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Monthly Archives: March 2016

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Technology has made it possible for us to stick both of our virtual feet in our virtual mouths.

Last week, I wrote about poor sportsmanship by a father at a basketball game. Before I started the column, I asked my wife if she thought he might see the article and get upset. She said, “Wait, first, what’s the chance that he’ll look for it; and, second, it’s not like you’re going to be naming names.”

She was right. I wasn’t planning to put his name in the paper or call attention to him. He made a sudden barking noise while one of the players on the other team was about to shoot a free throw. The players on the other team, their coach and, most importantly, the referee took exception to his conduct. The referee ejected him.

Recognizing that there was something to share with TBR readers, I wrote about the incident. I’m sure this gentleman isn’t the only one to cross a line at a child’s sporting event. I’ve heard parents screaming at their kids, at their kids’ coaches, at referees and anyone who will listen in the heat of the moment. After all, these games are critically important. A loss might mean their child only gets a second-place trophy that will collect dust on a shelf somewhere, while a win would mean they would get a slightly bigger trophy that collects slightly more dust on a shelf somewhere else.

I wrote the column, sent it to my editor electronically and went about the usual business of my day. By about 6 p.m., it occurred to me that my editor didn’t acknowledge the column the way she usually does. Then it hit me, like a punch to my stomach. My breathing got shorter and shallower and my hands felt hot and cold at the same time.

With an anxious scowl on my face, I went back to my email “sent” folder and I saw it. “Oh no!” I shouted, stunned by my blunder. You see, my editor and the wife of the man who made a scene at the basketball game have the same first name. I had typed the first three letters of my editor’s name and the computer mischievously misdirected the column. I stand by what I wrote, but I had no intention of sending the column to this man’s wife.

Realizing my error, I frantically called my wife, which compounded my mistake. In the panic of the moment, I dialed my daughter’s cellphone number, who was in the middle of volleyball practice. She raced to call me back in case something was wrong. Something was, indeed, wrong, but I didn’t want to distract her. Forcing myself to try to sound calm, I said something like, “Nah-everything-all-right-bye.”

I finally reached my wife, who patiently talked me back from the ledge. She suggested I write to the man’s wife and tell her that I misfired in my email. It wasn’t the end of the world and, before long, my wife assured me I’d find it funny in a “I can’t believe I really did that” way.

I did what my wife suggested and the man’s wife said she thought I had sent her the column on purpose. I assured her it was a mistake. That’s where the conversation ended.

I have been on the other side of such emails. One of my editors wrote to someone she thought was another editor about how annoyed she was with my story. It’s about 20 years since that email reached me and I had almost forgotten about it … almost.

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By Nancy Burner, Esq.

Each January, the governor of the State of New York puts out a proposed budget from which the legislative and executive branches will base their negotiations to determine a final budget.  The budget is set to be passed by March 31; the date that marks the end of the fiscal year for the state. Just as in years before, our state legislature is in the process of reviewing the proposed budget.

There are several proposals in the budget that, if passed, will have an impact on the Medicaid program as we know it in New York State. Specifically, two in particular will affect married couples in need of care. 

For the 27th year there is a proposal that “spousal refusal” be abolished in the home care Medicaid setting. Spousal refusal is the mechanism by which the spouse of a Medicaid applicant can maintain a Community Spouse Resource Allowance (CSRA) of assets above the Medicaid level as long as the spouse receiving Medicaid maintains assets below the permissible amount of $14,850.00. 

The removal of this provision from our program would not only apply to spouses but to other “legally responsible relatives” including the parents of children in need of the Medicaid program to help pay for the cost of care. The fear of losing the spousal refusal option is that this will force individuals to put a child or spouse in a nursing home in order to maintain enough assets to support themselves or force divorce or separation. 

Compounding the issue of the loss of spousal refusal in the home care setting is the proposal to reduce the CSRA to $23,844.00. Currently, the law in New York states that a spouse can have up to $74,820.00 while the federal maximum is $119,220.00.  Many fear that reducing the CSRA would make it difficult for couples to have a large enough emergency fund, putting them one leaky roof or flooded basement away from impoverishment. 

Oftentimes, the spouse requiring Medicaid may live a long life beyond that of their sick spouse. The loss of these two important parts of our Medicaid program will force the healthy spouse to spend all of their money on the sick spouse and be left without assets to take care of his or her own needs.

Nancy Burner, Esq. practices elder law and estate planning from her East Setauket office.

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The author poses with Tyler Christopher, aka Prince Nikolas Cassadine, of ‘General Hospital.’ Photo by Rebecca Budig

By Kerri Glynn

“5 … 4 … 3 …”

Time to move. Walk through the beaded curtain. Pause by the table. Chat with the bearded man. Exit downstage.

But wait! What’s my motivation?  Who is this man? My husband? Lover? Business partner? What was I doing here in Las Vegas — so far from Port Charles?

I was a cast member on “General Hospital.” Okay. I was an extra. But I’d dreamt about this for 39 years and it was finally happening.

Rewind to November 17, 1981. I was one of 30 million people who watched the wedding of “General Hospital’s”  Luke and Laura. I was directing a high school production of “Barefoot in the Park” and my stage manager brought in a small, portable TV — the kind with rabbit ears — and we halted our rehearsal to watch the nuptials. It was the highest rated hour in American soap opera history, and the super couple ended up on the cover of People and Newsweek magazines. They were credited with taking daytime out of the closet so people were no longer ashamed to say “I watch a soap opera.”

I was never ashamed.

I’ve been watching “General Hospital” on and off since 1967. Sometimes I didn’t see it for weeks, sometimes months, even years. But I’d catch up on holidays and summer vacations, and it was pretty easy to do. So many of the same characters remained; so many story lines were recapped script after script. And there was always the Soap Opera Digest magazine to grab and peruse while waiting for my turn at the supermarket counter.

As an English teacher and Vassar graduate, many of my colleagues were shocked to hear me admit my devotion to the show. Why, I wondered? What did Charles Dickens write that couldn’t be classified as soap opera? For that matter, how different is “Downtown Abbey”? The Crawleys just have a bigger house, better clothes and cooler accents.

But I never imagined the day would come when I would join the cast of my favorite show, and it was the star of that early production of “Barefoot in the Park” who made it happen. My former student is now a writer/actor and good friend of the executive producer of “General Hospital.” When he heard I was visiting LA, he asked if I could be an extra on the soap. The answer was yes and my adventure began.

A week before filming, I was contacted by the casting coordinator. Would I be a patient being wheeled down the hospital hall? Or a barfly at the Metrocourt Hotel, swilling a dirty martini? When I was told  I’d play a guest at an upscale Las Vegas hotel, I was intrigued. A Las Vegas hotel? “General Hospital” takes place in Port Charles, New York. Which characters would be visiting Las Vegas? And what would they be doing there?

I received a list of instructions — everything from a confidentiality clause (in other words, I couldn’t share any knowledge of the plot before the episode was aired) to my wardrobe instructions. Since I don’t tweet and still carry a flip phone, the first instruction was easy to follow. The second was a little harder, but it earned me a $10 wardrobe allowance.

I was due at Prospect Studios in Los Angeles at 2 in the afternoon. Most of the cast had arrived at 7 that morning and wouldn’t leave till 7 that night. After getting my ID badge from the guard, I proceeded to the stage manager’s desk to sign in. Then on to the Business Office with my passport to fill out a W-4. I was going to get paid for this? How cool was that!

The studio has seven sound stages and “Grey’s Anatomy” is another of the shows filmed there. The space was huge and held multiple sets. I could walk past the hospital chapel and the Floating Rib to the Quartermaine mansion. I recognized each one.

The other four extras were sitting in the Green Room where we’d wait for our call. Our names were Hotel Staffer and Guests 1-4. The others were professional actors, struggling to book commercials and dreaming of their big breaks. One of them had punched Luke out in an earlier episode, another had sat at Laura’s table at the Nutcracker Ball. Who would I be acting with? Fifty three scenes were being shot that day, and the characters included Scottie, Franco, Nina, Dante — you’ll recognize all these names if you, too, watch the show. (But don’t admit it.)

Then HE walked in — Tyler Christopher, “Prince Nikolas Cassadine,” the character I’d named my favorite cat after. He’s been on the show for 20 years and I’d long had a crush on him. There he was in the flesh … holding his script and getting a cup of coffee with the rest of us. I got up the courage to do it — to introduce myself and tell him about the cat and he laughed. We talked about his long lost love, “Emily” and how I longed to have her dug up and returned to him. It could happen. Characters have been revived even after they had been shot, drowned, frozen and had their major organs given to other characters. He was joined by his co-star, Rebecca Budig, aka “Hayden,” but formerly “Greenlee” from “All My Children.” She was just as nice and welcoming as Tyler. They promised me a picture after the taping.

So, it was sit and wait, and watch the monitors as other scenes were being filmed in the building. There were two directors working that day and multiple cast members. My 10 scenes would be set in the Las Vegas hotel where Nikolas and Hayden were getting married. I couldn’t have been more excited than if I’d won that Mega Powerball.

So many things surprised me that day — the size of the crew, the speed at which each scene was taped, the actors’ voices that seemed to whisper on set but be clear as a bell on video. People may mock soap opera scripts and actors, but everyone was a consummate professional. An average television series has 13 to 22 episodes, some a half hour, some a whole hour. “General Hospital” shoots about 286 one-hour episodes a year.

When my scene was called, the primary actors walked on set with their scripts in hand. The director told them where to stand and when to move. Then two of us extras were brought in. We were given our instructions. On the count of 3, we entered through the curtain. Chatted. Left. I’ll nail it next time, I thought. I’ll create my own back story. I’ll look for the cameras. I’ll …

“Taping scene 39.”

What?

“5, 4, 3 …”

We enter again. We chat. We leave.

“That’s a take.”

Four times I was called to the set. I sat and pretended to check my iPhone. I crossed the lobby with a blond girl. My daughter? Four hours later, we were thanked and asked to leave. The others did. But Rebecca Budig (bless her heart) remembered the promise and found “Nikolas” for my picture. She even took it.

As I left the studio, I looked at all the photos on the walls — pictures of cast members. The original cast — Dr. Hardy and Nurse Jessie Brewer, the Quartermaine family … and Luke and Laura’s wedding portrait. My life had come full circle. The boy I was directing would grow into a man who made my dream come true. Three weeks later I got to see myself on TV — on my favorite show — with my favorite soap star. And two weeks after that, I received a check in the mail for $260. I’d been paid for two days work because my fourth scene appeared the following day.

I’m not ashamed to say it. I LOVE that show. 

Kerri Glynn is a retired English teacher who has lived in Setauket with her husband Tim for many years. Today she is a writer and tutor as well as the director of education for the Frank Melville Memorial Park.

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Comsewogue school board President John Swenning and Superintendent Joe Rella, along with the rest of the board and administration, have begun 2018-19 budget preparations. File photo by Alex Petroski

If Comsewogue School District wants to maintain all of its academic programs in the coming year, it’s going to need state officials to return aid that was previously taken away.

Superintendent Joe Rella released his first budget draft for the 2016-17 school year at a board of education meeting on Monday night, projecting an $87.2 million spending plan that would keep all existing programs. That budget would represent an increase of about $2 million over the current school year, due in large part to increasing costs in instruction.

But Rella’s proposed budget hinges upon a full restoration of the Gap Elimination Adjustment, a deduction of state aid taken from all New York school districts, enacted several years ago in an effort to close a state budget deficit.

State Sen. John Flanagan (R-East Northport), his chamber’s majority leader, recently sponsored legislation that would completely eliminate the adjustment in the next school year, though nothing is set in stone — his bill, S6377, passed in the Senate in January but has yet to come to a vote in the Assembly.

Comsewogue is not alone; school districts statewide are counting on a full restoration of the GEA this year due to a relatively low state-mandated cap on tax levy increases, which limits the amount of property taxes districts can collect and is largely determined each year by the rate of inflation. Before exemptions for a few items, such as spending on capital projects, school districts are looking at a 0.12 percent limit on how much they can add to their tax levies next year.

Comsewogue’s exempted spending, which includes funds to replace the roof at Clinton Avenue Elementary School, brings its proposed tax levy increase to 1.2 percent.

Restored state aid from the GEA could be crucial for some.

“If that doesn’t happen, then it’s a whole different world,” Rella said in an interview. “We’re anticipating it will happen. Albany’s been very quiet about it, and I’m taking that as ‘no news is good news.’”

Rella’s proposal suggests there would be cuts to staffing, including teachers, coaches and aides, as well as clubs, supplies and athletics if the schools don’t receive that additional state aid. His presentation also says Comsewogue would have to use $425,000 in reserves to help fund whatever is left.

If the state funding does come in, according to his proposal, the district would receive about $30 million in total state aid, which is an increase of $1.9 million over the current year.

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By Kevin Redding

“We have a problem, and that problem is heroin. It’s a harsh reality.”

Setauket Fire Commissioner Jay Gardiner spoke at length about the heroin and opiate addiction issue that has swept Suffolk County at a Three Village Civic Association meeting at the Emma S. Clark Library on Monday night.

As guest speaker, Gardiner addressed the importance of having a dialogue with teens and children about the dangerous consequences of these specific drugs and staying on top of how much medication people consume to avoid overdoses. Gardiner also said it was important that residents recognize why heroin has become so prevalent.

According to Gardiner, the county’s affluence plays a large factor.

“Among the most common hard drugs, including methamphetamine and crack, heroin is the most expensive,” Gardiner said. “Out on the South Shore and other areas on Long Island that have different financial demographics, cheap drugs like methamphetamine and crack are much more obtainable while heroin isn’t. High schoolers and college students in Suffolk County, whose ages make up the majority of users, might have an ability to buy the more expensive drug.”

In the United States, drug overdose deaths have exceeded car crashes as the number one cause of injury death, according to U.S. Sen. Chuck Schumer (D-N.Y.). Two Americans die of drug overdoses every hour and 2,500 youths aged between 12 and 17 abuse prescription drugs for the first time every day. According to the Centers for Disease Control and Prevention (CDC), opioids — a class of drugs that include prescription pain medications and heroin — were involved in 28,648 deaths nationwide in 2014.

Gardiner admitted that he can’t lecture on how to control every North Shore kid’s behavior, however, and steered his presentation less on how to prevent the drug use and more on how to recognize when somebody is experiencing an overdose and being able to take the appropriate steps to save their lives. He specifically focused on using the anti-opiate overdose antidote Naloxone, sold under the brand name Narcan.

Gardiner said he knows of hundreds of cases just last year in which Narcan saved someone’s life from overdose in Suffolk County, and said that number is growing exponentially.

“We use this atomizing medication Narcan when the person we see is not responding,” said Gardiner, who demonstrated how to exert the intranasal spray into each of the patient’s nostrils. “You will revive these patients, if you’re fortunate enough to be in the right place at the right time, in minutes. We use the nose because it’s a large area where it will be absorbed to the bloodstream and remove the opiate effects in that bloodstream quickly.”

As Gardiner explained in his presentation, it’s nearly impossible to find an IV on a patient who has just overdosed because the veins are often badly sclerosed, as indicated by track marks all over the arm. On top of a quick and effective route for absorption, by using the nose as an entry, there’s a much lower risk of exposure to blood.

Because Narcan is also effective against more commonly taken opiate drugs, pain reducers like morphine, oxycodone and fentanyl, older people especially should be aware of how it’s used in a worst case scenario where too many pills are taken to subside an excruciating pain, and an overdose occurs.

Shawn Nuzzo, president of the Three Village Civic Association who brought Gardiner in to speak, says that despite the war on drugs in our country being a failure socially and medically, normal everyday people can make a difference now.

“It’s like having a fire extinguisher in your house,” said Nuzzo. “It’s not gonna fix faulty wiring, but it’s good to have it there if you need it. It’s so important that people learn how to use antidotes like this. People need to learn how to use a fire extinguisher and they need to learn how to use Narcan.”

Earlier this month, New York Gov. Andrew Cuomo announced that pharmacies across New York State would be providing Narcan to its customers without prescription, making it an extremely convenient and important addition to every resident’s medicine cabinet.

“Addiction’s an illness,” Gardiner said. “If you’re a diabetic, you carry insulin. If you’re bipolar, you have drugs to treat bipolar illness. We can’t treat addiction with drugs but we can certainly have these things around in case of an emergency because it is an illness and it’s so important to have this in your home. We can’t cure the addiction, but we can save the life even if it’s only temporarily.”

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Port Jefferson's Matteo DeVincenzo, left, grapples with his Locust Valley opponent Hunter Dusold in the New York State finals matchup. DeVincenzo edged out Dusold, 2-1, for his second state championship crown. Photo by Luci DeVincenzo

Matteo DeVincenzo felt relieved.

As the clock wound down and the whistle blew, the 126-pound Port Jefferson powerhouse put another state championship title in the record books with a 2-1 victory over Locust Valley’s Hunter Dusold.

Matteo DeVincenzo hugs head coach Mike Maletta after earning his second New York State championship crown. Photo by Luci DeVincenzo
Matteo DeVincenzo hugs head coach Mike Maletta after earning his second New York State championship crown. Photo by Luci DeVincenzo

“I expected to win, so it wasn’t surprising, but it felt good,” DeVincenzo said. “Overall, I wrestled real solid and dominated up until the finals.”

That focus and determination from day one led the Royal to an undefeated season. DeVincenzo was 32-0 heading into the state championship bracket. The first upstate challenger he faced he topped 12-2; the second match, a Section X grappler, he ruled over 9-1; the third, a Section III opponent he outscored 8-4. The finals win against Dusold capped it all off for a perfect 36-0 season.

“This whole year has been about domination and preparation, so I’d say no matter where I was in the bracket I would’ve had the same outlook,” he said.

But the senior and his coaches Mike Maletta, Ian Schneider and Nick Miceli were happy to see him avenge his state semifinal loss from last season, to once again stand atop the New York podium.

“This was really his last time wrestling in New York so we knew of the significance of it and it being special,” head coach Maletta said. “Matteo is one of the best of the best. He was unstoppable.”

Schneider, the team’s assistant coach, said being just 23 years old and having the opportunity to coach in the state championship was a phenomenal feeling.

Port Jefferson's Matteo DeVincenzo, right, sizes up his competitor Hunter Dusold of Locust Valley. Photo by Luci DeVincenzo
Port Jefferson’s Matteo DeVincenzo, right, sizes up his competitor Hunter Dusold of Locust Valley. Photo by Luci DeVincenzo

“It was absolutely incredible to watch him do what he does best on the wrestling mat,” he said. “It was exciting, it was nerve-racking, it was all the emotions that ended joyously with him coming out on top. I may not ever coach a kid of his caliber in any sport again. I hope to have that, but he’s one of a kind and he’s something else as a person, as an individual and as a wrestler. He’s one of those rare gems that are out there. It was an absolute honor to coach him.”

Besides the four-time Suffolk County and two-time Eastern States champion, the Royals also sent two other wrestlers to Albany.

Sophomore 120-pounder Joe Evangelista and freshman 99-pounder Ricky D’Elia garnered some extra experience battling the bracket. Evangelista, a three-time All-County wrestler who became a county champion this year and finished with a 22-10 record, had to battle two tough All-State kids. D’Elia, who ended the season 25-7, made a couple of mistakes in a 5-3 first-round loss that sent him to the wrestlebacks.

“For their first time, it was cool for them to see the process for themselves and for Matteo,” Maletta said.

Matteo DeVincenzo has his arm raised by the referee after winning his New York State championship finals matchup. Photo by Luci DeVincenzo
Matteo DeVincenzo has his arm raised by the referee after winning his New York State championship finals matchup. Photo by Luci DeVincenzo

Although DeVincenzo will take one final trip with his coach, and D’Elia, to Virginia for nationals, but then the senior star is taking his talents to the mats of Princeton University. In college-level wrestling he will join his older brother, Tristin, who wrestles at the University of Pennsylvania, and another former Royal, Paul Cavanagh, who competes for the U.S. Merchant Marine Academy.

The Royals had 11 All-County wrestlers this season. In addition to the three who traveled upstate, Brendan Rodgers, Robbie Williams, Vin Miceli, Joe Longo, Alex Frohnen, Dallas Brett, Jack Collins and Ryan Walsh all earned the accolade.

“I’m proud of what we’re doing here at Port Jeff and people notice us — from the biggest school in Suffolk County to the smaller schools that we wrestle with,” Maletta said. “They know if they’re competing against a kid with a Port Jeff singlet, they’re going to be prepared.”

Seven of those 11 will be returning to the roster next season. And with a young squad that will not soon graduate, the Royals expect only to gain players over the next two seasons.

“We’re moving in the right direction,” Schneider said. “Our middle school program has a bunch of kids where we’ve lacked in the upper weight classes, so when we can fill out the lineup we’ll be that much harder to beat.”

Maletta has enjoyed his time with his grand grappler, and hopes for even bigger and better things in the future.

“I’m 45 years old and there’s been great days in my life — getting married and having kids — but putting on my suit and heading down to see Matteo be crowned a state champion was pretty special, and I’m thankful that Matteo was brought into our lives and into our wrestling room at Port Jeff,” he said. “We put a lot of effort into this and I’m aware that many coaches don’t get to coach a Matteo. I’ve been coaching for 20 years and this is a kid that will be linked with me forever.”

Matteo DeVincenzo stands atop the 126-pound competitors. Photo by Luci DeVincenzo
Matteo DeVincenzo stands atop the 126-pound competitors. Photo by Luci DeVincenzo

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By Fr. Francis Pizzarelli

The primary season that will ultimately determine who the candidates are for the next presidential election is moving forward with great speed. The money being spent on political propaganda is out of control. It could probably feed and house the homeless for at least a year.

On many levels it is a tragic waste of money that could be better spent on social programs to help the poor and/or the growing number of drug addicts in our country.

So much of the political literature is a creative repackaging of the old rhetoric that has painfully put us in the position we are in today.

Senator Bernie Sanders from Vermont is a breath of fresh air. His passion for the people of our nation is refreshing. His commitment to high ideals, to economic equity and to respect for the human rights of all is refreshing. His courage is shaping our national social agenda!

Sanders is urging us to debate ideas outside the box. Agree or respectfully disagree with the solutions — but allow these kinds of conversations to invigorate our civic life.

The Sanders’ candidacy has provoked young and old alike to get involved with the election of the next president, to take back our government and to let it once again be a government for the people and by the people. His challenging ideas are causing many of us to stop and think about what is really important to all Americans. He is urging us to dream again and genuinely believe that American dreams can come true.

Besides the profound waste of money on “ad hominem attacks,” the language and tone of this year’s presidential campaign is scandalous. It is outright disrespectful, and the attacks on a person’s character and the attacks on groups of people are reprehensible and embarrassing; and people wonder why so many of our youth are out of control.

Hopefully, once the candidates for the White House are determined, they will refocus the campaign and return to civility and respect and challenge the nation with ideas that will build a stronger America. Although the political landscape is pretty disturbing, people never stop amazing me and renewing and strengthening my hope that people really do care.

At the end of January there was a striking headline in the news that said “I forgive you!” A cardiologist from our larger community under the influence of alcohol in the early hours of the morning struck and killed an extraordinary woman. She was married with children and was a very active woman within our larger community.

At his sentencing the doctor, who also is an extraordinary person, expressed his profound remorse for what he had done to this family. The family stood before the court and the oldest son said, “You’re still a great doctor. You’re still a great man — I forgive you!”

That act of compassion and forgiveness is extraordinary. This remarkable family has profoundly reminded us that good people unfortunately make horrific mistakes but are still good people and deserve a second chance at redemption.

Fr. Pizzarelli is the director of Hope House Ministries in Port Jefferson. The opinions of columnists are their own. They do not speak for the paper.

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Stock photo

Reflux (GERD) disease, sometimes referred to as heartburn, though this is more of a symptom, is one of the most commonly treated diseases. Continuing with that theme, proton pump inhibitors (PPIs), which have become household names, are one of the top-10 drug classes prescribed or taken in the United States. In fact, CDC data shows that use has grown precipitously in the last 10 years in those ages 55 to 64, from 9 percent of the population to 16 percent (1). This is a 78 percent increase in the number of prescriptions for these drugs.

In 2010, there were 147 million prescriptions filled for PPIs (2). The class of drugs includes Prevacid (lansoprazole), Prilosec (omeprazole), Nexium (esomeprazole), Protonix (pantoprazole) and Aciphex (rabeprazole). This growth may not capture the fact that several of these medications are now available over the counter.

I remember when PPIs were touted as having one of the cleanest side-effect profiles. This may still be true, if we are using them correctly for reflux disease. They are supposed to be used for the short term. This can range from 7 to 14 days for over-the-counter PPIs to 4 to 8 weeks for prescription PPIs.

Why did we not know that this class of drugs might be associated with chronic kidney disease, dementia, bone fractures and Clostridium difficile (a bacterial infection of the gastrointestinal tract) before they were approved? Well, if you look at the manufacturers’ package inserts for these drugs, the trials, such as for Protonix, were no longer than a year (3), yet we are putting patients on these medications for decades. And the longer people are on them, the more complications arise.

Typical symptoms of reflux are heartburn and/or regurgitation. Atypical symptoms include coughing and throat clearing. But these atypical symptoms may not be as common as you might think. In fact, in one study, coughing and throat clearing taken together only resulted in a very small portion of patients having reflux disease (4). Having one of these two symptoms showed a slightly higher risk of reflux, but very modest.

Let’s look at some of the research.

Though PPIs may increase the risk of a number of complications, keep in mind that none of the data are from randomized controlled trials (RCTs), which are the gold standard of studies, but mostly observational studies that suggest an association, but not a link. Long-term RCTs to determine side effects are prohibitively expensive.

PPI and kidney disease

In two separate studies, results showed that there was an increase in chronic kidney disease with prolonged PPI use (5). All of the patients started the study with normal kidney function based on glomerular filtration rate (GFR). In the Atherosclerosis Risk in Communities (ARIC) study, there was a 50 percent increased risk of chronic kidney disease, while the Geisinger Health System cohort study found there was a modest 17 percent increased risk. The first study had a 13-year duration, and the second had about a six-year duration. Both demonstrated a modest, but statistically significant, increased risk of chronic kidney disease. But as you can see, the medications were used on a chronic basis for years. In an accompanying editorial to these published studies, the author suggests that there is overuse of the medications or that they are used beyond the resolution of symptoms and suggests starting with diet and lifestyle modifications as well as a milder drug class, H2 blockers (6).

PPI and dementia

A recent German study looked at health records from a large public insurer and found there was a 44 percent increased risk of dementia in the elderly who were using PPIs, compared to those who were not (7). These patients were at least age 75. The authors surmise that PPIs may cross the coveted blood-brain barrier and have effects by potentially increasing beta-amyloid levels, markers for dementia. With occasional use, meaning once every 18 months for a few weeks to a few months, there was a much lower increased risk of 16 percent. The researchers also suggested that PPIs may be significantly overprescribed in the elderly. Unfortunately, there were confounding factors that may have conflated the risk, such as multiple drug use, having diabetes, or patient also having depression or a stroke history. Researchers also did not take into account family history of dementia, high blood pressure or excessive alcohol use, all of which have effects on dementia occurrence.

PPI and bone fractures

In a recent meta-analysis (a group of 18 observational studies), results showed that PPIs can increase the risk of hip fractures, spine fractures and any-site fractures (8). Interestingly, when it came to bone fractures, it did not make a difference whether patients were taking PPIs for more or less than a year. How much less than a year was not delineated. They found increased fracture risks of 58, 26 and 33 percent for spine, hip and any site, respectively. It is not clear what may potentially increase the risk; however, it has been proposed that it may have to do with calcium absorption through the gut. PPIs reduce the amount of acid, which may be needed to absorb insoluble calcium salts. In another study, seven days of PPIs were shown to lower the absorption of calcium carbonate supplements when taken without food (9).

Need for magnesium

PPIs may have lower absorption effects on several electrolytes including magnesium, calcium and B12. There were two recent studies on magnesium. In one observational study, PPIs combined with diuretics caused a 73 percent increased risk of hospitalization due to low magnesium (10). Diuretics are water pills that are commonly used in disorders such as high blood pressure, heart failure and swelling.

Another study confirmed these results. In this second study, which was a meta-analysis (a group of nine studies), PPIs increased the risk of low magnesium in patients by 43 percent, and when researchers looked only at higher quality studies, the risk increased to 63 percent (11). The authors note that a significant reduction in magnesium could lead to cardiovascular events.

The bottom line is even though some PPIs are over-the-counter and some are prescription medications, it is best if you confer with your doctor before starting them. You may not need PPIs, but rather a milder medication referred to as H2 blockers (Zantac, Pepcid). Even better, start with lifestyle modifications including diet, not eating later at night, raising the head of the bed, losing weight and stopping smoking, if needed, and then consider medications (12). If you do need medications, know that PPIs don’t give immediate relief and should only be taken for a short duration: 7 to 14 days, according to the FDA (13), without a doctor’s consult, and 4 to 8 weeks with one. Most of the problems occur with long-term use.

References:

(1) cdc.gov. (2) PLoS Med. 2014;11(9):e1001736. (3) protonix.com. (4) J Clin Gastroenterol. Online Jul 18, 2015. (5) JAMA Intern Med. 2016;176(2). (6) JAMA Intern Med. 2016;176(2):172-174. (7) JAMA Neurol. online Feb 15, 2016. (8) Osteoporos Int. online Oct 13, 2015. (9) Am J Med. 118:778-781. (10) PLoS Med. 2014;11(9):e1001736. (11) Ren Fail. 2015;37(7):1237-1241. (12) Am J Gastroenterol 2015; 110:393–400. (13) fda.gov.

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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From left, Hans Paul Hendrickson, Steven Uihlein, Andrew Gasparini and Dana Bush in a scene from ‘The Adventures of Peter Rabbit.’ Photo by Peter Lanscombe, Theatre Three Productions, Inc.

By Heidi Sutton

When Theatre Three announces the return of a perennial favorite, “The Adventures of Peter Rabbit,” everyone knows that spring is just around the corner. Even more fitting, this year marks 150 years since the birth of Beatrix Potter, who created all of the wonderful characters in the production, from Mrs. Rabbit, Flopsy, Mopsy and Cotton-Tail to Peter Rabbit, Benjamin Bunny and the McGregors. Written by Jeffrey E. Sanzel and the late Brent Erlanson, the show mimics Potter’s “The Tale of Peter Rabbit” closely with a kinder, softer story line. Sanzel directs a talented cast of eight adult actors to bring us this delightful musical that has become a wonderful tradition for families all over the Island.

The cast of ‘The Adventures of Peter Rabbit.’ Photo by Peter Lanscombe, Theatre Three Productions Inc.
The cast of ‘The Adventures of Peter Rabbit.’ Photo by Peter Lanscombe, Theatre Three Productions Inc.

The story follows a mischievous Peter Rabbit who, because of his insatiable appetite for parsley, cucumbers, tomatoes, string beans and lettuce, is constantly drawn to Mr. McGregor’s garden despite his mother’s wishes. Many trips to the garden patch with his cousin, Benjamin Bunny, eventually wear down the farmer’s patience, ending in a great chase scene through the theater, which is reenacted in slow motion later on.

The show opens with a sweet rendition of “Morning” by Mrs. Rabbit, played by Amanda Geraci, and never loses its momentum. Marquéz Catherine Stewart, Jenna Kavaler and Melanie Acampora are the good little bunnies Flopsy, Mopsy and Cotton-Tail, respectively, who spend most of the show trying to find their “wayward brother” Peter, played with unbounded energy by Hans Paul Hendrickson. Dana Bush returns as a patient Mrs. McGregor after a few year’s absence and Andrew Gasparini tackles the role of Mr. McGregor for the very first time, playing the stingy and cranky farmer perfectly, sans the desire to eat the rabbits. Steven Uihlein, who plays the role of cousin Benjamin Bunny, rounds out the cast and does a terrific job.

Imagination plays a big part in the show, as the set design is sparse, utilizing a trapdoor on stage as a rabbit hole and constructing a makeshift scarecrow. Costumes, designed by Teresa Matteson, are on point, from Mr. McGregor’s overalls to the little white tails on the rabbits. Kudos to Michelle Manda for a terrific job on the lighting, especially during a Mission Impossible scene when Peter and Benjamin attempt to retrieve Peter’s clothes from the scarecrow.

The musical numbers, written by Kevin F. Story and accompanied on piano by Steve McCoy, are all showstoppers, especially “One More Time Around,”  “Beware! Mr. McGregor!” and “Peter’s Socks,” which Stewart, also the choreographer, has converted to a fun hip-hop piece. All of the songs are incorporated into the finale, a perfect ending to a Theatre Three classic.

Souvenir bunnies in various colors are up for sale during intermission, and the entire cast is in the lobby after the show for a meet-and-greet.

Theatre Three, 412 Main St., Port Jefferson will present “The Adventures of Peter Rabbit” through March 26. Children’s theater will continue on the Mainstage with “Cinderella” from April 16 to June 11, “The Emperor’s New Clothes” from July 8 to Aug. 5 and “The Misadventures of Robin Hood” from Aug. 5 to 13. All seats are $10. For more information, call the box office at 631-928-9100 or visit www.theatrethree.com.

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Steven Matz winds up. Photo by Clayton Collier

Steven Matz became the first member of the Mets’ young rotation to take the mound in a Florida Grapefruit League game Monday against the St. Louis Cardinals at Roger Dean Stadium in Jupiter.

The former Ward Melville star breezed through the first two innings before allowing a run in the third.

He walked two during his three-
inning stint and struck out the side in the second on only 12 pitches.

Matz was battling against Cardinals ace Adam Wainwright, who walked three in two scoreless innings, gave up two hits and struck out two.

The Mets chose to delay their rotation a week in an effort to make sure each pitcher was strong for their first spring-training start, which will be a scheduled three innings this year rather than the typical two. As a result, the Mets hope to be sharper at an earlier date, and Matz looked that way, with a responsive curveball and a fastball in the mid-90s.

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