Yearly Archives: 2017

Arthritis, a history of stroke and Parkinson’s disease can contribute to fall risk.
Increased risk can begin at the age of 45

By David Dunaief, M.D.

Dr. David Dunaief

When we are young, falls usually do not result in significant consequences. However, when we reach middle age and chronic diseases become more prevalent, falls become more substantial. And, unfortunately, falls are a serious concern for older patients, where consequences can be devastating. They can include brain injuries, hip fractures, a decrease in functional ability and a decline in physical and social activities (1). Ultimately, falls can lead to loss of independence (2).

Of those over the age of 65, between 30 and 40 percent will fall annually (3). Most of the injuries that involve emergency room visits are due to falls in this older demographic (4).

What can  increase the risk of falls?

Many factors contribute to fall risk. A personal history of falling in the recent past is the most prevalent. But there are many other significant factors, such as age; being female; and using drugs, like antihypertensive medications used to treat high blood pressure and psychotropic medications used to treat anxiety, depression and insomnia.

Chronic diseases, including arthritis, as an umbrella term; a history of stroke; cognitive impairment and Parkinson’s disease can also contribute. Circumstances that predispose us to falls also involve weakness in upper and lower body strength, decreased vision, hearing disorders and psychological issues, such as anxiety and depression (5).

How do we prevent falls?

Fortunately, there are ways to modify many risk factors and ultimately reduce the risk of falls. Of the utmost importance is exercise. But what do we mean by “exercise”? Exercises involving balance, strength, movement, flexibility and endurance, whether home based or in groups, all play significant roles in fall prevention (6). We will go into more detail below.

Many of us in the Northeast suffer from low vitamin D, which may strengthen muscle and bone. This is an easy fix with supplementation. Footwear also needs to be addressed. Nonslip shoes, if recent winters are any indication, are of the utmost concern. Inexpensive changes in the home, like securing area rugs, can also make a big difference.

Medications that exacerbate fall risk

There are a number of medications that may heighten fall risk. As I mentioned, psychotropic drugs top the list. Ironically, they also top the list of the best-selling drugs. But what other drugs might have an impact?

High blood pressure medications have been investigated. A propensity-matched sample study (a notch below a randomized control trial in terms of quality) showed an increase in fall risk in those who were taking high blood pressure medication (7). Surprisingly, those who were on moderate doses of blood pressure medication had the greatest risk of serious injuries from falls, a 40 percent increase. One would have expected those on the highest levels to have the greatest increase in risk, but this was not the case.

While blood pressure medications may contribute to fall risk, they have significant benefits in reducing the risks of cardiovascular disease and events. Thus, we need to weigh the risk-benefit ratio, specifically in older patients, before considering stopping a medication. When it comes to treating high blood pressure, lifestyle modifications may also play a significant role in treating this disease (8).

Where does arthritis fit into this paradigm?

In those with arthritis, compared to those without, there is an approximately two-times increased risk of two or more falls and, additionally, a two-times increased risk of injury resulting from falls, according to the Centers for Disease Control and Prevention (1). This survey encompassed a significantly large demographic; arthritis was an umbrella term including those with osteoarthritis, rheumatoid arthritis, gout, lupus and fibromyalgia.

Therefore, the number of participants with arthritis was 40 percent. Of these, about 13 percent had one fall and, interestingly, 13 percent experienced two or more falls in the previous year. Unfortunately, almost 10 percent of the participants sustained an injury from a fall. Patients 45 and older were as likely to fall as those 65 and older.

Why is exercise critical?

All exercise has value. A meta-analysis of a group of 17 trials showed that exercise significantly reduced the risk of a fall (9). If the categories are broken down, exercise had a 37 percent reduction in falls that resulted in injury and a 30 percent reduction in those falls requiring medical attention. Even more impressive was a 61 percent reduction in fracture risk.

Remember, the lower the fracture risk, the more likely you are to remain physically independent. Thus, the author summarized that exercise not only helps to prevent falls but also fall injuries. The weakness of this study was that there was no consistency in design of the trials included in the meta-analysis. Nonetheless, the results were impressive.

Unfortunately, those who have fallen before, even without injury, often develop a fear that causes them to limit their activities. This leads to a dangerous cycle of reduced balance and increased gait disorders, ultimately resulting in an increased risk of falling (10).

What specific types of exercise are useful?

Many times, exercise is presented as a word that defines itself. In other words: Just do any exercise and you will get results. But some exercises may be more valuable or have more research behind them. Tai chi, yoga and aquatic exercise have been shown to have benefits in preventing falls and injuries from falls.

A randomized controlled trial, the gold standard of studies, showed that those who did an aquatic exercise program had a significant improvement in the risk of falls (11). The aim of the aquatic exercise was to improve balance, strength and mobility. Results showed a reduction in the number of falls from a mean of 2.00 to a fraction of this level — a mean of 0.29. There was no change in the control group.

There was also a 44 percent decline in the number of patients who fell. This study’s duration was six months and involved 108 postmenopausal women with an average age of 58. This is a group that is more susceptible to bone and muscle weakness. Both groups were given equal amounts of vitamin D and calcium supplements. The good news is that many patients really like aquatic exercise.

Thus, our best line of defense against fall risk is prevention. Does this mean stopping medications? Not necessarily. But for those 65 and older, or for those who have “arthritis” and are at least 45 years old, it may mean reviewing your medication list with your doctor. Before considering changing your BP medications, review the risk-to-benefit ratio with your physician. The most productive way to prevent falls is through lifestyle modifications.

References: (1) MMWR. 2014; 63(17):379-383. (2) J Gerontol A Biol Sci Med Sci. 1998;53(2):M112. (3) J Gerontol. 1991;46(5):M16. (4) MMWR Morb Mortal Wkly Rep. 2003;52(42):1019. (5) JAMA. 1995;273(17):1348. (6) Cochrane Database Syst Rev. 2012;9:CD007146. (7) JAMA Intern Med. 2014 Apr;174(4):588-595. (8) JAMA Intern Med. 2014;174(4):577-587. (9) BMJ. 2013;347:f6234. (10) Age Ageing. 1997 May;26(3):189-193. (11) Menopause. 2013;20(10):1012-1019.

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, visit www.medicalcompassmd.com or consult your personal physician.

Humphrey Bogart and Ingrid Bergman star in ‘Casablanca.’
‘Here’s looking at you, kid’

In celebration of its 75th anniversary, “Casablanca” will return to select movie theaters nationwide on Sunday, Nov. 12 and Wednesday, Nov. 15, courtesy of Fathom Events, Turner Classic Movies and Warner Bros. The screening will include an exclusive commentary from TCM Host Ben Mankiewicz who will give insight into this classic film.

Paul Henreid and Humphrey Bogart in a scene from ‘Casablanca’

Considered one of Hollywood’s greatest and most iconic films, “Casablanca” won an Academy Award for Best Picture, Best Director Michael Curtiz and Best Adapted Screenplay by Julius J. Epstein, Philip G. Epstein and Howard Koch. Set against the backdrop of World War II, the 1942 classic stars Humphrey Bogart as Rick Blaine, the owner of a nightclub in Vichy-controlled Casablanca, whose life changes forever when his lost love, Ilsa (Ingrid Bergman), walks into his club and back into his life.

Participating movie theaters in our neck of the woods include AMC Loews Stony Brook 17 (at 2 and 7 p.m. on both days); Farmingdale Multiplex Cinemas (at 2 p.m. on Nov. 12 and at 2 and 7 p.m. on Nov. 15); and Island 16 Cinema de Lux in Holtsville (at 2 p.m. on Nov. 12 and at 2 and 7 p.m. on Nov. 15). To purchase your ticket in advance, visit www.fathomevents.com.

Photos courtesy of Warner Bros. Home Entertainment

Above from left, Paloma Papageorge, Jaden Chimelis, Irene Ruddock and Will Boonin
Honored Artist Muriel Mussara.

ART FOR A LIFETIME The Setauket Artists’ Exhibition, now in its 37th year, held an opening reception at the Setauket Neighborhood House on Oct. 22. Longtime member Muriel Mussara was this year’s Honored Artist, an award chosen by her peers, while art scholarships in memory of artists JoAnn Coaine, Burton Woods and Andrew Schmitt were awarded to Setauket Elementary School students Paloma Papageorge, Jaden Chimelis and Will Boonin. Coordinated by Irene Ruddock, the exhibit, which features the works of over 40 artists, will run through Nov. 20 with viewing daily from 10 a.m. to 5 p.m.

Photos by Marlene Weinstein

Many boomers plan on using their assets to make their golden years golden.

By Linda M. toga, Esq.

Linda M. Toga, Esq.

THE FACTS: My husband and I are in our sixties and have three grown children. All were given the same opportunities growing up, but they did not all take advantage of those opportunities or make wise decisions about their futures. Our two daughters are financially secure and doing very well. Our son, however, has struggled and we expect will continue to struggle to make ends meet his entire life.

My husband and I have accumulated significant assets over the years. We have been generous to our children and have made an effort to treat them all the same despite the differences in their financial well-being.

Despite this fact, my son seems to be under the impression that because he needs more, he is entitled to more. He has made comments on a number of occasions suggesting that since we have the means to make his life easier, we should do so. It is clear that he expects that we will be leaving him a sizable inheritance, perhaps even more than we leave our daughters.

We are bothered by these comments for a number of reasons, not the least of which is that my husband and I are planning on using our hard earned money to travel and, if needed, to cover our health care costs. While we fully expect that all of our children will inherit some money from us, I do not believe that we will be leaving any of them substantial assets.

THE QUESTION: How do we make this clear to our son who seems to think he will see a windfall when we die?

THE ANSWER: You and your husband are not alone in having accumulated significant assets that you hope to spend on yourselves. Many boomers benefited by parents who were conservative savers and cautious spenders. Consequently, these parents often accumulated more wealth than they spent and passed that wealth on to their boomer children.

The boomers, on the other hand, may not have been such conscientious savers. Even if they were, they are finding that they are living longer, may need more money for health care and often believe that they need not leave substantial assets to their children since they did so much for them during their lives.

Like you and your husband, many boomers plan on using their assets to make their golden years golden. That is your right. You earned it. You can spend it. However, if you do not want your son to be surprised or resentful when he does not inherit the kind of money he may expect will be coming his way, the best thing to do is to tell him outright.

Perhaps you can share with him the choices you made over the years that resulted in having a significant nest egg. Then tell him how you hope to spend your hard earned money on yourselves while you enjoy a long and healthy life.

You may discover that the comments he has made about a large inheritance were made in jest and that he isn’t really counting on a windfall. That would be the best scenario.

Even if he expresses disappointment and/or anger, you and your husband should feel better about the fact that you were open and honest with him. He can ignore what you say or he can use what you tell him to better plan for his future. In either case, having the conversation will ensure that when you and your husband pass away, he is not blindsided.

Linda M. Toga provides personalized service and peace of mind to her clients in the areas of elder law, estate administration and estate planning, real estate, marital agreements and litigation. Visit her website at www.lmtogalaw.com or call 631-444-5605 to schedule a free consultation.

Abstract artist Peter Galasso’s Setauket studio will be one of the stops on the tour. Photo from Peter Galasso

By Heidi Sutton

The North Shore is teeming with talented artists and local venues like the Mills Pond House Gallery, the Reboli Center for Art and History, The Long Island Museum, Gallery North, the Port Jefferson Village Center and libraries are more than eager to show off their artwork. But what if you could hit the rewind button and observe the artist working on the piece right before your eyes?

That rare opportunity will arise this weekend as the North Shore Artist Coalition hosts its second annual Artist Open Studio Tour.

Doug Reina will be working on a painting during the tour. Photo from Doug Reina

The self-guided event will offer an intimate glimpse into the working studios of 11 award-winning artists living in Miller Place, St. James, Setauket, Port Jefferson and Stony Brook, giving visitors a personal opportunity to meet and talk with artists about their work and the creative process.

The coalition, whose core artist group is Nancy Bueti-Randall, Mary Jane van Zeijts, Jim Molloy, Doug Reina and Pam Brown, formed last year to contribute to the community through exhibitions, open studio tours and educational programs. “Fundamentally we believe the arts improve our lives and enrich our communities culturally, socially and economically. As well our mission is to promote and increase regional awareness of professional artists working in a wide range of styles and studio practices,” said Brown in a recent email.

Artists Peter Galasso, Kelynn Z. Adler, Sungsook Setton, Christian White, Hugh McElroy and Marlene Weinstein were invited to participate in this year’s tour.

Artist Pam Brown’s studio is one of the stops on the tour. Photo from Pam Brown

“Each year we invite artists from the Three Village and surrounding areas [to join us],” Brown explained. “Our goal is to invite more artists each year as the Studio Tour grows.” In addition to the Artist Studio Tour, the group aims to have yearly pop-up exhibitions. This past June, Mary Jane van Zeijts hosted an exhibition at her Setauket studio titled Five @ 268 Art on Main that featured the core group. Upcoming projects include a curated exhibition of the Artists in the Studio Tour. “Currently we are looking for exhibition spaces in our local area,” said Brown.

At each studio, which can be in a backyard barn, garage, house, storefront or outdoor space, visitors will be able to talk freely with the artists and ask questions about their approach and individual styles to making art. “They can visit as long as they like,” said Brown. “Additionally some of the artists will be doing demonstrations and talking directing about their processes and the materials they use.”

Visitors can also expect to see a variety of artwork on display including original paintings, sculptures, ceramics, pastels, photographs, prints and textiles. Additionally, artwork will be for sale.

Brown is hoping to attract even more visitors to this year’s event. “Last year’s Studio Tour was very successful and well-attended, we received positive feedback from local art organizations and other cultural venues, plus we had incredible support from fellow artists, friends and our community at large,” she said.

“It is our hope that people walk away with a deeper meaning and understanding of art, the Artist, and the important role that art plays in our community.”

The North Shore Artist Coalition’s Artist’s Open Studio Tour will be held on Saturday, Nov. 11 and Sunday, Nov. 12 from 11 a.m. to 5 p.m. The event will be held rain or shine and admission is free. Refreshments will be served at several studios. For a list of the 11 locations, visit www.facebook.com/NorthShoreArtistCoalition. For more information, call 631-834-9036.

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MEET BLUE! This sweet and energetic puppy is Blue. An 8-month-old male husky mix, he just recently came from Puerto Rico to Kent Animal Shelter and he is looking for a loving home with a big backyard to run and play for the rest of his days. One look into his blue and brown eyes and you will be hooked! Blue comes neutered, microchipped and up to date on all his vaccines. Kent Animal Shelter is located at 2259 River Road in Calverton. For more information on Blue and other adoptable pets at Kent, please call 631-727-5731 or visit www.kentanimalshelter.com.

Update: Blue is still available for adoption as of Dec. 21.

Long Island is an ideal environment for many species of ticks, specifically the deer tick.

By Matthew Kearns, DVM

I commonly get the question, “What month can I stop using tick preventatives?” My answer is always, “That depends.” It used to be that somewhere around late October/November until late March/early April one could stop using flea and tick preventatives. However, with changing climate conditions and parasite adaptation this is no longer true.

The tick life cycle contains four stages: egg, larval, nymph (young adult) and adult. After the larval stage hatches out from the egg, it must feed and go through a molt between each successive stage. Ticks are sensitive to environmental changes throughout their life cycle but, ironically, are most resistant to temperature changes. It has to be below 35°F for ticks to even “overwinter.”

Overwinter is a term that refers to a process many species use to pass through the period of the year when “winter” conditions (cold or sub-zero temperatures, ice, snow, limited food supplies) make normal activity or even survival difficult or near impossible. During the overwinter period all activity nearly completely ceases until conditions become more favorable. If conditions become more favorable (above 45°F) ticks will set out in search of a host.

To kill a tick temperatures must be consistently below 10°F for many days in a row. If the tick is able to bury itself in the vegetation below a layer of snow, even below 10 degrees may not kill them. It is pretty routine even in January to have one or two days that are in the 20s during the day, dropping to the teens or single digits at night followed by a few days in the 50s.

Ironically, as resistant as ticks are to colder temperatures, they are much more sensitive to higher temperatures and humidity (or lack thereof). Eggs will desiccate, or dry out, and die during hot dry periods. The other life stages are at risk for dehydration due to increased respiratory rate in an effort to thermoregulate (control body temperature) and questing (looking for hosts).

Hotter, drier temperatures mean less vegetation. Less vegetation causes multiple problems for ticks: less protection from the elements and less vegetation for hosts.

The white-footed mouse is the primary host for the larval stage of the deer tick. This mouse survives on vegetation, and less vegetation and less resources for the mouse means a subsequent decrease in the mouse population. A decrease in population means less hosts. Less hosts, less ticks survive from the larval stage to adulthood. Fortunately, and unfortunately for us, the northeast United States rarely sees prolonged droughts. Even if we have hot, dry periods during the summer, we usually make up for it in the fall. It is an ideal environment for many species of ticks, specifically the deer tick.

In summary, it is my feeling that the tick season is 9 to 10 months out of the year. You may be able to stop applying preventative during the months of January, February, and March (this depends on temperature), but the rest of the year ticks are active.

Dr. Kearns practices veterinary medicine from his Port Jefferson office and is pictured with his son Matthew and his dog Jasmine.

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Follow @TBRNewspapers or check #TBRVotes on Twitter for our reporters’ on-the-ground and up-to-the-minute coverage of tonight’s election results.

Proposal 1: Constitutional Convention

Yes: 13.38%            No: 86.61%

Proposal 2: Amendment on public pension forfeiture

Yes: 69.19%            No: 30.8%

Proposal 3: Amendment on use of forest preserve land

Yes: 48.63%            No: 51.36%

 

Suffolk County District Attorney

    Ray Perini (R)               Tim Sini (D)
        36.41%                        62.08%

 

Suffolk County Sheriff

 Larry Zacarese (R)      Errol Toulon Jr. (D)
         48.93%                        49.41%

 

Suffolk County Legislator
5th District:
    Kara Hahn (D)              Ed Flood (R)
       63.39%                         36.56%

 

6th District:   
    Sarah Anker (D)      Gary Pollakusky (R)
          54.93%                       45.02%

 

12th District:
Leslie Kennedy (R)        Kevin Hyms (D)
         67.4%                         32.55%
13th District:
      Rob Trotta (R)        Coleen Maher (D)
           67.62%                     32.32%
16th District:
 Susan Berland (D)      Hector Gavilla (R)
          54.93%                      45.03%
18th District:

William Spencer (D)      Dom Spada (R)
          53.12%                      45.65%

Town of Brookhaven

Supervisor

  Ed Romaine (R)        Jack Harrington (D)
        61.91%                        38.06%

 

Councilperson
1st District:

Valerie Cartright (D)   James Canale (R)
          60.3%                      39.66%
2nd District:

   Jane Bonner (C)        Mike Goodman (D)
         63.53%                       36.42%
3rd District:

  Kevin LaValle (R)       Alfred Ianacci (D)
         65.52%                       33.98%

 

Highway Superintendent

Dan Losquadro (R)     Anthony Portesy (D)
         60.32%                      39.65%

 

Town Clerk

    Donna Lent (I)         Cindy Morris (D)
          57.26%                      42.36%

Town of Huntington

Supervisor
Tracey Edwards (D)    Chad Lupinacci (R)
         43.87%                       53.85%

Huntington Town Councilwoman Tracey Edwards conceded to state Assemblyman Chad Lupinacci. “I want to wish supervisor-elect Lupinacci congratulations on a hard-fought race,” she said. “I have no regrets about not running for town board. I could not be prouder [of my party]. We ran together and ran a positive race talking about issues important to us.”

Town Board

Mark Cuthbertson (D)    Emily Rogan (D)
         25.49%                        23.91%

   Jim Leonick (R)             Ed Smyth (R)
          24.92%                        25.6%

Emily Rogan on her loss in her first political race: “Not the way we waned, but I feel so blessed and full of gratitude,” she said. “This is one election. We are not done yet.”

 

Town of Smithtown

Supervisor

  Ed Wehrheim (R)        Kristen Slevin (I)
          56.79%                       7.85%

 

     Bill Holst (D)
          35.07%

“I feel terrific,” Ed Wehrheim said of winning. “It’s been a long, long campaign because of the primary, which was a very tough one, but this is the culmination of all of it. It feels great to be here with all my supporters and family and friends — they’ve been with me the whole way. It’s a great victory for Smithtown in my opinion, a great victory for my supporters and the residents. I’m looking forward to rolling my sleeves up and getting to work in January.”

Town Council

 Tom McCarthy (R)      Lynne Nowick (R)
        22.45%                       24.45%

    Bob Doyle (C)           Tom Lohmann (C)
           9.63%                        9.18%

Amy Fortunato (D)    Patricia Stoddard (D)
         17.62%                      16.44%

All percentages are unofficial results as per the Suffolk County Board of Elections

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Suffolk County Police 2nd Squad detectives are investigating a two-vehicle crash that killed a Centerport man Nov. 6.

Tyler Gomes was driving a 2007 Subaru eastbound on Cuba Hill Road in Greenlawn when he lost control of his vehicle, crossed into the westbound lane and struck a 2016 Toyota 4Runner, driven by Allison Raich, at approximately 9:35 a.m.

Gomez, 26, who was alone in his vehicle, was transported to Huntington Hospital where he was pronounced dead. Raich, 33, of East Northport, and her 9-month-old son were transported to Huntington Hospital where Raich was treated for broken bones and the child was evaluated and released.

Both vehicles were impounded for a safety check and the investigation is ongoing. Detectives are asking anyone with information on this crash to call the 2nd Squad at 631-854-8252.

Councilwoman Tracey Edwards walking in the Cow Harbor Day Parade on Sunday, Sept. 20. Photo by Victoria Espinoza

Supervisor

Edwards’ leadership is needed

As Supervisor Frank Petrone (D) steps down from his 24-year reign, Huntington faces a number of challenging issues ranging from gang violence to balancing smart economic growth with traffic and parking. It will take a tough individual to get the job done.

Two great candidates have stepped forward to fill Petrone’s shoes. While there is no doubt that Assemblyman Chad Lupinacci (R) is overall well-liked by Huntington’s residents, Councilwoman Tracey Edwards (D) has shown she has breadth of community support and the gritty determination needed to bring about change.

In her first term in town office, Edwards has spearheaded the creation of the Huntington Opportunity Resource Center and pushed hard for the revitalization of Huntington Station. There’s a master plan in place for the station. The mixed-use Northridge Project is no longer a vision of what could be, but a constructed reality prepared to open by the end of this year.

Edwards said she’s had an inside seat to the town’s affairs “long enough to know what to keep, what things need to change and what things need to be tweaked.” From our perspective, taking time to directly observe first before demanding change is a sign of wisdom.

If we have to choose one, we encourage you to vote for Edwards. We wish Lupinacci continued success.

Town Board

We choose Cuthbertson, Rogan

Councilman Mark Cuthbertson (D) offers the sole voice of political experience in the four-way race for two seats on Huntington Town Board. It’s clear by his knowledge of the area’s issues, the challenges in overcoming them, and familiarity with the town code.

Cuthbertson is running on the Democratic ticket with Emily Rogan, who is a political newcomer, but claims to have refined her communication and negotiation skills as a member of Huntington school district’s board of education when Jack Abrams Intermediate School was temporarily shut down and transformed into a STEM magnet school.

When listening to these somewhat “reluctant” running mates, it became clear to us that together the Democrats offer a blend of institutional knowledge and a refreshing new point of view. It’s a team with the right combination of governmental skill and fresh energy that is needed to push Huntington forward.

We appreciate the efforts of Jim Leonick and Ed Smyth in running for public office, but had difficulty fully understanding their future vision for Huntington. They took issue with town codes but didn’t fully know how the impact of the changes they proposed, which left us feeling uncertain. The future leadership of Huntington needs to be not only strong, but have a firm grasp on the details.