Health

Inflammatory responses are at the heart of allergy symptoms        

By David Dunaief, M.D.

Dr. David Dunaief

After last week’s extended blast of winter, we’re all looking forward to warmer weather. This past weekend, we adjusted our clocks for Daylight Saving Time, the unofficial end of winter. We’re just a few weeks out from tree buds and daffodil sprouts. What joy!

However, for people who suffer from seasonal allergic rhinitis, hay fever, seasonal allergies or whatever you would like to call it, life is about to get miserable.

Just over 19 million U.S. adults were diagnosed with seasonal allergies in 2018, and an additional 5.2 million children were diagnosed, according to the Centers for Disease Control and Prevention (1).

The triggers for seasonal allergies are diverse. They include pollen from leafy trees and shrubs, grass and flowering plants, as well as weeds, with the majority from ragweed (mostly in the fall) and fungus (summer and fall) (2).

What triggers allergic reactions? 

A chain reaction occurs in seasonal allergy sufferers. When foreign substances such as allergens (pollen, in this case) interact with immunoglobulin E (IgE), antibodies that are part of our immune system, they cause mast cells in the body’s tissues to degrade and release inflammatory mediators. These include histamines, leukotrienes and eosinophils in those who are susceptible. In other words, it is an allergic inflammatory response.

The revved up immune system then responds with sneezing; red, itchy and watery eyes; scratchy throat; congestion; sinus headaches; postnasal drip; runny nose; diminished taste and smell; and even coughing (3). Basically, it emulates a cold, but without the virus. If symptoms last more than 10 days and are recurrent, then it is more than likely you have allergies.

If allergic rhinitis is not properly treated, complications such as ear infections, sinusitis, irritated throat, insomnia, chronic fatigue, headaches and even asthma can result (4).

Treating allergies with medications

The best way to treat allergy attacks is to prevent them, but this can mean closing yourself out from the enjoyment of spring by literally closing the windows, using the air-conditioning, and using recycling vents in your car.

On the medication side, we have intranasal glucocorticoids (steroids), oral antihistamines, allergy shots, decongestants, antihistamine and decongestant eye drops, and leukotriene modifiers (second-line treatment only).

The guidelines for treating seasonal allergic rhinitis with medications suggest that intranasal corticosteroids (steroids) should be used when quality of life is affected. If there is itchiness and sneezing, then second-generation oral antihistamines may be appropriate (5). Two well-known inhaled steroids are Nasacort (triamcinolone) and Flonase (fluticasone propionate). While inhaled steroids are probably most effective in treating and preventing symptoms, they need to be used every day and do have side effects.

Oral antihistamines, on the other hand, can be taken on an as-needed basis. Second-generation antihistamines, such as loratadine (Claritin), cetirizine (Zyrtec) and fexofenadine (Allegra), have less sleepiness as a side effect than first-generation antihistamines.

Possible alternative treatments

Butterbur (Petasites hybridus), an herb, has several small studies that indicate its efficacy in treating hay fever. In one randomized controlled trial (RCT) involving 131 patients, results showed that butterbur was as effective as cetirizine (Zyrtec) in treating this disorder (6).

In another RCT, results showed that high doses of butterbur — 1 tablet given three times a day for two weeks — was significantly more effective than a placebo (7). Researchers used butterbur Ze339 (carbon dioxide extract from the leaves of Petasites hybridus L., 8 mg petasines per tablet) in the trial.

A post-marketing follow-up study of 580 patients showed that, with butterbur Ze339, symptoms improved in 90 percent of patients with allergic rhinitis over a two-week period (8). Gastrointestinal upset occurred as the most common side effect in 3.8 percent of the population.

The caveats to the use of butterbur are several. First, the studies were short in duration. Second, the leaf extract used in these studies was free of pyrrolizidine alkaloids (PAs). This is very important, since PAs may not be safe. Third, the dose was well-measured, which may not be the case with over-the-counter extracts. Fourth, there are interactions with some prescription medications.

Can you treat allergies with diet?

While there are no significant studies on diet, there is one review of literature that suggests that a plant-based diet may reduce symptoms of allergies, specifically rhinoconjunctivitis, affecting the nose and eyes, as well as eczema and asthma. This is according to the International Study of Asthma and Allergies in Childhood study in 13- to 14-year-old teens (9). In my clinical practice, I have seen patients who suffer from seasonal allergies improve and even reverse the course of allergies over time with a vegetable-rich, plant-based diet, possibly due to its anti-inflammatory effect.

While allergies can be miserable, there are a significant number of over-the-counter and prescription options to help reduce symptoms. Diet may play a role in the disease process by reducing inflammation, though there are no formal studies. There does seem to be promise with some herbs, especially butterbur. However, alternative supplements and herbs lack large, randomized clinical trials with long durations. Always consult your doctor before starting any supplements, herbs or over-the-counter medications.

References: 

(1) CDC.gov. (2) acaai.org/allergies/types/pollen-allergy. (3) J Allergy Clin Immunol. 2003 Dec;112(6):1021-31.. (4) J Allergy Clin Immunol. 2010 Jan;125(1):16-29.. (5) Otolaryngol Head Neck Surg. 2015 Feb;2:197-206. (6) BMJ 2002;324:144. (7) Arch Otolaryngol Head Neck Surg. 2004 Dec;130(12):1381-6. (8) Adv Ther. Mar-Apr 2006;23(2):373-84. (9) Eur Respir J. 2001;17(3):436-443.

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. 

This LINCATS map shows the hospitals, incubators and collaborative institutions that will be involved in the regional initiative to translate biomedical discoveries into clinical applications to improve health outcomes, address health disparities across communities, and educate the workforce.

The initiative, secured by Senator Schumer, will receive $10 million in federal funds

Stony Brook University will lead a new, innovative network of regional biomedical research institutions to accelerate translational research that will impact and advance clinical care for many physical and mental health conditions. Called the Long Island Network for Clinical and Translational Science (LINCATS), it will be headquartered at Stony Brook University. The initiative will be in collaboration with Brookhaven National Lab (BNL), Cold Spring Harbor Laboratory, and the Northport VA Medical Center. Central to LINCATS establishment is $10 million in federal funding secured by Senator Chuck Schumer and supported by Senator Gillibrand, part of Congress’ omnibus funding bill of which Long Island will receive some $50 million.

The overall mission of LINCATS is to accelerate the public health impact of research, especially for underserved communities across Long Island, by offering access to innovative and transformative research programs and educational services. To improve the health of Long Island’s three million-plus population, the bioscience collaborative will engage in work ranging from basic research and clinical trials, to addressing vulnerable populations and disparities, and incorporating innovative research and practices such as the use of bioinformatics, artificial intelligence, telehealth, genotyping, proteomics, and engineering-driven medicine.

“I am incredibly grateful to Senator Schumer for securing such crucial funding for the establishment of the Long Island Network for Clinical and Translational Science (LINCATS) at Stony Brook University,” said Stony Brook University President Maurie McInnis. “Through LINCATS, the entire Long Island community and the greater New York region will have access to a comprehensive health research network that is capable of a rapid response to emergent healthcare risks, including a future global pandemic. New York and the nation are fortunate to have such a visionary leader as Senator Schumer, who champions the cutting-edge science research and health innovation that will provide important and much-needed economic boosts to development on Long Island.”

The initial funding will help to scale-up operations of this research and healthcare service network, creating an ecosystem that will fast-track the application of new scientific discoveries in clinical medical care, helping to provide new treatments to more patients throughout Long Island.

“With renowned institutions like BNL, Cold Spring Harbor Lab, and Stony Brook University, Long Island is a hub for world-class scientific research and groundbreaking discoveries,” said Senator Chuck Schumer. “To bolster continued success and innovation, I worked to ensure that, as part of Congress’s historic bipartisan budget agreement, $10 Million will head to Stony Brook to help create the Long Island Network for Clinical and Translation Science. This federal funding will help scale-up operations of this research and healthcare service network, creating an ecosystem that will fast-track the application of new scientific discoveries in clinical medical care. Not only will LINCATS put Long Island on the map as a center of clinical healthcare research, it will help provide innovative new treatments to benefit more patients throughout the region.“

One specific aspect of the collaborative work will be researching and addressing diseases and environmental factors that are prevalent on Long Island, such as Lyme disease, emerging pathogens and environmental risks due to the impact of climate change on coastal resiliency, as well as the unique challenges related to opiate addiction.

“LINCATS is Stony Brook’s response to the National Institutes of Health’s call to action to create research hubs designed to expand and elevate the bench-to-bedside ecosystem within communities nationwide,” said Richard J. Reeder, PhD, Vice President for Research at Stony Brook University. “We are fully committed to supporting this prominent team of biomedical researchers and practitioners who are set to lead and deliver groundbreaking discoveries.”

LINCATS will also serve as a catalyst to create hundreds of new jobs in the bioscience sector, and potentially thousands of jobs when the infrastructure is fully operational. The network will provide a workforce of both scientists and clinicians from multiple institutions working in partnership with all communities across Long Island to address all health care challenges.

Anissa Abi-Dargham, MD, SUNY Distinguished Professor, Vice Chair for Research and the Lourie Endowed Chair in Psychiatry, will serve as the Principal Investigator and Director of LINCATS. The LINCATS leadership team at Stony Brook includes 17 members, virtually all of whom are prominent faculty scientists and medical scientists in multiple fields at the University, such as Pharmacological Sciences, Infectious Diseases, Biotechnology, and Public Health.

“I am extremely thankful for Senator Schumer’s support of LINCATS. The funds will allow us to deepen our investments in the infrastructure, training, and community engagement pillars necessary to fulfill the mission of LINCATS,” says Dr. Abi-Dargham. “I am also grateful for the team of scientists, educators and community members who worked with me to develop the large collaborative project, and for the assistance of the Office of Proposal Development under the direction of Nina Maung.”

When the program is officially in place, funds will also be used for core personnel, supplies and equipment, support for multidisciplinary research, and the construction of an inpatient research unit at Stony Brook Hospital for the purpose of translational and clinical biomedical research.

 

During the height of the pandemic, a COVID-19 drive-thru testing area was set up in the South P Lot of Stony Brook University. Photo by Stony Brook Medicine

This week marked two years after the World Health Organization declared COVID-19 a pandemic, leading to the shutdown of schools, the closing of businesses, a surge in emergency room visits, and a desperate search for treatments to a new disease that was sickening and killing people around the world.

Pastor Doug Jansson, below, of Living Word Church in Hauppauge hugs his family while in SBU hospital for COVID-19. Photo from Stony Brook Medicine

For health care providers, life two years after the pandemic has dramatically improved from those first few days when medical professionals had far more questions than answers.

“The cloud that was hanging over our heads seems to have disbursed,” said Dr. Sunil Dhuper, chief medical officer at Port Jefferson’s St. Charles Hospital. “I feel a lot more optimistic now.”

Indeed, Suffolk County officials tracked a host of numbers throughout the pandemic, which carried different meanings at different times. In 2020, state officials considered a 5% positive testing rate as a potential warning sign to consider closing schools. Entering another phase of reopening businesses required that hospitals have at least 30% of their hospital beds available.

Those numbers, fortunately, have declined dramatically, with the current positive seven day testing rate at 1.5% for Suffolk County as of March 15 and 35% of hospital beds available, according to the New York State Department of Health.

Lessons learned

Amid much more manageable levels of COVID-19, health care officials reflected on the last two years.

For Dr. Adrian Popp, chair of Infection Control at Huntington Hospital/Northwell Health, the “most important lesson we have learned is that we can never lose hope,” he said in an email.

Despite an initial United States response to the pandemic that Popp described as disorganized and confusing, he said “communities got together fast, local leaders took charge and, I think, we did our best under the circumstances.”

Carol Gomes, chief executive officer for Stony Brook University Hospital, suggested that one of the biggest lessons was to remain flexible, with the “ability to pivot into paradigm shifts that were unimaginable,” she wrote in an email.

She described how most good business practices suggest a just-in-time inventory, which is efficient and cost effective.

“During the pandemic, when the national supply chain was considerably weakened, we shifted to an entirely different model and now focus on stockpiling key supplies to ensure continuity of services,” Gomes wrote in an email.

Stony Brook Hospital has dedicated more space to ensure the availability of supplies by securing additional warehouse facilities, Gomes said.

Dhuper said a high level of coordination and cooperation in health care created the ability to “work wonders. A classic example of that is the mRNA COVID-19 vaccines. I think it has been a phenomenal accomplishment and a true game changer,” Dhuper said.

Signage outside of Stony Brook University Hospital. Photo from Stony Brook Medicine

Low point

Amid a series of challenges over the last two years, health care professionals also described some of the low points.

Popp recalled April of 2020, when COVID hit one of the nursing homes in the community. Of the 50 elderly residents under his care, 24 died in the span of two weeks. During this time, the hospital couldn’t even test for COVID. Popp described the losses as “heartbreaking.”

Dhuper, meanwhile, pointed to the roller coaster created by variants that brought concerns about infections and sicknesses back even as vaccinations seemed to create a viral firewall.

The delta variant followed by omicron “eroded confidence” in the viral response, as millions of people contracted variants that were more infectious than the initial Wuhan strain.

Monoclonal antibodies were also not as effective against these strains, which was “another blow,” Dhuper said. “Everything seemed like there was no end in sight and we were not going to come out of it” any time soon.

Message from 2020

If he could go back in time and provide advice to health care providers and the public in the early stages of the pandemic, Dhuper said he would encourage more mask wearing, particularly before vaccines became available.

“The mask was the only guaranteed protection in the absence of any medications,” Dhuper said. “That message was not very well delivered. Hand washing was good, but masks definitely helped.”

Gomes would urge the 2020 version of herself to remain on the same path traveled, which is to focus on the “safety and well being of our community, including our staff, faculty, patients and community at large,” she explained in an email. “What has worked well in the past may not necessarily help with a new crisis. Flexibility is key.”

Next steps

Recognizing the burden COVID-19 placed on health care providers, area hospitals have focused resources on the mental health strain.

Stony Brook has “significantly expanded its resources to provide support and assistance for health care staff,” Gomes explained. Resilience at Stony Brook is a special location within the hospital dedicated for staff and faculty that includes pet therapy, aromatherapy, massage chairs, counseling services, mindfulness and meditation classes, among other options.

Stony Brook also has a crisis management intervention team to support staff and faculty.

Outside the clinical setting, Dr. Adam Gonzalez, director of the Mind-Body Clinical Research Center and assistant professor of Psychiatry at the Renaissance School of Medicine at Stony Brook University, said several studies have shown a rise in anxiety and depression across the country and increases in suicide ideation for sub-groups.

Stony Brook Medicine launched depression screening throughout its practices to identify those in need of mental health care.

Positive signs

Health care providers appreciated the support they received from the community and the collaborative spirit that strengthened the medical community.

“We functioned as a team often working with health care providers that were not our usual team members,” Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital, explained in an email. “It was not uncommon to see adult and pediatric physicians covering care of COVID-infected patients or working with residents across the spectrum of specialties making rounds together.”

For many health care workers, including Popp, the support from the community for health care workers was helpful and inspiring.

“I saw people and businesses alike help frontline workers in any way they could, making masks, bringing in food to the hospital, helping quarantined people with food shopping,” Dr. Popp wrote in an email.

Charles K. Vorkas, MD

A Stony Brook University physician-scientist has identified that mucosal-associated invariant T (MAIT) cells, an unconventional form of immune cell, exercise several complex roles during healthy and disease states. The findings, published in the Journal of Immunology, the flagship journal of the American Association of Immunologists, may help to serve as a benchmark for future research on MAIT cells as targets for immunotherapies and vaccines.

In recent years, MAIT cells have received increasing attention by researchers because of their abundance in the human body, the fact that they can be rapidly activated by non-peptide vitamin intermediates from microbes, and because of their involvement in both infectious and non-infectious disease processes. Despite emerging interest in MAIT cells, it is not fully understood how they are involved in fighting disease.

“We used single cell RNA sequencing technology and immunologic techniques to reveal that despite being ‘one cell type with a semi-invariant T cell receptor,’ MAIT cells demonstrate marked heterogeneity that recapitulates conventional T cell biology,” explains lead author Charles K. Vorkas, MD, Assistant Professor in the Departments of Medicine, Microbiology and Immunology at the Renaissance School of Medicine at Stony Brook University.

Dr. Vorkas and colleagues demonstrated in the laboratory that this marked heterogeneity includes distinct CD4+ and CD8+ lineages, as well as “killer,” “helper,” and “regulatory” cell phenotypes – an indication that MAIT cells exercise complex functions.

He emphasizes that in light of recent studies showing that MAIT cells respond to infectious diseases like COVID-19, as well as during inflammatory events of autoimmune disease such as in lupus, or during tumorigenesis, a better understanding of their roles will help us to develop new therapies.

Dr. Vorkas and colleagues are now trying to identify MAIT cell subpopulations responding to initial infection with Mycobacterium tuberculosis, the causative agent of TB disease, as well as to tick-borne infections endemic to Long Island. His lab hopes to harness MAIT cells and other innate lymphocyte populations to develop immunotherapeutic alternatives to antibiotic drugs and to design novel vaccines.

This work was supported by the Ludwig Center for Cancer Immunotherapy, the Tri-Institutional TB Research Unit, part of the Tuberculosis Research Units Network through National Institute of Allergy and Infectious Diseases (Grant U19AI111143), National Cancer Institute Grants (P30CA008748 and U54CA209975), a NIAID career development award( K08AI132739), and a Potts Memorial Foundation Award.

 

Avocados are a great source of micronutrients. METRO photo
Improving calorie quality makes a difference

By David Dunaief, M.D.

Dr. David Dunaief

The road to weight loss, or even weight maintenance, is complex. Many things influence our eating behavior, including food addictions, boredom, lack of sleep and stress. This can make weight management or weight loss very difficult to achieve.

Unfortunately, awareness of a food’s caloric impact doesn’t always matter, either. Studies assessing the impact of nutrition labeling in restaurants gave us a clear view of this issue: knowing an item’s calories either doesn’t alter behavior or encourages higher calorie purchases (1, 2).

Does this mean we are doomed to acquiesce to food temptation? Actually, no: It is not solely about willpower. Changing diet composition is more important.

In my clinical experience, increasing the quality of food has a tremendous impact. Foods that are the most micronutrient dense, such as plant-based foods, rather than those that are solely focused on macronutrient density, such as protein, carbohydrates and fats, tend to be the most satisfying. In a week to a few months of focusing on micronutrients, one of the first things patients notice is a significant reduction in cravings. But don’t take my word for it. Let’s look at the evidence.

Refined carbohydrates

Many of us know that refined carbohydrates are not beneficial. Worse, however, a randomized control trial (RCT) showed refined carbohydrates may cause food addiction (3). Certain sections of the brain involved in cravings and reward are affected by high-glycemic foods, as shown by MRI scans of trial subjects.

Study participants consumed a 500-calorie shake with either a high-glycemic index or a low-glycemic index. They were blinded (unaware) as to which they were drinking. The ones who drank the high-glycemic shake had higher levels of glucose in their blood initially, followed by a significant decline in glucose levels and increased hunger four hours later. The region of the brain that is related to addiction, the nucleus accumbens, showed a spike in activity with the high-glycemic intake.

According to the authors, this effect may occur regardless of the number of calories consumed. Granted, this was a very small study, but it was well designed. High-glycemic foods include carbohydrates, such as white flour, sugar and white potatoes. The conclusion: Everyone, but especially those trying to lose weight, should avoid refined carbohydrates. Calorie composition matters.

Comparing macronutrients

We tend to focus on macronutrients when looking at diets. These include protein, carbohydrates and fats, but are these the elements that have the greatest impact on weight loss? In an RCT, when comparing different macronutrient combinations, there was very little difference among groups, nor was there much success in helping obese patients reduce their weight (4, 5). Only 15 percent of patients achieved a 10 percent reduction in weight after two years.

The four different macronutrient diet combinations involved overall calorie restriction. In addition, each combination had either high protein, high fat; average protein, high fat; high protein, low fat; or low protein, low fat. Carbohydrates ranged from low to moderate (35 percent) in the first group to high (65 percent) in the last group. This was another well-designed study, involving 811 participants with an average BMI of 33 kg/m², which is classified as obese.

Again, focusing primarily on macronutrient levels and calorie counts did very little to improve results.

Micronutrient deficiency

In an epidemiological study looking at National Health and Nutrition Examination Survey data, results demonstrate that those who are overweight and obese tend to be lacking in micronutrients (6). These include carotenoids, such as lutein, zeaxanthin, beta-carotene, alpha-carotene and beta-cryptoxanthin, as well as vitamin B12, folate and vitamins C, E and D.

Unfortunately, taking supplements won’t solve the problem; supplements don’t compensate for missing micronutrients. Quite the contrary, micronutrients from supplements are not the same as those from foods. With a few exceptions, such as vitamin D and potentially B12, most micronutrient levels can be raised without supplementation, by adding variety to your diet. Please ask your doctor.

Cortisol levels

The good news is that once people lose weight, they may be able to continue to keep the weight off. In a prospective (forward-looking) study, results show that once obese patients lose weight, the levels of cortisol metabolite excretion decrease significantly (7).

Why is this important? Cortisol is a glucocorticoid, which means it raises the level of glucose and is involved in mediating visceral or belly fat. This type of fat has been thought to coat internal organs, such as the liver, and result in nonalcoholic fatty liver disease. Decreasing the level of cortisol metabolite may also result in a lower propensity toward insulin resistance and may decrease the risk of cardiovascular mortality. This is an encouraging preliminary, yet small, study involving women.

Controlling or losing weight is not solely about willpower or calorie-counting. While calories have an impact, the nutrient density of the food may be more important. Thus, those foods high in a variety of micronutrients may also play a significant role in reducing cravings, ultimately helping to manage weight.

References: 

(1) Am J Pub Health 2013 Sep 1;103(9):1604-1609. (2) Am J Prev Med.2011 Oct;41(4):434–438. (3) Am J Clin Nutr Online 2013;Jun 26. (4) N Engl J Med 2009 Feb 26;360:859. (5) N Engl J Med 2009 Feb 26;360:923. (6) Medscape General Medicine. 2006;8(4):59. (7) Clin Endocrinol.2013;78(5):700-705.

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.

Photo from Attorney General's Office

New York Attorney General Letitia James today delivered more than $640,000 to five nonprofit organizations that are leading the fight against breast cancer. The funds were recovered by the Office of the Attorney General (OAG) from organizations and individuals who defrauded New Yorkers into making donations that went into the pockets of telemarketers.

The OAG recovered the funds from the Breast Cancer Survivors Foundation, Inc. (BCSF), a sham organization, and Garrett Morgan, a telemarketer who misled donors into contributing to a sham breast cancer organization on Long Island. The $644,054.79 in restitution was distributed to the American Cancer Society, Living Beyond Breast Cancer, West Islip Breast Cancer Coalition, Babylon Breast Cancer Coalition, and Manhasset Women’s Coalition Against Breast Cancer.

“It is unconscionable that organizations and telemarketers preyed on the public’s generosity and deprived breast cancer patients of vital support during a time of tremendous physical, mental, and emotional distress,” said Attorney General James. “Today, I am honored to return these funds to the people and organizations that need them most. My office is proud to be a partner to these five incredible organizations and help them in supporting breast cancer patients and survivors throughout their journey.”

In 2017, OAG announced an agreement with BCSF and its president and founder. The BCSF posed in phone and mail solicitations as a medical center for breast cancer patients, when in reality it was a shell organization funneling donations to an outside fundraiser, which pocketed 92 cents of every dollar donated to BCSF. The OAG’s agreement required BCSF to shut down immediately and pay more than $300,000 in restitution, the last of which was received by OAG in 2021. The OAG also obtained $40,000 from BCSF’s auditors, McEnerney, Brady & Company LLC and Edmund Brady.

In 2013, OAG won a judgment against Garrett Morgan for fraud in raising funds for the Coalition Against Breast Cancer, a sham Long Island organization. The organization raised millions of dollars with solicitations that claimed there was a “mammography fund,” when there was none, and that donations would provide free mammograms to uninsured women. Morgan did not pay the judgment and, acting on a motion by OAG, the court appointed a receiver to collect or sell Morgan’s property to satisfy the judgment. In 2021, the receiver delivered $303,747.86 to OAG.

The OAG’s Charities Bureau selected five nonprofit organizations to receive the restitution funds, including:

The American Cancer Society ($314,054.79): The American Cancer Society will use the award to support an initiative that increases breast cancer screening in high poverty areas, including screening among women who have never been screened before or who are not up to date with screening. The initiative focuses on uninsured and underinsured women by partnering with community health centers. With funds from OAG, the American Cancer Society will launch a new cohort of community health centers to participate in the mammogram initiative.

“The American Cancer Society is committed to expanding access to care for all and removing barriers that prevent cancer patients from getting the care and treatment they need,” said Dr. Karen Knudsen, CEO, American Cancer Society. “The pandemic brought about dramatic declines in breast cancer screenings. We are grateful that funds from the New York Attorney General’s Office will expand our lifesaving initiative to increase cancer screening rates and ultimately save lives.”

Photo from Attorney General’s Office

Living Beyond Breast Cancer ($225,000): Living Beyond Breast Cancer, a national nonprofit organization, will use the award to support its Living Beyond Breast Cancer Fund, which provides one-time grants to help those on limited incomes manage the financial burden of breast cancer. Grants range from $500 to $1,000 and are for living expenses. Grants are paid directly to vendors or billers. Recipients of the one-time grants must be in active treatment for breast cancer or living with metastatic breast cancer, and have a household income under 400 percent of the U.S. federal poverty line.

“We are honored to have been selected by the New York Attorney General’s Office,” said Jean Sachs, CEO, Living Beyond Breast Cancer. “Living Beyond Breast Cancer was founded over 30 years ago to offer trusted information and a community of support for all people directly impacted by breast cancer. We annually serve over 600,000 people across the country. A critical program of ours is the Living Beyond Breast Cancer Fund, a financial assistance program that pays the bills for women in treatment for basic needs such as rent, utilities, and transportation. Since 2006, we have been able to disburse over 3,150 grants for an approximate total of $2,530,000 to women and their families. Since the pandemic began, we have doubled the number of grants available to give to recipients as a way to alleviate financial hardship faced by so many across the country. The funds provided by the New York Attorney General’s Office will allow us to continue this intensive support, and help women in treatment focus on their health and not on their bills.”

West Islip Breast Cancer Coalition on Long Island ($30,000): West Islip Breast Cancer Coalition of Long Island, Inc., will use the award to provide patients undergoing breast cancer treatment with services such as transportation, meals, childcare, house cleaning, wigs, advice, and support from former cancer patients.

“The West Islip Breast Cancer Coalition for Long Island, Inc. is extremely grateful to the Attorney General’s Office and its commitment to overseeing that funds raised to help women with breast cancer go to legitimate organizations that provide services to the many women on Long Island going through chemotherapy and radiation,” said Margaret Campise, president, West Islip Breast Cancer Coalition. “This award will ensure that many Long Island women will be taken care of through our ‘Lend A Helping Hand’ program, which offers free services like house cleaning, transportation to treatments, co-payments, wigs, prosthesis, and post-operative care. On behalf of the many women going through breast cancer, and the West Islip Breast Cancer Coalition for Long Island, I want to thank the Attorney General’s Office.”

Babylon Breast Cancer Coalition ($35,000): Babylon Breast Cancer Coalition, Inc., will use the award to provide an array of services to patients undergoing treatment for breast cancer and gynecological cancers, including transportation to medical appointments, housekeeping, meals, and childcare as needed during treatment.

“About 1 in 8 U.S. women (13 percent) will develop invasive breast cancer over the course of a lifetime and when that happens a woman’s life, and the lives of those who love her, are thrown into turmoil as she undergoes a horrific treatment ordeal,” said Nick Radesca, volunteer & vice president of finance, Babylon Breast Cancer Coalition. “Because most people’s lives have been impacted by this disease, many willingly donate to breast cancer charities. I want to thank the New York State Attorney General’s Office for bringing unscrupulous individuals to justice and redistributing defrauded donors’ funds to legitimate organizations. Babylon Breast Cancer Coalition, Inc. will use its share to provide free support services such as transportation to and from medical appointments, housecleaning, financial assistance, childcare, meal preparation, and other needed services.”

Manhasset Women’s Coalition Against Breast Cancer ($40,000): Manhasset Women’s Coalition Against Breast Cancer, Inc., will use the award to support its outreach program, which provides services to patients in the form of transportation, childcare, house cleaning, wigs, and non-financial support including advice and general emotional support of other former patients.

“The Manhasset Women’s Coalition Against Breast Cancer congratulates the Office of the New York Attorney General’s Charities Bureau for their efforts in pursuing the shutdown of the Coalition Against Breast Cancer and the Breast Cancer Survivor’s Foundation, both fraudulent organizations,” said Lynn Minutillo, member of board of directors, Manhasset Women’s Coalition Against Breast Cancer. “The MWCABC is so very grateful to be designated as a recipient of funds secured in the settlements of these cases. The women with breast cancer with whom we engage will be better served financially, emotionally, and educationally. Be assured we will strive to be conscientious stewards of the funds entrusted to us.”

The recovered funds distributed today are part of OAG’s Operation Bottomfeeder, which is an initiative of the Charities Bureau to identify fraudulent charities and their fundraisers. This is done through an analysis of annual financial reports, fundraising contracts, and other documents that nonprofit corporations file with the Charities Bureau, and has allowed OAG to take appropriate enforcement action against those engaging in fraud. In 2020, as a part of Operation Bottomfeeder, Attorney General James announced a multi-agency agreement imposing a nationwide, permanent, ban on Outreach Calling, a for-profit fundraiser, from charitable fundraising. To date, Operation Bottomfeeder has recovered approximately $1.7 million from sham charities and their fundraisers and has redistributed that money to legitimate charities.

This matter was handled by Enforcement Section Co-Chief Yael Fuchs and Assistant Attorneys General Peggy Farber, William Wang, and Sharon Sash under the supervision of Charities Bureau Chief James Sheehan and Deputy Bureau Chief Karin Kunstler-Goldman. The Charities Bureau is a part of the Division for Social Justice, which is led by Chief Deputy Attorney General Meghan Faux and overseen by First Deputy Attorney General Jennifer Levy.

Director of the Heart Rhythm Center at Stony Brook Heart Institute Dr. Eric Rashba is holding the new Watchman FLX device, which provides protection from strokes for people with atrial fibrillation. Photo from Stony Brook Medicine

The butterflies that color backyards are welcome companions for spring and summer. The ones that flutter towards the upper part of people’s chests can be discomforting and disconcerting.

In an effort to spread the word about the most common form of heart arrhythmia amid American Heart Month, the Stony Brook Heart Institute recently held a public discussion of Atrial fibrillation, or A-fib.

Caused by a host of factors, including diabetes, chronic high blood pressure, and advanced age, among others, A-fib can increase the risk of significant long-term health problems, including strokes.

In atrial fibrillation, the heart struggles with mechanical squeezing in the top chamber, or the atrium. Blood doesn’t leave the top part of the heart completely and it can pool and cause clots that break off and cause strokes.

Dr. Eric Rashba, who led the call and is the director of the Heart Rhythm Center at Stony Brook Heart Institute, said in an interview that A-fib is becoming increasingly prevalent.

A-fib “continues to go up rapidly as the population ages,” Rashba said. It occurs in about 10% of the population over 65. “As the population ages, we’ll see more of it.”

The Centers for Disease Control and Prevention estimates that 12.1 million people in the United States will have A-fib over the next decade.

As with many health-related issues, doctors advised residents to try to catch any signs of A-fib early, which improves the likely success of remedies like drugs and surgery.

“We prefer to intervene as early as possible in the course of A-fib,” Dr. Ibraham Almasry, cardiac electrophysiologist at the Stony Brook Heart Institute, said during a call with three other doctors. “The triggers tend to be more discreet and localized and we can target them more effectively.”

Different patients have different levels of awareness of A-fib as it’s occurring.

“Every single patient is different,” said Dr. Roger Ran, cardiac electrophysiologist at the Stony Brook Heart Institute. Some people feel an extra beat and could be “incredibly symptomatic,” while others have fatigue, shortness of breath, chest discomfort, and dizziness.

Still other patients “don’t know they are in it and could be in A-fib all the time.”

Doctors on the call described several monitoring options to test for A-fib.

Dr. Abhijeet Singh, who is also a cardiac electrophysiologist at the Stony Brook Heart Institute, described how the technology to evaluate arrhythmias has improved over the last 20 years.

“People used to wear big devices around their necks,” Singh said on the call, which included about 150 people. “Now, the technology has advanced” and patients can wear comfortable patches for up to 14 days, which record every single heartbeat and allow people to signal when they have symptoms.

Patients can also use an extended holter monitor, which allows doctors to track their heartbeat for up to 30 days, while some patients receive implantable recorders, which doctors insert under the skin during a five-minute procedure. The battery life for those is 4.5 years.

Additionally, some phones have apps that record heartbeats that patients can send by email, Singh said. “We have come a long way in a few years.”

Dr. Roger Fan, a cardiac electrophysiologist at the Stony Brook Heart Institute, added that all these technologies mean that “we are virtually guaranteed to get to the bottom” of any symptoms.

Drugs vs. surgery

Doctors offer patients with confirmed cases of A-fib two primary treatment options: drugs or surgery.

The surgical procedure is called an ablation and involves entering the body through veins in the groin and freezing or burning small areas that are interfering with the heart’s normal rhythm. The procedure breaks up the electrical signals in irregular heartbeats.

Performed under general anesthetic, the procedure generally takes two to three hours. Patients can return home the same day as the operation, Rashba said.

As with any surgery, an ablation has some risks, such as stroke or heart attack, which Rashba said are “very rare” and occur in fewer than one percent of the cases. Additionally, patients may have groin complications, although that, too, has declined as doctors have used ultrasound to visualize the blood vessels.

In extremely rare occasions, some patients also have damage to the esophagus behind the heart, said Rashba, who is also a professor of medicine.

For patients experiencing symptoms like A-fib, doctors recommended a trip to the emergency room, at least the first time.

“If it’s not going away, one, you can reassure yourself, two, you can get treatment, and three, you can get a diagnosis quickly,” said Almasry.

The Stony Brook doctors said choosing the best treatment option depends on the patient.

“Everybody has different manifestations of their A-fib,” said Fan.

Among other questions, doctors consider how dangerous the A-fib is for the patients, how severe the symptoms are, and how much they affect the quality of life.

Doctors urged residents to make the kind of healthy lifestyle choices that keep other systems functioning effectively. Almasry cited a direct correlation between obesity and A-fib.

Reducing body weight by 10%, while keeping the weight off, can reduce the likelihood of A-fib recurrence, he said.

METRO photo
Some medication side-effects include increased fall risk

By David Dunaief, M.D.

Dr. David Dunaief

This has been a particularly challenging winter here in the Northeast. Instead of snow, we’ve had a fair amount of ice and variable temperatures that caused snowy surfaces to ice over.

Many older adults are concerned about falling, thus they stayed inside and sedentary. While this addressed the immediate challenge of icy sidewalks, it may have increased their risk of falling in the future.

What drives this concern about falls? Even without icy steps and walkways, falls can be serious for older patients, where the consequences can be devastating. They can include brain injuries, hip fractures, a decrease in functional ability and a decline in physical and social activities (1). Ultimately, a fall can lead to loss of independence (2).

There are many factors. A personal history of falling in the recent past is the most prevalent. However, there are other significant factors, such as age and medication use. Some medications, like antihypertensive medications, which are used to treat high blood pressure, and psychotropic medications, which are used to treat anxiety, depression and insomnia, are of particular concern. Chronic diseases can also contribute.

Circumstances that predispose us to falls also involve weakness in upper and lower body strength, decreased vision, hearing disorders and psychological issues, such as anxiety and depression (3).

Setting yourself up for success

Of the utmost importance is exercise. But what do we mean by “exercise”? We mean exercises involving balance, strength, movement, flexibility and endurance, all of which play significant roles in fall prevention (4). The good news is that many of these can be done inside with no equipment or with items found around the home.

Footwear also needs to be addressed. Nonslip shoes are crucial indoors, and footwear that prevents sliding on ice in winter, such as slip-on ice cleats that fit over your shoes, is a must. In the home, inexpensive changes, like securing area rugs and removing other tripping hazards, can also make a big difference.

Does medication increase risk?

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

High blood pressure medications have been investigated. A well-designed study showed an increase in fall risk in those who were taking high blood pressure medication (5). Those on moderate doses of blood pressure medication had the greatest risk of serious injuries from falls, a 40 percent increase.

Blood pressure medications have significant benefits in reducing the risks of cardiovascular disease and events. Thus, we need to weigh the risk-benefit ratio in older patients before stopping a medication. We also should consider whether lifestyle modifications, which play a significant role in treating this disease, can be substituted for medication (6).

The value of exercise

A meta-analysis showed that exercise significantly reduced the risk of a fall (7). It led to a 37 percent reduction in falls that resulted in injury and a 30 percent reduction in falls requiring medical attention. Even more impressive was a 61 percent reduction in fracture risk.

Remember, the lower the fracture risk, the more likely you are to remain physically independent. The author summarized that exercise not only helps to prevent falls but also fall injuries.

Unfortunately, those who have fallen before, even without injury, often develop a fear that causes them to limit their activities. This leads to a dangerous cycle of reduced balance and increased gait disorders, ultimately resulting in an increased risk of falling (8).

What types of exercise help?

Any consistent exercise program that improves balance, flexibility, and muscle tone and includes core strengthening should help you improve your balance. Among those that have been studied, tai chi, yoga and aquatic exercise have all been shown to have benefits in preventing falls and injuries from falls.

A randomized controlled trial showed that those who did an aquatic exercise program had a significant improvement in the risk of falls (9). The aim of the aquatic exercise was to improve balance, strength and mobility. Results showed a reduction in the overall number of falls and a 44 percent decline in the number of exercising patients who fell during the six-month trial, with no change in the control group.

If you don’t have a pool available, tai chi, which requires no equipment, was also shown to reduce both fall risk and fear of falling in older adults (10).

Another pilot study used modified chair yoga classes with a small assisted living population (11). Participants were those over 65 who had experienced a recent fall and had a resulting fear of falling. While the intention was to assess exercise safety, researchers found that participants had less reliance on assistive devices and three of the 16 participants were able to eliminate their use of mobility assistance devices.

Thus, our best line of defense against fall risk is prevention with exercise and reducing slipping opportunities. Should you stop medications? Not necessarily. But for those 65 and older, or for those who have arthritis and are at least 45 years old, it may mean reviewing your medication list with your doctor. Before you consider changing your blood pressure medications, review your risk-to-benefit ratio with your physician.

References: 

(1) MMWR. 2014; 63(17):379-383. (2) J Gerontol A Biol Sci Med Sci. 1998;53(2):M112. (3) JAMA. 1995;273(17):1348. (4) Cochrane Database Syst Rev. 2012;9:CD007146. (5) JAMA Intern Med. 2014 Apr;174(4):588-595. (6) JAMA Intern Med. 2014;174(4):577-587. (7) BMJ. 2013;347:f6234. (8) Age Ageing. 1997 May;26(3):189-193. (9) Menopause. 2013;20(10):1012-1019. (10) Mater Sociomed. 2018 Mar; 30(1): 38–42. (11) Int J Yoga. 2012 Jul-Dec; 5(2): 146–150.

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. 

White-tailed deer are prevalent on Long Island. METRO photo

By Matthew Kearns, DVM

Dr. Matthew Kearns

I recently saw an article that researchers in Canada were concerned with transmission of COVID-19 from deer (white-tailed deer) to a human, as well as deer. I thought that we only had to worry about white-tailed deer as a reservoir for Lyme disease. Now COVID? Ugghhh!!! 

The Canadian scientists that performed this study did not have definitive proof that the individual that tested positive was infected directly from a deer. However, this individual had the same strain of COVID as the deer in the area and the individual did spend a considerable amount of time around deer.

The good news is a human has a much higher chance of catching COVID from another human than from a deer. Also, the symptoms this individual had were not more severe than a human to human infection. Canadian health officials do caution hunters to take additional precautions such as washing hands thoroughly, wearing goggles, and wearing a well-fitted mask when handling the respiratory tissues of a deer.  

Previously, the only documented cases of animals passing the virus to humans were in mink. Six countries — Denmark, the Netherlands, Spain, Sweden, Italy and the United States — have reported cases of farmed mink infected with the coronavirus to the World Health Organization. Danish authorities also documented over 200 humans that contracted the virus from mink. Unfortunately, many of these minks were required to be culled to prevent further spread. 

The main concern with any animal reservoir is the ability of the COVID, or any coronavirus for that matter, to mutate so easily. 

The good news? Of the 31 species of animals that have been documented infected with COVID, current data shows that dogs and cats are terrible reservoirs of the virus. Although there are documented cases of both dogs and cats testing positive for COVID-19, there is no evidence that a human has been infected directly from a dog or cat. The CDC advises all pet owners to avoid contact with their pets when isolating with an infection (if possible). If a pet is exposed, symptoms are usually very mild or none at all.  

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

Allied Pediatrics celebrated their grand opening on Feb. 16. Photo from Allied Pediatrics

Allied Physicians Group, an independent provider of high-quality comprehensive family health care services for both children and adults, recently held their grand opening and ribbon cutting ceremony for its new office, Allied Pediatrics of Rocky Point, at 346 Route 25A, Rocky Point, on Feb. 16. The new office is the 24th Allied location on Long Island, bringing the total number of pediatric offices in the New York Metropolitan Area to 36, and is also Allied’s first office that has been constructed from the ground up.  

The 5,500 sq. ft., state-of-the-art pediatric office has eight employees, with three pediatricians Dr. Nubia Vargas-Chen, Dr. Eric Levene and Dr. Daniel Freidman. With an urgent need for Pediatricians in the area, these physicians will provide the highest quality of care to all patients in the Rocky Point and surrounding communities.  

The event was attended by Councilwoman Jane Bonner on behalf of the Town of Brookhaven.

Councilwoman Jane Bonner presents Dr. Kerry Fierstein, CEO of Allied Physicians Group, with a Certificate of Congratulations from the Town of Brookhaven on Feb. 16.

“I am very happy to welcome Allied Physicians Group’s to the Rocky Point community. This is an important new business in our community and I wish Dr. Fierstein and her staff the best of luck. We have a growing number of families with young children in the area who will be well served. This new office will be convenient for families living here in Rocky Point and the surrounding area,” said Councilwoman Bonner. 

The Rocky Point office has health safety protocols in place to protect patients from the spread of COVID-19 and other illnesses. Design elements include separate sick and well areas and a state-of-the-art HVAC system with UV lighting to improve air quality. Services for patients and families includes wellness care, vaccinations, sick care, a new parent helpline, breastfeeding support, telehealth services, nutrition assistance, asthma control education (ACE) and community education (webinars, CPR classes). 

“Our experienced pediatricians and clinicians are committed to providing high quality care and exceptional service to families and children of the Rocky Point community,” said Dr. Kerry Fierstein, CEO of Allied Physicians Group. “With a growing number of children in the community, this new office is convenient for families in Rocky Point and the surrounding areas.” 

Pictured in top photo are, from left, Lauren Diguisieppe, Angela Holdorf, Ariele Alon, Angela M. Noncarrow, District Office Director for Senator Palumbo, Pat Athanasakes, Nicole Mann, Dr. Gregson Pigott, Commissioner of the Suffolk County Department of Health Services, Dr. Nubia Vargas-Chen, lead physician at Allied Pediatrics of Rocky Point, Town of Brookhaven Councilwoman Jane Bonner, Dr. Kerry Fierstein, CEO of Allied Physicians Group, Andrew Phillips, Kevin Edwards, SVP of Business Development, Patricia Martin-Quinn, Allen Wirtenson, David Baskin, Jennifer Colamartino, Sylvia DaCunha, Heather Edwards, Executive Director of Allied Foundation, Tina Colangelo, Mary Ellen LaSala, Cathryn Mackie, Margaret Galatioto, Jack Rosebery, Josh Klinger, Brianne Chidichimo, Director of Marketing for Allied Physicians Group.

For more information, call 631-315-7747 or visit www.alliedphysiciansgroup.com.