CDPAP gives Medicaid recipients an alternative way to receive home-care services. Stock photo
By Nancy Burner, Esq.
Nancy Burner, Esq.
The Consumer Directed Personal Assistance Program (CDPAP) is a Medicaid program that allows a Medicaid applicant, or their representative, to choose the individual (or individuals) to provide care at home rather than using an aide from a home health agency.
Under the Medicaid process, once an applicant is approved for Medicaid, they will undergo at least one assessment to help determine how many hours of care the applicant will receive with a managed long-term care (MLTC) plan. The applicant then signs up with a home-care agency that contracts with the MLTC, and aides are sent to the home to provide the hours of care.
If the applicant is unhappy with the current aide, he or she can request that the agency replace the aide; however, the agency has full discretion on choosing a substitute. The agency only needs to make sure that they are providing the care set up by the predetermined hours.
There are also limits as to what the aide can do in terms of the care they provide. An aide can assist with most tasks, such as walking, bathing, grooming, light cleaning and cooking, but they cannot perform “skilled tasks,” such as administering medication.
For example, if an applicant is diabetic and requires daily insulin injections, the aide is not allowed to administer the injection. An aide, however, can give certain cues, such as placing medication in front of the patient, letting them know it is time to take said medication.
Many applicants are satisfied with the care provided by the home health aides, but there are some that may require an aide that can perform skilled tasks, or others already have an established relationship with a specific aide and do not want to switch to a different caregiver.
Under CDPAP, any individual can be hired as the caregiver so long as said individual is not a legally responsible relative, such as the applicant’s spouse or guardian.
The applicant, or their representative, will determine who the aide will be, their work schedule, and what kind of assistance the aide will provide. There is no prerequisite to be certified as a home health aide or registered nurse. Training the aide occurs at the home and the aide gets paid through Medicaid. The aide can perform skilled tasks that are not otherwise allowed under the standard Medicaid program.
It is important to note that under CDPAP, the aide is considered an independent contractor, not an employee of the agency.The applicant is therefore fully responsible for finding and setting up the care. The applicant will also not be able to take advantage of some of the benefits an agency provides, such as sending in backup care if the current aide is sick or cannot work for whatever reason.
To discuss your options, you should contact an elder law attorney who has extensive experience in this field and can navigate the Medicaid system to help provide you with the best care for your specific needs.
Nancy Burner, Esq. practices elder law and estate planning from her East Setauket office
The Christmas season is upon us. The village of Port Jefferson is decked out with lights and wreaths — there is definitely a spirit of Christmas in the air.
The world is a crazy place. The violence and hate has become infectious, but the reason for the season has taken a hold of us once again in a number of places. People are reaching out and bridging differences.
One such instance is Christmas Magic, an event that magically touches hearts old and young alike with the spirit of giving, sharing and serving others. Started more than 25 years ago by a young attorney who wanted his children to understand the real meaning of Christmas, his act of kindness and generosity has touched thousands of people across our county every Christmas season.
Hundreds of caring high school students to college students, from youth programs and church communities sacrifice their time and reach out to thousands of children living in our shelters during the holiday season.
Close to 3,000 people gathered at Carnegie Hall on the second Monday in December this year for a Christmas concert. The headliners were powerful: Andy Cooney and his band, the Hibernian Festival Singers, the Irish Tenors, the New York Tenors and eight young men who have become a band of brothers supported by an extraordinary female voice that makes the H.I.M.S. and Her such an extraordinary musical talent.
This band of brothers are young men who are broken and wounded, from all over, trying to reclaim their lives while living in a long-term nontraditional treatment program for addictions. The story of these men is a story of powerful change and transformation. Their performance at Carnegie Hall brought that packed house of concertgoers to their feet. It was a night of inspiration to remember.
A few days before their performance at Carnegie Hall these gifted and talented men volunteered to sing Christmas carols at the retirement home for the Dominican Sisters at their motherhouse in Amityville. I started to visit these sisters every Advent because I’m a product of Dominican education. In my junior high school years, I was profoundly influenced by three very dynamic women of faith. This has been my simple way of saying thank you.
After serving the church in a variety of leadership roles for more than 50 years, my former eighth-grade teacher took a job at Pax Christi, an emergency men’s shelter in Port Jefferson. She began working five days a week until she was 85 years old cleaning toilets, making beds and bringing hope to countless men who thought their lives were hopeless.
Today Sr. Beata is in her mid-90s. She is still as sharp as can be but has a difficult time getting around. The sisters she lives with range in age from their mid-70s to 107 years old.
After caroling that Saturday morning, the young men walked among these extraordinary women hugging and kissing them; the room was aglow. The sister who is 107 years old came over to me to thank me for bringing these young men. She said it was her greatest Christmas present. All her family has died and her friends as well. She has no visitors. After one of the young men hugged her she started to cry. She hadn’t been hugged in over a year and she said thank you for helping her feel alive again.
As we drove home, these men on the road to recovery and wellness were on fire — not realizing how in their brokenness with their simple carols they brought so much joy to a community of women who were such a source of hope and light for so many generations.
Christmas seems to be that time of year to remind each other of the profound goodness that lives within each of us and to be conscious that each one of us has the power to make a difference that really does count.
Merry Christmas!
Fr. Pizzarelli, SMM, LCSW-R, ACSW, DCSW, is the director of Hope House Ministries in Port Jefferson.
This week’s shelter pet is Beaux, a handsome 2½- year-old Shepherd mix rescued from a high kill shelter in Texas and now safe at Kent Animal Shelter.
Beaux has such soulful eyes and is as sweet as can be. He’s looking for someone to spend the rest of his days with. Could that be with you? He comes neutered, microchipped and is up to date on his vaccines.
Kent Animal Shelter is located at 2259 River Road in Calverton. The adoption center is open from 10 a.m. to 4 p.m. every day.
For more information on Beaux and other adoptable pets at Kent, call 631-727-5731 or visit www.kentanimalshelter.com.
This time of year, people around the world are no doubt sending you lists of things they want through emails, blogs, tweets and old-fashioned letters. In the spirit of giving, I’d like to offer you some advice.
Let’s face it: You aren’t exactly the model of good health. Think about the example you’re setting for all those people whose faces light up when they imagine you shimmying down their chimneys. You have what I’d describe as an abnormally high BMI (body mass index). Since you are a role model to millions, this sends the wrong message.
We already have an epidemic of overweight kids, leading to an ever increasing number of type 2 diabetics at younger and younger ages. According to the Centers for Disease Control and Prevention, as of 2015, more than 100 million U.S. adults are living with diabetes or prediabetes. It complicates the issue that approximately two-thirds of the U.S. population is overweight and/or obese. This is just one of many reasons we need you as a shining beacon of health.
Obesity has a much higher risk of shortening a person’s life span, not to mention quality of life and self-image. The most dangerous type of obesity is an increase in visceral adipose tissue, which means central belly fat. An easy way to tell if someone is too rotund is if a waistline, measured from the navel, is greater than or equal to 40 inches for a man, and is greater than or equal to 35 inches for a woman. The chances of diseases such as pancreatic cancer, breast cancer, liver cancer and heart disease increase dramatically with this increased fat.
Santa, here is a chance for you to lead by example (and, maybe by summer, to fit into those skinny jeans you hide in the back of your closet). Think of the advantages to you of being slimmer and trimmer. Your joints wouldn’t ache with the winter cold, and you would have more energy. Plus, studies show that with a plant-based diet, focusing on fruits and vegetables, you can reverse atherosclerosis, clogging of the arteries.
The importance of a good diet not only helps you lose weight, but avoid strokes, heart attacks and peripheral vascular diseases, among other ailments. But you don’t have to be vegetarian; you just have to increase your fruits, vegetables and whole-grain foods significantly. With a simple change, like eating a handful of raw nuts a day, you can reduce your risk of heart disease by half. Santa, future generations need you. Losing weight will also change your center of gravity, so your belly doesn’t pull you forward. This will make it easier for you to keep your balance on those steep, icy rooftops.
Exercise will help, as well. Maybe for the first continent or so, you might want to consider walking or jogging alongside the sleigh. As you exercise, you’ll start to tighten your abs and slowly see fat disappear from your midsection. Your fans everywhere leave you cookies and milk when you deliver presents. It’s a tough cycle to break, but break it you must. You — and your fans — need to see a healthier Santa.
You might let slip that the modern Santa enjoys fruits, especially berries, and veggies, with an emphasis on cruciferous veggies like broccoli florets dipped in humus, which have substantial antioxidant qualities and can help reverse disease. And, of course, skip putting candy in the stockings. No one needs more sugar, and I’m sure that, over the long night, it’s hard to resist sneaking a piece, yourself.
As for your loyal fans, you could place fitness videos under the tree. In fact, you and your elves could make workout videos for those of us who need them, and we could follow along as you showed us “12 Days of Workouts with Santa and Friends.” Who knows, you might become a modern version of Jane Fonda or Richard Simmons or even the next Shaun T!
How about giving athletic equipment, such as baseball gloves, footballs and basketballs, instead of video games? You could even give wearable devices that track step counts and bike routes or stuff gift certificates for dance lessons into people’s stockings. These might influence the recipients to be more active.
By doing all this, you might also have the kind of energy that will make it easier for you to steal a base or two in this season’s North Pole Athletic League’s Softball Team. The elves don’t even bother holding you on base anymore, do they?
As you become more active, you’ll find that you have more energy all year round, not just on Christmas Eve. If you start soon, Santa, maybe by next year, you’ll find yourself parking the sleigh farther away and skipping from chimney to chimney.
The benefits of a healthier Santa will ripple across the world. Think about something much closer to home, even your reindeer won’t have to work so hard. You might also fit extra presents in your sleigh. And Santa, you will be sending kids and adults the world over the right message about taking control of their health through nutrition and exercise. That’s the best gift you could give!
Wishing you good health in the new year,
David
P.S. I could really use some new baseballs, if you have a little extra room in your sleigh.
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.
٭We invite you to check out our new weekly Medical Compass MD Health Videos on Times Beacon Record News Media’s website, www.tbrnewsmedia.com.٭
At this time of year, I love to ask any Italian-Americans I know what they are cooking for Christmas Eve because so many of them celebrate it with a grand meal that includes seven or more different kinds of fish, a custom most sources attribute to the Roman Catholic tradition of the fasting vigil awaiting the midnight birth of Jesus.
What I enjoy about the answers I get is the incredible variety of fish courses that each family considers the absolutely inviolable menu. The only constant, as far as I can tell, is baccala, or salt-cured cod, and from there the meal proceeds on to a pasta, usually with some sort of seafood sauce, clams, shrimp, something fried and, in many extravagant cases, finally lobster.
If you think of Christmas Eve as a special night or occasion, if you like fish, if you like Italian food, then by all means use these recipes and others or get yourself invited to one of these hours long repasts that surely is not just one of the highlights of the holiday but also one of the best Italian-American culinary traditions.
Baccala (Dry Salted Cod)
YIELD: Makes 4 to 6 servings.
INGREDIENTS:
1 pound dry salted cod, cut into 3-inch pieces
1/3 cup olive oil
2 large onions, coarsely chopped
3 pounds potatoes, scrubbed and coarsely chopped
One 28-ounce can diced tomatoes with juice
2 tablespoons capers, rinsed and drained
1 tablespoon fresh oregano or 1 teaspoon dried
½ cup chopped fresh parsley
1 garlic clove, minced
1½ teaspoons hot red pepper flakes
DIRECTIONS:
Changing the water at least 6 times, soak the cod in a bowl or pan of cold water for 24 hours in a cool place. Taste a piece to determine if it is too salty. If it is, soak longer. In a large pot heat oil, add onions and cook, stirring occasionally, until soft and translucent. Add potatoes and stirring frequently, cook until golden brown. Add 3½ cups water to pan and bring to a boil; reduce heat, cover and cook 5 minutes. Uncover pot, add tomatoes, capers, oregano, parsley, garlic and pepper flakes; stir; gently lay cod on top, cover pan and carefully turning fish once midway through, simmer until it is cooked through, about 30 minutes. Serve hot, warm or at room temperature with garlic bread and black or green Italian olives.
Spaghetti with Anchovy Sauce
YIELD: Makes 4 to 6 servings.
INGREDIENTS:
1 pound spaghetti
½ cup extra virgin olive oil
4 garlic cloves, minced
4 to 6 salted or oil-packed anchovies, rinsed
½ teaspoon hot red pepper flakes
DIRECTIONS:
Cook spaghetti according to package directions, reserving ½ to 1 cup of pasta water. Meanwhile, in a small skillet combine oil and garlic and cook over low heat until garlic is softened but not browned. Add anchovies and with a fork, mash well; add pepper flakes, stir and cook 2 to 3 minutes. Set aside to keep warm, then toss with cooked spaghetti, adding some of the pasta water if too dry. Serve hot or warm with a well-chilled dry white wine and breadsticks.
Baked Stuffed Clams
Baked Stuffed Clams
YIELD: Makes 4 to 6 servings.
INGREDIENTS:
2 cups bread crumbs, seasoned with coarse salt and freshly ground black pepper to taste
1/3 cup extra virgin olive oil
2 garlic cloves, minced
½ cup chopped fresh Italian parsley
Freshly squeezed juice of one lemon
24 cherrystone or littleneck clams, scrubbed and opened, top shell discarded
2 cups clam juice
2 lemons cut into wedges
DIRECTIONS:
Preheat oven to 400 F. In a medium bowl combine bread crumbs with salt and pepper; then add oil, garlic, parsley and lemon juice. Place clams in nonreactive baking pan and carefully pack about two teaspoons of bread crumb mixture on top of each one, Being careful not to wash away bread crumbs, pour clam juice around clams. Bake 15 to 20 minutes, until bread crumb mixture starts to brown. Remove from oven, drizzle a little of cooking liquid over them and serve hot with lemon wedges and prosecco.
As we marinate in the warmth of the holidays, we have a chance to spend time with friends and family.
We’ve chosen most of our friends ourselves. OK, maybe that’s not exactly true, as we inherit friends from our parents when we’re young: “Oh, why don’t you play with Timmy, who is the son of my best friend whom I met when I was your age”; and from our children when we’re older: “Hey, dad, can you hang out with Allisa’s parents while we wander through Great Adventure theme park.”
Despite the somewhat limited pool of people from which to choose our friends, we often pick those people who share similar values, a sense of humor or a tolerance for politicians.
We don’t have the same luxury with our families. We have nutty family members who say and do all kinds of things that make us cringe, that cause us to laugh long after the events are over or who simply make us scratch our heads.
We often think it’s the other family members who are the oddballs but, in truth, we’re all pretty strange.
Long before people voted each other off shows or islands in situations that seemed completely contrived in reality TV shows, family members confronted the awkward moments when they saw each other, year after year, at holidays, birthdays, special occasions and, perhaps, uncomfortable or less-than-ideal moments.
Families provide us with opportunities to test ourselves and our theories without worrying about losing a job, losing a friend or losing our minds. We can challenge ourselves and our families with ideas percolating in our heads, but that may not be exactly what we believe.
Our families receive the best and the worst of our impulses, as we step forward to help each other, but also encourage independent growth and development.
As older members of families, we hope to lead not only by our words but by our examples. Failing that, however, we hope that our spouses, children, parents and siblings can see us for the range of our contributions to the family, and not just for that ignominious moment that we’d just as soon forget.
Families offer reality checks on the myths we create for ourselves. “No, Dan, you didn’t win that horseback-riding ribbon because you had such a great ride. You fell off the horse and the judges felt sorry for you when you landed in horse manure. Good try, though.”
These moments when families hold up mirrors to us can help ground us, keeping us from becoming too proud or mighty. On the other side, however, when we’re feeling down, families can serve as the perfect counterweight, suggesting that we have succeeded in more difficult circumstances and that they are certain of a positive outcome, even if we harbor significant doubts.
Movies about families often run the gamut of emotions, from slapstick, to comical, to serious and even bruising, as rivalries that run amok can become the origin of dysfunction even when we step away from these familial contacts.
Certainly, therapists often start and end with the family dynamic, drawing an understanding of habits we may not know we have until we look back at the lives and roles that brought us to this point.
At their best, families can inspire and encourage, while suggesting that we can and should believe in ourselves while we pursue our goals. Ultimately, families who demonstrate unconditional love and support, even if they do laugh at us periodically, set the kind of example that makes the accomplishments of the next generation possible. Here’s to everything we give, get and laugh about from the people we call family.
TBR News Media held a free screening of its first feature film, 'One Life to Give,' at the Staller Center for the Arts at Stony Brook University in June. Photo by Heidi Sutton
Leah Dunaief
By Leah Dunaief
The end of the year has snuck up on us. Have you noticed that the pace of the passing years seems to have accelerated? This is our last regular issue for 2018, and it seems fitting to take a bird’s-eye look at where we’ve been and what lies ahead.
Most immediately coming are the next two issues of special note, that of Dec. 27 and Jan. 3. The first is People of the Year, and we call it our only all-good-news issue. This is the 43rd year we are honoring outstanding residents for going that extra mile and thereby helping to make our hometowns the special places they are. In doing so, they quietly elevate the quality of our lives.
We solicit nominations for this issue from you, our readers, community leaders and neighbors. The editorial board meets with focus groups in the last quarter of the year over breakfast or lunch to discuss nominees and to further inform us of what is happening here, sometimes quietly, sometimes not so much. It is a treat for us to interact with the community on such a pleasant mission. We also get suggestions via emails, texts, phone calls and even an occasional petition; our Facebook, Instagram and Twitter accounts are available, too.
We then take those names back to our conference room and amid lively discussions, select those whose stories we print in the People of the Year issue. Sometimes the ones that don’t fit become feature stories we run in the new year. I have been told that there are collectors who have all 43 issues. What a shelf life!
The second, the Year in Review, is new this year and is done in pictures in a kind of Life magazine treatment. It is on special white stock to help enhance the photo reproduction and is in full color. Life magazine — for whom I worked when in my early 20s and is no more — eat your heart out! A chronology of the way we were, we suspect that it, too, will have a long shelf life.
Some special offerings of this past year certainly should include our first full-length movie, “One Life to Give,” which was screened in June at the Staller Center for the Arts at Stony Brook University to a full house of more than 1,000 viewers. The story follows the early years of the Revolutionary War, specifically through the lives of Nathan Hale and Benjamin Tallmadge, and the start of Washington’s Culper Spy Ring that was headquartered in Setauket.
I am pleased to be able to tell you that we have filmed a sequel, called “Traitor,” that takes place four years later. It is now 1780, and with great luck the Patriots have captured British spymaster, John André. Again Tallmadge is central to the plot that reveals the discovery of Benedict Arnold’s betrayal and the ultimate fate of André. It will be screened in the spring and you will all be invited.
Another first for us this past year was the Cooks, Books & Corks event at the Bates House off Main Street in Setauket. Many local authors came with their books for sale, and many local restaurants came with their specialties for tasting on a sweet summer evening. There was wine and unending good food for both the body and the mind. Our engaging headline speakers were Guy Reuge from Mirabelle Restaurant, internationally famous naturalist Carl Safina and the inspirational dean of the School of Journalism at SBU, Howard Schneider. The event raised money to fund a journalism intern next summer. In answer to the many times we have been asked, yes, we are planning to do it again.
A new print offering this past year was the sleek Washington’s Spy Trail booklet. In 1790, Washington took a slow, ceremonial coach trip along what is now 25A, from Great Neck to Port Jefferson, to honor the Setauket spies who had contributed so much to the victory of the colonists. The booklet marks the route, which this year sports road signs, with information about various points of interest along the way. We will again be publishing the story with updates.
I am running out of space, but there was a lot more that we innovated this past year with much more to come in 2019. Meanwhile thank you for your participation. We could not do any of this without you.
Studies show that walking a modest distance can reduce triglyceride levels. Stock photo
Reducing carbohydrates may be more important than restricting calories
By David Dunaief, M.D.
Dr. David Dunaief
Triglycerides are part of the lipid, or cholesterol, profile. They get less attention than the other substances, HDL (“good”) and LDL (“bad”) cholesterol, but they’re no less significant.
For 30 years, we have debated whether a high triglyceride level is a biomarker for cardiovascular disease — heart disease and stroke — or an independent risk in its own right (1, 2). Either way, triglycerides are important.
What are they? The most rudimentary explanation is that they are a kind of fat in the blood. They are composed of sugar alcohol and three fatty acids. Thus, it’s no surprise that alcohol, sugars and excess calorie consumption may be converted into triglycerides.
Risk factors for high triglycerides include obesity, smoking, a high carbohydrate diet, uncontrolled diabetes, hypothyroidism (underactive thyroid), cirrhosis (liver disease), excessive alcohol consumption and some medications (3).
What levels are normal? Optimal levels are <100 mg/dL; however, less than 150 mg/dL is considered within normal range. Borderline triglycerides are 150–199 mg/dL, high levels are 200–499 mg/dL, and very high are >500 mg/dL (3).
While medicines that focus on triglycerides, fibrates and niacin can lower them significantly, this reduction may not result in clinical benefits, such as reducing the risk of cardiovascular events. The ACCORD Study, a randomized controlled trial, questioned the effectiveness of medication; when these therapies were added to statins in type 2 diabetes patients, they did not further reduce the risk of cardiovascular disease and events (4). Instead, it seems that lifestyle modifications may be the best way to control triglyceride levels. Let’s look at the evidence.
Exercise — timing and intensity
If you need a reason to exercise, here is a really good one. Study results showed that walking a modest distance with alacrity and light weight training approximately an hour after eating (postprandial) reduced triglyceride levels by 72 percent (5). However, if patients did the same workout prior to eating, postprandial triglycerides were reduced by 25 percent. This is still good, but not as impressive.
Participants walked a modest distance of just over 1 mile (2 kilometers). This was a small pilot study of 10 young healthy adults for a very short duration. The results are intriguing, nonetheless, since there are few data that give specifics on the optimal amount and timing of exercise.
Exercise trumps calorie restriction
There is good news for those who want to lower triglycerides: Calorie restriction may not be the best answer. Instead, we probably should be looking at exercise and carbohydrate intake.
In a well-controlled trial, results showed that those who walked and maintained 60 percent of their maximum heart rate, which is a modest level, showed an almost one-third reduction in triglycerides compared to the control group (maintain caloric intake and no exercise expenditure) (6). Those who restricted their calorie intake saw no difference compared to the control. This was a small study of 11 young adult women. Thus, calorie restriction was trumped by exercise.
Carbohydrate reduction, not calorie restriction
In addition, when calorie restriction was compared to carbohydrate reduction, results showed that carbohydrate reduction was more effective at lowering triglycerides (7). In this small, but well-designed study, patients with nonalcoholic fatty liver disease were randomized to one of two diets, lower calorie (1200–1500 kcal/day) or lower carbohydrate (20 g/day). Both groups lost similar amounts of weight and significantly reduced triglycerides, but the lower carbohydrate group reduced triglycerides by 55 percent versus 28 percent for the lower calorie group. The reason for this difference may have to do with oxidation in the liver and the body as a whole. However, the weakness of this study was its duration of only two weeks.
Fasting versus nonfasting blood tests
The paradigm has been that, when cholesterol levels are drawn, fasting levels provide a more accurate reading. Except this may not be true.
NHANES III data suggest that nonfasting and fasting levels yield similar results related to all-cause mortality and cardiovascular mortality risk. LDL levels were similarly predictive, regardless of whether a patient had fasted or not. The researchers used 4,299 pairs of fasting and nonfasting cholesterol levels. The duration of follow-up was strong, with a mean of 14 years (8).
With regards to stroke risk assessment, nonfasting triglycerides may be more valuable than fasting. In a study involving 13,596 participants, results showed that as nonfasting triglycerides rose, the risk of stroke also rose significantly (9). Compared to those who had levels below 89 mg/dL (the control), those with 89–176 mg/dL had a 1.3-fold increased risk of cardiovascular events, whereas those within the range of 177–265 mg/dL had a twofold increase, and women in the highest group (>443 mg/dL) had an almost fourfold increase. The results were similar for men, with a threefold increase.
The benefit of nonfasting is that it is more realistic and, according to the authors, also involves remnants of VLDL and chylomicrons, other components of the cholesterol profile that interact with triglycerides and may affect the inner part (endothelium) of the arteries.
What have we learned? Triglycerides need to be discussed. Elevated triglycerides may result in heart disease or stroke. The higher the levels, the more likely there will be increased risk of mortality — both all-cause and cardiovascular. Therefore, we ideally should reduce levels to less than 100 mg/dL.
Lifestyle modifications using carbohydrate restriction and modest levels of exercise after a meal may achieve the best results, though the studies are small and need more research. Nonfasting levels may be as important as fasting levels when it comes to triglycerides and the cholesterol profile as a whole; they potentially give a more realistic view of cardiovascular risk, since we don’t live in a vacuum and fast all day.
References:
(1) Circulation. 2011;123:2292-2333. (2) N Engl J Med. 1980;302:1383–1389. (3) nlm.nih.gov. (4) N Engl J Med. 2010;362:1563-1574. (5) Med Sci Sports Exerc. 2013;45(2):245-252. (6) Med Sci Sports Exerc. 2013;45(3):455-461. (7) Am J Clin Nutr. 2011;93(5):1048-1052. (8) Circulation Online. 2014 July 11. (9) JAMA 2008;300:2142-2152.
Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management.
٭We invite you to check out our new weekly Medical Compass MD Health Videos on Times Beacon Record News Media’s website, www.tbrnewsmedia.com
New name honors long-standing support fromRenaissance Technologies families
By Kenneth Kaushansky, M.D.
Dr. Kenneth Kaushansky
There’s an old adage that things get better with age: The relationship between Stony Brook University and the families of Renaissance Technologies is certainly proof of that, having maintained a close connection for more than 35 years.
Throughout the years, 111 families at Renaissance Technologies have donated more than $500 million to the university. Now in recognition of their contributions and generosity, Dr. Samuel L. Stanley Jr., Stony Brook University president, recently announced that Stony Brook University School of Medicine will now be known as the Renaissance School of Medicine at Stony Brook University. This new name was recently voted on and approved by the board of trustees of the State University of New York.
The relationship began in 1982 when Jim Simons, the former chair of the Department of Mathematics at Stony Brook University, made a $750 unrestricted gift to the university’s annual fund, becoming the first at Renaissance Technologies to contribute to the Long Island institution.
Since that time, current and former employees of Renaissance Technologies and their families have donated more than $500 million to date in support of Stony Brook’s students, faculty and primarily research in life sciences and medicine. This significant investment has improved the quality of medical education at Stony Brook, creating 34 endowed faculty chairs and professorships, nine innovative academic and research centers and $35 million for student scholarships and fellowships.
Gifts have supported areas where the personal interests of the Renaissance families intersect with the strategic investment needs of the university, such as Stony Brook Children’s Hospital, basic science research, imaging, health care for those who are underserved, cancer research, medicine and the Staller Center for the Arts.
This incredible engagement by Renaissance employees and their 111 donor families — very few of whom attended our university — has created a true “renaissance” at Stony Brook.
As dean of the School of Medicine, I’m so proud that our school will carry their name in recognition of the excellence they’ve helped create at Stony Brook. During the Campaign for Stony Brook alone, more than 72 Renaissance Technologies employees and their families donated $166.5 million that directly benefited Stony Brook Medicine and the School of Medicine and a total of over $400 million to the university as a whole.
The Renaissance School of Medicine is the top-ranked public medical school in New York State and ranks 57th in the nation, according to U.S. News and World Report.
A member of the Association of American Medical Colleges (AAMC) and a Liaison Committee on Medical Education (LCME)-accredited medical school, the Renaissance School of Medicine was established in 1971. With 25 academic departments, it trains over 500 medical students and more than 750 medical residents and fellows annually.
The investments in medicine and throughout Stony Brook by Renaissance families have transformed the university and the communities it serves by deploying the most inventive new solutions to the most important issues of our time.
And as the years go on, things will only get better as their contributions ensure continued access to groundbreaking medical treatments and leading-edge, innovative medical care for the residents of Suffolk County and beyond.
Kenneth Kaushansky, M.D., is the senior vice president of Health Sciences and dean of Renaissance School of Medicine at Stony Brook University.
Danny Bluestein and Wei-Che Chiu, a Stony Brook biomedical engineering
doctoral student, with ventricular assist devices. Photo from SBU
By Daniel Dunaief
Some day, a doctor may save your life, repairing a calcified heart valve that jeopardizes your health. But then, the doctor may owe his or her latest lifesaving procedure to the work of people like Danny Bluestein, a professor in biomedical engineering and the director of the Biofluids Laboratory at Stony Brook University, and an international team of colleagues.
The group is working on restoring blood flow from the heart to the body using approaches for patients for whom open heart surgery is not an option.
Recently, the National Institutes of Health awarded the research crew a five-year $3.8 million grant to work on a broad project to understand ways to improve transcatheter aortic valve replacements, or TAVR, while reducing or minimizing complications from the procedure.
Danny Bluestein with his wife, Rita Goldstein. Photo from D. Bluestein
The grant is “not just about developing a new device, which we’ve been developing already for several years, but it’s also developing it in such a way that it answers challenges with disease and what clinical problems current technology offers solutions for,” Bluestein said.
TAVR provides a prosthetic valve for high-risk surgery patients. Like stents, TAVR is inserted through an artery, typically near the groin, and is delivered to the heart, where it improves the efficiency of an organ compromised by calcification on a valve and on the aorta itself.
Patients who have been candidates for TAVR are usually over 70 and often struggle to walk, as their hearts are enlarged and lose flexibility.
TAVR surgeries are performed in as many as 40 percent of such operations in some parts of Europe and the United States. The numbers have been increasing in the last couple of years as the technology has improved in different iterations of TAVR.
These valves are not only helping high-risk patients, but they are also assisting moderate and lower risk candidates.
Doctors have used TAVR for off-label uses, such as for people who have congenital difficulties with their valves, and for people who have already had open heart surgeries whose replacement valves are failing and who may be at risk for a second major heart operation.
Recovery from TAVR is far easier and less complicated than it is for cardiac surgery, typically requiring fewer days in the hospital.
Indeed, numerous researchers and cardiologists anticipate that this percentage could climb in the next several years, particularly if the risks continue to decline.
The team involved in this research effort is working with a polymer, hoping to reduce complications with TAVR and develop a way to tailor the valve for specific patients.
“If you’re a polymer person like me, you know we can make this work,” said Marvin Slepian, the director of the Arizona Center for Accelerated BioMedical Innovation at the University of Arizona. Slepian is pleased to continue a long collaboration with Bluestein, whose expertise in fluids creates a “unique approach to making something happen.”
The tandem is working with Rami Haj-Ali, the Nathan Cummings Chair in Mechanics in the Faculty of Engineering at Tel-Aviv University in Ramat Aviv, Israel. “To enable this technology, we need to better understand the current” conditions, said Haj-Ali, who uses computer methods to study the calcium deposited on the valve to understand the stages of the disease.
The valve Bluestein is proposing includes “new designs, new simulations, and new materials” that can create “less reactions with patients and overcome” problems TAVR patients sometimes face, Haj-Ali explained.
One of the significant challenges with TAVR is that it typically only lasts about five to six years.
“The idea of the NIH and this project is to extend the built-in efficiency of such a procedure,” Bluestein said. “TAVR is moving very fast to extend its functionality and durability.”
When the valve is inserted into the body, it is folded to allow it to fit through the circulatory system. This folding, however, can damage the valve, making it fail faster than in the surgical procedure.
As a part of this research, Bluestein and his team will explore ways to change the geometry of the TAVR according to the needs of the patient, which will enhance its functionality for longer. Bluestein and others will test these changing shapes through models constructed on high-performance computers, which can test the effect of blood flowing through shapes with specific physical passageways.
“Eventually, the future would involve custom designed valves, which would be optimal for the specific patient and will extend the lifespan of such a device,” Bluestein said.
A current off-label use of the TAVR valve involves assisting people born with an aortic valve that has two leaflets. Most aortic valves have a third leaflet. People with bicuspid aortic valves develop symptoms similar to those with calcification.
Going forward, Bluestein and his team plan to design valves that are specific for these patients.
A small percentage of patients with TAVR also require pacemakers. The device can interact with the electrophysiology of the heart and impair its rhythm because it creates pressure on the tissue. It is likely pushing against special nodes that generate the heart rhythm.
These studies include exploring the mechanical stress threshold that requires implantation of a pacemaker. By moving the device to a slightly different location, it may not interfere with the heart rhythm.
A resident of Melville and Manhattan, Bluestein is married to Rita Goldstein, who is a professor of psychiatry and neuroscience at the Icahn School of Medicine at Mount Sinai.
Bluestein was raised in Israel, where he did his doctoral work. He became intrigued by the study of the flow of blood around and through the heart because he was interested in blood as a living tissue.
As for the ongoing work, Haj-Ali is optimistic about the group’s prospects. The scientists that are a part of this effort “bring something to the table that, in combination, doesn’t exist” elsewhere, he said.
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