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By Nancy Burner, Esq.

Consider this scenario: An individual executes a will in 1995. The will leaves all of his personal property (household furnishings and other personal effects), to his friend who is also the named executor. The rest of his estate he leaves to his two sisters. When he died in 2012, his two sisters had predeceased him. There were no other individuals named as beneficiaries of the will.

The executor brought a petition requesting that the court construe the decedent’s will so that she would inherit the entire estate as the only living beneficiary in the will. The executor stated that the decedent intended to change his will to name her as the sole beneficiary, but he died before he signed the new will. There was also an unwitnessed handwritten will that left his entire estate to the executor.

The court held that the testator’s intent to give his residuary estate to his two sisters was unambiguous. Having failed to anticipate, at the time that the will was executed, that his two sisters would predecease him, the court was not allowed to find that the decedent intended a gift of the residuary estate to his friend, the executor.

The court held that there were limitations on its ability to rewrite the decedent’s will to accomplish the outcome sought by the executor. Since the executor was only named as the beneficiary of personal effects, she could not inherit the rest of his estate. This is because the sisters predeceased him and they had no children, the will failed to name a contingent beneficiary.

The result was that the individuals who would have inherited had he died without a will would inherit. In the case at hand he had a distant cousin (to whom he never intended to leave anything) who was entitled to inherit all of his residuary estate. If the decedent had no other known relatives, his residuary estate would have escheated to New York State at the conclusion of the administration of the estate.

What it is important to realize here is how crucial it is to review and update your estate planning documents regularly. This is especially true after experiencing a significant life event such as a birth, death, marriage and/or divorce. You want your documents to reflect your intentions as they are today, not as they were 20 or 30 years ago.

If you are an unmarried person, with no children, living parents or siblings and your only relatives are aunts, uncles and/or cousins with whom you do not have close relationships, you especially want to make sure you have estate planning documents in place to avoid intestacy and having these relatives inherit by default. With these family circumstances, you also want to consider avoiding probate all together with a revocable or irrevocable trust.

If you have missing relatives, the nominated executor would have the burden of finding your aunts, uncles and/or cousins wherever they may be located to obtain their consent to the probate of your will. This can be expensive in both time and money. If these relatives cannot be found, the court will require a citation to be issued to these unknown relatives and a guardian ad litem will be appointed to investigate the execution of the will on their behalf. This is another layer of added expense and delay to the probate process, and a good reason to avoid it.

Whether you have a will or a trust, you want to be sure to review and update it regularly to make sure that your designated beneficiaries are still living. In a situation such as the scenario above, you also want to pay special attention to your contingent beneficiaries. The contingent beneficiaries take precedence if a primary beneficiary has predeceased. If you are unsure about naming contingent beneficiaries at the time you execute your will or trust, you may want to consider choosing a charity or allowing your executor/trustee to choose a charity for a cause you care about as a contingent beneficiary. This way, no matter what happens, your estate does not escheat to New York State.

The takeaway from the scenario above is how crucial it is to regularly review and update your estate planning documents. You want to be sure that whoever you want to inherit at your death, actually inherits your property.

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

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Erik Muller. Photo by Yizhi Meng

By Daniel Dunaief

Diamonds may not only be a girl’s best friend, they may also be important for doctors, particularly those using radiation to treat cancer patients.

Erik Muller, a principal investigator and adjunct professor in the Department of Materials Science and Chemical Engineering at Stony Brook University, recently demonstrated that a particular type of synthetic diamond can measure the flux, position and timing of radiation beams used in cancer therapies. His research seeks to adapt diamond detectors for use with an emerging type of therapy using high-energy protons and carbon ions. “There currently does not exist a technology which can precisely measure the flux, position and timing of these proton and carbon ion beams used in radiotherapy,” Muller explained.

The diamonds Muller and his team use are more pure than any natural diamond. They contain fewer than five parts per billion of nitrogen and less boron or other impurities. They are clear with no color. Nitrogen gives diamonds a yellow or brown color and acts as a charge trap, making natural diamond unsuitable for radiation detectors.

As an SBU postdoctoral researcher, Muller joined an effort at Brookhaven National Laboratory to investigate the use of diamond as an electron source. During that study, researchers found that diamond was a valuable X-ray detector. The success of that work led to the Department of Energy funding work to develop sensors for radiotherapy.

Diamonds can provide information that enable scientists to measure in real time the development of the beam.

Once diamond growers send the product to his lab, Muller and his team screen for a defect that can lead to unwanted hot spots in the detector response to X-rays. When Muller’s lab receives the diamonds, they look like small square pieces of glass. These diamonds are bread sliced into two to three pieces that are about half the thickness of a human hair.

Partners at the Center for Functional Nanomaterials at BNL prepare, characterize, etch and pattern the diamonds in the cleanroom. The Instrumentation Division at BNL provided custom electronics, circuit design, wire bonding and assembly. “The development of the detectors, particularly the pixellated diamond X-ray detector, would not be possible without the talent and expertise” in the Instrumentation Division, Muller explained.

Muller also lauded the contribution of the Stony Brook University students who worked on the diamond effort, including Mengjia Gaowei, Tianyi Zhou, Mengnan Zou and Wenxiang Ding. In preparing a proposal for the Department of Energy to improve beam diagnostics for particle therapy, Muller met Samuel Ryu, chair of the Department of Radiation Oncology and deputy director for clinical affairs at Stony Brook University’s Cancer Center. Ryu “expressed a strong interest in using these detectors for X-ray beam therapy and we have been pursuing that as well,” Muller said.

Ryu said the existing conventional detector, which measures radiation dosage, is “limited in some sense.” He likened the radiation detector to a thermometer. If a thermometer indicates that it’s 90 degrees, it may be 91 degrees, but the thermometer may not read the temperature with enough precision to indicate the exact temperature. Similarly, the diamond detector “will improve” the precision of the radiation dose measurement. The gap in the detection of the radiation dose has been like that for more than 100 years, Ryu said.

Ryu said the addition of the diamond to the detector should be commercialized and that he and Muller are “really trying to find out how we can use these detectors in the clinic.” Ryu said he doesn’t know the time frame for when this might become available in a radiation delivery system, but he would “like to see it as soon as possible.” Ryu and his staff meet regularly with Muller and his team to analyze the data and discuss how to proceed. He described Muller as “very open-minded” and indicated that it is a “very good collaboration.”

One of the challenges in taking this diamond discovery to the next step is to ensure that the software is robust and that it has enough redundancies to turn the beam off amid any contradictory readings. Before diamonds can become a part of these carbon or ion beam treatments, researchers need to demonstrate that the radiation itself won’t damage the diamond. While Muller doesn’t expect this to happen, he said he has to prove its viability.

In the bigger picture, Muller said he and the members of his lab spend considerable time understanding the physics of radiation sensing devices in high-radiation environments. “Diamond is a very promising material in this field for continued development and is our current focus,” he suggested. “In general, I am interested in any technique and material where we can understand how the structure affects the device function.”

Residents of South Setauket, Muller lives with his wife Yizhi Meng, an assistant professor in the Department of Materials Science and Chemical Engineering at Stony Brook, and their daughter, who is in primary school. Meng, who is a graduate of Ward Melville High School, develops drug delivery materials for breast cancer and osteosarcoma, a type of bone cancer. The couple met when they were graduate students at Cornell University. They shared an interest in photography. Meng uses Nikon cameras, while Muller prefers Canon. “There’s a funny rivalry between us,” Meng said.

As for his work, Muller is optimistic that it will have an application in radiation delivery. He believes he can address the engineering challenges and is “planning to continue the commercialization of these devices.” Meng is excited by the progress Muller has been making. Muller is “working with some really great people,” she said. “It’s really exciting.”

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Exercise is important in reducing the risk of fractures. Stock photo

By David Dunaief, MD

Osteoporosis is a complex disease. For one thing, it progresses with no symptoms, until the more severe stage of fractures that cause potential disability and increase mortality. For another, the only symptoms are from the treatment with medications, better known as side effects. Third, lifestyle modifications and supplements, while important, require adherence to a regimen.

I am not a big advocate of medication, as I am sure you have gathered from my previous articles; however, medication does have its place. There are studies that show benefit from the two main classes for osteoporosis, bisphosphonates such as alendronate (Fosamax, though it is now generic) and the newer class that involves monoclonal antibodies such as denosumab (Prolia). And, of course, I am a big advocate of lifestyle modifications including diet, exercise, smoking cessation and even some supplements. The side effects of these modifications are better health outcomes for chronic diseases and disorders in general. What I can’t advocate for, as a physician sworn to help people, is the new emerging cohort that I refer to as the “do-nothing group.”

Recently, a New York Times article on June 1, 2016, entitled, “Fearing Drugs’ Rare Side Effects, Millions Take Their Chances With Osteoporosis,” reported that prescriptions for medications to treat the disease have fallen by more than 50 percent from 2008 to 2012 because of the fear of the side effect profile that include rare instances of atypical fractures and jawbone necrosis (1).

In the article, one doctor mentions that patients prefer diet and exercise, but that it does not work. Well, he may be partially correct. Diet and exercise may not work if they’re not implemented. However, if people actually make lifestyle modifications, there could be substantial benefit. Just to give up on the medications for osteoporosis or to refuse to take them is not going to improve your chances or reduce your risk of getting fractures in the spine, hip, wrist or other locations. In other words, the “do-nothing” approach won’t help and may significantly increase your risk of fracture and other complications, such as death.

At the top of the list of risk factors for osteoporosis is nontraumatic fractures — in other words, breaking of bone with low-impact events. In this case, once you have had a fracture, the probability of having a recurrent or subsequent fracture increases more than three times in the first year, according to a recent Icelandic study (2). Lest you think that you are in the clear after a year since your first fracture: After 10 years, the risk of subsequent fracture still remains high, with a twofold increased risk.

Osteoporosis involves bone loss. We typically measure this through the bone mineral density (BMD) biomarker using a DXA scan. However, another component is bone quality. Sarcopenia, or loss of lean muscle mass, may play a role in bone quality. There are vitamins, such as vitamin K2, that can have beneficial effects on bone based on bone quality as well. No, this is not the same as the more well-known vitamin K1 used in clotting, which may also have a smaller benefit in preserving bone.

Let’s look at the evidence.

Avoiding sacropenia

Sarcopenia is a fancy word for a depressing phenomenon that occurs as we age and become more and more sedentary; it is the loss of lean skeletal muscle mass at the rate of 3 to 8 percent each consecutive decade after 30 and also loss of strength (3). It may have significant effects on about one-third of those over age 60 and half of those over 80. Unless, of course, you are physically active on a regular basis. In the Study for Osteoporotic Fractures in Men, results show that sarcopenia plus osteoporosis, taken together, increases the risk of fracture more than three times in older men (4).

The researchers assessed muscle wasting by using the European Working Group on Sarcopenia in Older Patients (EWGSOP), which takes into account weakness (grip strength <20 kg for men), slowness (walking=0.8 m/s) and low lean muscle mass (< 20 percent). This involved over 5,000 men with a mean age of about 74. The group with sarcopenia had significantly lower grip strength and was less physically active. In another study, those who were healthy 65-year-old adults who had sarcopenia or low lean muscle mass were at a greater than two times risk of experiencing a low-trauma fracture within three years (5). This was according to the EWGSOP1 cutoff criteria for sarcopenia.

Preventing sarcopenia

Well, beyond the obvious of physical activity and formal exercise, there is a medication that has potentially shown positive results. This is the bisphosphonate alendronate (Fosamax). In a study, results showed that alendronate increased muscle mass significantly over a one-year period (6). In the appendicular (locomotive) skeletal muscle, there was a 2.5 times increase in muscle mass, while in lower limb muscle mass there was a greater than four times increase. This was a retrospective (backward-looking), case-control study involving about 400 participants. While these results are encouraging, we need a prospective (forward-looking), randomized controlled trial. For those who don’t want to or can’t for some reason exercise, then medication may help with muscle mass.

Exercise! Exercise! Exercise!

In a meta-analysis (a group of 10 trials), results showed there was a significant 51 percent reduction in the risk of overall fracture in postmenopausal women who exercised (7). This study involve over 1,400 participants. Does exercise intensity matter? Fortunately, the answer is no. If you like jogging or running, that’s great, but walking was also beneficial. This is important, since you want to do the type of activity that is more enjoyable to you, especially since the benefit of exercise dissipates when you stop doing it regularly (8).

The importance of K2

In a recent study, vitamin K2 was shown to reduce the risk of hip fracture by 60 percent, vertebral fracture by 77 percent and nonvertebral fractures by a whopping 81 percent (9). According to the authors, this benefit may be derived from bone strength (BMC, or bone mineral content) rather than from bone mineral density (BMD). There were 325 postmenopausal women in this study. It was a randomized controlled trial with one group receiving vitamin K2 (MK-4, menatetrenone) supplementation of 45 mg/day and the other a placebo group.

Don’t forget fruits and vegetables

In the Singapore Chinese Health Study, a prospective population-based study, results showed that there was a 34 percent reduction in the risk of hip fracture in the highest quintile of vegetable-fruit-soy (VFS) intake, compared to the lowest quintile (10). This study involved over 63,000 men, premenopausal and postmenopausal women with an age range from 45 to 74 years old. The results showed a dose-dependent curve, meaning the more VFS, the higher the reduction in hip fracture risk. Interestingly, there was no difference in risk of fracture when meat in the form of meat dim-sum was used instead of plant-based protein. The researchers concluded that an Asian plant-based diet may help reduce the risk of hip fracture. I’m not saying to take medications for osteoporosis, but you need to do something — either medications, lifestyle modifications, supplements or all three — especially if you have a history of low-trauma fractures, because your risks of disability, complications and death increase significantly with subsequent fractures. But, do not be part of the growing “do-nothing” group.

References:

(1) J Bone Miner Res. 2015;30(12):2179-2187. (2) World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases 2016. Abstract 0C35. (3) Curr Opin Clin Nutr Metab Care. 2009; 12(1):86–90. (4) American Society of Bone and Mineral Research 2013. Abstract 1026. (5) Age Ageing.2010;39:412-423. (6) Osteoporos Sarcopenia. 2015;1(1):53-58. (7) Osteoporos Int. 2013;24(7):1937. (8) Ann Intern Med. 1988;108(6):824. (9) Osteoporos Int. 2007;18(7):963-972. (10) J Nutr. 2014;144(4):511-518.

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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Tulip tree. Photo by Fred Drewes

By Ellen Barcel

In early June I was driving home from a trip to the East End when I saw a beautiful large tree with creamy colored blooms. Interesting, I thought, only to remember that it must have been a tulip tree (Liriodendron tulipifera), also known as a tulip poplar.

Where did the name tulip tree come from? There are two schools of thought. One is that the shape of the leaves resembles tulip flowers. A second is the shape of the beautiful flowers, which bloom in late May to early June in our area. Or, maybe it’s both!

Actually, spring flowering tulip bulbs and tulip trees are not really related at all, other than the fact that they are both flowering plants. This deciduous tree is definitely colorful. The fragrant, spring flowers are yellowish color with orange splotches deep in the flower. The leaves turn a bright yellow in autumn. They are in the same family as the magnolia tree. Interestingly, neither the magnolia nor the tulip tree blooms as a very young plant; both can take a number of years for seedlings to reach an age where flowers will appear. The wood was used by Native Americans to make canoes. The leaves provide food for the eastern tiger swallowtail butterfly caterpillar, and it is the state tree of Kentucky, Tennessee and Indiana.

Fred Drewes of Heritage Park in Mount Sinai noted that cardinals enjoy eating the winged seed pods (samaras) of the tree.

Now, if you decide that you want to add one or more specimens of this beautiful tree, you need to know some basics, some pros and cons. The tree is native to the eastern part of North America, meaning that you would be adding a native specimen to the area. It’s more adapted to the highs and lows of rainfall and temperature that we commonly have. So, this is a pro.

Note that there is an Asian variety of the tulip tree (Liriodendron chinenese), but the flowers don’t have the orange coloring of the American variety. The tulip tree is hardy (U.S. Department of Agriculture hardiness zones) from zones 4 to 9. With Long Island being zone 7, right in the middle, you can be reasonably confident that your new addition will not suffer from winter-kill, as some of the local crape myrtle and hydrangeas have. The mature size of the tree can be anywhere from 70 to 90 feet tall or more and up to 40 feet wide — this is a big one. It spreads out, providing plenty of shade.

Now, here’s where the home gardener really needs to be careful. Since the tree gets so big and spreads out so much, it can be a positive in the garden if you’re looking for lots of shade and want a shade garden under the tree. On the other hand, if you have a small piece of property and want to plant lots of sun-loving plants — like roses or veggies — then this tree is not for you. The large size can be a great big (pardon the pun) negative.

As with most flowering trees, the tulip tree will do best in full sun but tolerates part shade. Full sun is generally defined as having six or more hours of sun a day. The tree prefers acidic, sandy soil, ideal for Long Island’s soil conditions. It is a fast grower, easily adding one to two feet of height a year and is generally disease and insect resistant.

Ellen Barcel is a freelance writer and master gardener. Send your gardening questions to [email protected]. To reach Cornell Cooperative Extension and its Master Gardener program, call 631-727-7850.

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A beautiful lawn can also be a danger to your pet. Stock photo

By Dr. Matthew Kearns, DVM

Everyone wants a yard to be proud of (me included). However, what really gives the yard some “pop” can also be very dangerous to our pets. Here’s a short list of hazardous items commonly used to make are yards look beautiful.

Fertilizers

Fertilizer that is spread on grass rarely leads to symptoms of poisoning. Those cases that do only show mild gastrointestinal, or GI, upset (mild diarrhea, decreased appetite). However, if a patient ingests a large quantity (literally eats into a bag) of fertilizer, the GI symptoms are worse (severe vomiting, diarrhea) and may require hospitalization for IV fluids to avoid complications of dehydration and shock.

Mulch

Regular mulch is not usually too much of a problem, but cocoa mulch can be dangerous. Cocoa mulch smells delicious not only to us humans but also to our pets. This is why many try it. If there is a large amount of cocoa beans and hulls in the mulch, a dog can ingest the same two products as in chocolate: theobromine and caffeine. These two products not only cause an upset stomach (vomiting, diarrhea) but also are powerful stimulants. In large enough quantities pets can develop symptoms of tachycardia (accelerated heart rate), tachypnea (accelerated breathing) and, potentially, seizures. These symptoms usually require hospitalization and can (with large exposures) be life threatening.

Lilies

Not all lilies are toxic but those that are can be quite lethal. Oxalates from the poisonous lilies will chelate, or bind, to calcium in the bloodstream and deposit into the tissues. Cat’s kidneys are particularly sensitive to this process, and as little as a few leaves or petals can lead to acute kidney failure. Acute kidney failure secondary to lily ingestion is heartbreaking because most times the damage is done when one begins showing symptoms and either the patient passes on their own or must be humanely euthanized.

Bone or blood meal

Bone meal or blood meal are by-products from the meat packing industry that are commonly used as an organic alternative in fertilizer components or as deer, rabbit and wildlife repellants. These products (because they are bone or blood meal) are very palatable and pets (especially dogs) tend to ingest them in large quantities. Exposure in large quantities can lead to GI obstructions (which can lead to surgery), pancreatitis or generalized GI irritation (vomiting, diarrhea). Dogs also tend to dig up flower bulbs planted in soil dusted with bone or blood meal, and this is a double whammy: the complications of bone/blood meal and ingestion of flower bulbs (flower bulbs also cause GI upset), not to mention your flowers never bloom if the bulbs are destroyed.

Compost pile

Another way to recycle and make your flower gardens look beautiful is to use a compost pile. During decomposition, molds grow and mold can produce a poisonous waste called mycotoxins. Ingestion of large quantities of moldy material from compost piles can lead to neurologic symptoms (weakness, tremors, even full-blown seizures). There is no true antidote, so many patients need to be hospitalized until the toxins clear their systems. Limiting access to these substances is the best option, but that is not always possible (dogs are more at risk than cats). If limiting access is not possible, it is best to choose another option to beautify the yard.

Dr. Matthew Kearns practices veterinary medicine from his Port Jefferson office.

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Iron is important for exercise motivation and may play a role in peak mental functioning. Stock photo

I believe the most salient teaching point in medical school and beyond was when a professor explained, as it relates to the patient diagnosis, when you hear hooves think horses not zebras. What this means is think of the more common or more likely diseases or disorders in a differential diagnosis rather than the more esoteric or rare diseases. And when a patient presents with fatigue, one of the more common reasons is iron deficiency.

Major causes of low iron are anemia of chronic disease, iron deficiency anemia, sideroblastic anemia and thalassemia. Of these, iron deficiency anemia is the most common. However, there is a much less known, but not uncommon, form of low iron. This is called iron deficiency without anemia. Unlike iron deficiency anemia, the straightforward CBC (complete blood count) that is usually drawn cannot detect this occurrence since the typical indicators, hemoglobin and hematocrit, are not yet affected.

So how do we detect iron deficiency without anemia? Not to despair, since there is a blood test done by major labs called ferritin. What is ferritin? Ferritin is a protein that is involved in iron storage. When ferritin is less than 10 to 15 ng/ml, the diagnosis of iron deficiency is most likely indicated. Even healthy people with ferritin slightly higher than this level may also have iron deficiency (1). The normal range of ferritin is 40-200 ng/ml.

At this point, you should be asking who does low ferritin affect and what are the symptoms? Women and athletes are affected primarily, and low ferritin levels may cause symptoms of fatigue. It is also seen with some chronic diseases such as restless leg syndrome (RLS) and attention deficit hyperactivity disorder (ADHD) in children.

Effect on women

In a prospective (forward-looking) study done in 1993 looking at primary care practices, it was determined that 75 percent of patients complaining of fatigue were women (2). Interestingly, less than 10 percent of these women had abnormal lab results when routine labs were drawn, most probably without a ferritin level. Many of them had experienced these symptoms for at least three months.

There was a randomized controlled trial (RCT), the gold standard of studies, that showed women who were suffering from fatigue and low or low-normal ferritin levels (less than 50 ng/ml), but who did not have anemia, benefited from iron supplementation (3). When comparing women with these ferritin levels, many of those who were given 80 mg of oral prolonged release ferrous (iron) sulfate supplements daily saw a significant improvement in their fatigue symptoms when compared to those women who were not given iron. Almost half the women taking iron supplements had a significant improvement in fatigue symptoms. The results were seen in a very short 12-week period. This is nothing to sneeze at, since fatigue is one of main reasons people go to the doctor. Also, although this was a small study, there were 198 women involved, ranging from 18 to 53 years old.

There are caveats to these study results. There was no improvement in depression or anxiety symptoms, nor in overall quality of life. Even though it was blinded, stool changes occur when a patient takes iron. Therefore, the women taking supplements may have known. Nonetheless, the study results imply that physicians should check ferritin level, not only a CBC, when a premenopausal woman complains of fatigue. Note that all of the women in the study were premenopausal. This is important to delineate, since postmenopausal women are at much higher risk of iron overload, rather than deficiency. They are no longer menstruating and therefore do not rid themselves of significant amounts of iron.

Athletes

According to an article in The American Journal of Lifestyle Medicine, athletes’ endurance may be affected by iron deficiency without anemia (4). Low ferritin levels are implicated, as in the previous study. Iron is important for exercise motivation and may play a role in peak mental functioning, as reported in “Iron: Nutritional and Physiological Significance.” In animal studies, iron deficiency without anemia is associated with reduction in endurance because of a decrease in oxygen-based enzymatic activity within the cells.

However, this has not been shown definitively in human athletes and remains an interesting, but yet to be proven, hypothesis. Interestingly, female endurance athletes are more likely to be affected by iron deficiency without anemia, which occurs in about 25 percent of this population, according to studies (5). Low ferritin is not seen as much in male athletes. This difference in gender may be due to the fact that women not only menstruate, losing iron on a regular basis, but also their intake of dietary iron seems to be lower (6).

However, male athletes are not immune. At the end of the season for high school runners, 17 percent had iron deficiency without anemia (7). Do not take iron supplements without knowing your levels of hemoglobin and ferritin and without consulting a doctor. Studies are mixed on the benefits of iron supplementation without anemia for athletes.

Impact on restless leg syndrome

Iron deficiency with a ferritin level lower than 50 ng/ml affects approximately 20 percent of patients who suffer from restless leg syndrome (8). Restless leg syndrome, classified as a neurologic movement disorder, causes patients to feel like they need to move their legs, most commonly about a half-hour after going to bed. In a very small study, patients with restless leg syndrome who had ferritin levels lower than 45 ng/ml saw significant improvement in symptoms within eight days with iron supplementation (9).

Before you get too excited, the caveat is that 75 percent of restless leg patients have high ferritin levels. It is impressive in terms of being an easy fix for those who have low ferritin levels. And, it may be that high ferritin levels in RLS has the same symptoms as low ferritin for this is the case when it comes to iodine levels in hypothyroid patients. Iron is a trace mineral, meaning we only need small amounts to maintain proper levels.

Ferritin levels — both high and low — may play a role in a number of diseases and symptoms. If you are suffering from fatigue, a CBC test may not be enough to detect iron deficiency. You may want to suggest checking your ferritin level. Though iron supplementation may help those with symptomatic iron deficiency without anemia, it is very important not to take iron supplements without the direct supervision of your physician.

References: (1) Br J Haematol. 1993;85(4):787-798. (2) BMJ 1993;307:103. (3) CMAJ. 2012;184(11):1247-1254. (4) Am J Lifestyle Med. 2012;6(4):319-327. (5) J Am Diet Assoc. 2005;105:975–978. (6) J Pediatr. 1989;114:657–663. (7) J Adolesc Health Care. 1987;8:322–326. (8) Am Fam Physician. 2000;62(4):736. (9) Sleep Med. 2012;13(6):732-735. 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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Three Village fourth-grade students hear about the carriage shed and about the horse and carriage days during a Founder’s Day program. Photo from Beverly Tyler

By Beverly C. Tyler

Photographers have been taking pictures of the Caroline Church Carriage Shed in all seasons for many years. Since it was completed in the spring of 1887 at a cost of $273, this simple open building has aged gracefully, becoming more beautiful as the roof took on a natural wave shape that added to its special appeal. In addition, its utilitarian construction of white oak beams, white pine boards, cedar shingles and black locust posts allows us to see the construction methods that date back beyond when the shed was constructed, to the beginnings of our community when our homes, barns and out-buildings were built using these same local materials.

The shed’s seven bays for horses and carriages were funded by Mary Smith, Thomas Hodgkins, Margaret Dickenson and Sarah Dominick, General Francis Spinola, Shepard Jones, Mrs. Frank Norton and William Edwards, local residents who wanted shelter for their horses and carriages. A painted family name board was attached to the rear wall of each stall or bay.

In November of 1892, Thomas Hodgkins, who built the Emma Clark Library for the community in memory of his niece, wrote a note to library trustee Israel Tyler, “It has just occurred to me that my horse shed at the Episcopal Church may be of some use to yourself and family, and as I shall never again have any use for it, I hereby offer it to you as a free gift. Very Truly Yours, Thomas G. Hodgkins.”

Hodgkins died in December 1892 and is buried along the entrance walk in the Caroline Church graveyard. Israel Tyler’s name is still there on shed bay number three.

Barbara Russell, a member of the Caroline Church Historical Committee wrote, “What appears to some as a building that outgrew its original use about 100 years ago is … a rather unique parking place, the vehicles just changed. I always preferred it on rainy Sundays, as I could exit my car and open my umbrella without getting wet. In summer months, my car stayed cool in the shade. Those Victorians knew what they were doing when they planned and built a simple structure to make life a little more pleasant. The sliding windows on the west wall just gave the horses a little air and a view … Horses like to see what is going on around them.

“What does it look like to residents who travel Main Street or Dyke Road, and pass it everyday? What does it look like to a newcomer, maybe shopping for a home in Setauket? What does it look like to a child who sees it for the first time? To know the answers, you will have to ask your friends, your new neighbors, and the seven-year-old who lives down the street. But most important: What does it look like to you?

“Is it a humble structure that reminds you of a simpler life? Life may have been simple, but it wasn’t easy. We can rush through the morning, jump into the car and drive to church in a temperature-controlled car. In 1887, in addition to getting ourselves ready, we would have fed, groomed and harnessed the horse to our carriage. Then we made our way to church, rain or shine, hot or cold.”

In 1991, the church and cemetery, including the carriage shed, were listed on the National Register of Historic Places. The criteria include age, integrity and significance. The carriage shed, still in its original location, easily meets all of these.

In April, 2016, 450 fourth-grade students from the Three Village Central School District toured Setauket’s original settlement area including the carriage shed. They learned about the shed and about the horses and carriages that were a part of life here for more than 300 years. They also discovered that before the carriage shed was built, a colonial one-room schoolhouse stood on the site. From 1700, until a new school was built in the center of the Setauket Village Green in 1869, all of the children from Setauket, East Setauket and Drowned Meadow (now Port Jefferson) attended school here, including all the local children who later became members of the Revolutionary War Culper Spy Ring.

Tours of Caroline Church and the churchyard, as well as tours by the Three Village Historical Society include the historic Caroline Church Carriage Shed and speak to the many centuries when horses and carriages were essential to our lives.

Today the carriage shed needs extensive restoration. Caroline Church has hired an architect for plans to restore the shed to its original condition and has applied for grant funding to help offset the cost of restoration. “We believe the 1887 carriage shed, as the 1729 Caroline Church building, are historic parts of the Three Village community,” reported Don Muffly, senior warden at Caroline Church. “We need the community’s financial support as the cost of restoration is beyond the resources of the church alone.” If you can help, please send your tax deductible contribution to Save the Carriage Shed, C/O Caroline Church, 1 Dyke Road, Setauket, NY 11733. For further information call 631-941-4245.

Beverly Tyler is the Three Village Historical Society historian and author of books available from the Three Village Historical Society.

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Aunt Amy’s Creek at West Meadow Creek, site of an early Native American village and an archaeological exploration by New York State Archaeologist William Ritchie. Photo from Beverly Tyler

By Beverly C. Tyler

From Native American hunter-gatherers through Colonial times, West Meadow Beach, West Meadow Creek and the adjacent tidal wetlands were a valuable resource.

On Saturday, July 16, an historic walk will be conducted by Barbara Russell, historian, Town of Brookhaven, and Beverly Tyler, historian, Three Village Historical Society. The walk, along Trustees Road from the pavilion at West Meadow Beach to the Gamecock Cottage, is sponsored by the Town of Brookhaven and cosponsored by the Three Village Historical Society.

Come and explore the area that sustained Native Americans and provided needed materials for settlers from the Colonial period to the present day. The walk is free and open to the public. No pre-registration required, however be on time as the walk will commence at 10:30 a.m. sharp. An exhibit in the Gamecock Cottage at the end of the walk will include artifacts gathered from the West Meadow Creek area.

We don’t know all the details about life on Long Island before the Europeans came because the people living here did not leave us a written or photographic record of their lives.

Archaeological excavations have given us most of the details of how people lived in this area as early as 5,000 years ago. One of the most famous sites in New York State was a nearby shell midden named The Stony Brook Site, excavated by State Archaeologist William Ritchie in 1955.

From archaeological digs by Ritchie and others, we know that, between 5,000 and 3,000 years ago, the native people were hunters and gatherers, dependent upon hunting local animals and gathering plants, stones, and clay for food, shelter, tools, clothes, and medicines.

The Fischetti Site, a prehistoric Indian site for manufacturing tools and spear points, was discovered during a cultural resource investigation of a proposed residential development in November 1980. Salvage excavations continued through October 1981.

The site, on the east side of West Meadow Creek, opposite the horse show grounds, was occupied by Algonquin Indians about 3,000 years ago. We know they used this location then because of the type of arrow and spear points and blades recovered. The major activity here, on the edge of Stony Brook creek, was making stone tools. We know this by the large quantities of stone flakes and roughed-out stones.

The almost total absence of food remains at the site shows that this was not the location of a village. However, a village site, The Stony Brook Site, did exist about 800 yards to the south, along what is now known as Aunt Amy’s Creek, during the same time period.

For thousands of years the Indians used natural resources, wood, stone, and animals, to make their housing, tools, and clothing. About 3,000 years ago, their way of life changed with the introduction of three things: pottery, the bow and arrow, and horticulture (farming). Like the earlier Indians, the Woodland Indians continued to rely on natural resources.

The artifacts taken from The Fischetti Site are part of the collection of the Three Village Historical Society. Artifacts from the Ritchie site are a part of the collection of the New York State Museum.

Beverly Tyler is the Three Village Historical Society historian and author of books available from the Three Village Historical Society.

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By Nancy Burner, Esq.

While discussing an estate plan with a client, she stopped me and said “What is probate.” Sometimes we forget to explain the simplest concepts. Probate is the process by which a last will and testament is given effect. Under New York State Law, a will is admitted to probate after the executor files a Petition for Probate with the decedent’s will attached and gives proper notice to the individuals that would have inherited from the decedent had the decedent died without a will. The proceeding for the probate of a will takes place in the Surrogate’s Court in the county where the decedent resided at the time of his or her death. The probate proceeding gives the interested parties (distributees) the right and opportunity to object to the probate of the will.

Typically, we advise that a client that creates a will consider if there are any circumstances that will make the probate proceeding an expensive one. For instance, is any distributee being disinherited? If so, that disgruntled distributee may come to Surrogates Court and object to the will. The litigation objecting to a will can be long and drawn out — and expensive as well. Are there missing heirs that must be found before the will can be probated? If so, it could be very expensive and time-consuming to find all the individuals that are required to be given notice and an opportunity to object. Is there real property owned by the decedent in different states? If so, then the will would have to be probated in each state. If any of these circumstances exist, you may want to avoid probate altogether.

We also suggest avoiding probate if you are the surviving spouse and your spouse is or has received Medicaid benefits. Medicaid has a lien against the spouse’s estate for any Medicaid benefits paid for the other spouse within 10 years of the death of the surviving spouse.

Another reason to avoid probate is if you have a disabled beneficiary as the Surrogate’s Court may appoint a guardian ad litem to protect that person’s interest. That could be another delay and cost to the estate.

The next question to consider is how do you avoid probate? One way to avoid probate is to name beneficiaries on all your accounts. But I rarely, if ever, suggest that a client resort to this solution without first considering the consequences. First, it may not be possible to name beneficiaries on all your accounts. What if your beneficiaries are minor’s or disabled? If that is the case, the minor or disabled beneficiary would have to have a guardian appointed to collect the bequest. This is also timely.

For minor’s, the guardian would have to put the money in a bank account, earn little or no interest and turn the money over to the beneficiary when he or she turned 18. If the account was a retirement account, the result is even harsher. The IRA or other retirement account would have to be liquidated, all income taxes paid and then put into a custodial account at a bank, earn little interest and then be paid to the beneficiary at age 18.

Most clients, when given the choice, would rather protect their heirs from divorcing spouses, Medicaid liens, creditors and taxes than avoid probate. We can protect beneficiaries by having their assets paid to trusts. This can be done in a will (and probate) or by avoiding probate altogether by using a revocable trust.

The important point here is that it is a mistake to make the avoidance of probate the overriding consideration when embarking upon an estate plan. Not everyone needs a revocable trust, but some people will be well served by using a trust, if the circumstances make probate impractical.

One size does not fit all. A successful estate plan takes all factors into consideration. In a world where people are computer savvy and everything is available on the internet, it is easy to believe that you can just do it yourself. The fact is attorneys are called counselors at law for a reason. The documents are only part of the problem and solution. The fact is, there is no substitute for competent legal advice.

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

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By Linda M. Toga, Esq.

The Facts: I am named executor in my brother’s will. He died recently and his assets include a bank account and a house. Someone told me that since I am the named executor, I can close the account and sell his house simply by presenting the will.

The Question: Is that true?

The Answer: Absolutely not! Although you are named in your brother’s will as the executor of his estate, the surrogate’s court in the county in which your brother resided at the time of his death must admit the will to probate and issue letters testamentary to you before you can take any action with respect to your brother’s assets.

In other words, you must establish to the court’s satisfaction that the will is valid before you are able to act as executor. You cannot assume the responsibilities of executor without the court’s explicit approval.

The complexity, cost and time involved in having a will admitted to probate will vary with the number of beneficiaries named in the will, as well as the number of heirs to the estate, the ease with which your attorney can locate the beneficiaries and heirs, how cooperative those people may be with the attorney in moving forward, the value of the estate and whether anyone contests the admission of the will to probate, among other factors.

While the probate process can be straightforward and relatively inexpensive, there are numerous issues that can arise in the probate process that are best handled by an experienced estate attorney. Some of the most common issues with probate are not being able to locate individuals who are entitled to notice and dealing with individuals who contest the validity of the will.

Fortunately, the percentage of cases where a will is contested and ultimately not admitted to probate is small but, if there are objections filed to the probate of a will, the process can drag on for quite some time, significantly increasing the expenses of the estate.

Assuming the probate process goes smoothly and your brother’s will is ultimately admitted to probate, you will be issued letters testamentary by the court. Only then will you be in a position to marshal your brother’s assets, pay any legitimate outstanding debts your brother may have had, and make distributions in accordance with the wishes set forth in your brother’s will.

Once you have located and distributed your brother’s assets, you will be required to file with the court an inventory of your brother’s assets and releases from the beneficiaries stating that they received the bequests to which they were entitled under the will.

Linda M. Toga provides personalized service and peace of mind to her clients in the areas of estate administration and estate planning, real estate, marital agreements and litigation from her East Setauket office.

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