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Above, members of the New York Chapter of The Children’s Heart Foundation present CSHL Research Assistant Professor Michael Ronemus with a $50,000 check from The Children’s Heart Foundation for his recently funded research grant on Feb. 23. Photo courtesy of ©C. Brukin, 2017/Cold Spring Harbor Laboratory

By Daniel Dunaief

Just before he took a holiday break in December, Michael Ronemus received a welcome surprise. “In the last afternoon before the holidays, I got a call from William Foley. He said, ‘Congratulations,’” recalled Ronemus, a research assistant professor at Cold Spring Harbor Laboratory. “I submitted the application in May and I didn’t know what to expect.”

Foley, the executive director at the Children’s Heart Foundation, was reaching out to Ronemus to let him know he was one of seven researchers — six in North America and one in Europe — to receive funding for his research. Ronemus received a check for $50,000 at a presentation ceremony on Feb. 23.

Scientists are seeking out private foundations more as they search for sources of funding, said Ronemus. The funds will help Ronemus use next-generation sequencing to look closely at 120 families for evidence of copy number variation in their genes.

 

When a person has a different number of copies of a part of a specific gene, that can be a positive, neutral or negative event, depending on the consequence for the individual. Most copy number variations are neutral, which is why people have hundreds of them in their genes. Copy number variations can contribute, however, to de novo mutations, presenting changes in a genetic code that can make the genes of an offspring different from those of his or her parents. If these mutations damage a gene that’s essential for normal development of the heart, they can contribute to congenital heart defects.

Michael Ronemus explains the relevance of his research to the community at the check presentation event on Feb. 23. Photo courtesy of ©C. Brukin, 2017/Cold Spring Harbor Laboratory

Indeed, the Children’s Heart Foundation has contributed $8.7 million to research, hoping to improve the ability to prevent, diagnose and treat the 40,000 people born each year in the United States with a heart defect. Of the children born with a heart defect, about one in four, has a form of critical congenital heart disease, said Jon Kaltman, the chief in the Heart Development and Structures Diseases Branch of the National Heart, Lung and Blood Institute. That means he or she will most likely require surgery within the first year of life, although most have it within the first month.

At this point, doctors and researchers understand the genetic cause of congenital heart disease for a small percent of people. The work of the Pediatric Cardiac Genomics Consortium hopes to make this true for a larger number of people with a congenital heart defect, Kaltman said.

Knowing the genetics of a patient and his or her family could be “helpful for that family to understand what might have caused the congenital heart disease” said Kaltman, who has been a pediatric cardiologist since 2005. “If that family were to have another child” the genetics could help assess the “risk that a second child will also have a congenital heart defect.”

A greater awareness of the genes involved in heart disease could also provide a guide for the way the defect might react to treatment. “We see patients with identical looking hearts [on an echocardiogram] from different families in which they undergo surgery” and have different reactions, Kaltman said. “One does well and has few complications and the other develops arrhythmias at 15 and heart failure at 25.”

The differences in respones to treatment for those patients may be genetic. “For the patient with the genetic signal for the complicated course, we can do more interventions early on,” Kaltman said, which could include earlier valve replacements or more aggressive arrhythmia surveillance.

Working with Bruce Gelb, a professor in pediatrics and cardiology at Mount Sinai Hospital, Ronemus is focusing on a group of patients with a condition called tetralogy of Fallot. Children with this defect develop a bluish color in their skin and can have trouble breathing when they exercise.

New York Chapter president of the Children’s Heart Foundation Jackie Pecora speaks at the check presentation event. Photo courtesy of ©C. Brukin, 2017/Cold Spring Harbor Laboratory

Doctors treat people with this condition with open heart surgery, which fixes a hole between the ventricles and opens up a narrowed right ventricular outflow tract. “Early diagnosis can lead to a straightforward procedure and good outcome,” Ronemus said. “If there is any reason to suspect [that a developing fetus has this condition], we’d like to know.”

By studying copy number variation, Gelb and Ronemus can search for signatures or markers in prenatal screening, which doctors can do through amniocentesis or cell-free fetal DNA analysis, which is a noninvasive form of prenatal testing. A definitive diagnosis even before birth could help doctors prepare for quick intervention that could be more effective, Ronemus said. If not diagnosed, a third of the children with the condition die within the first year and 50 percent in the first three years, Ronemus explained. If doctors know a child has the condition, they can take precautions, like have supplementary oxygen or drugs nearby.

Ronemus, who started his career in plant genetics and then became involved in the study of autism, is applying a genetic technique he co-developed at CSHL for copy number variation detection called SMASH. He applied for the Children’s Heart Foundation grant because of a meeting at CSHL with Jackie Pecora, a resident of East Northport, who is New York Chapter president of the Children’s Heart Foundation. The foundation has 11 chapters throughout the country and raises funds through events like the Long Island Congenital Heart Walk, which will take place on May 21 in Sunken Meadow State Park. Ronemus will be an honorary co-chair for the walk.

Foley said Ronemus’ approach is a “unique way” of looking at congenital heart defects. During the medical advisory board’s discussion of which projects to fund “there was a lot of enthusiasm” for this project. Ronemus is the first New York researcher to receive CHF funds since 2009.

A resident of East Meadow, Ronemus lives with his wife Ana Rodriguez-Fernandez, who is an associate professor of microbiology at the NYU School of Medicine. The couple has three children, Martin, 14, Silvia, 12, and Daniel, 11.

Pecora has family experience with congenital heart disease. After she gave birth to twins 18 years ago, doctors discovered that her daughter Chloe had a heart defect that required surgery. Nine days after she was born, Chloe died from an infection. Pecora got involved because of a bumper sticker for another grassroots fundraiser for a baby with the same heart condition as Chloe. That led her to the Children’s Heart Foundation. While the awareness among the public is improving, there’s still a way to go to combat a prevalent condition, Pecora said. “Look at the clock: Every 15 minutes a baby is born with congenital heart disease. People don’t realize the magnitude.”

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Native to North America, mountain laurel produces beautiful white to dark pink flowers with purple markings in May and June. Photo by Ellen Barcel

By Ellen Barcel

Most varieties of holly need at least one male plant in the area to produce an abundance of red berries. Photo by Ellen Barcel

Broadleaf evergreens are not conifers (which evolved about 300 million years ago), but flowering plants (which evolved about 125 million years ago). It’s just that broadleaf evergreens happen to keep their leaves throughout the winter and in many cases can be used the same way that conifers can — as a year-round privacy screen. Yes, eventually they will lose their leaves, but they will stay on the plant over winter and will present a beautiful, almost Christmas card, scene covered with snow.

Azaleas and rhododendrons immediately come to mind, especially in Long Island’s acidic soil. But, there are a number of other evergreen shrubs to consider.

Euonymus come in a wide variety of sizes and colors. Small cream-colored flowers will produce red berries in autumn on some varieties. Some are fast growers that reach an enormous size and need to be pruned back several times a year — unless you really want a massive shrub. The golden variety can revert to type (that is, have its leaves turn all green), resulting in a shrub that’s part golden and part green.

The foliage on the euonymus often reverts to green, so you wind up with a bush that’s half green and half yellow. Photo by Ellen Barcel

Some are considered invasive in Suffolk County, including Euonymus alatus (winged euonymus, also called burning bush due to its red leaves in autumn) and E. fortunei (winter creeper), and are on the Do Not Sell/Transfer list. I had one that had a branch root underneath a house shutter — how’s that for invasive? Since this shrub has a number of negatives, why plant it? Do so only if you find noninvasive varieties and are sure you have the room to grow it to its potential.

Holly is one of my favorite shrubs, although over time, they can reach the size of small specimen trees. Most varieties need at least one male plant (which does not produce red berries) in the area to pollinate the female shrubs. Even holly varieties that are self-fertile will produce more red berries with a male plant in the vicinity. Holly prefers an acidic soil, so is ideal for Long Island’s soil. Another plus is that they are fairly disease and insect resistant. Some varieties are even deer resistant. While a number of my shrubs has been munched on by deer, the holly have never been touched.

Native to North America, mountain laurel produces beautiful white to dark pink flowers with purple markings in May and June. Photo by Ellen Barcel

Mountain laurel (Kalmia latifolia), in the heather family, is native to North America. It blooms in May and June and is hardy in zones 4 to 9. This can be a very large shrub, maturing at 7 to 15 feet tall and easily about as wide. Do not plant this one in front of a window, unless you really want to block the view. However, it is a slow grower. It prefers full sun and, like rhodies, prefers an acidic soil (in a pH range of 4.5 to 5.5). The plant is toxic to humans and some animals — this is strictly an ornamental here. Its uniquely shaped flowers bloom in white to dark pink colors, all with purple markings.

Firethorn (Pyracantha) are thorny, evergreen shrubs in the Rosaceae family. They tend to be upright, rather than bushy shrubs, and due to the thorns should not be planted anywhere near walkways or pools. The plants can get to be quite tall, up to 12 feet at maturity. They present small white flowers in spring and summer that mature to either orange or yellow berries in autumn, which the birds love but are not edible for humans. They are hardy in zones 6 to 9. It’s an easy plant to grow and pretty much pest free. They grow in a wide variety of soil pH levels from acidic to alkaline. They grow well in shady areas and, an added bonus for those of you with clay soil, do well in sandy, loamy and even heavy (clay) soils. If it wasn’t for the thorns, this would be pretty much a perfect plant.

No plant is perfect for every location. Always read plant tags carefully to check for requirements and final size. You don’t want your home to have its windows blocked by giant shrubs or spend entirely too much time pruning them back.

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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Banana Walnut Bread

By Barbara Beltrami

Rich in fiber and potassium, bananas are considered a healthful addition to most diets and a quick and satisfying snack. However I don’t usually get excited about them. If I do condescend to eat one, it must be just this side of ripe, firm with just a touch of green near the ends. On the other hand, my husband loves bananas that are just this side of rotten, soft and brown and begging for a visit from fruit flies. Those are the ones I use in recipes.

All that being said, I must confess that there are a couple of versions of bananas that I sometimes actually get a craving for. One is a banana on a popsicle stick, dipped in chocolate sauce and put in the freezer. Try that for a summer treat. Another is banana walnut bread, a comfort food if there ever was one. A third is Bananas Foster, a caramel-y dessert made with split bananas cooked with butter and brown sugar in a skillet, a heavely topping for whipped cream or vanilla ice cream. And how about banana-butterscotch cookies, a (somewhat) healthful goody that can be especially appreciated and popular with even the younger set of avowed junk foodies. Come to think of it, maybe I do like bananas!

Banana Walnut Bread

This recipe comes from one of those spiral bound cookbooks put out by some organization that my mother belonged to many many years ago. Although it is torn and tattered, I still cherish it for this recipe and a few others.

Banana Walnut Bread

YIELD: Makes 10 to 12 servings

INGREDIENTS:

½ cup shortening

1 cup sugar

2 eggs, well beaten

2 cups flour

1 teaspoon baking soda

3 ripe bananas, mashed

¼ cup chopped walnuts

DIRECTIONS: Preheat oven to 375 F. Grease a 9-inch loaf pan. In large mixing bowl, combine shortening, sugar and eggs. Sift together the flour and baking soda and add to wet mixture. Stir in bananas and walnuts. Pour into greased loaf pan and bake one hour or until toothpick inserted in center comes out clean. Serve warm with butter, cream cheese or jam and hot tea or coffee.

Bananas Foster

This dish originated in New Orleans in the 1950s and is traditionally made with a rum flambé. Playing with fire makes me nervous so I leave out the flambé part and just add a splash of rum to the bananas in the skillet right before serving.

Bananas Foster

YIELD: Makes 4 servings

INGREDIENTS:

Half a stick of unsalted butter

4 bananas, peeled and sliced in half lengthwise

1½ cups brown sugar

1 tablespoon vanilla extract

¾ teaspoon cinnamon

Pinch of salt

2 ounces rum (optional)

One pint vanilla ice cream or 1 pint heavy cream, whipped

DIRECTIONS: In large skillet melt butter over medium heat. Gently add bananas; cook over medium heat until golden, about two minutes; gently turn and cook other side until golden, about two minutes. (Don’t worry if they break; they’ll still taste wonderful!). Remove from skillet and set aside to keep warm. Add brown sugar, vanilla, cinnamon and salt to skillet and cook, stirring constantly, over low heat about two minutes. Turn off heat, add rum to skillet, if using, stir, and stand back in case it flames. Return bananas to skillet and gently spoon sauce over them. Place a scoop or two of vanilla ice cream or whipped cream in four dessert dishes. Top with bananas and sauce and serve immediately with vanilla wafers or ginger snaps.

Banana Butterscotch Cookies

I’ve had this recipe a long time, and as with so many old recipes, I can’t remember who gave it to me. There’s something about the combination of bananas and butterscotch that is absolutely intoxicating, especially as the cookies are baking.

Banana Butterscotch Cookies

YIELD: Makes 2 to 3 dozen cookies

INGREDIENTS:

2½ cups flour

½ teaspoon salt

2 teaspoons baking powder

¼ teaspoon baking soda

¾ cup white granulated sugar

¼ cup brown sugar

²⁄₃ cup unsalted butter

2 eggs

1 teaspoon vanilla extract

Two very ripe bananas, mashed

2 cups butterscotch chips

DIRECTIONS: Preheat oven to 400 F. Grease cookie sheet. Sift together the flour, salt, baking power and baking soda. Cream together both sugars and the butter until light and fluffy. Mix in eggs and vanilla and combine with dry ingredients. Add mashed banana and butterscotch chips and stir in thoroughly. Drop by spoonfuls onto cookie sheet and bake 12 to 15 minutes. Place on rack to cool before serving.

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By Nancy Burner, ESQ.

Nancy Burner, Esq.

Being hyperfocused on avoiding probate can be an estate planning disaster. First, what exactly is “probate”? Probate is the legal process whereby a last will and testament is determined by the court to be authentic and valid. The court will then “admit” the will to probate and issue “letters testamentary” to the executor so that the executor can carry out the decedent’s intentions in accordance with the last will and testament.

That usually involves paying all funeral bills, administrative expenses, debts, settling all claims, paying any specific bequests and paying out the balance to the named beneficiary or beneficiaries. Avoiding probate can be accomplished by creating a trust to hold your assets during your lifetime and then distributing the assets at your death in the same manner and sequence as an executor would if your assets passed through probate.

Typically, this would be accomplished by creating a revocable trust and transferring all nonretirement assets to the trust during your lifetime, thereby avoiding probate at your death. Retirement assets like 403Bs, IRAs and nonqualified annuities are not transferred to revocable trusts as they have their own rules and should transfer after death by virtue of a beneficiary designation.

Retirement assets should not be subject to probate. The designation of a beneficiary is vital to avoid costly income taxes if retirement assets name the estate or default to the estate. The takeaway here is that you should make sure that you have named primary and contingent beneficiaries on your retirement assets.

If you name a trust for an individual, you must discuss that with a competent professional that can advise you if the trust can accept retirement assets without causing adverse income tax consequences. Not all trusts are the same.

Avoiding probate can be a disaster if it is not done as part of a comprehensive plan, even for the smallest estate. For example, consider this case: Decedent dies with two bank accounts, each naming her grandchildren on the account. This is called a Totten trust account. Those accounts each have $25,000. She has a small IRA of $50,000 that also names the grandchildren as beneficiaries. She owns no real estate. Sounds simple, right?

The problem is that the grandchildren are not 18 years of age. The parents cannot collect the money for the children because they are not guardians of the property for their minor children. Before the money can be collected, the parents must commence a proceeding in Surrogates Court to be appointed guardians of the property for each child. After time, money and expenses, and assuming the parents are appointed, they can collect the money as guardian and open a bank account for each child, to be turned over to them at age 18. The IRA would have to be liquidated, it could not remain an IRA and the income taxes will have to be paid on the distribution.

I do not know of a worse scenario for most 18-year-old children to inherit $50,000 when they may be applying for college and seeking financial aid, or worse, when deciding not to go to college and are free to squander it however they want.

If the grandparent had created an estate plan that created trusts for the benefit of the grandchild, then the trusts could have been named as the beneficiaries of the accounts and the entire debacle could have been avoided. The point is that while there are cases where naming individuals as beneficiaries is entirely appropriate, there are also times that naming a trust as beneficiary is the less costly option, and neither should be done without a plan in mind.

When clients have a large amount of assets and large retirement plans, the result can be even more disastrous. Consider the case where a $500,000 IRA names a child as a direct beneficiary. If a properly drawn trust for the benefit of the child was named as beneficiary, there would be no guardianship proceeding and the entire IRA could be preserved and payments spread out over the child’s life expectancy, amounting to millions of dollars in benefits to that child over their lifetime. If payable directly to the child, there will be guardianship fees and the $500,000 will likely be cashed in, income taxes paid and the balance put in a bank account accruing little interest and payable on the 18th birthday of the beneficiary.

The concern is that individuals are encouraged to avoid probate by merely naming beneficiaries but with no understanding of the consequences. At a time when the largest growing segment of the population is over 90, it does not take long to figure out that the likely beneficiaries will be in their 60s, 70s or older when they inherit an asset.

Thought must be given to protecting those beneficiaries from creditors, divorcing spouses (one out of two marriages end in divorce) and the catastrophic costs of long-term care. Whether the estate is large or small, most decedents want to protect their heirs. A well-drafted beneficiary trust can accomplish that goal.

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

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CoQ10 is the first new ‘drug’ in over a decade to show survival benefits in heart failure.
A supplement reduces the risk of cardiovascular events

By David Dunaief, M.D.

Heart attacks and heart disease get a lot of attention, but chronic heart failure is something that tends to be overlooked by the press. The reason may be that heart failure is not acute like a heart attack.

Dr. David Dunaief

To clarify by using an analogy, a heart attack is like a tidal wave whereas heart failure is like a tsunami. You don’t know it is coming until it may be too late. Heart failure is an insidious (slowly developing) disease and thus may take years before it becomes symptomatic. It also increases the risk of heart attack and death.

Heart failure occurs in about 20 percent of the population over the age of 40 (1). There are about 5.8 million Americans with heart failure (2). Not surprisingly, incidence of heart failure increases with age (3).

Heart failure (HF) occurs when the heart’s pumping is not able to keep up with the body’s demands and may decompensate. It is a complicated topic, for there are two types — systolic heart failure and diastolic heart failure. The basic difference is that the ejection fraction, the output of blood with each contraction of the left ventricle of the heart, is more or less preserved in diastolic HF, while it can be significantly reduced in systolic HF.

We have more evidence-based medicine, or medical research, on systolic heart failure. Fortunately, both types can be diagnosed with the help of an echocardiogram, an ultrasound of the heart. The signs and symptoms may be similar, as well, and include shortness of breath on exertion or when lying down; edema or swelling; reduced exercise tolerance; weakness and fatigue. The risk factors for heart failure include diabetes, coronary artery disease, high blood pressure, obesity, smoking, heart attacks and valvular disease.

Typically, heart failure is treated with blood pressure medications, such as beta blockers, ACE inhibitors and angiotensin receptor blockers. We are going to look at how diet, iron and the supplement CoQ10 impact heart failure.

Effect of diet

If we look beyond the usual risk factors mentioned above, oxidative stress may play an important role as a contributor to HF. Oxidative stress is thought to potentially result in damage to the inner lining of the blood vessels, or endothelium, oxidation of cholesterol molecules and a decrease in nitric oxide, which helps vasodilate blood vessels.

In a population-based, prospective (forward-looking) study, called the Swedish Mammography Cohort, results show that a diet rich in antioxidants reduces the risk of developing HF (4). In the group that consumed the most nutrient-dense foods, there was a significant 42 percent (p<0.001) reduction in the development of HF, compared to the group that consumed the least. According to the authors, the antioxidants were derived mainly from fruits, vegetables, whole grains, coffee and chocolate. Fruits and vegetables were responsible for the majority of the effect.

This nutrient-dense approach to diet increased oxygen radical absorption capacity. Oxygen radicals have been implicated in cellular damage and DNA damage, potentially as a result of increasing chronic inflammation. What makes this study so impressive is that it is the first of its kind to investigate antioxidants from the diet and their impacts on heart failure prevention.

This was a large study, involving 33,713 women, with good duration — follow-up was 11.3 years. There are limitations to this study, since it is an observational study, and the population involved only women. Still, the results are very exciting, and it is unlikely there is a downside to applying this approach to the population at large.

CoQ10 supplementation

Coenzyme Q10 is a substance produced by the body that helps the mitochondria (the powerhouse of the cell) produce energy. It is thought of as an antioxidant. In a meta-analysis (group of 13 studies), the results showed that supplementation with CoQ10 may help improve functioning in patients with heart failure (5). This may occur because of a modest rise in ejection fraction functioning. It seems to be important in systolic heart failure. Supplementation with CoQ10 may help to reduce its severity.

The doses used in the meta-analysis ranged from 60 mg to 300 mg. Interestingly, those that were less than or equal to 100 mg showed statistical significance, while higher doses did not reach statistical significance. This CoQ10 meta-analysis was small. It covered 13 studies and fewer than 300 patients.

Like some other supplements, CoQ10 has potential benefits, but more study is needed. Because there are no studies showing significant deleterious effects, which doesn’t mean there won’t be, it is worth starting HF patients with comprised ejection fractions on 100 mg CoQ10 and titrating up, as long as patients can tolerate it, although the next study would suggest 300 mg was the appropriate dose.

CoQ10 — a well-run study

Results of the Q-SYMBIO study, a randomized controlled trial, the gold standard of studies, showed an almost 50 percent reduction in the risk of all-cause mortality and 50 percent fewer cardiac events with CoQ10 supplementation (6). This one randomized controlled trial followed 420 patients for two years who had severe heart failure. This involved using 100 mg of CoQ10 three times a day compared to placebo.

The lead author goes as far as to suggest that CoQ10 should be part of the paradigm of treatment. This the first new “drug” in over a decade to show survival benefits in heart failure. Thus, if you have heart failure, you may want to discuss CoQ10 with your doctor.

Iron deficiency

Anemia and iron deficiency are not synonymous, since iron deficiency can occur without anemia. A recent observational study that followed 753 heart failure patients for almost two years showed that iron deficiency without anemia increased the risk of mortality in heart failure patients by 42 percent (7).

In this study, iron deficiency was defined as a ferritin level less than 100 ug/L (the storage of iron) or, alternately, transferrin saturation less than 20 percent (the transport of iron) with a ferritin level in the range 100-299 ug/L.

The authors conclude that iron deficiency is potentially more predictive of clinical outcomes than anemia, contributes to the severity of HF, and is common in these patients. Thus, it behooves us to try to prevent heart failure through dietary changes, including high levels of antioxidants, because it is not easy to reverse the disease. Those with HF should have their ferritin and iron levels checked, for these are correctable. I am not typically a supplement advocate; however, based on the latest results, CoQ10 seems like a compelling therapy to reduce risk of further complications and potentially death. Consult with your doctor before taking CoQ10 or any other supplements, especially if you have heart failure.

References: (1) Circulation. 2002;106(24):3068. (2) Circulation. 2010;121(7):e46. (3) J Am Coll Cardiol. 2003;41(2):21. (4) Am J Med. 2013 Jun:126(6):494-500. (5) Am J Clin Nutr. 2013 Feb;97(2):268-275. (6) JACC Heart Fail. 2014 Dec;2(6):641-649. (7) Am Heart J. 2013;165(4):575-582.

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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Nico Signore

By Fr. Francis Pizzarelli

Father Frank Pizzarelli

The noise across the American landscape is deafening. Every day the perverse rhetoric is further polarizing our nation. This polarization is intensifying the anxiety in many communities and families around the country. It has gotten so out of hand that people are not talking to one another. The anger and disrespect is becoming infectious everywhere.

On the positive side, I have never seen more people interested in government and its social policies. More and more young people are considering public service and government leadership as career paths. People are watching the news and reading the paper much more consistently.

The media is being challenged daily to report the truth based on real facts. It is unfortunate in the age of social media that truth continues to be manipulated and misrepresented. We must support a free press and a free media and urge them to genuinely commit themselves to presenting the truth. In a free society, they are key to holding those in power accountable for their actions and their leadership; they are key in demanding honesty from all who lead us.

As a teacher on the college level for more than three decades, it continuously amazes me how little the present generation of young people know about American government and our social policies. Hopefully, the chaos in Washington will give life to a better, more informed younger generation who are willing to stand for the truth and work courageously to build new bridges of human understanding among us.

Every now and then in the midst of this chaos, I am forced to take pause and think about the fragile life and world in which we live. In early March a 14-year-old boy from Miller Place was riding his bicycle and was killed. It was documented that it was a genuine accident with no recklessness or human impediments involved. A few days after this senseless loss of life, I presided at Nico’s funeral at the Catholic Church of St. Louis de Montfort in Sound Beach. He was a veteran lacrosse player — every coach’s dream athlete. He possessed passion and energy for this sport that was extraordinary. He was small in stature but was a giant in heart and commitment to the game.

This tragic death brought an entire community together. As we celebrated his life that morning, we were forced to think about how all life is fragile, that we need to stand strong because we need each other. Nico played lacrosse since he was eight years old; it was in his blood. It was his favorite sport. However, the brotherhood that was fostered because of lacrosse laid the foundation for other human values that are desperately needed today. He and his buddies were committed and are committed to community service, to volunteering for a wide range of noble causes. Their service was done with dedication, love and passion, the same energy they brought to the lacrosse playing field.

At 14 years of age, Nico touched more people with his wit, charm, love and compassion than most of us will do in a lifetime. The world is definitely brighter and better because Nico walked, lived and loved among us.

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

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Photo courtesy of Three Village School District

By Michael Tessler

Throughout our brief but impactful history, America’s protesters have accomplished quite a bit. From the Sons of Liberty dumping nearly $1.7 million worth of English tea into Boston Harbor (talk about destruction of property) to Dr. King sharing his dream during the March on Washington. Protests, petitions, walkouts and other acts of civil disobedience certainly have earned their chapter in the American story, not always for good reasons, unfortunately.

My first protest was back in 1999 at Scraggy Hill Elementary in Port Jefferson. Things, as you may remember, were a bit simpler back then. Before the advent of social media, before digital petitions and fake news blogs we were forced to have conversations with one another.

Esther Fusco, my former principal, had an office tucked away behind the school’s reception area. Inside she had an old-fashioned metal candy dispenser that only accepted pennies. Whenever you were called into her office, she made sure you got to crank out a handful of M&Ms. Between that and her famed “Star Assemblies,” there was a lot to love as a student.

Unfortunately, for reasons beyond the comprehension of a six-year-old, Dr. Fusco had her assignment changed by the school board and was no longer working in the school. When I heard she was gone, I went home and asked quite innocently, “Where’s Dr. Fusco?” That unknowingly became the rallying call for the first protest I ever participated in.

My mom, an impassioned activist for early childhood education, organized with other community members to picket, protest and attend meetings. This was an extraordinary lesson in civics for a little boy and one that I treasure to this day. You can imagine my excitement when almost 20 years later I hear about petitions circulating through Ward Melville High School. Young people were speaking up about an issue they were passionate about.

The new cap and gown style at Ward Melville High School. Photo from Three Village School District

To provide a bit of context, Ward Melville’s principal introduced a new uniformed graduation gown that combines the school’s signature green and gold. In the past, they had been separated by gender. However, with the school’s growing transgender and gender-fluid population, they wanted to adjust with the times. Naturally, there was pushback as it was altering a 50-year tradition.

What should have followed was a debate on the BEST method to preserve tradition while accommodating changing times and the needs of the student body. What actually transpired was unfortunately quite the opposite. Petitions began to grow and with them hateful comments about transgender and gay/lesbian individuals.

During a student walkout, several students held up signs saying “STRAIGHT LIVES MATTER” and imagery often associated with the former Confederate States. There’s a fundamental difference between fighting for tradition and using the guise of tradition as a means of marginalizing another group.

Here’s the unfortunate reality: 41 percent of transgender youth and 20 percent of gay/lesbian/bisexual youth will attempt suicide at some point in their lives. Just for perspective, 4.6 percent of the general population will attempt suicide. Words matter, and if you’re wondering how those numbers got to be so staggering, look no further than the comments on some of these petitions.

If someone is willing to keep something like that a secret for their whole life, if the pain of that secret is enough cause for them to take their own life, then who the heck am I to question who they are and why? We were not born wearing blue or pink. We were born human beings and being human isn’t always easy so let’s stop making it harder on each other.

Nonviolence and peaceful demonstrations remain the second greatest force of change in this country next to democracy itself. To my young friends at Ward Melville, on all sides, keep fighting for what you believe in. Do so however, while showing respect and civility. You are stewards not just of your own rights, but those of all Americans. Just remember, “Nobody’s right if everybody’s wrong.”

Seriously though, where is Dr. Fusco? If anyone sees her, please tell her Michael Tessler sends his regards. I’m 18 years overdue for some M&Ms!

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Joseph Schwartz, right, with a collaborator, Daichi Shimbo, the director of the Translational Lab at the Center for Behavioral Cardiovascular Health at Columbia University Medical Center, in front of a poster they presented at an annual meeting of the American Society of Hypertension in New York City in 2013.Photo by John Booth, III

By Daniel Dunaief

The cardiovascular skies may be clear and sunny, but there could also be a storm lurking behind them. About one in eight people who get a normal reading for their blood pressure have what’s called masked hypertension.

That’s the finding in a recent study published in the American Journal of Epidemiology led by Joseph Schwartz, a professor of psychiatry and sociology at Stony Brook University and a lecturer of medicine at the Columbia University Medical Center. Schwartz said his research suggests that some people may need closer monitoring to pick up the kinds of warning signs that might lead to serious conditions.

“The literature clearly shows that those with masked hypertension are more likely to have subclinical disease and are at an increased risk of a future heart attack or stroke,” Schwartz explained in an email.

Tyla Yurgel, Schwartz’s lab manager from 2005 to 2016 who is now working in the Department of Psychiatry, wears the ambulatory blood pressure cuff that was a part of the study. Photo by Arthur Stone

Schwartz and his colleagues measured ambulatory blood pressure, in which test subjects wore a device that records blood pressure about every half hour, collecting a set of readings as a person goes about the ordinary tasks involved in his or her life. Through this reading, he was able, with some statistical monitoring, to determine that about 17 million Americans have masked hypertension, a term he coined in 2002.

Schwartz, who started studying ambulatory blood pressure in the late 1980s, has been actively exploring masked hypertension for over a decade. Ambulatory blood pressure monitoring is more effective at predicting subclinical disease such as left ventricular hypertrophy and the risk of future cardiovascular events, said Schwartz. “There was some rapidly growing evidence it was a better predictor of who would have a heart attack or stroke than in the clinic, even when the blood pressure in the clinic was properly measured,” he said.

To be sure, the expense of 24-hour monitoring of ambulatory blood pressure for everyone is unwieldy and unrealistic, Schwartz said. The list price for having an ambulatory blood pressure recording is $200 to $400, he said. Wearing the device is also a nuisance, which most people wouldn’t accept unless it was likely to be clinically useful or, as he suggested, they were paid as a research participant.

Schwartz said he used a model similar to one an economist might employ. Economists, he said, develop simulation models all the time. He said over 900 people visited the clinic three times as a part of the study. The researchers took three blood pressure readings at each visit. The average of those readings was more reliable than a single reading.

The study participants then provided 30 to 40 blood pressure readings in a day and averaged those numbers. He collected separate data for periods when people were awake or asleep. A patient close to the line for hypertension in the clinical setting was the most likely to cross the boundaries that define hypertension. “You don’t have that far to go to cross that boundary,” Schwartz said.

After analyzing the information, he came up with a rate of about 12.3 percent for masked hypertension of those with a normal clinic blood pressure. The rate was even higher, at 15.7 percent, when the researchers used an average of the nine readings taken during the patient’s first three study visits.

William White, a professor of medicine at the Calhoun Cardiology Center at the University of Connecticut School of Medicine in Farmington was a reviewer for one of these major studies. “They are excellent,” said White, who has known Schwartz for about a decade. “We should be monitoring blood pressure more outside of the clinical environment.”

Indeed, patients have become increasingly interested in checking their blood pressure outside of the doctor’s offices. “We have a 200 to 300 percent increase in requests for ambulatory blood pressure monitoring from our clinical lab during the last five to ten years — in all age groups, genders and ethnicities,” explained White.

The challenge, however, is that tracking hypertension closely for every possible patient is difficult clinically and financially. “There are no obvious clinical markers for masked hypertension other than unexpectedly high self-blood pressure or unexplained hypertensive target organ damage,” White added.

Schwartz himself has a family history that includes cardiovascular challenges. His father, Richard Schwartz, who conducted nonmedical research, has a long history of cardiovascular disease and had a heart attack at the age of 53. His grandfather had a fatal heart attack at the same age. When Schwartz reached 53, he said he had “second thoughts,” and wanted to get through that year without having a heart attack. He’s monitoring his own health carefully and is the first one in his family to take blood pressure medication.

Schwartz, who grew up in Ithaca, New York, came to Stony Brook University in 1987. He called his upbringing a “nonstressful place to grow up.” He now lives in East Setauket with his wife Madeline Taylor, who is a retired school teacher from the Middle Country school district. The couple has two children. Lia lives in Westchester and works at Graham Windham School and Jeremy lives in Chelsea and works for Credit Suisse.

As for his work, Schwartz said the current study on masked hypertension was a part of a broader effort to categorize and understand pre-clinical indications of heart problems and to track the development of hypertension.

Now that he has an estimate of how many people might have masked hypertension, he plans to explore the data further. That analysis will examine whether having masked hypertension puts a patient at risk of having cardiovascular disease or other circulatory challenges. “We are very interested in whether certain personality characteristics and/or circumstances (stressful work situation) makes it more likely that one will have masked hypertension,” he explained.

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Ideally, window boxes should be filled with plants that bloom continuously throughout the growing season. Photo by Ellen Barcel

By Ellen Barcel

Depending on your home and gardening style, you may want to add window boxes to at least the first floor’s front windows. I also have window boxes on windows that look out on my back patio. I like sitting in the back yard, reading my newspaper and being surrounded by these colorful plants.

In general, since window boxes are not very deep, think in terms of smaller plants, ones where the tops can be seen through the windows from inside the house, but not so tall that they totally obscure the view.

Most people use annuals since perennials will usually grow too large. I have seen window boxes filled with hydrangeas, which presented a beautiful scene all growing season long, but there are a number of problems associated with keeping perennials growing in a window box such as overwintering them. The small pots needed to fit into a window box may not provide enough protection from the cold. For another, the plants really want to get much bigger and will eventually block the view. They will easily become root bound — all roots and no soil.

Geraniums are ideal, easy care plants for window boxes. Photo by Ellen Barcel

Ideal window box plants are those that bloom more or less continuously throughout the growing season. I particularly like geraniums (Pelargonium) because they are drought tolerant and are, for the most part, disease and insect pest free. In other words, once planted you can pretty much ignore them except during periods of drought when they do need supplemental water. Use a good-quality potting soil and add fertilizer, following package directions. If a little is good, a lot is not necessarily better.

Other annuals that look great in a window box include marigolds and petunias. Consider adding some Dusty Miller for its contrasting light blue-gray leaves. If your window boxes don’t get a lot of sunlight, use coleus, impatiens or fuchsia.

Adding some vinelike plants creates a charming effect, as they cascade down between the flowering plants. Consider orange nasturtium scattered between white geraniums, for example, or green potato vines between hot pink geraniums in a black window box.

Herbs are great in window boxes, especially boxes that are outside kitchen windows. Usually there is enough sun and it makes harvesting the herbs for use with a meal really easy — just open your window and pick what you need. There are many herbs that are suited to window boxes such as mints, thyme and parsley. But those that get very tall, like pineapple sage, may block out your view.

These early spring flowering plants may be replaced later in the season with ones that do well in summer and fall. Photo by Ellen Barcel

Unless you have very sturdy window boxes, it may be easier for you to transfer your small seedlings into larger pots and settle those pots into the window box, rather than filling the window box itself with soil. This is especially important if your window boxes are made of wood, which may soon rot away with the damp soil. To deal with this problem, I have liners of a man-made material in several of my window boxes.

For those more exuberant gardeners, you can change the plants in the widow boxes seasonally. Maybe you want mums in the fall or small bulbs in the spring. Deadheading is one chore that annoys me but really should be done with window boxes, since the plants in them are so visible, especially those on the front of your house. So, whether you go for a very formal look, a riot of colors or a way to grow your herbs, consider widow boxes this coming gardening season.

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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Banana Oatmeal Muffins with Chocolate Chips

By Barbara Beltrami

I like to think of muffins as healthful cupcakes. Basically individual-sized quick breads, they seem to be synonymous with comfort and warmth and coziness and goodness. According to Wikipedia, the word “muffin” first appeared in 1703 as “moofen,” possibly a derivative of the low German “muffen,” the plural of small cake. That sounds viable. Whatever their derivation, they’ve become a staple of the roster of edibles that Americans have come to think of as the companions for their coffee or tea, the takeout breakfast goodies that make getting up in the morning a worthwhile exercise.

Like many good-for-you foods that I write about, muffins can be adaptable to what you have on hand and what your tastes dictate. Below is a basic recipe for sweet muffins to get you started. I’ve also included a couple of my favorite muffin recipes that are a little different from the basic one. I can pretty much guarantee that when you slip these into the oven on a cold winter morning, the aroma will elicit smiles and maybe even a little conversation from the usual grumps and grouches.

Basic Sweet Muffin Recipe

YIELD: Makes 12 muffins

INGREDIENTS:

¾ cup whole wheat flour

1 cup unbleached all-purpose flour

2½ teaspoons baking powder

½ teaspoon salt

½ cup milk

½ cup honey

One egg, well beaten

1/3 cup oil

DIRECTIONS: Preheat oven to 400 F. Stir together both flours, baking powder and salt. In a separate bowl, thoroughly mix milk, honey, egg and oil. Make a well in the center of dry ingredients and add liquid mixture. Stir until just moistened. Let rest for one minute. Fill greased or paper-lined muffin pans two-thirds full. Bake 20 minutes or until toothpick inserted in center comes out clean. Serve with butter, jam, honey or cream cheese.

Banana Oatmeal Muffins

Banana Oatmeal Muffins with Chocolate Chips

I don’t remember where this recipe came from — I just know I’ve been making it for years and it’s always a hit. Sometimes I add a cup of chopped nuts or chocolate chips; sometimes I don’t.

YIELD: Makes about 14 muffins

INGREDIENTS:

1½ cups all-purpose flour

1 cup quick-cooking oatmeal

2 teaspoons baking powder

1 teaspoon baking soda

½ teaspoon salt

One egg, well beaten

½ cup milk

1/3 cup oil

2/3 cup mashed ripe banana

DIRECTIONS: Preheat oven to 400 F. Stir together the flour, oatmeal, baking powder, baking soda and salt. In a separate bowl, mix the egg, milk, oil and banana and add to dry mixture. Stir until just moistened. Let sit for one minute. Fill greased or paper-lined muffin pans two-thirds full. Bake for 20 minutes or until golden brown and a toothpick inserted in center comes out clean. Serve with butter, honey, jam, peanut butter or cream cheese.

Pineapple Ginger Almond Muffins

Pineapple Ginger Almond Muffins

With the tang of the pineapple, the zing of the ginger and the crunch of the almonds, these muffins are especially good with tea, but great with coffee too.

YIELD: Makes 16 to 18 muffins

INGREDIENTS:

2½ cups all-purpose flour

1 tablespoon baking powder

½ teaspoon baking soda

½ teaspoon salt

1/3 cup sugar

1 teaspoon cinnamon

¾ teaspoon powdered ginger

One egg, well beaten

1 cup buttermilk

¼ cup oil

½ cup dark molasses

1 cup finely chopped canned pineapple, well drained and patted dry

1 cup toasted crushed sliced almonds

DIRECTIONS: Preheat oven to 400 F. Stir together the flour, baking powder, baking soda, salt, sugar, cinnamon and ginger. Mix egg, buttermilk, oil and molasses and add to dry ingredients. Stir until just moistened. Gently fold in pineapple and almonds. Let sit one minute. Fill greased or paper-lined muffin pans two-thirds full. Bake for 20 minutes or until a toothpick inserted in center comes out clean. Serve with butter, cream cheese, jam, honey or yogurt.

Suggestions and tips: Add half a cup to one cup of any of the following. (If adding more than one ingredient, adjust amount of each accordingly.)

Chopped walnuts, almonds or pecans

Raisins or other dried fruit(chopped)

Pared, cored and grated apple or pear

Berries

Chocolate chips

For a nice surprise, fill muffin cups with half a cup of batter, add a heaping teaspoon of jam or brown sugar, then top with remaining batter.

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