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While they can be scary, most thyroid nodules are benign

By David Dunaief, M.D.

Dr. David Dunaief

Thyroid nodules are diagnosed, often incidentally, on radiologic exams, such as CT scans of the chest, MRI scans, PET scans and ultrasounds of the carotid arteries in the neck, rather than because of symptoms (1). More than 50 percent of people have thyroid nodules detectable by high-resolution ultrasound (2). Fortunately, most are benign. A small percent are malignant. Depending on the study, this can range from 1.1 to 6.5 percent of nodules (3, 4). 

There is a conundrum of what to do with a thyroid nodule. It depends on the size. If it is over one centimeter, usually it is biopsied by fine needle aspiration (FNA) (5). While most are asymptomatic, if there are symptoms, these might include difficulty swallowing, difficulty breathing, hoarseness, pain in the lower portion of the neck and a goiter (6).

FNA biopsy is becoming more common. In a study evaluating several databases, there was a greater than 100 percent increase in thyroid FNAs performed over a five-year period from 2006 to 2011 (7). This resulted in a 31 percent increase in thyroidectomies, surgeries to remove the thyroid partially or completely.

However, the number of thyroid cancers diagnosed with the surgery did not rise in this same period. Thyroid nodules in this study were least likely to be cancerous when the initial diagnosis was by incidental radiologic exam (8).

Evaluating indeterminate FNA results

As much as 25 percent of FNA biopsies are indeterminate. We are going to look at two techniques to differentiate between benign and malignant thyroid nodules when FNA results are equivocal: a PET scan and a molecular genetics test.

A meta-analysis of six studies of PET scan results showed that it was least effective in resolving an unclear FNA biopsy. The PET scan was able to rule out patients who did not have malignancies, but it did not do a good job of identifying those who did have cancer (9).

On the other hand, a molecular-based test was able to potentially determine whether an indeterminate thyroid nodule by FNA was malignant or benign (10).

Unlike in the PET scan study above, the researchers were able to not only rule out the majority of malignancies but also to rule them in. It was not perfect, but the percent of negative predictive value (ruled out) was 94 percent, and the positive predictive value (ruled in) was 74 percent. The combination test improved the predictive results of previous molecular tests by 65 to 69 percent. This is important to help decide whether or not the patient needs surgery to remove at least part of the thyroid.

Significance of calcification

Microcalcifications in the nodule can be detected on ultrasound. The significance of this may be that patients with microcalcifications are more likely to have malignant thyroid nodules than those without them, according to a small prospective study involving 170 patients (11). This does not mean necessarily that a patient has malignancy with calcifications, but there is a higher risk.

Considering a “wait and follow-up” approach

As I mentioned above, most thyroid nodules are benign. The results of one study go even further, showing that most asymptomatic benign nodules do not progress in size significantly after five years (12). The factors that did contribute to growth of about 11 percent of the nodules were age (<45 years old had more growth than >60 years old), multiple nodules, greater nodule volume at baseline and being male.

The authors’ suggestion is that, after the follow-up scan, the next ultrasound scan might be five years later instead of three years. However, they did discover thyroid cancer in 0.3 percent after five years.

Thyroid function’s role

In considering risk factors, it’s important to note that those who had normal thyroid stimulating hormone (TSH) were less likely to have a malignant thyroid nodule than those who had high TSH, implying hypothyroidism. There was an almost 30 percent prevalence of cancer in the nodule if the TSH was greater than >5.5 mU/L (13).

Fortunately, most nodules are benign and asymptomatic, but the number of cancerous nodules found is growing. Why the mortality rate remains the same year over year for decades may have to do with the slow rate at which most thyroid cancers progress, especially of the two most common forms, follicular and papillary.

References: 

(1) uptodate.com. (2) AACE 2013 Abstract 1048. (3) Thyroid. 2005;15(7):708. (4) European Thyroid Journal. 2022 Jun 29;11(4) online. (5) AACE 2013 Abstract 1048. (6) thyroid.org. (7) AAES 2013 Annual Meeting. Abstract 36. (8) AACE 2013 Abstract 1048. (9) Cancer. 2011;117(20):4582-4594. (10) J Clin Endocrinol Metab. Online May 12, 2015. (11) Head Neck. 2008 Sep;30(9):1206-1210. (12) JAMA. 2015;313(9):926-935. (13) J Clin Endocrinol Metab. 2006;91(11):4295.

Dr. David 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.

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United States Supreme Court. Pixabay photo

By Nancy Marr

In December of this year, the case Moore v. Harper is scheduled for argument before the Supreme Court of the United States. Its decision will resolve whether there is a doctrine of constitutional interpretation known as the “independent state legislature” which would give state legislatures unreviewable power to redraw congressional districts and appoint state electors who cast votes for president and vice-president. It would remove the power from state courts, including the state’s highest court, to invalidate gerrymandered congressional districts drawn by state legislatures. 

The history

On November 4, 2021, the North Carolina General Assembly adopted a new congressional voting map based on 2020 Census data. The legislature, at that time, was controlled by the Republican Party and the gerrymandering was so extreme that an evenly divided popular vote would have awarded ten seats to ten Republicans and only four to the Democrats. According to the Brennan Center, the map was a statistical outlier more favorable to Republicans than 99.9999% of all possible maps.

In 2019 in Rucho v. Common Cause,  the Supreme Court held that federal courts lack jurisdiction to resolve claims of unconstitutional partisan gerrymandering because there is no prohibition of partisan districting in the U. S. Constitution. 

Subsequently, in the case Harper v. Hall (2022), a group of voters and nonprofit organizations affiliated with the Democratic Party challenged the North Carolina map in state court, alleging that the new map was a partisan gerrymander and violated the state constitution. 

In February 2022, the North Carolina Supreme Court agreed with voters and struck down the map, describing it as an “egregious and intentional partisan gerrymander designed to enhance Republican performance, and thereby gave a greater voice to those voters than to any others.”

The unrepentant legislature then proposed a second gerrymandered map, prompting a state court to  order a special master to create a fair map for the 2022 congressional elections. Unwilling to accept this outcome, two Republican legislators asked the U. S. Supreme Court to step in and reinstate their gerrymandered map.

In March, the Supreme Court rejected the legislature’s emergency appeal to put the gerrymander back in place. At the urging of four of the justices, the legislators filed a regular appeal, asking the court to review the case. In June, the Court agreed to do so. 

The issue 

In urging the Supreme Court to reinstate the gerrymandered congressional map, the North Carolina legislators were relying on a reading of the U.S. Constitution’s Election Clause known as the independent state legislature theory (ISL). The Election Clause (ARTICLE 1, SECTION 4) reads: The times, places and manner of holding elections for senators and representatives, shall be prescribed in each State by the legislature thereof; but the Congress may at any time by law make or alter such regulations…

Section 5 reads: Each House shall be the judge of the elections, terms and qualifications of its own members.

Proponents of the ISL theory reason that the Elections Clause gives state legislators exclusive authority to regulate all elections. This allows them to violate the state constitution (which disallows partisan gerrymandering) when drawing congressional maps and that neither the state nor federal courts have the power to stop them. Proponents of the theory also believe it gives the state legislature control over the electors who will certify the election, as advocated by deniers of the 2020 election results.  

Opponents of the ISL theory argue that the term “legislature” does not mean solely “the legislature.” The standard interpretation of “legislature,” by groups like the bipartisan Conference of Chief Justices, means the state’s general lawmaking process, including all the normal procedures and limits. The Cato Institute, a right-leaning think-tank founded and funded by the Koch Brothers, published analyses that concluded that the ISL theory relies on a “long rejected” interpretation of the Constitution that would disrupt “settled law.”

What is next?

The Supreme Court could decide Moore without having to address the ISL theory. The immediate issue in Moore is whether the voters across the country will have judicial remedy in state court to fight partisan gerrymandering. A majority of Americans want fair maps, with representatives determined by voters, not self-interested politicians seeking personal gain. Every state should use maps that guarantee that every vote counts equally and every voice is heard. 

Nancy Marr is Vice-President of the League of Women Voters of Suffolk County, a nonprofit nonpartisan organization that encourages the informed and active participation of citizens in government and influences public policy through education and advocacy. For more information, visit www.lwv-suffolkcounty.org or call 631-862-6860.

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Pixabay photo

By Leah S. Dunaief

Leah Dunaief

Here are three of my most feared words: what’s your password? I understand that passwords were designed to keep out the unwelcome in any digital circumstance. Early passwords worked for ATM machines. After all, we didn’t want anyone else to be able to get our money, right?  OK, so that was four numbers that we could remember, certainly easier than committing our social security number to memory, for example.

Not any longer do we enjoy such brevity. Now we are asked to use eight or 10 numbers and letters, the combinations of which must contain capitals, lower case, numbers and some other vital symbol, like an asterisk or a dollar sign or an exclamation point. And we are admonished not to use the same password twice for fear of opening the gates to financial ruination. I would bet the fact is, though, that the only person kept at bay by the request for the password is the password holder who has forgotten the sacred assemblage of letters, numbers and pound signs.

Further, needing the password makes no sense since the frequently asked question, “Forgot your password? Press here to make another,” often allows anyone to bypass the gate anyway. All the intruder has to do is come up with a new password, and they are in.

Some passwords are useful. Certainly, we don’t want just anyone to access our banking records if we bank online. And if we pay for a service, like a subscription to a newspaper, we don’t want an undesignated person to share it. But some of the pass requirements are just plain stupid. Who else but me cares how many steps I walk per day? Or how much sleep I averaged over the past week?? Or how much I weigh? Almost as soon as I apply for an app, I have to select a password to use it, even though the app is free.

Passwords are just one irritant of the digital age, however. As long as I am voicing my frustrations, let’s consider telephones and what has become of what was a perfectly helpful way to enter in conversation with another human. Just try to call an airline or an insurance company and see how long you are put on hold. Sometimes they will tell you that the operator will be with you in 28 minutes and ask if you would like them to hold your place in line and call you back. That’s civilized. Or the automated voice will try to shove you off to their website. But you cannot ask questions of a home page beyond the couple of programmed Q&As posted there. 

When you finally get a person on the other end, after pressing any number of buttons, they will ask you to hold for the correct extension, which will ring and ring and finally disconnect you. Then you have to start all over.

I recognize that there is an attempt to have a paperless world. I understand that companies are feeling pressured financially and are trying to cut down on personnel. But does the world have to get there by driving us to distraction first? Some technology is actually helpful. Instead of a password, some apps ask for fingerprint ID. Once you register with your thumb or whichever finger you choose, you need only to present that finger in the future, and you are immediately admitted. Why isn’t that more commonly used to authenticate the user? Or ask a personal question as the price of admission only the user would be able to answer, like the name of your junior high school or your first pet’s name. Sometimes I am asked two or three questions like that, but only after I have already offered my password. And usually it’s my mother’s maiden name, which by itself used to work but no longer. Not complicated enough, I guess.

One friend figured she had solved the password problem by putting all her passwords into one file on her cellphone. Only trouble? She has forgotten the file’s password. 

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By Daniel Dunaief

Daniel Dunaief

As we reach the beginning of December, we are only a month away from the inevitable promises to shed unwanted pounds.

Today, however, only a few days after our journeys to visit friends and families for Thanksgiving, I’d like to urge you to consider shedding unwanted baggage.

Metaphorically, we all lug unwanted baggage with us — remembering the spot where a girlfriend or boyfriend broke up with us; the moment we decided to substitute the wrong player in a game we were coaching; and the time our teacher gave someone else partial credit for the same answer on which we received no credit.

Some of that baggage is constructive, giving us the tools and the memory to learn from our mistakes and to have a perspective on the things that happen to us.

We might, for example, learn to cope with losses on the athletic field more gracefully when recalling how we felt the time we shouted at a coach, an umpire or an opposing player. Days, weeks, or years later, we might realize that we have the tools and the distance to understand the moment better and to develop a grace we might not have possessed when we were younger.

Extending the baggage metaphor, it seems that the more we carry with us everywhere, the harder it is to move forward. Baggage, like those unwanted pounds that make it harder to hike up a hill or to climb stairs, keeps us in place, preventing us from improving and moving forward.

Shedding pounds, which isn’t so easy itself, has a prescribed collection of patterns, often involving an attention to the foods we might mindlessly eat and a dedication to exercise.

But how do we get rid of the emotional baggage that gets in our way? What do we do to move forward when the burdens around us weigh us down?

For starters, we might learn to forgive people for whatever they did that annoys or puts us down. Forgiveness isn’t easy, of course. We sometimes hold onto those slights as if they are a part of our identity, becoming a doctor to show our biology teacher who didn’t believe in us that we are capable and competent or developing into a trained athlete after a neighbor insulted us.

Holding onto those insults gives other people unnecessary power over us. We can and should set and achieve our goals because of what we want and not because we continue to overcome limits other people tried to set for us.

We also might feel weighed down by our own self-doubt. As I’ve told my children, their peers and many of their teammates, we shouldn’t help our competitors beat us. Believing the best about ourselves is difficult.

We also don’t, and won’t, always win. It’s easier to carry the memories of the times we failed a test or when we didn’t reach the top of the mountain on a hike. Carrying those setbacks around with us for anything other than motivation to try again or to go further than we did before makes it harder to succeed.

Now is the time to set down that baggage, to walk, jog or even run forward, unencumbered by everything that might make us doubt ourselves and our abilities and that might make it harder to achieve our goals. While all that baggage might feel familiar in our hands, it also digs into our palms, twists our fingers and slows our feet.

Even before we resolve to eat better, to exercise, to lose weight and to look our best, let’s check or even cast aside our emotional and psychological luggage. Maybe dropping that baggage in the last month of the year will make achieving and keeping our New Year’s resolutions that much easier.

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Split Pea Soup

By Heidi Sutton

In Seinfeld‘s infamous episode #93, “The Soup,” Jerry is gifted a brand new Armani suit by fellow comedian Kenny Bania. In return, Jerry agrees to take Kenny out for a meal. When Kenny only orders soup, the two debate whether soup actually constitutes a meal and if Jerry is now obligated to take Kenny out to dinner for a second time.

If Kenny had ordered one of the following soups (instead of  consommé), Jerry would’ve been off the hook. Hearty, delicious and perfect for this chilly weather, these recipes have remained popular in my family through the years and I’m sure your family will love them too. 

Split Pea Soup

Split Pea Soup

YIELD: Makes 8 servings

INGREDIENTS: 

1 tablespoon oil (canola or vegetable)

3 carrots, thinly sliced

2 stalks of celery, thinly sliced

1 Russet potato peeled and cubed

1 onion, diced

1 clove of garlic, minced

1 bay leaf

1 teaspoon marjoram

1 ham bone with fat cut off

1 bag of green split peas

1/2 cup cooked diced ham

4 cups reduced salt chicken broth

4 cups water

DIRECTIONS:

In a 5 quart pot, heat oil and saute carrots celery, potato and onion for 10minutes. Add garlic, saute 1 minute. Add bay leaf, marjoram, ham bone and split peas. Add chicken broth and water and simmer for 1 hour, stirring occasionally. Remove ham bone, cool, cut off meat and add to soup. Add diced ham. Serve with French bread or baked sweet potato fries.

Pasta, Sausage and Bean Soup

YIELD: Makes 8 servings

INGREDIENTS: 

2  tablespoons oil 

One pound Italian sausages, casings removed .

1/2 cup chopped onions

1 tablespoon chopped garlic

1 celery stalk with leaves, sliced

1 teaspoon dried basil

1 1/2 cups sliced carrots

1/2 teaspoon dried rosemary

1/4 teaspoon crushed dried red pepper flakes (optional)

5 cups canned chicken broth

1 14 1/2 ounce can diced tomatoes

1 can kidney beans, drained and rinsed

3/4 cup elbow macaroni

Salt and pepper to taste

DIRECTIONS:

Heat oil in a 6 quart Dutch Oven. Add sausages, and saute until beginning to brown, breaking up with back of spoon, about 5 minutes. Add onions, garlic, celery, basil, carrots, rosemary, and red pepper. Saute until vegetables begin to soften, about 10 minutes. Add broth, tomatoes with their juices and beans. Bring soup to a boil, reduce heat and simmer for 15 minutes. Add elbow macaroni and simmer until tender, about 15 minutes. Season to taste with salt and pepper. Serve with cheesy garlic bread.

Beef Barley Soup

Beef Barley Soup

YIELD: Makes 6 servings

INGREDIENTS: 

2 tablespoons oil

About 1 lb of beef shank cross cut

3 large carrots, sliced

3 celery stalks, sliced

1 onion, sliced

8 oz. mushrooms, sliced

1 Russet potato, cut into cubes

1/3 cup barley

1/2 teaspoon oregano

4 cups of reduced salt beef broth

1 cup hot water

1/2 package of frozen, chopped spinach

Salt to taste

DIRECTIONS:

In a 5 quart pot, heat oil, add the beef and brown well on both sides. Remove to plate and let cool. Cut meat into very small juices; save the bone. In the same pot, cook all vegetables until slightly softened. Return the meat and bone, add barley, oregano, beef broth and water. Simmer until meat is tender, about 45 minutes. Add spinach, cook 10 more minutes. Remove bone. Taste and add salt if needed. Serve with cornbread muffins.

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By Nancy Burner, Esq.

Nancy Burner, Esq.

A Durable Power of Attorney (“DPOA”) is a statutory form that enables a person to empower a loved one or trusted individual to manage finances and property on their behalf. The concept is, even if one lacks legal capacity to handle their own financial and business affairs, their appointed agent will be able to use the document to access bank accounts, sign checks, pay bills, and carry out essential estate planning for Medicaid asset protection purposes. Note that not all powers of attorney are the same, the particular powers that the agent will have will depend on how the document is drafted.

As long-term care, including home care and nursing home care, is not covered by health insurance, many people look to Medicaid as a pay source. Medicaid, however, is a means- based program for which qualification requires an individual prove they have no more than $16,800 in assets (in 2022). Further, there is a 5-year lookback period for nursing home Medicaid. This means that upon application, there is a scrutiny of the prior five years of the financial life of the applicant and their spouse, looking for any assets gifted within the 5 years prior to applying. While there are certain allowable or exempt transfers, all other transfers will result in a “penalty period,” a period of time during which Medicaid will not assist with the costs of care.

Fortunately, there are several exempt transfers that do not incur a penalty period, the most common being a transfer of assets to one’s spouse. Thus, if one urgently needs nursing home care, but has assets above the Medicaid limit, they can transfer assets to their spouse to bring themselves under the resource limit to qualify for Medicaid without penalty. In certain circumstances, assets can also be transferred to individuals other than the spouse,

This is where the DPOA comes into play because if the Medicaid applicant lacks mental capacity, they will not be able to transfer assets. And, contrary to popular belief, a spouse does not have the authority to access the other’s bank accounts or other assets simply because they are married—unless the spouse were a joint owner, they would need a DPOA or be appointed legal guardian by the court, a costly and time-consuming process.

Since the standard statutory form does not include any gifting over $5,000, modifications must be included with additional provisions supplementing the authority granted to the agent. For starters, the document must specifically authorize gifting. In the scenario where assets need to be transferred to the spouse and the spouse is the agent in the document, it must also specify the authority for self-gifting.

While authorizing your agent to gift assets to themselves can be critical to securing Medicaid coverage, it should not be done without careful consideration. Any assets transferred would no longer be governed by the will, trust, or other estate planning documents of that person. Once property is transferred to another person, it is theirs and, while one would hope they would follow the wishes of the principal, it raises the risk that chosen beneficiaries will be disinherited. Choosing an agent that a principal trusts completely to follow their wishes and only do what is in their best interest is a necessary part of this type of planning.

The decision whether to grant the agent the authority to self-gift under a DPOA is not an easy one and there is no “right” answer. On the one hand, allowing the agent to gift assets to themselves may be the only way to quickly qualify for nursing home Medicaid coverage if one lacks the legal capacity to transfer the assets. On the other hand, an agent may never be needed to gift or self-gift because Medicaid is not needed or there are other ways of gaining eligibility.

The moral of the story is to address estate planning with an experienced elder law attorney sooner rather than later to advise on these issues and draft the appropriate DPOA document. There are various strategies by which assets can be protected for Medicaid eligibility while effectively ensuring that assets are left to chosen beneficiaries at the time of death.

Nancy Burner, Esq. is the founder and managing partner at Burner Law Group, P.C with offices located in East Setauket, Westhampton Beach, New York City and East Hampton.

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Photo by Heidi Sutton

SPREADING JOY

We think it’s safe to say that Scrooge doesn’t live here! This house on the corner of Barnum Avenue and Oakes Street in the Village of Port Jefferson definately makes the Nice List as it spreads holiday cheer to all who pass it with a 15-foot tall Rudolph, Frosty and even Santa Claus (hiding behind Frosty) with giant ornaments hanging over the porch. See it for yourself this Sunday before the Santa Parade heads down Main Street at 3 p.m. with the real Santa Claus! Photo by Heidi Sutton

Send your Photo of the Week to [email protected]

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Shop local! METRO photo

After tackling the Black Friday frenzy at local malls and major department stores, the Saturday after Thanksgiving is set aside for our small businesses.

For over a decade, holiday shoppers have taken part in Small Business Saturday, an initiative created by American Express and the nonprofit National Trust for Historic Preservation in the midst of a recession.

The annual event is an excellent opportunity to patronize mom-and-pop stores in our towns and villages. Many of these places provide personal services that consumers can’t find at larger retailers or by shopping online, such as exceptional customer service and wrapping gifts.

When shoppers support a neighborhood store, they are also helping the surrounding community. Many small business owners sponsor local sports teams or events. Those same owners also pay sales taxes to local municipalities, involving dollars going back into nearby public schools, parks, roads and so much more.

The multiplier effect of small businesses creates more jobs in our communities, too. With many mom-and-pops suffering from the aftereffects of pandemic shutdowns, shoppers at local businesses play a part in keeping small brick-and-mortar stores open and people employed.

We know with lingering COVID-19 concerns, it can be overwhelming for some to step into a store sometimes. Many have become accustomed to ordering online, but if you can’t get out or don’t want to, many local businesses have websites or social media pages where buyers can purchase goods online. 

There are also quiet weekdays to stop by a local store and check out their unique items. Shopping small doesn’t have to be restricted to one day out of the year.

After a long day of shopping, remember small businesses aren’t limited to clothing or gift stores, either. Get a bite to eat or a drink at a restaurant or bar in town. Buy a gift certificate to your favorite Friday night spot for a friend or family member. Or maybe someone waiting at home would appreciate flowers from the local florist. Have a loved one who loves yoga, dancing or self-defense classes? Many schools and gyms offer gift certificates, and it’s an easy way for people to try out a business before committing to it.

Most of all, frequenting small businesses creates a stronger sense of community. The last few years have been difficult for many, and the support of others, especially neighbors, can make a huge difference in someone’s life and livelihood.

It is time that we think about the big picture. If we fail to support our local small businesses, then we will soon be left with vacant storefronts. Blighted downtowns can affect property values and diminish the quality and character of our community.

This Saturday, remember to patronize your local mom-and-pops. It may seem like a small gesture, but it can make a big difference for our community. 

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Luke
Luke
Luke

This week’s shelter pet is Luke, a fox hound mix waiting at the Smithtown Animal Shelter for his furever home. 

This lovely boy was a pandemic puppy, adopted out of boredom without the effort or knowledge needed to make him a healthy and happy dog. Luke has had no socialization and lived in a chaotic environment where he spent most of his time locked away on his own. He is a sweet boy that needs a patient home that can socialize and expose him to the world. He may have food aggression with other animals and he shows no interest in other animals at the shelter except concern.

If you would like to meet Luke, please call ahead to schedule an hour to properly interact with him in a domestic setting.

The Smithtown Animal & Adoption Shelter is located at 410 Middle Country Road, Smithtown. Visitor hours are currently Monday to Saturday from 10 a.m. to 3 p.m. (Sundays and Wednesday evenings by appointment only). For more information, call 631-360-7575 or visit www.townofsmithtownanimalshelter.com.

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By Michael Christodoulou

You can find many ways to support charitable organizations. One method that’s gained popularity over the past few years is called a donor-advised fund. Should you consider it?

The answer depends on your individual situation, because donor-advised funds are not appropriate for everyone. However, if you’re in a position to make larger charitable gifts, you might at least want to see what this strategy has to offer.

Here’s how it works:

Contribute to the fund. You can contribute to your donor-advised fund with cash or marketable securities, which are assets that can be converted to cash quickly. If your contribution is tax deductible, you’ll get the deduction in the year you make the contribution to the fund. Of course, these contributions are still subject to IRS limits on charitable tax deductions and whether you itemize your deductions. 

If you typically don’t give enough each year to itemize and plan on making consistent charitable contributions, you could consider combining multiple years’ worth of planned giving into a single donor-advised fund contribution, and claim a larger deduction in that year. This move may be especially impactful if you have years with a higher amount of income, with an accompanying higher tax rate. If you contribute marketable securities, like stocks and bonds, into the fund, a subsequent sale of the securities avoids capital gains taxes, maximizing the impact of your contribution.

Choose an investment. Typically, donor-advised funds offer several professionally managed diversified portfolios where you can place your contributions. You’ll want to consider the level of investment risk to which your fund may be exposed. And assuming all requirements are met, any investment growth is not taxable to you, the donor-advised fund or the charity that ultimately receives the grant, making your charitable gift go even further.

Choose the charities. You can choose grants for the IRS-approved charities that you want to support. You decide when you want the money donated and how it should be granted. You’re generally free to choose as many IRS-approved charitable organizations as you like. And the tax reporting is relatively easy — you don’t have to keep track of receipts from every charity you support. Instead, you can just keep the receipts from your contributions to the fund.

Although donor-advised funds clearly offer some benefits, there are important trade-offs to consider. For one thing, your contributions are irrevocable, which means once you put the money in the fund, you cannot access it for any reason other than charitable giving. And the investments you choose within your fund will carry some risk, as is true of all investments. Also, donor-advised funds do have investment management fees and other costs. So, consider the impacts of these fees when deciding how you want to give.

In any case, you should consult with your tax and financial professionals before opening a donor-advised fund. And if the fund becomes part of your estate plans, you’ll also want to work with your legal advisor. But give this philanthropic tool some thought — it can help you do some good while also potentially benefiting your own long-term financial strategy.

Michael Christodoulou, ChFC®, AAMS®, CRPC®, CRPS® is a Financial Advisor for Edward Jones in Stony Brook. Member SIPC.

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