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Comeback follows sidelines from heart condition, brain surgery

Thomas Liantonio, an attack for Long Island University and former Miller Place standout, scored four goals in his rerun to the field after undergoing brain surgery three months prior. Photo from LIU Post

Thomas Liantonio was overcome with emotion as his lacrosse teammates rushed to give him a hug after his first goal. The excitement followed a series of unfortunate events fit for a Lemony Snicket novel.

After undergoing brain surgery just three months earlier, the Miller Place resident and current Long Island University Post attack led the Pioneers with four goals and an assist in an 18-7 home win against University of the District of Columbia on his return April 17.

Thomas Liantonio following brain surgery this past January. Photo from Thomas Liantonio

“Scoring my first goal back was definitely a special moment,” he said. “To be given the opportunity to start and produce off that opportunity is something I’m very fortunate for.”

Prior to the surgery, the junior said he was experiencing headaches and eye pain but didn’t think too much of it. As problems persisted he decided to get checked out and was shocked when doctors told him he had a brain tumor that would require surgery.

“I was scared, taken aback,” he said, recalling when he heard the news Jan. 2. “I’m a big believer of doing stuff to get your mind off things, and I did what I could to keep things as normal as possible for me. I realized you can’t get down on yourself — you have to keep looking forward to the next day and roll with the punches.”

He returned home following a few days in the hospital, and got started on the path to recovery. Long Island University first-year head coach Eric Wolf said he felt devastated for his student-athlete, especially knowing Liantonio also missed the 2017 season as a result of a heart condition.

“I know how hard he had worked after missing all of last season,” Wolf said. “I know in the front of Thomas’ mind he was thinking he would come back this season, and it was more so in the back of mine. Bottom line: I just wanted him to be healthy. If he could ever play again that would just be icing on the cake.”

Thomas Liantonio crosses the field for Miller Place. File photo by Desirée Keegan

Almost exactly a year prior, Jan. 10, 2017, Liantonio found out he had myocarditis, inflammation of the middle layer of the heart wall caused by a viral infection that can weaken the heart and lead to heart attacks, heart failure or sudden death if his blood pressure were to rise too high. He said he was having some chest pains, and again didn’t think anything of it, assuming he had a respiratory infection. After visiting a walk-in
medical center, he found out he had an irregular heartbeat. Following an EKG, MRI and cardiogram, he was told of the infection.

“To see him get blindsided by two things back-to-back and see how it was affecting his morale, as a parent, that’s very disheartening,” his father Steve Liantonio said. “He’s a strong kid, and luckily he has great friends and people at LIU Post that he relied on to keep his spirits up, keep him positive. We thought good things were going to come for him, and it worked out.”

The Pioneers’ head coach said after a week-and-a-half of practice, he could see his player shaking off the rust. Wolf first opted to sideline Liantonio after he practiced at midfield and, after a night’s sleep, decided he needed him out on the field.

Liantonio, who first picked up a lacrosse stick in second grade, said he couldn’t imagine not playing the sport again.

“I love the fast pace,” he said. “I saw the opportunity I had to go far in the sport and wanted to take it. I didn’t think I’d make it back to the lacrosse field this season, but getting cleared, I was so happy I didn’t know what to do.”

Thomas Liantonio with his mother Maria following his first game back. Photo from Thomas Liantonio

Given the amount of physical contact in lacrosse, Liantonio’s dad thought a return to the field was risky, afraid of a push or helmet-to-helmet contact, but said the return also provided a lesson to his son.

“You can only hold somebody back for so long,” he said. “He was strong-willed and after several conversations he felt determined and healthy enough to do it. At some point in time you just have to let go and say, ‘Go for it.’ This proves when you put your mind to something you can overcome anything.”

Wolf said he asked current attackmen, who’d had successful campaigns up to that point, to let Liantonio return to his rightful position. He said his players were selfless, and he was moved by what Liantonio brought to the team in his first game in nearly two years.

“I was shocked, but not surprised given who Thomas is,” he said. “He played awesome. The emotional lift that he gave our team could not be measured.”

The coach said while there’s no tiptoeing around the contact in the sport, he knew his player was all in, and has improved and grown more confident with each game he’s played since.

“He works hard, has a positive attitude and makes his teammates better — he does everything we ask,” Wolf said. “To see a guy go through what he has gone through over the past two years and to keep persisting through real adversity … it’s incredible.”

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Scenes from Fortunato Breast Health Center's 2018 Families Walk for Hope in Port Jefferson and Belle Terre villages. Photo by Alex Petroski
Scenes from Fortunato Breast Health Center's 2018 Families Walk for Hope in Port Jefferson and Belle Terre villages. Photo by Alex Petroski
Scenes from Fortunato Breast Health Center's 2018 Families Walk for Hope in Port Jefferson and Belle Terre villages. Photo by Alex Petroski
Scenes from Fortunato Breast Health Center's 2018 Families Walk for Hope in Port Jefferson and Belle Terre villages. Photo by Alex Petroski
Scenes from Fortunato Breast Health Center's 2018 Families Walk for Hope in Port Jefferson and Belle Terre villages. Photo by Alex Petroski
Scenes from Fortunato Breast Health Center's 2018 Families Walk for Hope in Port Jefferson and Belle Terre villages. Photo by Alex Petroski
Scenes from Fortunato Breast Health Center's 2018 Families Walk for Hope in Port Jefferson and Belle Terre villages. Photo by Alex Petroski
Scenes from Fortunato Breast Health Center's 2018 Families Walk for Hope in Port Jefferson and Belle Terre villages. Photo by Alex Petroski
Scenes from Fortunato Breast Health Center's 2018 Families Walk for Hope in Port Jefferson and Belle Terre villages. Photo by Alex Petroski
Scenes from Fortunato Breast Health Center's 2018 Families Walk for Hope in Port Jefferson and Belle Terre villages. Photo by Alex Petroski
Scenes from Fortunato Breast Health Center's 2018 Families Walk for Hope in Port Jefferson and Belle Terre villages. Photo by Alex Petroski
Scenes from Fortunato Breast Health Center's 2018 Families Walk for Hope in Port Jefferson and Belle Terre villages. Photo by Alex Petroski

By Alex Petroski

Who knew walking could do so much good.

The Fortunato Breast Health Center, John T. Mather Memorial Hospital in Port Jefferson’s arm dedicated to treatment of breast cancer, played host to Families Walk for Hope, a fundraising event May 5 featuring a five-mile walk through Port Jefferson and Belle Terre villages. The event raised more than $81,000 for the center as of midday May 7. To donate to the center, visit familieswalkforhope.kintera.org.

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Lifestyle modifications play a role in reducing the risk of developing dementia. Stock photo
Managing biological age through diet can reduce risk

By David Dunaief, M.D.

Dr. David Dunaief

Dementia may be diagnosed when someone experiences loss of memory plus loss of another faculty, such as executive functioning (decision-making) or language abilities (speaking, writing or reading). The latter is known as aphasia. Alzheimer’s disease is responsible for approximately 60 to 80 percent of dementia cases (1).

Unfortunately, there are no definitive studies that show reversal or a cure for Alzheimer’s disease. This is why prevention is central to Alzheimer’s — and dementia in general.

In terms of dementia, there is good news and some disappointing news.

We will start with the good news. Though chronological age is a risk factor that cannot be changed, biological age may be adjustable. There are studies that suggest we may be able to prevent dementia through the use of both lifestyle modifications and medications.

Telomeres’ length and biological age

Biological age may be different from chronological age, depending on a host of environmental factors that include diet, exercise and smoking. There are substances called telomeres that are found at the ends of our chromosomes. They provide stability to this genetic material. As our telomeres get shorter and shorter, our cellular aging and, ultimately, biological aging, increases.

In a preliminary case-control study, dementia patients were shown to have significantly shorter telomere length than healthy patients (2). Interestingly, according to the authors, men have shorter telomere length and may be biologically older by four years than women of the same chronological age. The researchers caution that this is a preliminary finding and may not have clinical implications.

What I find most intriguing is that intensive lifestyle modifications increased telomere length in a small three-month study with patients who had low-risk prostate cancer (3). By adjusting their lifestyles, study participants were potentially able to decrease their biological ages.

Diet’s effect

Lifestyle modifications play a role in many chronic diseases and disorders. Dementia is no exception. In a prospective observational study, involving 3,790 participants, those who had the greatest compliance with a Mediterranean-type diet demonstrated a significant reduction in the risk of Alzheimer’s disease, compared to the least compliant (4). Participants were over the age of 65, demographics included substantial numbers of both black and white participants, and there was a mean follow-up of 7.6 years. Impressively, those who adhered more strictly to the diet performed cognitively as if they were three years younger, according to the authors.

Beta-carotene and vitamin C effect

In a small, preliminary case-control study (disease vs. healthy patients), higher blood levels of vitamin C and beta-carotene significantly reduced the risk of dementia, by 71  and 87 percent, respectively (5). The blood levels were dramatically different in those with the highest and lowest blood levels of vitamin C (74.4 vs. 28.9 µmol/L) and beta-carotene (0.8 vs. 0.2 µmol/L).

The reason for this effect may be that these nutrients help reduce oxidative stress and thus have neuroprotective effects, preventing the breakdown of neurons. This study was done in the elderly, average 78.9 years old, which is a plus, since as we age we’re more likely to be afflicted by dementia.

It is critically important to delineate the sources of vitamin C and beta-carotene in this study. These numbers came from food, not supplements. Why is this important? First, beta-carotene is part of a family of nutrients called carotenoids. There are at least 600 carotenoids in food, all of which may have benefits that are not achieved when taking beta-carotene supplements. Second of all, beta-carotene in supplement form may increase the risk of small-cell lung cancer in smokers (6).

Foods that contain beta-carotene include fruits and vegetables such as berries; green leafy vegetables; and orange, red or yellow vegetables like peppers, carrots and sweet potato. It may surprise you, but fish also contains carotenoids. In my practice, I test for beta-carotene and vitamin C as a way to measure nutrient levels and track patients’ progress when they are eating a nutrient-dense diet. Interestingly, many patients achieve more than three times higher than the highest beta-carotene blood levels seen in this small study.

Impact of high blood pressure medications

For those patients who have high blood pressure, it is important to know that not all blood pressure medications are created equal. When comparing blood pressure medications in an observational study, two classes of these medications stood out. Angiotensin II receptor blockers (known as ARBs) and angiotensin-converting enzyme inhibitors (known as ACE inhibitors) reduce the risk of dementia by 53 and 24 percent respectively, when used in combination with other blood pressure medications.

Interestingly, when ARBs were used alone, there was still a 47 percent reduction in risk; however, ACE inhibitors lost their prevention advantage. High blood pressure is a likely risk factor for dementia and can also be treated with lifestyle modifications (7). Otherwise, ARBs or ACE inhibitors may be the best choices for reducing dementia risk.

Ginkgo biloba disappoints

Ginkgo biloba, a common herbal supplement taken to help prevent dementia, may have no benefit. In the GuidAge study, ginkgo biloba was shown to be no more effective than placebo in preventing patients from progressing to Alzheimer’s disease (8). This randomized controlled trial, considered the gold standard of study designs, was done in elderly patients over a five-year period with almost 3,000 participants. There was no difference seen between the treatment and placebo groups. This reinforces the results of an earlier study, Ginkgo Evaluation of Memory trial (9). Longer studies may be warranted. The authors stressed the importance of preventive measures with dementia.

Fish oil: not the last word

Many of us take fish oil supplements in the hope of preventing dementia. However, in a meta-analysis (a group of three randomized controlled trials), the results did not show a difference between treatment groups and placebo in older patients taking fish oil with omega-3 fatty acids (10). The authors stress that this is not the final word since studies have been mixed. 

The longest of the three studies was 40 months, yet may not have been long enough to see a beneficial effect. Also participants in the meta-analysis did not necessarily have low omega-3 levels at the beginning of the studies. This doesn’t necessarily mean fish oil doesn’t work for dementia prevention, it is just discouraging, as the authors emphasize. Fish consumption, however, has shown an inverse association with Alzheimer’s and dementia overall (11).

There may be ways to prevent dementia from occurring, whether through lifestyle modifications or through the selection of medications, if they are necessary.

References:

(1) www.uptodate.com. (2) Arch Neurol. 2012 Jul 23:1-8. (3) Lancet Oncol. 2008;9(11):1048-1057. (4) Am J Clin Nutr. 2011;93:601-607. (5) J Alzheimers Dis. 2012;31:717-724. (6) Am. J. Epidemiol. 2009; 169(7):815-828. (7) Neurology. 2005;64(2):277. (8) Lancet Neurol. 2012;11(10):851-859. (9) JAMA. 2008;300(19):2253-2262. (10) Cochrane Summaries online June 13, 2012. (11) Neurology. 2007;69(20):1921.

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

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Pediatric nurse specialist and Centereach resident Lisa Rendina helps Stony Brook Children’s Hospital take part in “Take a Pop, Share a Smile" campaign

Cancer survivors Aubri Krauss, Erin Ersoy and Delaney Unger enjoy ice pops from the Stony Brook Children's Hospital's new freezer containing a lifetime supply. Photo by Kyle Barr

For the young cancer patients at Stony Brook Children’s Hospital, one of the worst side effects from chemotherapy, beyond the pain and the nausea, is mouth sores. The best way to soothe the pain, according to 12-year-old cancer survivor Delaney Unger, is with ice pops.

Husband and wife Frank and Lynn Antonawich, assistant director of nursing at the Neonatal Intensive Care Unit at Stony Brook Children’s Hospital, and pediatric nurse specialist Lisa Rendina at the unveiling of Frankie’s Freezer. Photo by Kyle Barr

“When I had mouth sores, I had to tell my dad right away, because I knew they would get worse if I didn’t treat them right,” Delaney said. “Sometimes using other stuff would make [the pain] worse, so I would usually eat ice pops.”

Stony Brook Children’s Hospital announced Thursday it would be taking part in the nonprofit American Childhood Cancer Organization’s Take a Pop, Share a Smile campaign that donates a lifetime supply of freezer pops to hospitals for its cancer patients. The hospital will be receiving a total of 2,000 ice pops to start, and the ACCO will keep the freezer consistently stocked every year.

To hold the new bounty of ice pops is a new freezer named Frankie’s Freezer, which was dedicated in memory of Francis “Frankie” Antonawich, a 25-year-old who died in February from Hodgkin lymphoma before he could realize his dream of becoming a pediatric oncology nurse.

“I think he would have been thrilled about this, because he really loved kids,” Antonawich’s mother and assistant director of nursing at the Neonatal Intensive Care Unit, Lynn Antonawich, said. “He not only felt that he could help a child, but also the parents of those children who would feel helpless.”

Frankie’s Freezer was named after 25-year-old Frankie Antonawich, who died from Hodgkin lymphoma in February. Photo from the Antonawichs

His father, Frank Antonawich, told an audience of Girl Scouts and families at a press conference May 3, trying to hold back tears, that the disease never stopped his son.

“Frank was a very active young man — it never stopped him going to work, going to the gym — he even continued to volunteer as a wrestling coach at his alma mater, St. John the Baptist Parish,” the West Islip resident said.

Stony Brook Children’s Hospital pediatric nurse specialist Lisa Rendina, who had worked with the family before and during Frankie Antonawich’s treatment, decided she wanted to get involved and contacted the ACCO, which donated the freezer too.

“As a mother, my heart broke for Lynn, and I wanted to do something to honor Frankie,” she said. “We just wanted to bring Frankie’s story to life.”

Rendina is the leader of Girl Scout Troop 105. Her troop, along with other members from Girl Scouts Service Unit 45 from Centereach, attended the unveiling. The Scouts wrote inspirational phrases all over the freezer like “No one fights alone” and “The one who falls and gets up is so much stronger than the one who never fell.”

The event also honored three cancer survivors from Stony Brook Children’s Hospital, including Delaney, 12-year-old Erin Ersoy and 10-year-old Aubri Krauss, all of whom are Girl Scouts from Centereach. The parents of the three girls agreed that ice pops were one of the simplest ways to deal with the mouth sores, while also aiding in hydration and nutrition.

The freezer donated by nonprofit American Childhood Cancer Organization’s “Take a Pop, Share a Smile” campaign was named “Frankie’s Freezer” in memory of Francis “Frankie” Antonawich. Photo by Kyle Barr

“I remember what happened with my daughter and mouth sores, it was terrible,” said Delaney’s father Berk Unger of his daughter who finished her final treatment last August. “Ice pops were the only thing that helped.”

Lynn Antonawich  said her son was in such severe pain following a stem cell transplant that he couldn’t eat.

“They were thinking of tube feeding him,” she said. “And he was a 24-year-old man. I couldn’t imagine what the pain must be like for a kid.”

Those who work in the children’s hospital said one of the most important things young patients need is to feel like their lived are as normal as possible.

“Anything helps,” Lynn Antonawich said. “From donations of gifts, such as iPads and game systems, they are able to take part in a more normal life like they would at home.”

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Accumulating evidence supports an association between depression and inflammation. Stock photo
C-reactive protein is an important biomarker

By David Dunaief, M.D.

Dr. David Dunaief

Many of us have inflammation in our bodies, inflammation that is a potential underlying cause for a great number of diseases. Can we demonstrate the level of inflammation by measuring it? The answer is yes.

One of the most widely studied biomarkers for inflammation is high-sensitivity C-reactive protein (hsCRP), also referred to as CRP. High sensitivity means that we can measure levels as low as 0.3 mg/L more accurately.

What is the significance of the different levels? In heart disease, individuals who have levels lower than 1.0 mg/L are in the optimal range for low risk of inflammation. Levels of 1 to 3 mg/L represent the average risk range, and greater than 3.0 mg/L is a higher risk profile. Above 10.0 mg/L is less specific to heart disease, although still related, but more likely associated with other causes, such as infection and autoimmune diseases (1, 2). This biomarker is derived from the liver.

CRP is not specific to heart disease, nor is it definitive for risk of the disease. However, the upside is that it may be helpful with risk stratification, which helps us understand where we sit on a heart disease risk spectrum and with progression in other diseases, such as age-related macular degeneration, diabetic retinopathy, depression and autoimmune diseases. Let’s look at the evidence.

Age-related macular degeneration

Age-related macular degeneration (AMD) is the leading cause of blindness in patients over the age of 65 (3). Therefore, it is very important to help define risk stratification for this disease. In a prospective study, results showed that hsCRP levels were inversely associated with the risk of developing AMD. The group with an hsCRP greater than 3.0 mg/L had a 50 percent increased risk of developing overall AMD compared to the optimal group with hsCRP lower than 1.0 mg/L. But even more interestingly, the risk of developing neovascular, or wet, AMD increased to 89 percent in this high-risk group.

The significance of wet AMD is that it is one type of advanced-stage AMD that results in blindness. This study involved five studies where the researchers thawed baseline blood samples from middle-aged participants who had hsCRP levels measured. There were more than 2,000 participants with a follow-up as long as 20 years. According to the study’s authors, annual eye exams and lifestyle modifications, including supplements, may be able to stem this risk by reducing hsCRP.

These results reinforce those of a previous prospective study that showed that elevated hsCRP increased the risk of AMD threefold (4). This study utilized data from the Women’s Health Study, which involved over 27,000 participants. Like the study mentioned above, this one also defrosted blood samples from baseline and looked at follow-up incidence of developing AMD in initially healthy women.

The highest group had hsCRP levels over 5.2 mg/L. Additionally, when analyzing   similar cutoffs for high- and low-level hsCRP, as the above trial used, those with hsCRP over 3.0 had an 82 percent increased risk of AMD compared to those with an hsCRP of lower than 1.0 mg/L.

Diabetic retinopathy — a complication of diabetes

We know that diabetes affects approximately 10 percent of the U.S. population and is continuing to rise at a rapid rate. One of the complications of diabetes affects the retina (back of the eye) and is called diabetic retinopathy. This is a leading cause of vision loss (5). One of the reasons for the vision loss is macular edema, or swelling, usually due to rupture of tiny blood vessels below the macula, a portion of the back of the eye responsible for central vision.

The Diabetes Control and Complications Trial (DCCT), a prospective study involving over 1,400 Type 1 diabetes patients, showed an 83 percent increased risk of developing clinically significant macular edema in the group with the highest hsCRP levels compared to those with the lowest (6). Although these results were with Type 1 diabetes, patients with Type 2 diabetes are at equal risk of diabetic retinopathy if glucose levels, or sugars, are not well controlled.

Depression

Depression is a very difficult disease to control and is a tremendous cause of disability. If we can minimize the risk of complications and hospitalizations, this is probably the most effective approach.

Well, it turns out that inflammation is associated with depression. Specifically, in a prospective observational trial, rising levels of CRP had a linear relationship with increased risk of hospitalization due to psychological distress and depression (7).

In other words, compared to levels of less than 1 mg/L, those who were 1 to 3 mg/L, 3 to 10 mg/L and greater than 10 mg/L had increased risk from 30 to 84 to 127 percent, respectively. This study involved over 70,000 patients.

What can be done to reduce inflammation?

This is the key question, since we now know that hsCRP is associated with systemic inflammation. In the Nurses’ Health Study, a very large, prospective observational study, the Dietary Approaches to Stop Hypertension (DASH) diet decreased the risk of both heart disease and stroke, which is impressive. The DASH diet also decreases the levels of hsCRP significantly, which was associated with a decrease in clinically meaningful end  points of stroke and heart disease (8).

The DASH diet is nutrient dense with an emphasis on fruits, vegetables, nuts, seeds, legumes and whole grains and a de-emphasis on processed foods, red meats, sodium and sweet beverages.

Conclusion

As the evidence shows with multiple diseases, hsCRP is a very valuable nonspecific biomarker for inflammation in the body.

To stem the effects of inflammation, reducing hsCRP through lifestyle modifications and drug therapy may be a productive way of reducing risk, slowing progression and even potentially reversing some disease processes.

The DASH diet is a very powerful approach to achieving optimal levels of hsCRP without incurring potential side effects. This is a call to arms to have your levels measured, especially if you are at high risk or have chronic diseases such as heart disease, diabetes, depression and autoimmune diseases. HsCRP is a simple blood test with easy-to-obtain results.

References:

(1) uptodate.com. (2) Diabetes Technol Ther. 2006;8(1):28-36. (3) Prog Retin Eye Res. 2007 Nov;26(6):649-673. (4) Arch Ophthalmol. 2007;125(3):300-305. (5) Am J Ophthalmol. 2003;136(1):122-135. (6) JAMA Ophthalmol. 2013 Feb 7;131:1-8. (7) JAMA Psychiatry. 2013;70(2):176-184. (8) Arch Intern Med. 2008;168(7):713-720.

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

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By Eric Rashba, M.D.

Dr. Eric Rashba

Atrial fibrillation, or AFib, is generally considered to be reaching epidemic numbers, especially among people over age 60. This condition, which is characterized by an erratic, irregular heartbeat, can cause problems ranging from unpleasant symptoms to serious problems like heart failure or stroke.

At the Stony Brook Heart Rhythm Center, our physicians and entire team of heart rhythm experts are constantly working to help people with AFib live better and longer. These are some of the important new state-of-the-art therapies:

Reducing stroke risk for people with atrial fibrillation

People with AFib have a 5 to 7 percent increased risk of having a stroke compared to people without AFib. To help prevent strokes, blood thinners such as warfarin or direct oral anticoagulants (DOACs) are prescribed. Most people do well with medication, but some experience bleeding problems or have other reasons why blood thinners aren’t the best option. 

At the Heart Rhythm Center, our specialists are treating appropriate patients with an implantable heart device, called Watchman™, to offer lifelong protection against stroke. For people who have AFib that’s not caused by a heart valve problem, the device provides an alternative to the lifelong use of blood thinners by blocking blood clots from leaving the heart and possibly causing a stroke. 

Miniaturized pacemaker for people with bradycardia

Bradycardia, also called slow heart rate, is when the heart beats at 60 times a minute or less. Not everyone with a slow heart rate needs a pacemaker — the presence of symptoms and the type of rhythm disorder are key. At our Heart Rhythm Center, for people whose slow heart rate can be treated with a pacemaker in just one of the four heart chambers, we use a pacemaker that is 93 percent smaller than traditional pacemakers, called Micra™. It is the world’s smallest pacemaker available and it offers some big benefits to the patient. 

Conventional, bulkier pacemakers are visible under the skin and have a lead wire that is threaded from the pacemaker into the heart. Our team implants the Micra pacemaker in the electrophysiology lab where the device is placed aboard a catheter (a thin, flexible tube) and moved up to the heart through the femoral vein in the leg. The device lasts for about a decade, and because it is so small, another one can be added to the same heart chamber years down the road when needed. The patient can also be safely scanned using certain types of full-body MRI.  

Zero-radiation ablation

Ablation is a procedure that uses cauterization to burn or scar the electric pathways that trigger the arrhythmia or abnormal heart rhythm. During a conventional ablation procedure, real-time X-ray, called fluoroscopy, is used and it delivers the equivalent radiation of up to 830 chest X-rays. At Stony Brook, my colleague, Dr. Roger Fan routinely performs complex ablations for AFib without any fluoroscopy at all. This important advance eliminates radiation exposure to the patient, with the same excellent results as conventional ablation. Zero-radiation ablation is such an important advance for the overall health of the patient, since excessive radiation can lead to medical problems over the long term. 

Questions about your heart’s rhythm? Call Dr. Rashba at 631-444-3575 or call 631-444-3278. Interested in learning more about your heart health? Take the free heart health online risk assessment at www.stonybrookmedicine.edu/hearthealth.

Dr. Eric Rashba is the director of the Heart Rhythm Center at the Stony Brook University Heart Institute.

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A ribbon cutting kicks off last year's event. Photo by Alex Petroski

Spring has sprung and that means it’s time for the Greater Port Jefferson Chamber of Commerce’s annual Health & Wellness Fest. Celebrating its ninth year, the event returns to the Earl L. Vandermeulen High School, 350 Old Post Road, Port Jefferson on Saturday, April 28 from 9 a.m. to 1 p.m.  

Sample healthy snacks at the event.
Photo by Alex Petroski

Visitors to the free event will enjoy healthy food samples at a food court sponsored by St. Charles Hospital. Their new executive chef Thomas Mulzoff along with dietitians, nutritionists and staff will be on hand to assist hungry attendees and answer questions about healthy eating and diet. A nutritional menu will be offered with a variety of breakfast and lunch items including delicious multigrain breakfast parfaits, strawberry oat bars, tacos two ways (turkey carnitas and freekeh), white bean guacamole and chocolate hummus.So bring you appetite and enjoy great tasting food that is healthy for you!

The selection of health professionals and organizations is extensive, and information will be given out about supporting healthy lifestyles. Members of the Suffolk County Sheriff’s Office will be on hand to speak about their sponsored Yellow Dot Program, a free service designed to help first responders provide life-saving medical attention during that first “golden hour” after a crash or other emergency. A yellow dot in the driver’s-side rear window of your vehicle will alert first responders that vital medical information is stored in the glove compartment. In addition there will be representatives from alternative residential communities, health practitioners and low-cost health insurance plans and programs.   

There will be lots of free giveaways at the event.
Photo by Alex Petroski

Attendees also will have the benefit of many free giveaways and screenings that are so important for good health including blood pressure, body mass index (BMI) screening, glucose, lung cancer, colorectal cancer, otoscopy for cerumen (earwax), hearing, cholesterol, balance and fall prevention and posture.

If this was not enough, there will be many activities to engage in! If you like yoga why not join yoga master Diane McDonald, a life transition coach and yoga teacher, in a short mini-yoga class that will introduce you to the therapeutic benefits of physical, mental and spiritual practices.

How about visiting with licensed, registered and board-certified art therapists? Art therapy allows older adults to be creative and allows them to be reached in a way that promotes a unique form of mental health treatment. And let’s not forget man’s best friend. Learn about healthy food for your pets including Natural Hounds, which offers human-grade wet food, preportioned, nourishing dog treats tailored to your dog’s individual needs.   

New this year

Stop by the Port Jefferson Free Library table for some fun! Photo by Alex Petroski

What’s friendly, furry and can be in the room with grieving families? A trained service dog that specializes in grief therapy. Owned by Peter Moloney of Moloney Funeral Homes, Koda, a 2½-year-old black Lab Weimaraner mix, comes to the funeral home where people pet him and he shows affection to those who want it. He is the first grief therapy dog on Long Island. Come meet Koda at the Health & Wellness Fest.

A special tai chi demonstration will take place at 11:30 a.m., performed by the Authentic Shaolin Kung Fu School of Holtsville. See how these internal Chinese martial arts can be practiced for both their defense training and their health benefits through the forces of yin and yang. After the demonstration attendees will be asked to join in! 

Other activities will include pilates demonstrations by Port Jefferson Pilates located in Port Jefferson Village. Pilates is a physical fitness system developed in the early 20th century and has shown that regular sessions can help muscle conditioning in healthy adults, when compared to doing no exercise.

Don’t forget to stop by the Port Jefferson Free Library table for free giveaways, puzzle solving, coloring for all ages and brain games! Solve a riddle and win a puzzle, while supplies last. Island Christian Church members will have face painting and balloon time with additional children’s activities as well.

Family Fun Run

The Health & Wellness Fest has partnered with the Royal Educational Foundation of Port Jefferson, which will be celebrating its fifth annual Power of One Family Fun Run on April 28 as well. 

The event is designed to encourage physical activity and is intended to celebrate the positive influence we can have on one another within our families and community. Whether you wish to walk or run, the 2-mile course is open to all ages.

Christian Neubert, a Port Jefferson Schools music teacher, volunteer fireman and Port Jefferson Library trustee will be honored with the Power of One Award for his significant positive impact on the village and school community. The proceeds of this fundraiser will be used to enhance the quality of education in the Port Jefferson School District. 

The run begins at 8 a.m. at the Port Jefferson Village Center, at 101A East Broadway, continues through the streets of Port Jefferson Village, and ends at the high school where runners are welcome to visit the health fest. 

You may register by downloading the registration form at www.pjref.com (click on the Power of One Fun Run tab). You may also register the day of the run between 7:30 and 8 a.m. at the Village Center. Advanced registrants need to check in no later than 8:15 a.m.  

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The Greater Port Jefferson Chamber of Commerce’s 9th annual Health & Wellness Fest has something for the entire family. Mark your calendar now. When you finish attending the fest, visit the downtown business community for its first Port Jefferson Sidewalk Sale Days event from 1 to 5 p.m. Shop at over 20 different retailers throughout the heart of the village. If you are lucky you might win one of the two door prizes that will be raffled off at the fest, each having $250 worth of gift certificates to our local merchants in support of the Port Jefferson Retailers Association. 

For more information, please visit www.portjeffhealth.com.

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0 2023
Pedometers can be the first step to helping those with mild COPD. Stock photo
Lifestyle changes can reduce COPD exacerbations

By David Dunaief, M.D.

Dr. David Dunaief

COPD, or chronic obstructive pulmonary disease, is the third leading cause of mortality in the United States (1), although it’s not highlighted much in the layman’s press.

COPD is an umbrella term that includes emphysema, chronic bronchitis of more than three months for two consecutive years and/or chronic obstructive asthma. It is an obstructive lung disease that limits airflow. The three most common symptoms of the disease involve shortness of breath, especially on exertion, production of sputum and cough. This disease affects 6.7 percent of the U.S. population (2).

It tends to be progressive, meaning more frequent and severe exacerbations over time. Since it is a devastating and debilitating chronic disease with no cure, anything that can identify and prevent COPD exacerbations, as well as comorbidities (associated diseases), is critically important.

What are the traditional ways to reduce the risk of and treat COPD exacerbations? The most important step is to stop smoking, since 80 percent of COPD is related to smoking. Supplemental oxygen therapy and medications, such as corticosteroids, bronchodilators (beta-adrenergic agonists and anticholinergics) and antibiotics help to alleviate symptoms (3).

One of the underlying components of COPD may be chronic inflammation (4). Therefore, reducing inflammation may help to stem COPD exacerbations. There are several inflammatory biomarkers that could potentially help predict exacerbations and mortality associated with this disease, such as interleukin-6 (IL-6), C-reactive protein (CRP), leukocyte (white blood cell) count and fibrinogen (a clotting factor of the blood).

How do we reduce inflammation, which may contribute to exacerbations of this disease? Some drugs, such as statins, work partially by reducing inflammation. They may have a role in COPD. Lifestyle changes that include a high-nutrient, anti-inflammatory diet and exercise may also be beneficial. Let’s look at the evidence.

Biomarkers for inflammation

In a recent population-based study with over 60,000 participants, results show that as three biomarkers (CRP, leukocyte count and fibrinogen) were elevated, the risk of COPD exacerbation increased in a linear manner (5). In other words, the risk of frequent exacerbation increased 20, 70 and 270 percent within the first year as the number of elevated biomarkers increased from one to three, compared to patients who did not have biomarker elevations.

As time progressed beyond the first year of follow-up, risk exacerbation continued to stay high. Patients with all three biomarkers elevated for longer periods had a 150 percent increased risk of frequent exacerbations. These predictions were applicable to patients with stable and with mild COPD.

In an observational study, results showed that when the biomarker IL-6 was elevated at the start of the trial in stable COPD patients, the risk of mortality increased almost 2.7-fold (6). Also, after three years, IL-6 increased significantly. Elevated IL-6 was associated with a worsening of six-minute walking distance, a parameter tied to poor physical performance in COPD patients. However, unlike the previous study, CRP did not show correlation with increased COPD exacerbation risk. This was a small trial, only involving 53 patients. Therefore, the results are preliminary.

These biomarker trials are exciting for their potential to shape treatments based on level of exacerbation risk and mortality, creating more individualized therapies. Their results need to be confirmed in a randomized controlled trial (RCT). Many of these biomarkers mentioned in the two trials are identifiable with simple blood tests at major labs.

Statin effect

Statins have been maligned for their side effects, but their efficacy has been their strong suit. An observational trial showed that statins led to at least a 30 percent reduction in the risk of COPD exacerbations, with the effect based on a dose-dependent curve (7). In other words, as the dose increased, so did the benefit.

Interestingly, even those who had taken the statin previously saw a significant reduction in COPD exacerbation risk. The duration of statin use was not important; a short use of statins, whether presently or previously, had substantial benefit. 

However, the greatest benefit was seen in those who had been on a medium to high dose or were on the drug currently. The researchers believe that the mechanism of action for statins in this setting has to do with their anti-inflammatory and immune-modulating effects. This was a retrospective (backward-looking) study with over 14,000 participants. We will need a prospective (forward-looking) study and an RCT to confirm the results.

Exercise

Pedometers can be the first step to helping those with mild COPD. Stock photo

Exercise is beneficial for almost every circumstance, and COPD is no exception. But did you know that a pedometer might improve results? In a three-month study, those with mild COPD were much more successful at achieving exercise goals and reducing exacerbations and symptoms when they used pedometers, compared to the group given advice alone (8). Pedometers gave patients objective feedback on their level of physical activity, which helped motivate them to achieve the goal of walking 9,000 steps daily. This is a relatively easy way to achieve exercise goals and reduce the risk of COPD exacerbations.

When exercising, we are told to vary our exercise routines on a regular basis. One study demonstrates that this may be especially important for COPD patients (9). Results show that nonlinear periodization exercise (NLPE) training is better than traditional routines of endurance and resistance training in severe COPD patients. The goal of NLPE is to alter the time spent working out, the number of sets, the number of repetitions and the intensity of the workout on a regular basis.

This study was randomized, involved 110 patients and was three months in duration. Significantly more severe COPD patients achieved their exercise goals using NLPE rather than the traditional approach. The group that used NLPE also had an improved quality of life response. The researchers believe that compliance with an NLPE-type program is mostly likely going to be greater because patients seem to enjoy it more.

Chronic inflammation may play a central role in COPD exacerbation. Nonspecific inflammatory biomarkers are potentially valuable for providing a more personalized approach to therapy. Drugs that can control inflammation, such as statins, show promise. But don’t forget the importance of lifestyle changes, such as quitting smoking and committing to an exercise regimen that is varied and/or involves the use of a pedometer. And potentially a high-nutrient, anti-inflammatory diet will also contribute positively to reducing the frequency and severity of COPD exacerbations.

References:

(1) Natl Vital Stat Rep. 2011 Dec.;59(10):1-126. (2) cdc.gov. (3) N Engl J Med. 2002;346:988-994. (4) www.goldcopd.org. (5) JAMA. 2013;309:2353-2361. (6) Respiratory Research. 2013;14:24. (7) Am J Med. 2013 Jul;126:598-606. (8) ATS 2013 International Conference: Abstract A1360. (9) Am J Respir Crit Care Med. 2013; online Feb. 28.

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

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A NEW YOU: RSVP Suffolk will host a free Better Choices, Better Health workshop on Mondays, May 7, 14, 21 and June 4, 11 and 18 at the Rose Caraccapa Senior Center, 739 Route 25A, Mt. Sinai from 1 to 3 p.m. This six-week led program will help you self-manage your chronic illness and live a healthier life. The course will address healthy eating, the importance of exercise and relaxation and stress reduction. Highly recommended for people who need to make healthy lifestyle changes before elective surgery.  Please register at the Center or call (631) 476-6431.

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0 2462
In addition to bananas, plenty of other foods are high in potassium. Above are just a few examples. Stock photo
Most Americans don’t consume enough potassium

By David Dunaief M.D.

Dr. David Dunaief

One of the most popular food additives is also one of the most dangerous: salt. We need salt, but not in excess. On the other hand, potassium is beneficial in our diet. However, we have the opposite problem with potassium: It is under-consumed.

More than 90 percent of people consume far too much sodium, with salt being the primary culprit (1). Sodium is found in foods that don’t even taste salty. Bread and rolls are the primary offenders, since we eat so much of them. Other foods with substantial amounts of sodium are cold cuts and cured meats, cheeses, pizza (which has both bread and cheese), fresh and processed poultry, soups, meat dishes, pastas and snack foods. Foods that are processed and those prepared by restaurants are where most of our consumption occurs (2).

By contrast, only about 2 percent of people get enough potassium from their diets (3). According to one study, we would need to consume about eight sweet potatoes or 10 bananas each day to reach appropriate levels. Why is it important to reduce sodium and increase potassium? A high sodium-to-potassium ratio increases the risk of cardiovascular disease by 46 percent, according to the study, which looked at more than 12,000 Americans over almost 15 years (4). In addition, both may have significant impacts on blood pressure and cardiovascular disease.

To improve our overall health, we need to tip the sodium-to-potassium scales, consuming less sodium and more potassium. Let’s look at the evidence.

Reduced sodium

There are two studies that illustrate the benefits of reducing sodium in high blood pressure and normotensive (normal blood pressure) patients, ultimately preventing cardiovascular disease, including heart disease and stroke.

The first study used the prestigious Cochrane review to demonstrate that blood pressure is reduced by a significant mean of −4.18 mm Hg systolic (top number) and −2.06 mm Hg diastolic (bottom number) involving both normotensive and hypertensive participants (5). When looking solely at hypertensive patients, the reduction was even greater, with a systolic blood pressure reduction of −5.39 mm Hg and a diastolic blood pressure reduction of −2.82 mm Hg.

This was a meta-analysis (a group of studies) that evaluated data from randomized clinical trials, the gold standard of studies. There were 34 trials reviewed with more than 3,200 participants. Salt was reduced from 9 to 12 grams per day to 5 to 6 grams per day. These levels were determined using 24-hour urine tests. The researchers believe there is a direct linear effect with salt reduction. In other words, the more we reduce the salt intake, the greater the effect of reducing blood pressure. The authors concluded that these effects on blood pressure will most likely result in a decrease in cardiovascular disease.

In the second study, a meta-analysis of 42 clinical trials, there was a similarly significant reduction in both systolic and diastolic blood pressures (6). This meta-analysis included adults and children. Both demographics saw a reduction in blood pressure, though the effect, not surprisingly, was greater in adults. Interestingly, an increase in sodium caused a 24 percent increased risk of stroke incidence but, more importantly, a 63 percent increased risk of stroke mortality. The risk of mortality from heart disease was increased as well, by 32 percent.

In an epidemiology modeling study, the researchers projected that either a gradual or instantaneous reduction in sodium would save lives (7). For instance, a modest 40 percent reduction over 10 years in sodium consumed could prevent 280,000 premature deaths. These are only projections, but in combination with the above studies may be telling. The bottom line is: decrease sodium intake by almost half and increase potassium intake from foods.

Potassium’s positive effects

When we think of blood pressure, sodium comes to mind, but not enough attention is given to potassium. The typical American diet doesn’t contain enough of this mineral.

In a meta-analysis involving 32 studies, results showed that as the amount of potassium was increased, systolic blood pressure decreased significantly (8). When foods containing 3.5 to 4.7 grams of potassium were consumed, there was an impressive −7.16 mm Hg reduction in systolic blood pressure with high blood pressure patients. Anything more than this amount of potassium did not have any additional benefit. Increased potassium intake also reduced the risk of stroke by 24 percent. This effect was important. If this does not sound like a large reduction, consider that, by comparison, aspirin has been shown to reduce the risk of stroke by 20 percent.

The reduction in blood pressure was greater with increased potassium consumption than with sodium restriction, although there was no head-to-head comparison done. The good news is that potassium is easily attainable in the diet. Foods that are potassium rich include bananas, sweet potatoes, almonds, raisins and green leafy vegetables such as Swiss chard.

Lowering sodium intake may have far-reaching benefits, and it is certainly achievable. We need to reduce our intake and give ourselves a brief period to adapt — it takes about six weeks to retrain our taste buds, once we reduce our sodium intake. We can also improve our odds by increasing our dietary potassium intake, which also has a substantial beneficial effect, striking a better sodium-to-potassium balance.

References:

(1) Am J Clin Nutr. 2012 Sep;96(3):647-657. (2) www.cdc.gov. (3) Am J Clin Nutr. 2012 Sep;96(3):647-657. (4) Arch Intern Med. 2011;171(13):1183-1191. (5) BMJ. 2013 Apr 3;346:f1325. (6) BMJ. 2013 Apr 3;346:f1326. (7) Hypertension. 2013; 61: 564-570. (8) BMJ. 2013; 346:f1378.

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

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