Pilot programs aimed at identifying and aiding trafficking victims and potential targets
Dr. Santhosh Paulus, of Huntington Hospital, and Shandra Woworuntu, a human trafficking survivor, together at Huntington Hospital. Photo by Sara-Megan Walsh
Huntington Hospital is taking the first step toward helping its health care workers better identify and aid human trafficking victims in the community.
Dr. Santhosh Paulus, a hospitalist at Huntington Hospital, will launch a pilot program for Northwell Health aiming to train hospital staff how to recognize and then provide support to human trafficking victims.
“Six months ago, when I was asked to join a human trafficking task force I said, ‘Gee, that’s interesting. I’m here 19 years and I’ve never come across a patient involved in human trafficking,’” said Judy Richter, a social worker at Huntington Hospital. “We have been missing quite a few patients as we had not been trained in how to recognize the signs or what we can do to help them.”
“We need to promote humane work in hospitals. This is the front line to identify victims.” — Shandra Woworuntu
In December 2017, the former owner of the Thatched Cottage in Centerport was indicted on federal charges for allegedly illegally trafficking workers from the Philippines.
Paulus and his approximately 30-member task force is undergoing training from Restore NYC, a nonprofit organization whose mission is to end trafficking in New York. The task force will then train the hospital’s emergency room department and ambulatory center in recognizing signs of both current victims and potential victims.
“Labor trafficking in agriculture or the restaurant industry looks so different from sex trafficking,” Paulus said, noting human trafficking occurs in more than 25 different trades. “There are so many avenues of how you can be trafficked, there’s no simple answer.”
Some signs physicians will look for are patients seeking treatment accompanied by another individual who is holding onto a patient’s documents and identification for them, answering all questions for them, avoiding eye contact and certain tattoos.
“Human trafficking victims are hard to identify because it’s hidden, you cannot see it with plain sight,” said Shandra Woworuntu, a member of the U.S. Council on Human Trafficking. “Sometime, they walk around. When [my captors] escorted me around, nobody saw me.”
“Human trafficking victims are hard to identify because it’s hidden, you cannot see it with plain sight” — Shandra Woworuntu
As a sex trafficking survivor, Woworuntu spoke to hospital staff Jan. 12 to share her personal perspective. The former bank manager and money market trader came to the United States at age 34, when religious persecution made her feel unsafe in her home country of Indonesia. She arrived at John F. Kennedy Airport through an employment agency that promised her a $5,000-a-month job working in a Chicago hotel. Instead, her passport was seized and she was abducted into a sex trafficking ring operating out of Queens.
“[My captor] demanded from me $30,0000 to be free,” Woworuntu said. “I was compliant due to the abuse, the violence, guns and knife.”
She would make her escape by climbing through a second-story bathroom window. However, Woworuntu said she faced skepticism when initially seeking help from New York City police, churches and even the Indonesian consulate. When brought to a hospital, she recalled screaming as physicians examined her because she didn’t speak any English and wasn’t fully informed what procedures were being done.
“Even if I came from a place that was dirty, I am still human,” Woworuntu said. “We need to promote humane work in hospitals. This is the front line to identify victims.”
As a survivor, Woworuntu hoped sharing her story with Paulus and other Huntington Hospital would help staff members to treat victims with dignity. She now runs Mentari, a 501(c)(3) organization in New York that provides support, basic necessities and vocational training for trafficking victims.
U.S. Rep. Lee Zeldin tours Elsie Owens Health Center in Coram before a press conference in which he called on Congress to reauthorize CHIP. Photo from Zeldin's office
By Alex Petroski
Political gridlock is nothing new in Washington, but if an agreement on a federal funding bill isn’t reached by Jan. 19, this time children’s health will be at risk.
In September, the Children’s Health Insurance Program expired, and Congress passed a short-term funding bill just before Christmas to keep the federal government funded through this Friday. The program, also known as CHIP, is a service that provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. Originally enacted in 1997, CHIP provides matching funds to states for health insurance to families with children. It was slated to run for 10 years, but has since been reauthorized on several occasions since 2007. In 2016, almost 9 million children were enrolled in the program, according to Medicaid.gov. The program covers routine check-ups; immunizations; doctor visits; prescriptions; dental and vision care; and emergency services for enrollees. In November, the House passed a five-year reauthorization bill to keep the program running, but it never reached the Senate floor.
U.S. Rep. Lee Zeldin (R-Shirley) urged lawmakers to pass a bill reauthorizing funding for the program, which also provides funding for community health centers, during a press conference Jan. 12 at Elsie Owens Health Center in Coram. A long-term bill will need to be passed to keep services like CHIP running for the remainder of 2018.
“These essential programs provide millions of children, veterans and individuals with the healthcare services they need,” Zeldin said. “In New York alone, CHIP provides health insurance for 300,000 New York children, while nearly 2 million New Yorkers rely on Community Health Centers for their health care services. On behalf of the millions of New Yorkers who rely on CHIP and Community Health Centers, we must reach across the aisle and work together to preserve these vital programs.”
Although more political debates will likely ensue on other issues pursuant to funding the government through the end of the year, Zeldin said he doesn’t expect reauthorization of CHIP to be used for bargaining by either political party.
“I do not expect to see a partial shutdown after next Friday, so everyone anticipates the funding to continue, but this also presents an opportunity to add the reauthorization language into the next funding bill,” Zeldin said in an interview after the event. “It’s two parts that have been running on different tracks. However, I believe that there is an opportunity here to add the reauthorization language to get it through the House, through the Senate, signed by the President — and reauthorization done.”
New York’s U.S. Sens. Chuck Schumer (D) and Kirsten Gillibrand (D) have each stressed the importance of renewing CHIP as part of larger federal funding discussions.
“We have two weeks to negotiate a budget deal that must also address a host of other items, #ExtendCHIP, community health centers, disaster aid, and of course, the #Dreamers,” Schumer said in a Jan. 3 tweet.
HRH Care Community Health President and Chief Executive Officer Anne Kauffman Nolon, Elsie Owens Health Center Medical Director Nadia Arif and Brookhaven Memorial Hospital Medical Center President and CEO Richard Margulis were among the healthcare professionals in attendance who applauded Zeldin’s calls for funding.
“Not extending the funding for these vital programs could have a devastating effect on both our population, and BMHMC, which also faces potential cuts as a Disproportionate Share Hospital,” Margulis said.
According to the Congressional Budget Office, five-year reauthorization of CHIP would cost $800 million over a 10-year period.
Vapes, or electronic cigarettes, are becoming more and more popular among young people, despite a lack of research about the health effects. Photo by John Petroski
By Sabrina Petroski
The “vape life” has found its way into the Port Jefferson School District, making it one of many being forced to address the new trend.
On Jan. 10, Earl L. Vandermeulen High School hosted a community forum about the dangers associated with the use of electronic cigarettes and vaping among young people. The forum, led by the Senior Drug Abuse Educator with the Suffolk County Department of Health, Stephanie Sloan, gave parents and teachers a wealth of information on the issue.
The use of e-cigarettes rose exponentially between 2011 and 2015 across the United States within both middle and high schools, according to Sloan, who cited statistics from a 2016 report on the matter by the office of the U.S. Surgeon General. Sloan said e-cigarette use increased from less than 2 percent in high schools to 15 percent, and less than 1 percent in middle schools to 5 percent over that time period. According to Sloan, more young people are using the various devices because they are curious, there are fun flavors, and there is no perception of risk.
“They are not harmless and we have to work together to encourage healthier decisions among adults and youth,” Sloan said.
Though there isn’t a lot of conclusive research on e-cigarettes yet, what we do know is the liquid, known as e-juice, is made of a combination of nicotine and propylene glycol, with traces of diacetyl, acetoin, ultrafine particles of metal, and benzene. Sloan pointed out, there is no water in the vapor being inhaled.
The devices come in different shapes and sizes; some as small as an actual cigarette, while others are the size of a cellphone. The smallest, and most popular among young adults is the size and shape of a USB drive, and it leaves no odor, making it easy to hide on school grounds.
“They are not harmless and we have to work together to encourage healthier decisions among adults and youth.”
— Stephanie Sloan
“The problem is, it is very difficult to detect,” said Christine Austen, the high school principal. “Compared to cigarettes there’s no scent, there’s no smoke, and there’s no evidence unless other students report it.”
The trend started in Port Jeff last school year but has become much more frequent since, according to leadership in the district. In an effort to stop students from picking up the habit, the school district has added a section about the dangers of e-cigarettes into the curriculum of every health class.
“We want the kids to know that there are varying amounts of nicotine and other synthetics in these vapes,” said Danielle Turner, the Director of Health, Physical Education and Athletics. “Prevention is most important because of what we still don’t know.”
Though there are age restrictions on buying e-cigarettes and vapes, the underage students are still finding ways to obtain them. According to Robert Neidig, Port Jefferson Middle School principal, students say they can access them online with gift cards or through older siblings and friends.
E-cigarettes have recently been added to the Clean Indoor Air Act, making it illegal for them to be used anywhere tobacco products are banned, including on school grounds. Sloan urged administrators to treat the devices the same as cigarettes when punishment is being decided.
According to Superintendent Paul Casciano, punishments for students caught with e-cigarettes on school property are handled on a case by case basis. A parent of both a middle school and a high school student said during the forum he believes there should be a blanket punishment.
“Just a phone call home isn’t enough,” he said. “All of the students should be treated the same in spite of other infractions. The first offense should be a warning, and the second should be a blanket punishment.”
The Port Jeff school district received a grant which will allow it to install vapor detectors in the bathrooms of the school, and going forward the district plan is for the faculty and staff to continue their efforts to keep the community aware and educated.
If you know of or suspect any stores that are selling e-cigarettes or accompanying items to people under the age of 21, you can contact the Department of Health Services Investigation Team by calling 631-853-3162. For more information on the dangers associated with e-cigarettes contact Stephanie Sloan by calling 631-853-8554, or emailing [email protected].
EAT YOUR FRUITS AND VEGGIES: Studies have shown that eating five servings or more of fruits and vegetables daily can reduce your risk of cardiovascular disease. Stock photo
Cardiovascular disease is pervasive but preventable
By David Dunaief, M.D.
Dr. David Dunaief
Heart disease is so pervasive that men who are 40 years old have a lifetime risk of 49 percent. In other words, about half of men will be affected by heart disease. The statistics are better for women, but they still have a staggering 32 percent lifetime risk at age 40 (1).
The good news is that heart disease is on the decline due to a number of factors, including better awareness in lay and medical communities, improved medicines, earlier treatment of risk factors and lifestyle modifications. We are headed in the right direction, but we can do better. Heart disease is something that is eminently preventable.
Heart disease risk factors
Risk factors include obesity, high cholesterol, high blood pressure, smoking and diabetes. Unfortunately, both obesity and diabetes are on the rise. For patients with type 2 diabetes, 70 percent die of cardiovascular causes (2). However, high blood pressure, high cholesterol and smoking have declined (3).
Of course, family history also contributes to the risk of heart disease, especially with parents who experienced heart attacks before age 60, according to the Women’s Health Study and the Physician’s Health Study (4). Inactivity and the standard American diet, rich in saturated fat and calories, also contribute to heart disease risk (5). The underlying culprit is atherosclerosis (fatty streaks in the arteries).
The newest potential risk factor is a resting heart rate greater than 80 beats per minute (bpm). In one study, healthy men and women had 18 and 10 percent increased risks of dying from a heart attack, respectively, for every increase of 10 bpm over 80 (6). A normal resting heart rate is usually between 60 and 100 bpm. Thus, you don’t have to have a racing heart rate, just one that is high-normal. All of these risk factors can be overcome, even family history.
The role of medication
Cholesterol and blood pressure medications have been credited to some extent with reducing the risk of heart disease. The compliance with blood pressure medications has increased over the last 10 years from 33 to 50 percent, according to the American Society of Hypertension.
In terms of lipids, statins have played a key role in primary prevention. Statins are effective at not only lowering lipid levels, including total cholesterol and LDL — the “bad” cholesterol — but also inflammation levels that contribute to the risk of cardiovascular disease. The Jupiter trial showed a 55 percent combined reduction in heart disease, stroke and mortality from cardiovascular disease in healthy patients — those with a slightly elevated level of inflammation and normal cholesterol profile — with statins.
The downside of statins is their side effects. Statins have been shown to increase the risk of diabetes in intensive dosing, compared to moderate dosing (7).
Unfortunately, many on statins also suffer from myopathy (muscle pain). I have a number of patients who have complained of muscle pain and cramps. Their goal when they come to see me is to reduce and ultimately discontinue their statins by following a lifestyle modification plan involving diet and exercise. Now I will address the role of lifestyle modification as a powerful ally in this endeavor. There is an abundance of studies showing exciting effects.
Lifestyle effects
There was significant reduction in mortality from cardiovascular disease with participants who were followed for a very long mean duration of 18 years. The Baltimore Longitudinal Study of Aging, a prospective (forward-looking) study, investigated 501 healthy men and their risk of dying from cardiovascular disease. The authors concluded that those who consumed five servings or more of fruits and vegetables daily with <12 percent saturated fat had a 76 percent reduction in their risk of dying from heart disease compared to those who did not (8). The authors theorized that eating more fruits and vegetables helped to displace saturated fats from the diet. These results are impressive and, most importantly, to achieve them it only required a modest change in diet.
The Nurses’ Health Study shows that these results are also seen in women, with lifestyle modification reducing the risk of sudden cardiac death (SCD). Many times, this is the first manifestation of heart disease in women. The authors looked at four parameters of lifestyle modification, including a Mediterranean-type diet, exercise, smoking and body mass index. There was a decrease in SCD that was dose dependent, meaning the more factors incorporated, the greater the risk reduction. There was as much as a 92 percent decrease in SCD risk when all four parameters were followed (9). Thus, it is possible to almost eliminate the risk of SCD for women with lifestyle modifications.
Heart risk and decreased sexual function in men
A meta-analysis (group of studies) showed that with lifestyle modifications and medication therapies, the risk of cardiovascular disease was reduced significantly, which appeared to result in improvements in erectile dysfunction (10). The lifestyle modifications included dietary changes and increased physical activity. When statin medications were not included, the risk reduction remained relatively constant, demonstrating the strength of lifestyle changes. This research is important, since those with chronic erectile dysfunction are likely to have heart disease within two to five years, according to the authors.
How do you know that you are reducing your risk of heart disease and how long does it take?
These are good questions that I have been asked by a number of patients. We use cardiac biomarkers, including inflammatory markers like C-reactive protein, blood pressure, cholesterol and body mass index. A cohort (a certain group of people) study helped answer these questions. It studied both high-risk participants and patients with heart disease. The results showed an improvement in biomarkers, as well as in cognitive function and overall quality of life.
Participants followed extensive lifestyle modification: a plant-based, whole foods diet accompanied by exercise and stress management. The results were statistically significant with all parameters measured. The best part is the results occurred over a very short period to time — three months from the start of the trial (11). Many patients I have seen have had similar results.
Ideally, if patient needs to use medications to treat risk factors for heart disease, it is for the short term. For some patients, it may be appropriate to use medication and lifestyle changes together; for others, lifestyle modifications may be sufficient, as long as patients are willing to take an active role.
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.
New law closes loophole to permanently ban replacement of old, primitive cesspool technology to reduce nitrogen levels in water
Suffolk County Executive Steve Bellone, center, displays the new county law banning the updating or instillation of primitive cesspools and the technology associated with them, as he’s surrounded by local leaders and environmental group organizers during a press conference. Photo from Suffolk County Executive Steve Bellone’s office
Repairing old cesspools is now a thing of the past in Suffolk County.
“It marks another historic step forward in our ongoing effort to reverse decades of nitrogen pollution that has degraded water quality in our lakes, bays and harbors, and it is a step that is long overdue,” Bellone said. “It is fairly unusual for the local governments, environmental groups and the region’s largest builders group to agree on the importance of tightening up outdated regulations to protect water quality, but that is exactly what happened in this instance. This inclusive, collaborative approach is making a huge difference in our efforts to reduce decades of nitrogen pollution.”
Cesspools have been identified as primary sources of nitrogen pollution that have degraded water quality throughout Suffolk County, contributing to harmful algae blooms, beach closures and fish kills. The use of cesspools in new construction has been banned in the county since 1973, when a requirement for the addition of a septic tank was added, but the county sanitary code did not require that homeowners add a septic tank when replacing an existing cesspool, making it legal to install a new cesspool to replace an existing one. By now closing this loophole, it will advance the water quality efforts undertaken by the county and set the stage for the evolution away from the use of nonperforming cesspools and septic systems to the use of new, state-of-the-art technologies that reduce nitrogen in residential wastewater by up to 70 percent, according to Bellone.
“With this action, I would like to say that we, as a county, have adopted the policies necessary to adequately address our region’s nitrogen pollution problems, but in reality, this gets us closer to where we should have been in the decades following 1973,” said county Legislator Kara Hahn (D-Setauket), a co-sponsor of the Article 6 revisions and chairwoman of the Suffolk County Legislature’s Environment, Planning and Agriculture Committee. “I look forward to continuing the process of finally bringing Suffolk County’s sanitary code into the 21st century.”
In addition to banning the installation of new cesspools, the law approved by the Suffolk County Legislature Dec. 5 requires the wastewater industry to provide data regarding system replacement and pumping activities to the Department of Health Services beginning July 1, 2018. It also mandates permits for replacement of existing systems effective July 1, 2019, and requires business properties with grandfathered nonconforming wastewater flows to install nitrogen-reducing advanced systems if making significant changes to the use of the property.
Adrienne Esposito, executive director of Citizens Campaign for the Environment, joined forces with other environmental group leaders in thanking the county for what was a necessary step in eliminating nitrogen from groundwater.
“We can no longer allow inadequately treated sewage to mix with our sole source of drinking water,” she said. “Modernizing our health codes is a commonsense action that is critically needed for water protection.”
Richard Amper, executive director of the Long Island Pine Barrens Society, said he was overjoyed by the “huge step,” ending pollution by what he called Suffolk’s No. 1 threat to clean water.
“Now, we’re not just complaining,” he said. “We’re doing something about it.”
For the past three years, Suffolk’s Legislature has instituted a pilot program to test the new technologies, using a lottery system to select homeowners willing to have a donated system installed to demonstrate system performance. Under the pilot program, a total of 14 different technologies have been installed at 39 homes throughout the county. Four have been provisionally approved for use after demonstrating six months of acceptable operating data. As part of continued efforts, a voluntary Septic Improvement Program, the first of its kind in the state, was launched in July 2017 to provide grants and low-interest financing to make the replacement of cesspools and septic systems with new innovative/alternative technologies affordable for homeowners who choose to upgrade their systems. Over the first five months, nearly 850 homeowners have registered for the program, 228 have completed applications and 160 have been awarded grants and are moving toward installation of the new systems.
Suffolk County was the first in the state to apply for funding from New York State’s newly created $75 million Septic System Replacement Fund and will use the funding to expand its efforts to see the new technologies installed throughout the county.
The changes are the first in what is expected to be a series of updates to the county sanitary code over the next several years as county officials consider whether to put in place policies that require new nitrogen-
reducing systems in new construction projects, require installation of the new systems when a cesspool or septic system fails and needs to be replaced, or upon sale of a property. For now, all parties involved are on the same page moving forward, including both a working group comprised of county legislators, town planners and engineers with members of environmental organizations, as well as the Long Island Builders Institute.
“There is more work to do,” said Kevin McDonald, conservation finance and policy director for The Nature Conservancy on Long Island. “But passage of this bill means less nitrogen pollution in our water, and more resilient, healthy bays and people for generations to come.”
The path to improved health: Your body needs vitamins and minerals, known as micronutrients, to nourish and keep it healthy and to reduce risk for chronic diseases.
Getting them through food ensures that your body can absorb them properly.
Increasing food quality makes a difference
By David Dunaief, M.D.
Dr. David Dunaief
Hunger is only one reason we eat. There are many psychological and physiological factors that influence our eating behavior, including addictions, lack of sleep, stress, environment, hormones and others. This can make weight management or weight loss for the majority who are overweight or obese — approximately 75 percent of the U.S. adult population — very difficult to achieve (1).
Since calorie counts have been required on some municipalities’ menus, we would expect that consumers would be making better choices. Unfortunately, studies of the results have been mostly abysmal. Nutrition labeling either doesn’t alter behavior or encourages higher calorie purchases, according to most studies (2, 3).
Does this mean we are doomed to acquiesce to temptation? Actually, no: It is not solely about will power. Changing diet composition is more important.
What can be done to improve the situation? In my clinical experience, increasing the quality of food has a tremendous impact. Foods that are the most micronutrient dense, such as plant-based foods, rather than those that are solely focused on macronutrient density, such as protein, carbohydrates and fats, tend to be the most satisfying. In a week to a few months, one of the first things patients notice is a significant reduction in their cravings. But don’t take my word for it. Let’s look at the evidence.
Effect of refined carbohydrates
By this point, many of us know that refined carbohydrates are not beneficial. Well, there is a randomized controlled trial (RCT), the gold standard of studies, with results that show refined carbohydrates may cause food addiction (4). There are certain sections of the brain involved in cravings and reward that are affected by high-glycemic (sugar) foods, as shown by MRI scans of participants.
The participants consumed a 500-calorie shake with either a high-glycemic index or with a low-glycemic index. The participants were blinded (unaware) as to which type they were drinking. The ones who drank the high-glycemic shake had higher levels of glucose in their blood initially, followed by a significant decline in glucose levels and increased hunger four hours later. In fact, the region of the brain that is related to addiction, the nucleus accumbens, showed a spike in activity with the high-glycemic intake.
According to the authors, this effect may occur regardless of the number or quantity of calories consumed. Granted, this was a very small study, but it was well designed. High-glycemic foods include carbohydrates, such as white flour, sugar and white potatoes. The conclusion: Everyone, but especially those trying to lose weight, should avoid refined carbohydrates. The composition of calories matters.
Comparing macronutrients
We tend to focus on macronutrients when looking at diets. These include protein, carbohydrates and fats, but are these the elements that have the most impact on weight loss? In a RCT, when comparing different macronutrient combinations, there was very little difference among groups, nor was there much success in helping obese patients reduce their weight (5, 6). In fact, only 15 percent of patients achieved a 10 percent reduction in weight after two years.
The four different macronutrient diet combinations involved an overall calorie restriction. In addition, each combination had either high protein, high fat; average protein, high fat; high protein, low fat; or low protein, low fat. Carbohydrates ranged from low to moderate (35 percent) in the first group to high (65 percent) in the last group. This was another relatively well-designed study, involving 811 participants with an average BMI of 33 kg/m², which is defined as obesity (at least 30 kg/m²). Again, focusing primarily on macronutrient levels and calorie counts did very little to improve results.
Impact of obesity
In an epidemiological study looking at National Health and Nutrition Examination Survey data, results demonstrate that those who are overweight and obese tend to be lacking in micronutrients (7). The authors surmise that it may have to do with the change in metabolic activity associated with more fat tissue. These micronutrients include carotenoids, such as lutein, zeaxanthin, beta-carotene, alpha-carotene and beta-cryptoxanthin, as well as vitamin B12, folate and vitamins C, E and D.
However, it does not mean this population should take supplements to make up for the lack of micronutrients. Quite the contrary, micronutrients from supplements are not the same as those from foods. Overweight and obese patients may need some supplements, but first find out if your levels are low, and then see if changing your diet might raise these levels. With a few exceptions, such as vitamin D and potentially B12, most micronutrient levels can be raised without supplementation. Please ask your doctor.
Steroid levels
It may seem like there are numerous factors influencing weight loss, but the good news is that once people lose weight, they may be able to continue to keep the weight off. In a prospective (forward-looking) study, results show that once obese patients lose the weight, the levels of cortisol metabolite excretion decreases significantly (8).
Why is this important? Cortisol is a glucocorticoid, which means it raises the level of glucose and is involved in mediating visceral or belly fat. This type of fat has been thought to coat internal organs, such as the liver, and result in nonalcoholic fatty liver disease. Decreasing the level of cortisol metabolite may also result in a lower propensity toward insulin resistance and may decrease the risk of cardiovascular mortality. This is an encouraging preliminary, yet small, study involving women.
Therefore, controlling or losing weight is not solely about willpower. Don’t use the calories on a menu as your sole criteria to determine what to eat; even if you choose lower calories, it may not get you to your goal. While calories may have an impact, the nutrient density of the food may be more important. Thus, those foods high in micronutrients may also play a significant role in reducing cravings, ultimately helping to manage weight.
References: (1) www.cdc.gov. (2) Am J Pub Health 2013 Sep 1;103(9):1604-1609. (3) Am J Prev Med.2011 Oct;41(4):434–438. (4) Am J Clin Nutr Online 2013;Jun 26. (5) N Engl J Med 2009 Feb 26;360:859. (6) N Engl J Med 2009 Feb 26;360:923. (7) Medscape General Medicine. 2006;8(4):59. (8) Clin Endocrinol.2013;78(5):700-705.
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.
Rivera is honored by members of Brookhaven Town Board for his advocacy and support work surrounding the disease. Photo from Councilwoman Cartright's office
By Jennifer Sloat
He has been called an angel, the personification of goodness and strength, a champion of the underrepresented and an inspiration. Frank Rivera is all of that and more.
Rivera is the founder and president of Sarcoidosis of Long Island, an awareness and advocacy group for sarcoidosis, a rare and often debilitating disease from which the Coram resident is suffering. In 2004 at the age of 36, he received an incorrect diagnosis of lung cancer for which he underwent treatment. The X-ray showed lumps in his lungs. It was after a hospital visit in 2011 for abdominal pain that he was correctly diagnosed with sarcoidosis.
Frank Rivera, at center, cuts a ribbon at Mount Sinai’s Heritage Park to signal the start of his Sarcoidosis Awareness 5K. Photo from Councilwoman Cartright’s office
Things got even tougher for Rivera as complications from the disease arose. It attacked his neurological system, eyes and gallbladder. In April 2012, he went back to the hospital with more stomach cramps and learned his colon had ruptured. He contracted sepsis and nearly died.
Through it all Rivera continues to fight, not only for his own health, but for the health of others affected by the disease. His organization raises awareness for sarcoidosis patients at local, state and federal levels, and helps them find doctors and treatment.
Suffolk County Legislator Sarah Anker (D-Mount Sinai) said Rivera came to her office a few years ago and told her his story and idea to start a not-for-profit organization.
Anker said his tireless work with elected officials and medical research experts have provided him the guidance and resources to help residents dealing with sarcoidosis.
“He has accomplished so much,” Anker said. “It was his goal, and it remains his goal.”
County Legislator William “Doc” Spencer (D-Centerport), a practicing ear, nose and throat physician, said when he heard Rivera was creating awareness, he reached out to lend support. Spencer, who lost his mother to the disease, said he was fascinated by the work Rivera does.
“It hit close to home,” the legislator said. “Many have not even heard of the disease.”
Spencer said that what Rivera has done also generated a lot of funding to aid sarcoidosis patients in seeking medical attention and emotional support.
“I hope to continue to support him,” he said. “I hope to see him do more great things for those who don’t have champions.”
Some of the organization’s efforts include a health fair and a 5K run/walk at Heritage Park in Mount Sinai.
“He gets folks together to share ideas and stories, and to support one another,” Anker said. “It is amazing what Frank has done considering he is dealing with his own challenges, both physical and mental.”
The Town of Brookhaven celebrates National Sarcoidosis Awareness Month in April, and it’s a direct result of Rivera’s work and dedication.
“The town board has learned an overwhelming amount about the misconceptions surrounding sarcoidosis and the hurdles patients face who are suffering from rare diseases,” said town Councilwoman Valerie Cartright (D-Port Jefferson Station). “This is due in large part to Frank’s efforts. Listening to Frank speak about his personal experiences is a testament to his strength of character.”
In an interview with RARE Daily, a Global Genes patient advocacy organization, Rivera said his focus is helping others with hardships before worrying about himself.
“There are 200,000 sarcoidosis patients,” he said. “I always consider myself a representative for those 200,000 patients. I always think about what they need.”
Anker said despite his own struggles he’s always being positive to inspire others to have the will to get through the tough times.
“He always has a smile on his face and goodness in his heart,” Anker said. “His mind is going 1,000 miles an hour to accomplish what he has set out to do. He has been able to accomplish so many of his goals.”
As you become more active, Santa, you’ll find that you have more energy all year round, not just on Christmas Eve.
By David Dunaief, M.D.
Dr. David Dunaief
Dear Santa,
This time of year, people around the world are no doubt sending you lists of things they want through emails, blogs, tweets and old-fashioned letters. In the spirit of giving, I’d like to offer you — and maybe your reindeer — some advice.
Let’s face it: You aren’t exactly the model of good health. Think about the example you’re setting for all those people whose faces light up when they imagine you shimmying down their chimneys. You have what I’d describe as an abnormally high BMI (body mass index). To put it bluntly, you’re not just fat, you’re obese. Since you are a role model to millions, this sends the wrong message.
We already have an epidemic of overweight kids, leading to an ever increasing number of type 2 diabetics at younger and younger ages. According to the Centers for Disease Control and Prevention, as of 2015, more than 100 million U.S. adults are living with diabetes or prediabetes. It complicates the issue that approximately two-thirds of the U.S. population is overweight and/or obese. This is just one of many reasons we need you as a shining beacon of health.
Obesity has a much higher risk of shortening a person’s life span, not to mention quality of life and self-image. The most dangerous type of obesity is an increase in visceral adipose tissue, which means central belly fat. An easy way to tell if someone is too rotund is if a waistline, measured from the navel, is greater than or equal to 40 inches for a man, and is greater than or equal to 35 inches for a woman. The chances of diseases such as pancreatic cancer, breast cancer, liver cancer and heart disease increase dramatically with this increased fat.
Santa, here is a chance for you to lead by example (and, maybe, by summer, to fit into those skinny jeans you hide in the back of your closet). Think of the advantages to you of being slimmer and trimmer. For one thing, Santa, you would be so much more efficient if you were fit. Studies show that with a plant-based diet, focusing on fruits and vegetables, people can reverse atherosclerosis, clogging of the arteries.
The importance of a good diet not only helps you lose weight but avoid strokes, heart attacks, peripheral vascular diseases, etc. But you don’t have to be vegetarian; you just have to increase your fruits, vegetables and whole-grain foods significantly. With a simple change, like eating a handful of raw nuts a day, you can reduce your risk of heart disease by half. Santa, future generations need you. Losing weight will also change your center of gravity, so your belly doesn’t pull you forward. This will make it easier for you to keep your balance on those steep, icy rooftops.
Exercise will help, as well. Maybe for the first continent or so, you might want to consider walking or jogging alongside the sleigh. As you exercise, you’ll start to tighten your abs and slowly see fat disappear from your midsection, reducing risk and practicing preventive medicine. Your fans everywhere leave you cookies and milk when you deliver presents. It’s a tough cycle to break, but break it you must. You — and your fans — need to see a healthier Santa. You might let slip that the modern Santa enjoys fruits, especially berries, and veggies, with an emphasis on cruciferous veggies like broccoli florets dipped in humus, which have substantial antioxidant qualities and can help reverse disease.
As for your loyal fans, you could place fitness videos under the tree. In fact, you and your elves could make workout videos for those of us who need them, and we could follow along as you showed us “12 Days of Workouts with Santa and Friends.” Who knows, you might become a modern version of Jane Fonda or Richard Simmons or even the next Shaun T!
How about giving athletic equipment, such as baseball gloves, footballs and basketballs, instead of video games? You could even give wearable devices that track step counts and bike routes or stuff gift certificates for dance lessons into people’s stockings. These might influence the recipients to be more active.
By doing all this, you might also have the kind of energy that will make it easier for you to steal a base or two in this season’s North Pole Athletic League’s Softball Team. The elves don’t even bother holding you on base anymore, do they?
As you become more active, you’ll find that you have more energy all year round, not just on Christmas Eve. If you start soon, Santa, maybe by next year, you’ll find yourself parking the sleigh farther away and skipping from chimney to chimney.
The benefits of a healthier Santa will ripple across the world. Think about something much closer to home, even. Your reindeer won’t have to work so hard. You might also fit extra presents in your sleigh. And Santa, you will be sending kids and adults the world over the right message about taking control of their health through nutrition and exercise. That’s the best gift you could give!
Wishing you good health in the new year,
David
P.S. I could really use a new baseball bat, if you have a little extra room in your sleigh.
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.
John T. Mather Memorial Hospital in Port Jefferson. File photo from Mather Hospital
A historic change at a nearly 90-year-old Port Jefferson institution has been finalized.
John T. Mather Memorial Hospital will officially finalize an affiliation agreement with Northwell Health Dec. 21, according to a Mather board member, who asked not to be referred to by name. Leadership from Mather Hospital signed a letter of intent to join Northwell, New York’s largest health care provider, in August, though the sides had not yet finalized the terms of the agreement at that time. It is the first time in the hospital’s history it will be affiliating with a larger health system, and a signing ceremony is set to take place Thursday, Dec. 21, at 3 p.m. in a conference room at the hospital. The board member said he expects Northwell Health president and chief executive officer Michael Dowling as well as Mather board of directors chairman Ken Jacoppi to attend the signing.
Mather Hospital is set to join Northwell Healht. Photo from Huntington Hospital
“We’re very pleased Northwell has committed to making an investment in our community and bringing their extraordinary capabilities to our community,” the board member said. “They’ve committed to preserve our culture of patient safety.”
The board member said part of the agreement is that Mather’s board and CEO will remain in place through an initial period of five years, allowing the hospital to remain “largely self-governing” during that time with collaboration and cooperation from Northwell. The Mather board member did not specify the total length or any other specifics of the agreement. A spokesperson from Mather confirmed the ceremonial signing will take place Dec. 21 and that the agreement has been reached, but declined to confirm any details relating to the contract.
The board member summed up what the change might mean for hospital patients going forward.
“In the near term the experience should not change at all,” he said. “We happen to believe that’s a good experience, generally speaking. In the long term Northwell has greater capabilities than we do and we’ll gain those. They’re committed to supporting our residency program as well.”
In August, state Sen. Ken LaValle (R-Port Jefferson) voiced opposition to the agreement, saying he would have preferred Mather affiliate with Stony Brook University Hospital.
“I don’t think it’s a good decision,” LaValle said at the time. “For 50 years-plus there’s been a culture in place if people needed tertiary care they would go from Mather to Stony Brook. Stony Brook will still be in place, will still offer services and people if they choose can go to Stony Brook.”
Mather Hospital vice president of public affairs Nancy Uzo said in August Stony Brook was considered an option for affiliation and offered an explanation by email.
“Our goal through this process is to ensure that our communities continue to have access to advanced, high-quality care and superior satisfaction close to home, and to serve the best interests of our medical staff and employees,” she said.
Dowling commented similarly about Mather Hospital’s reputation around the letter of intent signing in August, and as to why Northwell would be a good fit for Mather.
“Mather Hospital is known for patient-centric care both in the community and throughout the industry,” he said. “That deeply embedded sense of purpose is the type of quality we want to represent Northwell Health, along with an excellent staff of medical professionals and physicians. Together, Mather and Northwell will play a crucial partnership role expanding world-class care and innovative patient services to Suffolk County residents.”
A public relations representative from Northwell did not immediately respond to requests for comment.
This story was updated Dec. 19 to include a Mather spokesperson’s confirmation of the signing ceremony.
How do we protect one of our most valued assets, our infrastructure? Not roads and bridges, but our bones. When we think of bone fractures as a child or young adult, we think of short-term pain and inconvenience, but usually we recover without long-term consequences.
However, as we get older, fractures can be a lot more significant, with potentially life-altering or life-ending consequences. Osteoporosis is a silent disease that affects millions of patients, most commonly, but by no means exclusively, postmenopausal women. The trend is for low bone mass and osteoporosis diagnoses to increase by 29 percent from 2010 to 2030.
Osteoporosis is where there is bone loss, weakening of the bones and small deleterious changes in the architecture of the bone over time that may result in fractures with serious consequences (1).
One way to measure osteoporosis is with a dual-energy X-ray absorptiometry (DXA) scan for bone mineral density. Osteopenia is a slightly milder form that may be a precursor to osteoporosis. However, we should not rely on the DXA scan alone; risk factors are important, such as a family or personal history of fractures as we age. The Fracture Risk Assessment Tool (FRAX) is more thorough for determining the 10-year fracture risk. Those who have a risk of fracture that is 3 percent or more should consider treatment with medications. A link to the FRAX tool can be found at www.shef.ac.uk/FRAX.
Most of us have been told since we were young that we need more calcium to make sure we have strong bones. In fact, the National Osteoporosis Foundation recommends that we get 1,000 to 1,200 mg per day of calcium if we are over 50 years old (2). Recommendations vary by sex and age. This would be mostly from diet but also from supplements. However, the latest research suggests that calcium for osteoporosis prevention may not be as helpful as we thought.
The under/overmedication treatment paradox
Depending on the population, we could be overtreating or undertreating osteoporosis. In the elderly population that has been diagnosed with osteoporosis, there is undertreatment. One study showed that only 28 percent of patients who are candidates for osteoporosis drugs are taking the medication within the first year of diagnosis (3). The reason most were reluctant was that they had experienced a recent gastrointestinal event and did not want to induce another with osteoporosis medications, such as bisphosphonates. The data were taken from Medicare records of patients who were at least 66 years old.
On the other hand, as many as 66 percent of the women receiving osteoporosis medications may not have needed it, according to a retrospective study (4). This is the overtreatment population, with half these patients younger, between the ages of 40 and 64, and without any risk factors to indicate the need for a DXA scan. This younger population included many who had osteopenia, not osteoporosis.
Also, the DXA scan may have shown osteoporosis at what the researchers described as nonmain sites in one-third of patients diagnosed with the disease. Main sites, according to the International Society for Clinical Densitometry recommendations, would be the anterior-posterior spine, hip and femoral neck. A nonmain site in this review was the lateral lumbar spine. Before you get a DXA scan, make sure you have sufficient risk factors, such as family or personal history of fracture, age and smoking history. When the DXA scan is done, make sure it is interpreted at the main sites. If you are not sure, have another physician consult on the results.
We all need calcium to prevent osteoporosis, right?
Calcium has always been the forefront of prevention and treatment of osteoporosis. However, two studies would have us question this approach. Results of one meta-analysis of a group of 59 randomized controlled trials showed that dietary calcium and calcium supplements with or without vitamin D did increase the bone density significantly in most places in the body, including the femoral neck, spine and hip (5). Yet the changes were so small that they would not have much clinical benefit in terms of fracture prevention.
Another meta-analysis of a group of 44 observational dietary trials and 26 randomized controlled trials did not show a benefit with dietary or supplemental calcium with or without vitamin D (6). There was a slight reduction in nonsignificant vertebral fractures, but not in other places, such as the hip and forearm. Dietary calcium and supplements disappointed in these two trials.
Does this mean calcium is not useful? Not so fast!
In some individual studies that were part of the meta-analyses, the researchers mentioned that dairy, specifically milk, was the dietary source on record, and we know milk is not necessarily good for bones. But in many of the studies, the researcher did not differentiate between the sources of dietary calcium. This is a very important nuance. Calcium from animal products may increase inflammation and the acidity of the body and may actually leach calcium from the bone, while calcium from vegetable-rich, nutrient-dense sources may be better absorbed, providing more of an alkaline and anti-inflammatory approach. This would be a good follow-up study, comparing the effects of calcium from animal and plant-based dietary sources.
What can be done to improve the situation?
Studies have shown that yoga can help prevent osteoporosis by improving mobility, posture and strength.
Yoga used to be on the fringe of society. Now, it has become more prevalent and part of mainstream exercise. This is a good trend since this type of exercise may have a big impact on prevention and treatment of osteoporosis. In a small pilot study, the results showed that those who practiced yoga had an increase in their spine and hip bone density compared to those who did not (7). There were 18 participants in this trial.
The researchers were encouraged by these results, so they increased the number of participants in another study. The results showed that 12 minutes of yoga daily or every other day significantly increased the bone density from the start of the study in both the spine and femur, the thigh bone (8). There was also an increase in hip bone density, but this was not significant. The strength of the study includes its 10-year duration. However, one weakness was that this trial did not include a control group.
Another was that 741 participants started the trial, but only 227 finished, less than one-third. Of those, 202 were women. Significantly, prior to the study there were 109 fractures in the participants, most of whom had osteoporosis or osteopenia, but none had yoga-related fractures by the end of the trial. The “side effects” of yoga include improved mobility, posture, strength and a reduction in anxiety. The researchers gave a nice road map of specific beneficial poses. Before starting a program, consult your doctor.
The moral of the story is that exercise is beneficial. Yoga may be another simple addition to this exercise regimen. Calcium may be good or bad, depending on its dietary source. Be cautious with supplemental calcium; it does have side effects, including kidney stones, cardiovascular events and gastrointestinal symptoms, and consult with your doctor to assess whether you might be in an overtreatment or undertreatment group when it comes to medication.
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.
Prev
