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Those affected or who know someone affected by preeclampsia headed to Heritage Park in Mount Sinai June 16 to raise awareness and funds for the rare but life-threatening pregnancy disorder. Photo by Kevin Redding

By Kevin Redding

Families and friends walked to raise awareness and funds to help put an end to a life-threatening pregnancy disorder.

Coram mom Jen DiSanza was 33 weeks pregnant with her second child in early 2016 when she started experiencing what felt like really bad heartburn, which she was told was a common symptom experienced at the end of pregnancy.

Coram resident Jen DiSanza, who was diagnosed with HELLP syndrome, a complication of preeclampsia, during her second pregnancy, hosted a Promise Walk for Preeclampsia to raise awareness to and fund for the disease. Photo by Kevin Redding

Even though a recent visit to the doctor had ensured her everything was going well, in a matter of days, she was vomiting, her blood pressure was up to 188/110 and her liver was shutting down while in labor seven weeks ahead of schedule at Stony Brook University Hospital.

“My liver enzymes were very high, my blood stopped clotting and my platelet count dropped — normal is around 200,000 and I was at 27,000,” DiSanza said. “I couldn’t even walk down the hallway in the hospital because if I stubbed my toe, I could internally bleed to death.”

She was soon diagnosed with HELLP syndrome, which is a complication of preeclampsia, an all-too-prevalent but widely overlooked pregnancy disorder that threatens the lives of mothers and their unborn babies. HEELP gets the acronym for hemolysis, elevated liver enzymes, low platelet count, which are all affected by the disorder.

There is currently no direct cause, which affects .2 to .6 percent of all pregnancies, which symptoms include headaches to swelling, according to the American Pregnancy Association. Women in the United States are at a higher risk for maternal death than women in 47 other countries, and about 4 to 12 percent of women diagnosed with preeclampsia develop HELLP syndrome.

Since giving birth to her perfectly healthy daughter, Elisandra, at midnight Feb. 4, 2016, DiSanza has bounced back from a post-birth health crisis and become an active volunteer with the nationwide Preeclampsia Foundation, an empowered community of patients and experts that aims to raise public awareness of the disorder and funds for research and a cure.

The foundation is a driving force behind two bipartisan bills currently trying to be passed in Congress that would support states in their efforts to identify a cause for the disorder and use their findings to improve healthcare quality and ultimately inform change.

Those affected or know someone affected by preeclampsia headed to Heritage Park in Mount Sinai June 16 to raise awareness and funds for the rare but life-threatening pregnancy disorder. Photo by Kevin Redding

DiSanza, with the support of several sponsors including Macaroni Kid and Eurofins NTD, organized the Promise Walk for Preeclampsia June 17, where dozens of local residents affected by the disorder in some way or another walked a mile and half around Heritage Park in Mount Sinai in support of disorder recognition and research.

A goal for donations to the foundation was set at $5,000, $3,000 of which was raised before the event even started. Gift certificates to local businesses were raffled off and a post-walk workout session was offered by Energy Fitness of Miller Place, where DiSanza works as an instructor. Face painting was available for kids.

“A lot of people aren’t aware of what preeclampsia actually is, and how serious it can be and how quickly it comes up,” DiSanza said to the small crowd before the walk began. “There’s a lot that women just don’t know to look for. Being here, and telling all your friends and family why we’re here, helps to share that message. [The foundation] sends out pamphlets to doctors’ offices and clinics around the country, they explain the warning signs and what to look for.”

Laura Moakley, a Seaford resident who helped DiSanza coordinate the event, and her 6-year-old daughter, Rowan, wore a pink shirt that read “Kick Preeclampsia to the Curb.” Moakley was diagnosed while 32 weeks pregnant with Rowan in 2011 after her midwife mistreated the signs.

Ray and Jen DiSanza with their two children. Elisandra, on left, was who Jen DiSanza was pregnant with when she was diagnosed with HELPP syndrome, a complication of preeclampsia. Photo by Kevin Redding

Feeling scared and uncertain of what awaited her, having been told she or her child could die in labor, Moakley had an emergency Cesarean section and woke up with a photo of Rowan next to her pillow. Her daughter spent 35 days in the Neonatal Intensive Care Unit.

“I felt robbed of a normal pregnancy … why didn’t I have the picture perfect pregnancy that our society needs to see? My goal was for no other woman to ever have to go through this,” Moakley said as a happy and healthy Rowan hugged her. “Awareness is key — we must continue forward with all of our work, our walks, changes in the medical community and even Congress.”

She eventually discovered the foundation online and found a network of women and men to talk to and get support from.

“I feel more connected … I feel like we’re not alone,” she said. “I feel like there’s a movement happening and there could be change in the future. I already see there’s more awareness and support … not just for women, but men, who are just as deeply affected by it also. There’s the stress of coming home without a baby or of having to take care of a premature baby.”

Ray DiSanza, whose wife Jen was who was diagnosed with HELLP syndrome, said more mothers need to be aware of the deadly disease and its all-too-common symptoms. Photo by Kevin Redding

DiSanza’s husband, Ray, could vouch for that stress.

“It was the single most horrifying experience of my life,” he recalled. “I didn’t know all that much about preeclampsia before it happened … it was a good thing that Jen did, because if we had both been as ignorant of it as I was, we might not be here today.”

Dr. Terrence Hallahan, of Eurofins Clinical Diagnostics in Melville, spoke of a recently developed test screening for early onset preeclampsia at the lab, which is the only one offering the test at the moment.

“It’s something near and dear to our hearts,” Hallahan said. “We now have the ability to test pregnant women in the first trimester, and determine which are most likely to develop early onset preeclampsia. Not only can we detect this, we can now prevent it. People need to know.”

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Studies show that wine may have heart benefits in well-controlled patients with type 2 diabetes.
Wine — yes, wine — may have benefits

By David Dunaief, M.D.

Dr. David Dunaif

Soda has a lot of sugar, with 39 grams per 12-ounce can. Not surprisingly, soda is associated with increased risk of diabetes. However, the drink with the lowest amount of sugar is wine, red or white. Even more surprising, it may have benefits in reducing complications associated with diabetes. Wine has about 1.2 grams of sugar in five ounces. I know what you’re thinking: These different drinks are based on different quantities; however, per ounce, soda has the most and wine has the least.

Why is this important? Well, it wouldn’t be if diabetes were going the way of the dodo bird. Instead, the prevalence of diabetes has continued to climb over three decades in the United States at an alarmingly rapid rate to its current level of 12 to 14 percent (1). The even scarier news is that more than one-third don’t know they have diabetes. The number of patients with prediabetes (HbA1C of 5.7-6.4 percent) is greater than one in three in this country.

So where do we stand? Only recently did the United States Preventive Services Task Force (USPSTF) and the American Diabetes Association (ADA) converge on screening guidelines. However, originally, the USPSTF recommended that asymptomatic patients not be screened for diabetes since the evidence is inconclusive and screening may not improve mortality. Now they give the evidence a grade of B, which means there is a moderate amount of evidence, not even a grade of A. ADA guidelines suggest testing those who are overweight and who have one or more risk factors for diabetes and all of those who are over 45 (2, 3).

It turns out that, for those with diabetes, cardiovascular risk and severity may not be equal between the sexes. In two trials, women had greater risk than men. In one study, women with diabetes were hospitalized due to heart attacks at a more significant rate than men, though both had substantial increases in risk, 162 percent and 96 percent, respectively (4). This was a retrospective (backward-looking) study. The same result was found in a second study (5). In this meta-analysis (a group of 19 studies), there was a 38 percent greater increased risk of cardiovascular events in women than men. The latter was presented as a poster, not fully published data.

What may reduce risks of disease and/or complications? Fortunately, we are not without options. Several factors may help. These include timing of blood pressure medications, lifestyle modifications (diet and exercise) and wine.

Diet trumps popular drug for prevention

All too often in the medical community, we are guilty of reaching for drugs and either overlooking lifestyle modifications or expecting that patients will fail with them. This is not only disappointing, but it is a disservice; lifestyle changes may be more effective in preventing this disease. In a head-to-head comparison study (Diabetes Prevention Program), diet plus exercise bests metformin for diabetes prevention (7). This study was performed over 15 years of duration in 2,776 participants who were at high risk for diabetes because they were overweight or obese and had elevated sugars.

There were three groups in the study: those receiving a low-fat, low-calorie diet with 15 minutes of moderate cardiovascular exercise; those taking metformin 875 mg twice a day; and a placebo group. Diet and exercise reduced the risk of diabetes by 27 percent, while metformin reduced it by 18 percent over the placebo, both reaching statistical significance. While these are impressive results that speak to the use of lifestyle modification and to metformin, this is not the optimal diabetes diet.

Wine is beneficial, really?

Alcohol in general has mixed results. Wine is no exception. However, the CASCADE trial, a randomized controlled trial, considered the gold standard of studies, shows wine may have heart benefits in well-controlled patients with type 2 diabetes by altering the lipid (cholesterol) profile (6).

Patients were randomized into three groups, each receiving a drink with dinner nightly; one group received five ounces of red wine, another five ounces of white wine, and the control group drank five ounces of water. Those who drank the red wine saw a significant increase in their “good cholesterol” HDL levels, an increase in apolipoprotein A1 (the primary component in HDL) and a decrease in the ratio of total cholesterol-to-HDL levels compared to the water drinking control arm. In other words, there were significant beneficial cardiometabolic changes.

White wine also had beneficial cardiometabolic effects, but not as great as red wine. However, white wine did improve glycemic (sugar) control significantly compared to water, whereas red wine did not. Also, slow metabolizers of alcohol in a combined red and white wine group analysis had better glycemic control than those who drank water. This study had a two-year duration and involved 224 patients. All participants were instructed on how to follow a Mediterranean-type diet.

Does this mean diabetes patients should start drinking wine? Not necessarily, because this is a small, though well-designed, study. Wine does have calories, and these were also well-controlled type 2 diabetes patients who generally were nondrinkers.

Drugs — not diabetes drugs — show good results

In the May 11, 2017 column I wrote that taking blood pressure medications at night may control blood pressure better than only taking these medications in the morning. Well, it turns out this study also shows that taking blood pressure medications has another benefit, lowering the risk of diabetes (8). There was a 57 percent reduction in the risk of developing diabetes in those who took blood pressure medications at night rather than in the morning.

It seems that controlling sleep-time blood pressure is more predictive of risk for diabetes than morning or 48-hour ambulatory blood pressure monitoring. This study had a long duration of almost six years with about 2,000 participants.

The blood pressure medications used in the trial were ACE inhibitors, angiotensin receptor blockers and beta blockers. The first two medications have their effect on the renin-angiotensin-aldosterone system (RAAS) of the kidneys. According to the researchers, the drugs that blocked RAAS in the kidneys had the most powerful effect on preventing diabetes. Furthermore, when sleep systolic (top number) blood pressure was elevated one standard deviation above the mean, there was a 30 percent increased risk of type 2 diabetes. Interestingly, the RAAS blocking drugs are the same drugs that protect kidney function when patients have diabetes.

We need to reverse the trend toward higher diabetes prevalence. Diet and exercise are the first line for prevention. Even a nonideal diet, in comparison to medication, had better results, though medication such as metformin could be used in high-risk patients that were having trouble following the diet. A modest amount of wine, especially red, may have effects that reduce cardiovascular risk. Blood pressure medications taken at night, especially those that block RAAS in the kidneys, may help significantly to prevent diabetes.

References: (1) JAMA 2015;314(10):1021-1029. (2) uspreventiveservicestaskforce.org. (3) Diabetes Care 2015;38(Suppl. 1): S1–S94. (4) Journal of Diabetes and Its Complications 2015;29(5):713-717. (5) EASD 2015; Poster #269. (6) Ann Intern Med. 2015;163(8):569-579. (7) Lancet Diabetes Endocrinol. Online Sept. 11, 2015. (8) Diabetologia. Online Sept. 23, 2015.

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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Teen patients from Stony Brook Children’s Hospital dance at the June 10 prom. Photo from Stony Brook Children's Hospital

By Rita J. Egan

Attending a prom is an important milestone for most teenagers, but for children who are dealing with an illness, they may not always get the chance to experience the rite of passage.

Stony Brook Children’s Hospital ensured their teenaged inpatients as well as outpatients had the opportunity to enjoy the same special moments their peers do when they held their second annual Children’s Hospital Prom June 10. Many of the teenagers were unable to attend this year’s school prom or a previous year’s, or due to life-limiting illnesses may never have the opportunity.

Before the event, many prom-goers had their hair and nails done by volunteers from the New York Institute of Beauty. Photo from Stony Brook Children’s Hospital

Maureen Cole, associate director of nursing at the hospital, said 50 patients between ages 12 and 21 along with their guests attended this year’s prom.

For the event, a youth advisory council was created so the patients could be involved in the planning. She said they chose a Hawaiian luau themed prom that featured tiki torches, grass huts, colorful flowers, Polynesian-influenced cuisine and warm breezes on the hospital’s Level 5 patio. The council also met with chefs and picked the food to be served.

The evening began at 4 p.m. with complimentary hair styling, makeup and nail services all provided inside the hospital by the New York Institute of Beauty. Cole said all the children looked incredible, and there was a waiting area, suggested by the council, for those who chose not to get their hair and nails done to play video games and wait for their guests who were getting pampered.

With physicians, nurses and employees from Child Life Services who volunteered their time in attendance, the teenagers enjoyed a night filled with red carpet snapshots, dancing and games such as limbo.

Michael Reed, a 16-year-old outpatient of the hospital who just completed 10th grade at MacArthur High School in Levittown, was part of the youth council. He said it felt great to see the results of the work of the half dozen members.

“It was, the way that I looked at it, not a masterpiece, but it was what me and a few other people invented, what we helped out with, what we created,” he said.

Reed, who attended last year’s prom, felt getting the opinions of the teens by forming a council was a great idea.

“It looked like everyone had a really fun time,” he said.

Cole said the children miss many special events at school, and despite programs available through Child Life Services, the hospital experience is not a fun one for them.

“It’s our way of giving back,” she said. “And, having a big prom party for them, so they feel that a hospital is not just a bad place to come to because you come here usually when you are sick.”

Two girls dance at the luau-themed prom organized especially for teen patients at Stony Brook Children’s Hospital. Photo from Stony Brook Children’s Hospital

Joan Alpers, director of Child Life Services at the hospital, said it’s important for children to spend time with their peers who are going through the same situation they are.

“This gives kids an opportunity to know that they are not alone in the world, that other kids are there struggling just like they are, trying to keep up with school and doing all the things that are hard to do when you are managing a chronic illness and are a teenager,” Alpers said.

The director attended the prom and said it was delightful.

“A lot of kids were anxious and eager to get to the party,” she said. “They had their hair and nails done, and they felt really special. A lot of the boys were wearing flowered shirts with their suits.”

Alpers said there was a sick child in the hospital who they thought may not be able to attend, but she put on her dress and had her hair and nails done. Later in the day, she received the go-ahead from doctors to attend.

“It was so lovely to see her come down [from the ward],” Alpers said. “She wanted to be there so badly.”

Cole said she hopes the hospital will continue to be able to organize the prom every year.

“I really think it’s important for them to feel special because they really are special to us, all the kids,” she said.

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Suffolk Aspergers/Autism Support and Information founders Stephanie Mendelson, on left, and Priscilla Arena, in blue, get emotional while receiving $7,000 from donors for SASI's advocacy program. Photo by Kevin Redding
Residents raise money while gambling during Suffolk Aspergers/Autism Support and Information's Blue Party fundraiser. Photo by Kevin Redding
Suffolk Aspergers/Autism Support and Information founders and Mount Sinai residents Priscilla Arena and Stephanie Mendelson at the Blue Party fundraiser. Photo by Kevin Redding
Shoreham resident Alonna Rubin and her son Jack, who has autism, place tickets for various raffle prizes during Suffolk Aspergers/Autism Support and Information's Blue Party fundraiser. Photo by Kevin Redding
Daniel Korcz, a 22-year-old Islandia resident with autism, with his mother Amy during Suffolk Aspergers/Autism Support and Information's Blue Party fundraiser. Photo by Kevin Redding
Monica Nichols, on right, with members of New York Therapy Sensory Gym & Speech and Language Center in Port Jefferson Station, during Suffolk Aspergers/Autism Support and Information's Blue Party fundraiser. Photo by Kevin Redding
Suffolk Aspergers/Autism Support and Information founders Stephanie Mendelson and Priscilla Arena on stage during SASI's Blue Party fundraiser. Photo by Kevin Redding
Anthrax frontman Dan Nelson with a bandmate, who performed during Suffolk Aspergers/Autism Support and Information's Blue Party fundraiser. Photo by Kevin Redding
Residents raise money while gambling during Suffolk Aspergers/Autism Support and Information's Blue Party fundraiser. Photo by Kevin Redding

When two Mount Sinai moms whose sons fall on the autism spectrum noticed a lack of support and resources in Suffolk County to help families affected by the disorder, they took to Facebook to form “a little support group” — made up of 12 moms in a living room.

A year and a half and 1,500 members later, the nonprofit Suffolk Aspergers/Autism Support and Information has blossomed into a haven for those dealing with disabilities, enriching the lives of special needs families through essential services and programs, as well as emotional and financial support.

“We’ve literally become an autism family,” said SASI co-founder Priscilla Arena, whose 10-year-old son was diagnosed at a younger age. “We feel a great sense of responsibility to every single parent and child and doing the right thing by all of them. I’m doing this not just for my son, but for everyone’s children because we need to do this.”

Shoreham resident Alonna Rubin, on right, and her son Jack, who has autism, during Suffolk Aspergers/Autism Support and Information’s Blue Party fundraiser.Photo by Kevin Redding

While the group grows at an exponential rate, as does autism diagnoses throughout Long Island. Its founders, Arena and Stephanie Mendelson, took their outreach for autism to whole new heights June 8 with their first annual Blue Party fundraiser.

In a grandiose ballroom at The Inn at East Wind in Wading River, hundreds of local residents, business representatives, elected officials and celebrity guests dressed in blue, the official color of autism awareness, danced the night away to live music and took part in casino gaming, raffles and auctions all in the name of SASI and autism.

Sponsors of the gala included Sky Zone Trampoline Park in Mount Sinai, Powerhouse Gym in Miller Place and Investors Bank in East Northport. An international theme was represented by cuisines from different cultures because, as Arena said, “Autism doesn’t discriminate based on race or socioeconomics.”

All funds raised went toward a physical office for the nonprofit, as its members currently meet once a month at Mather Hospital, and the expansion of the nonprofit’s numerous programs for families, including their Life Skills program, a 12-week program that teaches teenagers and young adults how to be independent — everything from tying their shoes to reading off a menu and paying bills.

Mendelson, whose eight-year-old son Jacob struggles with motor skills, speech delay and overwhelming anxiety as a result of his autism, said she realized early on that he wasn’t meeting the milestones his twin sister was. When she and her husband got the diagnosis, she said she felt a mixture of relief and profound sadness.

“We felt alone with everything that was occurring with our son, and heard about the group … he now has friends he can relate to. We’ve learned a lot … it’s incredible and I don’t feel like I’m alone.”

— Lisa Gerstein

“My instinct was to wrap him in a cocoon and protect him,” Mendelson told the room. “I realized at that moment that it was my job to be his advocate, his coach, his teacher, his biggest fan. I felt overwhelmed and scared at the idea of his outcome and future resting on my shoulders … nevertheless, we began our journey and immersed ourselves in the world of autism.”

After she met Arena at a business meeting in late 2015, the two shared a desire to provide families a place to go where they didn’t have to feel as lonely and isolated as they did.

Part of the $7,000 donated to the advocacy program will help parents struggling to get proper services within school districts and raise awareness and acceptance among regular kids. The group does not yet know the grand total raised during the event, but the goal was $50,000.

“We want to be the autism resource center in Suffolk County, a central resource for parents no matter what their issue is,” Mendelson said. “And if we don’t know, we can find somebody who does.”

Monica Nichols, who serves as parent liaison at New York Therapy Sensory Gym & Speech and Language Center in Port Jefferson Station, which provides programs and social skills groups for those with autism, said connecting with other parents helped her most when her own child was diagnosed.

“By far, for me, the most valuable resources have been other parents, because it’s really from other parents where you learn what’s out there in a more meaningful way than what a doctor can tell you — it’s what makes it special,” Nichols said. “[SASI] has been a big shift, they’ve really done a great job at outreach and membership and making each individual family feel part of a bigger family.”

When Lisa Gerstein, of Centereach, first joined the group in its beginning stages, things got better quickly.

“We felt alone with everything that was occurring with our son, and heard about the group … he now has friends he can relate to,” Gerstein said. “We’ve learned a lot in terms of what to do with dealing with the school district and what to ask for … it’s incredible and I don’t feel like I’m alone.”

Suffolk Aspergers/Autism Support and Information founders Stephanie Mendelson, on left, and Priscilla Arena, on right, with former World Wrestling Entertainment competitor Mick Foley at SASI’s Blue Party fundraiser. Photo by Kevin Redding

Daniel Korcz, a 22-year-old college student with autism, who hopes to mentor young people on the spectrum, said the nonprofit has brought him a lot of happiness. “It’s pretty amazing that there’s an organization to help people like me, who are smart kids that are on the spectrum,” the Islandia resident said. “It provides them support and assistance that they might need.”

Among some of the entertainment of the evening were TKA, a Latin freestyle trio prominent in the 1980s and early 1990s, and former Anthrax singer Dan Nelson, who performed Beatles and Elvis songs with his band “Dan Nelson and The Downfall.”

World Wrestling Entertainment Inc. Hall of Famer Mick Foley, of Smithtown, showed up to the fundraiser willing to help in any way, as the cause hits him close to home. His 16-year-old son Mickey is on the spectrum.

“This is an issue that kind of chose me, so I readily agreed to be part of this,” Foley said, adding he hopes this is a big success for the group.

Discussing his experience as a parent of an autistic child, he said he wished he’d been more aware.

“I look back at the videos when he was much younger and realize I should’ve known a long time ago,” he said. “I think it’s important that people become aware and acceptance is incredibly important. Learn as much as you can, find a great support group and don’t feel like it’s the end of the world because it’s not. Being the parent of a child with autism is definitely a struggle, but it’s also a great adventure.”

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Stock photo.

By Chris Zenyuh

Throughout our evolution, fruit stood as the primary source of sugars in our diet. That we evolved to desire sweetness, I contend, was not for energy but for the vitamins, minerals, fiber and antioxidants that come with the fruit. The fiber helps slow sugar absorption and reduce its negative metabolic potential, and the vitamins compensate.

The limitations of seasonal fruit accessibility made getting too much of these sugars infrequent, at most. Access to purified cane sugar was limited as well, due its tropical origins. The cost of growing and shipping cane sugar slowed its consumption, certainly for those of lesser means. Still, the demand for sugar steadily increased, a fact that the English monarchy used to fund its war chest.

William Duffy (in his book “Sugar Blues”) has suggested that the sugar machine was largely behind English colonization and enslavement through the 1800s. Duffy suggests that denying sugar’s responsibility for metabolic dysfunction dates back to Dr. Thomas Willis, private physician to King Charles II. Willis both discovered and named diabetes mellitus. Smart enough to recognize the illness and its sugar-related cause, Willis was also smart enough to name it after “honey” instead of sugar, perhaps to keep his job and his head!

Enjoying rations of sugar and rum, tens of thousands of the British sailors who guarded the sugar routes fell ill and died from scurvy. School children are taught that scurvy is a vitamin C deficiency, as it was discovered that the symptoms could be reversed with the addition of citrus to the rations. Sadly, this well-known story promotes the denial of the cause: too much sugar (and rum). Our food, medical and supplement industries continue to promote the use of fortification and vitamin supplements to “protect” against illnesses like scurvy, rather than incur financial loses that would result from curtailed consumption of sugars.

The spiraling decline of our general health gained momentum in 1973, when then Secretary of Agriculture Earl Butz instituted a 180 degree change in the farm subsidy program. Prior to 1973, farmers were directed by the government to curtail production to keep the supply and demand for corn in check. Sometimes, the farmers were instructed not to grow corn but were compensated for lost income. The restricted supplies kept corn prices high, making it too expensive to use high fructose corn syrup as a sweetener. Sugar cane, expensive due to its tropical origins, found itself in a limited range of food products.

The new program launched in 1973 rewarded corn farmers for producing as much corn as possible. Soon, the science to produce more corn, then the science to engineer additional uses for the extra corn became big businesses. High fructose corn syrup and cattle feed businesses were early beneficiaries of the new system. The ranchers and corn refiners lobbied to pay below cost for corn. Corn farmers would lose money, but, the new farm bills enabled the farmers to make up their losses (and more) by receiving the subsidies, funded by tax dollars. That made it cheaper to feed cattle corn than to feed them grass and cheaper to sweeten food with high fructose corn syrup (HFCS) than with sugar.

Americans were now able to purchase foods sweetened with HFCS and corn-fed meat at much cheaper prices than ever before. The cost, of course, does not include the medical expenses that may be incurred from chronic exposure to glucose and fructose, though.

The Sugar Association, still burdened with the expense of sugar cane’s tropical origins, has expanded its use of sugar beets to become price competitive in the caloric sweetener market. Farmed and processed in the continental United States, sugar beets are used to sweeten processed foods almost as cheaply as HFCS. If the ingredient label doesn’t specify cane sugar, it may very well be beet sugar. Of course, it is still sucrose.

Now you know why caloric sweeteners are omnipresent in our food system and how “food” can be available so cheap. You might want to reconsider the amount that you consume of what nature so frugally offers. Regardless of its source or history, it is metabolically the same!

Chris Zenyuh is a science teacher at Harborfields High School and has been teaching for
30 years.

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Dr. Jennifer Arnold leads the Parade of Survivors. Photo by Cindy Swanson

By Heidi Sutton

On Sunday, June 4, hundreds of thousands of people gathered in various locations across the country for National Cancer Survivors Day, a celebration of life for anyone who has been touched by cancer. Locally, the Stony Brook Cancer Center hosted its 13th annual event, made possible by sponsorship from the Stony Brook School of Medicine and Stony Brook University.

The weather cooperated as attendees participated in a variety of outdoor activities, such as the popular dunk-a-doc, bedpan golf, chemo bag toss and face painting, as well as musical entertainment. The day culminated with the Parade of Survivors to the tune of Journey’s “Don’t Stop Believing.”

Dr. Yusuf Hannun

“There is really no activity that I look forward to more every year than what we are doing here today, to celebrate you and to celebrate survivorship,” said Dr. Yusuf Hannun, director of the Stony Brook Cancer Center, to a crowd of survivors, doctors, nurses, family members and friends. “Looking around … I am really humbled to see how this event has been growing exponentially, from very modest beginnings of a handful of dedicated volunteers and determined survivors, to today with over 1,300 [attendees], 300 of them survivors,” he said.

Hannun also took the opportunity to speak about the new 245,000 square-foot, state-of-the-art Medical and Research Translation (MART) building, which served as the backdrop to the event and is scheduled to open by the end of this year. The director stated the new facility “will allow us to serve twice as many patients and their families … and allow us to continue to push back against cancer at all times. We are very excited to move into that building.”

The keynote speaker of the day was Dr. Jennifer Arnold, who is featured on TLC’s docudrama, “The Little Couple” along with her husband, Bill, who is originally from Port Jefferson Station, and their beautiful children, Will and Zoey. The show has served as an invaluable way to break down barriers and educate the public about people with disabilities.

Dr. Jennifer Arnold

Standing at just 3 feet and 2 inches, Arnold was born with a rare type of dwarfism called spondyloepiphyseal dysplasia, Strudwick type and has undergone over 30 surgeries in her lifetime. In 2013 she was diagnosed with stage 3 choriocarcinoma, a rare cancer that developed after a non-viable pregnancy. She graciously chose to share her fight with viewers of her show.

Now a three-year cancer survivor, Arnold shared her journey and personal lessons learned at Sunday’s event with a dynamic, motivational and inspirational presentation titled Surviving with Grace and received several standing ovations.

“Although I had a lot of life lessons [growing up], nothing taught me more than going through cancer,” said Arnold. “Sometimes life throws a wrench into the middle of your world and you have to be ready for that because life is short, no pun intended.”

“Going through chemotherapy changes you a lot, physically, emotionally, mentally…,” she said. After chemo, “I didn’t go back to normal, but I did go back to life. Truly it takes a village to go through your treatment and survivorship. It’s okay to accept that help.”

Arnold continued, “This is a wonderful life that we have and I am so blessed to be alive and to be able to share my story and I know that many of you in the audience feel the same way. … Whether it’s the fact that you’ve undergone treatment for cancer or whether you’ve had other obstacles in life, I hope that you too can overcome those obstacles and that you can survive with grace.”

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Treatment options vary wildly

By David Dunaief, M.D.

Dr. David Dunaief

With summer almost here and — believe it or not — beach weather around the corner, millions of Americans will expose their toes. Some will be more self-conscious about it than others because of a disease called onychomycosis, better known as nail fungus.

Nail fungus usually affects toenails but can also affect fingernails. It turns the nails yellow, makes them potentially brittle, creates growth underneath the nail (thickening of the nails) and may cause pain.

Many patients are bothered by this disorder. Most patients consider getting treatment for cosmetic reasons, but there are also medical reasons to treat, including the chronic or acute pain caused by nail cutting or pressure from bedsheets and footwear. There is an increased potential risk for infections, such as cellulitis, in those with compromised immune systems (1).

Onychomycosis is not easy to treat and can be quite uncomfortable. Onychomycosis affects approximately 8 percent of the population (2). The risk factors are unclear but may be relate to family history, tinea pedis (athlete’s foot), older age, swimming, diabetes, psoriasis, suppression of the immune system and/or living with someone affected by it (3).

There are many organisms that can affect the nail. The most common class is dermatophytes, but others are yeast (Candida) and nondermatophytes. A test commonly used to differentiate the organisms is a KOH (potassium hydroxide) preparation, which is a simple microscopic exam of skin and nail shavings. This is important since some medications work better on one type than another. Also, yellow nails alone may not be caused by onychomycosis; they can be a sign of the autoimmune disease psoriasis.

There are a plethora of therapies available for treatment. These range from over-the-counter alternative therapies to prescription topical medications to systemic, or oral, prescription therapies to laser therapies and, finally, surgery. I am regularly asked which treatment works best.

With all of these options, how is one to choose? Well, there are several important criteria, including effectiveness, length of treatment and potential adverse effects. The bad news is that none of the treatments are foolproof, and the highest “cure” rate is around two-thirds. Oral medications tend to be the most efficacious, but they also have the most side effects. The treatments can take from around three months to one year. So there is no overnight success. Unfortunately, the recurrence rate of fungal infection is thought to be approximately 20 to 50 percent with patients who have experienced “cure” (4).

Fortunately, most cases of nail fungus are benign, with only a fraction leading to infections. Infection is most common in those with diabetic neuropathy, where the patient loses feeling in their feet. Let’s look at the evidence.

Oral antifungals

There are several options for oral antifungals, including terbinafine (Lamisil), fluconazole (Diflucan) and itraconazole. These medications tend to have the greatest success rate, but the disadvantages are their side effects.

In a small but randomized controlled trial (RCT), terbinafine was shown to work better in a head-to-head trial than fluconazole (5). Of those treated, 67 percent of patients experienced a clearing of the fungus in their toenails with terbinafine, whereas 21 and 32 percent experienced these benefits with fluconazole, depending on the duration. The patients in the terbinafine group were treated with 250 mg of the drug for 12 weeks. Those in the fluconazole group were treated with 150 mg of the drug for either 12 or 24 weeks, with those in the 24-week group experiencing the better results.

Thus, this would imply that terbinafine is the more effective drug. This is a small trial, but the results are intriguing. The disadvantage of terbinafine is the risk of potential hepatic (liver) damage and failure, though it’s an uncommon occurrence. Liver enzymes need to be checked while using terbinafine. Its advantages are the efficacy and the duration.

Another approach to reducing side effects is to give oral antifungals in a pulsed fashion. In a RCT, fluconazole 150 or 300 mg was shown to have significant benefit compared to the control arm when given on a weekly basis (6). However, the efficacy was not as great as with terbinafine or itraconazole (7).

Topical medication

A commonly used topical medication is ciclopirox (Penlac). The advantage of this lacquer is that there are minor potential side effects. However, the disadvantages are that it takes approximately a year of daily use, and its efficacy is not as great as the oral antifungals. In two randomized controlled trials, the use of ciclopirox showed a 7 percent “cure” rate in patients, compared to 0.4 percent in the placebo groups (8). There is also a significant rate of fungus recurrence. In one trial, ciclopirox had to be applied daily for 48 weeks. These results were in patients with mild to moderate levels of fungus in the surface area of the infected nails.

Laser therapy

Of the treatments, laser therapy would seem to be the least innocuous. However, there are very few trials showing significant benefit with this approach. A study with one type of laser treatment (Nd:YAG 1064-nm laser) did not show a significant difference after five sessions (9). This was only one type of laser treatment, but it does not bode well. To make matters worse, many laser treatments are not covered by insurance, and they can be expensive. Another research paper that reviewed the current literature concluded that laser therapies are lacking in randomized clinical trials (10).The advantage of laser treatment is the mild side effects. The disadvantages are the questionable efficacy and the cost. We need more research to determine if they are effective.

Alternative therapy

The success of using this product is largely due to its ingredients, which includes menthol, camphor and eucalyptus oil.

Vicks VapoRub may have a place in the treatment of onychomycosis. In a very small pilot trial with 18 patients, 27.8 percent or 5 of the patients experienced complete “cure” of their nail fungus (11). Additionally, partial improvement occurred in the toenails of 10 patients. But what is more interesting is that all 18 patients rated the results as either “satisfying” or “very satisfying.” The gel was applied daily for 48 weeks. The advantages are low risk of side effects and low cost. The disadvantages are a lack of larger studies for efficacy, the duration of use and a lower efficacy when compared to oral antifungals.

So when it comes to onychomycosis, what should one do? None of the treatments are perfect. Oral medications tend to be the most efficacious but also have the most side effects. If treatment is for medical reasons, then oral may be the way to go. If you have diabetes, then treatment may be of the utmost importance.

If you decide on this approach, discuss it with your doctor; there are appropriate precautionary tests, such as liver enzyme monitoring with terbinafine (Lamisil), that need to be done on a regular basis. However, if treatment is for cosmetic reasons, then topical medications or alternative approaches may be the better initial choice. No matter what you and your physician agree upon as the appropriate treatment, have patience. The process may take a while; nails, especially in toes, grow very slowly.

References: (1) J Am Acad Dermatol. 1999 Aug.;41:189–196; Dermatology. 2004;209:301–307. (2) J Am Acad Dermatol. 2000;43:244–248. (3) J Eur Acad Dermatol Venereol. 2004;18:48–51. (4) Dermatology. 1998;197:162–166; uptodate.com. (5) Pharmacoeconomics. 2002;20:319–324. (6) J Am Acad Dermatol. 1998;38:S77. (7) Br J Dermatol. 2000;142:97–102; Pharmacoeconomics. 1998;13:243–256. (8) J Am Acad Dermatol. 2000;43(4 Suppl.):S70-S80. (9) J Am Acad Dermatol. 2013 Oct.;69:578–582. (10) Dermatol Online J. 2013 Sept. 14;19:19611. (11) J Am Board Fam Med. 2011;24:69–74.

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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Dr. Kourtsounis, center, and his staff cut the ribbon in front of their new Centereach location as Councilman LaValle, center in back, and Leg. Muratore, far right, look on. Photo from office of Leg. Muratore

GRAND OPENING: On May 21, Legislator Tom Muratore (R-Ronkonkoma) and Brookhaven Town Councilman Kevin LaValle (R-Selden) joined Dr. Paraskevas Kourtsounis and the staff at Dental Smiles 4 Kids at their Grand Opening celebration and Ribbon Cutting event for Dental Smiles 4 Kids in Centereach. To commemorate the event, the legislator presented Kourtsounis (“Dr. K.”) and his staff a Certificate of Recognition and a warm welcome to the community.

Dental Smiles 4 Kids is a team of professionals whose goal is to offer quality dental care to children and adolescents in a safe, nonthreatening environment. In addition to the new Centereach location at 7 Mark Tree Road, they have offices in Whitestone, Ronkonkoma and Astoria. “I love welcoming new businesses to the community,” stated Muratore. “I wish Dr. K. and the friendly staff at Dental Smiles 4 Kids much success.

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Men as well as women are at risk

By David Dunaief, M.D.

Dr. David Dunaif

Osteoporosis is a very tricky disease. What do osteoporosis, high blood pressure and high cholesterol have in common? They are all asymptomatic until the later stages. You can’t directly measure the progression or risk of osteoporosis fractures; you can only make an educated guess. The medical community does this mainly by using the Fracture Risk Assessment Tool (FRAX) score (1). FRAX estimates the 10-year risk of fracture in an untreated patient. You can find this tool at www.shef.ac.uk/FRAX.

There are a number of risks including genetics — family history, advanced age and demographics, with Asians being at highest risk — lifestyle, medications such as steroids and chronic diseases. A specific chronic disease that has come into focus relatively recently is heart disease. We will discuss this in more detail. Also, it does not seem that diabetes, neither type 1 nor type 2, contributes to osteoporosis (2).

When we think of osteoporosis, we tend to associate it predominately with postmenopausal women; however, it does affect a significant number of men.

Back pain, caused by changes in the vertebrae, may be the first sign that you have osteoporosis.

Treatments range from lifestyle modifications including diet, exercise and smoking cessation to supplements and medications. The medications that are considered first-line therapy are bisphosphonates, such as Reclast or Zometa (zoledronic acid), Fosamax (alendronate), Actonel (risedronate), Boniva (ibandronate) and Didronel (etidronate).

While all of these drugs have reduced fractures, zoledronic acid has shown disappointing results in reducing fracture risk in the elderly population.

The relatively new medication on the block is Prolia (denosumab), an injectable human monoclonal antibody that works through a different mechanism of action, though the result is the same; it blocks the osteoclastic (breakdown) activity of the bone (3). It has been shown to increase bone mineral density, or thickening of the bone, and reduce fracture risk. Prolia was approved at the end of 2012, so it has not been on the market nearly as long as the bisphosphonates. However, like bisphosphonates, it does have side effects.

As far as supplements go, exciting news is that melatonin may help to increase bone mineral density. Let’s look at the research.

The forgotten sex: men

Rarely are men the forgotten sex when it comes to medical research, but osteoporosis is an exception. Approximately one-third of fractures occur in men, resulting in a 37 percent mortality rate. One in five men over the age of 50 will experience a fracture with osteoporosis as a contributing factor. The predictions are that these rates will climb precipitously and that men need to be treated appropriately (4). Currently, less than 50 percent of men with osteoporosis are receiving treatment (5).

Is bariatric surgery useful?

Though bariatric surgery has been shown to have a number of benefits for many chronic diseases, osteoporosis is not one of them. In the Swedish Obesity Study, results show that women who underwent bariatric surgery were at 50 percent increased risk of fractures as well as long-term osteoporosis (6). The results in men were not statistically significant. The duration of the study was 25 years. The authors hypothesize that malnutrition may play a role in causing this effect. Supplementation may be important to overcome this, as well as frequent follow-ups with blood tests to track micronutrient levels.

Heart disease, really?

When we think of heart disease, we associate it with lots of complications, but osteoporosis is not typically one of them. Well, think again. In the Hertfordshire Cohort Study, results show that there was a significantly increased risk of wrist fracture of the radius in those with heart disease (7). These results were shown overall. However, when the sexes were analyzed separately, this effect held true for men but was not true for women, although the results in women did trend toward significance. This may be an example where men are at greater risk than women. Therefore, it may be important to think about osteoporosis when someone is diagnosed with heart disease, especially since it is not intuitive. Lifestyle factors could be a contributor to this association, as well as estrogen deficiency.

A bisphosphonate that disappointed

Bisphosphonates are the mainstay of treatment for osteoporosis, increasing bone density and decreasing fracture risk. However, zoledronic acid had surprisingly disappointing results in a randomized controlled trial (RCT) (8). Results showed that while zoledronic acid increased bone density over two years, it did not decrease the risk of fracture in elderly women in nursing homes. This does not necessarily have broad implications for other bisphosphonates. There were also weaknesses in this trial, the most serious being that fracture risk was not a primary end point. Additionally, the study may have been too small. However, this still is a very intriguing study.

Melatonin for osteoporosis

What could melatonin possibly have to do with osteoporosis? There are surprisingly positive results with melatonin. In a very small RCT, melatonin in combination with 800 mg/day of vitamin D3 and 800 mg/day of calcium increased bone density significantly in the spine and femoral neck over a one-year period, compared to the control, or placebo, arm containing vitamin D3 and calcium of similar dosage (9).

Interestingly, with melatonin the amount of calcium excreted through the urine in a 24-hour measurement decreased by 12.2 percent. There was a dose-related curve, where melatonin 3 mg/day in combination with vitamin D3 and calcium showed greater results than 1 mg/day of melatonin, which showed significant results over the control arm.

This was a preliminary study involving 81 postmenopausal women divided into three groups. Fracture risk reduction was not an end point. Larger studies with fracture risk as a primary end point are needed. Having said this, these results are exciting. A caveat: If you’re going to use calcium 800 mg/day, it’s best if you split the dose into 400 mg twice a day; the body does not typically absorb more than 500 mg of calcium at one time.

Though medications such as bisphosphonates and a monoclonal antibody may have an important place in the treatment of osteoporosis, not all medications may be equal. It is important to treat with lifestyle modifications including potentially supplements — melatonin, calcium and vitamin D3 — as well as diet, exercise and overall behavior modifications. Heart disease’s unexpected association with osteoporosis is a good reason to treat the whole patient, not just the disease. And don’t forget that men may have this disease too!

References: (1) uptodate.com. (2) Exp Clin Endocrinol Diabetes. 2001;109 Suppl 2:S493-514. (3) epocrates.com. (4) iofbonehealth.org. (5) J Bone Miner Res. 2014;29:1929-1937. (6) ECO 2015. Abstract T8:OS3.3. (7) Osteoporos Int. 2015;26(7):1893-1901. (8) JAMA Intern Med. Online April 13, 2015. (9) J Pineal Res. Online June 3, 2015.

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

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By Yusuf A. Hannun, M.D. 

Dr. Yusuf Hannun

Because of major advances in cancer prevention, early detection and treatment, many patients with cancer are enjoying longer lives and maintaining their quality of life, as the number of cancer survivors grows.

National Cancer Survivors Day®, an annual worldwide celebration of life, is held each year on the first Sunday in June. Anyone living with a history of cancer — from the moment of diagnosis through the remainder of life — is a cancer survivor, according to the National Cancer Survivors Day Foundation. In the United States alone, there are more than 14.5 million people living with a history of cancer.

Stony Brook University Cancer Center will host its 13th Annual Cancer Survivors Day this  Sunday, June 4, from 11 a.m. to 3 p.m. at the Cancer Center, located on the Stony Brook Medicine campus.

The event is a celebration for those who have survived cancer and serves as an inspiration for those who have been recently diagnosed. In addition, this event is a gathering of support for families and friends. Attendees will also have the opportunity to meet and mingle with Stony Brook Medicine physicians, nurses and support staff.

The day features inspirational speaker Jennifer Arnold, MD, MSc, FAPP, who will share her story of perseverance, resilience and strength to bring hope to others facing obstacles and difficulties. Dr. Arnold, a three-year cancer survivor, stars in TLC’s docu-drama “The Little Couple” along with her husband, Bill, and their children, Will and Zoey.

All cancer survivors are invited, whether they were treated at Stony Brook or not. In addition to Dr. Arnold’s talk, attendees can enjoy a variety of outdoor activities, such as dunk-a-doc, bedpan golf, chemo bag toss and face painting, as well as musical entertainment and light refreshments. They can also participate in the very moving Parade of Survivors. This event is free but registration is required. To register, visit cancer.stonybrookmedicine.edu/survivors2017 or call 631-444-4000.

National Cancer Survivors Day is just one of many ways Stony Brook reaches out to the community. The Cancer Center has created several initiatives and programs to help make life easier for patients with cancer, including support groups, cancer prevention screenings and the School Intervention and Re-Entry Program for pediatric patients.

As a leading provider of cancer services in Suffolk County, the Cancer Center is on the forefront of research, discovery and cancer care. In the new Kavita and Lalit Bahl Center for Metabolomics and Imaging, for instance, we are receiving international recognition for our pioneering studies in metabolism and cancer. It’s changing what is known about the role metabolism plays in cancer and brings us closer than ever before to understanding how to prevent and treat it.

And next year, Stony Brook Cancer Center will relocate to a state-of-the-art Medical and Research Translation (MART) building that will focus on cancer research and care. This 240,000-square-foot facility will allow scientists and physicians to work side by side to advance clinical cancer research and improve treatment options.

Propelled by these advances, we continue to bring comprehensive cancer resources to you in your community. Our ambitious drive to transform cancer care and research is just one more reason for hope and celebration.

Dr. Yusuf A. Hannun is the Director of Stony Brook University’s Cancer Center, 
Vice Dean for Cancer Medicine and 
Joel Strum Kenny Professor in Cancer Research

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