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Brie is a very versatile cheese and pairs nicely with a multitude of wines. Stock photo

By Bob Lipinski

“How can you govern a country which has 246 varieties of cheese?”  — Charles de Gaulle, 1890–1970, President of France, 1962 speech

According to popular legend, Emperor Charlemagne supposedly first tasted Brie in around 774 at a monastery and fell in love with its creamy flavors and inviting texture. There are stories that put Brie’s beginnings several hundred years earlier, but those cannot be proven.

At the Congress of Vienna (1814–1815) a jury of ambassadors each brought a cheese from their respective countries for a judging. France’s statesman, Talleyrand, brought Brie and after a vote, the conference delegates proclaimed it the King of Cheeses.

Brie, which is a double-crème, cow’s milk cheese is made in the French province of Brie, in the department of Seine-et-Marne, northeast of Paris, although it is also made in the United States and other countries. Brie is similar to Camembert (France), Coulommiers (France), Crèma Danica (Denmark) and Paglia (Italy).

The term Brie covers a small family of cheeses, which carry the name of the town or village where they are made. The finest Brie is generally considered to be Brie de Meaux while another variety is Brie de Melun.

Prior to aging, the small or large wheels of cheese are washed with a salt brine, then rubbed or sprayed with a culture of pure-white mold spores. After that, the cheeses are taken to the curing room for many months of aging. Brie has a thin, edible, white rind, with a creamy yellow interior.

When Brie begins to get old, the white rind turns brown and an odor of ammonia can be detected. Its texture is soft and smooth, almost honey-like, but definitely not runny. It is mild to pungent tasting with hints of mushrooms, cognac, heavy cream, nuts and even truffles. After one hour or so opened at room temperature, Brie becomes runny with a buttery and earthy flavor and is quite spreadable. It is sometimes flavored with herbs, peppers and mushrooms.

I generally serve Brie at room temperature, and for guests, with the aid of a sharp knife, I remove the top rind and immediately brush the cheese with lemon juice. Next I spread a thin layer of apricot or peach preserves, followed by raisins previously soaked in white wine, in the center. Spread slivered almonds or pecans in a circular fashion around the raisins. Place in a 425 F oven for approximately 7 to 10 minutes. Remove and let rest for 10 minutes, then serve with crackers.

Brie is a very versatile cheese and pairs nicely with a multitude of wines including some reds — Beaujolais, cabernet franc, cabernet sauvignon, grenache, merlot, pinot noir and zinfandel. White wines include chardonnay, chenin blanc, Gewürztraminer, riesling and sauvignon blanc. Let’s not forget Champagne and sparkling wines.

Two New York State Finger Lakes wines I recently paired with Brie were:

Standing Stone 2013 Cabernet Sauvignon: Bright ruby colored with aromas of wild cherry, red candy and spicy blueberries. Should develop into a stunning wine.

Standing Stone 2014 Dry Vidal: Vidal is a white French hybrid of Ugni Blanc and Rayon d’Or, developed in 1929 by Jean-Louis Vidal. The wine has an aroma of grapefruit, kiwi and peaches. It has plenty of acidity, which keeps it clean and crisp tasting. Definitely one of the best dry Vidal wines I have encountered!

Bob Lipinski, a local author, has written 10 books, including “101: Everything You Need to Know About Vodka, Gin, Rum & Tequila” and “Italian Wine & Cheese Made Simple” (available on Amazon.com). He conducts training seminars on wine, spirits and food and is available for speaking engagements. He can be reached at www.boblipinski.com or [email protected].

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Above, variegated azalea grown from a sport, but the azalea is ‘reverting to type’ growing some solid green leaves. Photo by Ellen Barcel

By Ellen Barcel

Recently, I received a U.S. stamp with a couple of bright red pears pictured on it. The paperwork that came with the stamp noted that pear trees, along with apple trees, are noted for putting out sports.

Botanically, sports are genetic mutations that arise naturally in plants. And yes, pear and apple trees do put out sports, which can lead to new varieties of plants being developed. On a pear tree, which normally produces green pears, you may see a branch that has reddish pears. Or on an apple tree, you may find a branch that has larger or different colored apples.

Now, I’m not talking about trees that are grafted to produce more than one variety of fruit — you can see these advertised in magazines and gardening catalogs — but a tree that naturally produces one or more unusual branches and fruit. This is referred to as “throwing a sport.”

Certain plants are more prone to produce these genetic mutations than others. For example, hostas easily produce sports, leading to the literally hundreds of varieties of hostas on the market today, from tiny to enormous, variegated, bluish, etc.

When these sports are propagated, the new plants will resemble the sport, not the parent plant. Propagate the unusual hosta and you now have a new cultivar. Propagate the red pear sport and you now have an entire tree filled with those red pears.

But sometimes, these sports are not stable. They “revert to type,” that is, they revert to the genetic makeup of the original plant. It’s usually not the whole plant that reverts, but a small part of it. A branch will grow, for example, that looks just like the original plant.

This dwarf Alberta spruce is reverting to type. Note the unusual branches growing out of the top of the tree.
This dwarf Alberta spruce is reverting to type. Note the unusual branches growing out of the top of the tree. Photo by Ellen Barcel

Dwarf Alberta spruce (Picea glauca var. albertiana f. conica) is a lovely, slow-growing, compact coniferous evergreen, which as its name implies stays very small. It makes an ideal decorative plant and easily grows in tubs. Many people like them decorated at Christmas. The dwarf Alberta spruce is a naturally occurring mutation of white spruce. Yes, it can revert to type. A couple of years ago, I saw a walkway lined with them; and yes, there growing from the top of one was a branch that had reverted to type.

So, what do you do if you find a sport on one of your plants, or, a plant grown from a sport reverts to type? That depends on whether you like the appearance or not.

Ignore it. If you find that the sport, or the reversion, is pleasing, you can just ignore it. That’s what I did when my variegated azaleas began to revert to solid green leaves. The flowers are the same gorgeous ones on all the branches, and the reversion actually has larger green leaves than the variegated ones.

Remove it. If you don’t like the sport or the reversion, find it ruins the plant etc., you can simply prune it out. I could have done this with my azaleas, but as I said above, it didn’t affect the flowers and made the overall plant larger.

Propagate it. If you absolutely love the sport, you can attempt to cultivate it. Usually vegetative propagation is the best since a sport is a mutation, a change in the genes. For hostas, this usually means digging up the plant and dividing it, detaching the different variety. Make sure you have the roots with the division. Replant the original plant and plant the sport in a different location, giving it a new home. Commercial growers sometimes use tissue culture, but this is really a specialized group of techniques that is beyond the home gardener. If the plant with the sport is a woody one, you can try to take woody cuttings. Use rooting hormone and sterile soil for best results.

You can, of course, collect the seeds from any flowers that form on a sport and try to grow the sport from seed. Chances are that if the seeds are not sterile, you will get a wide range of results from the original plant to the sport. Growing from seed, however, is time consuming as many plants can take years of growth before they mature. Plants like the dwarf Alberta spruce generally don’t produce cones and, therefore, no seeds. So, growing from seed is very iffy.

Note that if you find a really different branch with totally different flowers, on say, a rose bush, trace it back to its origin. Chances are you will find that the branch goes all the way back to the ground. Chances are that this is a grafted plant and that those roots are sprouting, rather than the graft. Usually grafted plants are made up of a common root stock with a beautiful plant on top. Unless you absolutely love what’s growing on the root sprouts, remove them at the soil level, below the graft (the large bump on the stem just above soil level). This will send the energy of the plant into the beautiful graft rather than the common root stock.

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

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Wei Zhu with a photo of her mother, Shenzhen Du. Photo by Joyce Ruan

By Daniel Dunaief

Wei Zhu’s long personal and professional journey began in China. Devoted to her mother, Shenzhen Du, Zhu watched her hero fight through a long illness with chronic kidney disease. Shortly before she died, her mother woke from a coma and suggested that her daughter become a doctor, like the people who were helping her in the hospital.

Driven to fulfill her mother’s request, Zhu attended college where, despite aspirations to become a writer like Charles Dickens or Charlotte Bronte, she studied math. She found the subject challenging but stuck with it. “Math was absolutely hard work,” she recalled. “We had to devote longer time to our study than many other majors. It all paid off in my case.”

Indeed, after she completed a one-year graduate program in math, she and her husband, Yeming Ma, came to the United States, where she used her experience in math to explore ways to understand how statistics can provide a perspective on everything from drug dosage to global warming to the causes of cancer.

“You can use math to improve people’s health,” said Zhu, who is now the deputy chair and professor in the Department of Applied Mathematics & Statistics at Stony Brook University.

Wei Zhu with her daughter, Merry Ma. Photo by Merry Ma
Wei Zhu with her daughter, Merry Ma. Photo by Merry Ma

At the beginning of the year, Yusuf Hannun, the director of the Stony Brook Cancer Center, emailed Zhu to ask her to pitch in to help understand a major question about cancer. In the prestigious journal Science, several researchers had concluded that the “bad luck” hypothesis suggested cancer was something that was written in a person’s genes. This scientific conclusion was akin to suggesting that a character’s fate in a play may have been written in the stars.

Hannun, Song Wu, an assistant professor in her department, Scott Powers, a professor in the Department of Pathology and Zhu came to a different conclusion, which they published in the equally prestigious magazine Nature.

Putting the data and the theory together, the group suggested that lifestyle choices and environmental exposure were also instrumental in this disease. The argument is the equivalent of nature versus nurture for a deadly disease.

“We were able to quantify what we observed,” Zhu said. For most cancers, the group concluded, the majority of the risk was due to lifestyle and environmental factors other than pure intrinsic genetic mutations. The disease debate, scientists recognize, doesn’t end there.

“The entire cancer research community still has a long way to go in order to perfectly understand the causes, prevention and treatments for each cancer, for each individual,” Zhu explained.

Hannun suggested that the direction cancer research is going requires advanced expertise in several areas of applied mathematics, physics and related disciplines. These are now needed for working with large data sets, for modeling pathways and events and for generating new hypotheses and organizing principles, Hannun wrote in a recent email. Hannun described Zhu as “terrific, highly dedicated and very collaborative” and suggested that the work has been “rewarding.”

Zhu is hoping that the recent Nature publication will trigger additional funding to support more research with this team of Stony Brook University scientists.

Wu, who was the first author on the Nature article, described Zhu as “well respected in the scientific community. She has done a lot of work on the analyses of brain image and proteomics data,” he wrote in an email.

Throughout her career, Zhu has sought to use statistics, bioinfomatics and other modern tools to enhance a scientific understanding of complex questions. She recently worked with Ellen Li, a professor of medicine and chief of the Division of Gastroenterology and Hepatology at Stony Brook University School of Medicine, who wanted to understand the development of digestive diseases such as inflammatory bowel disease and colon cancer. Putting the numbers together could provide the kind of information that offers an understanding of how lifestyle and food choices contribute to some diseases over time, Zhu said.

“We have published several papers together over the years,” Zhu said. “We are still in the data collecting stage for the diet analysis.” In her career, which spans 24 years, Zhu has worked on a wide range of topics. She has helped analyze data on the regions of the brain that are active in addiction and helped refine and enhance global climate models. In her early work, she also help pharmaceutical companies come up with optimal drug dosage. Numbers have been a part of Zhu’s life wherever she goes. “You do see numbers in the air,” she said. “When it’s getting hot,” she asks, “what does it have to do with my climate model? Does it fit the data?”

In more recent years, Zhu has struggled with the tension between contributing to larger projects and budgetary constraints. She worries that the “funding situation has changed the dynamics of the job market for the young generation of statisticians,” she said. “Now the majority of my doctoral students hope to focus their research on financial models, instead of biological models.”

Zhu and her husband Ma, who is a financial manager for GE, live in Setauket. Their son Victor, 24, recently earned his graduate degree in finance, while their daughter Merry, 11, attends Mount Elementary School. Zhu appreciates living on Long Island, where she can be close to the ocean.

As she looks back on the developments in her life that brought her to this point in her career, Zhu recognizes that the decision to learn more about math and statistics provided her with the kind of background that allowed her to fulfill her mother’s wish. “I can always honestly tell young students that it is a good idea to choose mathematics or statistics as their undergraduate majors,” she said. It will pave the way for them to have “a solid foundation for a variety of future graduate studies.”

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Pan Roasted Maple Dijon Chicken. Stock photo

As summer comes to an end and the reality of back-to-school season sets in, it can be challenging to get organized and jump back into your day-to-day routine. But even as things get hectic, it’s still possible to create delicious dishes — such as Pan-Roasted Maple Dijon Chicken and Chicken Thighs and Tomatoes — that leave you plenty of time to savor meals together as a family.

Chicken Thighs and Tomatoes

Chicken Thighs and Tomatoes. Stock photo
Chicken Thighs and Tomatoes

YIELD: Serves 4

INGREDIENTS:

1 pint cherry tomatoes

pepper

kosher salt

olive oil

4 chicken thighs (skin-on, bone-in)

1 cup white wine

1 clove garlic

1 lemon, juice only

DIRECTIONS: Heat oven to 400 F. In cast iron skillet, toss tomatoes with pinch of pepper, kosher salt and light drizzle of olive oil and place in oven. Roast tomatoes for 20 minutes. Set aside. Heat skillet on stove top. Once hot, sear chicken thighs. Flip chicken and sear bottom side for about 1 minute. Remove chicken from pan and set aside. With pan still hot, pour in white wine. Once wine has settled, add minced garlic. Add juice of one lemon. Return chicken thighs and tomatoes to skillet. Bake for 35 to 40 minutes and serve.

Source: Edna Valley Vineyard

Pan-Roasted Maple Dijon Chicken with Butternut Squash and Brussels Sprouts

Pan Roasted Maple Dijon Chicken. Stock photo
Pan Roasted Maple Dijon Chicken

YIELD: Serves 4

INGREDIENTS:

1 tablespoon olive oil

4 chicken thighs

4 chicken drumsticks

3/4 teaspoon kosher salt

1/2 teaspoon freshly ground pepper

1 tablespoon unsalted butter

16 Brussels sprouts (about 8 ounces), bottom trimmed, outer leaves removed and halved

2 cups diced (1/2 inch) butternut squash

1 1/2 cups chicken stock

2 tablespoons maple syrup

2 teaspoons Dijon mustard

DIRECTIONS: In saute pan large enough to hold chicken in single layer, heat olive oil over medium-high heat. Season chicken with salt and pepper. Add chicken to pan, skin side down, and saute about 4 to 5 minutes per side, or until chicken is browned. Remove chicken from pan and reserve. In same pan, add butter. Allow butter to melt over medium heat. Add sprouts and squash to pan and saute, tossing occasionally, until outsides are golden brown, about 3 to 4 minutes. Remove from pan and hold separately from chicken.

Turn heat to high and add stock, syrup and mustard. Stir and bring to boil, stirring to scrape up brown bits on bottom of pan. Add chicken back to pan, cover and reduce heat to medium-low. Cook over medium-low heat 20 to 25 minutes, or until chicken registers 170 F with instant read thermometer. Add vegetables back to pan, cover again and cook another 8 to 10 minutes until vegetables are tender. Move chicken and vegetables to serving platter, placing vegetables around chicken. Turn heat to high and boil sauce until it is reduced and slightly thickened, about 2 to 3 minutes. Spoon sauce over chicken and serve.

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By Nancy Burner, Esq.

In my practice as an elder law attorney, clients often inquire about the benefits of gifting to reduce taxes or to qualify for Medicaid. As a senior with the unexpected need for long-term care in the future, the consequences of gifting may have unexpected results.

It is a common myth that everyone should be gifting monies during their life to avoid taxation later. Currently, a person can give away during life or die with $5.45 million before any federal estate tax is due. For married couples, this means that so long as your estate is less than $10.9 million, federal estate taxes are not a problem. For New York State estate tax, the current exemption is $4.1875 million and is currently slated to reach the federal estate tax exemption by 2019.

While it is true that there are gifting estate plans that can reduce estate taxes, any gift that exceeds the annual gift exclusion must be reported on a gift tax return during the decedent’s life and is deducted from their lifetime exemption. In 2016, that exclusion is $14,000. However, while gifting may be good if the goal is to reduce estate tax, it can be detrimental if the donor needs Medicaid to cover the cost of long-term care within five years of any gifts.

It is important to remember that the $14,000 only refers to the annual gift tax exclusion under the Internal Revenue Code. The Medicaid rules and regulations are different. In New York, Medicaid requires that all applicants and their spouses account for transfers made in the five years prior to applying for Institutional Medicaid. These gifts are totaled, and for each $12,633 that was gifted, one month of Medicaid ineligibility is imposed for Long Island applicants. It is also important to note that the ineligibility begins to run on the day that the applicant enters the nursing home and is “otherwise eligible for Medicaid” rather than on the day that the gift was made.

For example, if a grandfather gifted $100,000 over the course of five years to his grandchildren and then needed nursing home care, those gifts would be considered transfers and, if they cannot be returned, would create a period of ineligibility for Medicaid benefits for approximately eight months. What makes this even more difficult for some families is that an inability to give the money back or help the grandfather pay for his care is not taken into consideration, causing many families great hardship.

It would have been far better for the grandfather to have put assets into a Medicaid-qualified trust five years ago to start the period of ineligibility and allow the trustee to make the annual gifts. Another concern when gifting is considering to whom you are gifting? Once a gift is made to a person, it becomes subject to their creditors, legal status and can adversely affect their government benefits.

Accordingly, if you make a gift to a person who has creditors or who later gets a divorce, that gift could be lost to those debts. Consider creating a trust for the benefit of the debtor-beneficiary to ensure that their monies are protected. Another problem arises when making gifts to minors. Because a minor cannot hold property, if gifted substantial sums, someone would have to be appointed as the guardian of the property for that child before the funds could be used.

To avoid this problem, consider creating a trust for the minor beneficiary and designate a trustworthy trustee who will manage the money for the minor until they are old enough to manage it themselves.

Finally, if gifting to a disabled beneficiary, make sure to review what government benefits they may be receiving. If any of the benefits are “needs based,” even small gifts may disqualify them for their benefits. In order to maintain eligibility, a Supplemental Needs Trust could be created to preserve benefits for the disabled beneficiary.

A common phrase comes to mind “do not try this at home.” Before doing any kind of substantial gifting, or even if you have begun gifting, see an elder law attorney who concentrates their practice in Medicaid and estate planning to help optimize your chances of qualifying for Medicaid and/or reduce estate taxes, while still preserving the greatest amount of assets.

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

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By losing just 10 pounds, you can prevent deadly illness, alleviate daily pain and improve your quality of life. Stock photo

By David Dunaief, M.D.

Some research shows that obesity may be reaching a plateau. Is this true? It depends on how the data is analyzed. According to one study, yes; it has plateaued when looking at short, two-year periods from 2003 to 2011 (1).

However, another published study shows a picture that is not as positive (2). The study’s authors believe obesity has not plateaued; when looking over a longer period of time, statistics suggest that obesity has reached a new milestone. There are now more obese patients in the United States than there are overweight patients. And no, it is not because we have fewer overweight patients. This is based on a study that reviewed data from the National Health and Nutrition Examination Survey (NHANES). These results were in adults over the age of 20. This should be an eye-opener.

Unfortunately, according to one study, the probability is not very good for someone to go from obese to “normal” weight in terms of body mass index (3). In this observational trial, results show that an obese man has a 0.5 percent chance of achieving normal weight, while a woman has a slightly better chance, 1 percent. This study used data from the UK Clinical Practice Datalink. The data were still not great for men and women trying to achieve at least a 5 percent weight loss, but better than the prior data. Patients who were more obese actually had an easier time losing 5 percent of their body weight.

What are two major problems with being obese? One, obesity is a disease in and of itself, as noted by the American Medical Association in 2013 (4). Two, obesity is associated with — and is even potentially a significant contributor to — many chronic diseases such as cardiovascular disease (heart disease and stroke), high blood pressure, high cholesterol, atrial fibrillation, diabetes, cancer, cognitive decline and dementia. When I attended the 28th Blackburn Course in Obesity Medicine in June 2015 at Harvard Medical School, a panel of experts noted that there are over 180 chronic diseases associated with obesity.

In this article, we will focus on one significant multifaceted disease, cancer. Watch out for cancer One of the more unpredictable diseases to treat is cancer.

What are the risk factors?

Beyond family history and personal history, obesity seems to be important. In fact, obesity may be a direct contributor to 4 percent of cancer in men and 7 percent of cancer in women (5). This translates into 84,000 cases per year (6). On top of these stunning statistics, there is about a 50 percent increased risk of death associated with cancer patients who are obese compared to those with normal BMIs (7).

What about with breast cancer?

The story may be surprising and disappointing. According to an analysis of the Women’s Health Initiative, those who were obese had increased risks of invasive breast cancer and of death once the diagnosis was made (8). The severity of the breast cancer and its complications were directly related to the severity of the obesity. There was a 58 percent increased risk of advanced breast cancer in those with a BMI of >35 kg/m2 versus those with normal BMI of <25 kg/m2. And this obese group also had a strong association with estrogen-receptor-positive breast cancer.

However, those who lost weight did not reduce their risk of breast cancer during the study. There were 67,000 postmenopausal women between the ages of 50 and 79 involved in this prospective (forward-looking) study. The researchers do not know why patients who lost weight did not reduce their risk profile for cancer and suggest the need for further studies. This does not imply that lifestyle changes do not have a beneficial impact on breast cancer.

What can we do?

We find that fat is not an inert or static substance, far from it. Fat contains adipokines, cell-signaling (communicating) proteins that ultimately may release inflammatory factors in those who have excessive fat. Inflammation increases the risk of tumor development and growth (9).

There is a potentially simple step that obese cancer patients may be able to take — the addition of vitamin D. In a study in older overweight women, those who lost weight and received vitamin D supplementation were more likely to reduce inflammatory factor IL-6 than those who had weight loss without supplementation (10). This was only the case if the women were vitamin D insufficient. This means blood levels were between 10 and 32 ng/mL to receive vitamin D.

Interestingly, it has been suggested that overweight patients are more likely to have low levels of vitamin D, since it gets sequestered in the fat cells and, thus, may reduce its bioavailability. Weight loss helps reduce inflammation, but the authors also surmise that it may also help release sequestered vitamin D. The duration of this randomized controlled trial, the gold standard of studies, was one year, involving 218 postmenopausal women with a mean age of 59.

All of the women were placed on lifestyle modifications involving diet and exercise. The treatment group received 2,000 IU of vitamin D3 daily. Those women who received vitamin D3 and lost 5 to 10 percent of body weight reduced their inflammation more than those in the vitamin D group who did not lose weight.

What does medicine have to offer?

There are a host of options ranging from lifestyle modifications to medications to medical devices to bariatric surgery. In 2015, the FDA approved two medical devices that are intragastric (stomach) balloons (11). The balloons are filled with 500 mL of saline after inserting them in the stomach via upper endoscopy. They need to be removed after six months, but they give the sense of being satiated more easily and help with weight loss.

One, the ReShape Dual Balloon, is intended to go hand-in-hand with diet and exercise. It is meant for obese patients with a BMI of 30-40 kg/m2 and a comorbidity, such as diabetes, who have failed to lose weight through diet and exercise. In a randomized controlled trial involving 326 obese patients, those who received the balloon insertion lost an average of 14.3 lb in six months, compared 7.2 lb for those who underwent a sham operation.

Lifestyle modifications

In an ode to lifestyle modifications, a study of type 2 diabetes patients showed that diet helped reduce weight, while exercise helped maintain weight loss for five years. In this trial, 53 percent of patients who had initially lost 23 lb (9 percent of body weight) over 12 weeks and maintained it over one year were able to continue to maintain this weight loss and preserve muscle mass through diet and exercise over five years (12). They also benefited from a reduction in cardiovascular risk factors. In the initial 12-week period, the patients’ HbA1C was reduced from 7.5 to 6.5 percent, along with a 50 percent reduction in medications.

We know that obesity is overwhelming. It’s difficult to lose weight and even harder to reach a normal weight; however, the benefits far outweigh the risks of remaining obese. Lifestyle modifications are a must that should be discussed with your doctor. In addition, there are a range of procedures available to either help jump start the process, to accelerate progress or to help maintain your desired weight.

References: (1) JAMA 2014;311:806-814. (2) JAMA Intern Med 2015;175(8):1412-1413. (3) Am J Public Health 2015;105(9):e54-59. (4) ama-assn.org. (6) cancer.gov/cancertopics/factsheet/risk/obesity. (7) N Engl J Med 2003;348:1625-1638. (8) JAMA Oncol online June 11, 2015. (9) Clin Endocrinol 2015;83(2):147-156. (10) Cancer Prev Res 2015;8(7):1-8. (11) fda.gov. (12) ADA 2015 Abstract 58-OR.

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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A drone carrying medicine and lab samples lands in a village in Madagascar. Photo courtesy of SBU

By Daniel Dunaief

Stony Brook University is taking to the skies to help people on the ground in Madagascar. Through its Global Health Institute, SBU plans to bring drones to the island nation off the southwest coast of Africa that will carry medical samples from hard-to-reach villages to its state-of-the-art research facility, Centre ValBio.

Late last month, Peter Small, the founding director at GHI, brought a drone to Madagascar, where it flew from the research station to a nearby village. The drones can fly like an airplane over 40 miles of terrain, while they take off and land like a helicopter, enabling a smooth ride to protect the samples inside the cargo area.

“Our challenge is to align the most pressing challenges that are amenable to supply chain and specimen transport and intervention,” Small said. Madagascar is dealing with “high rates of tuberculosis” among other health challenges, he said, adding that a university like Stony Brook can take complicated problems and find solutions in the real world.

The drones can provide two important functions for Madagascar: monitoring the outbreak of any unknown and potentially dangerous disease and offering health care for people who live in areas that are inaccessible by road, Small said.

A view of Madagascar from the SBU drone. Photo courtesy of SBU
A view of Madagascar from the SBU drone. Photo courtesy of SBU

“Diseases like Ebola and Zika frequently pop up in remote areas,” said Small, a medical doctor who worked at the Bill & Melinda Gates Foundation prior to joining Stony Brook University in 2015. Having sites where drones can land and collect specimens will allow village health workers to send off specimens for analysis, providing greater clarity on the incidence of specific diseases throughout the country.

Additionally, people in remote areas can send samples back to a lab to test for medical conditions, such as tuberculosis. After medical technicians run tests, the drones can return not only with drugs that can treat the condition but also with instructions on how to treat patients.

The drones can carry a special box to record whether a pill bottle is opened. The box also can carry a sound recorder that can recognize and count coughs, Small said. When the drone returns with another supply of medication, the previous medicine can make the return trip to the lab, where doctors can determine whether the cough is getting better and can see how much medicine the patient took.

Medicine is delivered to villages in Madagascar by way of drones. Photo courtesy of SBU
Medicine is delivered to villages in Madagascar by way of drones. Photo courtesy of SBU

Ideally, the drones will not require any specialized knowledge to fly. Once people in rural villages have a signal, they can request a drone, which can transport samples to a lab or bring medicine back to the village.

“We want to put these drones in the hands of the village health workers and the local health system,” said Small. He said those working with this project hoped people in the village would welcome this medical service but were unsure how it would be received. “We had no idea how people would respond to these” drones, Small said. The initial run, however, was successful. GHI plans to bring two more drones to Madagascar in the next few months.

A company in Michigan called Vayu manufactures the drones, which weigh 35 pounds, are about the size of a picnic table and can carry up to a 5-pound payload, said Daniel Pepper, the company’s chief executive officer. Using an electric, rechargeable battery, the drones can travel up to 40 miles. In the near future, Pepper hopes to increase that distance to as many as 65 miles.

Vayu has manufactured dozens of these drones. The recent Madagascar test was the first time they had used the unit in an international setting. Pepper is “speaking to partners and potential customers in over a dozen countries,” including the United States, where drones might offer a connection between medical centers in urban areas and harder-to-reach rural communities.

Pepper said the drone was the only one on the market that’s electric powered and can carry this payload over this range. “It takes off automatically and lands vertically,” he said and described the landing as “soft.”

According to Small, Madagascar could benefit from these drones, particularly in diagnosing the myriad health challenges of the area. “Madagascar is a remarkable area to start addressing some of these problems and bringing innovation,” he said.

In some villages, as many as 90 percent of people have intestinal parasites, which contributes to malnutrition and stunts growth, Small said. Small and Patricia Wright, the founder and executive director of Centre ValBio who has been working in the area for 30 years, are hoping to broaden and deepen the connection between Stony Brook and Madagascar.

The dental school has coordinated dental missions to treat hundreds of patients a day. Small said the dean of the dental school, Mary Truhlar, recently visited Madagascar to go beyond medical missions to “engage in improving the quality and training, care and health system issues.”

Small is excited with the way computational science and high-end mathematics are coming in to describe the complexities of health problems to the government of Madagascar. This will assist the government in generating medical priorities. Small has set some large goals for his role: “If life is not palpably better in five, 10 or 15 years” in Madagascar, “I will have failed at my job.”

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Lavender has long been used for its strong scent. Photo by Ellen Barcel

By Ellen Barcel

Every garden is a reflection of the tastes of the gardener: a children’s play area, fresh veggies, grapes for homemade wine or jam, a place to read and relax in the extensive greenery, privacy around a swimming pool, etc.

While some plants have little or no scent, or an unappealing one, many have a sweet or pleasing scent. Depending on your preference, you may want a very fragrant garden; or, if you’re allergic to sweet scents, you may want to know which plants to avoid. Here’s a rundown of some very fragrant, sweetly scented plants that will perfume your garden and your home.

Lilacs are known for their beautiful scent. Unfortunately, most only produce flowers in spring. Depending on your other choices, you may want to plant them as part of a whole plan — a number of fragrant plants blooming throughout the growing season. There are some varieties that are billed as rebloomers. The second bloom is usually not as lush as the first.

Roses should be selected by reading the tags or catalog descriptions carefully. Some roses have been cultivated to be beautiful but have little scent. Research your selections carefully so that you get exactly what you want. ‘Double Delight’ has a fruity or spicy scent, while ‘Julia Child’ has the scent of licorice and ‘Fragrant Cloud’ has a sweet perfume.

Honeysuckle is very sweetly scented, but note that some varieties are on the Do Not Sell List because of their invasive nature. Honeysuckle is native to the northern hemisphere, including North America, Europe and Asia. The plant is particularly popular for its intensely fragrant white flowers.

Mints are herbaceous perennials with a strong aroma. They can be used in cooking (jams, jellies, iced tea, etc.) or just enjoyed in the garden. Brush against the leaves and you release the wonderful scent. Lavender is in the mint family. Lavender is not native to the Americas but has been grown here since colonial times. It has been used as an insect repellent, to freshen clothes, to flavor foods and to scent cosmetics and soaps.

Lily of the Valley is a woodland plant that is very sweetly scented. Another benefit is that it does well in shady areas. But, be careful here, as the plant is toxic. As with all plants you are considering adding to your garden, make sure that no little children or pets can ingest it.

Bee balm is also a member of the mint family. A native of North America, it has even been used to make a tea. Flower colors range from red to purple.

Gardenias are extremely fragrant, but must be grown as a house plant on Long Island — they are cold tolerant only to zone 8. Yes, they can be moved to the outdoors in the summer and they will certainly add to the fragrance.

Jasmine is so strongly scented that some people avoid it as a result. Jasmine does well in zones 6 through 10 and requires full sun. Blossoms can be used to scent water in indoor arrangements and can also be used to scent tea.

Viburnum is a woody shrub that can easily reach 10 or more feet tall. Some species have flowers that are strongly scented. The white flowers are followed by bright red berries.

Mock orange is a woody shrub that does well in zones 4 to 7. It blooms in summer with lovely white flowers and an orangey aroma.

Flowering tobacco (Nicotiana) has sweetly scented, tube-shaped flowers available in a variety of colors: pink, white, red. It is usually grown as an annual but don’t be surprised if it survives a mild winter.

Hyacinths are spring blooming bulbs with a very strong sweet scent. Plant them in autumn before the ground has frozen. Like all spring flowering bulbs, after the flowers have died down, allow the green leaves to continue growing to provide food for the bulbs for next year. By summer those leaves will have disappeared.

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

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By Linda Toga

The Facts: My father died last year and I was issued letters testamentary by the Surrogate’s Court. When going through my father’s desk, I found a bank statement dated June, 1999, for a savings account I did not know existed. The balance in the account in 1999 was nearly $5,000. Unfortunately, the bank that held the account no longer exists.

The Question: How can I find out if my father removed the money from the account prior to his death?

The Answer: If the statement you found had been dated within the last five (5) years, you could likely find out which bank took over the assets of your father’s bank and contact them to see if the account still exists. However, in New York State, if a bank account is dormant for an extended period of time, after five years, the bank can hand over all of the money in the account to the State Comptroller’s Office.

In other words, after the requisite waiting period, the account will escheat to the state. While bank accounts escheat to the state after five (5) years, other types of assets and property such as insurance policies escheat after only three (3) years and checks issued by the state escheat after only one (1) year.

If you believe the money in your father’s account was escheated to the state, you can obtain information by calling the New York State Comptroller’s Office, which oversees the New York Office of Unclaimed Funds. You can also go online to www.osc.state.ny.us/ouf/ and search under your father’s name and address for any of his property that may have escheated to the state.

If your father ever lived outside New York, you may also want to search on the sites maintained by the offices of unclaimed funds in other states to be sure you don’t miss anything.

While you are searching for assets belonging to your father that may have escheated to the state, you should also search on your own name and address. You may be pleasantly surprised to find that a rent or utility deposit you forgot you even made or dividends on stocks that you once owned have escheated to the state and are available to you. There is no statute of limitations on unclaimed property, and online searches are free, so you have nothing to lose.

While it is highly unlikely that you will find you are entitled $6.1 million like the largest unclaimed property recipient but, you never know!

If you are lucky enough to find that the balance in your father’s account did, in fact, escheat to the state, you can request that the funds be sent to you. To do so, you must file a claim and provide sufficient information to establish your entitlement to the funds. Since you are the executrix of your father’s estate, you will be asked to provide your letters testamentary as well as documents establishing that your father was, in fact, the person named on the account. Any unclaimed funds that you collect as executrix should be considered as part of your father’s probate estate and distributed in accordance with the provisions in his will.

The process of recouping unclaimed property can be very frustrating because it takes quite some time. It is not unusual to be asked to resubmit paperwork previously provided or to provide documents that were not initially requested. However, being able to get your hands on “found” money is exciting and usually worth the effort.

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

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Trump's diet has been brought to the forefront during this election year.

By David Dunaief, M.D.

Donald Trump could learn a thing or two from Bill Clinton. No, we are not talking about politics; we are talking about health. Trump is a public persona, and his diet has been brought to the forefront. As was Clinton’s when he was the United States’ 42nd president. An Aug. 8 New York Times article discussed Trump’s love for fast food and his ironic obsession with cleanliness (1).

Trump’s approach to diet seems to be eerily similar to the standard American diet — with the added detriment of fast food. Though he likes the cleanliness of fast food chains, his arteries may not like the “dirtying” effect of atherosclerosis, or arterial plaques.

Admittedly, I don’t know anything about his family history, including whether or not cardiovascular disease is an issue; nor his blood chemistries, such as cholesterol levels; nor whether or not he has high blood pressure. However, one thing is clear: He is overweight with a significant amount of visceral fat, or belly fat. This type of body fat is considered the most dangerous because it surrounds the internal organs such as the heart (2). This promotes potential cardiovascular disease and diabetes.

For a long time, Bill Clinton also had a love for fast food and the standard American diet. However, this resulted in atherosclerosis, which caused significant blockage of coronary arteries and resulted in coronary artery bypass surgery involving four arteries in 2004. Since then, he has been on a mission to reform his diet. Through the influence of physicians like Drs. Dean Ornish and Caldwell Esselstyn, both advocates of plant-based diets, Clinton has done much better and lost significant weight, as well.

Thus, this is more about the standard American diet, with its high saturated fat, high sugar, refined grains, processed meats and elevated salt versus the nutrient-dense, more likely plant-based, approach with fruits, vegetables and whole grains and their respective effects on cardiovascular disease, atherosclerosis and even mortality.

These type of plant-based diets include the Mediterranean-type diet, the DASH diet, the Ornish diet and the Esselstyn diet.

If we look solely at the differences between saturated fats and unsaturated fats, a recent study involving over 120,000 participants showed that when just 5 percent of pure saturated fats in the diet were replaced with unsaturated fats, this resulted in a significant reduction in all-cause mortality of up to 27 percent over 32 years (3). For more details on this study analysis, see my recent article, “Let the dietary fat wars begin,” which can be found online at www.tbrnewsmedia.com.

I am a firm believer in leading by example. I think it is a powerful way to get patients to follow through with lifestyle changes, especially diet and exercise. That is why the dietary changes I ask my patients to make, I also have been following for years.

Data on cardiovascular disease

Recently, the Centers for Disease Control and Prevention released data about cardiovascular disease that is downright depressing. From 2000 to 2010, the risk of dying from this disease was decreasing by almost 4 percent a year in both men and women (4). However, from 2010 to 2014, this decrease slowed precipitously to 0.23 percent in men and 1.17 percent in women. The reason for this slowdown is that we may have reached a ceiling in the effectiveness of traditional medical interventions. The suggestions are that we concentrate more efforts on lifestyle modifications, specifically diet, physical activity and not smoking.

At the same time, 2011-2012 NHANES data showed a significant increase in obesity and diabetes (5). The bad news is we have not changed our lifestyles enough, especially diet. The good news is that there is a large upside for change and progress!

Reversing heart disease

This research includes both Ornish and Esselstyn. Both physicians have shown it is possible, through a plant-based approach, to have a significant impact on cardiovascular disease, reversing atherosclerosis and preventing a cardiovascular event such as a heart attack.

Esselstyn’s research includes a small study with 24 of his own patients (6). Of these, 18 patients completed the five-year study. These 18 patients had experienced 49 cardiovascular events in the previous eight years. Results show that with a plant-based diet, none of the 18 had a cardiovascular event. Eleven patients chose to have angiographic analysis to determine stenosis, or blockage. None of the 11 progressed; in fact, eight showed regression in atherosclerosis.

Though this was a small study with no control group, the duration, the reversal of atherosclerosis at the study end point and the severity of cardiovascular disease prior to the study make these results intriguing and impressive.

This study was extended to 12 years with similar results and only one additional patient dropping out. Interestingly, those who discontinued the study had a subsequent total of 13 cardiovascular events. One of the key study markers was keeping total cholesterol to lower than 150 mg/dL. The diet emphasized fruits, vegetables, beans, legumes and whole grains.

Then, Esselstyn’s group looked at 198 patients with cardiovascular disease (7). The results were similar to the smaller initial study, with those in the adherent group following a nutrient-dense, plant-based diet experiencing a most astonishing cardiovascular event rate of only 0.6 percent, while the 21 who were nonadherent (the unbeknownst control group, per se) experienced an event rate of 62 percent over 3.7 years.

What about Ornish’s research? Not surprisingly, the results were very similar to Esselstyn’s. In the Ornish study, results showed a reversal in atherosclerosis of 7.9 percent in the treatment group compared to baseline, whereas those in the control arm over the same period showed a 27.7 percent increase in atherosclerosis or plaques in the arteries (8). Also, the control group experienced more than two times as many cardiovascular events as seen in the treatment group. The patients in the treatment group were on a plant-based diet.

There were 48 patients with moderate to severe cardiovascular disease at the beginning of the study, with 28 patients in the treatment group and 20 assigned to the control arm. Of these patients about 75 percent in each group completed the study. The duration of the study was five years. Again, these results are intriguing, and each study reinforces the others.

A clinical example

In my practice, I recently had a 69-year-old white male patient with cardiovascular disease and an extensive family history of the disease, who went to the cardiologist prior to working with me. The initial carotid Doppler (sonogram of the neck arteries) showed a 16 to 50 percent blockage in both carotid arteries. After a year, the carotid Doppler results had been reduced to between 1 and 15 percent blockages in both carotid arteries. The patient’s total cholesterol had dropped to 146 mg/dL, and this result included discontinuing his cholesterol medication, though it was not a statin. Of course, this is anecdotal, but it is consistent with the results mentioned in the studies above.

In conclusion, now you see why Bill Clinton followed the advice of at least two very wise physicians after his quadruple bypass surgery. Lifestyle with a nutrient-dense, plant-based diet not only can prevent cardiovascular disease but may be able to arrest and even reverse plaques in the arteries. Trump would be wise to follow suit and focus on cleanliness of his arteries rather than just cleanliness of the restaurant, as we all would.

References: (1) NYTimes.com. (2) Crit Pathw Cardiol. 2007;6(2):51-59. (3) JAMA Intern Med. 2016;176(8):1134-1145. (4) JAMA Cardiol. online June 29, 2016. (5) cdc.gov/nchs/nhanes. (6) J Fam Pract. 1995;41(6):560-568. (7) J Fam Pract. 2014;63(7):356-364b. (8) JAMA. 1998;280(23):2001-2007.

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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