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TBR News Media covers everything happening on the North Shore of Suffolk County from Cold Spring Harbor to Wading River.

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By David Dunaief

Steroids have been in the news with headlines about sports figures like Alex Rodriguez, the NY Yankees baseball player notorious for their illegal use. However, if we look beyond the flashy headlines to rudimentary use, we see that corticosteroids, or steroids, play an important role in medicine. This is a commonly prescribed class of medications. In fact, our bodies make corticosteroids, the indigenous form of steroids, in the cortex of the adrenals, glands that sit on top of the kidneys. Here, we are going to concentrate on the exogenous form, meaning from the outside as medication.

The use or benefit
Steroids have an anti-inflammatory effect. This is critical since many acute and chronic diseases are based at least partially on inflammation. Chronic diseases that benefit include allergic, inflammatory and immunological diseases (1). These types of diseases touch on almost every area of the body from osteoarthritis and  autoimmune diseases — rheumatoid arthritis, inflammatory bowel disease, multiple sclerosis, lupus, psoriasis and eczema — to asthma, COPD (emphysema and chronic bronchitis) and eye disorders. This type of medication is pervasive.

The delivery
Steroids are delivered via the oral route, as topical creams, lotions and eye drops or via injections, intravenous solutions and inhaled formulations. The most commonly known medication is prednisone, but there is a plethora of others, including prednisolone, methylprednisolone, cortisone, hydrocortisone and dexamethasone.
Their benefits can be tremendous, improving functionality and reducing pain or improving breathing. You could say they are lifesaving in some instances, and with rescue inhalers they may just be that.

The bad
However, there is a very big caveat: they come at a price. Steroids have lots and lots of adverse events associated with them. This is where the bad part comes in and keeps on coming. Steroids cause weight gain, increased glucose (sugars), high blood pressure, cardiovascular events, osteoporosis, change in mood (psychoses), cataracts, glaucoma, infection, peptic ulcers, Cushing’s syndrome and the list goes on. Ironically, steroids help with breathing; however, as I’ve seen in my clinical experience, they can cause shortness of breath when weaned from a longer-use high dose too quickly.

The upshot
The good news is that a plant-based diet may have similar beneficial effects in chronic diseases as steroids without all the downsides. Let’s look at the evidence.

The role in pneumonia
Pneumonia is among the top-10 leading causes of death in the world (2). It can be a most painful and debilitating disease. I know, for I experienced it personally while I was in my medical training. Every time I coughed, it felt like there was a fire in my chest.
In a meta-analysis (a group of nine studies), there was no overall effect of corticosteroids in reducing the risk of mortality in community-acquired pneumonia (3). However, don’t fret; when the data was broken into subsets, the findings were different. In subset data of those who had severe pneumonia, there was a statistically significant 74 percent reduction in mortality. And when duration was the main focus in subgroup analysis, those who received prolonged use of steroids reduced their risk of mortality by half. Unfortunately, with the benefit comes an increased risk of adverse events, and this meta-analysis was no exception. There was a greater than two times increased risk of abnormally high glucose levels with prolonged use. Thus, when giving steroids, especially for a prolonged use, it may be wise to check glucose levels.
In a more recent randomized controlled trial (RCT), the gold standard of studies, the results reinforced the beneficial effects of steroids on pneumonia. They showed that in those with both severe pneumonia and high inflammation, there was a two-thirds reduction in treatment failures when corticosteroids were added to the regimen (4). There were 120 patients involved in the study. They received antibiotics plus either methylprednisolone or placebo for five days.

Osteoarthritis: surprising results
As we know, osteoarthritis specifically of the knee is very common, especially as the population continues to age. Intra-articular (in the joint) injections directly into the knee are becoming routine treatment. A recent study compared injectable hyaluronic acid to injectable corticosteroid (5). The results showed that over three months, the corticosteroid was superior to hyaluronic acid in terms of reducing pain, 66 percent versus 43.8 percent, respectively. Interestingly, over the longer term, 12 months, hyaluronic acid reduced the pain and maintained its effect significantly longer than the steroid, 33 percent versus a meager 8.2 percent, respectively. Study groups received five injections of either steroid or of hyaluronic acid directly to the knee over a five-week period. Thus, steroids may not always be the most effective choice when it comes to pain reduction. Hyaluronic acid may have caused this beneficial effect by reducing inflammation, protecting cartilage and preventing cell death, according to the authors.

COPD: length may not matter
It is not unusual to treat COPD patients with oral steroids. But what is the proper duration? The treatment paradigm has been two weeks with 40 mg of corticosteroids daily. However, results in an RCT showed that five days with 40 mg of corticosteroid was noninferior (equivalent) to 14 days of the same dosage and frequency (6). About one-third of patients in each group experienced a COPD exacerbation within the six-month duration of the trial. The hope is that the shorter use of steroids will mean fewer side effects. There were over 600 patients in this trial. We have come a long way; prior to 1999, eight weeks of steroids was a more commonplace approach to treating acute COPD exacerbations.

Topical steroid risk
Even topical creams and lotions are not immune to risk. For example, potent topical creams and lotions placed around the orbit of the eye with prolonged use may negatively affect vision (7). However, the evidence is based mostly on case reporting, which is a low level of evidence.

Dietary effect
One of the great things about steroids is that they reduce inflammation, and we know that the basis of greater than 80 percent of chronic disease is inflammation. A plant-based diet involving lots of vegetables and fruits and some grains may have a similar effect as steroids. The effect of diet on chronic disease may be to modify the immune system and reduce inflammation (8). The bioactive substances from plants thought to be involved in this process are predominantly the carotenoids and the flavonoids. Thus, those patients who respond even minimally to steroids are likely to respond to a plant-based diet in much the same beneficial way without the downsides of a significant number of side effects. Diet, unlike steroids, can be used for a long duration and a high intake, with a direct relationship to improving disease outcomes.
In conclusion, it is always better to treat with the lowest effective dose for the shortest effective period when it comes to steroids. The complications of these drugs are enumerable and must always be weighed against the benefits. Sometimes, other drugs may have more beneficial effects over the long term such as hyaluronic acid injections for knee osteoarthritis. A plant-based diet, with anti-inflammatory properties similar to steroids, may be a useful alternative for chronic disease or may be used alongside these drugs, possibly reducing their dosage and duration.

REFERENCES
(1) uptodate.com. (2) N Engl J Med. 1995;333(24):1618-24. (3) PLoS One. 2012;7(10):e47926. (4) JAMA. 2015;313(7):677-686. (5) Open Access Rheum 2015;7:9-18. (6) JAMA. 2013;309(21):2223-31. (7) Australas J Dermatol. Mar 5, 2015. (8) Int J Vitam Nutr Res. 2008 Dec;78(6):293-8.

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 and/or consult your personal physician.

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By Michael R. Sceiford

If you are interested in saving for retirement, here’s some good news: For 2015, the IRS has raised the maximum contribution limits for 401(k) plans from $17,500 to $18,000. And if you’re 50 or older, you can put in an extra $6,000, up from $5,500 in 2014.

These same limits also apply to 403(b) plans, for employees of public schools and nonprofit organizations, and to 457(b) plans, for employees of state and local governments and other governmental agencies, such as park boards and water districts. So, in other words, a lot of workers have gotten a “raise” in their ability to contribute to tax-advantaged retirement plans.

Although you may not think you will ever contribute the maximum amount to your retirement plan, you may still benefit from making small increases each year. Unfortunately, many people don’t do this. In fact, approximately 30 percent of eligible workers don’t even participate in their employer’s 401(k)-type plan, according to the Employee Benefits Security Administration, an agency of the U.S. Department of Labor. And the median savings rate for these plans is just 6 percent of eligible income, with only 22 percent of employees contributing more than 10 percent of their pay, according to a recent report by Vanguard, an investment management company.

In any case, you do have some pretty strong motivations to put in as much as you can possibly afford. First of all, your 401(k) earnings grow on a tax-deferred basis, which means your money has more growth potential than it would if it were placed in an account on which you paid taxes every year. Eventually, though, you will be taxed on your withdrawals, but by the time you start taking out money, presumably in retirement, you might be in a lower tax bracket.

But you can also get a more immediate tax-related benefit from contributing as much as you can to your 401(k). Consider this hypothetical example. Suppose that you are in the 28 percent tax bracket. For every dollar you earn, you must pay 28 cents in taxes (excluding state and other taxes), leaving you 72 cents to spend as you choose. But if you put that same dollar into your 401(k), which is typically funded with pre-tax dollars, you will reduce your taxable income by one dollar — which means that if you did contribute the full $18,000, you’d save $5,040 in federal income taxes. Your particular tax situation will likely be impacted by other factors, but you’d have that $18,000 working for you in whatever investments you have chosen within your 401(k) plan. If you kept contributing the maximum each year, you will be giving yourself more potential for a sizable fund for your retirement years.

Even if you couldn’t afford to “max out” on your 401(k), you should, at the very least, contribute enough to earn your employer’s match, if one is offered. (A common match is 50 cents per dollar, up to 6 percent of your pay.) Your human resources department can tell you how much you need to contribute to get the greatest match, so if you haven’t had that conversation yet, don’t put it off.

As we’ve seen, investing in your 401(k) is a good retirement strategy — you get tax benefits and the chance to build retirement savings. And with the contribution limit increasing, you’ve got the chance for more savings in the future.

This article was written for use by local Edward Jones Financial Advisor Michael R. Sceiford.

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By Leah Dunaief

Almost 20 years ago this Easter, I left the comforts of home to go on a tour 10,000 miles away. The adventure was originally billed as a trip to Australia and New Zealand, but the tour company representative called to tell me about a month in advance that New Zealand was going to be eliminated from the itinerary to shorten the trip — and we would just visit Australia. I was terrifically disappointed and made my feelings known. After all, how often did I plan to be in the neighborhood? As long as I was making that long flight, I was intent on touring both countries.

Since I knew the tour owner personally, I carried on about my disappointment long and hard. Finally he called with a proposal. While the official visit was now only to Australia, there was a small group of six people, whom he knew well, who were indeed going on their own tour of New Zealand. One of their group had been stationed there during World War II and had put together a pre-tour visit. At my friend’s suggestion, they were now prepared to include me. Did I want to go with them?

“Would I be like a seventh wheel,” I asked. “No,” he assured me, “they would really like you to join them.” “Did they all know each other beforehand,” I worried. “Yes, the three couples were quite good friends,” he explained, “and lots of fun.” I worried more. “Here, take their phone numbers and call them — you can decide for yourself,” he said as he ended the call, glad to have finally solved the problem.

I did call one of them, a hasty call because she was running between two appointments, but she did encourage me to come. They were leaving from three different corners of the United States: Seattle, Los Angeles and Sarasota. So I agreed to meet them on the South Island in Christchurch, the second largest city of New Zealand, in a specific hotel lobby on Easter Sunday at 7 a.m. I can only marvel today at my daring.
The drama intensified.

Before I got on the plane to begin my trip, I came down with a nasty cold. By the time I got to Auckland, New Zealand’s gateway city on the North Island at 6 a.m. I had a temperature of 102 degrees and felt rotten. Fortunately I had included a Z-Pak antibiotic in my luggage, and I swallowed down the first dose on the bus to the motel. That bus ride went on forever, seeming to stop at every corner. When I finally arrived at the motel and got into bed, one thought occurred to me: Everyone in the world who cared about me enough to take care of me was on the other side of the world. With that, I drifted off to sleep.

When I awoke in the afternoon and wandered outside, looking for a place to eat, I was surprised to find all stores tightly closed and the streets almost empty Finally catching up to a pedestrian, I asked why.

“Everything is closed on Good Friday!” he exclaimed, looking at me as if I had just dropped down from Mars. Which indeed is how I felt. “Only the tourist shops and the movies are open today,” he added, sensing that I needed further help.

I took a bus to the center of the city and chatted up the bored clerks in all the tourist shops I could find. Auckland, a clean and beautiful city on the water, felt the size of Boston. Then, when the tourist places closed, I found the city’s equivalent of Times Square and went to see “The English Patient.” There weren’t many people in the cinema, and those few didn’t hear all the dialogue because by that time, I was coughing very hard. But it was a gorgeously filmed movie, even if I didn’t understand the plot entirely, which I attributed to my illness.

The next day I flew to Christchurch, a city that could have been located in rural England, and at the appointed hour on Easter morning I met my six traveling companions, who looked a little nervous too. Fortunately we hit it off, had a fabulous trip through the South Island, from glaciers to beaches, saw about 60 million sheep and have been friends ever since. It was a Happy Easter memory and I wish you one this year too.

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By Daniel Dunaief

I have a modest proposal: How about a new holiday, either in each school or in each town, every year? I’m not talking about taking any more time off from school or interrupting the flow of work, especially in a year when snow, ice and record-breaking blizzards that never happened upset our busy schedules. I’d like to suggest, rather, that we celebrate, recognize or mark the occasion for a different moment every year. We could create such a holiday some day in June, when classes are winding down and we’re just about to kick off the start of the summer.

Every year, Americans stop to recognize 9/11 in September. It’s a somber occasion and a chance to reflect on who we lost and what might have been. It’s also an opportunity to recognize the unimaginable bravery of those who did whatever they could to save strangers, friends and fellow New Yorkers and Americans.

Perhaps, one year, we might also recognize all the medical miracles that have made lives possible. I’ll never forget the day a colleague of mine at Bloomberg picked up the phone and his face went white. Seemingly unable to verbalize the terror in his mind, he grabbed his jacket and sprinted out of the room. His sudden and panicked motion created considerable concern from his colleagues.

As he told our editor the next morning in a barely audible voicemail, his wife went into premature labor and, less than an hour later, delivered a baby girl who weighed close to 1 pound.

For weeks, whenever he came to work, he seemed to look past us, searching for any kind of help, spiritual or otherwise, for his daughter’s fragile life. After several months, she grew enough to improve her prospects for survival. We knew things were getting better because we heard the welcome return of laughter from our friend. We also saw him exhale for the first time in months, loosening and relaxing the taut muscles in his chest.

Perhaps, one school might find the names of the doctors and scientists who improved the treatment and care for premature babies who had considerably poorer prognoses 50 or 100 years earlier.

We might also pause to recognize those working in fertility clinics or in reproductive research, who have made it possible for couples having trouble conceiving to celebrate the marvel of their child.

Maybe we could celebrate the considerable achievements of scientists who have helped prevent an HIV diagnosis from becoming a death sentence. When Magic Johnson revealed that he was HIV positive, many of us probably never imagined we’d see him cheering for his Michigan State basketball team to make it to the Final Four in 2015.

It is through remarkable medical breakthroughs, incredible dedication and a desire to defeat diseases like cancer and AIDS that we can extend the quantity and quality of our lives and the lives of our friends and family.

Some of these achievements and lifesaving discoveries wouldn’t have been possible without the insights and inspiration of scientists, researchers and doctors on Long Island.

Perhaps we can take a moment to appreciate and acknowledge the guiding hand and valuable contributions religious leaders make to us. Bringing us together and encouraging us through our battles elevates us when we’re down.

We see headlines about people who take lives and make poor decisions. Perhaps, we could use a day to recognize those who, to borrow a phrase from just about every political ad, truly “fight for us.” And maybe, by acknowledging these achievements, we inspire the next generation.

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Suffolk County Executive Steve Bellone file photo

By Julianne Cuba

At his fourth State of the County address, Suffolk County Executive Steve Bellone began by ensuring the county government and public that he has never been more optimistic about the current state of the region and its future.

At the William H. Rogers Legislative Building in Hauppauge on March 26, Bellone (D) also took time commending the county legislature for successfully and efficiently reducing government by more than 10 percent — an initiative that will save Suffolk County taxpayers more than $100 million a year. The county executive announced that when he took office three years ago, the unemployment rate for Suffolk County stood at 8.2 percent. As of the end of 2014, it stands at 4.2 percent.

However, Bellone continued, “I’m not here to talk about where we are today. I am much more interested in talking about where we are going and what the future could look like.”

In order to combat what Bellone said he considers the fundamental issue of our time — a two-decade trend of losing young, qualified and educated people to other regions of the county — he pointed to the county’s economic development plan, Connect Long Island.

“We cannot reach our economic potential, we cannot build a more prosperous future, if we are not a region that can attract and retain the young, high-knowledge, high-skill workers necessary to build an innovative economy,” he said.

Connect Long Island will make progress on the five crucial issues that are driving young people away, which, according to Bellone include high costs, lack of transportation options, lack of quality affordable rental housing, lack of affordable housing in desired environments and a lack of high-paying jobs.

“We build walkable, transit-oriented downtowns that have strong, public transportation links to one another and to universities, research centers, job centers and parks and open space. Effectively, what Connect LI will do is to build a quality of life ecosystem that will be attractive to young people,” he said.

But, unfortunately, Bellone said, the lack of sewage systems in many of Suffolk County’s downtown areas — which are critical parts of the region’s future — is limiting the opportunity for growth.

Suffolk County’s sewage problem impacts not only the regions economic development but its water quality as well. The water quality issue was one of the three major problems on which Bellone focused.

“We have 360,000 unsewered homes in Suffolk County — that is more than the entire state of New Jersey. Those 360,000 homes represent, potentially, 360,000 customers. So I’m happy to report that four companies donated 19 systems, which we are putting into the ground to test under local conditions. At the same time, with the leadership of Southampton Town Supervisor Anna Throne-Holst and Dr. Samuel Stanley, [Stony Brook University] will begin a new program to identify the next generation of septic technology, with the goal of providing better, more cost-efficient options for Suffolk County residents,” Bellone said.

Bellone announced that with the help of Gov. Andrew Cuomo (D), the county’s state and federal partners, and U.S. Sen. Chuck Schumer (D-NY) and Sen. Kirsten Gillibrand (D-NY), he was able to secure $383 million for one of the largest investments in clean water infrastructure in more than 40 years — the Reclaim Our Water Initiative.

Legislator and Minority Leader Kevin McCaffrey (R) said that he agrees 100 percent with everything the county executive said in regard to economic development and improving drinking water. However, he added that the county’s debt must be cut and the legislature needs increased oversight.

“We must ask ourselves if we are going to control the irresponsible and reckless spending and borrowing, we must become more focused on the county’s ever-increasing debt,” McCaffrey said.  “We must ask ourselves if we want to throw debt on the backs of our children and our grandchildren. It’s time to cut up the credit cards and learn how to live within our means.”

 

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Council head mulls creating new lecture series

Marc Courtade photo from Huntington Arts Council

Marc Courtade, the new executive director of the Huntington Arts Council, is rolling up his sleeves and getting ready to work.

Courtade follows Diana Cherryholmes as the new leader of the arts organization and officially stepped in to fill her position on March 2. Cherryholmes, who was at the helm of the Huntington Arts Council for more than 16 years, left to work for Suffolk County.

Before joining the Huntington Arts Council, Courtade was the business manager for Tilles Center for the Performing Arts at LIU Post for the past 17 years.

“I am delighted to bring my skills, passion and energy to the Huntington Arts Council, and look forward to helping the arts remain a vibrant part of our community,” he said in a statement.

While at Tilles, Courtade was an integral part of the center’s performance season, where he assisted in planning and organizing many of the performances and special events. At Tilles, he also created the pre-performance series, “Performance PLUS!” while simultaneously producing and acting as artistic director for 10 years. Courtade continues to teach musical theater and opera courses for the honors program at LIU and The Hutton House Lectures at Lorber Hall.

“At the moment, I just want to help to continue the good work and move the organization forward … I’m still transitioning and working on a 50th anniversary reception,” he said in a phone interview. “This is the 50th anniversary of the concerts at Heckscher Park, so we’re currently working on finalizing that programming.”

Courtade said that the planning for the 50th anniversary of the concerts in the park is all still in the works, but he is looking to hold a small reception before the anniversary concert on June 27.

Courtade said that over the years he has given many lectures and would like to continue that while at HAC.

“I would love to begin a lecture series here, presentations about the arts,” he said. “Different art genres. I would like to tailor it across a wide variety of art genres. I would give some and I would like to have speakers from the outside as well on arts-related topics.”

While Courtade’s personal focus is in the performing arts, the Huntington Arts Council offers a wide variety of arts, including both performing and visual.

Courtade said that on April 10, HAC will be holding its opening reception of a self-portrait visual arts show entitled, “I see me!” It will be a juried show and the winners will be announced very soon, he said.

In addition to his involvement at Tilles and now at HAC, Courtade has been a speaker for the New York Council for the Humanities since 2007. He is a frequent speaker all over Long Island and the New York-area.

Before Tilles, Courtade worked in development for Lincoln Center for the Performing Arts and New York City Opera.

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Irina DeSimone works her way around a Sayville opponent last season. File photo by Kevin Freiheit

Expectations are running high for a strong season, and for good reason — the Huntington High School girls’ lacrosse team returns many talented players to the field this spring.

Coached by Kathy Wright and Molly Burnett, the Blue Devils were relegated to the gym for the first week of practice since snow covered their outdoor field. Players made the best of the situation, but the squad is looking forward to warmer temperatures.

Huntington compiled a 15-3 overall mark last spring, with a 12-2 record in Division II, reaching the Suffolk Class B Final Four before losing in overtime at home to Sayville, 14-13.

Caitlin Knowles races to scoop up a ground ball. File photo by Kevin Freiheit
Caitlin Knowles races to scoop up a ground ball. File photo by Kevin Freiheit

Junior midfielder Emma DeGennaro, senior midfielder Samantha Lynch, junior midfielder Katie Reilly and senior goalkeeper Anna Tesoriero were named All-County.

Senior attack Alyssa Amorison, junior midfielder Irina DeSimone, senior defender Caitlin Knowles and sophomore defender Camille Stafford won All-Division honors. Senior defender Cassidie Gianmarino and junior defender Brianna McDonald were recognized as All-Tournament. Junior defender Hailey Bengston was Huntington’s Unsung Hero Award recipient. Lynch, Knowles and Tesoriero also garnered Academic All-American honors.

All of last season’s postseason honorees are back on the field this spring.

“I think the team is already looking really good,” said Reilly, who had 49 goals and 85 assists last year. “We have so much talent in every position. Emma, Irina, Alyssa and Samantha will have huge roles this year for the offense and the defense is looking better than ever.”

Reilly’s 134 points led the team last season. Lynch notched 86 goals and 17 assists. DeGennaro (54 goals; 17 assists) and Amorison (30 goals; 16 assists) were also potent offensively. DeSimone had 12 goals and four assists and played a key role on both ends of the field.

Gianmarino, Bengston  and Knowles continue to be integral to Huntington’s aggressive defense, while Stafford is currently sidelined from an injury.

Alyssa Amorison maintains possession while carrying the ball into Shoreham-Wading River’s zone last season. File photo by Kevin Freiheit
Alyssa Amorison maintains possession while carrying the ball into Shoreham-Wading River’s zone last season. File photo by Kevin Freiheit

Tesoriero recorded 140 saves in goal last year and looks to improve as a senior. The Blue Devils will also be relying on senior attack Mackenzie Maloney, freshman midfielder Emma Greenhill, junior goalie Taylor Moreno and senior faceoff and defensive specialist Heather Forster, along with several skilled underclassmen.

“The team is excited and hopeful about the upcoming season,” Lynch said. “We are returning almost every player and have some great new additions in our underclassmen. The team worked especially hard … in our first outdoor practice, in preparation for [the first] two scrimmages. With a tough schedule ahead of us, the team plans to focus on one opponent at a time. We are looking to top last year’s county semifinal appearance with a trip to the finals.”

As the Blue Devils settle into outdoor practice, players are already returning to top form.

“It was a little unfortunate that we had to play indoors for the first week, but that makes it that much better to finally be on the turf,” Reilly said.

The team took to the field today at Islip at 4:30 in the first Division II game of the season, but results were not available by press time.

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By David Dunaief

As the population ages, we see more and more osteoarthritis (OA); but as the population gets heavier, we see more; and as people become more active, we see more; and as the population becomes more sedentary (weakened muscles), we see more. The point is that age, although a strong factor, may not be the only one, and while there are conflicting contributors, there are many, nonetheless.

Over 27 million people in the U.S. suffer from OA (1). Osteoarthritis is insidious, developing over a long period of time, and is chronic by nature. It is a top cause of disability (2). What can we do about it?

It turns out that OA is not just caused by friction or mechanical breakdown based on age but rather on a multitude of factors including friction but also local inflammation, genes and metabolic processes at the cellular level (3). Being a more complicated process means that we may be able to prevent and treat it better than we thought through exercise, diet, medication, injections and possibly even with supplements.

Let’s look at some of the research.

Don’t wait to lose weight!
In an older study, results showed that even a small 10-pound weight loss could result in an impressive 50 percent reduction of symptomatic knee OA over a 10-year period (4).

How can exercise be beneficial?
One of the exercises that most of us either can tolerate or actually enjoy is walking. We have heard that walking can be dangerous for exacerbating OA symptoms; the pounding can be harsh on our joints, especially our knees. Well, maybe not. Walking may have benefits. And once we figure out what exercise might be useful, in this case walking, how much should we do? In the Multicenter Osteoarthritis Study (MOST), results showed that walking may indeed be useful to prevent functional decline (5). But certainly not in overweight or obese patients and not older patients, right?

Actually, the patients in this study were a mean age of 67 and were obese, with a mean body mass index (BMI) of 31 kg/m2, and either had or were at risk of knee arthritis. In fact, the most interesting part of this study was that the researchers quantified the amount of walking needed to see a positive effect. The least amount to see a benefit was between 3250 and 3750 steps per day, measured by an ankle pedometer. The best results were seen in those walking >6000 steps per day, a relatively modest amount. This was random, unstructured exercise. In addition, for every 1000 extra steps per day, there was a 16 to 18 percent reduced risk of functional decline two years later.

Where does vitamin D fit in?
For the last decade or so, we thought vitamin D was the potential elixir for chronic diseases. If it were low, that meant higher risk for disease, and we needed to replete the levels. Well, a recent randomized controlled trial (RCT), the gold standard of studies, has shown that low vitamin D levels may indeed contribute to knee osteoarthritis (6). However, repleting levels of vitamin D did not seem to stem disease progression. In fact, it had no effect on the disease, to the bewilderment of the researchers. There was no change in joint space, knee pain, mobility or cartilage loss slowing. Hmm. The patients were supplemented with vitamin D 2000 IU for two years. There were 146 patients involved in the study. Blood levels of vitamin D were raised by 16.1 ng/ml in the treatment group to >36 ng/ml, which was significantly greater than the 2.1 ng/ml increase in the placebo group. Since the reasons for the results are unclear, work to maintain normal levels of vitamin D to possibly prevent OA, rather than wait to treat it later.

Acetaminophen may not live up to its popularity
Acetaminophen is a popular initial go-to drug for the treatment of osteoarthritis, but what does the research say about its effectiveness? The answer might surprise you. Although acetaminophen doesn’t have anti-inflammatory properties, it does have analgesic properties. However, in a recent meta-analysis (involving 137 studies), acetaminophen did not reduce the pain for OA patients (7). In this study, all other oral treatments were significantly better than acetaminophen including diclofenac, naproxen and ibuprofen as well as intra-articular (in the joint) injectables, such as hyaluronic acid and corticosteroids, except for an oral cox-2 inhibitor, celecoxib, which was only marginally better.

What about NSAIDs?
NSAIDs (nonsteroidal anti-inflammatory drugs) by definition help to reduce inflammation. However, they have side effects that may include gastrointestinal bleed and have a black box warning for heart attacks. Risk tends to escalate with a rise in dose. But now there is a new twist; the FDA has approved a new formulation of an NSAID, diclofenac (Zorvolex) (8). This formulation uses submicron particles, which are roughly 20 times smaller than the older version; since they provide a greater surface area that helps the drug to dissolve faster, they require less dosage.

The approved dosage for OA treatment is 35 mg, three times a day. In a 602-patient, one-year duration, open-label randomized controlled trial, the new formulation of diclofenac demonstrated improvement in pain, functionality and quality of life (9). The adverse effects, or side effects, were similar to the placebo. The only caveat is that there was a high dropout rate in the treatment group; only 40 percent completed the trial when they were dosed three times daily.

Don’t forget about glucosamine and chondroitin
Study results for this supplement combination or its individual components for the treatment of OA have been mixed. In a double-blind RCTß, the combination supplement improved joint space, narrowing and reducing the pain of knee OA over two years. However, the pain was reduced no more than was seen in the placebo group (10). In a Cochrane meta-analysis review study (involving 43 RCTs) results showed that chondroitin with or without glucosamine reduced the symptom of pain modestly compared to placebo in short-term studies (11). However, the researchers stipulate that most of the studies were of low quality.

So, think twice before reaching for the Tylenol. If you are having symptomatic OA pain, NSAIDs such as diclofenac may be a better choice, especially with SoluMatrix fine-particle technology that uses a lower dose and thus hopefully means fewer side effects. Even though results are mixed, there is no significant downside to giving glucosamine-chondroitin supplements a chance. However, if it does not work after 12 weeks, it is unlikely to have a significant effect. And above all else, if you need to lose weight and do, it would reduce your risk of OA significantly.

REFERENCES
(1) Arthritis Rheum. 2008;58:26-35. (2) Popul Health Metr. 2006;4:11. (3) Lancet. 1997;350(9076):503. (4) Ann Intern Med.1992;116:535-539. (5) Arthritis Care Res (Hoboken). 2014;66(9):1328-36. (6) JAMA. 2013;309:155-162. (7) Ann Intern Med. 2015;162:46-54. (8) FDA.gov. (9) ACR 2014 Annual Meeting: Abstract 249. (10) Ann Rheum Dis. Online Jan 6, 2014. (11) Cochrane Database Syst Rev. 2015 Jan 28;1:CD005614.

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 and/or consult your personal physician.

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Gunshots rang out in the night on March 11 in Huntington Station. The bullets from the gun of someone fleeing a traffic stop struck Suffolk Police Officer Mark Collins in the neck and hip, triggering an immediate reaction in a team of medical and emergency personnel with one goal: Do whatever can be done to keep Collins alive.

Seeing the injuries to Collins’ neck, the medics at the scene directed the injured officer to the Stony Brook Trauma Center, where the Code T Team — the highest level activated — was called in. Several medical professionals prepared for his arrival, including a board-certified general surgeon and an anesthesiologist, in case the officer needed emergency surgery. The center also held open an operating room and a CT scanner and had several other medical professionals, including a radiology technician, at the ready.

“We bring all the necessary resources to handle any array of injuries,” said Dr. James Vosswinkel, chief of Division of Trauma, Emergency Surgery and Surgical Critical Care at Stony Brook Medicine.

A gunshot wound to the neck “doesn’t sound good,” said Vosswinkel, who was home in East Setauket before the incident. When Collins came in, “we mobilized all the appropriate services.”

The prospect of such a serious injury raised concerns for their incoming patient.

Any time there is a Code T alert, “your blood pressure goes up a little bit,” Vosswinkel said. Still, he and the other members of the medical crew were prepared to follow a system that uses a “standard algorithmic approach” for injured patients, “where we have people come in and everybody knows their role.” The medical staff relies on a set of instructions that involve multiple people whose responsibilities range from stabilizing the patient to identifying injuries.

How does a surgeon who might be required to spend hours with a patient at any given time — and often late in the night, as was the case with this officer — prepare for the moment when he might ask his or her body and mind to focus on something unexpected?

Vosswinkel’s response, like those of the police who deal with emergency situations in our communities, was simple: training. Four years of medical school, five years of general surgery and then a few years of additional trauma training helped him prepare emotionally and physically.

The doctors also “try to keep ourselves in good shape with a healthy lifestyle and the necessary rest,” which gives them emotional and physical control. “You’re prepared when you’re on call,” he said. “The first priority” in an emergency is to “get a good enough team and good enough number of people together so you can handle the rigors that may be required.”

Vosswinkel said he does what many people who confront a high-stress situation do: He takes a slow deep breath, moves a step back and does whatever he can to remain focused and logical.

“Practicing in a hospital like this allows you to keep focus and keep your emotions in control,” he said.

The bullet in Collins’ neck was an inch away from a much more precarious outcome. The surgical team put him in a medically-induced coma. Standing behind Collins in a wheelchair as other officers saluted their wounded colleague, Vosswinkel brought Collins out of the hospital.

Vosswinkel said he and the staff were inspired by Collins’ dedication as a police officer and his contribution to the community.

“How could you not be inspired by someone like him?” Vosswinkel asked. “These guys are out there making it safe so something bad doesn’t happen to us.” And, when something bad happens to them, the trauma unit stands ready.

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Several joyous events are coming together for us at Times Beacon Record Newspapers. One is the 39th anniversary of the founding of our media group, which began with the first issue of The Village Times on April 8, 1976. While we had little doubt that we would be successful, such being the perception of total ignorance, we look back at the intervening years with astonishment and humility. We are astonished by all that has transpired in the communications industry during that time, from the advent of typesetting and desktop computers to the soon-to-be released Dick Tracy watch from Apple. And we are deeply grateful for our endurance, the result of a selfless and totally committed staff and a trusting and supportive readership and advertising base. We are incredibly appreciative that we have with us staff who have been with the company for so many of those years, and subscribers and advertisers who still think we are worth the cost. And we highly value those who have joined us most recently, for they keep us on the cutting edge.

In creating The Village Times, in effect we created a microscopic world within our office in which talented staffers worked as a team to publish a hometown newspaper each week. Everyone learned to fill almost every position because we never knew who would be called away without finishing the allotted work. Why would that happen? Because we were mainly a group of mothers with young children, and I can say in all truthfulness that we invented the concept of job sharing.

As a result of so much teamwork, we tightly bonded then, even as we have continued the tradition of helping each other every day. Those bonds are much in evidence whenever former staffers, now highly successful perhaps in larger communications corporations, stop by to say “hello” and catch up on the latest. For we know of each others’ families, challenges and successes over the years and we delight in staying in touch.

As we built and grew newspapers, we also worked diligently to build and grow community. That is, after all, the consequence of a community newspaper that exists to share the problems and triumphs of the latest news, The net effect is to encourage bonding among residents for the common good and for pride of place. Where there is a strong sense of community, everyone benefits, from school districts and local governments to commercial, cultural and athletic efforts.

This weekend, we will celebrate the 39th annual party honoring the men and woman of the year as selected in our last issue of this past year. By appreciating their work in going the extra mile and enhancing our lives with their accomplishments, we are also strengthening our pride in community and encouraging communications among all segments of our hometown. When we get all those leaders into one room at one time socializing together, we like to think we are cross-pollinating for future cooperation and success. We will run some photos from the event in next week’s papers so that everyone can feel pleased with where and among whom we live.

Besides all that fun stuff, we are bringing out our latest publication, a beautiful magazine: LIFESTYLE. It will be inserted in all our newspapers each month, and we hope it will offer a breath of fresh air alongside some of our more somber news articles. In LIFESTYLE, we will examine activities and issues that animate our region and some that we might hope to enjoy. LIFESTYLE is intended to upgrade and augment our regular supplements, like Focus on Health, Our House, SummerTimes and HarvestTimes, and we will develop ideas and go farther afield in geography in its pages.

And finally, I will share with you our excitement over our revamped and upgraded website. With our new platform, we will be able to bring more news, more photos, more features, more voices and more interactivity to our communities. The official rollout is next week but, like the news itself, it will be an ongoing work in progress.

We create these new products and events to further your pleasure and the value you feel in our media company. But we cannot succeed in any of these efforts without your support and input. We will be delighted, as always, to hear from you. Happy Spring!

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