From left, Allison McLarty, MD, Marc Goldschmidt, MD, Hal Skopicki, MD, PhD. Photo from Stony Brook Medicine
In 2010, Stony Brook Heart Institute’s Ventricular Assist Device (VAD) Program was established on Long Island to implant this life saving device. A VAD, also often called a left ventricular assist device or LVAD, is a surgically implanted, battery powered pump that, by supporting the lower left ventricle (the heart’s main pumping chamber), helps a failing heart to do its job more efficiently. The VAD can be used as an intermediary step before heart transplantation or, in patients who, due to advanced age or medical condition are not transplant candidates, as a long-term “destination” device.
VAD patient Joseph Cerqueira and his wife.
Now 10+ years later, patients, their families and medical staff from the Heart Institute gathered on June 15, to celebrate the anniversary of this life saving heart device and program. (The 10-year event was postponed in 2020 due to Covid-19.)
“Nobody knew when we began putting in heart pumps 13 years ago that they would be this durable and reliable,” says Allison McLarty, MD, Surgical Director of the VAD program. “This amazing device has revolutionized the management of advanced heart failure.”
“For the VAD team, there is the immense reward of seeing these extraordinary individuals return to their homes and families with a much better quality of life,” added Marc Goldschmidt, MD, Director, Heart Failure and Cardiomyopathy Center and Medical Director, Ventricular Device Program.
“A VAD program at Stony Brook Heart Institute has been a tremendous asset for both the community and the hospital. Patients with the most complex heart conditions have access right here, close to home, to all the state-of-the-art services they need,” said Hal Skopicki, MD, PhD, Co-Director, Stony Brook Heart Institute and Chief of Cardiology.
Among the patients who attended today’s event was Joseph Cerqueira, 63, who received a VAD in 2017 and a heart transplant the following year. Following his surgery, Joseph returned to his work as a corporate chef.
“Everybody went the extra mile to make me comfortable and knowledgeable on how to adapt to every aspect of life with a VAD,” said Cerqueira. “Now my quality of life is perfect. I still get tired and I know my limitations, but besides that I do whatever has to be done.”
Legislator Stephanie Bontempi (standing left) thanks the presenter and welcomes attendees at the Cold Spring Harbor Library.
Legislator Stephanie Bontempi (R-18th L.D.) recently joined with the Alzheimer’s Association Long Island Chapter to deliver an informative presentation to the public entitled, “10 Warning Signs of Alzheimer’s.”This event took place at the Cold Spring Harbor Library and drew people of varying ages interested in the sensitive subject matter.
“Alzheimer’s is a major issue that affects both individuals and families,” said Bontempi.“Being aware of the warning signs can put those involved in a much better position to deal with the condition and seek treatment when the issues appear.”
The event’s presenter outlined the signs most commonly associated with the onset of Alzheimer’s, and educated the attendees on assessment tests and other helpful resources available.The importance of early detection was made abundantly clear.
To learn more about the Alzheimer’s Association Long Island Chapter, along with their programs and resources, visit: https://www.alz.org/longisland.
New York Cancer & Blood Specialists (NYCBS) has announced the appointments of Paul Kazemier to Senior Vice President of Patient Communications and Kathryn Paliotta to Vice President of Patient Communications.
“Paul’s appointment as Senior Vice President of Patient Communications is a testament to his exceptional leadership in overseeing a team of over 275+ employees and his continued dedication to enhancing patient communication,” said Jeff Vacirca, MD, CEO of NYCBS. “His forward-thinking approach and adaptability to change will enable the organization to achieve improved outcomes for healthcare providers and patients, demonstrating our commitment to delivering exceptional value to our partners, patients, and the community.”
“Kathryn’s dedication and leadership have been invaluable to our organization, and we are thrilled to recognize her contributions with this well-deserved promotion,” said Vacirca. “Her extensive clinical background, coupled with her ability to effectively manage our patient communication departments, has allowed us to provide even better care and support to our patients. We look forward to seeing her continued success in her new role as Vice President of Patient Communications.”
“I am incredibly grateful for this promotion and the opportunity to continue to lead and grow my departments. It means the world to me,” said Kazemier. “My goal is to not only ensure the highest level of patient satisfaction and experience but also to foster an environment where employees can grow within the company and achieve their own success.”
“I am immensely grateful to have found my niche,” Paliotta said. “Working for an organization as diverse as ours has afforded me the privilege to care for patients across various specialties. I have also had the pleasure to learn from an inspiring group of mentors and look forward to growing my career at NYCBS.”
A potassium-rich diet may help to reduce blood pressure. Stock photo
By David Dunaief, M.D.
Dr. David Dunaief
Hypertension, also commonly called “high blood pressure,” is pervasive in the U.S., affecting approximately 47 percent of adults over 18 (1). Since 2017, hypertension severity has been categorized into three stages, each with its recommended treatment regimen.
One of the most interesting shifts with this recategorization was the recategorization of what we used to call “prehypertension” into what we now call “elevated” blood pressure and “hypertension stage 1.”
Elevated blood pressure is defined as systolic blood pressure (the top number) of 120-129 mmHg and diastolic blood pressure (the bottom number) of less than 80 mmHg, while Stage 1 includes systolic blood pressure of 130-139 mmHg or diastolic blood pressure of 80-89 mmHg (2). A simple chart of all levels can be found on The American Heart Association’s website at www.heart.org.
Both elevated blood pressure and stage 1 hypertension have significant consequences, even though there are often no symptoms. For example, they increase the risks of cardiovascular disease and heart attack dramatically.
In an analysis of the Framingham Heart Study, researchers found a 3.5-fold increase in the risk of heart attack and a 1.7-fold increase in the risk of cardiovascular disease among those with prehypertension (3). This is why it’s crucial to address it, even in these early stages.
Another study, the Women’s Health Initiative, which followed more than 60,000 postmenopausal women for an average of 7.7 years, showed an increase in heart attack deaths, heart attacks and strokes compared to those with normal blood pressure (less than 120/80 mmHg). In the Strong Heart Study, prehypertension independently increased the risk for cardiovascular events at 12 years significantly (4).
The good news is that, over the last decade, new and extended studies have given us better clarity about treatments, stratifying approaches to ensure the best outcomes.
Do you need to treat elevated blood pressure?
In my view, it would be foolish not to treat elevated blood pressure. Updated treatment recommendations, according to the Joint National Commission (JNC) 8, the association responsible for guidelines on the treatment of hypertension, include lifestyle modifications (5).
Lifestyle changes include dietary changes. A Mediterranean-type diet or the DASH (Dietary Approaches to Stop Hypertension) diet are both options. It’s important to focus on fruits, vegetables, sodium reduction to a maximum of 1500 mg (2/3 of a teaspoon on a daily basis), exercise, weight loss and no more than moderate amounts of alcohol (1 or fewer drinks for women and 2 or fewer drinks for men on a daily basis) (6).
Some studies have also shown that a diet rich in potassium helps to reduce blood pressure (7). Fortunately, foods like fruits, vegetables, beans and legumes have significant amounts of potassium. However, do not take potassium supplements unless instructed for other reasons by a physician; high potassium can be very dangerous and may precipitate a heart attack.
Some drugmakers advocate for using medication with those who have elevated blood pressure. The Trial of Preventing Hypertension (TROPHY) suggests the use of a hypotensive agent, the blood pressure drug Atacand (candesartan) to treat prehypertensive patients (8)(9). The drug reduced the incidence of hypertension significantly compared to placebo over two years. However, after stopping therapy, the following two years showed only a small benefit over placebo. Still, the authors implied that this may be a plausible treatment. The study was funded by Astra-Zeneca, which makes the drug.
In an editorial, Jay I. Meltze, M.D., a clinical specialist in hypertension at Columbia University’s College of Physicians and Surgeons, noted that the results were interpreted in an unusually favorable way (10).
Elevated blood pressure has been shown to respond well to lifestyle changes – so why add medication when there are no long-term benefits? I don’t recommend treating elevated blood pressure patients with medication. Thankfully, the JNC8 agrees.
Do lifestyle changes help with Stage 1 hypertension?
For those with Stage 1 hypertension, but with a low 10-year risk of cardiovascular events, these same lifestyle modifications should be implemented for three-to-six months. At this point, a reassessment of risk and blood pressure should determine whether the patient should continue with lifestyle changes or needs to be treated with medications (11).
It’s important to note that your risk should be assessed by your physician.
I am encouraged that the role of lifestyle modifications in controlling hypertension has been recognized and is influencing official recommendations. When patients and physicians collaborate on a lifestyle approach that drives improvements, the side effects are only better overall health.
References:
(1) cdc.gov. (2) heart.org. (3) Stroke 2005; 36: 1859–1863. (4) Hypertension 2006;47:410-414. (5) Am Fam Physician. 2014 Oct 1;90(7):503-504. (6) J Am Coll Cardiol. 2018 May, 71 (19) 2176–2198. (7) Archives of Internal Medicine 2001;161:589-593. (8) N Engl J Med. 2006;354:1685-1697. (9) J Am Soc Hypertens. Jan-Feb 2008;2(1):39-43. (10) Am J Hypertens. 2006;19:1098-1100. (11) Hypertension. 2021 Jun;77(6):e58-e67.
Dr. David 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.
Dr. Justice Achonu. Photo by Jeanne Neville/ Stony Brook Medicine
Justice Achonu, MD, an orthopaedic surgery resident at Stony Brook Medicine, is one of four orthopaedic surgeons in the U.S. to be selected for the American Board of Orthopaedic Surgery’s (ABOS) Resident Advisory Panel. Responsible for providing insight into the resident experience, the panel collaborates with multiple other committees within the ABOS to support the interests of residents throughout the country. His two-year term on the panel begins July 1, 2023.
According to the ABOS, each applicant to the panel is reviewed by at least two ABOS Board members who are all accomplished leaders in their field. Applicants practice in all regions of the country. Dr. Achonu’s panel cohort is the third ever selected by the ABOS. Every year, the panel is tasked with identifying and completing a project that will benefit orthopaedic residents across more than 200 accredited training programs nationwide.
Panelists are encouraged to provide the ABOS with recommendations, several of which have been adopted by the Board, including an official Residency to Retirement Roadmap.
Dr. Achonu received a B.S. in neuroscience from the University of Pittsburgh in 2015 and graduated from the Renaissance School of Medicine at Stony Brook University in 2020. He resides in Holbrook.
Stony Brook’s Department of Orthopaedics provides full-service patient care and sub-specialty resident and faculty training in all areas of Orthopaedics. The department includes a comprehensive Orthopaedic Research Program featuring clinical and laboratory facilities and resources for investigation of molecular, biologic, and biomechanical research topics.
Canadian wildfire smoke reduced the amount of sunlight reaching the ground over Long Island. Photo by Terry Ballard from Wikimedia Commons
Brian Colle saw it coming, but the word didn’t get out quickly enough to capture the extent of the incoming smoke.
Dr. Jeffrey Wheeler, director of the emergency room at St. Charles Hospital in Port Jefferson. File photo from St. Charles Hospital
The smoke from raging wildfires in Quebec, Canada, last week looked like a “blob out of a movie” coming down from the north, said Colle, head of the atmospheric sciences division at Stony Brook University’s School of Marine and Atmospheric Sciences. As the morning progressed, Colle estimated the chance of the smoke arriving in New York and Long Island was “80 to 90 percent.”
Colle, among other scientists, saw the event unfolding and was disappointed at the speed with which the public learned information about the smoke, which contained particulate matter that could affect human health.
“There’s a false expectation in my personal view that social media is the savior in all this,” Colle said. The Stony Brook scientist urged developing a faster and more effective mechanism to create a more aggressive communication channel for air quality threats.
Scientists and doctors suggested smoke from wildfires, which could become more commonplace amid a warming climate, could create physical and mental health problems.
Physical risks
People in “some of the extremes of ages” are at risk when smoke filled with particulates enters an area, said Dr. Jeffrey Wheeler, director of the emergency room at St. Charles Hospital in Port Jefferson. People with cardiac conditions or chronic or advanced lung disease are “very much at risk.”
Dr. Robert Schwaner, medical director of the Department of Emergency Medicine and chief of the Division of Toxicology at Stony Brook University Hospital. Photo from Stony Brook University
Dr. Robert Schwaner, medical director of the Department of Emergency Medicine and chief of the Division of Toxicology at Stony Brook University Hospital, believed the health effects of wildfire smoke could “trickle down for about a week” after the smoke was so thick that it reduced the amount of sunlight reaching the ground.
Amid smoky conditions, people who take medicine for their heart or lungs need to be “very adherent to their medication regimen,” Schwaner said.
Physical symptoms that can crop up after such an event could include wheezing, coughing, chest tightness or breathing difficulties, particularly for people who struggle with asthma or chronic obstructive pulmonary disease.
When patients come to Schwaner with these breathing problems, he asks them if what they are experiencing is “typical of previous exacerbations.” He follows up with questions about what has helped them in the past.
Schwaner is concerned about patients who have had lung damage from COVID-related illness.
The level of vulnerability of those patients, particularly amid future wildfires or air quality events, will “play out over the next couple of years,” he said. Should those who had lung damage from COVID develop symptoms, that population might “need to stay in contact with their physicians.”
It’s unclear whether vulnerabilities from COVID could cause problems for a few years or longer, doctors suggested, although it was worth monitoring to protect the population’s health amid threats from wildfire smoke.
Local doctors were also concerned about symptoms related to eye irritations.
Schwaner doesn’t believe HEPA filters or other air cleansing measures are necessary for the entire population.
People with chronic respiratory illness, however, would benefit from removing particulates from the air, he added.
Wildfire particulates
Dr. Mahdieh Danesh Yazdi, an air pollution expert and environmental epidemiologist from Stony Brook University’s Program in Public Health. Photo from Stony Brook University
Area physicians suggested the particulates from wildfires could be even more problematic than those generated from industrial sources.
Burning biomass releases a range of toxic species into the air, said Dr. Mahdieh Danesh Yazdi, an air pollution expert and environmental epidemiologist from Stony Brook University’s Program in Public Health.
The U.S. Environmental Protection Agency has done a “fairly decent job” of regulating industrial pollution over the last few decades “whereas wildfires have been increasing” amid drier conditions, Yazdi added.
In her research, Yazdi studies the specific particulate matter and gaseous pollutants that constitute air pollution, looking at the rates of cardiovascular and respiratory disease in response to these pollutants.
Mental health effects
Local health care providers recognized that a sudden and lasting orange glow, which blocked the sun and brought an acrid and unpleasant smell of fire, can lead to anxiety, which patients likely dealt with in interactions with therapists.
As for activity in the hospital, Dr. Poonam Gill, director of the Comprehensive Psychiatric Emergency Program at Stony Brook Hospital, said smoke from the wildfires did not cause any change or increase in the inpatient psychiatric patient population.
In addition to the eerie scene, which some suggested appeared apocalyptic, people contended with canceled outdoor events and, for some, the return of masks they thought they had jettisoned at the end of the pandemic.
“We had masks leftover” from the pandemic, and “we made the decision” to use them for an event for his son, said Schwaner.
When Schwaner contracted the delta variant of COVID-19, he was coughing for three to four months, which encouraged him to err on the side of caution with potential exposure to smoke and the suspended particulates that could irritate his lungs.
We should be more concerned about fiber than protein.
By David Dunaief, M.D.
Dr. David Dunaief
Growing up, I often heard admonitions to get enough protein. Even now, I am often asked how to be sure someone is getting enough. Most of us — except perhaps professional athletes or long-distance runners — get enough protein in our diets.
What we should be more concerned about is whether we’re getting enough fiber in our diets. Most Americans are woefully deficient in fiber, consuming between 10 and 15 grams per day. Consumption of legumes and dark green vegetables are the lowest in comparison to other fiber subgroups (1). This has significant implications for our overall health and weight.
So, how much is enough? USDA guidelines stratify their recommendations based on gender and age. For adult women, they recommend between 22 and 28 grams per day, and for adult men, the targets are between 28 and 35 grams (1). Some argue that even these recommendations are on the low end of the scale for optimal health.
Though fiber comes in supplement form, most of your daily intake should be from diet. It is actually relatively painless to increase your fiber consumption; you just have to be aware of which foods are fiber-rich.
Does fiber type make a difference?
One of the complexities is that there are a number of different classifications of fiber, from soluble to viscous to fermentable. Within each of the types, there are subtypes of fiber. Not all fiber sources are equal.
At a high level, we break dietary fiber into two overarching categories: soluble and insoluble. Soluble fibers slow digestion and nutrient absorption and make us feel fuller for longer. Sources include oats, peas, beans, apples, citrus fruits, flax seed, barley and psyllium. On the other hand, insoluble fibers accelerate intestinal transit, which promotes digestive health. Sources include wheat bran, nuts, berries, legumes and beans, dark leafy greens, broccoli, cabbage and other vegetables.
Many plant-based foods contain both soluble and insoluble fiber, in varying amounts.
Fiber’s effects on disease progression and longevity
Fiber has powerful effects on our overall health. A very large prospective cohort study showed that fiber may increase longevity by decreasing mortality from cardiovascular disease, respiratory diseases and other infectious diseases (2). Over a nine-year period, those who ate the most fiber were 22 percent less likely to die than those in the lowest group.
Patients who consumed the most fiber also saw a significant decrease in mortality from cardiovascular disease, respiratory diseases and infectious diseases. The authors of the study believe that it may be the anti-inflammatory and antioxidant effects of whole grains that are responsible for the positive results.
A study published in 2019 that performed systematic reviews and meta-analyses on data from 185 prospective studies and 58 clinical trials found that higher intakes of dietary fiber and whole grains provided the greatest benefits in protecting participants from cardiovascular diseases, type 2 diabetes, and colorectal and breast cancers, along with a 15-30 percent decrease in all-cause mortality for those with the highest fiber intakes, compared to those with the lowest (3).
We also see benefit with prevention of chronic obstructive pulmonary disease (COPD) with fiber in a relatively large epidemiologic analysis of the Atherosclerosis Risk in Communities study (4). The specific source of fiber was important. Fruit had the most significant effect on preventing COPD, with a 28 percent reduction in risk. Cereal fiber also had a substantial effect, but it was not as great.
Fiber also has powerful effects on breast cancer treatment. In a study published in the American Journal of Clinical Nutrition, soluble fiber had a significant impact on breast cancer risk reduction in estrogen negative women (5). Most beneficial studies for breast cancer have shown results in estrogen receptor positive women. This is one of the few studies that has illustrated significant results in estrogen receptor negative women.
The list of chronic diseases and disorders that fiber prevents and/or treats is continually expanding.
How do I increase my fiber intake?
Emphasize plants on your plate. Animal products don’t contain natural fiber. These days, it’s easy to increase your fiber by choosing bean- or lentil-based pastas, which are becoming more prevalent in general grocery stores. Personally, I prefer those based on lentils. Read the labels, though; you want those that are solely made from lentils without rice.
If you are trying to prevent chronic diseases in general, I recommend getting fiber from a wide array of sources. Make sure to eat meals that contain substantial amounts of fiber, which has several advantages: it helps you avoid processed foods, reduces your risk of chronic disease, and increases your satiety and energy levels.
Certainly, while protein is important, each time you sit down at a meal, rather than asking how much protein is in it, you now know to ask how much fiber is in it.
Dr. David 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.
Personal Woman’s Care, a comprehensive women’s health practice in Smithtown, has officially joined Suffolk OBGYN’s growing network of providers. Board-certified obstetrician-gynecologists Drs. Richard Halpert and Keith L. Sommers will continue to practice at 148 Terry Road in Smithtown.
Dr. Keith L. Sommmers
“We’re thrilled to welcome Dr. Halpert and Dr. Sommers to the Suffolk OB/GYN team,” said Dr. Rohit Reejsinghani, FACP, MBA, Executive Director of NY Health. “Our team is dedicated to providing exceptional care to every patient, and their addition will strengthen our ability to serve the community with high-quality obstetrics and gynecological services.”
Dr. Halpert and Dr. Sommers are two highly skilled OB/GYNs who share a passion for providing specialized care to women and are both experts in minimally invasive surgery. Dr. Halpert’s love of genetics and his deep connections with women and their families have inspired him to focus on using advanced technologies to diagnose and treat genetic disorders.
“As a physician, I believe that patient care should always come first,” said Dr. Halpert. “I am proud to be part of NY Health, an organization that puts patients at the center of everything they do. We are dedicated to making every aspect of healthcare easier and more pleasant for our patients. It’s a philosophy that I embrace and one that guides me in my practice every day.”
“As an OB/GYN, I have seen firsthand the importance of early detection of breast cancer,” Dr. Sommers said. “I always encourage my patients to get yearly mammograms, especially after the age of 40. In my experience, regular mammograms have helped detect breast cancer in its early stages, often before it has a chance to progress. By catching it early, we have a better chance of treating it successfully. It’s a simple step that can make a big difference in a woman’s health.”
For more information, call 631- 862-4000 or visit nyhealth.com.
New York Imaging Specialists has announced the addition of Dr. Jennifer Ripton-Snyder, a fellowship-trained breast imager. Dr. Ripton-Snyder will practice at 118 North Country Road in Port Jefferson.
“Dr. Ripton-Snyder’s expertise in Breast Imaging and her dedication to patient well-being aligns perfectly with our mission to prioritize women’s health and ensure their comfort throughout the imaging process,” said Dr. Jeff Vacirca, CEO.
Driven by her passion for patient care, Dr. Ripton-Snyder was inspired to specialize in Breast Imaging. “I was inspired to enter the field of Breast Imaging because of the patient care aspects and the fact that I could practice a specialty that was also so integral to primary care for women.” As a fellowship-trained breast imager, she holds a particular interest in post-operative imaging for women with a previous cancer diagnosis, as well as screening in women with above-average cancer risk.
“I very much look forward to joining the practice as the imaging component is being integrated into women’s health centers,” Dr. Ripton-Snyder said. “I think it’s a wonderful idea for women to have cancer screenings and other imaging done as comfortably and conveniently as possible.” For more information, call 833-269-4624 or visit nyimaging.com.
New York State Department of Environmental Conservation (DEC), along with the State Department of Health (DOH) issued an Air Quality Health Advisory for Long Island on Thursday, June 8 as the smoke and haze from the Canadian wildfires continue to blanket the region. This air quality alert has been extended through this evening, June 8, until 11:59 p.m. and is potentially forecasted to continue into tomorrow as well.
The pollutant of concern is Fine Particulate Matter. Fine particulate matter consists of tiny solid particles or liquid droplets in the air made of many different types of particles. Exposure can cause short-term health effects such as irritation to the eyes, nose, and throat, coughing, sneezing, runny nose, and shortness of breath. Exposure to elevated levels of fine particulate matter can also worsen medical conditions such as asthma and heart disease. People with heart or breathing problems, and children and the elderly may be particularly sensitive to particle matter
What can you do to protect yourself?
Wear masks outside (Preferably a K95)
Limit outdoor exposure (Pets too)
Keep windows closed and use air purifiers
Consider rescheduling or canceling any outdoor activities
Prev
