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Insomnia is frustrating because it does not necessarily have one cause.
Untreated insomnia can have long-term health effects

By David Dunaief, M.D.

Dr. David Dunaief

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

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

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

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

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

Let’s look at the evidence.

Heart failure

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

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

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

Prostate cancer

Prostate cancer has a plethora of possible causes, and insomnia may be a contributor. Having either of two components of insomnia, difficulty falling asleep or staying asleep (sleep disruption), increased the risk of prostate cancer by 1.7 and 2.1 times, respectively, according to an observational study (5).

However, when looking at a subset of data related to advanced or lethal prostate cancer, both components, difficulty falling asleep and sleep disruption, independently increased the risk even further, 2.1 and 3.2 times, respectively.

This suggests that sleep is a powerful factor in prostate cancer, and other studies have shown that it may have an impact on other cancers as well. There were 2,102 men involved in the study with a duration of five years. While there are potentially strong associations, this and other studies have been mostly observational. Further studies are required before any definitive conclusions can be made.

What about potential treatments?

Ambien: While nonbenzodiazepine hypnotics may be beneficial, this may come at a price. In a report by the Drug Abuse Warning Network, part of the Substance Abuse and Mental Health Services Administration (SAMHSA), the number of reported adverse events with Ambien that perpetuated emergency department visits increased by more than twofold over a five-year period from 2005 to 2010 (6). Insomnia patients most susceptible to having significant side effects are women and the elderly. The director of SAMHSA recommends focusing on lifestyle changes for treating insomnia: by making sure the bedroom is sufficiently dark, getting frequent exercise and avoiding caffeine.

In reaction to this data, the FDA required the manufacturer of Ambien to reduce the dose recommended for women by 50 percent (7). Ironically, sleep medication like Ambien may cause drowsiness the next day — the FDA has warned that it is not safe to drive after taking extended-release versions (CR) of these medications the night before.

Magnesium: The elderly population tends to suffer the most from insomnia, as well as nutrient deficiencies. In a double-blinded, randomized controlled trial (RCT), the gold standard of studies, results show that magnesium had resoundingly positive effects on elderly patients suffering from insomnia (8).

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

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

Cognitive behavioral therapy

In a study, just one 2½-hour session of cognitive behavioral therapy delivered to a group of 20 patients suffering from chronic insomnia saw subjective, yet dramatic, improvements in sleep duration from 5 to 6½ hours and decreases in sleep latency from 51 to 22 minutes (9). The patients who were taking medication to treat insomnia experienced a 33 percent reduction in their required medication frequency per week. The topics covered in the session included relaxation techniques, sleep hygiene, sleep restriction, sleep positions and beliefs and obsessions pertaining to sleep. These results are encouraging.

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

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

References: (1) Sleep. 2009;32(8):1027. (2) American Academy of Sleep Medicine, 2nd edition, 2005. (3) Arch Intern Med. 1998;158(10):1099. (4) Eur Heart J. online 2013;Mar 5. (5) Cancer Epidemiol Biomarkers Prev; 2013;22(5):872–879. (6) SAMSHA.gov. (7) FDA.gov. (8) J Res Med Sci. 2012 Dec;17(12):1161-1169. (9) APSS 27th Annual Meeting 2013; Abstract 0555.

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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Exercise significantly reduces breast cancer risk in postmenopausal women

By David Dunaief, M.D.

Dr. David Dunaief

Pink is everywhere this month, as we make a fashion statement to highlight Breast Cancer Awareness Month. This awareness is critical. The incidence of invasive breast cancer in 2017 in the U.S. is estimated to be over 250,000 new cases, with approximately 40,000 patients dying from this disease each year (1). The good news is that from 2003 to 2012 there was decreased mortality in the U.S. across all racial and ethnic populations (2).

We can all agree that screening has merit. Television commercials tout that women in their 30s and early 40s have discovered breast cancer with a mammogram, usually after a lump was detected. Does this mean we should be screening earlier? Screening guidelines are based on the general population that is considered “healthy,” meaning no lumps were found nor is there a personal or family history of breast cancer.

All guidelines hinge on the belief that mammograms are important, but at what age? Here is where divergence occurs; experts can’t agree on age and frequency. The U.S. Preventive Services Task Force recommends mammograms starting at 50 years old, after which time they should be done every other year through age 74 (3). The American College of Obstetricians and Gynecologists recommends consideration of annual mammograms starting at 40 years old and continuing until age 75. They encourage a process of shared decision-making between patient and physician (4).

The best way to treat breast cancer — and just as important as screening — is prevention, whether it is primary, preventing the disease from occurring, or secondary, preventing recurrence. We are always looking for ways to minimize risk. What are some potential ways of doing this? These may include lifestyle modifications, such as diet, exercise, obesity treatment and normalizing cholesterol levels. Additionally, although results are mixed, it seems that bisphosphonates do not reduce the risk of breast cancer nor its recurrence. Let’s look at the evidence.

Bisphosphonates

October is Breast Cancer Awareness Month

Bisphosphonates include Fosamax (alendronate), Zometa (zoledronic acid) and Boniva (ibandronate) used to treat osteoporosis. Do they have a role in breast cancer prevention? It depends on the population, and it depends on study quality.

In a meta-analysis involving two randomized controlled trials, results showed there was no benefit from the use of bisphosphonates in reducing breast cancer risk (5). The population used in this study involved postmenopausal women who had osteoporosis, but who did not have a personal history of breast cancer. In other words, the bisphosphonates were being used for primary prevention.

The study was prompted by previous studies that have shown antitumor effects with this class of drugs. This analysis involved over 14,000 women ranging in age from 55 to 89. The two trials were FIT and HORIZON-PFT, with durations of 3.8 and 2.8 years, respectively. The FIT study involved alendronate and the HORIZON-PFT study involved zoledronic acid, with these drugs compared to placebo. The researchers concluded that the data were not evident for the use of bisphosphonates in primary prevention of invasive breast cancer.

In a previous meta-analysis of two observational studies from the Women’s Health Initiative, results showed that bisphosphonates did indeed reduce the risk of invasive breast cancer in patients by as much as 32 percent (6). These results were statistically significant. However, there was an increase in risk of ductal carcinoma in situ (precancer cases) that was not explainable. These studies included over 150,000 patients with no breast cancer history. The patient type was similar to that used in the more current trial mentioned above. According to the authors, this suggested that bisphosphonates may have an antitumor effect. But not so fast!

The disparity in the above two bisphosphonate studies has to do with trial type. Randomized controlled trials are better designed than observational trials. Therefore, it is more likely that bisphosphonates do not work in reducing breast cancer risk in patients without a history of breast cancer or, in other words, in primary prevention.

In a third study, a meta-analysis (group of 36 post-hoc analyses — after trials were previously concluded) using bisphosphonates, results showed that zoledronic acid significantly reduced mortality risk, by as much as 17 percent, in those patients with early breast cancer (7). This benefit was seen in postmenopausal women but not in premenopausal women. The difference between this study and the previous study was the population. This was a trial for secondary prevention, where patients had a personal history of cancer.

However, in a RCT, the results showed that those with early breast cancer did not benefit overall from zoledronic acid in conjunction with standard treatments for this disease (8). The moral of the story: RCTs are needed to confirm results, and they don’t always coincide with other studies.

Exercise

We know exercise is important in diseases and breast cancer is no exception. In an observational trial, exercise reduced breast cancer risk in postmenopausal women significantly (9). These women exercised moderately; they walked four hours a week. The researchers stressed that it is never too late to exercise, since the effect was seen over four years. If they exercised previously, but not recently, for instance, five to nine years ago, no benefit was seen.

To make matters worse, only about one-third of women get the recommended level of exercise every week: 30 minutes for five days a week. Once diagnosed with breast cancer, women tend to exercise less, not more. We need to expend as much energy and resources emphasizing exercise as a prevention method as we do screenings.

Soy intake

Contrary to popular belief, soy may be beneficial in reducing breast cancer risk. In a meta-analysis (a group of eight observational studies), those who consumed more soy saw a significant reduction in breast cancer compared to those who consumed less (10). There was a dose-response curve among three groups: high intake of >20 mg per day, moderate intake of 10 mg and low intake of <5 mg.

Those in the highest group had a 29 percent reduced risk, and those in the moderate group had a 12 percent reduced risk, when compared to those who consumed the least. Why have we not seen this in U.S. trials? The level of soy used in U.S. trials is a fraction of what is used in Asian trials. The benefit from soy is thought to come from isoflavones, plant-rich nutrients.

Western vs. Mediterranean diets

A Mediterranean diet may decrease the risk of breast cancer significantly.

In an observational study, results showed that, while the Western diet increases breast cancer risk by 46 percent, the Spanish Mediterranean diet has the inverse effect, decreasing risk by 44 percent (11). The effect of the Mediterranean diet was even more powerful in triple-negative tumors, which tend to be difficult to treat. The authors concluded that diets rich in fruits, vegetables, beans, nuts and oily fish were potentially beneficial.

Hooray for Breast Cancer Awareness Month stressing the importance of mammography and breast self-exams. However, we need to give significantly more attention to prevention of breast cancer and its recurrence. Through potentially more soy intake, as well as a Mediterranean diet and modest exercise, we may be able to accelerate the trend toward a lower breast cancer incidence.

References: (1) breastcancer.org. (2) cdc.gov. (3) Ann Intern Med. 2009;151:716-726. (4) acog.org. (5) JAMA Inter Med online. 2014 Aug. 11. (6) J Clin Oncol. 2010;28:3582-3590. (7) 2013 SABCS: Abstract S4-07. (8) Lancet Oncol. 2014;15:997-1006. (9) Cancer Epidemiol Biomarkers Prev online. 2014 Aug. 11. (10) Br J Cancer. 2008;98:9-14. (11) Br J Cancer. 2014;111:1454-1462. Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management.

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Stuart Vincent, director of public relations at John T. Mather Memorial Hospital speaks to Ann Moran about hospital services. Photo by Heidi Sutton
Barbara Delledonne of Santi Yoga conducts a chair yoga workshop. Photo by Heidi Sutton
Richard Nebiosini of The Chiropractic Joint speaks to residents during the fair. Photo by Heidi Sutton
Heidi and Mark Sutton of Farmingville get their blood pressure taken during the Sound Beach Civic Association’s Health & Wellness Expo. Photo from Ernestine Franco
Kelly Donlan, of Ear Works Audiology, gives Ann Moran a checkup. Photo by Heidi Sutton
Dr. Helena Chykyda, Dr. Minyoung Kim and Dr. James James of Mather Primary Care gave free blood pressure and blood sugar readings. Photo by Heidi Sutton
Sound Beach Civic Association volunteers who helped put together the expo were on hand at the event. Photo by Heidi Sutton

By Ernestine Franco

The Sound Beach Civic Association brought together a number of health professionals at a health and wellness expo Oct. 21.

At the health fair, professionals were on hand to provide blood pressure screenings, nutritionists discussed how to live a healthier life, representatives from the police department collected unused and unwanted medication and the Sound Beach Fire Department provided tips for calling 911 in case of an emergency

Participants, screeners and presenters participating in the even included: The Chiropractic Joint, The Community Growth Center, Ear Works Audiology, Echo Pharmacy,
Harbor View Medical Services, John T. Mather Memorial
Hospital, the LI Chapter of NYC + PANDAS/PANS Awareness Group and NY PANS Awareness Group, North Shore Youth Council, Rite Aid, Santi Yoga Community, Senior Callers, Suffolk Center for Speech,  Suffolk County Health Department, Suffolk County Police Department’s 7th Precinct., Wellness and Chiropractic Solutions and Young Living Essential Oils.

Patty Pulick, a Sound Beach resident, said she absolutely loved the health fair.

“The various tables were very informative,” she said. “I got my sugar checked, learned about healthy alternatives and discussed hearing issues. It was great that the SCPD was there so I could dispose of my unused medications. I hope they have it again.”

Civic association president Bea Ruberto extended her gratitude to BPN Home Improvement Inc., Echo Pharmacy, Harbor View Medical Services, John T. Mather Memorial Hospital, Matt’s One Stop, Pern Editorial Services, Schwamb Plumbing and Heating and St. Charles Hospital, who sponsored the event.

“I would also like to give a special thank you to all the volunteers who worked tirelessly to coordinate this event, as well as Bonnie Boeger, a Coldwell Banker residential broker who provided water,” Ruberto said. “As everything else we work on, it’s the generosity of the people in the Sound Beach community that made this event possible.”

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Lt. Katherine Biggs aboard Comfort, a U.S. Navy hospital ship administering aide to Puerto Rico. Photo by Stephane Belcher

A Naval emergency medicine physician from Port Jefferson Station is trying to provide comfort while aboard a ship named for it in Puerto Rico.

Hurricane Maria made landfall in September as a historic Category 5 storm, devastating Puerto Rico with sustained gusts nearing 200 mph. When Lt. Katherine Biggs, a resident at Naval Medical Center Portsmouth in Virginia currently receiving training in military-specific medicine, was offered the chance to travel to the storm-ravaged island, the 2006 Comsewogue High School graduate said it was an opportunity she couldn’t pass up.

Lt. Katherine Biggs and other sailors aboard the Military Sealift Command hospital ship USNS Comfort treat a patient from Centro Medico in San Juan, Puerto Rico. Photo by Stephane Belcher

Biggs is one of five from the residency program aboard the Military Sealift Command hospital ship Comfort, which reached Puerto Rico Oct. 3 and does not have a scheduled return date, working on the boat’s casualty receiving area administering medical aide to those affected. Catastrophic flooding, damaged infrastructure and a lack of supplies, drinking water and electricity have created a dangerous situation for most Puerto Ricans trying to restore their regular routine.

“We’ll be here as long as directed and as long as needed,” Biggs said in a phone interview from Puerto Rico. “I’ll stay here as long as they’ll let me.”

She called the trip thus far a great learning experience, and said it’s been a change of pace helping people with severe respiratory and heart issues, for example, because she’s used to providing medical attention to those with traumatic, combat-related injuries. Biggs has treated some with broken bones, but said many of the patients she has been tasked with treating are people with chronic issues that are flaring up because they’ve been unable to take their prescribed medicines for various reasons.

The lieutenant said she knew when she was in ninth or tenth grade at Comsewogue that she wanted to pursue a career in medicine as a way to help people in need. After four years at Binghampton University as an undergraduate, she moved on to medical school at New York Institute of Technology in the College of Osteopathic Medicine, graduating in 2015. Biggs said she was able to afford the schooling thanks to the Health Professions Scholarship Program, a financial assistance offering from the U.S. military, which she heard about from a neighbor. She is in the third year of her residency in Portsmouth, and it is a rarity for residents to be asked to go on a trip like the one she’s on now, according to residency program director Commander John Devlin.

“This opportunity may be tough in the sense of the people struggling, but it is allowing my daughter to do what she was meant to do — help people in need.”

— Laurie Biggs

“I say it’s win-win,” Devlin said in a statement. “The people of Puerto Rico are getting more emergency medicine physician manpower than they would have had, had we gone with the original plan. And from the resident standpoint and the Navy’s standpoint, we are getting five junior physicians that, for their entire career, will have this experience base to carry forward to apply to missions in the future.”

With the help of the “Sea Knights” of Helicopter Sea Combat Squadron, Biggs and the other residents have been able to personally assist in medical evacuation missions around the island to return people to the ship for treatment via helicopter.

“When I heard about Katie’s plans to head to Puerto Rico I was incredibly proud,” Biggs’ mother Laurie said in an email. “I remember reminding her that this is why she joined the Navy and wanted to become a doctor. This opportunity may be tough in the sense of the people struggling, but it is allowing my daughter to do what she was meant to do — help people in need.”

Biggs’ mother added she knew from an early age her daughter, who is the oldest of four, was a caring and helpful person, ever aware of helping the less fortunate.

“To us she will always just be Katie, the daughter and older sister that is always there when you need her,” she said.

Biggs said her biggest takeaway from the mission thus far has been the dedication of responders on the ground to do whatever it takes to help both individuals and the island as a whole return to normalcy. To contribute to the relief effort, visit the American Red Cross website at www.redcross.org/donate.

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Brookhaven Town Supervisor Ed Romaine, state Assemblyman Steve Englebright, county Legislator Kara Hahn during opening ceremonies. Photo by Greg Catalano
Local legislators join Gloria Rocchio, president of The Ward Melville Heritage Organization, third from left, during opening ceremonies. Photo by Greg Catalano
Some participants in the Walk for Beauty in Stony Brook brought their pets. Photo by Greg Catalano
Some participants in the Walk for Beauty in Stony Brook brought their pets. Photo by Greg Catalano
Runners start the race at the Hercules on the Harbor 10K Run. Photo by Greg Catalano
Runners start the race at the Hercules on the Harbor 10K Run. Photo by Greg Catalano
Runner in the Hercules on the Harbor 10K Run approaches the finish line. Photo by Greg Catalano
Runner in the Hercules on the Harbor 10K Run approaches the finish line. Photo by Greg Catalano
Runners in the Hercules on the Harbor 10K Run approach the finish line. Photo by Greg Catalano
Participants in the Walk for Beauty in Stony Brook enjoying a beautiful day. Photo by Greg Catalano
Friends and family members came out to show support of runners and walkers. Photo by Greg Catalano
Brookhaven Town Councilwoman Valerie Cartright and county Legislator Kara Hahn. Photo by Greg Catalano
Participants in the Walk for Beauty in Stony Brook enjoying a beautiful day. Photo by Greg Catalano
Dancers demonstrate some moves to stay healthy. Photo by Greg Catalano
Brookhaven Town Councilwoman Valerie Cartright joins in on the fun. Photo by Greg Catalano
Cheerleaders show their support for runners and walkers Oct. 22. Photo by Greg Catalano

The streets of Stony Brook were filled with more than 300 runners and an estimated 460 walkers participating in the Walk for Beauty and Hercules on the Harbor 10K Run Oct. 22. Cancer survivors along with family members and friends collect donations to support their walk or run, which takes them through the scenic and historic Stony Brook. All proceeds go directly to a targeted research fund at Stony Brook Medicine for Breast Cancer Research and The WMHO Unique Boutique for wigs.

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Foods high in Vitamin D include egg yolks, beef, shiitake mushrooms, cheese, milk and cold-water fatty fish like salmon, above.
In most geographic locations, sun exposure will not correct vitamin D deficiencies

By David Dunaief, M.D.

Dr. David Dunaief

Vitamin D is one the most widely publicized and important supplements. We get vitamin D from the sun, food and supplements. With our days rapidly shortening here in the Northeast, I thought it would be worthwhile to explore what we know about vitamin D supplementation.

Vitamin D has been thought of as an elixir for life, but is it really? There is no question that, if you have low levels of vitamin D, replacing it is important. Previous studies have shown that it may be effective in a wide swath of chronic diseases, both in prevention and as part of the treatment paradigm. However, many questions remain. As more data come along, their meaning for vitamin D becomes murkier. For instance, is the sun the best source of vitamin D?

At the 70th annual American Academy of Dermatology meeting, Dr. Richard Gallo, who was involved with the Institute of Medicine recommendations, spoke about how, in most geographic locations, sun exposure will not correct vitamin D deficiencies. Interestingly, he emphasized getting more vitamin D from nutrition. Dietary sources include cold-water fatty fish, such as salmon, sardines and tuna.

We know its importance for bone health, but as of yet, we only have encouraging — but not yet definitive — data for other diseases. These include cardiovascular and autoimmune diseases and cancer.

There is no consensus on the ideal blood level for vitamin D. The Institute of Medicine recommends more than 20 ng/dl, and The Endocrine Society recommends at least 30 ng/dl. More experts and data lean toward the latter number.

Skin cancer

Vitamin D did not decrease nonmelanoma skin cancers (NMSCs), such as squamous cell and basal cell carcinoma. It may actually increase them, according to one study done at a single center by an HMO (1). The results may be confounded, or blurred, by UV radiation from the sun, so vitamin D is not necessarily the culprit. Most of the surfaces where skin cancer was found were sun exposed, but not all of them.

The good news is that, for postmenopausal women who have already had an NMSC bout, vitamin D plus calcium appears to reduce its recurrence, according to the Women’s Health Initiative study (2). In this high-risk population, the combination of supplements reduced risk by 57 percent. However, unlike the previous study, vitamin D did not increase the incidence of NMSC in the general population. NMSC occurs more frequently than breast, prostate, lung and colorectal cancers combined (3).

Cardiovascular mixed results

Several observational studies have shown benefits of vitamin D supplements with cardiovascular disease. For example, the Framingham Offspring Study showed that those patients with deficient levels were at increased risk of cardiovascular disease (4).

However, a small randomized controlled trial (RCT), the gold standard of studies, calls the cardioprotective effects of vitamin D into question (5). This study of postmenopausal women, using biomarkers such as endothelial function, inflammation or vascular stiffness, showed no difference between vitamin D treatment and placebo. The authors concluded there is no reason to give vitamin D for prevention of cardiovascular disease.

The vitamin D dose given to the treatment group was 2,500 IUs. Thus, one couldn’t argue that this dose was too low. Some of the weaknesses of the study were a very short duration of four months, its size — 114 participants — and the fact that cardiovascular events or deaths were not used as study end points. However, these results do make you think.

Weight benefit

There is good news, but not great news, on the weight front. It appears that vitamin D plays a role in reducing the amount of weight gain in women 65 years and older whose blood levels are more than 30 ng/dl, compared to those below this level, in the Study of Osteoporotic Fractures (6).

This association held true at baseline and after 4.5 years of observation. If the women dropped below 30 ng/dl in this time period, they were more likely to gain more weight, and they gained less if they kept levels above the target. There were 4,659 participants in the study. Unfortunately, vitamin D did not show statistical significance with weight loss.

Mortality decreased

In a meta-analysis of a group of eight studies, vitamin D with calcium reduced the mortality rate in the elderly, whereas vitamin D alone did not (7). The difference between the groups was statistically important, but clinically small: 9 percent reduction with vitamin D plus calcium and 7 percent with vitamin D alone.

One of the weaknesses of this analysis was that vitamin D in two of the studies was given in large amounts of 300,000 to 500,000 IUs once a year, rather than taken daily. This has different effects.

USPSTF recommendations

The U.S. Preventive Services Task Force recommends against giving “healthy” postmenopausal women the combination of vitamin D 400 IUs plus calcium 1,000 mg to prevent fractures (8). It does not seem to reduce fractures and increases the risk of kidney stones. There is also not enough data to recommend for or against vitamin D with or without calcium for cancer prevention.

Need for clinical trials

We need clinical trials to determine the effectiveness of vitamin D in many chronic diseases, since it may have beneficial effects in preventing or helping to treat them (9). Right now, there is a lack of large randomized clinical trials. Most are observational, which provides associations, but not links. The VITAL study is a large RCT looking at the effects of vitamin D and omega-3s on cardiovascular disease and cancer. It is a five-year trial, and the results should be available in 2018.

When to supplement?

It is important to supplement to optimal levels, especially since most of us living in the Northeast have insufficient to deficient levels. While vitamin D may not be a cure-all, it may play an integral role with many disorders.

References: (1) Arch Dermatol. 2011;147(12):1379-1384. (2) J Clin Oncol. 2011 Aug 1;29(22):3078-3084. (3) CA Cancer J Clin. 2009;59(4):225-249. (4) Circulation. 2008 Jan 29;117(4):503-511. (5) PLoS One. 2012;7(5):e36617. (6) J Women’s Health (Larchmt). 2012 Jun 25. (7) J Clin Endocrinol Metabol. online May 17, 2012. (8) AHRQ Publication No. 12-05163-EF-2. (9) Endocr Rev. 2012 Jun;33(3):456-492.

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

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From left, Gary Gerard, lead interventional/cardiac catheterization technologist, Stony Brook Southampton Hospital; Dr. Travis Bench, director, Cardiac Catheterization Lab, Stony Brook Southampton Hospital; Helen VanDenessen, nurse manager, Imaging, Stony Brook Southampton Hospital; and Dr. Dhaval Patel, cardiologist, Stony Brook Medicine. Photo from SBU

By Javed Butler, MD

Dr. Javed Butler

Stony Brook Medicine has opened the new Cardiac Catheterization (Cath) Laboratory at Stony Brook Southampton Hospital to improve access to lifesaving heart care for residents of the East End of Long Island.

The lab provides emergency and elective treatments delivered by Stony Brook University Heart Institute specialists, for easier, faster access to the highest standards of cardiac care. The standard of care for a person experiencing a heart attack is that the blocked artery should be opened within 90 minutes of contact with medical care. That procedure can only be done in a cardiac catheterization lab by highly trained personnel.

For the rapidly increasing population of the East End, the nearest cath lab was previously located at Stony Brook University Hospital, up to 70 miles and a 60- to 90-minute drive. Even transportation by ambulance or helicopter could result in a life-threatening delay.

The new cath lab, led by interventional cardiologist Dr. Travis Bench, is currently the only facility in the East End capable of providing clinically complex care to critically ill heart patients. Bench and his partner, Dr. Dhaval Patel, have East End cardiology practices in Southampton and Center Moriches.

The lab will save lives by providing more immediate intervention for serious heart events such as myocardial infarctions (heart attacks). A delay in restoring blood flow through an artery increases the likelihood for significant damage to the heart. By allowing physicians to open a blocked artery in Southampton, without having to first transport a patient to Stony Brook, damage to the heart can be minimized and total heart failure may be prevented.

At the Southampton cath lab, doctors will be able to perform percutaneous coronary intervention (PCI), a nonsurgical procedure in which a physician inserts catheters through the skin to reach affected structures. The PCI treatments at Stony Brook Southampton Hospital include emergency and elective procedures.

The Southampton lab is staffed every day, around the clock, by Stony Brook Heart Institute’s interventional cardiologists with the most up-to-date knowledge and skills to diagnose and treat patients with heart disease.

For patients who need emergency catheterization, Stony Brook’s “Code H” protocol has produced an average “door-to-perfusion” time of 56 minutes, almost 45 minutes below the New York State regulated treatment guidelines. That is the level of care we strive for at Stony Brook Southampton Hospital. The systems and processes are in place and we look forward to taking care of our patients out east with that same dedication to quality and excellence.

To view a video and learn more about the Cath Lab at Stony Brook Southampton Hospital, visit www.heart.stonybrookmedicine.edu.

Dr. Javed Butler is the co-director of the Heart Institute and chief of the Division of Cardiology at Stony Brook Medicine.

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Smithtown United Civic Association published the above master plan aimed at revitalizing Main Street and the downtown area on its Facebook page Oct. 6. Photo from Smithtown United Civic Association

A small group of Smithtown citizens have come together to draft and present a plan they hope may lead to big changes for Main Street.

The Smithtown United Civic Association unveiled a detailed conceptual plan for downtown revitalization Oct. 6 on its Facebook page. The group is asking residents to review the proposal and provide feedback via social media before they present it to town officials.

Timothy Small, president of Smithtown United, said the organization’s goal is to give local residents a voice in the future of their town. It was formed when Smithtown residents came together earlier this year after two events: New York Gov. Andrew Cuomo (D) allocated $20 million for sewers in Smithtown and the proposed sale of Smithtown school district administration headquarters on New York Avenue to the town for a sewer treatment plant to support a condominium development. Small said the two events set in motion real opportunity for revitalization of the town.

“If you look at the downtown areas of Smithtown, Kings Park and St. James, they are tired looking,” he said. “There’s a lot of vacant shops and properties. We live in a wonderful town. The schools are wonderful, we love our homes, but it’s our downtown business districts that are deeply suffering.”

Small, a retired engineer who held an executive position at a utility company, said for approximately six months the group assessed the community needs and drew inspiration from surrounding towns including Huntington, Patchogue, Sayville, Bay Shore, Farmingdale and Babylon for changes they’d like to see in Smithtown.

Smithtown United’s plan for the western downtown area focuses on several key points including consolidation of the town offices into the New York Avenue school building and retaining the sports field behind it for public use.

“It’s the last green space that remains in all of downtown,” Small said. “I would consider that an anchor for the western edge of redevelopment. It would be tragic to see that property lost to dense development.”

The civic supports the town’s acquisition of the property in exchange for selling off its other buildings scattered across the business district, but discussions of the deal have been tabled by the Smithtown school officials. The plan also proposes several existing downtown storefronts be made into two-story, mixed-use buildings with retail on the first floor and apartments above. These housing options, according to Small, would be attractive to young adults and senior citizens. Behind the existing New York Avenue school district property, the plan calls for construction of a new sports and community center.

“We need a place for our kids to go in the evening,” Small said. “There needs to be a community space for our residents and young adults.”

The conceptual design also calls for several changes to Smithtown’s existing roadways, including a rotary at the intersection of Main Street and New York Avenue and rerouting Edgewater Avenue to run parallel to Main Street. This would cause Edgewater Avenue to empty onto Maple Avenue, and there would be a new set of village townhouses built on the southwest corner of the new intersection.

To further increase available housing, the proposed plan suggests the construction of three-story, transit-oriented housing near the Long Island Rail Road train station and municipal parking lots.

Initial feedback on the plan from residents on the civic’s Facebook page has been a mix of positive and negative, along with offers to help refine it. Supporters have praised the organization for taking action, while critics expressed traffic concerns.

“Main Street is already undersized for what it is used for,” said John McCormick, 29, of Smithtown. “[The] parking does not look to be sufficient for customers of the first-floor shops and people renting out upstairs apartments.”

McCormick, a young homeowner, feared adding townhouses and apartments would change the character of the local community and the plan’s possible impact on the school district.

Smithtown resident Michael Tarquinio, 20, said the plan was a step in the right direction but needed to be more innovative.

“They need to stop thinking with a Robert Moses mind-set,” Tarquinio said, who is studying environmental science at the University of Maine. “I’m all for it, but you can’t wipe out your heritage and start fresh. You need to know where you came from to know where you are going.”

He said he believes successful downtown revitalization will require the civic to work with town, county and state officials to improve roadways and mass transportation options to reduce traffic.

Small said he agreed the proposed overhaul of both the business and residential space in downtown Smithtown required cooperation at several levels of government. It would only be possible if sewers can be brought to the downtown area.

“Anyone who is going to invest money into redevelopment won’t unless there is adequate sanitary sewer conditions,” Small said. “It’s essential.”

The civic group has tentative plans to present its proposal to Smithtown officials at the Oct. 26 town board meeting at 7 p.m. at town hall.

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Melinda Murray, on left, and Karen Acompora, on right, who are the founders of Copiague-based Heart Screen New York, gave Shoreham-Wading River Girl Scout Jordan McClintock, at center, a $400,000 grant to help with her Gold Award project. Photo by Kevin Redding

A Shoreham-Wading River senior showed a lot of heart this past weekend by making sure her fellow students and community members got theirs checked out.

Jordan McClintock, a 17-year-old Girl Scout, saw the culmination of a two-year Gold Award project Saturday, Oct. 14, as Albert G. Prodell Middle School’s gymnasium became a mini medical center fully staffed with cardiologists, physicians and nurse practitioners from hospitals across the state, bringing with them life-saving equipment. The medical professionals provided more than 400 registrants — between the ages 12 and 25 — with free, all-day heart screenings in an effort to raise awareness about sudden cardiac arrest, the leading cause of death in young athletes.

A volunteer shows a girl how to use an AED machine. Photo by Kevin Redding

With help from a $400,000 grant by Copiague-based Heart Screen New York, McClintock’s event allowed students from Shoreham-Wading River and beyond to get thorough cardiovascular screenings, which included an electrocardiogram test, a blood pressure reading and final consultation with medical professionals. Pediatric cardiologists were available in case further testing was needed and students were given hands-only CPR and automatic external defibrillator training after their exams.

As heart screenings are not generally covered by health insurance, the event also made it possible for parents to evaluate a crucial component of their children’s health without spending up to $1,000 per exam.

“This is amazing,” said Maureen MacDowell, whose son, a cross country runner at the school, was screened Saturday. “It’s a huge deal that the girl who organized this did so. It’s definitely worth having.”

Marlene Baumeister, the mother of a football player, said other school districts should use the event as a model for their own heart screenings.

Tony Zajac, a Shoreham-Wading River parent and coach, called the program excellent.

“It’s very educational for these kids and more in-depth than I thought,” Zajac said. “It gives them feedback on their own heart health while teaching them how to potentially save somebody else’s life.”

Sudden cardiac arrests claim the lives of more than 2,000 people under 25 in the country every year, according to the American Academy of Pediatrics, and yet they are not included in most routine physical exams or pre-participation sports physicals. One out of 100 students that attend a heart screening will discover an underlying heart condition.

“If I can save one life with early detection, my work for the past two years will have been all worth it.”

—Jordan McClintock

“If I can save one life with early detection, my work for the past two years will have been all worth it,” said McClintock, an aspiring pediatrician. “I’m really hoping it initiates some conversations among my peers and their families.”

The Girl Scout developed her project as a freshman after she got her own heart screening done at St. Francis Hospital in Roslyn, which was offered in partnership with Heart Screen New York, based on her family’s history of cardiac problems.

It was through the procedure, which she referred to as “painless” and “relieving,” that McClintock began her years-long correspondence with Karen Acompora, the co-founder of Heart Screen New York.

Acompora lost her 14-year-old son to a sudden cardiac arrest during a high school lacrosse game in 2000 after a ball struck his chest between heartbeats. She and Melinda Murray, a Queens-based mother whose son collapsed on a basketball court and died from an undetected heart condition, formed Heart Screen New York together as a way to detect heart trouble in local youths and prevent as many deaths as possible.

Heart Screen New York hosts only two screenings per year due to the expenses and resources needed for each one.

“I thought it was an amazing program and would be great if I could bring it to Shoreham,” McClintock said. “Out here we’ve never really had anything like this that’s free and promotes cardiovascular health in student-athletes and the community in general. I was very inspired by Karen’s story.”

McClintock’s perseverance paid off, literally, early last year when Heart Screen New York representatives informed her Shoreham-Wading River would be the site of their October 2017 screening.

A young boy is shown how to perform CPR. Photo by Kevin Redding

“I think the screening is certainly opening a lot of eyes in the Shoreham community and Jordan’s done such a nice job of advertising and promoting the event,” Acompora said. A founder of another group called the Louis J. Acompora Memorial Foundation, in memory of her son, the Northport mother hopes heart screenings will eventually become a mandatory part of physicals. In fact, she and Murray have been pushing legislation for years to make electrocardiograms part of student-athlete’s preparticipation screening process.

“There’s a lack of knowledge on the part of individuals who feel it’s too costly to do heart screenings, but how do you put a price tag on life?” said Murray, whose 17-year-old son Dominic died in 2009, exactly three years after his father died from a massive heart attack. “We’re really proud of Jordan. It’s having a great impact at the school and is really spreading the awareness of the importance of heart screenings.”

Among the volunteers at the event was Shoreham senior and baseball player Jack Crowley, who, two years ago, at 15 years old, was declared medically dead after a line drive hit him in the chest. Crowley’s heart stopped and he was unable to breathe. He was brought back to life from the shock of an automatic external defibrillator — which Heart Screen New York had pushed to make available in as many locations as possible.

“They’re the reason I’m here,” Crowley said. “Get a heart screening. It’s so much better than learning the hard way that you have an issue.”

Senior volleyball player Lindsay Deegan said of the screening: “This is something I never would’ve thought of doing this before, so it’s cool to know what’s going on.”

McClintock is expected to receive her Gold Award during a ceremony in Spring 2018.

“Girl Scouts pledge to help people at all times, and Jordan’s stellar work truly exemplifies that promise,” said Yvonne Grant, President and CEO for Girl Scouts of Suffolk County. “Jordan’s Gold Award project is an inspiring and extraordinary way to bring awareness.”

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Students take samples from Nissequogue River to analyze. Photo by Sara-Megan Walsh

By Sara-Megan Walsh

Hundreds of students from Smithtown to Northport got wet and dirty as they looked at what lurks beneath the surface of the Nissequogue River.

More than 400 students from 11 schools participated in “A Day in the Life” of the Nissequogue River Oct. 6, performing hands-on citizens scientific research and exploring the waterway’s health and ecosystem. The event was coordinated by Brookhaven National Laboratory, Central Pine Barrens Commission, Suffolk County Water Authority and New York State Department of Environmental Conservation.

Northport High School students analyze soil taken from the bottom of Nissequogue River. Photo by Sara-Megan Walsh

“’A Day in the Life’ helps students develop an appreciation for and knowledge of Long Island’s ecosystems and collect useful scientific data,” program coordinator Melissa Parrott said. “It connects students to their natural world to become stewards of water quality and Long Island’s diverse ecosystems.”

More than 50 students from Northport High School chemically analyzed the water conditions, marked tidal flow, and tracked aquatic species found near the headwaters of the Nissequogue in Caleb Smith State Park Preserve in Smithtown. Teens were excited to find and record various species of tadpoles and fish found using seine net, a fishing net that hangs vertically and is weighted to drag along the riverbed.

“It’s an outdoor educational setting that puts forth a tangible opportunity for students to experience science firsthand,” David Storch, chairman of science and technology education at Northport High School, said. “Here they learn how to sample, how to classify, how to organize, and how to develop experimental procedures in an open, inquiry-based environment. It’s the best education we can hope for.”

Kimberly Collins, co-director of the science research program at Northport High School, taught students how to use Oreo cookies and honey to bait ants for Cold Spring Harbor Laboratory’s Barcode Long Island. The project invites students to capture invertebrates, learn how to extract the insects’ DNA then have it sequenced to document and map diversity of different species.

Children from Harbor Country Day School examine a water sample. Photo by Sara-Megan Walsh

Further down river, Harbor Country Day School students explored the riverbed at Landing Avenue Park in Smithtown. Science teacher Kevin Hughes said the day was one of discovery for his fourth- to eighth-grade students.

“It’s all about letting them see and experience the Nissequogue River,” Hughes said. “At first, they’ll be a little hesitant to get their hands dirty, but by the end you’ll see they are completely engrossed and rolling around in it.”

The middle schoolers worked with Eric Young, program director at Sweetbriar Nature Center in Smithtown, to analyze water samples. All the data collected will be used in the classroom to teach students about topics such as salinity and water pollution. Then, it will be sent to BNL as part of a citizens’ research project, measuring the river’s health and water ecosystems.

Smithtown East seniors Aaron Min and Shrey Thaker have participated in this annual scientific study of the Nissequogue River at Short Beach in Smithtown for last three years. Carrying cameras around their necks, they photographed and documented their classmates findings.

“We see a lot of changes from year to year, from different types of animals and critters we get to see, or wildlife and plants,” Thaker said. “It’s really interesting to see how it changes over time and see what stays consistent over time as well. It’s also exciting to see our peers really get into it.”

Maria Zeitlin, a science research and college chemistry teacher at Smithtown High School East, divided students into four groups to test water oxygenation levels, document aquatic life forms, measure air temperature and wind speed, and compile an extensive physical description of wildlife and plants in the area.

Smithtown High School East students take a water and soil sample at Short Beach. Photo by Sara-Megan Walsh

The collected data will be brought back to the classroom and compared against previous years.

In this way, Zeitlin said the hands-on study of Nissequogue River serves as a lesson in live data collection. Students must learn to repeat procedures multiple times and use various scientific instruments to support their findings.

“Troubleshooting data collection is vital as a scientist that they can take into any area,” she said. “Data has to be reliable. So when someone says there’s climate change, someone can’t turn around and say it’s not true.”

The Smithtown East teacher highlighted that while scientific research can be conducted anywhere, there’s a second life lesson she hopes that her students and all others will take away  from their studies of the Nissequogue River.

“This site is their backyard; they live here,” Zeitlin said. “Instead of just coming to the beach, from this point forward they will never see the beach the same again. It’s not just a recreational site, but its teeming with life and science.”

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