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Gaofeng Fan
Gaofeng Fan at Cold Spring Harbor Laboratory. Photo by Siwei Zhang

The terror in the opening of the horror movie “When a Stranger Calls” comes when the police tell an anxious babysitter that threatening calls are “coming from inside the house.”

With the killer disease cancer, researchers spend considerable energy and time focusing on signals that might be coming from outside the cell. Many of those signals bind to a receptor in the membrane that corrupt a cell’s normal pathways, leading the cell to uncontrolled growth, the production of tumors or other unhealthy consequences.

Working in the laboratory of Nicholas Tonks, a professor at Cold Spring Harbor Laboratory, postdoctoral researcher Gaofeng Fan has spent over four and a half years studying a particular signal that comes from inside the cell. I

n a recent study published in Genes & Development, Fan demonstrated that a protein called FER, which adds a phosphate group to the inside part of a receptor called MET, plays a role in the ability of ovarian cancer to spread or metastasize. Already the target of drug development, MET is overexpressed in 60 percent of ovarian tumors. Thus far, developing drugs that block MET alone has not been particularly effective. Indeed, a humanized antibody that prevents human growth factor from binding to this receptor has shown “weak anti-tumor effect” in clinical trials, Fan suggested. In his research in cells, cultures and animal models, Fan demonstrated that ovarian cancer doesn’t spread and may have a different prognosis without FER.

“We found that the ligand [the human growth factor] is not necessary for the activation of the MET,” Fan said. “In the presence of FER, without the ligand, MET can be activated.” Understanding the role of FER in ovarian cancer may offer some clues about why only preventing signals from the outside aren’t enough to protect the cell. While Fan worked with ovarian cancer, he explained other scientists have shown that FER activation has been reported in lung, hepatic, prostate, breast and ovarian cancer. FER plays a part in cell motility and invasion, drug resistance and programmed cell death.

Fan’s work with FER started with a genetic experiment. Taking FER out of a cell, through a process called a loss-of-function assay, Fan found that the cell motility, or its ability to move, decreases. Once he took out FER, he also looked closely at MET activation. If the receptor required only human growth factor, which he included in his experiment, the removal of FER shouldn’t have any effect on its activity. “We found the opposite result,” Fan said.

Gaofeng Fan with his son Ruihan at Tall Ships America in Greenport in 2015. Photo by Xan Xu
Gaofeng Fan with his son Ruihan at Tall Ships America in Greenport in 2015. Photo by Xan Xu

A set of experiments with mice provided stronger evidence to support his belief that FER played a role in the spread of ovarian cancer. One of the mice had normal FER expression, while the other was missing the FER protein. When he compared the ability of cancer to metastasize, he found that cancer spread in a more limited way in the mice without the protein. “This confirmed the in vitro data and all the cell-based assays,” he said.

After six and a half years as a postdoctoral researcher, Fan is now looking for opportunities to teach and, perhaps, start his own lab in his native China. Fan hopes to continue to work on this system and would like to be a part of the discovery process that might find a small molecule inhibitor for FER. Once he and others find a FER inhibitor, they might be able to use it in combination with other drugs, including small molecules that inhibit human growth factor’s effect on the MET receptor.

Fewer than one in four women with Stage 3 ovarian cancer, which is typically the stage at which doctors find the disease, survive for five years.

Fan said he feels driven to help find a way to slow down the progression of this disease. “There’s an urgency to find a good, effective treatment.” To be sure, Fan cautioned that these studies, while encouraging and an important step in learning about ovarian cancer metastasis, require considerable work to become a part of any new treatment.

In his work, Fan was grateful for the support of Peter A. Greer, a principal investigator at the Cancer Research Institute at Queen’s University at Kingston in Ontario, Canada. Greer “is the leading scientist in research of FER proteins and he opened up all his toolbooks to me,” Fan said.

In an email, Greer described Fan as a “very gifted scientist with an outstanding training experience.” He hopes to “continue our collaboration in the area of ovarian cancer after [Fan] establishes his independent research program” in China. Greer, who spoke with Fan regularly through the process, said he is hopeful that the publication of the study in Genes & Development, in addition to other studies he and other labs have published, will “encourage drug development aimed at FER inhibitors suitable for clinical use.”

Fan also appreciated the guidance and flexibility of his CSHL mentor Nicholas Tonks, famous for his work on tyrosine phosphatase in which he studies the effect of removing phosphate groups. Fan’s research, however, involved understanding adding a phosphate group, through a kinase. “I got humongous support” from Tonks. “Without his help, I couldn’t come this far.”

A resident of Port Jefferson, Fan lives with his wife Yan Xu, who is earning her Ph.D. in materials science at Stony Brook. The couple has a six-year old son, Ruihan, who has enjoyed the Summer Sunday opportunities at Brookhaven National Laboratory, where Ruihan spent hours viewing and constructing the structure of DNA. As for his work, Fan sees opportunities to help people battling this disease.“If we can collect more evidence from this story, we can propose” a way to boost the outcome of treatment, he said.

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Narcan, a drug that stops opioid overdoses. File photo by Jessica Suarez

“[CARA] is the culmination of so many families that had to lose loved ones over the last several years.” —Steve Chassman

Help is on the way, as President Barack Obama (D) signed a multibillion dollar bill into law this week that takes aim at the growing drug abuse problem facing many North Shore residents and families.

The Comprehensive Addiction and Recovery Act of 2016 is an $8.3 billion plan to fight drug addiction in the United States, with a significant amount of funding for prevention and treatment.

Obama said in a statement last Friday though, that he feels the bill could have gone further with funding for prevention.

“This legislation includes some modest steps to address the opioid epidemic,” he said. “Given the scope of this crisis, some action is better than none.” However, Obama was critical of the amount of money allotted for treatment options.

CARA funding includes $160 million for the expansion of medication-assisted treatment options, including grants that will be awarded to state, local and tribal governments to provide opioid abuse services. These grants will help fund programs that could expand treatment alternatives to incarcerations — with consent of attorneys and participants — for individuals who meet the program’s criteria.

Funding will also help develop, implement and expand prevention programs and training for first responders to administer opioid overdose reversal drugs, like Narcan. It will also fund investigations of unlawful opioid distribution activities.

Obama said he is committed to ensuring that support continues for individuals and families who are struggling with drug addiction.

President Barack Obama said he wanted even more funding for treatment. File photo
President Barack Obama said he wanted even more funding for treatment. File photo

“I have heard from too many families across the country whose lives have been shattered by this epidemic … I’m going to continue fighting to secure the funding families desperately need,” he said. “In recent days, the law enforcement community, advocates, physicians and elected officials from both sides of the aisle have also joined in this call.”

U.S. Rep. Lee Zeldin (R-Shirley), who is a co-sponsor of the bill, has been vocal about asking the Senate and the president to pass the bill, after it went through the House of Representatives with a bipartisan vote of 407 to 5 in mid-July. It was passed by the Senate with a bipartisan vote of 92 to 2 the following week.

“Our communities and families on Long Island have been severely impacted by the rise of prescription drug abuse and the growing epidemic of heroin, and I will continue working with local elected officials, law enforcement, health professionals, community groups, parents, concerned residents and those in recovery to discuss and develop a more localized solution to address this crisis by increasing treatment and recovery services, education, and stopping the influx of illegal substances,” he said in a statement on Monday.

Steve Chassman, executive director of the Long Island Council on Alcoholism and Drug Dependence, said the law is “arguably the most comprehensive bill” out there concerning the combat against drug abuse.

“It is heavy in education, prevention and treatment,” he said. “We are not just going to incarcerate our way out of this. [CARA] deals with this crisis as the crisis is.”

Chassman has attended multiple drug forums, prevention talks and community meetings on this growing problem, and said the new law is “the culmination of so many families that had to lose loved ones over the last several years.”

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Iron is important for exercise motivation and may play a role in peak mental functioning. Stock photo

I believe the most salient teaching point in medical school and beyond was when a professor explained, as it relates to the patient diagnosis, when you hear hooves think horses not zebras. What this means is think of the more common or more likely diseases or disorders in a differential diagnosis rather than the more esoteric or rare diseases. And when a patient presents with fatigue, one of the more common reasons is iron deficiency.

Major causes of low iron are anemia of chronic disease, iron deficiency anemia, sideroblastic anemia and thalassemia. Of these, iron deficiency anemia is the most common. However, there is a much less known, but not uncommon, form of low iron. This is called iron deficiency without anemia. Unlike iron deficiency anemia, the straightforward CBC (complete blood count) that is usually drawn cannot detect this occurrence since the typical indicators, hemoglobin and hematocrit, are not yet affected.

So how do we detect iron deficiency without anemia? Not to despair, since there is a blood test done by major labs called ferritin. What is ferritin? Ferritin is a protein that is involved in iron storage. When ferritin is less than 10 to 15 ng/ml, the diagnosis of iron deficiency is most likely indicated. Even healthy people with ferritin slightly higher than this level may also have iron deficiency (1). The normal range of ferritin is 40-200 ng/ml.

At this point, you should be asking who does low ferritin affect and what are the symptoms? Women and athletes are affected primarily, and low ferritin levels may cause symptoms of fatigue. It is also seen with some chronic diseases such as restless leg syndrome (RLS) and attention deficit hyperactivity disorder (ADHD) in children.

Effect on women

In a prospective (forward-looking) study done in 1993 looking at primary care practices, it was determined that 75 percent of patients complaining of fatigue were women (2). Interestingly, less than 10 percent of these women had abnormal lab results when routine labs were drawn, most probably without a ferritin level. Many of them had experienced these symptoms for at least three months.

There was a randomized controlled trial (RCT), the gold standard of studies, that showed women who were suffering from fatigue and low or low-normal ferritin levels (less than 50 ng/ml), but who did not have anemia, benefited from iron supplementation (3). When comparing women with these ferritin levels, many of those who were given 80 mg of oral prolonged release ferrous (iron) sulfate supplements daily saw a significant improvement in their fatigue symptoms when compared to those women who were not given iron. Almost half the women taking iron supplements had a significant improvement in fatigue symptoms. The results were seen in a very short 12-week period. This is nothing to sneeze at, since fatigue is one of main reasons people go to the doctor. Also, although this was a small study, there were 198 women involved, ranging from 18 to 53 years old.

There are caveats to these study results. There was no improvement in depression or anxiety symptoms, nor in overall quality of life. Even though it was blinded, stool changes occur when a patient takes iron. Therefore, the women taking supplements may have known. Nonetheless, the study results imply that physicians should check ferritin level, not only a CBC, when a premenopausal woman complains of fatigue. Note that all of the women in the study were premenopausal. This is important to delineate, since postmenopausal women are at much higher risk of iron overload, rather than deficiency. They are no longer menstruating and therefore do not rid themselves of significant amounts of iron.

Athletes

According to an article in The American Journal of Lifestyle Medicine, athletes’ endurance may be affected by iron deficiency without anemia (4). Low ferritin levels are implicated, as in the previous study. Iron is important for exercise motivation and may play a role in peak mental functioning, as reported in “Iron: Nutritional and Physiological Significance.” In animal studies, iron deficiency without anemia is associated with reduction in endurance because of a decrease in oxygen-based enzymatic activity within the cells.

However, this has not been shown definitively in human athletes and remains an interesting, but yet to be proven, hypothesis. Interestingly, female endurance athletes are more likely to be affected by iron deficiency without anemia, which occurs in about 25 percent of this population, according to studies (5). Low ferritin is not seen as much in male athletes. This difference in gender may be due to the fact that women not only menstruate, losing iron on a regular basis, but also their intake of dietary iron seems to be lower (6).

However, male athletes are not immune. At the end of the season for high school runners, 17 percent had iron deficiency without anemia (7). Do not take iron supplements without knowing your levels of hemoglobin and ferritin and without consulting a doctor. Studies are mixed on the benefits of iron supplementation without anemia for athletes.

Impact on restless leg syndrome

Iron deficiency with a ferritin level lower than 50 ng/ml affects approximately 20 percent of patients who suffer from restless leg syndrome (8). Restless leg syndrome, classified as a neurologic movement disorder, causes patients to feel like they need to move their legs, most commonly about a half-hour after going to bed. In a very small study, patients with restless leg syndrome who had ferritin levels lower than 45 ng/ml saw significant improvement in symptoms within eight days with iron supplementation (9).

Before you get too excited, the caveat is that 75 percent of restless leg patients have high ferritin levels. It is impressive in terms of being an easy fix for those who have low ferritin levels. And, it may be that high ferritin levels in RLS has the same symptoms as low ferritin for this is the case when it comes to iodine levels in hypothyroid patients. Iron is a trace mineral, meaning we only need small amounts to maintain proper levels.

Ferritin levels — both high and low — may play a role in a number of diseases and symptoms. If you are suffering from fatigue, a CBC test may not be enough to detect iron deficiency. You may want to suggest checking your ferritin level. Though iron supplementation may help those with symptomatic iron deficiency without anemia, it is very important not to take iron supplements without the direct supervision of your physician.

References: (1) Br J Haematol. 1993;85(4):787-798. (2) BMJ 1993;307:103. (3) CMAJ. 2012;184(11):1247-1254. (4) Am J Lifestyle Med. 2012;6(4):319-327. (5) J Am Diet Assoc. 2005;105:975–978. (6) J Pediatr. 1989;114:657–663. (7) J Adolesc Health Care. 1987;8:322–326. (8) Am Fam Physician. 2000;62(4):736. (9) Sleep Med. 2012;13(6):732-735. 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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Continuous positive airway pressure (CPAP) therapy is a common treatment for obstructive sleep apnea. Stock photo

By David Dunaief, MD

Most of us have experienced a difficult night’s sleep. However, those with obstructive sleep apnea (OSA) may experience a lack of restful sleep much more frequently.

OSA is an abnormal pause in breathing while sleeping that occurs at least five times an hour. There are a surprising number of people in the United States who have this disorder. The prevalence may be as high as 20 percent of the population, and 26 percent are at high risk for the disorder (1). There are three levels of OSA: mild, moderate and severe.

The risk factors for OSA are numerous and include chronic nasal congestion, large neck circumference, being overweight or obese, alcohol use, smoking and a family history.

Not surprisingly, about two-thirds of OSA patients are overweight or obese. Smoking increases risk threefold, while nasal congestion increases risk twofold (2). Fortunately, as you can see from this list, many of the risk factors are modifiable.

The symptoms of OSA are significant: daytime fatigue, loud snoring, breathing cessation observed by another, impaired concentration and morning headaches. These symptoms, while serious, are not the worst problems. OSA is also associated with a list of serious complications, such as cardiovascular disease, high blood pressure and cancer.

There are several treatments for OSA. Among them are continuous positive airway pressure — known as CPAP — devices; lifestyle modifications, including diet, exercise, smoking cessation and reduced alcohol intake; oral appliances; and some medications.

Cardiovascular disease

In an observational study, the risk of cardiovascular mortality increased in a linear fashion to the severity of OSA (3). In other words, in those with mild-to-moderate untreated sleep apnea, there was a 60 percent increased risk of death; and in the severe group, this risk jumped considerably to 250 percent. However, the good news is that treating patients with CPAP considerably decreased their risk by 81 percent for mild-to-moderate patients and 45 percent for severe OSA patients. This study involved 1,116 women over a duration of six years.

Not to leave out men, another observational study showed similar risks of cardiovascular disease with sleep apnea and benefits of CPAP treatment (4). There were more than 1,500 men in this study with a follow-up of 10 years. The authors concluded that severe sleep apnea increases the risk of nonfatal and fatal cardiovascular events, and CPAP was effective in stemming these occurrences. In a third study, this time involving the elderly, OSA increased the risk of cardiovascular death in mild-to-moderate patients and in those with severe OSA 38 and 125 percent, respectively (5). But, just like in the previous studies, CPAP decreased the risk in both groups significantly. In the elderly, an increased risk of falls, cognitive decline and difficult-to-control high blood pressure may be signs of OSA.

Though all three studies were observational, it seems that OSA affects both genders and all ages when it comes to increased risk of cardiovascular disease and death, and CPAP may be effective in reducing these risks.

Cancer association

In sleep apnea patients under 65 years old, a study showed an increased risk of cancer (6). The authors believe that intermittent low levels of oxygen, which are caused by the many frequent short bouts of breathing cessation during sleep, may be responsible for the development of tumors and their subsequent growth.

The greater the percentage of time patients spend in hypoxia (low oxygen) at night, the greater the risk of cancer. So, for those patients with more than 12 percent low-oxygen levels at night, there is a twofold increased risk of cancer development, when compared to those with less than 1.2 percent low-oxygen levels.

Sexual function

It appears that erectile dysfunction may also be associated with OSA. CPAP may decrease the incidence of ED in these men. This was demonstrated in a small study involving 92 men with ED (7). The surprising aspect of this study was that, at baseline, the participants were overweight — not obese — on average and were young, at 45 years old. In those with mild OSA, the CPAP had a beneficial effect in over half of the men. For those with moderate and severe OSA, the effect was still significant, though not as robust, at 29 and 27 percent, respectively.

Dietary effect

Although CPAP can be quite effective, as shown in some of the studies above, it may not be well tolerated by everyone. In some of my patients, their goal is to discontinue their CPAP. Diet may be an alternative to CPAP, or may be used in combination with CPAP.

In a small study, a low-energy diet showed positive results in potentially treating OSA. It makes sense, since weight loss is important. But even more impressively, almost 50 percent of those who followed this type of diet were able to discontinue CPAP (8). The results endured for at least one year. Patients studied were those who suffered from moderate-to-severe levels of sleep apnea. Low-energy diet implies a low-calorie approach. A diet that is plant-based and nutrient-rich would fall into this category. One of my patients who suffered from innumerable problems was able to discontinue his CPAP machine after following this type of diet.

The bottom line is that if you think you or someone else is suffering from sleep apnea, it is very important to go to a sleep lab to be evaluated, and then go to your doctor for a follow-up. Don’t suffer from sleep apnea and, more importantly, don’t let obstructive sleep apnea cause severe complications, possibly robbing you of more than sleep. There are effective treatments for this disorder, including diet and/or CPAP.

References: (1) WMJ. 2009;108(5):246. (2) JAMA. 2004;291(16):2013. (3) Ann Intern Med. 2012 Jan 17;156(2):115-122. (4) Lancet. 2005 Mar 19-25;365(9464):1046-1053. (5) Am J Respir Crit Care Med. 2012;186(9):909-916. (6) Am J Respir Crit Care Med. 2012 Nov. 15. (7) APSS annual meeting: abstract No. 0574. (8) BMJ. 2011;342:d3017.

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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Prevention and treatment improve outcome

By David Dunaief, M.D.

Cataracts are incredibly common; about 50 percent of Americans will have a cataract or have had cataract surgery by age 80 (1). Cataracts, the nuclear type, reduce visual acuity in an insidious process. Cataract surgery can resolve this, reducing the risk of falls and hip fracture. At the same time, it can reduce pressure in the eye.

Interestingly, research suggests that a diet rich in carotenoids may prevent the occurrence of cataracts. However, statins may have the reverse effect by increasing risk.

Let’s look at the evidence.

Cataract surgery and hip fracture

In one study, elderly cataract patients who underwent surgery were significantly less likely to experience a hip fracture during a year of follow-up than those who did not have surgery (2). This was a retrospective (backward-looking) observational study, and its size was considerable, with over one million patients ages 65 and older. The results showed a 16 percent reduction in the risk of hip fractures overall. Those who were older, between ages 80 and 84, had the most to gain, with a 28 percent reduction in hip fracture risk.

The increased fall risk and subsequent hip fracture risk among those with cataracts result from decreases in visual acuity and depth perception and a reduction in visual field that accompany cataracts (3). Hip fractures have a tremendous impact on the ability of elderly patients to remain independent. Many of these patients do not regain their prior mobility. Thus, avoiding hip fractures is the best strategy.

Cataract surgery and intraocular pressure

Yet another benefit of cataract surgery is the potential reduction in intraocular pressure (IOP). Why is intraocular pressure (pressure within the eye) important? High IOP has been associated with an increased risk of glaucoma.

A comparative case series (looking at those with and without cataract surgery) utilizing data from the Ocular Hypertension Treatment Study showed that those cataract patients with ocular hypertension (higher than normal pressure in the eye) who underwent cataract surgery saw an immediate reduction in IOP (4). This effect lasted at least three years. The removal of the cataract lowered the IOP by 16.5 percent from 23.9 mm Hg to 19.8 mm Hg. This is close to the low end of glaucoma treatments’ pressure reduction goals, which are 20 to 40 percent. Therefore, cataract surgery may be synergistic with traditional glaucoma treatment.

Cataract surgery and macular degeneration risk

There has been conflicting information in recent years about whether cataract surgery increases the risk of age-related macular degeneration (AMD) progression. A 2009 study suggested that, rather than increasing AMD risk, cataract surgery may uncover underlying AMD pathology that is hidden because the cataract obfuscates the view of the retina (back of the eye) (5). The study’s strengths were the use color retinal photographs and fluorescein angiography (dye in blood vessels of eye), both very thorough approaches.

Cataract prevention with dietary carotenoids

Diet may play a significant role in prevention of cataracts. In the Women’s Health Initiative Observational Study, carotenoids, specifically lutein and zeaxanthin, seem to decrease cataract risk by 23 percent in women with high blood levels of carotenoids, compared to those with low blood levels (6). In fact, those in the highest quintile (the top 20 percent) had an even more dramatic 32 percent risk reduction when compared to those in the bottom quintile (the lowest 20 percent).

As the authors commented, it may not have been just lutein and zeaxanthin. There are more than 600 carotenoids, but these were the ones measured in the study. Some of the foods that are high in carotenoids include carrots, spinach, kale, apricots and mango, according to the USDA. Interestingly, half a cup of one of the first three on a daily basis will far exceed the recommended daily allowance. Thus, it takes a modest consistency in dietary carotenoids to see a reduction in risk.

Vitamin C effect

The impact of vitamin C on cataract risk may depend on the duration of daily consumption. In other words, 10 years seems to be the critical duration needed to see an effect. According to one study, those participants who took 500 mg of vitamin C supplements for 10 or more years saw a 77 percent reduction in risk (7). However, only very few women achieved this goal in the study, demonstrating how difficult it is to maintain supplementation for a 10-year period.

Those who took vitamin C for fewer than 10 years saw no effect in prevention of cataracts. In the well-designed Age-Related Eye Disease Study, a randomized controlled trial, the gold standard of studies, those who received 500 mg of vitamin C supplements along with other supplements did not show any cataract risk reduction, compared to those who did not receive these supplements (1). There were 4,629 patients involved in the cataract study with a duration of 6.3 years of daily supplement consumption. Therefore, I would not rush to take vitamin C as a cataract preventative.

Statin use

Statins have both positive and negative effects, and the effect on the eyes according to one sizable study is negative. In the Waterloo Eye Study with over 6,000 participants, those patients taking statins were at a 57 percent increased risk of cataracts (8). Diabetes patients saw an increased risk of cataracts as well. And in diabetes patients, statins seem to increase the rate at which cataracts occurred.

The authors surmise that this is because higher levels of cholesterol may be needed for the development of epithelial (outer layer) cells and transparency of the lens. This process may be blocked with the use of statins. Before considering discontinuing statins, it is important to weigh the risks with the benefits.

Thus, if you have diminished vision, it may be due to cataracts. It is important to consult an ophthalmologist for diagnosis and, perhaps, cataract surgery, which can reduce your risks of falls, hip fractures and intraocular pressure. For those who do not have cataracts, a diet rich in carotenoids may significantly reduce their risk of occurrence.

References:

(1) nei.nih.gov. (2) JAMA. 2012;308:493-501. (3) J Am Geriatr Soc. 2009 Oct;57(10):1825-1832. (4) Ophthalmology. 2012;119:1826-1831. (5) Arch Ophthalmol. 2009;127:1412-1419. (6) Arch Ophthalmol. 2008;126(3):354-364. (7) Am J Clin Nutr. 1997 Oct;66(4):911-916. (8) Optom Vis Sci 2012;89:1165-1171.

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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Raccoons are naturally occurring hosts for the Leptospira bacteria. Stock photo

By Matthew Kearns, DVM

May and June always kick off the annual checkup season and with all our exams, we discuss vaccines. When I talk about vaccines like distemper, rabies, kennel cough and Lyme, I always see a nod of understanding. However, when I bring up the leptospirosis vaccine, the quizzical look on people’s faces always reveals a lack of knowledge on this disease.

I think the reason is that as little as 10 years ago, leptospirosis was limited to very rural areas primarily where dogs had more of a risk of coming in contact with wildlife. The more “suburban sprawl” we see brings us (and our pets) in closer contact with the natural reservoirs of this disease. 

Leptospirosis is a bacterial infection caused by various strains of the Leptospira bacteria.  This bacteria is carried by many wild animals. Naturally occurring hosts are raccoons, opossums, foxes, skunks and various rodents. Raccoons and skunks are scavengers as much as hunters, so they will commonly venture into our yards to knock over garbage pails etc., in search of food.

It has also been estimated that approximately 90 percent of rats in major cities carry leptospirosis, so it has become more of an urban threat than previously realized. These hosts shed, or pass, the bacteria in their urine, contaminating both the environment and water sources. Not only can these hosts carry the bacteria without showing symptoms of disease, they also can shed the bacteria for extended periods of time.

Once in the soil or water, the Leptospira bacteria is very hearty and can survive for weeks to months waiting for another host. The bacteria can gain access to a new host through the membranes of the mouth (drinking contaminated water) or through abrasions and cuts on the skin (from the soil). Once in the bloodstream the bacteria travels to the kidneys and starts to divide.  When the bacterial numbers are high enough, the new host will start shedding bacteria via the urine. 

No specific breed of dog appears to be more susceptible or resistant to the infection. However, middle-aged dogs (as compared to young or old) and male dogs (compared to female) appear to be at higher risk. It is theorized that middle-aged male dogs are more likely to wander and get into more trouble (so far as coming in contact with a natural host). 

The most common organ system affected is the kidneys, but the Leptospira bacteria can also affect the liver, lungs and central nervous system.  Once the bacteria reaches the kidneys replication, as well as inflammation, damages kidney cells.

The symptoms of leptospirosis can be quite general in the beginning. Anything from a drop in appetite and an increase in thirst to vomiting, severe lethargy and in some cases death.

The good news is that leptospirosis is a bacterial infection that can be treated with antibiotics and other supportive care (IV fluids, IV medications etc.). The bad news is many times the initial infection is cleared but there is permanent damage to the kidneys. 

An effective vaccine is now available to prevent this disease. So, check with your veterinarian if your dog is at risk (dogs that get out of the yard, are in contact with many other dogs, have wildlife nearby and standing water) and should be vaccinated.  Let’s keep our dogs safe this summer.

Dr. Kearns practices veterinary medicine from his Port Jefferson office and is pictured with his son Matthew and his dog Jasmine.

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A new chemical rating system will inform people using dry cleaners in Suffolk. File photo

Customers will soon have more information about how their clothes are being cleaned.

The Suffolk County Legislature recently approved a new law that will require dry cleaners to share information with customers about the types of chemical solvents they are using and the environmental effects of those solvents.

County Legislator Kara Hahn (D-Setauket) had proposed the law, which passed on June 2. Under the new requirements, the county health department will categorize dry cleaning solvents, ranking “each chemical grouping based on both human and environmental impacts,” according to a press release from Hahn’s office.

From there, during the existing annual inspections for dry cleaners, county officials will provide the businesses with color-coded signs that “indicate the cleaning methods and solvents used by each individual shop.”

The dry cleaners would have to post the signs in their windows and behind their counters.

On the government side, the health department will also have a website — the address of which will be on the color-coded signs — with environmental and health information about different dry cleaning solvents and processes.

“This bill empowers consumers and allows them to make more informed decisions, which in the end is good for all of us,” Hahn said in a statement. “While it is common for consumers to read food ingredient lists and nutrition labels and to search out reviews for other products, most are hard-pressed to find the time to research details related to a myriad of dry cleaning solvents, figure out the exact solvent used by their cleaner and then investigate its potential impact on his or her self, family and environment.”

Suffolk County Executive Steve Bellone (D) still has to sign the approved bill into law.

Hahn’s bill was related to a previous one she put before the Legislature, which was also approved in mid-April, to stop garment-cleaning businesses from using the term “organic” to describe their services, because there are no set criteria for its usage in consumer goods and services and could be misleading. The legislator has given the example of dry cleaning chemicals that are harmful to the environment but might be referred to as organic because they contain naturally occurring elements such as carbon.

“Organic in this context is a technical term, and does not mean chemical-free,” Beth Fiteni, owner of Green Inside and Out Consulting, an advocacy organization committed to empowering the public to find healthier alternatives to common toxins, said in a statement at the time the bill passed the Legislature. “This legislation in Suffolk County helps address possible confusion.”

That law prohibited dry cleaners from using the term to advertise their services, with fines between $500 and $1,000 for violating the rule.

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Vapors is located on Main Street in Port Jefferson. Photo by Elana Glowatz

Local governments are cracking down on smoking in all its forms by confining related businesses to certain locations.

Brookhaven Town recently restricted smoke shops and lounges and one village is looking to strengthen rules already in place for the establishments.

The action started in the fall, when the Port Jefferson Village Board of Trustees passed a law that effectively banned hookah shops, as well as tattoo parlors and adult entertainment. Residents and village officials had been vocal about what they perceived to be too many shops on Main Street selling hookahs — water pipes used for smoking flavored tobacco — and their related products. Many had complained that the businesses attract an undesirable type of person to the area and sell unhealthy items. Some also said they feared the shops would sell paraphernalia and dangerous substances to underage patrons.

The dissent propelled a law that now restricts future hookah shops, tattoo parlors and adult establishments like topless bars to the Light Industrial I-2 District zone. While the preexisting shops are not affected, the law effectively bans future shops because only two properties in the entire village are zoned light industrial — and both of those Columbia Street plots are already occupied.

Hookah City is located on Main Street in Port Jefferson. Photo by Elana Glowatz
Hookah City is located on Main Street in Port Jefferson. Photo by Elana Glowatz

Passing an outright ban would have been an illegal action.

Port Jefferson Village is now seeking to tighten its restrictions by folding into the law marijuana dispensaries and stores selling products linked to e-cigarettes and vaporizers. The village code proposal, which will come up for a public hearing on June 6, states that such establishments bring “well-documented negative secondary effects … such as increased crime, decreased property values and reduced shopping and commercial activities.” It also cites the health risks of e-cigarettes and the dangers of exposing children to the behavior.

“The expansion of the foregoing businesses has resulted in increased anti-social behavior involving minors,” it says.

Among the restrictions, the shops in the light industrial zone could not be within a certain distance of facilities such as community centers, churches or schools.

The Town of Brookhaven got on the same train recently when its town board passed a law on May 12 that restricts indoor smoking establishments — businesses in which tobacco in any form, including through e-cigarettes and vaporizers, or other substances are smoked indoors. New shops can now no longer open within certain distances of residential areas, schools, churches, parks or other family- or child-oriented places. They also cannot open within 1 mile of one another.

Councilwoman Jane Bonner (C-Rocky Point), who came up with the idea, touted it as a measure to prevent kids from using drugs.

“You cannot believe how creative addicts and users are when it comes to situations like this,” she said, “what they can do and how they can manipulate this apparatus.”

Some have used hookahs, vaporizers and other tobacco devices to smoke marijuana, among other substances.

“This legislation came to pass because of what we see, what’s happening in our communities all over the place,” Bonner said. “This is a very important first step and we may take further steps as we see how this works out.”

Both the town and village laws have had their critics. In Port Jefferson, Trustee Bruce D’Abramo and other residents did not want the village interfering with the free market, which would determine how many smoke shops one neighborhood could sustain, and did not want the village policing people’s heath. They compared the smoke shops to the numerous bars in downtown Port Jefferson.

And Alex Patel, who works at Rocky Point Smoke & Vape Shop, said the town law might have little payoff because parents buy devices for their kids or the kids shop online — those under 21 may still get what they are looking for.

“Online, I see people buying left and right,” Patel said about vaporizers and similar devices. “It’s much cheaper online because they’re buying in bulk.”

But the town law also had community support: “When I think of these [smoking] lounges I think of heroin dens, something I read about and saw movies about when I was a child and scared the heck out of me,” Jeff Kagan, of the Affiliated Brookhaven Civic Organization, said May 12. “I believe that we don’t really know what these dens are all about or what’s really going to go on in these facilities. We don’t know the long-term impact.”

Alex Petroski contributed reporting.

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By L. Reuven Pasternak, M.D.

At Stony Brook University Hospital, we’ve created a culture of excellence based on health care tailored to meet each individual’s needs and preferences. We want to ensure that our neighbors, friends and families on Long Island who come to us feel comforted, respected and confident about the care they receive from Stony Brook.

Our dedication to providing quality care has earned recognition from numerous organizations in the medical community. Many departments have been recognized by their specialty associations for meeting standards that directly benefit patients:

•Our Endoscopy Unit was recognized for endoscopic quality and safety by the American Society for Gastrointestinal Endoscopy.

•Our Stroke Program was awarded the highest recognition possible for quality care by the American Heart Association/American Stroke Association’s Get With the Guidelines program.

•Our Trauma Center has been ranked in the top decile in the nation for specific outcome measures.

•Stony Brook’s Cardiac Catheterization Laboratory was awarded a bronze-level Beacon Award for Excellence and our Cardiothoracic Intensive Care Unit earned a silver-level Beacon Award for Excellence, both from the American Association of Critical Care Nurses.

•Our Pediatric Nephrology Program has achieved a ranking within the Top 50 Best Children’s Hospitals from U.S. News and World Report.

Our dedication to providing quality care has earned recognition from numerous organizations in the medical community.

•The prestigious Press Ganey Guardian of Excellence Award was presented to our Ambulatory Surgery Center in recognition of its high level of patient satisfaction.

•We have been named a top performer in a New York State Department of Health project to improve nutrition for preterm babies in the Neonatal Intensive Care Unit (NICU).

•The New York State Perinatal Quality Collaborative has recognized our performance in reducing elective early-term deliveries by 75 percent, to lower the risk of serious health problems and death for newborns.

And the New York State Department of Health has given us leadership positions in important health care initiatives:

•We received a planning grant to serve as the leader in building a regionalized health care system throughout Suffolk County through the Delivery System Reform Incentive Payment (DSRIP) program.

•Stony Brook is spearheading a SBIRT (Screening, Brief Intervention and Referral to Treatment) program, which will screen and provide early intervention and treatment for people with substance use disorders.

Quality of care and patient safety are and always will be our top priorities. We’re proud of the recognition Stony Brook University Hospital has won, but the real winners, of course, are our patients and the community.

L. Reuven Pasternak, M.D. is the CEO of  Stony Brook University Hospital and the vice president for Health Systems at Stony Brook Medicine.

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Mather Hospital changed its visitation policies Nov. 23. File photo by Alex Petroski

In the National Football League, it is widely believed that team success can be traced back to a long, stable relationship between head coach and quarterback. The longer those two have been working together and in perfect harmony, the likelihood for success usually goes up.

The board of directors at John T. Mather Memorial Hospital have followed a similar blueprint, and they couldn’t be happier with the results. Mather’s board chairman is Kenneth Jacoppi,  and he has held that position for about 10 years, though he began serving on the board in May 1977. Konrad Kuhn joined the board a year later. One year after that, Harold Tranchon joined. All three remain on the board of directors to this day.

“Honestly, when you have board members who have been there for a long length of time they have institutional memory and a long understanding of [the] changing field of medical care,” hospital President Kenneth Roberts said in a phone interview.

He has a long tenure as well: This June marks the 30th anniversary of when Roberts took over that post. Prior to becoming president he served four years as the vice president.

Jacoppi, 78, who was the president of his senior class at Port Jefferson High School and later went on to become a lawyer, reflected on his near 40 years at Mather and his lifetime in the community in a phone interview.

“Never in my wildest dreams did I think I would serve this long,” he said.

Jacoppi referred to others on the board as his “Mather family,” and said that his fondness and pride for his community have contributed to keeping him in the position for so long.

During the decades under the current leadership team, Mather has earned a Magnet designation for nursing excellence, achieved the highest patient experience scores in Suffolk County, been recognized as the only hospital in New York State to earn nine consecutive A ratings for patient safety and quality from the Leapfrog Group and established a new graduate medical education program, among many other accomplishments.

“You have a stability you don’t have in most organizations,” Jacoppi said. “We obviously want to provide the best possible care to people in the area.”

‘Never in my wildest dreams did I think I would serve this long.’
—Kenneth Jacoppi

Jacoppi added one of the things he’s picked up in his experience over the years is to be “a bit more laid back and patient.” He referred to himself when he started as a “hard-charging young lawyer” who had to learn to listen to other viewpoints and think about the effect decisions would have on doctors and the community.

Clearly Jacoppi and the rest of the board have figured out a way to stay on top of their game in what he and Roberts both referred to as an extremely challenging time for health care.

“In the old days, the volunteers held grand card parties under the huge old tree on the Mather lawn that helped raise money to provide exceptional health care for the community,” Jacoppi said in a statement from the hospital.

Times may have changed, but the Mather board of directors has not.

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