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Dr. Adam Gonzalez Photo by John Griffin/SBU

By Melissa Arnold

It’s been a rough year for all of us, that’s for sure, but no one has felt the sting of the COVID-19 pandemic more keenly than those who have contracted the virus.

As of Aug. 6, more than 43,000 Suffolk County residents have tested positive for COVID-19, and many more have faced the virus without an official diagnosis. Its symptoms can vary widely, from mild fatigue and chills to flu-like illnesses or even respiratory distress requiring hospital care.

The virus is unpredictable, and dealing with symptoms along with a quarantine, lengthy recovery and uncertain long-term effects is daunting. It’s only natural that many will experience tough emotions along the way.

Stony Brook Medicine is now offering a virtual support group for past and present COVID-19 patients. The weekly sessions will give patients a space to discuss their experiences and feelings while learning healthy coping mechanisms.

The support group is hosted by the Mind-Body Clinical Research Center at the Stony Brook Renaissance School of Medicine. Under the direction of founder Dr. Adam Gonzalez, the center focuses on the integration of mental and physical health for overall wellbeing.

“We wanted to see what we could do to support these members of the community who had COVID-19 and shared that they were feeling anxious, isolated and afraid of transmitting the virus to others,” Gonzalez explained. “Our goal is to provide a telehealth platform for patients to come together and bolster one another, exchange information, and learn skills to cope with stress brought on by their illness.”

Leading the group is Jenna Palladino, a licensed clinical psychologist and clinical assistant professor of psychiatry. Palladino is hopeful that participants will feel comfortable opening up about their struggles with COVID-19 in the company of others who know what it’s like.

“Research supports the idea that sharing your story helps you to work through the emotions related to it. And talking to others experiencing similar feelings helps to normalize the experience,” Palladino said. “It’s important for people going through COVID-19 to know that they’re not alone.”

The initial group is expected to run for 12 weeks, covering topics like coping with isolation, deep breathing, managing anxiety, muscle relaxation and mindfulness, to name a few.

Palladino is also leaving plenty of room for participants to ask questions and discuss topics that interest them, allowing the group to better meet their specific needs and concerns.

Gonzalez added that the support group will act as a pilot program for researchers seeking to understand the experiences of people living with COVID-19. They’ll collect data at the beginning and end of the program to see how patients are doing, if the support group was beneficial and how it can be improved.

While the initial group is limited to 10 patients, Palladino and her team are prepared to quickly begin additional groups if there is an interest, she said.

The virtual COVID-19 support group will be held from 6 to 7 p.m. Thursdays via the free Microsoft Teams video conferencing platform. The group is limited to 10 participants at a time. Registration is required to attend by calling 631-632-8657. For more information and resources, visit www.stonybrookmedicine.edu/COVID19support.

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Debra Bowling of Pasta Pasta talks to County Executive Steve Bellone. Photo by Kyle Barr

This past weekend, President Donald Trump (R) was in Suffolk County, raising money for this reelection. During his time on Long Island, he called requests for financial aid amid the pandemic a bailout, repeating some of the language he used two years in response to Puerto Rico’s request for financial aid after Hurricane Maria.

“I couldn’t disagree with this more,” County Executive Steve Bellone (D) said today on a conference call with reporters. “We need federal disaster assistance to respond to, and recover from, COVID-19.”

Bellone said the county abided by guidelines from the U.S. Centers for Disease Control and Prevention and that it shut down its economy to protect the health of its population, lowering the death toll at the cost of the economy.

Approaching an argument the president has made against the reaction to the murder by police of Minneapolis resident George Floyd, Bellone suggested that the lack of financial support from the federal government would be a form of defunding the police, taking away salaries from public health workers and removing the financial support necessary for the safe return of students to in-person learning this fall.

“This should have nothing to do with politics,” he argued. “We are still in the middle of fighting a pandemic.”

The county executive urged the federal government to provide vital financial resources to fund these recovery efforts.

“When President Trump talks about federal disaster assistance as a bailout, this is flat out wrong,” Bellone said. The money he has requested, including during a recent trip to Washington, DC, he argued will pay for police officers. Bellone also pointed out that Long Island has provided ample financial resources to the federal government during more prosperous years through tax dollars.

By taking away state and local property tax deductions, the federal government has added billions to what Long Island sends to Washington as a region every year, Bellone said.

“The notion of a bailout suggests we did something wrong in Suffolk County,” the county executive continued. “The fact of the matter is, we all did our jobs here.”

Viral Numbers

Separately, Bellone said Suffolk County has managed to keep illnesses and deaths down in the public health battle against COVID-19.

In the last day, the number of people who have tested positive for the virus was 55 out of a total of 5,030 people who received a test. The rate of just over 1 percent is tracking with the positive tests for the last few weeks and is well below the 5 percent threshold schools have for reopening.

The number of residents who tested positive for the antibody to COVID-19 stands at 24,392.

Hospitalizations, meanwhile, continued to be well below the worst of the pandemic, when the health care system strained under the weight of sick residents.

The number of people hospitalized with COVID-19 stands at 33, which is an increase of 2. The number of people in the Intensive Care Unit was three.

Hospital bed occupancy stood at 72 percent overall and at 67 percent in the ICU.

The number of people who have died from complications related to the virus stands at 1,998. Four people were discharged the hospital in the last day.

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Gov. Andrew Cuomo. Photo by Sara-Megan Walsh

Gov. Andrew Cuomo (D) said the morning of Aug. 7 that all regions in New York are given the green light to reopen in the fall.

The governor said he based the decision off of the infection rate in each region in the state. Much of New York has been hovering around a 1 percent infection rate for the past several weeks. 

Cuomo previously said if the infection rate in any region breaches 5 percent the state would immediately order schools’ closure.

“You look at the infection rate — we are probably in the best situation in the country,” Cuomo said during a media call Friday. 

Most school districts submitted reopening plans by the deadline of July 31. Some, like South Huntington and Northport-East Northport, submitted their plans after being granted an extension. Many have come forward with hybrid plans at at least some grade levels, meaning students will spend a few days in school and then the rest of the week learning from home. Some parents have criticized districts like Three Village for deciding on a full-time schedule for all grade levels. Other parents in districts like Smithtown have rallied for children to be back in school full time.

Still, Cuomo has said multiple times that each school district’s reopening plan is dependent on the district officials in communion with parents and teachers, saying “this is not a bureaucratic decision, this is a parental decision.” 

However, there were still many questions left open over what policies districts can hold, especially regarding the safety of teachers. Yesterday, Aug. 6, teachers union New York State United Teachers put out a news release calling for any school to close if any one individual in a school that tests positive should mean an immediate 14-day closure. The release also requested specific answers to how districts should conduct quarantining of potential cases and contact tracing.

The governor largely left the questions of those two elements up to individual school districts, though state Department of Health guidelines do mandate school districts conduct testing of symptomatic students. They also mandate people to wear masks when they are unable to socially distance at six feet, and if a student does not have a mask, the district is mandated to provide one.

“I can’t fashion a plan that would work in every school district because the circumstances are too different,” he said during the media call.“

Though school districts are mandated to take the temperature of every student that comes through its doors, the fear of asymptomatic spread, of the virus infecting people from carriers, is still a big concern. Cuomo called that a continuing “conversation.”

The tenor of the governor’s announcement revolved around the notion that parents, teachers and districts all had to agree to the plans. The next few weeks, Cuomo said, should be spent in even more discussion amongst the community to try and reach more common ground.

“I believe in New Yorkers, and New Yorkers will do it and they can decide how they will do it,” he said.

 

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Stock photo

People are using too much hand sanitizer. That’s one of several observations from Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital.

Sharon Nachman of SBU’s pediatrics department. Photo from SBU

Nachman suggests that sanitizer requires only a small amount on people’s hands. If, after applying it, someone has wet and sticky hands, they have overdone it.

“When I see people using hand sanitizer, they glop it on,” Nachman said in an interview. She recommends not using more than the standard volume, even amidst a return to school during the ongoing fallout from the COVID-19 pandemic.

In a wide-ranging conversation about the health of students who are returning to campus, Nachman urged students to pay closer attention to their health, to keep themselves and their classmates safe.

Students can tell if they’re too close to each other if they both reach out and can touch each other’s fingers.

The signs of COVID-19 in older teenagers and young 20-somethings are similar to the ones that occur in adults. They include fever, fatigue, feeling ill, loss of taste, and dry coughs. College students also have a high rate of being asymptomatic, which makes it difficult to find and isolate sick students.

While multi-symptom inflammatory disease in children, or MSI-C, cropped up during the worst of the pandemic in Suffolk County, the overall numbers of cases and infection rate on Long Island have fallen enough to reduce the likelihood of this COVID-related illness among children.

“Its all about how big the hit is in the community,” she said. “If you go to Texas or Florida, they are clearly seeing it. On Long Island, we aren’t seeing it” because of the way residents have helped flatten the infection curve among the population.

Nachman urged college students to be responsible when a contact tracer reaches out to them. In college campuses throughout the country, contact tracing will help mitigate the spread of the infection by quarantining people who might have been exposed to an active form of the virus. Isolating people will keep the spread of the virus in check.

Students, faculty and university administrators are well aware of the possibility that schools will need to return to an all-remote education model if infections reach a high enough level. Indeed, Nachman urged students to develop a plan for what they would pack and take home and where they would go if campuses closed. By being prepared for change, students can react to altered circumstances. High school students also need such preparation, in case any school that open need to close to protect students, faculty and staff.

As for the potential overlap of the flu and COVID, Nachman suggested students should get the flu shot by October, before the flu season begins.

Nachman is an advocate for masks.

“The smartest thing people can do is really wearing their masks,” she said. “Come to college prepared with enough masks that you can wash and wear them.”

The ideal number of masks is nothing fewer than two per day. She likes the washable ones, which are easy to put in the laundry and wash with the rest of a student’s clothing. The two-ply cloth masks work well and can be “personalized to reflect someone’s mood, to match clothing or to make a statement.”

Masks are important not only to protect other members of the student body, but also to protect the wearer.

“This idea that I’m wearing it to protect you is half right,” she said. “It’s protection for both of us.”

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Colby Rowe and Roseanna Ryan making a delivery of over 100 iPads for patient-family communication. Photo by Scott Lamarsh

While Stony Brook University Hospital staff were taking care of the sickest residents in the midst of the pandemic in Suffolk County, residents did what they could to return the favor.

Colby Rowe’s truck is filled with 3M N95 masks. Photo by Colby Rowe

In addition to cheering for health care workers, first responders and essential employees each night at 7 p.m., numerous residents and businesses made donations of everything from lifesaving N95 masks to food to comfort care.

After 10 weeks of accepting donations from March through early June, Stony Brook had collected nearly one million pieces of personal protective equipment, including masks, gloves and head and food coverings, 33,500 comfort care items such as snacks, hand lotion, puzzles and coloring books, 18,000 meal donations, 575 video messages of support and 435 iPads for telemedicine.

These donations bolstered the spirits of the staff and provided vital comfort during everything from the process of conducting COVID-19 tests in the South P Lot to the recharging breaks doctors, nurses and hospital staff took after caring for patients.

“The comfort piece was a bit more striking for the patients and the staff,” said Roseanna Ryan, director of Patient Advocacy & Language Assistance Services at SBU Hospital. “The need for the staff to have a respite area to recharge during this extremely challenging time was something that we might not have initially anticipated. The donations we were able to use went such a long way.”

Indeed, even some of the smaller items helped the masked men and women health care heroes throughout the hospital system.

During testing, some of the medical professionals worked 12-hour shifts, administering test after test for reeling residents. Items such as breath mints, ChapStick and even eye coverings that would help health care workers take a nap in their car before returning for the next shift proved incredibly helpful, said Colby Rowe, Trauma Center Education & Prehospital outreach coordinator. Rowe worked with the emergency management team at the university, primarily coordinating the donation center.

“I received lots of text messages from people on the receiving end saying, ‘Thank you so much.’ They felt appreciated by the community, Rowe said.

Rowe added that the hospital performed ably in ensuring that the staff had sufficient PPE equipment to help them with their dangerous but important work.

The university took a wide range of assistance. Some donations, like snack food, found a home in the break room. Others, however, wound up helping people in different locations.

Stony Brook received more than 400 Easter baskets. Rowe was on the phone with a civilian friend from the U.S. Department of Defense, who told him that Fort Hamilton in Brooklyn had to postpone an Easter event.

Rowe loaded up his truck and drove the Easter baskets to Brooklyn. That’s not where the community spirit stopped. On the way, several baskets blew out of his truck on Route 347.

Snacks from the hospital break room at SBUH. Photo from Stony Brook University.

“I had about four cars pull over to help me” retrieve the boxes, Rowe said. “That’s a sign of the times.”
None of the boxes, which were donated to the children of soldiers, sustained any damage.

Rowe also said the university worked to make sure support staff, including housekeeping and the people moving the carts to usher patients around the hospital, benefited from these gifts.

The most consistent donated items were the three-dimensional printed face shields and hand sanitizer, which faculty who stayed to help frontline workers made on campus. In total, the university received more than 14,000 face shields and 509 gallons of hand sanitizer.

Ryan and Rowe said the hospital was grateful and humbled by each donation they received.
Several groups offered consistent gifts. The Three Village Coronavirus Forum Facebook group, which Three Village resident Michael Ehrlich led, raised hundreds each week through membership donations. They shopped at Target and Walmart to buy comfort care items.

Frito-Lay donated a couple of truckloads of chips to stock the respite room, while the Three Village Dads Foundation raised money to feed frontline workers.

The donations helped fill in some gaps during the year as well. National Nurses Week and National EMS week both occurred in May. While the hospital typically honors these professionals with gifts to show their appreciation, the response to COVID-19 was the priority during those times. The donations, however, provided material for care packages.

The pandemic triggered needs the hospital never had before, Ryan said.

“We had to identify different ways to allow our patients to communicate with their loved ones, while there was no visitation or limited visitation,” Ryan said. The hospital redeployed nursing staff into family liaison roles to provide friends and family with updates.

Rowe delivers Easter baskets to the families of soldiers at Fort Hamilton. Photo by Colby Rowe.

For the patients, the hospital put together comfort bags, which included activities like word searches, crossword puzzles, stress balls, aroma therapy, eye masks, and dry erase boards to allow patients who were able to write to communicate with nurses outside a door, which helped preserve PPE.

At this point, the university has some supplies left over, which it will likely use during the current, planned reopening of the university side of Stony Brook.

In addition to receiving donations from the community, Stony Brook also benefited from donations from people in other countries, including China, Korea and Germany.

“People sent really moving and emotional notes,” Rowe said. “We saw a lot of good in people” during a difficult time.

Ryan was also grateful for all the support from the university.

“The planning and preparation from senior leadership put us in a position where we were able to be successful in getting to the other side of this,” Ryan said. “Leadership at the state level also helped tremendously with that.”

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It is important to drink water prior to and during exercise to avoid heart palpitations. METRO photo
Consequences of mild dehydration are subdued mood, decreased concentration, fatigue and headaches

By David Dunaief, M.D.

Dr. David Dunaief

With this summer’s hottest days right around the corner, discussing dehydration is timely. Even air conditioning can be dehydrating.

Complications and symptoms of dehydration can be mild to severe, ranging from constipation, mood changes, headaches and heart palpitations to heat stroke, migraines and heart attacks.

Dehydration is simple to avoid, right? Not necessarily. We may be dehydrated before experiencing symptoms of thirst.

Headaches and migraines

Temperature is a potential trigger for headaches and migraine. As the temperature rises by intervals of 9 degrees, the risk for headache and migraines increases by eight percent (1). This study involved 7,054 participants from one emergency room site. Warmer temperatures can potentially reduce blood volume in the body, causing artery dilation and resulting in higher risk of headaches and migraines.

In another study, those who drank four cups more water had significantly fewer hours of migraine pain than those who drank less (2). Headache intensity decreased as well. Anecdotally, I had a patient who experienced a potentially dehydration-induced migraine after playing sports in the sweltering heat of Florida. He had the classic aura and was treated with hydration, Tylenol and caffeine, which helped avoid much of the suffering.

Heart palpitations

It is important to drink water prior to and during exercise to avoid heart palpitations. METRO photo

Heart palpitations are very common and are broadly felt as a racing heart rate, skipped beat, pounding sensation or fluttering. Dehydration and exercise are contributing factors (3). They occur mainly when we don’t hydrate prior to exercise. All we need to do is drink one glass of water prior to exercise and then drink during exercise to avoid palpitations. Though these symptoms are not usually life-threatening, they are anxiety producing for patients.

Potential for heart attacks

The Adventist Health Study, an observational study, showed a dose-response curve for men (4). In other words, group one, which drank more than five glasses of water daily, had the least risk of death from heart disease than group two, which drank more than three glasses of water daily. Those in group three, which drank fewer than two glasses per day, saw the least amount of benefit, comparatively. For women, there was no difference between groups one and two; both fared better than group three.

The reason for this effect, according to the authors, may relate to blood or plasma viscosity (thickness) and fibrinogen, a substance that helps clots form.

Mood and energy levels

In a study, mild dehydration resulted in decreased concentration, subdued mood, fatigue and headaches in women (5). In this small study the mean age of participants was 23, and they were neither athletes nor highly sedentary. Dehydration was caused by walking on a treadmill with or without taking a diuretic (water pill) prior to the exercise. The authors concluded that adequate hydration was needed, especially during and after exercise.

I would also suggest, from my practice experience, hydration prior to exercise.

Ways to stay hydrated

Now we realize we need to stay hydrated, but how do we go about this? How much water we need to drink depends on circumstances, such as diet, activity levels, environment and other factors. It is not true necessarily that we all should be drinking eight glasses of water a day. In a review article, the authors analyzed the data, but did not find adequate studies to suggest that eight glasses is supported in the literature (6). It may actually be too much for some patients.

You may also get a significant amount of water from the foods in your diet. Nutrient-dense diets, like Mediterranean or Dietary Approaches to Stop Hypertension (DASH), have a plant-rich focus. A study notes that diets with a focus on fruits and vegetables increases water consumption (7). As you may know, 95 percent of the weights of many fruits and vegetables are attributed to water. An added benefit is an increased satiety level without eating calorically dense foods.

Is coffee dehydrating?

In a review, it was suggested that caffeinated coffee and tea don’t increase the risk of dehydration, even though caffeine is a mild diuretic (8). With moderate amounts of caffeinated beverages, the liquid has a more hydrating effect than its diuretic effect.

Thus, it is important to stay hydrated to avoid complications — some are serious, but all are uncomfortable. Diet is a great way to ensure that you get the triple effect of high nutrients, increased hydration and sense of feeling satiated without calorie-dense foods. However, don’t go overboard with water consumption, especially if you have congestive heart failure or open-angle glaucoma (9).

References:

(1) Neurology. 2009 Mar 10;72(10):922-7. (2) Handb Clin Neurol. 2010;97:161-72. (3) my.clevelandclinic.org. (4) Am J Epidemiol 2002 May 1; 155:827-33. (5) J. Nutr. February 2012 142: 382-388. (6) AJP – Regu Physiol. 2002;283:R993-R1004.  (7) Am J Lifestyle Med. 2011;5(4):316-319. (8) Exerc Sport Sci Rev. 2007;35(3):135-140. (9) Br J Ophthalmol. 2005:89:1298–1301.

Dr. David 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.

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Nail fungus usually affects toenails. METRO photo
Treating nail fungus requires patience

By David Dunaief, M.D.

Dr. David Dunaief

As we begin our forays into summer public spaces, we are also beginning to expose our toes at the beach and in strappy sandals. Some are more self-conscious about it because of a disease called onychomycosis, better known as nail fungus.

Nail fungus usually affects toenails but can also affect fingernails. It turns the nails yellow, makes them potentially brittle, creates growth underneath the nail (thickening of the nails) and may cause pain.

Many consider getting treatment for cosmetic reasons, but there are also medical reasons to treat, including the chronic or acute pain caused by nail cutting or pressure from bedsheets and footwear. There is also an increased potential risk for infections, such as cellulitis, in those with compromised immune systems (1).

Onychomycosis is not easy to treat, although it affects approximately eight percent of the population (2). The risk factors are unclear but may relate to family history, tinea pedis (athlete’s foot), older age, swimming, diabetes, psoriasis, suppression of the immune system and/or living with someone affected (3).

Many organisms can affect the nail. The most common class is dermatophytes, but others are yeast (Candida) and nondermatophytes. A potassium hydroxide (KOH) preparation can be used to differentiate them. This is important, because some medications work better on one type than another. Also, yellow nails alone may not be caused by onychomycosis; they can be a sign of psoriasis.

When considering treatment, there are several important criteria, including effectiveness, length of treatment and potential adverse effects. The bad news is that none of the treatments are foolproof, and the highest “cure” rate is around two-thirds. Oral medications tend to be the most effective, but they also have the most side effects. The treatments can take from around three months to one year. Unfortunately, the recurrence rate of fungal infection is thought to be approximately 20 to 50 percent with patients who have experienced “cure” (4).

Oral treatments

There are several oral antifungal options, including terbinafine (Lamisil), fluconazole (Diflucan) and itraconazole. These tend to have the greatest success rate, but the disadvantages are their side effects. In a small but randomized controlled trial (RCT), terbinafine was shown to work better in a head-to-head trial than fluconazole (5). Of those treated, 67 percent of patients experienced a clearing of toenail fungus with terbinafine, compared to 21 and 32 percent with fluconazole, depending on duration. Patients in the terbinafine group were treated with 250 mg of the drug for 12 weeks. Those in the fluconazole group were treated with 150 mg of the drug for either 12 or 24 weeks, with the 24-week group experiencing better results.

The disadvantage of terbinafine is the risk of potential hepatic (liver) damage and failure, though it’s an uncommon occurrence. Liver enzymes need to be checked regularly while using terbinafine.

Another approach to reducing side effects is to give oral antifungals in a pulsed fashion. In an RCT, fluconazole 150 or 300 mg was shown to have significant benefit compared to the control arm when given on a weekly basis (6). However, efficacy still was not as great as with terbinafine or itraconazole (7).

Topical options

A commonly used topical medication is ciclopirox (Penlac). The advantage of this lacquer is that there are minor potential side effects. However, it takes approximately a year of daily use, and its efficacy is not as great as oral antifungals. In two randomized controlled trials, the use of ciclopirox showed a 7 percent “cure” rate in patients, compared to 0.4 percent in the placebo groups (8). There is also a significant rate of fungus recurrence. In one trial, ciclopirox had to be applied daily for 48 weeks in patients with mild to moderate levels of fungus.

Laser therapy

Of the treatments, laser therapy would seem to be the least innocuous. However, there are very few trials showing significant benefit with this approach. A study with one type of laser treatment (Nd:YAG 1064-nm laser) did not show a significant difference after five sessions (9). In a small study of 56 patients comparing laser only with laser plus topical antifungals, the best complete “cure” rates were achieved with the combination therapy, 21 percent versus 11 percent with laser only (10).

The advantage of laser treatment is the mild side effects. The disadvantages are the questionable efficacy and the cost.

Alternative therapy

Vicks VapoRub may have a place in the treatment of onychomycosis. In a very small pilot trial with 18 patients, 27.8 percent or 5 of the patients experienced complete “cure” of their nail fungus (11). Partial improvement occurred in the toenails of 10 patients. The gel was applied daily for 48 weeks. The advantages are low risk of side effects and low cost. The disadvantages are a lack of larger studies for efficacy, the duration of use and a lower efficacy when compared to oral antifungals.

None of the treatments are perfect. Oral medications tend to be the most efficacious but also have the most side effects. If treatment is for medical reasons, then oral may be the way to go. If you have diabetes, then treatment may be of the utmost importance.

If you decide on this approach, discuss it with your doctor and comply with precautionary tests on a regular basis, such as liver enzyme monitoring. However, if treatment is for cosmetic reasons, then topical medications or alternative approaches may be the better choice. No matter what, have patience. The process may take a while; nails, especially in toes, grow very slowly.

References:

(1) J Am Acad Dermatol. 1999 Aug.;41:189–196; Dermatology. 2004;209:301–307. (2) J Am Acad Dermatol. 2000;43:244–248. (3) J Eur Acad Dermatol Venereol. 2004;18:48–51. (4) Dermatology. 1998;197:162–166; uptodate.com. (5) Pharmacoeconomics. 2002;20:319–324. (6) J Am Acad Dermatol. 1998;38:S77. (7) Br J Dermatol. 2000;142:97–102; Pharmacoeconomics. 1998;13:243–256. (8) J Am Acad Dermatol. 2000;43(4 Suppl.):S70-S80. (9) J Am Acad Dermatol. 2013 Oct.;69:578–582. (10) Eur J Med Res. 2018; 23: 53. (11) J Am Board Fam Med. 2011;24:69–74.

Dr. David 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.

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Kim Bardes, right, and her husband Bruce just before she started her first round of chemotherapy July 28. Both she and her husband have recently been diagnosed with two different types of cancer. Photo from Bruce Bardes’ Facebook

By Odeya Rosenband

Kim and Bruce Bardes, husband and wife, of Shoreham are in need of support, as one after the other have now been diagnosed with cancer. A friend of the family has started a GoFundMe campaign that has raised $24,100 of its $50,000 goal, as of July 28.

“Back in April, Bruce noticed that one of his legs was swollen,” Kim said. “But he didn’t want to go to the hospital because of COVID-19.” 

Kim Bardes, right, and her husband Bruce have recently been diagnosed with two different types of cancer. Photo from Bardes’ GoFundMe

After eventually visiting the emergency room when the swelling worsened, Bruce was told he had a blood clot in one of his legs but was quickly discharged due to coronavirus guidelines. On May 6, after gardening in the backyard — one of his favorite activities, according to his wife — Bruce suffered a heart attack and stroke in the family home. When he was found unresponsive, his son ran to the neighbor’s house who was trained in CPR. Doctors suspected Bruce had cancer, and a week later, May 21, Bruce was diagnosed with stage IV metastatic lung cancer. 

Nearly two months after Bruce’s diagnosis, the family received more devastating news. Kim was diagnosed with aggressive inflammatory breast cancer. 

“It was seven weeks of me just getting my mindset around the fact that this was happening, trying to be his supporter and his support system, taking care of all of his medical needs — doing what any wife would do — when I had noticed one day that my left breast felt different in one area.” 

With a “funky family history,” Kim had gotten routine mammograms since she was 30 years old. When she visited her doctor June 30, she received a diagnosis for a type of breast cancer she had never even heard of. 

Bruce began his chemotherapy treatments in May, and Kim started hers July 28.

“I know our condition is going to get even worse because now I’m not just going to be tired from running my husband around and taking care of home, now, I got to add myself to this scenario somehow. And I don’t know how I’m going to feel from the treatments,” she said.

With a crackling voice, Kim describes their “love story turned tragedy,” as she calls it. They met at 15 years old, as sophomores at Half Hollow Hills East in Dix Hills. The basketball player and cheerleader were locker neighbors and a year later — thanks to Bruce’s persistence — they were a couple. They started dating when they were 16 years old, 34 years ago. High school sweethearts, Bruce and Kim got married in 1995 and had their first son, Austin, in 1996 and their second, Tanner, in 1999. 

“We met 35 years ago and never had a fight,” Bruce jokingly adds from the next room. “If we can’t joke, then we cry. And we’ve already done too much crying.” 

“Anybody would describe my husband as the kindest person they have ever met,” Kim said. According to their GoFundMe, Bruce coached youth basketball and baseball teams in Long Island for many years. Although he has been on disability leave since 2013 due to back injuries, he continues to be remembered as a beloved coach and has a “huge baseball family that has been giving them a lot of support,” Kim added. Kim, whose eBay business was already struggling due to the pandemic, had to halt her sales in order to care full time for her husband. 

“I don’t have a job where I can take sick leave,” Kim expressed. Now, the family has no source of income. 

“We were so excited for this year — we were turning 50, celebrating our 25th wedding anniversary, and were looking forward to the second half of our lives,” she said. “Our kids are now grown up and we were getting back to being us again … we even talked about moving to Florida.” 

Kim added, “I feel blessed that we have never been hit this hard, but I didn’t expect that when we would be hit, it would be this hard.”

Overall, Bruce has been feeling better following his chemotherapy treatments. 

“He hasn’t lost a stitch of hair, which I’m definitely going to be jealous of,” Kim joked. The hardest part is going through their doctors’ visits alone, due to coronavirus guidelines. 

“COVID is making it 10 times harder because we can’t have any normalcy even if we try to,” she said. “It’s a weird feeling to ask for help because that’s not who I am, ever. But I’ve had to put my pride aside a little bit …. I can’t do it all.”

Kim, whose extended family describes her as the “matriarch,” had adopted the role of hosting Thanksgivings and annual Fourth of July celebrations. Now, without the time or energy, she’s struggling to adapt to her new normal that doesn’t include her regular hobbies like cooking and hosting. 

“This isn’t the life we had, not even close to it,” Kim said. “It seems like somebody else’s life.” 

Kim and Bruce’s family, friends and Shoreham community have been great supporters — in addition to the GoFundMe — offering their services, giving gift cards to local restaurants and writing letters. 

“Our younger son is now a shadow and doesn’t leave us alone,” Kim said. 

Their older son moved back home from Brooklyn in order to help. Kim’s mom and dad, who are 75 and 78, respectively, live in an apartment attached to the Bardes’ house and have also been significant supporters. Kim is one of three children who have all had cancer. Her sister is a nurse and has been instrumental in assisting the family, especially with their medical needs. Kim’s brother passed away at 33 years old from lymphoma. 

“You do the best you can for people and try to do the right thing and it doesn’t matter who you are but sometimes life just attacks you. It feels like we are under attack … and I don’t know why,” she said.

A statement on their GoFundMe reads: “As you may know, medical expenses and life expenses add up quickly and the family needs to make financial decisions based on the best prognosis and not the cost of care … If you are able to support the family during this time please donate. But if not, that’s okay, please join them in prayer.” 

The GoFundMe is available at:  https://www.gofundme.com/f/nqp2qt-help-bruce039s-fight-against-cancer.

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At a time when budgets will be extremely tight amid the gradual economic recovery caused by the virus-induced economic shutdown, investing in organizations that help people deal with mental health problems and substance abuse now could save considerably more money later.

That’s the argument Family and Children’s Association Chief Executive Officer Dr. Jeffrey Reynolds makes, particularly as Suffolk and Nassau County Executives Steve Bellone (D) and Laura Curran (D) urge more federal aid for Long Islanders.

“When you have untreated mental health and substance abuse disorders, the county will pay for that one way or the other,” Reynolds said in an interview. “The question is: do you want to pay for it upfront or on the back end,” with the loss of life from drug overdoses.

Jeffrey Reynolds, the CEO of the Family and Children’s Association. Photo from FCA website

Throughout Long Island, Reynolds, who had previously been the Executive Director of the Long Island Council on Alcoholism and Drug Dependence, said the emphasis on basic needs among families has increased, particularly as the number of unemployed in the area has approached 200,000.

Many of the unemployed are “involved in low wage jobs to begin with” and are living “at the margins,” so there is a need for food, rental assistance, and housing, he said. The basic needs have increased significantly.

The transition to telehealth has been effective for those with mild or moderate challenges and, in some ways, is even easier than walking into a church basement or going to a center. The first step, which is often the hardest in entering any kind of treatment program, involves fewer logistical challenges and allows people to remain anonymous.

At the same time, however, some of these virtual efforts are problematic for those who are dealing with a significant level of impairment.

People who have a more acute mental health condition are “less likely to engage via telehealth” and the same holds true for people with severe substance abuse, Reynolds said. “A virtual session is not the same as seeing them in person and groups are not the same as they were before.”

FCA has seen an increased demand for services for people who were anxious or depressed. Fear or a lack of control brought on by the virus is bringing some of these symptoms to the surface.

“Across the board, we are seeing an increased demand for services,” Reynolds said. “There is now space in which we’re not seeing that request.”

The virus has made health care disparities more visible. The numbers of illnesses and fatalities in Brentwood, for example, are 12 times higher than in Garden City. That relates to preexisting conditions like obesity and diabetes, but also to the crowded living conditions in Brentwood.

The combination of the business closings such as gyms, restaurants, movie theaters, and other enterprises creates anxiety and impacts family structure and family functioning, Reynolds said.

Long Island has had to cope with previous recessions and downturns from disasters like Superstorm Sandy, but this is “even deeper. I imagine we’re going to see the ripple effects for a decade to come.”

Reynolds is concerned about people returning to their normal lives at some point, without addressing underlying problems in the communities or with other families.

Still, Reynolds feels fortunate to work for an organization that has existed and helped communities and neighborhoods for 135 years. That means the group was around during the Spanish Flu in 1918 and 1919.

“What keeps me going is that we’re always had to do more with less,” Reynolds said. “We found hope in people’s lives where it seems like there isn’t.”

Indeed, the group not only survived the Spanish Flu, but also made it through both World Wars, the Great Depression, 9/11, and numerous natural disasters.

Additionally, on the positive side, the FCA can provide services in a much timelier way. People who call with a drug or alcohol problem can get some help within ten minutes. The current environment provides the equivalent of “treatment on demand,” Reynolds said.

The FCA head urged people to get involved, which could mean volunteering time at a school, offering help to a local charity or checking on an elderly neighbor.

He urged people to dedicate some of the time they spend on social media to helping others.

Reynolds has spoken with numerous people who have alcohol dependency. When they finally get treatment, some of them have said, “If it was that bad, why didn’t anybody say something to me?”

He urged friends and family to care for each other, asking about weight loss or prolonged sleep. He suggested having conversations that go beneath the surface.

Children and families benefit from structure, especially in a challenging environment. Reynolds suggested a regular evening meal time and a consistent time and place for homework.

Ultimately, as the head of a 135-year old organization, Reynolds said people need to believe that “you can get through this,” he said. “Even if it feels like the world is ending, it’s not.”

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After returning from speaking with the Long Island’s bipartisan congressional delegation in Washington, Suffolk County Executive Steve Bellone (D) again reiterated just how imperative it is that Congress sends relief to local governments desperately in need.

Bellone’s plea also comes off the back of horrific financial reports, including that the U.S. gross domesticproduct has suffered a 32.9 percent shrinkage in the second quarter of 2020. The deadline for the additional $600 added on to unemployment will run out by the end of this week. While a House of Representatives bill would restore that, among other pandemic benefits, the Senate has proposed a replacement $200 on top of unemployment checks. Senate Republicans have not yet proposed a comprehensive plan to update coronavirus relief, which includes money toward local governments hard hit by the pandemic.

Suffolk has already frozen salaries for management, embargoed funds from various departments and utilized resources from the tax stabilization reserve fund, which has resulted in $100 million in mitigation. The county executive said they are looking at other things they can do to cut costs at a local and state level.

The county executive said without such federal relief, Suffolk will need to start slashing several departments that many needy depend on and would result in higher taxes on already overburdened Long Islanders who have suffered months of job losses and belt tightening.

And as school districts release plans this week for reopening in the fall, many are still unsure if they will receive the state aid promised to them in this year’s New York State budget. Gov. Andrew Cuomo (D) has said state aid may need to be cut at a point toward the end of this year if they do not receive any federal disaster relief.

“Schools putting their plans in place, and they’re doing that in an environment if they don’t know they’ll have the funding to do everything they need to do for our kids,” Bellone said.  “We need [Senate Majority Leader Mitch McConell (R)] to step forward and agree to a comprehensive plan here, give us the resources we need to get through this storm.”

Though the county files a budget in mid-September, Bellone said they can’t wait until then to get relief.

“Schools are weeks away from opening, we need a comprehensive package that faces all the challenges we face right now,” he said.

The pandemic has also created a crisis beyond the over 2,000 people dead from the virus in Suffolk County. Bellone said the number of suicide hotline calls are up 100 percent compared to pre-pandemic levels. COVID-19 has meant a huge increase in demand for food-service based programs, such as Meals on Wheels which has seen a 60 percent increase in demand, according to the county exec.

The potential for another wave of COVID is still on the table, Bellone said, saying that Suffolk feels like it is “in the eye of the storm,” whereas the rest of the country has seen severe spikes in the number of coronavirus cases. If a second wave does hit the county, it could result in

“We’ve been hit as hard as you can get hit and still be standing,” Bellone said. “We know swirling all around us the storm is raging.”

Bellone said Suffolk will need to be communicating with school districts as “[COVID-19] cases inevitably happen in our schools.”

Viral Numbers

Suffolk County is currently looking at 43,170 positive cases overall, and in the last 24 hours the county has seen 86 new positive cases.. This is out of 6,247 tests conducted, putting the county at a 1.4 positive test rate. The positive test rate has fluctuated around 1 percent for the past few weeks.

19,127 people have tested positive for antibodies, meaning they had the virus.

Hospitalizations have hovered around the mid to low 40s over the past week, and over the past day it dipped to 38. Bellone said it was the first time since March that new hospitalizations were in the 30s.

Meanwhile, five more people have occupied ICU beds over the past day to a total of 15 in Suffolk. With 3,020 beds in Suffolk andwith 772 currently available, it makes Suffolk’s capacity at 74 percent. As far as ICU beds, the county has 395, with 147 available, meaning a 53 percent capacity.

Over the past four days, Suffolk has experienced no deaths related to COVID-19.

Bellone said while the percentage capacity of available beds is higher than the state’s goal of 70 percent, he is not worried as the number has fluctuated as more people have willingly entered the hospital for non-COVID related injuries or ailments.

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