Health

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Katherine Lewin with her newborn son Jonathan at St. Catherine Hospital's new maternity wing. Photo by Kyle Barr

St. Charles Hospital’s nearly $4 million new maternity wing has one thing at the top of the mind, privacy.

St. Catherines officials cut the ribbon on the new maternity wing. Photo by Kyle Barr

At a ribbon cutting for the new renovated 16-room maternal/child pavilion Dec. 19, hospital officials boasted rooms with “hotel-like atmosphere,” that focus on letting families stay together with their newborn in relative quiet.

“Today the standard in the community is probably for privacy for mothers, because now their husbands stay with them, so you need to have more people in the room,” said Jim O’Connor, the president of St. Charles Hospital.

O’Connor said the new wing cost around $3.8 million, most of which came from the hospital’s capital budget, and took around 10 months to build. During that time patients were moved to the 3-West wing, in order to avoid the disturbance of construction for the doctors, nurses and patients.

The hospital’s foundation and auxiliary contributed about $500,000 to the construction, said Lisa Mulvey, executive director of the hospital’s foundation. Funds were raised through trustees and events such as their annual golf outing and spring luncheons. The end result, she said, was well worth it.

“It’s beautiful,” Mulvey said. “I couldn’t have pictured something more beautiful.”

Each room features new beds and more accommodations for person’s significant others with new sofa chairs and larger, walk-in showers. The rooms also include more modern isolettes for newborn children.

One of the new rooms at St. Catherine Hospital maternal unit. Photo by Kyle Barr

Dr. Jerry Ninia, the director of obstetrics and gynecology at the hospital, said the new wing’s technology helps in emergencies, but it’s always moreso the staff involved.

“It goes beyond the nice showers and the nice digs, so to speak,” he said. “It helps the staff, it’s always nice to work in a nice facility.”

The wing officially opened about three weeks ago, and patients are already making use of the facilities.

Ed Casper, an architect from Stantec engineering company that worked on the new wing, said just that morning he had become a grandfather, his grandson being born right there in the new wing.

“Our experience through the night last night was absolutely phenomenal,” he said.

One of the first children to be born in the new maternity ward was young Jonathan Lewin, less than a week old. His sparse, brown hair is already as long as thumbtacks. His mother, Katherine Lewin, 31, a nurse from Wading River, said her care there was “excellent, everyone here is great.”

She is excited to take her new son home, where she expects her 2 ½ year-old daughter is excited to be a sister.

“She asked if she could bring him home,” Lewin said.

File photo

The Comsewogue School District has added its name to the list of districts that are standing up to New York State on a proposal that would mandate the HPV vaccine in state schools. 

The proposed amendment to Section 2164 of the public health law would require that all students born after 2009 receive the human papillomavirus vaccine as part of the state’s mandated school immunization program.

In a letter sent to Gov. Andrew Cuomo (D), Dec. 6, the district detailed its stance on the matter. 

“While the vaccination may be helpful in preventing certain forms of cancer, the choice as to whether to have children vaccinated should be made by parents in consultation with their physician,” John Swenning, board president, said in the letter. 

The HPV vaccine is designed to prevent cancer-causing infections, but several school districts including Shoreham-Wading River and Three Village have written letters similar to Comsewogue’s saying it is unnecessary.

In a letter signed by the school board and superintendent, SWR said they did not believe it was necessary for a vaccine for something not usually transmitted in schools.

“The HPV vaccination has historically been a parental decision, is not transmitted in schools, lacks the full support of the medical community and would require schools to enforce a widely unpopular mandate by excluding children,” the letter stated. “It should not be adopted.”

The Comsewogue School district went on to say the activities that cause this spread of HPV should not be occurring on school grounds, and HPV is not a public health risk in the school setting. They also said that if this bill passes, it will preclude children from being able to access a public school education.

In addition to the letter, Comsewogue district board held a workshop Dec. 5 to discussed the proposed mandate.

Superintendent Jennifer Quinn said the feeling she got from speaking with local officials is that the proposed mandate will not likely pass, but is still concerned about what it could potentially mean for students and parents in the district. 

“They told me that it is not happening,” she said. “I’m concerned that the other immunization changes happened so fast … that this might pass at the 11th hour, which could happen. It has been a little hard to predict lately.”

Quinn and other board members urged parents to reach out to local lawmakers. 

“It’s our kids, I don’t know if it’s the right thing to do but they’re telling you what they can put in their bodies,” Swenning said. 

Parents in attendance also brought up how the mandate could harm immunocompromised children, who can’t take certain vaccines and how the state may take away exemptions for the HPV vaccine. Current vaccine mandates exempt people who are immunocompromised.

Others were concerned the mandate would take away a parent’s prerogative and choice whether or not their child would get the vaccine. 

School officials also brought up the possibility of setting up a legislative committee session between elected officials and residents.

The main symptom of a heart attack is chest pain. Stock photo
As many as 35 percent of heart attacks may present without chest pain

By David Dunaief, M.D.

Dr. David Dunaief

Heart disease is the most common chronic disease in America. When we refer to heart disease, it is an umbrella term; heart attacks are one component. 

Fortunately, the incidence of heart attacks has decreased over the last several decades, as have deaths from heart attacks. However, there are still 790,000 heart attacks every year, and almost three-quarters of these are first heart attacks (1).

If you think someone is having a heart attack, call 911 as quickly as possible and have the patient chew an adult aspirin (325 mg) or four baby aspirins. While the Food & Drug Administration does not recommend aspirin for primary prevention of a heart attack, the use of aspirin here is for treatment of a potential heart attack, not prevention.

Heart attack symptoms

The main symptom is chest pain, which most people don’t have trouble recognizing. However, there are a number of other, more subtle, symptoms such as discomfort or pain in the jaw, neck, back, arms and epigastric, or upper abdominal areas. Others include nausea, shortness of breath, sweating, light-headedness and tachycardia (racing heart rate). One problem is that less than one-third of people know these other major symptoms (2). About 10 percent of patients present with atypical symptoms — without chest pain — according to one study (3).

It is not only difficult for the patient but also for the medical community, especially the emergency room, to determine who is having a heart attack. Fortunately, approximately 80 to 85 percent of chest pain sufferers are not having a heart attack. More likely, they have indigestion, reflux or other non-life-threatening ailments.

There has been a raging debate about whether men and women have different symptoms when it comes to heart attacks. Several studies speak to this topic.

Men vs. women

There is data showing that, although men have heart attacks more commonly, women are more likely to die from a heart attack (4). In a Swedish prospective (forward-looking) study, after having a heart attack, a significantly greater number of women died in hospital or near-term when compared to men. The women received reperfusion therapy, artery opening treatment that consisted of medications or invasive procedures, less often than the men.

However, recurrent heart attacks occurred at the same rate, regardless of sex. Both men and women had similar findings on an electrocardiogram; they both had what we call ST elevations. This was a study involving approximately 54,000 heart attack patients, with one-third of them being women.

One theory about why women are treated less aggressively when first presenting in the ER is that they have different and more subtle symptoms — even chest pain symptoms may be different. Women’s symptoms may include pain in the lower portion of the chest or upper portion of the abdomen and may have significantly less severe pain that could radiate or spread to the arms. But, is this true? Not according to several studies.

In one observational study, results showed that, though there were some subtle differences in chest pain, on the whole, when men and women presented with this main symptom, it was of a similar nature (5). There were 34 chest pain characteristic questions used to determine if a difference existed. These included location, quality or type of pain and duration. Of these, there was some small amount of divergence: The duration was shorter for a man (2 to 30 minutes), and pain subsided more for men than for women. The study included approximately 2,500 patients, all of whom had chest pain. The authors concluded that determination of heart attacks with chest pain symptoms should not factor in the sex of patients.

This trial involved an older population; patients were a median age of 70 for women and 59 for men, with more men having had a prior heart attack. The population difference was a conspicuous weakness of an otherwise solid study, since age and previous heart attack history are important factors.

In the GENESIS-PRAXY study, another observational study, but with a younger population, the median age of both men and women was 49. Results showed that chest pain remained the most prevalent presenting symptom in both men and women (6). However, of the patients who presented without distinct chest pain and with less specific EKG findings (non-ST elevations), significantly more were women than men. Those who did not have chest pain symptoms may have had some of the following symptoms: back discomfort; weakness; discomfort or pain in the throat, neck, right arm and/or shoulder; flushing; nausea; vomiting; and headache.

If the patients did not have chest pain, regardless of sex, the symptoms were diffuse and nonspecific. The researchers were looking at acute coronary syndrome, which encompasses heart attacks. In this case, independent risk factors for disease not related to chest pain included both tachycardia (rapid heart rate) and being female. The authors concluded that there need to be better ways to calibrate non-chest pain symptoms.

Some studies imply that as much as 35 percent of patients do not present with chest pain as their primary complaint (7).

Let’s summarize

So what have we learned about heart attack symptoms? The simplest lessons are that most patients have chest pain, and that both men and women have similar types of chest pain. However, this is where the simplicity stops and the complexity begins. The percentage of patients who present without chest pain seems to vary significantly depending on the study — ranging from less than 10 percent to 35 percent.

Non-chest pain heart attacks have a bevy of diffuse symptoms, including obscure pain, nausea, shortness of breath and light-headedness. This is seen in both men and women, although it occurs more often in women. When it comes to heart attacks, suspicion should be based on the same symptoms for both sexes. Therefore, know the symptoms, for it may be your life or a loved one’s that depends on it.

References:

(1) cdc.gov. (2) MMWR. 2008;57:175–179. (3) Chest. 2004;126:461-469. (4) Int J Cardiol. 2013;168:1041-1047. (5) JAMA Intern Med. 2014 Feb. 1;174:241-249. (6) JAMA Intern Med. 2013;173:1863-1871. (7) JAMA 2012;307:813-822.

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.  

District Hires Environmental Firm to Test Middle School

Northport district officials have found an alternative location for its bus depot. Photo from Close Northport MS Facebook page

In response to a Nov. 20 TBR News Media article that uncovered that the Northport-East Northport school district was in violation of laws governing petroleum bulk storage, district officials announced at the Dec. 12 board meeting that they found a new bus depot and refueling location.

“We have found an alternate location and the resolution would allow the school board to enter negotiations to finalize that work with Cavay’s [Building & Lumber Supply] on Brightside Ave.,” Robert Banzer, superintendent of schools, said.

Over the last several weeks, the district addressed its violations with the Suffolk County Health Department and officials there said that the site was reinspected without violations found.

A separate resolution unanimously passed that would allow the district to utilize the fueling facilities operated by the Village of Northport for its bus fleet and maintenance.

“We are still seeking other possible methods of fueling, including [reaching out to] some of our other municipalities. We have reached out to them and they are considering it, “ Banzer said. “By January we should have this [relocation] in motion, if not sooner.”

Other highlights of the meeting include the board approving the subcommittee’s recommendations in hiring PW Grosser Consulting, a Bohemia-based environmental firm to begin framing a soil testing plan for the Northport Middle School. The firm would recommend soil testing parameters to the district beginning sometime in January.

The subcommittee members said that the firm could come do an initial walk-through of the building as early as later that week and would do other work throughout the winter break when students aren’t in school.

The announcements were made just days after students were again evacuated from several classrooms in the middle school after children were overcome by fumes.

A parent of a middle school student who spoke at the meeting said that children should be moved out of the school while testing is being done.

“We are very concerned, we need an answer ourselves on how this [testing] is going to happen,” he said. “The safe alternative is that they [the students] leave the school, and you do your testing.”

Subcommittee member Lauren Handler said as a group they haven’t discussed that as an official topic but agreed that the kids shouldn’t be in the building when they don’t know if its safe.

No vote was formally conducted on that issue.

State and county health officials have stated that the school board has jurisdiction over air quality at the school and not health officials.

The subcommittee plans to meet each Monday, beginning Jan. 6 or 13 of next year.

 

Studies have shown that eating fresh fruit and cinnamon may be beneficial to diabetics. Stock photo
Fresh fruit and cinnamon may reduce risk

By David Dunaief, M.D.

Dr. David Dunaief

What causes Type 2 diabetes? It would seem like an obvious answer: obesity, right? Well, obesity is a contributing factor but not necessarily the only factor. This is important because the prevalence of diabetes is at epidemic levels in the United States, and it continues to grow. The latest statistics show that about 12.2 percent of the U.S. population aged 18 or older has Type 2 diabetes, and about 9.4 percent when factoring all ages (1).

Not only may obesity play a role, but sugar by itself, sedentary lifestyle and visceral (abdominal) fat may also contribute to the pandemic. These factors may not be mutually exclusive, of course.

We need to differentiate among sugars, because form is important. Sugar and fruit are not the same with respect to their effects on diabetes, as the research will help clarify. Sugar, processed foods and sugary drinks, such as fruit juices and soda, have a similar effect, but fresh fruit does not.

Sugar’s impact

Sugar may be sweet, but it also may be a bitter pill to swallow when it comes to its effect on the prevalence of diabetes. In an epidemiological (population-based) study, the results show that sugar may increase the prevalence of Type 2 diabetes by 1.1 percent worldwide (2). This seems like a small percentage, however, we are talking about the overall prevalence, which is around 9.4 percent in the U.S., as we noted above.

Also, the amount of sugar needed to create this result is surprisingly low. It takes about 150 calories, or one 12-ounce can of soda per day, to potentially cause this rise in diabetes. This is looking at sugar on its own merit, irrespective of obesity, lack of physical activity or overconsumption of calories. The longer people were consuming sugary foods, the higher the incidence of diabetes. So the relationship was a dose-dependent curve. Interestingly, the opposite was true as well: As sugar was less available in some countries, the risk of diabetes diminished to almost the same extent that it increased in countries where it was overconsumed.

In fact, the study highlights that certain countries, such as France, Romania and the Philippines, are struggling with the diabetes pandemic, even though they don’t have significant obesity issues. The study evaluated demographics from 175 countries, looking at 10 years’ worth of data. This may give more bite to municipal efforts to limit the availability of sugary drinks. Even steps like these may not be enough, though. Before we can draw definitive conclusion from the study, however, there need to be prospective (forward-looking) studies.

Effect of fruit

The prevailing thought has been that fruit should only be consumed in very modest amounts in patients with — or at risk for — Type 2 diabetes. A new study challenges this theory. In a randomized controlled trial, newly diagnosed diabetes patients who were given either more than two pieces of fresh fruit or fewer than two pieces had the same improvement in glucose (sugar) levels (3). Yes, you read this correctly: There was a benefit, regardless of whether the participants ate more fruit or less fruit.

This was a small trial with 63 patients over a 12-week period. The average patient was 58 and obese, with a body mass index of 32 (less than 25 is normal). The researchers monitored hemoglobin A1C (HbA1C), which provides a three-month mean percentage of sugar levels.

It is very important to emphasize that fruit juice and dried fruit were avoided. Both groups also lost a significant amount of weight while eating fruit. The authors, therefore, recommended that fresh fruit not be restricted in diabetes patients.

What about cinnamon?

It turns out that cinnamon, a spice many people love, may help to prevent, improve and reduce sugars in diabetes. In a review article, the authors discuss the importance of cinnamon as an insulin sensitizer (making the body more responsive to insulin) in animal models that have Type 2 diabetes (4).

Cinnamon may work much the same way as some medications used to treat Type 2 diabetes, such as GLP-1 (glucagon-like peptide-1) agonists. The drugs that raise GLP-1 levels are also known as incretin mimetics and include injectable drugs such as Byetta (exenatide) and Victoza (liraglutide). In a study with healthy volunteers, cinnamon raised the level of GLP-1 (5). Also, in a randomized control trial with 100 participants, 1 gram of cassia cinnamon reduced sugars significantly more than medication alone (6). The data is far too preliminary to make any comparison with FDA-approved medications. However, it would not hurt, and may even be beneficial, to consume cinnamon on a regular basis.

Sedentary lifestyle

What impact does lying down or sitting have on diabetes? Here, the risks of a sedentary lifestyle may outweigh the benefits of even vigorous exercise. In fact, in a recent study, the authors emphasize that the two are not mutually exclusive in that people, especially those at high risk for the disease, should be active throughout the day as well as exercise (7).

So in other words, the couch is “the worst deep-fried food,” as I once heard it said, but sitting at your desk all day and lying down also have negative effects. This coincides with articles I’ve written on exercise and weight loss, where I noted that people who moderately exercise and also move around much of the day are likely to lose the greatest amount of weight.

As a medical community, it is imperative that we reduce the trend of increasing prevalence by educating the population, but the onus is also on the community at large to make lifestyle changes. So America, take an active role.

References:

(1) www.cdc.gov/diabetes. (2) PLoS One. 2013;8(2):e57873. (3) Nutr J. published online March 5, 2013. (4) Am J Lifestyle Med. 2013;7(1):23-26. (5) Am J Clin Nutr. 2007;85:1552–1556. (6) J Am Board Fam Med. 2009;22:507–512. (7) Diabetologia online March 1, 2013.

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.      

Stock photo
Speedy diagnosis and treatment improves outcomes

By David Dunaief, M.D.

Dr. David Dunaief

TIA (transient ischemic attack) is sometimes referred to as a “mini-stroke.” This is a disservice since it makes a TIA sound like something that should be taken lightly. Ischemia is reduced or blocked blood flow to the tissue, due to a clot or narrowing of the arteries. Symptoms may last less than five minutes. However, a TIA is a warning shot across the bow that needs to be taken very seriously on its own. It may portend life-threatening or debilitating complications that can be prevented with a combination of medications and lifestyle modifications.

Is TIA common?

It is diagnosed in anywhere from 200,000 to 500,000 Americans each year (1). The operative word is “diagnosed,” because it is considered to be significantly underdiagnosed. I have helped manage patients with symptoms as understated as the onset of double vision. Other symptoms may include facial or limb weakness on one side, slurred speech or problems comprehending others, dizziness or difficulty balancing or blindness in one or both eyes (2). TIA incidence increases with age (3).

What is a TIA?

It is a brief episode of neurological dysfunction caused by focal brain ischemia or retinal ischemia (low blood flow in the back of the eye) without evidence of acute infarction (tissue death) (4). In other words, TIA has a rapid onset with potential to cause temporary muscle weakness, creating difficulty in activities such as walking, speaking and swallowing, as well as dizziness and double vision.

Though they are temporary, TIAs have potential complications, from increased risk of stroke to heightened depressive risk to even death. Despite the seriousness of TIAs, patients or caregivers often delay receiving treatment.

Stroke risk

A TIA is a stroke that lasts only a few minutes.
Stock photo

After a TIA, stroke risk goes up dramatically. Even within the first 24 hours, stroke risk can be 5 percent (5). According to one study, the incidence of stroke is 11 percent after seven days, which means that almost one in 10 people will experience a stroke after a TIA (6). Even worse, over the long term, the probability that a patient will experience a stroke reaches approximately 30 percent, one in three, after five years (7).

The EXPRESS study, a population-based study that considered the effect of urgent treatment of TIA and minor stroke on recurrent stroke, evaluated 1,287 patients, comparing their initial treatment times after experiencing a TIA or minor stroke and their subsequent outcomes (8).

The Phase 1 cohort was assessed within a median of three days of symptoms and received a first prescription within 20 days. In Phase 2, median delays for assessment and first prescription were less than one day. All patients were followed for two years after treatment. Phase 2 patients had significantly improved outcomes over the Phase 1 patients. Ninety-day stroke risk was reduced from 10 to 2 percent, an 80 percent improvement.

The study’s authors advocate for the creation of TIA clinics that are equipped to diagnose and treat TIA patients to increase the likelihood of early evaluation and treatment and decrease the likelihood of a stroke within 90 days. The moral of the story is: Treat a TIA as a stroke should be treated, the faster the diagnosis and treatment, the lower the likelihood of sequalae, or complications.

Predicting the risk of stroke

Both DWI (diffusion-weighted imaging) and ABCD2 are potentially valuable predictors of stroke after TIA. The ABCD2 is a clinical tool used by physicians. ABCD2 stands for Age, Blood pressure, Clinical features and Diabetes, and it uses a scoring system from 0 to 7 to predict the risk of a stroke within the first two days of a TIA (9).

Heart attack

In one epidemiological study, the incidence of a heart attack after a TIA increased by 200 percent (10). These were patients without known heart disease. Interestingly, the risk of heart attacks was much higher in those over 60 years of age and continued for years after the event. Just because you may not have had a heart attack within three months after a TIA, this is an insidious effect; the average time frame for patients was five years from TIA to heart attack.

Mortality

TIAs decrease overall survival by 4 percent after one year, by 13 percent after five years and by 20 percent after nine years, especially in those over age 65 (11). The reason younger patients had a better survival rate, the authors surmise, is that their comorbidity (additional diseases) profile was more favorable.

Depression

In a cohort study that involved over 5,000 participants, TIA was associated with an almost 2.5-times increased risk of depressive disorder (12). Those who had multiple TIAs had a higher likelihood of depressive disorder. Unlike with stroke, in TIA it takes much longer to diagnose depression, about three years after the event.

What can you do?

Awareness and education are important. While 67 percent of stroke patients receive education about their condition, only 35 percent of TIA patients do (13). Many risk factors are potentially modifiable, with high blood pressure being at the top of the list, as well as high cholesterol, increasing age (over 55) and diabetes.

Secondary prevention (preventing recurrence) and prevention of complications are similar to those of stroke protocols. Medications may include aspirin, antiplatelets and anticoagulants. Lifestyle modifications include a Mediterranean and DASH diet combination. Patients should not start an aspirin regimen for chronic preventive use without the guidance of a physician.

If you or someone you know has TIA symptoms, the patient needs to see a neurologist and a primary care physician and/or a cardiologist immediately for assessment and treatment to reduce risk of stroke and other long-term effects.

References:

(1) Stroke. Apr 2005;36(4):720-723; Neurology. May 13 2003;60(9):1429-1434. (2) mayoclinic.org. (3) Stroke. Apr 2005;36(4):720-723. (4) N Engl J Med. Nov 21 2002;347(21):1713-1716. (5) Neurology. 2011 Sept 27; 77:1222. (6) Lancet Neurol. Dec 2007;6(12):1063-1072. (7) Albers et al., 1999. (8) Stroke. 2008;39:2400-2401. (9) Lancet. 2007;9558;398:283-292. (10) Stroke. 2011; 42:935-940. (11) Stroke. 2012 Jan;43(1):79-85. (12) Stroke. 2011 Jul;42(7):1857-1861. (13) JAMA. 2005 Mar 23;293(12):1435.

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.    

Peter Scully, Suffolk County deputy county executive and water czar, responds to questions from  TBR News Media’s editorial staff:

1. You’ve been called Suffolk County’s water czar. Why does Suffolk County need a water czar?

The need for the county to have a high-level point person to advance the water quality agenda of County Executive Steve Bellone [D] is a result of two factors: The high priority that the county executive has placed on water quality issues, and the tremendous progress his administration has made over the past seven years in building a solid foundation to reverse decades of nitrogen pollution that has resulted primarily from the lack of sewers in Suffolk County and reliance on cesspools and septic systems that discharge untreated wastewater into the environment. The county executive succeeded in landing $390 million in post-Hurricane Sandy resiliency funding to eliminate 5,000 cesspools along river corridors on the South Shore by connecting parcels to sewers, and the county’s success in creating a grant program to make it affordable for homeowners to replace cesspools and septic systems with new nitrogen-reducing septic systems in areas where sewers are not a cost-effective solution, prompted the state to award Suffolk County $10 million to expand the county’s own Septic Improvement Program. These are the largest investments in water quality Suffolk has seen in 50 years, and the county executive saw the need to appoint a high-level quarterback to oversee the implementation of these programs.

 

2. Which groundwater contaminants are the highest priorities for Suffolk County? 

In 2014, the county executive declared nitrogen to be water quality public enemy No. 1. The nitrogen in groundwater is ultimately discharged into our bays, and about 70 percent of this nitrogen comes from on-site wastewater disposal (septic) systems. Excess nutrients have created crisis conditions, causing harmful algal blooms, contributing to fish kills and depleting dissolved oxygen necessary for health aquatic life. They have also made it impossible to restore our once nationally significant hard clam and bay scallop fisheries, have devastated submerged aquatic vegetation and weakened coastal resiliency through reduction of wetlands. Nitrogen also adversely impacts quality of drinking water, especially in areas with private wells, although public water supply wells consistently meet drinking water standards for nitrogen.

Other major contaminants of concern include volatile organic compounds, known as VOCs. For example, there is perchloroethlyene, historically from dry cleaners; and petroleum constituents — most recently MTBE, a gasoline additive — from fuel storage and transfer facilities.

Then there are pesticides. Active ingredients such as chlordane, aldicarb and dacthal have been banned, but some legacy contamination concerns exist, especially for private wells. Some currently registered pesticides are appearing in water supplies at low levels, including simazine/atrazine, imidacloprid and metalaxyl.

Emerging contaminants include PFAS, historically used in firefighting foams, water repellents, nonstick cookware; and 1,4-dioxane, an industrial solvent stabilizer also present at low levels in some consumer products. 

 

3. Are the chemicals coming from residential or industrial sites?

Contamination can emanate from a variety of sites, including commercial, industrial and residential properties. Many of the best-known cleanup sites are dealing with legacy impacts from past industrial activity. Examples include Grumman in Bethpage, Lawrence Aviation in Port Jefferson Station, Brookhaven National Laboratory in Upton and the Naval Weapons Industrial Reserve Plant in Calverton. There have been hundreds of Superfund sites on Long Island. Fortunately, most are legacy sites and new Superfund sites are relatively rare.

More recently, the use of firefighting foam has resulted in Superfund designations at the Suffolk County Firematics site in Yaphank, Francis S. Gabreski Air National Guard Base in Westhampton, and East Hampton Airport. The foam was used properly at the time of discharge, but it was not known that PFAS would leach and contaminate groundwater.

The county’s 2015 Comprehensive Water Resources Management Plan found that some chemicals, such as VOCs, continue to increase in frequency of detection and concentration. While some of this is attributable to legacy industrial plumes, experts believe that residential and small commercial sites are partially responsible for contamination. This is partly because any substances that are dumped into a toilet or drain will reach the environment, and because solvents move readily through our sandy aquifer. Septic waste is, of course a major of contamination. Residential properties can be also responsible for other pollution, such as nitrogen from fertilizers and pesticides.

4. Which industries currently generate the most groundwater pollution in Suffolk County? 

The county’s Department of Health Services Division of Environmental Quality staff advise that, historically, the major contributors to groundwater pollution in the county were dry cleaners, and fuel storage and transfer facilities. However, current dry cleaning practices have minimized any possible groundwater discharges, and modern fuel facilities are engineered to more stringent code requirements that have substantially eliminated catastrophic releases. Low-level discharges are still a concern, and are the subject of the county’s VOC action plan to increase inspections and optimize regulatory compliance.

There are thousands of commercial and industrial facilities, most of which have the potential to pollute — for example, with solvent cleaners. Best management practices and industrial compliance inspections are key to minimizing and eliminating further contamination.

 

5. The word “ban” is often a dirty word in politics, but do you see benefits to banning certain products, and/or practices, for the sake of protecting the county’s drinking water supply? (The bans on DDT, lead in gasoline and HFCS, for example, were very effective at addressing environmental and human health concerns.) 

Policymakers have not hesitated to ban the use of certain substances — DDT, lead in gasoline, chlordane, MTBE — in the face of evidence that the risks associated with the continued introduction of a chemical into the environment outweigh the benefits from a public health or environmental standpoint. Based on health concerns, I expect that there will be active discussion in the years ahead about the merits of restricting the use of products that introduce emerging contaminants like 1,4-dioxane and PFCs into the environment.

 

6. If people had more heightened awareness, could we slow or even eliminate specific contaminants? As consumers, can people do more to protect groundwater? 

There is no question that heightened awareness about ways in which everyday human activities impact the environment leads people to change their behaviors in ways that can reduce the release of contaminants into the environment. A good example is the county’s Septic Improvement Program, which provides grants and low interest loans for homeowners who choose to voluntarily replace their cesspools or septic systems with new nitrogen-reducing technology. More than 1,000 homeowners have applied for grants under the program, which set a record in October with more 100 applications received.

If a home is not connected to sewers, a homeowner can replace their cesspool or septic system with an innovative/alternative on-site wastewater treatment system. Suffolk County, New York State and several East End towns are offering grants which can make it possible for homeowners to make this positive change with no significant out-of-pocket expense. Consumers can choose to not flush bleaches or toxic/hazardous materials down the drain or into their toilets. Consumers can also take care to deliver any potentially toxic or hazardous household chemicals to approved Stop Throwing Out Pollutants program sites. Homeowners can choose not to use fertilizers or pesticides, or to opt for an organic, slow-release fertilizer at lowest label setting rates.

 

7. Can you offer examples of products to avoid or practices to adopt that would better protect the drinking water supply? 

Consumers can choose to not flush bleaches or household hazardous materials down the drain or into their toilets. Consumers can also take care to deliver any potentially toxic or hazardous household chemicals to approved STOP program sites. Homeowners can choose not to use fertilizers or pesticides, or to opt for an organic, slow release fertilizer at lowest label setting rates.

 

8. Aside from banning products or chemicals, and raising awareness, how do you address the issue?

Promoting the use of less impactful alternatives to products which have been shown to have a significant and/or unanticipated impact on public health or the environment, on a voluntary basis, is a less contentious approach than banning a substance or placing restrictions on its use through a legislative or rulemaking process. Such an approach should only be taken with the understanding that its success, value and significance will depend in large part on public awareness and education.

 

9. What about product labeling, similar to the U.S. Office of the Surgeon General warnings about cigarettes, or carcinogens in California, etc.? Can the county require products sold to include a groundwater contamination warning?

The question of whether the county Legislature has authority to implement labeling requirements could be better addressed by an attorney.

 

10. People, including some elected officials and people running for public office, sometimes say that sewage treatment plants remove all contaminants from wastewater. Can you set the record straight? What chemicals, including radioactive chemicals, are and are not removed from wastewater via sewage treatment?

Tertiary wastewater treatment plants are designed primarily to remove nitrogen, in addition to biodegradable organic matter. However, wastewater treatment is also effective at removing many volatile organic compounds. Some substances, such as 1,4-dioxane, are resistant to treatment and require advanced processes for removal. Evidence shows that the use of horizontal leaching structures instead of conventional drainage rings may facilitate removal of many pharmaceuticals and personal care products, known as PPCPs. Advanced treatment technologies, such as membrane bioreactors, are also being tested for efficacy of removal of PPCPs.

Staff advise that the mere presence of chemicals in wastewater in trace amounts does not necessarily indicate the existence of a public health risk. All wastewater treatment must treat chemicals to stringent federal and state standards. In some cases, such as for emerging contaminants, specific standards do not exist. In those cases, the unspecified organic contaminant requirement of 50 parts per billion is commonly applied.

 

11. Can you provide an example of a place where residential and industrial groundwater contamination concerns were reversed or adequately addressed?

There are numerous examples, mostly under the jurisdiction of U.S. Environmental Protection Agency or NYS Department of Environmental Conservation, in which groundwater concerns have been addressed through treatment to remove contaminants. Because health and safety are always the most important issues, the first priority is typically to make sure that people who live near an impacted site have a safe supply of drinking water. In areas served by public water suppliers — Suffolk County Water Authority or a local water district — this is not usually an issue, since public water suppliers are highly regulated and are required to test water supply wells regularly. In areas where people are not connected to a public water system, and rely instead on private wells, the Suffolk County Department of Health Services will work with the water supplier to identify properties that are not connected to a public water system and then contact homeowners to urge them to have their water tested at no charge to make sure that it is safe for consumption. 

Over the past several years, Suffolk County, New York State and the Suffolk County Water Authority have worked together to connect hundreds of homes that had relied on private wells to the public water system, to make sure people have access to safe drinking water.

 

12. Are you hopeful about addressing the issues? 

I am hopeful and optimistic about the success of efforts to reverse the ongoing degradation of water quality that has resulted from reliance on cesspools and septic systems. For the first time in Long Island’s history, environmentalists, business leaders, scientists, organized labor and the building trades all agree that the long-term threat that has resulted from the lack of sewers to both the environment and economy is so great that a long-term plan to address the need for active wastewater treatment is not an option, but a necessity. Experience shows that public awareness can be a significant factor in driving public policy.

Eat the colors of the rainbow to reduce the risk of dementia. Stock photo
Intensive lifestyle changes may grow protective telomeres

By David Dunaief, M.D.

Dr. David Dunaief

Dementia may be diagnosed when someone experiences loss of memory plus loss of another faculty, such as executive functioning (decision-making) or language abilities (speaking, writing or reading). The latter is known as aphasia. Alzheimer’s disease is responsible for approximately 60 to 80 percent of dementia cases (1).

Unfortunately, there are no definitive studies that show reversal or a cure for Alzheimer’s disease. This is why prevention is central to Alzheimer’s — and dementia in general.

In terms of dementia, there is good news and some disappointing news.

We will start with the good news. Though chronological age is a risk factor that cannot be changed, biological age may be adjustable. There are studies that suggest we may be able to prevent dementia through the use of both lifestyle modifications and medications.

Telomeres’ length and biological age

Biological age may be different from chronologic age, depending on a host of environmental factors that include diet, exercise and smoking. There are substances called telomeres that are found at the ends of our chromosomes. They provide stability to this genetic material. As our telomeres get shorter and shorter, our cellular aging and, ultimately, biological aging, increases.

In a preliminary case control study, dementia patients were shown to have significantly shorter telomere length than healthy patients (2). Interestingly, according to the authors, men have shorter telomere length and may be biologically older by four years than women of the same chronological age. The researchers caution that this is a preliminary finding and may not have clinical implications.

What I find most intriguing is that intensive lifestyle modifications increased telomere length in a small three-month study with patients who had low-risk prostate cancer (3). By adjusting their lifestyles, study participants were potentially able to decrease their biological ages.

Diet’s effect

Lifestyle modifications play a role in many chronic diseases and disorders. Dementia is no exception. In a prospective observational study, involving 3,790 participants, those who had the greatest compliance with a Mediterranean-type diet demonstrated a significant reduction in the risk of Alzheimer’s disease, compared to the least compliant (4). Participants were over the age of 65, demographics included substantial numbers of both black and white participants, and there was a mean follow-up of 7.6 years. Impressively, those who adhered more strictly to the diet performed cognitively as if they were three years younger, according to the authors.

Beta-carotene and vitamin C effect

In a small, preliminary case-control study (disease vs. healthy patients), higher blood levels of vitamin C and beta-carotene significantly reduced the risk of dementia, by 71 percent and 87 percent, respectively (5). The blood levels were dramatically different in those with the highest and lowest blood levels of vitamin C (74.4 vs. 28.9 µmol/L) and beta-carotene (0.8 vs. 0.2 µmol/L).

The reason for this effect may be that these nutrients help reduce oxidative stress and thus have neuroprotective effects, preventing the breakdown of neurons. This study was done in the elderly, average 78.9 years old, which is a plus, since as we age we’re more likely to be afflicted by dementia.

It is critically important to delineate the sources of vitamin C and beta-carotene in this study. These numbers came from food, not supplements. Why is this important? First, beta-carotene is part of a family of nutrients called carotenoids. There are at least 600 carotenoids in food, all of which may have benefits that are not achieved when taking beta-carotene supplements. Second, beta-carotene in supplement form may increase the risk of small-cell lung cancer in smokers (6).

Foods that contain beta-carotene include fruits and vegetables such as berries; green leafy vegetables; and orange, red or yellow vegetables like peppers, carrots and sweet potato. In my practice, I test for beta-carotene and vitamin C as a way to measure nutrient levels and track patients’ progress when they are eating a nutrient-dense diet. Interestingly, many patients achieve more than three times higher than the highest beta-carotene blood levels seen in this small study.

Impact of high blood pressure medications

For those patients who have high blood pressure, it is important to know that not all blood pressure medications are created equal. When comparing blood pressure medications in an observational study, two classes of these medications stood out. Angiotensin II receptor blockers (known as ARBs) and angiotensin-converting enzyme inhibitors (known as ACE inhibitors) reduce the risk of dementia by 53 and 24 percent, respectively, when used in combination with other blood pressure medications.

Interestingly, when ARBs were used alone, there was still a 47 percent reduction in risk; however, ACE inhibitors lost their prevention advantage. High blood pressure is a likely risk factor for dementia and can also be treated with lifestyle modifications (7). Otherwise, ARBs or ACE inhibitors may be the best choices for reducing dementia risk.

Ginkgo biloba disappoints

Ginkgo biloba, a common herbal supplement taken to help prevent dementia, may have no benefit. In the GuidAge study, ginkgo biloba was shown to be no more effective than placebo in preventing patients from progressing to Alzheimer’s disease (8). This randomized controlled trial was done in elderly patients over a five-year period with almost 3,000 participants. There was no difference seen between the treatment and placebo groups. This reinforces the results of an earlier study, Ginkgo Evaluation of Memory trial (9). Longer studies may be warranted. The authors stressed the importance of preventive measures with dementia.

You may be able to prevent dementia, whether through lifestyle modifications or, if medications are necessary, through medication selection.

References:

(1) www.uptodate.com. (2) Arch Neurol. 2012 Jul 23:1-8. (3) Lancet Oncol. 2008;9(11):1048-1057. (4) Am J Clin Nutr. 2011;93:601-607. (5) J Alzheimers Dis. 2012;31:717-724. (6) Am. J. Epidemiol. 2009; 169(7):815-828. (7) Neurology. 2005;64(2):277. (8) Lancet Neurol. 2012;11(10):851-859. (9) JAMA. 2008;300(19):2253-2262.

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.      

20190102.01_New Childrens Signage and Lobby

By Margaret McGovern, M.D., Ph.D.

Dr. Margaret McGovern

Stony Brook Children’s Hospital offers the most advanced pediatric specialty care in the region, which means that the smallest babies, the sickest children and the most complex pediatric traumas all get sent to Stony Brook Children’s. 

Since 2010, when Stony Brook Children’s was first formed, we’ve been committed to the nearly half a million children in Suffolk County whose pediatric health care needs were underserved. Our goal was, and still is, to provide sophisticated pediatric care close to home for the many families who previously had to travel long distances.

Now with the completion and opening of our new building earlier this month, we are able to expand our capabilities to meet the growing health care needs of children and their families across Long Island. 

More than 180 pediatric specialists

As the leading children’s hospital on Long Island with more than 180 pediatric specialists in more than 30 specialties, we offer a full range of medical services to support the physical, emotional and mental development of infants, children and young adults. We also can provide leading-edge care for just about every diagnosis — from a simple fracture to a kidney transplant.

Groundbreaking clinical trials

Stony Brook Children’s also provides cutting-edge research, child-sized technological innovations, clinical trials and breakthrough techniques to benefit pediatric patients as Long Island’s only children’s teaching hospital.

A child-first, family-first philosophy

The new hospital was designed with patients at the center of our thinking and planning, to promote their safety, well-being and healing. It’s the only children’s hospital on Long Island with all single-patient rooms, which allows us to combine the best practices in modern pediatric medicine with a child-first, family-first philosophy. The hospital’s design and amenities are supported by research that shows that a child-friendly environment contributes to better outcomes for children.

Each room of the new hospital includes patient, family and health care provider areas. State-of-the-art hospital beds capture and download patient information directly into the patients’ charts. Every room contains a proprietary security system, interactive televisions, in-room refrigerators, kid-focused menus as well as multicolored wall lights controlled by patients to give them a greater sense of control over their environment during what can be a frightening time for them and their families.

Other child-friendly features include separate child and teen playrooms, common areas, including an outdoor garden, and a classroom with Wi-Fi so students can keep up with their studies.

There’s also a new Ronald McDonald Family Room to offer a welcoming place for family respite, comfort and support.

Uplifting local artwork that soothes and inspires 

We’ve enjoyed the support of Long Island’s artistic community in providing artwork with a Long Island nautical theme, complete with a play lighthouse and wall-sized live feed from the Long Island Aquarium. It’s truly an outstanding art collection for the entire community living in harmony with the building’s architecture and reflecting the healing mission of Stony Brook Children’s.

To learn more, visit www.stonybrookchildrens.org.

Dr. Margaret McGovern is the Knapp Chair in Pediatrics, dean for clinical affairs and Renaissance School of Medicine physician-in-chief at Stony Brook Children’s Hospital.

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#ResilientInSmithtown

November is Mental Health Awareness Month and the Town of Smithtown is seizing it as an opportunity to implement a social media campaign that highlights simple activities that help boost personal resilience. From Nov. 18 to 22, the Town’s Horizons Counseling & Education Center, the Youth Bureau and the Response Crisis Center will share advice, tips and resources to Twitter, Facebook and Instagram using the hashtag #ResilientInSmithtown. 

 This campaign is designed to educate residents about four kinds of personal attributes that boost mental well-being: physical, mental, emotional and social.  Strengthening these attributes contributes to living longer, happier lives, with a heightened ability to cope with life’s stressors. 

“This is a wonderful opportunity for residents to learn how they can have more control over their own personal resiliencies and be able to guide and support family members and friends,” said Stacey Standers, Town of Smithtown Youth Bureau executive director.

Residents of all ages are encouraged to participate in the educational campaign, which relies upon easy and fun exercises that will help Smithtown residents build upon their own personal strengths. 

Approximately one out of every five children in America has a diagnosable mental health disorder. Anxiety, depression and substance abuse are major issues impacting young people and their families, as well as schools and communities. Community education about the importance of bolstering one’s own personal resilience is beneficial at any age, town officials explain, and can be a vital component in maintaining mental health.

“There is a very clear and distinct correlation between childhood trauma and mental health issues and substance addiction,” said Matthew Neebe, director of Horizons Counseling & Education Center. “Problematic mental health issues experienced in childhood can very easily and often do follow individuals into maturity, creating a variety of long-term mental health issues that may cause self-medication through excessive drinking or substance abuse.” 

The campaign promotes scientifically validated activities that contribute to personal well-being. 

Physical resilience means the body can withstand more physical stress and heal itself faster. Mental resilience includes strengthening mental focus, discipline and will power, which is like a muscle that gets stronger the more it is exercised. Emotional resilience provokes powerful, positive emotions like curiosity or love, precisely when it’s needed the most. Social resilience strengthens from bonds with friends, family, neighbors and community.

Some of the recent posts include the following advice:

  • If you cannot change the situation, change your mind.
  • Once a situation is accepted for what it is, begin working on uncommon or creative solutions.
  • Humor can boost one’s mood, alleviate emotional distress and even buffer against depression.  Laughter and humor improve immune response, enhance perceptual flexibility and offset the effects of stress.
  • Positive reframing allows you to take control of your response to a situation by reframing it into a potential growth experience.
  • The first step of a good plan is to define what success looks like.

The postings are part of an ongoing campaign and represent one part of this initiative.

Look for Smithtown Youth Bureau on Facebook to find the different exercises and more information about #ResilientInSmithtown.