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If you’re missing out on shut-eye, your body will soon show the signs. Stock photo
Getting enough sleep helps clear brain clutter

By David Dunaief, M.D.

Dr. David Dunaief

The brain is the most complex organ, yet what we know about the brain is inverse to its importance.

We do know that certain drugs, head injuries and lifestyle choices negatively impact the brain. There are also numerous disorders and diseases that affect the brain, including neurological (dementia, Parkinson’s, stroke), infectious (meningitis), rheumatologic (lupus and rheumatoid arthritis), cancer (primary and secondary tumors), psychiatric mood disorders (depression, anxiety, schizophrenia), diabetes and heart disease.

These varied diseases tend to have three signs and symptoms in common: They either cause altered mental status, physical weakness or change in mood — or a combination of these.

Probably our greatest fear regarding the brain is cognitive decline. Dementia, whether mild or full-blown Alzheimer’s, is cruel; it robs us of functioning.

Fortunately, there are several studies that show we may be able to prevent cognitive decline by altering modifiable risk factors. They involve rather simple lifestyle changes: sleep, exercise and possibly omega-3s. Let’s look at the evidence.

The impact of clutter

The lack of control over our mental capabilities as we age is what frightens us most. Those who are in their 20s seem to be much sharper and quicker. But are they really?

In a study, German researchers found that educated older people tend to have a larger mental database of words and phrases to pull from since they have been around longer and have more experience (1). When this is factored into the equation, the difference in terms of age-related cognitive decline becomes negligible.

This study involved data mining and creating simulations. It showed that mental slowing may be at least partially related to the amount of clutter or data that we accumulate over the years. The more you know, the harder it becomes to come up with a simple answer to something. We may need a reboot just like a computer. This may be possible through sleep, exercise and omega-3s.

The importance of sleep

Why should we dedicate 33 percent of our lives to sleep? There are several good reasons. One involves clearing the mind, and another involves improving our economic outlook.

For the former, a study shows that sleep may help the brain remove waste, such as those all-too-dangerous beta-amyloid plaques (2). When we have excessive plaque buildup in the brain, it may be a sign of Alzheimer’s. This study was done in mice. When mice were sleeping, the interstitial space (the space between brain gyri, or structures) increased by as much as 60 percent.

This allowed the lymphatic system, with its cerebrospinal fluid, to clear out plaques, toxins and other waste that had developed during waking hours. With the enlargement of the interstitial space during sleep, waste removal was quicker and more thorough, because cerebrospinal fluid could reach much farther into the spaces. A similar effect was seen when the mice were anesthetized.

In another study, done in Australia, results showed that sleep deprivation may have been responsible for an almost 1 percent decline in gross domestic product for the country (3). The reason is obvious: People are not as productive at work when they don’t get enough sleep. They tend to be more irritable, and concentration may be affected. We may be able to turn on and off sleepiness on short-term basis, depending on the environment, but we can’t do this continually.

According to the Centers for Disease Control and Prevention, 4 percent of Americans report having fallen asleep in the past month behind the wheel of a car (4). I hope this hammers home the importance of sleep.

Time to exercise

How can I exercise, when I can’t even get enough sleep? Well there is a study that just may inspire you to exercise.

In the study, which involved rats, those that were not allowed to exercise were found to have rewired neurons in the area of their medulla, the part of the brain involved in breathing and other involuntary activities. There was more sympathetic (excitatory) stimulus that could lead to increased risk of heart disease (5). In rats allowed to exercise regularly, there was no unusual wiring, and sympathetic stimuli remained constant. This may imply that being sedentary has negative effects on both the brain and the heart.

This is intriguing since we used to think that our brain’s plasticity, or ability to grow and connect neurons, was finite and stopped after adolescence. This study’s implication is that a lack of exercise causes unwanted new connections. Of course, these results were done in rats and need to be studied in humans before we can make any definitive suggestions.

Omega-3 fatty acids

In the Women’s Health Initiative Memory Study of Magnetic Resonance Imaging Study, results showed that those postmenopausal women who were in the highest quartile of omega-3 fatty acids had significantly greater brain volume and hippocampal volume than those in the lowest quartile (6). The hippocampus is involved in memory and cognitive function.

Specifically, the researchers looked at the levels of eicosapentaenoic acid and docosahexaenoic acid in red blood cell membranes. The source of the omega-3 fatty acids could either have been from fish or supplementation. The researchers suggest eating fish high in these substances, such as salmon and sardines, since it may not even be the omega-3s that are playing a role but some other substances in the fish.

It’s never too late to improve brain function. You can still be sharp at a ripe old age. Although we have a lot to learn about the functioning of the brain, we know that there are relatively simple ways we can positively influence it.

References:

(1) Top Cogn Sci. 2014 Jan.;6:5-42. (2) Science. 2013 Oct. 18;342:373-377. (3) Sleep. 2006 Mar.;29:299-305. (4) cdc.gov. (5) J Comp Neurol. 2014 Feb. 15;522:499-513. (6) Neurology. 2014;82:435-442.

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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Duck Breasts with Orange Sauce

By Barbara Beltrami

Like any holiday, Hanukkah deserves a special dinner, something beyond the ordinary but not too far away from the traditional. Along with the potato latkes and doughnuts, the spinning of the dreidel and the Hanukkah gelt for the kids, there is that moment when families and friends gather to celebrate and share their holiday joy around the table. Of course, there’s nothing wrong with a nice roasted chicken or a pot roast or hearty winter stew that everybody loves. But how about changing it up a little and doing a duck breast or sweet and sour brisket or Hungarian goulash? 

Duck Breasts with Orange Sauce

Duck Breasts with Orange Sauce

YIELD: Makes 4 servings

INGREDIENTS:

4 approximately half-pound duck breasts

2 tablespoons freshly grated orange zest

¾ cup orange juice

¼ cup honey

¼ cup soy sauce

Freshly ground pepper, to taste

Fresh orange slices for garnish

DIRECTIONS:

Score fatty side of each duck breast in a cross-hatch pattern of approximately 1-inch squares. In a large resealable plastic bag combine zest, juice, honey, soy sauce and pepper. Add duck, turn to coat evenly, and reseal bag. Refrigerate at least 4 hours, preferably 8 or overnight. Remove breasts from bag; set marinade aside. Place duck in a large heavy skillet; do not preheat. Frequently moving pieces around, cook over low heat, skin side down, and turning once, until fat is rendered and skin is golden brown, about 15 minutes. Cover and continue cooking until thermometer inserted in thickest part reads 120 F for medium rare (about 3 to 5 minutes), longer for more well done. 

Transfer to a cutting board, tent with aluminum foil and let rest for 10 minutes. Meanwhile, pour fat from skillet and discard or save for later use; replace with marinade; simmer until liquid is thick and syrupy, 5 to 10 minutes. Place duck on platter, spoon sauce over it and garnish with orange slices. Serve with wild rice, Brussels sprouts and a good red wine.

Sweet and Sour Brisket

YIELD: Makes 6 servings

INGREDIENTS:

2½ pounds beef brisket

1 onion sliced thin

Freshly squeezed juice of one lemon

1 bay leaf

2 to 3 tablespoons sugar

2/3 cup very hot water

Salt and freshly ground pepper, to taste

3 to 6 gingersnaps (optional)

DIRECTIONS:

Place meat in heavy pot or Dutch oven; add remaining ingredients, except gingersnaps. Cover and simmer 2½ to 3 hours, until tender. Taste and add more sugar or lemon juice as needed to balance the sweet and sour. If using, break up gingersnaps and stir into liquid from roast to thicken it a little. Slice and serve with sweet potatoes, green beans and carrots.

Hungarian Goulash

YIELD: Makes 6 to 8 servings

INGREDIENTS:

3 pounds chuck, cut into 1½-inch cubes

2 tablespoons melted vegetable shortening or oil

6 cups beef stock

2 garlic cloves

1 bay leaf

Salt, to taste

1 tablespoon paprika

DIRECTIONS:

Stirring constantly, brown meat in hot fat. Add stock, garlic, bay leaf, salt and paprika. Simmer slowly, 2½ hours; remove bay leaf and discard. Serve with broad noodles or mashed potatoes, cabbage or cauliflower and pickled beets.

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Stock photo

By Bob Lipinski

‘I only drink Champagne when in love and when not.’

— Christian Pol Roger

Bob Lipinski

Pol Roger founded the Champagne Pol Roger house in 1849, in Epernay, France. In the ensuing years, Pol Roger has created a name and reputation as one of finest Champagnes in the world. Perhaps the biggest lover of Pol Roger was Sir Winston Churchill, prime minister of the United Kingdom.

In 1945, in celebration of the liberation of France, Churchill was served Pol Roger 1928 at his residence in Paris. According to his son Randolph, Winston was so enamored by the Champagne he bought up all the 1928 and 1934 Pol Roger that was remaining.

Every year for his birthday, in tribute to the great friendship between the Pol Roger family and Winston Churchill, he would receive a case of Pol Roger until his death in 1965. The labels of the Champagne sent to England after his death were bordered in black.

To pay permanent tribute to the great statesman, Pol Roger introduced Cuvée Sir Winston Champagne. The first vintage of Cuvée Sir Winston was 1975, released in 1984. The precise blend of Sir Winston is a family secret and is produced only in the finest vintages.

The following are my tasting notes from a press event:

Pol Roger Brut Reserve NV “White Foil”: Blend of pinot noir, meunier, and chardonnay grapes. Pale golden color with a fruity bouquet of green apples and pears. Medium bodied with delicate bubbles and hints of grass and citrus.

Pol Roger “Blanc de Blancs” 2009: 100 percent chardonnay. Pale straw colored with a delicate bouquet and flavor of apples, brioche, chamomile, citrus and ginger. Superbly balanced with a very long lingering aftertaste.

Pol Roger Brut 2008: Blend of pinot noir and chardonnay. Light yellow colored with a full bouquet of Granny Smith apples, citrus, pears and tangerine. Medium bodied and full of flavor. A smooth finish and pleasing, long aftertaste.

Pol Roger Brut Rosé 2009: Blend of pinot noir and chardonnay. Salmon colored with a bouquet bursting of raspberries, wild cherries, pomegranate and oranges. The wine is dry, yet a fruity flavor persists to the end.

Pol Roger “Cuvée Prestige Sir Winston Churchill” 2006: The wine is aged for an average of 10 years before release. An elegant and well-developed bouquet of toasted brioche, jasmine, citrus, toast, pears and anise. Superbly balanced with a velvety texture and lingering flavors of spices, almonds and anise. An excellent Champagne with which to celebrate the holidays.

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

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A bypass trust was designed to prevent the estate of the surviving spouse from having to pay estate tax. Stock photo

By Nancy Burner, Esq.

Nancy Burner, Esq.

For a traditional married couple, the estate planning has become simpler in many ways. Before the estate tax was increased on both the state and federal level, we were fixated on saving estate taxes. Simple techniques like bypass and marital trusts and insurance trusts called ILITs were the gold standard in estate planning. Today many of those types of plans are irrelevant and maybe even harmful in an estate plan.

Bypass trusts are trusts created in the estate of the first spouse to die. So, for example, if a husband died when the exemption was $1.0, his will left $1.0 million in his bypass trust to protect his exemption (the amount he could pass to a nonspouse tax free) and then the balance would be distributed to his surviving spouse tax free. The idea was that when the second spouse died, she would have her own exemption and the monies in the bypass trust would pass tax free to the next generation.

If the exemption was $1.0 (or more) when the survivor died, then both the bypass trust amount and the exemption amount when the second spouse died would escape estate taxation. This is the most common type of estate plan that was utilized in the last 25 years and many clients still have these documents in place. In instances where the first spouse has died, there still exists a bypass trust for the benefit of the surviving spouse. For those couples with these types of estate plan but with assets under $5.25 million, it’s not too late to change them.

But, what if one spouse has died and the surviving spouse is still alive with assets in a bypass trust. Is there more planning to be done?   

Assume a couple in 2000 with $1.8 million worth of assets. Husband died and $1.0 million was payable to the bypass trust under his will for the benefit of his wife. According to the terms of the trust: (1) she can have all the income, (2) she is entitled to distributions for her health, education and support, and (3) a trustee can distribution all the trust assets to her for any purpose, even if the trust is depleted. The purpose of this trust was clearly to shield the first million of the estate from estate taxes when the surviving spouse later died but gave the trustee the power to make unlimited distributions to the spouse.

Now also assume the wife has, in the intervening years, protected her own $800,000 from the cost of long-term care by placing those assets into an irrevocable trust. In the meantime, the bypass trust has grown to $1.6 million dollars. There are two glaring problems: Capital gains tax and cost of long-term care.

When the surviving spouse dies, the assets in her irrevocable trust will be counted as part of her taxable estate. If she dies this year, she will have a New York state estate tax exemption of $5.25 million (increasing to $5.49 million in 2019) and her federal exemption is $11.18 million. Clearly, she does not have a taxable estate. Her assets will pass tax free to the next generation. However, the assets in the bypass trust will have a capital gains tax for any growth in principal.

Assuming the capital gain of $600,000 and a capital gain rate of 33 percent, there could be a capital gains tax of just under $200,000. If the bypass trust assets were not in the trust, but in the surviving spouse’s estate, there would be no estate tax and no capital gains tax. In this case, assuming no other facts, it would be best to distribute the assets to the surviving spouse and allow the assets to obtain a “step-up in basis at her death.”

The second problem with the bypass trust is that the broad distribution rights under the trust makes those trust assets available to pay for the spouse’s long-term care. She has protected her own assets, but likely the $1.6 million is available to be spent down. In this case, if the trustee were to distribute the trust assets to the surviving spouse, she could add those assets to her irrevocable grantor trust. She would enjoy the income in the trust, her estate (i.e., her heirs) would get a step-up in basis on her death, and the assets could be shielded for the cost of nursing home care or catastrophic illness after five years.

This same scenario applies in the case of insurance trusts that were created during the life of the first spouse to die. The trust was likely intended to shield the surviving spouse’s estate from estate taxes, but the increased exemptions make the insurance trust unnecessary. There is an income tax return due each year that is a burden in both time and money. There is no step-up in basis at the death of the surviving spouse, and the assets are probably not protected from the cost of long-term care.

While the trusts in this example give the trustee wide latitude in distributing trust assets to spouses, not all trusts are the same. If the trustee does not have the power to distribute outright to the spouse, there may be an alternative way to accomplish these objectives. New York state has a very generous decanting statute that may be utilized to “fix” the trust. It may not be too late.

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

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A common grackle collects mud from the banks of the Swan River in East Patchogue to use to build its nest. Photo by Luke Ormand

By John Turner

As the famous philosopher Yogi Berra once said, “You can observe a lot by just watching,” and between the passage of the 2,018 common nighthawks we tallied over the 41 days of the 2018 season at the Stone Bridge Nighthawk Watch, we had plenty of time to watch and observe.

One of those observations involved the daily movement of large mixed-blackbird flocks, flying north each evening, their destination being the communal nightly roost they established in the reed (Phragmites) beds at the southern edge of Conscience Bay, just north of the Grist Mill in Frank Melville Memorial Park in Setauket.

Joined by European starlings, red-winged blackbirds and brown-headed cowbirds, the flocks, numerically dominated by common grackles, would stream over us at the Stone Bridge and then, as they passed over the northern bridge at the northern end of the pond, descend abruptly to land on the narrow and slightly arching stalks of the Phragmites.

Their predictable movement each night of the Nighthawk Watch reminded me of another characterization, this one by the famous scientist Rachel Carson, who described the regular movement of birds such as these blackbird flocks as “faithful commuters” in the sky.

As they flew over us, the members of the flock vocalized continuously with quick sharp calls and we wondered why they might do that. One answer for the continuous calling may be a way for a bird in a flock to let neighboring birds — in front, behind and to the sides — know of its presence, helping to maintain a buffer between the birds, thereby reducing the chance of collisions.

Maintaining this space is vital given the fact the several dozen to several hundred members of the blackbird flock are moving through the sky together, at 20-30 miles per hour, separated by mere inches. Makes you wish drivers on the Long Island Expressway were so talented, no?

One evening recently my wife Georgia and I walked to the north bridge to watch the blackbirds spill from the sky into the reeds. They descended into the marsh on both sides of the meandering tidal creek that flows from the spillway at the bridge. A constant cacophony of squeaks (one call sounds like a rusty gate opening), rasps and whistles filled the air as the birds called incessantly. Having landed, the grackles and other blackbird species must now be vocalizing for a different reason, but frankly we have no idea.

Scientists conjecture that crows murmuring together at the end of a day in a winter communal roost do so to exchange information about the day they just experienced, such as what predators they encountered and food sources discovered. Could this be at least a partial answer to explain the thousands of garrulous grackles vocalizing into early evening, as they settle in to sleep for the night in the marshes of Frank Melville Park? Could there be other reasons? Maybe, but we just don’t know.

I often encounter grackles in different settings, as evidenced by a recent walk in the county park just north of the Sherwood-Jayne House. Heading up the west side of the property, I came to an opening in the forest where a small flock of 20 to 25 grackles was feeding on the ground. They systematically flipped over leaves, pieces of bark and other woodland debris searching with their beautiful golden-yellow, black-centered eye, for food which for them consists of a variety of small insects, other invertebrates like slugs and worms, caterpillars, small salamanders and fruits and seeds, which collectively make up their omnivorous lifestyle.    

If you are an astute observer of grackles you might notice that adult birds vary in their coloration. Not surprisingly, males are showier than the females, their plumage infused with a purplish iridescence. But you might occasionally see, especially during the colder months, individual grackles tending to have more of a bronzy-colored tint to their feathers, rather than purple. The latter bird is referred to as the “bronzed grackle” while the former is the “purple grackle.” For many years they were considered different species but are now recognized for what they are — interbreeding color morphs of the same species.   

If you leave the friendly confines of the Three Village area and travel to the Island’s South Shore, you might encounter another grackle species native to Long Island — the boat-tailed grackle. This larger species, a breeder amid the salt marshes of the South Shore bays, gets its name from the keel shape tail tip of the bird, quite visible when a male flies directly away from you.

Want to experience grackles and their blackbird brethren closer to home though? Just head to the bridge next to the Grist Mill in Frank Melville Park (www.frankmelvillepark.org) as dusk descends on an autumn day and face north toward the dense phalanx of reeds. If your senses aren’t overloaded by the sound and movement, perhaps you can figure out what the birds are saying to each other.

John Turner, a Setauket resident, 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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The decision to take a statin is an important one. Stock photo
Fatigue and cataracts are downsides

By David Dunaief, M.D.

Dr. David Dunaief

Statins are one of the most commonly prescribed medications in the United States. Yet, some in the medical community believe that more patients should be on this class of drugs while others think it is one of the most overprescribed medications. Suffice to say, this is one of the most polarizing topics in medicine — probably rightfully so.

The debate is over primary prevention with statins. Primary prevention is treating people with high cholesterol and/or inflammation who may be at risk for a cardiovascular event, such as a stroke or heart attack.

Fortunately, most physicians would agree that statins have their place in secondary prevention — treating patients who have had a stroke or heart attack already or have coronary artery disease.

We are going to look at benefits and risks for the patient population that could take statins for primary prevention. On one side, we have the statin as Rocky Balboa, coming out to fight off cancer risk, both overall and esophageal, as well as improving quality of life and glaucoma. On the other, we have the statin as Evel Knievel, demonstrating that reckless heroics don’t provide longevity, but they do increase diabetes risk, promote fatigue and increase cataracts. Let’s look at some of the evidence.

Effect on cancer

A study published in The New England Journal of Medicine involved 300,000 Danish participants and investigated 13 cancers. It showed that statin users may have a 15 percent decreased risk of death from cancer (1). This is exciting news.

However, there were major limitations with the study. First, the researchers did not control for smoking, which we know is a large contributor to cancer. Second, it was unknown which of the statin-using population might have received conventional cancer treatments, such as radiation and chemotherapy. Third, the dose of statins did not correlate to risk reduction. In fact, those who took 1 to 75 percent of prescribed statin levels showed more benefit in terms of cancer mortality risk than those who took more. We need a better-designed trial that is prospective (forward looking) to determine whether there really is an effect. I would say that Rocky Balboa came out of this fight pretty banged up.

Another study showed that statins may play a role in reducing the risk of esophageal cancer. This is important, since esophageal cancer, especially adenocarcinoma that develops from Barrett’s esophagus, is on the rise. The results showed a 28 percent risk reduction in this type of cancer. The authors of the study surmise that statins may have a protective effect. This was a meta-analysis of 13 observational studies (2).

Although there is an association, these results need to be confirmed with randomized controlled trials. Remember, aspirin has about the same 30 percent reduction in colorectal cancer, yet is not recommended solely for this use because of side effects.

Eye diseases: mixed results

In two common eye diseases, glaucoma and cataracts, statins have vastly different results. In one study, statins were shown to decrease the risk of glaucoma by 5 percent over one year and 9 percent over two years (3). It is encouraging that the longer the duration of statin use, the greater the positive effect on preventing glaucoma.

Statins also help to slow glaucoma progression in patients suspected of having early-stage disease at about the same rate. This was a retrospective (backward-looking or looking in the past) study analyzing statin use with patients at risk for open-angle glaucoma. There is a need for prospective (forward-looking) studies. With cataracts, it is a completely different story. Statins increase the risk of cataracts by over 50 percent, as shown in the Waterloo Eye Study (4). Statins exacerbate the risk of cataracts in an already high-risk group: diabetes patients.

Quality of life and longevity: a mixed bag

In a meta-analysis involving 11 randomized controlled trials, considered the gold standard of studies, statins did not reduce the risk of all-cause mortality in moderate to high-risk primary prevention participants (5). This study analysis involved over 65,000 participants with high cholesterol and at significant risk for heart disease.

However, in this same study, participants at high risk of coronary heart disease saw a substantial improvement in their quality of life with statins. In other words, the risk of a nonfatal heart attack was reduced by more than half and nonfatal strokes by almost half, avoiding the potentially disabling effects of these cardiovascular events.

Fatigue effect

Some of my patients who are on statins ask if statins can cause fatigue. A randomized controlled trial published in the Archives of Internal Medicine reinforces the idea that statins increase the possibility of fatigue (6).

Women, especially, complained of lower energy levels, both overall and on exertion, when they were blindly assigned to a statin-taking group. The trial was composed of three groups: two that took statins, simvastatin 20 mg and pravastatin 40 mg; and a placebo group. The participants were at least 20 years old and had LDL (bad) cholesterol of 115 to 190 mg/dl, with less than 100 mg/dl considered ideal.

In conclusion, some individuals who are at high risk for cardiovascular disease may need a statin, but with the evidence presented, it is more likely that statins are overprescribed in primary prevention. Evidence of the best results points to lifestyle modification, with or without statins, and all patients with elevated LDL (bad) cholesterol should make changes that include a nutrient-dense diet and a reduction in fat intake, as well as exercise.

References:

(1) N Engl J Med 2012;367:1792-1802. (2) Clin Gastroenterol Hepatol. 2013 Jun; 11(6):620–629. (3) Ophthalmology 2012;119(10):2074-2081. (4) Optom Vis Sci 2012;89:1165-1171. (5) Arch Intern Med 2010;170(12):1024-1031. (6) Arch Intern Med 2012;172(15):1180-1182.

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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I may be conflating two holidays, but this year, I’m thankful for love. Yes, I recognize that Valentine’s Day is a few months away.

I’m not just talking about romantic love between two people who laugh, plan and enjoy building a life together while dealing with the inevitable chaos and curveballs.

No, I’m talking about the kind of love that makes a cold, wet day manageable. We recently added a puppy to our home. We brought this new furry creature into our lives because we were moving and it seemed liked a way to add something to our house that would be ours in a new setting.

It also seemed to be a way to enhance our ability to socialize with our neighbors. Who, after all, can resist a cute puppy bounding down the street? Well, as it turns out, almost everyone, particularly on unexpectedly cooler days in a city that was supposed to be much warmer. Sure, people wave through their gloves and smile behind the wheel, but no one has stopped to ask if he or she can pet the little fella. No one has asked his age, his name or where we got him.

But, hey, this isn’t about love for our neighbors, although I suspect over time we may come to love the distance we have from everyone or, on the bright side, a friendship that may seem inevitable after we meet other people eager to connect with those living nearby.

No, this is about that moment when I open the door to the puppy’s room and he greets me with a tail moving so quickly that it could generate enough electricity to power the house for the day.

As we and our kids get older, the excitement at greeting each other after absences, even for a few hours or a day, left the arena of unbridled joy. Sure, we’re delighted to see each other, but the squeal with delight moments have morphed into understated greetings and subtle head nods that don’t displace carefully coiffed hair.

We can also love the moments our senses pick up a familiar signal. That could be the scent of a pumpkin pie wafting across the living room, sending us back to our childhood when we visited with extended family that has long ago moved away. It could be the sound of our children practicing an instrument with such dexterity that the end of the composition brings both pride and sadness as the intricate sound has given way to silence.

It could also be an appreciation for a warm, crackling fire late on a cold day as the winter sunset turns the light outside a deep orange, contrasting with the yellow hue near the sizzling logs.

This is also the incredible season of anticipation, as we love the prospect of seeing people we haven’t seen in person in weeks, months or years. We can love the expectation of seeing their faces, sharing stories, taking long walks on quiet roads or windy beaches, as we tell tales about everything from the miraculous to the mundane in intersecting lives interrupted by time and distance.

As well, we can love the gift of time with each other, on our own or without particular commitment.

Then again, we can love a positive result at work, if we’ve sold the unsellable property, finally checked something off a to-do list that seemed to be festering forever, or found some unexpected result in a lab that may one day lead to a treatment for an insidious or life-depriving disease.

We are a thinking species, which ruminates over the past, contemplates the present and ponders the future. We are also blessed with the power of love, as Huey Lewis and the News sang in 1985. It’s still a powerful thing, even 33 years later.

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Photo by Ela Elyada

By Daniel Dunaief

What if, instead of defeating or removing enemy soldiers from the battlefield, a leader could convince them to join the fight, sending them back out to defeat the side they previously supported? That’s the question Giulia Biffi, a postdoctoral researcher at Cold Spring Harbor Laboratory, is asking about a particular type of cells, called fibroblasts, that are involved in pancreatic cancer.

Fibroblasts activated by cancer cells secrete a matrix that surrounds cancer cells and makes up about 90 percent of pancreatic tumors.

Giulia Biffi. Photo by ©Gina Motisi, 2018/CSHL

Responding to a molecule called IL-1, an inflammatory potential tumor-promoting fibroblast may enhance the opportunity for cancer to grow and spread. Another type of fibroblast responds to TGF-beta, which potentially enables them to restrain tumors.

Researchers had suggested that the inflammatory fibroblasts are tumor promoting, while the myofibroblasts are tumor defeating, although at this point, that still hasn’t been confirmed experimentally.

Researchers knew TGF-beta was important in biology, but they didn’t know that it was involved in preventing the activation of an inflammatory tumor-promoting version.

Biffi, however, recently found that IL-1 promotes the formation of inflammatory fibroblasts. She believes these fibroblast promote tumor growth and create an immunosuppressive environment.

In an article published in the journal Cancer Discovery, Biffi showed that it’s “not only possible to delete the population, but it’s also possible to convert [the fibroblasts] into the other type, which could be more beneficial than just getting rid of the tumor-promoting cells,” she said.

Biffi works in Director Dave Tuveson’s CSHL Cancer Center laboratory, which is approaching pancreatic cancer from numerous perspectives.

Her doctoral adviser, Sir Shankar Balasubramanian, the Herchel Smith Professor of Medicinal Chemistry at the University of Cambridge, suggested that the work she did in Tuveson’s lab is an extension of her successful research in England.

“It is evident that [Biffi] is continuing to make penetrating and important advances with a deep and sophisticated approach to research,” Balasubramanian explained in an email. “She is without a doubt a scientist to watch out for in the future.”

To be sure, at this stage, Biffi has performed her studies on a mouse model of the disease and she and others studying fibroblasts and the tumor microenvironment that dictates specific molecular pathways have considerable work to do to extend this research to human treatment.

She doesn’t have similar information from human patients, but the mouse models show that targeting some subsets of fibroblasts impairs cancer growth.

“One of the goals we have is trying to be able to better classify the stroma from pancreatic cancer in humans,” Biffi said. The stroma is mixed in with the cancer cells, all around and in between clusters of cells.

The results with mice, however, suggest that approaching cancer by understanding the molecular signals from fibroblasts could offer a promising additional resource to a future treatment. In a 10-day study of mice using a specific inhibitor involved in the pathway of inflammatory fibroblasts, Biffi saw a reduction in tumor growth.

If Biffi can figure out a way to affect the signals produced by fibroblasts, she might be able to make the stroma and the cancer cells more accessible to drugs. One potential reason other drugs failed in mouse models is that there’s increased collagen, which is a barrier to drug delivery. Drugs that might have failed in earlier clinical efforts could be reevaluated in combination with other treatments, Biffi suggested, adding if scientists can manage to target the inflammatory path, they might mitigate some of this effect.

A native of Bergamo, Italy, which is near Milan, Biffi earned her doctorate at the Cancer Research UK Cambridge Institute. Biffi lives on a Cold Spring Harbor property which is five minutes from the lab.

When she was young, Biffi wanted to be a vet. In high school, she was fascinated by the study of animal behavior and considered Dian Fossey from “Gorillas in the Mist” an inspiration. When she’s not working in the lab, she enjoys the opportunity to see Broadway shows and to hike around a trail on the Cold Spring Harbor campus.

Biffi started working on fibroblasts three years ago in Tuveson’s lab. “I really wanted to understand how fibroblasts become one population or the other when they were starting from the same cell type,” she said. “If they have different functions, I wanted to target them selectively to understand their role in pancreatic cancer to see if one might have a tumor restraining role.”

A postdoctoral researcher for over four years, Biffi is starting to look for the next step in her career and hopes to have her own lab by the end of 2019 or the beginning of 2020.

When she was transitioning from her doctoral to a postdoctoral job, she was looking for someone who shared her idealistic view about curing cancer. Several other researchers in Cambridge suggested that she’d find a welcome research setting in Tuveson’s lab. Tuveson was “popular” among principal investigators in her institute, Biffi said. “I wanted to work on a hard cancer to treat and I wanted to work with [Tuveson].”

Biffi hopes that targeting the inflammatory pro-tumorigenic fibroblasts and reprogramming them to the potentially tumor-restraining population may become a part of a pancreatic cancer treatment.

She remains optimistic that she and others will make a difference. “This can be a frustrating job,” she said. “If you didn’t have hope you can change things, you wouldn’t do it. “I’m optimistic.”

Biffi points to the hard work that led to treatments for the flu and for AIDS. “Years back, both diseases were lethal and now therapeutic advances made them manageable,” she explained in an email. “That is where I want to go with pancreatic cancer.”

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By Fr. Francis Pizzarelli

Father Frank Pizzarelli

Midterm elections are complete. We need to continue to stand up and give voice to social justice and human rights for all. Those we have elected and re-elected are there to serve us, “We the People,” not special interests, not a particular party but all of us. We have a responsibility to hold those who hold public office to serious accountability. They need to support the issues that are most important to the constituents they represent.

As the holiday season approaches, we need to put the divisive, disrespectful rhetoric of this past election season behind us. Let us look for new ways to build bridges with our differences instead of building walls. Let us engage in conversations that are inclusive and life-giving. Even if after the conversation is complete we agree to disagree, let us still embrace a spirit of respect for one another and keep the door open to new conversations that can make our communities better and stronger.

For Thanksgiving, I am forever grateful to our community. In our diversity is also the foundation of our greatness. I have seen firsthand this community build strong bridges that transcend racial, religious, social, political and economic issues; we are better for these bridges.

We’re not perfect, but in our imperfection we continue to feed the poor, to provide shelter and support for the homeless and to afford mental health services for those who are overwhelmed with life and so much more.

Our local hospitals, our fire departments, our ambulance services are on call 24/7 to respond to any kind of human trauma and/or tragedy. They are among the most compassionate and giving people I have ever been privileged to know; their self-sacrifice and service to others is an inspiration.

Our local schools are among the best in the state and probably the nation. Maryhaven Center of Hope is a historical landmark within our community. For more than 100 years, its compassionate and comprehensive services have provided invaluable support for the most vulnerable among us.

We are blessed to have a wide range of religious traditions actively engaged in our larger community, reminding us regularly of the importance to love, to forgive and to be generous to those in need without judgment or exclusion. Our religious leaders have consistently been an invaluable source of wisdom and support for our diverse community.

As I get ready to celebrate my 39th Thanksgiving in Port Jefferson, I will especially give God thanks for our community that reminds me every day that hope lives and must be the anthem of our souls! I am forever grateful for our community’s warmth, generosity and service. A blessed Thanksgiving to all and thank you!

Fr. Pizzarelli, SMM, LCSW-R, ACSW, DCSW, is the director of Hope House Ministries in Port Jefferson.

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