PARTY OF SEVEN Jane Edsall spotted this family of mute swans swimming in Mount Sinai Harbor two weeks ago. She writes, “I am a resident of Mount Sinai and have enjoyed the harbor and its wildlife my whole life.” Brought to this country from Europe in the mid-1800s to adorn city parks and large estates, mute swans are known to mate for life. The cygnets will stay with their parents through the first winter.
Send your Photo of the Week to [email protected].
By Barbara Beltrami
Some of you may remember Starkist’s Charlie the Tuna, the suicidal fish who boasted about the superiority of his peers who made it to the cannery. I don’t even know if he’s still around, but I do know that good tuna is a real treat whether it’s white albacore whipped into a salad with mayonnaise and celery and maybe a little onion or belly tuna packed in olive oil and served as part of an antipasto or just a fresh tuna steak, seasoned, then seared on the outside and rare or raw on the inside.
Beyond these basic and familiar tuna preparations are myriad dishes that seem to emanate particularly from the Mediterranean countries and are real palate pleasers. An unusual summer sandwich is something called pan bagnat, French for “wet bread,” composed of tuna, olive oil, vinegar, tomatoes and anchovies plus variable other ingredients on crusty French bread. Now think about a fresh grilled tuna burger with wasabi mayonnaise or tonnato sauce, a creamy tuna emulsion that is as good as a dip as it is as a sauce.
Pan Bagnat
YIELD: Makes 4 servings
INGREDIENTS:
One crisp-crusted baguette about 18 inches long
4 to 6 flat anchovies
¼ cup extra virgin olive oil
1 tablespoon red wine vinegar
½ teaspoon Dijon mustard
½ teaspoon coarse sea salt or to taste
Freshly ground black pepper, to taste
Two 6-ounce cans oil-packed tuna with their oil
One medium red onion, peeled and cut into thin rings
Two hard-boiled eggs, sliced thin
½ cup chopped Kalamata olives
One large firm ripe tomato, thinly sliced
DIRECTIONS: Slice the baguette in half along its length. Scoop out enough of the soft part of the bread inside to make a well in each half. With a fork, evenly distribute the anchovies along the length of the bottom half of the bread. In a small bowl, whisk together the olive oil, vinegar, mustard, salt, pepper and oil from tuna until it forms a creamy emulsion. Place the tuna, onion, eggs, olives and tomato in order given on top of anchovies. Drizzle oil mixture evenly over layered ingredients and immediately cover with top half of baguette. Wrap tightly in plastic wrap, set on a flat surface at room temperature and weight down with a heavy skillet in which have been placed a couple of heavy cans or objects. Let sit at least two hours; then slice into four sandwiches. Serve with potato salad or chips, fruit and cheese and a light red wine or ice cold beer.
Tuna Burger with Wasabi Mayonnaise
YIELD: Makes 4 servings
INGREDIENTS:
1 tablespoon sesame oil
1 tablespoon soy sauce
½ teaspoon dried hot red pepper flakes
1 pound ahi or sushi-grade tuna, finely chopped
One egg, beaten ¼ cup minced onion
½ cup bread crumbs
Coarse sea salt to taste
Freshly ground black pepper to taste
1 tablespoon wasabi powder
1/4 cup mayonnaise
4 hamburger rolls
1 cup lettuce leaves, washed and dried
4 slices tomato
DIRECTIONS: In a medium bowl whisk together the sesame oil, soy sauce and pepper flakes. Add tuna, egg, onion, bread crumbs and salt and pepper. Mix thoroughly and form into four patties, cover and refrigerate half an hour. Meanwhile, preheat grill on high and mix wasabi powder with two teaspoons warm water; add resulting paste to mayonnaise and mix thoroughly. Grill tuna patties one and a half minutes on each side for rare, longer for medium and well done. Place on bottom halves of rolls, top with lettuce and tomato and spread top halves with wasabi mayonnaise. Serve immediately with potato chips or french fries and cole slaw.
Tonnato (Tuna) Sauce or Dip
YIELD: Makes 1½ cups
INGREDIENTS:
One 4-ounce jar Italian oil-packed tuna with oil
3 anchovy filets, chopped
1½ tablespoons capers, drained and rinsed
1 tablespoon fresh lemon juice
½ cup extra virgin olive oil
3 tablespoons mayonnaise
1/3 cup chopped Italian flat-leaf parsley
Freshly ground black pepper, to taste
DIRECTIONS: Puree all ingredients in electric food processor until smooth. Cover and refrigerate until ready to use. Serve with crostini, potato chips, crackers, crudités or over simply seasoned pork, fish, chicken, veal or pasta.
By David Dunaief, M.D.
What better way to start an article than with a pretest?
1) What minimum amount of exercise will reduce cardiovascular disease risk?
a. 5 to 10 minutes per day b. 30 minutes most days c. 60 minutes most days d. I don’t care — I don’t like pretests
2) How does inactivity affect menopausal symptoms?
a. Increases hot flashes b. Worsens risk of anxiety and depressive moods c. Decreases memory and concentration d. B and C
3) Exercise may have an impact on the following: a. Changing gene expression b. Metabolic aging c. Weight management d. All of the above
With all that’s been written about exercise in the past few years, I’ll bet you did well. The answers to the quiz are: 1) a, 2) d, 3) d. Before we go further, let’s differentiate between physical activity and exercise. Physical activity involves skeletal muscle contraction. It’s an umbrella term that includes exercise, but it also includes housework, yard work, movement on the job, etc. Exercise involves repetitive movements, structure and goal orientation such as walking, running, resistance training or playing sports (1). While you want to be physically active, exercise has more benefit.
We have long-held paradigms in medicine that may or may not be accurate. Medicine is always changing with the evolution of evidence-based research. We know that exercise has benefits for helping to prevent and possibly reverse some chronic diseases, but it also may have benefit for menopausal symptoms, slowing the metabolic aging process and even changing our genes, or at least gene expression.
The Fountain of Youth
Ponce de León sought a physical fountain of youth. While we tend to chuckle at that thought, metaphorically there may be at least some truth to the mythical fountain. Exercise may be a step toward reversing the metabolic clock. Until recently, we thought that when we hit 40 years old, we should expect a decline in physical abilities, with each passing year raising the probability of greater muscle atrophy. This may not actually be the case. Just because a paradigm has been around a long time does not make it correct.
In a small observational study, results showed that the participants, spanning ages 55 to 79, were unable to be differentiated based on age for the majority of tests (2). In other words, those who were in their 70s performed similarly to those in their 50s for many, but not all, parameters. It would be impossible to tell who was what age based purely on the data.
Participants were also compared to standards related to typical aging in each group, such as comparing 70-year-old cyclists versus inactive 70-year-olds. The ones who were cyclists were metabolically much younger. Thus, the researchers concluded that activity, rather than chronological age, may play a more important role in the aging process. The cyclists were not professional athletes, though they were required to pass a cycling endurance test prior to being accepted into the study. To at least some degree, we are more in control of our aging than we had thought. This is good news; we would all like to turn back the physical clock.
Can we really change our genes?
One of the greatest achievements of modern medicine has been mapping the human genome. However, gene therapy mostly has lagged. Well, there is a field called epigenetics. This word literally means “above” or “on” the gene. Epigenetics explores how to alter which of our genes get expressed and how. How can we do this? Methyl groups, one of the most basic groups of atoms in organic chemistry, latch on to genes and help to turn on and off their expression. Lifestyle modifications, like exercise, influence methylation groups to affect genes.
In a small study, results showed greater than 5,000 alterations in the genes of muscle cells such that there were different patterns of methyl groups that occurred in exercised legs compared to inactive legs (3). The genes that were affected are known to be involved in insulin sensitivity and inflammation. Let me explain further.
The researchers had 23 healthy volunteers use a stationary bike for 40 minutes, four times a day, for three months. Here is the catch: Participants only used one leg and did not exercise the other leg, limiting confounding variables. In the same participant, the leg that was exercised had dramatic changes in gene expression, whereas the other leg did not.
How can exercise elongate cell life?
In another study, exercise appeared to prevent or reduce the risk of shortened telomeres. Telomeres are important for protecting the DNA and, ultimately, the cell (4). There were four different categories of exercises surveyed. If respondents said yes to each category, there was an exponentially greater chance that they would not have very short telomeres.
The categories included walking, running, walking/riding a bike to work or school and weight lifting. When a participant was involved in one category in the previous month, there was a 3 percent reduced risk of shorter telomeres, whereas participants who were involved in all four categories had a 59 percent reduced risk of having very short telomeres. This greatest impact was seen in adults between ages 40 and 65.
Menopause symptoms
Although menopause is a rite of passage for women, not a disorder, there are symptoms that may negatively impact quality of life. Exercise may help alleviate menopausal symptoms. In a study, women who exercised regularly (resistance training twice weekly, plus either 150 minutes weekly of moderate activity, like walking, or 75 minutes weekly of intense exercise, like jogging or running) had a better overall sense of well-being and fewer symptoms during menopause compared to their less active counterparts (5). Those who were less active were more likely to be in depressed/anxious moods, have “brain fog,” difficulties with memory and concentration and experience increased vasomotor symptoms. Interestingly though, there was no change in hot flashes between the two groups.
I don’t have time to exercise!
There have been several studies that have shown that you can have obscenely short intervals of exercise and still get significant benefit. In one study, a one-minute intensive interval was broken into 20-second intervals within 10 minutes of exercise three times a week (6). Overweight participants had improved blood pressure and endurance capacity, as well as beneficial gains among other parameters.
In another study, as little as five to 10 minutes of running a day reduced the risk of dying from any cause by 30 percent and dying from heart disease by 45 percent (7). The best part of the results was that there was a significant difference between runners and nonrunners, but not between those who ran at a less-than-six-minute-mile pace and those who ran at a slower-than-10-minute-mile pace.
References: (1) uptodate.com. (2) J Physiol. online Jan. 6, 2015. (3) Epigenetics. Dec. 7, 2014. (4) Med Sci Sports Exerc. 2015;47(11):2347-2352. (5) Maturitas. 2015 Jan;80(1):69-74. (6) PLoS One. 2014;9(11):e111489. (7) J Am Coll Cardiol. 2014;64(5):472-481.
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.
By Fr. Francis Pizzarelli
We are a nation out of control. The partisan divide has become almost unbridgeable. Our social media is feeding a frenzy that has little respect for human dignity and basic human rights. Where is the notion and concept of accountability? We need to hold each other accountable for the choices we make. We must lead by example and it must begin at the top!
The president is our president; he must lead by example, words and deeds. He should be the principal architect of our national social discourse. We should be able to engage in difficult conversations without the fear of demeaning responses because we disagree!
Those men and women elected to lead us should be about leadership that builds bridges not walls, that unites not divides. They should be about a civil discourse that brings us together and does not polarize us. Unfortunately, there is no bipartisan dialogue or working together on building compromise.
The blame game must end. We must demand accountability from all who lead us in public life. Our elected representatives from both sides of the aisle must get about doing the people’s business. They must forge a bipartisan effort to solve the great problems facing our nation and work at creating a cooperative spirit that seeks common solutions that will resolve our problems and make America great!
Despite the social landscape, this year’s senior class is extraordinary. A growing number of our high school seniors are choosing career paths that serve the needs of others. There is such a positive spirit around community service and a spirit of inclusiveness that is refreshing, especially since we live in a world that seems more grounded in narcissism and self-centeredness, rather than thinking about others first, especially those in need.
Seniors, as you continue your journey do not let the social filters of our time enable bigotry, exclusivity and social injustice. Always try to realize that being human and sensitive to others is more important than a successful academic record. Showing compassion and understanding rooted in justice is more significant than a science formula. These are difficult lessons to learn because they demand that you risk all that you are now for what you could become tomorrow.
Look around you! We are living in a very challenging world. A new revolution is afoot. Your generation is moving away from the indifference and complacency of yesterday, and moving toward a new idealism of freedom and responsibility.
As you graduate from high school, keep these simple thoughts in mind: May you discover enough goodness in others to believe in a world of peace and to work for peace grounded in justice and human rights.
May a kind word, a reassuring touch and a warm smile be yours every day of your life. Remember the sunshine when the storm seems unending. Teach love to those who know hate and let that love embrace you as you continue in the world.
Don’t judge a book by its cover or stop at the introduction. Seek the meaning and messages it offers for life, for everyone’s life is sacred, even those who are different from you or who you do not like. Be more inclusive than exclusive. Don’t be blinded by those who tend to use shame, blame, guilt and religion to shackle people down and divide them. Set people free with your respect and nonjudgmental way.
May you never become too concerned with material matters, but instead place immeasurable value on the goodness in your hearts and the hearts of others. Find time each day to see beauty and love in the world around you. Realize you have limitless opportunities and possibilities.
Get up every day and be grateful for what you have. Suck the marrow out of life, as you face life’s challenges. Don’t see the glass as half empty; only see it as half full; see every life experience and human encounter as a learning experience, as an opportunity to grow and become more than you are now.
May your moral compass be grounded in respect for all human beings, no matter what their color, their race, their creed or their sexual orientation. May this compass guide you on a path that is committed to working for peace and social justice.
As Gandhi once said, “Be the change you hope for in the world.”
Congratulations graduates of 2017. Thanks for making the world a little richer, a little brighter and a better place to be!
Fr. Pizzarelli, SMM, LCSW-R, ACSW, DCSW, is the director of Hope House Ministries in Port Jefferson.
By Nancy Burner, ESQ.
For most of us, if a time ever comes when we need assistance, the preferred option would be to remain at home and receive whatever care services we need in our familiar setting surrounded by family. For many, the Community-Based Long-Term Care Program, commonly referred to as Community Medicaid makes that an affordable and viable option.
Often we meet with families who are under the impression that they will not qualify for these services through the Medicaid program due to their income and assets. In most instances, that is not the case.
Although an applicant for Community Medicaid must meet the necessary income and assets levels, often with planning we are able to assist in making an individual eligible with little wait. An individual who is applying for home care Medicaid may have no more than $14,850 in nonretirement liquid assets. Retirement assets will not be counted as a resource so long as the applicant is receiving monthly distributions from the account. An irrevocable prepaid burial fund is also an exempt resource.
The primary residence is an exempt asset during the lifetime of the Medicaid recipient. However, if the applicant owns a home, it is advisable to consider additional estate planning to ensure that the home will be protected once the Medicaid recipient passes away.
With respect to income, an applicant for Medicaid is permitted to keep $825 per month in income plus a $20 disregard. However, if the applicant has income that exceeds that $845 threshold, a pooled income trust can be established to preserve the applicant’s excess income and direct it to a fund that can be used to pay his or her household bills.
It is important to note that there is no “look-back” for Community Medicaid. These pooled trusts are created by not-for-profit agencies and are a terrific way for persons to take advantage of the many services available through Community Medicaid while still preserving their income for use in meeting their monthly expenses.
Functionally, the way that these trusts work is that the applicant sends a check to the fund monthly for the amount that exceeds the allowable limit. Together with the check, the applicant submits household bills equal to the amount sent to the trust fund. The trust deducts a small monthly fee for servicing these payments and then, on behalf of the applicant, pays those household bills.
This process allows the applicant to continue relying on his or her monthly income to pay his or her bills and, at the same time, reduce the countable income amount to the amount permitted under the Medicaid rules. Once an individual is financially approved by the local Department of Social Services for Community Medicaid, he or she must enroll with a Managed Long-Term Care agency. This is the agency that will coordinate care services for the Medicaid recipient.
The MLTC will send a nurse to the Medicaid recipient in order to evaluate and create a care plan. The evaluation will result in an award of hours to the Medicaid recipient for a home health aide to come to the home and assist the recipient with activities of daily of living.
The amount of hours can vary from a few hours per day where the needs are less all the way to live-in care. This award of hours depends solely on the needs of the Medicaid recipient. If the Medicaid recipient is satisfied with the care plan, he or she may choose to enroll with the MLTC. Otherwise, he or she can request another evaluation with a different MLTC. What this means is that for most people, with minimal planning, both the income and asset requirements can be met with a minimal waiting period, allowing families to mitigate the cost of caring for their loved ones at home.
Nancy Burner, Esq. practices elder law and estate planning from her East Setauket office.
MEET ANNABELLE!
Hi, I’m Annabelle. I have lived in a house with a family my whole life, but now someone in that family has developed allergies and I need to find a new place to live. I am extremely sweet and enjoy being petted. I will sit on your lap and watch TV with you if you’ll let me. All I want is a nice, quiet home where I can spend the rest of my life being someone’s best friend. I come spayed, microchipped and I’m up to date on all my vaccines. Come visit me at Kent Animal Shelter, 2259 River Road in Calverton and see for yourself what a sweetheart I am. For more information on me and other adoptable pets at Kent, please call 631-727-5731 or visit www.kentanimalshelter.com.
By Linda Toga, Esq.
THE FACTS: After my mother’s death, my father met a woman, Mary, who was his partner for many years. They lived in my father’s house, which has a value in excess of $3 million. In his will my father left the house to Mary. He also named Mary as the beneficiary of his life insurance policy, which has a death benefit in excess of $2 million. He left his residuary estate to me and my sister. However, the will states that any estate taxes that may be owed are to come out of his residuary estate. My concern is that paying the estate taxes will likely deplete the residuary estate, leaving my sister and me with nothing.
THE QUESTION: Is there some way we can compel Mary to pay the estate tax from the funds she is receiving? It does not seem fair that we may be paying the taxes on the assets which she will be enjoying.
THE ANSWER: Since your father clearly intended for you and your sister to be beneficiaries of his estate, it appears that he may not have understood which of his assets would be considered in calculating his estate’s tax liability.
If, for example, your father and Mary were married at the time of his death, the value of the assets passing to Mary would be excluded from the value of the estate used to calculate the estate tax liability. That is because there is an unlimited marital deduction that applies when determining whether or not federal or New York state estate tax is due.
It is possible that your father believed the exclusion would apply based upon the fact that he and Mary were living together as husband and wife. Unfortunately for you and your sister, the taxing authorities do not see it that way.
Another possibility is that your father assumed that the death benefit from his life insurance policy would not be included in his gross estate for estate tax purposes. That is a common misconception that often leads to an unexpected tax liability.
Estate taxes are calculated based upon the value of all the assets owned or controlled by an individual at the time of death. Since your father could have changed the beneficiary listed on his life insurance policy up until the time of his death, he had “control” over the $2 million death benefit. For that reason, the value of the death benefit is included in his estate for purposes of calculating the estate tax owed.
It is noteworthy that some people actually buy life insurance so that the death benefit can be used to cover the estate taxes that may be assessed against their estates. By doing so, the decedent provides his beneficiaries with liquid assets that can be used to pay any estate taxes that are assessed against the estate. This, in turn, eliminates the possibility that the beneficiaries may need to sell estate assets just to pay the estate tax.
Even if your father was aware of how the estate tax would be calculated, he may not have realized that his will dictated that all of the taxes be paid from his residuary estate. If that fact had been explained to your father, he may have chosen to apportion the estate tax liability between all of the beneficiaries of his estate.
By apportioning the taxes that were due, Mary would be responsible for the taxes attributed to the value of the house, for example. That would have certainly decreased the amount of taxes being paid from the residuary estate earmarked for you and your sister.
In light of the fact that your father’s will does not provide for the apportionment of the estate, the full tax liability will be paid from the residuary estate unless Mary is willing to pay some or all of the estate tax assessed against your father’s estate. If she is not willing, there is nothing the executor of the estate can do but pay the taxes in accordance with the provisions of the will.
The amount of the estate tax due from your father’s estate will depend on when your father died since the exclusion amount on both the federal and New York state estate tax has been increasing annually for a number of years.
Since April, 2017, the exclusion amount for both federal and New York state estate tax exceeds $5.2 million. Even without apportionment, there is a chance that no estate tax will be due unless the value of your father’s estate exceeds the current exclusion amounts. If it does not, the full amount of the residuary estate will pass to you and your sister without any tax liability.
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.
By David Dunaief, M.D.
Ah, summer is upon us. Unfortunately, this means that tick season is getting into full swing. Projections for this year’s tick population are ominous, because of seemingly unrelated issues like an increase in last year’s acorn population, which feeds mice that are carriers, and a relatively mild winter (1).
Thus, it is good timing to talk about Borrelia burgdorferi, better known as the bacteria that causes Lyme disease. This bacteria is from the spirochete class and is typically found in the deer tick, also known as the blacklegged tick.
What do deer ticks look like? They are small and can be as tiny as a pencil tip or the size of a period at the end of a sentence. The CDC.gov site is a great resource for tick images and other information related to Lyme disease.
What if you have been bitten by a tick? The first thing you should do is remove it with forceps, tweezers or protected fingers (paper) as close to the skin as possible and pull slow and steady straight up. Do not crush or squeeze the tick, for doing so may spread infectious disease (2). In the study, petroleum jelly, fingernail polish, a hot kitchen match and 70 percent isopropyl alcohol all failed to properly remove a tick. The National Institutes of Health recommend not removing a tick with oil (3).
When a tick is removed within 36 to 48 hours, the risk of infection is quite low, according to the Centers for Disease Control and Prevention (4). However, a patient can be given a prophylactic dose of the antibiotic doxycycline, one dose of 200 mg, if the erythema migrans, or bulls-eye rash — a red outer ring and red spot in the center — has not occurred, and it is within 72 hours of tick removal (5). Those who took doxycycline had significantly lower risk of developing the bulls-eye rash and thus Lyme disease; however, treatment with doxycycline did have higher incidence of nausea and vomiting than placebo.
What are the signs and symptoms of Lyme disease? There are three stages of Lyme disease: early stage, where the bacteria are localized; early disseminated disease, where the bacteria have spread throughout the body; and late-stage disseminated disease. Symptoms for early localized stage and early disseminated disease include the bulls-eye rash, which occurs in about 80 percent of patients, with or without systemic symptoms of fatigue (54 percent), muscle pain and joint pain (44 percent), headache (42 percent), neck stiffness (35 percent), swollen glands (23 percent) and fever (16 percent) (6).
Early disseminated disease may cause neurological symptoms such as meningitis, cranial neuropathy (Bell’s palsy) and motor or sensory radiculoneuropathy (nerve roots of spinal cord). Late disseminated disease can cause Lyme arthritis (inflammation in the joints), heart problems, facial paralysis, impaired memory, numbness, pain and decreased concentration (3).
How do we prevent this disease? According to the CDC, we should wear protective clothing, spray ourselves with insect repellent that includes at least 20 percent DEET and treat our yards (4). Always check your skin and hair for ticks after walking through a woody or tall grassy area. Many of us on Long Island have ticks in the yard, so remember to check your pets; even if treated, they can carry ticks into the house. My Golden Retriever, Buddy, whom I loved dearly, died of Lyme complications.
Diagnosis of Lyme disease
Many times Lyme disease can be diagnosed within the clinical setting. When it comes to serologic or blood tests, the CDC recommends an ELISA test followed by a confirmatory Western blot test (4). However, testing immediately after being bitten by a tick is not useful, since the test will tend to be negative, regardless of infection or not (7). It takes about one to two weeks for IgM antibodies to appear and two to six weeks for IgG antibodies (8). These antibodies sometimes remain elevated even after successful treatment with antibiotics.
The cardiac impact
What are some of the complications of Lyme disease? Lyme carditis is a rare complication affecting 1.1 percent of those with disseminated disease, but it can result in sudden cardiac death due to second- or third-degree atrioventricular (AV) node conduction (electrical) block. Among the 1.1 percent who had Lyme carditis, there were five sudden deaths (9). If there are symptoms of chest pain, palpitations, light-headedness, shortness of breath or fainting, then clinicians should suspect Lyme carditis.
Does chronic Lyme disease exist?
There has been a debate about whether there is something called “chronic Lyme” disease. The research, unfortunately, has not shown consistent results that indicate that it exists. In the most recent report, chronic Lyme is refuted (10). In the analysis, the authors comment that the definition of chronic Lyme disease is obfuscated and that extended durations of antibiotics do not prevent or alleviate post-Lyme syndromes, according to several prospective trials. The authors do admit that there are prolonged neurologic symptoms in a subset population that may be debilitating even after the treatment of Lyme disease. These authors also suggest that there may be post-Lyme disease syndromes with joint pain, muscle pain, neck and back pain, fatigue and cognitive impairment.
A previous analysis suggested that chronic Lyme may indeed exist and that post-Lyme disease syndrome is a nebulous term (11). The authors point to several randomized controlled trials (RCT) to help validate their point (12). They believe that the bacteria may be able to evade shorter courses of antibiotics.
Ultimately, it comes down to the IDSA (Infectious Diseases Society of America) arguing against chronic Lyme but in favor of post-Lyme disease syndromes, while the ILADS (International Lyme and Associated Diseases Society) believes chronic Lyme exists.
Regardless, the lingering effects of Lyme can be debilitating. This may be as a result of systemic inflammation (13). Systemic inflammation and its symptoms can be improved significantly with dietary and other lifestyle modifications.
But to throw one more wrench in the mix, the CDC recommends that physicians look beyond Lyme for other possible diagnoses before diagnosing someone with chronic Lyme disease (14).
So what have we learned? Prevention is key to helping stem Lyme disease. If this is not possible, treating prophylactically when pulling off a tick is an important step. Contact your physician as soon as you notice a tick. If you have a bulls-eye rash and it is early, then treatment for two to three weeks needs to be started right away. If it is prolonged and disseminated, then treatment should be for approximately three to four weeks with antibiotics. If it has affected the central nervous system, then IV antibiotics could be needed. Post-Lyme syndrome vs. chronic Lyme disease needs to be discussed with your physician. Symptoms attributed to chronic Lyme could have another cause.
References: (1) npr.org online March 6, 2017. (2) Pediatrics. 1985;75(6):997. (3) nlm.nih.gov. (4) cdc.gov. (5) N Engl J Med. 2001;345(2):79. (6) N Engl J Med. 2003;348(24):2472. (7) Clin Infect Dis. 2008;47(2):188. (8) uptodate.com. (9) MMWR. 2014;63(43):982-983. (10) Expert Rev Anti Infect Ther. 2011;9(7):787-797. (11) Future Microbiol. 2008;3(6):621-624. (12) Neurology 70,992-1003 (2008). (13) J Infect Dis. 2009;199(9:1379-1388). (14) JAMA Intern Med. online Nov. 3, 2014.
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.
By Ellen Barcel
Long Island is primarily a large sandbar — something that gardeners have had to deal with by adding topsoil, compost, etc. But, what if you are one of the minority who has some clay soil? There are basically two things you need to do. One is to amend the soil for optimum plant grown. The other is to select plants that do well in heavy clay soil.
Amending clay soil
Many people assume that the best way to improve clay soil is to add sand to it. Wrong! Think about what bricks are made of — yes, clay and sand. The best way to amend clay soil is to add organic matter, like lots of compost, to it. Compost helps aerate clay soil and encourages it to drain. You can also add aged manure or straw.
Along this same line, when you mulch, use organic material since it will break down into compost. A gardening friend of mine also mentioned that clay soil is very heavy and can be very difficult to dig into. Because you need strength, you may need help.
Test the soil pH and see if it is compatible with the plants you wish to grow in that area. If it’s too acidic, then add lime. Remember that once you start changing the pH (either making it more or less acidic), it is something you must do on an annual basis.
Old-fashioned Hydrangea macrophylla will be blue in acidic soil and more purple or pink as the soil becomes more alkaline. People who buy these older pink hydrangeas and don’t add lime to their soil periodically will wind up with blue hydrangeas in a few years as the plants react to the more acidic soil.
Selecting plants
When selecting plants for clay soil, remember that you must also take into account the usual considerations: How much sunlight does the area receive? Does the area flood periodically? Does the area not drain well at all? Does the area receive a lot of salt spray? Are the plants in the area exposed to air pollution as can be found along busy roadways?
Rule of thumb — if, when you are researching plants, the source notes that those particular plants like well-drained soil, they probably will not do well in clay soil. Another observation when selecting plants: If you want plants that don’t do well in clay soil, consider planting them in containers that you fill with a good-quality potting soil.
The following are plants to consider for clay soil:
• Shrubs: weigela, forsythia (blooms in early spring), flowering quince (slow growing, blooms in spring), roses (sun loving), hydrangeas (partial shade, water loving so do well if the location is slow to drain).
• Veggies: shallow rooted such as lettuce, snap beans, broccoli, cabbage and scarlet runner beans (Phaseolus coccineus), which are raised primarily for their abundance of red flowers.
• Annuals and herbaceous perennials: asters, black-eyed Susans, daylilies, cannas (tender bulls, plant in spring), coreopsis (deer resistant), purple coneflowers (deer resistant), perennial geraniums (deer resistant), bee balm, a.k.a monarda (attractive to butterflies), irises (plant in fall), hostas (shade loving, come in a wide variety of sizes from tiny for rock gardens to enormous and colors from green to yellow and blue leaves), ferns (ideal for shade gardens).
• Grasses: Miscanthus — ornamental grasses such as fountain grass, silver grass, pampas grass, etc. Ornamental grasses do best in a sunny location.
• Trees: eastern pin oak (oaks do very well on Long Island with its acidic soil), ginkgo (“fossil” tree, known to be pollution resistant, plant male trees unless you want the fruit).
Ellen Barcel is a freelance writer and master gardener. To reach Cornell Cooperative Extension and its Master Gardener program, call 631-727-7850.
HOO ARE YOU? Noah A. Colamussi of Rocky Point spotted this eastern screech owl just hanging out in a tree in his backyard last week after a rain shower. Despite their name, screech owls do not screech, instead communicating through whinnies and soft trills. Night hunters, their diet consists mostly of large insects and small rodents.
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