Arts & Entertainment

Baked Custard

By Barbara Beltrami

We all talk about comfort foods — chicken soup and meatloaf and mac and cheese and the myriad foods that linger in our memory from childhood. But what about comfort desserts? What about those sweet smooth custards and puddings that soothed sore throats and upset tummies, sickbed treats for which we roused ourselves from the fumes of Vick’s Vaporub and aftertastes of stale ginger ale to savor a few spoonfuls of soothing pleasure that would hold us over until the next delivery of a new coloring book and even bigger box of crayons arrived.

Lemon Pudding

Lemon Pudding

YIELD: Makes 4 servings

INGREDIENTS:

¾ cup sugar

¼ cup cornstarch

2½ cups milk

3 egg yolks, lightly beaten

1½ tablespoons very finely grated lemon zest

1/8 teaspoon salt

½ cup freshly squeezed lemon juice

2 tablespoons unsalted butter, softened

DIRECTIONS:

In a medium to large saucepan, thoroughly combine sugar and cornstarch. Whisking constantly, add milk and when mixture is smooth slowly add egg yolks, lemon zest and salt. Cook over medium heat, stirring frequently and then constantly until mixture is thickened and coats the back of the spoon, about 10 to 15 minutes. Remove from heat, stir in lemon juice and butter and pour through sieve to catch any lumps. Divide into individual bowls, cover with plastic wrap and chill. Serve cold with lemon cookies.

Baked Custard

Baked Custard

YIELD: Makes 4 servings

INGREDIENTS:

3 eggs

½ cup sugar

¼ teaspoon salt

Dash of vanilla

2¼ cups milk, heated until not quite boiling

DIRECTIONS:

Preheat oven to 350 F. Beat together the eggs, sugar and salt, add vanilla and milk and briefly beat together. Divide mixture into 4 oven proof ramekins and set them in a shallow pan filled with hot water that comes halfway up their sides.  Bake 45 to 55 minutes until knife inserted in center comes out clean. Remove ramekins from oven. (To avoid hot water sloshing and scalding, let pan with water cool before removing from oven). Cover ramekins with plastic wrap and refrigerate or serve warm with vanilla cookies.

Rice Pudding

Rice Pudding

YIELD: Makes 4 to 6 servings

INGREDIENTS:

3 cups cooked short or medium grain rice

3 cups milk

2/3 cup sugar

2 tablespoons unsalted butter

1 teaspoon vanilla extract

½ cup raisins (optional)

1 teaspoon cinnamon

DIRECTIONS:

In a medium saucepan over medium heat, combine rice, milk, sugar, butter, vanilla, raisins, if using,, and half the cinnamon. Cook, stirring frequently, until liquid is absorbed, about 20 to 25 minutes. Divide evenly among dessert bowls and sprinkle with remaining half of cinnamon. Cover with plastic wrap and refrigerate or serve warm with raisin cookies.

Nugget. Photo courtesy of Kent Animal Shelter

MEET NUGGET!

This week’s shelter pet is a very handsome cat named Nugget. This one-year-old love bug was found outside as a stray and clearly belonged to someone at some point. He is now safe at Kent Animal Shelter but would rather be curled up in your arms for Valentine’s Day.

Nugget is neutered, up to date with vaccinations, has tested negative for feline AIDS and leukemia and is microchipped. Come on down and meet Nugget! 

Kent Animal Shelter is located at 2259 River Road in Calverton. The adoption center is open from 10 a.m. to 4 p.m. every day. For more information on Nugget and other adoptable pets at Kent, call 631-727-5731 or visit www.kentanimalshelter.com.

Bourbon must be aged in new, charred oak barrels.

By Bob Lipinski

Bob Lipinski

What is bourbon whiskey? Bourbon whiskey is a distinctive whiskey of Kentucky made from a grain mixture of a minimum 51 percent corn and aged in new, charred oak barrels.

Where is it made? Technically, bourbon whiskey can be produced anywhere in the United States, although in practice over 90 percent is made in Kentucky. Bourbon is also produced in 48 states, but not in Hawaii and South Dakota.

Is bourbon made in Bourbon County, Kentucky? Yes, even though Bourbon County is a “dry county,” where alcohol can’t be sold, Bourbon whiskey can be made there.

Where did the name bourbon originate? Back in the 1700s practically all of Kentucky was a part of Virginia and a large part of the region was called “Bourbon County.” In 1785, it was named by settlers in honor of the French royal family — the Bourbons, who helped the colonists win the American Revolutionary War.

However, another account says the whiskey was named after Bourbon Street, the entertainment district in New Orleans. Bourbon whiskey was being shipped to New Orleans and eventually people asked for the whiskey sold on Bourbon Street.

When was the first bourbon whiskey made? In 1783 at the Old Evan Williams Distillery, a Welshman named Evan Williams, an early Kentucky settler and pioneer earned his permanent role in American history when he built the area’s first commercial distillery on the banks of the Ohio River in Louisville.

In 1789, a Baptist minister, Elijah Craig, made a distilled spirit by combining spring water, corn, rye and barley malt. Craig is often erroneously credited as the inventor of bourbon whiskey.

What are the ingredients? Federal regulations require that bourbon whiskey be made from a minimum of 51 percent corn; however, 65 to 75 percent is generally used. The blend of other grains is dictated by the distiller’s own private formula; barley, oats, rye and wheat can be used.

How long is bourbon aged? There is no minimum amount of aging for non-straight bourbon whiskey, and technically a distiller could pump the clear distillate into a new charred oak barrel and then immediately empty it.

What about straight bourbon whiskey? For bourbon to be labeled “straight,” it must be aged a minimum of two years. If it is released before the fourth year of aging, it must be stated on the label. In addition, no alcohol, caramel coloring or flavoring can be added.

Bob Lipinski is the author of 10 books, including “101: Everything You Need to Know About Whiskey” and “Italian Wine & Cheese Made Simple” (available on Amazon.com). He conducts training seminars on wine, spirits and food and is available for speaking engagements. He can be reached at www.boblipinski.com OR [email protected].

Third-place winners from Commack High School from left, Luke Maciejewski, Nathan Cheung, Riley Bode, Louis Vigliette and Kevin Chen. Photo from BNL
Commack and Walt Whitman high schools take home honors
Fourth-place winners from Walt Whitman High School in Huntington Station, from left, Rena Shapiro, Eliot Yoon, Matthew Kerner and Aiden Luebker. Photo from BNL

Brookhaven National Laboratory in Upton held its annual Long Island Regional High School Science Bowl on Jan. 26. Out of 20 teams from across Long Island, Levittown’s Island Trees High School took the top spot and was awarded an all-expenses-paid trip to the National Finals in Washington, D.C., scheduled for Apr. 25 to 29. 

Old Westbury’s Wheatley School took home second place; Commack High School placed third; and Walt Whitman High School in Huntington Station placed fourth.

The event was just one of the nation’s regional competitions of the 29th Annual DOE National Science Bowl (NSB). 

A series of 111 regional high school and middle school tournaments are held across the country from January through March. Teams from diverse backgrounds are each made up of four students, one alternate, and a teacher who serves as an adviser and coach. These teams face off in a fast-paced question-and-answer format where they are tested on a range of science disciplines including biology, chemistry, Earth science, physics, energy and math. The NSB draws more than 14,000 middle- and high-school competitors.

“The National Science Bowl has grown into one of the most prestigious and competitive science academic competitions in the country, challenging students to excel in the STEM fields so vital to America’s future,” said U.S. Secretary of Energy Rick Perry. “I am proud to oversee a Department that provides such a unique and empowering opportunity for our nation’s students, and I am honored to congratulate Island Trees High School for advancing to the National Finals, where they will be competing against some of the brightest science, technology and engineering students across the country.”

The top 16 high school teams and the top 16 middle school teams in the National Finals will win $1,000 for their schools’ science departments. Prizes for the top two high school teams for the 2019 NSB will be announced on a later date.

In the competition at Brookhaven Lab, participating students received a Science Bowl T-shirt and winning teams also received trophies, medals and cash awards. Prizes were courtesy of BNL’s event sponsor, Brookhaven Science Associates, the company that manages and operates the lab for DOE.

For more information, visit www.science.energy.gov

Snowy Owl by Rainy Sepulveda

By Heidi Sutton

Something special is in the air. From Feb. 9 to 21, the Four Harbors Audubon Society (FHAS) will present a photography exhibit titled A Valentine to Whitman’s Paumanok, featuring the wildlife and landscapes that influenced the early life of one of America’s greatest poets, at The Bates House in Setauket. The venue is a fitting one as it is nestled in the 26-acre Frank Melville Memorial Park where many of the photographs in the exhibit were taken. 

In a recent interview, curator Patricia Paladines, outreach chairman of the FHAS board, said the show will feature the works of 12 photographers who were invited to submit up to five images each. 

The concept for the exhibition came about when Paladines heard from her friend Lise Hintze, who manages The Bates House, that the venue was interested in hosting an art exhibit of some sort. A shutterbug herself, Paladines was familiar with many talented nature photographers who shoot locally. “The whole idea worked very well with the mission of the Four Harbors Audubon Society,” she said. 

Kingfisher by William Walsh

Indeed, the 60-piece collection features breathtaking images of nature, from a great blue heron searching for his next meal, a juvenile kingfisher perched on a branch, a seahorse gripping onto a blade of seagrass in the swift current, to a nest of fluffy cygnets, each more visually stunning than the next.

Exhibiting photographers include Dr. Maria Bowling, Maria Hoffman, Joe Kelly, Anita Jo Lago, Luke Ormand, Christopher Paparo, Derek Rogers, Rainy Sepulveda, Alexandra Srp, Kevin Walsh, William Walsh and Debra Wortzman

“I wanted the show to be a platform for the work of these photographers who dedicate a lot of time capturing the natural beauty of Long Island and hopefully in turn inspire the viewers to make time to go out and enjoy it too in the many parks, preserve and natural shorelines that surround us,” Paladines explained, adding that the idea was to “raise awareness of the variety of wildlife that we can see if we just look around this lovely island.”

The fact that Whitman’s 200th birthday will be celebrated all over the country this year was just coincidental in referencing America’s most celebrated literary figure in the title. “Actually I found that out later,” said Paladines. “I was delighted to learn that it is the bicentennial of Walt Whitman’s birth. I like his poetry and Long Island is where, of course, he was born and where he was inspired early in his life. He uses nature in a lot of his poetry. [When deciding the title] I though it’s Valentine’s Day, this exhibit should be about Long Island and I’ve always liked Whitman’s poem that starts out “Starting from fish-shape Paumanok …” 

Lined Seahorse by Chris Paparo

Paladines is hopeful that this show will become an annual event. “We’ll see how it goes this year,” she laughed.

Join the Four Harbors Audubon Society for an opening reception on Saturday, Feb. 9 from 2 to 3:30 p.m. Special guest Darrel Blaine Ford, historian, ornithologist and Walt Whitman personator, will read a few poems from “Leaves of Grass” including “There Was a Child Went Forth.” Refreshments will be served. The exhibit will be on view at The Bates House, 1 Bates Road, Setauket through Feb. 21. All the photographs will be for sale. Call 631-689-7054 or visit www.thebateshouse.org for viewing hours.

Serving the Townships of Smithtown and Northwest Brookhaven, the Four Harbors Audubon Society’s mission is to advocate education and conservation efforts for the enjoyment, preservation and restoration of birds, wildlife and habitat in our communities. The society hosts monthly bird walks at Frank Melville Memorial Park and West Meadow Beach in Setauket, and Avalon Park & Preserve in Stony Brook; lectures at Emma S. Clark Memorial Library; Friday movie nights at the Smithtown Library; field trips; and bird counts including the popular Stone Bridge Nighthawk Watch. For more information, visit www.fourharborsaudubon.com.

Amber Ferrari. Photo by Rich Balter

By Rita J. Egan

Music lovers who enjoy taking a trip down memory lane will be in for a treat Feb. 9 at Theatre Three. Long Island performer Amber Ferrari returns to the Port Jefferson venue with “Joplin’s Pearl Featuring Amber Ferrari,” a production that celebrates singer Janis Joplin’s musical legacy.

The show is described on the theater’s website as a two-act musical explosion. While the second act is jam-packed with the music of Joplin including “Me and Bobby McGee” and “Piece of My Heart,” the show opens with a mixture of hits from various artists. 

Amber Ferrari. Photo by Rich Balter

Reached by phone, Ferrari said she will be singing musical hits from legends throughout the decades, including Pat Benatar, Linda Ronstadt, Madonna, Lady Gaga, Queen, Led Zeppelin and Carole King. The singer said she also plans on performing one of her own songs.

Ferrari’s artistic relationship with Theatre Three began in 2005 when she performed in the venue’s “Woodstock-mania: Woodstock in Concert,” a show that inspired her to create “Joplin’s Pearl.” The singer said through the years she has performed the Joplin musical performance many times at the Port Jeff venue and also debuted her shows dedicated to Pat Benatar and Madonna there. Last summer, she once again participated in “Woodstock-Mania.”

“That’s my home theater, that’s my heart and soul,” said Ferrari. 

Douglas Quattrock, Theatre Three’s artistic associate and director of development, said he is looking forward to Ferrari returning to the theater with the show.

“I am thrilled to have Amber back at Theatre Three,” Quattrock said. “Her show is always filled with an incredible amount of energy, and her audiences always get a first-rate performance.”

The February performance follows a busy few months for Ferrari who presented her “Material Girl Featuring Amber Ferrari” at 89 North Music Venue in Patchogue last month and Napper Tandy’s Irish Pub in Smithtown last October as well as her Joplin show at Riverhead’s Suffolk Theater back in November.

On the night of Feb. 9, in addition to paying tribute to Joplin, the singer said she is looking forward to performing a Queen number. Ferrari said she feels the show has something for everyone and hopes audience members will enjoy how she and her band interpret the music of all the artists she is featuring.

“I’m hoping the people who don’t like a specific artist will just enjoy the way we do it because I don’t try to imitate anyone,” Ferrari said.

The singer said at the Feb. 9 performance bass player Michael Chiusano, guitarist Chris Ferrari, keyboardist Chris Cuvier, drummer Gary Gonzalez and percussionist Jim Carroll will join her on stage. She will also perform with a horn section that includes Lenny La Pinta on alto/tenor sax, Jonathan Holford playing baritone sax, Dan Yeager on trumpet and trombonist Tim Cassera.

Theatre Three, 412 Main St., Port Jefferson will present ‘Joplin’s Pearl Featuring Amber Ferrari’ on Saturday, Feb. 9 at 8 p.m. Tickets are $39. For more information or to order, visit www.theatrethree.com or call 631-928-9100. 

For more information on Amber Ferrari, visit www.amberferrari.com.

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132 pounds lost, a new life gained - Michael Tessler in a before and after photo

By Michael Tessler

We’ve got quite a bit to catch up on. It has been over a year since I published what I thought was the last Open Mike column. In that time I’ve lived what feels like a dozen lives. 

I’ve moved across the country twice; hosted a radio program; attended the premiere of our first feature film at the prestigious Stony Brook University Staller Center; helped produced an underwater television special starring Sir Richard Branson and the grandson of ocean explorer Jacques Cousteau; successfully filmed several historic short films taking place in the 18th, 19th and 20th centuries; and was brought on as a ghostwriter for a compelling biography for a fitness guru/entrepreneur in Atlanta. 

Shortly thereafter I began developing an online school for emotional intelligence and am in the process of writing a corresponding children’s book. Interspersed between all that I founded my own production company, announced my candidacy for a local councilman position and, perhaps most importantly, lost 132 pounds in my effort to live a healthier and happier life.

It has been a long, hard and wonderful year riddled with obstacles and seemingly insurmountable odds. Reflecting back on it all, it doesn’t quite feel real. I’m writing all this because I’m exhausted and a little frustrated at the pace of things lately. Sometimes we as people have to force ourselves to look at our progress rather than just our mistakes or perceived failures. Don’t worry, I make plenty of mistakes too and have been the proud beneficiary of a practical education of failed efforts and misguided attempts.

Presently, I’m at home sitting in a very comfortable leather chair several blocks south from the Hollywood sign. Internally, I’m making the most difficult Los Angeles decision a person can make: protein shake or grilled chicken with avocado? God, what I’d do for a New York bagel.

Being a New Yorker in Los Angeles is a lucrative thing. You’ve got the hustle, honesty and helium-like ego required to keep up and in some cases rise above the fast-paced, self-obsessed world of glamour, fame and film. I’ve been here just three months so far. It truly feels like a lifetime. 

This city is quite a change of pace from Orlando where I lived for nine months after my dad’s fourth brain surgery. Being so far away from family during such a difficult time just didn’t settle right. I’m blessed I was able to pick up my life and move down south. After a whirlwind of a time in Florida that included some serious self-reflection and losing 132 lb (a column for another time), a very scary experience with internal bleeding and lots of personal development, my family finally said it was time for me to pursue my dreams and to stop sleeping on their couch.

From my rooftop you’ve got an ideal view of the Hollywood sign and the massive Netflix building. Sometimes I swear these monuments stare me down — as if to taunt with motivation. These two icons represent the new and old of an ever-evolving industry. Every decision I make must be done to create not just forward professional momentum in the film/television industry that is, but also upward professional propulsion toward the film/television that will be. This can be frustrating and conflicting at times.

My apartment complex is brand new. Since my roommate is from Texas, neither of us were able to visit the place before signing the lease. It is a competitive process to find the right location and price. “Adulting” is hard. Up until the moment my car pulled up, I was not entirely convinced the place was real. Was half-expecting we’d find an abandoned auto body shop or sketchy cash-only “jewelry” store. Thankfully, my internal optimist prevailed.

It’s a nice place, almost too nice — always imagined my first place in Hollywood would have at least some kind of varmint living in the walls. Nothing yet, just very annoying ice cream trucks and the occasional scream in the distance — we live near a high school so it’s hard to tell whether it is an excitable soccer mom or a murder most foul. Gotta love city living. Now that I’m a pseudo-grownup, all of our furniture matches one style instead of the typical postcollegiate hodgepodge of couches and chairs acquired curbside on Sheep Pasture Road in Port Jefferson. This is progress, people.

While I’ve always loved the IDEA of being an adult — this notion that my workday would end with a copy of the Wall Street Journal in my hands, Bing Crosby on the record player and myself looking dapper in tweed jacket with elbow patches is quite different than the reality. Just yesterday I found myself alternating between opening bills and handwashing a massive stack of dishes that were so dirty even the dishwasher quit. This of course occurred while I was blasting SpongeBob reruns on my television. I’m 25 years old and I’ll defend SpongeBob till the day I die.

In all the many changes this year brought, I’m often reminded of where it came from. Part of why I’m bringing Open Mike back is because it was this community that raised me. You paid the taxes that paid for my schooling — you might as well see some return benefit in the form of my column.

Heidi, our amazing leisure editor is going to throw a fit when she sees how long this so let me wrap it up.

What story do you leave behind in a city of stars and storytellers? For some it’d be the Oscars or Emmy perhaps. For me? I’d like to do something to make my hometown proud. Something worthy of a plaque on the Hall of Fame at Port Jeff High School. I know that sounds silly, but where you come from and never allowing distance or success to make you forget — that is what I strive for. All of my good fortune, my confidence and dreams began because of the place and people who raised me. So I give my everlasting thanks and gratitude to you. Home is always home, so yes, Hooray for Hollywood … but most importantly, GO ROYALS!

Catch Open Mike on a monthly basis in TBR News Media’s Arts & Lifestyles.

By Heidi Sutton

The Town of Brookhaven held its annual Groundhog Day celebration at the Holtsville Ecology Site and Animal Preserve on Saturday, Feb. 2. Many families with young children braved the frigid weather to hear a very important prediction from Suffolk County’s most famous weatherman, Holtsville Hal, and the little guy did not disappoint.

At 7:25 a.m., before a crowd of several hundred spectators, the groundhog awoke from his slumber and did not see his shadow, joining Pennsylvania’s Punxsutawney Phil, Malverne Mel, Staten Island Chuck and Dunkirk Dave in predicting that spring weather is right around the corner.

Councilman Kevin LaValle (R-Selden), who was joined by Councilman Neil Foley (R-Blue Point), served as honorary Mayor of the Day and read Hal’s prognostication:

“Upon waking up this morning from my long winter’s nap, I heard Honey Bear yawning after this unusual cold snap, Lucy the Buffalo was up, Victoria the eagle too, wondering what everyone is planning to do. I exited my burrow and took a step out, realizing that my prognostication is what this is all about. Hundreds have gathered waiting to hear, will it be an early spring or more snow this year. I know you’re all anxious to hear what I have to say, I won’t keep you waiting at 7:25 on this cold blustery day. When I came out of my burrow and put my paws on the floor, I did not see the shadow I was looking for. According to folklore, go home and ready your lawn, spring is coming and the winter is more than half gone.”

Superintendent of Highways Daniel Losquadro (R), who was not able to attend the event this year, issued a statement on Monday.  “I’m sure we are all looking forward to an early spring and keeping our fingers crossed that our resident weatherman maintains his accuracy,” he said. “Regardless, the Brookhaven Highway Department remains ready to handle whatever Mother Nature decides to send our way.”

After the event, festivalgoers were treated to bagels and hot chocolate and were able to visit the 100 animals that call the Ecology Site home including deer, horses, goats, llamas, hawks and its newest addition, a pine martin. The center, which is open all year round, also includes jogging and exercise trails.

Greg Drossel, who has been Holtsville Hal’s handler for 22 years, said, “I remember when this ecology site was started by Harold Malkmes [Brookhaven’s longtime superintendent], 25, 30 years ago with a pair of buffalo and a pair of bald eagles and now it’s a gem in the Town of Brookhaven and I’m happy to be a part of it.”

Located at 249 Buckley Road, Holtsville, the Ecology Site will next host the 2019 Home & Garden Show on March 23, 24, 30 and 31 from 11 a.m. to 5 p.m. Admission is free. For more information, call 631-758-9664.

Smoking and salt consumption add to the risk of GERD. Stock photo
Simple lifestyle changes are among the most effective treatments

By David Dunaief, M.D.

Dr. David Dunaief

It seems like everyone is diagnosed with gastroesophageal reflux disease (GERD). I exaggerate, of course, but the pharmaceutical companies do an excellent job of making it appear that way with advertising. Wherever you look there is an advertisement for the treatment of heartburn or indigestion, both of which are related to reflux disease.

GERD, also known as reflux, affects as much as 40 percent of the U.S. population (1). Reflux disease typically results in symptoms of heartburn and regurgitation brought on by stomach contents going backward up the esophagus. For some reason, the lower esophageal sphincter, the valve between the stomach and esophagus, inappropriately relaxes. No one is quite sure why it happens with some people and not others. Of course, a portion of reflux is physiologic (normal functioning), especially after a meal (2).

GERD risk factors are diverse. They range from lifestyle — obesity, smoking cigarettes and diet — to medications, like calcium channel blockers and antihistamines. Other medical conditions, like hiatal hernia and pregnancy, also contribute (3). Diet issues include triggers like spicy foods, peppermint, fried foods and chocolate.

Smoking and salt’s role

One study showed that both smoking and salt consumption added to the risk of GERD significantly (4). Risk increased 70 percent in people who smoked. Surprisingly, people who used table salt regularly saw the same increased risk as seen with smokers.

Medications

The most common and effective medications for the treatment of GERD are H2 receptor blockers (e.g., Zantac and Tagamet), which partially block acid production, and proton pump inhibitors (e.g., Nexium and Prevacid), which almost completely block acid production (5). Both classes of medicines have two levels: over-the-counter and prescription strength. Here, I will focus on PPIs, for which more than 113 million prescriptions are written every year in the U.S. (6).

PPIs include Nexium (esomeprazole), Prilosec (omeprazole), Protonix (pantoprazole) and Prevacid (lansoprazole). They have demonstrated efficacy for short-term use in the treatment of Helicobacter pylori-induced (bacteria overgrowth in the gut) peptic ulcers, GERD symptoms and complication prevention and gastric ulcer prophylaxis associated with NSAID use (aspirin, ibuprofen, etc.) as well as upper gastrointestinal bleeds.

However, they are often used long-term as maintenance therapy for GERD. PPIs used to be considered to have mild side effects. Unfortunately, evidence is showing that this may not be true. Most of the data in the package inserts is based on short-term studies lasting weeks, not years. The landmark study supporting long-term use approval was only one year, not 10 years. However, maintenance therapy usually continues over many years.

Side effects that have occurred after years of use are increased risk of bone fractures and calcium malabsorption; Clostridium difficile, a bacterial infection in the intestines; potential vitamin B12 deficiencies; and weight gain (7).

Bacterial infection

The FDA warned that patients who use PPIs may be at increased risk of a bacterial infection called C. difficile. This is a serious infection that occurs in the intestines and requires treatment with antibiotics. Unfortunately, it only responds to a few antibiotics and that number is dwindling. In the FDA’s meta-analysis, 23 of 28 studies showed increased risk of infection. Patients need to contact their physicians if they develop diarrhea when taking PPIs and the diarrhea doesn’t improve (8).

B12 deficiencies

Suppressing hydrochloric acid produced in the stomach may result in malabsorption issues if turned off for long periods of time. In a study where PPIs were associated with B12 malabsorption, it usually took at least three years’ duration to cause this effect. B12 was not absorbed properly from food, but the PPIs did not affect B12 levels from supplementation (9). Therefore, if you are taking a PPI chronically, it is worth getting your B12 and methylmalonic acid (a metabolite of B12) levels checked and discussing possible supplementation with your physician if you have a deficiency.

Lifestyle modifications

A number of modifications can improve GERD, such as raising the head of the bed about six inches, not eating prior to bedtime and obesity treatment, to name a few (10). In the same study already mentioned with smoking and salt, fiber and exercise both had the opposite effect, reducing the risk of GERD (5). This was a prospective (forward-looking) trial. The analysis by Journal Watch suggests that the fiber effect may be due to its ability to reduce nitric oxide production, a relaxant for the lower esophageal sphincter (11).

Obesity

In one study, obesity exacerbated GERD. What was interesting about the study is that researchers used manometry, which measures pressure, to show that obesity increases the pressure on the lower esophageal sphincter significantly (12). Intragastric (within the stomach) pressures were higher in both overweight and obese patients on inspiration and on expiration, compared to those with normal body mass index. This is yet another reason to lose weight.

Eating prior to bed — myth?       

Though it may be simple, it is one of the most powerful modifications we can make to avoid GERD. A study that showed a 700 percent increased risk of GERD for those who ate within three hours of bedtime, compared to those who ate four hours or more prior to bedtime. Of note, this is 10 times the increased risk of the smoking effect (13). Therefore, it is best to not eat right before bed and to avoid “midnight snacks.”

Although there are a number of ways to treat GERD, the most comprehensive have to do with modifiable risk factors. Drugs have their place in the arsenal of choices, but lifestyle changes are the first — and most effective — approach in many instances. Consult your physician before stopping PPIs since there may be rebound hyperacidity (high acid produced) if they are stopped abruptly.

References:

(1) Gut 2005;54(5):710. (2) Gastroenterol Clin North Am. 1996;25(1):75. (3) emedicinehealth.com. (4) Gut 2004 Dec.; 53:1730-1735. (5) Gastroenterology. 2008;135(4):1392. (6) JW Gen Med. Jun. 8, 2011. (7) World J Gastroenterol. 2009;15(38):4794–4798. (8) www.FDA.gov/safety/medwatch/safetyinformation. (9) Linus Pauling Institute; lpi.oregonstate.edu. (10) Arch Intern Med. 2006;166:965-971. (11) JWatch Gastro. Feb. 16, 2005. (12) Gastroenterology 2006 Mar.; 130:639-649. (13) Am J Gastroenterol. 2005 Dec.;100(12):2633-2636.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

Your spouse receives his/her elective share from your estate at the time of your death. Stock photo

By Nancy Burner, Esq.

Nancy Burner, Esq.

We are frequently asked whether it is a good idea to disinherit your spouse due to the possibility of nursing home care in the future. While updating your estate planning documents is a good idea, simply disinheriting your spouse may not protect your estate in the event she or he needs to go to a nursing facility. 

If your spouse requires care in a nursing facility and wants to rely on Chronic Medicaid to pay for it, the Department of Social Services will conduct a five-year lookback. 

During the examination, the Department of Social Services will inquire whether your spouse received his or her “elective share” from your estate at the time of your death. If your spouse did not receive his/her elective share, the Department of Social Services will issue a dollar for dollar penalty that will delay Chronic Medicaid benefits.

An elective share ensures that surviving spouses in New York receive the first $50,000 or one-third of an estate, whichever is greater. The surviving spouse has a time limit when he or she must demand the elective share. If the elective share is not demanded within the time frame, the surviving spouse forfeits his/her right to receive the share.  

For example, if you pass away with $300,000 in your estate, your spouse would be entitled to $100,000 even though your last will and testament specifically excluded your spouse. If the elective share of $100,000 is not paid from your estate, the Department of Social Services will issue a penalty of about seven months. In other words, Medicaid will not pay for the first seven months of care in the nursing facility.  

There are options available to you now in order to preserve your estate even if your spouse requires care in a nursing facility. One option is to set up a supplemental needs trust through your last will and testament that benefits your spouse but protects the estate. You would appoint a trustee to manage the assets in the trust on behalf of your spouse. 

The supplemental needs trust is a vehicle to supplement and not supplant government benefits. This would allow the money to be used for your spouse’s benefit but not interfere with an application for Medicaid benefits. Another option would be to provide that your spouse receives one-third of your estate and the reminder goes to your children.

Finally, in New York State, we have a program called Community Medicaid, which will pay for a home health aide to come into your home and assist your spouse with activities of daily living. If your spouse received this assistance in the home, there would not be a five-year lookback and he or she would not be required to elect against your estate. This may be a viable option now, so you are not the sole caregiver.    

It is important to review your estate planning documents with an elder law attorney in your area to ensure you and your spouse are protected and have the appropriate documents in place for your specific situation.  

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