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The band H.I.M.S. performs at the War on Addiction Rally. Photo by Alex Petroski

By Fr. Francis Pizzarelli

Father Frank Pizzarelli

On Saturday, April 21, more than 1,000 people gathered to rally against drug addiction at Bald Hill in Farmingville. It was a powerful demonstration of our human spirit!

The event was spearheaded by two parents, who buried their son, who died of a heroin overdose, two years ago. Instead of burying their heads in the sand, they decided to become proactive and raise people’s awareness to the painful affliction of addiction. They urged greater advocacy for more accessible residential treatment beds for those battling addiction.

The speakers were challenging and heart wrenching. Each one eloquently reminded us to be a voice for change — urging us to speak loudly about the stigma and shame that so many people live with because of addiction and its infection.

A mother wrote a piercing letter that was read about her son who overdosed and died last year. She spoke of the heartache she still endures a year later. N.L. was in his mid-20s. He was bright, handsome, very athletic and born into an extraordinary family. After an athletic injury and being prescribed opiates for pain, his nightmare began. His family’s nightmare began as well.

N.L. constantly struggled with long-term recovery and abstinence. His mother recounted that during one of the periods of abstinence, her son was working hard at recovery. One day he was at a local bagel store in his community waiting on line and saw the father of a friend. He went to shake his hand but the man turned his back and walked away! What was that about? 

N.L.’s sister was also tortured on social media. What happened to reaching out and providing support and encouragement for those struggling with recovery?

The rally that Saturday morning did provide support. However, it was bittersweet. So many who attended have already buried their children, and many others were struggling with sons and daughters who are still out there and using.

Too often when we talk about addiction, we talk about the dark side of this painful health epidemic. The day ended on a note of hope. So often we focus on all those who’ve overdosed and died because of this horrific health crisis.

People do recover! A group of young men who live in a long-term nontraditional rehabilitation residence in our community formed a band known as the H.I.M.S. — Hope Inspired Men Sing. They closed the rally with a powerful rendition of “Go Light Your World” by Chris Rice.

“There is a candle in every soul. Some brightly burning, some dark and cold. There is a Spirit who brings a fire. Ignites a candle and makes His home. … Cause we are a family whose hearts are blazing. So let’s raise our candles and light up the sky. … Make us a beacon in darkest times. … Hold out your candle for all to see it. Take your candle, and go light your world!”

These extraordinary young men, ranging in age from 25 to 46, stood before this crowd as a reminder that people do get better. People can reclaim their lives, rejoin their families and contribute to making the world a better place.

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

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It is very important to take white-coat hypertension seriously. Stock photo
As many as 30 percent of patients experience this phenomenon

By David Dunaief, M.D.

Dr. David Dunaief

White-coat hypertension (high blood pressure) is defined as blood pressure that is elevated to at least 140/90 mm Hg at a physician’s office, but “normal” when measured at home. The blood pressure considered normal at home for most Americans is less than 135/85 mm Hg. This is a real phenomenon caused by the anxiety or stress of being in a doctor’s office. It is also known as “isolated office hypertension.”

About 15 to 30 percent of patients experience white-coat hypertension (1). However, when the diastolic (bottom number) blood pressure is greater than 105 mm Hg, it is unlikely to be simply caused by doctor’s office-related stress (2).

Consequences

What are the consequences of white-coat hypertension? The first challenge is that physicians may overtreat it, prescribing medications that lead to low blood pressure when not in the office. Alternately, we sometimes discount it because it seems benign or harmless. However, some studies show that it may increase the risk of sustained hypertension, which is a major contributor to developing cardiovascular disease — heart disease and stroke.

It is very important to take white-coat hypertension seriously because Centers for Disease Control and Prevention data show that the percentage of adults age 20 and over with hypertension reached 33.5 percent in the 2013-14 period (3).

What can be done?

What can be done about white-coat hypertension? Well, it does not need to be treated with medication, except potentially in elderly patients (over 80 years of age) but should involve lifestyle modifications, including dietary changes, stress reduction and exercise. In terms of diet, increased beet juice, green leafy vegetables and potassium, as well as decreased sodium intake may be important. You should monitor the blood pressure at home, taking multiple readings during the day, or by 24-hour ambulatory blood pressure readings, which require wearing a monitor. The latter provides the additional advantage of blood pressure readings during your sleep.

If you do monitor your blood pressure at home, the American Heart Association has suggestions on how to get the most accurate readings, such as measurements early in the morning before exercising and eating, as well as in the evening (4). You should also be comfortably seated, don’t cross your legs, and sit/relax for a few minutes before taking a reading. Let’s look at the evidence.

Risk of sustained high blood pressure

There were no substantial studies demonstrating any consequences from white-coat hypertension until 2005. Most previous studies on white-coat hypertension were not of long enough duration.

In the 2005 population-based Ohasama study, results showed that the participants who had white-coat hypertension were 2.9 times more likely to develop sustained hypertension, compared to those who had normal blood pressure in the doctor’s office (5). There were almost 800 participants involved in this study, with a mean age at the start of 56. What was really impressive about the study was its duration, with an eight-year follow-up. This gives a better sense of whether white-coat hypertension may develop into sustained hypertension. The researchers concluded that it may lead to a less than stellar outlook for cardiovascular prognosis.

Another study, published in 2009, reinforced these results. The PAMELA study showed that those with white-coat hypertension had about a 2.5-times increased risk of developing sustained high blood pressure, compared to those who had normal readings in all environments (6). There were 1,412 participants involved in the study, ranging in age from 25 to 74. Just like the previous study, an impressive aspect was the fact that there was a long follow-up period of 10 years. Thus, this was a substantial study, applicable to the general population over a significant duration.

Prevention of sustained hypertension

In a small, randomized controlled trial, beet juice was shown to reduce blood pressure significantly (7). Patients either were given 250 ml (about 8 ounces) of beet juice or comparable amounts of water. The patients who drank the beet juice saw an 11.2 mm Hg decrease in blood pressure, while those who drank water saw a 0.7 mm Hg reduction. This effect with the beet juice continued to remain significant. Even after 24 hours, there was a sustainable 7.2 mm Hg drop in blood pressure, compared to readings taken prior to drinking the juice. Although these results are encouraging, we need to study whether these effects can be sustained over the long term. Also, this study was done in patients with high blood pressure. I don’t know of any prevention studies done in patients with white-coat hypertension.

The researchers believe the effect is caused by high nitrate levels in beet juice that are converted to nitrite when it comes in contact with human saliva. Nitrite helps to vasodilate, or enlarge blood vessels, and thus helps to decrease blood pressure in a similar way as some antihypertensive (blood pressure) medications. The authors go on to surmise that green leafy vegetables offer protection from cardiovascular disease in part due to increased nitrite levels, similar to those in beet juice. 

A subsequent double-blind, placebo-controlled clinical trial with 68 hypertensive patients found that blood pressure was significantly reduced in the clinic and in home readings over a four-week period, when compared to nitrate-free beet juice (8).

If you have diabetes, prediabetes, a family history or a high risk for diabetes, I recommend eating beets instead, since drinking beet juice will raise your sugar levels.

Increasing potassium levels significantly through food sources, not supplements, has a profound effect in reducing blood pressure. In a study where 3,500 to 4,700 mg of potassium were consumed through foods, the systolic (top number) blood pressure was reduced by 7.1 mm Hg (9). We should be getting 4,700 mg of potassium daily, which equates to about 10 bananas daily. Almonds, raisins and green leafy vegetables, such as Swiss chard, also have significant amounts of potassium.

White-coat hypertension should not be neglected. It is important to monitor blood pressure at home for at least three days with multiple readings, and then send them to your physician for review. Though patients don’t need to be on blood pressure medications at this stage, it does not mean you should be passive about the process. Make lifestyle modifications to reduce your risk of developing sustained hypertension.

References:

(1) Hypertension. 2013;62:982-987, originally published Nov 13, 2013. (2) J Hypertens. 2001;19(6):1015. (3) cdc.gov. (4) Am Fam Physician. 2005 Oct 1;72(7):1391-1398. (5) Arch Intern Med. 2005 Jul 11;165(13):1541-1546. (6) Hypertension. 2009; 54: 226-232. (7) Hypertension. Online 2013; April 15. (8) Hypertension. 2015 Feb; 65(2): 320–327. (9) BMJ. 2013 Apr 3;346:f1378. 

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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Gholson Lyon. Photo courtesy of Cold Spring Harbor Laboratory

By Daniel Dunaief

With the cost of determining the order of base pairs in the human genome decreasing, scientists are increasingly looking for ways to understand how mutations lead to specific characteristics. Gholson Lyon, an assistant professor at Cold Spring Harbor Laboratory, recently made such a discovery in a gene called NAA15.

People with mutations in this gene had intellectual disability, developmental delay, autism spectrum disorder, abnormal facial features and, in some cases, congenital cardiac anomalies.

In a recent interview, Lyon explained that he is trying to understand how certain mutations influence the expression of specific traits of interest, such as intelligence, motor development and heart development. He’s reached out to researchers scattered around the world to find evidence of people who had similar symptoms, to see if they shared specific genetic mutations in NAA15 and found 37 people from 32 families with this condition.

“I really scoured the planet and asked a lot of people about this,” said Lyon, who recently published his research in The American Journal of Human Genetics. The benefit of this kind of work, he explained, is that it can help screen for specific conditions for families at birth, giving them an ability to get an earlier diagnosis and, potentially, earlier treatment. “Being able to identify children at birth and to know that they are at risk of developing these disorders would, in a perfect world” allow doctors to dedicate resources to help people with this condition, he said.

Lyon published a similar study on a condition he named Ogden syndrome seven years ago, in which five boys in a single family died before they reached the age of 3. A mutation in a similar gene, called NAA10, led to these symptoms, which is linked to the X chromosome and was only found in boys.

Lyon found the genes responsible on NAA15 by comparing people with these symptoms to the average genome. The large database, which comes from ExAC and gnomAD, made it possible to do a “statistical calculation,” he said. The next steps in the research is to look for protein changes in the pathway in which these genes are involved. The people he studied in this paper are all heterozygous, which means they have one gene that has a mutation and the other that does not.

With this condition, they have something called haploinsufficiency. In these circumstances, they need both copies of the fully functioning gene to produce the necessary proteins. These mutations likely decrease the function of the protein. Lyon would like to study each of these cases more carefully to understand how much the mutation contributes to the various conditions. He looked for evidence of homozygous mutations but didn’t find any. “We don’t know if they don’t exist” because the defective gene may cause spontaneous miscarriages or if they just didn’t find them yet, he said.

Lyon plans on reaching out to geneticist Fowzan Alkuraya, who was trained in the United States and is working at King Faisal Specialist Hospital and Research Centre clinic in Saudi Arabia. The geneticist has studied the genes responsible for a higher rate of genetic disorders linked to the more common practice of people having children with cousins in what are called consanguineous marriages. 

Alkuraya works on the Saudi Human Genome Program, which studies the inherited diseases that have a higher incidence in Saudi Arabia.

For Lyon, finding the people who carry this mutation was challenging, in part because it hasn’t run in the family for multiple generations. Instead, Lyon and his colleagues, including Holly Stessman of Creighton University in Omaha, Nebraska and Linyan Meng at Baylor College of Medicine in Houston, Texas, found 32 unrelated families. In some of these families, one or two siblings carried this mutation in a single mutation.

By defining a new genetic disease, the scientists could help families seeking a diagnosis, encourage the start of early intervention such as speech therapy and connect patients with the same diagnosis. This can provide a support network in which people with this condition and their families know they are not battling this genetic challenge alone, Meng, the assistant laboratory director at Baylor Genetics and assistant professor at Baylor College of Medicine, explained in an email.

Every patient with an NAA15 mutation won’t have the same symptoms. “We see a range of phenotypes in these patients, even though they carry the same diagnosis with defects in the same disease,” Meng added. “Early intervention could potentially make a difference for NAA15 patients.”

Lyon works as a psychiatrist in Queens providing medication management. During his undergraduate years at Dartmouth College, in Hanover, New Hampshire, Lyon said he was interested in neurology and psychology. As he went through his residency at NYU, Columbia and New York State Psychiatric Institute, he gravitated toward understanding the genetic basis of autism, which he said is easier than conditions like schizophrenia because autism is more apparent in the first few years of life.

Lyon recently started working part time at the Institute for Basic Research in Developmental Disabilities on Staten Island. While Lyon appreciates the opportunity to work there, he is concerned about a potential loss of funding. “These services are vital” on a clinical and research level, he said. He is concerned that Gov. Andrew Cuomo (D) is thinking about decreasing the budget for this work. Reducing financial support for this institution could cause New York to lose its premiere status in working with people with developmental disabilities, he said.

“It has this amazing history, with an enormous number of interesting discoveries in Down syndrome, Alzheimer’s disease and Fragile X,” he said. “I don’t think it gets enough credit.”

As for his work with NAA, Lyon plans to continue to search for other people whose symptoms are linked to these genes. “I am looking for additional patients with mutations in NAA10 or NAA15,” he said.

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Creating an estate plan can give you the peace of mind you need. Stock photo

By Nancy Burner, ESQ.

Nancy Burner, Esq.

Planning for the future can sometimes be difficult. Creating an estate plan can give you the peace of mind you need, while also making it easier for your loved ones to handle your affairs when you die. We often find that while our clients understand the basics of certain estate planning documents, they are often surprised to see that many of these documents are multifaceted and serve multiple purposes.

A last will and testament is a legal document memorializing your wishes on how you, the testator or creator of the will, want your estate to be distributed after you die. If you die without a will, your assets will be distributed according to state statute, also known as the laws of intestacy.  

For example, in New York State, if you die with a surviving spouse and children, your spouse will receive the first $50,000 of your estate and then one-half of the balance. The remainder will be distributed equally among your children. This is not ideal for someone who wants all their assets to go to their surviving spouse.   

Instead of being bound by the laws of intestacy, one can create a will that specifies to whom they want their assets to go and how they want their assets to be distributed. Under the scenario above, a will would allow the testator to distribute their assets to their surviving spouse. Only if the spouse predeceases the testator should the assets be distributed to their children.

The will has functions other than just listing the distribution of assets upon death. For parents with young children, a will allows a guardian to be named for minor children. Also, if there are beneficiaries that are minors or incapacitated, the will can provide that the assets be distributed in trusts on behalf of those beneficiaries. 

Many clients will choose to leave assets to beneficiaries in trusts in other circumstances, such as for creditor protection or to delay the age by which they can have full access to the funds. 

A will can also create a supplemental needs trust for beneficiaries who currently receive, or may be in need of, means-tested government benefits.  

Another advantage of executing a will is that it allows the creator to waive any bond that the executor would otherwise have to pay in order to administer the estate. A bond is often required by the court to protect the interests of the distributees and beneficiaries of one’s estate.  

Depending on the size of the estate, the bond may have a large annual premium that will be paid out of the assets of the estate. A will can also provide for the decedent’s wishes regarding funeral arrangements and cremation.

It is important to have a will even for individuals who hold all accounts jointly with another person. While the joint assets will go directly to the co-owner, the terms of the will can be used to administer any assets that are held outside of the joint accounts. An estate account will have to be opened to cash any checks delivered after death that are made payable to the decedent, including tax refunds or a return of other funds. Having a will ensures that these funds are distributed to the appropriate persons.  

Creating a last will and testament can help avoid many of the pitfalls that occur when a person dies without any estate plan in place. We strongly recommend seeking a trust and estates and elder law professional to help determine the right estate plan for you.

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

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Chocolate-Raspberry Muffins

By Barbara Beltrami

You love Mom. Mom loves you … and chocolate. What a treat for her to have not just breakfast in bed on Mother’s Day but a chocolate breakfast in bed. Imagine how delighted she will be to awaken to a beautiful tray (with a flower on it, of course) and discover chocolate-raspberry muffins, white chocolate chip pancakes or a chocolate banana smoothie. Of course, you don’t have to do all of these, but you can. And the following recipes are all for multiple servings, so you can jump onto the bed and join Mom! Whatever you decide, don’t forget to include a cup of nice hot coffee or tea for her to sip along with all her goodies. And another thing:  Remember to be kind and sweet and helpful to Mom all day long, just as you always are. 

Chocolate-Banana Smoothie

YIELD: Makes 4 servings.

INGREDIENTS:

4 cups milk

2 bananas

3 tablespoons cocoa powder

1 teaspoon brown sugar

2 ice cubes

DIRECTIONS: 

Place all ingredients in a blender and liquefy until thick and foamy. Serve immediately with muffins, pancakes, waffles, fresh fruit or a granola bar.

Chocolate-Raspberry Muffins

YIELD: Makes 12 muffins.

INGREDIENTS:

2 cups flour

1 cup sugar

¾ cup chocolate chips

½ cup unsweetened cocoa powder

1 teaspoon baking soda

1 egg

1 cup plain Greek yogurt

½ cup milk

1 teaspoon vanilla extract

1 stick unsalted butter, melted

1 cup raspberries

DIRECTIONS: 

Preheat oven to 400 F. Grease or line muffin tin with foil or paper cups. In a large bowl combine flour, sugar, chocolate chips, cocoa powder and baking soda. In another bowl, whisk together the egg, yogurt, milk, vanilla and butter. Stir in raspberries. Bake until a cake tester inserted in center comes out clean, about 20 minutes. Remove from oven and cool on wire rack. Serve warm or at room temperature with hot coffee or tea.

White Chocolate Chip Pancakes

White Chocolate Pancakes

YIELD: Makes 4 to 6 servings.

INGREDIENTS:

½ stick unsalted butter

1 cup milk

1¼ cups flour

1 tablespoon sugar

1 tablespoon + 1 teaspoon baking powder

3/4 teaspoon salt

2 large eggs

2/3 cup white chocolate morsels

1 tablespoon unsalted butter

DIRECTIONS: 

In a small saucepan warm the butter and milk, but do not let it boil. Let cool slightly. Meanwhile in a medium bowl combine the flour, sugar, baking powder and salt. In a large bowl, whisk the eggs; add the butter and milk mixture, then the dry ingredients and the chocolate morsels just until blended. Melt 1 tablespoon butter on a griddle over medium heat; ladle one-quarter cup of batter for each pancake onto the griddle. When bubbly, flip and cook 30 seconds more. Serve hot with butter, maple syrup and bacon.

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Photo courtesy of Kent Animal Shelter

MEET JESSE!

Just look at those beautiful brown eyes! This handsome boy is Jesse, a 2-year-old lab mix who was rescued from a high kill shelter in Texas and is now waiting for a new home at Kent Animal Shelter. Jesse had a rough start in life and because of this has tested positive for heartworm. He is currently undergoing treatment and is on the road to a full recovery! He just can’t wait to live the good life with a family and home of his own. So hurry up and come down to meet him today! Jesse comes neutered, microchipped and is up to date on all 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 Jesse and other adoptable pets at Kent, visit www.kentanimalshelter.com or call 631-727-5731. 

Update: Jesse has been adopted!

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HOME AT LAST

Mary Mayrick of Kings Park snapped this action shot of an osprey returning to its nest at Nissequogue River State Park on April 17. She writes, ‘The  osprey nest is over the area that changes from river to Long Island Sound water with the tide. It is an amazing place to view many of their habits from a safe distance without disturbing them.’

Send your Photo of the Week to [email protected].

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From the time I was a young girl, I wanted to be a mother. The urge to hold and to love a baby, my baby, was a conscious one. I also had professional ambitions, so in those days, before women expected to be able to do it all, there was a bit of a conflict in my head. Curiously, while I don’t remember telling anyone about my maternal urges, I did mention it on my first date to the man I eventually married. He told me that he too looked forward to having children, so the rest is history.

When I did have my first child, I was quietly terrified. I was the caboose child in my parents’ families, meaning that my parents were older, and everyone in my generation was already born before I came on the scene. There were no babies for me to practice on, I had never given a baby a bottle nor changed a diaper, and I was afraid I was inadvertently going to do some terrible harm to a helpless infant. It wasn’t until the baby’s one-month checkup, when the pediatrician exalted about how his development — size and weight — were “off the charts,” that I began to relax and believe the baby would survive my ignorance.

After that the parenting urge was so fulfilling that we did it twice more in record time. Judging from my friends’ tales of their children, we had it easy with three boys. They were exceedingly energetic but never moody, didn’t hold a grudge for more than three minutes, weren’t particular about what clothes they wore and could be entertained with a generous supply of miniature trucks on rainy, “indoor” days or any ball game on “outside” days. Baseball on our dead end street was their favorite, and I became a pretty good pitcher, if I do say so myself.

They didn’t much like it when I started the first newspaper and was away from the house a great deal. They were all in elementary school by that point and they came to accept the new arrangement, even were infrequently pleased with my new occupation. And since my office was only some five minutes from the house and three minutes from their school, I felt I could get to them quickly if they needed me. I was able to look in on them in the course of each day. In fact, I had more trouble convincing my mother than my
children that it was acceptable to work both inside and outside the home. I just could never understand how all three unfailingly picked friends who lived on the farthest ends of the school district and had to be driven back and forth. That and the constant car pooling for games and music lessons made me grateful that I had learned to drive — not a typical skill among my urban classmates when I was growing up.

I weathered their teenage years as best I could, sometimes marveling that only my children could make me scream (and my mother). At the same time, my husband and I vicariously enjoyed the children’s various successes: academic, musical and athletic. They were blossoming into young adults and we were regularly irritated by them and immensely proud of them.

As the children reached their later teenage years, the family dynamic shifted. My husband was terminally ill, and the children were forced to deal with death. My mother and my father had both passed on by then, and the boys had been deeply touched by their loss, but the death of a parent at a far younger age than expected for either their father or themselves struck me as a cruel trick. Somehow we had not lived up to our part of the parenting contract.

I guess that was when my children started to become my friends. It probably would have happened around that age anyway, but we became allies in the face of adversity. And then life’s wonderful joys unfurled. … They graduated, got jobs, found their loved ones and eventually made me a grandmother. That’s a club one can’t apply to oneself, but having arrived there, I can endlessly sing its praises.

Bottom line: How ultimately satisfying it is for me to be a mom.

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It’s only May and, despite the warm weather, it feels a bit like October around here, at least, if you talk to fans of the Yankees and Red Sox.

The two best teams in baseball, as of earlier this week, were preparing to go head-to-head in a three-game
series that seemed to have more on the line than a typical series between the heated rivals at this point
in spring.

The Red Sox had that incredibly hot start, winning 17 of their first 19 games, tearing up the league and anyone who dared to try to compete with them. The Yankees, meanwhile, started slowly, sputtering to a .500 record.

And then the Yankees seemed to have gotten as hot as the weather, scoring runs in the clutch, pitching with confidence and bringing in rookies like Gleyber Torres and Miguel Andujar, who play more like seasoned veterans.

On a recent evening, my wife and I made a quick stop to the grocery store. As we were walking out, a friend saw me in my Yankees sweatshirt. The friend asked if the team pulled out a win, even though they were losing 4-0 in the eighth inning.

As my wife waited patiently, I recounted nearly every at bat that led to another improbable Yankees comeback. A man who worked at the supermarket came over to listen, put up his hand to high-five me and said he had a feeling they might come back.

While the team measures the success of the season by the ability to win the World Series, the fans, particularly during a season with so much early promise, can bask in the excitement of individual games or series.

The first season, as the incredibly long 162 games from March through October is called, can include
numerous highlights that allow fans to appreciate the journey, as well as the destination.

Nothing is a given in a game or a season. We attend or watch any game knowing that the walk-off home run the rookie hit could just as easily have been an inning ending double play.

Ultimately, the most important part of the season is the recognition that it is a game. You can see that when the players mob each other at the plate or smile through their interviews with the sideline reporters after a tight contest.

Year after year, all these teams with all their fans hope the season ends with a victory parade. They want to be able to say, “I was there.”

Ultimately, in life, that’s what we’re hoping for. Moments to cheer for friends and family, to celebrate victories and to enjoy these contests.

Indeed, the winners often look back on the moments when nothing came easily, when their team, their family or their opportunity seemed to be so elusive. These are occasions when nothing that seems to go right turns into those where everything goes according to plan. They don’t happen because you’ve got the right fortune cookie, put on the right socks or asked for some deity to help your team beat another team full of equally worthy opponents, whose fans utter the same prayers.

They happen because of the hard work and dedication. They also often happen because people are taking great pride in doing their jobs and being a part of a team.

Right now, it feels like these two blood rivals are well-matched, facing off in a May series that can bring the energy of October. And, hey, if you’re looking to connect with someone, put on a Yankees or Red Sox sweatshirt and head to the supermarket.

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If it wasn’t for the side effects, corticosteroids would be a magic bullet. Stock photo
Getting to the source of the itch

By Matthew Kearns, DVM

My last column introduced the seasonal allergies that our pets can suffer from, also known as atopic dermatitis. This second part of the two-part article focuses more on the treatment of atopic dermatitis. The treatments we will discuss only focus on systemic medications. It does not include supplements, topical creams/powders/sprays, medicated shampoos/conditioners, etc. I’ll make sure to cover that in the future. 

Now, if we remember from the first part of the article, atopy is defined as, “a genetic predisposition to develop a sensitivity to allergens (proteins in the environment).” The body develops antibodies against these allergens (primarily IgE) and, once a threshold is reached, the IgE antibodies trigger signals to certain white blood cells called basophils and mast cells to release inflammatory chemicals into the system (primarily histamine). This release of histamine triggers all the itch and secondary skin and ear infections that frustrate both pet owners and veterinarians. What is out there to help with the problem?

Antihistamines

Antihistamines block the histamine receptors on nerves, vessels, muscle cells and the lining of stomach and small intestine. They are readily available without a prescription and safe so they can be an excellent first choice. Unfortunately, antihistamines do not block the release of histamine from basophils and mast cells but rather block the receptors on the cells of the organs they affect.  

Now, you can’t block every receptor with medication so it very much depends how severely the individual pet responds to an atopic, or allergic, reaction. Pets with mild allergies will do well with antihistamines. However, pets with more severe forms of allergies either do not respond well or respond temporarily to antihistamines and eventually need a stronger medication.

 Corticosteroids 

Corticosteroids, glucocorticoids, or “steroids,” as they are sometimes referred to, are all cortisone derivatives. Systemic cortisone medications are prescription only. However, corticosteroids are inexpensive and very effective at treating atopic diseases. They block the production of all cytokines (mediators of inflammation) and, if it wasn’t for the side effects, would be a magic bullet. Short-term use is relatively safe and very beneficial. Side effects include drinking/urinating more, eating more and panting. 

However, long-term side effects include gastrointestinal upset/possible ulcers, a suppressed immune system, diabetes mellitus, liver damage, pancreatitis, thromboemboli (blood clots), increased risk of urinary and other types of infections, lethargy and, sometimes, aggression. 

We, as veterinarians, try to transition patients with chronic, recurrent skin and ear problems to other, safer long-term medications.

Immunomodulators 

These prescription medications are more effective than antihistamines and safer to use long term than corticosteroids. Medications like Atopica (cyclosporine) and Apoquel (oclacitinib) block a specific receptor and prevent specific cytokines associated with the allergic itch. These are newer medications with minimal side effects and safe to use long term but are more expensive than antihistamines or corticosteroids.

Biologic therapy 

This is the newest kid on the block. Biologic therapy uses the body’s immune system to target cytokines, or chemicals that induce inflammation. Cytopoint (lokivetmab) is a once monthly injection that induces your dog’s immune system to produce antibodies against a specific class of cytokines called interleukins. Interleukins have been linked to the itch in allergic or atopic dermatitis.

Multiple factors play into what medication we choose: severity, age of pet, pre-existing disease and cost of medication. I hope pet owners will start the discussion with their own vet as to which medication is best for their pet.  

Dr. Kearns practices veterinary medicine from his Port Jefferson office and is pictured with his son Matthew and his dog Jasmine.

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