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Authors Posts by Daniel Dunaief

Daniel Dunaief

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Commack resident Theodore Wawryk, above, recently received shockwave intravenous lithotripsy at Huntington Hospital. Photo from Wawryk

Theodore Wawryk, a resident of Commack who performs maintenance work at the Bronx Gardens nursing home, had six stents placed in his heart in 2005.

One of the doctors performing the procedure was Dr. Gaurav Rao. Photo from Rao

This past February, Wawryk, 52, had a buildup of calcium behind some stents at their edges, which could lead to restenosis, or a narrowing of the arteries again.

The patient came to Huntington Hospital, where his cardiologist, Dr. Raj Patcha, director of the Cardiac Catheterization Laboratory, couldn’t initially get through the blockage.

Patcha reached out to Dr. Gaurav Rao, director of Interventional Cardiology at Huntington Hospital, to see if Wawryk might be a candidate to become the first Huntington Hospital patient to receive shockwave intravascular lithotripsy, also known as IVL.

Rao had used the shockwave treatment, which uses pressure waves to create fractures in the calcium, for over a year at other hospitals and was prepared to introduce the procedure at Huntington Hospital.

Other options for breaking through the calcium, such as orbital or rotational atherectomies, which act more like miniature jackhammers breaking up the calcium in the arteries, are off label when a stent is nearby because it can shave off the metal in the stent, leading to other complications, Rao said.

Additionally, placing another stent in the area without modifying the calcium leads to stent failure.

Rao and Patcha performed the procedure in early February.

“This is a much safer” approach, Rao said. “It’s revolutionary in the way we deliver classic cardiac care.”

Shockwave IVL enables the placement of stents by creating fractures in the calcium that allow doctors to put in functional and durable stents, Rao explained.

Other area hospitals have used shockwave IVL for circulatory issues as well. Stony Brook Hospital, for example, uses shockwaves for peripheral arteries. Huntington Hospital also uses shockwaves to treat peripheral vascular disease.

While every surgical procedure includes risks, Rao cited studies that indicate that the possibility of a dissection, or a tear in the wall of the aorta, for heart-focused IVL is 0.3% for shockwave IVL, which is substantially lower than the 3.4% rate for orbital atherectomy and 3% for rotational atherectomy.

Rao said about 70% of patients who are coming in for stents are eligible for IVL, while the remainder are still candidates for atherectomy.

Extremely long lesions or lesions where the entry point is small so that doctors can’t deliver an IVL balloon make atherectomies, with their front cutting abilities, the preferred approach, he said.

So far at Huntington Hospital, the growing number of patients eligible for shockwave IVL have chosen to have this approach.

“No one has shied away from shockwave therapy,” Rao said.

Patient experience

As for the patient experience, Wawryk recalled how the operation, felt “a little weird.”

Wawryk described how the doctors told him he’d feel a “little zap” inside his body.

Indeed, Rao said the procedure uses an electrical pulse that can cause the heart rate, particularly for someone with a resting pulse below 60 per minute, to accelerate for about 10 seconds.

Intravenous lithotripsy, which uses a low energy pressure wave of about 8 to 10 nanojoules and involves inserting a tube through the arm or leg, is generally “well-tolerated” Rao said. Many patients don’t feel the effect of the procedure.

Even with the slight shockwave, Wawryk said he would recommend the procedure to other patients considering it.

Wawryk, whose father died of a heart attack at the age of 46, is grateful for the cardiac care he received. He appreciates the time he gets to spend with his wife Nydia and his 19-year-old son Michael.

The Commack resident spent a day at the hospital, as the procedure started at 7 a.m. and he was heading home by 7 p.m. that night. He said he felt like the staff treated him as if he were at a “five-star resort.”

Rao is pleased to offer this interventional cardiac approach at Huntington Hospital, which makes it possible for residents nearby to receive the treatment and head home, without a longer ride back from a hospital further away.

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Pixabay photo

By Daniel Dunaief

Daniel Dunaief

When our children were young, we tried the Ferber method to encourage them to put themselves to sleep.

No, we didn’t abandon them in their room and return six hours later with a smile and a wink. We walked out of the room, told them to go to bed, and slowly extended the time before we returned.

It worked, although the complaints sometimes frayed our nerves to the point where we would argue about who drank the last of the milk, and I can’t even drink milk.

When the children got sick, all bets were off. Walking out of the room when they couldn’t breathe, when they had toxic sludge coming out of one or both ends, and when they had a fever was not an option for us, no matter how little sleep we’d had the night, week, or month before.

Once they recovered from their illness, however, we had to go back to the gradual Ferber method again, as they seemed to have forgotten that they might not need anything from us and that they should just close their eyes and go to sleep.

Parenting in the wake of the pandemic is a little like trying to figure out what role to play after the world has been sick for a few years and when we had to adapt whatever parenting rules we had established.

Do we tell them to “suck it up,” to “fend for themselves,” and to “tough it out,” or do we continue to offer support after they, and we, endured a new set of rules designed to keep us safe in the long term, but that caused all kinds of frustration in the shorter term?

Parenting always seems to have more questions than answers, but the number of questions and the frequency with which we ask them seems to have increased.

Indeed, even as our children have reached the age when we no longer have to strain our backs to make sure they don’t walk too close to the edge of a pool or to a rough surf, we still wonder what role, and how aggressively and consistently, we should play after the pandemic.

How many times have we wanted to agree with them in the last few years when they complained that “this isn’t fair?” Offering the reply, “who said life was fair,” didn’t seem appropriate, sympathetic or understanding. That response would only reinforce the reality that a year without graduation, proms, or downtime that didn’t involve a phone or a Monopoly board was definitely not fair.

Recently, I chatted with a parent in my neighborhood whom I haven’t seen in months. Within seconds, she shared her son’s recent tale of woe. Returning to the soccer field, he injured his leg badly enough that he’ll likely be out of action for soccer and several other sports for the next six months.

That, she said, is heartbreaking on top of all the time he missed on the field.

Amid all the concern for his physical well-being, she shared her worry about his mental health. She reached out to psychiatrist and psychologist friends, hoping to find someone with whom he might talk about yet another interruption in his plans to enjoy participating in a team sport.

To her dismay, she found that the mental health care system is as overburdened as the physical one was during the worst of the pandemic. Concerned about the context for her son’s life, she has dialed back her urge to encourage him to return to school on crutches, standing at the ready to bring him home whenever he feels physically and emotionally overwhelmed.

I completely understand that. At the same time, I wonder if and when we might deploy a safe Ferber-style approach after all the disruption of the last few years.

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Above, from left, CSHL Associate Professor Steven Shea, Yunyao Xie, a former postdoctoral researcher in Shea’s lab, and Roman Dvorkin at work. Photo from CSHL

By Daniel Dunaief

The black box has a blue spot.

Often considered so mysterious that it has been called “the black box,” the brain has a small cluster of cells called the locus coeruleus (LC), or blue spot because it appears blue.

The LC is the predominant source of the neurotransmitter noradrenaline, which plays numerous roles, including triggering the “fight or flight” response, sleep/wake regulation and memory.

Recently, Cold Spring Harbor Laboratory Associate Professor Stephen Shea and his post doctoral researcher Roman Dvorkin demonstrated that the LC was involved in normal maternal social behavior. In the publication Journal of Neuroscience, they demonstrated that surrogate mothers had a spike in this neurotransmitter just at the time when they retrieved young pups that had rolled out of the nest.

“Most of the research on noradrenaline and the LC has been involved in non-social behavior,” said Shea. Researchers have recorded it extensively during “cognitive tasks and memory formation.”

The evidence for its involvement in social behaviors has been more indirect. With the exception of a study 35 years ago that made a few recordings in cats, the current research is the “first time anyone has recorded” the LC during a more normal social behavior, Shea said.

Research on this blue spot could prove valuable in connection with understanding and treating a wide range of diseases and disorders. Noradrenaline (NA) is “one of the systems that is disturbed in anxiety and depression,” Dvorkin said. It also may be involved in other diseases, like autism. Scientists have conducted research on the LC and ADHD, Parkinson’s disease and Alzheimer’s disease, Dvorkin explained.

Some studies have also linked Rett syndrome, for example, which is a rare inherited genetic disorder that affects mostly girls and can alter the ability to speak, walk and eat, to lower levels of noradrenaline.

“There’s evidence that the LC has pathology in Mecp2 mice,” said Shea, referring to a gene traced to Rett. “We are working on that directly.”

Researchers believe studying the structure of the LC could lead to diagnostics and therapeutics for some of these diseases. Dvorkin suggested that this kind of research is “important to see how it works under normal, awake conditions.”

Monitoring the release of this neurotransmitter during a typical social behavior among female mice provides a context-connected understanding of its potential role.

“When people are studying this, they often use investigator-contrived tasks,” Shea said. “This is the system that preexisted for mice to use for other purposes.”

Shea has done earlier work with the LC, particularly as the sense of smell is so prominent in social interactions for mice. He demonstrated that anesthetized mice exposed to the scent of an unfamiliar mouse react as if they have a familiarity with the mouse. 

She believes the LC initiates sensory plasticity or sensory learning. NA can affect the sensory responses in parts of the brain that carry information, creating a stored memory. While his extensive work offers some clues about the role of the LC in mice, all vertebrates have the LC in their brain stems, including humans.

Shea said other research has demonstrated the involvement of the LC in cognitive tasks and memory formation, including during periods of sleep and wakefulness.

Blocking the release of noradrenaline is challenging in part because it is compact and the cells in the brain interact with so many of their neighbors, which makes turning on or off a specific signal from one region especially challenging.

At the University of Washington, Richard D. Palmiter and S.A. Thomas published a visible and definitive paper in 1997 in the journal Cell that brought the LC to other researcher’s attention.

These researchers created complete knockout mice, where they found that rodents lacking noradrenaline were “really bad mothers,” according to Shea.

In their research, Dvorkin and Shea used optogenetics and chemogenetics to inactivate the LC and the release of noradrenaline.

Future experiments

Below, a mouse retrieving a pup that has rolled out of its nest. Photo by Roman Dvorkin

The next step in this research could involve understanding the relative importance of the signal from the LC and noradrenaline.

In typical life settings, mice and other vertebrates confront competing signals, in which a pup rolls out of the nest at the same time that one of their many predators, like a hawk or other bird is circling overhead.

“That could be a next step” in this research, said Dvorkin.

Dvorkin believes it is possible to increase or decrease the threat level for mice gradually, in part because mice learn quickly when the threat is not real or what to avoid if the threat is too risky.

Shea is also looking more closely at courtship behavior.

The LC could be involved in sexual selection and in dominance hierarchies, enhancing the aggressive behavior of alpha males towards less dominant males. 

“We see big signals associated with events in courtship, including when the female and male begin to mate,” said Shea.

A resident of East Northport, Dvorkin lives with his wife Paolina and their nine year-old son Adam, who is in third grade at Pulaski Road School.

Originally from Afula in northern Israel, Dvorkin has been working in Shea’s lab for over five years. Outside the lab, he enjoys spending time with his family, taking pictures, and swimming at the JCC.

Dvorkin has enjoyed his work at CSHL, which he described as a “great experience in a beautiful place,” where he can appreciate the quiet and where he has received considerable support.

In the future, he’d like to apply his expertise in working on neuronal cell cultures and behaving animals to address translative questions, such as neurodegeneration.

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Many doctors are suggesting people learn to live with the virus and begin returning to usual activities such as going to the movies. Photo from Pixabay

Dr. Gregson Pigott went to the movies this week.

While the activity would be considered mundane in 2019, the decision to go to the theater to catch a flick is yet another example of how local doctors, or, in this case, commissioner of the Suffolk County Department of Health Services, is practicing what he preaches.

“We need to learn to live with the virus,” said Pigott, who has also been to a few Brooklyn Nets basketball games. Pigott, who is not using a mask except in situations where it is required, such as on a plane or on public transit, suggested people are “trying to resume life as it was pre-COVID.”

While the percentage of positive tests has risen, the numbers haven’t raised any alarm bells.

The percentage of COVID positive tests increased to a seven-day average of 2.6% as of April 2, according to figures from the New York State Department of Health.

That figure is higher than it had been in the weeks prior, when the percentage dipped below 2%.

“I certainly expected this,” Dr. Sean Clousten, associate professor of Public Health at Stony Brook University explained in an email. “I suspect this increase is due to unmasking at public schools because many kids who are infected are asymptomatic or the symptoms are different.”

Pigott said the current symptoms for the newer variant of omicron, called BA.2, which is becoming the dominant strain across the country and through much of the world, includes stuffy noses, scratchy throat and a slight cough.

Clousten added that the symptoms can also appear more like a bad stomach bug.

Second booster

Recently, the Food and Drug Administration approved a second booster for people over 50 and for those who are immunocompromised and who had a first booster more than four months ago.

Pigott said he would urge people who are over 65 or those who are immunocompromised to consider getting another jab.

“Most of the general population is fine with the three-shot regimen,” Pigott said. “Your body will recognize any kind of COVID infection and deal with it quickly.”

Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital, indicated in an email that Stony Brook has been “advocating for switching vaccines.”

Switching vaccines could mean triggering a different response to the shot for the second booster, Nachman added.

Data about a second booster shows that the shot provides “good protection” against serious COVID, Nachman said. “Will it protect against any infection (meaning you might get a runny nose, cough or upper respiratory infection)? Not really.”

Nachman urged people to consult with their primary care doctor to decide whether to take a booster. What people are doing and where they are going can and should affect that decision.

Finally, daily activities such as going back to a crowded office or starting to take New York City transit could be “excellent reasons” to get a booster, she said.

Nachman plans to get a booster, although she is working on the best timing for another shot.

“Before I travel abroad is key to making sure I have my booster and am protected,” Nachman added.

Conferences

Nachman is encouraged that people are returning to in-person conferences and other activities.

“It will be great to have people starting to get back to routine living, and that means being with other people,” she explained in an email.

She urged people to stay at home if they don’t feel well.

“Now is not the time to push to go to that meeting or get together with extended family, since you might just be responsible for getting someone else sick,” she explained.

She suggested people should be patient and understanding of others who choose to wear masks or continue to practice social distancing.

“Don’t shame anyone who is wearing a mask,” Nachman advised. “If that is what it takes to get them together with you in public, go for it.”

In another sign of a return to a pre-pandemic life, Pigott suggested that the Health Department was planning to direct more resources to tracking illnesses like Lyme disease.

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Female Cowbird. Pixabay photo

By Daniel Dunaief

Daniel Dunaief

A huge fan of our avian neighbors, I have collected numerous anecdotes during my travels on Long Island and around the world. As we delve deeper into the spring, I’d like to share a few.

The brood parasite: Many years ago, OK, decades, I did some research on the brown-headed cowbird. This bird, whose scientific name is Molothrus ater, which means “black vagabond,” shares a lifestyle with the cuckoo. You see, the cowbird, which spends considerable time eating food near farms or settled lands, doesn’t build nests. It lays its eggs in the nests of other birds and contributes nothing to the parenting of its young.

When I was in college, I wondered how these birds knew they were cowbirds and didn’t form attachments to the numerous other species who unwittingly contribute to its success. Their hosts raise these aggressive young that sometimes outcompete their own chicks for food. Speaking with people who lived in Mammoth Lakes, California, where I performed my research, I met several people who were in their early 20s, who listened attentively to the story of my research. When I finished, one of them smiled and said, “Wow, what terrible parents. They must only live in California, right?”

The beak smackers: When I attended Gelinas Junior High School, I learned about the Galapagos Islands. I couldn’t wait to visit a place where sea lions barely budged when people walked near them. I finally traveled to these wonderful islands, made famous by Charles Darwin’s trip where he posited the theory of evolution. As I hiked with my family on a tour, our guide stopped and told us to listen. Smacking sounds, as if people were sword fighting with whiffle ball bats, came from just over a ridge. When we reached the top, we saw albatrosses engaged in extended beak smacking.

Once pairs of these white birds finished their ritualistic and individualized pattern, they started again. Closing my eyes, I could imagine the rhythm of several of these courtship routines becoming the percussion section of a song.

Seeing red: When I studied birds in college, I recalled hearing about the dominance hierarchies of the red-winged blackbird, which occupies marshy areas all around Long Island. With red stripes on their shoulders, these birds are also distinctive for their loud and extended squeaks. The size of the red color reflects the dominance of the birds. Without the bright red indicating the equivalent of a social rank, even the most dominant bird loses his status and preferred spot in a habitat.

Foul play: The black cormorants, which sit low in the water, are excellent divers. They are not, however, particularly well-suited for their watery lifestyle. Their feathers are not waterproof, the way a duck’s are. After they get sufficiently waterlogged, they stand on docks or pilings with their wings outstretched, as if they were holding their feathers on a drying line. They use the wind to dry themselves out. It seems especially cruel and maladaptive for a bird that lives in the water to endure extended periods of being waterlogged.

You want a coke with that? My family was enjoying a meal in Miami after a morning in the sun. Sitting outside, where we had an unobstructed view of the beach and where the wind provided welcome relief from the hot sun, we ordered burgers and fries. I picked up a French fry and lifted it near my head to make a point. Accustomed to human patterns, a seagull saw the opening, grabbed the fry without touching my hand, and flew off to consume his prize.

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Stock photo

As travel-related restrictions from COVID-19 continue to ease, people are considering heading out on the road, to the airport, the pier, or the train station, eager to feed their curiosity and hunger about different regions and cultures.

Dr. Daniel Jamorabo is the assistant professor of medicine in the Division of Gastroenterology and Hepatology at Stony Brook University’s Renaissance School of Medicine.
Photo by Jeanne Neville/Stony Brook Medicine

While these travelers may be excited about the flavor of the unknown, their stomachs may not be as thrilled with these journeys, demanding attention at inopportune times or threatening to revolt with the biological equivalent of a magma eruption.

Local gastroenterologists — stomach doctors — urged travelers to take precautions as they prepare for journeys to exotic locations, on cruises or even across the country.

“Depending on where people are traveling, they may need shots,” said Dr. David Purow, a gastroenterologist at Huntington Hospital. Some areas might have a higher incidence of cholera or traveler’s diarrhea, which is typically an E. coli infection, he added. People often refer to it as Montezuma’s revenge.

Purow suggested consulting the Centers for Disease Control and Prevention’s website initially, although the government organization which has coordinated much of the response to the COVID-19 pandemic is considered a conservative organization.

Purow urged travelers to search for whether pathogens are endemic to an area, which could include reading message boards. Those boards, however, can be as reliable as so much of the rest of the material on the web, he said, which means residents should use their own judgment about the reliability of what they read.

Upset stomachs can come from a host of sources, including food that’s been out for an extended period or from various forms of contaminated water.

“Always be wary of foods that are room temperature,” said Dr. Daniel Jamorabo, a gastroenterologist and assistant professor of Medicine in the Division of Gastroenterology and Hepatology at Stony Brook University’s Renaissance School of Medicine. “That’s often how people get food poisoning. Listeria is common in dairy, such as goat cheese.”

Water

Often the source of upset stomachs that can put a porcelain damper on traveling, water can cause problems for travelers.

Prior to becoming a gastroenterologist, Jamorabo himself visited Kenya, where he unwittingly picked up the parasite Giardia, which is also a threat to people drinking creek or river water on camping trips.

Jamorabo was sick for three weeks, which encouraged him on future trips to stick to bottled water during his travels for peace of mind.

When bottled water isn’t accessible, he suggested drinking boiled water or using purifier tablets. Some tablets can take up to two hours to purify a gallon of water, although others, which afford less protection, take 35 to
40 minutes.

Jamorabo said salads or fruits, which are peeled or prepared with sources of water that are hard to track, can be
a problem.

He suggested asking residents whether they have filtration systems in their homes or if they use bottled water.

Purow added that “if there is concern, use bottled water as much as you can.”

What to bring

Doctors suggested that people tend to bring stomach remedies with them when they travel, sometimes even taking them prophylactically.

Purow said some people bring probiotics, which are “unlikely to hurt you and may decrease the chance of getting anything or shortening the duration once it’s acquired.”

Pepto Bismol and Imodium could also help prevent or treat an upset stomach, particularly for people who are anxious travelers and who get so-called “traveler’s diarrhea,” doctors said.

Purow warned that people could get black stools from some of these medications, which could also be a warning sign of a gastrointestinal bleed or ulcer.

Taking these medications for symptomatic relief, however, is “fine” and will “not suppress” the need to remove something from the body, Purow added.

One of the dangers of diarrhea is that it can cause dehydration, as the body loses necessary fluids.

Jamorabo suggested traveling with or searching for Pedialyte as a way to restore hydration.

As for the dangers of going on cruise ships, doctors recommended being careful about touching tongs or servers at buffets that many other travelers, who might have brought their own pathogens with them, might also have handled.

“On these cruises, it’s like traveling in a small city,” Jamorabo said. Stomach bugs can “spread like wildfire.”

“Always be wary of foods that are room temperature. That’s often how people get food poisoning. Listeria is common in dairy, such as goat cheese.”

— Dr. Daniel Jamorabo

Mental health

Even for those who stay at home, people may be struggling with their stomach’s response to the mental health strain created by COVID-19, the Russian attack on Ukraine, and concerns about issues like violent storm and global warming.

Stomach doctors have increasingly referred patients to psychologists and psychiatrists.

“Stress can exacerbate” irritable bowel syndrome, said Purow. Concerns about the state of the world have “unmasked GI symptoms for those who didn’t have it before.”

Purow has seen a significant increase in alcoholic liver disease, as people stuck at home raided their own liquor cabinet amid health threats, lockdowns and economic uncertainty.

Jamorabo said more stressful times can lead to an increase in stomach-related discomfort or symptoms.

“We have to pay attention to what triggers people” to have panic attacks, nausea or diarrhea, Jamorabo added.

An under-treated mood disorder could compound GI-related symptoms.

Focusing on the things people can control can help soothe the stomach, such as sleeping well, exercising and eating a healthy diet.

“Look within yourself for your own mental health,” Purow suggested. Outlets such as bottles of vodka don’t tend to help, while speaking to friends and family and eating right can aid overall health, giving digestive systems relief and resilience.

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METRO photo

By Daniel Dunaief

Daniel Dunaief

I’ve tried to dodge the question for years.

For some reason, it comes up despite an eagerness on my part to point to the sky and shout, “Look, it’s a flying turtle,” or to ask, “Wait, aren’t Derek Jeter, Halle Berry and Eva Mendes all sitting together over there?”

You see, I have a dairy allergy. When I first noticed over three decades ago that I couldn’t eat or drink milk products, the world wasn’t as prepared, accustomed and, most of all, accommodating toward allergies.

I’d go in a restaurant, even a fancy one, and tell the waiter or waitress that I was allergic to dairy. I’d get this dubious look like she thought she was on candid camera or that I wanted the fancy French chef to make me a Big Mac.

I tried to order quietly while everyone was looking at their menus or diving for the gold coins I’d thrown across the room as a distraction while I whispered about my allergy to a waitress, begging for a chance to order without facing the inevitable food inquiry.

Alas, more often than not, my distraction techniques and whispering rarely worked.

“I’m allergic to dairy,” I’d mumble.

“Say what?” she’d say.

The restaurant would go silent as if EF Hutton were telling people how to invest.

“I can’t eat anything made with milk, cheese, butter or cream,” I’d say.

“So, what do you want to eat? The chef can’t redo the entire kitchen just for you,” she’d reply, while snarling, blowing the bangs off her forehead and rolling her eyes.

Typically, I’d come up with something creative like a plate of lettuce, an unbuttered bagel, a hard-boiled egg or a Chinese meal. Asian restaurants rarely use milk or butter, which makes Chinese, Japanese and Thai food among my favorites.

Once I’d finally placed the order and was ready to engage in a non-food-related conversation, someone would look me in the eye and ask.

“So, what happens to you if you eat dairy?”

And there it is. I’m not sure what to say. Going into graphic detail forces me to relive unpleasant experiences.

Over the years, I’ve looked at my wife for help. She’s tried to point out the scar from the IV she got when she gave birth to our daughter, shared some exciting anecdote from work, or offered a story from her childhood.

The more we try to redirect the question, the more likely it is to persist.

“No, really, what happens? Would you die?” people have asked eagerly. Sometimes, their tone is so matter of fact that I wonder if they’d like popcorn, with plenty of butter, to watch the death by dairy event.

Do I carry an EpiPen? Would my throat close? Would I need immediate medical attention?

While the answer to all three questions is “No,” I prefer not to think about, and relive, the consequences of a few mouthfuls of key lime pie.

Describing the discomfort that starts in my mouth and continues all the way to my, well, other exit point, requires me to share unpleasant details.

I try to shorten the interaction by suggesting, in general terms, that I’m in intense digestive discomfort.

“How long does it last?” someone asks.

“Long enough that I haven’t had ice cream for over three decades.”

While the question is unpleasant, the modern reality is not. Waiters and waitresses often arrive at the table and ask about food allergies.

Then again, out of habit, some of them ask at the end of my order if I’d like cheese in my omelet or on my burger.

I smile, waiting for them to look me in the eye.

“Right, right,” they eventually grin. “No dairy. I knew that.”

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Joel Marimuthu, supervisor of rehabilitation services at Huntington Hospital, and physical therapist Ada Kalmar demonstrate some warm-up exercises. Above, an elastic band helps to work on throwing mechanics and sport specific strengthening of the shoulder muscles. Photos by Joseph Colombo

Play ball, carefully.

An intervention a therapist would use for a patient recovering from shoulder surgery. Photo by Joseph Colombo

That’s the advice of area physical therapists and orthopedic surgeons as Major League Baseball returns with a shortened spring training.

Some of the less experienced players, particularly those who might feel they need to prove something each time they step on the field, are especially vulnerable to injuring themselves, suggested Dr. James Penna, orthopedic surgeon and chief of Sports Medicine at Stony Brook Medicine.

“You’ll see the experienced players won’t go through it [but] the injury rate among the [players that have been in the league] for five years and under will be higher,” Penna said.

The challenge for players, even at the professional level, is that their training strengthens their body and increases their speed, but it doesn’t help with the kind of urgency a game situation creates for athletes.

“They’re not doing stuff that’s high stakes,” Penna added. “That’s the real difference.”

Staying busy in leagues where no one is watching and then returning to the bright lights of Yankee Stadium or a nationally televised game can cause stress hormones like cortisol to increase.

“It takes three to six years [as a professional athlete] depending on the sport, where you start to get into a routine where it’s not all energy and angst,” Penna said. The athletes who do the same thing all the time won’t have any change in their bodies or their minds when they return to major league games.

Pitchers are among the most vulnerable baseball athletes, as they may try to stretch themselves out with too many pitches and too many innings quickly, said Joel Marimuthu, supervisor of rehabilitation services at Huntington Hospital.

Looking back at 2020, when spring training was also shortened amid the COVID-19 pandemic, the number of injuries increased, Marimuthu said.

“If the players are watching what happened in 2020, especially with all the increased elbow, shoulder, back, hamstring pulls, they’ll be mindful this season,” Marimuthu said.

Complete preparation for game situations includes a range of training and body conditioning and a gradual increase from working in a gym or on a field somewhere to playing in a game.

“You never want to go from 0 to 60 as an athlete,” said Marimuthu. “You want to come up to speed gradually.”

Training a range of muscles involved in different activities can improve strength and flexibility and reduce the risk of injuries, doctors said.

“We see the most benefit from athletes staying balanced,” Penna said. “If you work on a flexion activity, you have to work on an extension activity. As much as it’s become cliche, you have to cross train.”

Even if athletes don’t participate in different sports, they need to engage in activities such as yoga, pilates and lower body work to prevent injuries, Penna said.

Athletes at any level, who think they might have sustained an injury, run the risk of more significant damage if they play through discomfort that goes beyond the usual wear and tear from sports.

Physical therapists use the acronym PRICE as a guide: protect, rest and ice, Marimuthu said.

College sports injuries

The pandemic has created a similar situation for college athletes, who weren’t able to compete for varying lengths of time amid canceled and shortened seasons.

With fewer games and matches, numerous athletes got injured as they returned to
game action.

“We saw a very, very rapid uptick in injuries,” Penna said.

Athletes had higher injury rates in upper body, lower body and core muscles.

Sports hernias were also prevalent, as student athletes didn’t do enough dynamic exercises to strengthen their core and increase their flexibility.

For female athletes, the injuries to their lower extremities are “through the roof,” Penna said, including to the anterior cruciate ligament in the knee. “The ACL [injury] rates among girls is bad.”

Penna urges athletes not to wear cleats on turf. Even though a sneaker might slip, and athletes might not be able to run as fast, they won’t likely have the kind of tearing that comes from a shoe that’s gripping the ground while the rest of the leg moves in another direction.

Coaches and trainers should “go to great lengths to make sure their quads are balanced with their hamstrings and their core is well maintained,” Penna said.

Young athletes in general ignore their core, which means more than just sit ups. Penna suggested they do more dynamic motions, like lunges.

Penna said it’s natural amid stronger competition for athletes of any level to push themselves to levels that might cause injury.

With so many experts available to help with sports injuries, injured athletes of any age and ability, from weekend warriors to high school and college athletes, have numerous places they can go for advice and care after an injury.

Marimuthu and Penna both suggested that the first point of contact should be a primary care physician.

“I’ve always felt comfortable keeping strong primary care doctors around to keep us honest,” Penna said.

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By Daniel Dunaief

Daniel Dunaief

We’ve only visited The Fly, a grassy area behind Audubon Park in New Orleans that sits along the edge of the Mississippi River, four times, and yet we can’t possibly travel to the Crescent City without stopping there.

A wide open space that draws students from nearby Tulane and Loyola universities, residents of all ages, screeching seagulls and supersized cormorants that look like genetically altered cousins of Long Island’s water foul, The Fly has hosted some of our most enjoyable visits to see our freshman son in college.

The first time we walked to The Fly, our son was in that miserable, confusing, bees-buzzing-around-his-overlong-hair state when he wasn’t sure where he wanted to attend college and when everything, particularly enthusiastic parents, was irritating.

We had to wait what seemed like forever in searing heat for a freight train with endless cars to cross in front of us to climb over a small hill and reach The Fly. The endless train took so long to pass at a snail’s pace that my son and I sat down on dry grass, while my wife took a few pictures. We tried to keep the moment light, even though our son felt the weight of college uncertainty on his broad shoulders.

When the gates finally went up and we crossed the tracks, the first thing I noticed was the relief the refreshing gusts of wind that came off the river provided.

As we approached the water, we passed young families sitting on blankets and eating picnic lunches, college students playing “never have I ever” games and birds lifting off and circling the shoreline of the river, using their bodies as kites in the swirling winds.

The open green space between the back of the zoo at Audubon Park and the river energized my son and me, calling to us to play.

As we inched closer to the pathway near the river, we stared into the active water, which looked as busy as a bustling city. The main current in the middle traveled one way, while swirling eddies circled near the shore.

Sitting on a sturdy wooden bench, we soaked in the scene and could see our son’s shoulders lower and his breathing slow. The water show helped allay any anxiety he had about class assignments, making friends, learning about a new place, or living far from home.

An ocean going cargo ship passed within 100 feet of us. These enormous ships, sometimes pulled by muscular tugboats, seemed impossibly close, acting like an outdoor theater with an oversized screen.

During several other visits to The Fly, we have delighted in the unexpected. Once, we brought a football and ran patterns in a heavy but warm rain while my wife watched comfortably from the car. Playing on an empty, soggy field with my son made me feel as if I were jogging through the fountain of youth.

While the Fly has become one of my favorite places to visit, I have increasingly come to see settings as much more than backdrops for life and action: they have become like characters, encouraging, inspiring, challenging and reviving us. Like the salty smell of West Meadow Beach, they can also give us the chance to travel through time in our minds, reminding us of earlier visits and the people who traveled with us through life to these locations.

Our son has visited The Fly several times over the last few months. He has taken short videos of the moving water, the frolicking birds, and that first wooden bench where we shared a respite from the college process. The videos he sends are a short visit with him and our friend The Fly.

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Heather Lynch Photo courtesy of Rolf Sjogren/ National Geographic

By Daniel Dunaief

To borrow from the Pink song in the movie Happy Feet, the Pew Trusts for Marine Conservation recently delivered “something good” to Stony Brook University’s Heather Lynch. 

Endowed chair for ecology and evolution at Stony Brook University’s Institute for Advanced Computational Science, Lynch was selected as one of six Pew Fellows in Marine Conservation.

Lynch, who uses a host of tools including physics and satellite imagery to study penguin populations in Antarctica and associated island groups including in South Georgia and the South Sandwich Islands, is one of six international recipients of the 2022 fellowship, which includes $150,000 over three years, and is a mid-career prize.

Lynch plans to use the funds to chronicle species health in the macaroni and king penguin and forecast risks to Antarctica’s penguin populations.

Lynch’s work is “really important,” said Claire Christian, Executive Director of the Antarctic and Southern Ocean Coalition (ASOC), who nominated Lynch for the fellowship. Lynch provides the kind of information “we need to make effective decisions about protecting Antarctica.”

Christian, who has known Lynch for about five years, said Lynch’s consistent commitment helps “provide a broader picture of what’s happening down there over a longer time frame.”

Christian is particularly pleased that Lynch’s work in the Antarctic brings necessary attention to the region, even though “it’s far away at the end of the world,” she said. “People understand that [the Antarctic] is worth investing time and resources into studying.”

The Pew Fellows Program in Marine Conservation provides recipients with an opportunity to interact with other winners and alumni. This year, the Pew Trust received over 50 nominees.

Past honorees at Stony Brook University include Endowed Professor of Ocean Conservation Sciences at the School of Marine and Atmospheric Science Ellen Pikitch and Endowed Research Chair for Nature and Humanity Carl Safina.

Jane Lubchenco, who won a Pew Fellowship in marine conservation in the 1992, was the first woman to lead the National Oceanographic and Atmospheric Administration and is the current Deputy Director for Climate and Environment in the White House.

Rebecca Goldburg, Director of Environmental Sciences at the Pew Charitable Trusts, appreciates the mixture of high-level research Lynch produces and the application of her discoveries to conservation and added that Lynch has “outstanding scientific achievement that is well-integrated into decision making.”

Climate change

While researchers haven’t broadly chronicled the movement of macaroni penguins into the Antarctic, Lynch anticipates that climate change would draw them into the Antarctic.

“My hope is that a focus on macaroni penguin census data will illuminate their trends,” she explained in an email.

King penguins, meanwhile, have recently arrived in the Antarctic. The presence of king penguins would represent a turning point for Lynch, as they would suggest that the Antarctic is starting to show ecological similarities with the sub-Antarctic.

King penguins have attempted to breed on Elephant Island, which is about 800 miles from their typical habitat in South Georgia. While this species of penguin has traveled this distance in prior years, their decision to settle and try to raise chicks, which they haven’t successfully done, is “new and ecologically interesting,” Lynch explained.

Lynch suggested such a geographic expansion is rare because these birds are long-lived and an established pair will breed in the same location for years. Even in young individuals traveling to new territories, the rate of range shift is slow and hard to track.

“The movement of king penguins into Antarctica is exactly what would have been predicted and so it is an exciting (if, from a climate perspective, disturbing) time to be watching this all unfold,” she said.

King penguins can form large colonies, which could, over the course of a longer period of time, create competition for space with chinstraps. Lynch suggested that the region could be in the early days of an ecologically important event.

Where’s Waldo?

As for macaroni penguins, whose stories about how they got their name include one involving a sailor slang for men who dressed in bright colors, they have frequently been the “Where’s Waldo?” of what Lynch does, she said, as she encounters them by chance in a colony of another species.

She is pulling together several decades of offhand notes about her findings on macaronis to track them systematically. She believes collecting information about populations of macaroni and king penguins in Antarctica is going to be informative.

In analyzing penguin populations across species, Lynch plans to take the kind of approach portfolio managers apply when they consider where to focus their attention.

A mutual fund manager with a large percentage of the value of the fund linked to changes in the stock price of Apple would likely track the earnings of the company and its share price more closely than stocks in which she has smaller holdings or whose values don’t fluctuate much.

For penguins, Lynch suggested that scientists and conservationists may “need to understand those colonies, and there may not be that many, that contain a large percentage of the world’s population,” she said.

For a long time, researchers have focused on colonies that were easier to study because they were small and close by. “I don’t think we can justify that approach anymore,” Lynch said.

Picking penguin spots

Goldburg appreciates Lynch’s framework for penguin conservation.

Lynch will address the “key penguin colonies,” some of which are contributing disproportionately to the risk of penguin declines, Goldburg said. This approach will enable conservationists to monitor important sites because they “can’t do everything.” 

Understanding penguin populations goes beyond a simple rule that more of any population is necessarily better. Major increases or decreases should be cause for concern because they reflect shifts in the functioning of the ecosystem, she explained.

Christian is confident the work Lynch does will provide policy makers with key information.

“Her work is really important and it deserves to have a lot of visibility and funding,” Christian said. “Without understanding what’s happening to species that are living down there, we can’t” design effective strategies to protect them and their ecosystems.

Lynch provides the kind of information necessary to “make effective decisions about protecting Antarctica,” Christian added.

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