CLOSE
Health

by -
0 1519
Cognitive behavioral therapy may improve outcomes

By David Dunaief, M.D.

Dr. David Dunaief

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

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

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

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

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

Let’s look at the evidence.

Heart failure

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

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

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

What about potential treatments?

Ambien: While nonbenzodiazepine hypnotics may be beneficial, this may come at a price. In a report by the Drug Abuse Warning Network, part of the Substance Abuse and Mental Health Services Administration (SAMHSA), the number of reported adverse events with Ambien that perpetuated emergency department visits increased by more than twofold over a five-year period from 2005 to 2010 (5). Insomnia patients most susceptible to significant side effects are women and the elderly. The director of SAMHSA recommends focusing on lifestyle changes for treating insomnia by making sure the bedroom is sufficiently dark, getting frequent exercise, and avoiding caffeine.

In reaction to this data, the FDA required the manufacturer of Ambien to reduce the dose recommended for women by 50 percent (6). Ironically, sleep medication like Ambien may cause drowsiness the next day — the FDA has warned that it is not safe to drive after taking extended-release versions (CR) of these medications the night before.

Magnesium: The elderly population tends to suffer the most from insomnia, as well as nutrient deficiencies. In a double-blinded, randomized controlled trial (RCT), the gold standard of studies, results show that magnesium had resoundingly positive effects on elderly patients suffering from insomnia (7).

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

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

Cognitive behavioral therapy

In a study, just one 2½-hour session of cognitive behavioral therapy delivered to a group of 20 patients suffering from chronic insomnia saw subjective, yet dramatic, improvements in sleep duration from 5 to 6½ hours and decreases in sleep latency from 51 to 22 minutes (8). The patients who were taking medication to treat insomnia experienced a 33 percent reduction in their required medication frequency per week. The topics covered in the session included relaxation techniques, sleep hygiene, sleep restriction, sleep positions, and beliefs and obsessions pertaining to sleep. These results are encouraging.

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

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

References:

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

by -
0 1253
Walking routinely can reduce your risk of dialysis.Stock photo
Taking an active role can reduce your risk significantly

By David Dunaief, M.D.

Dr. David Dunaief

Heart disease is so pervasive that men who are 40 years old have a lifetime risk of 49 percent. In other words, about half of men will be affected by heart disease. The statistics are better for women, but they still have a staggering 32 percent lifetime risk at age 40 (1).

The good news is that heart disease is on the decline due to a number of factors, including better awareness in lay and medical communities, improved medicines, earlier treatment of risk factors and lifestyle modifications. We are headed in the right direction, but we can do better. Heart disease is something that is eminently preventable.

Heart disease risk factors

Risk factors include obesity, high cholesterol, high blood pressure, smoking and diabetes. Unfortunately, both obesity and diabetes are on the rise. For patients with type 2 diabetes, 70 percent die of cardiovascular causes (2). However, high blood pressure, high cholesterol and smoking have declined (3).

Of course, family history also contributes to the risk of heart disease, especially with parents who experienced heart attacks before age 60, according to the Women’s Health Study and the Physician’s Health Study (4). Inactivity and the standard American diet, rich in saturated fat and calories, also contribute to heart disease risk (5). The underlying culprit is atherosclerosis (fatty streaks in the arteries).

Another potential risk factor is a resting heart rate greater than 80 beats per minute (bpm). In one study, healthy men and women had 18 and 10 percent increased risks of dying from a heart attack, respectively, for every increase of 10 bpm over 80 (6). A normal resting heart rate is usually between 60 and 100 bpm. Thus, you don’t have to have a racing heart rate, just one that is high-normal. All of these risk factors can be overcome, even family history.

The role of medication

Cholesterol and blood pressure medications have been credited to some extent with reducing the risk of heart disease. The compliance with blood pressure medications has increased over the last 10 years from 33 to 50 percent, according to the American Society of Hypertension.

In terms of lipids, statins have played a key role in primary prevention. Statins are effective at not only lowering lipid levels, including total cholesterol and LDL — the “bad” cholesterol — but also inflammation levels that contribute to the risk of cardiovascular disease. The Jupiter trial showed a 55 percent combined reduction in heart disease, stroke and mortality from cardiovascular disease in healthy patients — those with a slightly elevated level of inflammation and normal cholesterol profile — with statins.

The downside of statins is their side effects. Statins have been shown to increase the risk of diabetes in intensive dosing, compared to moderate dosing (7).

Unfortunately, many on statins also suffer from myopathy (muscle pain). I have a number of patients who have complained of muscle pain and cramps. Their goal when they come to see me is to reduce and ultimately discontinue their statins by following a lifestyle modification plan involving diet and exercise. Lifestyle modification is a powerful ally.

Lifestyle effects

There was significant reduction in mortality from cardiovascular disease with participants who were followed for a very long mean duration of 18 years. The Baltimore Longitudinal Study of Aging, a prospective (forward-looking) study, investigated 501 healthy men and their risk of dying from cardiovascular disease. The authors concluded that those who consumed five servings or more of fruits and vegetables daily with <12 percent saturated fat had a 76 percent reduction in their risk of dying from heart disease compared to those who did not (8). The authors theorized that eating more fruits and vegetables helped to displace saturated fats from the diet. These results are impressive and, to achieve them, they only required a modest change in diet.

The Nurses’ Health Study shows that these results are also seen in women, with lifestyle modification reducing the risk of sudden cardiac death (SCD). Many times, this is the first manifestation of heart disease in women. The authors looked at four parameters of lifestyle modification, including a Mediterranean-type diet, exercise, smoking and body mass index. There was a decrease in SCD that was dose-dependent, meaning the more factors incorporated, the greater the risk reduction. There was as much as a 92 percent decrease in SCD risk when all four parameters were followed (9). Thus, it is possible to almost eliminate the risk of SCD for women with lifestyle modifications.

How do you know that you are reducing your risk of heart disease and how long does it take?

These are good questions. We use cardiac biomarkers, including inflammatory markers like C-reactive protein, blood pressure, cholesterol and body mass index. A cohort study helped answer these questions. It studied both high-risk participants and patients with heart disease. The results showed an improvement in biomarkers, as well as in cognitive function and overall quality of life.

Participants followed extensive lifestyle modification: a plant-based, whole foods diet accompanied by exercise and stress management. The results were statistically significant with all parameters measured. The best part is the results occurred over a very short period to time — three months from the start of the trial (10). Many patients I have seen have had similar results.

Ideally, if patient needs to use medications to treat risk factors for heart disease, it should be for the short term. For some patients, it may be appropriate to use medication and lifestyle changes together; for others, lifestyle modifications may be sufficient, as long as patients take an active role.

(1) Lancet. 1999;353(9147):89. (2) Diabetes Care. 2010 Feb; 33(2):442-449. (3) JAMA. 2005;293(15):1868. (4) Circulation. 2001;104(4):393. (5) Lancet. 2004;364(9438):93. (6) J Epidemiol Community Health. 2010 Feb;64(2):175-181. (7) JAMA. 2011;305(24):2556-2564. (8) J Nutr. March 1, 2005;135(3):556-561. (9) JAMA. 2011 Jul 6;306(1):62-69. (10) Am J Cardiol. 2011;108(4):498-507.

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.         

by -
0 1464
Yoga can be an effective way to increase bone density. Photo from Metro
Overtreatment and undertreatment of osteopenia and osteoporosis are common

By David Dunaief, M.D.

Dr. David Dunaief

As we get older, bone fractures can have potentially life-altering or life-ending consequences. Osteoporosis is a silent disease where there is bone loss, weakening of the bones and small deleterious changes in the architecture of the bone over time that may result in fractures with serious consequences (1). It affects millions of patients, most commonly postmenopausal women.

One way to measure osteoporosis is with a dual-energy X-ray absorptiometry (DXA) scan for bone mineral density. Osteopenia is a slightly milder form that may be a precursor to osteoporosis. However, we should not rely on the DXA scan alone; risk factors are important, such as a family or personal history of fractures as we age. The Fracture Risk Assessment Tool (FRAX) is more thorough for determining the 10-year fracture risk. Those who have a risk of fracture that is 3 percent or more should consider treatment with medications. A link to the FRAX tool can be found at www.shef.ac.uk/FRAX.

Most of us have been prompted all our lives to consume calcium for strong bones. In fact, the National Osteoporosis Foundation recommends that we get 1,000 to 1,200 mg per day of calcium from diet and supplements if we are over age 50, although recommendations vary by sex and age (2). However, research suggests that calcium for osteoporosis prevention may not be as helpful as we thought.

The current treatment paradox

Depending on the population, we could be overtreating or undertreating osteoporosis. In the elderly population that has been diagnosed with osteoporosis, there is undertreatment. One study showed that only 28 percent of patients who are candidates for osteoporosis drugs are taking the medication within the first year of diagnosis (3). The reason most were reluctant was that they had experienced a recent gastrointestinal event and did not want to induce another with osteoporosis medications, such as bisphosphonates. The data were taken from Medicare records of patients who were at least age 66.

On the other hand, as many as 66 percent of the women receiving osteoporosis medications may not have needed it, according to a retrospective study (4). This is the overtreatment population, with half these patients younger, between the ages of 40 and 64, and without any risk factors to indicate the need for a DXA scan. This younger population included many who had osteopenia, not osteoporosis.

Do we all need calcium?

Calcium has always been the forefront of prevention and treatment of osteoporosis. However, two studies would have us question this approach. Results of one meta-analysis of 59 randomized controlled trials showed that dietary calcium and calcium supplements with or without vitamin D did increase the bone density significantly in most places in the body, including the femoral neck, spine and hip (5). Yet the changes were so small that they would not have much clinical benefit in terms of fracture prevention.

Another meta-analysis of 44 observational dietary trials and 26 randomized controlled trials did not show a benefit with dietary or supplemental calcium with or without vitamin D (6). There was a slight reduction in nonsignificant vertebral fractures, but not in other places, such as the hip and forearm. Dietary calcium and supplements disappointed in these two trials.

Does this mean calcium is not useful? Not so fast!

In some individual studies that were part of the meta-analyses, the researchers mentioned that dairy, specifically milk, was the dietary source on record, and we know milk is not necessarily good for bones. But in many of the studies, the researcher did not differentiate between the sources of dietary calcium. This is a very important nuance. Calcium from animal products may increase inflammation and the acidity of the body and may actually leach calcium from the bone, while calcium from vegetable-rich, nutrient-dense sources may be better absorbed, providing more of an alkaline and anti-inflammatory approach.

What can be done to improve the situation?

Yoga has become more prevalent and part of mainstream exercise. This is a good trend since this type of exercise may have a big impact on prevention and treatment of osteoporosis. In a small pilot study of 18 participants, the results showed that those who practiced yoga had an increase in their spine and hip bone density compared to those who did not (7).

The researchers were encouraged by these results, so they performed another study. The results showed that 12 minutes of yoga daily or every other day significantly increased the bone density from the start of the study in both the spine and femur, the thigh bone (8). There was also an increase in hip bone density, but this was not significant. The strength of the study includes its 10-year duration; however, this trial did not include a control group. Also, while 741 participants started the trial, only 227 finished. Of those, 202 were women. 

Significantly, prior to the study there were 109 fractures in the participants, most of whom had osteoporosis or osteopenia, but none had yoga-related fractures by the end of the trial. The “side effects” of yoga included improved mobility, posture, strength and a reduction in anxiety. The researchers provided a road map of specific beneficial poses. Before starting any exercise program, consult your physician.

The moral of the story is that exercise is beneficial. Yoga may be another simple addition to this exercise regimen. Calcium may be good or bad, depending on its dietary source. Be cautious with supplemental calcium; it does have side effects, including kidney stones, cardiovascular events and gastrointestinal symptoms, and consult with your doctor to assess whether you might be in an overtreatment or undertreatment group when it comes to medication.

References:

(1) uptodate.com. (2) nof.org. (3) Clin Interv Aging. 2015;10:1813-1824. (4) JAMA Intern Med. online Jan. 4, 2016. (5) BMJ 2015; 351:h4183. (6) BMJ 2015; 351:h4580. (7) Top Geriatr Rehabil. 2009; 25(3); 244-250. (8) Top Geriatr Rehabil. 2016; 32(2); 81-87.

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.    

by -
0 404
Barbara Zinna. Photo courtesy of Mather Hospital

Mount Sinai resident Barbara Zinna, a Mather Hospital, Northwell Health volunteer, was elected to a one-year term as president of the Nassau-Suffolk Council of Hospital Auxiliaries. Her term expires June 2020.

Zinna, an auxilian for 30 years, says one of her major roles as an auxilian is to raise awareness about the community services her hospital offers. Evidence of that commitment occurred when the Mather Auxiliary received the Healthcare Association of New York State’s Best Auxiliary Award in 2017. Also current president of Suffolk County Homemakers, an organization with 26 chapters throughout Long Island, Zinna previously served Mather Hospital’s Auxiliary as its president for four years. 

In her role as president of the Nassau-Suffolk Council of Hospital Auxiliaries, Zinna will continue to lead this organization of hospital volunteers that is aligned with the Nassau-Suffolk Hospital Council, the organization that represents Long Island’s not-for-profit and public hospitals.

Hospital auxilians play a vital role in the delivery of compassionate care at each of their facilities and are major fundraisers for their respective institutions. 

Collectively, Long Island’s volunteer auxilians raise millions through gift shop and thrift shop sales, fashion shows, boutiques and other events. In addition, they are actively involved in advocating on federal, state and local levels on behalf of their hospitals and the thousands of patients that these institutions serve each day.

by -
0 286
German become Long Island’s official Man of the Year for the Leukemia and Lymphoma Society after raising a record-breaking $470,000 in 10 weeks.

Asaf German said he grew up with nothing and played stickball in the streets of Brooklyn. This year, the 47-year-old Lloyd Neck resident has become Long Island’s official Man of the Year for the Leukemia and Lymphoma Society after raising a record-breaking $470,000 in 10 weeks.

“What he’s been able to accomplish is priceless,” said Meagan Doyle, who serves as campaign director for the  Leukemia and Lymphoma Society in its Melville office.

Each year the society recruits candidates to compete and run a 10-week fundraising campaign. Proceeds go towards finding a cure for blood cancers leukemia, lymphoma myeloma and Hodgkin’s disease. Eight candidates on Long Island competed and collectively raised $863,000 for the organization.

German, who raised more than anyone ever has on Long Island, pulled together a team of 75 people, mostly women, who helped him organize events and solicit donations. In total, more than 5,000 people contributed to German’s team with donations ranging from $5 to $55,000.

“Nobody said no,” German said. “I am a machine and found very special, passionate, amazing, like-minded people to help.”

Two pediatric cancer patients or survivors participate in the society’s Man of the Year campaign as Boy and Girl of the Year honorees.  Jesse Pallas, age 12, of Miller Place and Morgan Sim, age 5, of Port Washington served as inspiration for German and his team.

“When I met Asaf in person for the first time, he shook my hand and said I’m going to win this thing.  Who would have known that just 10 weeks later he would raise $470,000,” said RuRu Sim, Morgan’s mother. “It was almost unbelievable and he turned my skepticism into pure admiration.  Asaf poured his heart and soul into the Man of the Year campaign and he helped us take a huge step closer to finding a cure for cancer.  The cancer community is so blessed to have found such a dedicated and wonderful man!”

Prior to the fundraising campaign, German, a real estate attorney, knew nothing about fundraising or blood cancer diseases.  He’s become passionate about the cause.

“It’s been the second most rewarding experience of my life after having children,” German said.

Nationally, the society raised $52 million through the Man of the Year campaigns. German ranked eighth nationally in total funds raised.

German thanks Mary Jo White, who had previously pulled together a Woman of the Year campaign for the society.  He said she shared fundraising suggestions with him.  He’s become close with White and her husband through the society’s fundraising mission.  So close, he said he spent Christmas with them.

“People keep telling me ‘Do you realize the magnitude of what you just did,’” said German. “I can’t stop here. I’m a machine.”

He’s recruiting now for next year’s ambassador.

German’s two children, with the help of a committee at Accompsett Elementary and Middle Schools, where they’re students, raised $500 for the cause at Ralph’s Italian Ices on Maple Avenue in Smithtown.

“It’s not all about the money,” German said. “It’s about raising awareness and saving people’s lives.”

by -
0 2155
Participants in the Empower Spinal Cord Injury program held at Stony Brook University play quad rugby. Photo from Empower Spinal Cord Injury

Stony Brook University students and local community members stopped by the Walter J. Hawrys Campus Recreation Center July 23 to check out the latest equipment created to make life easier for those with spinal cord injuries.

Empower Spinal Cord Injury program participant turned mentor Jack Gerard poses with his dog Radar. Photo by Rita J. Egan

Organized by Boston-based nonprofit Empower Spinal Cord Injury, the expo featured vendors from the health care field who specialize in innovative products for individuals with spinal cord injuries. On display were products such as the Action Trackchair that can handle rocky, dirt roads and go through streams, and a wheelchair called permobil that helps those who are paralyzed to maneuver upright. Participants also demonstrated a wheelchair rugby game called quad rugby, also known as murderball, where players sit in custom-made, manual wheelchairs and play a chair-based form of rugby, physical contact and all.

In attendance were participants from Empower SCI’s two-week program that began July 14 at the university. The residential program, in its eighth year at SBU, provides an opportunity for participants to be involved in an immersive rehabilitation experience with a mix of recreational activities such as cycling, yoga, quad rugby and kayaking in Setauket Harbor. Attendees also learn techniques such as how to make getting out of bed and dressing for the day easier on the body.

Stephanie Romano, assistant director of the program, said each year approximately 50 volunteers help a dozen program participants regain independence and passion in activities, as spinal cord injuries alter the ability to control parts of the body.  According to the organization, more than 17,000 people are affected by the injuries each year in the United States.

Andrew Gallo, from Lake Grove, has participated in the program for the last two years. The 28-year-old was injured in December 2016 while diving in the ocean in Florida when he hit a sandbar. He learned about the program through his therapy office, and he said a friend told him, “There’s life before Empower, and there’s life after Empower and that I had to go.”

Participants in the Empower Spinal Cord Injury program held at Stony Brook University play quad rugby. Photo from Empower Spinal Cord Injury

Gallo said it’s difficult for wheelchair users to get together, and he said he learned from his fellow participants several tricks to help navigate the day a little easier.

“To be around like people makes all the difference,” Gallo said. “You get to interact with them and see what they would do at home in their regular lifestyle.”

He said due to this year’s program he had a chance to try kayaking again, something he had done a few times before his accident. After last year’s event, he has tried adaptive hand cycling, and now he’s looking into buying his own bike.

Jack Gerard, of Massachusetts, who was injured three years ago while swimming in Cape Cod, was also in attendance with his service dog Radar, named after the M*A*S*H character. He first attended the program a few years ago when he couldn’t get out of bed or dress on his own. This year he is a mentor.

“We learn to adapt here rather than trying to change things, Gerard said. “So, I just find a different way to do it, and that’s how I go forward in my life.”

Gerard said he wanted to use the skills that helped him look at life differently and share them with others. He said his life is back on track with returning to school at the University of Massachusetts, playing sports and attending social events. The former lacrosse player and high school track and field player is now into quad rugby, adaptive surfing and hand cycling where he recently cycled 750 miles.

Everyone learns from each other, he said, even mentors from volunteers, especially since sometimes people don’t know what’s possible until others show them.

“One of the biggest things is that you have to be vulnerable to be brave,” he said. “There are a lot of things in our lives that we have to figure out by saying maybe this isn’t the right way to do it. I need to push through this wall to find a different way to get around it.”

For more information about Empower Spinal Cord Injury, visit www.empowersci.org.

by -
0 1423
Walking for a five-minute duration every 30 minutes can reduce the risk of diabetes. Stock photo
Screening guidelines still miss 15 to 20 percent of cases

By David Dunaief, M.D.

Dr. David Dunaief

Finally, there is good news on the diabetes front. According to the Centers for Disease Control and Prevention, the incidence, or the rate of increase in new cases, has begun to slow for the first time in 25 years (1). There was a 20 percent reduction in the rate of new cases in the six-year period ending in 2014. This should help to brighten your day. However, your optimism should be cautious; it does not mean the disease has stopped growing. It means it has potentially turned a corner in terms of the growth rate, or at least we hope. This may relate in part to the fact that we have reduced our consumption of sugary drinks like soda and orange juice.

Get up, stand up!

It may be easier than you think to reduce the risk of developing diabetes. Standing and walking may be equivalent in certain circumstances for diabetes prevention. In a small, randomized control trial, the gold standard of studies, results showed that when sitting, those who either stood or walked for a five-minute duration every 30 minutes, had a substantial reduction in the risk of diabetes, compared to those who sat for long uninterrupted periods (2).

There was a postprandial, or postmeal, reduction in the rise of glucose of 34 percent in those who stood and 28 percent reduction in those who walked, both compared to those who sat for long periods continuously in the first day. The effects remained significant on the second day. A controlled diet was given to the patients. In this study, the difference in results for the standers and walkers was not statistically significant.

The participants were overweight, postmenopausal women who had prediabetes, HbA1C between 5.7 and 6.4 percent. The HbA1C gives an average glucose or sugar reading over three months. The researchers hypothesize that this effect of standing or walking may have to do with favorably changing the muscle physiology. So, in other words, a large effect can come from a very small but conscientious effort. This is a preliminary study, but the results are impressive.

Do prediabetes and diabetes have similar complications?

Diabetes is much more significant than prediabetes, or is it? It turns out that both stages of the disease can have substantial complications. In a study of those presenting in the emergency room with acute coronary syndrome (ACS), those who have either prediabetes or diabetes have a much poorer outcome. ACS is defined as a sudden reduction in blood flow to the heart, resulting in potentially severe events, such as heart attack or unstable angina (chest pain).

In the patients with diabetes or prediabetes, there was an increased risk of death with ACS as compared to those with normal sugars. The diabetes patients experienced an increased risk of greater than 100 percent, while those who had prediabetes had an almost 50 percent increased risk of mortality over and above the general population with ACS. Thus, both diabetes and prediabetes need to be taken seriously. Sadly, most diabetes drugs do not reduce the risk of cardiac events. And bariatric surgery, which may reduce or put diabetes in remission for five years, did not have an impact on increasing survival (3).

What do the prevention guidelines tell us?

The United States Preventive Services Task Force (USPSTF) renders recommendations on screening for diseases. In 2015, the committee drafted new guidelines suggesting that everyone more than 45 years old should be screened, but the final guidelines settled on screening a target population of those between the ages of 40 and 70 who are overweight or obese (4). They recommend that those with abnormal glucose levels pursue intensive lifestyle modification as a first step.

This is a great improvement, as most diabetes patients are overweight or obese; however, 15 to 20 percent of diabetes patients are within the normal range for body mass index (5). So, this screening still misses a significant number of people.

Potassium’s effect

When we think of potassium, the first things that comes to mind is bananas, which do contain a significant amount of potassium, as do other plant-based foods. Those with rich amounts of potassium include dark green, leafy vegetables; almonds; avocado; beans; and raisins. We know potassium is critical for blood pressure control, but why is this important to diabetes?

In an observational study, results showed that the greater the exertion of potassium through the kidneys, the lower the risk of cardiovascular disease and kidney dysfunction in those with diabetes (6). There were 623 Japanese participants with normal kidney function at the start of the trial. The duration was substantial, with a mean of 11 years of follow-up. Those who had the highest quartile of urinary potassium excretion were 67 percent less likely to experience a cardiovascular event or kidney event than those in the lowest quartile. The researchers suggested that higher urinary excretion of potassium is associated with higher intake of foods rich in potassium.

Where does this leave us for the prevention of diabetes and its complications? You guessed it: lifestyle modifications, the tried and true! Lifestyle should be the cornerstone, including diet and at least mild to moderate physical activity.

References:

(1) cdc.gov. (2) Diabetes Care. online Dec. 1, 2015. (3) JAMA Surg. online Sept. 16, 2015. (4) Ann Intern Med. 2015;163(11):861-868. (5) JAMA. 2012;308(6):581-590. (6) Clin J Am Soc Nephrol. online Nov 12, 2015.

by -
0 457
Students from Northport, Huntington and Southampton high schools, as well as from Tug Valley High School in West Virginia, are working together to curb the opioid crisis. Photo from Northport-East Northport Union Free School District

Students from Northport, Huntington and Southampton high schools, along with the hard-hit Tug Valley High School in Kermit, West Virginia, have been working together to address the opioid crisis through a unique exchange program. Northport students, who are a part of the Students for 60,000 Club, visited West Virginia earlier this year on a service trip and were deeply affected by the magnitude of the crisis. 

Club advisers Darryl St. George and Kim Braha coordinated a “student exchange” in which the students from West Virginia came to visit Long Island to discuss realistic steps to solving the crisis. 

During the week of July 7, the students met in a variety of forums to learn from each other and discuss ways to address and solve the crisis. Students met with U.S. Rep. Thomas Suozzi (D-Glen Cove) and Suffolk County Executive Steve Bellone (D) in Huntington to engage in discussion and also visited Southampton High School to hear from local Southampton representatives. Students asked questions, shared personal experiences and offered their thoughts on curtailing opioid use. 

Ideas included creating more mental health programs in schools and providing a greater sense of purpose for students. 

At the end of the week, students spent some time volunteering at the Northport VA. 

“The most inspiring part of this week long student exchange experience included seeing how empowered our Northport students were working with Southampton, Huntington and West Virginia students,” said Braha, “and the incredible opportunities to have conversations about how we can all work together to improve our communities.

by -
0 1361
Belly fat can play a critical role in increased risk of pancreatitis. Stock photo
Central obesity is more important than body mass index

By David Dunaief, M.D.

Dr. David Dunaief

Pancreatitis is among the top gastrointestinal reasons for patients to be admitted to a hospital, and its incidence has been growing steadily (1). Typically it’s severe abdominal pain that drives patients to the emergency room, but diagnosis is more complex.

First, let’s define pancreatitis. A rudimentary definition is an inflammation of the pancreas. There are both acute and chronic forms. We are going to address the acute — abrupt and of short duration — form. There are three acute types: mild, moderate and severe. Those with the mild type don’t have organ failure, whereas those with moderate acute pancreatitis experience short-term or transient (less than 48 hours) organ failure. Those with the severe type have persistent organ failure. One in five patients presents with moderate or severe levels (2).

What are the symptoms?

To diagnosis this disease, the American College of Gastroenterology guidelines suggest that two of three symptoms be present. The three symptoms include severe abdominal pain; enzymes (amylase or lipase) that are at least three times greater than normal; and radiologic imaging that shows characteristic disease findings (3). Most of the time, the abdominal pain is in the central upper abdomen near the stomach, and it may also present with pain in the right upper quadrant of the abdomen (4). Approximately 90 percent of patients also experience nausea and vomiting (5). In half of patients, there is also pain that radiates to the back.

What are the risk factors?

Acute pancreatitis risk factors include gallstones, alcohol, obesity and, to a much lesser degree, drugs. Gallstones and alcohol may cause up to 75 percent of the cases (2). Many other cases of acute pancreatitis are considered idiopathic (of unknown cause). Although medications are potentially responsible for between 1.4 and 5.3 percent of cases, making it rare, the number of medications implicated is diverse (6, 7). These include certain classes of diabetes therapies, some antibiotics — metronidazole (Flagyl) and tetracycline — and immunosuppressive drugs used to treat ailments like autoimmune diseases. Even calcium may potentially increase risk.

Obesity effects

In a study using the Swedish Mammography Cohort and the Cohort of Swedish Men, results showed that central obesity is an important risk factor, not body mass index or obesity overall (8). In other words, it is the fat in the belly that is very important, since this may increase risk more than twofold for the occurrence of a first-time acute pancreatitis episode. Those who had a waist circumference of greater than 105 cm (41 inches) experienced this significantly increased risk compared to those who had a waist circumference of 75 to 85 cm (29.5 to 33.5 inches). The association between central obesity and acute pancreatitis occurred in both gallbladder-induced and non-gallbladder-induced disease. There were 68,158 patients involved in the study, which had a median duration of 12 years. Remember that waistline is measured from the navel, not from the hips.

Mortality risks

What makes acute pancreatitis so potentially dangerous is the surprisingly high rate of organ failure and mortality. A prospective (forward-looking) observational trial involving 1,005 patients found that the risk of mortality was 5 percent overall. This statistic broke out into a smaller percentage for mild acute pancreatitis and a greater percentage for severe acute pancreatitis, 1.5 and 17 percent, respectively (9). However, in another study, when patients were hospitalized, the mortality rate was higher, at 10 percent overall (10).

Diabetes risks

The pancreas is a critical organ for balancing glucose (sugar) in the body. In a meta-analysis (24 observational trials), results showed that more than one-third of patients diagnosed with acute pancreatitis went on to develop prediabetes or diabetes (11). Within the first year, 15 percent of patients were newly diagnosed with diabetes. After five years, the risk of diabetes increased 2.7-fold. By reducing the risk of pancreatitis, we may also help reduce the risk of diabetes.

Surgical treatments

Gallstones and gallbladder sludge are major risk factors, accounting for 35 to 40 percent of acute pancreatitis incidences (12). Gallstones are thought to cause pancreatitis by temporarily blocking the duct shared by the pancreas and gallbladder that leads into the small intestine. When the liver enzyme ALT is elevated threefold (measured through a simple blood test), it has a positive predictive value of 95 percent that it is indeed gallstone-induced pancreatitis (13). 

If it is gallstone-induced, surgery plays an important role in helping to resolve pancreatitis and prevent recurrence. In a retrospective study with 102 patients, results showed that surgery to remove the gallbladder was better than medical treatment when comparing hospitalized patients with this disease (14). Surgery trumped medical treatment in terms of outcomes, complication rates, length of stay in the hospital and overall cost for patients with mild acute pancreatitis.

Can diet have an impact?

The short answer is: Yes. What foods specifically? In a large, prospective observational study, results showed that there was a direct linear relationship between those who consumed vegetables and a decreased risk of non-gallstone acute pancreatitis (15). For every two servings of vegetables, there was 17 percent drop in the risk of pancreatitis. Those who consumed the most vegetables — the highest quintile (4.6 servings per day) — had a 44 percent reduction in disease risk, compared to those who were in the lowest quintile (0.8 servings per day). There were 80,000 participants involved in the study with an 11-year follow-up. The authors surmise that the reason for this effect with vegetables may have to do with their antioxidant properties, since acute pancreatitis increases oxidative stress on the pancreas.

References:

(1) Gastroenterology. 2012;143:1179-1187. (2) www.uptodate.com. (3) Am J Gastroenterol. 2013;108:1400-1415. (4) JAMA. 2004;291:2865-2868. (5) Am J Gastroenterol. 2006;101:2379-2400. (6) Gut. 1995;37:565-567. (7) Dig Dis Sci. 2010;55:2977-2981. (8) Am J Gastroenterol. 2013;108:133-139. (9) Dig Liver Dis. 2004;36:205-211. (10) Dig Dis Sci. 1985;30:573-574. (11) Gut. 2014;63:818-831. (12) Gastroenterology. 2007;132:2022-2044. (13) Am J Gastroenterol. 1994;89:1863-1866. (14) Am J Surg online. 2014 Sept. 20. (15) Gut. 2013;62:1187-1192.

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.  

by -
0 3118
From left to right: Daniel Lozeau, Galo Del Heirro, Alexander Dagum, Marissa Ayasse, Richard J Scriven. Photo from SBU

By David Luces

For one Ecuadorian native, attending a lecture by Stony Brook Medicine doctors changed his life.

Galo Del Hierro, 44, who works for the Charles Darwin Foundation in the Galapagos, was attending a lecture given by the Stony Brook Medicine team about skin cancer screenings and prevention in the archipelago. After the lecture, Del Hierro approached Alexander Dagum, a reconstructive plastic surgeon at Stony Brook, and showed him a lesion he had on his right eyelid that was not going away and had grown bigger in the last couple of years.

“He came up to me and said, ‘I’ve had this spot that has gotten larger for some time,’” Dagum said. “I looked at it and thought it was pretty suspicious and told him he should see one of our dermatologists.”

The team’s trip in March was part of a mission through Blanca’s House, a Long Island non-profit organization that works to bring much-needed, quality medical care to countries and communities throughout Latin America. The seven-person team from Stony Brook planned on providing screenings and other care for the local community. As they further examined Del Hierro, they realized they might have to bring him 3,051 miles away to Stony Brook for care.

Dr. Daniel Lozeau, a dermatologist and clinical assistant professor at Stony Brook Medicine, took a look at Del Hierro’s lesion and determined that they needed to do a biopsy. After testing was done, Del Hierro was diagnosed with a malignant melanoma.

Lozeau said given the location of the melanoma it would make it difficult to remove.

“On the eyelid you have less room to work with,” he said. “It not like when it’s on someone’s back, where we have a lot more real estate [to work with].”

Dagum said if people in the Galapagos had anything serious, they would have to go over to the mainland in Ecuador, which is quite far. Initially, he tried to find a doctor on the mainland to perform the surgery for Del Hierro instead of bringing him to Stony Brook as it was more convenient for Del Hierro, but he couldn’t find anyone that could do it.

Lozeau said the cancer Del Hierro had is aggressive, and he could have lost his eye and his life.

Dagum then got clearance to perform the surgery as a teaching case at Stony Brook Medicine and with help from the Darwin Foundation and Blanca’s House, Del Hierro was able to come to Stony Brook for the surgery in May.

The Stony Brook plastic surgeon said the procedure takes several days and requires using skin grafts to reconstruct and support the lower eyelid.

“It was important they we got [the melanoma] out as quickly as possible,” Dagum said.

Dagum and colleagues removed the lesion in full around his eyelids, and reconstructed skin around the eyelid so Del Hierro could see properly and blink normally. He had a second procedure to adjust the eyelid.

The Ecuadorian native said through a translator that he was grateful and impressed with the care he received at Stony Brook.

Del Hierro said that he had first noticed the spot on his eyelid when he was 18 years old.

“It was a tiny little dot, and I didn’t really think much of it, I thought it was just a mole,” he said.

He admitted when he first got his diagnosis, he was worried for himself and his family, but trusted Dagum and the team.

With the procedures complete, Dagum said they are waiting for the swelling to go down and everything should settle in and heal up in the next couple of months.

Dagum expects Del Hierro to live normally; however, he recommends he should continue to get screened and have the eyelid area examined periodically.

Del Hierro’s case and the team’s experiences bring to light the importance of skin cancer screening and skin protection, especially during the summer season.

Lozeau said the Academy of Dermatology recommends sunscreen of SPF 30 or higher.

“Most important thing is to constantly re-apply frequently every couple of hours,” he said. “Hats are good to wear and make sure you have eye protection.”

The dermatologist said when it comes to skin cancer, if one notices a spot that hasn’t gone away or has grown in size, he or she should get it checked out. Also, he mentioned spots that constantly bleed or scab over.

“Galo was really fortunate. He was at the right place at the right time,” Lozeau said.

Prev1...132133134...181Next Page 133 of 181
TBR News Media is your local news and entertainment website.
We provide you with the latest breaking news and information for your community.
Contact us: [email protected]

Most Viewed

©