Above, Stony Brook Medicine’s Puerto Rico medical relief team. Photo from SBU
By Kenneth Kaushansky, M.D.
Dr. Kenneth Kaushansky
As the holidays arrive, our thoughts turn to giving — and giving back to those who need our help. Stony Brook Medicine’s Puerto Rico medical relief team did just that, spending two weeks on the devastated island to treat patients and give a much-needed break to health care workers there.
We got word, after Category 5 Hurricane Maria swept through, of the conditions in Puerto Rico. Pharmacies were in ruins. Patients with chronic illnesses who needed to see their primary care physicians could not get appointments. Health care professionals couldn’t tend to their own families, nor repair their damaged homes, because their services were needed around the clock.
Relief efforts for those in Puerto Rico took on many forms. In my role as chair of the Greater New York Hospital Association board of directors, I served as part of an organization that teamed up with the Healthcare Association of New York State to establish the New York Healthcare’s Puerto Rico Hurricane Relief Fund to assist hospitals, health care workers and their families in Puerto Rico. The fund is a vehicle for New York’s hospital community to show its support for frontline caregivers and their families who have suffered significant losses.
I’m proud how Stony Brook Medicine also responded to this human health crisis. As part of a 78-member relief team of personnel from hospitals around the region, Stony Brook organized a team of health care professionals that was deployed to Puerto Rico. They signed on to spend two weeks living and working 12-hour days in less-than-ideal conditions, with widespread shortages of food, water and electricity.
Our 23 care providers — three physicians, two nurse practitioners, nine nurses, four paramedics, four nursing assistants and one pharmacist — split up after arriving in Puerto Rico. Most were stationed in the city of Manatí, while the rest went to the city of Fajardo and then to the U.S. Navy hospital ship USNS Comfort. They worked closely with military personnel, federal agencies and the people of Puerto Rico. They saw more than 2,000 patients and helped local health care workers get some rest and get back on their feet.
Our team returned home in November to cheers and hugs from their co-workers and loved ones who met them at Stony Brook University Hospital. Despite the hardships and long hours, they spoke of the deeply fulfilling experiences they had in Puerto Rico. Their trip embodied the reasons why people choose a career in health care in the first place — to be of service and to provide excellent care.
Stony Brook Medicine’s mission is to deliver world-class, compassionate care to patients and families. And sometimes that mission extends well beyond our own four walls. We are making a difference, not only here at home but in communities around the world.
All of us at Stony Brook Medicine are so extremely proud of our Puerto Rico relief team. The work they did was heroic, generous in the extreme and so worthwhile. Our thanks also go to their families and to their Stony Brook colleagues who stepped up to cover extra shifts while the team was away.
Having heard many of their experiences, I cannot say enough about the team members and their devotion. I know they have returned much better for the experience and are now safely back to continue their efforts to improve the health of our patients.
Dr. Kenneth Kaushansky serves as dean of the School of Medicine and senior vice president of Health Sciences at State University of New York at Stony Brook.
New one-stop clinic opens in Commack to provide care for 9/11 first responders
First responder John Feal gets a checkup at the Stony Brook WTC Wellness Program center, which opened a new facility in Commack, Nov. 28. Photo from Stony Brook WTC Wellness Program website
Accessing medical treatment on Long Island has become easier for 9/11 first responders.
Stony Brook WTC Wellness Program celebrated the official opening of its new one-stop health clinic in Commack Nov. 28. The program relocated from Islandia to the Stony Brook Medicine Advanced Specialty Care building, located at 500 Commack Road. The move allowed the program to expand from a monitoring facility into a 20,000-square-foot, integrative clinic where World Trade Center responders can receive more comprehensive medical treatment under one roof.
Dr. Benjamin Luft, program director and principal investigator, said the clinic is dedicated to caring for approximately 10,000 patients suffering from illnesses after volunteering at Ground Zero after 9/11. He said the responders suffer from a wide variety of conditions and the new location will provide the medical staff more resources. Among the new services available will be blood testing and imaging, which weren’t available in Islandia and caused patients to have to go elsewhere.
“This is ideal for the World Trade responder patient population, and the reason why is these patients who have been so severely affected by the World Trade Center disaster have a compendium of various abnormalities and disorders which are directly related to 9/11,” Luft said. “These included diseases ranging from psychiatry diseases to respiratory and gastrointestinal problems, to cancer.”
“The program is now a state-of-the-art facility that not only monitors you, but treats you and gives you top-notch medical care all in one facility.”
— John Feal
The doctor said the program has a research team dedicated to studying neurocognitive problems, autoimmune issues and cancer-related illness. The new Commack location has an in-house laboratory that will make accessing patients’ samples and processing them easier. He said many of the illnesses related to the disaster were not initially recognized, and the number of patients has grown approximately 8 to 10 percent each year since the monitoring clinic first opened on the Stony Brook University campus shortly after 9/11.
The day of the Commack grand opening, the Stony Brook WTC Wellness Program honored John Feal, a first responder and founder of the Fealgood Foundation. A Nesconset resident and Commack native, he said having the clinic where he grew up is special to him. Feal and members of his organization worked tirelessly to get the James Zadroga 9/11 Health and Compensation Act passed in Dec. 2010 and again in 2015. The act enables first responders, volunteers and survivors of the Sept. 11 attacks to receive health monitoring and financial aid.
Luft said at first the program treated many patients who lacked medical insurance coverage. “So when they got sick, they didn’t have health insurance or have someone to take care of their acute problems,” he said. “We established our clinic to do that at no additional costs to the patients.”
Feal, who was a patient at the Islandia clinic and recently had his physical in Commack, said he was impressed with the new location.
“The program is now a state-of-the-art facility that not only monitors you, but treats you and gives you top-notch medical care all in one facility,” Feal said.
He said having a one-stop clinic is important to many, especially for those who have become too frail to travel. Aging is an issue as many are now in their mid-50s or older.
“As we get further away from 9/11, the illnesses are getting worse,” Feal said. “One, because of age and, two, because with these illnesses, some latency periods and manifestations in the body take this long.”
The first responder said it was humbling to be honored for his work Nov. 28.
“We’re talking about human life, and I’m never going to apologize for anything I ever said or did, because at the end of the day I only care about helping those who are sick from 9/11,” Feal said. “And so many people are getting sick. It’s not ending anytime soon.”
A recent study found that those who walk with more pace are more likely to decrease their mortality from all causes and increase their longevity.
Look beyond the number of steps you take
Dr. David Dunaief
By David Dunaief, M.D.
For most of us, exercise is not a priority during the winter months, especially during the holiday season. We think that it’s okay to let ourselves go and that a few more pounds will help insulate us from the anticipated cold weather, when we will lock ourselves indoors and hibernate. Of course I am exaggerating, but I am trying to make a point. During the winter, it is even more important to put exercise at the forefront of our consciousness, because we tend to gain the most weight during the Thanksgiving to New Year holiday season (1).
Many times we are told by the medical community to exercise, which of course is sage advice. It seems simple enough; however, the type, intensity level and frequency of exercise may not be well defined. For instance, any type of walking is beneficial, right? Well, as one study that quantifies walking pace notes, some types of walking are better than others, although physical activity is always a good thing compared to being sedentary.
We know exercise is beneficial for prevention and treatment of chronic disease. But another very important aspect of exercise is the impact it has on specific diseases, such as diabetes and osteoarthritis. Also, certain supplements and drugs may decrease the beneficial effects of exercise. They are not necessarily the ones you think. They include resveratrol and nonsteroidal anti-inflammatory drugs (such as ibuprofen). Let’s look at the evidence.
Walking with a spring in your step
While pedometers give a sense of how many steps you take on a daily basis, more than just this number is important. Intensity, rather than quantity or distance, may be the primary indicator of the benefit derived from walking.
In the National Walkers’ Health Study, results showed that those who walk with more pace are more likely to decrease their mortality from all causes and to increase their longevity (2). This is one of the first studies to quantify specific speed and its impact. In the study, there were four groups. The fastest group was almost jogging, walking at a mean pace of less than 13.5 minutes per mile, while the slowest group was walking at a pace of 17 minutes or more per mile.
The slowest walkers had a higher probability of dying, especially from dementia and heart disease. Those in the slowest group stratified even further: Those whose pace equaled 24-minute miles or greater had twice the risk of death compared to those who walked with greater speed. However, the most intriguing aspect of the study was that there were big differences in mortality reduction in the second slowest category compared to the slowest, which might only be separated by a minute-per-mile pace. So don’t fret: You don’t have to be a speed walker in order to get significant benefit.
Mind-body connection
The mind also plays a significant role in exercise. When we exercise, we tend to beat ourselves up mentally because we are disappointed with our results. The results of a new study say that this is not the best approach (3). Researchers created two groups. The first was told to find four positive phrases, chosen by the participants, to motivate them while on a stationary bike and repeat these phrases consistently for the next two weeks while exercising.
Members of the group who repeated these motivating phrases consistently, throughout each workout, were able to increase their stamina for intensive exercise after only two weeks, while the same could not be said for the control group, which did not use reinforcing phrases.
‘Longevity’ supplement may have negative impact
Resveratrol is a substance that is thought to provide increased longevity through proteins called Sirtuin 1. So how could it negate some benefit from exercise? Well, it turns out that we need acute inflammation to achieve some exercise benefits, and resveratrol has anti-inflammatory effects. Acute inflammation is short-term inflammation and is different from chronic inflammation, which is the basis for many diseases.
In a small randomized controlled study, treatment group participants were given 250 mg supplements of resveratrol and saw significantly less benefit from aerobic exercise over an eight-week period, compared to those who were in the control group (4). Participants in the control group had improvements in both cholesterol and blood pressure that were not seen in the treatment group. This was a small study of short duration, although it was well designed.
Impact on diabetes complications
Unfortunately, type 2 diabetes is on the rise, and the majority of these patients suffer from cardiovascular disease. Drugs used to control sugar levels don’t seem to impact the risk for developing cardiovascular disease.
So what can be done? In a recent prospective (forward-looking) observational study, results show that diabetes patients who exercise less frequently, once or twice a week for 30 minutes, are at a higher risk of developing cardiovascular disease and almost a 70 percent greater risk of dying from it than those who exercised at least three times a week for 30 minutes each session. In addition, those who exercised only twice a week had an almost 50 percent increased risk of all-cause mortality (5). The study followed more than 15,000 men and women with a mean age of 60 for five years. The authors stressed the importance of exercise and its role in reducing diabetes complications.
Fitness age
You can now calculate your fitness age without the use of a treadmill, according to the HUNT study [6]. A new online calculator utilizes basic parameters such as age, gender, height, weight, waist circumference and frequency and intensity of exercise, allowing you to judge where you stand with exercise health. This calculator can be found at www.ntnu.edu/cerg/vo2max. The results may surprise you.
Even in winter, you can walk and talk yourself to improved health by increasing your intensity while repeating positive phrases that help you overcome premature exhaustion. Frequency is important as well. Exercise can also have a significant impact on complications of chronic diseases, such as cardiovascular disease and resulting death with diabetes.
When the weather does become colder, take caution when walking outside to avoid black ice or use a treadmill to walk with alacrity. Getting outside during the day may also help you avoid the winter blues.
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.
This Thanksgiving, offer healthy dessert options like dairy-free pumpkin pudding, above, or fruit salad.
Eating well can set the table for a year of well-being
By David Dunaief, M.D.
Dr. David Dunaief
Many of us give thanks for our health on Thanksgiving. Well, let’s follow through with this theme. While eating healthy may be furthest from our minds during the holidays, it is so important.
Instead of making Thanksgiving a holiday of regret, eating foods that cause weight gain, fatigue and that increase your risk for chronic diseases, you can reverse this trend while maintaining the traditional theme of what it means to enjoy a festive meal.
What can we do to turn Thanksgiving into a bonanza of good health? Phytochemicals (plant nutrients) called carotenoids have antioxidant and anti-inflammatory activity and are found mostly in fruits and vegetables. Carotenoids make up a family of more than 600 different substances, such as beta-carotene, alpha-carotene, lutein, zeaxanthin, lycopene and beta-cryptoxanthin (1).
Carotenoids help to prevent and potentially reverse diseases, such as breast cancer; amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease; age-related macular degeneration; and cardiovascular disease — heart disease and stroke. Foods that contain these substances are orange, yellow and red vegetables and fruits and dark green leafy vegetables. Examples include sweet potato, acorn squash, summer squash, spaghetti squash, green beans, carrots, cooked pumpkin, spinach, kale, papayas, tangerines, tomatoes and Brussels sprouts.
Let’s look at the evidence.
Breast cancer effect
We know that breast cancer risk is high among women, especially on Long Island. An American woman has an average risk of 12.4 percent for getting breast cancer (2). Therefore, we need to do everything within reason to reduce risk.
In a meta-analysis (a group of eight prospective or forward-looking studies), results show that women who were in the second to fifth quintile blood levels of carotenoids, such as alpha-carotene, beta-carotene and lutein and zeaxanthin, had significantly reduced risk of developing breast cancer (3).
Thus, there was an inverse relationship between carotenoid levels and breast cancer risk. Even modest amounts of carotenoids can have a resounding effect in potentially preventing breast cancer.
ALS is a disabling and feared disease. Unfortunately, there are no effective treatments for reversing this disease. Therefore, we need to work double time in trying to prevent its occurrence.
In a meta-analysis of five prestigious observational studies, including The Nurses’ Health Study and the Health Professionals Follow-Up Study, results showed that people with the greatest amount of carotenoids in their blood from foods like spinach, kale and carrots had a decreased risk of developing ALS and/or delaying the onset of the disease (4). This study involved over 1 million people with more than 1,000 who developed ALS.
Those who were in the highest carotenoid level quintile had a 25 percent reduction in risk, compared to those in the lowest quintile. This difference was even greater for those who had high carotenoid levels and did not smoke, a 35 percent reduction. According to the authors, the beneficial effects may be due to antioxidant activity and more efficient function of the power source of the cell: the mitochondria. This is a good way to prevent a horrible disease while improving your overall health.
Positive effects of healthy eating
Despite the knowledge that healthy eating has long-term positive effects, there are several obstacles to healthy eating. Two critical factors are presentation and perception.
Presentation is glorious for traditional dishes, like turkey, gravy and stuffing with lots of butter and creamy sauces. However, vegetables are usually prepared in either an unappetizing way — steamed to the point of no return, so they cannot compete with the main course — or smothered in cheese, negating their benefits, but clearing our consciences.
Many consider Thanksgiving a time to indulge and not think about the repercussions. Plant-based foods like whole grains, leafy greens and fruits are relegated to side dishes or afterthoughts. Why is it so important to change our mindsets? Believe it or not, there are significant short-term consequences of gorging ourselves.
Not surprisingly, people tend to gain weight from Thanksgiving to New Year. This is when most gain the predominant amount of weight for the entire year. However, people do not lose the weight they gain during this time (5). If you can fend off weight gain during the holidays, just think of the possibilities for the rest of the year.
Heart attack risk: Even in the short term
Also, if you are obese and sedentary, you may already have heart disease. Overeating at a single meal increases your risk of heart attack over the near term, according to the American Heart Association (6). However, with a little Thanksgiving planning, you can reap significant benefits. What strategies should you employ for the best outcomes?
• Make healthy, plant-based dishes part of the main course. I am not suggesting that you forgo signature dishes, but add to tradition by making mouthwatering vegetable-based dishes for the holiday.
• Improve the presentation of vegetable dishes. Most people don’t like grilled chicken without any seasoning. Why should vegetables be different? In my family, we make sauces for vegetables, like a peanut sauce using mostly rice vinegar and infusing a teaspoon of toasted sesame oil. Good resources for appealing dishes can be found at www.PCRM.org, www.DrFuhrman.com, www.EatingWell.com, www.wholefoodsmarket.com and many other resources.
• Replace refined grains. A study in the American Journal of Clinical Nutrition, showed that replacing wheat or refined grains with whole wheat and whole grains significantly reduced central fat, or fat around the belly (7). Not only did participants lose subcutaneous fat found just below the skin but also visceral adipose tissue, the fat that lines organs and causes chronic diseases such as cancer. For even better results, consider substituting finely chopped cauliflower for rice or other starches.
• Create a healthy environment. Instead of putting out creamy dips, processed crackers and candies as snacks prior to the meal, put out whole grain brown rice crackers, baby carrots, cherry tomatoes and healthy dips like hummus and salsa. Help people choose wisely.
• Offer healthy dessert options. Options might include dairy-free pumpkin pudding and fruit salad.
The goal should be to increase your nutrient-dense choices and decrease your empty-calorie foods. You don’t have to be perfect, but improvements during this time period have a tremendous impact — they set the tone for the new year and put you on a path to success. Why not turn this holiday into an opportunity to de-stress, rest and reverse or prevent chronic disease by consuming plenty of carotenoid-containing foods.
References: (1) Crit Rev Food Sci Nutr 2010;50(8):728–760. (2) SEER Cancer Statistics Review, 1975–2009, National Cancer Institute. (3) J Natl Cancer Inst 2012;104(24):1905-1916. (4) Ann Neurol 2013;73:236–245. (5) N Engl J Med 2000; 342:861-867. (6) www.heart.org. (7) Am J Clin Nutr 2010 Nov;92(5):1165-71Givi.
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.
Lifestyle modifications, particularly switching to plant-based diets, are effective tools in reversing diabetes.
Antioxidants in foods may reduce diabetes risk
By David Dunaief, M.D.
Type 2 diabetes continues to be an epidemic that is monopolizing health care budgets. According to the Centers for Disease Control and Prevention, the incidence of diabetes has tripled in the last 20 years (1). We need a plan to prevent the disease and to reverse its course.
In medicine, our arsenal of drug therapies has grown considerably, but there are unpleasant side effects. Drugs have even been shown to reduce cardiovascular disease in diabetes patients, which is the number one reason that patients die.
However, there is nothing potentially more powerful with beneficial side effects than lifestyle modifications, especially diet and exercise. And when it comes to reversal, lifestyle modifications are the only potential source.
Two large observational studies, the Adventist Health Study 2 and the EPIC trial, have shown the considerable prevention abilities of diet. In terms of reversal, several studies with a plant-based diet, including one run by Dr. Neal Barnard and another that I published with Dr. Joel Fuhrman, indicate its efficacy. These are backed up by additional anecdotal stories from my clinical experience over an 11-year period.
Let’s look at the research.
Prevention of diabetes with diet
Lifestyle modifications, particularly switching to plant-based diets, are effective tools in reversing diabetes.
A recently published prospective study of the E3N EPIC trial showed considerable benefit from the antioxidant capacity of foods including fruits, vegetables and tea (2). Those who consumed the highest quintile of antioxidants reduced their diabetes risk 39 percent compared to the lowest quintile. After adjusting for weight loss, there was still a statistically significant 27 percent reduction. Interestingly, fruits had the greatest impact with a 23 percent decrease in risk, and vegetables followed with a 19 percent decrease.
This study serves two purposes: one, it shows that antioxidant capacity is important in food; and two, it demonstrates that fruit actually has beneficial effects for those at risk of diabetes. This was not solely a plant-based diet or a vegan or vegetarian diet. This is an impressive effect considering that people may have been eating many other items that may not have been beneficial in addition to fruits and vegetables.
Study participants were 64,223 women who did not have diabetes or cardiovascular disease at the beginning of the study. One of the major weakness of this trial is that the food frequency questionnaire was only used at the study’s start. This means we have to assume people continued to eat the same way throughout the study.
In the Adventist Health Study, the results of a plant-based diet were very powerful. This showed significant effects and, unlike the EPIC trial, compared people who were trying to eat healthy with those who ate either a vegan or vegetarian plant-based diet. Results showed that those who ate a vegan plant-based diet and those who ate a lacto-ovo vegetarian diet were at 62 and 38 percent, respectively, lower risk of developing diabetes than those who were eating a health-conscious omnivore diet (3). This study reaffirms how a plant-based diet is so important when it comes to preventing diabetes.
There were 15,200 men and 26,187 women in this study, and the results were as impressive in both blacks and nonblacks.
Reversal of diabetes with diet
A randomized controlled trial, considered the gold standard of trials, used drug therapy to reduce HbA1C to near nondiabetes levels; however, they could not achieve this before multiple deaths occurred (4). The reason, the researchers surmise, was polypharmacy, or too many drugs.
Fortunately, this is not the case with lifestyle modifications. In one randomized controlled trial, Barnard compared a low-fat vegan diet to the American Diabetes Association diet at the time. The results showed that with a low-fat vegan diet, HbA1C was reduced significantly more than with the ADA diet (5). This trial included 49 patients on the low-fat vegan diet and 50 patients on the ADA diet. The trial duration was 74 weeks. This trial, though small, does show substantial benefit with a low-fat vegan diet.
The benefits of a plant-based diet have been known for many decades. In a 1979 study on diabetes, results showed that insulin was significantly reduced by more than half on a high carbohydrate, high-plant fiber diet (HCF) compared to a control diet (6). This effect was seen in approximately 2.5 weeks.
Involving 20 men with type 2 diabetes who had a mean duration with diabetes of 8 years, patients were started on the control diet for seven days and then switched to the HCF diet for 16 days. This showed reversal with diet over a short period of time and reduction in medication. Thus, diet does not only have an insidious (slow) effect, but it also has an acute (immediate) effect on diseases. Of course, insulin was the gold standard of treatment at the time.
More recently, in a retrospective (backward-looking) case series with 13 men and women with type 2 diabetes, results showed that HbA1C was reduced from a mean of 8.2 to 5.8 percent over a seven-month period (7). This was an impressive 2.4 percent reduction in HbA1C, and 62 percent of patients reached normal sugar levels.
At baseline, patients were on an average of four medications, including diabetes medications. By seven months, they were able to reduce this to one medication while significantly decreasing their HbA1C. In addition, their blood pressure and triglycerides improved. These patients were following a nutrient-dense, plant-based diet. This study was performed by myself and Fuhrman using patients in his practice. The study’s weaknesses were that there was no control arm and that it was retrospective. But this does imply that there is potential for diabetes reversal.
In my clinical practice, I have seen many diabetes patients successfully reverse their disease. Let me share one anecdotal story. A 55-year-old diabetes male Caucasian patient told me that no relative had lived past 57 because they died from diabetes complications. He is currently 60 years old or, as he likes to put it, “three years past expiration date.”
When he first came to see me, he was on four diabetes medications, including insulin, plus a statin. He is no longer on any of these medications. These results were seen in only two months. He did lose weight, but at a much slower pace than the metabolic changes that took place in his body. This anecdotal story is inspirational and reinforces the research above.
In conclusion, while medications are important for the treatment of diabetes, nothing seems to trump lifestyle modifications. Diet, especially, can play both prevention and reversal roles. Even fruit plays a significant role in reducing the incidence of diabetes. Regardless of family history, as demonstrated by my patient, these results can be achieved. Whether or not you are on medications, if you have diabetes, lifestyle modifications should be adopted to get optimal results.
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.
Chronic Medicaid is the program that covers nursing home care.
By Nancy Burner, ESQ.
Nancy Burner, Esq.
When someone enters a nursing facility, an application for Chronic Medicaid may be appropriate. The average cost of a nursing facility on Long Island is $15,000 per month. This type of cost would exhaust assets very quickly in most cases.
Chronic Medicaid is the program that covers nursing home care. Medicaid is a needs-based program, which means there are resource and income requirements that must be met.
For 2017, an individual applying for Chronic Medicaid can have no more than $14,850 in liquid nonqualified assets, an unlimited amount of retirement assets so long as the applicant is taking a monthly required distribution and an irrevocable prepaid funeral trust. The applicant may keep no more than $50 per month in income.
Chronic Medicaid has a five-year look-back. The look-back refers to the period of time that the Department of Social Services will review your assets and any transfers that you have made. To the extent that the applicant has made transfers or has too many assets in their name to qualify, they will be ineligible for Medicaid. If the applicant gifted or transferred money out of his or her name in order to qualify for Medicaid, the Department of Social Services will total the dollar amount of gifts and for each approximately $12,811 that was gifted, one month of Medicaid ineligibility is imposed.
For example, if an individual gifted away approximately $50,000 within the five-year time period, the Department of Social Services will impose a four-month penalty. It is also important to note that the ineligibility begins to run on the day that the applicant enters the nursing home rather than on the day that the gift was made.
If the applicant entered the nursing home in September, the four-month penalty would run for September, October, November and December. Medicaid would pick up starting in January and the applicant would be responsible for the nursing home bill from September through December. If the applicant exceeds $14,850 in liquid assets, there are certain planning mechanisms that can be used in order to qualify the applicant for Chronic Medicaid benefits. One of those mechanisms is establishing an irrevocable pre-need funeral. New York State law mandates that pre-need burial trusts for applicants or recipients of Medicaid be irrevocable.
This means that the prearrangement may not be canceled prior to death nor can funds be refunded if the actual funeral costs are less than then funded agreement. Thereby, an individual with a revocable agreement would have to convert it to an irrevocable agreement if they were to require Medicaid in the future.
The Medicaid applicant is also permitted to set up pre-needs for a spouse, minor and adult children, stepchildren, brothers, sisters, parents and the spouses of these persons. The timing of when these pre-need funeral trusts are established can be crucial to the Medicaid application.
It is important to note aside from the irrevocable pre-need there are other exempt transfers that can be used to qualify an individual for Chronic Medicaid. Transfer of assets to a spouse in an unlimited amount, transfer of the primary residence to a caretaker child, transfer of assets to a disabled child and transfer of the primary residence to a sibling with an equity interest are exempt transfers used to qualify an individual for Chronic Medicaid. Even when there are no exempt transfers, there is last minute planning that can be accomplished that could save approximately half of the remaining assets.
It is crucial to consult an elder law attorney in your area as soon as possible in order to preserve the maximum amount of assets.
Nancy Burner, Esq. practices elder law and estate planning from her East Setauket office. For more information, call 631-941-3434 or visit www.burnerlaw.com.
Fort Salonga resident Wayne Trumbull ran his first marathon in honor of his friend Paul Gugliuzzo who survived respiratory failure. Photo from Wayne Trumbull
To honor his close friend’s fight for life, a Fort Salonga resident took his mark in Staten Island Sunday morning for the run of his.
Wayne Trumbull was among the 50,000 participants in the TCS New York City Marathon Nov. 5, running the 26.2-mile race from Staten Island to Central Park to commemorate his friend Paul Gugliuzzo’s perseverance during a harrowing battle with lung failure last year. It was his first time running a marathon.
Trumbull, 50, ran as a member of the American Lung Association team and raised $11,000 for the organization leading up to the marathon. The funds raised will go toward research, advocacy and medical equipment for lung diseases.
Trumbull, a professional tax partner and part-time sports coach, completed the five-borough race with an unofficial time of four hours, 29 minutes, to the roar of thousands of people lining the streets. The loudest of cheers for him came from members of the Fort Salonga community, including Gugliuzzo, who gave Trumbull a high five as he passed by.
“It’s not easy for a casual runner like me to run 26 miles, but when the chips are down, I’m focusing on what Paul went through,” Trumbull said prior to the race. “He was on the brink of death and he bounced back. This is very motivating and emotional for me.”
Wayne Trumbull and his friend Paul Gugliuzzo. Photo from Wayne Trumbull
Gugliuzzo — a Fort Salonga resident, former construction manager and a friend of Trumbull’s since their sons joined the same Kings Park youth baseball team 10 years ago — was diagnosed with upper lobe emphysema and chronic obstructive pulmonary disease in 2009.
His conditions progressively worsened, and in March 2016 he underwent a bilateral lung volume reduction surgery at Columbia Presbyterian Hospital in New York City. His doctors initially advised it would keep him in the hospital for a week. Medical complications occurred, however, and the day after the surgery, Gugliuzzo went into respiratory failure. He was placed into a medically induced coma for five weeks. He spent 107 days in the surgical intensive care unit — during which time his blood was oxidized with an ECMO machine and he battled multiple bouts with pneumonia. He was released from the hospital in August 2016.
Throughout the lengthy ordeal, Trumbull spent every Friday night at his friend’s bedside offering Gugliuzzo’s wife, Patti, and family members a much-needed reprieve as they were there 24 hours a day, seven days a week.
“Wayne supported us at a time when we needed it most,” Patti Gugliuzzo said. “Truly, if it weren’t for Wayne and our friends in Fort Salonga who rallied around us, I don’t know how we would’ve made it.”
It was during these nights Trumbull realized he had to do something significant for Gugliuzzo.
“At that point I didn’t know if it was going to be to honor his life or his battle — fortunately it ended up being his battle,” Trumbull said.
A casual runner who had previously only competed in Northport’s Great Cow Harbor 10K and other smaller races for charity, Trumbull began the process of fundraising for the American Lung Association. He learned that it was a sponsor for the New York City Marathon.
“The marathon was never something I had on my bucket list, but I knew it was significant and something that took a lot of effort and commitment, and would be a fight in and of itself,” he said. “This is just what I consider being a good friend.”
As the 2016 American Lung Association’s team filled its limited spots by the time Trumbull pursued entry, he applied for this year’s team as soon as they took applications. He was part of a strict training program beginning this past summer and ran five days a week for four months in preparation.
Gugliuzzo, who said his lungs are better now than they’ve been in 15 years, is in the process of rehabilitating himself. He’s looking to Trumbull’s participation in the marathon as motivation to hop on the treadmill every once in awhile.
“If Wayne can do 26 miles, I can do two,” Gugliuzzo said. “Me inspiring him in turn inspires me back. It’s heartwarming what he’s done for me.”
He said his hope one day is to run in the Great Cow Harbor 10K alongside Trumbull.
Kelly and Donna and McCauley held the third annual Butterfly Breakfast for a Cure fundraiser at Applebee’s in Miller Place. Photo by Kevin Redding
By Kevin Redding
A mother-daughter duo from Rocky Point raised thousands of dollars last weekend to help those with epidermolysis bullosa — a rare and painful skin disease that hits close to home.
Donna McCauley, who was born with the genetic condition that causes the skin to blister and tear at the slightest friction, and her daughter Kelly, a former Girl Scout, raised $4,000 during the 3rd Annual Butterfly Breakfast for a Cure fundraiser Nov. 4 at Applebee’s in Miller Place. More than 100 locals gathered at the restaurant to eat pancakes, take part in a Chinese auction with huge prizes for adults and kids and learn about “EB,” which is largely considered “the worst disease you’ve never heard of” and affects one in 20,000 births in the United States.
Donna McCauley auctioned off prizes to raise more funds. Photo by Kevin Redding
All proceeds are going toward Debra of America, a New York City-based nonprofit that provides assistance and support to families with children born with the disease through funding research for a cure and treatment initiatives.
As a teenager, Donna McCauley, whose parents were told she was going to die young from this “genetic anomaly,” made a conscious choice not to let EB — which turns run-of-the-mill activities like getting out of bed, taking clothes on and off and showering into daily struggles — define her life. Instead, she strived to be a role model for other “butterfly children,” a term given to young people with the disease, as their skin is said to be as fragile as a butterfly’s wings.
She became involved with Debra when she was 16, which opened her eyes to a community of others like her, and made sure to get her license, go to college and pursue jobs, vowing “not to be afraid to live” despite her condition.
“I can sit in the corner and rock and be sad, or I can get up and do what I need to do,” said McCauley, 49, who lives in constant pain and must wrap her wounds in bandages each day in order to prevent infections. She is currently in a clinical trial for a new treatment drug by Amicus Therapeutics that helps mend her wounds. “Things like this fundraiser give me hope that people become more aware, and more money is raised. Each day they are getting closer to finding a treatment and a cure.”
Although McCauley has been the face of the event since it started in 2015, the Rocky Point resident who referred to herself as a professional volunteer and remains a coordinator with local Girl Scout troops, pointed to her daughter as the real driving force behind the fundraiser.
“I can sit in the corner and rock and be sad, or I can get up and do what I need to do.”
— Donna McCauley
“One of the things that strikes me the most is that Kelly has a sense of empathy and compassion that I don’t think you can teach,” McCauley said. “I’m so proud of her initiative to make other people more aware of disabilities. She has always been the person who includes the one that isn’t included.”
Kelly McCauley, 19, a current student at Dominican College in Orangeburg, New York, started advocating for EB support as a sophomore at Rocky Point High School by selling bracelets decorated with butterflies to peers and administrators and ended up raising $500 for Debra. This prompted her to want to step things up a notch, and she soon went door to door to local businesses in search of a venue for her own bigger and better fundraiser.
McCauley’s daughter said growing up and witnessing her mom’s perseverance encouraged her to get involved in the first place.
“I saw just how strong she was and how much it took for her just to wake up every day,” she said. “She’s definitely the strongest woman I know. This disease is so much on a person. You wake up and you hurt no matter what. But she still gets up, she goes to church, she volunteers, she works as a religion teacher — she does all these things even though she’s always in some sort of pain.”
McCauley’s determination to live a normal life has served as a foundation for her younger brother, Bob Newfield, a Setauket resident who was also born with EB.
“It’s tough — what would take most people 15 minutes to get ready for work in the morning takes me an hour,” Newfield said. “But there are other things in life that are tough too, so you just have to deal with the cards you’re given. It’s such a rare disease and doesn’t get the funds it needs.”
Local residents, like Miller Place resident Joan Lowry, on right, attended the fundraiser. Photo by Kevin Redding
His wife, Marianne, explained how it’s been to observe the disease firsthand.
“His mind wants to go, go, go, but his body holds him back at times — but those with it are the strongest people I know,” she said. “They don’t really let anything get them down. Bob puts on a happy face every day even though his feet kill him; many days are hard.”
Residents that donated to the cause by purchasing raffle tickets ranged from those living with the disease to others who had never heard of it before.
Bonnie Harris, who grew up in Port Jefferson, said she and a majority of her family have the condition.
“The disease itself doesn’t get better when you get older, but you get better as you get older,” Harris said. “You’re not as clumsy when you’re falling and you’re able to take care of it better. My mom, who had it, always said, ‘You can do anything you want to do — you just have to work harder than everybody else.’”
Miller Place resident Joan Lowry heard of the fundraiser through St. Louis de Montfort R.C. Church in Sound Beach, a parish where McCauley is extremely active.
“There are too many people who fall in the cracks and need the help,” Lowry said, “and that’s the reason I’m here.”
If you wish to make a contribution, visit Debra.org/butterflybreakfast2017.
Jack Law with his wife Kim and his two children, Max and Seth
With a simple swab of your cheek, you can be added to bone marrow registry.
HELP SAVE A LIFE! St. Louis de Montfort Church, 75 New York Ave., Sound Beach will host a “swab drive” to find a bone marrow donor for Sound Beach resident Jack Law, and the many others on the National Registry with life-threatening blood cancers, on Thursday, November 30 from 3 p.m. to 9 p.m.
A newly retired Air Force officer, Law was recently diagnosed with AML Leukemia. His doctors agree that a bone marrow transplant/stem cell transplant is his best option. Call the church at 631-744-8566 for further details.
For more information on the Myths & Facts of donating bone marrow please visit
https://bethematch.org/support-the-cause/donate-bone-marrow/donation-faqs/
Thank you for your support! Please consider liking and sharing posts from this page to help spread awareness of this event.
Arthritis, a history of stroke and Parkinson’s disease can contribute to fall risk.
Increased risk can begin at the age of 45
By David Dunaief, M.D.
Dr. David Dunaief
When we are young, falls usually do not result in significant consequences. However, when we reach middle age and chronic diseases become more prevalent, falls become more substantial. And, unfortunately, falls are a serious concern for older patients, where consequences can be devastating. They can include brain injuries, hip fractures, a decrease in functional ability and a decline in physical and social activities (1). Ultimately, falls can lead to loss of independence (2).
Of those over the age of 65, between 30 and 40 percent will fall annually (3). Most of the injuries that involve emergency room visits are due to falls in this older demographic (4).
What can increase the risk of falls?
Many factors contribute to fall risk. A personal history of falling in the recent past is the most prevalent. But there are many other significant factors, such as age; being female; and using drugs, like antihypertensive medications used to treat high blood pressure and psychotropic medications used to treat anxiety, depression and insomnia.
Chronic diseases, including arthritis, as an umbrella term; a history of stroke; cognitive impairment and Parkinson’s disease can also contribute. Circumstances that predispose us to falls also involve weakness in upper and lower body strength, decreased vision, hearing disorders and psychological issues, such as anxiety and depression (5).
How do we prevent falls?
Fortunately, there are ways to modify many risk factors and ultimately reduce the risk of falls. Of the utmost importance is exercise. But what do we mean by “exercise”? Exercises involving balance, strength, movement, flexibility and endurance, whether home based or in groups, all play significant roles in fall prevention (6). We will go into more detail below.
Many of us in the Northeast suffer from low vitamin D, which may strengthen muscle and bone. This is an easy fix with supplementation. Footwear also needs to be addressed. Nonslip shoes, if recent winters are any indication, are of the utmost concern. Inexpensive changes in the home, like securing area rugs, can also make a big difference.
Medications that exacerbate fall risk
There are a number of medications that may heighten fall risk. As I mentioned, psychotropic drugs top the list. Ironically, they also top the list of the best-selling drugs. But what other drugs might have an impact?
High blood pressure medications have been investigated. A propensity-matched sample study (a notch below a randomized control trial in terms of quality) showed an increase in fall risk in those who were taking high blood pressure medication (7). Surprisingly, those who were on moderate doses of blood pressure medication had the greatest risk of serious injuries from falls, a 40 percent increase. One would have expected those on the highest levels to have the greatest increase in risk, but this was not the case.
While blood pressure medications may contribute to fall risk, they have significant benefits in reducing the risks of cardiovascular disease and events. Thus, we need to weigh the risk-benefit ratio, specifically in older patients, before considering stopping a medication. When it comes to treating high blood pressure, lifestyle modifications may also play a significant role in treating this disease (8).
Where does arthritis fit into this paradigm?
In those with arthritis, compared to those without, there is an approximately two-times increased risk of two or more falls and, additionally, a two-times increased risk of injury resulting from falls, according to the Centers for Disease Control and Prevention (1). This survey encompassed a significantly large demographic; arthritis was an umbrella term including those with osteoarthritis, rheumatoid arthritis, gout, lupus and fibromyalgia.
Therefore, the number of participants with arthritis was 40 percent. Of these, about 13 percent had one fall and, interestingly, 13 percent experienced two or more falls in the previous year. Unfortunately, almost 10 percent of the participants sustained an injury from a fall. Patients 45 and older were as likely to fall as those 65 and older.
Why is exercise critical?
All exercise has value. A meta-analysis of a group of 17 trials showed that exercise significantly reduced the risk of a fall (9). If the categories are broken down, exercise had a 37 percent reduction in falls that resulted in injury and a 30 percent reduction in those falls requiring medical attention. Even more impressive was a 61 percent reduction in fracture risk.
Remember, the lower the fracture risk, the more likely you are to remain physically independent. Thus, the author summarized that exercise not only helps to prevent falls but also fall injuries. The weakness of this study was that there was no consistency in design of the trials included in the meta-analysis. Nonetheless, the results were impressive.
Unfortunately, those who have fallen before, even without injury, often develop a fear that causes them to limit their activities. This leads to a dangerous cycle of reduced balance and increased gait disorders, ultimately resulting in an increased risk of falling (10).
What specific types of exercise are useful?
Many times, exercise is presented as a word that defines itself. In other words: Just do any exercise and you will get results. But some exercises may be more valuable or have more research behind them. Tai chi, yoga and aquatic exercise have been shown to have benefits in preventing falls and injuries from falls.
A randomized controlled trial, the gold standard of studies, showed that those who did an aquatic exercise program had a significant improvement in the risk of falls (11). The aim of the aquatic exercise was to improve balance, strength and mobility. Results showed a reduction in the number of falls from a mean of 2.00 to a fraction of this level — a mean of 0.29. There was no change in the control group.
There was also a 44 percent decline in the number of patients who fell. This study’s duration was six months and involved 108 postmenopausal women with an average age of 58. This is a group that is more susceptible to bone and muscle weakness. Both groups were given equal amounts of vitamin D and calcium supplements. The good news is that many patients really like aquatic exercise.
Thus, our best line of defense against fall risk is prevention. Does this mean stopping medications? Not necessarily. But for those 65 and older, or for those who have “arthritis” and are at least 45 years old, it may mean reviewing your medication list with your doctor. Before considering changing your BP medications, review the risk-to-benefit ratio with your physician. The most productive way to prevent falls is through lifestyle modifications.
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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