Columns

Heather Lynch at Spigot Peak in the Antarctic. Photo by Catherine Foley

By Daniel Dunaief

Counting penguins is like riding the highs and lows of Yankees rookie Aaron Judge’s home run streaks, followed by his series of strike outs. He’s not as bad as his strike outs suggest, although he’s also not a sure thing at the plate either.

Similarly, in local populations, the Adélie penguin, which waddles to and fro squawking on land and gliding gracefully through the water, isn’t as clear a barometer of changes in the environment. Also, like Judge, when populations rise and fall, people are eager to offer their explanations for exactly what’s happening, even if the sensational explanations — he’s not that good, no, wait, he’s the greatest ever — may overstate the reality.

Heather Lynch visits Cape Lookout in Antarctica during recent trip that included an NBC TV crew that produced a feature for ‘Sunday Night with Megan Kelly.’ Photo by Jeff Topham

“We have to be careful not to be overreactive,” said Heather Lynch, an associate professor of ecology and evolution at Stony Brook University. “The concern is that, when we see increases or decreases, the implication is that there’s a miraculous recovery or a catastrophic crash.”

That, however, is inconsistent with Lynch’s recent results, which were published in the journal Nature Communications. Examining penguin data from 1982 to 2015, Lynch, Christian Che-Castaldo, who is a postdoctoral researcher in Lynch’s lab, and nine other researchers looked to see if there’s a way to connect the size of the population to changes in the environment. The study involved two teams of researchers, one supported by NASA and the other backed by the National Science Foundation.

“It’s a noisy system,” Lynch concluded. Managers of the populations of krill, small crustaceans that are the mainstay of the Adélie diet, try to use time series of key indicator species to understand what’s going on in the marine realm. In this article, Lynch said, local Adélie penguin populations may not be a clear signal of the health of the krill stocks because penguin abundance fluctuates for reasons she and her team couldn’t pinpoint.

These penguins, which Lynch has counted during her field work in the Antarctic, exhibit changes in population that can run contrary to the health, or stressed condition, of the environment.

“You can’t have your finger on the pulse” with the available data, Lynch said. “Part of our inability to model year-to-year changes is because we can’t measure the right things in the environment.”

The drivers of abundance fluctuations likely involve other animals or aspects of the krill fisheries they couldn’t model, she suggested.

“There’s a lot we don’t know about what penguins do under water, where they spend a large portion of their time and where they feed,” Grant Humphries, who was in Lynch’s lab for a year and now runs his own data science company in Scotland called Black Bawks Data Science Ltd, explained in an email. “The signals that drive year to year changes might actually lie there.”

Tom Hart, a researcher of the Department of Zoology at the University of Oxford who was not involved in this study, explores local scale variation in penguin populations. Locally, Hart said in an interview by Skype, “Things are incredibly noisy. When you aggregate, you get good signals, but with some error.” He suggested that this research drives him on further, showing that “local influences are important” because there’s so much variance left to explain. Lynch’s research is “a really good study and shows very well what’s happening on the regional scale, but leaves open what happens below that,” he said.

Indeed, Lynch suggested that by putting sites together, researchers can look at larger areas, which provide a clearer picture on shorter time scales.

Michael Polito, an assistant professor in the Department of Oceanography and Coastal Sciences at Louisiana State University who was not involved in the study, suggests that this extensive analysis indicates that “you can still look at the relationship between the abundance of penguins and the environment in a robust way. Even though any individual time series may not be the best way to understand these relationships, in the aggregate you can use them.”

Managers who set fishery policies in Antarctic waterways are often concerned about harvesting too much krill, leaving the penguins without enough food to survive and feed their chicks.

The challenge with this result, Lynch acknowledges, is that it makes setting krill boundaries more difficult.

A strategy that involves resetting conservation targets based on annual monitoring appears unrealistic given these results, Lynch said. “From a practical standpoint, we threw in everything we could and could explain only a tiny fraction of the variation,” she said.

Hart added that this is “not an argument to fish away,” he said. “We need to understand what’s going on at a local scale and we’re not there yet.”

To get people involved, Lynch and her team created a science competition, called Random Walk of the Penguins, to see who could predict the overall penguin populations for Adélie, gentoo and chinstrap penguins from the 2014 to 2017 seasons.

The competition, which was a collaborative effort with Oceanites, Black Bawks Data Science and Driven Data included $16,000 in prize money, which was donated by NASA. Entrants could use data from the 1982 through the 2013 seasons. The contest drew competitors from six continents. Of the five winners, all were from different countries.

Humphries, who was the lead on the data science computation, said the results were “somewhat humbling” because competitors were able to make “decent predictions” using only the time series. “With long-term predictions and for determining the tipping points, there is still a lot of work to be done.”

Lynch is relieved that her co-authors supported the direction the article took. “I’m a skeptic by nature and more than happy to throw orthodoxy (or even my own previous work) under the bus,” she wrote in an email. “I do hope that others will use our model as a starting point and we’ll never go back to the old days where everyone looked only at ‘their sites.’”

Deep Dish Apple Pie

By Barbara Beltrami

Eden. A garden. Adam and Eve. That apple. Not a pear or a persimmon or a pineapple, mind you. An apple whose invitational impact launched one of the biggest, if not the biggest, succession of events ever. I don’t know what variety that first apple was, but we descendants have more varieties to choose from that you can shake a candy apple on a stick at, and many of them are grown right here in our own state. So here we are eons later still tempted by that apple and turning it into everything from sauce to pie to chutney to cake to cider and that’s the short list. If you think it was easy deciding what apple recipes to share, guess again. Anyway, here’s how I’ve narrowed that selection.

Apple Coffee Cake

Apple Coffee Cake

YIELD: Makes 8 to 10 servings

INGREDIENTS:

3 cups peeled, cored and sliced

Granny Smith apples (about 6)

5 tablespoons + 2 cups sugar

4 teaspoons cinnamon

3 cups flour

3 teaspoons baking powder

Scant teaspoon salt

1 cup vegetable or corn oil

4 eggs

¼ cup apple juice

1 tablespoon vanilla extract

DIRECTIONS: Preheat oven to 375 F. Grease a 9- or 10-inch tube pan. In a medium bowl combine the apple slices, five tablespoons sugar and cinnamon. Set aside. Sift the flour, baking powder, salt and remaining 2 cups sugar into a medium bowl. Make a well in the center and pour in oil, eggs, apple juice and vanilla. Beat with a wooden spoon until well blended. Drain the reserved apple mixture of excess liquid. Spoon one-third of the batter into prepared pan. Arrange half the apple mixture in a circle on top of the batter. (Make sure no apples touch the side of the pan.)

Repeat procedure with another third of the batter, then the remaining apple mixture and finally the last third of the batter. Bake for 1 to 1¹/₄ hours, until cake tester inserted in middle of circle comes out clean. If top browns too much before inside is done, cover with aluminum foil. Cool to lukewarm; invert onto serving plate. Serve with whipped cream and steaming mugs of coffee or tea.

Deep Dish Apple Pie

Deep Dish Apple Pie

YIELD: Makes 6 to 8 servings

INGREDIENTS:

6 to 8 slightly tart apples

1 cup sugar

½ teaspoon salt

½ teaspoon cinnamon

1/8 teaspoon nutmeg

2 tablespoons flour

2 tablespoons butter

1 pie crust (10 inches or more)

2 to 3 tablespoons milk

DIRECTIONS: Preheat oven to 425 F. Peel, core and cut apples into thin slices; place in baking dish or deep pie dish. In a small bowl combine sugar, salt, spices and flour; sprinkle mixture evenly over apples. Dot with butter. Gently place pastry on top, fold edges under and press them against rim of dish with fingers or fork tines. Brush crust with milk. Bake 40 minutes or until crust is golden and apples are tender. Serve with vanilla ice cream or cheddar cheese.

Crispy Baked Apples

YIELD: Makes 6 servings

INGREDIENTS:

6 tart apples, cored, then peeled halfway down

3 tablespoons melted butter

2 tablespoons flour

½ cup brown sugar

DIRECTIONS: Preheat oven to 425 F. Place apples, peeled side up, in a baking dish. Combine the butter, flour and sugar and pat it onto tops of apples. Bake at 425 F until crust is set; lower oven to 350 F and continue to bake until apples are tender (about 30 minutes). Serve with unwhipped heavy cream.

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The recently aired story of Queen Elizabeth II’s uncle forcefully reminded me of my mother. I was probably thinking of my mother, since it would have been her birthday this past Monday. She was born in 1906, one year after Prince John. The sixth and last child of the then-Prince of Wales and Mary — by 1910, King George V and Queen Mary — young John was a handsome but unusually rambunctious member of the House of Windsor. That may have had something to due with his diagnosis of epilepsy at age 4.

From that time, Prince John lived increasingly out of public view, looked after by a governess, and there are no official portraits of him after age 8. He died from a severe seizure when he was just 13 years old. Only then was his illness disclosed to the general public along with his learning disability, and on some official family trees of the royals his name was erased altogether.

It was not at all unusual at that time and through much of the ensuing 20th century for families to hide their imperfect children. Often those were separated from their families and sent to institutions, where they died, perhaps from inattention or wanton neglect. Another such prominent family with a less-than-perfect child was that of Arthur Miller, the acclaimed writer of morality plays. He and his third wife had a mentally retarded son who was separated from his parents and sister, given over to the care of an older, childless couple and barely acknowledged, an apparent embarrassment to his cerebral father.

Into this world my younger sister, Maxine, was born in 1942. She was diagnosed with Down syndrome almost immediately, and my mother’s highly regarded New York City obstetrician advised my parents to “do yourselves a favor and throw her into the nearest garbage can.” We live in an entirely different world today, made so by much of the investigative reporting of journalists like Geraldo Rivera and his expose of terrible and unconscionable conditions at the Willowbrook State School on Staten Island in the 1970s. The courageous outing of their disabled sister by the Kennedys in the 1960s was also a transformative moment in this change from hiding away children with handicaps to helping them develop as humans entitled to their lives.

Fully supported in her decision by my father, my mother fiercely insisted that my sister had every right to be loved and brought up alongside her other two children. She then devoted the rest of her life to caring for and teaching Maxine to the extent possible.

There were no public schools to help the mentally challenged at the time any more than there were facilities to aid those with physical disabilities. But my mother, with infinite patience, taught my “profoundly retarded” (that was her diagnosis) sister to read and do simple arithmetic on perhaps a second-grade level. In addition, Maxine was accepted into a private school for those with disabilities run by the Catholic Church in Brooklyn, which further helped her development.

My sister was a delightful member of our family with a wickedly good sense of humor and a heart full of kindness and love. She enriched all our lives and lived until 2008, something of a record for those with Down syndrome.

Maxine was unlucky to be born with a severe disability and in the first half of the 20th century. But she was incredibly lucky to have my father and mother as her parents. My mother completely ignored the stares of passersby on the streets and on the buses of New York who had never before seen a person with Down syndrome. She valiantly withstood the ire of her sisters, who emotionally urged her to “put Maxine away,” the euphemistic phrase for institutionalizing, because she would ruin the good marriage prospects of the next generation if she were seen. And she integrated Maxine into her daily life to the edification of the neighborhood, whose residents came to greatly respect my parents and enjoy Maxine.

Happy Birthday, Mom.

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I’m going to start with a headline relationship that would make Niccolò Machiavelli proud and work my way toward life on Main Street. You remember Machiavelli? That’s the author who wrote “The Prince,” which was first published way back in 1532, about how to manipulate people to survive and use any means available.

Wait, please don’t go. There won’t be a test and that’s the last date I’ll put in this column. Promise.

So, I’m thinking about relationships because of the new and improved dynamic between President Donald Trump and his Best Friend for Now — BFN, anyone? — Sen. Mitch McConnell. After a few tough losses, the Republican leaders seemed testy in their exchanges.

No, no, they said earlier this week, that wasn’t so. They are buddies and they agree on everything. Well, almost everything. According to sources, the senior senator also wants two scoops of ice cream when he visits the White House, but the commander in chief has no intention of changing his ice cream policies, even for his BFN.

Anyway, what brought these two older white men together? Did they talk about what it’s like to be misunderstood? Were they eager to find a friend in Washington, D.C., and did neither of them want to get a dog, as the expression goes?

No, they came together because they need to. It’s so much easier, they decided, to agree and to work together than to disagree. That sounds reasonable, but what would Machiavelli think? I suspect he’d be thrilled. After all, it’s about surviving, learning to fight another day and moving the chess pieces of life around on the board. Fortunately, and I won’t put the date in here because I don’t want to break my promise, chess was invented before “The Prince” was published. If you want to find it, you can look it up on the internet, which is the source of all information and misinformation in the universe. So, Machiavelli would have known about chess and the need to sacrifice the short-term humiliation of needing anyone and the mutually assured long-term gain of having allies in Washington.

OK, so let’s step away from the seat of our democracy and go out into the real world. Why do the rest of us need relationships and what can they do for us?

Are we like ants and bees, who need each other for specialized jobs?

Yes and no. Certainly, I would have a hard time building my own house. I feel as if I have an incompetence allergy to the words “some assembly required.” I am also visual-arts deficient. People offer all kinds of false modesty, saying things like, “I used to ski a little” or “I used to do a bit of singing,” when they almost made the Olympic team and were a few auditions short of starring next to Julie Andrews on Broadway. I, however, am not being modest. If I were responsible for building walls and decorating them, we’d be living in caves and would be staring at uninspiring chalk drawings of woolly mammoths.

So, yes, our individual deficiencies suggest we do need each other. But, maybe, we benefit not just what we get from others.

One of my good friends is in a new relationship. He has always been in decent physical shape. He’s not much of a reader and has shied away from even the shortest of reading assignments. Anyway, he’s dating a woman who is a regular runner and an avid reader. Lo and behold, he recently beamed after completing a half marathon and is happily building his own personal library.

Maybe the best and longest lasting relationships are those that push us to find the best in ourselves. It’s not exactly Machiavelli 101 and it doesn’t require a press conference, but maybe the right relationships are those that help us develop in unexpected ways.

Adam Gonzalez. Photo from SBU

By Daniel Dunaief

More than four days after lift off, pioneering astronauts Neil Armstrong and Buzz Aldrin had landed in the Sea of Tranquility on the surface of the moon. The NASA schedule, which included preparing the vehicle for an emergency abort of the mission in the event of a problem, called for a nap of four hours. Once they were there, however, Armstrong and Aldrin couldn’t imagine taking a four-hour respite.

“Both Armstrong and Aldrin were, understandably, excited about where they were and decided to forgo the sleeping and changed history,” Thomas Williams, element scientist in Human Factors and Behavioral Performance at NASA, described in an email.

A future trip to Mars, however, would involve considerably longer delayed gratification, with the round trip estimated to take over 400 days. The stresses and strains, the anxiety about an uncertain future and the increasing distance from family and friends, not to mention the smell of cut grass and the appearance of holiday decorations, could weigh on even the most eager of astronauts.

Determined to prepare for contingencies, NASA is funding research to understand ways to combat the mental health strains that might affect future astronauts who dare to go further than anyone has ever gone.

‘Being in long-duration space missions with other people, we expect the mental health risk will be much more elevated’. — Adam Gonzalez

Gonzalez, an assistant professor of psychiatry at Stony Brook University, received over $1 million in funding from NASA to explore ways to help these future astronauts who might be anxious or depressed when they’re on the way to the red planet.

In a highly competitive process, Gonzalez received the financial support to provide guidance on what NASA considers a low-probability, high-consequence mental health event, according to Williams.

Gonzalez “was funded because of the soundness of his research proposal and the clinical and technological expertise of the research team he assembled to help NASA address this research gap,” Williams explained.

Gonzalez started providing three different types of psychological assistance to 135 people in the middle of September. He is testing ways to provide mental health assistance with a delay that could require over 40 minutes to travel back and forth.

One group of test subjects will use a system called myCompass, which is a mental health self-help program. Another group will use myCompass coupled with a delayed text messaging response from a therapist, and a third will have a myCompass system along with delayed video messaging from a therapist.

“Being in long-duration space missions with other people — in this case, months and potentially years — stuck in extremely close quarters with others, we expect the mental health risk will be much more elevated relative to what they are going to have on the International Space Station,” Gonzalez said.

Williams said astronauts to date have not had any diagnosable disorders, but NASA has seen fluctuations in their mood, which appears linked to workload demands and the phase of the mission, Williams said. For astronauts, NASA does not want a continuing negative trend that, over a longer term, could turn into a problem.

“Part of what we hope to achieve with [Gonzalez’s] research is a validated approach to address any of these concerns,” Williams said, adding that astronauts typically understand that their contributions involve work in “high-demand, extreme environments,” Williams said.

Still, like explorers in earlier centuries, astronauts on a trip to Mars will journey farther and for a longer period of time than anyone up to that point. MyCompass is a “good, efficacious program” that takes a “trans-diagnostic cognitive behavioral therapy approach,” Gonzalez said. He suggested that the program is broad enough to help individuals manage their emotions more generally, as opposed to targeting specific types of health disorders.

Gonzalez emphasized that the choice of using myCompass as a part of this experiment was his and might not be NASA’s. The purpose of this study is to investigate different methods for communicating for mental health purposes when real-time communication isn’t possible.

William suggested that Gonzalez’s work, among others, could lead to individualized procedures for each astronaut. In addition to his work with NASA, Gonzalez also assists people at the front lines after man-made or natural disasters. He has worked with Benjamin Luft, the director of Stony Brook University’s WTC Wellness Program, on a program that offers assistance to first responders after the 9/11 attacks.

Gonzalez’s father, Peter, was a police officer who worked on the World Trade Center cleanup and recovery efforts. The elder Gonzalez has since had 9/11-related health conditions.

Gonzalez and associate professor Anka Vujanovic, the co-director of the Trauma and Anxiety Clinic at the University of Houston, are putting together a research project for the Houston area. Vujanovic did a mental health survey on Houston area firefighters earlier this year. They are inviting these firefighters to complete an online survey and telephone assessment to determine their mental health after Hurricane Harvey.

They are also conducting a three- to four-hour resilience training workshop for Houston area firefighters engaged in Harvey disaster relief efforts. “This resilience program, developed by [Gonzalez] and his colleagues, has shown promising results in reducing various mental health symptoms when tested among first responders in the aftermath of Hurricane Sandy,” Vujanovic explained in an email.

Vujanovic has known Gonzalez for over 10 years and suggested his questions were focused on “how can we better serve others, how can we improve existing interventions and how can we develop culturally sensitive approaches for vulnerable, understudied populations.” Gonzalez, who grew up in Bensonhurst, Brooklyn, and came to Stony Brook in 2012, said he was always interested in helping others.

Williams suggested that this kind of research can help people outside the space program. “We openly share and encourage the sharing of any of our relevant research findings to help address societal needs,” he added. Gonzalez’s research is “a great example of how a NASA focus on delivering personalized interventions in support of long-duration spaceflight could potentially be generalized to more rural settings where mental health providers may be scarce.”

Lower triglycerides may reduce cardiovascular risk

By David Dunaief, M.D.

Dr. David Dunaief

The lipid, or cholesterol, profile is one of the most common batteries of blood tests. Why? Abnormal cholesterol levels may have an integral role in exacerbating a number of chronic diseases. These diseases are some of the most common, including atherosclerosis (hardening of the arteries), cardiovascular disease (heart disease and stroke) and vascular dementia. It’s even thought to be a component of age-related macular degeneration, the number one cause of vision loss in those who are at least age 60 in industrialized countries (1).

Let’s delve into the components that make up the cholesterol profile. The lipid panel is made up of several components. These include total cholesterol, HDL or “good cholesterol,” LDL or “bad cholesterol” and triglycerides. Many people focus more on total cholesterol, HDL, and LDL and less on triglycerides. We worry about whether the levels are high enough for HDL and are low enough for total cholesterol and LDL. Is this the proper focus? With total cholesterol and LDL, this seems to be appropriate.

However, with HDL it is becoming more complicated; it is less about how high the levels are and more about the functionality of HDL. There are drugs that increase HDL levels, such as niacin and the fibrates, without significantly reducing cardiovascular events. This was demonstrated in the AIM-HIGH trial (2). In this trial, niacin added to a statin drug increased HDL levels and decreased triglyceride levels without a change in the primary end point of cardiovascular outcomes. Thus, they were deemed less than satisfactory and the trial was abruptly ended. However, triglycerides get the short end of the stick. Just look at the lack of coverage in the mainstream media. In this article, we will explore the different components of the lipid panel and the supposed roles they play in our health. Let’s look at the research.

HDL — the good cholesterol that may not be so good

Eating one-and-a-half cups of oatmeal each day can lower your cholesterol by 5 to 8 percent.

For years, when patients were told their total cholesterol and LDL are high, they asked if their HDL levels compensated for this. Of course, we in the medical community are partially to blame for fueling this thinking. More and more studies point to the importance of HDL functionality rather than the level.

In a study investigating a specific gene variant, or mutation, those who had very high levels of HDL, a mean of 106 mg/dL, and two copies of a P376L mutation, had an increased risk of heart disease (3). In a population of 300 participants with this very high level of HDL, only one had this mutation.

When the investigators broadened the number to 1,282 participants, the results were the same. Results were consistent when they looked at a meta-analysis of 300,000 participants with high HDL.

Carriers of the gene mutation, meaning they had one copy instead of two, were at a 79 percent increased risk of heart disease. Those who had this gene mutation were mostly Ashkenazi Jews of European descent. The good news is that this gene mutation is rare. However, it does show that in certain circumstances, HDL is not always good.

Lest you become too relaxed about this study, since the occurrence was uncommon, another study’s results showed that there is a U-shaped curve when it comes to HDL levels (4). In other words, those on the lowest and the highest ends of HDL levels had higher risk of death from both cardiovascular and noncardiovascular death. There were associations among HDL and other factors, like vegetable and fruit consumption, high blood pressure, diabetes, age and sex. Thus, HDL may not by itself be an indicator of heart disease death risk as suggested by the investigators in the trial. This was a large population-based study with over 600,000 participants.

In a third study, results showed that functionality is more important than HDL level (5). What is called the cholesterol-efflux capacity may be central to HDL functionality. This technique calibrates the reverse transport of cholesterol. Cholesterol is removed from a type of white blood cell in the wall of the artery, put back into the bloodstream and removed by the liver. The importance of the functionality is that a higher cholesterol-efflux capacity results in a lower risk of cardiovascular disease. In other words, you may not be able to rely on HDL levels to determine cardioprotective effects.

Triglycerides should get their due

Triglycerides need their 15 minutes of fame, just like the rest of the cholesterol profile. Triglycerides may be an independent risk factor for cardiovascular disease. In a study, results showed that triglycerides are an independent risk factor for all-cause mortality in those with heart disease (6). But even more interesting is that those with high normal levels, those between 100 and 150 mg/dL, have a significantly increased risk of cardiovascular death. In other words, those who are still within normal limits, but at the upper end, should consider reducing their levels.

The results also showed a dose-dependent curve; the higher the levels of triglycerides, the higher the risk of death from cardiovascular disease. Measurements used included borderline high of 150-199 mg/dL, moderately high of 200-499 mg/dL and very high of >500 mg/dL. This was a secondary prevention trial, meaning the patients already had heart disease. Unfortunately, a disproportionate number of patients were men, 81 percent. However, this study had a strong duration of 22 years with data based on 15,000 patients. The weakness of this trial was its inability to control for confounders such as sickness, treatments and cause of death. Still, this signifies that triglycerides have an important role in our health.

Triglycerides are affected by diet. The elements in the diet that raise levels include sugars, grains — for some even whole grains — and starchy vegetables as well as saturated fats and trans fats.

What about whole eggs? Good, bad or neutral?

Today, the debates in the medical community over eggs’ merits, detriments or neutrality continue. In an observational trial from Finland, results show that one egg a day did not increase the risk of heart disease (7). Whew, now we can put that debate behind us and eat eggs, right? NOT SO FAST!

While the strength of the trial was its very impressive duration of 21 years, the weaknesses of the trial were huge. First, participants were asked for a four-day dietary history at the start of the trial and then never again. It was assumed that they were eating the same foods over this long time period. Second, there were no blood tests taken specifically for the study. In other words, there are no cholesterol levels for the trial. So we don’t know if one egg a day — and remember we’re making a gigantic assumption that they did eat one egg a day — had any negative impact on cholesterol levels. Third, this study population did not include women. There were 1,032 men involved. Having said all this, you could try an egg a day. However, I would highly recommend a physician’s supervision.

In my practice, I had several patients eat two eggs a day, and their total cholesterol levels went up by approximately 100 mg/dL in one month. But this is anecdotal data from my clinical experience.

In conclusion, don’t think you’re safe if you have a high HDL level. It is best to lower your triglycerides to below 100 mg/dL, and an effective way to do this is by reducing sugars, grains, starchy vegetables and saturated fat in your diet. However, there is subset data suggesting that the fibrate class of drugs may have benefit in those who have triglycerides of at least 500 mg/dL (6).

References: (1) www.nlm.nih.gov. (2) N Engl J Med 2011; 365:2255-2267. (3) Science 2016; 351:1166-1171. (4) AHA 2015 Scientific Sessions; Nov. 10, 2015. (5) N Engl J Med. 2014;371(25):2383-2393. (6) Circ Cardiovasc Qual Outcomes 2016;9:100-108. (7) Am J Clin Nutr. 2016;103(3):895-901.

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.

A pet trust is effective immediately upon your death whereas a will can take months to execute.

By Linda Toga

Linda Toga, Esq.

THE FACTS: My mother has a dog, Fido, who means the world to her. When it comes to Fido, money is no object. She is very concerned about what will happen to Fido when she dies. Not only does she worry about who will care for Fido but also about who will pay for Fido’s care.

THE QUESTION: Should these issues be addressed in her will?

THE ANSWER: While the long-term care of Fido can be addressed in her will, your mother needs to make arrangements for Fido’s care for the period immediately following her death because the provisions of her will are not effective until the will is probated. That could take some time.

I always suggest that pet owners arrange in advance for someone to take care of their pet in the event they are unable to do so either because of disability or death. It is important that a caregiver is identified and is ready and willing to take the pet on relatively short notice. These temporary arrangements need not be in writing unless the owner feels that people are going to fight over who will care for the pet.

For example, if you and your siblings agree with your mother that Mary will take care of Fido, there is no need to put the arrangement in writing. However, if all of you want to take care of Fido, your mother should put her wishes in writing to avoid conflicts.

As for the long-term care of Fido after your mother’s passing and the cost of that care, I suggest that your mother include in her will a pet trust. When thinking about the provisions to include in the pet trust, your mother should not only consider who will care for Fido for the rest of his life but also whether the appointed caregiver has the resources to cover the costs associated with pet ownership.

Even if money is not an issue for the caregiver, your mother should confirm in advance that the caregiver’s living arrangements are suitable for Fido. Some apartment buildings and residential communities do not permit residents to own pets. If the caregiver of choice lives in such a community, or lives in a setting that is not large enough for Fido, your mother should consider naming someone else to adopt Fido after her death.

Once she has settled on a caregiver, your mother should think about the types of care she wants Fido to receive after she is gone. For example, does she want Fido groomed once a month or to have his teeth cleaned three times a year? Does she want Fido to be fed certain types of food? Does Fido suffer from any ailments that require medication or close monitoring? If so, these things should be addressed in the pet trust. If your mother has been using the same groomer and vet for years, she may want the caregiver to continue using the same providers. This is particularly important if Fido is receiving any specialized care or treatment. If this information is not included in the pet trust itself, your mother definitely should provide this information to the caregiver in a letter.

While the reason for including a pet trust in her will is to ensure that Fido will be cared for after she dies, it can also serve as a vehicle for providing the caregiver with instructions with respect to the handling of Fido’s remains after he dies. This information is important and useful to the caregiver who will certainly want to honor your mother’s wishes.

In addition to setting forth in the pet trust the name of the caregiver and the type of care she wants Fido to receive, both during his lifetime and upon death, your mother will need to allocate a certain amount of money to the trustee of the pet trust.

The job of the trustee is to distribute the funds in the trust to the caregiver as needed to be used for Fido’s benefit. The money will be used to pay for Fido’s food and care, but your mother can also allocate some of the money in the trust directly to the caregiver in recognition of the time, effort and responsibility he/she assumed by caring for Fido. If she wants, your mother can name the caregiver as trustee of the pet trust. She need not name two different people for these roles.

A final decision that your mother will have to make in connection with the pet trust is what happens to any of the funds left in the trust after Fido dies. Many people who have a pet trust direct that any money left in the trust after the death of their pet goes to the caregiver. Another popular arrangement is for the money to be donated to an organization that cares for abandoned and/or abused animals. Of course, your mother can also have the funds left in the pet trust divided between you and your siblings. Regardless of how she wants the funds distributed, it is important to include her wishes in the pet trust.

In light of the number of issues, your mother should discuss if she wants to create a pet trust, and the fact that it will be part of her will, with an experienced estate planning attorney. That is the best way to ensure that Fido will be cared for in accordance with her wishes.

Linda M. Toga, Esq. provides legal services in the areas of estate planning, probate, estate administration, litigation, wills, trusts, small business services and real estate from her East Setauket office.

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The informal gardens at Beatrix Potter's Hill Top Farm

By JoAnn Canino

Documenting your garden by keeping a garden journal not only creates a complete record but also allows you to make informed decisions to improve your garden from season to season. Now is a good time to start a garden journal. It is a way of extending the joy we get from our gardens well into the winter months.

Keeping a journal can be as simple as making notations in a notebook as you make your daily rounds in the garden. I use a lined composition notebook for observations and an unlined sketchbook to make drawings. To organize my notes, sketches and research I use a loose-leaf binder divided into sections. Setting up the binder, include a pocket to save plant tags, seed packets and receipts. Use graph paper for sketching layouts of each bed.

Sissinghurst Castle Garden

Vita Sackville-West, a noted garden writer, and her husband, Harold Nelson, diplomat and journalist, designed the Sissinghurst Castle Garden in Kent, England. They suggested careful planning should begin with a detailed architectural drawing that includes plans for color and seasonal changes.

Make lists of plants you would like to try. Keep plant profiles: date planted, care instructions, watering and fertilizing schedules. Include sketches and photos. For the kitchen garden, keep a plant and seed tracker. Include seed sources, date planted and germination date. Note success rate and expected harvest yield. Details can be recorded in your notebook then transferred to index cards for easy reference. Track the weather from season to season: Note dates of frost this year as compared to last year. How many inches of rain actually fell? How many days of sunshine? Remember to add photos to document the changes.

Monticello vegetable garden

Thomas Jefferson, president, architect, scientist and gardener, kept detailed notes of his observations and activities in his “Garden Kalender.” He noted dates seeds were planted, harvest schedules and when the beds were manuered at his plantation in Monticello. His notes were as simple as, “Peas killed by frost. Oct. 23, 1809.” But Jefferson’s vegetable garden was set up for experimentation. He imported squashes and broccoli from Italy, beans and salsify collected by the Lewis and Clark expedition, figs from France and peppers from Mexico. Jefferson’s intention was to eliminate “inferior” varieties. “I am curious to select one or two of the best species or variety of every garden vegetable and to reject others from the garden to avoid the dangers of mixing and degeneracy,” he wrote.

Recording your experiences and observations will allow you to develop a greater awareness of the changes that occur from day to day and from season to season. Be open to discovery, use your senses to look closely at nature in your own backyard. Listen to sounds and look for patterns. Create a habitat for wintering wildlife. Put up a birdbath or a small pond. Plant native plants, mulch leaves and add bird feeders.

The Mount garden

If you are exploring different garden themes, it is helpful to have a section in the binder for pictures of gardens that inspire you as well as articles and research on the typical needs of each design. For example, a formal garden with groomed hedges and a balanced symmetry would follow an Italianate design. Edith Wharton’s garden, The Mount, in Lenox, Massachusetts, follows this formal plan. Her gardens were a source of inspiration for her writing.

Beatrix Potter at Hill Top Farm in the Lake District, England, followed the philosophy of William Morris of the Arts and Crafts Movement, which celebrated fine craftsmanship. While she had a separate walled vegetable garden, her beds and borders were informal.

She mixed hardy flowers with bulbs and fruit shrubs. As an artist and naturalist, she made detailed studies of the plants and animals on her farm. Her much loved “Tales of Peter Rabbit” have entertained many readers. Illustrations for her books were painted in her garden.

Between 1883 and 1897, Potter studied and painted mushrooms and lichens. Her paper, “On the Germination of the Spores of Agaricinae,” was based on these studies. Consider how you are a part of the ecosystem and let your garden be your inspiration for writing, drawing and discovery.

Autumn tips for your garden

•Take time to observe where the sunlight falls now.

• Fill any gaps in borders with autumn flowering plants such as sedum, asters and chrysanthemums.

• Continue to feed and deadhead the hanging baskets to extend the color.

• As the weather cools, bring indoor plants back inside.

• Refresh the soil and repot to avoid bringing insects inside.

• Select flowering bulbs: tulips, narcissi, hyacinths, iris, allium and fritillaries to plant as temperatures cool.

• Cut hydrangea flowers for fall table designs and wreaths.

JoAnn Canino is an avid journal writer and gardener and a member of the Three Village Garden Club.

New England Clam Chowder

By Barbara Beltrami

If you’re wondering what the difference is between soup and chowder, don’t ask me. I have no idea, nor can I find anyone who knows. I do know they both are chunky mixtures with some featured ingredient usually enhanced by potatoes, celery and onions, sometimes cream, sometimes broth, often bacon and a few other veggies or herbs.

Most chowders I’ve come across emanate from New England, feature clams or local fish and are thick and creamy … except for Rhode Island’s which has a relatively clear broth and is full of the above-mentioned seafood as well as lots of diced veggies. Moving down the eastern seaboard we come to New York and its Manhattan clam chowder (which appalls New Englanders, by the way), which features tomatoes as well as lots of the potatoes and celery and generous sprinklings of thyme.

Then there is Maryland and its crab chowder. All this is not to say that chowders are indigenous to the east coast and middle Atlantic states. Further south chowders feature shrimp and other local products and across the continent it is hardly surprising to find salmon chowder from Washington, Oregon and Alaska.

What this tells us is that the best food comes from the nearby land and sea and that what is available is the engine that drives local and regional recipes. In the interests of geographic diversity I offer you New England Clam Chowder and Manhattan Clam Chowder. And some other time we’ll go into all the vegetarian versions of chowder … corn, bean, veggie, tofu … all of which corroborate my opening question. Really, what is the difference between soup and chowder?

All this is not to say that chowders are indigenous to the east coast and middle Atlantic states. Further south chowders feature shrimp and other local products and across the continent it is hardly surprising to find salmon chowder from Washington, Oregon and Alaska.

What this tells us is that the best food comes from the nearby land and sea and that what is available is the engine that drives local and regional recipes. In the interests of geographic diversity I offer you New England Clam Chowder, Manhattan Clam Chowder and Pacific Salmon Chowder. And some other time we’ll go into all the vegetarian versions of chowder…corn, bean, veggie, tofu…all of which corroborate my opening question. Really what is the difference between soup and chowder?

New England Clam Chowder

New England Clam Chowder

YIELD: Makes 6 to 8 servings

INGREDIENTS:

3 slices thick bacon, cut into thin strips crosswise

3 tablespoons unsalted butter

2 medium onions, diced

3 celery ribs with leaves, diced

4 cups clam broth

2 large potatoes, peeled and diced

¼ cup chopped fresh flat-leaf parsley

1 tablespoon fresh thyme leaves

One whole bay leaf

Salt and freshly ground pepper, to taste

1 cup half-and-half or light cream

2 cups chopped cooked clams, preferably fresh

DIRECTIONS: Place a large heavy saucepan or Dutch oven over medium heat, add bacon and cook until golden and just crisp. Remove pan from heat, drain bacon fat from pan, but leave bacon. Add butter to pan. Melt over low heat, add onions and celery and cook, stirring frequently, until the pieces are opaque and soft, about 10 minutes. Add the clam broth, potatoes, parsley, thyme, bay leaf and salt and pepper; cook over medium heat until potatoes are tender, about 10 to 15 minutes; discard bay leaf. Scoop 1½ cups of solids and ½ cup of liquid out of pot and transfer to food processor. Puree until smooth, then return to pot. Add cream and bring to a boil. Remove from heat, stir in clams and serve immediately with saltines, oyster crackers or pilot crackers.

Manhattan Clam Chowder

Manhattan Clam Chowder

YIELD: Makes 6 to 8 servings

INGREDIENTS:

4 dozen cherrystone clams

3 tablespoons olive oil

2 tablespoons unsalted butter

2½ cups diced onions

2 cups diced celery

1 cup diced carrots

One large clove garlic, minced

3 cups diced tomatoes

2½ cups dry white wine

3 cups peeled diced potatoes

1 tablespoon fresh thyme leaves or 1 teaspoon dried

Sea salt and black pepper, to taste

DIRECTIONS: Place 3 cups water and clams in a large shallow pan; cover and cook over medium heat until clams open, 5 or 6 minutes. With tongs remove clams from pan and set aside until cool enough to handle. Strain liquid several times through fine mesh sieve; set liquid aside. Place oil and butter in a large pot over medium heat. Add onions, celery, carrots and garlic and cook a few minutes until vegetables are slightly softened. Add tomatoes, 2½ cups of the clam broth, the wine, 4 cups water, the potatoes and herbs and simmer until potatoes are tender, about 10 to 15 minutes. Meanwhile remove clams from shells, dice, add to pot and simmer 3 to 5 minutes until heated through. Season with salt and pepper. Serve with saltines, oyster crackers or garlic bread.

Pacific Salmon Chowder

Pacific Salmon Chowder

YIELD: Makes 4 servings

INGREDIENTS:

4 slices bacon

½ cup diced onion

2 cups very hot fish broth

1 cup diced potatoes

1 pound fresh salmon, skinned, boned and cubed

2 cups hot milk

Salt and freshly ground black pepper, to taste

1 tablespoon chopped fresh flat-leaf parsley

1 tablespoon chopped fresh dill

DIRECTIONS: In a large skillet cook bacon until crisp. Remove and crumble; set aside. Saute onion until tender in remaining bacon fat. Gently and carefully pour in hot fish broth and potatoes and cook over low heat until potatoes are tender. Add salmon and cook until tender but not falling apart, about 10 minutes. Add milk, reserved bacon, salt, pepper and herbs and gently reheat. Serve with buttered pumpernickel toast and cucumber salad.