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By Linda Toga, Esq.

Linda Toga, Esq.

THE FACTS: I am one of four children. My siblings are Joe, Bill and Mary. My mother died last month. About 15 years ago, she went to her attorney and had a will prepared in which she named me as executor.

Rather than divide her estate equally between her four children, my mother essentially disinherited my brother Joe and divided her estate equally between me, Bill and Mary. At the time she executed her will, the reason my mother gave for her decision to leave Joe out was that he ignored her and was never around when she needed help.

About 10 years ago, Joe moved to a house within a mile of my mother’s house and started spending time with her. He has encouraged his children to visit their grandmother and my mother and Joe’s wife and children have actually vacationed together. Since he lived closer to my mother than any of her other children, Joe became the one my mother relied upon whenever she needed assistance of any kind.

Over the years, Joe and my mother developed a very special relationship. I don’t know why my mother never revised her will but I am convinced, based upon her relationship with Joe and things that she told me, that she would want him to receive a share of his estate.

THE QUESTION: As the named executor, am I able to divide my mother’s estate into four equal shares so that Joe receives one-fourth of the estate? I feel terrible leaving him out but Mary and Bill are adamant that I must follow the instructions set forth in my mother’s will. Are they correct?

THE ANSWER: Unfortunately for Joe, Bill and Mary are correct. As executor, it is your responsibility to marshal your mother’s assets and to distribute them in accordance with the terms of her will. As much as you may want to include Joe, and as convinced as you may be that that is what you mother may have wanted at the time of her death, you do not have any discretion with respect to the distribution of your mother’s assets.

If you unilaterally decide to pass part of the estate to Joe, Bill and Mary will be well within their rights to ask the court to remove you as executor. They could also ask that the judge surcharge you so that you would be personally responsible for the funds that were diverted to Joe.

The only way you can pass a share of the estate to Joe is if Bill and Mary agree that Joe should share in the estate. If everyone is in agreement, it is simply a matter of you, Bill and Mary each transferring a portion of your inheritance to Joe. If Bill and Mary do not want to share, you can always give Joe some or all of what you are entitled to under the will. As long as Bill and Mary receive what they are entitled to under the will, they will not have a basis for objecting.

It is unfortunate that your mother did not review her will and revise it once her relationship with Joe improved. If she had gone back to her attorney, it would have been relatively easy for the attorney to prepare a new will for your mother in which all of her children were named as equal beneficiaries, or to prepare a codicil to her will that would have the same end result.

It is important that people understand that estate planning is not the sort of thing that is done once and forgotten. Wills and other estate planning documents should be reviewed periodically and changed to reflect changed circumstances. If your mother had revised her will or had a new will prepared that took into consideration her improved relationship with Joe, you would not be in the position you are now of trying to make things right.

Linda M. Toga provides personalized service and peace of mind to her clients in the areas of estate planning, estate administration, real estate, marital agreements and litigation from her East Setauket office. Visit her website at www.lmtogalaw.com or call 631-444-5605 to schedule a free consultation.

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By Daniel Dunaief

Daniel Dunaief

Breaking up is spectacularly awkward, highly charged and, in retrospect, filled with humorous potential. Two people get together for a picnic, where a public scene might be difficult for the recipient.

“Want some tabouli? What is tabouli anyway?”

“No thanks, and I don’t know what it is. You ordered it, not me.”

“Good point, so, I was thinking. It’s probably a good time for us to separate.”

“Um, what, excuse me?”

The lip quivers, the breathing becomes short and erratic and the eyebrows, shoulders and neck all droop at the same time.

“No, yeah, I mean, you’re great and this has been a total blast but, you know, it’s just, I don’t know, it’s not working for me.”

“A total blast? You’d call this a total blast? Besides, nothing is perfect. I know my family can be difficult and I know I wake up with bad breath and I do, on occasion, correct your speech, but we can work around that. Don’t you want to try to make it work?”

“I’m thinking that it’s probably time to do other things. I’m thinking of moving to Vancouver and you hate the cold.”

“Vancouver? Really? Wait, have you been seeing other people? You and my sister get along a little too well. As soon as you start dating her, she won’t be interested. I know I share genes with her, but she’s a horrible person who has ruined my life over and over again.”

“No, really, this has nothing to do with your sister. I wouldn’t do that to you or myself, especially after what you just said.”

“Oh, so, now there’s something wrong with my sister? At least she’s not dumping me.”

“No, no, I think we have a great friendship and I’d like to stay in touch.”

“You’d like to stay in touch? After all we’ve been through, you’re offering me your friendship? You’re not even that good of a friend. You rarely listen and you forget all the important dates in the year and you always want to go to the same restaurants, even though we have so many other choices.”

“Right, exactly, I’m so boring, so maybe you’re ready to be done with me?”

“Why do we have to end it now? It’s not like I was expecting to marry you. I can’t imagine having a younger version of you in the house. You can somehow shoot baskets from all over a gym floor that land in a hoop, but you have no ability to throw the dirty T-shirt you wore to play basketball into a much larger hamper that’s also closer to the ground, even though you roll the shirt into a ball.”

“I agree. You could do so much better.”

“I’m sure there are plenty of better people out there, but we had some fun, right? We were supposed to go to that dinner next Saturday with the Smiths. They’re your friends, so maybe we should see what works between now and then?”

“It’s OK, I already canceled that.”

“What? That horrible person Jessica Smith knew you were going to break up with me before I did? How could you do this to me?”

“Sorry, I didn’t tell them anything. I just said we couldn’t make it.”

“We couldn’t make it because you were going to break up with me today over tabouli. You’re an idiot.”

“Right, well, maybe we shouldn’t stay in touch?”

“Oh, so now I’m not good enough to be your friend?”

“I’m going to be a boring idiot elsewhere.”

“Wait, you’re leaving me?”

“Yes, and I’ve googled ‘tabouli.’ It’s a Lebanese salad with vegetables, wheat and parsley, just so you know.”

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By Leah S. Dunaief

Leah Dunaief

One of the best plays I have seen on Broadway is the drama, “The Ferryman.” Written by Jez Butterworth, directed by Sean Mendes and playing at the Bernard B. Jacobs Theatre only until July 7, it is so deserving of winning four Tony Awards, including best play, and should not be missed. The story is about a large Irish family in rural County Armagh in Northern Ireland and conjures up Tennessee Williams and “August: Osage County” for its familial interactions of love, lust, betrayal, anger, contradictions, secrets, repression and murder. But it is so much more.

It is historic, being set in 1981 at the height of The Troubles involving the British, loyalist Irish Protestants who want to remain in the United Kingdom, and nationalist Irish Catholics, including the Irish Republican Army, who want a united Ireland.

It is a story about storytelling as three generations live under one roof of a large farmhouse and slowly reveal much about their own histories. It is about human kindness, as personified by the appealing leading character, farmer Quinn Carney, husband and father of seven children ranging in age from 16 years to nine months. He houses and employs Tom Kettle, an Englishman, whose mind is not all there, as his handyman; and Caitlin, wife of Carney’s long-missing brother and her son, Oisin, as well as aged aunts and an uncle. Yet Carney is also a former active member of the IRA, with its brutality and bloodshed, which he has ultimately rejected. It has homey fairy tales and classic epics in the mix, hopeless love, and lots of barroom talk and drinking, happy celebrating and passionate confrontations. Amid all that activity, with a cast of well-defined characters, it has genuine, laugh-out-loud humor.

The play is also remarkable for its length. It runs three and a quarter hours with only one 15-minute intermission after Act 1 and a three-minute dimming of the house lights following Act 2. Yet not for a minute, for me and my companions, did it keep from being riveting as it pulsated with suspense interspersed with hearthside family goodness that is set against the background report of Irish Republican hunger strikers dying one by one in a Belfast prison.

There are even live animals in the form of an affectionate goose, a feral rabbit and a real, sweet baby. Artfully they all come together to deliver a memorable play and to live in the minds of the viewers well past the end of the performance.

The prologue, set against a crumbling, graffiti-splayed urban wall, sets the sinister mood with an encounter between craven Father Horrigan and Muldoon, a major figure in the IRA. And every subsequent scene in which the priest appears seethes with tension. He delivers the news that Seamus, Caitlin’s missing husband, has been found face down, preserved by the acid in a bog, hands tied behind him and a bullet in the back of his head. The mystery of his disappearance deepens because he was not involved in The Troubles.

There is an Aunt Pat and Uncle Patrick, as well as an often mentally absent Aunt Maggie, whose roles are largely to unveil past history even as their passions define them as three dimensional characters within the family and their country. Their narratives give their lives shape and substance.

With the discovery of the body, the past meets the future as Muldoon attempts to contain the truth of the missing husband’s murder from emerging. In the process, other truths seep out in the appropriately furnished great room of the farmhouse that serves as the only site where all subsequent action takes place.

In the beginning, the viewer is puzzled as to who the family members are and their relationships to each other, which create an air of mystery. As the plot develops, the answers powerfully emerge, carrying us along, absorbed and engaged. And while the plot is masterfully orchestrated, I don’t want to give away the most important details in the hope that you will still get tickets and join me in your admiration for a remarkable play.

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Fusheng Wang. Photo from SBU

By Daniel Dunaief

Long Island’s opioid-related use and poisoning, which nearly doubled from 2015 to 2016, was higher among lower income households in Nassau and Suffolk counties, according to a recent study in the American Journal of Preventive Medicine.

Looking at hospital codes throughout New York to gather specific data about medical problems caused by the overuse or addiction to painkillers, researchers including Fusheng Wang, an assistant professor in the Department of Biomedical Informatics at Stony Brook University, George Leibowitz, a professor in Stony Brook’s School of Social Welfare, and Elinor Schoenfeld, a research professor of preventive medicine at the Renaissance School of Medicine at Stony Brook, explored patterns that reveal details about the epidemic on Long Island.

“We want to know what the population groups are who get addicted or get poisoned and what are the regions we have to pay a lot of attention to,” Wang said. “We try to use lots of information to support these studies.”

Data from The Journal

The Stony Brook team, which received financial support from the National Science Foundation, explored over 7 years of hospital data from 2010 to 2016 in which seven different codes — all related to opioid problems — were reported.

During those years, the rates of opioid poisoning increased by 250 percent. In their report, the scientists urged a greater understanding and intervening at the community level, focusing on those most at risk.

Indeed, the ZIP codes that showed the greatest percentage of opioid poisoning came from communities with the lowest median home value, the greatest percentage of residents who completed high school and the lowest percentage of residents who achieved education beyond college, according to the study.

In Suffolk County, specifically, the highest quartile of opioid poisoning occurred in communities with lower median income.

Patients with opioid poisoning were typically younger and more often identified themselves as white. People battling the painkilling affliction in Suffolk County were more likely to use self-pay only and less likely to use Medicare.

In Suffolk County, the patients who had opioid poisoning also were concentrated along the western section, where population densities were higher than in other regions of the county.

The Stony Brook scientists suggested that the data are consistent with information presented by the Centers for Disease Control and Prevention, which has found significant increases in use by women, older adults and non-Hispanic whites.

“The observed trends are consistent with national statistics of higher opioid use among lower-income households,” the authors wrote in their study. Opioid prescribing among Medicare Part D recipients has risen 2.84 percent in the Empire State. The data on Long Island reflected the national trend among states with older residents.

“States with higher median population age consume more opioids per capita, suggesting that older adults consume more opioids,” the study suggested, citing a report last year from the American Journal of Preventive Medicine.

Nationally, between 21 to 29 percent of people prescribed opioids for pain misused them, according to the study, which cited other research. About 4 to 6 percent of people who misuse opioids then transition to heroin. Opioid costs, including treatment and criminal justice, have climbed to about $500 billion, up from $55.7 billion in 2007, according to a 2017 study in the journal Pain Physician.

The findings from the current study on Long Island, the authors suggest, are helping regional efforts to plan for and expand capacity to provide focused and targeted intervention where they are needed most.

Limited trained staff present challenges for the implementation of efforts like evidenced-based psychosocial programs such as the Vermont Hub and Spoke system.

The researchers suggest that the information about communities in need provides a critical first step in addressing provider shortages.

New York State cautioned that findings from this study may underreport the burden of opioid abuse and dependence, according to the study. To understand the extent of underreporting, the scientists suggest conducting similar studies in other states.

Scientists are increasingly looking to the field of informatics to analyze and interpret large data sets. The lower cost of computing, coupled with an abundance of available data, allows researchers to ask more detailed and specific questions in a shorter space of time.

Wang said this kind of information about the opioid crisis can provide those engaging in public policy with a specific understanding of the crisis. “People are not [generally] aware of the overall distribution” of opioid cases, Wang said. Each hospital only has its own data, while “we can provide a much more accurate” analysis, comparing each group.

Gathering the data from the hospitals took considerable time, he said. “We want to get information and push this to local administrations. We want to eventually support wide information for decision-making by the government.”

Wang credited his collaborators Leibowitz and Schoenfeld with making connections with local governments.

He became involved in this project because of contact he made with Stony Brook Hospital in 2016. Wang is also studying comorbidity: He’d like to know what other presenting symptoms, addictions or problems patients with opioid-related crises have when they visit the hospital. The next stage, he said, is to look at the effectiveness of different types of treatment.

A resident of Lake Grove, Wang believes he made the right decision to join Stony Brook. “I really enjoy my research here,” he said.

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By John Turner

One of the many joys of summer in Setauket is spending time in the backyard relaxing with a book, swimming in the pool, gardening or enjoying a family meal together. I’ve come to realize that during these backyard experiences we’re often not alone. We’re sharing the space around us — as wrens, orioles and robins fly about and butterflies dance among flowers. Sometimes I’ll catch a glimpse of a chipmunk or squirrel scampering around, all going about their daily lives.

I’ve come to look especially forward to seeing one creature each summer and to do so I must gaze skyward to look for a small bird in ceaseless flight, dipping and zooming here and there, all the while twittering away.

Photo courtesy of the National Audubon Society

I’m referring to the chimney swift (Chaetura pelagica), a sooty brown bird with sharp sickle-shaped wings that’s been aptly described as a “cigar with wings.” I think that’s a little bit inaccurate — it’s more like a “half-smoked cigar with wings,” with its stubby tail reminiscent of the chewed on end of the cigar. The genus name Chaetura means “bristle tailed” in Greek, a reference to the stubby tail, tipped with small pointy feathers (these bristles help anchor the bird when roosting on vertical surfaces).

The chimney swift is one of four swift species native to North America; the other three — the slightly smaller Vaux’s swift and the slightly larger black- and white-throated swifts are western birds.

When nesting and roosting, chimney swifts live up to their names, taking refuge within chimneys, old wells, the eaves of barns and other human structures. Before human structures became available, they presumably nested on cliffs and in caves and tree hollows, which a few still do today.

Swifts don’t so much fly as appear to flutter. With surprisingly shallow wing beats, this fluttering bird cuts through the air remarkably well, flying ceaselessly about in wide and tight circles as it searches for the aerial prey that sustains them.

In fact, swifts are the most aerial of all birds. A study published in 2016 documented a common swift, the European counterpart to our chimney swift, staying in the air for 10 months; that’s right, flying around for 10 entire months, not 10 weeks or 10 days, which would be enough of an outstanding feat to make any ultra-marathoner proud, but 10 months of not touching land! Scientists made the obvious conclusion the bird routinely slept on the wing, shutting down half its brain at a time while keeping the other half active. She finally came back to earth to mate, lay eggs and raise young.

Occasionally swifts break from their typical fluttery flights to display courtship behavior. During these displays a mated pair flies together, about a foot or two apart, and synchronously throw their wings into a deep V-shaped position and glide for a second or two before resuming regular flight. It’s a little joy to behold and life is worth living due to little joys, right?

Chimney swifts raise their young in small, half-moon-shaped nests made of small sticks built onto the sides of walls. Both sexes help to build the nest and they employ an interesting material to bind the nest together — saliva. During the breeding season the salivary glands of both sexes swell, producing a gluelike saliva that hardens to hold the nest together.

On a related note: If you’ve ever heard of, or perhaps tried, bird’s nest soup, you’re consuming a food made from the edible saliva of two bird species related to the chimney swift — Asian swiftlets. These nests support an industry worth hundreds of millions of dollars annually. In fact, the nests of swiftlets are among the most expensive animal products in the world, fetching as much as several thousand dollars per kilogram. So if you’ve tried the soup, kudos to you because you’re obviously financially well off!

The eggs are incubated for about three weeks and, once born, the young grow rapidly, fledging in about the same amount of time. Development of the young is accelerated by “helpers at the nest”; unpaired adult swifts that sometimes assist in the raising the young of paired swifts, helping the young birds to fledge more quickly.

Ornithologists aren’t exactly sure why the helpers do this although it is a behavior seen in a few other bird species. Research has shown that some of the unpaired birds are young from the previous year so perhaps they know they’re helping to pass along genes similar to their own.  

Wooden chimney swift towers at West Meadow Beach. Photo by John Turner

One last fascinating aspect of chimney swifts is their ability to go into torpor, a physical condition halfway between full active mode and hibernation. In torpor a swift’s breathing and heart rate diminishes, as does its overall metabolic activity, thereby helping to get them through periods of cold, inclement weather when little to no food, in the form of small aerial insects, is available. 

Some good places nearby to see chimney swifts are the Stony Brook Village Center and Port Jefferson Village. A little further afield you can enjoy their flight over more urban areas of Long Island, where chimneys are available, including downtown Riverhead, Islip and Bay Shore.

As part of an Eagle Scout project, wooden chimney swift towers were constructed at West Meadow Beach in the hopes of attracting them but to date do not appear to be used. Perhaps someday they will be.

A resident of Setauket, John Turner is conservation chair of the Four Harbors Audubon Society, author of “Exploring the Other Island: A Seasonal Nature Guide to Long Island” and president of Alula Birding & Natural History Tours.

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Toenail fungus can have medical implications

By David Dunaief, M.D.

Dr. David Dunaief

Summer is almost here, and millions of Americans are beginning to expose their toes. Some are more self-conscious about it because of a disease called onychomycosis, better known as nail fungus.

Nail fungus usually affects toenails but can also affect fingernails. It turns the nails yellow, makes them potentially brittle, creates growth underneath the nail (thickening of the nails) and may cause pain.

Many consider getting treatment for cosmetic reasons, but there are also medical reasons to treat, including the chronic or acute pain caused by nail cutting or pressure from bedsheets and footwear. There is also an increased potential risk for infections, such as cellulitis, in those with compromised immune systems (1).

Onychomycosis is not easy to treat, although it affects approximately 8 percent of the population (2). The risk factors are unclear but may relate to family history, tinea pedis (athlete’s foot), older age, swimming, diabetes, psoriasis, suppression of the immune system and/or living with someone affected (3).

Many organisms can affect the nail. The most common class is dermatophytes, but others are yeast (Candida) and nondermatophytes. A KOH (potassium hydroxide) preparation can be used to differentiate them. This is important since some medications work better on one type than another. Also, yellow nails alone may not be caused by onychomycosis; they can be a sign of psoriasis.

When considering treatment, there are several important criteria, including effectiveness, length of treatment and potential adverse effects. The bad news is that none of the treatments are foolproof, and the highest “cure” rate is around two-thirds. Oral medications tend to be the most efficacious, but they also have the most side effects. The treatments can take from around three months to one year. Unfortunately, the recurrence rate of fungal infection is thought to be approximately 20 to 50 percent with patients who have experienced “cure” (4).

Oral antifungals

There are several oral antifungal options, including terbinafine (Lamisil), fluconazole (Diflucan) and itraconazole. These tend to have the greatest success rate, but the disadvantages are their side effects. In a small but randomized controlled trial (RCT), terbinafine was shown to work better in a head-to-head trial than fluconazole (5). Of those treated, 67 percent of patients experienced a clearing of toenail fungus with terbinafine, compared to 21 and 32 percent with fluconazole, depending on duration. Patients in the terbinafine group were treated with 250 mg of the drug for 12 weeks. Those in the fluconazole group were treated with 150 mg of the drug for either 12 or 24 weeks, with the 24-week group experiencing better results.

The disadvantage of terbinafine is the risk of potential hepatic (liver) damage and failure, though it’s an uncommon occurrence. Liver enzymes need to be checked while using terbinafine.

Another approach to reducing side effects is to give oral antifungals in a pulsed fashion. In an RCT, fluconazole 150 or 300 mg was shown to have significant benefit compared to the control arm when given on a weekly basis (6). However, efficacy was not as great as with terbinafine or itraconazole (7).

Topical medication

A commonly used topical medication is ciclopirox (Penlac). The advantage of this lacquer is that there are minor potential side effects. However, it takes approximately a year of daily use, and its efficacy is not as great as oral antifungals. In two randomized controlled trials, the use of ciclopirox showed a 7 percent “cure” rate in patients, compared to 0.4 percent in the placebo groups (8). There is also a significant rate of fungus recurrence. In one trial, ciclopirox had to be applied daily for 48 weeks in patients with mild to moderate levels of fungus.

Laser therapy

Of the treatments, laser therapy would seem to be the least innocuous. However, there are very few trials showing significant benefit with this approach. A study with one type of laser treatment (Nd:YAG 1064-nm laser) did not show a significant difference after five sessions (9). This was only one type of laser treatment, but it does not bode well. The advantage of laser treatment is the mild side effects. The disadvantages are the questionable efficacy and the cost. We need more research to determine if they are effective.

Alternative therapy

Vicks VapoRub may have a place in the treatment of onychomycosis. In a very small pilot trial with 18 patients, 27.8 percent or 5 of the patients experienced complete “cure” of their nail fungus (10). Partial improvement occurred in the toenails of 10 patients. The gel was applied daily for 48 weeks. The advantages are low risk of side effects and low cost. The disadvantages are a lack of larger studies for efficacy, the duration of use and a lower efficacy when compared to oral antifungals.

None of the treatments are perfect. Oral medications tend to be the most efficacious but also have the most side effects. If treatment is for medical reasons, then oral may be the way to go. If you have diabetes, then treatment may be of the utmost importance.

If you decide on this approach, discuss it with your doctor; and do appropriate precautionary tests on a regular basis, such as liver enzyme monitoring with terbinafine. However, if treatment is for cosmetic reasons, then topical medications or alternative approaches may be the better choice. No matter what, have patience. The process may take a while; nails, especially in toes, grow very slowly.

References:

(1) J Am Acad Dermatol. 1999 Aug.;41:189–196; Dermatology. 2004;209:301–307. (2) J Am Acad Dermatol. 2000;43:244–248. (3) J Eur Acad Dermatol Venereol. 2004;18:48–51. (4) Dermatology. 1998;197:162–166; uptodate.com. (5) Pharmacoeconomics. 2002;20:319–324. (6) J Am Acad Dermatol. 1998;38:S77. (7) Br J Dermatol. 2000;142:97–102; Pharmacoeconomics. 1998;13:243–256. (8) J Am Acad Dermatol. 2000;43(4 Suppl.):S70-S80. (9) J Am Acad Dermatol. 2013 Oct.;69:578–582. (10) J Am Board Fam Med. 2011;24:69–74.

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.       

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By Matthew Kearns, DVM

Dr. Matthew Kearns

I often get asked, “Are vaccines really necessary for my pet every year?” The answer is, “Yes and no.” This two-part series will hopefully expand on that murky answer.

A brief review of how the immune system works is a good place to start. The immune system has two major components: humoral and cell mediated. Humoral immunity refers to the portion of the immune system that produces antibodies. Antibodies are proteins that are made by certain white blood cells against specific diseases (viral, bacterial, fungal, etc.).

These proteins attach to these foreign invaders and release chemical signals to recruit a different set of white blood cells to attack. This other set of white blood cells are labeled as cell-mediated immunity and they attack and kill foreign invaders before they can harm our pets.

The body needs BOTH humoral and cell-mediated immunity to effectively fight infections; without one, the other is useless. Vaccines are designed to stimulate both components of the immune system without causing disease or infection.

Once the vaccination is administered, our pet’s immune system processes these proteins to produce antibodies against these invaders and prime the white blood cells to be ready to fight if they are exposed to infection naturally.

Here is the problem. When measuring the body’s ability to fight infection, veterinarians can only measure one part of the immune system: the humoral component, or antibodies. Antibodies are proteins; so a blood sample is sent to the laboratory to measure antibody titers produced by the immune system against certain diseases. If the level is high enough, it is deemed “adequate titers.”

Unfortunately, since antibodies are only signals to the cell-mediated component of the immune system, adequate antibody levels do not guarantee the ability to fight infection in all cases. There are both human and veterinary studies that back this finding.

The good news is that there are also studies that have proven that inadequate antibody titers does not always mean that your pet will become sick even if exposed to certain infections. Sound confusing? If it makes you feel any better, this is confusing to us veterinarians and we’re supposed to be the experts. 

Veterinarians will follow the recommendations of the vaccine manufacturer, and the manufacturers have made it a little easier with vaccine trials. Vaccine trials refer to studies where, after administering a vaccine not only are antibody levels measured, but patients are also exposed to the actual infection to see if they develop symptoms. The initial series of vaccines and recommended updates are based on these trials. 

I hope this gives you the knowledge base to continue the discussion in my next article. It will discuss in more depth concerns about how often vaccines should be given, risk factors in the administration of vaccines and both New York State and Suffolk County laws on mandatory vaccination.

Dr. Kearns practices veterinary medicine from his Port Jefferson office and is pictured with his son Matthew and his dog Jasmine. Have a question for the vet? Email it to [email protected] to see his answer in an upcoming column.

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Rita J. Egan — Editor

On occasions like Father’s Day, my thoughts turn not only to my dad, but also to his parents and my uncles. My father passed away in 2004, and I always picture him reunited with his parents. Ten years ago, his brother, my Uncle John, died and a few years later my Uncle Jimmy. I often wonder if, after death, one gets to hang out with those they knew on Earth. I’d like to think they are talking about the old days in the Bronx and Astoria, hopefully with a few cold beers on hand. Most of all, I always hope that my grandparents know that my cousins and I benefited from their sacrifices — leaving Ireland when they were young adults to seek a better life. I also hope my father and uncles know how much they have influenced me and my cousins. For this, I carry them all in my heart. Happy Father’s Day in heaven to all of them. 

Kyle Barr — Editor

I didn’t know what to say to you the night you came home after learning your mother had passed away.

To be perfectly honest, she was never close to me, and it was hard for me to place my emotions, but I knew you were doing your best to deal with the shock and the grief. I saw you hop on a plane the very next morning after working nine hours the day before. I didn’t know how to say I’m sorry you went through that, and I know when I spoke to you on the phone, I must have sounded close to a narwhal trying to approximate human emotion.

But I saw how you were when you came back. You caught up with your sister. You had a new plan, and though you were leaving me to move into her old house, you could now say you were moving on.

You need to know how proud I am that you’re my dad.

David Luces — Reporter

On Father’s Day, I would like to highlight two father figures in my life growing up. One was my grandfather and the other my uncle. Both men were instrumental in my upbringing, and as a young man, they were individuals to whom I definitely looked up. I’m grateful for the experiences I’ve been able to have with them as a kid, whether it’s going to my first Yankee game or hours of playing catch in the backyard.

My grandfather unfortunately passed away in 2012, but the lessons he taught me remain. His guidance over the years has molded me into the man I am today. The same could be said for my uncle, as he has always been there for me and continues to be. I’ve been lucky to have these two great men in my life. I want to thank them for everything — it has meant so much to me.

Leah Chiappino — Intern

Every time I turn on the car or reflect on the education I received, I have my dad to thank. The son of a mechanic and restaurant waitress, he fought to pull himself through college, working 80-hour weeks at Howard Johnson’s and attending classes at community college after working the graveyard shift, funded by his own pocket. A successful public servant, he has fueled my passion for politics, philosophy and sports my entire life. This Father’s Day, I will probably be debating one of these topics with Dad, who taught me to have an opinion on and to question everything.

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MEET MAY!

This week’s shelter pet is May, a 5-year-old Lab mix currently looking for a forever home filled with happiness and unconditional love!

Rescued off of the streets of Puerto Rico, May is a very sweet dog with lots of love to offer. She is the perfect walking companion and loves to play. A recent arrival at the shelter, she has already wiggled her way into the staff’s hearts! Why not stop by and say hello?

May comes spayed, microchipped and is up to date on all her vaccines.

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

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Brendan Boyce, center, with Xiangjiao Yi, left, and Jinbo Li, who are graduate students at the University of Rochester. Photo by Jianguo Tao.

By Daniel Dunaief

Chances are high you won’t see Dr. Brendan Boyce when you visit a doctor. You will, however, benefit from his presence at Stony Brook University Hospital and on Long Island if you have bone or soft tissue lesions and you need an expert pathologist to diagnose what might be happening in your body.

A professor at the University of Rochester for 20 years, the internationally renowned Boyce joined the Renaissance School of Medicine at SBU in November, splitting his time between Rochester and Long Island.

Dr. Ken Shroyer, the chair of the Department of Pathology, reached out to Boyce with an unusual bone tumor case last spring. After that discussion, the two considered the possibility of Boyce adding his bone and soft tissue pathology expertise to the growing department. Boyce was receptive to the idea, particularly because his daughter Jacqueline lives in Woodbury with two of his seven grandchildren.

For local patients, Boyce adds a relatively rare expertise that could shorten the time for a diagnosis and improve the ability for doctors to determine the best course of action during surgeries.

“While the patient is already undergoing a surgical procedure, the preliminary diagnosis can guide the process of the surgery,” said Shroyer. “That’s difficult to achieve if we are dependent on an outside consultant. It happens, more or less in real time, if Boyce can look at the slides as they are being prepared and while the patient is still on the operating table.”

Prior to Boyce’s arrival, Stony Brook functioned the same way most academic medical centers do around the country when it came to bone and soft tissue cancers or disorders.

“There are only a handful of soft tissue and bone surgical pathology subspecialists around the country,” Shroyer said. “There’s an insufficient number of such individuals to make it practical like this at every medical school in the country.”

Many of these cases are “rare” and most pathologists do not see enough cases to feel comfortable diagnosing them without help from an expert, Boyce explained.

Boyce “was recruited here to help this program at Stony Brook continue to grow,” Shroyer said. “He enhances the overall scope of the training we can provide to our pathology residents through his subspecialty expertise. Everything he does here is integrated with the educational mission” of the medical school.

While bone and soft tissue tumors are relatively rare compared to other common cancers, such as colorectal or breast cancer, they do occur often enough that Stony Brook has developed a practice to diagnose and treat them, which requires the support of experts in pathology. Stony Brook hired Dr. Fazel Khan a few years ago as the orthopedic surgeon to do this work.

“To establish a successful service, there needs to be a mechanism to financially support that service that’s not solely dependent on the number of cases provided,” Shroyer said.

Boyce’s recruitment was made possible by “investments from Stony Brook University Hospital and the School of Medicine, in addition to support from the Department of Orthopedics and Pathology.”

Shroyer was thrilled that Boyce brings not only his expertise but his deep and well-developed background to Stony Brook.

It was “important to me that he was not only a highly skilled surgical pathologist, but also was a physician scientist, which made him a very attractive recruit,” Shroyer said.

Indeed, while Boyce will provide pathology services to Stony Brook, he will continue to maintain a laboratory at the University of Rochester.

Boyce’s research is “focused on the molecular mechanisms that regulate the formation of osteoclasts and their activity,” Boyce said. He emphasizes the effects of pro-inflammatory cytokines and NF-Kappa B, which are transcription factors that relay cytokine signaling from the cell surface to the nucleus.

These factors drive osteoclast formation and activity in conditions affecting the skeleton, which include rheumatoid arthritis, postmenopausal and age-related osteoporosis and cancers affecting the skeleton.

Osteoclasts degrade bone, which carve out deformities or the equivalent of potholes in the bone, while osteoblasts help rebuild the bone, repaving the equivalent of the roads after the osteoclasts have cleared the path. There are over a million sites of bone remodeling in the normal human skeleton and the number of these increases in diseases.

Boyce has studied various aspects of how bone remodeling occurs and how it becomes disturbed in a variety of pathological settings by using animal models. He uses cellular and molecular biological techniques to answer these questions.

On behalf of Boyce and three other researchers, the University of Rochester Medical Center just finished licensing a compound to a company in China that he recently contacted, which will do animal studies that will test the toxicity of a treatment for myeloma.

At this point, Boyce is applying in July for another five-year grant from the National Institutes of Health for research in his Rochester lab. He hopes to renew another NIH grant next year, which he has for four years. After he renews that grant, he will continue writing up papers and studies with residents and collaborating on basic science at Stony Brook as well.

Boyce and his wife Ann, have three children and seven grandchildren. Originally from Scotland, Boyce has participated in Glasgow University Alumni activities in the United States, including in New York City, where he walked in this year’s Tartan Parade with his daughters and their children.

As for his work at Stony Brook, Boyce is enjoying the opportunity to contribute to the community.

“The setting and faculty are very nice and congenial and I’ve been made to feel welcome,” he said.

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