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Yearly Archives: 2015

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A TIA (transient ischemic attack) is sometimes referred to as a “mini-stroke.” This is a disservice since it makes a TIA sound like something that should be taken lightly. Ischemia is reduced or blocked blood flow to the tissue, due to a clot or narrowing of the arteries. Symptoms may last less than five minutes. However, a TIA is a warning shot across the bow that needs to be taken very seriously on its own merit. It may portend life-threatening or debilitating complications that can be prevented with a combination of medications and lifestyle modifications.

Is TIA common? It is diagnosed in anywhere from 200,000 to 500,000 Americans each year (1). The operative word is “diagnosed,” because it is considered to be significantly underdiagnosed. I have helped manage patients with symptoms as understated as the onset of double vision. Other symptoms may include facial or limb weakness on one side, slurred speech or problems comprehending others, dizziness or difficulty balancing or blindness in one or both eyes (2). TIA incidence increases with age (3).

What is a TIA? The definition has changed over time from one purely based on time (less than one hour), to differentiate it from a stroke, to one that is tissue-based. It is a brief episode of neurological dysfunction caused by focal brain ischemia or retinal ischemia (low blood flow in the back of the eye) without evidence of acute infarction (tissue death) (4). In other words, TIA has a rapid onset with potential to cause temporary muscle weakness, creating difficulty in activities such as walking, speaking and swallowing, as well as dizziness and double vision.

Why take a TIA seriously if its debilitating effects are temporary? Though they are temporary, TIAs have potential complications, from increased risk of stroke to heightened depressive risk to even death.

Despite the seriousness of TIAs, patients or caregivers often delay receiving treatment.

Stroke

After a TIA, stroke risk goes up dramatically. Even within the first 24 hours, stroke risk can be 5 percent (5). According to one study, the incidence of stroke is 11 percent after seven days, which means that almost one in 10 people will experience a stroke after a TIA (6). Even worse, over the long term, the probability that a patient will experience a stroke reaches approximately 30 percent, one in three, after five years (7).

To go even further, there was a study that looked at the immediacy of treatment. The EXPRESS study, a population-based study that considered the effect of urgent treatment of TIA and minor stroke on recurrent stroke, evaluated 1,287 patients, comparing their initial treatment times after experiencing a TIA or minor stroke and their subsequent outcomes (8).

The Phase 1 cohort was assessed within a median of three days of symptoms and received a first prescription within 20 days. In Phase 2, median delays for assessment and first prescription were less than one day. All patients were followed for two years after treatment. Phase 2 patients had significantly improved outcomes over the Phase 1 patients. Ninety-day stroke risk was reduced from 10 percent to 2 percent, an 80 percent improvement.

The study’s authors advocate for the creation of TIA clinics that are equipped to diagnose and treat TIA patients to increase the likelihood of early evaluation and treatment and decrease the likelihood of a stroke within 90 days. The moral of the story is thus, treat a TIA as a stroke should be treated, the faster the diagnosis and treatment, the lower the likelihood of sequalae or complications.

Predicting the risk of stroke complications

Both DWI (diffusion weighted imaging) and ABCD2 are potentially valuable predictors of stroke after TIA. The ABCD2 is a clinical tool used by physicians. ABCD2 stands for Age, Blood pressure, Clinical features and Diabetes, and it uses a scoring system from 0 to 7 to predict the risk of a stroke within the first two days of a TIA (9).

Heart attack

In one epidemiological study, the incidence of a heart attack after a TIA increased by 200 percent (10). These were patients without known heart disease. Interestingly, the risk of heart attacks was much higher in those over 60 years of age and continued for years after the event. Just because you may not have had a heart attack within three months after a TIA, this is an insidious effect; the average time frame for patients was five years from TIA to heart attack. Even patients taking statins to lower cholesterol were at higher risk of heart attack after a TIA.

Mortality

If stroke and heart attack were not enough, TIAs decrease overall survival by 4 percent after one year, by 13 percent after five years, and by 20 percent after nine years, especially in those over age 65, according to a study published in Stroke online on Nov. 10, 2011. The reason younger patients had a better survival rate, the authors surmise, is that their comorbidity (additional diseases) profile was more favorable.

Depression

In a cohort (particular group of patients) study that involved over 5,000 participants, TIA was associated with an almost 2.5 times increased risk of depressive disorder (11). Those who had multiple TIAs had a higher likelihood of depressive disorder. Unlike with stroke, in TIA it takes much longer to diagnose depression, about three years after the event.

What can you do?

Awareness and education are important. While 67 percent of stroke patients receive education about their condition, only 35 percent of TIA patients do (12). Many risk factors are potentially modifiable, with high blood pressure being at the top of the list, as well as high cholesterol, increasing age (over 55) and diabetes.

Secondary prevention (preventing recurrence) and prevention of complications are similar to those of stroke protocols. Medications may include aspirin, antiplatelets and anticoagulants. Lifestyle modifications include a Mediterranean and DASH diet combination. Patients should not start an aspirin regimen for chronic preventive use without the guidance of a physician.

In researching information for this article, I realized that there are not many separate studies for TIA; they are usually clumped with stroke studies. This underscores the seriousness of this malady. If you or someone you know has TIA symptoms, the patient needs to see a neurologist and a primary care physician and/or a cardiologist immediately for assessment and treatment to reduce risk of stroke and other long-term effects.

References:

(1) Stroke. Apr 2005;36(4):720-723; Neurology. May 13 2003;60(9):1429-1434. (2) mayoclinic.org. (3) Stroke. Apr 2005;36(4):720-723. (4) N Engl J Med. Nov 21 2002;347(21):1713-1716. (5) Neurology. 2011 Sept 27; 77:1222. (6) Lancet Neurol. Dec 2007;6(12):1063-1072. (7) Albers et al., 1999. (8) Stroke. 2008;39:2400-2401. (9) Lancet. 2007;9558;398:283-292. (10) Stroke. 2011; 42:935-940. (11) Stroke. 2011 Jul;42(7):1857-1861. (12) JAMA. 2005 Mar 23;293(12):1435.

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 or consult your personal physician.

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By Dexter A. Bailey

This fall, the Stony Brook Foundation celebrates its 50th anniversary — five decades as a crucial catalyst during Stony Brook University’s transformation into one of the world’s leading universities (now ranked in the top 1 percent), helping advance globally significant research and innovation.

Since the foundation was created in 1965, Stony Brook University has grown from a school with 500 students into a prestigious institution of higher education with a diverse student body of more than 24,000.

Many donors helped lay the groundwork for Stony Brook’s evolution by providing scholarships to top undergraduate and graduate students, funding centers recognized around the world for learning and research, and attracting and endowing professors who are leaders in their fields.  These three factors have been instrumental to the university’s becoming a major economic engine for the region. It is the largest single-site employer on Long Island, generating nearly 60,000 jobs and an annual economic impact of $4.65 billion.

In just 50 years, the foundation has raised more than $800 million in gifts — including more than $68.5 million in student financial aid, keeping college affordable for all students. Although New York State support is generous compared with other states, only 18 percent of the university’s total annual operating budget comes from Albany, making the foundation’s philanthropic partnership ever more critical.

“The Stony Brook Foundation, and the philanthropic funds it raises from our friends and alumni near and far, has been essential to the university’s incredible trajectory,” said Stony Brook University President Dr. Samuel L. Stanley Jr. “This partnership has helped us to attract and retain the best students and faculty, push the boundaries in research, strengthen our signature STEM and liberal arts programs and ensure excellence in all we do.”

Philanthropy has funded world-renowned centers and institutes, including the Simons Center for Geometry and Physics, the Global Health Institute, the C.N. Yang Institute for Theoretical Physics, the Institute for Advanced Computational Science, the Laufer Center for Physical and Quantitative Biology and the Alan Alda Center for Communicating Science.

Next year, a new research facility, the Medical and Research Translation (MART) building, will open with support provided in part through the foundation. It will double the university’s capacity to deliver cutting-edge cancer care on Long Island, while generating an additional 4,200 jobs. In addition, donors from the community have supported construction of the future new home of Stony Brook Children’s Hospital, which is expected to open in 2017.

Stony Brook would not be the university it is today without the generous philanthropic support from donors who recognize the incredible return on their investment in the deserving students, faculty and special academic community at Stony Brook. With the support of the Stony Brook Foundation, the university, Long Island and the state of New York will continue to prosper together.

Dexter A. Bailey is the senior vice president for advancement at Stony Brook University and the executive director of the  Stony Brook Foundation.

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By Matthew Kearns, DVM

In the Aug. 13 article we focused on the causes of chronic otitis externa (external ear infections). This article will focus on treatment. First, relieve yourself of the guilt that you did not treat the “infection” correctly. If your pet has chronic ear infections, that usually indicates some predisposing factor (usually genetic in origin). Second, get over the frustration of assuming that because we veterinarians use the term “ear infection” that if treated once, it will never return. 

Chronic otitis externa is a problem that can be managed, not cured.  Therefore, general maintenance of the ear is much better than waiting for things to get out of control. Talk to your veterinarian about ear cleaners, or if you look for an ear cleaner at the pet store make sure it states that it is a cleaner and a drying agent. This means it will have some isopropyl alcohol and usually propylene glycol to not only break up the wax but also to dry the lining of the ear canal.

Those dogs (or cats) that produce excessive wax should have their ears cleaned regularly (once to twice weekly).  If your pet’s ears are really inflamed/infected, you will need medication from your veterinarian to get things under control. However, once the infection clears up, maintenance cleaning is imperative. I have many a pet owner tell me how guilty they feel about cleaning their pet’s ears because they know it hurts and the pet runs away.

However, these same owners usually wait until there is a full-blown infection. Therefore, it is much easier to clean the ears when there is no infection, as compared to waiting until the lining of the ear canal is inflamed and sensitive.  Remember, “an ounce of prevention…”

There are some cases that get so out of hand that your veterinarian may suggest sedating your pet to obtain samples for testing (ear cultures, etc.), as well as a deep ear flush to evaluate the ear drum and the middle ear behind it. Although the problem may originate in the external ear canal, it can progress to a middle ear infection (otitis media) and systemic medication may be indicated. 

Talk to your veterinarian about exploring the underlying causes of the ear infection. As we discussed in the previous article, it is estimated that 80 to 90 percent of recurrent ear infections are secondary to allergies. Newer, more accurate blood tests can diagnose food allergies, seasonal allergies or both. Avoiding certain foods (including treats), as well as managing seasonal allergies can decrease (or sometimes eliminate altogether) the need for cleaning the ears at all. 

As a last resort, there are two surgical procedures that can be performed in severe cases. The first is called a lateral ear canal ablation. This procedure reconstructs a portion of the external ear canal so it more resembles a human ear canal. This allows better airflow and makes cleaning and treatment easier.

The second procedure is called a total ear canal ablation and bulla osteotomy, or TECA-BO (pronounced, “teeka-boo”) for short. This is reserved for end-stage ear canals where over the years so much scar tissue has developed, no medication can be introduced into the canal. This procedure involves removing the entire external ear canal and part of the middle ear as well.

A percentage of patients lose their hearing, but it will eliminate a significant source of chronic pain. The good news is that in almost every case, the patient is deaf before the surgery secondary to chronic disease. 

I hope this sheds a little light on a confusing (and sometimes frustrating) disease in pets. 

Dr. Kearns has been in practice for 16 years and is pictured with his son, Matthew, his dog, Jasmine.

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Centereach's Paige Emerson fights for possession of the ball. Photo by Bill Landon

By Bill Landon

Being young didn’t stop these Cougars from pouncing onto their prey.

The Centereach field hockey team commanded the field, owned the time of possession and held Port Jefferson scoreless on their own home turf to take a 4-0 victory in nonleague action Saturday. 

Centereach's Lindsey Noack carries the ball toward the cage. Photo by Bill Landon
Centereach’s Lindsey Noack carries the ball toward the cage. Photo by Bill Landon

“This is the first time we’ve played on our own turf and today we clicked,” Centereach head coach Michelle Cocchiaro said. “This afternoon we communicated well, which is something we didn’t do until today.”

A pair of freshman started the scoring for Centereach when forward Caroline McParland’s shot found the back of the cage off an assist by forward and midfielder Sophie Alois for the 1-0 lead.

Port Jefferson head coach Deb Brown said her team is also very young, with one senior and two freshmen on the forward line.

“It’s the first time on turf,” Brown said. “I think they got a little bit tired, but I think we handled ourselves OK. Some of the girls were out of position, and we’re inexperienced on turf.”

Centereach junior Lindsey Noack, a forward and midfielder, answered next when her shot found its mark to help the Cougars edge ahead 2-0.

Noack said her team had good communication on the field with good ball movement, and added that she thought the midfielders were effective in getting the ball to the forwards.

“Today I saw teamwork, which is a big difference from our first scrimmage against Newfield, where we were all over the place,” Noack said. “Today we meshed together and we played as one.”

Centereach junior Paige Emerson, also a midfielder and forward, lit up the scoreboard next with just over three minutes left in the first half.

The Royals spent much of the game on defense trying to contain the offensive pressure, and had few opportunities for shots on goal as a result.

Port Jefferson's Jackie Brown fights to keep the ball in bounds. Photo by Bill Landon
Port Jefferson’s Jackie Brown fights to keep the ball in bounds. Photo by Bill Landon

Port Jefferson junior forward and midfielder Jackie Brown said she thought her team did well despite this being their first game on turf.

“We passed well, but we’re not used to the speed of the ball because we play on grass,” she said, adding that she thinks her team needs to do a better job at cutting in front of the defense as the Royals prepare for their next game against Sayville.

Centereach sophomore forward Jessica Whalen rounded out the scoring for the Cougars with 14 minutes left to play, to give the team a 4-0 advantage, and the game its final score.

With time running out and desperate to get on the scoreboard, the Royals continued to push for a goal until the final horn.

“I thought we did really well, but we have to work on shooting on cage,” Port Jefferson junior defender Isabelle Koutsantanou said. “We have to get better getting our forwards back [faster] to help out on defense.”

Centereach junior defender Cassidy Treanor was also proud of her team’s efforts, especially being an almost completely new team compared to last year’s roster.

“We’re a brand new team — we had 10 seniors graduate last year so literally the junior varsity team is now the varsity team, with four extra players,” she said. “We’re so young and to see the players who are just now freshmen being able to compete with seniors is so big for us. They have such skills for being so young.”

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Annual Huntington Lighthouse Music Fest comes to town for 9th year

The Huntington Lighthouse Preservation Society held its annual Huntington Lighthouse Music Festival on Saturday, Sept. 5. This festival, which is only accessible by boat, featured nine music acts and was enjoyed by all ages. The society also announced the launch of The Beacon Society initiative, a challenge grant program established by Bernadette Castro, long time Lloyd Harbor resident, successful business woman and former New York State commissioner of Parks, Recreation and Historic Preservation, to benefit the ,lighthouse’s capital campaign. The initiative is designed to raise $80,000 within the next 10 months to help fund Huntington Harbor Lighthouse’s $1.5 million Foundation for the Future capital campaign for critical repairs to the historic structure’s foundation its watertight integrity.

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The sound engineer for the Huntington Lighthouse Music Festival. Photo by Dan Woulfin
Freeride performs at the festival. Photo by Dan Woulfin
Three attendees enjoy the festival. Photo by Dan Woulfin
The sound engineer for the Huntington Lighthouse Music Festival. Photo by Dan Woulfin
Volunteers arrive at the lighthouse. Photo by Dan Woulfin
The volunteer dock at the Huntington Lighthouse Festival. Photo by Dan Woulfin
The Huntington Lighthouse is dressed up in sponsorship signs for the festival. Photo by Dan Woulfin
King Wellington prepares to play at the top of the lighthouse. Photo by Dan Woulfin
King Wellington performs at the Huntington Lighthouse Music Festival. Photo by Dan Woulfin
King Wellington performs at the Huntington Lighthouse Music Festival. Photo by Dan Woulfin.
Pamela Setchell, president of the Huntington Lighthouse Preservation Society, dances in front of the lighthouse. Photo by Dan Woulfin
A volunteer decked out in pirate garb goes off into the audience to sell t-shirts to support the lighthouse. Photo by Dan Woulfin
Boating safety is paramout during the summer, especially Labor Day weekend. File photo by Dan Woulfin

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File photo

The Huntington Community First Aid Squad responded to an emergency call on Saturday morning after a crash between a motorcycle and a car on East Jericho Turnpike in Huntington Station, near Longfellow Drive.

While on the way to the scene, the ambulance personnel learned that both the motorcycle and its motorcyclist were on fire, the ambulance company said.

When they arrived on scene, the responders found a conscious man complaining of pain to his right leg, and he had severe burns on about 10 percent of his body.

According to the ambulance company, the responders hooked up the man to an IV and gave him pain medication on the way to Nassau University Medical Center.

The road was closed in both directions while the scene was cleaned up.

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Crab Meadow Beach in Northport. File photo by Rohma Abbas

Three boys got more than they bargained for on Monday when they paddled their canoe toward the Long Island Sound with the hopes of fishing and met powerful winds that blew them 1.5 miles offshore.

According to the Suffolk County Police Department, the Huntington Station kids — brothers Davin Miles, 12, and Kenyon Miles, 10, and their friend, 12-year-old Chris Gurr — launched the canoe from Northport’s Crab Meadow Beach early in the evening but as the paddled away from the shoreline, the wind picked up and they were blown out 1.5 miles.

Marine Bureau officers Michael O’Leary and Charles Marchiselli, on SCPD patrol vessel Marine Bravo, were on routine patrol on the Sound when they discovered the kids and brought both them and their canoe aboard.

Police said the boys were all wearing flotation devices and were uninjured, but had been unable to paddle back to the beach because of 15 to 20 mile-per-hour winds and 2-foot waves.

O’Leary and Marchiselli brought the kids to their parents, who were waiting at Crab Meadow.

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File photo

A car crashed into a guardrail on Route 347 and caught fire early Saturday morning, killing the elderly woman inside.

The Suffolk County Police Department said the woman, a 77-year-old Port Jefferson Station resident, had been driving west in a 2006 Chrysler 300 on the road, just past Old Town Road, at about 5 a.m. when she hit the guardrail.

The woman, whom police did not identify, was pronounced dead at the scene, but it was not immediately clear whether she died in the crash or the ensuing fire.

Police impounded her car for a safety check.

Detectives from the SCPD’s 6th Squad are investigating the East Setauket single-car crash. Anyone with information is asked to call them at 631-854-8652.

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Rides will be free on the town bus system’s fixed routes beginning Sept. 21-26 and Sept. 28-Oct. 3. Photo by A.J. Carter

Huntington Area Rapid Transit (HART) buses will be fare-free for two weeks later this month, a move town officials hopes encourages residents to consider the town transit system as an alternative to driving their cars.

The weeks of free fare span Monday, Sept. 21 through Saturday, Sept. 26, and again on Monday, Sept. 28 through Saturday, Oct. 3. There will be no fare charged on HART’s fixed route buses, according to a town spokesperson. The promotion is being held in coordination with International Car Free
Day on Sept. 22. That is an annual event celebrated in more than 1,500 cities in 40 countries during which people are encouraged to get around without cars, using alternate transportation such as transit, biking or carpooling.

Locally, Car Free Day Long Island will be celebrated for the third consecutive year under the auspices of Transit Solutions and 511NYRideshare, who are partnering with the town in presenting the Fare Free Weeks.

The goal of the promotion is to increase ridership on HART, the only town-operated bus system on Long Island.

HART, which has been operating since 1978, revised its routes in January 2013 to adapt to changing demand, improve service and reduce waiting times. This year, HART upgraded its fleet, putting 15 new vehicles into service, including seven 20-passenger clean diesel buses that provide easier maneuverability, greater fuel efficiency and easier passenger access than the 29-passenger vehicles they replaced. HART also has three hybrid buses that are part of the fixed-route service.

“Over its 35 years in existence, HART has developed a loyal, devoted ridership, composed of people who appreciate the ability to get from place to place in the Town without having to use a car,” Huntington Town Supervisor Frank Petrone (D) said in the statement. “We hope that Fare Free Weeks will prompt new riders to give HART a try, learn for themselves what great service HART provides and become frequent riders after the promotion ends.”

The Huntington Town Board authorized Fare Free Weeks in a resolution it approved unanimously at its July 14 meeting. The resolution noted that the town would seek sponsorships to offset the lost passenger revenue.

Petrone and his Town Board colleagues expressed their appreciation to these businesses and organizations that have agreed to become Fare Free Weeks sponsors: Covanta Energy; Stop & Shop; Target; The Paramount; Renaissance Downtowns; Clever Devices; the Huntington Township Chamber of Commerce; and the Huntington Station Business Improvement District.

“HART bus is one of those unique services the town provides, giving people who don’t have cars, including teenagers, the mobility they need for their daily activities,” Councilwoman Tracey Edwards (D) said in a statement. “But HART also provides an opportunity for car owners to get around town and, as the old Greyhound commercial used to say, leave the driving to us, especially if the ride is free.”

Rosemary Mascali, the manager of Transit Solutions and co-chair of the Car Free Day Long Island event, lauded the fare-free initiative.

“We’re thrilled to see the Town of Huntington join in the international celebration of Car Free Day by providing a free ride on HART buses during these two Fare Free Weeks,” Mascali said. “This puts the town at the leading edge of Long Island municipalities in their efforts to encourage residents to try a commute alternative.”

The free rides are available only on fixed route service. Paratransit is unaffected by the promotion. For details on routes and schedules, riders can visit the HART Bus page on the town’s website, https://www.huntingtonny.gov.

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Stock photo

AMVETS Post 1998 in Port Jefferson Station is hosting a fundraising barbecue to support aging and otherwise needy local veterans.

The nonprofit’s annual BBQ will fire up on Saturday, Sept. 12, at 1 p.m. at the American Legion Post, 1450 Hallock Ave., Port Jefferson Station. There will be chicken, hot dogs, burgers, clams, drinks and dessert, as well as a Chinese auction and a raffle.

Tickets are $25 for adults, and kids under 12 are free. They can be purchased through AMVETS Post Commander Barbara Alt at 631-509-4151 or Post Historian Ed Bednarek at 631-331-3853. The tickets will also be on sale at the American Legion on the day of the barbecue.

Contact Alt or Bednarek for more information about the event.

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