Health

Fort Salonga resident Wayne Trumbull ran his first marathon in honor of his friend Paul Gugliuzzo who survived respiratory failure. Photo from Wayne Trumbull

To honor his close friend’s fight for life, a Fort Salonga resident took his mark in Staten Island Sunday morning for the run of his.

Wayne Trumbull was among the 50,000 participants in the TCS New York City Marathon Nov. 5, running the 26.2-mile race from Staten Island to Central Park to commemorate his friend Paul Gugliuzzo’s perseverance during a harrowing battle with lung failure last year. It was his first time running a marathon.

Trumbull, 50, ran as a member of the American Lung Association team and raised $11,000 for the organization leading up to the marathon. The funds raised will go toward research, advocacy and medical equipment for lung diseases.

Trumbull, a professional tax partner and part-time sports coach, completed the five-borough race with an unofficial time of four hours, 29 minutes, to the roar of thousands of people lining the streets. The loudest of cheers for him came from members of the Fort Salonga community, including Gugliuzzo, who gave Trumbull a high five as he passed by.

“It’s not easy for a casual runner like me to run 26 miles, but when the chips are down, I’m focusing on what Paul went through,” Trumbull said prior to the race. “He was on the brink of death and he bounced back. This is very motivating and emotional for me.”

Wayne Trumbull and his friend Paul Gugliuzzo. Photo from Wayne Trumbull

Gugliuzzo — a Fort Salonga resident, former construction manager and a friend of Trumbull’s since their sons joined the same Kings Park youth baseball team 10 years ago — was diagnosed with upper lobe emphysema and chronic obstructive pulmonary disease in 2009.

His conditions progressively worsened, and in March 2016 he underwent a bilateral lung volume reduction surgery at Columbia Presbyterian Hospital in New York City. His doctors initially advised it would keep him in the hospital for a week. Medical complications occurred, however, and the day after the surgery, Gugliuzzo went into respiratory failure. He was placed into a medically induced coma for five weeks. He spent 107 days in the surgical intensive care unit — during which time his blood was oxidized with an ECMO machine and he battled multiple bouts with pneumonia. He was released from the hospital in August 2016.

Throughout the lengthy ordeal, Trumbull spent every Friday night at his friend’s bedside offering Gugliuzzo’s wife, Patti, and family members a much-needed reprieve as they were there 24 hours a day, seven days a week.

“Wayne supported us at a time when we needed it most,” Patti Gugliuzzo said. “Truly, if it weren’t for Wayne and our friends in Fort Salonga who rallied around us, I don’t know how we would’ve made it.”

It was during these nights Trumbull realized he had to do something significant for Gugliuzzo.

“At that point I didn’t know if it was going to be to honor his life or his battle — fortunately it ended up being his battle,” Trumbull said.

A casual runner who had previously only competed in Northport’s Great Cow Harbor 10K and other smaller races for charity, Trumbull began the process of fundraising for the American Lung Association. He learned that it was a sponsor for the New York City Marathon.

The marathon was never something I had on my bucket list, but I knew it was significant and something that took a lot of effort and commitment, and would be a fight in and of itself,” he said. “This is just what I consider being a good friend.”

As the 2016 American Lung Association’s team filled its limited spots by the time Trumbull pursued entry, he applied for this year’s team as soon as they took applications. He was part of a strict training program beginning this past summer and ran five days a week for four months in preparation.

Gugliuzzo, who said his lungs are better now than they’ve been in 15 years, is in the process of rehabilitating himself. He’s looking to Trumbull’s participation in the marathon as motivation to hop on the treadmill every once in awhile.

“If Wayne can do 26 miles, I can do two,” Gugliuzzo said. “Me inspiring him in turn inspires me back. It’s heartwarming what he’s done for me.”

He said his hope one day is to run in the Great Cow Harbor 10K alongside Trumbull.

Kelly and Donna and McCauley held the third annual Butterfly Breakfast for a Cure fundraiser at Applebee’s in Miller Place. Photo by Kevin Redding

By Kevin Redding

A mother-daughter duo from Rocky Point raised thousands of dollars last weekend to help those with epidermolysis bullosa — a rare and painful skin disease that hits close to home.

Donna McCauley, who was born with the genetic condition that causes the skin to blister and tear at the slightest friction, and her daughter Kelly, a former Girl Scout, raised $4,000 during the 3rd Annual Butterfly Breakfast for a Cure fundraiser Nov. 4 at Applebee’s in Miller Place. More than 100 locals gathered at the restaurant to eat pancakes, take part in a Chinese auction with huge prizes for adults and kids and learn about “EB,” which is largely considered “the worst disease you’ve never heard of” and affects one in 20,000 births in the United States.

Donna McCauley auctioned off prizes to raise more funds. Photo by Kevin Redding

All proceeds are going toward Debra of America, a New York City-based nonprofit that provides assistance and support to families with children born with the disease through funding research for a cure and treatment initiatives.

As a teenager, Donna McCauley, whose parents were told she was going to die young from this “genetic anomaly,” made a conscious choice not to let EB — which turns run-of-the-mill activities like getting out of bed, taking clothes on and off and showering into daily struggles — define her life. Instead, she strived to be a role model for other “butterfly children,” a term given to young people with the disease, as their skin is said to be as fragile as a butterfly’s wings.

She became involved with Debra when she was 16, which opened her eyes to a community of others like her, and made sure to get her license, go to college and pursue jobs, vowing “not to be afraid to live” despite her condition.

“I can sit in the corner and rock and be sad, or I can get up and do what I need to do,” said McCauley, 49, who lives in constant pain and must wrap her wounds in bandages each day in order to prevent infections. She is currently in a clinical trial for a new treatment drug by Amicus Therapeutics that helps mend her wounds. “Things like this fundraiser give me hope that people become more aware, and more money is raised. Each day they are getting closer to finding a treatment and a cure.”

Although McCauley has been the face of the event since it started in 2015, the Rocky Point resident who referred to herself as a professional volunteer and remains a coordinator with local Girl Scout troops, pointed to her daughter as the real driving force behind the fundraiser.

“I can sit in the corner and rock and be sad, or I can get up and do what I need to do.”

— Donna McCauley

“One of the things that strikes me the most is that Kelly has a sense of empathy and compassion that I don’t think you can teach,” McCauley said. “I’m so proud of her initiative to make other people more aware of disabilities. She has always been the person who includes the one that isn’t included.”

Kelly McCauley, 19, a current student at Dominican College in Orangeburg, New York, started advocating for EB support as a sophomore at Rocky Point High School by selling bracelets decorated with butterflies to peers and administrators and ended up raising $500 for Debra. This prompted her to want to step things up a notch, and she soon went door to door to local businesses in search of a venue for her own bigger and better fundraiser.

McCauley’s daughter said growing up and witnessing her mom’s perseverance encouraged her to get involved in the first place.

“I saw just how strong she was and how much it took for her just to wake up every day,” she said. “She’s definitely the strongest woman I know. This disease is so much on a person. You wake up and you hurt no matter what. But she still gets up, she goes to church, she volunteers, she works as a religion teacher — she does all these things even though she’s always in some sort of pain.”

McCauley’s determination to live a normal life has served as a foundation for her younger brother, Bob Newfield, a Setauket resident who was also born with EB.

“It’s tough — what would take most people 15 minutes to get ready for work in the morning takes me an hour,” Newfield said. “But there are other things in life that are tough too, so you just have to deal with the cards you’re given. It’s such a rare disease and doesn’t get the funds it needs.”

Local residents, like Miller Place resident Joan Lowry, on right, attended the fundraiser. Photo by Kevin Redding

His wife, Marianne, explained how it’s been to observe the disease firsthand.

“His mind wants to go, go, go, but his body holds him back at times — but those with it are the strongest people I know,” she said. “They don’t really let anything get them down. Bob puts on a happy face every day even though his feet kill him; many days are hard.”

Residents that donated to the cause by purchasing raffle tickets ranged from those living with the disease to others who had never heard of it before.

Bonnie Harris, who grew up in Port Jefferson, said she and a majority of her family have the condition.

“The disease itself doesn’t get better when you get older, but you get better as you get older,” Harris said. “You’re not as clumsy when you’re falling and you’re able to take care of it better. My mom, who had it, always said, ‘You can do anything you want to do — you just have to work harder than everybody else.’”

Miller Place resident Joan Lowry heard of the fundraiser through St. Louis de Montfort R.C. Church in Sound Beach, a parish where McCauley is extremely active.

“There are too many people who fall in the cracks and need the help,” Lowry said, “and that’s the reason I’m here.”

If you wish to make a contribution, visit Debra.org/butterflybreakfast2017.

Jack Law with his wife Kim and his two children, Max and Seth
With a simple swab of your cheek, you can be added to bone marrow registry.

HELP SAVE A LIFE!  St. Louis de Montfort Church, 75 New York Ave., Sound Beach will host a “swab drive” to find a bone marrow donor for Sound Beach resident Jack Law, and the many others on the National Registry with life-threatening blood cancers, on Thursday, November 30 from 3 p.m. to 9 p.m.

A newly retired Air Force officer, Law was recently diagnosed with AML Leukemia. His doctors agree that a bone marrow transplant/stem cell transplant is his best option. Call the church at 631-744-8566 for further details.

For more information on the Myths & Facts of donating bone marrow please visit
https://bethematch.org/support-the-cause/donate-bone-marrow/donation-faqs/

Thank you for your support! Please consider liking and sharing posts from this page to help spread awareness of this event.

Arthritis, a history of stroke and Parkinson’s disease can contribute to fall risk.
Increased risk can begin at the age of 45

By David Dunaief, M.D.

Dr. David Dunaief

When we are young, falls usually do not result in significant consequences. However, when we reach middle age and chronic diseases become more prevalent, falls become more substantial. And, unfortunately, falls are a serious concern for older patients, where consequences can be devastating. They can include brain injuries, hip fractures, a decrease in functional ability and a decline in physical and social activities (1). Ultimately, falls can lead to loss of independence (2).

Of those over the age of 65, between 30 and 40 percent will fall annually (3). Most of the injuries that involve emergency room visits are due to falls in this older demographic (4).

What can  increase the risk of falls?

Many factors contribute to fall risk. A personal history of falling in the recent past is the most prevalent. But there are many other significant factors, such as age; being female; and using drugs, like antihypertensive medications used to treat high blood pressure and psychotropic medications used to treat anxiety, depression and insomnia.

Chronic diseases, including arthritis, as an umbrella term; a history of stroke; cognitive impairment and Parkinson’s disease can also contribute. Circumstances that predispose us to falls also involve weakness in upper and lower body strength, decreased vision, hearing disorders and psychological issues, such as anxiety and depression (5).

How do we prevent falls?

Fortunately, there are ways to modify many risk factors and ultimately reduce the risk of falls. Of the utmost importance is exercise. But what do we mean by “exercise”? Exercises involving balance, strength, movement, flexibility and endurance, whether home based or in groups, all play significant roles in fall prevention (6). We will go into more detail below.

Many of us in the Northeast suffer from low vitamin D, which may strengthen muscle and bone. This is an easy fix with supplementation. Footwear also needs to be addressed. Nonslip shoes, if recent winters are any indication, are of the utmost concern. Inexpensive changes in the home, like securing area rugs, can also make a big difference.

Medications that exacerbate fall risk

There are a number of medications that may heighten fall risk. As I mentioned, psychotropic drugs top the list. Ironically, they also top the list of the best-selling drugs. But what other drugs might have an impact?

High blood pressure medications have been investigated. A propensity-matched sample study (a notch below a randomized control trial in terms of quality) showed an increase in fall risk in those who were taking high blood pressure medication (7). Surprisingly, those who were on moderate doses of blood pressure medication had the greatest risk of serious injuries from falls, a 40 percent increase. One would have expected those on the highest levels to have the greatest increase in risk, but this was not the case.

While blood pressure medications may contribute to fall risk, they have significant benefits in reducing the risks of cardiovascular disease and events. Thus, we need to weigh the risk-benefit ratio, specifically in older patients, before considering stopping a medication. When it comes to treating high blood pressure, lifestyle modifications may also play a significant role in treating this disease (8).

Where does arthritis fit into this paradigm?

In those with arthritis, compared to those without, there is an approximately two-times increased risk of two or more falls and, additionally, a two-times increased risk of injury resulting from falls, according to the Centers for Disease Control and Prevention (1). This survey encompassed a significantly large demographic; arthritis was an umbrella term including those with osteoarthritis, rheumatoid arthritis, gout, lupus and fibromyalgia.

Therefore, the number of participants with arthritis was 40 percent. Of these, about 13 percent had one fall and, interestingly, 13 percent experienced two or more falls in the previous year. Unfortunately, almost 10 percent of the participants sustained an injury from a fall. Patients 45 and older were as likely to fall as those 65 and older.

Why is exercise critical?

All exercise has value. A meta-analysis of a group of 17 trials showed that exercise significantly reduced the risk of a fall (9). If the categories are broken down, exercise had a 37 percent reduction in falls that resulted in injury and a 30 percent reduction in those falls requiring medical attention. Even more impressive was a 61 percent reduction in fracture risk.

Remember, the lower the fracture risk, the more likely you are to remain physically independent. Thus, the author summarized that exercise not only helps to prevent falls but also fall injuries. The weakness of this study was that there was no consistency in design of the trials included in the meta-analysis. Nonetheless, the results were impressive.

Unfortunately, those who have fallen before, even without injury, often develop a fear that causes them to limit their activities. This leads to a dangerous cycle of reduced balance and increased gait disorders, ultimately resulting in an increased risk of falling (10).

What specific types of exercise are useful?

Many times, exercise is presented as a word that defines itself. In other words: Just do any exercise and you will get results. But some exercises may be more valuable or have more research behind them. Tai chi, yoga and aquatic exercise have been shown to have benefits in preventing falls and injuries from falls.

A randomized controlled trial, the gold standard of studies, showed that those who did an aquatic exercise program had a significant improvement in the risk of falls (11). The aim of the aquatic exercise was to improve balance, strength and mobility. Results showed a reduction in the number of falls from a mean of 2.00 to a fraction of this level — a mean of 0.29. There was no change in the control group.

There was also a 44 percent decline in the number of patients who fell. This study’s duration was six months and involved 108 postmenopausal women with an average age of 58. This is a group that is more susceptible to bone and muscle weakness. Both groups were given equal amounts of vitamin D and calcium supplements. The good news is that many patients really like aquatic exercise.

Thus, our best line of defense against fall risk is prevention. Does this mean stopping medications? Not necessarily. But for those 65 and older, or for those who have “arthritis” and are at least 45 years old, it may mean reviewing your medication list with your doctor. Before considering changing your BP medications, review the risk-to-benefit ratio with your physician. The most productive way to prevent falls is through lifestyle modifications.

References: (1) MMWR. 2014; 63(17):379-383. (2) J Gerontol A Biol Sci Med Sci. 1998;53(2):M112. (3) J Gerontol. 1991;46(5):M16. (4) MMWR Morb Mortal Wkly Rep. 2003;52(42):1019. (5) JAMA. 1995;273(17):1348. (6) Cochrane Database Syst Rev. 2012;9:CD007146. (7) JAMA Intern Med. 2014 Apr;174(4):588-595. (8) JAMA Intern Med. 2014;174(4):577-587. (9) BMJ. 2013;347:f6234. (10) Age Ageing. 1997 May;26(3):189-193. (11) Menopause. 2013;20(10):1012-1019.

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.

Insomnia is frustrating because it does not necessarily have one cause.
Untreated insomnia can have long-term health effects

By David Dunaief, M.D.

Dr. David Dunaief

Insomnia is an all-too-common complaint. Though the statistics vary widely, about 30 percent of Americans are affected, according to the most frequently used estimate, and women tend to be affected more than men (1). Insomnia is thought to have several main components: difficulty falling asleep, difficulty staying asleep, waking up before a full night’s sleep and sleep that is not restorative or restful (2).

Unlike sleep deprivation, patients have plenty of time for sleep. Having one or all of these components is considered insomnia. There is debate about whether or not it is actually a disease, though it certainly has a significant impact on patients’ functioning (3).

Insomnia is frustrating because it does not necessarily have one cause. Causes can include aging; stress; psychiatric disorders; disease states, such as obstructive sleep apnea and thyroid dysfunction; asthma; medication; and it may even be idiopathic (of unknown cause). It can occur on an acute (short term), intermittent or chronic basis. Regardless of the cause, it may have a significant impact on quality of life. Insomnia also may cause comorbidities (diseases), two of which we will investigate further: heart failure and prostate cancer.

Fortunately, there are numerous treatments. These can involve medications, such as benzodiazepines like Ativan and Xanax. The downside of these medications is they may be habit forming. Nonbenzodiazepine hypnotics (therapies) include sleep medications, such as Lunesta (eszopiclone) and Ambien (zolpidem). All of these medications have side effects. We will investigate Ambien further because of its warnings.

There are also natural treatments, involving supplements, cognitive behavioral therapy and lifestyle changes.

Let’s look at the evidence.

Heart failure

Insomnia may perpetuate heart failure, which can be a difficult disease to treat. In the HUNT analysis (Nord-Trøndelag Health Study), an observational study, results showed insomnia patients had a dose-dependent response for increased risk of developing heart failure (4). In other words, the more components of insomnia involved, the higher the risk of developing heart disease.

There were three components: difficulty falling asleep, difficulty maintaining sleep and nonrestorative sleep that is not restful. If one component was involved, there was no increased risk. If two components were involved, there was a 35 percent increased risk, although this is not statistically significant.

However, if all three components were involved, there was a 350 percent increased risk of developing heart failure, even after adjusting for other factors. This was a large study, involving 54,000 Norwegians, with a long duration of 11 years.

Prostate cancer

Prostate cancer has a plethora of possible causes, and insomnia may be a contributor. Having either of two components of insomnia, difficulty falling asleep or staying asleep (sleep disruption), increased the risk of prostate cancer by 1.7 and 2.1 times, respectively, according to an observational study (5).

However, when looking at a subset of data related to advanced or lethal prostate cancer, both components, difficulty falling asleep and sleep disruption, independently increased the risk even further, 2.1 and 3.2 times, respectively.

This suggests that sleep is a powerful factor in prostate cancer, and other studies have shown that it may have an impact on other cancers as well. There were 2,102 men involved in the study with a duration of five years. While there are potentially strong associations, this and other studies have been mostly observational. Further studies are required before any definitive conclusions can be made.

What about potential treatments?

Ambien: While nonbenzodiazepine hypnotics may be beneficial, this may come at a price. In a report by the Drug Abuse Warning Network, part of the Substance Abuse and Mental Health Services Administration (SAMHSA), the number of reported adverse events with Ambien that perpetuated emergency department visits increased by more than twofold over a five-year period from 2005 to 2010 (6). Insomnia patients most susceptible to having significant side effects are women and the elderly. The director of SAMHSA recommends focusing on lifestyle changes for treating insomnia: by making sure the bedroom is sufficiently dark, getting frequent exercise and avoiding caffeine.

In reaction to this data, the FDA required the manufacturer of Ambien to reduce the dose recommended for women by 50 percent (7). Ironically, sleep medication like Ambien may cause drowsiness the next day — the FDA has warned that it is not safe to drive after taking extended-release versions (CR) of these medications the night before.

Magnesium: The elderly population tends to suffer the most from insomnia, as well as nutrient deficiencies. In a double-blinded, randomized controlled trial (RCT), the gold standard of studies, results show that magnesium had resoundingly positive effects on elderly patients suffering from insomnia (8).

Compared to a placebo group, participants given 500 mg of magnesium daily for eight weeks had significant improvements in sleep quality, sleep duration and time to fall asleep, as well as improvement in the body’s levels of melatonin, a hormone that helps control the circadian rhythm.

The strength of the study is that it is an RCT; however, it was small, involving 46 patients over a relatively short duration.

Cognitive behavioral therapy

In a study, just one 2½-hour session of cognitive behavioral therapy delivered to a group of 20 patients suffering from chronic insomnia saw subjective, yet dramatic, improvements in sleep duration from 5 to 6½ hours and decreases in sleep latency from 51 to 22 minutes (9). The patients who were taking medication to treat insomnia experienced a 33 percent reduction in their required medication frequency per week. The topics covered in the session included relaxation techniques, sleep hygiene, sleep restriction, sleep positions and beliefs and obsessions pertaining to sleep. These results are encouraging.

It is important to emphasize the need for sufficient and good-quality sleep to help prevent, as well as not contribute to, chronic diseases, such as cardiovascular disease and prostate cancer. While medications may be necessary in some circumstances, they should be used with the lowest possible dose for the shortest amount of time and with caution, reviewing possible drug-drug and drug-supplement interactions.

Supplementation with magnesium may be a valuable step toward improving insomnia. Lifestyle changes including sleep hygiene and exercise should be sought, regardless of whether or not medications are used.

References: (1) Sleep. 2009;32(8):1027. (2) American Academy of Sleep Medicine, 2nd edition, 2005. (3) Arch Intern Med. 1998;158(10):1099. (4) Eur Heart J. online 2013;Mar 5. (5) Cancer Epidemiol Biomarkers Prev; 2013;22(5):872–879. (6) SAMSHA.gov. (7) FDA.gov. (8) J Res Med Sci. 2012 Dec;17(12):1161-1169. (9) APSS 27th Annual Meeting 2013; Abstract 0555.

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.

Exercise significantly reduces breast cancer risk in postmenopausal women

By David Dunaief, M.D.

Dr. David Dunaief

Pink is everywhere this month, as we make a fashion statement to highlight Breast Cancer Awareness Month. This awareness is critical. The incidence of invasive breast cancer in 2017 in the U.S. is estimated to be over 250,000 new cases, with approximately 40,000 patients dying from this disease each year (1). The good news is that from 2003 to 2012 there was decreased mortality in the U.S. across all racial and ethnic populations (2).

We can all agree that screening has merit. Television commercials tout that women in their 30s and early 40s have discovered breast cancer with a mammogram, usually after a lump was detected. Does this mean we should be screening earlier? Screening guidelines are based on the general population that is considered “healthy,” meaning no lumps were found nor is there a personal or family history of breast cancer.

All guidelines hinge on the belief that mammograms are important, but at what age? Here is where divergence occurs; experts can’t agree on age and frequency. The U.S. Preventive Services Task Force recommends mammograms starting at 50 years old, after which time they should be done every other year through age 74 (3). The American College of Obstetricians and Gynecologists recommends consideration of annual mammograms starting at 40 years old and continuing until age 75. They encourage a process of shared decision-making between patient and physician (4).

The best way to treat breast cancer — and just as important as screening — is prevention, whether it is primary, preventing the disease from occurring, or secondary, preventing recurrence. We are always looking for ways to minimize risk. What are some potential ways of doing this? These may include lifestyle modifications, such as diet, exercise, obesity treatment and normalizing cholesterol levels. Additionally, although results are mixed, it seems that bisphosphonates do not reduce the risk of breast cancer nor its recurrence. Let’s look at the evidence.

Bisphosphonates

October is Breast Cancer Awareness Month

Bisphosphonates include Fosamax (alendronate), Zometa (zoledronic acid) and Boniva (ibandronate) used to treat osteoporosis. Do they have a role in breast cancer prevention? It depends on the population, and it depends on study quality.

In a meta-analysis involving two randomized controlled trials, results showed there was no benefit from the use of bisphosphonates in reducing breast cancer risk (5). The population used in this study involved postmenopausal women who had osteoporosis, but who did not have a personal history of breast cancer. In other words, the bisphosphonates were being used for primary prevention.

The study was prompted by previous studies that have shown antitumor effects with this class of drugs. This analysis involved over 14,000 women ranging in age from 55 to 89. The two trials were FIT and HORIZON-PFT, with durations of 3.8 and 2.8 years, respectively. The FIT study involved alendronate and the HORIZON-PFT study involved zoledronic acid, with these drugs compared to placebo. The researchers concluded that the data were not evident for the use of bisphosphonates in primary prevention of invasive breast cancer.

In a previous meta-analysis of two observational studies from the Women’s Health Initiative, results showed that bisphosphonates did indeed reduce the risk of invasive breast cancer in patients by as much as 32 percent (6). These results were statistically significant. However, there was an increase in risk of ductal carcinoma in situ (precancer cases) that was not explainable. These studies included over 150,000 patients with no breast cancer history. The patient type was similar to that used in the more current trial mentioned above. According to the authors, this suggested that bisphosphonates may have an antitumor effect. But not so fast!

The disparity in the above two bisphosphonate studies has to do with trial type. Randomized controlled trials are better designed than observational trials. Therefore, it is more likely that bisphosphonates do not work in reducing breast cancer risk in patients without a history of breast cancer or, in other words, in primary prevention.

In a third study, a meta-analysis (group of 36 post-hoc analyses — after trials were previously concluded) using bisphosphonates, results showed that zoledronic acid significantly reduced mortality risk, by as much as 17 percent, in those patients with early breast cancer (7). This benefit was seen in postmenopausal women but not in premenopausal women. The difference between this study and the previous study was the population. This was a trial for secondary prevention, where patients had a personal history of cancer.

However, in a RCT, the results showed that those with early breast cancer did not benefit overall from zoledronic acid in conjunction with standard treatments for this disease (8). The moral of the story: RCTs are needed to confirm results, and they don’t always coincide with other studies.

Exercise

We know exercise is important in diseases and breast cancer is no exception. In an observational trial, exercise reduced breast cancer risk in postmenopausal women significantly (9). These women exercised moderately; they walked four hours a week. The researchers stressed that it is never too late to exercise, since the effect was seen over four years. If they exercised previously, but not recently, for instance, five to nine years ago, no benefit was seen.

To make matters worse, only about one-third of women get the recommended level of exercise every week: 30 minutes for five days a week. Once diagnosed with breast cancer, women tend to exercise less, not more. We need to expend as much energy and resources emphasizing exercise as a prevention method as we do screenings.

Soy intake

Contrary to popular belief, soy may be beneficial in reducing breast cancer risk. In a meta-analysis (a group of eight observational studies), those who consumed more soy saw a significant reduction in breast cancer compared to those who consumed less (10). There was a dose-response curve among three groups: high intake of >20 mg per day, moderate intake of 10 mg and low intake of <5 mg.

Those in the highest group had a 29 percent reduced risk, and those in the moderate group had a 12 percent reduced risk, when compared to those who consumed the least. Why have we not seen this in U.S. trials? The level of soy used in U.S. trials is a fraction of what is used in Asian trials. The benefit from soy is thought to come from isoflavones, plant-rich nutrients.

Western vs. Mediterranean diets

A Mediterranean diet may decrease the risk of breast cancer significantly.

In an observational study, results showed that, while the Western diet increases breast cancer risk by 46 percent, the Spanish Mediterranean diet has the inverse effect, decreasing risk by 44 percent (11). The effect of the Mediterranean diet was even more powerful in triple-negative tumors, which tend to be difficult to treat. The authors concluded that diets rich in fruits, vegetables, beans, nuts and oily fish were potentially beneficial.

Hooray for Breast Cancer Awareness Month stressing the importance of mammography and breast self-exams. However, we need to give significantly more attention to prevention of breast cancer and its recurrence. Through potentially more soy intake, as well as a Mediterranean diet and modest exercise, we may be able to accelerate the trend toward a lower breast cancer incidence.

References: (1) breastcancer.org. (2) cdc.gov. (3) Ann Intern Med. 2009;151:716-726. (4) acog.org. (5) JAMA Inter Med online. 2014 Aug. 11. (6) J Clin Oncol. 2010;28:3582-3590. (7) 2013 SABCS: Abstract S4-07. (8) Lancet Oncol. 2014;15:997-1006. (9) Cancer Epidemiol Biomarkers Prev online. 2014 Aug. 11. (10) Br J Cancer. 2008;98:9-14. (11) Br J Cancer. 2014;111:1454-1462. Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management.

By Ernestine Franco

The Sound Beach Civic Association brought together a number of health professionals at a health and wellness expo Oct. 21.

At the health fair, professionals were on hand to provide blood pressure screenings, nutritionists discussed how to live a healthier life, representatives from the police department collected unused and unwanted medication and the Sound Beach Fire Department provided tips for calling 911 in case of an emergency

Participants, screeners and presenters participating in the even included: The Chiropractic Joint, The Community Growth Center, Ear Works Audiology, Echo Pharmacy,
Harbor View Medical Services, John T. Mather Memorial
Hospital, the LI Chapter of NYC + PANDAS/PANS Awareness Group and NY PANS Awareness Group, North Shore Youth Council, Rite Aid, Santi Yoga Community, Senior Callers, Suffolk Center for Speech,  Suffolk County Health Department, Suffolk County Police Department’s 7th Precinct., Wellness and Chiropractic Solutions and Young Living Essential Oils.

Patty Pulick, a Sound Beach resident, said she absolutely loved the health fair.

“The various tables were very informative,” she said. “I got my sugar checked, learned about healthy alternatives and discussed hearing issues. It was great that the SCPD was there so I could dispose of my unused medications. I hope they have it again.”

Civic association president Bea Ruberto extended her gratitude to BPN Home Improvement Inc., Echo Pharmacy, Harbor View Medical Services, John T. Mather Memorial Hospital, Matt’s One Stop, Pern Editorial Services, Schwamb Plumbing and Heating and St. Charles Hospital, who sponsored the event.

“I would also like to give a special thank you to all the volunteers who worked tirelessly to coordinate this event, as well as Bonnie Boeger, a Coldwell Banker residential broker who provided water,” Ruberto said. “As everything else we work on, it’s the generosity of the people in the Sound Beach community that made this event possible.”

Lt. Katherine Biggs aboard Comfort, a U.S. Navy hospital ship administering aide to Puerto Rico. Photo by Stephane Belcher

A Naval emergency medicine physician from Port Jefferson Station is trying to provide comfort while aboard a ship named for it in Puerto Rico.

Hurricane Maria made landfall in September as a historic Category 5 storm, devastating Puerto Rico with sustained gusts nearing 200 mph. When Lt. Katherine Biggs, a resident at Naval Medical Center Portsmouth in Virginia currently receiving training in military-specific medicine, was offered the chance to travel to the storm-ravaged island, the 2006 Comsewogue High School graduate said it was an opportunity she couldn’t pass up.

Lt. Katherine Biggs and other sailors aboard the Military Sealift Command hospital ship USNS Comfort treat a patient from Centro Medico in San Juan, Puerto Rico. Photo by Stephane Belcher

Biggs is one of five from the residency program aboard the Military Sealift Command hospital ship Comfort, which reached Puerto Rico Oct. 3 and does not have a scheduled return date, working on the boat’s casualty receiving area administering medical aide to those affected. Catastrophic flooding, damaged infrastructure and a lack of supplies, drinking water and electricity have created a dangerous situation for most Puerto Ricans trying to restore their regular routine.

“We’ll be here as long as directed and as long as needed,” Biggs said in a phone interview from Puerto Rico. “I’ll stay here as long as they’ll let me.”

She called the trip thus far a great learning experience, and said it’s been a change of pace helping people with severe respiratory and heart issues, for example, because she’s used to providing medical attention to those with traumatic, combat-related injuries. Biggs has treated some with broken bones, but said many of the patients she has been tasked with treating are people with chronic issues that are flaring up because they’ve been unable to take their prescribed medicines for various reasons.

The lieutenant said she knew when she was in ninth or tenth grade at Comsewogue that she wanted to pursue a career in medicine as a way to help people in need. After four years at Binghampton University as an undergraduate, she moved on to medical school at New York Institute of Technology in the College of Osteopathic Medicine, graduating in 2015. Biggs said she was able to afford the schooling thanks to the Health Professions Scholarship Program, a financial assistance offering from the U.S. military, which she heard about from a neighbor. She is in the third year of her residency in Portsmouth, and it is a rarity for residents to be asked to go on a trip like the one she’s on now, according to residency program director Commander John Devlin.

“This opportunity may be tough in the sense of the people struggling, but it is allowing my daughter to do what she was meant to do — help people in need.”

— Laurie Biggs

“I say it’s win-win,” Devlin said in a statement. “The people of Puerto Rico are getting more emergency medicine physician manpower than they would have had, had we gone with the original plan. And from the resident standpoint and the Navy’s standpoint, we are getting five junior physicians that, for their entire career, will have this experience base to carry forward to apply to missions in the future.”

With the help of the “Sea Knights” of Helicopter Sea Combat Squadron, Biggs and the other residents have been able to personally assist in medical evacuation missions around the island to return people to the ship for treatment via helicopter.

“When I heard about Katie’s plans to head to Puerto Rico I was incredibly proud,” Biggs’ mother Laurie said in an email. “I remember reminding her that this is why she joined the Navy and wanted to become a doctor. This opportunity may be tough in the sense of the people struggling, but it is allowing my daughter to do what she was meant to do — help people in need.”

Biggs’ mother added she knew from an early age her daughter, who is the oldest of four, was a caring and helpful person, ever aware of helping the less fortunate.

“To us she will always just be Katie, the daughter and older sister that is always there when you need her,” she said.

Biggs said her biggest takeaway from the mission thus far has been the dedication of responders on the ground to do whatever it takes to help both individuals and the island as a whole return to normalcy. To contribute to the relief effort, visit the American Red Cross website at www.redcross.org/donate.

The streets of Stony Brook were filled with more than 300 runners and an estimated 460 walkers participating in the Walk for Beauty and Hercules on the Harbor 10K Run Oct. 22. Cancer survivors along with family members and friends collect donations to support their walk or run, which takes them through the scenic and historic Stony Brook. All proceeds go directly to a targeted research fund at Stony Brook Medicine for Breast Cancer Research and The WMHO Unique Boutique for wigs.

Foods high in Vitamin D include egg yolks, beef, shiitake mushrooms, cheese, milk and cold-water fatty fish like salmon, above.
In most geographic locations, sun exposure will not correct vitamin D deficiencies

By David Dunaief, M.D.

Dr. David Dunaief

Vitamin D is one the most widely publicized and important supplements. We get vitamin D from the sun, food and supplements. With our days rapidly shortening here in the Northeast, I thought it would be worthwhile to explore what we know about vitamin D supplementation.

Vitamin D has been thought of as an elixir for life, but is it really? There is no question that, if you have low levels of vitamin D, replacing it is important. Previous studies have shown that it may be effective in a wide swath of chronic diseases, both in prevention and as part of the treatment paradigm. However, many questions remain. As more data come along, their meaning for vitamin D becomes murkier. For instance, is the sun the best source of vitamin D?

At the 70th annual American Academy of Dermatology meeting, Dr. Richard Gallo, who was involved with the Institute of Medicine recommendations, spoke about how, in most geographic locations, sun exposure will not correct vitamin D deficiencies. Interestingly, he emphasized getting more vitamin D from nutrition. Dietary sources include cold-water fatty fish, such as salmon, sardines and tuna.

We know its importance for bone health, but as of yet, we only have encouraging — but not yet definitive — data for other diseases. These include cardiovascular and autoimmune diseases and cancer.

There is no consensus on the ideal blood level for vitamin D. The Institute of Medicine recommends more than 20 ng/dl, and The Endocrine Society recommends at least 30 ng/dl. More experts and data lean toward the latter number.

Skin cancer

Vitamin D did not decrease nonmelanoma skin cancers (NMSCs), such as squamous cell and basal cell carcinoma. It may actually increase them, according to one study done at a single center by an HMO (1). The results may be confounded, or blurred, by UV radiation from the sun, so vitamin D is not necessarily the culprit. Most of the surfaces where skin cancer was found were sun exposed, but not all of them.

The good news is that, for postmenopausal women who have already had an NMSC bout, vitamin D plus calcium appears to reduce its recurrence, according to the Women’s Health Initiative study (2). In this high-risk population, the combination of supplements reduced risk by 57 percent. However, unlike the previous study, vitamin D did not increase the incidence of NMSC in the general population. NMSC occurs more frequently than breast, prostate, lung and colorectal cancers combined (3).

Cardiovascular mixed results

Several observational studies have shown benefits of vitamin D supplements with cardiovascular disease. For example, the Framingham Offspring Study showed that those patients with deficient levels were at increased risk of cardiovascular disease (4).

However, a small randomized controlled trial (RCT), the gold standard of studies, calls the cardioprotective effects of vitamin D into question (5). This study of postmenopausal women, using biomarkers such as endothelial function, inflammation or vascular stiffness, showed no difference between vitamin D treatment and placebo. The authors concluded there is no reason to give vitamin D for prevention of cardiovascular disease.

The vitamin D dose given to the treatment group was 2,500 IUs. Thus, one couldn’t argue that this dose was too low. Some of the weaknesses of the study were a very short duration of four months, its size — 114 participants — and the fact that cardiovascular events or deaths were not used as study end points. However, these results do make you think.

Weight benefit

There is good news, but not great news, on the weight front. It appears that vitamin D plays a role in reducing the amount of weight gain in women 65 years and older whose blood levels are more than 30 ng/dl, compared to those below this level, in the Study of Osteoporotic Fractures (6).

This association held true at baseline and after 4.5 years of observation. If the women dropped below 30 ng/dl in this time period, they were more likely to gain more weight, and they gained less if they kept levels above the target. There were 4,659 participants in the study. Unfortunately, vitamin D did not show statistical significance with weight loss.

Mortality decreased

In a meta-analysis of a group of eight studies, vitamin D with calcium reduced the mortality rate in the elderly, whereas vitamin D alone did not (7). The difference between the groups was statistically important, but clinically small: 9 percent reduction with vitamin D plus calcium and 7 percent with vitamin D alone.

One of the weaknesses of this analysis was that vitamin D in two of the studies was given in large amounts of 300,000 to 500,000 IUs once a year, rather than taken daily. This has different effects.

USPSTF recommendations

The U.S. Preventive Services Task Force recommends against giving “healthy” postmenopausal women the combination of vitamin D 400 IUs plus calcium 1,000 mg to prevent fractures (8). It does not seem to reduce fractures and increases the risk of kidney stones. There is also not enough data to recommend for or against vitamin D with or without calcium for cancer prevention.

Need for clinical trials

We need clinical trials to determine the effectiveness of vitamin D in many chronic diseases, since it may have beneficial effects in preventing or helping to treat them (9). Right now, there is a lack of large randomized clinical trials. Most are observational, which provides associations, but not links. The VITAL study is a large RCT looking at the effects of vitamin D and omega-3s on cardiovascular disease and cancer. It is a five-year trial, and the results should be available in 2018.

When to supplement?

It is important to supplement to optimal levels, especially since most of us living in the Northeast have insufficient to deficient levels. While vitamin D may not be a cure-all, it may play an integral role with many disorders.

References: (1) Arch Dermatol. 2011;147(12):1379-1384. (2) J Clin Oncol. 2011 Aug 1;29(22):3078-3084. (3) CA Cancer J Clin. 2009;59(4):225-249. (4) Circulation. 2008 Jan 29;117(4):503-511. (5) PLoS One. 2012;7(5):e36617. (6) J Women’s Health (Larchmt). 2012 Jun 25. (7) J Clin Endocrinol Metabol. online May 17, 2012. (8) AHRQ Publication No. 12-05163-EF-2. (9) Endocr Rev. 2012 Jun;33(3):456-492.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For more information, visit www.medicalcompassmd.com.