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Monthly Archives: February 2016

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Have you ever heard the paradox, the more I know, the more I realize how much I don’t know? I think this statement can be aptly applied to our knowledge of hypertension, better known as high blood pressure. When it comes to high blood pressure, it is not clear if it is a disease, in itself, or a condition that may contribute to diseases such as heart disease, heart attacks, stroke, kidney failure and even death (1). Or high blood pressure may be an indicator of blood vessel disease. And if this is not confusing enough, no matter how you want to classify high blood pressure, what is the best way to control it, and what levels are ideal?

Another frightening fact is that high blood pressure has a very high prevalence in the United States. The lifetime risk of having this disorder is 90 percent for those who are 55 and older. Thus, we need to be able to effectively reverse or prevent high blood pressure.

Upheaval among the ranks in terms of blood pressure levels

What are the goals for those patients with high blood pressure? The Joint National Committee is the most recognized organization to provide evidence-based guidelines to the medical community for blood pressure. This committee’s latest iteration, referred to as JNC 8, actually relaxed the levels to control blood pressure in those 60 years and older to less than 150/90 mmHg. For everyone below the age of 60, it should be less than 140/90, even for those who have diabetes (2). Interestingly, there is insufficient evidence on the systolic (top) number for those 30-59 years old and on the diastolic (bottom) number for those under 30 years old. Therefore, the recommendations for those under 60 are based on expert consensus. Of course, these levels are based on the assumption that we are treating with blood pressure medication.

The new evidence, but buyer beware

However, in a recent randomized controlled trial (SPRINT trial), results showed that when systolic blood pressure was reduced to below 120 mmHg, compared to the previous standard of 140 mmHg, there was a significant 30 percent reduction in the primary composite end point in the intensive vs. standard treatment groups (3). The composite end point involved nonfatal heart attack, nonfatal stroke, acute coronary syndrome, heart failure, or cardiovascular death. There was also a 25 percent reduction in all-cause mortality in the intensive treatment group. This trial involved 9,361 patients followed over 3.2 years. The trial was stopped early because of these positive results.

Does this mean we should treat aggressively with medication?

The caveats to this trial are several. One, the population was very specific. It involved patients who were at high risk of cardiovascular disease. The Framingham coronary heart disease risk score was at least 15 percent but with a mean of 20 percent. Two, the trial excluded diabetes patients and those with previous strokes. Considering these two factors, it means that one in six patients with high blood pressure would be appropriate for intensive blood pressure treatment with medication to a target systolic blood pressure of less than 120 mmHg.

Three, this study, does not take into account lifestyle modifications, which are very important to controlling and possibly reversing high blood pressure. Four, there was a significant increased risk of adverse events, such as hypotension (low blood pressure). If someone were to change their lifestyle, it might exacerbate this problem even more.

How can we better control blood pressure?

Office readings are not enough to know if blood pressure is controlled. Home readings are very important as well, although they are not always the most accurate. So, how do we determine what the home readings mean? A recent study tries to shed light on this issue. In the study of 286 patients, results showed that those who had at least three out of 10 systolic readings of >135 mmHg were likely to have uncontrolled high blood pressure confirmed using the gold standard of testing, 24-hour ambulatory blood pressure monitoring (4). Those who had these elevated readings were at higher risk for end organ damage affecting the heart and surrounding blood vessels. This isn’t a perfect system, but it is better than using clinic blood pressures readings alone.

What about sodium?

The recommended levels for daily sodium vary from organization to organization and depending on whether or not you have high blood pressure. The most lenient recommendation, from the 2015 U.S. Dietary Guidelines, is 2300 mg per day (5), and the most stringent, by the American Heart Association, is 1500 mg per day for everyone, though there seems to be a general consensus for targeting less than 1500 mg per day for those with high blood pressure. Whatever level you may deem appropriate, a recent study shows that about 90 percent of adult Americans are consuming more than 2300 mg per day and 86 percent of high blood pressure patients are not maintaining appropriate levels (6).

So, should we lay off the salt shaker? Not necessarily. We are getting 75 percent of our intake from restaurants and from processed foods, those that come in a box (7). In fact, small amounts of iodized salt may be beneficial. However, fancy salts such as Himalayan Pink, sea salt, kosher and others may not be iodized.

These guidelines don’t seem to differentiate between added sodium and sodium that occurs naturally in foods. In fact, if you eat a diet rich in dark leafy green vegetables, there is about 700-800 mg of naturally occurring sodium in these foods. What is great about this is that these vegetables also contain nutrients that help counterbalance the effects of sodium, such as potassium and nitrates. They also have an anti-inflammatory effect that benefits the endothelial layer, or the inner lining, of your blood vessels.

My recommendation is to avoid salt from processed foods by reading labels, although meats such as chicken can be injected with sodium without labeling. And if you do eat out, request that the chef not salt the food. If you use salt at home, use only iodized salt.

Added sugar – not so sweet

Dentists are right when they say don’t eat sugar. Their reasons are to protect to protect your teeth from decay. Well, there are many other reasons not to eat sugar. The recent REGARDS study found that a high-sugar (Southern or sweets/fat) diet may be associated with the risk of high blood pressure, whereas a plant-based diet was not (8). The mechanisms for this effect may have to do with the fact that added sugar raises insulin levels, which may raise the levels of aldosterone, the hormone responsible for the reabsorption of sodium from the kidneys. Those with the highest amount of insulin were found to have a greater than three times increased risk of high blood pressure.

When treating high blood pressure with medications, we need to individualize treatment. However, lifestyle modifications can be applied to everyone, regardless of age or risk of heart disease. If you have high blood pressure, you should take home readings and show them to your doctor for review.

References:

(1) J of Hypertension 2011:29:896-905. (2) JAMA. 2014;311(5):507-520. (3) N Engl J Med 2015; 373:2103-2116. (4) Ann Fam Med. 2016;14:63-69. (5) U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition. December 2015. (6) Morb Mortal Wkly Rep. 2016;64:1393-1397. (7) cdc.org. (8) Obesity Week 2015 Abstract T-OR-2108.

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 Matthew Kearns, DVM

February is National Pet Dental Health Month and I thought this would be a good time to discuss pediatric dental health in pets. So, how young is too young to start evaluating the teeth? The evaluation actually starts on the first exam.

The first thing we veterinarians look for is occlusion. Occlusion refers to how the teeth contact each other. Proper occlusion is necessary not only for prehension (the chewing process where food is grabbed and brought into the mouth), but also mastication (the chewing process where food is crushed and ground by the teeth). If the teeth on the maxilla (upper portion of the jaw) and mandible (lower portion of the jaw) do not line up properly this not only makes the chewing process more difficult, but also leads to issues with your pet’s teeth later in life.

Why does it lead to problems? Well, just like us humans, dogs and cats plaque on their teeth. Plaque is a thin film of bacteria, saliva, and food will accumulate on the enamel of the tooth within 24 hours of last cleaning. If plaque is not removed it will mineralize within 10 days. (This is called tartar or calculus.)

Once tartar takes hold, a shift develops from aerobic bacteria (bacteria that need oxygen to survive) to nasty anaerobic bacteria (those that need little or no oxygen to survive). These anaerobic bacteria secrete toxins that inflame the gums and lead to small abscesses or pockets under the gums. If left unchecked, these bacteria start to destroy the periodontal ligament and perialveolar bone. This is very painful. I have seen many a pet where I could see that they were chewing on one side of their mouth by the amount of tartar and gingivitis on the other side. I have also had patients that go back to eating hard food after diseased teeth were extracted.

A mouth with normal or appropriate occlusion is like a self-cleaning oven. When your dog or cat is grabbing at food with the more rostral teeth (the teeth closer to the nose) it cleans the incisors, or front teeth, and canines, fang teeth; the friction removes plaque before it can develop into tartar and progress into more advanced periodontal disease. Ideally, the maxilla is slightly longer than the mandible. If the conformation of the jaw does not match this, there are options that can be discussed with your veterinarian.

The second thing we look at is proper eruption. Proper eruption of teeth refers to when the teeth first appear above the gumline. In puppies the deciduous, or temporary teeth, erupt between 4-6 weeks and kittens between 3-4 weeks. Adult teeth erupt in puppies between 4-7 months and, in kittens, between 4-6 months. The eruption of adult teeth triggers the resorption of the deciduous roots causing those teeth to spontaneously fall out. Unfortunately, in some cases that either does not happen in a timely manner, or at all.

Conditions such as delayed eruption, supernumerary (extra) teeth, or persistent deciduous teeth can occur for a variety of reasons but need to be diagnosed and treated early on. If not, these conditions not only lead to pain, but also lead to dental malocclusion and other problems (dental cysts, etc.).

Diagnosis of malocclusion, delayed eruption, and retained deciduous teeth early on (especially in severe cases) opens the discussion to early intervention, a key to preventing disease. So, get your pet to show their teeth (and hopefully not use them on the vet) at your next visit. SMILE!!

Dr. Kearns has been in practice for 16 years.

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Mount Sinai High School comes in a close second

From left, Farmingdale High School winners Clarisse Baes, Ramin Chowdhury, Hamza Malick, Suraj Muralidharan, Jake Chammas and coach Peter Macchia pose for a photo after winning the High School Science Bowl. Photo from Brookhaven National Laboratory

Farmingdale High School students have one contest down to a science.

For the second consecutive year the team won the Brookhaven National Laboratory’s Long Island Regional High School Science Bowl in Upton on Saturday, Jan. 30. Now the students and their coach will head to Washington, D.C., on April 28 for the National Science Bowl finals. The teams were comprised of five students whose science and math knowledge were put to the test with a fast-paced jeopardy-style contest.

Farmingdale seniors Clarisse Baes, Ramin Chowdhury, Suraj Muralidharan, Jake Chammas and junior Hamza Malick beat out 19 teams for the top spot, including their toughest competitors, the Mount Sinai High School team, which came in second place. Their coach, Peter Macchia, an earth science teacher, said the team tried something new to prepare for this year’s Science Bowl competition.

“Instead of trying to win a trophy, they were preparing for college,” Macchia said. “So, they benefitted from studying together almost every day, and win or lose, they can now be successful in college.”

Coach Gina Sing led the Mount Sinai High School team to second place. The team included Andrew Rodriguez, Nick Eberhard, Danny O’Mara, Alexander Mule and Patrick Hanaj. Great Neck South and Lynbrook High School took third and fourth place, respectively.

While these three teams won’t get an all-expense paid trip to Washington, D.C., for the finals, the top 16 high school teams and top eight middle school teams in Nationals will win $1,000 to go toward their school’s science department. The National Finals in Washington, D.C., will be from April 28 to May 2.

BNL started hosting the LI Regional Competition for the National Science Bowl in 1991. U.S. Secretary of Energy Ernest Moniz said the Science Bowl “continues to be one of the premier academic competitions across the country, and prepares [American] students for future success in some of the world’s fastest growing fields in research and engineering.”

For more information about BNL’s Science Bowl, call 631-344-2345.

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File photo

Two men were killed and one was seriously injured in the early hours of Tuesday morning, after police say one of them lost control of his car and slammed into a tree.

The Suffolk County Police Department said 26-year-old Hauppauge resident Leland Acampora crashed the Hyundai Sonata at about 4:30 a.m. while heading west on Fort Salonga Road near Makamah Road.

Both he and 26-year-old Commack resident Woody Zalman, who had been sitting in the back seat, were pronounced dead at the scene, police said. However, front seat passenger Paul Weingart, a 26-year-old from East Northport, was in serious condition at Stony Brook University Hospital, after being airlifted there by police helicopter.

Police impounded the Hyundai for a safety check.

Detectives from the SCPD’s 2nd Squad are investigating the single-car crash. Anyone with information is asked to call them at 631-854-8252.

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According to Brookhaven Town Supervisor Ed Romaine, harmful chemicals are also found in telephone poles. Photo by Giselle Barkley

After four decades the government is finally updating the Toxic Substances Control Act of 1976 with partial thanks to Brookhaven Town officials.

President Gerald Ford signed the act decades ago to regulate the introduction of new chemicals into society, excluding those found in food, pesticides, tobacco, firearms, drugs and cosmetics. The act gave the United States Environmental Protection Agency the authority to require documentation of chemical substances to determine if the chemical is hazardous to humans. The 62,000 chemicals that existed before 1976 were grandfathered into the act and deemed safe for humans and the act wasn’t updated until last year.

The government amended the act with Toxic Substances Control Modernization Act of 2015. Its bill, the Frank R. Lautenberg Chemical Safety for the 21st Century Act updates the act and requires the EPA to establish a risk-based screening process for new chemicals. Supervisor Ed Romaine (R) and his fellow town board officials proposed the bill, which states the EPA must determine if a certain amount of old or new chemicals are safe for humans by a certain deadline. The EPA will reprimand manufacturers who don’t comply with safety requirements by restricting or prohibiting the creation, processing, distribution and disposal of new chemicals.

The EPA did not return requests seeking comment by press time.

According to Romaine, the uptick in cancer cases, particularly breast cancer on the North Shore, over the years was troubling. With advancements in science and technology scientists have found that some of the chemicals previously deemed as safe actually pose potential health risks for humans. This includes development of cancers and endocrine and immune system-related complications among other issues.

“We have a concern about the high rates of cancer in children and we’re concerned because people are trying to get answers,” Romaine said.

There were around 142.7 cases of cancer in Suffolk County between 2000 and 2004 according to the National Cancer Institute. The cases increased to around 528 per 100,000 people between 2008 and 2012 according to the cancer institute’s State Cancer Profiles.

County Legislator Sarah Anker (D-Mount Sinai), who has focused on the environment and its health effects for more than a decade, said these chemicals could be particularly harmful to children and their health.

“When you’re exposed to something when you’re growing up … it stays in your body,” Anker said. “As you get older something may set off the cancer…It takes decades sometimes for cancer to evolve.”

In a 2008-2009 study from the United States Department of Health and Human Services, scientists found 300 pollutants in the umbilical cord blood of newborn babies. According to the study, children are more vulnerable to chemical pollutants in the environment because of their size and poorer immune systems.

According to Rep. Lee Zeldin (R-Shirley) these chemicals are found in everyday products like soaps and toothpastes among other items used on a daily basis. There are around 85,000 chemicals that are currently in use. But Zeldin said “the flaws in TSCA have left many of these new chemicals untested and unregulated.”

While Zeldin said the government should update important bills like TSCA, it’s common for some acts to go untouched for several years while others are updated almost annually.

“There are certainly examples of both extremes,” Zeldin said. “TSCA happens to be an example of one of those bills that really should have been updated many years ago, if not decades ago.”

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Port Jefferson Trustee Larry LaPointe stands with code officers, from left, James Murdocco, John Vinicombe, Paul Barbato and Gina Savoie as they pose with their proclamations. Photo by Elana Glowatz

Port Jefferson Village honored five code enforcement officers on Monday night who officials say went above the call of duty to serve the community.

Two helped save an overdosing man’s life, one attempted to revive a car crash victim, another thwarted a burglary and a lieutenant protected the village during the recent heavy snowstorm. The board of trustees presented them with proclamations for their service to cheers from the audience at Village Hall.

Gina Savoie was commended for preventing a break-in at a home in the Harbor Hills area earlier this month after she saw suspicious activity and called for police assistance. According to code bureau Chief Wally Tomaszewski, two Coram residents were arrested for loitering as a result.

Paul Barbato, who received a proclamation last year for reviving a man in cardiac arrest at a Port Jefferson restaurant, was honored again Monday for attempting to save a Belle Terre man trapped inside a Lamborghini that had crashed into a pole on East Broadway. Barbato, the first on the scene of the mid-December crash near High Street, got inside the car and performed CPR.

Lt. John Borrero is honored. Photo by Elana Glowatz
Lt. John Borrero is honored. Photo by Elana Glowatz

Although his attempt ultimately proved unsuccessful, he “tried desperately to save his life,” Tomaszewski said in a previous interview. “Believe me, his boots were filled with blood.”

A couple of weeks later, James Murdocco and John Vinicombe responded to an opioid overdose at the Islandwide Taxi stand near the Port Jefferson Long Island Rail Road station. Mayor Margot Garant said Monday that the officers were told the young victim was dead, and they found no pulse or respiration. Murdocco and Vinicombe each administered the anti-overdose medication Narcan and Murdocco performed CPR.

The man regained consciousness and “became violent,” she said, and had to be restrained.

Garant added an unplanned honor to Monday night’s affair, commending Lt. John Borrero for his work during the blizzard, commonly dubbed Winter Storm Jonas, that hit Long Island hard on Jan. 23.

“I cannot tell you what this one gentleman did, on tour all day, making sure our streets are safe, shutting down roads, calling other code enforcement officers in during a massive blizzard — he’s out there helping employees get to work at St. Charles Hospital,” the mayor said. “Your service to this community is just invaluable, John. I cannot tell you the amount of respect you earned that night.”

She told the audience that there is more to the code enforcement bureau than meets the eye.

“These officers are not merely giving out tickets,” Garant said, “but they’re saving lives.”

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Holtsville Hal, his handler Greg Drossel and Master of Ceremonies Wayne Carrington make their way onstage to cheers and applause on Groundhog Day. Photo by Alex Petroski

To the delight of about 100 people in attendance on Tuesday, it was announced that famed Brookhaven groundhog Holtsville Hal did not see his shadow, indicating spring would come early this year.

Excited Holtsville Hal fans collected streamers as a keepsake from Groundhog Day. Photo by Alex Petroski
Excited Holtsville Hal fans collected streamers as a keepsake from Groundhog Day. Photo by Alex Petroski

Hal made his yearly Groundhog Day appearance at Brookhaven Town’s Holtsville Wildlife and Ecology center at about 7:30 a.m., before a crowd with fresh memories of being walloped with more than 2 feet of snow in a recent blizzard.

Tradition says that if Hal — or, as he’s known in the Town of Brookhaven as a throwback to the classic Bill Murray movie “Groundhog Day,” the Great Prognosticator of Prognosticators — sees his shadow when he wakes from hibernation on Groundhog Day, the community is in for six more weeks of winter.

“As I stood by my burrow and looked to the ground, there was no shadow for me to be found,” Brookhaven Town Highway Superintendent Dan Losquadro (R) read from a large scroll as Hal was presented to the mass of onlookers. “So kids and their families, put away your sleds and snow blowers.” There were raucous cheers.

Holtsville Hal is presented to a group of young onlookers on Groundhog Day. Photo by Alex Petroski
Holtsville Hal is presented to a group of young onlookers on Groundhog Day. Photo by Alex Petroski

Holtsville Hal was handled by Greg Drossel as he posed for photos with Master of Ceremonies Wayne Carrington, Councilmen Neil Foley (R) and Dan Panico (R) and Councilwoman Valerie Cartright (D), members of the Holtsville Fire Department and many others. He even posed for a selfie with one young admirer.

Last year, Hal also predicted an early spring. This year he might be right, if only just for Tuesday, as those who woke up early to attend the event were treated to a mild, sunny morning by the time the groundhog made his much-anticipated appearance.

With the viewers in good spirits, Carrington reminded the crowd to donate whatever they could to the ecology center to support its programs.

This version corrects the spelling of Councilwoman Valerie Cartright’s name.

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Police say they seized drugs and cash from a Coram home last week. Photo from SCPD

Police will execute more search warrants and make more arrests at known hotspots for drug activity under a new initiative officials announced over the weekend.

The same day police arrested a father and son and seized more than a kilogram of drugs from the father’s home, the Suffolk County Police Department said it is focusing more on shutting down houses in residential areas where drug activity is suspected to be taking place.

That father-son pair was nabbed on Jan. 29, police said, after investigators executed a search warrant on a Coram home and found 730 grams of cocaine, 318 grams of heroin, 36 grams of oxycodone and $200,000 in cash. It was just the most recent in a string of busts through the initiative, which uses detectives from the Special Operations Team “to work with residents to obtain information on who is dealing and where,” according to an SCPD statement. “Armed with that information, detectives will be executing more search warrants of drug houses and making felony arrests at those locations.”

The effort is “fueled in part by residents’ complaints,” the SCPD said in the recent press release.

Police officials at a Jan. 26 civic meeting at the Comsewogue Public Library in Port Jefferson Station had reported raids at three local drug houses in the week leading up to the meeting, two in Gordon Heights and one in Centereach. At the latter location, 6th Precinct Inspector Bill Murphy said, cops busted a repeat offender and caught him with 4 ounces of cocaine and 2 ounces of heroin.

Police say they seized drugs and cash from a Coram home last week. Photo from SCPD
Police say they seized drugs and cash from a Coram home last week. Photo from SCPD

“He’s going away for a long time,” Murphy said.

In the police department’s announcement of its new initiative, it said investigators had executed nine search warrants in the several weeks since the effort started, seizing thousands of grams of drugs — including crack cocaine and heroin — as well as seven guns, hundreds of thousands of dollars in cash and drug paraphernalia.

“This new narcotics initiative will target residences where drug dealing is occurring,” Acting Police Commissioner Tim Sini said in a statement. “Drug houses in our neighborhoods degrade our sense of community, public safety and quality of life.”

In the Jan. 29 bust, 40-year-old Joseph Fearon, who police said lived at the Avalon Pines Drive home, was charged with two counts of first-degree criminal possession of a controlled substance, four counts of third-degree criminal possession and two counts of second-degree criminal use of drug paraphernalia.

Fearon’s attorney, Central Islip-based Glenn Obedin, did not return a call seeking a comment on his client.

The defendant’s son, 23-year-old Jasheme Fearon, a Middle Island resident, was charged with fifth-degree criminal possession of a controlled substance and second-degree criminal impersonation. Police also said that he was arrested on a New York State parole warrant and a bench warrant.

Attorney information for the younger Fearon was not available.

Drug activity can create spikes in other types of crimes. At the civic meeting last week in the Comsewogue library, Murphy said overall crime has dropped in his precinct but heroin arrests have doubled in the last five years — from 148 in 2011 to 298 last year — and the addicts are behind many of the area’s burglaries and robberies.

“Unfortunately, a lot of the serious crimes we have are driven by drug abuse: [The perpetrators are] addicted to heroin and they’re so addicted to it, they have to get money to go and buy these drugs,” he said.

He and Officer Will Gibaldi invited Port Jefferson Station and Terryville residents at the civic meeting, including some who expressed their frustrations and fears relating to local drug activity, to reach out to them if they have a problem in their neighborhoods.

“If you contact me with a problem, you will get a response,” the inspector said. “You will not be ignored.”

The police’s new drug-house initiative is likewise geared toward responding to community members’ concerns.

“Working together with our law enforcement partners and sharing information is imperative to getting dangerous drugs off our streets and out of our communities,” Legislator Sarah Anker said in a statement about the crackdown on community drug dealing. “If you see something, say something.”

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The entire cast of ‘Junie B. Jones, The Musical’ performs at the Engeman Theater. Photo by Jessie Eppelheimer

By Rita J. Egan

“Junie B. Jones, The Musical” opened at the John W. Engeman Theater in Northport this past Saturday to an audience filled with young children eager to see their favorite literary characters in the flesh, and with a fun, lively show, the cast did not disappoint.

The musical, based on the children’s book series by Barbara Park, follows the adventures of Junie B. Jones as she tackles life’s little obstacles she finds along the way in first grade. Among the many challenges she faces are losing her best friend, Lucille, to twins Camille and Chenille, finding out she needs glasses, and being unable to participate in the big kickball tournament. However, with the help of her family and friends, and jotting everything down in her Top-Secret Personal Beeswax Journal, the endearing redhead figures everything out and learns that when life hands you lemons you make lemonade.

Kate Keating is youthful and charming as the main character, Junie. As lead on many of the numbers, her clear soprano voice is perfect for revealing the story through song, and she easily draws the young audience in as she talks directly to them in a number of scenes.

Playing the role of mother, as well as fellow first-graders Grace and Sheldon, is Suzanne Mason whose stage presence as always is a strong one. The actress especially shines as the awkward, stuffy-nosed Sheldon, and she elicited loud giggles during a scene where Sheldon, ready to play the cymbals at the kickball tournament, experiences stage fright. Mason convincingly delivers the song “Sheldon Potts’ Halftime Show” as if she were a child herself.

Kate Keating stars in Junie B. Jones The Musical at the Engeman Theater through March 6. Photo by Leila Scandar
Kate Keating stars in Junie B. Jones The Musical at the Engeman Theater through March 6. Photo by Leila Scandar

Joshua Cahn plays Mr. Scary, Daddy and Gladys Gutzman, and it’s as Gutzman, the cafeteria lady, that Cahn takes center stage. The way he delivers the role is reminiscent of Edna Turnblad from “Hairspray,” and with funny lines and a cute dance number with Keating, he received well-deserved laughs and giggles from the audience members.

Michael Verre tackles dual roles as Junie’s new friend Herb and one of the twins, Chenille. While Verre is sweet as Herb, particularly during the number with Keating, “You Can Be My Friend,” he is hilarious as Chenille, where he good-naturedly dons a wig and dress, and gracefully sings and dances along with Camille and Lucille during the number “Lucille, Camille, Chenille” to the delight of the audience.

Jennifer Casey as Camille and Jose, Allie Eibeler as Lucille and Lennie, and Alyson Clancy as May and Bobbie Jean handle their role changes seamlessly, and no matter what part they are playing, effortlessly add to the fun and high energy of the musical.

Written by Marcy Heisler, with music by Zina Goldrich, “Junie B. Jones” features upbeat, fun-filled numbers that are perfect for a musical geared toward young children. Stand out songs in the first act include the opening number “Top-Secret Personal Beeswax” where Junie tells the audience all about her new journal, and at the end of the act, “Now I See,” where, with the help of her friends, Junie begins to like her new glasses. Act 2 also features the heartwarming number “Writing Down the Story of My Life” that will inspire little ones to record their adventures.

Directed by Jennifer Collester Tully, “Junie B. Junes, The Musical” is a journal-worthy theater experience for the whole family. The set is colorful, the actors are energetic, and the story is a relatable one for children. Most of all, the delightful story will warm the hearts of young and old.

The John W. Engeman Theater, 250 Main St., Northport will present “Junie B. Jones The Musical” through March 6. Tickets are $15 each. For more information, call 631-261-2900 or visit www.engemantheater.com.

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By Linda M. Toga

The Facts:    I want to leave a significant amount of money to my granddaughter in my will, but I am concerned that she is not particularly good with money.

The Question:  Is there a way I can leave her a bequest but be assured that the money will not be spent foolishly?

The Answer:  Yes, absolutely! Clients frequently express concern that bequests they make in their will may be squandered either because their beneficiaries lack the maturity to handle the funds in a responsible manner or suffer from some sort of substance abuse or addiction that clouds their judgment.

In such circumstances, it is best not to make an outright bequest to the beneficiary but to instead have the funds pass through a testamentary trust that you (the testator) create in your will.

In order to create such a trust in your will, you will need to identify the individuals who are going to be the beneficiaries of the trust, indicate which assets will be held in the trust and name a trustee who will administer the trust. You will also need to set forth the terms of the trust, i.e., how the trust funds are to be used, when distributions will be made to the beneficiaries, whether the trustee has the discretion to withhold or accelerate the distributions, whether distributions are contingent on the performance of the beneficiary and what will happen to the trust assets if the beneficiary dies before the trust terminates.

My clients who want to avoid a beneficiary receiving a large inheritance at an early age generally direct their trustee to distribute all of the trust assets by the time the beneficiary is 30. They sometimes have the trustee make a single distribution of the entire trust corpus at a specific age but, just as often, they spread the distributions out over time. In either case, it appears that the general consensus is that most people have learned to handle money responsibly by the time they reach the age of 30 since most of the testamentary trusts I draft terminate by the time the beneficiary turns 30.

In contrast, clients who have me prepare testamentary trusts for beneficiaries who suffer from substance abuse or addiction often include a provision that directs the trustee to continue making distributions for the lifetime of the beneficiary. Such distributions may be made to the beneficiary directly but, more often than not, the trustee is directed to make payments to third parties on behalf of the beneficiary. For example, the trustee may be directed to pay the beneficiary’s rent or mortgage or to cover the cost of insurance or tuition.

Whether the beneficiary is simply young and inexperienced or dealing with an addiction, my clients generally give their trustee discretion to distribute trust assets to the beneficiary if they believe doing so is in the beneficiary’s best interest.

As mentioned above, a testamentary trust can provide that distributions are conditioned on the performance of the beneficiary. Some people liken this feature to giving the testator the ability to control from the grave.

While that might be true, it should be noted that there are limits to how much control can be maintained from the grave. For example, while a testator can certainly direct his trustee to only distribute the trust assets upon the beneficiary’s graduation from college, he cannot condition distributions on the beneficiary divorcing his/her spouse or only marrying within the faith. Such conditions are against public policy and are unenforceable.

Despite any limitations that might exist, testamentary trusts are incredibly flexible and allow for a great deal of creativity. They can not only protect a testator’s assets from being squandered after his death, but they can protect the beneficiary against his/her own foolishness or bad habits. As such, it would be worthwhile to discuss with an attorney experienced in estate planning whether a testamentary trust is right for you and your granddaughter.

Linda M. Toga provides legal services in the areas of wills and trusts, estate planning and estate administration, marital agreements, small business services, real estate and litigation from her East Setauket office.

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