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Sedentary lifestyle increases risk in the young

By David Dunaief, M.D.

Dr. David Dunaief

First, the good news: We have made great strides in reducing mortality from heart attacks. When we compare cardiovascular disease — heart disease and stroke — mortality rates from 1975 to the present, there is a substantial decline of approximately one-quarter. However, if we look at these rates since 1990, the rate of decline has slowed (1).

Plus, one in 10 visits to the emergency room are related to potential heart attack symptoms. Luckily, only 10 to 20 percent of these patients actually are having a heart attack (2). We need to reduce our risk factors to improve this scenario.

Some risk factors are obvious, while others are not. The obvious ones include age (men at least 45 years old and women at least 55 years old), family history, high cholesterol, high blood pressure, obesity, sedentary lifestyle, diabetes and smoking. Less obvious risk factors include gout, atrial fibrillation and osteoarthritis. Lifestyle modifications, including a high-fiber diet and exercise, also may help allay the risks.

Let’s look at the evidence.

Obesity

On a board exam in medicine, if smoking is one of the choices with disease risk, you can’t go wrong by choosing it. Well, it appears that the same axiom holds true for obesity. But how substantial a risk factor is obesity? In the Copenhagen General Population Study, results showed an increased heart attack risk in obese

(BMI >30 kg/m²) individuals with or without metabolic syndrome (high blood pressure, high cholesterol and high sugar) and in those who were overweight (BMI >25 kg/m²) (3). The risk of heart attack increased in direct proportion to weight. Specifically, there was a 26 percent increase in heart attack risk for those who were overweight and an 88 percent increase in risk for those who were obese without metabolic syndrome. This study had a follow-up of 3.6 years.

It is true that those with metabolic syndrome and obesity together had the highest risk. But, it is quite surprising that obesity, by itself, can increase heart attack risk when a person is “metabolically healthy.” Since this was an observational trial, we can only make an association, but if it is true, then there may not be such thing as a “metabolically healthy” obese patient. Therefore, if you are obese, it is really important to lose weight.

Lifestyle modifications such as weight loss, physical activity and diet can help decrease the risk of heart attacks.

Sedentary lifestyle

If obesity were not enough of a wake-up call, let’s look at another aspect of lifestyle: the impact of being sedentary. A recent observational study found that activity levels had a surprisingly high impact on heart disease risk (4). Of four key factors — weight, blood pressure, smoking and physical inactivity — age was the determinant as to which one had the most negative effect on women’s heart disease risk. Those under the age of 30 saw smoking as most negatively impactful. For those over the age of 30, lack of exercise became the most dominant risk factor for heart disease, including heart attacks.

For women over the age of 70, the study found that increasing physical activity may have a greater positive impact than addressing high blood pressure, losing weight, or even quitting smoking. However, since high blood pressure was self-reported and not necessarily measured in a doctor’s office, it may have been underestimated as a risk factor. Nonetheless, the researchers indicated that women should make sure they exercise on a regular basis to most significantly reduce heart disease risk.

Osteoarthritis

The prevailing thought with osteoarthritis is that it is best to suffer with hip or knee pain as long as possible before having surgery. But when do we cross the line and potentially need joint replacement? Well, in a recent study, those with osteoarthritis of the hip or knee joints that caused difficulty walking on a flat surface were at substantially greater risk of cardiovascular events, including heart attack (5). Those who had surgery for the affected joint saw a substantially reduced heart attack risk. It is important to address the causes of osteoarthritis to improve mobility, whether with surgery or other treatments.

Gout

When we think of gout, we relate it to kidney stones. But gout increases the risk of heart attacks by 82 percent, according to an observational study (6). Gout tends to affect patients more when they are older, but the risk of heart attack with gout is greater in those who are younger, ages 45 to 69, than in those over 70. What can we do to reduce these risk factors?

There have been studies showing that fiber decreases the risk of heart attacks. However, does fiber still matter when someone has a heart attack? In a recent analysis using data from the Nurses’ Health Study and the Health Professional Follow-up Study, results showed that higher fiber plays an important role in reducing the risk of death after a heart attack (7). Those who consumed the most fiber, compared to the least, had a 25 percent reduction in post-heart attack mortality.

Even more impressive is the fact that those who increased their fiber after the cardiovascular event had a 31 percent reduction in mortality risk. In this analysis, it seemed that more of the benefit came from fiber found in cereal. The most intriguing part of the study was the dose-response. For every 10-g increase in fiber consumption, there was a 15 percent reduction in the risk of post-heart attack mortality. Since we get too little fiber anyway, this should be an easy fix.

Lifestyle modifications are so important. In the Nurses’ Health Study, which followed 120,000 women for 20 years, those who routinely exercised, ate a quality diet, did not smoke and were a healthy weight demonstrated a whopping 84 percent reduction in the risk of a cardiovascular event such as a heart attack (8).

What have we learned? We can substantially reduce the risk of heart attacks and even potentially the risk of death after sustaining a heart attack with lifestyle modifications that include weight loss, physical activity and diet — with, in this case, a focus on fiber. While there are a number of diseases that contribute to heart attack risk, most of them are modifiable. With disabling osteoarthritis, addressing the causes of difficulty with mobility may also help reduce heart attack risk.

References: (1) Heart. 1998;81(4):380. (2) JAMA Intern Med. 2014;174(2):241-249. (3) JAMA Intern Med. 2014;174(1):15-22. (4) Br J Sports Med. 2014, May 8. (5) Presented Research: World Congress on OA, 2014. (6) Rheumatology (Oxford). 2013 Dec;52(12):2251-2259. (7) BMJ. 2014;348:g2659. (8) N Engl J Med. 2000;343(1):16.

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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'Avalon Garden' by Sungsook Setton

By Irene Ruddock

Sungsook Setton of Setauket is a watercolor and ink artist whose work bridges East and West and has brought her international recognition. She has exhibited in Canada, Korea, Taiwan, England and the United States. Setton twice won Best in Show at the National Juried Exhibition by the Sumi-e Society of America.

Quote: ‘My work, based on East Asian brush painting and Western artistic innovation, can be seen as expressive abstraction, allowing me to harness the spirit of qi.’

When did you begin painting?

Sungsook Setton

From an early age, I was always drawn to art and painted in the traditional western style. However, I began East Asian water and ink brush painting while revisiting Korea searching for my roots. I studied with Chinese and Korean masters who had me practice one stroke at a time for a month until it was perfect. They taught me that, just as musicians play scales and dancers practice steps, watercolor-ink painters practice the basic strokes to prepare for more intricate work. This began my personal journey to meld traditions of eastern and western art into my art.

What is the most important lesson you learned from your teachers?

One of the most important lessons is to achieve tranquility while you paint. Becoming one with the brush is an essential meditative experience that leads to tranquility. Tranquility then leads to qi, which leads to the transcendence necessary for painting.

Can you tell us more about qi?

It is a life force or energy flow. It is a central Chinese principle — the harmony of yin and yang.

‘Flatiron Building’ by Sungsook Setton

What else influences your art?

The most influential classic book for the Chinese water-ink artist is the Qing Dynasty reference “Manual of the Mustard Seed Garden,” which teaches that polished skills lead to a deeper understanding of the wonders of nature. While engaged in painting landscape, it’s almost a spiritual nutrition for me. Surrounded by nature, my mind is calm and clear, and I can focus on my subject. I then use suggestions in my brushwork to interpret forms in their simplest state. By paring back, I hope to reveal and capture the qi of nature. Brush painting represents the perfect meeting between the qi of the artist and the qi of nature.

What is your best advice for people viewing your work?

When viewing the paintings, look also for the empty spaces as well as the positive spaces. The nonpainted area, called ying, is there to allow you to breathe deeply and to grow and to achieve peace.

You have just written a beautiful book titled “The Spirit of the Brush.” Can you explain why you chose the title?

My brush has taken me on a spiritual journey. With my brush, I feel that I am not only a painter, but a dancer and a musician. I sing songs with my brush and dance with it. It is the goal of every watercolor painter to become one with the brush, so the title “The Spirit of the Brush” is fitting for me.

‘West Meadow Beach’ by Sungsook Setton

Tell me more about the book.

It is a story of my personal journey. It is also a book that teaches others how to achieve water-ink paintings by providing information on brush and paper materials. It is a guide for learning how to incorporate this art form into their own unique work — finding their own path, or dao, to where their brush will lead them.

When you say that you sing songs with your brush, how has that transpired?

I’ve spent a lot of time depicting music in my paintings over the years. I was invited to participate in a multimedia performance Brush Voice. During the performance, my abstract expressionist paintings were projected onto a large screen while the Ardesco group played the music at the Wang Center at Stony Brook University. After that, I have done live performances with a jazz musician.

What is your best advice for artists?

My advice for artists is to remember that nature always has new things to teach you!.

Where can we view your paintings and purchase your new book?

Come visit me at my art studio at 22 Mud Road in Setauket where I also teach. I am exhibiting my paintings at the Art League of Long Island with the Long Island Sumi-e Society member show from April 22 to May 7. The exhibition is called The Fragrance of Ink. “The Spirit of the Brush” is coming out in June and may be preordered on Amazon today — bring it to my studio for signing! Book signing schedules will be announced soon! You may contact me at [email protected] or www.sungsooksetton.com.

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By Ellen Barcel

You may have seen ornamental pepper plants in the stores this time of year. NuMex Easter Ornamental Pepper (Capsicum anuum) is a neat plant for Easter decorating. The plant look like a bouquet of peppers above the dense greenery. This is a small plant, generally about 8 inches high and 10 inches wide, making it ideal as a hostess gift or a table centerpiece. It produces beautifully colored ornamental peppers (purple, cream, yellow and orange).

Yes, it can be grown from seed, but you won’t have a plant ready for this Easter. The ornamental pepper blooms and produces peppers all summer long, maturing in 72 days. While there are many varieties of peppers that are available as heirloom plants, the NuMex Easter is a hybrid. Can you save the seeds to grow in future? You can try it, but as with all hybrids, it’s unlikely that the plants will breed true. Buy the hybrid seeds if you want to grow this one in your garden or the plants from a nursery.

The name Easter pepper came from the pastel color of the peppers when they first appear on the plant. The plant was bred by the New Mexico State University’s Chili Pepper Institute — it also developed a Valentine’s Day pepper (red and white), a St. Patrick’s Day pepper (green) and a Halloween pepper (orange and black) among many others.

This is a great plant for Long Island considering it tolerates heat, humidity and drought. Tiny white flowers form first on the plant to be followed by the brightly colored peppers. Tidy up the plant periodically by removing old, dried peppers and there’s more of a chance of new peppers forming.

Like tomatoes, a close relative, pepper plants like sun. A soil pH of 6.0 or above provides optimal growing conditions, so yes, you probably need to lime your soil if growing them in the ground. If you are growing your peppers in a container and you’ve bought it already growing, the soil is probably just fine.

Is the Easter pepper edible? Different authorities have different opinions. Some say it’s purely an ornamental plant with taste varying from plant to plant. Other authorities, including the NMU say yes, it is edible but extremely hot. In any event, do not consume peppers from the plants grown commercially as ornamentals because you won’t know what kind of chemicals have been used on them.

This is also true of plants like potato vines. Yes, you sometimes get sweet potatoes from the vines in fall, but again, you don’t know what chemicals have been used by the grower, since they are not intended for human consumption. If you want peppers, or sweet potatoes, to eat, select varieties and plants that are grown specifically for human consumption. Besides unwanted chemicals, these plants have been selected for various qualities like taste, time to maturity, keeping quality and highest yield.

The NuMex Easter pepper plants are not frost tolerant, so, if growing them outdoors over the summer, you need to either treat them as an annual or bring them indoors for the winter. According to NMU, chili plants grown indoors in a sunny location and given optimal care can last for 10 or more years.

The plants are available locally usually where ornamental or house plants are sold. Seeds are available from a number of growers, but the seeds of this ornamental as well as many others developed at NMU are available from the Chili Pepper Institute itself (www.chile.nmsu.edu).

Looking for other Easter plants? Consider the Easter cactus — similar to the Christmas cactus but it blooms in spring — as well as a pot of spring flowering bulbs for this time of year. Remember, Easter lilies are highly toxic to cats. So, if you have cats either don’t bring Easter lilies into the house or make sure that the plants are in a room that the cats can’t get into. Not only is the plant toxic but the water that the cut flowers are in can be dangerous for them as well. Happy spring!

Ellen Barcel is a freelance writer and master gardener. To reach Cornell Cooperative Extension and its Master Gardener program, call 631-727-7850.

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Curried Deviled Eggs

By Barbara Beltrami

No need to take a hard-boiled attitude toward the surfeit of Easter eggs. I know, I know. How many hard-boiled eggs can a family eat, especially when there are alternatives like marshmallow peeps, jelly beans and chocolate bunnies? Actually, quite a few if they are recycled into other dishes. For eggs-ample, egg salad with green onions and dill, curried deviled eggs and sliced egg canapes, all of which, by the way, make eggs-cellent hors d’oeuvres before Easter dinner.

Egg Salad with Green Onions

Egg Salad with Green Onions

YIELD: Makes 8 servings

INGREDIENTS

8 hard-boiled eggs

½ cup mayonnaise

¼ cup chopped green onions

2 tablespoons chopped fresh dill or 2 teaspoons dried

Salt and freshly ground pepper, to taste

DIRECTIONS: Peel eggs and chop into small pieces. In a medium bowl, combine eggs, mayonnaise, green onions, dill and salt and pepper. Vigorously whip or stir. Cover and refrigerate until using. Serve with bread, crackers, chips, green salad or sliced tomatoes.

Curried Deviled Eggs

Curried Deviled Eggs

YIELD: Makes 8 servings

INGREDIENTS:

8 hard-boiled eggs

¼ cup mayonnaise

¼ teaspoon prepared mustard

1 teaspoon curry powder

1 heaping tablespoon minced fresh parsley or 1 heaping teaspoon dried

½ teaspoon cayenne pepper

Salt and pepper, to taste

DIRECTIONS: Peel eggs and slice in half end to end. Gently scoop out yolks and place in small bowl. Add mayonnaise, mustard, curry powder, cayenne, parsley and salt and pepper. Vigorously whip together until mixture has a smooth creamy consistency. Scoop or pipe into hollowed egg whites. Cover and refrigerate until using. Serve with pickles, olives or celery and carrot sticks.

Sliced Egg Canapes with Sun-dried Tomatoes and Prosciutto or Anchovies

YIELD: Makes 16 canapes

INGREDIENTS:

16 slices of French bread (baguette), toasted

1 large clove peeled garlic

4 tablespoons extra virgin olive oil

4 to 5 slices prosciutto or 16 anchovy filets

3 to 4 hard-boiled eggs, cut into quarter-inch slices

16 oil-packed sun-dried tomatoes, chopped

DIRECTIONS: Rub one side of toasted bread slices with garlic. Drizzle one teaspoon olive oil on each slice. Cut or tear each slice of prosciutto into approximate size of bread slice. If using anchovies, lay one anchovy filet on each bread slice and with a fork, mash into bread. Lay egg slices over prosciutto or anchovies to cover, then sprinkle sun-dried tomatoes on top. Do not refrigerate assembled canapes as bread will lose its crispness. Serve with wine, cocktails or soft drinks.

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Photo courtesy of Kent Animal Shelter

MEET BELLA! This little girl is Bella, who, as her name implies, is beautiful inside and out. A pug/beagle mix, she is 5 years young, spayed, microchipped and up to date on all her vaccines. Bella’s family was no longer able to care for her, so they ended up having to bring her to Kent Animal Shelter. She is great with other dogs, cats and children, is full of energy, very sweet and affectionate and just loves to play! She would love to find her forever home — could that be with you?

Kent Animal Shelter is located at 2259 River Road in Calverton. For more information on Bella and other adoptable pets at Kent, please call 631-727-5731 or visit www.kentanimalshelter.com.

Update: Bella has been adopted!

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Three Village Historical Society president Stephen Healy, Kristin Moller, Brookhaven Town historian Barbara Russell and Katherine Johnson at the society’s annual awards dinner. Photo by Beverly Tyler

By Beverly Tyler

The Three Village Historical Society’s R. Sherman Mills Young Historian Award was presented to Kristin Moller and Katherine Johnson, at the society’s annual awards dinner at the Old Field Club March 22. Moller and Johnson, both Ward Melville High School seniors, have been volunteers at the Three Village Historical Society for the past couple of years.

Both of these young women have made a positive impression on society staff members as well as the general public. Moller and Johnson work as docents at the history center’s SPIES! Exhibit, where they take visitors of all ages through the exhibit and answer questions about it and the men and women who were a part of the Culper Spy Ring.

Johnson and Moller pose with their awards. Photo by Beverly Tyler

Moeller has also volunteered for the society’s Spirits of the Three Village Cemetery Tour and the Candlelight House Tour. Johnson participated in Cupler Day, a daylong event about the Revolutionary War spies with organizations from Stony Brook and Port Jefferson.

In addition to volunteer efforts at the society, this year Moller participated in a walk on the Greenway Trail to support the Open Door Exchange, and also in a Martin Luther King festival.

“Kristin is a wonderful, cheerful and knowledgeable young lady,” Mary Folz Doherty, society volunteer, said. “She enjoys learning about our local history and she loves sharing what she learns with the community.”

“Krissy is a delightful young lady who has shown an interest in the community where she has grown up,” Karin Lynch, the society’s former treasurer, said.

Johnson has been a volunteer at Stony Brook Hospital for the past two years, one year in pediatric oncology and one year
in radiology.

“There is nothing better for a museum than to have excited young people greeting you with their youthful enthusiasm.”

— Donna Smith

“One cold, cloudy day when no one came to the exhibit, Katherine created an artistic expression of the Culper Spy Ring story on the white board, which was enthusiastically viewed by staff and visitors for many weeks,” Donna Smith, society education director, said.

“These two girls,” Smith said, “learned how to engage people. I’ve seen them grow in confidence. When they first started as docents, they were a bit shy. It’s exciting to see how confident they have become — engaging people and answering questions. We are especially pleased to have them as they worked with so many children who come to the exhibit, working with them on spy codes and invisible ink and helping children understand the importance of spies during the Revolutionary War. There is nothing better for a museum than to have excited young people greeting you with their youthful enthusiasm.”

At the society’s awards dinner, award presenter Barbara Russell, Brookhaven Town historian, noted how important it is for our youth to volunteer, especially to volunteer to help promote local history and how these two high school seniors have excelled as advocates for our area’s extensive local history and culture.

For more information about the society’s youth volunteer and other programs, contact the Three Village Historical Society.

Beverly Tyler is Three Village Historical Society historian and author of books available from the Society, 93 North Country Road. For more information, call 631-751-3730 or visit www.tvhs.org.

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At the first meeting of the HiTOP consortium. Kotov is in the center. Photo from HiTOP consortium.

By Daniel Dunaief

Instead of lamenting the shortcomings of a system they felt didn’t work as well as it should, Roman Kotov and a growing group of collaborators whose numbers now exceed 50 decided to do something about it. An associate professor of psychiatry at Stony Brook University, Kotov and his collaborators are building their own mental health tool, which, they hope, will offer specific diagnoses for everything from anxiety to schizophrenia.

Roman Kotov. Photo from SBU School of Medicine

The current resource psychologists and psychiatrists use is called the “Diagnostic and Statistical Manual of Mental Disorders 5,” which came out in 2013. The latest version of the DSM, as the manual that offers psychologists and psychiatrists a way to link a collection of symptoms to a diagnosis is called, “felt far too limited,” Kotov said. “Once we started discussing [an alternative], almost everyone was interested in the scientific community. They thought it was a good and necessary idea.”

Called the Hierarchical Taxonomy of Psychopathology, or HiTOP, the developing classification system uses scientific evidence, illness symptoms and impaired functioning in its diagnoses. Another HiTOP co-creator, David Watson, the Andrew J. McKenna Family professor of psychology at the University of Notre Dame, recognized Kotov’s important early work on the project.

Kotov “deserves sole credit for the idea of putting all of our data together to provide the basis for an alternative model,” Watson explained in an email. “He did some preliminary work along these lines, which convinced us that this was a great idea that was worth pursuing.” Watson, who served as Kotov’s graduate adviser at the University of Iowa, said that his former student leads meetings and conference calls for the HiTOP group.

The HiTOP system, which was recently described in the Journal of Abnormal Psychology, views mental disorders along a spectra, while also using empirical evidence to understand overlap among disorders and classify different symptoms within a given diagnosis. As an example, Kotov said that depression in the DSM is “treated as one thing. We know that depression is heterogeneous.”

Indeed, some people with depression may have lost their appetite and have trouble sleeping, while others may be eating and sleeping considerably more than they would if they weren’t depressed. “In some ways, these are opposite presentations, yet they get the same diagnosis” in the DSM, Kotov said.

HiTOP unpacks this variability into seven dimensions, which describe symptom types. That is helpful not only for a diagnosis but also for a treatment. HiTOP also goes beyond the binary description of the presence or absence of a particular symptom, offering clinicians a way of indicating the severity of a problem. At this point, HiTOP is a developing prototype and not a completed diagnostic tool. The scientists developing this tool have made inroads in four primary areas: anxiety and depression, substance use problems, personality problems and psychotic disorders.

“The HiTOP system currently is incomplete, as it primarily focuses on more common and widely studied forms of psychopathology,” Watson suggested, “but mental health professionals certainly could use it to assess/ diagnose a broad range of conditions.” Mental health professionals can view this new resource at the website https://medicine.stonybrookmedicine.edu/HITOP.

Kotov hopes this new paradigm will “focus on science and do everything we can to keep unpolitical, nonscientific considerations out of it,” he said. “We hope that it provides the most up-to-date alternative” to the DSM. The HiTOP approach, Kotov said, relies more heavily on scientific evidence, which can include genetic vulnerabilities, environmental risk factors and neurobiological abnormalities.

Kotov, who is working on several projects, said HiTOP takes about a quarter of his time. He is also involved with a long-term study of schizophrenia and bipolar disorders, which was started in the early 1990s, before he arrived at Stony Brook in 2006.

Kotov is following up on this cohort, looking at outcomes for treatment and analyzing risk factors and processes that determine the course of an illness. He is also leading a study on first responders to the 9-11 attack on the World Trade Center, which is exploring the physical and emotional consequences of participating in the response to the unprecedented attack.

Kotov and his collaborators are investigating the health of responders in their daily life using mobile technology. They are also studying how personalities affect their health, which may soon help guide personalized treatment.

Another project involves the study of children who are 14 to 17 years old and explores the emotional growth and personality development. This study includes reports, surveys and interviews. During those years, “much happens as far as personality development,” Kotov said.

Colleagues at Stony Brook praised Kotov’s scientific contributions. Kotov is a “rising star” and is “perhaps best known for his work on the role of personality in psychopathology and, increasingly, for work on classification of psychiatric disorders,” Daniel Klein, a distinguished professor in the Department of Psychology at Stony Brook, wrote in an email.

A resident of Port Jefferson, Kotov lives with his wife Tatiana, who is a controller for a small company in Manhattan. The couple has two young daughters. Kotov grew up in Russia in a small town near Moscow. He was always interested in science and developed a particular curiosity about psychology when a high school psychology teacher sparked his interest when he was 15.

As for the HiTOP effort, Kotov is convinced this endeavor will offer the mental health community a valuable tool. “We believe that describing patients more accurately, precisely and reliably will help provide better and more personalized care,” he said.

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Normally, one person is appointed as an agent on a health care proxy.

By Nancy Burner, ESQ.

QUESTION: I recently signed a health care proxy naming my daughter to make health care decisions for me. Is she able to access my medical records and speak to Medicare and my supplemental health insurance company?

ANSWER: It depends on the information your health care agent is attempting to gather. A health care proxy is a document in which you designate an agent to make health care decisions for you in the event you are unable to make these decisions for yourself.

The health care proxy often contains language allowing your health care agent to hire and fire physicians and health care professionals. Federal regulations, specifically HIPAA, or the Health Insurance Portability and Accountability Act, make it difficult for anyone, even a spouse, to obtain any medical information on your behalf absent a properly executed health care proxy.

You must read the health care proxy carefully and make sure the document gives your agent the ability to do exactly what you would like them to do, for example, have access to your medical records. It is also important to note that signing a new health care proxy will revoke the previous health care proxy you may have signed in the past. This is important when you take the time to establish a comprehensive health care proxy and then go to the hospital and sign a very basic health care proxy with the staff at the hospital, which will revoke the comprehensive one you signed previously.

In addition to the health care proxy, you can sign a HIPAA release form, which would allow the individuals listed in your health care proxy access to your medical records. The health care proxy itself may give the same authority; however, the HIPAA release form is a very simple form that is easily recognizable by most hospitals and doctors offices. This can simplify the process to get medical records instead of using the health care proxy.

In order for your agent to deal with Medicare or another health insurance company, even a properly drafted health care proxy is typically not enough. In many circumstances, a durable power of attorney is required in order for a third party to speak with these companies on your behalf. A validly executed power of attorney will allow you, the principal, to designate an agent to act on your behalf and virtually step into your shoes with respect to all of your matters. The HIPAA can facilitate the exchange of information between your health care providers and health insurance companies with your agent.

If you want to ensure that your designated agent has the ability to communicate on your behalf, there are a few steps that you can take now in conjunction with getting your estate planning documents in order. If you are enrolled in Medicare, there is a simple way of getting your agent on file. If you visit https://www.medicare.gov/MedicareOnlineForms/AuthorizationForm/OnlineFormStep.asp, you will be able to fill out an electronic form in order to make sure Medicare will speak to your agent in the event of your incapacity. Additionally, if you have other insurance or supplemental insurance, call the individual company and find out how to get your agent on file.

When a loved one is sick or incapacitated, the family is usually under a lot of stress and needs to deal with multiple agencies. If the authority is already established, it may help to alleviate some of the complications loved ones face. If you have any questions regarding your estate planning documents, you should visit your local elder law attorney.

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

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Join the community for a Hope Walk for Addiction at Cedar Beach in Mount Sinai on Saturday, April 22 at 10:30 a.m.

By Father Francis Pizzarelli

Father Frank Pizzarelli

That’s the headline on the cover of the April 3 edition of Time magazine. Definitely a provocative question with all that is happening in our nation and among our presidential administration. Fake facts, fake news, manipulative truth is contributing to a cesspool that is overflowing and infecting communities across our country.

Fact: Our president was elected by the Electoral College in November 2016 and was inaugurated as our president in January 2017.

Fact: The Republicans control Congress and the White House.

Fact: Presidential leadership is hard and complex!

The challenge for all of us is to seek the balance with insight, integrity and honesty with all that we do and say. An entire younger generation is hanging in the balance, waiting in the wings to see how we act and treat one another. It is critical that we lead by example and hold everyone accountable for what they say, for what they do and for what they have failed to do!

Change is disarming and difficult but necessary, if we are to grow and reach our full potential. It is frightening because we are being forced to move out of our comfort zone and genuinely look for truth and recognize that not all who lead us tell the truth. We must transcend all of our political differences and empower one another to work for the common good of all Americans, no matter what their social or political circumstance.

Our new presidential administration was elected on the principle of change, and it brings many creative new ideas that urge us to look at doing business differently. The opioid epidemic, according to our new president, is a priority social issue for his administration. Members of the administration want to confront, contain and ultimately end this lethal infection.

For more than 25 years, I have given voice to this serious epidemic issue. I have talked at more governmental task force meetings than I can count. Like many others in the trenches, I am disgusted with the rhetoric, which is on the slow track to nowhere. Every level of government promises action and has delivered little or nothing.

We need money, beds and long-term residential programs without red tape for people in need who can access it immediately before it’s too late. Every day I have to turn young people away from our long-term residential treatment program. The waiting list is growing exponentially. We try to network people to wherever a bed might be available. Today available beds are hard to come by.

Insurance companies make the issue of treatment even harder. They ask their clients who are heroin addicts to try outpatient treatment first and fail before they are willing to pay for a short-term 28-day residential program. They are failing in record numbers — they are dying! That is unconscionable!

On Saturday, April 22, the first annual Hope Walk for Addiction will take place at Cedar Beach in Mount Sinai at 10:30 a.m. It’s not only a memorial walk to honor and remember a 25-year-old who overdosed on heroin by the name of Billy Reitzig, but also a community effort to raise awareness, provide education and raise funds for individuals and families afflicted by addiction. For information, visit www.hopewalkforaddiction.org.

This effort is being championed by Billy’s dad, Bill Sr., who lost his son to heroin on April 22, 2016. He could have buried his head in the sand with grief and pain, but he chose to honor his son’s life by courageously giving voice to one of the nation’s most serious health crises in this century. He and his family’s efforts are courageous and heroic and are making a profound difference. They are genuinely inspiring us to do more. Miracles do happen. I see them everyday! Hope does not abandon us; we abandon hope!

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

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