Mather Hospital, 75 North Country Road, Port Jefferson officially opened a new Cardiac Rehabilitation Program on Jan. 16 designed to help those who have suffered a major cardiac event such as a heart attack regain their overall physical, mental, and social functioning.
Studies show that individuals who have recent cardiac events and who participate in cardiac rehabilitation realize many benefits including increased life expectancy; reduced hospitalization; improved function, exercise capacity, mood and overall quality of life; a strong correlation between number of cardiac rehabilitation sessions and long-term results; and improvement of modifiable risk factors such as physical activity, dietary choices, stress levels and more.
The program, which is housed in the Frey Family Foundation Medical Arts Building on the Mather campus, is tailored to meet individual needs, combining education and exercise in a supportive environment.
After an initial evaluation, Mather Hospital’s Cardiac Rehabilitation service guides patients through a 12-week program that includes exercise training with continuous ECG or heart monitoring, educational classes on heart health, and nutrition counseling.
Their team includes experienced cardiologists, registered nurses, physical therapists, registered dietitians, and licensed social workers. Together, they providea thorough health assessment and set up a personalized treatment plan to maximize a patient’s recovery and return to well-being.
Learn more at matherhospital.org/cardiacrehab or call 631-775-2456.
Before this decade is over, about a quarter of New York State’s population will be over the age of 60. Meanwhile, the 85-and-up populace is the fastest growing demographic subset in the state. This is a population that is inherently susceptible to abuse and exploitation, and the type of people who would take advantage of these vulnerable citizens know it.
A common con is the “grandma, it’s me” scam: A hysterical young person calls, pretending to be a grandchild and claiming to be in trouble for driving under the influence of cannabis and begging them not to tell the parents. The “grandchild,” whose voice is a little hard to make out because of the fake crying, puts a fake police officer on the phone, who instructs the victim to quickly wire over several thousand dollars for bail.
I am aware of an elderly couple — well-educated, intelligent people in their mid-80s — who fell for it, thinking their beloved grandson needed their help. They’re out $5,000.
Although as a group those over 65 are much less likely to become crime victims than younger people, the elderly are increasingly victimized by various forms of abuse — physical abuse, emotional abuse, sexual abuse, neglect, abandonment and, most commonly, financial exploitation. Solid statistics, though, are hard to come by since we only know what has been reported and, in many jurisdictions, mandatory reporting laws are either weak or inconsistent.
The federal government’s estimates range from 500,000 to two million incidents of elder abuse annually. In New York, the Office for the Aging cites the incidence of elder abuse at about 300,000 per year. The Centers for Disease Control and Prevention contends one in 10 Americans aged 60 and above have experienced some form of elder abuse in the last year alone.
A study by the New York State Bar Association, Under the Radar: New York State Elder Abuse Prevalence Study, showed that 14 percent of all older adults in New York State experienced some form of elder abuse since turning 60. What’s more, the Bar Association report concluded that for every incident documented by state agencies, 24 went unreported. Tragically, many elderly victims won’t report because they are embarrassed and that includes the couple I mentioned earlier who fell the “grandma it’s me” scam), or because the abuser is their caretaker—the only person nearby that they can “rely” on.
Researchers and experts can’t seem to agree on what “elder” means — over 60? over 65? or is it a matter of mental capacity rather than an arbitrary age? — let along what all constitutes “elder abuse.” What we do know is that the many, many shapes of elder abuse implicate all sorts of laws, criminal and civil.
Our criminal courts increasingly deal with physical assaults, fraud and other crimes perpetrated against an older population.
Our civil courts deal with such thorny issues as competency: Does the elderly person have the capacity to sign a contract, and if not is the contract enforceable?; does the elderly person have the capacity to consent to or refuse medical treatment?; does the elderly person have the capacity to intelligently change his or her will?; does the elderly person have the capacity to consent to marriage—and what standing has the relative convinced that the suitor is trying to work his way into grandma’s estate rather than her heart? These are thorny legal questions, and oftentimes there is no clear answer.
I think we all need to be on the alert for the signs of possible elder abuse. Are there unexplained bumps and bruises, and does the older person become guarded when you inquire? Does the individual suddenly seem withdrawn or scared? Has their personal hygiene declined noticeably? Is the individual transferring assets or writing checks for cash? Is their cellphone off more than it used to be, or are you getting odd responses to texts that may indicate someone else is “managing” their communications?
The tricky thing is, all of the above could be evidence of elder abuse. Or not.
A bill pending for years in the New York State Legislature would require the state Office for the Aging to develop elder abuse training and offer that training to senior service centers and contractors. However, experts say that elder abuse most commonly occurs in the home, which puts the onus on family, friends and neighbors to know the signs and maintain a watchful eye.
If you witness abuse, call 911. If you suspect someone is a victim of elder abuse, call the NYS Adult Protective Services Helpline at 1-844-697-3505. As with homeland security, if you see something, say something.
Hon. Gail Prudenti is the Former Chief Administrative Judge State of New York and a Partner at Burner Prudenti Law, P.C. focusing her practice on Trusts & Estates. Burner Prudenti Law, P.C. serves clients from New York City to the east end of Long Island with offices located in East Setauket, Westhampton Beach, Manhattan and East Hampton.
This article originally appeared in TBR News Media’s Prime Times senior supplement on 01/25/24.
Castle Connolly has named New York Cancer & Blood Specialists its #1 Physician Practice in New York for Most Top Doctors in Cancer Care. Nationally, only 7 percent of more than 950,000 practicing doctors in the United States earned Castle Connolly’s “Top Doctors” designation this year.
“Having our physicians recognized as ‘Top Doctors’ by Castle Connolly is a testament to the unmatched dedication and remarkable expertise of our physicians at New York Cancer & Blood Specialists,” said Jeff Vacirca, MD, Chief Executive Officer, New York Cancer & Blood Specialists. “This accolade highlights not only their individual excellence but also the collective strength within our practice where every day our physicians are committed to providing world-class patient-centered affordable care in their own communities,”
All Castle Connolly Top Doctors are nominated by their peers, and then the Castle Connolly research team evaluates important criteria to determine who makes the list, including professional qualifications, education, hospital and faculty appointments, research leadership, professional reputation, disciplinary history, interpersonal skills and outcomes data (where available).
Castle Connolly Accolades recognizes health systems, hospitals, and physician practices that provide an outstanding level of high-quality healthcare through their top-ranked Castle Connolly
About New York Cancer & Blood Specialists:
New York Cancer & Blood Specialists (NYCBS) is a leading oncology practice in the New York Metropolitan area committed to providing world-class, patient-centered, affordable care to patients with cancer and blood disorders in their own communities, close to family and friends. NYCBS has more than 30 locations and 35 hospital affiliations throughout Nassau and Suffolk counties, in the Bronx, Manhattan, Queens, Staten Island, Brooklyn and Upstate New York. We offer a multidisciplinary and comprehensive approach to care that utilizes the most advanced imaging, state-of-the-art therapies, cutting-edge clinical trials, on-site pharmacies, and an in-house laboratory with a full range of pathology services. Advocating for and ensuring the health and well-being of our patients is and always will be our top priority. For more information, visit www.nycancer.com.
Castle Connolly
With over 30 years’ experience researching, reviewing and selecting Top Doctors, Castle Connolly is a trusted and credible source. In fact, a study published in the Journal of Medical Research found that across several specialties evidence indicates that Castle Connolly’s peer-reviewed directory is methodologically more reliable than sites that just relied on patient reviews when it came to identifying quality care. Our mission is to help people find the best healthcare by connecting patients with best-in-class healthcare providers. For more information, visit https://www.castleconnolly.com.
You’ll be surprised at how much better you will feel — and how much sharper your thinking is if you add walking to your daily regimen. METRO photo
By David Dunaief, M.D.
Dr. David Dunaief
What does it take to get us out of our seats? We know that exercise is good for our long-term physical and mental health, but it’s still elusive for many of us. It’s just too tempting to let the next episode of our new favorite series autoplay or to answer those last few emails.
Many of us tried to get out of gym class as kids and, as adults, we “want” to exercise, but we “don’t have time.” I once heard that the couch is as bad as the worst deep-fried food; it perpetuates inactivity. Even sleeping burns more calories than sitting and watching TV.
I have good news. There is an easy way to get tremendous benefit in very little time. You don’t need expensive equipment, and you don’t have to join a gym. You can even sharpen your wits — with your feet.
The New York Times’ Science Times carried an article a few years ago about Esther Tuttle. At the time, Esther was 99 years old, sharp as a tack and was independently mobile, with no mobility aids required. She continued to stay active by walking in the morning for 30 minutes and then walking again in the afternoon. The skeptic might say that this is a nice story, but its value is anecdotal at best.
Well, evidence-based medicine backs up her claim that walking is a rudimentary and simple way to get exercise that shows incredible benefits. One mile of walking a day will help keep the doctor away. For the step-counters among you, that’s about 2,000 steps a day for an adult with an average stride length.
Does walking improve brain function?
Walking also has a powerful effect on preserving brain function and even growing certain areas of the brain (1). Walking between six and nine miles a week, or just one mile a day, reduced the risk of cognitive impairment over 13 years and actually increased the amount of gray matter tissue in the brain over nine years. Whoa!
Participants who had an increase in brain tissue volume also had a substantially reduced risk of developing cognitive impairment. Interestingly, the parts of the brain that grew included the hippocampus, involved with memory, and the frontal cortex, involved with short-term memory and executive decision making. There were 299 participants who were dementia free at the start of the trial. The mean participant age was 78. Imagine if you started younger?
In yet another study, moderate exercise reduced the risk of mild cognitive impairment with exercise begun in mid-to-late life (2).
Even better news is that, if you’re pressed for time or if you’re building up your stamina, you can split a mile into two half-mile increments. How long does it take you to walk a half-mile? You’ll be surprised at how much better you will feel — and how much sharper your thinking is.
How does walking affect mood?
Researchers performed a meta-analysis of other studies related to the relationship between exercise and depression. They found that adults who walked briskly for about 75 minutes per week cut their risk of depression by 18 percent (3). That’s only half of what the Centers for Disease Control recommend.
If you ratchet up your exercise to running, a study showed that mood also improves, mollifying anger (4). The act of running actually increases your serotonin levels, a hormone that, when low, can make people agitated or angry. So, exercise may actually help you get your aggressions out.
How do I reset my sitting ‘habit?’
A particular challenge I hear these days is that working from home reduces much of the opportunity to walk. There’s less walking down the hall to a meeting or to refill your water bottle. Instead, everything is only a few steps away. It’s as if our work environment is actually working against us.
If you need a little help getting motivated, here is a terrific strategy to get you off the couch or away from your computer: set an alarm for specific points throughout your day and use that as a prompt to get up and walk, even if it’s for only 15 minutes. The miles will add up quickly.
A client of my wife’s schedules meetings for no more than 50 minutes, so she can walk a “lap” around her house’s interior between meetings. She also looks for opportunities to have a good old-fashioned phone call, rather than a video call, so she can walk around while she’s talking or listening. Of course, this is one person, but it might give you some ideas that will work for you.
Walking has other benefits as well. We’ve all heard about the importance of doing weight-bearing exercise to prevent osteoporosis and osteoporotic fractures. Sadly, if you don’t use them, bones weaken and break. Walking is a weight-bearing exercise that helps strengthen your joints, bones and muscles.
So, remember, use your feet to keep your mind sharp and yourself even-tempered. Activities like walking will help you keep a positive attitude, preserve your bones and help increase the plasticity of your brain.
Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.
Decades ago, doctors endorsed cigarette smoking, promoting it in advertisements. That was back in the 1950’s, in the decade after the U.S. government shipped cigarettes to members of the armed forces during World War II.
On Jan. 11, 1964, Surgeon General Luther Terry released a landmark report that showed a nine to 10-fold higher risk of lung cancer for smokers compared with non smokers. At the time, about 40% of the adult population smoked. The report helped dramatically alter the perception of smoking. Indeed, a Gallup Survey from 1958 showed that 44% of Americans believed smoking caused cancer. By 1968, that number surged to 78%, according to a report from the National Institutes of Health.
Pulmonologist Dr. Norman Edelman, a professor of medicine at Stony Brook University and a core member of the program in public health at Stony Brook, celebrated the legacy of that landmark report, even as he urged ongoing efforts to reduce smoking.
Dr. Norman Edelman. Photo courtesy Stony Brook University
“It was a momentous occasion,” said Dr. Edelman, who suggested that the number of deaths in the country would be even higher without this report.
“By the beginning of the 1960’s, the medical literature was pretty clear that smoking causes lung cancer” but the tobacco lobby fought against warnings about the hazards of smoking, Edelman said.
Dr. Gregson Pigott, Suffolk County Health Commissioner, described the report as the “first step towards protecting the American people from the deleterious effects of tobacco use.”
Adult smoking rates have fallen from about 43% in 1965 to about 11.5% in 2011, according to Dr. Pigott.
The report, which was followed by 34 studies from the CDCs Office of Smoking and Health on the health consequences of smoking, validated the concerns of organizations like the American Cancer Society and helped reduce the prevalence of a habit that can have significant and fatal consequences.
“Smoking levels in teenagers are going down,” said Dr. Edelman. “It’s beginning to show up in the health effects” with lung cancer declining in men and plateauing in women.
Lung cancer deaths in men have fallen to 25.5 per 100,000 in 2021 from 65 per 100,000 in 1990, according to Dr. Pigott. More recently, smoking exacerbated the threat from Covid. An analysis of 22,900 people published in BMC Public Health in 2021 showed that 33.5% of people with a history of smoking experienced disease progression, compared with 21.9% of non-smokers.
A ways to go
While smoking is not as prevalent as it had been in the 1960’s, it is still a killer, accounting for an estimated 480,000 deaths each year in the United States, according to the Centers for Disease Control and Prevention. That’s about one in five deaths each year.
“Smoking still kills more people than other preventable causes of death,” said Dr. Edelman.
Dr. Edelman recognized the severity of other problems like the opioid and overdose crisis. In 2023, the CDC estimates that over 112,000 people died from overdoses.
Still, even with a reduction in smoking, the number of people who are smoking is high enough that the public should continue to look for ways to cut back on the harmful habit.
Over 16 million people live with at least one disease caused by smoking and 58 million non smoking Americans are exposed to secondhand smoke, explained Dr. Pigott, citing CDC data. Second hand smoke causes 40,000 to 60,000 deaths per year in the country, while smoking-related illnesses, which combine direct medical expenses, lost productivity and second hand smoke exposure, cost over $300 billion per year.
Increasing the cost of cigarettes has helped serve as a deterrent, Dr. Edelman said.
Suffolk County operates a smoking cessation program, which provides behavior modification and supportive pharmaceuticals to medically eligible participants, Dr. Pigott explained in an email. A nurse practitioner oversees the cessation groups, which the county provides at no cost to participants, who also receive personalized follow-up.Stony Brook has several cessation resources. Students interested in smoking cessation can consult a student health care provider who will help them develop a program.
Prescription medications, which are covered under student’s health insurance, are available at a pharmacy after a consultation with a student’s health care provider.
As for vaping, Dr. Pigott described it as “highly addictive” and explained that its long-term effect is not yet fully understood.
The 2023 Annual National Youth Tobacco Survey found that more than 2.1 million youth currently use e-cigarettes, which represents 7.7% of students in high school and middle school.
“We are especially concerned about the effect of vaping on young people,” Dr. Pigott added.
For the second year in a row, Stony Brook University Hospital (SBUH) has achieved the highest level of national recognition as one of America’s 50 Best Hospitals from Healthgrades, a leading resource that evaluates approximately 4,500 hospitals nationwide. This achievement places SBUH among the top 1% of hospitals nationwide reflecting its commitment to exceptional patient care. SBUH is the only hospital on Long Island to be ranked among the 50 Best Hospitals. As part of this ranking, Stony Brook Southampton Hospital also shares in this recognition.
“Stony Brook’s steady increase in rankings — from the top 250 since 2015, to the top 100 since 2019, and now the top 50 for two years in a row is a reflection of our steadfast commitment to bring the best in care to our patients,” says William A. Wertheim, MD, MBA, Interim Executive Vice President, Stony Brook Medicine.
“The exceptional care found at Stony Brook is only possible when a hospital commits to the highest standards of quality and continuous improvement throughout the organization,” says Carol A. Gomes, MS, FACHE, CPHQ, Chief Executive Officer, Stony Brook University Hospital. “I am grateful to our physicians, nurses and all our healthcare professionals for their dedication to excellence.”
To determine the top hospitals for 2024, Healthgrades evaluated risk-adjusted mortality and complication rates for more than 30 conditions and procedures at approximately 4,500 hospitals nationwide. The 2024 Healthgrades analysis revealed significant variation in hospital performance, making it increasingly important to seek care at top-rated programs. From 2020-2022, if all hospitals, as a group, performed similarly to America’s 50 Best Hospitals, 176,124 lives could potentially have been saved.
“Healthgrades commends Stony Brook University Hospital for their leadership and continued dedication to high quality care,” says Brad Bowman, MD, Chief Medical Officer and Head of Data Science at Healthgrades. “As one of America’s 50 Best Hospitals, Stony Brook University Hospital is elevating the standard for quality care nationwide and ensuring superior outcomes for the patients in their community.”
Stony Brook University Hospital has also been recognized with national Healthgrades Excellence Awards, five-star (the highest level) national ratings and New York State top five rankings for several specialties.
Cardiac Care Excellence Award™ (2015-24) and Five-Star Distinction for Heart Attack (2022-24) and Heart Failure (2014-24)
Neurosciences Excellence Award™ (2016-24) and Ranked #2 in New York State for Neurosciences (2024)
Cranial Neurosurgery Excellence Award™ (2020-24) and Five-Star Distinction (2020-24) for Cranial Neurosurgery (2020-24)
Stroke Care Excellence Award™ (2016-24), Five-Star Distinction for Treatment of Stroke (2015-24) and Ranked #2 in New York State for Stroke Care (2024)
Gastrointestinal Care Excellence Award™ (2024), Five-Star Distinction for Treatment of GI Bleed (2024) and Ranked #4 in New York State for Gastrointestinal Medical (2024)
Critical Care Five-Star Distinctions for treatment of sepsis (2015-24), pulmonary embolism (2024) and Respiratory Failure (2021-24)
To learn more about how Healthgrades measures hospital quality and access a patient-friendly overview of how Stony Brook rates, visit Healthgrades.com.
Mather Hospital in Port Jefferson announced on Jan. 23 that it is one of America’s 250 Best Hospitals for 2024, according to new research released by Healthgrades, aleading resource consumers use to find a hospital or doctor. This achievement puts Mather Hospital in the top 5% of hospitals nationwide for overall clinical performance and reflects Mather Hospital’s commitment to exceptional patient care. Mather Hospital has received the America’s 250 Best Hospitals Award for two years in a row (2023-2024).
“This recognition highlights Mather Hospital’s commitment to clinical excellence and patient safety,” said Executive Director Kevin McGeachy. “Together with Northwell Health we are continually investing in the future of health care for our communities, from recruiting the highly skilled physicians, the construction of our new advanced Emergency Department, and our commitment to advanced technology such as robotically assisted surgical systems. Congratulations to the entire Mather team for this achievement.”
To determine the top hospitals for 2024, Healthgrades evaluated risk-adjusted mortality and complication rates for more than 30 conditions and procedures at approximately 4,500 hospitals nationwide. Unlike other hospital studies, Healthgrades ratings are based solely on what matters most: patient outcomes. The 2024 Healthgrades analysis revealed significant variation in hospital performance, making it increasingly important to seek care at top-rated programs. From 2020-2022, if all hospitals, as a group, performed similarly to America’s 250 Best Hospitals, on average, 178,402 lives could potentially have been saved.*
“Healthgrades commends Mather Hospital for their leadership and continued dedication to high quality care,” said Brad Bowman, MD, Chief Medical Officer and Head of Data Science at Healthgrades. “As one of America’s 250 Best Hospitals, Mather Hospital is elevating the standard for quality care nationwide and ensuring superior outcomes for the patients in their community.”
Consumers can visit Healthgrades.com to learn more about how Healthgrades measures hospital quality and access a patient-friendly overview of how we rate and why hospital quality matters here.
*Statistics are based on Healthgrades analysis of MedPAR data for 2020 through 2022 and represent three-year estimates for Medicare patients only. Click here to view the complete 2024 America’s Best Hospital Awards Methodology.
Heart disease risk is influenced by family history and by lifestyle, including diet. But what if we could tackle genetic issues with diet?
A study involving the Paleo-type diet and other ancient diets suggests that there is a significant genetic component to cardiovascular disease, while another study looking at the Mediterranean-type diet implies that we may be able to reduce our risk factors with lifestyle adjustments. Most of the risk factors for heart disease, such as high blood pressure, high cholesterol, sedentary lifestyle, diabetes, smoking and obesity are modifiable (1). Let’s look at the evidence.
The role of genes in heart disease
Researchers used computed tomography scans to look at 137 mummies from ancient times across the world, including Egypt, Peru, the Aleutian Islands and Southwestern America (2). The cultures were diverse, including hunter-gatherers (consumers of a Paleo-type diet), farmer-gatherers and solely farmers. Their diets were not vegetarian; they involved significant amounts of animal protein, such as fish and cattle.
Researchers found that one-third of these mummies had atherosclerosis (plaques in the arteries), which is a precursor to heart disease. The ratio should sound familiar. It aligns with what we see in modern times.
The authors concluded that atherosclerosis could be part of the aging process in humans. In other words, it may be a result of our genes. Being human, we all have a genetic propensity toward atherosclerosis and heart disease, some more than others, but many of us can reduce our risk factors significantly.
However, other studies demonstrate that we can reduce our chances of getting heart disease with lifestyle changes, such as with a plant-rich diet, such as a Mediterranean-type diet.
Does diet affect our genetic response?
A New England Journal of Medicine study explores the Mediterranean-type diet and its potential impact on cardiovascular disease risk (3). Here, two variations on the Mediterranean-type diet were compared to a low-fat diet, with participants randomly assigned to three different groups. The two Mediterranean-type diet groups both showed about a 30 percent reduction in the risk of cardiovascular disease, compared to the low-fat diet. Study end points included heart attacks, strokes and mortality. Interestingly, risk improvement in the Mediterranean-type diet arms occurred even though there was no significant weight loss.
The study included three groups: a Mediterranean diet supplemented with mixed nuts (almonds, hazelnuts or walnuts), a Mediterranean diet supplemented with extra virgin olive oil (at least four tablespoons a day), and a low-fat control diet. The patient population included over 7,000 participants in Spain at high risk for cardiovascular disease.
The Mediterranean-type diet arms both included significant amounts of fruits, vegetables, nuts, beans, fish, olive oil and wine. I call them “Mediterranean diets with opulence,” because both groups consuming this diet had either significant amounts of nuts or olive oil and/or wine. If the participants in the Mediterranean diet groups drank wine, they were encouraged to drink at least one glass a day.
The strength of this study, beyond its high-risk population and its large size, was that it was a randomized clinical trial, the gold standard of trials. However, there was a significant flaw, and the results need to be tempered. The group assigned to the low-fat diet was not, in fact, able to maintain this diet throughout the study. Therefore, it really became a comparison between variations on the Mediterranean diet and a standard diet.
What do the leaders in the field of cardiovascular disease and integrative medicine think of the Mediterranean diet study? Interestingly there are two opposing opinions, split by field. You may be surprised by which group liked it and which did not.
Cardiologists, including well-known physicians Henry Black, M.D., who specializes in high blood pressure, and Eric Topol, M.D., former chairman of cardiovascular medicine at Cleveland Clinic, hailed the study as a great achievement. This group of physicians emphasized that now there is a large, randomized trial measuring meaningful clinical outcomes, such as heart attacks, stroke and death.
On the other hand, the integrative medicine physicians, Caldwell Esselstyn, M.D., and Dean Ornish, M.D., both of whom stress a plant-rich diet that may be significantly more nutrient dense than the Mediterranean diet in the study, expressed disappointment with the results. They feel that heart disease and its risk factors can be reversed, not just reduced. Both clinicians have published small, well-designed studies showing significant benefits from plant-based diets (4, 5). Ornish showed a reversal of atherosclerosis in one of his studies (6).
So, who is correct about the Mediterranean diet? Each opinion has its merits. The cardiologists’ enthusiasm is warranted, because a Mediterranean diet, even one of “opulence,” will appeal to more people, who will then realize the benefits. However, those who follow a more focused diet, with greater amounts of nutrient-dense foods, will potentially see a reversal in heart disease, minimizing risk — and not just reducing it.
So, what have we learned? Even with a genetic propensity for cardiovascular disease, we can alter our cardiovascular destinies with diet.
References:
(1)www.uptodate.com (2) BMJ 2013;346:f1591. (3) N Engl J Med 2018; 378:e34. (4) J Fam Pract. 1995;41(6):560-568. (5) Am J Cardiol. 2011;108:498-507. (6) JAMA. 1998 Dec 16;280(23):2001-2007.
Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.
For the first time since May 2023, Brookhaven National Laboratory required masks on site at its facility starting on Jan. 8, as the rate of hospital admissions for the virus that caused the pandemic climbed.
Following the Safer Federal Workforce Task Force, BNL, which is a Department of Energy-sponsored site, reinstituted the mask policy once Covid admissions climbed above 20 per 100,000 people in the county, as determined by the Centers for Disease Control and Prevention data.
The CDC level rose to 24.8 on the evening of Jan. 5 and the lab re-implemented its mask requirement on the following Monday. Area doctors said they’ve seen an increase in illnesses tied to Covid, particularly after people traveled during the December holidays.
“We’ve seen a lot more Covid,” said Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital.
Dr. Nachman said people who are talking to friends and neighbors are hearing regularly about those who are sick with Covid.
Stony Brook University Hospital is not requiring masking at all times. The hospital is recommending that people consider wearing masks. Medical staff entering patient rooms are wearing them.
People walking into the hospital will see “more people wearing masks” in general, she added. In addition to Covid, hospitals in the area are also seeing a “huge amount of flu,” Dr. Nachman said.
Most of the time, the fungus Candida albicans, which is ubiquitous on the skin, inside people’s mouths, throat, and guts, among other places, doesn’t cause problems. It can, however, be an opportunistic infection, particularly in people who are immunocompromised, leading to serious illness and even death.
Antifungal infections work best during the early stage of an infection. Once a severe infection becomes established, it responds less well to drugs, as resistance can become a problem.
James “Jamie” Konopka, Professor in the Department of Microbiology and Immunology in the Renaissance School of Medicine at Stony Brook University, is working to find the mechanism that enables C. albicans to resist attack by the immune system. His long term goal is to identify ways to make the fungus more vulnerable to immune defenses.
In a paper published recently in the journal mBio, which is published by the American Society of Microbiology, Konopka identified the mechanism by which hypochlorous acid, which is produced by cells in the immune system, attacks C. albicans.
He expanded this by testing forms of the fungus that lack specific genes. These mutants can be more vulnerable to attack by hypochlorous acid, which is produced by neutrophils and is also called “human bleach.” Longer term, Konopka hopes to find ways to sensitize the fungus to this acid, which would bolster the ability of the immune system to respond to an infection.
His study showed that hypochlorous acid disrupts the plasma membrane, which is a layer of lipids that surround the cell. Once this is breached, parts of the cell leak out, while more bleach can damage the fungus.
Hypochlorous acid reacts with proteins, lipids and DNA.
The activated immune system produces several chemicals known as “reactive oxygen species.” In some cells, particularly neutrophils, hydrogen peroxide is converted into hypochlorous acid to strengthen and diversify the attack.
To be sure, the discovery of the mechanism of action of hypochlorous acid won’t lead to an immediate alternative therapeutic option, as researchers need to build on this study.
Future studies will examine how some genes promote resistance, and which are likely to be the most promising targets for drug development, Konopka explained.
Increase sensitivity
These are C. albicans cells growing invasively into tissue in a mouse model of an oral infection. The candida hyphae are stained black, and the tissue is stained a blue/green. Image from James Konopka
Konopka suggested that increasing the sensitivity of the fungus to hypochlorous acid would likely prove more effective and less potentially toxic than increasing the amount of the acid, which could also damage surrounding tissue.
“Our idea is to sensitize fungal pathogens” to hypochlorous acid “rather than upping the dose of bleach, which could lead to negative consequences,” Konopka said. Ideally, he’d like to “take the normal level and make it more effective” in eradicating the fungus.
Other scientists funded by the National Institutes of Health created a set of about 1,000 different strains of the fungus, which provides a valuable resource for Konopka and others in the scientific community.
In a preliminary screen of plasma membrane proteins, Konopka and his team found that most of the mutants had at least a small increase in sensitivity. Some, however, had stronger effects, which will guide future experiments.
One of the challenges in working with a fungus over pathogens like bacteria or viruses is that fungi are more closely related biologically to humans. That means that an approach that might weaken a fungus could have unintended and problematic consequences for a patient.
“Although they may look very different on the outside, the inner workings of fungi and humans are remarkably similar,” Konopka explained in an email. This has made it difficult to find antifungal drugs that are not toxic to humans.
An ‘overlooked’ ally
Konopka suggested that scientists have been studying hydrogen peroxide, which is also made by immune system combatants like macrophages and neutrophils.
“It seemed to us that somehow bleach had been overlooked,” Konopka said. “It hadn’t been studied in the fungal world, so we launched” their research.
Konopka also believes the plasma membrane represents an effective place to focus his efforts on developing new drugs or for making current drugs more effective.
Hydrochlorous acid “fell into our wheel house,” he said. In initial tests, Konopka discovered that human bleach caused damage to the membrane within minutes if not sooner, allowing outside molecules to enter freely, which could kill the potentially dangerous infection.
Considering the ubiquitous presence of the fungus, immunocompromised people who might conquer an infection at any given time could still be vulnerable to a future attack, even after an effective treatment. Even people with a healthy immune system could be reinfected amid a large enough fungal load from a biofilm on a medical device or catheter.
Providing vulnerable people with a prophylactic treatment could lower the risk of infection. When and if those patients develop an ongoing and health-threatening infection, doctors could use another set of drugs, although such options don’t currently exist.
In other work, Konopka has identified proteins in C. albicans that help CoQ, or ubiquinone, protect the plasma membrane from oxidation by agents such as hydrogen peroxide and hypochlorous acid.
People can purchase ubiquinone at local stores, although Konopka urges residents to check with their doctors before taking any supplement.
Fish and beer
An organizer of a department wide Oktoberfest, Konopka was pleased that faculty, post doctoral researchers and students were able to decompress and enjoy the fall festival together for the first time since 2019.
In addition to a range of beer, attendees at the event, which occurred half way between the start of the semester and final exams, were able to partake in German food from Schnitzels in Stony Brook Village, which was a big hit.
An avid fly fisherman who catches and releases fish, Konopka said he caught some bigger striped bass this year than in previous years.
When he’s fishing, Konopka appreciates the way the natural world is interconnected. He pays attention to variables like the weather, water temperature, bait fish and the phases of the moon.
He particularly enjoys the wind and fresh air. This year, Konopka marveled at the sight of a bald eagle.
As for his work, Konopka said basic research may have an immediate effect or may contribute longer term to helping others in the scientific community build on his results, which could lead to the next breakthrough.
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