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Photo from Gurwin
Photo from Gurwin
Photo from Gurwin

Gurwin Healthcare System has announced the availability of 18 newly built studio apartments in its Gurwin Jewish ~ Fay J. Lindner Residences assisted living community. The construction of the new studios marks a new choice option for the 210-luxury apartment community, located on Gurwin’s lush 36-acre Commack campus, and comes in response to market interest for more streamlined residences at a lower price point.

Ranging in size from 241 to 278 sq. ft., the upscale studios feature dual living/sleeping areas, a kitchenette with stainless steel appliances, spacious closets and fully ADA-equipped bathrooms. Large windows welcome natural sunlight and several studios feature courtyard views. Pricing begins at $4950 per month and includes all utilities, as well as housekeeping and maintenance services. Other available services include personal laundry, including linens and towels, and appointment transportation. Included in the monthly fee is full access to the community’s amenities, including chef-prepared meals, scheduled social activities and local outings.

“The addition of studio apartments is an evolution of the Gurwin vision. We are pleased to have an expanded choice of senior living options to offer prospective residents,” said Stuart B. Almer, CEO of Gurwin Healthcare System. “With many already spoken for, our beautiful new studios meet the needs of Long Island seniors who desire a comfortable, smaller footprint residence within a caring, active and vibrant community.”

Gurwin’s Assisted Living community includes a formal dining room, a well-stocked library, tastefully appointed gathering areas, recreation and activity rooms, a synagogue, beauty/barber salon and rooms to host guests and family. Residents also have priority access to all levels of Gurwin’s care, including Gurwin’s rehabilitation and skilled nursing facility and on-site dialysis, home care programs and adult day care. In addition, residents enjoy the community’s manicured gardens, beautifully landscaped walking paths, and myriad outdoor activities including a shuffleboard court, putting green and LifeTrail exercise stations

About Gurwin Jewish ~ Fay J. Lindner Residences

Gurwin Jewish ~ Fay J. Lindner Residences assisted living community, located in Commack, Long Island, is part of the Gurwin Healthcare System, a renowned provider of a full continuum of healthcare and senior living services. In addition to its assisted living community, the System provides skilled nursing care, rehabilitation therapy, advanced care, ventilator and respiratory care, on-site dialysis, memory care, and palliative and hospice care, as well as adult day care programs and home care services. Skilled nursing and rehabilitation services are also available through Gurwin’s affiliate, Island Nursing and Rehab Center, located in Holtsville, Long Island. The campus is also home to Fountaingate Gardens, a newly opened 129-apartment independent living Life Plan Community for seniors age 62 and older.  For more information, visit www.gurwin.org or call 631-715-8500.   Follow Gurwin on Facebook (bit.ly/GurwinAssistedLiving) and on Twitter (@GurwinJewish).

 

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Osteoarthritis is a risk factor. METRO photo

By David Dunaief, M.D.

Dr. David Dunaief

Despite the best efforts of public campaigns and individual physicians, heart disease is still the number one cause of death in the U.S. (1). To put that in perspective, every 33 seconds, one person dies of heart disease.

While some risk factors are obvious, others are not. Obvious ones include family history, high cholesterol, high blood pressure, obesity, sedentary lifestyle, diabetes and smoking. In addition, age plays a role in risk: men at least 45 years old and women at least 55 years old are at greater risk. Less obvious risks include gout, atrial fibrillation and osteoarthritis. 

The good news is that we have more control than we think. Most of these risks can be significantly reduced with lifestyle modifications.

How much role does weight really play in heart disease risk?

Obesity continually gets play in discussions of disease risk. But how important is it, really?

In the Copenhagen General Population Study, results showed an increased heart attack risk in those who were overweight and in those who were obese – with or without metabolic syndrome, which includes a trifecta of high blood pressure, high cholesterol and high sugar levels (2). “Obese” was defined as a body mass index (BMI) over 30 kg/m², while “overweight” included those with a BMI over 25 kg/m².

Heart attack risk increased in direct proportion to weight. Specifically, there was a 26 percent increase in heart attack risk for those who were overweight and an 88 percent increase in risk for those who were obese without metabolic syndrome.

It is true that those with metabolic syndrome and obesity together had the highest risk. However, it is quite surprising that obesity, by itself, can increase heart attack risk when a person is “metabolically healthy.” Because this was an observational trial, the results represent an association between obesity and heart disease. Basically, it’s telling us that there may not be such a thing as a “metabolically healthy” obese patient. If you are obese, this is one of many reasons that it’s critical to lose weight.

Do activity levels really affect heart disease risk?

Let’s consider another lifestyle factor; activity levels. An observational study found that these had a surprisingly high impact on women’s heart disease risk (3). Of four key factors — weight, blood pressure, smoking and physical inactivity — age was the determinant as to which one had the most negative effect. Those under the age of 30 saw smoking as most negatively impactful. For those over the age of 30, lack of exercise became the most dominant risk factor for heart disease, including heart attacks.

For women over age 70, the study found that increasing physical activity may have a greater positive impact than addressing high blood pressure, losing weight, or even quitting smoking. However, since high blood pressure was self-reported, it may have been underestimated as a risk factor. Nonetheless, the researchers indicated that women should make sure they exercise on a regular basis to most significantly reduce heart disease risk.

How long should you suffer with osteoarthritis?

The prevailing thought with osteoarthritis is that it is best to live with hip or knee pain as long as possible before having surgery. But when do we cross the line and potentially need joint replacement? In a study, those with osteoarthritis of the hip or knee joints that caused difficulty walking on a flat surface were at substantially greater risk of cardiovascular events, including heart attack (4). Those who had surgery for the affected joint saw a substantially reduced heart attack risk. If you have osteoarthritis, it is important to improve mobility, whether with surgery or other treatments. Of course, I have written in previous columns about techniques for managing osteoarthritis.

When does fiber matter most?

Studies show that fiber decreases the risks of heart attack and of death after a heart attack. In a recent analysis using data from the Nurses’ Health Study and the Health Professional Follow-up Study, results showed that higher fiber plays an important role in reducing the risk of death after a heart attack (5).

Those who consumed the most fiber, compared to the least, had a 25 percent reduction in post-heart attack mortality. Even more impressive is that those who increased their fiber after a cardiovascular event had a 31 percent reduction in mortality risk. The most intriguing part of the study was the dose response. For every 10-gram increase in fiber consumption, there was a 15 percent reduction in the risk of post-heart attack mortality. For perspective, 10 grams of fiber is a little over one cup of raspberries or two-thirds of a cup of black beans or lentils.

How much does lifestyle really affect heart disease risk?

In the Nurses’ Health Study, which followed 120,000 women for 20 years, those who routinely exercised, ate a quality diet, did not smoke and were a healthy weight demonstrated a whopping 84 percent reduction in the risk of cardiovascular events such as heart attacks (6).

We can substantially reduce the risk of heart attacks and even potentially the risk of death after sustaining a heart attack with modifications that include weight loss, physical activity and diet. While there are many diseases that contribute to heart attack risk, most of them are modifiable.

References:

(1) cdc.gov. (2) JAMA Intern Med. 2014;174(1):15-22. (3) Br J Sports Med. 2014, May 8. (4) PLoS ONE. 2014, 9: e91286 (5) BMJ. 2014;348:g2659. (6) N Engl J Med. 2000;343(1):16.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

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Claudia Fortunato-Napolitano at her 'I Am Alive!' party.

By Stephanie Giunta

In honor of National Stroke Awareness Month, we would like to honor a local survivor, Claudia Fortunato-Napolitano, who is beyond inspirational. Here is her story.

On January 11, 2017, 34-year-old Huntington Village resident Claudia Fortunato-Napolitano, went to work like it was any other day, although she remembers having a bad headache. The passionate history buff and Executive Director at the Huntington Historical Society was making some personal calls during her lunch break. As she sat down to eat her lunch, she suddenly felt dizzy; her coworker asked if she was okay, and she couldn’t speak. Out of nowhere, a simple Wednesday became the day that forever-altered Napolitano’s future: the day she unexpectedly suffered a stroke. 

Once the stroke had occurred, Fortunato-Napolitano couldn’t remember what happened next, though she recounted her story by way of others at the scene. She was rushed to Huntington Hospital, and was then airlifted to North Shore University Hospital, where she resided for two weeks. When she woke up, she still couldn’t speak, had weakness in her right arm and couldn’t walk.

After a stint at the hospital, she was released into a rehab facility, but at the end of her week-long tenure, needed to move back into her parents’ house. Though the mobility in her arm was very low, she was slowly regaining the ability to walk, but couldn’t tackle the stairs up to her front door. She lived with her parents for three weeks, while simultaneously beginning outpatient rehab, seeing a handful of therapists to attempt to win her life back as her own through physical and cognitive recovery.

Claudia Fortunato-Napolitano at her ‘I Am Alive!’ party.

No warning signs 

Doctors were puzzled that a healthy 34-year-old, who had nothing more than a routine headache on the day of her stroke, could suffer something so unexpected and traumatic. At six months post-stroke, Fortunato-Napolitano began seeing a neurologist and underwent in-depth testing to reveal underlying notions of root cause.  She tested negative for everything doctors had assumed she would test positive for. Though they could confirm that the stroke was caused by a clogged blood vessel in her brain, the actual diagnosis remains inconclusive. 

A determined patient

After routinely attending speech therapy for six months, Fortunato-Napolitano still fought to talk. In our interview, she mentioned that she struggled with aphasia for the first two years during her recovery. Her therapist alluded to the fact that her speech would not improve — that she should simply get used to this new way of life. This led her down a dark path of depression, afraid that she would never regain her full ability to communicate with others. 

After 4-5 months, her parents encouraged her to seek a second opinion from another therapist who would work with her past the “6 month window.” As Fortunato-Napolitano stated during our interview, her mother “God bless her soul!” put her in touch with her current speech therapist, Judy Cavallo, who she still sees to this day. Cavallo even provides Fortunato-Napolitano with homework because she asks for it!

In addition to speech therapy, Fortunato-Napolitano continues to see an occupational therapist, Ian MacManus, to aid in her physical disabilities. Seven of her fingers work, but three fingers on her right hand are bent in a fixed manner. She dreams of the ability to wear high heels again, but walking is too difficult in any shoe aside from her signature Doc Martens and Birkenstocks — which she has in a wide variety of colors.  Her right foot cannot be fully-placed on the floor, and only the outside edge can go flat completely. 

To this day, Napolitano still goes to outpatient rehab twice per week (once to her speech therapist and once to her occupational therapist) to improve her skills and continually progress.

New realities 

Prior to the stroke, Fortunato-Napolitano was a writer. She wrote a historic Half Hollow Hills column for Patch Media on a weekly basis, as well as many articles for the Huntington Historical Society. Now, on average, it will take her about three hours to write three paragraphs. She mentioned that this has been the hardest thing for her to overcome from a professional perspective. But Siri is her best friend. She is so grateful for technology, which helps her text, post on social media, and write emails.  

Claudia Fortunato-Napolitano at her ‘I Am Alive!’ party.

A major milestone

Within the first five years of having a stroke, an individual is 50% more likely to suffer from a second stroke in comparison to a person of the same age. So, in January 2022, Fortunato-Napolitano threw herself an “I Am Alive!” party to celebrate meeting this critical milestone. There were over 85 people in attendance, including her neurologist and speech therapist, and she donned a stylish, sparkly green jumpsuit. Not only was this a celebration of how far she had come, but also that statistically, her chances of having another stroke or stroke-like episode would start to significantly decrease.  

Pivotal life lessons

Fortunato-Napolitano is so grateful to be alive. She could have been paralyzed and in a wheelchair; she may not have survived. But now, she makes sure that she lives every day to the fullest. She voluntarily chooses happiness.

Prior to the stroke, she was unhappy about stupid, inconsequential things. Now, Fortunato-Napolitano uses a “whatever!” mentality. She believes that life is worth living and she intends to make the most of the hand that she has been dealt. The biggest lesson she learned from her stroke, she mentioned, was, “I can be unhappy [about that] or I can just be happy. And I choose to be happy all of the time.” 

Fortunato-Napolitano fuels her happiness with her work. This February, she was newly-appointed as the Executive Director of the Greenlawn-Centerport Historical Association. She loves her job and the challenges it provides.

She is also a travel connoisseur — something she has been passionate about from a very young age. Her next destination includes heading to Cleveland on a baseball stadium tour for her husband’s birthday, but the top future spots on her international travel list include Africa, Argentina, Australia, and Turkey.

A message to all stroke survivors 

Fortunato-Napolitano’s hope is that someone in similar shoes reads this article, her story, and becomes happy due to reading it.  She can’t stress enough that you can and will get better — you just can’t stop believing in yourself. At six months post-stroke, her original speech therapist told her she would never speak again. Six years later, Fortunato-Napolitano is carrying on conversations beautifully. Each year, she sees subsequent progression and truly believes that she will continue to improve for the rest of her life.

There is a light at the end of the tunnel even during the darkest and most depressing of times. Her outlook on life has drastically changed from Year 2 to Year 6. She stressed the importance of self-dedication, while also surrounding yourself with a great support system.

Above all, Fortunato-Napolitano is a true inspiration.  She epitomizes optimism, and is dedicated, admirable, and determined. Her new dream is to become a life coach, as she hopes to help others through similar dark and unexpected times. She would love a platform in which to tell her story publicly. Fortunato-Napolitano is a happiness evangelist, a survivor to the nth degree, and only hopes she can inspire others, stroke conquerors or not, to live life to the fullest. 

Follow along with Claudia Fortunato-Napolitano’s journey on Instagram: @ayoungstrokerecovery.

This article first appeared in TBR News Media’s supplement Focus on Health on May 25, 2023.

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METRO photo
Chest pain is only one of many possible symptoms.

By David Dunaief, M.D.

Dr. David Dunaief

Each year, 805,000 people in the U.S. have heart attacks, or myocardial infarctions —about one every 40 seconds (1). These statistics traverse race and gender lines, even though symptoms may be experienced differently. Outcomes for those having a heart attack are significantly better if they receive immediate medical attention. First, however, you need to recognize the symptoms.

What are symptoms of a heart attack?

The most recognizable symptom is chest pain. However, there are a number of other, more subtle, symptoms such as discomfort or pain in the jaw, neck, back, arms and epigastric, or upper abdominal areas. Others include nausea, shortness of breath, sweating, light-headedness and tachycardia (racing heart rate).

Unfortunately, less than one-third of people know these symptoms (2). About 10 percent of patients present with atypical symptoms — without chest pain — according to one study (3).

It is not only difficult for the patient but also for the medical community, especially the emergency room, to determine who is having a heart attack. Fortunately, approximately 80 to 85 percent of chest pain sufferers are not having a heart attack. More likely, they have indigestion, reflux or other non-life-threatening ailments. However, don’t hesitate to seek immediate medical attention; it’s better to have a medical professional rule out a heart attack than to ignore one.

Are heart attack symptoms different for men and women?

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

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

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

One theory about why women receive less aggressive treatment when first presenting in the ER is that they have different and more subtle symptoms — even chest pain symptoms may be different. But, is this true? Not according to several studies.

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

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

In the GENESIS-PRAXY study, another observational study, the median age of both men and women was 49. Results showed that chest pain remained the most prevalent presenting symptom in both men and women (6). However, of the patients who presented without distinct chest pain and with less specific EKG findings, significantly more were women than men.

Those who did not have chest pain symptoms may have experienced back discomfort, weakness, discomfort or pain in the throat, neck, right arm and/or shoulder, flushing, nausea, vomiting and headache. If the patients did not have chest pain, regardless of sex, the symptoms were diffuse and nonspecific. 

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

What should you do if someone is having a heart attack?

Call 911 immediately, and have the patient chew an adult aspirin (325 mg) or four baby aspirins, provided they do not have a condition that precludes taking aspirin. The purpose of aspirin is to thin the blood quickly, but not if the person might have a ruptured blood vessel. The 911 operator or emergency medical technician who responds can help you determine whether aspirin is appropriate.

What are the most frequently occurring heart attack symptoms to watch for?

Most patients have chest pain, and both men and women have similar types of chest pain. However, this is where the simplicity stops and the complexity begins. The percentage of patients who present without chest pain seems to vary significantly depending on which study you review — ranging from less than 10 percent to 35 percent.

Non-chest pain heart attacks have a bevy of diffuse symptoms, including obscure pain, nausea, shortness of breath and light-headedness. This is seen in both men and women, although it occurs more often in women. It’s important to recognize heart attack symptoms, since quick action can save your life or that of a loved one.

References:

(1) Circulation. 2022;145(8):e153–e639. (2) MMWR. 2008;57:175–179. (3) Chest. 2004;126:461-469. (4) Int J Cardiol. 2013;168:1041-1047. (5) JAMA Intern Med. 2014 Feb. 1;174:241-249. (6) JAMA Intern Med. 2013;173:1863-1871. (7) JAMA. 2012;307:813-822.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

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Michael J. Fox in a scene from 'Still.' Photo courtesy of Apple TV

Reviewed by Jeffrey Sanzel

“A short kid from a Canadian army base becomes the international pop culture darling of the 1980s—only to find the course of his life altered by a stunning diagnosis. What happens when an incurable optimist confronts an incurable disease?”

— Tagline to Still: A Michael J. Fox Movie

Few people do not recognize Michael J. Fox. Fox (born 1961) launched into the public eye with the sitcom Family Ties (1982-89), in which he played Alex P. Keaton, the conservative son in a liberal family. From there, his star rose quickly with the Back to the Future trilogy (1985-1990), followed by Teen Wolf (1985), The Secret of My Success (1987), Doc Hollywood (1991), and others. Then, in 1996, he returned to the small screen with Spin City.

Fox combined a youthful sureness with the charm of a latter-day Jimmy Stewart, a genuine aw-shucks quality absent of artifice. Even in lesser vehicles, he offered strong, grounded performances.

During the run of Spin City, Fox went public with his Parkinson’s disease diagnosis. He became an advocate and spokesperson, establishing the Michael J. Fox Foundation in 2000, a not-for-profit focusing on research for a cure. Throughout the early 2000s, he continued to work—mostly guest spots and a few recurring roles. His last major undertaking was the semi-autobiographical The Michael J. Fox Show (2013-2013), an NBC comedy in which he played news anchor Mike Henry who gave up his career due to the same diagnosis. Following his official retirement in 2020, Fox published a memoir, No Time Like the Future: An Optimist Considers Mortality. 

Michael J. Fox and his wife Tracy Pollan met on the set of ‘Family Ties’ in 1985. Photo courtesy of Apple TV

Fox received numerous nominations, and among his accolades are Golden Globes, Emmys, and People’s Choice Awards. He met his wife, Tracy Pollan, when she appeared as his girlfriend on Family Ties. The pair married in 1988 and have four children. 

Still: A Michael J. Fox Movie chronicles Fox’s life and career. It opens with Fox having spent a drunken night with Woody Harrelson. He finds the pinky of his left hand trembling, a harbinger of what is to come. The film embarks on a chronological telling of his story, with present-day Fox commenting on his rise to fame, stardom, diagnosis, and aftermath. First, he is shown as a child in constant movement, then as a reluctant student and “serial fender bender.” He dropped out of school and went to Hollywood with his father’s help. Given his diminutive stature, he landed a series of small guest spots as much younger characters. Finally, Family Ties changed his entire trajectory.

The film follows Fox through the highs and lows, medication, alcoholism (now thirty years sober), intense work schedules, critical successes, and box office disappointments. The actor is forthcoming about his courtship and marriage to Pollan, raising children, and realization of the importance of family, especially after his diagnosis. “I was the boy prince of Hollywood. But it was an illusion.”

Director Davis  Guggenheim (An Inconvenient Truth, He Named Me Malala, Waiting for Superman) creates a hybrid of straight documentary and something akin to Behind the Music via True Crime Network. Most of the film is a series of interviews with Fox, sitting at a table, talking directly to the camera. In addition, he interacts with his family and physical therapists. The rest of the documentary comprises film clips from his movies and television shows, sometimes shown in context, other times coopted for emphasis. 

In addition, Guggenheim films  stand-ins for Fox and others over-the-shoulder shots, at a distance, or blurred, with music blaring during these peripatetic sections. Whether they are for contrast or effect is hard to discern. 

Where Still succeeds is in the one-on-one conversations with Fox, which fortunately occupy at least fifty percent. The camera is placed straight on with no music or fanfare. The focus remains solely on Fox as he answers the most personal questions. Sometimes, he physically struggles. Other times, he reflects before coming back with a revelation or a quip. 

Throughout his illness, he has fallen many times, shattering his cheek and breaking his hand. Philosophically, he retorts, “Gravity is real. Even when I’m falling from my height.” He is seen falling—but also getting back up. Fox appears open, raw, and completely honest.

From the very beginning, the documentary is unflinching. Fox reveals himself as he is: constantly off-balance, with uncontrollable spasms and involuntary movements, moments of freezing, and the sense of what is permanently lost. But his humor bubbles to the surface. “If I’m here twenty years from now, I’ll either be cured or a pickle.”

At one point, he is asked what it is like to be still. He takes a moment, then responds, “I wouldn’t know. I’ve never been still.” And while true, Still: A Michael J. Fox Movie captures not just the Hollywood icon but an intimate, bold, and uplifting portrait of an extraordinary human being.

The documentary is currently streaming on Apple TV.

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Many participants at last year's walk wore pink for breast cancer awareness. Photo from Mather Hospital

The fight against breast cancer in our community continues on Sunday, May 21 with the Northwell Health Walk at Mather Hospital located at 75 North Country Road in Port Jefferson. 

Presented by Bethpage Federal Credit Union, the Walk brings together family, friends and team members for a five-mile walk through the scenic villages of Port Jefferson and Belle Terre. The day includes a light breakfast, live music by Damaged Goods, raffles, photo props, a walker warm up session, and the popular Pink Your Pooch contest for the best “pinked” pup!

Sponsored by New York Cancer & Blood Specialists and King Quality Construction, the Northwell Health Walk at Port Jefferson benefits the Fortunato Breast Health Center and serves to raise awareness of the need for regular breast cancer screenings starting at age 40. 

Nearly 300,000 women in the United States will be diagnosed with breast cancer this year, and early detection through mammograms and other screenings can help find cancer at an early stage, before symptoms appear. In 2019, only 65 percent of women ages 45 and older were up to date with breast cancer screening, according to the American Cancer Society.

The hundreds of participants at this annual event walk for a family member or friend fighting breast cancer, a survivor who conquered breast cancer, or in memory of someone whose life was cut short by this disease.

The event will be held simultaneously with other walks in Riverhead, Jones Beach, Staten Island and Yorktown Heights. Last year’s Northwell Health Walk raised a total of nearly $1 million.

Check-in/registration starts at 8:30 a.m. with an opening ceremony at 9:45 a.m. followed by the walk at 10 a.m. To register, pleasevisit www.northwellhealthwalk.com.

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Joel Gonzalez, right, with his wife Amanda, daughter Isabella and son Julian. Photo courtesy Gonzalez

Joel Gonzalez was waking up in the middle of the night, gasping for air. During the day, if he ate too quickly, he felt like food was getting stuck in his throat.

In 2018, Gonzalez, who lives in Coram and is a high school counselor, was diagnosed with gastroesophageal reflux disease, or GERD. A small hiatal hernia, in which part of his stomach bulged through an opening in his diaphragm and into his chest, caused the condition.

Gonzalez started taking medications, which helped relieve the symptoms and enabled him to sleep without experiencing discomfort or waking up suddenly.

In August 2022, after learning that his hiatal hernia had gotten slightly larger and deciding he didn’t want to continue taking reflux medicine for the rest of his life, he met with Dr. Arif Ahmad, director of the St. Charles and St. Catherine of Siena Acid Reflux and Hiatal Hernia Centers of Excellence, to discuss the possibility of surgery.

Gonzalez was so convinced that the surgery would help and confident in Dr. Ahmad’s experience that he scheduled the procedure during that first meeting. Since his November surgery, which took about an hour, he hasn’t had any GERD symptoms and is not taking any medication for the condition.

Gonzalez said he would “absolutely” recommend the surgical procedure, which became a “simple decision” after consulting with Dr. Ahmad.

Caused by a mechanical problem with a valve at the bottom of the esophagus called the lower esophageal sphincter that allows stomach acid to enter the esophagus, GERD affects over 20% of the population.

Symptoms of GERD vary, which means doctors can and do take a range of approaches to treatment.

Hospitals, including St. Charles, St. Catherine of Siena, Stony Brook and Huntington Hospital, have been ramping up their efforts to evaluate and treat GERD.

Port Jefferson-based St. Charles and Smithtown-based St. Catherine of Siena, both part of the Catholic Health system, have been expanding these services at the Acid Reflux and Hiatal Hernia Centers of Excellence.

“There is a big need” for this increasingly focused effort to help patients dealing with the symptoms of GERD, said Dr. Ahmad.

At St. Charles and St. Catherine, Dr. Ahmad, who has been doing hiatal hernia and GERD-correcting surgery for over 25 years, created the center to ensure that the nurses on the floor, the people who do the testing, and the recovery staff are aware of the specific needs of these patients.

Dr. Ahmad has done presentations for the staff to ensure they have “the highest level of expertise,” he added.

Dr. Ahmad, also the director of the Center of Excellence in Metabolic and Bariatric Surgery at Mather Hospital, said he could perform surgery, if a patient needs it, at any of the hospitals, depending on a patient’s request.

Stony Brook’s efforts

At the same time, Stony Brook recently created a multidisciplinary Esophageal Center at Stony Brook Medicine, designed to provide a collaborative care model for diagnosing and treating GERD.

The center provides minimally invasive endoscopic treatments as well as surgical options.

Dr. Lionel D’Souza, chief of endoscopy, said the center provides a cohesiveness that “allows an evaluation by a group of people who are experts and can communicate with each other” to provide a patient-specific plan.

Dr. D’Souza suggested people seek medical attention from their primary care physician or gastroenterologist if they experience any of the following conditions: heartburn every day or severe heartburn several times a week, trouble swallowing, food getting stuck in the throat, anemia, blood in the stool or weight loss without another explanation.

Other partners in the Stony Brook GERD Center include Dr. Olga Aroniadis, chief of the division of gastroenterology, Dr. Alexandra Guillaume, director of the gastrointestinal motility center, and Dr. Konstantinos Spaniolas, chief of the division of bariatric, foregut and advanced GI surgery at Stony Brook Medicine and director of Stony Brook’s bariatric and metabolic weight loss center.

“When someone has a lot of excess weight, the chance of developing GERD is a lot higher,” Dr. Spaniolas said. “Sometimes, getting patients through a program to facilitate with weight loss can help [people] avoid GI symptoms, such as heartburn.”

Stony Brook will see patients in different parts of its network and then, depending on the needs, will determine who is best-suited to start their work up and treatment, Dr. Spaniolas added.

While a potential option, surgery is among a host of choices for people who have ongoing heartburn.

Huntington Hospital, meanwhile, will begin offering esophageal motility testing starting in June. Patients can call Northwell Health’s Heartburn and Reflux Center to schedule an appointment.

A team of gastroenterologists, surgeons and dietitians will work with patients at Huntington to determine the cause of GERD and possible treatments, according to Dr. David Purow, chief of gastroenterology.

Soft foods

Those who have surgery return to solid foods gradually.

Marlene Cross, a resident of St. James who struggled with GERD for about a decade, had the procedure in March.

For the first few weeks, she ate primarily liquids, with some protein drinks and puddings. She added Farina and oatmeal to her diet and then could eat flaky fish.

At 83, Cross, who lost sleep because of GERD-induced heartburn, said the surgery was a success.

“I’m not running a marathon, but I’m definitely feeling a lot better,” said Cross, who is a retired teacher’s assistant for special education students.

Cross urged others who might benefit from surgery to “see a specialist and ask questions and do it” if the doctor recommends it. “The younger you do it, the better.”

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Jaclyn Jahn in the Nursing clinical skills training area with Janet Galiczewski, DNP. Photo by Jeanne Neville

Jaclyn Jahn, a Stony Brook University School of Nursing student who will graduate on May 17, has been named the recipient of the 2023 Future Nurse Leader Award by the American Nurses Association – New York (ANA-NY).

The Future Nurse Leader Award is given to students nominated by their respective school as outstanding students who demonstrate leadership, make significant contributions to their school, promote activity in nursing organizations, and embody the values and ethics of nursing. This year ANA-NY is awarding 17 students in New York State with the honor.

Janet Galiczewski, DNP, Clinical Associate Professor, and Chair of Undergraduate Studies in the School of Nursing, and an ASA member, nominated Jahn for the award.

“Jaclyn Jahn has not only strong academic and leadership skills, she is caring, empathetic, and compassionate with patients and their families, and ensures that their questions are always answered,” says Galiczewski.

Jahn, a Long Island native from Rockville Centre, is enrolled in the baccalaureate nursing program and one of the students selected for the school’s Nursing Scholars Program, which includes students who have high academic standing and are involved with extracurricular work related to the field. She was nominated for the award by School of Nursing leadership for her scholarship, student leadership skills at Stony Brook and statewide, and her involvement in nursing-related research.

While at Stony Brook, Jahn demonstrated excellence in her coursework and displayed her leadership skills to help advance Stony Book’s chapter of the Student Nurses Association, first as second VP and as its current President. In this capacity, she coordinated many community service activities. Jahn also extended her leadership skills outside Stony Brook and served as the Northeast Regional Director for the Nursing Student Association of New York State.

Jahn has also demonstrated excellence in the field of discovery. Before she began her nursing studies, she contributed to a published paper related to aortic valve replacement in the Journal of International Cardiology. As part of the Nursing Scholars Program, she conducted research with the former dean of the school on the association between financial resources, student resources, and student success. She presented the findings at a conference by the Eastern Nursing Research Society this spring.

A graduate of South Side High School in Rockville Centre, Jahn took part in many clinical services at Stony Brook and other medical institutions on Long Island as part of her training, including Covid and Influenza vaccination dispensing at Stony Brook.

Jahn is Basic Life Support certified, HIPPAA and CITI trained, and has completed Sexual Assault and Suicide Prevention Bystander Intervention training. She also completed red watch band training at Stony Brook with others for the upstanding award.

Jahn’s goal is to become a critical care nurse working in an Intensive Care Unit.

Caption: Jaclyn Jahn in the Nursing clinical skills training area with Janet Galiczewski, DNP.

Credit: Jeanne Neville

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Block the Sun, Not the Fun event hosted by Stony Brook Cancer Center on Saturday, May 13, 2023. Skin Cancer Screenings were held at Stony Brook Dermatology Associates and at the Smith Haven Mall Center Court ( 5/13/23).
Block the Sun, Not the Fun event hosted by Stony Brook Cancer Center on Saturday, May 13, 2023. Skin Cancer Screenings were held at Stony Brook Dermatology Associates and at the Smith Haven Mall Center Court ( 5/13/23).
Block the Sun, Not the Fun event hosted by Stony Brook Cancer Center on Saturday, May 13, 2023. Skin Cancer Screenings were held at Stony Brook Dermatology Associates and at the Smith Haven Mall Center Court ( 5/13/23).
Block the Sun, Not the Fun event hosted by Stony Brook Cancer Center on Saturday, May 13, 2023. Skin Cancer Screenings were held at Stony Brook Dermatology Associates and at the Smith Haven Mall Center Court ( 5/13/23).
Block the Sun, Not the Fun event hosted by Stony Brook Cancer Center on Saturday, May 13, 2023. Skin Cancer Screenings were held at Stony Brook Dermatology Associates and at the Smith Haven Mall Center Court ( 5/13/23).
Block the Sun, Not the Fun event hosted by Stony Brook Cancer Center on Saturday, May 13, 2023. Skin Cancer Screenings were held at Stony Brook Dermatology Associates and at the Smith Haven Mall Center Court ( 5/13/23).
Block the Sun, Not the Fun event hosted by Stony Brook Cancer Center on Saturday, May 13, 2023. Skin Cancer Screenings were held at Stony Brook Dermatology Associates and at the Smith Haven Mall Center Court ( 5/13/23).

According to the American Academy of Dermatology, skin cancer is the most common form of cancer in the U.S. with 1 in 5 people being diagnosed with it in their lifetime. May is designated as National Skin Cancer and Melanoma Awareness Month and with summer right around the corner, it’s important to know how to keep your family sun-safe during outdoor activities. This past Saturday, May 13, families across Long Island attended Block the Sun, Not the Fun hosted by Stony Brook Cancer Center at Smith Haven Mall.

The interactive, fun, and educational event featured family fun opportunities presented by Healthcare and Community Partners and Stony Brook’s Wolfie mascot aimed at promoting sun safety and teaching the community about preventing skin cancer. Before the mall event, Stony Brook Cancer Center and Stony Brook Dermatology Associates hosted free skin cancer screenings for nearly hundred individuals and Dr. Tara Huston, Director of the Melanoma Disease Management Team at Stony Brook Medicine, led an educational program for patients about melanoma, the deadliest form of skin cancer.

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Stock photo
Proton pump inhibitors should be taken at the lowest dose for the shortest possible time.

By David Dunaief, M.D.

Dr. David Dunaief

Sometimes referred to as “reflux” or “heartburn,” Gastroesophageal reflux disease (GERD) is one of the most treated diseases in the U.S. Technically, heartburn is a symptom of GERD, so this is a bit of a misnomer.

Proton pump inhibitors (PPIs), first launched in 1989, have become one of the top-10 drug classes prescribed or taken over-the-counter (OTC). PPIs currently available OTC include Prilosec (omeprazole), Nexium (esomeprazole), Prevacid (lansoprazole), Protonix (pantoprazole), and Aciphex (rabeprazole). These and others are also available by prescription.

Their appeal among physicians has been their possible role in the reduction of esophageal cancer resulting from Barrett’s Esophagus. Interestingly, recent studies note that this perceived benefit may not be real (1).

PPIs are not intended for long-term use, because of their robust side effect profile. The FDA currently suggests that OTC PPIs should be taken for no more than a 14-day treatment once every four months. Prescription PPIs should be taken for 4 to 8 weeks (2).

However, their OTC availability can lead patients to take them too long or too often to manage reflux rebound effects when PPIs are discontinued without physician oversight. In addition, some existing medical risks are heightened by PPIs. 

Among potential associations with long-term use are chronic kidney disease, dementia, bone fractures, increased cardiac and vascular risks, vitamin malabsorption issues and Clostridium difficile, a bacterial infection of the gastrointestinal tract.

PPIs and the kidneys

In two separate studies, results showed that there was an increase in chronic kidney disease with prolonged PPI use (3). All of the patients started study with normal kidney function, based on glomerular filtration rate (GFR). In the Atherosclerosis Risk in Communities (ARIC) study, there was a 50 percent increased risk of chronic kidney disease, while the Geisinger Health System cohort study found there was a 17 percent increased risk.

The first study had a 13-year duration, and the second had about a six-year duration. Both demonstrated modest, but statistically significant, increased risk of chronic kidney disease. But as you can see, the medications were used on a chronic basis for years. In an accompanying editorial to these published studies, the author suggests that there is overuse of the medications or that they are used beyond the resolution of symptoms and suggests starting with diet and lifestyle modifications as well as a milder drug class, H2 blockers (4).

Increased dementia risk

A German study looked at health records from a large public insurer and found there was a 44 percent increased risk of dementia in the elderly who were using PPIs, compared to those who were not (5). These patients were at least age 75. The authors surmise that PPIs may cross the blood-brain barrier and potentially increase beta-amyloid levels, markers for dementia. With occasional use, meaning once every 18 months for a few weeks to a few months, there was a much lower increased risk of 16 percent.

The researchers also suggested that PPIs may be significantly overprescribed in the elderly. Unfortunately, there were confounding factors that may have conflated the risk. Researchers also did not take into account high blood pressure, excessive alcohol use or family history of dementia, all of which influence dementia occurrence.

Increased fracture risk

In a meta-analysis of 18 observational studies, results showed that PPIs can increase the risk of hip fractures, spine fractures and any-site fractures (6). Interestingly, when it came to bone fractures, it did not make a difference whether patients were taking PPIs for more or less than a year.

They found increased fracture risks of 58, 26 and 33 percent for spine, hip and any site, respectively. It is not clear what may potentially increase the risk; however, it has been proposed that it may have to do with calcium absorption. PPIs reduce acid, which may be needed to absorb insoluble calcium salts. In another study, seven days of PPIs were shown to lower the absorption of calcium carbonate supplements when taken without food (7).

Vitamin absorption issues

In addition to calcium absorption issues, PPIs may have lower absorption effects on magnesium and B12. In one observational study, PPIs combined with diuretics caused a 73 percent increased risk of hospitalization due to low magnesium (8). Diuretics are commonly prescribed for high blood pressure, heart failure and swelling.

A second study, a meta-analysis of nine studies, confirmed these results: PPIs increased the risk of low magnesium in patients by 43 percent, and when researchers looked only at higher quality studies, the risk increased to 63 percent (9). The authors note that a significant reduction in magnesium could lead to cardiovascular events.

Another study’s results showed long-term use of over two years increased vitamin B12 deficiency risk by 65 percent (10).

The bottom line

It’s best if you confer with your doctor before starting PPIs. You may not need PPIs, but rather a milder medication, such as an H2 blocker (Zantac, Pepcid). In addition, PPIs may interfere with other drugs you are taking, such as Plavix (clopidogrel).

Even better, start with lifestyle modifications including diet, not eating later at night, raising the head of the bed, losing weight and stopping smoking, if needed, and then consider medications (11).

If you do need medication, recognize that PPIs don’t give immediate relief and should only be taken for a short duration to minimize their side effects.

References:

(1) PLoS One. 2017; 12(1): e0169691. (2) fda.gov. (3) JAMA Intern Med. 2016;176(2). (4) JAMA Intern Med. 2016;176(2):172-174. (5) JAMA Neurol. online Feb 15, 2016. (6) Osteoporos Int. online Oct 13, 2015. (7) Am J Med. 118:778-781. (8) PLoS Med. 2014;11(9):e1001736. (9) Ren Fail. 2015;37(7):1237-1241. (10) Mayo Clinic Proceedings. 2018 Feb;93(2):240-246. (11) Am J Gastroenterol 2015; 110:393–400.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

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