Home Health

Body after baby: Fitness tips for new moms

by TBR Staff - May 29, 2015

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By Lisa Steuer

Getting into shape after giving birth can seem like a challenge. You may have gained a little more weight than you ever have before, you are not feeling your best, the baby is up all night and your to-do list has increased dramatically. But with the right support and plan of action, it is possible to not only lose the baby weight, but to get in even better shape than you were before giving birth.

Fit4Mom
One organization that is helping many moms get into shape is Fit4Mom, a franchise with more than 1,300 locations nationwide, said Britney Pagano, mom of two and founder of Fit4Mom Long Island. In fact, many Long Island moms have lost 70 or 80 pounds with the program, according to Pagano.

Fit4Mom Long Island classes are held at Sunken Meadow State Park in Kings Park, Heckscher Park in Huntington and Belmont Lake State Park in North Babylon. There are also classes in Nassau. For the full schedule, visit http://nassauandsuffolk.fit4mom.com. Stroller Strides, which is Fit4Mom’s most popular program according to Pagano, is a “Mommy and Me” type class. The children sit in strollers while the moms go through a 60-minute stroller-based workout that combines intervals of cardiovascular and resistance training. The nationally certified class instructors incorporate songs and activities to keep the kids entertained.

But Fit4Mom is more than just fitness classes, said Pagano. It’s about connecting moms, making friends and finding support. In addition to workouts, there are playgroups and monthly moms-night-out events.

“A lot of moms have told me that our program specifically has really saved them from postpartum depression because it’s given them something to do,” said Pagano. “It was helping them lose weight and meet friends, and they didn’t have the guilt of leaving their child in someone else’s care so that they can do something for themselves.”

Tips for Success
In addition to attending Fit4Mom classes like Stroller Strides, here are some other tips for getting your body back after baby:

Consult your doctor.
Before you start any kind of fitness program, be sure to check with your doctor. He or she knows your individual situation and can advise you when it’s best for you to return to being active. In addition, your doctor may be able to suggest a personalized approach for you.

Find a little time when you can work out during the day.
Once you get the OK from your doctor to work out and do any kind of cardio activity, get in a few minutes here or there doing squats, push-ups, crunches, high knees, other bodyweight or cardio moves or a fitness DVD, even if you can only do a few minutes at a time. You don’t have to do the workout all at once for it to be effective. Just find the time when you can. Visit www.fitnessrxwomen.com/life-health/fit-moms for tons of at-home workouts for moms and more tips.

Get out and go for a walk.
Get outside! Get the stroller and bring baby along for a ride.

Work on building your at-home gym.
Since you may find it hard to get to the gym, there are a few items that are fairly inexpensive that can help you get a good workout right in your own home. Resistance bands, a medicine ball, dumbbells, a jump rope and a stability ball are a good start.

Listen to your body.
If your body is telling you that you need to sleep, and the baby is sleeping, then you should sleep, too. If your energy is lacking, it’s all the more reason to get into a good fitness regimen, because this can help your energy levels, said Pagano.

Fuel up.
You won’t be able to get back in shape if your diet is not in check. Make sure to take care of yourself with a balanced diet: drink plenty of water, eat plenty of fruits and veggies and get your protein. Pagano encourages her clients to find the one day a week where they can get to the grocery store — when there is someone to look after the child — and use that day to plan out all the meals for the week. Chop up all the vegetables and fruit and put into single serve bags. “This way, during the week when hunger strikes, you just have to look in the refrigerator and everything is already done and prepared for you.”

Make time for yourself.
“A lot of times, especially with new moms, we kind of get lost in that and taking care of the baby,” said Pagano. “But make it a priority to take care of yourself.”

Lisa Steuer is the managing editor of FitnessRx for Women and FitnessRx for Men magazines. For more fitness tips, training videos and print-and-go workouts that you can take with you to the gym, visit www.fitnessrxformen.com and www.fitnessrxwomen.com.

Health & Wellness Expo hits Port Jefferson

by Heidi Sutton - May 11, 2015

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The Greater Port Jefferson Chamber of Commerce held its sixth annual Health & Wellness Expo on Saturday, May 9, from 9 a.m. to 1 p.m. in the Earl L. Vandermeulen High School gym.

The free event, with the theme “Healthy Living — It’s Your Choice,” kicked off with a 2K Fun Run hosted by the Port Jefferson Royal Education Foundation, and included free health screenings by Stony Brook University Hospital, St. Charles Hospital and John T. Mather Memorial Hospital. More than 40 vendors showed up and there were prizes, giveaways, games and raffles for free movie tickets to the Port Jeff Cinemas every 15 minutes. A mini-farmer’s market was held outside that featured Fairway Market and Sweet Melissa’s Dips, Cornucopia Cafe gave cooking demonstrations of healthy recipes and Starbucks and Phountain Water provided free refreshments. In addition, there were performances by members of the Port Jefferson high school choir and the Port Jefferson Jazz Combo.

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High blood pressure trumps the boogie man

by David Dunaief - May 6, 2015

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Hypertension (high blood pressure) deserves a substantial amount of attention. There are currently about 76 million people with high blood pressure in the U.S. Put another way, one in three adults have this disorder (1). If that isn’t scary enough, the newest statistic from the Centers for Disease Control and Prevention is that the number of people dying from complications of hypertension increased by 23 percent from 2000 to 2013 (2). Until these abysmal statistics change for the better, pay attention!

And talk about scary, it turns out that fear of the boogie man should take a back seat to high blood pressure during nighttime sleeping hours. This is when the probability of complications, such as cardiovascular events and mortality, may have their highest incidence.

Unfortunately, as adults, it does not matter what age or what sex you are; we are all at increased risk of complications from high blood pressure, even isolated systolic (top number) blood pressure, which means without having the diastolic (bottom number) elevated as well.

Fortunately, hypertension is highly modifiable in terms of reducing the risk of cardiovascular disease and mortality (3). At least some of the risk factors are probably familiar to you. These include being significantly overweight and obese (BMI >27.5 kg/m2), smoking, poor diet, lack of exercise, family history, age, increased sodium, depression, low vitamin D, diabetes and too much alcohol (4).

Of course, antihypertensive (blood pressure) medications treat this disorder. In addition, there are nonpharmacological approaches that have benefits. These include lifestyle modifications with diet, exercise and potentially supplements. There was a question on the game show “Jeopardy” that read: “You can treat it with diet and lifestyle changes as well as drugs: HBP.” The answer was, “What is high blood pressure?” We made the big time!

RISK FACTORS MATTER, BUT NOT EQUALLY:
In a recent study, the results showed that those with poor diets had 2.19 times increased risk of developing high blood pressure. This was the greatest contributor to developing this disorder (5). Another risk factor with a significant impact was being at least modestly overweight (BMI >27.5 kg/m2) at 1.87 times increased risk. This surprisingly, albeit slightly, trumped cigarette smoking at 1.83 times increased risk. Interestingly, weekly binge drinking at 1.87 times increased risk was equivalent to being overweight. This study was observational and involved 2,763 participants. The moral is that a freewheeling lifestyle can have a detrimental impact on blood pressure and cause at least stage 1 hypertension (systolic between 140 and 159 mmHg and/or diastolic between 90 and 99 mmHg).

HIGH BLOOD PRESSURE DOESN’T DISCRIMINATE:
One of the most feared complications of hypertension is cardiovascular disease because it can result in death. In a recent study, isolated systolic hypertension was shown to increase the risk of cardiovascular disease and death in both young and middle-aged men and women between 18 and 49 years old, compared to those who had optimal blood pressure (6). The effect was greatest in women, with a 55 percent increased risk in cardiovascular disease and 112 percent increased risk in heart disease death. High blood pressure has complications associated with it, regardless of onset age. Though this study was observational, which is not the best, it was very large and had a 31-year duration.

NIGHTMARES THAT MAY BE REAL:
Measuring blood pressure in the clinic can be useful. However, in a recent meta-analysis (involving nine studies from Europe, South America and Asia), the results showed that high blood pressure measured at nighttime was potentially a better predictor of myocardial infarctions (heart attacks) and strokes, compared to daytime and clinic readings. (7). For every 10 mmHg rise in nighttime systolic blood pressure, there was a corresponding 25 percent increase in cardiovascular events. This was a large meta-analysis that utilized studies that were at least one year in duration. Does this mean that nighttime readings are superior in predicting risk? Not necessarily, but the results are interesting. The nighttime readings were made using 24-hour ambulatory blood pressure measurements (ABPM).
There is something referred to as masked uncontrolled hypertension (MUCH) that may increase the risk of cardiovascular events in the nighttime. MUCH occurs in those who are well-controlled during clinic readings for blood pressure; however, their nocturnal blood pressure is uncontrolled. In the Spanish Society of Hypertension ABPM Registry, MUCH was most commonly seen during nocturnal hours (8). Thus, the authors suggest that ABPM may be a better way to monitor those who have higher risk factors for MUCH, such as those whose pressure is borderline in the clinic and those who are smokers, obese or have diabetes.
Previously, a study suggested that taking at least one antihypertensive medication at night may be more effective than taking them all in the morning (9). Those who took one or more blood pressure medications at night saw a two-thirds reduction in cardiovascular event risk. Now we can potentially see why. These were patients who had chronic kidney disease (CKD). Generally, 85 to 95 percent of those with CKD have hypertension.

DIETARY TIDBITS:
Diet plays a role in controlling high blood pressure. In a recent study, blueberry powder (22 grams) daily equivalent to one cup of fresh blueberries reduced systolic blood pressure by a respectable 7 mmHg and diastolic blood pressure by 5 mmHg over 2 months (10). This is not bad, especially since the patients were prehypertensive, not hypertensive, at baseline, with a mean systolic blood pressure of 138 mmHg. This is a modest amount of fruit with a significant impact, demonstrating exciting results in a small, preliminary, double-blind, placebo-controlled randomized trial. Blueberries increase a substance called nitric oxide, which helps blood vessels relax, reducing blood pressure.
The results of another study showed that girls who consumed higher levels of potassium-rich foods had a significant reduction in both systolic and diastolic blood pressure (11). The highest group consumed at least 2,400 mg of potassium daily, whereas the lowest group consumed less than 1,800 mg. The girls were 9 and 10 years old and were followed for a 10-year duration. Though the absolute change was not large, the baseline blood pressure was already optimal for both groups, so it is impressive to see a significant change.
In conclusion, nighttime can be scary for high blood pressure and its cardiovascular complications, but lifestyle modifications, such as taking antihypertensive medications at night and making dietary changes, can have a big impact in altering these serious risks.

REFERENCES
(1) Natl Health Stat Report 2011. (2) CDC.gov. (3) Diabetes Care 2011;34 Suppl 2:S308-12. (4) uptodate.com. (5) BMC Fam Pract 2015;16(26). (6) J Am Coll Cardiol 2015;65(4):327-35. (7) J Am Coll Cardiol 2015;65(4):327-35. (8) Eur Heart J 2015;35(46):3304-12. (9) J Am Soc Nephrol 2011 Dec;22(12):2313-21. (10) J Acad Nutr Diet 2015;115(3):369-77. (11) JAMA Pediatr online April 27, 2015.

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

Heart of Greenlawn family will go on after transplant

by Barbara Donlon - May 1, 2015

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Michele-Martines-Christian-Siems-w — Michele Martines smiles with her son Christian, 21, prior his heart transplant at Westchester Medical Center on Saturday. Photo from Michele Martines

A call at 11:47 p.m. last Friday changed the life of a 21-year-old Greenlawn man and his family for the better. On the other end of the line was a heart.

With tears of joy streaming down her face, Michele Martines gracefully accepted the heart on behalf of her son, Christian Siems, who was in desperate need of a transplant after suffering from congestive heart failure as a result of a genetic disease.

“We packed everything; we were running around scared trying to call people,” Martines said describing the moments after finding out her son would be getting a new heart.

Martines said she was overwhelmed with emotion as the moment she had been waiting for happened. She was happy and scared for her son, but she said he was ready.

“He was ready to go, ready to go, ready to go,” Martines said. “He wanted the heart.”

The quest for a new heart began on June 28, 2012, when Siems tried to donate blood at school. A nurse noticed he had an irregular heartbeat and suggested he see a doctor. His mom took him to the pediatrician, who suggested he see a cardiologist.

After having an echocardiogram, a test used to see how the heart is beating and pumping blood, he had to undergo an immediate test that showed his heart was functioning at less than 20 percent capacity. Doctors had to install a defibrillator, which delivers a dose of electrical energy to the heart, because Siems was at risk of cardiac arrest.

The condition was manageable with medication until last September, when Martines noticed something wasn’t right with her son.

“His heart started to fail,” Martines said.

Doctors found 80 pounds of fluid in his body as a result of congestive heart failure. He was rushed to Huntington Hospital and then airlifted to Westchester Medical Center in Valhalla, where he went into severe cardiac arrest.

“He was dying,” his mom said.

Siems underwent surgery and was living because a machine and a mechanical device helped his heart beat, Martines said.

Finally, in November, he was well enough to come home and his mom stepped in to tend to him as they patiently waited for a heart. While he was a priority on the donor list, some people can wait as long as 20 years, according to Siems’ doctor Alan Gass, the family’s cardiologist.

Gass said Siems was in need of a transplant and was lucky his wait was just months instead of years. Another factor helping the young man with his condition was his age, the doctor said.

“Young people can compensate well, even though they are getting worse quicker,” Gass said.

But while Siems was able to compensate, young people fall apart quickly, and his heart was deteriorating even though he was being treated for his condition. The need for a heart was vital.

On Saturday, just 12 hours after appearing at a press conference with County Executive Steve Bellone (D) in an effort to promote organ donation, Siems received the call that a heart was ready for him.

The family got into the car to drive to the hospital in Valhalla and anxiously waited for the surgery. At 7 a.m., the family said their goodbyes as Siems was wheeled off to get the heart he had been desperately waiting for.

While her son was getting prepped for the surgery, Martines was pacing back and forth, and ultimately she came in contact with the doctors who had her son’s new heart in a cooler. The small amount of doubt she had disappeared, as she said she knew her son was going to be just fine.

“I just couldn’t believe it,” she said. “It made it real that it was really happening.”

After a few minor complications and 14 hours in surgery, Siems’ new heart was in his chest and ready to go. And while he was unable to speak following his surgery, he used a pen and paper to let his loved ones and doctor know he was doing just fine.

“The best I felt in five years,” the white piece of paper read. The family teared up at the note. Siems’ dad, Gerald “Gerry” Siems, who was also a heart transplant recipient, died in 2013.

The young man is expected to stay in the hospital for roughly two weeks, according to Gass. In a few weeks, he will be able to return to a normal life, which entails playing sports and doing what he loves.

While Siems’ story ended well, the wait for organ donations may be far too long for some people. According to LiveOnNY, a nonprofit organ donor network, roughly 10,000 New Yorkers are waiting for various organ donations at any given time. On average, 18 people die every day while waiting for organ transplants in the U.S., according to the group’s website.

One donor can save and improve the lives of 58 people through organ and tissue donation. To learn more about organ donation, visit www.donatelifeny.org.

Community comes out for Butterfly Breakfast for a Cure

by TBR Staff - April 28, 2015

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Buttlerfly People — A local family came out for breakfast to support a great cause. Photo by Jenn Intravaia Photography

By Ernestine Franco

More than 160 people started their day recently at the Butterfly Breakfast for a Cure fundraiser held at Applebee’s in Miller Place.

The $4,000 raised on Saturday will benefit DEBRA for America, an organization that provides assistance and education to families with children born with epidermolysis bullosa (EB). Young people who suffer from this disease are called “butterfly children” because their skin is so fragile it blisters or tears from friction or trauma.

After the event, Donna McCauley, who organized the fundraiser, expressed her gratitude to everyone who participated in the fundraiser, “When [my daughter] Kelly asked to take on a fundraiser for DEBRA of America, we were so proud of her for taking such an interest to give back to this wonderful organization that has supported our family for so many years. Living with EB is not easy and often people ask me how I manage to be so involved in so many things. All of my servers worked out of the goodness of theirs hearts and for service hours and did a great job. In case it wasn’t obvious to all yesterday by [the number of people who came to] Applebee’s … It is because of the love and support of my fantastic family and a group of friends like all of you. I am truly humbled by the turnout.”

If you would like to donate to help find a cure, please visit www.DEBRA.org.

A long (and fat) winter’s night for pets

Health

by Matthew Kearns - April 22, 2015

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By Matthew Kearns, DVM

In our previous article we discussed predisposing factors to obesity such as breed, spay/neuter status, age and underlying disease. This article will focus on a brief overview of tackling the obesity problem. The short answer here is there is no magic bullet for weight loss, but rather the same answer there is for humans: diet and exercise. With that said let’s take a closer look at that and give some more specific recommendations.
Diet: In a veterinary article I recently read, management of obesity in dogs and cats is as easy as following the three A’s: awareness, accurate accounting and assessment.

Awareness refers not only to coming to terms with obesity in your pet but also certain risks as well (breed, spay/neuter status, etc.). How does one identify obesity in a pet? Usually it’s a vet (the bad guy) that hints at the fact that Spike has gotten a little husky or Fifi a little fluffy. However, you can actually assess your own pet at home. Just go online and look up “Body Conditioning Score,” or “BCS” for short. If, after reviewing information online you are still unsure, I would recommend scheduling an appointment to consult with your veterinarian.

Accurate accounting may be the hardest thing (for us as pet owners) to face. Food can be an act of bonding not only with other people but also with our pets. We had one pet owner at our clinic with an obese dog she swore was only getting its food and no extra snacks or table food. After a bit of investigation I found out that the owner loved to cook and the dog was the “official taster” for every meal. No table food meant no food directly from the table. This was a smart woman, but she felt that the dog would no longer love her if she took this bonding moment away. Unfortunately, this also meant the dog would soon have to be rolled into the clinic and not walk in under its own power.

To make life a little easier, there is a way to actually calculate calorie requirements by using a calculation called the Resting Energy Requirements, or RER for short. The RER is a starting point, and then in conjunction with your veterinarian or a veterinary nutritionist you can calculate how much food to give at each meal. After accurately calculating how much food your dog needs for the whole day, you can break that up into as many meals as you’d like. It has been found that it is more effective to feed at least two and up to four smaller meals a day to lose weight than to free feed (fill up the bowl).

Treats also have calories and should not exceed 10 percent of the diet. There are now low-calorie treats available both commercially and as prescription low-calorie treats through your veterinarian.

Lastly, in terms of assessment, it is important to either weigh your pet at home or bring your pet to your veterinarian’s office for a weight (this helps with consistency especially for larger pets). We encourage pet owners with obese pets trying to lose weight to bring their pets in (at no charge) to be weighed.

Exercise: Exercise is key to good health for many reasons: It helps to maintain and strengthen muscle, it promotes cardiovascular health, it provides mental stimulation, and it increases energy expenditure and fat oxidation.

Obese dogs should be given low-impact cardiovascular exercise (a longer walk or swimming rather than chasing a ball) to avoid heat stroke or injury.

Obese indoor-only cats should have their play geared toward outdoor hunting and playing behaviors (climbing, balancing, scratching). Toys work well for some cats, while others prefer cat trees or play stations. Interactive toys with the owner are best (especially for single-cat households) to lose weight, as well as promote bonding with the owner.

I hope that this series of articles will help to make our pets the healthiest and happiest pets ever this summer.

Dr. Kearns has been in practice for 16 years.

Rocky Point soup kitchen invites all to walk for hunger

by TBR Staff - April 22, 2015

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Invited INN to hold annual walkathon on Saturday

GiovanniCassino-MillerPlacew — Volunteer Giovanni Cassino, of Miller Place, helps set the table at the Invited INN soup kitchen at the Trinity Evangelical Lutheran Church in Rocky Point. File photo by Erika Karp

By Erin Dueñas

In order to raise funds to continue 23 years of preparing a warm and nutritious meal to those in need, the Invited INN soup kitchen of Rocky Point will host a walkathon this Saturday, April 25, at the Shrine of Our Lady of the Island in Manorville.

Every Thursday, volunteers at the soup kitchen cook and serve dinner to anywhere from 40 to 70 people who come seeking a fresh-cooked meal and the companionship that comes with eating together. According to Invited INN’s Director and President Carol Moor, the soup kitchen has a “no questions asked” policy on who gets served.

“We don’t check income or anything like that, some people come just for the company. Anyone who shows up gets a meal,” she said. “Everyone who comes is treated with dignity and respect.”

According to Moor, the guests of the Invited INN are a diverse group, including seniors and families with young children, as well as single adults. Although housed in the Trinity Evangelical Lutheran Church, the soup kitchen is ecumenical and any and all faiths are welcome to dine.

The INN, which stands for Interfaith Nutrition Network, is a nonprofit that provides food, shelter and support services to Long Island residents.

Moor said she helped start the soup kitchen more than two decades ago when she was chair of social ministries at Trinity.

“The church recognized a need for a soup kitchen,” she said. “We had the pantry, but we needed something more.”

The very first meal prepared at the Invited INN was served to just six people.

“It’s really grown since then and it’s been very successful,” Moor said. “People aren’t aware that people in their community need this kind of help.”

This is the seventh year the soup kitchen will host the walkathon, the only formal fundraiser it does throughout the year, according to Moor.

“You get a lot of bang for your buck doing a walkathon, and we tend to do very well,” Moor said. “The shrine is a beautiful place to walk and we make some money so it is really a win-win.”

Registration for the walk will begin at 10 a.m. and Moor said walkers can walk as many or as few times as they want around the shrine.

Every penny earned Saturday will go directly to providing the food prepared each Thursday. Running with no overhead and completely by volunteers, any donations the INN receives throughout the year goes solely toward buying food to prepare the weekly dinner.

Donated food items come from organizations such as Long Island Cares and Island Harvest, but the bulk of Invited INN’s monetary donations come from private donors: the congregation at Trinity, as well as from the Rocky Point Lions Club and the Rotary Club of Rocky Point.

Rotary member Tom Talbot said his organization’s intent is to provide help to people and that they enjoy giving to the Invited INN.

“The volunteers are very nice people who are so grateful for our help,” Talbot said. “They run a very important facility in Rocky Point.”

Talbot, who has volunteered at the soup kitchen as a pot washer for 10 years, said that the people who eat there seem to enjoy the meals.

“They are usually very satisfied with the food and it gives them the chance to be social too,” he said. “Some of them come early to make sure they get the same seat they have been sitting in for years.”

Trinity’s pastor Jeffrey Kolbo said that although the Invited INN is essentially a free hot meal program, he has found that it provides much more than that.

“For those who live on a limited income, money saved by eating each week at the Invited INN can be spent on other necessities,” he said. “For those who live by themselves, a night out at the INN breaks the tedium of eating alone. Our volunteers know this and do what they can to build community and feed those who come for our meals.”

To participate in the walkathon or sponsor a walker, contact Moor at 631-744-8686.

Rheumatoid arthritis: It’s not just about your joints

by TBR Staff - April 21, 2015

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By David Dunaief

We know that inflammation is a critical part of many chronic diseases. Rheumatoid arthritis (RA) is no exception. With RA, inflammation is rampant throughout the body and contributes to painful joints, most commonly concentrating bilaterally in the smaller joints of the body, including the metacarpals and proximal interphalangeal joints of the hand, as well as the wrists and elbows. With time, this disease can greatly diminish our ability to function, interfering with our activities of daily living. The most basic of chores, such as opening a jar, can become a major hindrance.

In addition, RA can cause extra-articular, a fancy way of saying outside the joints, manifestations and complications. These can involve the skin, eyes, lungs, heart, kidneys, nervous system and blood vessels. This is where it gets a bit dicier. With increased complications comes an increased risk of premature mortality (1).

Four out of 10 RA patients will experience complications in at least one organ. Those who have more severe disease in their joints are also at greater risk for these extra-articular manifestations. Thus, those who are markedly seropositive for the disease, showing elevated biomarkers like rheumatoid factor (RF), are at greatest risk (2). They have an increased risk of cardiovascular disease events, such as heart attacks and pulmonary disease. Fatigue is also increased, but the cause is not well understood. We will look more closely at these complications.

Are there treatments that may increase or decrease these complications? It is a very good question, because some of the very medications used to treat RA also may increase risk for extra-articular complications, while other drugs may reduce the risks of complications. We will try to sort this out, as well. The drugs used to treat RA are disease-modifying antirheumatic drugs (DMARDs), including methotrexate; TNF inhibitors, such as Enbrel (etanercept); oral corticosteroids; and NSAIDs (non-steroidal anti-inflammatory drugs).

It is also important to note that there are modifiable risk factors. We will focus on two of these, weight and sugar. Let’s look at the evidence.

CARDIOVASCULAR DISEASE BURDEN
We know that cardiovascular disease is very common in this country for the population at large. However, the risk is even higher for RA patients; these patients are at a 50 percent higher risk of cardiovascular mortality than those without RA (3). The hypothesis is that the inflammation is responsible for the RA-cardiovascular disease connection (4). Thus, oxidative stress, cholesterol levels, endothelial dysfunction and high biomarkers for inflammation, such as ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein), play roles in fostering cardiovascular disease in RA patients (5).

THE YING AND YANG OF MEDICATIONS
Although drugs such as DMARDS (including methotrexate and TNF inhibitors, Enbrel, Remicade, Humira), NSAIDs (such as celecoxib) and corticosteroids are all used in the treatment of RA, some of these drugs increase cardiovascular events and others decrease them. In meta-analysis (a group of 28 studies), the results showed that DMARDS reduced the risk of cardiovascular events by up to 30 percent, while NSAIDs and corticosteroids increased the risk (6). The oral steroids had the highest risk of heart complications, approximately a 50 percent rise in risk. This may be one reason rheumatologists encourage their RA patients to discontinue oral steroid treatments as quickly as possible.
In an observational study, the results reaffirm that corticosteroids increased the risk of a heart attack in RA patients, this time by 68 percent (7). The study involved over 8,000 patients with a follow-up of nine years. Interestingly, there was a dose-response curve. In other words, the results also showed that for every 5 mg increase in dosage, there was a corresponding 14 percent increase in heart attack risk.

BAFFLING DISEASE COMPLICATION
Most complications seem to have a logical connection to the original disease. Well, it was a surprise to researchers when the results of the Nurses’ Health Study showed that those with RA were at increased risk of cardiovascular disease and of respiratory disease (8). In fact, the risk of dying from respiratory disease was 106 percent higher in the women with RA compared to those without, and the risk was even higher in women who were seropositive (had elevated levels of rheumatoid factor). The authors surmise that seropositive patients have greater risk of death from respiratory disease because they have increased RA severity compared to seronegative patients. The study followed approximately 120,000 women for a 34-year duration.

WHY AM I SO TIRED?
While we have tactics for treating joint inflammation, we have yet to figure out how to treat the fatigue associated with RA. In a recently published Dutch study, the results showed that while the inflammation improved significantly, fatigue only changed minimally (9). The consequences of fatigue can have a negative impact on both the mental and physical qualities of life. There were 626 patients involved in this study for eight years of follow-up data. This study involved two-thirds women, which is significant; women in this and in previous studies tended to score fatigue as more of a problem.

LIFESTYLES OF THE MORE PAINFUL AND DEBILITATING
We all want a piece of the American dream. To some that means eating like kings of past times. Well, it turns out that body mass index plays a role in the likelihood of developing RA. According to the Nurses’ Health Study, those who are overweight or obese and are ages 55 and younger have an increased risk of RA, 45 percent and 65 percent, respectively (10). There is higher risk with increased weight because fat has pro-inflammatory factors, such as adipokines, that may contribute to the increased risk. Weight did not influence whether they became seropositive or seronegative RA patients.
With a vegetable-rich, plant-based diet you can reduce inflammation and thus reduce the risk of RA by 61 percent (11). In my clinical practice, I have seen numerous patients able to reduce their seropositive loads to normal or near-normal levels by following this type of diet.

SUGAR, SUGAR!
At this point, we know that sugar is bad for us. But just how bad is it? When it comes to RA, results of the Nurses’ Health Study showed that sugary sodas increased the risk of developing seropositive disease by 63 percent (12). In subset data of those over age 55, the risk was even higher, 164 percent. This study involved over 100,000 women followed for 18 years.

THE JUST PLAIN WEIRD – INFECTION FOR THE BETTER
Every so often we come across the surprising and the interesting. I would call it a Ripley’s Believe It or Not moment. In a recent study, those who had urinary tract infections, gastroenteritis or genital infections were less likely to develop RA than those who did not (13). The study did not indicate a time period or potential reasons for this decreased risk. However, I don’t think I want an infection to avoid another disease. When it comes to RA, prevention with diet is your best ally. Barring that, disease-modifying anti-rheumatic medications are important for keeping inflammation and its progression in check. However, oral steroids and NSAIDs should generally be reserved for short-term use. Before considering changing any medications, discuss it with your physician.

REFERENCES
(1) J Rheumatol 2002;29(1):62. (2) uptodate.com. (3) Ann Rheum Dis 2010;69:325–31. (4) Rheumatology 2014;53(12):2143-2154. (5) Arthritis Res Ther 2011;13:R131. (6) Ann Rheum Dis 2015;74(3):480-489. (7) Rheumatology 2013;52:68-75. (8) ACR 2014: Abstract 818. (9) RMD Open 2015. (10) Ann Rheum Dis. 2014;73(11):1914-1922. (11) Am J Clin Nutr 1999;70(6),1077–1082. (12) Am J Clin Nutr 2014;100(3):959-67. (13) Ann Rheum Dis 2015;74:904-907.

SBU donor event celebrates gift of life

by TBR Staff - April 8, 2015

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Buckleysw — Arleen Buckley donated a kidney to her husband of 43 years, Tom Buckley. Photo by Erin Dueñas

By Erin Dueñas

Arleen Buckley ticked off the places she and husband Tom had traveled to before he fell ill. The Port Jefferson couple had visited Italy, Ireland and even China, but a planned trip to Belgium last year had to be canceled after Tom’s battle with polycystic kidney disease — a hereditary condition where cysts develop on the kidneys, leading to the organ’s failure — kept him from traveling.

“He was just too sick,” his wife said. “We were lucky we could get him to the corner.”

Tom Buckley spent months undergoing dialysis three days a week, but the treatments left him weak.

“He wasn’t having a good reaction to the dialysis,” Arleen Buckley said. “I told him we can’t live life like this. It was a tough time.”

Arleen Buckley said she couldn’t bear seeing her husband of 43 years so ill. She suggested giving him one of her kidneys to resolve his health issue but he refused.

“He felt guilty. He didn’t want me putting my life at risk,” she said. “I told him I wanted to live a nice long life — but with him.”

It took months but she eventually convinced her husband to take her kidney, and in September of last year, the couple underwent the surgeries.

Arleen Buckley was up and about just three days later, and while her husband’s recovery took much longer — about six months — he said he feels great. They’re even planning a trip to Scandinavia.

“I couldn’t go anywhere, not even to the movies,” Tom Buckley said. “Now that I’m better I can do whatever I want.”

Last Thursday, April 2, the couple attended the Living Donor Award Ceremony at Stony Brook University Hospital, which honored Arleen Buckley and about 200 other kidney donors. Sponsored by the hospital’s Department of Transplant, kidney recipients presented their living donors with a state medal of honor for the second chance at life.

The ceremony’s keynote speaker was Chris Melz of Huntington Station, who donated a kidney in 2009 to his childhood friend Will Burton, who suffered from end-stage renal failure. The surgeries were successful, and Melz now works with the National Kidney Foundation raising awareness for living donors.

“I want to spark the drive for people to do good,” he said. “Giving is a beautiful thing.”

Arleen Buckley said she was happy to give a kidney to her husband, whom she has known for 50 years.

“I told him, ‘When I was 14 years old, I gave you my heart. At 64, I gave you my kidney,’” the wife said.

Dr. Wayne Waltzer, director of kidney transplantation services and chair of the Department of Urology at Stony Brook University School of Medicine, called kidney transplants a “new lease on life” for patients who are on dialysis.

“Transplants restore them,” Waltzer said. “They get back the same sense of well-being they had before they got sick.”

According to the National Kidney Foundation, 118,000 Americans are on a waiting list for an organ — 96,000 of those wait for a kidney. Roughly 13 people die daily waiting for the organ, the group said.

Stephen Knapik, Stony Brook University’s living donor coordinator, said that every 10 minutes someone in need of a kidney is added to that list. He called it an honor to work with donors who keep the list from growing.

“I’ve never been in a room with so many superheroes in my life,” Knapik said. “The greatest gift you can give isn’t a boat or a car, it’s the gift of life.”

Waltzer said that donating a kidney involves meeting certain criteria including compatible blood groups and matching body tissues between donor and recipient, as well as ensuring that the recipient has no antibodies that will work against the transplanted organ.

While he said the surgery is sophisticated, he called the science and medicine an incredible achievement.

“The immunosuppressive therapy is so good and the medication so effective that you can override any mismatches,” he said.

This allows for donors to give to loved ones that are not related by blood.

With the most active renal transplant program on Long Island, Stony Brook has done 1,500 transplants since 1981. Waltzer said that donors are doing an “amazing service,” not just to their recipient but also to one of the thousands of people who are on the waiting list for a kidney.

“There is a shortage of organs,” he said. “By donating, you are giving a chance to someone else on that waiting list.”

Ways to counter chronic stress

by TBR Staff - April 8, 2015

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By David Dunaief

Now that spring has sprung, the pace of life tends become more hectic. Although some stress is valuable to help motivate us and keep our minds sharp, high levels of constant stress can have detrimental effects on the body.
It is very likely that there is a mind-body connection when it comes to stress. In other words, it may start in the mind, but it can lead to acute or chronic disease promotion. Stress can also play a role with your emotions, causing irritability and outbursts of anger, and possibly leading to depression and anxiety. Stress symptoms are hard to distinguish from other disorders but can include stiff neck, headaches, stomach upset and difficulty sleeping. Stress may also be associated with cardiovascular disease, with an increased susceptibility to infection from viruses causing the common cold and with cognitive decline and Alzheimer’s (1).
A stress steroid hormone called cortisol is released from the adrenal glands and can have beneficial effects in small bursts. We need cortisol in order to survive. Some of cortisol’s functions include raising the glucose (sugar) levels when they are low and helping reduce inflammation and stress levels (2). However, when cortisol gets out of hand, higher chronic levels may cause inflammation, leading to disorders such as cardiovascular disease, as recent research suggests. Let’s look at the evidence.

Inflammation
Inflammation may be a significant contributor to more than 80 percent of chronic diseases, so it should be no surprise that inflammation is an important factor with stress. In a recent meta-analysis (a group of two observational studies), high levels of C-reactive protein, a biomarker for inflammation, were associated with increased psychological stress (3).
What is the importance of CRP? It may be related to heart disease and heart attacks. This study involved over 73,000 adults who had their CRP levels tested. The research went further to suggest that increased levels of CRP may result in more stress and also depression. With CRP higher than 3.0 there was a greater than twofold increase depression risk. The researchers suggest that CRP may heighten stress and depression risk by increasing levels of different proinflammatory cytokines, inflammatory communicators among cells (4).
In one recent study, results suggested that stress may influence and increase the number of hematopoietic stem cells (those that develop of all forms of blood cells), resulting in specifically an increase in inflammatory white blood cells (5). The researchers suggest that this may lead to these white blood cells accumulating in atherosclerotic plaques in the arteries, which ultimately could potentially increase the risk of heart attacks and strokes. Chronic stress overactivates the sympathetic nervous system — our “fight or flight” response — which may alter the bone marrow where the stem cells are found. This research is preliminary and needs well-controlled trials to confirm these results.

Infection
Stress may increase the risk of colds and infection. Cortisol over the short term is important to help suppress the symptoms of colds, such as sneezing, cough and fever. These are visible signs of the immune system’s infection-fighting response. However, the body may become resistant to the effects of cortisol, similar to how a type 2 diabetes patient becomes resistant to insulin. In one study of 296 healthy individuals, participants who had stressful events and were then exposed to viruses had a higher probability of catching a cold. It turns out that these individuals also had resistance to the effects of cortisol. This is important because those who were resistant to cortisol had more cold symptoms and more proinflammatory cytokines (6).

Cortisol
When we measure cortisol levels, we tend to test the saliva or the blood. However, these laboratory findings only give one point in time. Thus, when trying to determine if raised cortisol may increase cardiovascular risk, the results are mixed. However, in a recent study, measuring cortisol levels from scalp hair was far more effective (7). The reason for this is that scalp hair grows slowly, and therefore it may contain three months’ worth of cortisol levels. The study showed that those in the highest quartile of cortisol levels were at a three-times increased risk of developing diabetes and/or heart disease compared to those in the lowest quartile. This study involved older patients between the ages of 65 and 85.

Lifestyle and the Cellular Level
Lifestyle plays an important role in stress at the cellular level, specifically at the level of the telomere, which determines cell survival. The telomeres are to cells as the plastic tips are to shoelaces; they prevent them from falling apart. The longer the telomere, the slower the cell ages and the longer it survives. In a recent study, those women who followed a healthy lifestyle — one standard deviation over the average lifestyle — were able to withstand life stressors better since they had longer telomeres (8).
This healthy lifestyle included regular exercise, a healthy diet and a sufficient amount of sleep. On the other hand, the researchers indicated that those who had poor lifestyle habits lost substantially more telomere length than the healthy lifestyle group. The study followed women 50 to 65 years old over a one-year period.
In another study, chronic stress and poor diet (high sugar and high fat) together increased metabolic risks, such as insulin resistance, oxidative stress and central obesity, more than a low-stress group eating a similar diet (9). The high-stress group was caregivers, specifically those caring for a spouse or parent with dementia. Thus, it is especially important to eat a healthy diet when under stress.
Interestingly, in terms of sleep, the Evolution of Pathways to Insomnia Cohort study shows that those who deal with stressful events directly are more likely to have good sleep quality. Using medication, alcohol or, most surprisingly, distractors to address stress all resulted in insomnia after being followed for one year (10). Cognitive intrusions or repeat thoughts about the stressor also resulted in insomnia.
Psychologists and other health care providers sometimes suggest distraction from a stressful event, such as television watching or other activities, according to the researchers. However, this study suggests that this may not help avert chronic insomnia induced by a stressful event. The most important message from this study is that how a person reacts and deals with a stressors may determine whether they suffer from insomnia.

Constant stress is something that needs to be recognized. If not addressed, it can lead to suppressed immune response or increased levels of inflammation. CRP is an example of an inflammatory biomarker that may actually increase stress. In order to address chronic stress and lower CRP, it is important to adopt a healthy lifestyle that includes sleep, exercise and diet modifications. A good lifestyle may be protective against cell aging when exposed to stressors.

References:
(1) Curr Top Behav Neurosci. 2014 Aug. 29. (2) Am J Physiol. 1991;260(6 Part 1):E927-E932. (3) JAMA Psychiatry. 2013;70:176-184. (4) Chest. 2000;118:503-508. (5) Nat Med. 2014;20:754-758. (6) Proc Natl Acad Sci U S A. 2012;109:5995-5999. (7) J Clin Endocrinol Metab. 2013;98:2078-2083. (8) Mol Psychiatry Online. 2014 July 29. (9) Psychoneuroendocrinol Online. 2014 April 12. (10) Sleep. 2014;37:1199-1208.

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