bike team has created a Facebook group page, Coast-to-Coast for Mental Health, which will be updated to post stories and experiences of the team, as well as testimonies of those who have suffered. This trip is a humanitarian interactive wellness journey as seen through three young Long Island men who are raising awareness for those who suffer with mental health issues all too often in silence. 

Lombardo encourages people to share the funding page, the Facebook page, as well as sharing their own stories. His message to the public, “We’ll be seeing you on the trail.”

The Times of Huntington will provide updates of the team’s journey in upcoming issues.

The GoFundMe page, Give an Hour website and an overview of the charity from Charity Navigator  can be found at: 

GoFundMe: www.gofundme.com/tmt6z-coast-to-coast-for-mental-health

Give an Hour: www.giveanhour.org

Charity Navigator: www.charitynavigator.org/index.cfm?bay=search.summary&orgid=17415

In a recent study, those who watched at least six hours of TV per day during their lifetime had a decrease in longevity of 4.8 years. Stock photo
Television viewing can lower your physical and mental health

By David Dunaief, M.D.

Dr. David Dunaief

According to the Nielsen Company, Americans spend an average of 10½ hours per day watching programming of some kind, whether on a television, computer or a portable device (1). For our purposes, we’ll call this TV, because most is consumed while sitting, although the average watching modality has shifted considerably.

What impact does all this watching have on our lives? It may be hazardous to your health. I know this seems obvious, but bear with me. The extent of the effect is surprising. According to 2013 Netflix research, binge-watching, or watching more than two or more episodes of a single program in a row, is perceived as providing a refuge from our busy lives. This also has an addictive effect, prompting dopamine surges as we watch. Interestingly, it also can lead to postbinge depression when a show ends and to isolation and lower social interaction while viewing (2).

TV’s detrimental effect extends beyond the psychological, potentially increasing the risk of heart attacks, diabetes, depression, obesity and even decreasing or stunting longevity. My mother was right when she discouraged us from watching television, but I don’t think even she knew the extent of its impact.

Cardiovascular events including heart attacks 

There was a very interesting observational study published in the New England Journal of Medicine that showed watching sporting events increases the risk of heart attacks and other cardiovascular events, such as arrhythmia (irregular heartbeat) and unstable angina (severe chest pain ultimately due to lack of oxygen). The researchers followed Germans who watched the FIFA (soccer) World Cup playoffs in 1996. 

How much did watching increase the risk of cardiovascular events? This depended on what round of the playoffs and how close a game it was. The later the round and the closer the game, the greater the risk of cardiovascular events. Knockout games, which were single elimination, seemed to have the greatest impact on cardiovascular risk. When Germany was knocked out in the semifinals, the finals between France and Italy did not have any cardiovascular effect. 

Overall, men experienced a greater than threefold increase in risk, while women experienced an increased risk that was slightly below twofold. According to the authors, it was not the outcome of the game that mattered most, but the intensity. The study population involved 4,279 German residents in and around the Munich area (3). 

Another study found that, compared to fewer than two hours a day, those who watched four or more hours experienced an increased risk of cardiovascular disease mortality of 80 percent. I know this sounds like a lot of TV, but remember that the average daily American viewing time is significantly over this. This study, called the Australian Diabetes, Obesity, and Lifestyle study (AusDiab) was observational, looking at 8,800 adults over a six-year period (4). 

Impact on life expectancy 

The adage that life tends to pass you by when you watch TV has a literal component. An observational study found that TV may reduce the life expectancy of viewers. In the study, those who watched at least six hours per day during their lifetime had a decrease in longevity of 4.8 years. However, this is not the whole story. What is even more telling is that after the age of 25, for every hour of TV, one might expect to potentially lose 21.8 minutes of life expectancy (5). According to the authors, these results rival those for obesity and sedentary lifestyles.

Diabetes and obesity risk

In the Nurses’ Health Study, for every two hours of television viewing on a daily basis there were increased risks of type 2 diabetes and obesity of 23 and 14 percent, respectively (6). The results show that sitting at work for two hours at a time increased the risk of diabetes and obesity by only 5 and 7 percent, respectively, much less of an effect than TV watching. The authors surmise that we can reduce the incidence of diabetes and obesity by 43 and 30 percent, respectively, by cutting our TV time by 10 hours a week.

Modestly reducing the amount of television is a simple lifestyle modification that can have a tremendous impact on longevity, quality of life and prevention of the top chronic disease. So, step away from your television, tablet or computer and get out in the world.

References:

(1) Nielsen.com (2) nbcnews.com/better/health/what-happens-your-brain-when-you-binge-watch-tv-series-ncna816991. (3) N Engl J Med 2008; 358:475-483. (4) Circulation. 2010 Jan 26;121(3):384-391. (5) Br J Sports Med doi:10.1136/bjsm.2011.085662. (6) JAMA. 2003 Apr 9;289(14):1785-1791.

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. 

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Anthony Amen, back middle, with his emplyees at Redefine Fitness in Mount Sinai. Photo from Anthony Amen

Helping people and seeing the positive impacts on their lives is the best part of the job for Anthony Amen, the owner of Redefine Fitness in Mount Sinai. 

“There’s nothing better than that,” he said. 

Though for Amen, his path to opening his new business last fall started almost a decade ago when he was a sophomore in college at SUNY Oswego.  

It was there in February 2010 when Amen was playing broomball, a game played on ice in a similar way to hockey, but instead of a stick it’s done with a rubber-headed broom, and instead of skates players wear rubber-soled shoes. He was playing with his friends, but his life changed when a friendly game took a turn for the worse.

Anthony Amen after his injury in 2010. Photo from Amen

“We were playing a game and a friend of mine went in for a slide tackle,” he said. “I was trying to avoid the hit and slipped, fell backwards and whacked my head on the ice very hard.”

Amen suffered a serious concussion, along with injuries to his neck and back. For three-and-a-half months he was unable to look at any visible light and sat in his bed in the dark for much of the time.  

As a result of his head injury, Amen began suffering from debilitating migraines. He could barely move his head and he was unable to put his hands above his head. 

He said sought help from doctors, but each told him that concussions take time to recover from, and it was something he would have to learn to deal with. 

“I went to 25 different doctors and they all told me the same thing — ‘There’s nothing wrong with you. We can’t do anything,’” Amen said. “They put me on Percocet and muscle relaxants and told me ‘Good luck.’”

He said a doctor told him he was “a physician, not a magician. I don’t know what you want from me.”

It was those experiences that served as the catalyst that would change Amen’s life. 

Amen said he was stubborn, and he didn’t want to give up and didn’t want this to be his norm. 

“I started experimenting and working out in the gym to try to make myself better,” he said. “The more I did the better I felt.”

The Mount Sinai business owner said he was able to fix himself from getting migraines every week and being unable to get out of bed, to never having one in more than five years. 

“One of the biggest moments for me was being able to put my hands over my head again,” he said. 

Amen works on a fitness ball at his gym. Photo from Amen

Amen fell in love with fitness and wanted to teach people what he had learned. He began working at various gyms throughout Long Island as a trainer and in management, with a goal to eventually own a place of his own. A year-and-a-half ago, his vision became a reality when he decided he would open Redefine Fitness. 

“It was very stressful to open a business, but I was passionate about this and I had to try,” he said. ”I think it was the right time for me to try. I have no wife and kids — I didn’t want to regret not doing this.”  

In fall 2018, Redefine Fitness opened its doors with one of the goals of making the connection between fitness, medicine and rehabilitation. They use research-based information in conjunction with their certified trainers to make tailored workout programs for their clients. 

Amen admits the first few months open have gone better than he could have ever imagined.  

“The clients have been so great, they tell me they see the passion in me,” he said. 

One experience that sticks out to Amen was when he trained a 65-year-old woman who had a lung transplant and had a breathing machine. He said she would struggle to tie her own shoes. 

“We got her to squat 175 pounds and got her to run,” he said. “It was amazing seeing this woman’s life change from being told you couldn’t do something. It shows that if you put your mind to something you could achieve anything.”

The Mount Sinai gym has five trainers, including Amen, and offers one-on-one training sessions, weight loss programs and various classes as well as special needs and post-rehab programs. 

In the future, Amen hopes to expand the gym to other locations, and wants to continue making a positive impact in the community.  

Reflecting to his pre-college days, Amen said he was not the athlete type and used to run 15-minute miles and be happy about it. 

“Looking back I would’ve never pictured this in a million years,” he said. “I want to show [people] that there’s no giving up. I want to pass that knowledge and passion to everybody else.”

Members of the Royal Educational Foundation with Jill Nees Russell, center, in 2016

The Royal Educational Foundation of Port Jefferson is a not-for-profit educational corporation established in 1993 for the sole purpose of raising money to support and enhance the educational process in the Port Jefferson School District and to promote and support creative and innovative teaching techniques, programming initiatives and the utilization of new technologies in the classroom.  

Its board of trustees is comprised of community members who volunteer their time to organize fundraising events and to administer the foundation’s funds in cooperation with the school administration and board of education. Since its inception, the foundation has facilitated the granting of several hundred thousand dollars to the district.

Jill Nees Russell at Heritage Weekend in Port Jefferson in 2016.

Recently, the foundation lost a vital member of its board with the passing of Jill Nees Russell. She was a tremendous asset to the foundation, as well as to the school district and the greater Port Jefferson village community. She was a kind, caring and positive person who focused her energy on making Port Jefferson a better place. She led by example, was instrumental in moving many projects forward (new PTA events like the Science Fair and The Green Team, village programs like the Boater’s Maritime Festival, Heritage Weekend, Festival of Trees and The Holiday Light Show at Village Hall, just to name a few) and the positive impact of her selfless efforts will be felt for years to come. She is sorely missed by everyone who knew her.

At this time, the Royal Education Foundation takes special pride in announcing the renaming of the annual community walk-run event in Jill’s honor. Commencing with this year’s Family Fun Run, the event will be known as the Jill Nees Russell Power of One Family Fun Run!

The Power of One Award could not have a better namesake as Jill was the personification of its required attributes. The award inscription reads in part:

“The little things you do each day have the power to affect a great many people. You inspire us with your willingness and ability to help others. You take on the world, one day at a time, continuously searching for a way to make things better…”

This year will be the sixth time that the Royal Educational Foundation will present the award in conjunction with the annual Family Fun Run. The foundation is pleased to hold this event alongside the Port Jefferson Chamber of Commerce’s annual Health and Wellness Fest and looks to continue this partnership in the future.  

The Fun Run was started as a way to encourage physical activity and to celebrate the positive influence we can have on one another within our families and the community.    

The Power of One Award is presented to an outstanding community member who positively impacts the lives of those he/she touches on a daily basis. Past award recipients were Thomas Meehan, Richard Anderson, Deidre Filippi, Jesse Rosen and Christian Neubert. This year, the recipient of the Jill Nees Russell Power of One Award is Anthony Butera. Butera is an elementary school teacher in the district; heads the HS/MS drama program; and regularly volunteers for the Dickens Festival, the Harbor Ballet Theater’s “Nutcracker” production and with Theatre Three. The proceeds of this fundraiser will be used to enhance the quality of education in the Port Jefferson School District.

The Royal Educational Foundation invites you to participate in the 6th annual Jill Nees Russell Power of One Family Fun Run on Saturday, May 18. Whether you wish to walk or run, the 2-mile course is open to all ages. The run begins at 8 a.m. at the Port Jefferson Village Center, 101-A East Broadway, continues through the streets of Port Jefferson village, and ends in the High School Bowl. It coincides with the start of the Chamber of Commerce’s Health and Wellness Fest at 9 a.m. and all participants are invited, and urged, to attend.  

You may register for the run at www.reffundraiser.ticketleap.com/royal-educational-power-of-one-fun-run/ or on the day of the run between 7:30 and 8 a.m. at the Village Center. Advanced registrants need to check in no later than 8:15 a.m. 

Spring has sprung and that means it’s time for the Greater Port Jefferson Chamber of Commerce’s annual Health and Wellness Fest. Celebrating its 10th year, the event returns to the Earl L. Vandermeulen High School, 350 Old Post Road, Port Jefferson on Saturday, May 18 from 9 a.m. to 1 p.m. 

Face artist Joanie Baloney with friends.

Ten years of healthy living; what a milestone for this event! To help celebrate this anniversary there are a lot of special activities planned. For the younger visitors there will be three super heroes walking around for photo opportunities. Have fun meeting Captain America, Wonder Woman and Batman! Face painting will be provided by professional face painter Joanie Baloney. A face art service provider with top-notch skills, both personal and professional, she is an artist and longtime children’s physical therapist who is skilled and is sensitive in working with all ages.

For those who want to experience something more on the wild side, there will be Goat Yoga from 11 a.m. to noon. Goat Yoga is an interactive yoga class that helps you get Zen with goats. This class is suitable for beginners or experienced yogis looking to practice in a new setting. A certified yoga instructor will blend movements and gentle stretches with the playful antics of live goats. Try the “downward goat” or “stretching kid” poses. You won’t want to miss this unscripted one-of-a-kind experience. There will be a group of 12 goats that will assist you in your yoga positions. This will be great fun for those new to yoga or those who need more goats in their life! 

Enjoy goat yoga at this year’s event!

If you want to enjoy more traditional activities, there will be a Zumba class and join in for free lessons on how to line dance with My Country Radio station 96.1. 

In addition, 50 vendors will be on hand to share all types of health-related wellness products and services. This year learn about Community Supported Agriculture (CSA), a system that connects the producer and consumers within the food system more closely by allowing the consumer to subscribe to the harvest of a certain farm or group of farms! 

Or what about cryotherapy, an innovative, holistic wellness solution that enables the human body to recover and rejuvenate itself naturally. By exposing the body to extremely low temperatures (for 1 to 3 minutes), it triggers the body’s most powerful mechanisms of self-protection, self-recovery and self-rejuvenation! Stop by Vita Whole Body & Cryo table and experience a sampling of a facial or local cryotherapy.  

Visit the free food court at this year’s Health and Wellness Fest, courtesy of St. Charles Hospital!

Attendees also will have the benefit of many giveaways along with free screenings that are so important for good health, including blood pressure, body mass index screening (BMI), glucose, lung cancer, colorectal cancer, otoscopy for cerumen (earwax), hearing, cholesterol, balance and fall prevention and posture.

Longtime supporter St. Charles Hospital will again have its healthy food court offering free nutritional food all day. The event has partnered with the Royal Educational Foundation of Port Jefferson, which will be celebrating its sixth annual Power of One Family Fun Run. The 2k race finishes at the high school where runners are welcome to visit the health fest.

Come join the Greater Port Jefferson Chamber of Commerce for this fun Eat Well, Live Well free event. For further information, call 631-473-1414 or visit www.portjeffhealth.com.

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