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.
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.
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.
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.
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.
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.
President of the North Shore Community Association Gary Pollakusky, on left, who is running for legislator of the 6th district, with Rocky Point resident Ann Mattarella, who lost her son to drug addiction. The two were at a press conference in Rocky Point letting the public know of upcoming community forums related to drug addiction education. Photo by Kevin Redding
By Kevin Redding
As heroin and opiate-related deaths continue to rattle Suffolk County and devastate families, those personally affected are rallying the masses to help them stop the growing drug problem before it starts.
Tracey Farrell, president of North Shore Drug Awareness, talks to Rocky Point residents about the importance of educating youth on the effects and possible results of drug addiction. Photo by Kevin Redding
Residents holding pictures and wearing shirts covered in the names of loved ones who died from heroin, opiate and fentanyl overdoses stood together July 6 as Gary Pollakusky, president of the nonpartisan North Shore Community Association, announced the launch of a series of drug education and awareness-based community forums to be held at local school districts — starting Thursday, July 13, at Rocky Point Middle School. Pollakusky is running for Suffolk County Legislator Sarah Anker’s (D-Mount Sinai) seat, and has been backed by the Republican
The group, which was formed in 2013 to ensure transparency and advocate for local areas like Mount Sinai, Miller Place and Rocky Point, has kickstarted the forums alongside advocacy organizations Hugs Inc. and Thomas’ Hope Foundation, individuals in recovery and families and first responders who have witnessed the worsening problem firsthand. Collectively, all involved plan to lay a foundation for bigger and better drug awareness curriculums and assembly programs to be implemented in elementary, middle and high schools.
The mission is to prevent as many first-time users as possible by emphasizing the consequences of drugs to kids while pushing legislators to support stronger enforcement initiatives and treatment options.
Pollakusky said, at this point, the community can no longer rely on action to be taken by elected officials or school administrators.
“The families who have lost loved ones and those who are dealing with the results of this epidemic are outraged at our county government’s lack of action and responsiveness, and are looking to our community to come together to push for more drug awareness education and enforcement … now,” Pollakusky said to a crowd of local residents and first responders at Veterans Memorial Square in Rocky Point.
Tracey Farrell, a Rocky Point resident and president of the non-profits North Shore Drug Awareness and On Kevin’s Wings, knows both sides of the plague, as her son Kevin died of an overdose in 2012, and her daughter Breanna is currently three years in recovery.
“Children … they need to be afraid to ever try it and I don’t understand how they’re watching people die in the multitudes on a daily basis, and [they don’t want to educate].”
— Ann Mattarella
“We have organized this forum so that children and families can get more information on how to overcome this scourge and not feel alone in the battle,” she said. “It is imperative that our educational system consistently works to inform. … We are looking to support our community by having all of the community rise up and deal with this situation head-on.”
She said that while far too many lose their lives to these drugs, there’s hope for those that are still struggling and those who have yet to try anything. She has seen many overcome addiction through her nonprofit On Kevin’s Wings, which helps raise funds for those who can’t afford to get into, or get transportation to rehabilitation centers.
“It’s gotten so much worse, and now more than ever I need for people to use their voices because collectively we can make a difference,” Farrell said. “We need to shout from the rooftops that we need to look out for the next generation of kids. No one right now is willing to step up and we need that to change.”
Farrell said through these forums, she hopes to eventually implement a mandatory curriculum or program across the state, but added while many school districts in the area are on board for this type of serious drug education across the age groups, some parents don’t want to expose it their children to the harsh realities at such a young age.
Rocky Point resident Ann Mattarella, whose 29-year-old son died of an overdose, said she believes the younger the better when it comes to education.
Brian, Lauren and Nick Nardone speak about the loss of their sister and daughter to drug addiction. Photo by Kevin Redding
“There is no question to me that this needs to be brought up at an elementary school level,” Mattarella said, holding a framed collage of photos of her son. “Children need to be afraid to do this — they need to be afraid to ever try it and I don’t understand how they’re watching people die in the multitudes on a daily basis, and [they don’t want to educate]. Something has to be done to scare these children.”
Brian Nardone, a Rocky Point high school student whose sister died in 2008 battling a heroin addiction when he was just 6 years old, said drug education in the classroom is not handled as seriously as it should be.
“They go through it for a week and basically say ‘drugs are bad, don’t do drugs,’ but they don’t really emphasize the consequences of what can happen,” Nardone said, standing alongside his mother, Lauren, and father, Nick. “Frankly, I feel people should be going on the local, state and even national level just to show what’s going on in this country. You don’t know it exists until it happens to you. Ignorance kills.”
Pollakusky said the organization will pursue local small businesses and parent-teacher organizations to help fund an assembly program and hope to get the attention of elected officials and community leaders as their initiative grows.
The first community forum will be held Thursday, July 13, at Rocky Point Middle School from 6 p.m. to 8 p.m.
A scene from a health care vigil held in Huntington on the corner of Park Avenue and Main Street last week. Photo from Legislator Spencer’s office
Huntington doctors, legislators and community members gathered last Wednesday, June 28 for a health care vigil to protest and call for improvements to the Better Care Reconciliation Act, the U.S. Senate’s answer to the Affordable Care Act, known as Obamacare.
Although a vote for the bill was rescheduled until after the July Fourth recess, Republican senators have been working to swiftly pass their health care bill, which was passed in the House in May, and has been met with criticism.
The Congressional Budget Office has projected that over a decade, some 22 million fewer people would be insured compared to those currently covered under the ACA.
Huntington residents, concerned they will be uninsured and unable to care for themselves and their loved ones if the Senate bill is passed, attended the event.
Dr. Eve Meltzer-Krief, a pediatrician who works in Huntington village, has worked to organize many events encouraging Americans to speak out against the proposed health care bill.
“As a physician, it’s important to show we’re coming together against this bill,” Meltzer-Krief said in a phone interview. “I think it’s a terrible bill — it’s the opposite of what Robin Hood does.”
A scene from a health care vigil held in Huntington on the corner of Park Avenue and Main Street last week. Photo from Legislator Spencer’s office
The Huntington doctor said much of the public has fundamental misunderstandings about who Medicaid helps, and cuts to funding could be disastrous for many Long Islanders. The proposed Senate bill would rein in future growth of Medicaid spending — amounting to about $770 billion less funding over the course of a decade.
“Children, the elderly, the disabled, low-income families, they are the people who rely on Medicaid,” Meltzer-Krief said. “[These cuts] would affect so many people, it would hurt so many people. It’s an unethical bill and fundamentally wrong.”
Suffolk County Legislator Dr. William Spencer (D-Centerport) was in attendance for the event. Spencer is an ear, nose and throat physician.
“I felt it was important to attend because the crux of my passion for public office is to give a voice to the population that doesn’t have the voice,” Spencer said in a phone interview. “The disabled, children, the unemployed, they often don’t have a platform. This bill has the potential to change the lives of millions of people.”
Spencer said a bill this important needs input from both sides of the aisle: “This should be a bipartisan issue, these decisions shouldn’t be rushed in a back room.”
The legislator said it was very powerful to see the community reach out at the vigil, and see all walks of life attend including men and women, old and young, disabled residents, different races, and gay and straight people.
Meltzer-Krief said the proposed changes to states’ responsibilities to cover essential health benefits will affect all kinds of people, like women relying on maternity care and people dealing with drug addiction.
“The timing with how substance abuse is on the rise … it’s really terrible,” she said. “There are a lot of dangerous things about this bill. Every doctor and health organization I’ve talked to is against this bill. You should listen to your doctors when it comes to patient care, not [13] men behind closed doors.”
New York Sens. Chuck Schumer (D) and Kirsten Gillibrand (D) have both said they are against the Senate version of this bill and would not vote for it.
Drugs recovered thanks to tips from Crime Stoppers. File photo from SCPD
By Victoria Espinoza
The fight against substance abuse among young people on the North Shore and around Suffolk County is set to enter the 21st century.
Suffolk County Legislator and Presiding Officer DuWayne Gregory (D-Amityville) launched efforts for the county to develop a smartphone application at the June 20 legislative meeting that will provide users with quick and easy access to drug addiction services. It will also provide information on how to recognize and prevent opioid overdoses for families who are struggling with how to protect their loved ones.
“This mobile app will literally put life-saving information directly into the hands of those who need it most,” Gregory said at a press conference in Hauppauge last week. “There is a desperate need for instant access to addiction resources. Just a few weeks ago, 22 people over a two-day span overdosed on opioids in Suffolk. There are so many valuable resources and programs in our county, and we must do all we can to make it easier for those battling substance abuse to reach out for help.”
The app will provide locations of nearby hospitals and treatment centers, links to organizations and support hotlines and information on training to administer Narcan, an overdose reversal medication.
Gregory said he believes the app will be a worthwhile endeavor given the recent launch of New York City’s mobile app, Stop OD NYC, which provides overdose prevention education and connects individuals with local programs. According to his office, Suffolk officials are considering modeling Suffolk’s own app after the city’s version and have been in touch with city health officials as they look to develop the proposal request.
Suffolk County Health Commissioner James Tomarken said the addition of the app is another powerful weapon to use in the ongoing battle against drug addiction.
“Substance abuse affects everyone in the community,” he said at the event. “An application that consolidates information that can be accessed from anywhere on a mobile device offers one more tool in our toolkit for dealing with this public health crisis.”
Suffolk County Community Mental Hygiene Services Director Ann Marie Csorny agreed, saying this idea makes the most sense for the younger generation.
“Today’s youth have come to rely heavily on their smartphones, so putting substance abuse information into a format that is easily accessible to them makes sense,” she said.
Suffolk County is no stranger to the nation’s growing opioid problem. In 2014 Suffolk had the highest number of overdose deaths involving heroin of all New York counties and had the most overdose deaths where prescription opioids were a factor, according to a 2016 New York State Comptroller’s report.
Donna DiBiase, founder and executive director of A2R Magazine, a publication related to journeys in addiction and recovery said branching out to new platforms like cellphones are crucial to winning the fight.
“A mobile app of this nature could be a vital resource at a time when we are losing our next generation to this epidemic,” she said in a statement. “There isn’t a person that I meet who doesn’t know someone — a neighbor, a family member, a friend — who has been touched by this disease. Empowerment and education is so important, and we need to continue to find ways to get information to those who are struggling with addiction, whether it be through an app, a hotline or a magazine.”
The resolution was filed by Gregory at the June 20 meeting and will go before the Health Committee July 20.
Exercise may be a step toward reversing the metabolic clock.
Obscenely short intervals of exercise can still generate significant benefit
Dr. David Dunaief
By David Dunaief, M.D.
What better way to start an article than with a pretest?
1) What minimum amount of exercise will reduce cardiovascular disease risk?
a. 5 to 10 minutes per day b. 30 minutes most days c. 60 minutes most days d. I don’t care — I don’t like pretests
2) How does inactivity affect menopausal symptoms?
a. Increases hot flashes b. Worsens risk of anxiety and depressive moods c. Decreases memory and concentration d. B and C
3) Exercise may have an impact on the following: a. Changing gene expression b. Metabolic aging c. Weight management d. All of the above
With all that’s been written about exercise in the past few years, I’ll bet you did well. The answers to the quiz are: 1) a, 2) d, 3) d. Before we go further, let’s differentiate between physical activity and exercise. Physical activity involves skeletal muscle contraction. It’s an umbrella term that includes exercise, but it also includes housework, yard work, movement on the job, etc. Exercise involves repetitive movements, structure and goal orientation such as walking, running, resistance training or playing sports (1). While you want to be physically active, exercise has more benefit.
We have long-held paradigms in medicine that may or may not be accurate. Medicine is always changing with the evolution of evidence-based research. We know that exercise has benefits for helping to prevent and possibly reverse some chronic diseases, but it also may have benefit for menopausal symptoms, slowing the metabolic aging process and even changing our genes, or at least gene expression.
The Fountain of Youth
Ponce de León sought a physical fountain of youth. While we tend to chuckle at that thought, metaphorically there may be at least some truth to the mythical fountain. Exercise may be a step toward reversing the metabolic clock. Until recently, we thought that when we hit 40 years old, we should expect a decline in physical abilities, with each passing year raising the probability of greater muscle atrophy. This may not actually be the case. Just because a paradigm has been around a long time does not make it correct.
In a small observational study, results showed that the participants, spanning ages 55 to 79, were unable to be differentiated based on age for the majority of tests (2). In other words, those who were in their 70s performed similarly to those in their 50s for many, but not all, parameters. It would be impossible to tell who was what age based purely on the data.
Participants were also compared to standards related to typical aging in each group, such as comparing 70-year-old cyclists versus inactive 70-year-olds. The ones who were cyclists were metabolically much younger. Thus, the researchers concluded that activity, rather than chronological age, may play a more important role in the aging process. The cyclists were not professional athletes, though they were required to pass a cycling endurance test prior to being accepted into the study. To at least some degree, we are more in control of our aging than we had thought. This is good news; we would all like to turn back the physical clock.
Can we really change our genes?
One of the greatest achievements of modern medicine has been mapping the human genome. However, gene therapy mostly has lagged. Well, there is a field called epigenetics. This word literally means “above” or “on” the gene. Epigenetics explores how to alter which of our genes get expressed and how. How can we do this? Methyl groups, one of the most basic groups of atoms in organic chemistry, latch on to genes and help to turn on and off their expression. Lifestyle modifications, like exercise, influence methylation groups to affect genes.
In a small study, results showed greater than 5,000 alterations in the genes of muscle cells such that there were different patterns of methyl groups that occurred in exercised legs compared to inactive legs (3). The genes that were affected are known to be involved in insulin sensitivity and inflammation. Let me explain further.
The researchers had 23 healthy volunteers use a stationary bike for 40 minutes, four times a day, for three months. Here is the catch: Participants only used one leg and did not exercise the other leg, limiting confounding variables. In the same participant, the leg that was exercised had dramatic changes in gene expression, whereas the other leg did not.
How can exercise elongate cell life?
In another study, exercise appeared to prevent or reduce the risk of shortened telomeres. Telomeres are important for protecting the DNA and, ultimately, the cell (4). There were four different categories of exercises surveyed. If respondents said yes to each category, there was an exponentially greater chance that they would not have very short telomeres.
The categories included walking, running, walking/riding a bike to work or school and weight lifting. When a participant was involved in one category in the previous month, there was a 3 percent reduced risk of shorter telomeres, whereas participants who were involved in all four categories had a 59 percent reduced risk of having very short telomeres. This greatest impact was seen in adults between ages 40 and 65.
Menopause symptoms
Although menopause is a rite of passage for women, not a disorder, there are symptoms that may negatively impact quality of life. Exercise may help alleviate menopausal symptoms. In a study, women who exercised regularly (resistance training twice weekly, plus either 150 minutes weekly of moderate activity, like walking, or 75 minutes weekly of intense exercise, like jogging or running) had a better overall sense of well-being and fewer symptoms during menopause compared to their less active counterparts (5). Those who were less active were more likely to be in depressed/anxious moods, have “brain fog,” difficulties with memory and concentration and experience increased vasomotor symptoms. Interestingly though, there was no change in hot flashes between the two groups.
I don’t have time to exercise!
There have been several studies that have shown that you can have obscenely short intervals of exercise and still get significant benefit. In one study, a one-minute intensive interval was broken into 20-second intervals within 10 minutes of exercise three times a week (6). Overweight participants had improved blood pressure and endurance capacity, as well as beneficial gains among other parameters.
In another study, as little as five to 10 minutes of running a day reduced the risk of dying from any cause by 30 percent and dying from heart disease by 45 percent (7). The best part of the results was that there was a significant difference between runners and nonrunners, but not between those who ran at a less-than-six-minute-mile pace and those who ran at a slower-than-10-minute-mile pace.
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.
Nurses at Huntington Hospital smile during a shift. Photo from Northwell Health
By Victoria Espinoza
The nurses at Huntington Hospital are standing out for all the right reasons.
The staff recently received its fourth consecutive Magnet Recognition, the highest recognition for nursing excellence, becoming the first hospital staff on Long Island to achieve this success, and only the second in New York State.
In order to achieve Magnet Recognition, a staff must achieve strong patient outcomes, high levels of job satisfaction, low staff turnover rate, increased involvement in decision-making and more. The Magnet Recognition is awarded by the American Nurses Credentialing Center.
Susan Knoepffler, chief nursing officer at Huntington Hospital, said the success comes from the team collaboration constantly taking place within the hospital.
“The nurses here are able to make their own decisions about improving nursing care,” Knoepffler said in a phone interview. “Instead of me always explaining to them how things should be done, I take direction from them on the best way to deliver care.”
The strongest example of this method of practice leading to improved patient care comes in the form of the Nightingale phone, a communication device that helps link patients directly with their nurse.
The invention came from the oncology department, where nurses were trying to figure out how to better manage and monitor their patients’ pain levels. Patients have a phone with a red button that instantly connects them with their nurse, instead of having to call the nurses station or have someone go look for their nurse on the floor. The staff said it has decreased wait time for patients and improved patient pain control to a 90 percent success rate.
“It is absolutely the best practice,” Donna Tanzi, director of nursing education, said in a phone interview. “And it was created at our local community hospital.”
Tanzi said she loves that the nurses at Huntington have the ability to continue to grow on a daily basis and are committed to doing the best thing for their patients.
“They are caring for someone’s family members, and they treat their patients as if they’re their own family members,” she said.
Tanzi added Huntington Hospital has always been an organization focused on serving the community.
Knoepffler said the level of education of the nursing staff is another component that leads to such a high standard of care.
The chief nursing officer said by 2020 it will be an expectation at most hospitals that all nurses have a bachelor of science degree in nursing, and at Huntington 90 percent of the nurses already have a BSN. She also said the nursing staff at Huntington has a higher than average level of certified nurses in the departments they serve, like the emergency department or oncology.
“We have happier and more energized nurses because of their passion to succeed,” Knoepffler said. “We support them to try and get the highest education they can.”
As for the fourth Magnet Recognition, Knoepffler said it is “a distinction like no other,” calling it the gold standard of nursing.
“Health care is changing all the time, and this group is so adaptable, and that translates to a passion to have an impact at the bedside,” Knoepffler said.
At a National Nurses Week celebration last month, local officials and Huntington Hospital staff members gathered to thank the staff for its dedication and to celebrate their award.
“Your clinical excellence and attentive care are what make our physicians confident in Huntington Hospital and want to bring their patients here,” Michael B. Grosso, chief medical officer at Huntington Hospital, said.
“Nurses are the unsung heroes of our health care system,” Legislator William “Doc” Spencer (D-Centerport) said at the event.
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