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A view of the front entrance to Huntington Hospital on Park Avenue in Huntington. File photo

Hospitals across the North Shore and the country have been adapting to an entirely new set of medical codes over the last two months, completely changing the system in which a patient’s diagnosis is detailed.

As of October, all hospitals across the United States switched to the ICD-10 system, which allows for more than 14,000 different codes and permits the tracking of many new diagnoses. ICD-10, an international medical classification system by the World Health Organization, requires more specificity than the previous code system. Doctors at North Shore facilities said they agreed that although it’s time-consuming and has slowed productivity, it is more beneficial to patients in the end.

Dr. Michael Grosso, chairman of medicine at Huntington Hospital said these new codes should help make it easier for symptoms of various diseases to be tracked.

According to Gross, preparation for the new code started two years ago with a required education program for all physicians that described what all the new codes meant.

“Physicians are being called upon to provide more specificity and detail,” Grosso said in a phone interview. He described the codes as a “vast extension” to what the hospital was previously using and said it should “improve the quality of medical records and increase the amount of information that researchers can obtain and make for the best care for patients.”

Grosso also said that understanding and learning the codes was an important first step, but ongoing feedback on how the codes are being adopted is equally important. A feedback program has been created at each hospital.

John T. Mather Memorial Hospital in Port Jefferson. File photo
John T. Mather Memorial Hospital in Port Jefferson. File photo

John Ruth, director of revenue integrity and interim chief compliance officer at Stony Brook University Hospital, said Stony Brook used outside resource companies with online courses to teach the new code to their physicians and coding staff.

Ruth said that a new code system was necessary, as the previous system, ICD-9, was created by WHO in the 1970s. He called ICD-10 a natural progression.

“There are a lot more codes for specific organ systems, muscles, muscle tendons and nerves than were required with ICD-9,” he said in a phone interview.

Ruth also said that ICD-9 was mostly comprised of three- and four-digit codes, and ICD-10 is up to seven digits in length, which makes the new coding more challenging but more valuable.

“If a patient has PTSD, we can assign a code from where he got it from, not just that he has it, which is important for planning his future and ongoing care,” Ruth said.

Stacie Colonna, associate director of inpatient coding at Stony Brook University Hospital, said there has been approximately a 30 percent decrease in staff productivity with the changeover to ICD-10 and a shortage of trained staff.

“I get 10 questions a day just from internal staff,” Colonna said. But she also noted that staff frequently asked daily questions about the old system as well. She said she expects productivity to improve in the near future.

At John T. Mather Memorial Hospital in Port Jefferson, Chief Medical Information Officer Dr. Joseph Ng said the staff went through web training, too. One-on-one training was also available if a clinician requested it.

Ng agreed specificity is both the pro and con of ICD-10. “Because it’s so specific, it really allows clinicians to hone in on what’s really going on with patients and be able to communicate better with one another,” Ng said in an email. “But because it’s so specific, sometimes it’s hard to find the right code, especially when it comes to procedures. The codes are not all inclusive.”

Looking forward, Grosso said the new system had a lot to offer for hospitals across the country because of the amount of information people could potentially learn from it.

“A number of private and government parties will benefit from the ability to look at more detailed hospital data,” Grosso said.

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People at an anti-drug forum stay afterward to learn how to use the anti-overdose medication Narcan. Above, someone practices spraying into a dummy’s nostrils. Photo by Elana Glowatz

The Suffolk County Police Department handed out dozens of overdose rescue kits in the Port Jefferson high school on Monday night, at the conclusion of a crowded drug abuse prevention forum geared toward educating parents.

“We have to double-down on prevention,” said Tim Sini, a deputy county commissioner for public safety who has recently been nominated for police commissioner.

People at an anti-drug forum stay afterward to learn how to use the anti-overdose medication Narcan. Above, Jim Laffey assembles a syringe. Photo by Elana Glowatz
People at an anti-drug forum stay afterward to learn how to use the anti-overdose medication Narcan. Above, Jim Laffey assembles a syringe. Photo by Elana Glowatz

He and other officials from the police department, medical examiner’s office and community spoke at the forum to inform parents about the dangers of drug abuse, including how kids get introduced to and hooked on drugs in the first place. Much of the discussion focused on opioid drugs, which include heroin as well as prescription painkillers like Vicodin and Percocet, and on the lifesaving Narcan, an anti-overdose medication that blocks opioid receptors in the brain and can stop an overdose of those types of drugs.

According to Dr. Scott Coyne, the SCPD’s chief surgeon and medical director, in the three years since Suffolk officers have been trained to administer Narcan — the well-known brand name for naloxone — they have used it successfully 435 times.

Attendees who stayed after the forum were able to register in the police department’s public Narcan program and receive a kit with two doses of the medication, which can be sprayed into an overdose victim’s nostrils.

Narcan training classes are coming up
Want to learn how to use Narcan, the medication that stops an opioid overdose in its tracks? Training courses are taking place across Suffolk County over the next couple of months, including in Port Jefferson and in neighboring Centereach.

Narcan, the brand name of naloxone, blocks receptors in the brain to stop overdoses of drugs like heroin, Vicodin, Percocet, OxyContin or Demerol, among others. It can be administered through a nasal spray and will not cause harm if mistakenly given to someone who is not suffering an opioid overdose.

The local training sessions meet state health requirements, according to the Suffolk County Department of Health Services, and will teach trainees to recognize opioid overdoses, to administer Narcan and to take other steps until emergency medical personnel arrive on the scene. All participants will receive a certificate of completion and an emergency kit that includes Narcan.

The first course will be held on Monday, Dec. 14, from 6 to 7:30 p.m. at the county’s Office of Health Education in Hauppauge, at 725 Veterans Highway, Building C928. RSVP to 631-853-4017 or [email protected].

In Centereach, a course will take place on Friday, Jan. 15, from 6:30 to 7:30 p.m. in the Middle Country library at 101 Eastwood Blvd. RSVP before Jan. 11 at [email protected] or at 631-585-9393 ext. 213.

Later that month, Hope House Ministries will host another Narcan training session in its facility at 1 High St. in Port Jefferson, in the Sister Aimee Room. That event, held in conjunction with the Port Jefferson ambulance company, will take place on Thursday, Jan. 28, at 10 a.m. Call 631-928-2377 for more information or register at https://pjvac.enrollware.com/enroll?id=952865.

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By Dr. Matthew Kearns

Nothing makes a better gift for the family than a little bundle of barking fur. The expectation is that this is not only the perfect surprise, but also a relationship and responsibility builder for your children. How do we choose a puppy that is friendly and safe?

As with human development, a puppy’s temperament (personality) is determined by both genetics and environment. Purebred dogs will generally have different temperaments: retrieving, herding, hunting/guarding, etc, and come in different sizes. The type of dog chosen should match with your family’s activity levels, number and age of children, etc.

If you have younger children it is good to choose a breed that is big enough to not be injured by your child, but not too big as to knock your child into next Tuesday as the puppy develops into an adult dog. Also take into account that certain breeds may be very good with you and your children but may see your children’s friends as unwanted intruders. This not only becomes dangerous to guests, but also a potential financial liability for you.

Good breeders will match their dogs to appropriate families but poor breeding (puppy mills) can be dangerous. When purchasing a puppy from a breeder, the puppy is usually somewhere between 8-10 weeks old. This is a key time for the puppy to bond with your family (including younger family members) and quickly consider everyone part of their new “pack.”

Adopting from a shelter or rescue group is a noble but uncertain endeavor. The actual genetics is somewhat of a guessing game, and many of these puppies have traveled great distances with other dogs under stressful circumstances. When first introduced these puppies may appear calm (even timid) but it can take many days to weeks for their true personality to emerge. That does not mean that every dog from a shelter has a “Jekyll and Hyde” personality. However, make sure that the shelter or rescue has a clear (and timely) return policy if things aren’t working out.

Your own family dynamic plays a role. Children younger than school age can pose a problem. Toddlers are curious, but also are grabby and impulsive. What seems harmless (pulling at hair, stealing toys/food) could become a potentially dangerous point of conflict. This is very true as the puppy matures into a young adult dog.

What was once tolerable a few months ago as a puppy is now taken as an act of aggression or challenge. Therefore, many experts that recommend only adopting adult dogs with a proven temperament from a shelter if you have children or children under school age (6-7 years). An added benefit of an adult dog is that many times they are already housebroken (especially if spayed or neutered) and far less destructive than a puppy.

I hope this information is helpful in choosing the right dog for your home this holiday season. I want to wish all of the readers of this column both a safe and joyous holiday season and happy 2016. I also want to thank both Heidi Sutton, editor of the Arts and Lifestyles section, as well as all the staff of the Times Beacon Record and affiliates for another great year.

Dr. Kearns has been in practice for 16 years.

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Business employs other local disabled individuals

Pictured, Brittney (left) and Logan (right) Wohl, co-owners of Our Coffee with a Cause, with their mother Stacey Wohl (center), company founder/president. Photo from PRMG New York

The sister-and-brother team, Brittney, age 18, and Logan Wohl, age 16, of Northport, are the newly appointed co-owners of Our Coffee with a Cause Inc., a business that employs individuals with cognitive and developmental disabilities and funds local charities that support them. These siblings with autism have dedicated their time to helping other special-needs teens and adults by providing gainful employment opportunities in a supportive business setting.

Our Coffee with a Cause was founded in 2012 by Stacey Wohl, mother of Brittney and Logan, in response to the growing concern for special-needs individuals on Long Island who are aging out of schools to find job opportunities and a learning environment to acquire real-life skills. The employees package coffee, apply labels to the bags and coordinate shipments. Additional opportunities are available during Our Coffee with a Cause’s sales and informational events, during which employees work with an assistant to sell coffee and products using a custom-designed iPad app and interacting with customers.

A portion of the business proceeds benefit Our Own Place, a non-profit organization that Stacey Wohl founded to provide unique opportunities to special-needs children and their single parents. The organization’s ultimate mission is to open a weekend respite home for families of children with cognitive disabilities that will provide job training and socialization skills to its residents and will feature a café at which Our Coffee products will be brewed and sold.

Stacey Wohl and her mother and business partner, Susan Schultz, bring to the company a combined 50 years of business experience, along with the knowledge of addressing the unique needs of teens and adults with disabilities.

“Our Coffee with a Cause is dedicated to employing special-needs adults and showing that there is ability in disability,” says Stacey Wohl. “I am proud to name Brittney and Logan as the owners of this business, which provides careers to people with disabilities who may not otherwise have the opportunity.”

Although 53 million adults in the United States are living with a disability, as many as 70 percent of this working-age population are currently unemployed. For many, the current systems in place to support both young adults and their families disappear once the teen “ages out” of the education system, typically when they turn 21. In 2016, nearly 500,000 autistic persons will enter this category, in addition to adults with Down Syndrome and other cognitive conditions.

For more information, visit www.ourcoffeewithacause.net.

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By Melissa Arnold

Imagine this: You’re out with friends at a barbecue and wake up the next day with an unusual rash. On top of that, you’re just not feeling well.

Most people would head to a nearby urgent care center, emergency department or doctor’s office to get checked out. In all of these situations, though, you’re probably in for a wait of several hours. And in the case of a doctor’s office, you might have to wait a few days or even longer to be seen.

But what if you could take a picture of that rash with your cellphone and text it to a doctor, who responds right away with advice before calling in a prescription? Even better, what if you could do that at any time, seven days a week?

Such direct access to a doctor isn’t just a fantasy anymore. It’s a type of care called concierge medicine, and it’s spreading rapidly across the country.

Concierge practices come in several different forms, but in all cases, patients pay an annual or semi-annual fee to their physician, even if they don’t visit the office. In exchange, patients are guaranteed shorter wait times, longer, unrushed appointments and 24/7 access if a problem arises.

The fee varies widely depending on the location of the practice and the services they offer. Some physicians will also charge based on a patient’s age or medical status.

Dr. Bruce Feldman works independently, traveling throughout Long Island and occasionally elsewhere to meet his patients at their workplace, home or another location.

“My preferred population is an executive or professional who is too busy to go to the doctor. I go directly to them,” said Feldman, who also has offices in Melville and Port Washington. “If a guy is making a fair living, the idea of driving to the doctor and having to spend time waiting usually doesn’t sit well. And yet they want to be successful at their jobs and function at an optimal level.”

Feldman does have patients come in for an initial physical, but as he gets to know them, care becomes less about face-to-face contact and more about communicating by phone or email as needed.

The biggest difference between concierge and traditional medical care, Feldman said, is the focus on preventing future health issues instead of attempting to resolve existing problems.

Both Feldman and Dr. Vasilios Kalonaros of Northport agreed that preventative care is lacking in traditional medicine, and patients are suffering for it.

“When you’re only given 15 minutes with a patient, it’s like putting your finger in a dam — you can’t always take the time to treat every issue,” Kalonaros says.

Small practices are a hallmark in concierge medicine. Most doctors limit themselves to a few hundred patients, allowing for longer visits.

Before Kalonaros made the switch to concierge medicine eight years ago, he was seeing up to 40 patients a day. Now, it varies between eight and 12. Feldman sees about four patients each day, with only 60 patients total.

And statistics show that a doctor with time to spare makes a difference for patients. According to MDVIP, a private network of physicians that includes Kalonaros, concierge patients are hospitalized 72 percent less than those seeing a traditional doctor. In addition, the American Journal of Managed Care reports that concierge medicine ultimately saves the health care system more than $300 million in Medicare expenses.

Its popularity appears to be growing, too. There are now hundreds of concierge doctors throughout the country, and more than 20 on Long Island alone.

Before choosing a concierge doctor, it’s best to determine exactly what you want. Are you looking for a doctor who takes your insurance, does house calls or has inexpensive fees? Answering these questions will help narrow the field.

Then, ask for a consultation. Use that time to get to know them, learn about their services and determine if he or she is a good fit for your needs.

Fees vary widely in the concierge world, from under $2,000 annually to more than $20,000.

Concierge medicine is familiar to some, thanks to the USA Network’s medical drama series “Royal Pains.” The show follows a cardiac surgeon who becomes a private physician for the wealthiest residents of the Hamptons.

While some of the show’s themes are accurate, its sole focus on upper-class patients is just a stereotype.

“Most of my patients are not wealthy — they are middle and lower-middle class,” Kalonaros said. He added that a concierge doctor can be a great option for those with minimal or no insurance, because his $1,650 fee guarantees access to him at any time.

And Feldman argues that when you don’t get sick in the first place, this model will save you money that would be otherwise spent on medication or more extensive treatment.

But both doctors are quick to admit it’s not the best option for everyone.

“If you have a good relationship with your existing doctor, you don’t need a concierge doctor. But if you’re frustrated or not getting the care you need and are willing to pay more, a concierge doctor might be for you,” Feldman says. “It’s about having a partner in your wellness.”

For those interested, contact Dr. Bruce Feldman at (646) 801-7541, www.mypersonaldocny.com, and contact Dr. Vasilios Kalonaros at (631) 239-1677. Or visit www.mdvip.com to learn more about concierge medicine on Long Island.

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A PRAAT dog serves as a reading assistant at a local library. Photo from Dr. David Roy Hensen and Dr. Pamela Linden

By Lisa Steuer

It is quite obvious that people love their pets. In fact, 62 percent of U.S. households contain a pet, and about $45 billion is spent on pets annually, according to Pamela Linden LMSW, Ph.D., a clinical associate professor in the Occupational Therapy program at Stony Brook University.

But what many people may not realize is that these animals could be positively impacting the pet owner’s health, and that emerging research shows that therapy and comfort animals could have a place in therapeutic and trauma settings. Currently, a lot of the research on the health benefits of pet ownership has to do with the bond between the animal and its owner, Linden said.

“There’s a book by Meg Daley Olmert called ‘Made for Each Other’ and the whole book is about oxytocin — and that’s why we bond with others, including other mammals, like dogs,” said Linden. “A lot of it has to do with the gazing and the staring, so studies have been done, especially one interesting study that measured oxytocin levels in both the human and the dog after gazing— oxytocin levels raised for both of them,” resulting in good feelings not only for human, but for the dog, too.

Pella, of PRAAT, visits the children cancer ward at Stony Brook Hospital. Photo from Dr. David Roy Hensen and Dr. Pamela Linden
Pella, of PRAAT, visits the children cancer ward at Stony Brook Hospital. Photo from Dr. David Roy Hensen and Dr. Pamela Linden

Linden’s hope is that more people will be motivated to understand the role of pets in our lives. She developed the first social work internship with Patchogue Rotary Animal Assisted Therapy, a not-for-profit organization in Patchogue that screens, trains and supports human-dog teams that visit individuals in schools, hospitals and hospice facilities. Linden hopes to work with PRAAT to research the effect that comfort animals have on people who are already sick.

In addition, Linden is the faculty advisor for Stony Brook University’s first Animal Assisted Activity student club anticipated to begin in spring 2016. So far, more than 150 students have signed up for the club, which has goals to help provide education about animal -assisted therapy while partnering students with organizations like PRAAT and local shelters to help prepare dogs to become adoption-ready.

Linden pointed out that people often get confused between service animals, therapy dogs and comfort animals. Service dogs are protected by law, are allowed anywhere animals typically aren’t allowed and have been trained to perform special functions, like open doors, push buttons and retrieve objects for people with visual impairments, for instance. A comfort dog has been trained to visit hospitals, nursing homes and similar places to provide comfort to patients, and a therapy dog is an animal used by a licensed health professional to achieve a therapeutic outcome.

“I’ll give you an example [of a therapy dog],” said Linden. “As a social worker, I’m working with someone who is grieving. And they’re either too numb or too emotional to process the grief. I might bring in a dog with a therapeutic goal of bridging between the client and the therapist by doing those behaviors that we do— you can snuggle up to a dog, pet it, stare into the eyes and have your oxytocin kick in and relax.”

Physical, Psychological and Emotional Benefits

Although the research is limited, studies have demonstrated the healthy benefits of pet ownership and companionship. Linden shared the physical, psychological, and emotional benefits:

Hans, of PRAAT, provides comfort to students during college exams. Photo from Dr. David Roy Hensen and Dr. Pamela Linden
Hans, of PRAAT, provides comfort to students during college exams. Photo from Dr. David Roy Hensen and Dr. Pamela Linden

• Physical: Pet owners have fewer minor health complaints and have greater levels of exercises and physical fitness. Studies have found that pet owners had reductions in some common risk factors for cardiovascular disease, such as lower systolic blood pressures, plasma cholesterol and triglyceride values.

“People experience a decrease of blood pressure talking to pets. Blood pressure decreases for people with normal pressures and those with hypertension when watching fish in a standard aquarium,” said Linden.

• Psychological: Studies have found that pet owners enjoy better well-being than non-owners, and that pet owners have greater self-esteem and tend to be less lonely.

“People find comfort in talking to their animals. People walking with their dog experience more social contact and longer conversations than when walking alone — pets stimulate conversations between people,” Linden said. “Companion animals can help people to laugh and maintain a sense of humor.”

She added that Children with ADHD and defiant disorders exhibit significantly less antisocial and violent behavior than a matched group that did not involve animals.

• Emotional: Companion animals have been shown to alleviate anxiety. Stony Brook brings dogs in during exam time to help relax the undergraduate students.

“Any discussion regarding pets should include the notion of responsible pet ownership — ensuring that their physical, medical and emotional needs are met. This requires adequate financial resources and time to devote to caring for the pet,” added Linden.

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By Matthew Kearns, DVM

Flea allergic dermatitis was something that I used to only warn pet owners about in the summertime. However, with warm spells in the fall and winter, as well as the flea’s ability to set up shop in our homes, we really have a year-round problem.

Before we can address the problems fleas cause and how to treat/prevent them, we must understand the life cycle of the flea. The flea has four stages in its lifecycle: egg, larva, pupa, and adult.

An adult female flea can lay up to 2,000 eggs in a lifetime and eggs will usually hatch in one to six days. Once the eggs hatch, a slender, white, segmented flea larva forms; it looks similar to a maggot but, luckily, is too small to see with the naked eye. These larvae are not blood suckers, but rather feed on organic debris in the environment. The organic debris can be outside — leaves, dirt, etc. — or inside — carpet fibers and fibers from furniture or bedding.

After five to 11 days, the larvae will spin a whitish, loosely spun, silk-like cocoon, where they develop into pupae. The pupal stage, because of the outer cocoon, are very resistant to the environment and insecticides. The pupa is usually fully developed at seven to 14 days. However, the pupa can develop into an adult flea as quickly as a few days, or slowly, for many weeks, up to 180 days, depending on environmental conditions.

Once the adult flea emerges from the cocoon, it immediately starts looking for a host — our dogs and cats — for a blood meal. Fleas find hosts via various stimuli: body heat, movement, and exhaled carbon dioxide. Once a host is found, the flea feeds through a long, slender mouthpart called a proboscis. Before feeding, the flea pumps anticoagulant-containing saliva into the wound to prevent the blood from clotting. It is suspected that the anti-coagulant proteins in the saliva may be responsible for what is called Flea Allergic Dermatitis.

Luckily, fleas do not carry many parasites or organisms that cause significant disease in our pets. The most common parasite associated with fleas, in my experience, is tapeworm. This parasite is significant in younger pets but I will usually take tapeworms, seen on the fur, or in the stool, as a clue that there is an undiagnosed flea infestation in adult dogs and cats. More commonly, fleas lead to FAD.

Now, I understand that any dog or cat that has a flea infestation is going to be itchy. However, dogs or cats with FAD will break out with a rash that is much more severe from very few, or even a single, flea bites. More specifically, cut your pet in half — just kidding!

Actually, make an imaginary line dividing your pet into two halves: toward the head, and toward the tail. If the rash is primarily in the half of your pet towards his or her head, it is probably not FAD. If it is toward the tail, which would include the ventral (lower) abdomen, inguinal (groin), base of tail, and back legs, then one should put FAD at the top of the list.

Previously, we had to not only treat our pets with foul smelling, and even dangerous, shampoos, powders and dips, but also many times expose ourselves to noxious chemicals to treat the environment, like “flea bombs.” More recently, we found that although fleas need a host and will bite humans, they cannot live on us. More specifically, by treating our pets, we can treat the entire environment.

Nowadays, there is a large selection of flea preventatives that are much safer and treat the pet specifically. Some of the older products, and still best advertised, are now available over-the-counter. This is a double edged sword — the products are much safer and readily available without a prescription, but these products are ones in which I personally see significant failure and suspect resistance.

If you are seeing a specific rash that resembles FAD, even if you are using flea preventatives, see your veterinarian to not only get relief for your pet, but also to discuss alternative flea preventatives.

Dr. Kearns has been in practice for 16 years.

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Port Jefferson residents say taxes should cover cost of medical care

The ambulance company serves Port Jefferson, Belle Terre and Mount Sinai. File photo

A presentation about the service of the Port Jefferson Volunteer Ambulance Company devolved into an argument about perceived unfair billing practices on Monday night, with residents, village officials and the ambulance company’s deputy chief going back and forth for an hour.

A few villagers are in a lather over the process for recouping expenses after an ambulance ride through a billing program that began a handful of years ago. Faced with rising costs in the ambulance district — which also serves Belle Terre and Mount Sinai — Port Jefferson Village officials authorized the emergency medical organization to bill insurance companies for service within their jurisdiction, with the funds offsetting local ambulance taxes.

The friction that heated up Monday night’s Port Jefferson Village Board of Trustees meeting built around cases when an insurance company denied a claim or the patient had a hefty deductible — thus obligating the ambulance service and its third-party billing company to send a tab to that patient, according to PJVAC Deputy Chief Rob Stoessel.

Two residents who received such bills, Monica Williams and Mary Moore, expressed their dissatisfaction over the matter, saying the taxes they pay each year to the ambulance district should be enough and also complaining about the price tag.

“I’m paying my ambulance district tax,” Williams said. “I don’t really think that any village resident … should be looking at a bill like that. It’s surprising. It’s disappointing.”

She called it “being billed for the same thing twice.”

Before insurance, Stoessel said, the fee on a call for emergency medical care is $900, with an additional $18 for each mile the ambulance transports a patient.

“We went based on other agencies, other 911 services throughout the region,” he said about how the ambulance company arrived at that figure. “We went on what it cost us to provide the service,” including non-medical expenses like gasoline.

The deputy chief said the ambulance service and its billing company is required to make a “good faith attempt” to solicit deductibles from patients or whatever costs are associated with a trip that an insurance company denies coverage for.

According to comments from the residents, Williams was denied Medicare coverage for her treatment and Moore has a high deductible.

Mayor Margot Garant insisted it was not the board’s intention, when it authorized the ambulance company to bill insurance, to pass large bills along to residents.

“We didn’t want the resident to be pursued for any of the fees,” she said. But “the insurance companies, God bless them — collect every nickel from them.”

Although the mayor and Stoessel rejected responsibility, debating whether the billing was a village program or an ambulance program, they agreed that the idea was for patients to receive three notices for bills and there would be no consequences for not paying, as the ambulance company does not have a mechanism for collections.

But there was debate from the public about whether that was common knowledge in the village, or whether not paying would affect someone’s credit rating.

According to Garant, village officials are working out a method of waiving costs that would otherwise be passed along to patients — to limit the ambulance company to recouping costs only from insurance companies. She said that measure could be ready for approval by the next board meeting in two weeks.

Port Jefferson is not the only area with the idea of using insurance companies to offset taxpayer dollars. The Commack Volunteer Ambulance Corps argued recently that billing private insurance companies for patient care would ultimately save taxpayer dollars for constituents. At an August work session in Smithtown, Tom Lowenberg of the Commack VAC said insurance reimbursements are a resource utilized typically at private ambulance companies, but not as much by volunteer groups.

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By Lisa Steuer

In the 1990s, low-fat food products lined the shelves. Consumers believed that choosing a product with a low-fat label was essential for optimal health and fat loss. But today, experts say that a low-fat diet can be detrimental — as food that has the fat removed can instead be high in sugar and calories to make up for the lack of fat.

“The whole low-fat phase was problematic because people substituted refined carbohydrates, and that is a huge problem,” said Dr. Josephine Connolly-Schoonen, Ph.D., RD, the executive director of Stony Brook Medicine Nutrition Division and author of “Losing Weight Permanently with the Bull’s Eye Food Guide: Your Best Mix of Carbs, Proteins, and Fats.”

So with so many diets out there today, which work best for weight loss and health? Here is Connolly-Schoonen’s input.

Going Gluten Free
Gluten is a name for proteins found in wheat, and some common foods that contain gluten include pasta, bread, flour tortillas, oats, dressings, cereals, sauces and more. Go to any grocery store these days and you will most likely find a “gluten-free” section. And while people with Celiac disease cannot eat gluten because they will get sick, many people who aren’t allergic to gluten are touting the weight loss and health benefits of going gluten free.

But if you don’t have a gluten allergy, is it necessary or nutritionally wise to go gluten free?

“I think that many people are gluten intolerant and can benefit from a gluten-free diet,” said Connolly-Schoonen. “But, [it should be] a high-quality gluten-free diet — foods that never had gluten. So your starches are going to be from potato and rice and quinoa, not from gluten-free bread and gluten-free pasta.”

So while foods that are naturally gluten free are generally healthy, those who are not gluten-intolerant should be wary of processed foods that have had the gluten removed, as there now exists a big market and opportunity for companies wanting to take advantage of the gluten-free trend — and products such as “gluten-free cookies” may not necessarily be nutritionally sound.

“In my practice, I’ve seen many people benefit from gluten-free styles of eating, but using whole foods, not processed gluten-free food … A slice of gluten-free bread is rather small and has the same or perhaps a little bit more calories than regular bread,” said Connolly-Schoonen. “Foods that are naturally gluten-free are quite healthy and I really do think people may benefit from a gluten-free style of eating, but it has to be natural.”

The Paleo Diet and Going Vegan
The idea behind the paleo diet is that we should eat as our ancestors or “cavemen” ate, including meat, fish, vegetables and fruit, and excluding processed food, grains and dairy. And while many people have reportedly lost weight on the diet, some argue that the paleo diet does not necessarily follow what our ancestors ate, and there is now a market for processed paleo bars and drinks.

But Connolly-Schoonen says the concept of consuming fewer processed foods is a good one to follow, especially when it comes to sugar-laden beverages.

“With the advent of the high fructose corn syrup, it became so cheap to make sweetened beverages … that have the equivalent of 17, 19, 20 packets of sugar in them, and we genetically cannot handle that.”

In addition, some people choose to go vegan or vegetarian for a variety of reasons — moral, health or a combination. Both vegans and vegetarians do not eat meat, fish or poultry, while vegans also do not use other animal products and byproducts, such as eggs, honey, cosmetics, and more.

“I don’t think you need to be a vegetarian to be at your optimal health, but there is a lot of research over an extended period of time showing that vegetarians, more than vegans, who eat a high-quality vegetarian diet — so no Snickers bars — do quite well in terms of decreasing the risk for chronic illnesses like diabetes and heart disease, and there really is a lot of research behind the vegetarian diet to support that,” said Connolly-Schoonen. “Vegan diets could be healthy, but it’s much more challenging to make sure that you get all of your micronutrients.”

Juicing Up
Juicing is still considered healthy in moderation and as a quick way to get antioxidants. But when you use a juicer, the juice is extracted from fruits and vegetables, leaving behind a pulp that is often thrown away. In addition, this strips the fruit of its fiber but leaves the sugar.

“Even if you’re juicing vegetables, you’re still getting the sugar … and making the sugar much more highly available,” said Connolly-Schoonen. “And most people are more satiated when they chew their food.”

In addition, many people subscribe to the idea of doing juicing “detoxes” or “cleanses” every so often — which have found to be not really necessary, as we already have a natural detoxification system that occurs in our livers. In addition, any sort of diet that deprives one of nutrients is never a great idea. Instead, work on supporting your body’s natural ability to detox.

“If you have an unhealthy gut environment, you’re taxing your liver’s detoxification system. So first you want to have a healthy gut environment, which means lots of fiber and a good source of probiotics,” said Connolly-Schoonen. “Then you need to support your liver’s detoxification system with a wide array of micronutrients, which is going to come from a wide array of whole foods like protein, fish, lean meats, beans and then your vegetables, fruits and nuts.”

The Bottom Line
Instead of following a super strict diet, you may want to simply remember Connolly-Schoonen’s “two key factors” for healthy nutrition: quality and quantity. In terms of quality, choose foods that are less processed — lean proteins like chicken and fish, a huge variety of vegetables, beans, nuts and olive oil for healthy fats.

Once one works on the quality of foods in his or her diet, “it’s been my experience that patients can then much more easily work on moderating the quantity,” she said. “Once you’re eating whole foods and you’re mixing your quality proteins and fats, it becomes much easier to manage your appetite.”

Does this mean you can never have dessert again? Not at all.

“I tell patients if you’re eating ice cream, it should be real ice cream made from whole milk fat and real sugar. You shouldn’t get artificially sweetened products,” she said. “When you want chocolate and you want ice cream, have the real stuff. And that you should be able to include in your diet, maybe not every day, maybe a few times a week — it all just depends on how active you are.”

Lisa Steuer is the managing editor of FitnessRx for Women and FitnessRx for Men magazines. For fitness tips, training videos and healthy recipes, visit www.fitnessrxformen.com and www.fitnessrxwomen.com.

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When we were younger, falls usually did not result in significant consequences. However, when we reach middle age and chronic diseases become more prevalent, falls become more substantial. And, unfortunately, falls are a serious concern for older patients, where consequences can be devastating. They can include brain injuries, hip fractures, a decrease in functional ability and a decline in physical and social activities.(1) Ultimately, falls can lead to loss of independence.(2)

Of those over the age of 65, between 30 and 40 percent will fall annually.(3) Most of the injuries that involve emergency room visits are due to falls in this older demographic.(4)

What can increase the risk of falls?

A multitude of factors contribute to fall risk. A personal history of falling in the recent past is the most prevalent. But there are many other significant factors, such as age; being female; and using drugs, like antihypertensive medications used to treat high blood pressure and psychotropic medications used to treat anxiety, depression and insomnia. Chronic diseases, including arthritis, as an umbrella term; a history of stroke; cognitive impairment and Parkinson’s disease can also contribute. Circumstances that predispose us to falls also involve weakness in upper and lower body strength, decreased vision, hearing disorders and psychological issues, such as anxiety and depression.(5)

How do we prevent falls?

Fortunately, there are ways to modify many risk factors and ultimately reduce the risk of falls. Of the utmost importance is exercise. But what do we mean by “exercise?” Exercises involving balance, strength, movement, flexibility and endurance, whether home-based or in groups, all play significant roles in fall prevention.(6) We will go into more detail below.

Many of us in the northeast suffer from low vitamin D, which strengthens muscle and bone. This is an easy fix with supplementation. Footwear also needs to be addressed. Non-slip shoes, if last winter is any indication, are of the utmost concern. Inexpensive changes in the home can also make a big difference.

Medications that exacerbate fall risk

There are a number of medications that may heighten fall risk. As I mentioned, psychotropic drugs top the list. Ironically, they also top the list of the best-selling drugs. But what other drugs might have an impact?

High blood pressure medications have recently been investigated. A recent propensity-matched sample study (a notch below an randomized control trial in terms of quality) showed an increase in fall risk in those who were taking high blood pressure medication.(7) Surprisingly, those who were on moderate doses of blood pressure medication had the greatest risk of serious injuries from falls, a 40 percent increase. One would have expected those on the highest levels of BP medication to have the greatest increase in risk, but this was not the case.

While blood pressure medications may contribute to fall risk, they have significant benefits in reducing the risks of cardiovascular disease and events. Thus, we need to weigh the risk-benefit ratio, specifically in older patients, before considering stopping a medication. When it comes to treating high blood pressure, lifestyle modifications may also play a significant role in treating this disease.(8)

Where does arthritis fit into this paradigm?

In those with arthritis, compared to those without, there is an approximately two-times increased risk of two or more falls and, additionally, a two-times increased risk of injury resulting from falls, according to the Center for Disease Control and Prevention.(1) This survey encompassed a significantly large demographic; arthritis was an umbrella term including those with osteoarthritis, rheumatoid arthritis, gout, lupus and fibromyalgia. Therefore, the amount of participants with arthritis was 40 percent. Of these, about 13 percent had one fall and, interestingly, 13 percent experienced two or more falls in the previous year. Unfortunately, almost 10 percent of the participants sustained an injury from a fall. Patients 45 and older were as likely to fall as those 65 and older.

Why is exercise critical?

All exercise has value. A meta-analysis of a group of 17 trials showed that exercise significantly reduced the risk of a fall (9). If their categories are broken down, exercise had a 37 percent reduction in falls that resulted in injury and a 30 percent reduction in those falls requiring medical attention. But even more impressive was a 61 percent reduction in fracture risk. Remember, the lower the fracture risk, the more likely you are to remain physically independent. Thus, the author summarized that exercise not only helps to prevent falls, but also fall injuries. The weakness of this study was that there was no consistency in design of the trials included in the meta-analysis. Nonetheless, the results were impressive.

What specific types of exercise are useful?

Many times, exercise is presented as a word that defines itself. In other words: just do any exercise and you will get results. But some exercises may be more valuable or have more research behind them. Tai chi, yoga and aquatic exercise have been shown to have benefits in preventing falls and injuries from falls.

A randomized controlled trial, the gold standard of studies, showed that those who did an aquatic exercise program had a significant improvement in the risk of falls (10). The aim of the aquatic exercise was to improve balance, strength and mobility. Results showed a reduction in the number of falls from a mean of 2.00 to a fraction of this level — a mean of 0.29. There was no change in the control group.

There was also a 44 percent decline in the number of patients who fell. This study’s duration was six months and involved 108 post-menopausal women with an average age of 58. This is a group that is more susceptible to bone and muscle weakness. Both groups were given equal amounts of vitamin D and calcium supplements. The good news is that many patients really like aquatic exercise.

Thus, our best line of defense against fall risk is prevention. Does this mean stopping medications? Not necessarily. But for those 65 and older, or for those who have “arthritis” and are at least 45 years old, it may mean reviewing your medication list with your doctor. Before considering changing your BP medications, review the risk-to-benefit ratio with your physician. The most productive way to prevent falls is through lifestyle modifications.

(1) MMWR. 2014; 63(17):379-83. (2) J Gerontol A Biol Sci Med Sci. 1998;53(2):M112. (3) J Gerontol. 1991;46(5):M16. (4) MMWR Morb Mortal Wkly Rep. 2003;52(42):1019. (5) JAMA. 1995;273(17):1348. (6) Cochrane Database Syst Rev. 2012;9:CD007146. (7) JAMA Intern Med. 2014 Apr;174(4):588-95. (8) JAMA Intern Med. 2014;174(4):577-87. (9) BMJ. 2013;347:f6234. (10) Menopause. 2013;20(10):1012-1019.

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

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