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Hundreds flock to Cedar Beach to walk for hope

by TBR Staff - April 24, 2017

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As the number of drug-related overdoses on the Long Island grows, one parent refuses to bury his head in the sand.

On the one-year anniversary of his son’s fatal heroin overdose, William Reitzig wasn’t in bed grieving. Instead, the Miller Place parent was on stage at Cedar Beach in Mount Sinai asking hundreds of community members to hug one another.

“Hug your loved ones like I hugged my son every day … My hope is that you leave here today with the same mission as my wife and I — that with love and compassion, we have the power to overcome the perils of drug addiction.”

—Michael Reitzig

“Hug your loved ones like I hugged my son every day … don’t let a minute go by without saying ‘I love you,’” Reitzig said to a crowd of emotional parents, extended family members, friends and strangers. “My hope is that you leave here today with the same mission as my wife and I — that with love and compassion, we have the power to overcome the perils of drug addiction.”

That mission resonated throughout Hope Walk for Addiction, an April 22 fundraising event created by Reitzig and co-sponsored by Brookhaven Town and Hope House Ministries — a nonprofit based in Port Jefferson that supports people suffering the disease of addiction.

Reitzig, whose 25-year-old son Billy struggled for years with opioid pills and ultimately died after a one-time use of heroin last April, kickstarted “a war on addiction” by raising awareness, educating about addiction, raising money to help those struggling and unite the community.

“This is [really] for the community — it’s not about me, it’s not about my son, it’s to try and make a difference moving forward,” Reitzig said. “I can’t do anything about the past at this point, but going forward we can all chip in … we’re all in the same boat. Today is about all the families that struggle every day with this disease getting together because this is no longer acceptable and we need to do something.”

The large crowd, mostly loved ones of those battling addiction or those who died from it, collectively walked Cedar Beach’s Nature Pathway in memory of those who overdosed. About a dozen names could be seen on signs along the scenic trail.

“I don’t think people realize how many people are depressed and they don’t know how to handle that and so people self-medicate and that’s part of the issue. Ninety-one young people die every day [from this] and that’s unconscionable.”

—Francis Pizzarelli

Local leaders, self-help experts and bands occupied the stage to address the issue that brought everyone together. Various sponsors, including WALK 97.5 and St. Charles Hospital in Port Jefferson, were set up at tables taking donations and educating others, and representatives from the Suffolk County Sheriff’s Office gave seminars on how to use Narcan, a life-saving nasal spray that can revert the effects of an overdose.

More than 500 people registered for the event, and all proceeds — totaling more than $34,000 at the end of the day — went to Hope House, which currently doesn’t have enough space for the overwhelming amount of people who need its services.

Father Francis Pizzarelli, founder of Hope House, counseled Billy while he was rehabilitating in the facility’s outpatient treatment program for a few months, and ultimately presided over his funeral.

Reitzig worked closely with Pizzarelli, and Councilwoman Jane Bonner (C-Rocky Point), to make the Hope Walk a reality.

“Billy was a loving and caring guy, but like a lot of people today, he had his demons and struggled with that,” Pizzarelli said. “I don’t think people realize how many people are depressed and they don’t know how to handle that and so people self-medicate and that’s part of the issue. Ninety-one young people die every day [from this] and that’s unconscionable. [William] elected to say ‘we’re not going to let this continue, we’re going to do something about it and we’re going to protect the quality of life of all our younger and older people addicted to heroin.’”

This is a time to come together as a community, Pizzarelli added, and celebrate the hope Reitzig embodies.

“We need to help stop the stigmatized feeling that comes with addiction. The users feel alone as it is, they don’t feel proud of themselves. They are good people that made one bad decision.”

—Sue Meyers

“I don’t think I’ve met more resilient, strong, dedicated and passionate people in my whole life as I have in William and his family,” Bonner said. “He’s changing the future of so many people by doing this. We’re losing a generation to addiction and this is an opportunity to lift each other up and strip the layers of shame back. It’s all around us and no community is safe from it.”

Patty Eiserman, of Sound Beach, wore a shirt bearing the face of her nephew David Smallwood, who died in 2013 when he was just 22. She said her goal is to educate children as young as possible so they don’t start using.

“I don’t want to say it’s impossible to get them clean,” she said, “but it’s very, very hard.”

Manorville resident Melanie Ross, whose brother died last year after a 10-year battle with addiction, said the situation ravaged the family. It was the first time she’d attended an even like this.

Sue Meyers, a Setauket resident, said she was walking for her son, Michael Moschetto, a Ward Melville graduate who died in December at 28.

“It’s in his name, but I’m also here to help show support for other people and donate as much money as I have in my pockets,” Meyers said. “We need to help stop the stigmatized feeling that comes with addiction. The users feel alone as it is, they don’t feel proud of themselves. They are good people that made one bad decision. I think events like this really give people hope and a sense of direction.”

A lesson in sugar, not so sweet (part two: metabolic stressor)

by TBR Staff - April 24, 2017

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It’s time to connect sugars to metabolic dysfunction. As a quick reminder, sugar is a paired unit made up of glucose and fructose. These are the same two sugars (a term that can be used generically for the various related calorie-bearing sweeteners) that comprise high fructose corn syrup. Also notable is that starch is composed of long chains of glucose. Consuming too much of any or all of these substances puts stress on your body in numerous ways. Our individual metabolic vulnerabilities fall prey to this stress, as some individuals may develop diabetes and others cardiovascular disease, etc. This lesson will focus on the stress that too much glucose can place on your metabolism.

Since your body can use glucose for energy, we are quick to accept this “blood sugar” as a good thing. We are equally inclined to believe the marketing that encourages us to buy more (sport drinks, pasta, etc.) especially if we also believe the claims that dietary fat is unhealthy. It turns out, however, high blood levels of glucose (more than two teaspoons) can be lethal. Consuming a typical sugary beverage (or a bagel) threatens to introduce five to 10 times that amount.

Luckily, your body is equipped to protect itself from such assaults and in the case of a glucose “rush,” it calls upon cells buried within your pancreas to produce insulin. Insulin works like a verbal command to your fat cells, directing them to remove glucose from your blood before it can reach dangerous levels. The more glucose consumed, the more insulin produced and the more your fat cells are called into action. (Notably and ironically, high insulin levels actually reduce the ability of your muscle cells to absorb this energy, leaving them, and you, still hungry.)

These verbal directions, when repeated frequently throughout the day, become tiresome to your fat cells, which develop a sort of hearing loss described by the medical community as “insulin insensitivity.” Progressively more insulin than before will be required to get the job done, crossing the line to a pre-diabetic state. Eventually, the cells become unable to “hear” the insulin commands (insulin resistance), a condition known as diabetes.

If that is not concerning enough, insulin also functions as an inflammatory signal to your body. Inflammation, a topic of its own, is a critical component of our health maintenance. It should work in concert with our natural repair mechanisms. But when out of balance, it inhibits our recovery from even normal wear and tear. One may develop arthritis, cardiovascular disease, and/or require extended recovery times for illness and injury.

Recent research places the blame for heart attacks on the inflammation that can develop along the walls of your arteries. Ironically, the cholesterol that was once thought to be the culprit is now seen as evidence of your body’s attempts to repair this inflammation.

Similarly, obesity, once viewed as a pre-cursor to diabetes, is now known to be just one symptom of glucose management malfunction that may occur as diabetes progresses. The acronym TOFI (Thin on the Outside, Fat on the Inside) has been coined to describe individuals who appear healthy, but have metabolic dysfunction that is dangerously real.

Our society has yet to learn the difference between looks and health. Many thin individuals are unknowingly pre-diabetic or at risk for heart disease. Even the acronym TOFI continues to promote the stereotype that fat is unhealthy. And yet, there are plenty of active, overweight individuals who are metabolically healthier than many of the thin people who judge them.

Whether absorbed from starchy foods or literally half of table sugar, glucose represents both an energy source and a cause of disease, depending on the amount and frequency of its consumption. Knowing how your body metabolizes glucose is an important step in being able to make better food and beverage choices for a healthier life. Choose well, live well. “Chow for now!”

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

Advanced specialty care center opens in Commack

by TBR Staff - April 20, 2017

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Advanced4w — Kenneth Kaushansky speaks at the opening ceremony of the establishment. Photo by Kevin Redding

On April 18, Stony Brook Medicine officially extended its reach to residents in western Suffolk County, with a ribbon cutting for a new, state-of-the-art medical center that provides 30 specialty services under one roof.

Advanced Specialty Care in Commack, which opened to the public last month, serves as a “one-stop shopping” destination for the health care needs of patients no matter where they are located. The center itself sits near the Sunken Meadow Parkway, the Northern State Parkway and the Long Island Expressway.

The variety of specialties includes internal medicine, pediatrics, dermatology, urology, neurosurgery and radiology. A complete imaging center is on site to provide X-rays, mammograms, ultrasounds, bone densitometry, and CT and MRI scans. Stony Brook doctors, including primary and specialty care internists, gynecologists, orthopedists and surgeons of all kinds, make up the staff.

“But this facility is more than just a multi-specialty clinic,” Kenneth Kaushansky, M.D., senior vice president for health sciences and dean of Stony Brook University School of Medicine said, addressing a crowd of Stony Brook Medicine and university staff, elected officials and community members.

According to Kaushansky, one of the leaders behind the 120,000-square-foot center, patients who come to the center have easy access to “the power of Stony Brook medicine.”

“As part of Suffolk County’s only academic medical center,” he said “Advanced Specialty Care connects consumers to Stony Brook Medicine’s cutting-edge research, clinical trials and advanced technology. This is what truly distinguishes it from other physician practices in the area. You not only have access to Stony Brook primary care physicians and specialists, but also to the best ideas in medicine.”

He also said the Commack facility will soon be the new home of Stony Brook’s World Trade Center Health Program, a service that offers comprehensive, integrative health care for World Trade Center responders dealing with 9/11-related illnesses.

Samuel Stanley, M.D., Stony Brook University president, said the center signifies another Stony Brook step toward creating an aspiring, integrated health care network, focused on providing quality and value, for all of Long Island and beyond.

“Every day, we take ambitious ideas from the minds of our expert researchers who are working in medical laboratories, driven by their boundless curiosity, and bring those ideas to life at the patient’s bedside to continuously redefine health care in the 21st century,” Stanley said. “Through our leadership role in health care reform, we are driving forward with new initiatives to improve health, reduce costs and eliminate the unnecessary care for our patients.”

Among the elected officials in attendance were Suffolk County Legislators Kara Hahn (D-Setauket), Leslie Kennedy (R-Nesconset) and Rob Trotta (R-Fort Salonga); Brookhaven Town Councilwoman Valerie Cartright (D-Port Jefferson); and New York State Assemblymen Mike Fitzpatrick (R-Saint James) and Andy Raia (R-East Northport.)

Stanley said they were vital to what Stony Brook Medicine does, by helping with the budget and supporting Medicare and Medicaid for the state, among other important contributions.

Fitzpatrick and Raia presented an official New York State assembly citation to the center and its faculty.

“I just wanted to say thank you to Stony Brook for taking medicine to the next level by opening this beautiful facility here in Commack,” Fitzpatrick said. “Stony Brook is growing and is offering new services and treatment and wellness to people beyond just the Three Village area. Stony Brook represents excellence.”

Margaret McGovern, M.D., professor and chair of the department of pediatrics at the university’s School of Medicine and physician-in-chief at Stony Brook Children’s Hospital, said this is truly the “power of Stony Brook medicine, closer to you.”

“We’re extending the reach of Stony Brook Medicine,” she said, “offering medical expertise in a new and growing
market.”

She also commended Kaushansky for making the center possible.

“Ambitious ideas require exceptional leadership and imaginative solutions, and this project required both,” McGovern said. “I want to thank Ken Kaushansky, especially, for his vision and confidence in moving this project forward. By working together across traditional boundaries, we are achieving a new vision for the future of Stony Brook Medicine.”

Huntington official urges residents to be smart with their skin

by Victoria Espinoza - April 20, 2017

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Councilwoman uses personal experience with skin cancer as motivation to spread awareness

Councilwoman-Berland-with-Sunscreen-Dispenserw — Councilwoman Susan Berland stands with the free sunscreen dispenser now at Crab Meadow Beach in Northport. File photo from A.J. Carter

For one Huntington Town councilwoman, warning residents about the dangers of the sun isn’t just a work obligation — it’s personal.

Councilwoman Susan Berland (D) has been dealing with the effects of spending summers under the sun’s rays for nearly a decade, and it has motivated her to host “Melanoma Prevention: Avoiding the Dangers of Tanning,” an event open to the public Tuesday, April 25, at 7 p.m. at Town Hall, 100 Main St.

“I think it’s important for any parent whose kid wants to tan to learn spending too much time out in the sun is dangerous,” Berland said in a phone interview. “Hopefully this sways people from making bad decisions.”

Berland said she had her first run-in with skin cancer seven or eight years ago, when she discovered she had an irregular mole on her lower back that was precancerous. These moles, also known as dysplastic nevi, increase the risk of a patient developing melanoma in a mole elsewhere on the body.

“When I was in high school, I was one of the girls wearing Hawaiian Tropic [sunscreen] zero [SPF] and using tinfoil at the beach getting fried,” Berland said. “I did a lot of damage. Nobody knew, you just always thought you looked so much better with a tan.”

When she had kids, she said she was focused on making sure her children were protected with sunscreen, and would often “run out of steam,” by the time it got to her skin.

Berland, like many other people, learned of a “base tan,” a once-popular idea to get before vacations, where the thought was getting a starter level for a tan on your skin would help protect it from getting burnt when on tropical vacations. Many science and health organizations, including medical research group Mayo Clinic, have come out against base tans in recent years, saying they do not protect skin anymore than sunscreen and can actually cause more damage long term.

“I didn’t get fried anymore, and I really thought I was doing the right thing and getting a healthy tan,” Berland said. “Turns out there’s really no such thing as that.”

The councilwoman said she’s had six procedures so far — the most recent in March — to remove dangerous parts of her skin, and she goes for full-body checks every three months.

“I always hope to leave the doctor’s office as I came in but that hasn’t been the case yet,” she said. “The pain is just not worth it — it’s just not.”

In some cases she said skin abnormalities had to be removed with liquid nitrogen. “On a scale from one to 10, that’s about a seven, but in some cases I had to have the procedure on my lip and that is like a 50,” she said of the pain associated with the treatment. “And that is why I am doing this. People are not paying close enough attention. I am a total convert now, I lay under an umbrella at the beach and wear SPF 50.”

Berland said she hopes people will realize how serious skin protection is during the event, where Meghan Rothschild, a cancer survivor and spokesperson for the Melanoma Foundation of New England will be speaking about her fight against cancer and how to prevent melanoma, the deadliest form of skin cancer and the second most-common cancer in children, teens and young adults aged 15-29. New York State Attorney General Eric Schneiderman (D) will also be attending the event, and echoed the dangers of tanning.

“To many people, indoor tanning seems like a harmless activity — it’s not,” Schneiderman said. “Each session increases your risk of skin cancer and contributes to premature aging, eye damage, allergic reactions and more. There are many myths and misconceptions concerning the safety of tanning, many of them perpetrated by the indoor tanning salon industry. If you engage in indoor tanning or are thinking about it, it’s important to make sure you know the significant associated health risks.”

Berland said she would tell young children considering going to a tanning booth to get their tan out of a bottle.

“Spray tans or makeup, if you don’t like it you can wash it off and start again,” she said. “But in a booth there is nothing you can do to reverse the damage. It’s just not worth it. The pain you go through, the anxiety of wondering when the next spot will be found on your body. You’re playing Russian roulette with your body.”

Medical Compass: Preventing skin cancer

by David Dunaief - April 19, 2017

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Diet choices and vitamin B3 have surprising effects

By David Dunaief

Warmer weather is finally upon us, we now have long, sunny days and, soon, the beach. However, longer sun exposure does increase the risk of skin cancer. Melanoma is the most serious skin cancer, but fortunately it is not the most common. Basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC) are more prevalent, in that order. Here, we will focus on these two types.

The incidences of these skin cancers are very difficult to pin down because they are not readily reported. However, most of us either know someone who has had these types of skin cancer or have had them ourselves. There were roughly 3.5 million nonmelanoma skin cancer treatments in the U.S. in 2006, with the number of treatments increasing 77 percent from 1992 to 2006 (1). SCC and BCC outcomes diverge, with the former having a higher risk of metastases compared to the latter, which tends to grow much slower (2).

These skin cancers may present in different ways. BCC may have a bump that is pearly, waxy, light-colored or pink or flesh-colored or brown. It may bleed, ooze and crust, but may not heal, and can be sunken in the middle (3). SCC has the appearance of a growing nodule. It may also be scaly or crusty and may have flat reddish patches. It may be a sore that also may not heal. It is found on sun-exposed areas, more commonly the forehead, hands, lower lip and nose (3). Interestingly, SCC develops over years of gradual UV sun exposure, while BCC develops more like melanoma through intense multiple sporadic burns (4).

The more well-known risks for these types of skin cancer include sun exposure (UV radiation), light skin, age, ethnicity and tanning beds (2). But there are other risk factors, such as manicures. There are also ways to reduce risk with sunscreen reapplied every two hours, depending on what you are doing, but also NSAIDs (nonsteroidal anti-inflammatory drugs) and even vitamin B3. Let’s look at the research.

Beyond skin cancer

Though nonmelanoma skin cancers (NMSCs) have far less potential to be deadly, compared to melanoma, there are other risks associated with them. In the CLUE II cohort study of over 19,000 participants, results show something very disturbing: A personal history of NMSC can lead to other types of cancer throughout the body (5). The increased risk of another type of cancer beyond NMSC is 103 percent in those with BCC and 97 percent in those with SCC, both compared to those who did not have a personal history of NMSC.

Tanning beds — No surprise

We know that tanning beds may be a cause for concern. Now the FDA has changed the classification of tanning beds from low to moderate risk and requires a warning that they should not be used by those under the age of 18 (6). The catch is that this does not have teeth; if tanning salons ignore the new rules, there is no punishment.

However, in a prospective (forward-looking) study, results show that people’s responses to warnings depended on how the warnings were framed (7). Compared to the text-only FDA warning requirement, graphic warnings that emphasized the risks of skin cancer were more likely to help people stop using tanning beds, whereas graphic warnings that demonstrated the positive benefits of not using these devices had no effects. So you may have to scare the daylights out of those in their teens and early twenties.

A recent study showed that drying lamps used after a manicure could lead to skin cancer.

Manicure risk, really?

I am told women and some men love manicures. Manicures cannot possibly be dangerous, right? Not so fast. It is not the actual manicure itself, but rather the drying process that poses a risk. In a prospective study, results show that drying lamps used after a manicure may increase the risk of DNA damage to the skin, which could lead to skin cancer, though the risk is small per visit (8).

There were a lot of variables. The shortest number of visits to increase the risk of skin cancer was eight, but the intensity of the UVA irradiance varied considerably in 17 different salons. The median number of months it took to have carcinogenic potential with exposure was around 35, or roughly three years. The authors recommend either gloves or suntan lotion when using these devices, although both seem to be somewhat impractical with wet nails. It’s best to let your nails dry naturally.

Vitamin B3 to the rescue

Many vitamins tend to disappoint when it comes to prevention. Well, hold on to your hat. This may not be the case for vitamin B3. In the Australian ONTRAC study, the results showed that vitamin B3 reduced the risk of developing NMSC by 23 percent, compared to those who took a placebo (9). Even better was the fact that SCC was reduced by 30 percent.

The most interesting part about this study is that these results were in high-risk individuals who had a personal history of NMSC. The participants were given B3 (nicotinamide 500 mg) twice daily for one year.

After the patients discontinued taking B3, the benefits dissipated within six months. The study was on the small side, including 386 patients with two or more skin cancer lesions in the last five years, with a mean of eight lesions. The side effects were minimal and did not include the flushing (usually neck and facial redness) or headaches seen with higher levels of niacin, another derivative. The caveat is that this study was done in Australia, which has more intense sunlight. We need to repeat the study in the U.S. Nicotinamide is not expensive, and it has few side effects.

NSAIDs as beneficial?

Results have been mixed previously in terms of NSAIDs and skin cancer prevention. However, a more recent meta-analysis (nine studies of varying quality, with six studies considered higher quality) showed that especially nonaspirin NSAIDs reduced the risk of SCC by 15 percent compared to those who did not use them (10).

Diet — The good and the bad

In terms of diet studies, there have been mixed positive and neutral results, especially when it comes to low-fat diets. These are notoriously difficult to run because the low-fat group rarely remains low fat. However, in a prospective dietary study, results showed that effects on skin cancer varied depending on the foods. For those who were in the highest tertile of meat and fat consumption, compared to those in the lowest tertile, there was a threefold increased risk of a squamous cell cancer in those who had a personal history of SCC (11). But what is even more interesting is that those who were in the highest tertile of vegetable consumption, especially green leafy vegetables, experienced a 54 percent reduction in skin cancer, compared to those in the lowest consumption tertile.

Thus, know that there are modifiable risk factors that reduce the risk of nonmelanoma skin cancer and don’t negatively impact your enjoyment of summer. There may be easy solutions to help prevent recurrent skin cancer, as well, that involve both medication and lifestyle modifications.

References: (1) Arch Dermatol. 2010;146(3):283. (2) uptodate.com. (3) nih.gov. (4) Br J Cancer. 2006;94(5):743. (5) J Natl Cancer Inst. 2008;100(17):1215-1222. (6) federalregister.gov. (7) Am J Public Health. Online June 11, 2015. (8) JAMA Dermatol. 2014;150(7):775-776. (9) ASCO 2015 Annual Meeting: Abstract 9000. (10) J Invest Dermatol. 2015;135(4):975-983. (11) Am J Clin Nutr. 2007;85(5):1401.

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.

Long Island team explores ancient gene link to ALS

by Daniel Dunaief - April 19, 2017

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sbcshldubnauhammell — Ride For Life presents CSHL with $300,000 for ALS research: from left, CSHL Director of Annual Giving and Donor Relations Karen Orzel, CSHL Assistant Professor Molly Hammell, Ride for Life Founder Chris Pendergast, Stony Brook Associate Professor Josh Dubnau and Ride for Life board member Frank Verdone. Photo by Jessa Giordano, Cold Spring Harbor Laboratory

By Daniel Dunaief

The past can come back to haunt us, even in the world of genetics. Over the course of millions of years, plants and animals have battled against viruses, some of which inserted their genes into the host. Through those genetic struggles, explained Molly Hammell, an assistant professor at Cold Spring Harbor Laboratory, cells develop “elaborate ways to fight back,” even as they continue to make copies of these pieces of DNA.

Sometimes, when our defenses break down, these retrotransposons, or jumping genes, can become active again. Indeed, that appears to be the case in a fly model of amyotrophic lateral sclerosis, also known as ALS or Lou Gehrig’s disease.

Working on a fruit fly model of ALS, Joshua Dubnau, an associate professor at Stony Brook University, Lisa Krug, who earned her doctorate at Cold Spring Harbor Laboratory and is now working at Kallyope in New York, and Hammell showed that these ancient genetic invaders play an important role in the disease amid activation by a protein often linked to ALS called TDP-43.

A recent study, published in PLOS Genetics, “really proves that retroviral reactivation (as a consequence of TDP-activity) is … central to either causing or accelerating neuronal cell death when TDP-43 inclusions are present,” explained Hammell in an email. If TDP-43 plays the same role for humans, this would suggest that targeting this protein or the jumping genes, it activates could lead to potential treatment for ALS.

These collaborators showed that an aggregation of this protein turned on jumping genes. These genes can make copies of themselves and insert themselves in other parts of the genetic code. In this case, TDP-43 expression disrupts the normal immune-like system that silences retrotransposons such as gypsy, which is a particular type of jumping gene in the fruit fly.

When gypsy was activated, the fruit fly exhibited many of the features of ALS, including protein pathology, problems with movement, shortened life span and cell death or glia and neurons in the brain. The scientists were also able to turn gypsy off, which improved the health and extended the life span of the fly.

Mimicking this protein results in broad activation of several retrotransposons. If this also occurs in people, the disease may activate a retrotransposon that is the human analog to gypsy, called HERV-K, as well as other retrotransposons. The study also suggests that DNA damage caused by retrotransposons may active a cell suicide mechanism. Finally, this effort showed a means by which the protein disrupts the normal immune surveillance that keeps retrotransposons quiet.

To be sure, Dubnau cautioned that animal models of a disease may not translate when returning to people. Researchers need to look at more patients at all the retrotransposons in the human genome to monitor its prevalence, Dubnau suggested. If the link between retrotransposon activation and the development of ALS is as evident in humans as it is in the fruit fly, scientists may take an approach similar to that which they took to battle the human immuno-deficiency virus, or HIV. Retrotransposons have an RNA genome that needs to be copied to DNA. This, Dubnau explained, is the step in the process where researchers attacked the virus.

In a small subset of HIV patients who have motor neuron symptoms that are similar to ALS, Avi Nath, a senior investigator at the National Institutes of Health discovered that treating patients with the typical HIV medication cocktail helped relieve their ALS symptoms as well.

“What is not known is whether, for some reason, this subset of patients had an ALS syndrome caused by HIV or they were curing them” by treating HIV, Dubnau said. Nath is currently involved in one of two clinical trials to see if HIV medications help ALS patients. The next step for Dubnau and Hammell is to screen the tissue of numerous ALS patients after their death to see if their retrotransposons were elevated.

In addition to NIH funding, the scientists received financial support from Ride for Life, which is a not-for-profit organization started in 1997 that raises funds for research to find a cure for ALS, supports patients and their families through patient services and raises awareness of ALS. Every May, Ride for Life conducts a 12-day, 100-mile patient wheelchair ride across Long Island. Dubnau and Hammell, who received a $300,000 grant from Ride for Life in 2015, said they have been inspired by Ride for Life founder Chris Pendergast.

Meeting Pendergast “has had a big impact,” Dubnau said. “He’s a force of nature. He’s an incredibly strong and intelligent person.” Receiving funds from Ride for Life created a sense of personal obligation to Pendergast and many other people who “had raised that money through sweat and effort.”

Without funding from the Ride for Life Foundation, “We would not have the resources to obtain these samples and do the sequencing experiments necessary to prove that this is a clinically relevant phenomenon in a large number of ALS patients,” Hammell said.

Through an email, Pendergast explained that Ride for Life chose to fund the work by Dubnau and Hammell because the research met several criteria, including that it might lead to new strategies to treat ALS and the research was on Long Island, which is a “powerful affirmation for our generous donors.”

Pendergast emphasized the importance of funding basic ALS research. “We need to know why it develops, how it progresses [and] how it can be diagnosed and monitored,” he urged.

A resident of Huntington, Dubnau and his wife Nicole Maher, who works at the Nature Conservancy as a climate scientist, have a nine-year-old daughter, Caitlin. Reflecting both of her parents’ professional interests, Caitlin is going to a statewide science fair, where she is presenting her work on how temperature affects the life span of insects.

As for his research, Dubnau hopes a further exploration of TDP-43 might reveal an important step in the progression of ALS. He hopes this discovery may suggest a strategy researchers and clinicians can take that might “stop the cascade of events” in ALS.

Medical Compass: Reducing heart attack risk

by David Dunaief - April 14, 2017

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Sedentary lifestyle increases risk in the young

By David Dunaief, M.D.

First, the good news: We have made great strides in reducing mortality from heart attacks. When we compare cardiovascular disease — heart disease and stroke — mortality rates from 1975 to the present, there is a substantial decline of approximately one-quarter. However, if we look at these rates since 1990, the rate of decline has slowed (1).

Plus, one in 10 visits to the emergency room are related to potential heart attack symptoms. Luckily, only 10 to 20 percent of these patients actually are having a heart attack (2). We need to reduce our risk factors to improve this scenario.

Some risk factors are obvious, while others are not. The obvious ones include age (men at least 45 years old and women at least 55 years old), family history, high cholesterol, high blood pressure, obesity, sedentary lifestyle, diabetes and smoking. Less obvious risk factors include gout, atrial fibrillation and osteoarthritis. Lifestyle modifications, including a high-fiber diet and exercise, also may help allay the risks.

Let’s look at the evidence.

Obesity

On a board exam in medicine, if smoking is one of the choices with disease risk, you can’t go wrong by choosing it. Well, it appears that the same axiom holds true for obesity. But how substantial a risk factor is obesity? In the Copenhagen General Population Study, results showed an increased heart attack risk in obese

(BMI >30 kg/m²) individuals with or without metabolic syndrome (high blood pressure, high cholesterol and high sugar) and in those who were overweight (BMI >25 kg/m²) (3). The risk of heart attack increased in direct proportion to weight. Specifically, there was a 26 percent increase in heart attack risk for those who were overweight and an 88 percent increase in risk for those who were obese without metabolic syndrome. This study had a follow-up of 3.6 years.

It is true that those with metabolic syndrome and obesity together had the highest risk. But, it is quite surprising that obesity, by itself, can increase heart attack risk when a person is “metabolically healthy.” Since this was an observational trial, we can only make an association, but if it is true, then there may not be such thing as a “metabolically healthy” obese patient. Therefore, if you are obese, it is really important to lose weight.

Lifestyle modifications such as weight loss, physical activity and diet can help decrease the risk of heart attacks.

Sedentary lifestyle

If obesity were not enough of a wake-up call, let’s look at another aspect of lifestyle: the impact of being sedentary. A recent observational study found that activity levels had a surprisingly high impact on heart disease risk (4). Of four key factors — weight, blood pressure, smoking and physical inactivity — age was the determinant as to which one had the most negative effect on women’s heart disease risk. Those under the age of 30 saw smoking as most negatively impactful. For those over the age of 30, lack of exercise became the most dominant risk factor for heart disease, including heart attacks.

For women over the age of 70, the study found that increasing physical activity may have a greater positive impact than addressing high blood pressure, losing weight, or even quitting smoking. However, since high blood pressure was self-reported and not necessarily measured in a doctor’s office, it may have been underestimated as a risk factor. Nonetheless, the researchers indicated that women should make sure they exercise on a regular basis to most significantly reduce heart disease risk.

Osteoarthritis

The prevailing thought with osteoarthritis is that it is best to suffer with hip or knee pain as long as possible before having surgery. But when do we cross the line and potentially need joint replacement? Well, in a recent study, those with osteoarthritis of the hip or knee joints that caused difficulty walking on a flat surface were at substantially greater risk of cardiovascular events, including heart attack (5). Those who had surgery for the affected joint saw a substantially reduced heart attack risk. It is important to address the causes of osteoarthritis to improve mobility, whether with surgery or other treatments.

Gout

When we think of gout, we relate it to kidney stones. But gout increases the risk of heart attacks by 82 percent, according to an observational study (6). Gout tends to affect patients more when they are older, but the risk of heart attack with gout is greater in those who are younger, ages 45 to 69, than in those over 70. What can we do to reduce these risk factors?

There have been studies showing that fiber decreases the risk of heart attacks. However, does fiber still matter when someone has a heart attack? In a recent analysis using data from the Nurses’ Health Study and the Health Professional Follow-up Study, results showed that higher fiber plays an important role in reducing the risk of death after a heart attack (7). Those who consumed the most fiber, compared to the least, had a 25 percent reduction in post-heart attack mortality.

Even more impressive is the fact that those who increased their fiber after the cardiovascular event had a 31 percent reduction in mortality risk. In this analysis, it seemed that more of the benefit came from fiber found in cereal. The most intriguing part of the study was the dose-response. For every 10-g increase in fiber consumption, there was a 15 percent reduction in the risk of post-heart attack mortality. Since we get too little fiber anyway, this should be an easy fix.

Lifestyle modifications are so important. In the Nurses’ Health Study, which followed 120,000 women for 20 years, those who routinely exercised, ate a quality diet, did not smoke and were a healthy weight demonstrated a whopping 84 percent reduction in the risk of a cardiovascular event such as a heart attack (8).

What have we learned? We can substantially reduce the risk of heart attacks and even potentially the risk of death after sustaining a heart attack with lifestyle modifications that include weight loss, physical activity and diet — with, in this case, a focus on fiber. While there are a number of diseases that contribute to heart attack risk, most of them are modifiable. With disabling osteoarthritis, addressing the causes of difficulty with mobility may also help reduce heart attack risk.

References: (1) Heart. 1998;81(4):380. (2) JAMA Intern Med. 2014;174(2):241-249. (3) JAMA Intern Med. 2014;174(1):15-22. (4) Br J Sports Med. 2014, May 8. (5) Presented Research: World Congress on OA, 2014. (6) Rheumatology (Oxford). 2013 Dec;52(12):2251-2259. (7) BMJ. 2014;348:g2659. (8) N Engl J Med. 2000;343(1):16.

SBU Cancer Center receives generous donation from The Ward Melville Heritage Organization

by Heidi Sutton - April 13, 2017

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WMHO check — CHECK PRESENTATION: From left, Dr. Lina Obeid, Leg. Kara Hahn, Dr. Yusuf A. Hannun, Gloria Rocchio, Dr. Scott Powers, Carol Simco and Dr. Jun Lin. Photo from WMHO

On March 27, Stony Brook University’s Cancer Center received a donation of $40,000 from the Ward Melville Heritage Organization (WMHO), which were funds raised from WMHO’s 23rd Annual Walk for Beauty and Hercules Run held on Oct. 23 of last year in historic Stony Brook Village.

Suffolk County Legislator Kara Hahn (D-Setauket) and co-chair, Walk for Beauty; Gloria Rocchio, president, Ward Melville Heritage Organization and co-chair, Walk for Beauty; and Carol Simco, co-chair, Walk for Beauty, officially presented the check to Dr. Yusuf A. Hannun, director, Stony Brook Cancer Center, and vice dean, Cancer Medicine. Joining them were Dr. Jun Lin and Dr. Scott Powers, cancer researchers whose projects received funds raised from the 2015 Walk for Beauty, and Dr. Lina Obeid, dean for research, Stony Brook University School of Medicine.

Also present, but not shown, were Councilwoman Valerie M. Cartright (D-Port Jefferson Station), WMHO Trustee Anna Kerekes and Walk for Beauty committee members. Since its inception in 1994, Walk for Beauty has raised over $1.365 million toward breast cancer research. Funds raised also help to supply items such as wigs and prostheses for SBU Cancer Center patients. The event is an all-volunteer initiative with no administrative costs.

Registration is now open for the 2017 Walk for Beauty, which will take place on Sunday, Oct. 22. Visit www.wmho.org/wfb for more information.

Medical Compass: Osteoporosis – is milk the answer?

by David Dunaief - April 5, 2017

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Bones: What is beneficial and what is not?

The prevalence of osteoporosis is increasing especially as the population ages. Why is this important? Osteoporosis may lead to increased risk of fracture due to a decrease in bone strength (1). That is what we do know. But what about what we think we know?

For decades we have been told that if we want strong bones, we need to drink milk. Advertising slogans have morphed from “Milk does a body good” to “Got Milk?” to “Milk Life.” Celebrities have worn milk mustaches to show how important it is to our diet. This has been drilled into our brains since we were toddlers. Milk has calcium and is fortified with vitamin D, so milk could only be helpful, right? Not necessarily.

The data is mixed, but studies indicate that milk may not be as beneficial as we have been led to believe. Even worse, it may be harmful. The operative word here is “may.” We will investigate this further. Vitamin D and calcium are good for us. But do supplements help prevent osteoporosis and subsequent fractures? Again the data is mixed, but supplements may not be the answer for those who are not deficient.

Of course, we know which drugs are potentially beneficial for osteoporosis; however, which one works the best for whom may be unclear. There are minimal head-to-head trials comparing different drugs (2). They all have beneficial reductions in fracture risk in patients with osteoporosis, but they also have side effects.

What do the guidelines tell us about those who are at potential risk for osteoporosis and fracture? A study looked at the predictability, or reliability, of the United States Preventive Services Task Force (USPSTF) recommendations for screening patients for osteoporosis. Unfortunately, the study showed that USPSTF guidelines were a nominal improvement over chance (3). In other words, the guidelines were able to predict only 24 percent of patients who ended up developing osteoporosis between the ages of 50 and 64.

Milk — it’s not what you think

Recent studies involving men and women in Sweden showed that milk may be harmful.

The results of a large, observational study involving men and women in Sweden showed that milk may be harmful (4). When comparing those who consumed three or more cups of milk daily to those who consumed less than one, there was a 93 percent increased risk of mortality in women between the ages of 39 and 74. There was also an indication of increased mortality based on dosage.

For every one glass of milk consumed there was a 15 percent increased risk of death in these women. There was a much smaller, but significant, 3 percent per glass increased risk of death in men. Women experienced a small, but significant, increased risk of hip fracture, but no increased risk in overall fracture risk. There was no increased risk of fracture in men, but there was no benefit either. There were higher levels of biomarkers that indicate oxidative stress and inflammation found in the urine.

This study was 20 years in duration and is eye-opening. We cannot make any decisive conclusions, only associations, since it is not a randomized controlled trial. But it does get you thinking. The researchers surmise that milk has high levels of D-galactose, a simple sugar that may increase inflammation and ultimately contribute to this potentially negative effect, whereas other foods have many-fold lower levels of this substance.

Ironically, the USDA recommends that, from 9 years of age through adulthood, we consume three cups of dairy per day (5). This is interesting, since the results from the previous study showed the negative effects at this recommended level of milk consumption. The USDA may want to rethink these guidelines.

Prior studies show milk may not be beneficial for preventing osteoporotic fractures. Specifically, in a meta-analysis that used data from the Nurses’ Health Study for women and the Health Professionals Follow-up Study for men, for each additional glass of milk per day during the teenage years there was a 9 percent increased risk of hip fracture in men only (6). However, this effect was negated when height was taken into account. Neither men nor women saw any benefit from milk consumption in preventing hip fractures. In other words, the milk you drank during your teenage years might not reduce hip fractures later in life.

Calcium disappointments

Unfortunately, it is not only milk that may not be beneficial. There was a meta-analysis that included observational studies and clinical trials. In the meta-analysis involving a group of observational studies, there was no statistically significant improvement in hip fracture risk in those men or women ingesting at least 300 mg of calcium from supplements and/or food on a daily basis (7).

The researchers did not differentiate the types of foods containing calcium. In a group of randomized controlled trials analyzed in the same study, those taking 800 to 1,600 mg of calcium supplements per day also saw no increased benefit in reducing nonvertebral fractures. In fact, in four clinical trials the researchers actually saw an increase in hip fractures among those who took calcium supplements. A weakness of the large multivaried meta-analyses is that vitamin D baseline levels, exercise and phosphate levels were not taken into account.

Vitamin D benefit

Finally, though the data is not always consistent for vitamin D, when it comes to fracture prevention, it appears it may be valuable. In a meta-analysis (involving 11 randomized controlled trials), vitamin D supplementation resulted in a reduction in fractures (8). When patients were given a median dose of 800 IUs (ranging from 792 to 2,000 IUs) of vitamin D daily, there was a significant 14 percent reduction in nonvertebral fractures and an even greater 30 percent reduction in hip fractures in those 65 years and over. However, vitamin D in lower levels showed no significant ability to reduce fracture risk.

Just because something in medicine is a paradigm does not mean it’s correct. Milk may be an example of this. Also, ironically, the “Milk Life” slogan may need an overhaul, especially in women between the ages of 39 and 74 years old, where there is a potential increased risk of mortality. No definitive statement can be made about calcium, although even in randomized controlled trials with supplements there seemed to be no significant benefit. Of course, the patients in these trials were not necessarily deficient in calcium or vitamin D.

In order to get benefit from vitamin D supplementation to prevent fracture, patients may need at least 800 IUs per day, which is the Institute of Medicine’s recommended amount for a relatively similar population as in the study. Also, different drugs have different benefits and side effect profiles.

Remember that studies, though imperfect, are better than tradition alone. Prevention and treatment therefore should be individualized, and deficiency in vitamin D or calcium should usually be treated, of course. Please, talk to your doctor before adding or changing any supplements.

References: (1) JAMA. 2001;285:785-795. (2) Ann Intern Med. 2014;161(10):711-723. (3) NAMS 2014 Meeting: Abstract S-13. Oct. 16, 2014. (4) BMJ 2014;349:g6015. (5) choosemyplate.gov. (6) JAMA Pediatr. 2014;168(1):54-60. (7) Am J Clin Nutr. 2007 Dec;86(6):1780-1790. (8) N Engl J Med. 2012 Aug. 2;367(5):481.

Eye on Medicine: Stony Brook’s Advanced Specialty Care comes to Commack

by TBR Staff - April 5, 2017

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The front entrance to the new ambulatory care center. Photo from SBU

By L. Reuven Pasternak, M.D.

As a native Long Islander, I know that we Long Islanders like to have choices and flexibility in many aspects of our lives, and we’re not shy about saying so. Having choices and flexibility in the quality of medical care we receive is certainly no exception.

That is why, on March 1, Stony Brook Medicine opened a new, multispecialty ambulatory care center, Advanced Specialy Care, at 500 Commack Road in Commack. The new center has more than 30 specialties designed to meet the majority of families’ medical needs, all under one roof.

Not only does this provide convenience for you and your family, it provides peace of mind because it means you can expect to receive the high level of expertise and compassionate care Stony Brook Medicine primary care doctors and specialists are known to provide.

And if surgery or other specialty care or access to clinical trials is needed, you can go to Stony Brook University Hospital without any disruption in the continuity of your care. As part of the only academic medical center in Suffolk County, Advanced Specialty Care offers it all.

Stony Brook doctors located in the Commack facility include primary and specialty care internists and pediatricians, gynecologists and obstetricians, dermatologists, orthopedists and urologists, surgeons and neurosurgeons. We also have a complete imaging center on site to provide X-rays, mammograms, ultrasounds, bone densitometry, and CT and MRI scans.

Another indication of how committed we are to serving our patients in western Suffolk and beyond is the sheer size of our state-of-the-art facility. The Advanced Specialty Care center occupies nearly 120,000 square feet of space, with room to expand as additional services are added. The location is just minutes away from the Sunken Meadow Parkway (Sagtikos), the Northern State Parkway and the Long Island Expressway.

We want this to be as close to a one-stop shopping experience as possible for you and your family. Whether it’s for a regular checkup or something more, I hope you will take advantage of having the power of Stony Brook Medicine close by, under one roof, at Advanced Specialty Care in Commack.

Dr. L. Reuven Pasternak is CEO at Stony Brook University Hospital and vice president for health systems at Stony Brook Medicine.

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