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U.S. Sen. Chuck Schumer said there is need to increase the PPP loan funding, but he and Republicans have disagreed how. File photo by Kevin Redding

With a dramatic thumbs down gesture from U.S. Sen. John McCain (R-Arizona) in the middle of the night July 28, the GOP-backed health care bill was effectively killed in the United States Senate, leaving the future of health care in the country, state and county a mystery.

“First: I want to thank Sens. [Lisa Murkowski (R-Alaska)], [Susan Collins (R-Maine)], and McCain for showing such courage, strength, and principle.”

— Chuck Schumer

As a result of the vote, the Affordable Care Act, or Obamacare, remains the law of the land for the time being, despite rhetoric from President Donald Trump (R) suggesting the system is on the verge of collapse. In New York, a universal health care bill progressed past the state assembly and has been in committee since June 2016, awaiting state senate approval and a final signature from Gov. Andrew Cuomo (D). A New York State health care bill would supersede federal law.

“First: I want to thank Sens. [Lisa Murkowski (R-Alaska)], [Susan Collins (R-Maine)], and McCain for showing such courage, strength, and principle,” U.S. Sen. and Senate Minority Leader Chuck Schumer (D-New York) said on Twitter July 28. The three Republican senators voted in line with the 48 Democrats to effectively kill the bill, despite the GOP majority. “To everyone who called, tweeted, emailed, and raised their voice in any way: thank you. Your stories matter. But we are not celebrating. We are relieved — for the millions of Americans who can keep their insurance and breathe a little easier. Now, it’s time for the Senate to come together in a bipartisan way to fix the problems that exist in our health care system. We can stabilize the markets through funding cost sharing reduction and creating reinsurance programs, which keep premiums, deductibles down.”

U.S. Rep. for New York’s 3rd Congressional District Tom Suozzi (D-Glen Cove) released a proposal July 31 with the Problem Solvers Caucus, a bipartisan group of legislators which Suozzi serves as the vice-chair of, that would “stabilize the individual insurance market,” in the wake of the vote, according to a press release. The plan would create a dedicated stability fund to reduce premiums and limit losses of coverage, repeal the 2.3 percent medical device sales tax that is on all medical device supplies, provide clear guidelines for states that want to enter into regional control of their health care and create more options for customers, and more.

“Americans are desperate for Democrats and Republicans to work together to try and tackle the challenges our country faces,” Suozzi said in a statement. “The Problem Solvers Caucus, by proposing this major bipartisan first step, is like an oasis in a desert of dysfunction. We still have much more to do with health care and other issues and we hope our colleagues will join our efforts in this spirit of goodwill and compromise for the common good.”

“The Problem Solvers Caucus, by proposing this major bipartisan first step, is like an oasis in a desert of dysfunction.”

— Tom Suozzi

The New York State Assembly bill for the 2017-18 session, which is currently in committee, would establish The New York Health Act, to create a single-payer health care system.

A single-payer system requires a single-payer fund, which all New Yorkers would pay into to cover health care costs of an individual, instead of through private insurers. In a single-payer system every citizen is covered, patients have the freedom to choose their own doctors and hospitals, and employers would no longer be responsible for health care costs. Suozzi attended a March rally in Huntington in support of a single-payer system for New York.

The U.S. Senate version of the health care bill passed by the House of Representatives in May  would have resulted in drastic cuts to Medicaid funding for New Yorkers. According to the Kaiser Family Foundation, a nonprofit organization established to deliver health policy analysis to the public, nearly $92 billion in funding would be cut from New York’s Medicaid expansion dollars between 2020 and 2026.

The predominantly Republican support for the repeal of Obamacare stems from expensive premiums and an individual mandate requiring the purchase of health insurance for all Americans with a fine for noncompliance.

The U.S. Congressional Budget Office was no more optimistic about the GOP health care bill than the Kaiser Family Foundation. A July 20 report from the CBO on one of the many versions of the now-failed senate bill predicted 17 million Americans would be uninsured by 2018 had the bill passed, in addition to increases in premiums.

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Meghan Chiodo gets to know her new service dog Polly, who was given to her thanks to Canine Companions for Independence. Photo by Jenna Lennon

By Jenna Lennon

After interviews, reference forms, applications and a year and a half of waiting, 10th-grader Meghan Chiodo from Greenlawn was finally able to meet her assistance dog, Polly.

Meghan and Polly were introduced thanks to Canine Companions for Independence Wednesday, July 26, at the nonprofit’s headquarters in Medford.

Polly, a black female Labrador-Golden Retriever will help Meghan with many different tasks aside from becoming a loyal and loving companion. Meghan was born with spina bifida and has little to no feeling or control of her legs from her knees down, so Polly will be especially helpful with giving her all the assistance she needs.

“Meghan is sort of an ideal candidate in the sense that she’s in that age where she wants to be more independent and the dog can really help provide that to her especially as she’s getting into her later years of high school,” Jessica Reiss-Cardinali, the participant program manager for the Northeast Region of Canine Companions said in an interview.

Meghan said Polly will help with tasks like “bringing my laundry from the living room to my room … the dog can carry something or I can carry it and the dog can open the door,” she said at the event. “I think those are the two [commands] I’ll probably use the most.”

Meghan’s mother Kerri said Polly will be a great assistance around the house.

“The wheelchair is now in our home, so she doesn’t have her hands free always,” her mom said. “So the dog will provide an extra set of hands for her for a little more independence and companionship. That’s going to be a big one. She’s one of four children. She’s the youngest, two are leaving off for college, so it’s nice to have a buddy.”

Canine Companions, the nation’s largest provider for trained assistance dogs, is an organization founded in 1975 aimed at providing service dogs, hearing dogs, skilled companions and facility dogs to people with disabilities free of charge. The Northeast Regional Center for CCI opened in Medford in 1989 and has since placed 861 Canine Companion teams together.

Golden Retriever, Labrador and Golden-Lab puppies are trained by volunteer puppy raisers who provide them with a safe and happy living environment, a healthy diet, obedience training and socialization.

When they are about a year and a half old, the puppies then receive professional training at a Canine Companion training center for six to nine months, learning 40 advanced commands. Then, they are matched with a child or an adult with a disability.

“Four times a year we invite people that are on our waiting list to come, and they stay with us here in Medford,” said John Bentzinger, the public relations and marketing coordinator for the Northeast region of Canine Companions. “They stay at our facilities, and we call it ‘team training.’ The dogs are already fully trained, but we’re teaching the people how to use the commands and how to care for the dog.”

Participants spend the first few days getting acquainted with the different dogs and with the commands necessary to interact with them.

On the third day of the two-week program, the matches are revealed to the participants. Matches are based on the interactions that trainers and program coordinators see during the first few days of the program between the dogs and the participants, as well as what the participants need from the dogs.

“It’s like a jigsaw puzzle where everybody has to fit together,” Reiss-Cardinali said. “We like to say this is like a 10-year commitment, so if you’re going to sign on for 10 years, we’d like it to be something that’s going to work for you. It’s a very happy time, and for the staff too. We’re all crying in the room because there’s a lot of work that goes into that 20 minutes.”

As for the matchup between Polly and Meghan, Reiss-Cardinali said it was a no brainer.

“They’re sort of at the same stage in life,” she said. “Polly is just coming out of young adulthood so I really feel like as Meghan grows, it will be a really nice way for them to grow together.”

By the day that the matches are revealed, participants in the program have already learned several commands to use as part of their team training with their new companion.

“We did sit, down, heel, let’s go, side, release, wait, kennel and okay,” Meghan said. “That’s it so far.”

Her mother said that’s no small feat.

“That’s it so far, but that’s a lot in two days … I think today we get six whole new commands, so that’s a lot,” she said. “The instructors are incredibly patient. You’ve got so many different people with so many different needs, and they’re accommodating all of us. I’m really impressed with this whole facility and what they do here. It’s incredible. These dogs are amazing.”

Meghan and Polly and the rest of their Team Training Class will graduate Aug. 4 at 2:30 at the Genesis Center in Medford.

To learn more about canine companions visit www.cci.org.

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Leukemia survivor Aubri Krauss collected Band-Aid box donations for Stony Brook University Hospital’s hematology and oncology unit. Photo from Darcy Krauss

By Jenna Lennon

Three years ago, Jericho Elementary School student Aubri Krauss decided to start a Band-Aid drive to benefit Stony Brook University Hospital’s hematology and oncology unit.

She had been diagnosed with leukemia in 2011. At just over 3 years old, she toughed out the treatment, and when finished, decided she wanted to do something to help others.

“[I want to] bring smiles to other kids who are going through what I went through,” she said.

Leukemia survivor Aubri Krauss collected Band-Aid box donations for Stony Brook University Hospital’s hematology and oncology unit. Photo from Darcy Krauss

“We were at the pediatrician’s office, and she saw all the Band-Aids they had and she was like ‘You know what mom? We used so many Band-Aids when I was sick — wouldn’t it be great if we could get a bunch of Band-Aids for all the kids that are still sick?’” Aubri’s mother Darcy Krauss said. “When they have to get their finger pricked, those plain Band-Aids are boring. That was one of the great things for Aubri was she got to pick her own fun, kid Band-Aid.”

Last year, Aubri decided to try something different and hosted a wrapping paper drive for the events that the clinic holds for the children during the holidays.

Aubri decided to return to the Band-Aid drive this year because “she thinks it’s more personal to the kids,” Krauss said. When she began, she hoped to beat her collection of 700 boxes from her previous Band-Aid drive, and she’s done just that, collecting over 800.

“And they’re not all the little 20 packs,” Krauss said. “Some people brought boxes that have hundreds of Band-Aids, some people bought boxes that have 200 Band-Aids in it. So it’s a lot of Band-Aids.”

Middle Country Board of Education member Dina Phillips met Aubri in 2012 when her father was the assistant coach of her son’s baseball team.

“When I met Aubri, she endured countless tests, procedures, chemo treatments and much more, yet managed to do so without ever losing her sense of joy,” Phillips said. “She had to learn what it means to live part of her life in a hospital room, to lose her hair, and to lose some of the freedoms that other kids her age get to enjoy.”

“She endured countless tests, procedures, chemo treatments and much more, yet managed to do so without ever losing her sense of joy.”

—Dina Phillips

She said she was blown away by how Aubri did not let her circumstances define her.

“With a maturity far beyond her years, Aubri turned her illness into an opportunity to help other kids like her, and turned her pain into a way to bring smiles to others,” Phillips said. “I am extremely proud of her. I hope we can all do a simple gesture and help her achieve her goal.”

Band-Aid drives were held at Aubri’s elementary school, Raymour & Flanigan Furniture and Mattress Store in Lake Grove, and Stagecoach Elementary School, where Phillip’s son goes to school. The students there decorated the box for a collection at Stagecoach’s 50th Anniversary celebration on June 9th.

“I think when you go through something so hard and you can come out on the other end and be empathetic and understanding … it just makes me very happy and blessed to be her mom,” Krauss said. “Everyone is like ‘she’s so lucky to have you as her mom,’ and I’m like no, I definitely think I’m the luckier one to have her as my daughter.”

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New York State Senator Ken LaValle does not approve of the decision

John T. Mather Memorial Hospital in Port Jefferson. File photo from Mather Hospital

A Port Jefferson institution established in 1929 is set to undergo an unprecedented change, the likes of which has never occurred during its near-90-year history. John T. Mather Memorial Hospital leadership has signed a letter of intent to join Northwell Health, New York’s largest health care provider, which has 22 hospitals under its umbrella. Prior to the agreement, Mather was one of just two Long Island hospitals unaffiliated with a larger health system. Mather’s board considered affiliation with Stony Brook University Hospital, though ultimately decided on Northwell.

Mather Hospital is set to join Northwell Health. Photo from Huntington Hospital.

“I don’t think it’s a good decision,” State Sen. Ken LaValle (R-Port Jefferson) said in a phone interview. LaValle is a fervent supporter of the university, often publicly spotted wearing a red SBU baseball cap. “For 50 years-plus there’s been a culture in place if people needed tertiary care they would go from Mather to Stony Brook. Stony Brook will still be in place, will still offer services and people still if they choose can go to Stony Brook.”

LaValle said he didn’t know why Mather decided to go with Northwell, and members of Mather’s board declined to discuss specifics of the agreement with Northwell because discussions are ongoing. The changeover could take place as soon as prior to the end of the year.

“I would have wished that the Mather board would have been considerate of the people in their area rather than for whatever other reasons they made this decision,” LaValle said. “I don’t know whether Northwell came in with a bag of cash and that’s why they made the decision; but if they were making the decision based on the people they serve in their catchment area they would have gone with Stony Brook.”

Mather Hospital Vice President of Public Affairs Nancy Uzo, said Stony Brook was considered an option for affiliation and offered an explanation by email as to why it was ultimately spurned.

“I don’t think it’s a good decision.”

— Ken LaValle

“Our goal through this process is to ensure that our communities continue to have access to advanced, high quality care and superior satisfaction close to home and to serve the best interests of our medical staff and employees,” she said.

Mather Board of Directors Chairman Ken Jacoppi and President Ken Roberts declined to comment further through Uzo.

“Our community, employees and medical staff have a deep commitment to Mather Hospital,” Roberts said in a press release. “We chose a partner that would support our culture of caring as well as our future growth.”

Stony Brook University Senior Vice President for the Health Sciences and Dean of the School of Medicine Ken Kaushansky declined to comment on Mather’s decision via email. President Samuel L. Stanley Jr. did not respond to a direct request for comment nor through a university spokeswoman.

In 2016 the American Hospital Association released research suggesting hospital mergers like the one Mather is set to undertake result in cost savings and quality improvements. According to the research, mergers decrease costs due to economies of scale, reduced costs of capital and clinical standardization among other efficiencies. An analysis showed a 2.5 percent reduction in annual operating expenses at acquired hospitals. Other benefits include the potential to drive quality improvements through standardization of clinical protocols and investments to upgrade facilities and services at acquired hospitals, an expansion of the scope of services available to patients and improvements to existing institutional strengths to provide more comprehensive and efficient care.

New York State Sen. Ken Lavalle did not agree with Mather’s decision to join Northwell Health over Stony Brook University Medicine. File photo

Huntington Hospital joined North Shore-LIJ in 1994, which became known as Northwell Health in February 2016. After the merger is official, Mather and Huntington hospitals will be the only Northwell hospitals on the North Shore in Suffolk County.

“Mather Hospital is known for patient-centric care both in the community and throughout the industry,” Michael Dowling, Northwell’s president and CEO said in a statement. “That deeply embedded sense of purpose is the type of quality we want to represent Northwell Health, along with an excellent staff of medical professionals and physicians. Together, Mather and Northwell will play a crucial partnership role expanding world class care and innovative patient services to Suffolk County residents.”

In what some view as a related move, Stony Brook announced in a press release Aug. 1 that Southampton Hospital would become a member of the Stony Brook Medicine health system.

“Today we celebrate a unique opportunity in which academic medicine and community medicine can come together to benefit our entire region,” Stanley said. “We will continue to build on successful collaborations achieved over the past ten years, which have already brought many new programs to the East End, including a robust number of internship and residency programs at Stony Brook Southampton Hospital, and where students enrolled in graduate programs in the health sciences on the Stony Brook Southampton campus can put their training to good use as the next generation of allied health professionals to help address the shortage of providers on the east end and beyond.”

The acquisition will result in new offerings at Stony Brook including a provisional Level 3 Trauma Center, with 24-hour coverage by emergency medicine doctors and a trauma surgeon available within 30 minutes, a Hybrid Operating Room with sophisticated imaging capabilities and a new cardiology practice in Southampton with Stony Brook cardiologists, among other benefits.

LaValle declined to classify Mather’s decision as a “loss” for Stony Brook and added he expects Mather and the university to continue to enjoy a mutually beneficial relationship going forward.

“Stony Brook is close by and they will reach out and still try to encourage both local physicians and people to come to Stony Brook,” he said.

This version was edited Aug. 7 to include comments from Michael Dowling.

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Members of the community gather at Jackson Edwards’ Terryville home July 31 to welcome him home from a lengthy hospital stay in Maryland to battle leukemia. Photo by Kyle Barr

By Kyle Barr

After more than four months of treatment battling acute myeloid leukemia, a blood and bone marrow cancer, 11-year-old Jackson Edwards returned home Monday from Johns Hopkins Hospital in Baltimore, Maryland to the sound of a Terryville fire truck honking and the cheers of friends and family.

“I don’t know how to put it — it’s such a wave of emotions,” Jackson’s mother Danielle Edwards said. “We’re happy, finally. Jackson’s a little nervous because he’s so far away from the hospital and he’s thin from the treatment, but he’s happy to be with his people.”

Jackson waives to the crowd assembled at his home. Photo by Kyle Barr

Tired from the long trip and overwhelmed by the number of people who had shown up for the surprise homecoming, Jackson only stood outside for a few minutes July 31, waving to his friends and family before heading back inside. They had taken a 6-hour drive to get back to Terryville from Johns Hopkins.

“[Jackson and his mom] had no idea what was here,” Jackson’s aunt DeeDee Edwards said. She had helped plan the surprise homecoming, and was in charge of keeping the mother and son in the dark. “Jackson was counting the stoplights until we got here, and he was so overwhelmed by all the people who came to support him.”

Though the drive home was long, the real difficulty for Jackson and his family was the more than 100 days he spent in Baltimore fighting the rare form of cancer.. Jackson has always been a charismatic young man, according to his family. He’s a typical 11-year-old — he loves wrestling and football. His favorite comic book and show characters are Captain America and Optimus Prime. In December 2013 Jackson was diagnosed with AML. It was the start of an arduous treatment process that saw Jackson go into remission in May 2014.

Around Christmas 2016, Jackson started to feel sick again, and after taking him to Stony Brook University Hospital, the family learned that the his disease had returned and he had relapsed. In April he was transferred to Johns Hopkins in Maryland where he underwent a long and painful process of chemotherapy in preparation for a later bone marrow transplant. Meanwhile, friends and family worked hard to fund raise and help Jackson’s mother in finding options for his treatment.

Deirdre Cardarelli, a friend of the family, worked hard to help throw the surprise welcome for the Edwards’. For months Cardarelli was co-running the StayStrongJackson Facebook page alongside Jackson’s mom, and she was instrumental in forming a T-shirt drive and an Easter egg hunt to support the family’s travel and medical funds. The Facebook page and all the other social media efforts helped galvanize the local community in its support of Jackson, even those who were not necessarily close to the Edwards’..

Onlookers for the surprise homecoming brought signs of support to hold. Photo by Kyle Barr

“I don’t know the family personally, but our oldest, Michael, is in the same school with Jackson,” said community member Yoon Perrone. “We bought the shirts to support the family and we wanted to be here. I can’t imagine one of our own children having the disease.”

For the bone marrow transplant the family had to find a donor that was as close of a match as possible. Rocco Del Greco, a friend of the family, said he felt a deep need to help the young man and his family once he learned of the cancer’s relapse.

“Since I was not so emotionally connected to their son I was able to channel my anger for what happened to the young man,” Del Greco said. He helped to jump-start a YouCaring page to crowd fund for Jackson, which managed to raise more than $8,000. Del Greco  also managed several bone marrow drives during the search for a suitable donor. From January to early April, Del Greco helped facilitate for almost 1,800 people to test their DNA for matches to Jackson.

Finding a sufficient match was not easy for the Edwards’. Jackson’s mother had a 50 percent match from her own marrow. She served as the donor, and the transplant was successful. After about a month-long recovery, the doctors said he was safe to continue treatment from home.

The process kept Jackson away from school and friends and forced him to endure weeks of treatment, including chemotherapy. Jackson was not able to attend his fifth-grade graduation ceremony from elementary school in the Comsewogue School District, but his older brother Cortez James “C.J” Edwards walked up on stage in his place. Jackson’s mother said that while the treatment process and lengthy hospital stay did get tough, her son powered through it by making new friends.

Members of the community gather at Jackson Edwards’ Terryville home July 31 to welcome him home from a lengthy hospital stay in Maryland to battle leukemia. Photo by Kyle Barr

“He met a whole bunch of new people, because he’s very charismatic, and he stole a bunch of other people’s hearts,” she said.

The transplant has left his immune system weak, and for another eight months Jackson is restricted from coming too close in contact with other people while he heals. This will prohibit him from attending school for several months, but his mother said they plan on continuing his education with tutoring.

Though he said he is excited to eventually go back to school, for now Jackson celebrated a Christmas in July, including a tree and presents surrounding it. He was unable to celebrate Christmas with his family when his cancer relapsed back in December.

According to the United States Centers for Disease Control and Prevention, more than 47,000 people were diagnosed with leukemia in 2014, the most recent year on record with data on leukemia.

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Councilwoman Susan Berland stands with the free sunscreen dispenser now at Crab Meadow Beach in Northport. File photo from A.J. Carter

By Victoria Espinoza

One Huntington Town official is determined to have residents covered when it comes to their skin.

Councilwoman Susan Berland (D) received support from her Huntington Town Board colleagues to expand her pilot program and provide sunscreen protection for Huntington residents at 14 new locations in addition to Crab Meadow Beach.

Last summer Berland launched a free sunscreen dispenser program at Crab Meadow Beach after working in conjunction with IMPACT Melanoma, formerly known as the Melanoma Foundation of New England, an organization that provides education, prevention and support for the most serious form of skin cancer.

“The [Crab Meadow Beach dispenser] was a success,” Berland said in a phone interview. “It got a lot of use last year and this year. So I wanted to expand it to 14 other locations.”

For about $1,600, the town will purchase from IMPACT Melanoma 14 additional BrightGuard sunscreen dispensers along with a supply of BrightGuard Eco Sport Sunscreen Lotion SPF 30 for each designated location.

The new dispensers will be installed at Asharoken Beach, Centerport Beach, Crescent Beach, Fleets Cove Beach, Gold Star Battalion Beach, Hobart Beach, Quentin Sammis/West Neck Beach, Greenlawn Memorial Park, Heckscher Park, Ostego Park, Veterans Park, Crab Meadow Golf Course, Dix Hills Golf Course and Dix Hills Pool. The sunscreen is environmentally safe, made in America and Para-AminoBenzoic Acid (PABA) free, according to Berland’s office. The councilwoman said she chose locations based on need and their supervision.

“For example the town pool is where all town camp programs are held,” she said. “I’m willing to bet there are some kids who are not using sunscreen or will forget it and this can help.”

Berland said the reaction to the first dispenser and a melanoma prevention and awareness event she hosted earlier this summer have indicated both been a success.

“I get swarmed at the dermatologists office about how great the first dispenser is,” she said. “People can forget to pack their sunscreen or some people have never even used sunscreen before. It’s just not on their radar. So people are now trying it, it’s a great preventative for the residents.”

According to the Journal of Clinical Oncology regular sunscreen use can reduce the incidence of melanoma by 50 to 73 percent.

According the 2014 report “Surgeon General’s Call to Action to Prevent Skin Cancer,” skin cancer is the most commonly diagnosed cancer in the United States, and most cases are preventable. Melanoma is responsible for the most deaths of all skin cancers, killing almost 9,000 people each year. It is also one of the most common types of cancer among U.S. adolescents and young adults.

Berland is a skin cancer survivor herself and said this issue is very personal to her.

“People need to take care of themselves early in life,” she said. “This has opened up people’s eyes to the entire issue.”

The resolution will be presented to the board at the next town board meeting. Supervisor Frank Petrone (D) said in a phone interview he believes the program’s relatively low cost is an added benefit to the positives it will do for residents.

“It’s a very minimal price,” he said. “It’s not something to put my thumb down on.”

For more information about this program, call Berland’s office at 631-351-3173.

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Walking may reduce the need for dialysis. METRO photo
Are activity and exercise the same?

By David Dunaief, M.D.

Dr. David Dunaief

Let’s begin with a pretest. I want to make it clear that a pretest is not to check whether you know the information but that you have an open mind and are willing to learn.

1) Which may have the most detrimental impact on your health?

a.   Smoking

b.   Obesity

c.   Inactivity

d.   A and C

e.   All have the same impact

2) People who exercise are considered active.

a.   True

b.   False

3) Inactivity may increase the risk of what? Select all that apply.

a.   Diabetes

b.   Heart disease

c.   Fibromyalgia

d.   Mortality

e.   Disability

With the recent wave of heat and humidity, who wants to think about exercise? Instead, it’s tempting to lounge by the pool or even inside with air conditioning instead.

First, let me delineate between exercise and inactivity; they are not complete opposites. When we consider exercise, studies tend to focus on moderate to intense activity. However, light activity and being sedentary, or inactive, tend to get clumped together. But there are differences between light activity and inactivity.

Light activity may involve cooking, writing, and strolling (1). Inactivity involves sitting, as in watching TV or in front of a computer screen. Inactivity utilizes between 1 and 1.5 metabolic equivalent units — better known as METS — a way of measuring energy. Light activity, however, requires greater than 1.5 METS. Thus, in order to avoid inactivity, we don’t have to exercise in the dreaded heat. We need to increase our movement.

What are the potential costs of inactivity? According to the World Health Organization, over 3 million people die annually from inactivity. This ranks inactivity in the top five of potential underlying mortality causes (2). The consequences of inactivity are estimated at 1 to 2.6 percent of health care dollars. This sounds small, but it translates into actual dollars spent in the U.S. of between $38 billion and $100 billion (3).

How much time do we spend inactive? Good question. In an observational study of over 7,000 women with a mean age of 71 years old, 9.7 waking hours were spent inactive or sedentary. These women wore an accelerometer to measure movements. Interestingly, as BMI and age increased, the amount of time spent sedentary also increased (4).

Inactivity may increase the risk of mortality and plays a role in increasing risks for diseases such as heart disease, diabetes and fibromyalgia. It can also increase the risk of disability in older adults.

Surprisingly, inactivity may be worse for us than smoking and obesity. For example, there can be a doubling of the risk for diabetes in those who sit for long periods of time, compared to those who sit the least (5).

By the way, the answers to the pretest are 1) e; 2) b; 3) a, b, c, d and e.

Let’s look at the evidence.

Does exercise trump inactivity?

We tend to think that exercise trumps all; if you exercise, you can eat what you want and, by definition, you’re not sedentary. Right? Not exactly. Diet is important, and you can still be sedentary, even if you exercise. In a meta-analysis — a group of 47 studies — results show that there is an increased risk of all-cause mortality with inactivity, even in those who exercised (6). In other words, even if you exercise, you can’t sit for the rest of the day. The risk for all-cause mortality was 24 percent overall.

However, those who exercised saw a blunted effect with all-cause mortality, making it significantly lower than those who were inactive and did very little exercise: 16 percent versus 46 percent increased risk of all-cause mortality. So, it isn’t that exercise is not important, it just may not be enough to reduce the risk of all-cause mortality if you are inactive for a significant part of the rest of the day.

In an earlier published study using the Women’s Health Initiative, results showed that those who were inactive most of the time had greater risk of cardiovascular disease (7). Even those who exercised moderately but sat most of the day were at increased risk of cardiovascular disease. Moderate exercise was defined as 150 minutes of exercise per week. Those at highest risk were women who did not exercise and sat at least 10 hours a day. This group had a 63 percent increased risk of cardiovascular disease (heart disease or stroke).

However, those who sat fewer than five hours a day had a significantly lower risk of cardiovascular events. And those who were in the highest group for regular exercise (walking seven hours/week or jogging/running four to five hours/week) did see more benefit in cardiovascular health, even if they were inactive the rest of the day. Sitting longer did not have a negative impact on the individuals in the high exercise level group.

Worse than obesity?

Obesity is a massive problem in this country; it has been declared a disease, itself, and it also contributes to other chronic diseases. But would you believe that inactivity has more of an impact than even obesity? In an observational study, using data from the EPIC trial, inactivity might be responsible for two times as many premature deaths as obesity (8). This was a study involving 330,000 men and women.

Interestingly, the researchers created an index that combined occupational activity with recreational activity. They found that the greatest reduction in premature deaths (in the range of 16 to 30 percent) was between two groups, the normal weight and moderately inactive group versus the normal weight and completely inactive group. The latter was defined as those having a desk job with no additional physical activity. To go from the completely inactive to moderately inactive, all it took, according to the study, was 20 minutes of brisk walking on a daily basis.

All is not lost!

In another study, which evaluated 56 participants, walking during lunchtime at work immediately improved mood (9). This small study clearly shows that by lunchtime activity changed mood for the better, increasing enthusiasm and reducing stress when compared to morning levels, before participants had walked. Participants had to walk at least 30 minutes three times a week for 10 weeks; pace was not important.

So what have we learned thus far about inactivity? It is all relative. If you are inactive, increasing your activity to be moderately inactive by briskly walking for 20 minutes a day may reduce your risk of premature death significantly. Even if you exercise the recommended 150 minutes a week, but are inactive the rest of the day, you may still be at risk for cardiovascular disease. You can potentially further reduce your risk of cardiovascular disease by increasing your activity with small additions throughout the day.

The underlying message is that we need to consciously move throughout the day, whether at work with a walk during lunch or at home with recreational activity. Those with desk jobs need to be most attuned to opportunities to increase activity. Simply setting a timer and standing or walking every 30 to 45 minutes may increase your activity levels and possibly reduce your risk.

References: (1) Exerc Sport Sci Rev. 2008;36(4):173-178. (2) WHO report: https://bit.ly/1z7TBAF. (3) forbes.com. (4) JAMA. 2013;310(23):2562-2563. (5) Diabetologia 2012; 55:2895-2905. (6) Ann Intern Med. 2015;162:123-132, 146-147. (7) J Am Coll Cardiol. 2013;61(23):2346-2354. (8) Am J Clin Nutr. online Jan. 24, 2015. (9) Scand J Med Sci Sports. Online Jan. 6, 2015.

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

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Recent studies suggest that sleep deprivation results in weight gain. Stock photo
Even short-term sleep deprivation can negatively impact health

By David Dunaief, M.D.

Dr. David Dunaief

If you’ve ever felt fatigued, this article is for you. Fatigue is a common patient complaint, and there is a long list of maladies that may be responsible: sleep deprivation, infectious diseases (such as Lyme) and hypothyroidism (low thyroid functioning), to name a few.

In this week’s column, we are going to focus on sleep deprivation, since it may impact our quality of life and influence concerns like weight gain and disorders that involve insulin resistance, kidney function and cognition. Even a short duration of inadequate sleep can have a surprising impact.

How much sleep do we need? Conventional wisdom has always been eight hours (1). However, it varies depending on the individual. About 26 percent of Americans get eight or more hours of sleep per night (2). During the workweek, approximately 30 percent of individuals in the U.S. get fewer than six hours of sleep. When you get down to five hours or less per night, the evidence suggests that most people get into trouble.

Weight gain

In a small, prospective (forward-looking) study, results showed that sleep deprivation results in weight gain. Why is this? You actually burn more calories (about 5 percent more) when you sleep fewer hours, but you consume significantly more calories than you metabolize (3). The individuals who were sleep restricted gained about two pounds. That may not sound like much, but the scary part is it occurred over a short time period — one workweek, or five days.

Study participants were in a controlled setting, with half of them restricted to five hours of sleep and half of them permitted to sleep up to nine hours. Everyone was given access to ample amounts of food. Interestingly, not only did the amount of food consumed by those who were sleep deprived increase, but carbohydrate consumption became dominant. When participants who had been sleep deprived were transitioning toward adequate sleep in the second week, they began to make better food choices and started to lose weight.

In addition, researchers found that natural melatonin levels are altered by sleep deprivation, resulting in a change in our circadian rhythms or biological clocks that make it harder to fall asleep.

In another study, the results were similar (4). This one involved 225 healthy participants. Those who were sleep restricted gained about two pounds of weight over five days. Just like the previous study, participants were in a controlled laboratory where food was provided and their sleep monitored. In both studies, significant late-night eating was common.

In the Nurses’ Health Study, results showed that, for participants who regularly slept five hours or less, there was a 32 percent increased risk of gaining more than 30 pounds (5). This observational study involved approximately 68,000 women and was 16 years in duration.

Effects on aging

In a very small, but well-designed, randomized prospective study, adipocytes (fat cells) in sleep-deprived individuals became resistant or insensitive to ever-higher levels of insulin (6). This may be a precursor to increased risk of weight gain and diabetes. The sleep-deprived participants were allowed four-and-a-half hours of sleep per night over a period of four days compared to the control group, which was allowed eight-and-a-half hours per night. The most surprising effect found was that the fat cells of sleep-deprived individuals aged approximately two decades metabolically, so that participants in their 20s had fat cells that functioned similarly to those of people in their 40s.

Diabetes

In the Millennium Cohort Study, participants with inadequate sleep were at significantly greater risk of developing type 2 diabetes than those with sufficient sleep (7). In fact, participants who had five hours of sleep per night were at a 28 percent increased risk, and those who had fewer than five hours a night had a 52 percent greater risk. Adequate sleep was defined as at least seven hours. This was a prospective (forward-looking) observational study involving over 47,000 military personnel. The researchers brought up a good point: While sleep is on the decline, diabetes has been on the rise over the last three decades.

Cognition

Sleep deprivation’s impact on cognition may be immediate. In a study, healthy participants were subjected to sleep deprivation that resulted in decreased neurobehavorial functioning, or cognition, when compared to controls (8). Those in the sleep deprivation group were restricted for five days to four hours per night in bed, while those in the control group were allowed 10 hours per night. The sleep-deprived group was then allowed one night of 10 hours of sleep. While they recovered some neurobehavioral functioning, they didn’t reach their previous baseline levels. This study simulated the workweek followed by one day of recovery. The study was an in-laboratory, well-controlled study involving 159 healthy participants.

In the Familial Adult Children Study (FACS), presented at the prestigious 64th Annual American Academy of Neurology Meeting, participants with poor quality sleep were more likely to have high levels of amyloid beta plaques (9). The significance of these plaques is that they may be precursors to Alzheimer’s disease. The researchers discovered that participants who woke five times in each hour of sleep had a substantially greater risk of developing amyloid beta plaques. Thus, those with lesser sleep efficiency were more likely to have preclinical Alzheimer’s disease. None of the patients showed any symptomatic cognitive deficits, only early preclinical signs of Alzheimer’s. This is a very preliminary study that requires further prospective and randomized clinical trials.

At this point, we can agree that sleep deprivation is something to be taken seriously. If you are fatigued, it may not be a bad idea to have your glucose (sugars) checked. Also, getting sufficient sleep may help slow the metabolic aging of your cells — and most of us want to forestall the aging process. As we age, cognition is a central issue. If we can decrease our risk of cognitive decline while aging, this is an ideal scenario. So, make sure you are getting good quality and quantity of sleep that fits your individual needs. If you struggle to sleep, seek professional help. It is not just an inconvenience to be tired, it actually affects your health.

References: (1) Sleep. 1995;18:908. (2) National Sleep Foundation, 2005. (3) Proc Natl Acad Sci USA. 2013;110:5695-5700. (4) Sleep. 2013;36:981-990. (5) Am. J. Epidemiol. 2006;164:947-954. (6) Ann Intern Med. 2012;157:549-557. (7) Diabetes Care Online. July 2013. (8) Sleep. 2010;33:1013-1026. (9) AAN Abstract 703.

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

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Walking is an easy way to help you lose weight, which will help relieve pain and restore function in your joints. Stock photo
Walking can reduce the risk of functional decline

By David Dunaief, M.D.

Dr. David Dunaief

As the population ages, we see more and more osteoarthritis (OA); and as the population gets heavier, we see more; and as people become more active, we see more; and as the population becomes more sedentary (weakened muscles), we see more. The point is that age, although a strong factor, may not be the only one.

Over 27 million people in the U.S. suffer from OA (1). Osteoarthritis is insidious, developing over a long period of time, and it is chronic by nature. It is a top cause of disability (2). What can we do about it?

It turns out that OA is not just caused by friction or age-related mechanical breakdown but rather by a multitude of factors. These include friction, but also local inflammation, genes and metabolic processes at the cellular level (3). Being a more complicated process means that we may be able to prevent and treat it better than we thought by using exercise, diet, medication, injections and possibly even supplements. Let’s look at some of the research.

How can exercise be beneficial?

In an older study, results showed that even a small 10-pound weight loss could result in an impressive 50 percent reduction of symptomatic knee OA over a 10-year period (4).

One of the exercises that most of us either can tolerate or actually enjoy is walking. We have heard that walking can be dangerous for exacerbating OA symptoms; the pounding can be harsh on our joints, especially our knees. Well, maybe not. Walking may have benefits. And once we figure out what exercise might be useful, in this case walking, how much should we do? In the Multicenter Osteoarthritis Study (MOST), results showed that walking may indeed be useful to prevent functional decline (5). But certainly not in overweight or obese patients and not older patients, right?

Actually, the patients in this study were a mean age of 67 and were obese, with a mean body mass index (BMI) of 31 kg/m2, and either had or were at risk of knee arthritis. In fact, the most interesting part of this study was that the researchers quantified the amount of walking needed to see a positive effect. The least amount of walking to see a benefit was between 3,250 and 3,750 steps per day, measured by an ankle pedometer. The best results were seen in those walking >6,000 steps per day, a relatively modest amount. This was random, unstructured exercise. In addition, for every 1,000 extra steps per day, there was a 16 to 18 percent reduced risk of functional decline two years later.

Walking is an easy way to help you lose weight, which will help relieve pain and restore function in your joints.

Where does vitamin D fit in?

For the last decade or so, we thought vitamin D was the potential elixir for chronic diseases. If it were low, that meant higher risk for disease, and we needed to replete the levels.

Well, a randomized controlled trial (RCT), the gold standard of studies, has shown that low vitamin D levels may indeed contribute to knee osteoarthritis (6). However, repleting levels of vitamin D did not seem to stem disease progression. In fact, it had no effect on the disease, to the bewilderment of the researchers. There was no change in joint space, knee pain, mobility or cartilage loss slowing. Hmm. The patients were supplemented with vitamin D 2,000 IU for two years.

There were 146 patients involved in the study. Blood levels of vitamin D were raised by 16.1 ng/ml in the treatment group to >36 ng/ml, which was significantly greater than the 2.1 ng/ml increase in the placebo group. Since the reasons for the results are unclear, work to maintain normal levels of vitamin D to possibly prevent OA, rather than wait to treat it later.

Acetaminophen may not live up to its popularity

Acetaminophen (e.g., Tylenol) is a popular initial go-to drug for the treatment of osteoarthritis, but what does the research say about its effectiveness? The answer might surprise you. Although acetaminophen doesn’t have anti-inflammatory properties, it does have analgesic properties. However, in a meta-analysis (involving 137 studies), acetaminophen did not reduce the pain for OA patients (7).

In this study, all other oral treatments were significantly better than acetaminophen including diclofenac, naproxen and ibuprofen as well as intra-articular (in the joint) injectables, such as hyaluronic acid and corticosteroids, except for an oral Cox-2 inhibitor, celecoxib, which was only marginally better.

What about NSAIDs?

NSAIDs (nonsteroidal anti-inflammatory drugs) by definition help to reduce inflammation. However, they have side effects that may include gastrointestinal bleed, and they have a black box warning for heart attacks. Risk tends to escalate with a rise in dose. But there is a twist: the FDA has approved a newer formulation of an NSAID, diclofenac (Zorvolex) (8). This formulation uses submicron particles, which are roughly 20 times smaller than the older version; since they provide a greater surface area, which helps the drug to dissolve faster, they require less dosage.

The approved dosage for OA treatment is 35 mg, three times a day. In a 602-patient, one-year duration, open-label randomized controlled trial, the newer formulation of diclofenac demonstrated improvement in pain, functionality and quality of life (9). The adverse effects, or side effects, were similar to the placebo. The only caveat is that there was a high dropout rate in the treatment group; only 40 percent completed the trial when they were dosed three times daily.

Don’t forget about glucosamine and chondroitin

Study results for this supplement combination or its individual components for the treatment of OA have been mixed. In a double-blind RCT, the combination supplement improved joint space, narrowing and reducing the pain of knee OA over two years. However, pain was reduced no more than was seen in the placebo group (10). In a Cochrane meta-analysis review study (involving 43 RCTs) results showed that chondroitin, with or without glucosamine, reduced the symptom of pain modestly compared to placebo in short-term studies (11). However, the researchers stipulate that most of the studies were of low quality.

So, think twice before reaching for the Tylenol. If you are having symptomatic OA pain, NSAIDs such as diclofenac may be a better choice, especially with SoluMatrix fine-particle technology that uses a lower dose and thus means fewer side effects, hopefully. Even though results are mixed, there is no significant downside to giving glucosamine-chondroitin supplements a chance.

However, if it does not work after 12 weeks, it is unlikely to have a significant effect. Also, try increasing your walking step count gradually; this could improve your risk of functional decline. And above all else, if you need to lose weight and do, you will reduce your risk of OA significantly.

References: (1) Arthritis Rheum. 2008;58:26-35. (2) Popul Health Metr. 2006;4:11. (3) Lancet. 1997;350(9076):503. (4) Ann Intern Med.1992;116:535-539. (5) Arthritis Care Res (Hoboken). 2014;66(9):1328-1336. (6) JAMA. 2013;309:155-162. (7) Ann Intern Med. 2015;162:46-54. (8) FDA.gov. (9) ACR 2014 Annual Meeting: Abstract 249. (10) Ann Rheum Dis. Online Jan 6, 2014. (11) Cochrane Database Syst Rev. 2015 Jan 28;1:CD005614.

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

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The American Academy of Dermatology recommends sunscreen lotion with an SPF of 30 to be used daily by those who spend a lot of time in the sun.
Choose sunscreen and clothing as part of your sun protection regimen
Dr. David Dunaief

This holiday weekend, many headed to the beaches or fired up the outside barbecue for the first weekend of what’s shaping up to be a steamy summer. Long summer days spent outside conjure up pleasant images of friends and family relaxing together.

What could possibly be wrong with this picture? With all these benefits, you need to be cognizant of cutaneous (skin) melanoma. It is small in frequency, compared to basal cell and squamous cell carcinomas, responsible for only about 1 percent of skin cancers; however, it is much more deadly.

Statistics

Unfortunately, melanoma is on the rise. Over the last 40 years from 1970 to 2009, its incidence has increased by 800 percent in young women and by 400 percent in young men (1). These were patients diagnosed for the first time between 18 and 39 years old. Overall, the risk is greater in men, with 1 in 28 lifetime risk. The rate among women is 1 in 44. It is predicted that in 2017, there will have been over 87,000 new diagnoses, with over 11 percent resulting in death (2).

Melanoma risk involves genetic and environmental factors. These include sun exposure that is intense but intermittent, tanning beds, UVA radiation used for the treatment of psoriasis, the number of nevi (moles), Parkinson’s disease, prostate cancer, family history and personal history. Many of these risk factors are modifiable (3).

Presentation

Fortunately, melanoma is mostly preventable. What should you look for to detect melanoma at its earliest stages? In medicine, we use the mnemonic “ABCDE” to recall key factors to look for when examining moles. This stands for asymmetric borders (change in shape); border irregularities; color change; diameter increase (size change); and evolution or enlargement of diameter, color or symptoms, such as inflammation, bleeding and crustiness (4). Asymmetry, color and diameter are most important, according to guidelines developed in England (5).

It is important to look over your skin completely, not just partially, and have a dermatologist screen for potential melanoma. Screening skin for melanomas has shown a six-times greater chance of detecting them. Skin areas exposed to the sun have the highest probability of developing the disease. Men are more likely to have melanoma tumors on the back, while women are more likely to have melanoma on the lower legs, but they can develop anywhere (6).

In addition, most important to the physician, especially the dermatologist, is the thickness of melanoma. This may determine its probability to metastasize. In a retrospective (backward-looking) study, the results suggest that melanoma of >0.75 mm needs to not only be excised, or removed, but also have the sentinel lymph node (the closest node) biopsied to determine risk of metastases (7).

A positive sentinel node biopsy occurred in 6.23 percent of those with thickness >0.75 mm, which was significantly greater than in those with thinner melanomas. When the sentinel node biopsy is positive, there is a greater than twofold increase in the risk of metastases. On the plus side, having a negative sentinel node helps relieve the stress and anxiety that the melanoma tumor has spread. The two most valuable types of prevention are clothing and sunscreen. Let’s look at these in detail.

Clothing

Clothing can play a key role in reducing melanoma risk. The rating system for clothing protection is the ultraviolet protection factor (UPF). The Skin Cancer Foundation provides a list of which laundry additives, clothing and cosmetics that protect against the sun (8). Clothing that has a UPF rating between 15 and 24 is considered good, 25 and 39 is very good, and 40 and 50 is excellent. The ratings assess tightness of weave, color (the darker the better), type of yarn, finishing, response to moisture, stretch and condition. The most important of these is the weave tightness (9). There are many companies that produce fashionable and lightweight sun protective clothing lines. Gone are the days of needing to wear your jeans into the water while swimming to protect you from the sun.

Sunscreen

We have always known that sunscreen is valuable. But just how effective is it? In an Australian prospective (forward-looking) study, those who were instructed to use sun protective factor (SPF) 16 sunscreen lotion on a daily basis had significantly fewer incidences of melanoma compared to the control group members, who used their own sunscreen and were allowed to apply it at their discretion (10). The number of melanomas in the treatment group was half that of the control group’s over a 10-year period. But even more significant was a 73 percent reduction in the risk of advanced-stage melanoma in the treatment group. Daily application of sunscreen was critical.

The recommendation after this study and others like it is that an SPF of 15 should be used daily by those who are consistently exposed to the sun and/or are at high risk for melanoma according to the American Academy of Dermatology (11). The amount used per application should be about one ounce. However, since people don’t use as much sunscreen as they should, the academy recommends an SPF of 30 or higher.

Note that SPF 30 is not double the protection of SPF 15. The UVB protection of SPFs 15, 30 and 50 are 93, 97 and 98 percent, respectively. The problem is that SPF is a number that registers mostly the blocking of UVB but not so much the blocking of UVA1 or UVA2 rays. However, 95 percent of the sun’s rays that reach sea level are UVA. So what to do?

Sunscreens come in a variety of UV filters, which are either organic filters (chemical sunscreens) or inorganic filters (physical sunscreens). The FDA now requires broad-spectrum sunscreens pass a test showing they block both UVB and UVA radiation. Broad-spectrum sunscreens must be at least SPF 15 to decrease the risk of skin cancer and prevent premature skin aging caused by the sun. Anything over the level of SPF 50 should be referred to as 50+ (3).

The FDA also has done away with the term “waterproof.” Instead, sunscreens can be either water resistant or very water resistant, if they provide 40 and 80 minutes of protection, respectively. This means you should reapply sunscreen if you are out in the sun for more than 80 minutes, even with the most protective sunscreen (3). Look for sunscreens that have zinc oxide, avobenzone or titanium oxide; these are the only ones that provide UVA1 protection, in addition to UVA2 and UVB protection.

In conclusion, to reduce the risk of melanoma, proper clothing with tight weaving and/or sunscreen should be used. The best sunscreens are broad spectrum, as defined by the FDA, and should contain zinc oxide, avobenzone or titanium oxide to make sure the formulation not only blocks UVA2 but also UVA1 rays. It is best to reapply sunscreen every 40 to 80 minutes, depending on its rating. We can reduce the risk of melanoma occurrence significantly with these very simple steps.

References: (1) Mayo Clin Proc. 2012; 87(4): 328–334. (2) cancer.org. (3) uptodate.com. (4) JAMA. 2004;292(22):2771. (5) Br J Dermatol. 1994;130(1):48. (6) Langley, RG et al. Clinical characteristics. In: Cutaneous melanoma, Quality Medical, St. Louis, 1998, p. 81. (7) J Clin Oncol. 201;31(35):4385-4386. (8) skincancer.org. (9) Photodermatol Photoimmunol Photomed. 2007;23(6):264. (10) J Clin Oncol. 2011;29(3):257. (11) aad.org.

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

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