Children can discover the wonder of plants the Brookhaven Ecology Center next month. Photo from Town of Brookhaven
Spring Pee Wee Gardening
The Town of Brookhaven Highway Department offers Spring Pee Wee Gardening classes for ages 3 to 5 at the Wildlife Education & Ecology Center, 249 Buckley Road, Holtsville on Thursdays, April 12, 19 and 26, May 3, 10 and 17 or Fridays, April 13, 20 and 27, May 4, 11 and 18 at either 10 to 11 a.m. or 1 to 2 p.m. The children will learn about the environment, animals and plants through crafts and stories. $50 for six-week session. For more information, please call 631-758-9664, ext. 10.
Adult Horticulture Classes
The Town of Brookhaven’s Department of Highways will present Adult Horticulture Classes at the Holtsville Ecology Site, 249 Buckley Road, Holtsville on Wednesdays, April 11, 18 and 25 and May 2, 9 and 16. Participants will learn about starting plants through propagation, growing vegetables from seeds, spring gardening techniques and unique gardening crafts. Fee is $50 for six-week session. Deadline to register is March 29. For more info, call 631-758-9664, ext. 10.
Let’s help Einstein and his friends at Sweetbriar! The nature center, located at 62 Eckernkamp Drive, Smithtown seeks donations for its annual spring yard sale and fundraiser on April 28 and 29 including antiques, collectibles, memorabilia and other “cool” stuff. Please NO clothes, books, baby supplies, electronics or anything that weighs over 40 pounds unless it fits the above guidelines. Proceeds will go toward the center’s mission of providing nature education and wildlife rehabilitation. To make a donation, please call Eric at 631-979-6344 or Joe at 631-901-5911.
A plant-based diet involving lots of vegetables, fruits and some grains may have a similar effect as steroids in reducing inflammation. Stock photo
Steroids reduce inflammation, but it comes at a cost
By David Dunaief, M.D.
Dr. David Dunaief
Steroid use as a performance-enhancing drug was a significant factor in the recent Olympics, with the Russian team banned 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.
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.
Delivery
Steroids are delivered orally, topically as 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 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, 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.
Medicare and Medicaid are both invaluable programs that can be used to cover various medical and custodial expenses.
By Nancy Burner, ESQ.
Nancy Burner, Esq.
This is a question we receive often. Navigating the maze of healthcare coverage can be confusing.nFor starters, a brief overview of the programs will help to demystify and clear some of the confusion. Medicare is a federal government program first implemented in 1965 as part of the Social Security program to provide health coverage to persons 65 or older and in some cases younger so long as they can show a qualifying disability.
Coverage through Medicare is broken down into sections, Part A is considered hospital insurance and covers inpatient hospital care, rehabilitation in a skilled nursing facility, hospice services, lab tests surgery and home health care. There is no premium for Part A provided you or your spouse have worked at least forty quarters and paid into the program.
It is important to note that the coverage for skilled nursing is limited to the first twenty days in full and then there will be a co-pay of $167.50 per day for days twenty-one through one hundred. A person must continue to qualify based on their skilled need throughout the hundred-day period for Medicare to continue cover. There is no guarantee that a person will receive all hundred days of coverage. Custodial care and extended stays will not be covered by Medicare.
Part B covers doctors and other health care providers’ services and outpatient care. The monthly premium for Part B is typically $134.00 but can vary depending on the person’s income. Part D provides cover with respect to prescription drugs. This is a stand-alone drug plan that can assist in reducing prescription drug costs. Finally, Medicare Part C, is also known as the Medicare Advantage which are optional plans offered by Medicare-approved private companies which replace Medicare Part A and B.
Unlike Medicare, Medicaid is a means tested program and is state specific. Medicaid can provide coverage for a personal care aide at home through the Community Medicaid program or can also cover an extended custodial stay at a skilled nursing facility through the Chronic Medicaid program. In order to be financially eligible to receive services at home, an applicant for Community Medicaid cannot have liquid non-retirement assets in excess of $15,150.00.
Also exempt is an irrevocable pre-paid burial, retirement assets in an unlimited amount so long as the applicant is receiving monthly distributions and the primary residence. With respect to income, an applicant for Medicaid is permitted to keep $837.00 per month in income plus a $20.00 disregard. However, where the applicant has income which exceeds $862.00 threshold, a Pooled Income Trust can be established to preserve the applicant’s excess income.
Even though there is a resource limit of $15,150.00, there is no “look back” for Community Medicaid. In other words, both the income and asset requirements can be met with a minimal waiting period allowing families to mitigate the cost of caring for their loved ones at home.
With respect to coverage in a nursing facility, Chronic Medicaid can cover an extended custodial stay at a nursing facility. In New York, an applicant applying for Chronic Medicaid will be required to provide a sixty-month lookback with respect to all financial records, including bank statements and tax returns. Unlike Community Medicaid, an applicant for Chronic Medicaid will be penalized for any monies transferred out of the applicant’s name during the sixty-month lookback except for transfers to exempt individuals, including to but not limited to spouse or disabled child. If your loved one requires long term nursing home placement, it is imperative to consult and Elder Law attorney in your area to discuss how to preserve the maximum amount of assets.
Medicare and Medicaid are both invaluable programs that can be used to cover various medical and custodial expenses. Understanding the difference and what each program covers will allow you to be an advocate for yourself or a loved one.
Nancy Burner, Esq. practices elder law and estate planning from her East Setauket office.
TTG Board members Susan Emro (left) and Elizabeth Sprauer with Suffolk Legislator William R. Spencer Photo courtesy of TTG
Township Theatre Group (TTG), Long Island’s oldest continuously operating volunteer community theatre company, was recently awarded a 2018 Omnibus Grant for $7,000 through the office of Suffolk County Legislator William R. Spencer, MD. The grant is administered through the Suffolk County Department of Economic Development and Planning and is directed to cultural programs relevant to the enhancement of the tourism industry in Suffolk County, including theatrical activities. Spencer’s 18th Legislative District encompasses the Huntington area where TTG was founded in 1952 and currently performs.
“TTG greatly appreciates the support of Suffolk County and especially Legislator Spencer’s commitment to the arts in the Long Island community,” said Susan Emro, President, Township Theatre Group. The grant will assist with production costs for the group’s Spring Season musical, “The 25th Annual Putnam County Spelling Bee” from June 2 to 16. Details can be found at www.townshiptheatregroup.org.
From left, Kevin J. O’Neill; Rev. Rachel Vione (Interim Pastor, First Presbyterian Church of Northport); Donna Galluccio (Chairperson of the Ecumenical Lay Council Food Pantry); Martha Keller (Manager of the food pantry); and Richard T. Dolce. Photo courtesy of Engeman Theater
GIVING BACK: On March 6, co-owners of the John W. Engeman Theater, Richard T. Dolce and Kevin J. O’Neill, presented a check for $50,000 to the Ecumenical Lay Council Food Pantry of Northport. This is the fourth year that the Engeman Theater has raised funds for the Food Pantry and the First Presbyterian Church of Northport, which hosts the Food Pantry. Following each performance of the 2017 holiday production of “Annie,” cast members collected donations from audience members for the food pantry. “We’re very appreciative of the generosity of our patrons,” O’Neill said. “It sounds a bit cliché, but it’s true: community begets community. We feel it’s very important to invest back into our community in any way we can.”
Jimmy Stewart stars in Alfred Hitchcock’s thriller, ‘Vertigo.’ Photo courtesy of Fathom Events
In celebration of the 60th anniversary of Alfred Hitchcock’s “Vertigo,” Fathom Events, Turner Classic Movies and Universal Pictures will bring the classic film to select cinemas nationwide on Sunday, March 18, and Wednesday, March 21.
Considered one of Hitchcock’s greatest cinematic achievements, “Vertigo” is a dreamlike thriller from the Master of Suspense. Set in San Francisco, the film creates a dizzying web of mistaken identity, passion and murder after an acrophobic detective (James Stewart) rescues a mysterious blonde (Kim Novak) from the bay and must unravel the secrets of the past to find the key to his future.
Appearing as No. 11 on IMDb’s list of the Top 100 Greatest Movies of All Time, the film will also feature an exclusive commentary from TCM host Eddie Muller, who will give insight into this classic film. Participating movie theaters in our neck of the woods include AMC Loews Stony Brook 17, 2196 Nesconset Highway, Stony Brook at 2 and 7 p.m. on both days; and Farmingdale Multiplex Cinemas, 1001 Broadhollow Road, Farmingdale and Island 16 Cinema de Lux, 185 Morris Ave., Holtsville on March 18 at 2 p.m. and March 21 at 7 p.m. To purchase your ticket in advance, visit www.fathomevents.com.
How many more mass shootings have to claim innocent lives before we have the courage to stand up for justice and common sense?
The rhetoric that has erupted since the Parkland shootings in Florida is reprehensible. Innocent lives murdered, hundreds of survivors suffering from PTSD and we still cannot move forward with common sense federal regulations to protect all of us as citizens without infringing on someone’s Second Amendment rights.
The articulate, dynamic students from Parkland have given clear voice to the real issues that must be addressed since the massacre — thorough background checks on all who purchase guns, a national registry for all guns and their owners, raising the age to 21 for the purchase of any gun with few exceptions, banning assault weapons with the exception for law enforcement and the military and developing a standardized mental health screening to flag those with potential mental health issues.
Our schools are vulnerable, but as a longtime educator and former school administrator, arming teachers and increasing police presence with weapons is not going to deter a mentally ill person from killing people, if he or she is determined to do that.
We need to be more efficient and effective at identifying students who demonstrate by behavior, school deportment and their writing that there is a real problem.
Every difficult student cannot merely be expelled from school. We need to work with those at-risk students. However, that really becomes a problem every time a school district is on austerity. The first people who are laid off are school social workers, psychologists, nurse teachers and other support staff that are critical in the time of crisis.
Instead of building up an armed security force, we should build up our support services so that they can effectively intervene with the growing number of students who are at risk.
After Parkland, all the politicians from the president on down have talked about doing more to strengthen mental health services. However, our own president has reduced funding from his budget to support mental health services. His opioid commission made substantial recommendations to fight this national health crisis, but to date he has not allocated a dime to support new treatment initiatives and support services for addicts and their families.
The young people from Parkland have sparked a powerful new conversation across our country that speaks beyond the issue of gun control and gun safety. Their courageous voices are challenging us to come together as a nation, urging us to work together to protect all life because it is sacred and fragile. We need to start practicing what we preach!
Divisive and demeaning rhetoric is not going to make America great again; only constructive action on the part of all Americans will. Every citizen who is of age must register to vote. We must do our homework and know what the real issues are all about and not allow ourselves to be brainwashed by political operatives. Our political process and system is broken and ineffective. It needs immediate surgery!
We need to urge the best of the best to run for public office. We must be sure that they are not connected or beholden to the insurance industry, the NRA, the unions, just to name a few powerful entities that seem to be indirectly controlling our nation and its policies.
As Gandhi once said, we must “be the change we wish to see in the world.”
Fr. Pizzarelli, SMM, LCSW-R, ACSW, DCSW, is the director of Hope House Ministries in Port Jefferson.
Tom Manuel of The Jazz Loft, right, shown with TVHS President Steve Healy,
will be honored at the awards dinner on March 21. Photo by Heidi Sutton
By Heidi Sutton
On Wednesday, March 21, the Three Village Historical Society will once again host its annual Awards Dinner honoring volunteers, local businesses, society members and area residents who have made significant contributions to help preserve the shared heritage within the Three Village area.
Among the honorees will be Nan Guzzetta of Antique Costume and Prop Rental by Nan Guzzetta of Port Jefferson, who has been chosen to receive the Kate Wheeler Strong Memorial Award in recognition of significant contribution toward the fostering of interest in local history and a fuller appreciation of the rich historical and cultural heritage of this community. Guzzetta has earned this award with her years of inspiration and guidance with costumes for society events, especially the Spirits Tour.
Eva Glaser a longtime member and volunteer will receive the Maggie Gillie Memorial Award for contributions by a member of the society in recognition of overall dedicated service and for significant contributions furthering the goals of the society. Glaser’s award is for her years of support to the society and as the co-chair and inspiration for the first Candlelight House Tour 40 years ago.
An interest in volunteering led Richard Melidosian to the Three Village Historical Society. Melidosian has been and continues to be a docent at the SPIES Exhibit and the Candlelight House Tour and a guide at the Spirits Tour and Founder’s Day. For that, he will receive the Gayle Becher Memorial Award in recognition of volunteer efforts to help the society by performing those necessary tasks that facilitate its efficient operation. This award honors volunteers whose work consists of loyal support repeated on a regular basis.
Rebecca Fear, a student at Ward Melville High School, is this year’s honoree for the R. Sherman Mills Young Historian Award, a prestigious award presented for contributions to the society by a young person. Rebecca and her family have volunteered at many events including Culper Spy Day, the Long Island Apple Festival, the Spirits Tour and the society’s annual Yard Sale.
Three community award certificates will be handed out this year. The first, for enhancing or restoring a building used as a commercial structure in a way that contributes to the historic beauty of the area, will be awarded to Thomas J. Manuel of The Jazz Loft, 275 Christian Ave., Stony Brook for the conversion of this historic building to a cultural center for music in the Three Village area. The second, for house restoration or renovation and ongoing maintenance and preservation in keeping with the original architectural integrity, will be awarded to Andrew and Kathy Theodorakis for their home at 242 Christian Ave. in Stony Brook. The third award, for ornamental plantings or landscaping that enhances the beauty of the Three Village area, will be granted to Charles Regulinski of 24 Dyke Road, Setauket.
The event, now in its 41st year, will be held at the Three Village Inn, 150 Main St., Stony Brook from 6 to 9 p.m.
A three-course dinner, which includes a Caesar salad with rosemary focaccia croutons, choice of entree (pan-seared salmon with baby spinach and beurre blanc sauce, seared breast of free-range chicken with haricot vert and saffron potatoes or sliced Chateau steak with red wine sauce with Yukon Gold potato puree and baby carrots) and an apple crumb tartlet with whipped cream for dessert, will be served. (Vegetarian meal available upon request.) The evening will feature a cash bar, raffles and live music by the Ward Melville High School Honors Jazztet.
Please join them in honoring these worthy awardees. Tickets are $65 per person, $60 members. To order, visit www.TVHS.org or call 631-751-3730.
I’ve never kissed the Blarney Stone. I’ve never encountered a leprechaun (that I know of), but I have been known to raise a pint and mispronounce “Slainte!” And I do have some Irish blood in me, which must be the reason I adore corned beef and cabbage. In fact, at this time of year I buy a couple of corned beefs and freeze them so that I can use them throughout the year. While I am usually a traditionalist, every once in a while I go on a kick to reinvent and jazz up the ordinary and same old, same old, delicious as they might be.
And so it is this St. Patrick’s Day that I’ve come up with three variations on the corned beef and cabbage theme … a stew, a casserole and cabbage rolls. You can make them from scratch with fresh ingredients or from leftovers, but either way I think you’ll enjoy their welcome flavors and unique forms.
Corned Beef and Cabbage Stew
YIELD: Makes 4 to 6 servings
INGREDIENTS:
¼ cup vegetable oil
1 large onion, chopped
3 celery ribs, cleaned and chopped
4 carrots, peeled and diced
One 14-oz can diced tomatoes, with juice
3 cups beef broth
4 cups shredded cabbage
1 pound potatoes, peeled and diced
½ pound cooked corned beef, diced
1 bay leaf
Salt and freshly ground pepper, to taste
DIRECTIONS: In a large pot, heat the oil, add the onion, celery and carrots and cook, stirring frequently, over medium heat about 5 to 7 minutes, until onion is slightly opaque. Add the tomatoes, broth, cabbage, potatoes and 3 to 4 cups water; bring to a boil, then cook, uncovered, over medium heat until everything is tender. Add corned beef, bay leaf salt and pepper; then cook 5 more minutes. Remove and discard bay leaf. Serve hot with pumpernickel or rye bread and a light red wine, sauvignon blanc wine or beer.
Corned Beef and Cabbage Casserole
YIELD: Makes 8 servings
INGREDIENTS:
2 tablespoons vegetable oil
6 cups peeled cooked and sliced potatoes
4 cups cooked shredded cabbage
1 medium onion, diced and browned
½ pound corned beef, julienned
1½ cups shredded Swiss or Jarlsberg cheese
Salt and freshly ground pepper, to taste
8 eggs
1½ cups milk
¾ teaspoon dry mustard
½ teaspoon cayenne pepper
DIRECTIONS: Preheat oven to 350 F. Coat inside of a 9- by 13-inch baking dish with oil. Line bottom of pan with half the potatoes, then half the cabbage, half the onions, half the corned beef and half the cheese. Season with salt and pepper. Repeat layers with remaining halves of ingredients, but start with cabbage and end with potatoes. Season again. In a medium bowl, combine the eggs, milk, mustard, salt and pepper and cayenne pepper. Beat until foamy. Pour mixture over layered ingredients in baking dish. Bake until knife inserted in center comes out clean, mixture is set and top is golden and bubbly, about one hour. Remove from oven, let sit for 15 minutes, then serve with a tomato salad and crusty rolls with butter.
Corned Beef Hash Cabbage Rolls
YIELD: Makes 6 to 8 servings
INGREDIENTS:
1 large head cabbage, core removed
2 tablespoons vegetable oil
1 medium onion, finely chopped
3 cups finely diced cooked corned beef
3 cups finely diced cooked potatoes
1 large egg, beaten
3 cups beef broth
One 14-oz can petite diced tomatoes
Salt and pepper, to taste
DIRECTIONS: Preheat oven to 350 F. Carefully separate leaves from cabbage and in a large pot, steam until slightly wilted. Meanwhile in a small skillet, heat oil, add onion and sauté until golden. In a large bowl, combine the corned beef, potatoes, sautéed onion and egg. Lay a wilted cabbage leaf, inside facing up so it looks like a little dish, on a board or plate. Roll about 1½ to 2 teaspoons of corned beef mixture into a ball and lay in center of cabbage leaf. Tuck in ends and roll up. Place, seam side down, in a 9- by 13-inch nonreactive baking dish.
Repeat procedure with remaining cabbage leaves and mixture. Tuck any extra small cabbage leaves around cabbage rolls. Pour beef broth into baking dish; evenly distribute tomatoes and their juice over tops of cabbage rolls. Sprinkle with salt and pepper. Cover and cook 35 to 45 minutes until juice is bubbling and cabbage is tender. Place on a platter and spoon cooking liquid over and around cabbage rolls. Serve hot or warm with mustard, pickles, sharp cheese and bread.