CLOSE
Health

by -
0 1662
Simple lifestyle changes can make a big difference. Stock photo

By David Dunaief

Dr. David Dunaief

It seems like almost everyone is diagnosed with gastroesophageal reflux disease (GERD), or at least it did in the last few weeks in my practice. I exaggerate, of course, but the pharmaceutical companies do an excellent job of making it appear that way with advertising. Wherever you look there is an advertisement for the treatment of heartburn or indigestion, both of which are related to reflux disease.

GERD, also known as reflux, affects as much as 40 percent of the U.S. population (1). Reflux disease typically results in symptoms of heartburn and regurgitation brought on by stomach contents going backward up the esophagus. For some reason, the lower esophageal sphincter, the valve between the stomach and esophagus, inappropriately relaxes. No one is quite sure why it happens with some people and not others. Of course, a portion of reflux is physiologic (normal functioning), especially after a meal (2).

GERD risk factors are diverse. They range from lifestyle — obesity, smoking cigarettes and diet — to medications, like calcium channel blockers and antihistamines. Other medical conditions, like hiatal hernia and pregnancy, also contribute (3). Diet issues include triggers like spicy foods, peppermint, fried foods and chocolate.

Smoking and salt’s role

One study showed that both smoking and salt consumption added to the risk of GERD significantly (4). Risk increased 70 percent in people who smoked. Surprisingly, people who used table salt regularly saw the same increased risk as seen with smokers. Treatments vary, from lifestyle modifications and medications to surgery for severe, noticeable esophagitis. The goal is to relieve symptoms and prevent complications, such as Barrett’s esophagus, which could lead to esophageal adenocarcinoma. Fortunately, Barrett’s esophagus is not common and adenocarcinoma is even rarer.

Medications

The most common and effective medications for the treatment of GERD are H2 receptor blockers (e.g., Zantac and Tagamet), which partially block acid production, and proton pump inhibitors (e.g., Nexium and Prevacid), which almost completely block acid production (5). Both classes of medicines have two levels: over-the-counter and prescription strength. Here, I will focus on PPIs, for which more than 113 million prescriptions are written every year in the U.S. (6).

PPIs include Nexium (esomeprazole), Prilosec (omeprazole), Protonix (pantoprazole) and Prevacid (lansoprazole). They have demonstrated efficacy for short-term use in the treatment of Helicobacter pylori-induced (bacteria overgrowth in the gut) peptic ulcers, GERD symptoms and complication prevention, and gastric ulcer prophylaxis associated with NSAID use (aspirin, ibuprofen, etc.) as well as upper gastrointestinal bleeds.

However, they are often used long-term as maintenance therapy for GERD. PPIs used to be considered to have mild side-effects. Unfortunately, evidence is showing that this may not be true. Most of the data in the package inserts is based on short-term studies lasting weeks, not years. The landmark study supporting long-term use approval was only one year, not 10 years. Maintenance therapy usually continues over many years.

Side effects that have occurred after years of use are increased risk of bone fractures and calcium malabsorption; Clostridium difficile, a bacterial infection in the intestines; potential B12 deficiencies; and weight gain (7).

Fracture risks

There has been a debate about whether PPIs contribute to fracture risk. The Nurses’ Health Study, a prospective (forward-looking) study involving approximately 80,000 postmenopausal women, showed a 40 percent overall increased risk of hip fracture in long-term users (more than two years’ duration) compared to nonusers (8). Risk was especially high in women who also smoked or had a history of smoking, with a 50 percent increased risk. Those who never smoked did not experience significant increased fracture risk. The reason for the increased risk may be due partially to malabsorption of calcium, since stomach acid is needed to effectively metabolize calcium.

In the Women’s Health Initiative, a prospective study that followed 130,000 postmenopausal women between the ages of 50 and 79, hip fracture risk did not increase among PPI users, but the risks for wrist, forearm and spine were significantly increased (9). The study duration was approximately eight years.

Bacterial infection

The FDA warned that patients who use PPIs may be at increased risk of a bacterial infection called C. difficile. This is a serious infection that occurs in the intestines and requires treatment with antibiotics. Unfortunately, it only responds to a few antibiotics and that number is dwindling. In the FDA’s meta-analysis, 23 of 28 studies showed increased risk of infection. Patients need to contact their physicians if they develop diarrhea when taking PPIs and the diarrhea doesn’t improve (10).

B12 deficiencies

Suppressing hydrochloric acid produced in the stomach may result in malabsorption issues if turned off for long periods of time. In a study where PPIs were associated with B12 malabsorption, it usually took at least three years duration to cause this effect. B12 was not absorbed properly from food, but the PPIs did not affect B12 levels from supplementation (11). Therefore, if you are taking a PPI chronically, it is worth getting your B12 and methylmalonic acid (a metabolite of B12) levels checked and discussing possible supplementation with your physician if you have a deficiency.

My recommendations would be to use PPIs short-term, except with careful monitoring by your physician. If you choose medications for GERD management, H2 blockers might be a better choice, since they only partially block acid. Lifestyle modifications may also be appropriate in some of the disorders, with or without PPIs. Consult your physician before stopping PPIs since there may be rebound hyperacidity (high acid produced) if they are stopped abruptly.

Lifestyle modifications

A number of modifications can improve GERD, such as raising the head of the bed about six inches, not eating prior to bedtime and obesity treatment, to name a few (12). In the same study already mentioned with smoking and salt, fiber and exercise both had the opposite effect, reducing the risk of GERD (5). This was a prospective (forward-looking) trial. The analysis by Journal Watch suggests that the fiber effect may be due to its ability to reduce nitric oxide production, a relaxant for the lower esophageal sphincter (13).

Obesity

In one study, obesity exacerbated GERD. What was interesting about the study is that researchers used manometry, which measures pressure, to show that obesity increases the pressure on the lower esophageal sphincter significantly (14). Intragastric (within the stomach) pressures were higher in both overweight and obese patients on inspiration and on expiration, compared to those with normal body mass index. This is yet another reason to lose weight.

Eating prior to bed — myth or reality?

Though it may be simple, it is one of the most powerful modifications we can make to avoid GERD. There was a study that showed a 700 percent increased risk of GERD for those who ate within three hours of bedtime, compared to those who ate four hours or more prior to bedtime. Of note, this is 10 times the increased risk of the smoking effect (15). Therefore, it is best to not eat right before bed and to avoid “midnight snacks.” Although there are a number of ways to treat GERD, the most comprehensive have to do with modifiable risk factors. Drugs have their place in the arsenal of choices, but lifestyle changes are the first and most effective approach in many instances.

References:

(1) Gut 2005;54(5):710. (2) Gastroenterol Clin North Am. 1996;25(1):75. (3) emedicinehealth.com. (4) Gut 2004 Dec.; 53:1730-1735. (5) Gastroenterology. 2008;135(4):1392. (6) JW Gen Med. Jun. 8, 2011. (7) World J Gastroenterol. 2009;15(38):4794–4798. (8) BMJ 2012;344:e372. (9) Arch Intern Med. 2010;170(9):765-771. (10) www.FDA.gov/safety/medwatch/safetyinformation. (11) Linus Pauling Institute; lpi.oregonstate.edu. (12) Arch Intern Med. 2006;166:965-971. (13) JWatch Gastro. Feb. 16, 2005. (14) Gastroenterology 2006 Mar.; 130:639-49. (15) Am J Gastroenterol. 2005 Dec.;100(12):2633-2636.

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.

by -
0 1565

By David Dunaief, M.D.

I’m sure we all can agree that type 2 diabetes is an epidemic that needs to be discussed again. Again, because this disease is just not going away. There are a number of different drug classes to treat diabetes, and these classes keep on growing in number and diversity; each has its merits and drawbacks. Since there are so many drugs and drug classes, you will need a scorecard to keep track.

When we talk about this disease, the first thing that comes to mind is glucose levels, or sugar, which is what defines having diabetes. However, we are going to look beyond the sugars to the nonglycemic effects.

What do I mean by this? There seems to be a renaissance occurring where there is a focus in drug trials on the treatment of diabetes complications rather than just the lowering of sugars. Some of the complications that we will investigate include cardiovascular disease and nonalcoholic fatty liver disease (NAFLD). Several drugs may reduce the risk of cardiovascular disease (CVD) mortality. Diabetes patients who have cardiovascular disease are more likely to die about 12 years prematurely (1). However, new research suggests that relatively new diabetes drugs reduce the risk of CVD mortality. These include empagliflozin (Jardiance), a sodium-glucose cotransporter 2 (SGLT2) inhibitor, and liraglutide, a glucagon-like peptide-1 (GLP1) receptor agonist. There is also a third, older drug that has shown CVD risk benefit, metformin. Though these drugs are not without their caveats. Liraglutide has also been shown to potentially reduce the risk of nonalcoholic fatty liver disease.

In fact, the American College of Physicians has recently updated its recommendations on the treatment of type 2 diabetes with oral medications (2). The first line continues to be metformin, the tried and true. The favored second-line drugs to add to metformin may be the SGLT2 cotransporter inhibitors, such as empagliflozin, or DPP-4 inhibitors, such as sitagliptin. The sulfonylureas class, such as glimepiride, and thiazolidinediones class, such as pioglitazone, are also consider second line but not as favorable. GLP1 receptor agonists, such as liraglutide, are not on the list, since they are injectable medications. There are always downsides to drug therapy, and diabetes drugs are no exception. Drawbacks include expense with newer drugs, as well as adverse side effects with all of these drugs, new and old. Though empagliflozin has been shown to reduce CVD mortality, others in the same class have been shown to increase the risk of acute kidney failure.

Before I go any further, I want to state that lifestyle modifications including a plant-based diet and exercise are likely the most powerful tools we have in treating, preventing and reversing diabetes. So, I am not a proponent of diabetes drugs. But, there are many patients who could and do benefit from drug therapy. Lifestyle modifications should always be a significant component whether on drugs or not. Recently, plant-based diets were ranked highly for treating and preventing diabetes in U.S. News and World Report, with the DASH (dietary approach to stop hypertension) diet ranked number one and the Mediterranean diet number two (3), although rankings are not the be-all and end-all. Let’s look at the evidence.

New diabetes drugs may reduce cardiovascular mortality.

Drug benefit on cardiovascular disease

As I mentioned, there are two new drugs, empagliflozin and liraglutide, and one older drug, metformin, that have shown potentially beneficial effects on the macrovascular portion of diabetes treatment and prevention — cardiovascular disease. For the longest time, most diabetes drug trials were focused only on reducing sugars, not on clinical end points.

Empagliflozin

In a the EMPA-REG OUTCOME trial, a randomized, double-blind, placebo-controlled trial, results showed that empagliflozin reduces the risk of cardiovascular mortality (heart attack or stroke) by a relative 38 percent compared to placebo in patients with type 2 diabetes and cardiovascular disease (4). There was also a 32 percent reduction in all-cause mortality compared to the placebo group. Two different doses of empagliflozin were used with similar results, 10 mg and 25 mg once a day. There were 7,020 patients with a duration of 3.1 years. Most of those in the placebo arm were on statin (cholesterol) drugs, ACE inhibitors (blood pressure medication) and aspirin.

The FDA approved this drug for the prevention of heart attacks and strokes in diabetes patients with known cardiovascular disease (5). However, the FDA advisory board only narrowly recommended the drug for this label (6). The label change is based on one trial, and the mechanism for CVD mortality reduction is unclear. However, there are several pitfalls to this study. Empagliflozin was compared to placebo, rather than the usual standard of care, and these patients had cardiovascular disease, which means that we don’t know if the benefit actually holds true in those without CVD. Interestingly, the placebo group’s HbA1C was 8.2 percent at the trial’s end, while the treatment group was reduced to 7.8 percent, neither of which is considered controlling the sugar levels. The treatment group saw a 0.5 percent reduction in HbA1C, which is not overwhelming.

In terms of adverse reactions, empagliflozin increases the risk of urinary tract infections and diabetic ketoacidosis, since sugar is excreted through the urine. In fact, the FDA warned that two drugs from the same class as empagliflozin increase the risk of acute renal failure. These are canagliflozin (Invokana) and dapagliflozin (Farxiga) (5).

Liraglutide

In the LEADER trial, a randomized controlled trial, results showed that liraglutide 1.8 mg subcutaneous injection daily decreased the risk of CVD mortality by a significant 22 percent compared to placebo plus standard care after 3 years (7). This is the highest tolerated dose. This trial involved over 9,000 type 2 diabetes patients at high risk for CVD. Liraglutide also showed a 2.3-kg (5-lb) weight reduction and 0.4 percent HbA1C drop compared to placebo by the 3-year mark. The duration of trial was 3.5 to 5 years. The most significant side effects were gastrointestinal and increased heart rate. In another study, results showed that liraglutide reduced the liver fat in 57 NAFLD patients who were not adequately controlled on metformin, insulin or sulfonylureas (8). After six months, the liver fat in these patients decreased by 33 percent. The patients also lost almost 8 lb of weight and reduced HbA1C by 1.6 percent from 9.8 to 7.3.

Metformin

In a retrospective (backward-looking) study of over 250,000 diabetes patients, there was a greater than 40 percent reduction in cardiovascular events or mortality with metformin compared to sulfonylureas (9). However, a retrospective study is not the most reliable.

Triglyceride-lowering drug reduces CVD

Fenofibrate, which had been shown not to be of benefit, may actually help reduce CVD in a specific group of diabetes patients. In a recent analysis of the ACCORDION trial, a subset of data suggests that diabetes patients with triglycerides >204 mg/dL and HDL <34 mg/dL, when treated with fenofibrate in addition to statins, saw a 27 percent significant reduction in cardiovascular events (10). This was an observational study that requires confirmation with a randomized controlled trial. Thus, there may be a use, though a narrow one, for fenofibrate.

It is potentially exciting that drugs may reduce cardiovascular mortality in diabetes patients. If you do chose one or more of these drug therapies after discussing it with your physician, remember these drugs are in addition to continuing to work on diet and on exercise — the cornerstone of therapy.

References: (1) JAMA. 2015;314(1):52-60. (2) Ann Intern Med. online Jan. 3, 2017. (3) usnews.com. (4) N Engl J Med 2015; 373:2117-2128. (5) FDA.gov. (6) Medscape.com. (7) N Engl J Med 2016; 375:311-322. (8) J Clin Endocrinol Metab. Online Oct. 12, 2016. (9) Ann Intern Med. 2012 Nov. 6;157(9):601-610. (10) JAMA Cardiology online Dec. 28, 2016.

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.

by -
0 2108

By Daniel Dunaief

Born in Berlin just before World War II, Eckard Wimmer has dedicated himself in the last 20 years to producing something that would benefit humankind. A distinguished professor in molecular genetics and microbiology at Stony Brook University, Wimmer is hoping to produce vaccines to prevent the spread of viruses ranging from influenza, to Zika, to dengue fever, each of which can have significant health consequences for people around the world.

Using the latest technology, Wimmer, Steffen Mueller and J. Robert Coleman started a company called Codagenix in Melville. They aim to use software to alter the genes of viruses to make vaccines. “The technology we developed is unique,” said Wimmer, who serves as senior scientific advisor and co-founder of the new company.

Mueller is the president and chief science officer and Coleman is the chief operating officer. Both worked for years in Wimmer’s lab. Despite the potential to create vaccines that could treat people around the world facing the prospect of debilitating illnesses, Wimmer and his collaborators weren’t able to attract a pharmaceutical company willing to invest in a new technology that, he estimates, will take millions of dollars to figure out its value.“Nobody with a lot of money may want to take the risk, so we overcame that barrier right now,” he said.

Eckard Wimmer in his lab. Photo by Naif Mohammed Almojarthi

Codagenix has $6.2 million in funding. The National Institutes of Health initially contributed $600,000. The company scored an additional $1.4 million from NIH. It also raised $4.2 million from venture capital, which includes $4 million from TopSpin and $100,000 from Accelerate Long Island and a similar amount from the Center for Biotechnology at Stony Brook University.

Stony Brook University recently entered an exclusive licensing agreement with Codagenix to commercialize this viral vaccine platform. Codagenix is scheduled to begin phase I trials on a vaccine for seasonal influenza this year.

The key to this technology came from a SBU collaboration that included Wimmer, Bruce Futcher in the Department of Molecular Genetics & Microbiology and Steven Skiena in the Department of Computer Science. The team figured out a way to use gene manipulation and computer algorithms to alter the genes in a virus. The change weakens the virus, giving the attack dog elements of the immune system a strong scent to seek out and destroy any real viruses in the event of exposure.

Wimmer explained that the process starts with a thorough analysis of a virus’s genes. Once scientists determine the genetic code, they can introduce hundreds or even thousands of changes in the nucleic acids that make up the sequence. A computer helps select the areas to alter, which is a rapid process and, in a computer model, can take only one afternoon. From there, the researchers conduct experiments in tissue culture cells and then move on to experiment on animals, typically mice. This can take six months, which is a short time compared to the classical way, Wimmer said.

At this point, Codagenix has a collaboration with the Universidad de Puerto Rico at the Caribbean Primate Research Center to treat dengue and Zika virus in primates. To be sure, some promising vaccines in the past have been taken off the market because of unexpected side effects or even because they have become ineffective after the virus in the vaccine undergoes mutations that return it to its pathogenic state. Wimmer believes this is unlikely because he is introducing 1,000 changes within a vaccine candidate, which is much higher than other vaccines. In 2000, for example, it was discovered that the polio vaccines involve only five to 50 mutations and that these viruses had a propensity to revert, which was rare, to the type that could cause polio.

Colleagues suggested that this technique was promising. “This approach, given that numerous mutations are involved, has the advantage of both attenuation and genetic stability of the attenuated phenotype,” Charles Rice, the Maurice R. and Corrine P. Greenberg professor in virology at Rockefeller University explained in an email.

While Wimmer is changing the genome, he is not altering the structure of the proteins the attenuated virus produces, which is exactly the same as the virus. This gives the immune system a target it can recognize and destroy that is specific to the virus. Wimmer and his associates are monitoring the effect of the vaccines on mosquitoes that carry and transmit them to humans. “It’s not that we worry about the mosquito getting sick,” he said. “We have to worry whether the mosquito can propagate this virus better than before.” Preliminary results show that this is not the case, he said.

Wimmer said there are many safety precautions the company is taking, including ensuring that the vaccine candidate is safe to administer to humans. Wimmer moved from Berlin to Saxony after his father died when Wimmer was 3. He earned an undergraduate degree in chemistry in 1956 at the University of Rockstock. When he was working on his second postdoctoral fellowship at the University of British Columbia in Vancouver, he heard a talk on viruses, which brought him into the field.

A resident of Old Field, Wimmer lives with his wife Astrid, a retired English professor at Stony Brook. The couple’s daughter Susanne lives in New Hampshire and has three children, while their son Thomas lives in Portland, Oregon, and has one child. “We’re very happy Long Islanders,” said Wimmer, who likes to be near the ocean and Manhattan.

Through a career spanning over 50 years, Wimmer has won numerous awards and distinctions. He demonstrated the chemical structure of the polio genome and worked on polio pathogenesis and human receptor for polio. He also published the first cell-free creation of a virus.

“This was an amazing result that enabled a number of important mechanistic studies on poliovirus replication,” Rice explained. Wimmer has “always been fearless and innovative, with great enthusiasm for virology and discovery.”

With this new effort, Wimmer feels he will continue in his quest to contributing to humanity.

by -
0 1975
St. James author puts heart and soul in her first novel

Reviewed by Rita J. Egan

After 10 years of journaling, St. James resident, Cece Gardenia, recently published her first book, “Bringing the Inside Out: Peeling Away the Emotional Layers to Self Acceptance.” The fictional story based on her life centers around polio survivor Colette Aliamo, who throughout her life carries both physical scars as well as emotional ones from her disease and complicated relationships.

Cece Gardenia

In the book, Gardenia invites readers into the heart and soul of Colette who was diagnosed with spinal polio at 22 months in the 1950s. For a few years, the young child was required to use a brace and crutches and was in and out of the hospital until she was 11 years old.

The author delves honestly into the feelings of insecurities and anxiety that she was left with after beating the disease and the dynamics of relationships with family, romantic partners as well as others. Gardenia, who uses a pen name, hopes that readers will find their own path to wholeness, peace and joyfulness after reading her first literary venture. For anyone who has faced adversity in their life, they will easily relate to Colette’s battles with insecurity and anxiety that plagued her in life.

Recently, Gardenia took time to answer a few questions about her book via email.

What made you write this book based on your life experiences?

To offer the reader the idea that no matter what their struggles are, perseverance and the belief that their life can be altered for the best. I have gotten a tremendous amount of feedback from readers that say the story resonated for them and has put their challenges in perspective. Many can’t even imagine a child having polio nowadays. How do you explain what it was like for you as a child suffering from the disease? I felt frightened, isolated, deserted, lonely and often not physically well.

Describe the main character, Colette Aliamo?

Despite the hardships and feeling broken most of her life, she is a force of strength and defiance and is relentless in her beliefs to be true to herself, regardless of the consequences.

In your book, you discuss loss and fear but you also talk about healing and acceptance. What advice would you give those going through tough times?

Be strong in your beliefs and follow your true north. When you are authentic, you will never harbor regrets or guilt.

Was there anything you discovered about yourself while writing this book?

I realized how resilient I was, and how much more I healed than I initially thought.

You also write in the book how Colette learned from “The Oprah Winfrey Show” that she had the “disease to please” syndrome. How did you overcome worrying about what everyone thought?  

It was learning to believe in myself through my experiences of wellness. Once I conducted myself in a positive vein, I noticed a transformation, not only of confidence but I earned the respect of others. I don’t know if I could have done it alone however. Being medicated has allowed me to be the person I always wanted to be. I am still myself but a more whole person.

How did you come to the decision to take medication for depression?

After many efforts and paths taken to find a way to alleviate my depression, I exhausted my options and took the advice of my friend.

However, you don’t rely entirely on medication. What other things do you do to treat your anxiety and depression?

I did find in the end that I did not have coping mechanisms to rise above my condition and knew that medicating myself was the only alternative left. There are times if I am overly stressed I feel a shift in my well-being. Along with the medication, I resort to yoga (deep breathing) and being present and mindful in the moment enough to overcome my anxiety.

I understand that the painting of the little girl on the cover is of you. Tell me the story behind it.

I had a photo of myself that had been taken when I was a little girl which I wanted to use for the cover, but the publisher would not let me use that because they thought the professional photographer might still be alive 66 years later and would have an issue with it. I hunted for other photos but none reflected what this photo did for me. It depicted my strength and defiance, as if I was telling the photographer, “Go ahead, take my picture!”

I was despondent and my husband tried to comfort me, but there was no answer to the dilemma. We went to bed that night, but I was awoken at dawn’s break by my husband. I asked him, ”What are you doing?” He said, “I am looking for your photo.” With a limp hand I pointed to the armoire and went back to sleep. That morning I found the photo of me on the kitchen table and right next to it was a painting of that image that my husband had copied. A gift of love.

Do you have any future plans to write more books?

I’m considering the idea but don’t want to work on something unless it’s something I think is worthy.

Is there a website where people can visit to find out more about you and “Bringing the Inside Out”?  

There is a web page under the name Cece Gardenia but no blog is set up as of yet (www.cecegardenia.com). The better access is through my Facebook page, Bringing the Inside Out, Peeling Away the Emotional Layers to Self Respect by Cece Gardenia.

by -
0 2692
John T. Mather Memorial Hospital in Port Jefferson. File photo from Mather Hospital

No one wants to be sick enough to require a hospital visit, but North Shore residents learned last month they live near three of the best facilities in the Long Island/New York City area if that day should come.

Data compiled by Medicare based on patient surveys conducted from April 2015 through March 2016 and released in December ranked John T. Mather Memorial Hospital and St. Charles Hospital in Port Jefferson, as well as Stony Brook University Hospital, among the top seven in overall rating, and the top nine in likelihood patients would recommend the hospital to a friend or family member.

A patient receives care at John T. Mather Memorial Hospital in Port Jefferson, one of the top hospitals in the Long Island/New York City area based on patient survey data. File photo from Mather Hospital

Overall patient satisfaction ratings were based on recently discharged patient responses to survey questions in 10 categories, including effectiveness of communication by both doctors and nurses, timeliness of receiving help, pain management, cleanliness and noise level at night, among others.

Mather finished behind just St. Francis Hospital in Roslyn of the 27 hospitals considered in the New York/Long Island area in their overall rating. St. Charles ranked sixth and Stony Brook seventh. Mather was also the second most likely hospital for a patient to recommend to a family member or friend, with St. Charles and Stony Brook coming in eighth and ninth places, respectively. St. Francis also topped that category.

Stu Vincent, a spokesperson for Mather, said administration is proud to be recognized for its quality.

“The driving force behind everything we do at Mather is our commitment to our patients, their families and the communities we serve,” he said. “We know people have many choices in health care and we continually strive to ensure that our hospital exceeds their expectations through our employees’ commitment to continuous quality and patient satisfaction improvement.”

A spokesman from St. Charles expressed a similar sentiment.

“At St. Charles, the quality of care that we provide to our patients is first and at the center of everything we do,” Jim O’Connor, executive vice president and chief administrative officer at St. Charles said in a statement. “That commitment to quality is evidenced by these wonderful patient satisfaction scores and the successful number of high level accreditations St. Charles received recently.”

Stony Brook hospital spokeswoman Melissa Weir emailed a statement on behalf of hospital administration regarding its rank among other area facilities.

“We are constantly looking for ways to improve, and are continuously developing new approaches to ensure that our patients have the best experience while they are in our care,” she said. “One of our goals is to achieve top decile performance with a focus on matters such as improving communication, reducing noise, addressing pain management and implementing nurse leader hourly rounding and hourly comfort checks.”

Mather’s ratings were at or above average for New York and nationwide in nearly every category as well as the likelihood to be recommended by a patient. St. Charles beat New York averages in nearly every category and was above the national average in likelihood to be recommended. Stony Brook was also above average compared to the rest of the area in most categories.

All three hospitals received their highest scores in communication by doctors and nurses, along with their ability to provide information to patients for effective recovery at home. All three hospitals were given their lowest ratings in noise levels at night and in patient’s understanding of care after leaving the hospital.

For a complete look at the ratings visit www.medicare.gov/hospitalcompare.

by -
0 1413

By David Dunaief, M.D.

Dr. David Dunaief

When we think of losing weight, calories are usually the first thing that comes to mind. We know that the more calories we consume, the greater our risk of becoming overweight or obese and developing many chronic diseases, including top killers such as heart disease, diabetes and cancer. Despite this awareness, obesity and chronic diseases are on the rise according to the Centers for Disease Control and Prevention.

How can this be the case? I am usually focused on the quality of foods, rather than calories, and I will delve into this area as well, but we suffer from misconceptions and lack of awareness when it comes to calories. The minefield of calories needs to be placed in context. In this article, we will put calories into context, as they relate to exercise, and help to elucidate the effects of mindful and distracted eating. Let’s look at the studies.

Impact of energy expenditure

One of the most common misconceptions is that if we exercise, we can be more lax about what we are eating. But researchers in a recent study found that this was not the case (1). The results showed that when menu items were associated with exercise expenditures, consumers tended to make better choices and ultimately eat fewer calories. In other words, the amount of exercise needed to burn calories was paired on the menu with food options, resulting in a significant reduction in overall consumption.

The example that the authors gave was that of a four-ounce cheeseburger, which required that women walk with alacrity for two hours in order to burn off the calories. Those study participants who had menus and exercise expenditure data provided simultaneously, compared to those who did not have the exercise data, chose items that resulted in a reduction of approximately 140 calories, 763 versus 902 kcals.

Even more interestingly, study participants not only picked lower calorie items, but they ate less of those items. Although this was a small preliminary study, the results were quite impactful. The effect is that calories become a conscious decision rooted in context, rather than an abstract choice.

The importance of mindful eating

Most of us like to think we are multitaskers. However, when eating, multitasking may be a hazard. In a meta-analysis (a group of 24 studies), researchers found that when participants were distracted while eating, they consumed significantly more calories immediately during this time period, regardless of dietary constraints (2).

This distracted eating also had an impact on subsequent meals, increasing the amount of food eaten at a later time period, while attentive eating reduced calories eaten in subsequent meals by approximately 10 percent. Distracted eating resulted in greater than 25 percent more calories consumed for the day. When participants were cognizant of the amount of food they were consuming, and when they later summoned memories of their previous eating, there was a vast improvement in this process.

The authors concluded that reducing distracted eating may be a method to help in both weight loss and weight management, providing an approach that does not necessitate calorie counting. These results are encouraging, since calorie counting frustrates many who are watching their weight over the long term.

The perils of eating out

Most of us eat out at least once in a while. In many cultures, it is a way to socialize. However, as much as we would like to control what goes into our food, we lose that control when eating out. In a study that focused on children, the results showed that when they ate out, they consumed more calories, especially from fats and sugars (3).

Of the 9,000 teenagers involved in the study, between 24 and 42 percent had gone to a fast-food establishment and 7 to 18 percent had eaten in sit-down restaurants when asked about 24-hour recall of their diets on two separate occasions.

Researchers calculated that this resulted in increases of 310 calories and 267 calories from fast-food and sit-down restaurants, respectively. This is not to say we shouldn’t eat out or that children should not eat out, but that we should have more awareness of the impact of our food choices. For example, many municipalities now require calories be displayed in chain restaurants.

Quality of calories

Blueberries are one of the most nutrient dense and highest antioxidant foods in the world.

It is important to be aware of the calories we are consuming, not only from the quantitative perspective but also from a perspective that includes the quality of those calories. In another study involving children, the results showed that those offered vegetables for snacks during the time that they were watching television needed significantly fewer calories to become satiated than when given potato chips (4). The authors commented that this was true for overweight and obese children as well, however, they were more likely to be offered unhealthy snacks, like potato chips.

In a study published in JAMA in June 2012, the authors state that we should not restrict one type of nutrient over another but rather focus on quality of nutrients consumed (5). In my practice, I find that when my patients follow a vegetable-rich, nutrient-dense diet, one of the wonderful “side effects” they experience is a reduction or complete suppression of food cravings. As far as mindless eating goes, I suggest if you are going to snack while working, watching TV or doing some other activity, then snack on a nutrient-dense, low-calorie food, such as carrots, blueberries or blackberries. If you don’t remember how many vegetables or berries that you ate, you can take heart in knowing it’s beneficial. It can also be helpful to keep a log of what you’ve eaten for the day, to increase your cognizance of distracted eating.

Therefore, rather than counting calories and becoming frustrated by the process, be aware of the impact of your food choices. Why not get the most benefit out of lifestyle modifications with the least amount of effort? Rather than having to exercise more to try to compensate, if you actively choose nutrient-dense, low-calorie foods, the goal of maintaining or losing weight, as well as preventing or potentially reversing chronic diseases, becomes attainable through a much less painful and laborious process.

References: (1) J Exp Biol. 2013; Abstract 367.2. (2) Am J Clin Nutr. 2013 April;97:728-742. (3) JAMA Pediatr. 2013;167:14-20. (4) Pediatrics. 2013;131:22-29. (5) JAMA 2012; 307:2627-2634.

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.

by -
0 2000
Helping the Port Jefferson Station community has been Celina Wilson’s, center, mission since the 1980s. Photo from Facebook

By Rebecca Anzel

When Celina Wilson moved to Port Jefferson Station in 1985, she noticed her new community was underserved — and that she could help. Some Spanish-speaking female residents had problems accessing health care, specifically mammograms.

A nurse and Spanish-speaker herself, Wilson worked to partner with the American Cancer Association to bring these women informational materials, teach them how to conduct self-examinations and schedule mammograms with a mobile service.

She founded Bridge of Hope Resource Center in 1998 with her husband to continue helping Port Jefferson Station residents get free health care by partnering with other organizations and community leaders. As other issues the community faced came to her attention, Wilson expanded the scope of Bridge of Hope to include them.

The organization gets feedback from residents and takes them straight to public officials. So far, it has tackled issues such as safety in schools post-Sandy Hook and drug abuse awareness and prevention.

“I believe that the more awareness you raise about issues communities face, the less chance there is of our communities becoming unstable,” Wilson said. “I really want Port Jefferson Station to stay strong.”

For her work advocating for Port Jefferson Station residents and fighting to combat drug abuse, Times Beacon Record News Media is recognizing Celina Wilson as a Person of the Year.

“Celina Wilson is a resource for Port Jeff Station — she’s been doing this for decades,” Port Jefferson Mayor Margot Garant said in an interview. “She does this because she cares so much about not only her own children, but all our children, and I am just so impressed by her.”

Bridge of Hope uses education as a tool to help show community members why drug use is dangerous. Wilson said she thinks it is important to share information about the “basics” of drug abuse — what changes it makes in a user’s brain, risk factors that might lead to someone turning to drugs and signs someone is using.

“We work to make sure that when you look at Port Jefferson Station, people know it’s a community that’s got it together and can weather any problems.”

— Celina Wilson

She shared that information in an educational forum at Port Jefferson High School in mid-October. Also on the panel was a Stony Brook Children’s Hospital doctor of adolescent medicine and a scientist who focuses on addiction’s effect on the brain. The event marked the first time Bridge of Hope was able to host an educational event in a school.

The goal of the forum, Wilson said, was to educate parents and others in attendance about the “root causes” of drug abuse. She expressed to parents there are signs to look for and risk factors that might lead their children to turn to drugs — such as not understanding the world around them and a lack of confidence and self-esteem — and stressed the importance of keeping an open line of communication with their children.

“It’s important that parents are educated about these things so they don’t feel helpless,” Wilson said. “I found out a week or two later the parents there were receptive to the information we shared at the forum, which was a big accomplishment for us.”

Other educational efforts include publishing an article called “The Amazing Human Brain” on the Bridge of Hope website that focuses on brain function and working to create a traveling museum exhibit to make the community more aware of drug abuse.

Dori Scofield, founder of Dan’s Foundation for Recovery, worked with Wilson on the exhibit, which will launch next year. She said she loves the work Bridge of Hope does making a difference in the community.

“Celina is amazing and I love working with her on community issues,” she said. “She is an inspiration to all of us who work in the field of improving life for all.”

Bridge of Hope also works in Brentwood, Central Islip and Bay Shore, but creating a support system for residents in Port Jefferson Station is not any less important to Wilson now than it was when the organization was founded 18 years ago.

“We really want our community to stay strong and our families to have stability. We don’t want to hear about our youths overdosing,” Wilson said. “We work to make sure that when you look at Port Jefferson Station, people know it’s a community that’s got it together and can weather any problems.”

The organization also offers mentoring opportunities for teens in need of extra guidance.

To contact Bridge of Hope Resource Center call 631-338-4340 or visit www.bridgeofhoperc.com.

by -
0 1536
Skip the cookies and milk this year and reach for a piece of fruit or vegetable instead.

By Dr. David Dunaief

Dear Santa,

This time of year, people around the world are no doubt sending you lists of things they want through emails, blogs, tweets and old-fashioned letters. In the spirit of giving, I’d like to offer you ­— and maybe your reindeer — some advice.

David Dunaief, M.D.

Let’s face it: You aren’t exactly the model of good health. Think about the example you’re setting for all those people whose faces light up when they imagine you shimmying down their chimneys. You have what I’d describe as an abnormally high BMI (body mass index). To put it bluntly, you’re not just fat, you’re obese. Since you are a role model to millions, this sends the wrong message.

We already have an epidemic of overweight kids, leading to an ever increasing number of type 2 diabetics at younger and younger ages. From 2005 to 2007, according to the CDC and NIH, the prevalence of diabetes increased by an alarming rate of three million cases in the U.S. The rate is only getting worse. It complicates the issue that approximately two-thirds of the U.S. population is overweight and/or obese. This is just one of many reasons we need you as a shining beacon of health.

Obesity has a much higher risk of shortening a person’s life span, not to mention quality of life and self-image. The most dangerous type of obesity is an increase in visceral adipose tissue, which means central belly fat. An easy way to tell if someone is too rotund is if a man’s waist line, measured from the navel, is greater than or equal to 40 inches and for a woman is greater than or equal to 35 inches. The chances of diseases such as pancreatic cancer, breast cancer, liver cancer and heart disease increase dramatically with this increased fat.

Santa, here is a chance for you to lead by example (and, maybe, by summer, to fit into those skinny jeans you hide in the back of your closet). Think of the advantages to you of being slimmer and trimmer. For one thing, Santa, you would be so much more efficient if you were fit. Studies show that with a plant-based diet, focusing on fruits and vegetables, people can reverse atherosclerosis, clogging of the arteries.

The importance of a good diet not only helps you lose weight but avoid strokes, heart attacks, peripheral vascular diseases, etc. But you don’t have to be vegetarian; you just have to increase your fruits, vegetables and whole grain foods significantly. With a simple change, like eating a handful of raw nuts a day, you can reduce your risk of heart disease by half. Santa, future generations need you. Losing weight will also change your center of gravity, so your belly doesn’t pull you forward. This will make it easier for you to keep your balance on those steep, icy rooftops.

Skiing is a great way to get fit.

Exercise will help, as well. Maybe for the first continent or so, you might want to consider walking or jogging alongside the sleigh. As you exercise, you’ll start to tighten your abs and slowly see fat disappear from your mid-section, reducing risk and practicing preventive medicine. Your fans everywhere leave you cookies and milk when you deliver presents. It’s a tough cycle to break, but break it you must. You — and your fans — need to see a healthier Santa. You might let slip that the modern Santa enjoys fruits, especially berries, and veggies, with an emphasis on cruciferous veggies like broccoli florets dipped in humus, which have substantial antioxidant qualities and can help reverse disease.

As for your loyal fans, you could place fitness videos under the tree. In fact, you and your elves could make workout videos for those of us who need them, and we could follow along as you showed us “12 Days of Workouts with Santa and Friends.” Who knows, you might become a modern version of Jane Fonda or Richard Simmons!

How about giving athletic equipment, such as baseball gloves, baseballs, footballs and basketballs, instead of video games? You could even give wearable devices that track step counts and bike routes or stuff gift certificates for dance lessons into people’s stockings. These might influence the recipients to be more active.

By doing all this, you might also have the kind of energy that will make it easier for you to steal a base or two in this season’s North Pole Athletic League’s Softball Team. The elves don’t even bother holding you on base anymore, do they?

The benefits to a healthier Santa will ripple across the world. Think about something much closer to home, even. Your reindeer won’t have to work so hard. You might also fit extra presents in your sleigh. And Santa, you will be sending kids and adults the world over the right message about taking control of their health through nutrition and exercise. That’s the best gift you could give!

As you become more active, you’ll find that you have more energy all year round, not just on Christmas Eve. If you start soon, Santa, maybe by next year, you’ll find yourself parking the sleigh farther away and skipping from chimney to chimney.

Wishing you good health in the coming year,

David

P.S. I could really use a new baseball glove, if you have a little extra room in your sleigh.

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

by -
0 230
Doctors David Seligman, left, Jesse Chusid, center, and Jason Naidich, right, stand in front of one of the new machines at the center. Photo by Kevin Redding

By Kevin Redding

Residents of Smithtown and its surrounding neighborhoods now have easy access to quality radiologic care that eliminates the need for long and distressing hospital visits.

At Northwell Health Imaging at Smithtown, patients in need of a wide variety of diagnostic testing services including MRIs, low-dose CAT scans and ultrasounds are guaranteed the ease of a private practice with the expertise and equipment of an academic medical center.

The center, which took two years to build, provides 3D mammograms, bone density tests, digital X-rays and biopsies, all within a spa-inspired atmosphere that’s warm and comforting to its patients.

On Dec. 8, a ribbon cutting was held in the lobby of the $2.8 million facility — even though it officially opened to the public in early September. Northwell Health’s staff, local medical community members and dignitaries gathered to celebrate the center, which stands as the fourth imaging center in Suffolk County; the others are located in Huntington, Bay Shore and Islip.

“It’s convenient and far more patient-friendly and structured here … access is easier.”
—David Seligman

David Seligman, vice president of imaging services at Northwell Health, said radiology has become a much more community-based service and there isn’t much of a need anymore to go to the hospital for a brain scan, chest scan or mammogram. He said the quality of care at the center is just as good as it is in the best hospitals, but the experience for the patient is far better, especially in terms of scheduling and predictability.

“It’s convenient and far more patient-friendly and structured here … access is easier,” Seligman said at the ribbon cutting. “The environment obviously is intended to be spa-like; it’s quiet, inviting, private. We try to get patients in and out so they don’t have to waste an entire day coming in for a CT study [for instance]. The response to these community-based practices is far more positive in the general population.”

He said he’s excited because he knows patients who come to the center are going to have a high-quality and efficient experience.

Dr. Jesse Chusid, senior vice president of imaging services and a diagnostic radiologist said Northwell Health wanted to offer an alternative to the hassles associated with a hospital.

“When you go to a hospital, the parking isn’t very good, you have to walk through a giant building that’s complicated, signage is not always optimal and you’re in a place with a lot of sick patients,” Chusid said. “It’s not always a comfortable setting to be in when you’re a well person just going for a checkup, so I think you get to avoid all that by coming to an outpatient facility like this one. Everybody likes the way this facility is laid out; it’s comfortable for people. When you’re coming in for health care, it’s anxiety producing, everybody is always worried when they walk in the door so if you have an environment that’s warm and welcoming with people who can comfort then it makes the whole experience a lot easier and that’s what we have here.”

He said Northwell Health has Long Island’s largest group of fellowship-trained, subspecialized radiologists in its health system — upwards of 170, although only two will be at the center day to day, one more focused on general kinds of imaging and the other on women’s imaging and breast health.

The large group of radiologists across the system allows for focused expertise on specific problems patients might have. By interpreting and studying results in their specialized fields, the radiologists have proven to make more accurate diagnoses.

“The whole goal is to make it easy and convenient for patients to get the imaging they need and then route those images to somebody who’s uniquely trained to be able to give an expert interpretation.”
—Jesse Chusid

Even though not all the experts are in the building, if an imaging is done, it can be immediately shared with other radiologists in their network with the technology to which they have access.

“The whole goal is to make it easy and convenient for patients to get the imaging they need and then route those images to somebody who’s uniquely trained to be able to give an expert interpretation,” Chusid said.

He said the center invests a lot in newer technology and plans to keep doing so.

“The direction not just in radiology but in all of health care is toward telemedicine, and providing services remotely, which makes for more convenient access for patients and allows you to spread out subspecialized resources over a big network like this,” the senior vice president said. “By making a virtual network, you can get those images everywhere.”

The facility contains the sort of equipment found in major hospitals, like their CT scan, which is sleeker and less claustrophobic than most. While some scans have more depth and seem to encase anybody inside it, the one available at the center is much more open and patient-friendly.

Chusid said mammographers can take 3D images in breast cancer screenings to better detect early phases of cancer and get treatment started at a quicker pace.

The radiologists are also trained to perform minimally invasive surgical procedures. If a scan is performed and they notice something in the liver or thyroid gland, for example, they can do a biopsy with a needle and send that tissue to a pathologist to get a definitive answer on what it is.

Dr. Jason Naidich, chairman of the Radiology Department at Northwell Health, said having this high level of equipment in the local community is great for patients.

“It means they don’t have to travel to a big academic medical center to get this level of care,” Naidich said. “In radiology, the quality of the service you get is based largely on the equipment that is used. We also try to make it as convenient as possible for patients, so we have extended hours … evening hours, weekend hours. It’s important to make sure we’re accessible to patients who work during the day.”

by -
0 422
The Dec. 1, 2016 Ribbon cutting for the The Kavita and Lalit Bahl Center for Metabolomics and Imaging. From left to right: Dr. Lina Obeid, Dr. Yusuf Hannun, Lalit Bahl, Kavita Bahl, President Samuel L. Stanley and Dr. Kenneth Kaushansky.

By Yusuf Hannun, M.D.

Dr. Yusuf Hannun
Dr. Yusuf Hannun

Propelled by the vision and support of Kavita and Lalit Bahl of Setauket and their two generous gifts totaling $13.75 million, this month the Stony Brook University Cancer Center unveiled The Kavita and Lalit Bahl Center for Metabolomics and Imaging.

For all of us at the Cancer Center, we believe this combined gift will have a decades-long impact on advancing cancer research, individualized medical treatments and patient care, with potentially dramatic advantages for families on Long Island and beyond.

A state-of-the-art facility, the Bahl Center capitalizes on Stony Brook University’s strengths in three major areas: research, treatment and imaging. At the research level, many university departments, including engineering, informatics, applied math, physics and chemistry, will be instrumental in synthesizing data and collaborating on studies. In the clinical care arena, the Cancer Center’s physician experts will be a vital resource in developing prevention, diagnostic and treatment protocols from the new discoveries. Our medical imaging researchers will provide innovative approaches in using the technology and insight into the imaging studies.

Our ultimate goal is to transform precision-based cancer care by enabling scientists and physicians at our Cancer Center to learn more about the characteristics and behavior of each patient’s specific cancer. The center concentrates on the field of metabolomics, one of the most promising approaches to individualized cancer treatment. Metabolomics explores how cancer cells manufacture and use energy, allowing the disease to start, grow and spread, as well as how different types of cancer respond to different treatments. At its core, the Bahl Center is a translational research program that is uniquely positioned to drive innovative cancer research to the next level of discovery:

Cutting-edge Technology. The gift allows us to purchase a cyclotron, which is a particle accelerator that creates tracer molecules. The tracer molecules bind to cancer cells and can be viewed during a positron emission tomography (PET) scan.

Advanced Imaging. We will have two new PET scanners in close proximity to the cyclotron. By using the tracer molecules, our researchers will be able to develop novel applications of PET scans to image multiple aspects of cancers. This will provide new information about how cancer develops, how it can be detected with more precision and how therapy can be tailored and monitored.

Robust Research Program. We are fortunate to have widely respected researchers in the fields of lipids and metabolomics, cancer biology, medical imaging and computational oncology already here at Stony Brook. With this gift, we will be able to recruit key experts in areas that complement our strengths to drive the center to new levels of excellence.

The knowledge we gain will help revolutionize precision-based cancer diagnosis and care. It will lead to earlier detection, new treatment targets and improved monitoring of treatment response, as well as a better understanding of how to prevent cancer from developing in the first place.

For Long Island residents, the Bahl Center’s location at Stony Brook University Cancer Center means that patients will have the benefit of being treated by professionals who are on the forefront of transformative cancer discoveries.

The Kavita and Lalit Bahl Center for Metabolomics and Imaging research program was officially opened with a ribbon-cutting ceremony on Dec. 1. We’re currently working in Stony Brook University School of Medicine laboratories but will relocate to dedicated facilities in our new Medical and Research Translation (MART) building when it opens in 2018. To learn more, please visit www.cancer.stonybrookmedicine.edu.

Dr. Yusuf Hannun is the director of the Stony Brook University Cancer Center, vice dean for cancer medicine and Joel Strum Kenny Professor in Cancer Research.

Prev1...159160161...181Next Page 160 of 181
TBR News Media is your local news and entertainment website.
We provide you with the latest breaking news and information for your community.
Contact us: [email protected]

Most Viewed

©