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Mather is one of four separate Northwell hospitals approved for a catheterization lab. The hospitals are looking to compete for services amongst some of the larger health entities in New York state. Photo from Northwell

Mather Hospital in Port Jefferson will soon be joining nearby Stony Brook as one of the few places on Long Island to contain a cardiac catheterization lab to provide less invasive heart-related services.

New York State approved Northwell Health, which includes Mather in its group, to open four cardiac labs at different locations in New York. Alongside Mather, Lenox Health Greenwich Village, Plainview Hospital and Northern Westchester Hospital in Mount Kisco have been approved for labs. The lattermost was approved in December.

According to a Northwell release, these labs specialize in using X-ray guided catheters help open blockages in coronary arteries or repair the heart in minimally invasive procedures — ranging from stenting to angioplasty and bypass surgery – that are less traumatic to the body and speed recovery. 

The approval means a big leap for the Port Jefferson hospital, which plans a $11.4 million, 3,644-square-foot addition that will include catheterization and electrophysiology labs. The construction is expected to finish and both labs be open by early 2021.

“With the investment in these four new PCI programs, we are able to advance our mission of improving access, as well as bringing high quality complex cardiovascular services to our patients in their local communities,” William O’Connell, executive director of cardiology services at Northwell Health, said in a release. 

Mather president, Kenneth Roberts, has said in a previous interview with the Port Times Record that a big reason the hospital signed on with the health care network is to have the ability and room to innovate at the hospital and keep up with the times. He echoed that sentiment in a statement.

“With Northwell’s guidance and the diligence of our Mather team, Mather received approval from the New York State Department of Health to provide advanced cardiology programs which include cardiac catheterization, PCI and electrophysiology services,” he said. “Approximately 150 patients every year are [currently] transferred from Mather or St. Charles to have these services elsewhere.”

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Increasing fiber can reduce hemorrhoid inflammation

By David Dunaief

Dr. David Dunaief

Many of us have suffered at one time or another from inflamed hemorrhoids. They affect men and women equally, though women have a higher propensity during pregnancy and child birth. For some reason, there’s a social stigma associated with hemorrhoids, although we all have them. They’re vascular structures that aid in stool control. When they become irritated and inflamed, we have symptoms – and often say we “have hemorrhoids” – when we really mean our hemorrhoids are causing us pain. 

When they’re irritated, hemorrhoids may alternate between itchy and painful symptoms, making it hard to concentrate and uncomfortable to sit. This is because the veins in your rectum are swollen. They usually bleed, especially during a bowel movement, which may scare us. Fortunately, hemorrhoids are not a harbinger of more serious disease.

There are two types of hemorrhoids: external, occurring outside the anus, and internal, occurring within the rectum. 

How do you treat external hemorrhoids? 

Fortunately, external hemorrhoids tend to be mild. Most of the time, they are treated with analgesic creams or suppositories that contain hydrocortisone, such as Preparation H, or with a sitz bath, all of which help relieve the pain. Thus, they can be self-treated and do not require an appointment with a physician. The most effective way to reduce bleeding and pain is to increase fiber through diet and supplementation (1). However, sometimes there is thrombosis (clotting) of external hemorrhoids, in which case they may become more painful, requiring medical treatment.

How do you treat internal hemorrhoids?

Internal hemorrhoids can be a bit more complicated. The primary symptom is bleeding with bowel movement, not pain, since they are usually above the point of sensation in the colon, called the dentate line. If the hemorrhoids prolapse below this, there may be pain and discomfort, as well. Prolapse is when hemorrhoids fall out of place, due to weakening of the muscles and ligaments in the colon. 

The first step for treating internal hemorrhoids is to add fiber through diet and supplementation. Study after study shows significant benefit. For instance, in a meta-analysis by the Cochrane Systems Data Review 2005, fiber reduced the occurrence of bleeding by 53 percent (2). In another study, after two weeks of fiber and another two-week follow-up, the daily incidence of bleeding was reduced dramatically (3).

There are several minimally invasive options, including anal banding, sclerotherapy and coagulation. The most effective of these is anal banding, with an approximate 80 percent success rate (4). This is usually an office-based procedure where two rubber bands are place at the neck of each hemorrhoid. To avoid complications from constipation, patients should also take fiber supplementation. 

Side effects of the procedure are usually mild, and there is very low risk of infection. However, severe pain may occur if misapplication occurs with the band below the dentate line. If this procedure fails, hemorrhoidectomy (surgery) would be the next option.

How do you prevent hemorrhoids?

Adding more fiber to your diet will help prevent hemorrhoids.
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First, sitting on the toilet for long periods of time puts significant pressure on the veins in the rectum, potentially increasing the risk of inflammation. Though you may want private time to read, the bathroom is not the library. As soon as you have finished moving your bowels, it is important to get off the toilet.

Eating more fiber helps to create bulk for your bowel movements, avoiding constipation, diarrhea and undue straining. Thus, you should try to increase the amount of fiber in your diet, before adding supplementation. Fruits, vegetables, whole grains, nuts, beans and legumes have significant amounts of fiber. Grains, beans and nuts have among the highest levels of fiber. For instance, one cup of black beans has 12 g of fiber. 

Americans, on average, consume 16 g per day of fiber (5). The Institute of Medicine (IOM) recommends daily fiber intake for those <50 years old of 25 to 38 g, depending on gender and age (6). I typically recommend at least 40 g. My wife and I try to eat only foods that contain a significant amount of fiber, and we get approximately 65 g per day. You may want to raise your fiber level gradually; if you do it too rapidly, be forewarned – side effects are potentially gas and bloating for the first week or two.

Get plenty of fluids. It helps to soften the stool and prevent constipation. Exercise also helps to prevent constipation. It is important not to hold in a bowel movement; go when the urge is there or else the stool can become hard, causing straining, constipation and more time on the toilet. 

If you have rectal bleeding and either have a high risk for colorectal cancer or are over the age of 50, you should see your physician to make sure it is not due to a malignancy or other cause, such as inflammatory bowel disease. The message throughout this article is that Americans need to get more fiber, which is beneficial for inflamed hemorrhoid prevention and treatment.

References:

(1) Dis Colon Rectum. Jul-Aug 1982;25(5):454-456. (2) Cochrane.org. (3) Hepatogastroenterology 1996;43(12):1504-1507. (4) Dis Colon Rectum 2004 Aug;47(8):1364-1370. (5) usda.gov. (6) Am J Lifestyle Med. 2017 Jan-Feb; 11(1):80–85.

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.    

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File photo by Elana Glowatz

Comsewogue Public Library, 170 Terryville Road, Port Jefferson Station offers this life-saving training through New York State’s Office of Alcoholism and Substance Abuse Services (OASAS) on Thursday, Feb. 27, from 6:30 to 8 p.m. Learn to understand, recognize, respond to and reverse suspected opioid overdoses using naloxone. Attendees ages 16 and up will receive a free Narcan kit. Open to all. Please register, as seating is limited. Call 631-928-1212.

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Increasing fiber may reduce risk

By David Dunaief, M.D.

Dr. David Dunaief

Many patients say they have been diagnosed with diverticulitis, but this is a misnomer. Diverticulitis is actually a consequence of diverticular disease, or diverticulosis. Diverticulosis is one of the most common maladies that affects us as we age. For instance, 35 percent of U.S. 50-year-olds are affected and, for those over the age of 60, approximately 58 percent are affected (1). Many will never experience symptoms.

The good news is that it is potentially preventable through modest lifestyle changes. My goal in writing this article is twofold: to explain simple ways to reduce your risk, while also debunking a myth that is pervasive — that fiber, or more specifically nuts and seeds, exacerbates the disease.

What is diverticular disease? 

Diverticular disease is a weakening of the lumen, or wall of the colon, resulting in the formation of pouches or out-pocketing referred to as diverticula. The cause of diverticula may be attributable to pressure from constipation. Its mildest form, diverticulosis may be asymptomatic. 

Symptoms of diverticular disease may include fever and abdominal pain, predominantly in the left lower quadrant in Western countries, or the right lower quadrant in Asian countries. It may need to be treated with antibiotics.

Diverticulitis affects 10 to 25 percent of those with diverticulosis. Diverticulitis is inflammation and infection, which may lead to a perforation of the bowel wall. If a rupture occurs, emergency surgery may be required.

Unfortunately, the incidence of diverticulitis is growing. As of 2010, about 200,000 are hospitalized for acute diverticulitis each year, and roughly 70,000 are hospitalized for diverticular bleeding (2).

How to prevent diverticular disease

There are a number of modifiable risk factors, including fiber intake, weight and physical activity, to prevent diverticular disease.

In terms of fiber, there was a prospective (forward-looking) study published online in the British Medical Journal that extolled the value of fiber in reducing the risk of diverticular disease (3). This was part of the EPIC trial, involving over 47,000 people living in Scotland and England. The study showed a 31 percent reduction in risk in those who were vegetarian. 

But more intriguing, participants who had the highest fiber intake saw a 41 percent reduction in diverticular disease. Those participants in the highest fiber group consumed >25.5 grams per day for women and >26.1 grams per day for men, whereas those in the lowest group consumed less than 14 grams per day. Though the difference in fiber between the two groups was small, the reduction in risk was substantial. 

Another study, which analyzed data from the Million Women Study, a large-scale, population-based prospective UK study of middle-aged women, confirmed the correlation between fiber intake and diverticular disease, and further analyzed the impact of different sources of fiber (4). The authors’ findings were that reduction in the risk of diverticular disease was greatest with high intake of cereal and fruit fiber.

Most Americans get about 16 grams of fiber per day. The Institute of Medicine (IOM) recommends daily fiber intake for those <50 years old of 25-26 grams for women and 31-38 grams for men (5). Interestingly, their recommendations are lower for those who are over 50 years old.

Can you imagine what the effect is when people get at least 40 grams of fiber per day? This is what I recommend for my patients. Some foods that contain the most fiber include nuts, seeds, beans and legumes. In a study in 2009, specifically those men who consumed the most nuts and popcorn saw a protective effect from diverticulitis (6).

Obesity plays a role, as well. In the large, prospective male Health Professionals Follow-up Study, body mass index played a significant role, as did waist circumference (7). Those who were obese (BMI >30 kg/m²) had a 78 percent increased risk of diverticulitis and a greater than threefold increased risk of a diverticular bleed compared to those who had a BMI in the normal range of <21 kg/m². For those whose waist circumference was in the highest group, they had a 56 percent increase risk of diverticulitis and a 96 percent increase risk of diverticular bleed. Thus, obesity puts patients at a much higher risk of the complications of diverticulosis.

Physical activity is also important for reducing the risk of diverticular disease, although the exact mechanism is not yet understood. Regardless, the results are impressive. In a large prospective study, those with the greatest amount of exercise were 37 percent less likely to have diverticular disease compared to those with the least amount (8). Jogging and running seemed to have the most benefit. When the authors combined exercise with fiber intake, there was a dramatic 256 percent reduction in risk of this disease. 

Thus, preventing diverticular disease is based mostly on lifestyle modifications through diet and exercise.

References:

(1) www.niddk.nih.gov. (2) Clin Gastroenterol Hepatol. 2016; 14(1):96–103.e1. (3) BMJ. 2011; 343: d4131. (4) Gut. 2014 Sep; 63(9): 1450–1456. (5) Am J Lifestyle Med. 2017 Jan-Feb; 11(1): 80–85. (6) AMA 2008; 300: 907-914. (7) Gastroenterology. 2009;136(1):115. (8) Gut. 1995;36(2):276.  

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.   

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As the number of people infected with the new coronavirus climbs in China and countries limit travel to the beleaguered country, the incidence of infection in the United States remains low, with 11 people carrying the respiratory virus as of earlier this week.

“While the risk to New Yorkers is still low, we urge everyone to remain vigilant.”

— Gov. Andrew. Cuomo

American officials stepped up their policies designed to keep the virus, which so far has about a 2 percent mortality rate, at bay in the last week. For the first time in over half a century, the government established a mandatory two-week quarantine for people entering from China’s Hubei Province, which is where the outbreak began. The United States also said it would prevent foreign nationals who are not immediate family members of American citizens from entering within two weeks of visiting China.

Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention, called the viral outbreak an “unprecedented situation” and suggested that the American government has taken “aggressive measures” amid the largely expanding outbreak.

The actions, Messonnier said on a conference call earlier this week, were designed to “slow this down before it gets into the United States. If we act now, we do have an opportunity to provide additional protection.”

The number of deaths from coronavirus, which has reached almost 500, now exceeds the number for the sudden acute respiratory syndrome, or SARS, in 2003. The number of infected patients worldwide has reached above 25,000, triggering concerns about a pandemic. More than 1,000 have recovered from the virus.

The CDC, which has been coordinating the American response to the virus, has been testing potential cases of the disease. Symptoms include fever, coughing and shortness of breath.

In New York, 17 samples have been sent to the CDC for testing, with 11 coming back negative and six pending. New York created a hotline, 888-364-3065, in which experts from the Department of Health can answer questions about the virus. The DOH also has a website as a resource for residents, at www.health.ny.gov/diseases/communicable/coronavirus.

“While the risk to New Yorkers is still low, we urge everyone to remain vigilant,” Gov. Andrew Cuomo (D) said in a statement.

The CDC sent an Emergency Use Authorization to the Food & Drug Administration to allow more local testing during medical emergencies. Such an effort could expedite the way emergency rooms respond to patients who they might otherwise need to isolate for longer periods of time while they await a definitive diagnosis.

By speeding up the evaluation period, the CDC would help hospitals like Stony Brook University Hospital maintain the necessary number of isolation beds, rather than prolonging the wait period in the middle of flu season to determine the cause of the illness.

As for the university, according to its website,  approximately 40 students have contacted the school indicating they are restricted from returning to the U.S. With university approval, the students will not be penalized academically for being out or for taking a leave of absence.

“The most important thing is to keep your hands clean.”

— Bettina Fries

Testing for the new coronavirus, which is still tentatively called 2019-nCoV, would miss a positive case if the virus mutated. In an RNA virus like this one, mutations can and do occur, although most of these changes result in a less virulent form.

The CDC, whose website www.cdc.gov, provides considerable information about this new virus, is “watching for that,” said Bettina Fries, the chief of the Division of Infectious Diseases in the Department of Medicine at Renaissance School of Medicine at Stony Brook University. At this point, there “doesn’t seem to be much mutation yet.”

In the SARS outbreak, a mutation made the virus less virulent.

Fries added that the “feeling with SARS was that you weren’t infectious until were you symptomatic. The feeling with this one is that you are potentially infectious” before demonstrating any of the typical symptoms.

Fries assessed the threat from contracting the virus in the United States as “low,” while adding that the danger from the flu, which has resulted in over 10,000 deaths during the 2019-20 flu season, is much higher.

In the hospital, Fries said the health care staff puts masks on people who are coughing to reduce the potential spread of whatever is affecting their respiratory systems.

While Fries doesn’t believe it’s necessary to wear a mask to class, she said it’s not “unreasonable” in densely populated areas like airports and airplanes to wear one.

Masks don’t offer complete protection from the flu or coronavirus, in part because people touch the outside of the masks, where viruses condense, and then touch parts of their face. Even with the mask on, people touch their eyes.

“The most important thing is to keep your hands clean,” Fries suggested.

Fries believes the 14-day quarantine period for people coming from an area where coronavirus is prevalent is “probably on the generous side.” Scientists come up with this time period to establish guidelines for health care providers throughout the country.

Fries suggested that the only way these precautions are going to work is if they are aggressive and done early enough.

“Once the genie is out of the bottle” and an epidemic spreads to other countries, it becomes much more difficult to contain, Fries said.

The best-case scenario is that this virus becomes a contained problem in China. If it doesn’t spread outside the country, it could follow the same pattern as SARS, which abated within about eight months.

While there is no treatment for this new coronavirus, companies and governments are working on a possible vaccine. This, Fries estimated, could take about a year to create.

Looking out across the calendar, Fries wondered what would happen with the Olympics this year, which are scheduled for July 24 through Aug. 9 in Tokyo. Athletes who have been training for years certainly hope the virus is contained by then. A similar concern preceded the 2016 Olympics, when Zika virus threatened to derail the games in Brazil.

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By Matthew Kearns, DVM

When I bring up dental procedures with pet owners, the concern is pets require anesthesia for dental work. That invariably brings the question, “Is there anything we can do at home to prevent this?” The answer is a resounding “YES!!!”

First, I would like to briefly review the pathology of periodontal disease. Dogs and cats do not suffer from dental disease as much as humans. They suffer from periodontal disease. 

Dental disease refers to pathology with the tooth itself: caries, cavities, etc. Periodontal disease refers to pathology of the structures around the tooth: gingiva (gums), the periodontal ligament, perialveolar bone. 

Periodontal disease begins with plaque. It has been proven that even within 24 hours of a professional cleaning, a thin film of bacteria, saliva and food (also known as plaque) accumulates on the enamel of the tooth. Plaque that is not removed mineralizes within 10 days into tartar or a calculus. Once tartar takes hold a shift develops from aerobic bacteria (bacteria that need oxygen to survive) to nasty anaerobic bacteria (those that need little or no oxygen to survive). Anaerobic bacteria secrete toxins that inflame the gums and lead to small abscesses or pockets under the gums. Bacteria start to destroy the support structures around the tooth which is very painful. If not treated then the tooth will need to be removed. 

Brushing: Brushing the teeth removes this film before it has a chance to mineralize. If you do decide to brush your pet’s teeth first pick a toothbrush and toothpaste that is veterinary approved. We humans know to rinse and spit when done brushing, but our pets do not. Swallowing human toothpaste is harmful because it has too much sodium, fluoride and is sweetened with saccharin. 

Pet-safe toothpaste comes in a variety of flavors that pets will like (chicken, beef, fish, etc.) better than good old-fashioned fresh mint. When you first begin just put a little toothpaste on the end of the brush and let your pet investigate. If they sniff, lick or even just chew on the brush that is fine. Then start by gently just brushing the front teeth. Once they tolerate that, start to work toward the back teeth. 

Dental Treats/Diets: Effective brushing of your pet’s teeth needs to be done daily (at least four times per week) and scheduling time to brush your pet’s teeth can be difficult. I have yet to meet an owner able to teach his or her dog/cat to brush their own teeth. Certain prescription diets (Hill’s t/d® and Purina Pro Plan DH®) literally clean the teeth as your pet eats. There are also treats that do the same. Look for the Veterinary Oral Health Council (VOHC) seal on the packaging. If you can’t find a VOHC-approved treat, remember this slogan, “If you wouldn’t want to get hit in the knee with this dental treat, don’t let your pet chew on it.” That means if it is too hard your pet runs the risk of damaging their teeth. 

Rinses: Again, look for the VOHC seal of approval. The safest and most effective rinses contain chlorhexidine. Chlorhexidine is most effective against the development of plaque, and chlorhexidine-based rinses are considered the gold standard of veterinary oral rinses. Rinses containing xylitol, or fluoride, should be avoided in my opinion because of their potential for toxicity.

This is not a complete list of dental home care products so, as always, please consult with your own veterinarian for a more in-depth conversation. In addition, I can’t guarantee that even if you follow through with all these recommendations that your dog or cat will not need professional dental care (including extractions), but it certainly helps. Remember, BIG SMILES!!!

Dr. Kearns practices veterinary medicine from his Port Jefferson office and is pictured with his son Matthew and his dog Jasmine. Have a question for the vet? Email it to [email protected] and see his answer in an upcoming column.

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Lowering your meat intake may reduce cataract risk

By David Dunaief, M.D.

Dr. David Dunaief

Cataracts affect a substantial portion of the U.S. population. In fact, 24.4 million people in the U.S. over the age of 40 are currently afflicted, and this number is expected to increase approximately 61 percent by the year 2030 — only 10 years from now — according to estimates by the National Eye Institute (1).

Cataracts are defined as an opacity or cloudiness of the lens in the eye, which decreases vision over time as it progresses. It’s very common for both eyes to be affected. We often think of cataracts as a symptom of age, but we can take an active role in preventing them.

There are enumerable modifiable risk factors including diet; smoking; sunlight exposure; chronic diseases, such as diabetes and metabolic syndrome; steroid use; and physical inactivity. I am going to discuss the dietary factor.

Prevention

In a prospective (forward-looking) study, diet was shown to have substantial effect on the risk reduction for cataracts (2). This study was the United Kingdom group, with 27,670 participants, of the European Prospective Investigation into Cancer and Nutrition (EPIC) trial. Participants completed food frequency questionnaires between 1993 and 1999. Then, they were checked for cataracts between 2008 and 2009.

There was an inverse relationship between the amount of meat consumed and cataract risk. In other words, those who ate a great amount of meat were at higher risk of cataracts. “Meat” included red meat, fowl and pork. These results followed what is termed a dose-response curve. 

Compared to high meat eaters, every other group demonstrated a significant risk reduction as you progressed along a spectrum that included low meat eaters (15 percent reduction), fish eaters (21 percent reduction), vegetarians (30 percent reduction) and finally vegans (40 percent reduction). 

There really was not that much difference between high meat eaters, those having at least 3.5 ounces, and low meat eaters, those having less than 1.7 ounces a day, yet there was a substantial decline in cataracts. Thus, you don’t have to become a vegan to see an effect.

In my clinical experience, I’ve also had several patients experience reversal of their cataracts after they transitioned to a nutrient-dense, plant-based diet. I didn’t think this was possible, but anecdotally, this is a very positive outcome and was confirmed by their ophthalmologists.

Mechanism of action

Oxidative stress is one of the major contributors to the development of cataracts. In a review article that looked at 70 different trials for the development of cataract and/or maculopathies, such as age-related macular degeneration, the authors concluded antioxidants, which are micronutrients found in foods, play an integral part in prevention (3).

The authors go on to say that a diet rich in fruits and vegetables, as well as lifestyle modification with cessation of smoking and treatment of obesity at an early age, help to reduce the risk of cataracts. Thus, you are never too young or too old to take steps to prevent cataracts.

How do you treat cataracts?

The only effective way to treat cataracts is with surgery; the most typical type is phacoemulsification. Ophthalmologists remove the opaque lens and replace it with a synthetic intraocular lens. This is done as an outpatient procedure and usually takes approximately 30 minutes. Fortunately, there is a very high success rate for this surgery. So why is it important to avoid cataracts if surgery can remedy them?

Potential consequences of surgery

There are always potential risks with invasive procedures, such as infection, even though the chances of complications are low. However, more importantly, there is a greater than fivefold risk of developing late-stage age-related macular degeneration (AMD) after cataract surgery (4). This is wet AMD, which can cause significant vision loss. These results come from a meta-analysis (group of studies) looking at more than 6,000 patients. 

It has been hypothesized that the surgery may induce inflammatory changes and the development of leaky blood vessels in the retina of the eye. However, because this meta-analysis was based on observational studies, it is not clear whether undiagnosed AMD may have existed prior to the cataract surgery, since they have similar underlying causes related to oxidative stress.

Therefore, if you can reduce the risk of cataracts through diet and other lifestyle modifications, plus avoid the potential consequences of cataract surgery, all while reducing the risk of chronic diseases, why not choose the win-win scenario?

References:

(1) nei.nih.gov. (2) Am J Clin Nutr. 2011 May; 93(5): 1128-1135. (3) Exp Eye Res. 2007; 84: 229-245. (4) Ophthalmology. 2003; 110(10): 1960.

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.    

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Photo courtesy of Northwell Health

Huntington Hospital has achieved a prestigious four-star rating from the U.S. Centers for Medicare & Medicaid Services in its annual 2020 hospital rankings, its comprehensive quality measurement report released on Jan. 30.

CMS hospital rankings of more than 4,000 Medicare-certified facilities nationwide take into account over 50 performance measures that analyze health care outcomes such as readmission rates, patient experience, safety and quality of care. CMS’ hospital rankings are considered among the best hospital report cards to help inform where to receive medical care.

Huntington Hospital’s CMS rating follows its recognition as New York State’s highest-ranked community hospital by U.S. News & World Report in its 2019-20 Best Hospital list.

“From redesigning our Center for Mothers & Babies to include all private rooms for a better patient experience to consistently setting and meeting high benchmarks for health care quality, we at Huntington Hospital take our patients’ needs to heart as we thoughtfully provide them with world-class care,” said Dr. Nick Fitterman, executive director of Huntington Hospital. 

“We are always looking at ways to not only provide the necessary health care that our Suffolk County residents require, but to go above and beyond to give them the best medical care available,” he added.

Huntington Hospital nurses have received the highest nursing honor – Magnet designation – a Long Island record four times in a row.  The hospital’s orthopedics program has also been consistently been ranked by the Joint Commission with the gold seal of approval for its hip and knee replacements and was among the top 1 percent nationally in orthopedics, according to U.S. News. 

Huntington Hospital has also been designated as a Center of Excellence in Minimally Invasive Gynecology and a Center of Excellence in Robotic Surgery by the Surgical Review Corporation.

For more information about Huntington Hospital, go to www.huntington.northwell.edu or call 631-351-2000.

 

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Kidneys are one of our main stystems for removing toxins and waste. Stock photo
High sodium’s impact extends beyond hypertension

By David Dunaief, M.D.

By now, most of us have been hit over the head with the fact that too much salt in our diets is unhealthy. Still, we respond with “I don’t use salt,” “I use very little,” or “I don’t have high blood pressure, so I don’t have to worry.” Unfortunately, these are myths. All of us should be concerned about salt or, more specifically, our sodium intake.

Excessive sodium in the diet does increase the risk of high blood pressure (hypertension); the consequences are stroke or heart disease. Approximately 90 percent of Americans consume too much sodium (1).

Now comes the interesting part. Sodium has a nefarious effect on the kidneys. In the Nurses’ Health Study, approximately 3,200 women were evaluated in terms of kidney function, looking at the estimated glomerular filtration rate (GFR) as related to sodium intake (2). Over 14 years, those with a sodium intake of 2,300 mg had a much greater chance of an at least 30 percent reduction in kidney function, compared to those who consumed 1,700 mg per day.

Why is this study important? Kidneys are one of our main systems for removing toxins and waste. The kidneys are where many initial high blood pressure medications work, including ACE inhibitors, such as lisinopril; ARBs, such as Diovan or Cozaar; and diuretics (water pills). If the kidney loses function, it may be harder to treat high blood pressure. Worse, it could lead to chronic kidney disease and dialysis. Once someone has reached dialysis, most blood pressure medications are not very effective.

Ironically, the current recommended maximum sodium intake is 2,300 mg per day, or one teaspoon, the same level that led to negative effects in the study. However, Americans’ mean intake is twice that level.

If we reduced our consumption by even a modest 20 percent, we could reduce the incidence of heart disease dramatically. Current recommendations from the American Heart Association indicate an upper limit of 2,300 mg per day, with an “ideal” limit of no more than 1,500 mg per day (3).

If the salt shaker is not the problem, what is?

 Most of our sodium comes from processed foods, packaged foods and restaurants. There is nothing wrong with eating out on occasion, but you can’t control how much salt goes into your food. My wife is a great barometer of restaurant salt use. If food from the night before was salty, she complains of not being able to get her rings off.

Do you want to lose 5 to 10 pounds quickly? Decreasing your salt intake will allow you to achieve this goal. Excess sodium causes the body to retain fluids.

One approach is to choose products that have 200 mg or fewer per serving indicated on the label. Foods labeled “low sodium” have fewer than 140 mg of sodium, but foods labeled “reduced sodium” have 25 percent less than the full-sodium version, which doesn’t necessarily mean much. 

Soy sauce has 1,000 mg of sodium per tablespoon, but low-sodium soy sauce still has about 600 mg per tablespoon. Salad dressings and other condiments, where serving sizes are small, add up very quickly. Mustard has 120 mg per teaspoon. Most of us use far more than one teaspoon of mustard. Caveat emptor: Make sure to read labels on all packaged foods very carefully.

Is sea salt better than table salt? 

High amounts of salt are harmful, and the type is not as important. The only difference between them is slight taste and texture variation. I recommend not buying either. In addition to the health issues, salt tends to dampen your taste buds, masking the flavors of food.

If you are working to decrease your sodium intake, become an avid label reader. Sodium hides in all kinds of foods that don’t necessarily taste salty, such as breads, soups, cheeses and salad dressings. I also recommend getting all sauces on the side, so you can control how much — if any — you choose to use.

As you reduce your sodium intake, you might be surprised at how quickly your taste buds adjust. In just a few weeks, foods you previously thought didn’t taste salty will seem overwhelmingly salty, and you will notice new flavors in unsalted foods.

If you have a salt shaker and don’t know what to do with all the excess salt, don’t despair. There are several uses for salt that are actually beneficial. According to the Mayo Clinic, gargling with ¼ to ½ teaspoon of salt in eight ounces of warm water significantly reduces symptoms of a sore throat from infectious disease, such as mononucleosis, strep throat and the common cold. Having had mono, I can attest that this works.

Remember, if you want to season your food at a meal, you are much better off asking for the pepper than the salt.

References:

(1) cdc.gov. (2) Clin J Am Soc Nephrol. 2010;5:836-843. (3) heart.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.    

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In a Q&A with TBR News Media, Carol Gomes, interim chief executive officer at Stony Brook University Hospital, discusses a variety of topics including patient safety, quality control and curbing infections. Here is what she had to say. 

1. Being the interim chief executive officer at the hospital, how important is patient safety and  quality control to the day-to-day operations?

Stony Brook Medicine physicians and staff are committed to providing high-quality, safe patient care.

SBU Hospital CEO Carol Gomes discusses what the hospital is doing to reduce infection potential. Photo from SBU Hospital

Quality and patient safety is priority number one, and we focus on safe patient care every day. The Stony Brook Medicine team convenes a safety huddle that is part of the day-to-day operations in every area, which includes critical leaders from all over the hospital.

We start the day with approximately 35 care team members from nursing leadership, physician leadership and operational leadership who report on important safety or quality opportunities.  Our huddles are highly structured meetings that allow the hospital to focus on process changes with direct follow-up. This drives accountability to help ensure that adequate safety measures are in place for our patients at all times. 

2. Interim SBU President Michael Bernstein mentioned to us that you were making an effort to curb infections at the hospital among other things. Could you discuss some of the initiatives you’ve been implementing to improve in that area?

Stony Brook University Hospital has three primary strategic quality priorities — clinical outcomes, patient safety and the patient experience.

Proactively, Stony Brook works to provide safe and effective care to every patient via our patient safety work groups. These groups analyze processes, review relevant data and implement process changes to enhance patient safety and prevent patient harm.

The vast majority of projects and improvement efforts are aimed at reducing hospital associated infections. There are teams that implement best practices for CLABSI, or central line associated bloodstream infections; hand hygiene; CAUTI, or catheter-associated urinary tract infections; C. diff, or Clostridium difficile infections; SSI, or surgical site infections; and sepsis. 

Working groups incorporate real-time data to implement best practices to ensure hospital units continue to drive improvement efforts in achieving patient safety goals.

3. In general could you talk about the threat of infections to patients at hospitals? Most people view hospitals as a place of recovery and necessarily don’t think of other germs, sick people around them. Can you speak on that and the challenges you and others face?

As a matter of standard practice, the hospital adheres to rigorous infection control guidelines every day to ensure a clean environment for patients, staff and visitors. These practices are especially important during the flu season.

Being within the close quarters of a hospital, there is an increased incidence of transmission for infections. Many patients have recent surgical wounds, IVs and other catheters placing them at higher risk of infection. These risks may be enhanced by the acquisition of an infection from a visitor.

Family members and other visitors who suspect they may have the flu or other viruses are advised to not visit the hospital.

To lessen the spread of the flu virus, hand hygiene and attention to reducing the effects of droplets from respiratory illnesses such as the flu can enhance patient safety.

Hand washing prevents infection. It is one of the most important actions each of us can implement before and after every encounter with a patient.

The goal is to minimize that transmission while the patient is in the hospital.

4. Other practices/guidelines at the hospital?

The flu virus most commonly spreads from an infected person to others. It’s important to stay home while you’re sick, not visit people in the hospital and to limit close contact with others.

Visitors should wash their hands before entering a patient room and after seeing a patient, whether or not there is patient contact. 

As added protection, patients who have been identified as having infections are isolated appropriately from other patients in order to prevent accidental spread.

Therefore, if a patient has the flu or flulike symptoms, the hospital will place them in respiratory isolation. Likewise, a patient with measles or chicken pox is kept in appropriate isolation.

Visitors may be asked to wear masks on certain units.

5. How do patient safety grades affect how the hospital looks to improve
its quality? 

Stony Brook University Hospital supports the public availability of quality and safety information about hospitals. We are constantly looking for ways to improve and ensure the highest quality of care.

There is a wide variation of quality reports with different methodologies and results.

Clinical outcomes define our success as a hospital. Better clinical outcomes means we’re taking better care of our patients. Stony Brook Medicine initiated a major initiative to improve clinical outcomes. We have multidisciplinary groups improving outcomes in the following areas:

•  Increasing our time educating patients prior to their discharge in order to prevent hospital readmissions.

•  Improving the care of our patients receiving surgery to reduce postoperative complications.

•  Enhancing the diagnosis and care of patients with diabetes.

•  Improving the speed of diagnosis and treatment of sepsis.

In short, great effort is expended in identifying opportunities for improvement with a detailed and focused approach on enhancing patient outcomes.

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