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Yearly Archives: 2015

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By David Dunaief

Chronic kidney disease is much more common than you think. Those at highest risk for CKD include patients with diabetes, hypertension (high blood pressure) and those with first degree relatives who have advanced disease. But those are only the ones at highest risk. This brings me to my first question.

Why is CKD a tricky disease?
Unfortunately, similar to high blood pressure and dyslipidemia (high cholesterol), the disease tends to be asymptomatic, at least initially. Only in the advanced stages do symptoms become distinct, though there can be vague symptoms such as fatigue, malaise and loss of appetite in moderate stages.

What are the stages?
CKD is classified into five stages based on the estimated glomerular filtration rate (eGFR), a way to determine kidney function. Stages 1 and 2 are the early stages, while stages 3a and 3b are the moderate stages, and finally stages 4 and 5 are the advanced stages. This demarcation is based on an eGFR of >60 ml/min for early, 30-59 ml/min for moderate and <30 ml/min for advanced. Stage 5 is end-stage kidney disease or failure.

Why is CKD important?
The prevalence of the disease is predicted to grow by leaps and bounds in the next 15 years. Presently, approximately 13 percent of those over age 30 in the U.S. population are affected by CKD. In a new simulation model, it is expected to reach 16.7 percent prevalence in the year 2030. Currently, those who are ages 30 to 49 have a 54 percent chance of having CKD in their lifetimes; those 50 to 64 years of age, a slightly lower risk of 52 percent; and those 65 years and older, a 42 percent risk (1). Thus, a broad spectrum of people are affected. Another study’s results corroborate these numbers, suggesting almost a 60 percent lifetime risk of at least moderate stage 3a to advanced stage 5 CKD (2). If these numbers are correct, they are impressive, and the disease needs to be addressed. We need to take precautions to prevent the disease and its progression.

Who should be screened?
According to the U.S. Preventive Services Task Force, screening for CKD may not be warranted in the asymptomatic “healthy” population (3). This means people without chronic diseases. The studies are inconclusive in terms of benefits and harms. In order to qualify as CKD, there has to be a minimum of three months of decreased kidney function. This appears to be a paradox: remember, CKD is asymptomatic generally until the advanced stages. However, there are a number of caveats in the report.

Those who are at highest risk should be screened, including, as I mentioned above, patients with diabetes or hypertension. In an interview on www.Medscape.com entitled “Proteinuria: A Cheaper and Better Cholesterol?” two high-ranking nephrologists suggest that first-degree relatives to advanced CKD patients should also be screened and that those with vague symptoms of fatigue, malaise and/or decreased appetite may also be potential candidates (4). This broadens the asymptomatic population that may benefit from screening.

The fix!
Fortunately, there are several options available, ranging from preventing CKD with specific exercise to slowing the progression with lifestyle changes and medications.

Why exercise?
Here we go again, preaching the benefits of exercise. But what if you don’t really like exercise? It turns out that the results of a study show that walking reduces the risk of death and the need for dialysis by 33 percent and 21 percent respectively (5). And although some don’t like formal exercise programs, most people agree that walking is enticing.

The most prevalent form of exercise in this study was walking. The results are even more intriguing; they are based on a dose-response curve. In other words, those who walk more often see greater results. So, the participants who walked one-to-two times per week had a significant 17 percent reduction in death and a 19 percent reduction in kidney replacement therapy, whereas those who walked at least seven times per week experienced a more impressive 59 percent reduction in death and a 44 percent reduction in the risk of dialysis. Those who were in between saw a graded response. There were 6,363 participants for an average duration of 1.3 years.

Protein is important! Right?
Yes, protein is important for tissue and muscle health. But when it comes to CKD, more is not necessarily better, and may even be harmful. In a meta-analysis (a group of 10 randomized controlled trials, the gold standard of studies), results showed that the risk of death or treatment with dialysis or kidney transplant was reduced by 32 percent in those who consumed less protein compared to unrestricted protein (6). This meta-analysis used the Cochrane database to search for studies.

According to the authors, as few as two patients would need to be treated for a year in order to prevent one from either dying or reaching the need for dialysis or transplant. Unfortunately, the specific quantity of protein consumption that is ideal in CKD patients could not be ascertained since the study was a meta-analysis.

Sodium: How much?
The debate roils on: how much do we need to reduce sodium in order to see an effect? Well, the good news is that in a recent study, results showed that a modest sodium reduction in our diet may be sufficient to help prevent proteinuria (protein in the urine) (7). Different guidelines recommend sodium intake ranging from fewer than 1500 mg to 2300 mg daily. This particular study says that less than 2000 mg is beneficial, something all of us can achieve.

Of course medications have a place
We routinely give certain medications, ACE inhibitors or ARBs, to patients who have diabetes to protect their kidneys. What about patients who do not have diabetes? ACEs and ARBs are two classes of anti-hypertensives — high blood pressure medications — that work on the RAAS system of the kidneys, responsible for blood pressure and water balance (8). Results of a recent study show that these medications reduced the risk of death significantly in patients with moderate CKD. Most of the patients were considered hypertensive.

However, there was a high discontinuation rate among those taking the medication. If you include the discontinuations and regard them as failures, then all who participated showed a 19 percent reduction in risk of death, which was significant. However, if you exclude discontinuations, the results are much more robust with a 63 percent reduction. To get a more realistic picture, the intention-to-treat result (those that include both participants and drop outs) is probably the response that will occur in clinical practice unless the physician is a really good motivator or has very highly motivated patients.

While these two classes of medications, ACE inhibitors and ARBs, are good potential options for protecting the kidneys, they are not the only options. You don’t necessarily have to rely on drug therapies, and there is no downside to lifestyle modifications. Lowering sodium modestly, walking frequently, and lowering your protein consumption may all be viable options, with or without medication, since medication compliance was woeful. Screening for asymptomatic, moderate CKD may lack conclusive studies, but screening should occur in high-risk patients and possibly be on the radar for those with vague symptoms of lethargy as well as aches and pains. Of course, this is a discussion to have with your physician.

REFERENCES:
(1) Am J Kidney Dis. 2015;65(3):403-11. (2) Am J Kidney Dis. 2013;62(2):245-52. (3) Ann Int. Med. 2012;157(8):567-570. (4) www.Medscape.com. (5) Clin J Am Soc Nephrol. 2014;9(7):1183-9. (6) Cochrane Database Syst Rev. 2009;(3):CD001892. (7) Curr Opin Nephrol Hypertens. 2014;23(6):533-540. (8) J Am Coll Cardiol. 2014;63(7):650-658.

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, go to the website www.medicalcompassmd.com and/or consult your personal physician.

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Counterclockwise from front row left, John Haley, Geoffrey Girnun, Scott Powers and Patricia Thompson. Photo from Stony Brook University

When local teams bring in superstars, the typical sports fan salivates at the prospect of winning a national championship. At the player level, success often breeds success, as other stars and talented players are eager to join teams where they believe in the philosophy of management and the talent of their teammates.

With considerably less fanfare to the typical Suffolk County resident, Stony Brook University has lured some promising researchers from around the country to its growing pathology department. What’s more, the newest members of the team not only have big plans for themselves and their department — they want to help Long Islanders who are battling cancer.

Their research aims to give doctors tools to make a more informed cancer diagnosis, create jobs by developing start-up companies and contribute to the Cancer Center’s goal of receiving a National Cancer Institute designation, which would allow Stony Brook to bid on multimillion dollar grants.

“We are looking for new ways to advance the practice of pathology that will improve the quality of health care nationwide and worldwide,” said Ken Shroyer, the head of the pathology department.

When Shroyer arrived in 2007, he said his first goal was to bring together the talent that was already working at the university. Like siblings who grow apart after they leave home, the clinical research and basic research efforts were working in parallel, rather than together.

After finding common ground for those groups, Shroyer added staff on the clinical side. His next priority, he said, was to boost the research department, which had only one externally funded investigator. That number now stands at 12, with four of the new staff coming in the last 18 months.

The newest researchers joined the pathology department and became leaders in the Cancer Center. “Each of these four individuals has a national reputation and special expertise in a particular area of cancer research,” Shroyer explained, saying he combed the research landscape to find the right experts in their field.

For their part, the new staff share an enthusiasm for the department and a vision for where it’s heading. An expert in finding biomarkers that help identify patients at risk of cancer recurrence, Patricia Thompson plans to encourage basic scientists to make discoveries that affect patient care.

Geoffrey Girnun, meanwhile, continues to study how cancer’s metabolism works, hoping to find differences between cancer cells and normal cells that can become targets for intervention and therapy.

After two decades searching for therapeutic targets for cancer, Scott Powers shifted gears and is now looking for ways to detect cancer earlier.

John Haley is concentrating on exploring how cancer cells escape detection from the immune system and become metastatic.

The director of the Cancer Center, Yusuf Hannun said the partnership with the pathology department is “key to bridging basic research discoveries to cancer specific research and then to human applications,” which could include biomarker discoveries, new therapeutics and individualized and personalized genomic cancer research.

Hannun believes the Cancer Center will continue to push the envelope in diagnosis, treatment and prevention. “We want to bring more special and unique abilities in the war against cancer,” Hannun said. “The inroads in cancer are happening.”

Stony Brook could become involved in prevention, where doctors and scientists work with patients before they develop any signs of the disease. “That domain is clearly within the scope of the Cancer Center,” Hannun said. “We are working on novel biomarkers that could detect very early cancer.”

Hannun described Shroyer as his “alter ego” in the Cancer Center. “He is a very capable leader and does very exciting cutting edge research with a steeped history in early diagnostics.”

Shroyer focuses his work on the discovery of biomarkers that can be used to improve diagnostic accuracy, provide prognostic information and identify more effective treatments for cancer, he said.

Five years from now, the success of the effort will be reflected by the extent to which the group can enhance the national standing of Stony Brook Medicine and the Cancer Center as leading institutions in basic and translational cancer research, Shroyer said.

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Anne Shybunko-Moore, CEO of GSE Dynamics, New York Secretary of State Cesar Perales and Keith Barrett, president of Huntington Station Business Improvement District, speak last week. Photo from Laz Benitez

A state plan to raise the minimum wage made its way to Hauppauge to show how higher pay could impact close to home.

Cesar Perales, secretary of state under Gov. Andrew Cuomo (D), spoke at GSE Dynamics on Oser Avenue March 18 outlining the governor’s proposal to capitalize on New York’s economic recovery by raising the minimum wage from $8.75 to $10.50.

Perales said the state has already created more than 500,000 new private sector jobs since the big recession — the second most in the country. But at the same time, wages have not grown fast enough and people are being left behind, he alleged.

“We had a bad few years after the recession in 2008, but we are out of it now and we are moving forward,” he said. “Unemployment is down and, in every region of the state, jobs are up.”

Cuomo’s plan calls for a $10.50 minimum wage across the state, except for New York City, where he suggests the minimum wage be increased to $11.50. In total, he said more than 1.35 million workers would see a wage increase throughout the state, bringing a direct economic impact of nearly $3.4 billion.

“The minimum wage should allow people who work full-time jobs to support themselves and their families – but that is just not possible today,” Cuomo said. “Our proposal will help hundreds of thousands of New Yorkers better sustain themselves and live with dignity and respect. The State Legislature must pass our proposal this year, because the sweetest success is shared success and we won’t rest until we are all rising together.”

During four of the five recent increases in the state’s minimum wage dating back to 1991, data indicated an employment uptick each time the wage went up, Perales said.

“Under this plan, nearly 150,000 workers here in Long Island will see a pay raise,” he said. “In a family with two earners, the increase from $8.75 to $10.50 translates to more than $7,000 in additional income per year.”

The proposal said Long Island currently sees 85,264 total minimum-wage workers earning $8.75 today. But under the new plan, 202,248 Long Island workers would earn the minimum wage, bringing a direct economic value of $382.3 million to the island, Cuomo said.

Perales spoke alongside Keith Barrett, president of the Huntington Station Business Improvement District as well as Anne Shybunko-Moore, CEO of Hauppauge’s GSE Dynamics, to explain how higher minimum wages could bring better business to the North Shore.

“Raising the minimum wage is not just about money, it’s about opportunity,” Perales said. “It’s about saying that everyone who works a full-time job should have the chance to live a decent life and put food on the table for themselves and their loved ones. Because at the end of the day, we are all part of the same community and the same state, and we are at our best when we all do well together.”

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Stock photo

By Ali Gordon

This is my fourth year serving as a trustee of the Comsewogue Board of Education. I love every minute of it, because I love my community and I take very seriously the responsibility entrusted to me. The thoughts expressed here are my own. I do not speak for the Comsewogue School District or the Board of Education. We have been warned that a trustee who speaks out could be removed by the state education commissioner. But our schools and our children depend on those of us who were elected to represent the best interests of our community. I cannot stay quiet for fear of retribution from the New York State Education Department anymore.

There has been tremendous criticism of Gov. Andrew Cuomo’s recent decision to withhold state aid and extort legislators into passing his education reforms. Our state legislators are stuck between agreeing to terrible reforms or refusing, leading to a late state budget and a potential loss of millions of dollars for schools.

Cuomo’s proposals include measures such as increasing the time to earn tenure from three to five years and evaluating teachers more heavily based upon their students’ state test scores.

The reforms Cuomo is pushing are disingenuous and dangerous; he works out of the privatization handbook and uses inflammatory statistics. He cannot think of another way to move forward in education except through obsessive testing. Cuomo and the Board of Regents use a one-size-fits-all answer that will never work for every community, while an entire generation of students is being sacrificed for testing data.

Each of Cuomo’s education policies reflect a desire to remove local control. He insists that NYSED investigate the teacher evaluations procedures of Long Island school districts, thinking the system is skewed. Those local evaluation plans were approved by the very same entity, NYSED. Here is what Cuomo cannot fathom: Teachers on Long Island were rated highly effective or effective because they are. If Long Island was a state, we would rank near the top in high school graduation rates, Intel Science Talent Search semifinalists and Siemens Competition semifinalists. Cuomo prefers to ignore these statistics because they do not fit his narrative.

There are several ways to stop the destruction of public schools:

Cuomo must separate his education reforms from his executive budget proposal. If he believes in these reforms, he should let them stand alone as legislation, allow a healthy debate and not circumvent the separation of powers established by our Constitution.

The Legislature should ensure that new Board of Regents appointees have public education experience — they establish state education policies, and interviews are now being held for four appointees.

Parents must educate themselves and make a decision regarding testing in grades three through eight. This will be the third year my children have refused to take the state exams. This is the strongest weapon we have in the fight to save public education. As the number of test refusals grows, the reforms dependent upon those numbers will falter. We will starve the testing machine.

It is time to work together to elevate public education without destroying things that are already working. I cannot sit by quietly anymore and wait for someone else to stand up. I have a sworn duty to represent the interests of my community, including speaking out against policies that endanger the well-being of our students and faculty.

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Annual St. Baldrick’s event brings in five figures after students shave heads to benefit good cause

Commack High School students and administrators take turns trimming their hair or shaving it off completely to benefit cancer research. Photo by Jenni Culkin

By Jenni Culkin

A line of students from Commack High School trailed from the school’s gymnasium doors to the next hallway.
The students eagerly waited to cut their hair for a worthy cause while the room buzzed with music, pizza, smoothies, an auction and the countless surprised faces of the brave people who lost inches of hair to raise money and awareness for the St. Baldrick’s Foundation.

“Hey, free haircut!” one student joked.

According to St. Baldrick’s official website, the event, which took place on March 6, raised $75,304.50 by the end. During the event, students played all kinds of volunteering roles to join the fight against cancer.

“It’s a great cause,” said David Malinovsky, an 11th-grade Commack High School student who had his head shaved. “It’s one of the most special things that we can do besides giving money.”

Even some of the female students hopped into the chairs to get their hair cut significantly shorter. Some female students even decided to have their entire head shaved for the cause.

“My uncle recently died of cancer,” said Carrie Fishbane, a 12th-grade student who had her entire head shaved. “I’m doing this in memory of him.”

Others decided not to lose their precious locks but to still help out in other ways.

“I think it’d be fair for a change if everyone else had no hair,” says Kyle Critelli, a 10th-grade student.

Critelli volunteered to sweep hair from the gymnasium floor. Other students got involved by selling food, drinks and merchandise that would all benefit the students.

Even nonstudents from the community got involved in the effort. Tara Forrest, a professional hairdresser with 17 years of experience, has been volunteering to cut hair for St. Baldrick events for three years.

“My whole family does it,” Forrest said with excitement,

Forrest said she was first inspired to donate her time and effort after one of her young son’s classmates was diagnosed with kidney cancer. She told her son Michael that his classmate’s remission is credited to “people like us that raise money.”

With that inspiration, Michael, who is now in second grade, has helped to raise roughly $10,000 through St. Baldrick’s within three years.

But the Forrest family was not the only one to let a personal situation inspire them to participate in charity work.

Lee Tunick, a math teacher from Commack High School, became the advisor for Yodel Kadodel, an extracurricular club at the school that raises awareness and money for cancer research with various activities throughout the year. The club has been running a St. Baldrick event for the past six years. Since then, roughly $450,000 has been raised.

“I have a friend whose daughter is sick,” said Tunick. “You feel so helpless from one parent to another. You want to do something to help if you can.”

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Kim Revere of Kings Park In the kNOw speaks at the drug forum. Photo by Chris Mellides

By Chris Mellides

A grassroots advocacy group from Kings Park continued its quest to keep kids away from drugs last week with an informative forum flanked by a star-studded list of guest speakers.

Students attending William T. Rogers Middle School in Kings Park joined their parents at the school gym Wednesday night, March 4, in welcoming the speakers who assembled for the annual preventing destructive decisions forum.

Hosted by Kings Park In the kNOw (KPITK), a grassroots drug outreach and prevention organization, the forum served as an opportunity for parents and their children to become better educated on the perils of alcohol and drug addiction.

Opening the event, a member of the school faculty addressed parents and students who sat opposite a large stage and offered words of encouragement for the young members of the audience.

“Hopefully we can impress upon you tonight how much we love you and how much your families love you and the importance of the actions that you take at this level while you’re here with us at the middle school,” said the one faculty member, before introducing the night’s speakers.

The first speaker at the podium was Kim Revere, a volunteer for KPITK since 2007 and a mother of four. She described getting involved with the organization because of the growing drug problem gripping our communities and the difficulties she faced at home with her 27-year-old son, who at the time was struggling with heroin addiction.

“What Kings Park In the kNOw does is we try to bring educational programs into the schools and into the community to keep parents educated and educate kids as to what the trends are and try to have kids make positive decisions in their lives,” Revere said. “This town is growing and kids are dying. My son has been to rehab nine times; he is finally on the right track. He’s 27 years old and I will not trust him until the day I die. No matter how good he does. I don’t want another parent to live with that pain,” she added.

Suffolk County Legislator Robert Trotta (R-Fort Salonga) was also in attendance and drew from his 25-year background in law enforcement to discuss the lasting impact that narcotics have on local communities.

“I used to say you put the police radio on the counter and when it went off 90 percent of those calls coming out of there are drug or alcohol related,” Trotta said. “Whether it be domestic abuse, a car accident, a robbery or a theft, people break into houses to get stuff to sell to get drugs. They’re not going to be paying their mortgage with it.”

Trotta also delivered an overview of Suffolk County’s Social Host Law and New York State’s 911 Good Samaritan Law passed in 2011, which according to the legislator is a “great law” that states that if you are in a situation involving illicit substances and someone with you is in immediate danger that you should “call 911, and you will not be arrested” through implication.

Rounding out the forum were presentations from Thomas’ Hope founder and drug prevention advocate Linda Ventura, and Kym Laube, executive director of Human Understanding and Growth Services.

Ventura lost her son Thomas to drug addiction in March 2012, when he died from a heroin overdose. Since then she’s been making routine trips to Albany to push for change in the area of addiction treatment services and to better define how we should combat drug use in New York State. On the one-year anniversary of her son’s death, she launched Thomas’ Hope, a nonprofit foundation that promotes drug awareness, prevention and advocacy.

As executive director of HUGS, Laube recognizes the risks that are present for young people and that the unfortunate circumstances that shook Ventura’s household with the loss of her son are becoming increasingly common as drug use grows in popularity throughout Long Island and across the country.

Through the HUGS program she actively seeks to promote social growth among children and adolescents through leadership programs and retreats and allow them to bond and have fun in the absence of drugs and alcohol.

“All of our activities are meant to have kids feel like they are a part of something and a part of something bigger,” Laube said. “So, that we become just as fun of an activity as maybe some of the other high risk choices that are out there.”

Taking time to address the night’s event, Laube reminded parents and students that while beneficial, the real challenge presented to prevention experts and lecturers who engage with an audience is the impact of their messaging over the long term. In order for lasting change to occur, a large community effort is important and necessary, according to Laube.

“We know that unless we begin to have consistent messaging all throughout, that it’s just one night of information,” said Laube. “So what we encourage communities to do is to really begin to bring about that community-level change and to have events regularly and often, and have parenting sessions and get better programs in schools for kids so it moves beyond just this one-shot event.”

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Eczema is such a common problem in both children and adults that you would think there would be a plethora of research, right? Well, that’s only partly true. While there is a significant amount of research in primarily neonates and some on pediatric patients, there is not a lot of research on adults with eczema. But in my practice, I see a good number of patients who present with, among other disorders, eczema.
The prevalence of this disease rivals the prevalence of diabetes. In the United States, more than 10 percent of the adult population is afflicted (1). Twice as many females as males are affected, according to one study (2). Thus, we need more research.
Eczema is also more broadly referred to as atopic dermatitis. The cause is unknown, but it is thought that nature and nurture are both at play (3). Eczema is a chronic inflammatory process that involves symptoms of pruritus (itching) pain, rashes and erythema (redness) (4). There are three different severities: mild, moderate and severe. Adults tend to have eczema closer to the moderate-to-severe range.
Factors that can trigger eczema flare-ups include emotional stress, excessive bathing, dry skin, dry environment and detergent exposure (5). Treatments for eczema run the gamut from over-the-counter creams and lotions to prescription steroid creams to systemic (oral) steroids. Some use phototherapy for severe cases, but the research on phototherapy is scant. Antihistamines are sometimes used to treat the itchiness. Also, lifestyle modifications may play an important role, specifically diet. Two separate studies have shown an association between eczema and fracture, which we will investigate further.
Let’s look at the evidence.
ECZEMA DOESN’T JUST SCRATCH THE SURFACE
Eczema causes cracked and irritated skin, but it may also be related to broken bones. In a newly published observational study, results showed that those with eczema had a 44 percent increased risk of injury causing limitation and an even more impressive 67 percent risk of bone fracture and bone or joint injury for those 30 years and older (6). And if you have both fatigue or insomnia and eczema, you are at higher risk for bone or joint injury than having one or the other alone. Antihistamines may cause more fatigue. One reason for increased fracture risk, the researchers postulate, is the use of corticosteroids in treatment.
A side effect of steroids is that they may weaken bone, ligaments and tendons and may cause osteoporosis by decreasing bone mineral density. Chronic inflammation may also contribute to the risk of bone loss. There were 34,500 patients involved in the study ranging in age from 18 to 85.
Another study corroborates these results that eczema increases the risk for sustained injury (7). There was a 48 percent increased risk of fracture at any location in the body and an even greater 87 percent increased risk of fracture in the hip and spine when compared to those who did not have eczema. Interestingly, researchers’ hypotheses for the causes of increased fracture risk were similar to those of the above study: systemic steroid use and chronic inflammation of the disease. The researchers analyzed the database from NHANES 2005-2006, with almost 5,000 patients involved in this study. When oral steroid was given for at least a month, there was a 44 percent increased risk of osteoporosis. For those who have eczema and have been treated with steroids, it may be wise to have a DEXA scan.
ARE SUPPLEMENTS THE ANSWER?
The thought of supplements somehow seems more appealing for some than medicine. There are two well-known supplements for helping to reduce inflammation, evening primrose oil and borage oil. Are these supplements a good replacement for medications or at least a beneficial addition? The research is really mixed, leaning toward ineffective. In a recent meta-analysis (involving seven randomized controlled trials, the gold standard of studies), evening primrose oil was no better than placebo in treating eczema (8). The researchers also looked at eight studies of borage oil and found there was no difference from placebo in terms of symptom relief. One positive is that these supplements only had minor side effects. But don’t look to supplements for help.

WHERE ARE WE ON THE
DRUG FRONT?
The FDA has given fast track processing to a biologic monoclonal antibody known as dupilumab (9). In trials, the drug has shown promise for treating moderate to severe eczema when topical steroids are not effective. We will have to wait to see what the verdict is on this drug in development.

DO PROBIOTICS HAVE A PLACE?
When we think of probiotics, we think of taking a pill. However, there are also potentially topical probiotics with atopic dermatitis. In preliminary in-vitro (in a test tube) studies, the results look intriguing and show that topical probiotics from the human microbiome (gut) could potentially work as well as steroids (10). This may be part of the road to treatments of the future. However, this is in very early stage of development.

WHAT ABOUT LIFESTYLE
MODIFICATIONS?
Wouldn’t it be nice if what we ate could make a difference in eczema? Well, in a study involving pregnant women and their offspring, results showed that when these women ate either a diet high in green and yellow vegetables, beta carotene or citrus fruit there was a significant reduction in the risk of the child having eczema of 59 percent, 48 percent and 47 percent, respectively, when comparing highest to lowest consumption quartiles (11). This was a Japanese study involving over 700 mother-child pairings.
Elimination diets may also play a role. One study’s results showed when eggs were removed from the diet in those who were allergic, according to IgE testing, eczema improved significantly (12).
From an anecdotal perspective, I have seen very good results when treating patients who have eczema with dietary changes. My patient population includes about 15-20 percent of patients who suffer some level of eczema. Recently, a young adult had eczema mostly on the extremities. When I first met the patient, these were angry, excoriated, erythematous and scratched lesions. However, after several months of a vegetable-rich diet, the patient’s skin had all but cleared.
I also have a personal interest in eczema. I suffered from hand eczema, where my hands would become painful and blotchy and then crack and bleed. This all stopped for me when I altered my diet over eight years ago.
Eczema exists on a spectrum from annoying to significantly affecting a patient’s quality of life (13). Supplements may not be the solution, at least not borage oil or evening primrose oil. However, there may be promising topical probiotics ahead and medications for the hard to treat. It might be best to avoid long-term systemic steroid use; it could not only impact the skin but also may impact the bone. But don’t wait to treat the disease. Lifestyle modifications appear to be very effective, at least at the anecdotal level.
REFERENCES:
(1) J Allergy Clin Immunol. 2013;132(5):1132-8. (2) BMC Dermatol. 2013;13(14). (3) Acta Derm Venereol (Stockh) 1985;117 (Suppl.):1-59. (4) uptodate.com. (5) Br J Dermatol. 2006; 1553:504. (6) JAMA Dermatol. 2015;151(1):33-41. (7) J Allergy Clin Immunol. Online Dec. 13, 2014. (8) Cochrane Database Syst Rev. 2013;4:CD004416. (9) Medscape.com. (10) ACAAI 2014: Abstracts P328 and P329. (11) Allergy. 2010 Jun 1;65(6):758-65. (12) J Am Acad Dermatol. 2004;50(3):391–404. (13) Contact Dermatitis 2008; 59:43–7.

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, go to the website www.medicalcompassmd.com and/or consult your personal physician.

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Emily Krainer can hear the excitement in her father’s voice when she calls. After she gets off the phone, she tells her classmates about his work, which, one day, could influence their lives. Like Emily, they attend Vanderbilt University School of Medicine and, once they graduate, may use his work to help their patients.

The younger Krainer has “high hopes” for a promising new treatment her father developed for a potentially fatal disease.

Adrian Krainer, a professor and program chair of Cancer and Molecular Biology at Cold Spring Harbor Laboratory, has developed a drug for a pediatric neurological condition called spinal muscular atrophy, which is the leading genetic case of death among infants and affects about 1 in 6,000 newborns.

The drug, called an antisense oligonucleotide, is in phase III trials, which is the final stage before the Food and Drug Administration considers approving it.

SMA is a genetic disorder caused by a defective SMN1 gene. Patients with SMA rely on the SMN2 gene, which can produce normal survival of motor neuron protein but in low quantities because alternative splicing results in a shorter, unstable form of the protein.

Splicing is the process where important genetic information, exons, are joined together, while less important genetic parts, introns, are removed. The process starts with an RNA that is a copy of the gene, Krainer explained. For the SMN2 RNA, splicing leaves out the next to last exon. Krainer has found a way to encourage the splicing machinery to include exon 7 more efficiently.

These phase III trials involve two separate groups of patients. The first includes infants with type 1 SMA, which is the most severe version and has an average life expectancy of two years. Working with Isis Pharmaceuticals in California, doctors in these clinical trials will determine if the drug increases survival and reduces the need for ventilation.

In the second group, patients who are from two years of age up to 14 with type 2 SMA, which is an intermediate form of the disease, will receive the drug. Doctors will monitor improvements in neuromuscular function, Krainer said.

His Ph.D. advisor at Harvard, Tom Maniatis, praised his former student.

“This is beautiful and highly original work, which has already shown great promise for SMA therapy,” explained Maniatis, who is now chairman of the Department of Biochemistry and Molecular Biophysics at Columbia University Medical Center.

While Krainer is awaiting results of these trials, he is making new discoveries that may also affect future treatments.

In mouse models of SMA, Krainer has found that injecting the drug under the skin was even more effective than inserting it directly into the spinal chord.

Additionally, neutralizing the drug in the central nervous system didn’t prevent its effectiveness. The drug enabled spinal chord motor neurons to continue to function, even when it wasn’t active in that area.

“Surprisingly, the effect of the drug given that way is still dramatic,” he said.

Krainer cautioned that results in mice may not display a similar pattern in humans.

Still, the mouse data suggest treatment with this drug might be more effective if administered beneath the skin.

If this drug becomes an accepted treatment for SMA, the approach of creating a synthetic antisense oligonucleotide could also become an effective weapon against other diseases, such as familial dysautonomi, in which a mutation causes a reduction in the expression of a protein.

“It is estimated that 10 to 15 percent of all human disease causing mutations affect RNA splicing, so the tool [Krainer] has developed should have wide applications,” Maniatis suggested.

Maniatis has seen firsthand how Krainer has “a deep passion for science and a strong work ethic. More importantly, in my view, he has an incisive critical mind, which leads to the development of novel approaches and rigorous science.”

In addition to Emily, Krainer has two sons: Andrew, 22, who is in his last semester at CUNY-Baruch College, and Brian, 20, who is a junior at Carnegie-Mellon.

When she was young, Emily Krainer said she met children with SMA at conferences. These interactions “shaped my interest.”

Emily said her father is a role model and “hopes whatever I do in the future, I enjoy as much as he enjoys his work.”

As for the drug trials, the younger Krainer said her fellow future doctors want to know how this treatment works. She said her classmates hope he is “going to change the lives of so many patients.”

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Two girls prepare to have their locks chopped off at a St. Baldrick’s event last year. File photo

By Jenni Culkin

The St. Baldrick’s Foundation’s yearly fundraising effort to get local residents engaged in the fight against childhood cancers kicks off this month.

Participants volunteer to shave their heads and in the process raise money for cancer research.
Find an event in your community below, or visit www.stbaldricks.org/events for more information.

Miller Place
March 14
Napper Tandy’s Irish Pub
275 Route 25A

Port Jefferson
March 22, 2-7 p.m.
Hurricane Grill & Wings
1037 Route 112

March 28, 6-9:30 p.m.
Schafer’s
111 West Broadway

Stony Brook
March 29
Three Village Heroes at the Bench
1095 Route 25A

Lake Grove
March 15, 12-6 p.m.
Miller’s Ale House
4000 Middle Country Road

Centereach
March 6, 7 p.m.
Centereach Civic Association
Centereach Fire Department
9 South Washington Avenue

Kings Park
March 22
The Park Lounge
605 East Main Street

Commack
March 6
Commack School District
1 Scholar Lane

Huntington
March 18
Walt Whitman High School
301 West Hills Road

Northport
March 15, 5-8 p.m.
Laurel Avenue School
158 Laurel Avenue

March 14, 12-7 p.m.
Napper Tandy’s Irish Pub
229 Laurel Avenue

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Town Board members played along with Smithtown’s 350th anniversary celebration Tuesday night, dressing up in outfits similar to those when the town was first founded. Photo by Chris Mellides

By Chris Mellides

Take members of the Smithtown Town Board, dress them up in 17th century garb and the rest is history.

Officials commemorated the town of Smithtown’s 350th anniversary sponsored by the Smithtown 350 Foundation Tuesday with the opening of a time capsule and were joined by residents who braved the snow to attend the event at the Smithtown Center for the Performing Arts.

Town historian Bradley Harris hosted the night’s proceedings and was joined onstage by Supervisor Patrick Vecchio (R) and his colleagues who wore elaborate 17th century period clothing and read passages from the Richard Nicolls Patent of 1665 — which outlined instructions for governance under English rule of what are now the states of New York and New Jersey.

Throughout the presentation Harris and those town officials that participated onstage engaged in playful

Town Board members played along with Smithtown’s 350th anniversary celebration Tuesday night, dressing up in outfits similar to those when the town was first founded. Photo by Chris Mellides
Town Board members played along with Smithtown’s 350th anniversary celebration Tuesday night, dressing up in outfits similar to those when the town was first founded. Photo by Chris Mellides

banter and delivered light-hearted jokes that often got a rise out of the Long Islanders who watched from their seats.

As the night progressed, Harris often pulled from the pages of history and delivered facts about the founding of Smithtown that those in attendance might not have otherwise known.

Despite the witty quips and wisecracks exchanged in the theater room of what used to be a local cinema, the 71-year-old historian and Saint James resident was quite serious and resolute about the importance of preserving history and the passion he holds for his community.

“This town is very interesting because it started with one man’s dream to carve out a niche for himself where he would be his own master and I think that’s [Smithtown founder] Richard Smith in a lot of ways,” Harris said. “He’s left us so many things to venerate.”

During the course of the event, eyes were drawn to a 50-year-old milk can worn with age, which sat to the far right of the stage. The dirtied metal time capsule was originally buried in 1965, and thanks in large part to the town Engineering Department, which had a precise map of its location, its contents were ready to be shared for the first time with audience members.

Town officials and residents were on their feet and the excitement filling the room was palpable. With a hard crack of a hammer, the time capsule was forced open and placed on the long table, where Vecchio and his colleagues were seated.

Among the contents contained within the milk can were: two dusty hats, a phonebook, a local newspaper, a flyer advertising tercentenary pageant tickets and an assortment of aged coins.

James Potts a resident of Smithtown, who has lived in the area for 63 years, was among those in attendance. Potts’ father was the town surveyor, and, due to this, Potts claims to have a very strong knowledge of the town’s history.

Asked about the night’s presentation, Potts said he was very happy with how things shaped up.

“As you can see from how the theater filled up, it shows you the extent of the connection in this town with the residents and basically the pride in the town that they live in,” said Potts.

While he enjoyed the event, Potts expressed some disappointment with the contents of the time capsule and felt as though there could have been more items included that could have better illustrated what life was like on Long Island in the early 1960s.

Town Board members played along with Smithtown’s 350th anniversary celebration Tuesday night, dressing up in outfits similar to those when the town was first founded. Photo by Chris Mellides
Town Board members played along with Smithtown’s 350th anniversary celebration Tuesday night, dressing up in outfits similar to those when the town was first founded. Photo by Chris Mellides

Also expressing his dismay with the time capsule finds was Harris, who as a historian expected a lot more.

“It was the era of Kennedy’s assassination, and I would’ve thought there would have been some commentary on that, but there was nothing and that’s a little disappointing,” said Harris. “The guys who made up the time capsule certainly were trying to stir interest in the past and they did that, but what we learned tonight was very limited.”

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