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CoQ10 is the first new ‘drug’ in over a decade to show survival benefits in heart failure.
A supplement reduces the risk of cardiovascular events

By David Dunaief, M.D.

Heart attacks and heart disease get a lot of attention, but chronic heart failure is something that tends to be overlooked by the press. The reason may be that heart failure is not acute like a heart attack.

Dr. David Dunaief

To clarify by using an analogy, a heart attack is like a tidal wave whereas heart failure is like a tsunami. You don’t know it is coming until it may be too late. Heart failure is an insidious (slowly developing) disease and thus may take years before it becomes symptomatic. It also increases the risk of heart attack and death.

Heart failure occurs in about 20 percent of the population over the age of 40 (1). There are about 5.8 million Americans with heart failure (2). Not surprisingly, incidence of heart failure increases with age (3).

Heart failure (HF) occurs when the heart’s pumping is not able to keep up with the body’s demands and may decompensate. It is a complicated topic, for there are two types — systolic heart failure and diastolic heart failure. The basic difference is that the ejection fraction, the output of blood with each contraction of the left ventricle of the heart, is more or less preserved in diastolic HF, while it can be significantly reduced in systolic HF.

We have more evidence-based medicine, or medical research, on systolic heart failure. Fortunately, both types can be diagnosed with the help of an echocardiogram, an ultrasound of the heart. The signs and symptoms may be similar, as well, and include shortness of breath on exertion or when lying down; edema or swelling; reduced exercise tolerance; weakness and fatigue. The risk factors for heart failure include diabetes, coronary artery disease, high blood pressure, obesity, smoking, heart attacks and valvular disease.

Typically, heart failure is treated with blood pressure medications, such as beta blockers, ACE inhibitors and angiotensin receptor blockers. We are going to look at how diet, iron and the supplement CoQ10 impact heart failure.

Effect of diet

If we look beyond the usual risk factors mentioned above, oxidative stress may play an important role as a contributor to HF. Oxidative stress is thought to potentially result in damage to the inner lining of the blood vessels, or endothelium, oxidation of cholesterol molecules and a decrease in nitric oxide, which helps vasodilate blood vessels.

In a population-based, prospective (forward-looking) study, called the Swedish Mammography Cohort, results show that a diet rich in antioxidants reduces the risk of developing HF (4). In the group that consumed the most nutrient-dense foods, there was a significant 42 percent (p<0.001) reduction in the development of HF, compared to the group that consumed the least. According to the authors, the antioxidants were derived mainly from fruits, vegetables, whole grains, coffee and chocolate. Fruits and vegetables were responsible for the majority of the effect.

This nutrient-dense approach to diet increased oxygen radical absorption capacity. Oxygen radicals have been implicated in cellular damage and DNA damage, potentially as a result of increasing chronic inflammation. What makes this study so impressive is that it is the first of its kind to investigate antioxidants from the diet and their impacts on heart failure prevention.

This was a large study, involving 33,713 women, with good duration — follow-up was 11.3 years. There are limitations to this study, since it is an observational study, and the population involved only women. Still, the results are very exciting, and it is unlikely there is a downside to applying this approach to the population at large.

CoQ10 supplementation

Coenzyme Q10 is a substance produced by the body that helps the mitochondria (the powerhouse of the cell) produce energy. It is thought of as an antioxidant. In a meta-analysis (group of 13 studies), the results showed that supplementation with CoQ10 may help improve functioning in patients with heart failure (5). This may occur because of a modest rise in ejection fraction functioning. It seems to be important in systolic heart failure. Supplementation with CoQ10 may help to reduce its severity.

The doses used in the meta-analysis ranged from 60 mg to 300 mg. Interestingly, those that were less than or equal to 100 mg showed statistical significance, while higher doses did not reach statistical significance. This CoQ10 meta-analysis was small. It covered 13 studies and fewer than 300 patients.

Like some other supplements, CoQ10 has potential benefits, but more study is needed. Because there are no studies showing significant deleterious effects, which doesn’t mean there won’t be, it is worth starting HF patients with comprised ejection fractions on 100 mg CoQ10 and titrating up, as long as patients can tolerate it, although the next study would suggest 300 mg was the appropriate dose.

CoQ10 — a well-run study

Results of the Q-SYMBIO study, a randomized controlled trial, the gold standard of studies, showed an almost 50 percent reduction in the risk of all-cause mortality and 50 percent fewer cardiac events with CoQ10 supplementation (6). This one randomized controlled trial followed 420 patients for two years who had severe heart failure. This involved using 100 mg of CoQ10 three times a day compared to placebo.

The lead author goes as far as to suggest that CoQ10 should be part of the paradigm of treatment. This the first new “drug” in over a decade to show survival benefits in heart failure. Thus, if you have heart failure, you may want to discuss CoQ10 with your doctor.

Iron deficiency

Anemia and iron deficiency are not synonymous, since iron deficiency can occur without anemia. A recent observational study that followed 753 heart failure patients for almost two years showed that iron deficiency without anemia increased the risk of mortality in heart failure patients by 42 percent (7).

In this study, iron deficiency was defined as a ferritin level less than 100 ug/L (the storage of iron) or, alternately, transferrin saturation less than 20 percent (the transport of iron) with a ferritin level in the range 100-299 ug/L.

The authors conclude that iron deficiency is potentially more predictive of clinical outcomes than anemia, contributes to the severity of HF, and is common in these patients. Thus, it behooves us to try to prevent heart failure through dietary changes, including high levels of antioxidants, because it is not easy to reverse the disease. Those with HF should have their ferritin and iron levels checked, for these are correctable. I am not typically a supplement advocate; however, based on the latest results, CoQ10 seems like a compelling therapy to reduce risk of further complications and potentially death. Consult with your doctor before taking CoQ10 or any other supplements, especially if you have heart failure.

References: (1) Circulation. 2002;106(24):3068. (2) Circulation. 2010;121(7):e46. (3) J Am Coll Cardiol. 2003;41(2):21. (4) Am J Med. 2013 Jun:126(6):494-500. (5) Am J Clin Nutr. 2013 Feb;97(2):268-275. (6) JACC Heart Fail. 2014 Dec;2(6):641-649. (7) Am Heart J. 2013;165(4):575-582.

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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A nutrient-dense, plant-based diet that intensively controls blood sugar is likely to decrease the risk of diabetic retinopathy complication. Stock photo
Diabetic retinopathy is a leading cause of blindness.

By David Dunaief, M.D.

Dr. David Dunaief

With diabetes, we tend to concentrate on stabilization of the disease as a whole. This is a good thing. However, there is not enough attention spent on microvascular (small vessel disease) complications of diabetes, specifically diabetic retinopathy (negativity affecting blood vessels in the back of the eye), which is an umbrella term.

This disease, a complication of diabetes that is related to sugar control, can lead to blurred vision and blindness. There are at least three different disorders that make up diabetic retinopathy. These are dot and blot hemorrhages, proliferative diabetic retinopathy and diabetic macular edema. The latter two are the most likely disorders to cause vision loss. Our focus for this article will be on diabetic retinopathy as a whole and on diabetic macular edema.

Diabetic retinopathy is the No. 1 cause of vision loss in those who are of working age, 25 to 74 years old (1). Risk factors include duration of diabetes, glucose (sugars) that is not well-controlled, smoking, high blood pressure, kidney disease, pregnancy and high cholesterol (2).

What is diabetic macula edema, also referred to as DME? This disorder is edema, or swelling, due to extracellular fluid accumulating in the macula (3). The macula is a yellowish oval spot in the central portion of the retina — in the inner segment of the back of the eye — and it is sensitive to light. The macula is the region with greatest visual acuity. Hence, when fluid builds up from blood vessels leaking, there is potential loss of vision.

Whew! Did you get all that? If not, to summarize: Diabetic macula edema is fluid in the back of the eye that may cause vision loss. The highest risk factor for DME was for those with the longest duration of diabetes (4). Ironically, an oral class of drugs, thiazolidinediones, which includes rosiglitazone (Avandia) and pioglitazone (Actos), used to treat type 2 diabetes may actually increase the risk of DME. However, the results on this are conflicting.

DME is traditionally treated with lasers. But intravitreal (intraocular — within the eye) injections of a medication known as ranibizumab (Lucentis) may be as effective as laser. Studies suggest that injections alone may be as effective as injections plus laser treatments, though the studies are in no way definitive. Unfortunately, many patients are diagnosed with DME after it has already caused vision loss. If not treated after having DME for a year or more, patients can experience permanent loss of vision (5).

In a cross-sectional study (a type of observational study) using NHANES data from 2005-2008, among patients with DME, only 45 percent were told by a physician that the diabetes had affected their eyes (6). Approximately 46 percent of patients reported that they had not been to a diabetic nurse educator, nutritionist or dietician in more than a year — or never.

The problem is that the symptoms of vision loss don’t necessarily occur until the latter stages of the disorder. According to the authors, there needs to be an awareness campaign about the importance of getting your eyes examined on an annual basis if you have diabetes. Many patients are unaware of the association between vision loss and diabetes.

According to a study, there is good news in that the percentage of patients reporting visual impairment from 1997 to 2010 decreased (7). However, the absolute number of patients with vision loss has actually continued to grow, but at a lesser rate than diabetes as a disease has grown.

Treatment options: lasers and injections

There seems to be a potential paradigm shift in the making for the treatment of DME. Traditionally, patients had been treated with lasers. The results from a randomized controlled trial, the gold standard of studies, showed that intravitreal (delivery directly into the eye) injections with ranibizumab, whether given prompt laser treatments or treatments delayed for at least 24 weeks, were equally effective in treating DME (8).

In fact, some in the delayed group, 56 patients or about half, never even required laser treatments at all. Unfortunately, intravitreal injections may be used as frequently as every four weeks. Though in practice, ophthalmologists generally are able to inject patients with the drug less frequently. However, the advantage of receiving prompt laser treatments along with the injections was a reduction in the median number of injections.

Increased risk with diabetes drugs

You would think that drugs to treat type 2 diabetes would prevent DME from occurring as well. However, in the THIN trial, a retrospective (backward-looking) study, a class of diabetes drugs, thiazolidinediones, which includes Avandia and Actos, actually increased the occurrence of DME compared to those who did not use these oral medications (9). Those receiving these drugs had a 1.3 percent incidence of DME at year 1, whereas those who did not had a 0.2 percent incidence. This incidence was persistent through the 10 years of follow-up.

To make matters worse, those who received both thiazolidinediones and insulin had an even greater incidence of DME. There were 103,000 diabetes patients reviewed in this trial. It was unclear whether the drugs, because they were second-line treatments, or the severity of the diabetes itself may have caused these findings.

This is in contrast to a previous ACCORD eye substudy, a cross-sectional analysis, which did not show an association between thiazolidinediones and DME (10). This study involved review of 3,473 participants who had photographs taken of the fundus (the back of the eye).

What does this ultimately mean? Both of these studies were not without weaknesses. It was not clear how long the patients had been using the thiazolidinediones in either study or whether their sugars were controlled and to what degree. The researchers were also unable to control for all other possible confounding factors (11). Thus, there needs to be a prospective (forward-looking) trial done to sort out these results.

Diet

The risk of progression of diabetic retinopathy was significantly lower with intensive blood sugar controls using medications, one of the few positive highlights of the ACCORD trial (12). Medication-induced intensive blood sugar control also resulted in more increased mortality and no significant change in cardiovascular events. But an inference can be made: A nutrient-dense, plant-based diet that intensively controls blood sugar is likely to decrease the risk of diabetic retinopathy complications (13, 14).

The best way to avoid diabetic retinopathy is obviously to prevent diabetes. Barring that, it’s to have sugars well controlled. If you or someone you know has diabetes, it is imperative that they get a yearly eye exam from an ophthalmologist so that DME and diabetic retinopathy, in general, is detected as early as possible, before permanent vision loss can occur. It is especially important for those diabetes patients who are taking the oral diabetes class thiazolidinediones, which include rosiglitazone (Avandia) and pioglitazone (Actos).

References: (1) Diabetes Care. 2014;37 (Supplement 1):S14-S80. (2) JAMA. 2010;304:649-656. (3) www.uptodate.com. (4) JAMA Ophthalmol online. 2014 Aug. 14. (5) www.aao.org/ppp. (6) JAMA Ophthalmol. 2014;132:168-173. (7) Morb Mortal Wkly Rep. 2011;60:1549-1553. (8) ASRS. Presented 2014 Aug. 11. (9) Arch Intern Med. 2012;172:1005-1011. (10) Arch Ophthalmol. 2010 March;128:312-318. (11) Arch Intern Med. 2012;172:1011-1013. (12) www.nei.nih.gov. (13) OJPM. 2012;2:364-371. (14) Am J Clin Nutr. 2009;89:1588S-1596S.

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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7-year-old uses Disney award, projects to continue to brighten lives of pediatric patients

Kayla Harte poses by character Band-Aid boxes she collected from students at W.S. Mount Elementary School for pediatric patients at Stony Brook Children’s Hospital. Photo from Three Village school district

She may only be a 7-year-old, but Kayla Harte already has a huge heart. For the last two years, with the hopes of cheering up young patients, the second-grader has been a frequent visitor to Stony Brook Children’s Hospital’s pediatric oncology department.

Kayla’s mother, Robyn Harte, said when the W.S. Mount Elementary School student started visiting the patients, she would bring homemade get well cards and care packages. She began drawing cards with Minion characters from the film “Despicable Me” on them after she heard they were some of the children’s favorite characters, and she would always be looking for new things to bring them.

Kayla Harte with other donations she received as part of her Band-Aid and toy drives. Photo from Robyn Harte

“Every time we would go and deliver the items she would see that they would be so well received,” her mother said. “The coordinators would tell her how much the children would appreciate it and enjoy it, and it really motivated her to do more.”

During the summer while watching television, Kayla saw a commercial for the Disney Summer of Service grant through Youth Service America and asked her mother if she could apply for it. In November Kayla was one of 340 young leaders in the country awarded a $500 grant.

The money was given to Stony Brook Children’s Child Life Services Department, and Kayla and Director Joan Alpers decided it would be used to buy character bandages and musical toys for the patients. The young volunteer planned to match the grant by starting a project called Friends for Child Life, and she felt that boxes of Band-Aids as well as toys would be easy for people to bring to her, especially her fellow students.

“It makes me feel like she has this gift that she wants to give to other children, and she’s so genuine about it,” her mother said. “She really wants to help other children. She wants to make them feel better. It’s just such a lovely thing for me. It makes me feel really proud and very inspired.”

To kick off her character Band-Aid and musical toy drives, Kayla first asked friends and family members by emailing or texting them a video she and her mother created. Before she knew it, she received approximately 70 boxes of bandages and six musical toys. Her Girl Scout Troop 337 also donated items, and during Random Acts of Kindness Week at her school, fellow students joined the cause and she received close to 100 Band-Aid boxes that week, according to her mother.

“It makes me feel like she has this gift that she wants to give to other children, and she’s so genuine about it.”

— Robyn Harte

Kayla said she was excited when she heard she received the grant, and she’s happy with the amount of donations she has been receiving, especially since she is three-quarters of the way to her goal of 200 character Band-Aid boxes and 40 musical toys.

“I can’t wait to see the happy people at the hospital,” she said.

Even though her project for the Disney grant ends March 31, she plans to continue the drives on a smaller scale. The second-grader, who wants to play for the Mets one day, said once you start volunteering your time it feels so good that, “you can’t even stop doing it.”

Her mother said she and Kayla’s father, Dennis, are proud of how she ran with the project.

“I’m really proud of her,” she said. “I think she’s setting a really good example for other children her age to let them know that you don’t have to be a teenager or a grown-up to make a difference.”

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Rally participants listen to a speech Saturday in Huntington. Photo from Ron Widelec

With changes in health care looming thanks to the election of President Donald Trump (R), the issue took center stage in Huntington this past weekend, as more than 350 Long Island residents participated in a rally Feb. 25 to support the Affordable Care Act and advocate for a single-payer plan bill in Albany.

Organized by the group Long Island Activists with help from Our Revolution and the New York Progressive Action Network, the rally joined together residents from all nine New York State Senate districts.

Ron Widelec, a member of the LIA steering committee, said the event was intended to help educate more New Yorkers about the strengths of a Medicare for all system, as he said many misconceptions about the plan have been spread.

A single-payer or Medicare for all plan “is the only plan that actually brings us to a place where health care is a human right,” Widelec said in a phone interview. “We would see better results and it would [cost] less per person. We can cover everyone for less.”

A single-payer system requires a single-payer fund which all New Yorkers would pay into to cover health care costs of an individual, instead of through private insurers. In a single-payer system every citizen is covered, patients have the freedom to choose their own doctors and hospitals, and employers would no longer be responsible for health care costs.

The ACA established standards for health care in America when enacted in 2010, though it does not supersede state laws relating to health care.

Congressman Tom Suozzi speaks at the event. Photo from Ron Widelec

Martha Livingston, professor and chair of the Department of Public Health at SUNY Old Westbury said a Medicare for all system would be an improvement to the current system.

“We know from experience looking everywhere else it works better and costs less,” she said in a phone interview. The World Health Organization conducted a study on American health care in 2014, and cited one of the reasons the U.S. health system has high costs and poor outcomes includes a lack of universal health care.

“No one would have to make the tough choice between the cost of an EpiPen and feeding their family,” Widelec said, referring to the increase in cost of pharmaceutical products patients can’t opt to go without. Mylan Pharmaceuticals, the drug’s maker, drove the price of EpiPen up about $500 in recent years — some six times. Turing Pharmaceuticals did the same with Daraprim, a drug used by cancer and AIDS patients — although that price tag increased to $750 a pill from $13.50.

The Journal of the American Medical Association has confirmed the U.S. faces this trend of large increases in drug prices, more so than any other countries.

“Per capita prescription drug spending in the United States exceeds that in all other countries, largely driven by brand-name drug prices that have been increasing in recent years at rates far beyond the consumer price index,” the study said.

Livingston agreed the current system is flawed.

“Really what we want is fairness,” she said. “We’re the only country that doesn’t negotiate with insurance companies. We need to get rid of the profiteers standing between us and [health care].”

Aside from informing Long Islanders about the benefits of a Medicare for all system, the rally also focused on creating a game plan to help grow support for the New York Health Act, a bill passed in the 2015-16 New York State Assembly session but not in the New York State Senate.

The Assembly bill for the 2017-18 session, which is currently in committee, establishes the New York Health program, a single-payer health care system.

“The Legislature finds … all residents of the state have the right to health care,” the bill states. It acknowledges ACA helped bring improvements in health care and coverage to New Yorkers, however there are still many left without coverage. The legislation explicitly labels itself as a universal health plan with the intention to improve and create coverage for residents who are currently unable to afford the care they need.

“No one would have to make the tough choice between the cost of an EpiPen and feeding their family.” — Ron Widelec

If New York passed the law, residents would no longer have to pay premiums or co-pays, employers would not have to be responsible to provide health care — which currently costs business more than $1 billion annually, and all patients would be covered and could chose whatever doctor or hospital they wanted.

According to a new study by Gerald Friedman, chair of the University of Massachusetts at Amherst Economics Department, the cost of New York Health Act would be $45 billion less than what New York currently spends.

“Individuals often find that they are deprived of affordable care and choice because of decisions by health plans guided by the plan’s economic needs rather than their health care needs,” the bill states.

The New York Health Act is also in committee in the state Senate, where it has significantly less support.

“We want to flip some state Senate seats,” Widelec said. Participants also broke up into their state Senate districts to discuss plans of action to garner support for the bill in each area and put pressure on their elected leader at the end of the rally.

Steve Cecchini, a rally participant, said  many people are clearly in support of the bill.

“The only thing I learned was a lot of people were excited to hear about the New York Health Act,” he said in a phone interview. “One of the goals was to get people the tools they need to understand the act and talk about it. It’s really about getting enough support from the constituents. It’s ridiculous what we’re not getting and what we’re overpaying for right now.”

Widelec said there is a lot of misinformation about what a single-payer plan is, as many approach it as a socialist concept. But he affirmed the current system in not working and needs to be improved. According to the World Health Organization, the U.S. trailed more than 30 countries in life expectancy in 2015, and in a 2000 report by WHO, America was ranked 37 out of 191 countries for health care performance.

“It’s really exciting to see people inspired and activated,” Livingston said. “It’s looking to me like Long Islanders are eager to make a difference.”

The 3rd Congressional District U.S. Rep. Tom Suozzi (D-Glen Cove) spoke at the rally, after meeting with the Long Island Activists group in January and signing a pledge to sponsor a single-payer bill if the Democratic Party retakes control of the Congress. He has said until that time he will continue to defend the ACA.

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Stony Brook has the only regional Trauma Center in Suffolk County. File photo from SBU

By L. Reuven Pasternak, M.D.

Injury is the leading cause of death for all Americans under age 45. When an injury or trauma occurs, having fast access to comprehensive care can be the difference between life and death. Stony Brook Trauma Center was officially verified by the American College of Surgeons (ACS) and designated by the New York State Department of Health as Suffolk County’s only Adult and Pediatric Level 1 Trauma Center earlier this month.

Level 1 Trauma Centers are the highest level centers, capable of providing a full range of services to the most severely injured patients. Stony Brook Trauma Center is also designated by New York State as the Regional Trauma Center (the highest level) for adults and children and serves as Suffolk’s only regional burn center through the Suffolk County Volunteer Firefighters Burn Center at Stony Brook Medicine.

Meeting the strict quality and safety requirements established by the ACS further proves Stony Brook’s standing in the community as a center of excellence, able to offer a full range of medical services and world-class patient care. Patients who are seriously injured by major trauma require immediate attention from a team of medical professionals who are specially trained to recognize and treat immediate threats to life.

Led by Dr. James Vosswinkel, trauma medical director, and Dr. Richard Scriven, pediatric medical director, Stony Brook Trauma Center cares for close to 2,000 patients annually — adults and children, who have sustained blunt, penetrating or thermal traumatic injury. Ninety-five percent of these patients have sustained blunt injuries — the majority from falls or from motor vehicle crashes. Twenty-five percent of the center’s patients are transferred in from one of the county’s 10 other hospitals and every day Stony Brook flight paramedics are on board Suffolk County Police Department helicopters, providing timely and advanced care directly at the scene of an injury.

As a Level I Trauma Center, Stony Brook participates in a national quality program called TQIP (Trauma Quality Improvement Program). In the most recent TQIP report, it was found that patients who were seriously injured and then treated at Stony Brook Trauma Center were much less likely to die or to develop a major complication than patients treated at other TQIP trauma centers.

Stony Brook Trauma Center is committed to not only treating injury but to preventing injury from occurring. The trauma center regularly conducts many community prevention programs in partnership with other local agencies. They include:

Teddy Bear Clinics: These school-based safety programs target the use of booster seats, rear-facing car seats and use of helmets for sports.

Senior Fall Prevention: These community-based programs educate older adults and their families on how to remain independent and safe. Evidenced-based programs, such as Tai Chi, that are designed to build core strength and prevent fall injury are taught.

Traffic Violators: A bimonthly program with the Suffolk County Traffic Court teaches the consequences of risky driving and offers techniques for behavior change.

Bleeding Control for the Injured (B-Con): To help community members cope with public emergency situations, this important program, which is provided at no charge to universities, community groups and schools, teaches key lifesaving skills, including hands-only CPR, tourniquet making and wound treatment.

To learn more about Stony Brook Trauma Center, visit www.trauma.stonybrookmedicine.edu.

L. Reuven Pasternak, M.D., is the chief executive officer at Stony Brook University Hospital and the vice president for health systems at Stony Brook Medicine.

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File photo by Elana Glowatz

Deaths due to heroin and other opiates are increasing exponentially on Long Island, especially on the North Shore. Join the Port Jefferson Free Library, 100 Thompson St., Port Jefferson for a Narcan Training workshop on Sunday, Feb. 26 at 2 p.m. and help save a life.

Learn about the signs and symptoms of opiate overdose and what to do from health and safety education expert, Erik Zalewski. This 45-minute class also includes a free naloxone (Narcan) emergency kit. A 20-minute “hands-only” CPR class will follow. All are welcome. Questions? Call 631-473-0022.

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Donate Life supporters during a rally. File photo

By Kevin Redding

As of Feb. 14, National Organ Donor Day, a new state law rolled out by Gov. Andrew Cuomo (D) permits 16- and 17-year-olds to enroll in the New York State Donate Life Registry when they apply for a driver’s license, learner’s permit or nondriver ID, potentially growing enrollments in New York by thousands.

Sponsored by State Sens. John Flanagan (R-East Northport) and Kemp Hannon (R-Garden City), the legislation’s altered minimum age to sign up as an organ donor, which had previously been 18, serves as a big step for New York, which currently ranks 50th out of all 50 states when it comes to the percentage of residents enrolled to be organ donors.

Kidney recipient Tom D’Antonio and Brookhaven
Town Councilwoman Jane Bonner. Photo from Councilwoman Bonner

At just 28 percent, New York State is “way at the bottom of the pack” when it comes to enrollment, according to Flanagan, a strong advocate for organ donations because of his late friend, Assemblyman James Conte (R-Huntington Station), who was the recipient of two kidney transplants before losing a battle with cancer in 2012.

“[New York] has been a leader in many ways on a wide variety of issues and we should be the premiere state in terms of organ donation,” Flanagan said. “I just want to promote organ donation, and promote awareness. There are thousands and thousands of people who are waiting for transplants here in the state, kidney being the primary one. We don’t have enough people signing up, and it’s taken too long to [get here] but I think we’re moving in the right direction.”

The senator said Conte is the reason he’s a donor, and after his death, he realized he could use his own political platform to advocate for this cause and encourage others to get involved.

Like Flanagan, Brookhaven Town Councilwoman Jane Bonner (C-Rocky Point) is passionate about organ donation and takes every opportunity to raise awareness about the importance of becoming a donor when speaking publicly, regardless of the event.

“I could be at a civic event talking about town improvement projects or town issues, and I always use it as a soapbox to talk about organ donation,” Bonner said. “Roughly 125,000 people in the United States are waiting for a kidney and there are 350 million people in the United States, seemingly with healthy kidneys. If everybody who could donate, donated one, we wouldn’t have people waiting for a kidney anymore and lives can be saved.”

Bonner said that under the new law, 16- and 17-year-olds can make donations upon their death, and it includes safeguards where their parents or legal guardians have the option to rescind the decision if the minor dies before 18.

“It not only ups the amount of eligible organ donors there are to sign up and save lives, but also starts a conversation at an earlier age about its importance.”

— Megan Fackler

“Teenagers are very passionate about so many issues and I think this legislation was made because they’re employing every toy in the toolbox, knowing the state is dead last,” she said.

The councilwoman knows a thing or two about saving lives this way.

It was last April when Bonner donated her kidney to her childhood friend Tom D’Antonio, who had been diagnosed with diabetes at a young age, had suffered multiple health issues over the years and desperately needed a transplant.

“I said ‘I’ll do it, we’re the same blood type,’ and I donated blood to him when he got his first kidney transplant,” Bonner recalled.

D’Antonio was more than grateful for the donation his longtime friend made.

“I bounced back like a rockstar and I feel great, I have more energy and determination,” D’Antonio said, reflecting on the experience. “It’s my belief that there is something within a human being that takes that step and makes that heroic move to save a life; it moves me beyond a place I can easily describe. Not only did [Jane] save my life but she enriched the lives of those close to me, [like my wife].”

But D’Antonio is not a big fan of the new law, calling it “hugely irresponsible” and a “grossly inadequate response” to appease a need for more donors. 

“Sixteen- and seventeen-year-olds have enough trouble making a decision about what classes to take as seniors, their minds are still developing, and I’m appalled that this is the state’s answer,” he said. “What the state should do instead is put some money and effort into organ donor awareness and make it part of the teaching curriculum in high school.”

Karen Hill, the recipient of Tom Cutinella’s heart, and his mother Kelli Cutinella. Photo from Kelli Cutinella

Alternatively, Kelli Cutinella, whose son Tom died October 2014 following a head-on collision during a high school football game, spoke in Albany to help get the law passed, and said she’s glad to see it in effect.

Tom, who wanted to register when he was 16 at the DMV but was ultimately not allowed at the time, donated all vital organs, such as his heart, kidneys, liver, pancreas, bones and skin.

“He was a giver in life and would do anything for anybody, and it didn’t surprise me that he wanted to register at 16, it was just in his nature,” Cutinella said.

The mother, who has an ongoing relationship with Tom’s heart recipient and pancreas and kidney recipient, was recently notified by a New York Burn Center that a 30-year-old man from Brooklyn had received Tom’s skin after suffering severe burns in a house fire.

“Tom lives on now,” Cutinella said. “He’s not here in the physical sense, but he is with the recipients as they go on to live wonderful, fulfilling lives.”

According to Megan Fackler of LiveOnNY, a federally designated organ procurement organization, the new law is exciting.

“It not only ups the amount of eligible organ donors there are to sign up and save lives, but also starts a conversation at an earlier age about its importance,” Fackler said. “Donor family and recipient meetings have been the most touching. There are lots of things 16- and 17-year-olds can’t do, like rent a car, get a tattoo, vote, join the army, but they can save lives.”

Residents can visit the New York State Health Department’s website at www.health.ny.gov/donatelife to get more information about organ donation in New York State, including how to register as a donor.

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Kiddie Academy hosts second annual Hop-A-Thon to raise money for the Lukemia and Lymphona Society

On Feb. 17, kids between the ages 5 and 12 turned the music up and busted a move for good reason: they helped to raise $575 for those with leukemia and those working to find a cure.

For the second year in a row, Kiddie Academy Educational Child Care in Wading River sponsored a fun-filled and awareness-driven Hop-a-thon for the Long Island chapter of the Leukemia and Lymphoma Society, the largest voluntary health organization dedicated to funding research, finding cures and providing treatment access for blood cancer patients.

Leukemia and Lymphoma Society Campaign Specialist Alexa Landro speaks to kids at Kiddie Academy of Wading River. Photo by Kevin Redding

As part of the organization’s Student Series, which aims to involve young people in the fight against cancer through service learning and character education programs, the event is a dance celebration for kids who, along with their parents, contributed money to the important cause. As leukemia affects more children than any other cancer, the program lets kids help kids while having fun.

But before the academy’s school age kids took to the lobby to hop and bop to songs like Taylor Swift’s “Shake It Off,” they sat down for a brief presentation about what they donated money towards, engaging in true-or-false questionnaires about blood cancers and learning about the “honored heroes” on Long Island — students from local school districts who have beaten cancer.

“Thanks to each and every one of you helping to raise money, kids like these are 100 percent better today and happy and healthy,” Leukemia and Lymphoma Society Campaign Specialist Alexa Landro told the energetic kids. “You’re dancing for them and I can’t thank you enough.”

Kiddie Academy of Wading River students danced during its second annual Hop-A-Thon Feb. 17 to raise money for the Leukemia and Lymphoma Socoety. Photo by Kevin Redding

Samantha Wooley, a Kiddie Academy staff member, said the Hop-A-Thon is a reflection of the values of compassion and community contribution the students work on every month.

“In dancing, and just having fun, they’re working as a team and doing this all together,” Wooley said. “It’s broken up into different ages and levels, some of them are more shy while others are outgoing, and we’re just mixing them all together to have one big dance off.”

Kiddie Academy of Wading River reached out to the society last year to participate in the program to support one of its students who had been diagnosed with leukemia, and is currently in remission.

Christina St. Nicholas, the director of Kiddie Academy of Wading River, said in a press statement that the Hop-A-Thon was “exactly in line with our curriculum” and the child care’s “strong emphasis on character education.”

“[It’s] an exciting program that will engage our preschoolers and school-age children to help others in a fun, educational way,” St. Nicholas said. “Joining in this program to fight leukemia is one of the many ways we strive to model the values of community, compassion and cooperation each and every day.”

Kiddie Academy of Wading River staff member Michele Boccia, on left, and Leukemia and Lymphoma Society Campaign Specialist Alexa Landro, on right, talk to students about the lives they’re helping save. Photo by Kevin Redding

Nearly all 35 students in the school-age department of Kiddie Academy participated, with each classroom collecting bags of loose change. The childcare center also reached out to parents, who had the option to pay through a website or submit a check. Donations ranged from $25 to $75.

Kristin Lievre, a mother of two Kiddie Academy students from Wading River, said it’s important that the kids learn at an early age to give back to the community.

“I think it’s good to see there are ways we can help people through things like this,” she said. “This makes them feel good about what they can do for others.”

Sophia, 10, one of the star dancers of the day, echoed Lievre.

“It feels good because we can raise money for the people who are sick so they can get better,” she said, “and don’t have to deal with the sickness anymore.”

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Cocoa components reduce cardiovascular risk

By David Dunaief, M.D.

Dr. David Dunaief

Valentine’s Day is one of the wonderful things about winter. For many, it lifts the mood and spirit. A traditional gift is chocolate. But do the benefits of chocolate go beyond Valentine’s Day? The short answer is yes, which is good news for chocolate lovers. However, we are not talking about filled chocolates, but primarily dark chocolate and cocoa powder.

The health benefits of chocolate are derived in large part from its flavonoid content — compounds that are produced by plants. These health benefits are seen in cardiovascular disease, including stroke, heart disease and high blood pressure. This is ironic, since many chocolate boxes are shaped as hearts. Unfortunately, it is not necessarily the chocolates that come in these boxes that are beneficial.

Let’s look at the evidence.

Effect on heart failure

Heart failure is very difficult to reverse. Therefore, the best approach is prevention, and dark chocolate may be one weapon in this crusade. In the Swedish Mammography Cohort study, those women who consumed dark chocolate saw a reduction in heart failure (1). The results were on a dose-response curve, but only to a point. Those women who consumed two to three servings of dark chocolate a month had a 26 percent reduction in the risk of heart failure.

For the dark chocolate lovers, it gets even better. Women who consumed one to two servings per week had an even greater reduction of 32 percent. However, those who ate more than these amounts actually lost the benefit in heart failure reduction and may have increased risk. With a serving (1 ounce) a day, there was actually a 23 percent increased risk.

This study was a prospective (forward-looking) observational study that involved more than 30,000 women over a long duration, nine years. The authors comment that chocolate has a downside of too much fat and calories and, if eaten in large quantities, it may interfere with eating other beneficial foods, such as fruits and vegetables. The positive effects are most likely from the flavonols, a subset of flavonoids, which come from the cocoa solids — the chocolate minus the cocoa butter.

Impact on mortality from heart attacks

In a two-year observational study, results showed that chocolate seemed to reduce the risk of cardiac death after a first heart attack (2). Again, the effects were based on a dose-response curve, but unlike the previous study, there was no increased risk beyond a certain modest frequency.

Those who consumed chocolate up to once a week saw a 44 percent reduction in risk of death, and those who ate the most chocolate — two or more times per week — saw the most effect, with 66 percent reduced risk. And finally, even those who consumed one serving of chocolate less than once per month saw a 27 percent reduction in death, compared to those who consumed no chocolate.

The study did not mention dark or milk chocolate; however, this was another study that took place in Sweden. In Sweden, milk chocolate has substantially more cocoa solids, and thus flavonols, than that manufactured for the U.S. There were over 1,100 patients involved in this study, and none of them had a history of diabetes, which is important to emphasize.

Stroke reduction

I don’t know anyone who does not want to reduce the risk of stroke. We tell patients to avoid sodium in order to control blood pressure and reduce their risk. Initially, sodium reduction is a difficult thing to acclimate to — and one that people fear. However, it turns out that eating chocolate may reduce the risk of stroke, so this is something you can use to balance out the lifestyle changes.

In yet another study, the Cohort of Swedish Men, which involved over 37,000 men, there was an inverse relationship between chocolate consumption in men and the risk of stroke (3). Those who ate at least two servings of chocolate a week benefited the most with a 17 percent reduction in both major types of stroke — ischemic and hemorrhagic — compared to those who consumed the least amount of chocolate. Although the reduction does not sound tremendous, compare this to aspirin, which reduces stroke risk by 20 percent. However, chocolate consumption study was observational, not the gold standard randomized controlled trial, like aspirin studies.

Blood pressure

One of the most common maladies, especially in people over 50, is high blood pressure. So, whatever we can do to lower blood pressure levels is important, including decreasing sodium levels, exercising and even eating flavonoid-rich cocoa.

In a meta-analysis (a group of 20 RCTs), flavonoid-rich cocoa reduced both systolic (top number) and diastolic (bottom number) blood pressure significantly: −2.77 mm Hg and −2.20 mm Hg, respectively (4). These studies involved healthy participants, who are sometimes the most difficult in whom to show a significant reduction, since their blood pressure is not high initially. One of the weaknesses of this meta-analysis is that the trials were short, between two and 18 weeks.

Why chocolate has an effect

Consuming a small amount of dark chocolate twice a week may lower the risk of heart disease.

Chocolate has compounds called flavonoids. The darker the chocolate, the more flavonoids there are. These flavonoids have potential antioxidant, antiplatelet and anti-inflammatory effects.

In a small, randomized controlled trial comparing 22 heart transplant patients, those who received dark flavonoid-rich chocolate, compared to a cocoa-free control group, had greater vasodilation (enlargement) of coronary arteries two hours after consumption (5). There was also a decrease in the aggregation, or adhesion, of platelets, one of the primary substances in forming clots. The authors concluded that dark chocolate may also cause a reduction in oxidative stress.

It’s great that chocolate, mainly dark, and cocoa powder have such substantial effects in cardiovascular disease. However, certain patients should avoid chocolate such as those with reflux disease, allergies to chocolate and diabetes. Be aware that Dutch-processed, or alkalized, cocoa powder may have lower flavonoid levels and is best avoided. Also, the darker the chocolate is, the higher the flavonoid levels. I suggest that the chocolate be at least 60 to 70 percent dark.

Moderation is the key, for all chocolate contains a lot of calories and fat. Based on the studies, two servings a week are probably where you will see the most cardiovascular benefits. Happy Post-Valentine’s Day!

References: (1) Circ Heart Fail. 2010;3(5):612-616. (2) J Intern Med. 2009;266(3):248-257. (3) Neurology. 2012;79:1223-1229. (4) Cochrane Database Syst Rev. 2012:15;8:CD008893. (5) Circulation. 2007 Nov 20;116(21):2376-2382.

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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Reverend Richard Graugh on his 12th medical mission to Honduras. Photo from Graugh

By Alex Petroski

For a dozen years, a pastor from First Presbyterian Church of Port Jefferson has been making an annual trip to Honduras to provide people of all ages with desperately needed medical care.

Reverend Richard Graugh, a Mount Sinai native who has been at First Presbyterian since 2007, first joined a small group of doctors from across North America in making a trip to the third-world country 12 years ago.

Honduran women prepare food for physicians and those waiting to be seen by doctors. Photo from Richard Graugh

In the years since its inception, the mission has expanded to include the establishment of a nonprofit organization, and plans to construct a permanent medical clinic in Honduras now exist.

Belle Terre resident Jackie Gernaey, who has made the trip once before, attended the last visit to Honduras, from Dec. 31, 2016, to Jan. 10.

“It ends up turning into a giant village celebration when we show up,” Graugh said. “It’s not really a party, but they all get dressed up; they’re cooking food like pre-gaming at a football game.”

Graugh described the circumstances of the group’s annual January trip, which lasts for a week and is funded out of the pockets of the doctors and other volunteers who make the trek. The doctors pack suitcases with medical equipment, medicines, supplies and even crayons and coloring books, to hand out to children while they wait on lines to receive treatment. This year, 18 Americans from across the country joined twice as many Hondurans in setting up shop at the Hospital of San Lorenzo in southern Honduras to administer eye exams to 430 people — most for the removal of cataracts — dental care for more than 600 patients and other medical treatments to the hundreds of villagers. Dental and eye care are of extreme importance to the Honduran people because of a lack of clean water and a blistering hot sun year-round. Cataracts are a common problem for people of all ages.

A Honduran waits to be seen by a physician. Photo from Richard Graugh

Graugh said 12 years ago, it was a small operation started by doctors from Pennsylvania who essentially just asked around to see if anyone was interested in joining.

“We used to go down there and do this, and there would be no real organization behind it apart from people with good intentions and good faith and good skills to help these people,” he said.

A nonprofit organization called Key Humanitarian Initiative for Southern Honduras was established with bases in Virginia and Honduras, as a way to raise more funds for the annual mission. Now, the group is seeking donations and has received a plot of land to establish a permanent medical facility so that groups can make trips to provide care to Hondurans all year.

“Ostensibly, one from North America is astounded by the quality of joy they have in the day that we’re there,” Graugh said of the trips. “I don’t know if they have the joy all of the time, but there is a palpable sense of joy present even though these people live in very poor conditions.”

Despite the joy Graugh said he observes during his time in the country, the mission is far from a happy occurrence for him.

“If I’m totally honest, I always struggle with how important it is to the individual when it happens, but how small of an effect [it is] on the whole grand scale of things,” he said. “Life is hard. Doing this for 12 years, I’ve seen 12-year-olds [turn into] 24-year-olds [who] have two kids of their own. They’re rung out. Life is hard. At the same time they come and they smile.”

Volunteers during their annual medical mission to Honduras. Photo from Richard Graugh

He said beginning and continuing this mission has opened his eyes.

“If you’ve never been to the developing world, there’s a real straightening out of one’s priorities,” he said. “When you come back and we’re all so consumed with so many things and so busy it’s like, ‘did you have food today?’”

Melvin Tejada, one of the founders of KHISH who lives in Honduras, said in an email what the missions mean to the people of Honduras and the group’s mission to provide medical care to people in desperate need.

“[He is] a humble person with a great heart for the poor of my country,” Tejada said of Graugh in an email.

Graugh said he is just glad to be able to help in any way.

“It’s just this real minute part of improvement in their lives,” he said, “but if I can be part of that, it’s enough for me.”

To learn more about KHISH’s cause, to donate or to get involved, visit www.khishprojectvision.com.

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