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Joel Marimuthu, supervisor of rehabilitation services at Huntington Hospital, and physical therapist Ada Kalmar demonstrate some warm-up exercises. Above, an elastic band helps to work on throwing mechanics and sport specific strengthening of the shoulder muscles. Photos by Joseph Colombo

Play ball, carefully.

An intervention a therapist would use for a patient recovering from shoulder surgery. Photo by Joseph Colombo

That’s the advice of area physical therapists and orthopedic surgeons as Major League Baseball returns with a shortened spring training.

Some of the less experienced players, particularly those who might feel they need to prove something each time they step on the field, are especially vulnerable to injuring themselves, suggested Dr. James Penna, orthopedic surgeon and chief of Sports Medicine at Stony Brook Medicine.

“You’ll see the experienced players won’t go through it [but] the injury rate among the [players that have been in the league] for five years and under will be higher,” Penna said.

The challenge for players, even at the professional level, is that their training strengthens their body and increases their speed, but it doesn’t help with the kind of urgency a game situation creates for athletes.

“They’re not doing stuff that’s high stakes,” Penna added. “That’s the real difference.”

Staying busy in leagues where no one is watching and then returning to the bright lights of Yankee Stadium or a nationally televised game can cause stress hormones like cortisol to increase.

“It takes three to six years [as a professional athlete] depending on the sport, where you start to get into a routine where it’s not all energy and angst,” Penna said. The athletes who do the same thing all the time won’t have any change in their bodies or their minds when they return to major league games.

Pitchers are among the most vulnerable baseball athletes, as they may try to stretch themselves out with too many pitches and too many innings quickly, said Joel Marimuthu, supervisor of rehabilitation services at Huntington Hospital.

Looking back at 2020, when spring training was also shortened amid the COVID-19 pandemic, the number of injuries increased, Marimuthu said.

“If the players are watching what happened in 2020, especially with all the increased elbow, shoulder, back, hamstring pulls, they’ll be mindful this season,” Marimuthu said.

Complete preparation for game situations includes a range of training and body conditioning and a gradual increase from working in a gym or on a field somewhere to playing in a game.

“You never want to go from 0 to 60 as an athlete,” said Marimuthu. “You want to come up to speed gradually.”

Training a range of muscles involved in different activities can improve strength and flexibility and reduce the risk of injuries, doctors said.

“We see the most benefit from athletes staying balanced,” Penna said. “If you work on a flexion activity, you have to work on an extension activity. As much as it’s become cliche, you have to cross train.”

Even if athletes don’t participate in different sports, they need to engage in activities such as yoga, pilates and lower body work to prevent injuries, Penna said.

Athletes at any level, who think they might have sustained an injury, run the risk of more significant damage if they play through discomfort that goes beyond the usual wear and tear from sports.

Physical therapists use the acronym PRICE as a guide: protect, rest and ice, Marimuthu said.

College sports injuries

The pandemic has created a similar situation for college athletes, who weren’t able to compete for varying lengths of time amid canceled and shortened seasons.

With fewer games and matches, numerous athletes got injured as they returned to
game action.

“We saw a very, very rapid uptick in injuries,” Penna said.

Athletes had higher injury rates in upper body, lower body and core muscles.

Sports hernias were also prevalent, as student athletes didn’t do enough dynamic exercises to strengthen their core and increase their flexibility.

For female athletes, the injuries to their lower extremities are “through the roof,” Penna said, including to the anterior cruciate ligament in the knee. “The ACL [injury] rates among girls is bad.”

Penna urges athletes not to wear cleats on turf. Even though a sneaker might slip, and athletes might not be able to run as fast, they won’t likely have the kind of tearing that comes from a shoe that’s gripping the ground while the rest of the leg moves in another direction.

Coaches and trainers should “go to great lengths to make sure their quads are balanced with their hamstrings and their core is well maintained,” Penna said.

Young athletes in general ignore their core, which means more than just sit ups. Penna suggested they do more dynamic motions, like lunges.

Penna said it’s natural amid stronger competition for athletes of any level to push themselves to levels that might cause injury.

With so many experts available to help with sports injuries, injured athletes of any age and ability, from weekend warriors to high school and college athletes, have numerous places they can go for advice and care after an injury.

Marimuthu and Penna both suggested that the first point of contact should be a primary care physician.

“I’ve always felt comfortable keeping strong primary care doctors around to keep us honest,” Penna said.

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Stock photo
Dr. Kanika Kaur

Colorectal cancer is the third most common cancer and the second leading cause of cancer death in the United States, yet it is one of the most preventable types of cancer. For 2021, the National Cancer Institute reported nearly 150,000 new cases diagnosed with approximately 53,000 fatalities. Affecting men and women of all racial and ethnic groups, colorectal cancer is most often found in people age 50 and older.

One of the biggest challenges physicians face when discussing colorectal cancer is debunking myths surrounding identifying and treating the disease. Catholic Health Gastroenterologist Kanika Kaur, MD, addressed what she commonly hears from patients.

Myth: There is nothing I can do to lessen my risk of colon cancer.

Fact: There is a lot people can do to reduce their risk of colon cancer. A diet low in red meat and processed meat, high in fruits and vegetables is very important. Smoking is a well-known risk factor for colon cancer along with many other cancers. Also, regular exercise may reduce your risk of developing colorectal cancer. The single biggest modifiable risk factor for colorectal cancer is failure to be screened. Colorectal cancers develop from pre-cancerous polyps, which are growths on the lining of the colon and rectum. Screenings detect and allow doctors to remove polyps before they become cancerous.  Colonoscopy with polyp removal reduces the risk of developed colon cancer by up to 90%

Myth: Colorectal cancer is fatal.

Fact: Colorectal cancer is highly treatable, especially when detected early. More than 90% of patients with a localized cancer that is confined to the colon or rectum are alive five years after diagnosis. Sadly, about only one-third of colorectal cancers are diagnosed at an early stage. A majority of cases are identified when the disease has spread beyond the wall of the colon or rectum and to other parts of the body. This decreases the chances of the cancer being cured.

Myth: I should only have a screening if I have symptoms.

Fact: This is false. The reality is that early colorectal cancer usually has no symptoms. This is why it is important to get screened. It is recommended all men and women age 45 and older should have a screening. Those with a personal or family history of colon cancer, a history of inflammatory bowel disease and those with symptoms such as rectal bleeding are considered at high risk and may need to be screened before the age of 45. Additionally, women with a personal or family history of ovarian, endometrial or breast cancer may also need to be screened at an earlier age.

Myth: Only those with a family history of colon cancer are at risk.

Fact: Nearly three-quarters of all new colorectal cancer cancers are with individuals with no known risk factors for the disease.

Myth: Colorectal cancer affects only older, white men.

Fact: Colorectal cancer impacts men and women. Additionally, people of color are more likely to be diagnosed with colorectal cancer in its advanced stages, suggesting that they may require colon cancer screening at a younger age.

Myth: A colonoscopy is a difficult procedure.

Fact: A colonoscopy is not painful. The most unpleasant part of the procedure is the preparation that is required the day before the exam. But this is important as an inadequate prep may lead to missed findings such as polyps or a need to repeat the procedure.

Myth: Finding a colon or rectal polyp means I have cancer and need surgery.

Fact: A polyp is a pre-cancerous lesion that, if not treated, can progress to cancer. If polyps are detected early and removed before they can progress, colon cancer can be prevented. Colonoscopy and sigmoidoscopy have been shown to prevent deaths from colon cancer – a fact that has been well demonstrated over time. Most polyps are treated by removing them during the colonoscopy. Even large polyps can be removed without surgery. 

More information on Catholic Health’s comprehensive colorectal cancer and digestive health services may be found by visiting chsli.org. To find a Catholic Health physician near you, please call (866) MY-LI-DOC.

About Catholic Health

Catholic Health is an integrated system encompassing some of the region’s finest health and human services agencies. The health system has 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices.

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Photo from Pixabay
Medications and lifestyle changes can reduce your risk

By David Dunaief, M.D.

Dr. David Dunaief

With all of the attention on infectious disease prevention these past two years, many have lost sight of the risks of heart disease. Despite improvements in the numbers in recent years, heart disease still underpins one in four deaths in the U.S., making it the leading cause of death (1).

Heart disease is on the decline due to a number of factors, including better awareness in lay and medical communities, improved medicines, earlier treatment of risk factors and lifestyle modifications. We are headed in the right direction, but we can do better. Heart disease is something that is eminently preventable.

Reduce your baseline risks

Significant risk factors for heart disease include high cholesterol, high blood pressure and smoking. In addition, diabetes, excess weight and excessive alcohol intake increase your risks. Unfortunately, both obesity and diabetes are on the rise. For patients with type 2 diabetes, 70 percent die of cardiovascular causes (2).

Inactivity and the standard American diet, rich in saturated fat and calories, also contribute to heart disease risk (3). The underlying culprit is atherosclerosis, fatty streaks in the arteries.

Another potential risk factor is a resting heart rate greater than 80 beats per minute (bpm). In one study, healthy men and women had 18 and 10 percent increased risks of dying from a heart attack, respectively, for every increase of 10 bpm over 80 (4). A normal resting heart rate is usually between 60 and 100 bpm. Thus, you don’t have to have a racing heart rate, just one that is high-normal. All of these risk factors can be overcome.

Medication’s role in reducing risk

Cholesterol and blood pressure medications have been credited to some extent with reducing the risk of heart disease. Unfortunately, according to 2018 National Health and Nutrition Examination Survey (NHANES) data, only 43.7 percent of those with hypertension have it controlled (5). While the projected reasons are complex, a significant issue among those who are aware they have hypertension is a failure to consistently take prescribed medications, or medication nonadherence.

In terms of lipids, statins have played a key role in primary prevention. Statins are effective at not only lowering lipid levels, including total cholesterol and LDL — the “bad” cholesterol — but also inflammation levels that contribute to the risk of cardiovascular disease. The JUPITER trial showed a 55 percent combined reduction in heart disease, stroke and mortality from cardiovascular disease in healthy patients — those with a slightly elevated level of inflammation and normal cholesterol profile — with statins.

The downside of statins is their side effects. Statins have been shown to increase the risk of diabetes in intensive dosing, compared to moderate dosing (6).

Unfortunately, many on statins also suffer from myopathy (muscle pain). I have had a number of patients who have complained of muscle pain and cramps. Their goal is to reduce and ultimately discontinue their statins by following a lifestyle modification plan involving diet and exercise. Lifestyle modification is a powerful ally.

Do lifestyle changes really help?

The Baltimore Longitudinal Study of Aging, a prospective (forward-looking) study, investigated 501 healthy men and their risk of dying from cardiovascular disease. The authors concluded that those who consumed five servings or more of fruits and vegetables daily with <12 percent saturated fat had a 76 percent reduction in their risk of dying from heart disease compared to those who did not (7). The authors theorized that eating more fruits and vegetables helped to displace saturated fats from the diet. These results are impressive and, to achieve them, they only required a modest change in diet.

The Nurses’ Health Study shows that these results are also seen in women, with lifestyle modification reducing the risk of sudden cardiac death (SCD). Many times, this is the first manifestation of heart disease in women. The authors looked at four parameters of lifestyle modification, including a Mediterranean-type diet, exercise, smoking and body mass index. The decrease in SCD that was dose-dependent, meaning the more factors incorporated, the greater the risk reduction. SCD risk was reduced up to 92 percent when all four parameters were followed (8). Thus, it is possible to almost eliminate the risk of SCD for women with lifestyle modifications.

Monitoring your heart disease risk

To monitor your progress, cardiac biomarkers are telling, including inflammatory markers like C-reactive protein, blood pressure, cholesterol and body mass index. 

In a cohort study of high-risk participants and those with heart disease, patients implemented extensive lifestyle modification: a plant-based, whole foods diet accompanied by exercise and stress management (9). The results showed an improvement in biomarkers, as well as in cognitive function and overall quality of life. Most exciting is that results occurred over a very short period to time — three months from the start of the trial. Many of my patients have experienced similar results.

Ideally, if patient needs to use medications to treat risk factors for heart disease, it should be for the short term. For some patients, it may be appropriate to use medication and lifestyle changes together; for others, lifestyle modifications may be sufficient, as long as patient takes an active role.

By focusing on developing heart-healthy habits, we can improve the likelihood that we will be around for a long time.

References: 

(1)cdc.gov/heartdisease/facts.(2) Diabetes Care. 2010 Feb; 33(2):442-449. (3) Lancet. 2004;364(9438):93. (4) J Epidemiol Community Health. 2010 Feb;64(2):175-181. (5) Hypertension. 2022;79:e1–e14. (6) JAMA. 2011;305(24):2556-2564. (7) J Nutr. March 1, 2005;135(3):556-561. (8) JAMA. 2011 Jul 6;306(1):62-69. (9) Am J Cardiol. 2011;108(4):498-507.

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. 

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Photo from Facebook

Colon Cancer is Preventable, Treatable and Beatable. Early Detection Saves Lives

In support of Colorectal Awareness Month, Northwell Health Peconic Bay Medical Center (PBMC) has adopted the recommendation to lower the minimum age to start colorectal cancer screening from 50 to 45 years old. In partnership with the Cancer Services Program of Suffolk County, free screenings can now be administered to those 45 and older, conveniently, and discreetly at home to people who are uninsured, underinsured, or at-risk.

The Colorectal Surgery Program at PBMC has expert surgeons who treat patients with conditions affecting the colon and rectum, intestinal tract and pelvic floor, as well as the anal canal and perianal area.  Brett E. Ruffo, MD, colorectal surgeon and Ashanti L. Franklin, colorectal surgeon, lead the program using minimally invasive techniques such as robotic-assisted surgery which offers leading-edge precision for treatment of life-threatening cancers of the colon and rectum.

“Colorectal cancer is traditionally one of the deadliest forms of cancer, but it is treatable and beatable if caught during the early stages before it spreads. Making screenings more accessible at a time when younger people are being diagnosed will save lives,” said Dr. Ruffo. “With timely screenings, we can remove dangerous polyps before they become cancerous. Don’t wait for symptoms to get tested. Recommendations for colorectal cancer screening options vary for individuals. Please discuss with your primary care provider to determine the best option for you and your family.”

The United States Preventive Services Task Force has lowered its recommended age for colorectal cancer screening for people at average risk from age 50 to 45. Recent studies have also found that adults born around 1990 have twice the risk of colon cancer and four times the risk of rectal cancer compared to adults born around 1950.

Those with a family history of colorectal cancer or other bowel disease are at a higher risk and may need to begin screening before age 45. According to the National Cancer Institute, other heightened risk factors include obesity, physical inactivity, and smoking.

“I can’t stress enough how important it is for residents of Eastern Suffolk to get back to regular, on-time screenings,” said Maureen O’Connor, director of The Cancer Services Program of Suffolk County. “Talk to your health care provider about your risks for colorectal cancer and your testing options. Regular screening for colorectal cancer can save lives.”

Colorectal screenings are covered at little or no cost by most insurance plans. The Peconic Bay Medical Center in Riverhead and the Cancer Services Program of Suffolk County offer free colorectal, cervical, and breast cancer screening to eligible adults who do not have insurance. Call Maureen O’Connor, director of The Cancer Services Program of Suffolk County at (631) 548-6320 for any questions and to find out if you qualify for free cancer screening. Visit http://www.pbmchealth.org for more information.

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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. 

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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.

 

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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.

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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.

 

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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.

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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.

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