Rite Aid announced on April 30 it is now administering the COVID-19 vaccine at all locations, spanning more than 2,500 stores in 17 states. Following the latest guidance from the Biden Administration, all those aged 16 years or older are now eligible for vaccination, and Rite Aid encourages everyone to schedule an appointment as soon as possible.
While scheduling appointments in advance is recommended to reduce wait time and guarantee availability of the vaccine, Rite Aid is now also accommodating walk-in vaccines on a limited basis in every store. Enabling walk-in appointments supports customers that may not have access to internet while also meeting the need for flexibility for customers. People interested in a walk-in appointment are encouraged to visit their local Rite Aid to confirm availability.
“The availability of vaccines in every Rite Aid location is a major milestone in our ongoing effort to fight COVID-19. We’ve been on the front lines since the beginning of the pandemic, working across our store footprint to bring testing and vaccines directly to local communities,” said Jim Peters, chief operating officer, Rite Aid. “Vaccine availability is improving every day, and our pharmacists are ready to administer vaccines safely and efficiently, providing the benefits of pharmacist-administered vaccines in a safe and sterile environment right in your neighborhood. Also, in addition to the grassroots efforts we’ve undertaken with our community partners, the availability of these walk-in appointments provides another way for those with limited or no technology access to more easily obtain COVID vaccines. We encourage everyone to make an appointment, or walk-in, today.”
Through its participation in the Federal Retail Pharmacy Program and as an Official COVID-19 Vaccination Program Provider, Rite Aid has accelerated its COVID-19 immunization efforts as allocation has expanded. Rite Aid’s certified immunizing pharmacists are administering the Moderna, Pfizer-BioNTech and Johnson & Johnson (Janssen) vaccines.
Individuals ages 18 and over can schedule appointments using the Rite Aid scheduling tool found at www.RiteAid.com/covid-19. Those ages 16 and 17 can schedule an appointment with guardian consent at any store administering the Pfizer vaccine by contacting the store’s pharmacy directly. Those stores can be found here.
For more information about Rite Aid’s COVID-19 vaccine efforts, please visit www.RiteAid.com/covid-19.
Long-term proton pump inhibitor use may have serious side effects
By David Dunaief, M.D.
Dr. David Dunaief
Reflux (GERD) disease, sometimes referred to as heartburn, though this is more of a symptom, is one of the most commonly treated diseases. In line with this, proton pump inhibitors (PPIs) have become one of the top-10 drug classes prescribed or taken in the United States.
The class of drugs called PPIs includes Prevacid (lansoprazole), Prilosec (omeprazole), Nexium (esomeprazole), Protonix (pantoprazole) and Aciphex (rabeprazole). Several of these medications are now available over-the-counter, rather than by prescription. When they were first approved, they were touted as having one of the cleanest side-effect profiles. This may still be true, if we use them correctly. They are intended to be used only for the short term. This can range from 7 to 14 days for over-the-counter PPIs to 4 to 8 weeks for prescription PPIs.
Dangers of long-term use
While PPI pre-approval trials were short-term, not longer than a year, many physicians put patients on these medications for decades. And the longer people are on them, the more complications arise. Among potential associations with long-term use are chronic kidney disease, dementia, bone fractures and Clostridium difficile, a bacterial infection of the gastrointestinal tract.
Though PPIs may increase the risk of a number of complications, keep in mind that none of the data are from randomized controlled trials (RCTs), which are the gold standard of studies, but mostly observational studies that suggest an association, not a link.
Chronic kidney disease
In two separate studies, results showed that there was an increase in chronic kidney disease with prolonged PPI use (1). All of the patients started the 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 modest 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 (2).
Dementia
Stock photo
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 (3). These patients were at least age 75. The authors surmise that PPIs may cross the coveted 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 family history of dementia, high blood pressure or excessive alcohol use, all of which have effects on dementia occurrence.
Bone fractures
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 (4). 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 through the gut. 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 (5).
Need for magnesium
PPIs may have lower absorption effects on several electrolytes including magnesium, calcium and B12. In one observational study, PPIs combined with diuretics caused a 73 percent increased risk of hospitalization due to low magnesium (6). Diuretics are commonly prescribed for high blood pressure, heart failure and swelling.
Another study confirmed these results. In this second study, which was a meta-analysis of nine studies, 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 (7). The authors note that a significant reduction in magnesium could lead to cardiovascular events.
The bottom line is that it’s best if you confer with your doctor before starting PPIs. You may not need PPIs, but rather a milder medication, such as H2 blockers (Zantac, Pepcid). 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 (8).
If you do need medications, know that PPIs don’t give immediate relief and should only be taken for a short duration: 7 to 14 days, according to the FDA, without a doctor’s consult, and 4 to 8 weeks with one (9).
Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. Visit www.medicalcompassmd.com.
The Three Village Dads Foundation recently signed an official pledge with Stony Brook Children’s Hospital to donate $100,000 over the next 5 years to the Child Life Services program. A check in the amount of $10,000 was presented on April 21 in partnership with Jeff Hendel of Hendel Wealth Management.
Photo from TVDF
“Two years ago when our Foundation began it’s local philanthropic efforts, the Children’s Hospital was actually our very first recipient. What initially was supposed to be a small Three Village Dads group BBQ where I figured we could perhaps raise a few dollars for a great local cause, turned into something so much more. That event was wildly successful as we were able to raise $12,000 which opened our eyes to the effectiveness us Dads could have on our community,” said David Tracy, Three Village Dads Foundation President & Chairman.
“When we established that relationship with Stony Brook’s Child Life program we immediately felt as connected and dedicated to their mission as their wonderful staff do. To now be in a position where we are able to deliver so much more to this great organization truly means a lot to myself, my board members, and our amazing donors. Jeff Hendel of Hendel Wealth Management joined as a co-donor with this presentation. It is generous donors such as Mr. Hendel that have enabled us to do the good we strive to do in Three Village,” he said.
Pictured from left, Elisa Ruoff, Development Officer of Advancement at Stony Brook Hospital; Michael Attard, Child Life Specialist at Stony Brook Children’s Hospital; Vince DiCarlo, Three Village Dads Foundation board member; David Tracy, Three Village Dads Foundation President & Chairman; Jeff Hendel, Hendel Wealth Management President & CEO; and Three Village Dads Foundation board members Chris Carson and David Bitman.
Clinical Assistant Professor of Medicine at Stony Brook Medicine, Dr. Miguel Saldivar, wants residents to make vaccine decisions based on scientific information, rather than Internet speculation. Saldivar, who joined Stony Brook just months before the pandemic hit Long Island, sees improvement in the overall infection numbers, which have declined in recent weeks to about two to three percent from closer to five to six percent. In a wide-ranging interview (which can be seen online at tbrnewsmedia.com), Saldivar answered a host of questions.
TBR: Do you have any concerns about the number or percentage of people who are not lining up for vaccination?
Saldivar: In general, what we are more concerned about is the amount of misinformation that is out there. If you go on social media — if you go just on the internet, period — there’s a lot of people who are spreading lot of information that is really frankly inaccurate.
TBR: What are Stony Brook and others trying to do to counter misinformation?
Saldivar: There are a number of things we hear fairly frequently, probably the more common one I personally have heard, because Pfizer and Moderna are based on mRNA technology, everybody hears the term RNA and is worried that it’s going to change my genetic code and turn me into a mutant or cause a disease down the line. The first thing to understand about that, the way both of those vaccines work, it’s a set of instructions being given to the body cells, the moment it’s been delivered, the mRNA dissolves. It has no way of getting into the deeper part of the cells to change your genetic code.
TBR: Black and brown communities have a distrust of the federal government after some well known problems regarding Tuskegee Experiment and other issues. Is there broader acceptance now compared with a month or two ago?
Saldivar: Statistically, if you compare how this disease has affected minority communities, the risk of a severe outcome, hospitalization intubation and death is almost universally higher among minority communities. That has a number of factors, not just the disease itself. It’s also the fact that within those communities, it is more frequent to find some of the risk factors, meaning diabetes, obesity, preexisting pulmonary disease so on and so forth … What I have been personally involved with is reaching out to the community, we have found a lot of community centers have been very ready and willing to engage in a conversation. We have found places of worship to be wonderful places to have that conversation
TBR: What does the data tell you about the pandemic?
Saldivar: The last numbers I heard from the meeting this morning were between two to three percent positivity. We’ve been there for a week. Before that, we were staying pretty stable at like five to six percent or thereabouts. It looks like finally, this may be the effect of the vaccine, the numbers are finally starting to little by little trend their way down. We’ve been cautiously optimistic. There seems to be a little bit of a light at the end of the tunnel.
TBR: You have a bachelor’s degree in classical guitar performance. How did you wind up in infectious disease?
Saldivar: Through the nonprofit circle, I landed a job with the medical center at UCLA. That’s where I met a very, very good friend and mentor. She was key to helping me shape the path. I feel incredibly lucky to be part of this profession.
The prevalence of osteoporosis is increasing, especially as the population ages. Why is this important? Osteoporosis may lead to increased risk of fracture due to a decrease in bone strength (1). That is what we do know. But what about what we think we know?
For decades we have been told that if we want strong bones, we need to drink milk. This has been drilled into our brains since we were toddlers. Milk has calcium and is fortified with vitamin D, so milk could only be helpful, right? Not necessarily.
The data is mixed, but studies indicate that milk may not be as beneficial as we have been led to believe. Even worse, it may be harmful. The operative word here is “may.” We will investigate this further. Vitamin D and calcium are good for us. But do supplements help prevent osteoporosis and subsequent fractures? Again, the data are mixed, but supplements may not be the answer for those who are not deficient.
Does milk help or hurt?
The results of a large, observational study involving men and women in Sweden showed that milk may be harmful (2). When comparing those who consumed three or more cups of milk daily to those who consumed less than one, there was a 93 percent increased risk of mortality in women between the ages of 39 and 74. There was also an indication of increased mortality based on dosage.
For every one glass of milk consumed there was a 15 percent increased risk of death in these women. There was a much smaller, but significant, three percent per glass increased risk of death in men. Women experienced a small, but significant, increased risk of hip fracture, but no in-creased risk in overall fracture risk. There was no increased risk of fracture in men, but there was no benefit either. There were higher levels of biomarkers that indicate oxidative stress and inflammation found in the urine.
This study was 20 years in duration and is eye-opening. We cannot make any decisive conclusions, only associations, since it is not a randomized controlled trial. But it does get you thinking. The researchers surmise that milk has high levels of D-galactose, a simple sugar that may increase inflammation and ultimately contribute to this potentially negative effect, whereas other foods have many-fold lower levels of this substance.
Ironically, the USDA recommends that, from 9 years of age through adulthood, we consume three cups of dairy per day (3). This is interesting, since the results from the previous study showed the negative effects at this recommended level of milk consumption. The USDA may want to rethink these guidelines.
Prior studies show milk may not be beneficial for preventing osteoporotic fractures. Specifically, in a meta-analysis that used data from the Nurses’ Health Study for women and the Health Professionals Follow-up Study for men, neither men nor women saw any benefit from milk consumption in preventing hip fractures (4).
Does calcium help?
Stock photo
Unfortunately, it is not only milk that may not be beneficial. In a meta-analysis involving a group of observational studies, there was no statistically significant improvement in hip fracture risk in those men or women ingesting at least 300 mg of calcium from supplements and/or food on a daily basis (5).
The researchers did not differentiate the types of foods containing calcium. In a group of randomized controlled trials analyzed in the same study, those taking 800 to 1,600 mg of calcium supplements per day also saw no increased benefit in reducing nonvertebral fractures. In fact, in four clinical trials the researchers actually saw an increase in hip fractures among those who took calcium supplements. A weakness of the large multivaried meta-analyses is that vitamin D baseline levels, exercise and phosphate levels were not taken into account.
What about vitamin D?
Finally, though the data is not always consistent for vitamin D, when it comes to fracture prevention, it appears it may be valuable. In a meta-analysis (involving 11 randomized controlled trials), vitamin D supplementation resulted in a reduction in fractures (6). When patients were given a median dose of 800 IUs (ranging from 792 to 2,000 IUs) of vitamin D daily, there was a significant 14 percent reduction in nonvertebral fractures and an even greater 30 percent reduction in hip fractures in those 65 years and over. However, vitamin D in lower levels showed no significant ability to reduce fracture risk.
Just because something in medicine is a paradigm does not mean it’s correct. Milk may be an ex-ample of this. No definitive statement can be made about calcium, although even in randomized controlled trials with supplements, there seemed to be no significant benefit. Of course, the patients in these trials were not necessarily deficient in calcium or vitamin D.
In order to get benefit from vitamin D supplementation to prevent fracture, patients may need at least 800 IUs per day, which is the Institute of Medicine’s recommended amount for a relatively similar population as in the study.
Remember that studies, though imperfect, are better than tradition alone. Prevention and treatment therefore should be individualized, and deficiency in vitamin D or calcium should usually be treated, of course. Please, talk to your doctor before adding or changing any supplements.
References:
(1) JAMA. 2001;285:785-795. (2) BMJ 2014;349:g6015. (3) health.gov (4) JAMA Pediatr. 2014;168(1):54-60. (5) Am J Clin Nutr. 2007 Dec;86(6):1780-1790. (6) N Engl J Med. 2012 Aug. 2;367(5):481.
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.
Northwell Health has been named to Fortune’s “100 Best Companies to Work For,” for the second year in a row, catapulting to 19th from a ranking of 93rd last year on the prestigious annual list. The health system is one of nine health care organizations nationwide to make the list and the only one in New York State to be recognized.
Fortune’s top 100 list is based on results from America’s largest ongoing annual workforce study, representing more than 4.1 million employees this year alone. Employees responded to more than 60 statements describing the extent to which their organization creates a Great Place to Work For All™. Eighty-five percent of the evaluation is based on what employees report about their experiences of trust and reaching their full human potential within the organization, no matter who they are or what they do. Those experiences are analyzed relative to each organization’s size, workforce make up, and what’s typical in their industry and region. Other factors considered include an assessment of employees’ daily experiences of the company’s values, people’s ability to contribute new ideas and the effectiveness of their leaders.
With a workforce of more than 76,000 based at 23 hospitals and 830 outpatient facilities throughout New York City, Long Island and Westchester County, Northwell was selected from among thousands of companies nationwide.
Ninety percent of Northwell’s respondents reported being “proud to tell others” where they work and 84 percent said that “taking everything into account, they would say it is a great place to work,” a 2 percent increase from the previous year. The responses given during the ongoing pandemic reflect that Northwell team members feel more supported psychologically and emotionally, believe that Northwell cares about creating a good working environment, and that executive leadership embodies the best of Northwell.
Northwell’s focus on employee health, both emotional and financial were two major factors contributing to the health system’s recognition. For example, recognizing that frontline employees were under immense pressure, the health system created tranquility spaces – using tents outside hospitals during the surge – where behavioral health professionals were available free of charge, as well as chaplaincy services, well-being resources and more. This provided safe and calming environments for employees to reflect, meditate, or pray before or after a shift. The tents have now been replaced with indoor spaces as a permanent feature at Northwell hospitals.
To mitigate the worry many employees had of bringing the coronavirus home to their families, Northwell established partnerships with IHG Hotels, Ronald McDonald House, and various universities to provide housing so employees could physically distance from loved ones. Those who found alternative accommodations outside of this program were reimbursed for their expenses. Northwell also partnered with a transportation company to provide dedicated shuttles, so no one had to worry about potentially infecting other public transit passengers or being infected themselves.
To aid employees with young children the health system offered crisis care reimbursement and a subsidized in-person childcare program for the 2020-2021 school year to help offset financial strain on families. Recognizing the need for additional help, the Northwell Heroes Caregiver Support Fund was created to provide resources to employees who were financially impacted by the pandemic, such as a spouse’s job loss or a family member’s death. To date, the fund has disbursed $1,056,208.
In addition, the health system set up the Northwell Heroes Memorial Fund to support the families of employees who died from COVID-19, including help with funeral expenses, memorials, and other related expenses. The fund has raised more than $323,000 to cover salary and benefits that affected families continue to receive.
On December 14, 2020, Northwell was the first health system in the United States to immunize its frontline workers against COVID-19, and has continued to roll out its vaccination efforts to team members . Recently, Northwell established an enhanced program for family members of employees to assist in coordinating vaccine appointments. And while Northwell is focused on protecting team members, we’re also at the forefront of the vaccination effort throughout our communities with partnerships with county agencies, other health care providers, and community and faith-based organizations being sure the vaccine is reaching as many as possible.
Northwell’s Best Companies to Work For recognition comes on the heels of the health system being named to Fortune’sBest Workplaces in Health Care & Biopharma list, earning the No. 2 spot for the category of large health care organization.
To learn more about the exciting career opportunities at Northwell Health, go to: https://jobs.northwell.edu/.
The Town of Smithtown, Kings Park Central School District and Rite Aid successfully hosted a satellite vaccine site for residents, ages 50+ and school employees over the weekend. On Saturday, April 17, a temporary COVID-19 vaccine site was implemented at Kings Park High School. Rite Aid facilitated and administered 180 Moderna vaccines for the appointment-only event. Emergency response support for the day was provided by the Kings Park Fire Department. Assisting with logistics and registration at the event were roughly a dozen KPHS National Honor Society students, staff from the Smithtown Senior Center and Supervisor Ed Wehrheim’s office.
“The stars must truly align in order to implement an initiative of this magnitude. Without the assistance from Rite Aid, a fantastic relationship with surrounding School Districts, a phenomenal team in my office and our compassionate Senior Center staff, our volunteer first responders, and the leadership of Dr. Timothy Eagen at Kings Park Central School District, we could not help our local residents and school staff. This vital service was a success because we united together; the private sector, the public and various government agencies, to protect our community,” said Supervisor Wehrheim.
Several weeks ago, the Kings Park Central School District officially designated Kings Park High School as a potential vaccination site for the community. While most teachers throughout the township had been successful in obtaining vaccine appointments, many support staff such as School Aids and Bus Drivers were in need of a convenient process to suit their individual schedules.
“The purpose of this event was to provide an important public health service for our employees and local area Senior Citizens. Many employees and residents have experienced a significant amount of frustration and anxiety while trying to make a vaccination appointment. We wanted to take this potential roadblock away for those who are eligible and willing to be vaccinated,” said Dr. Timothy Eagen, KPCSD Superintendent of Schools
An important objective was to provide an easy registration process for those individuals who may have previously struggled with the online method. Eligible Smithtown residents and school faculty in the four surrounding districts were able to book appointments by phone or through email. Additionally, a dozen KPHS National Honor Society students were on hand, volunteering their time to assist in the registration and logistical process.
“You will not find a place on Earth where students embrace service more than in Kings Park. It was heartwarming to see about a dozen students give up a portion of their Saturday to assist in this public health effort, added Eagen.
Approximately 180 Moderna vaccines were supplied and administered to Smithtown residents and surrounding school district employees courtesy of Rite Aid Pharmacy. Individuals who received the vaccine on Saturday will return to Kings Park High School in 28 days to receive the Moderna booster shot.
DID YOU KNOW?:
If you receive either the Pfizer or Moderna COVID-19 vaccine, you will need a booster shot to be fully protected.
COVID-19 vaccines are not interchangeable. If you received a Pfizer or Moderna COVID-19 vaccine, you must get the same product/brand booster shot.
The CDC recommends getting your second shot even if you have side effects after the first, unless a vaccination provider or your doctor tells you not to get it.
When you book an appointment for a COVID-19 vaccine it is critical that you show up or give ample notice of cancellation.
When you do not cancel for a vaccine, you could be taking a vaccine from as many as nine other people.
Stony Brook, NY; Stony Brook University: School of Medicine 2018 Convocation Photo by Arthur Fredericks
Stony Brook, NY; Stony Brook University Medical Center: The White Coat Ceremony in the Student Activities Center. (8/14/2016)
Stony Brook, NY; Stony Brook University MART & Children's Hospital Pavilion: MART ribbon cutting, November 1, 2018. Left to right: New York State Assemblyman Steve Englebright; SUNY Trustee and Stony Brook Foundation board member Cary Staller; Stony Brook University President Samuel L. Stanley Jr., MD; New York State Senator Kenneth P. LaValle; SUNY Chancellor Kristina Johnson; Jim and Marilyn Simons; New York State Senate Majority Leader John Flanagan; Kevin Law, President of the Long Island Association and Chair of the Stony Brook Council; Kenneth Kaushansky, MD, Senior Vice President for Health Sciences and Dean of the School of Medicine; Director of the Stony Brook University Cancer Center Yusuf Hannun, MD; representing Governor Andrew Cuomo, Marta Santiago-Jones, Consultant Nurse Hospital Services Administrator at the New York State Department of Health.
Stony Brook, NY; Stony Brook University Medical Center: Donors David and Cynthia Lippe and Dean, School of Medicine and Senior Vice President of Health Sciences Ken Kaushansky outside of the garden area of the MART/Hospital Pavilion
Stony Brook, NY; Stony Brook University Hospital: Stony Brook Medicine rolled out new Mobile Stroke Units on March 18, 2019, to treat people who are having a stroke.
Left to right: Kimberly Noel, MD, Director, Telehealth, Stony Brook Medicine, Michael Guido III, MD, Neurologist, Director, Stony Brook Neurology Stroke Program, Ken Kaushansky, MD, Dean, Renaissance School of Medicine at Stony Brook University, David Fiorella, MD, PhD, Neurointerventionalist, Director, Stony Brook Cerebrovascular Center, Trevor Marshall, MD and Eric Niegelberg, Associate Director, Operations, Emergency Services and Internal Medicine
Stony Brook, NY; Stony Brook University: Chancellor Jim Malatras and Stony Brook University President McInnis Announce Partnership with SUNY Upstate Medical University to Launch Pooled Surveillance Testing for COVID-19.
Stony Brook to Test 5200 Students Each Week. Testing Expansion Follows FDA Approval of Groundbreaking Saliva Swab Test Developed at Upstate Medical University
By Daniel Dunaief
Like so many others, Ken Kaushansky had to alter his plans when the pandemic hit last March. Kaushansky had expected to retire after over 10 years as Dean of the Renaissance School of Medicine at Stony Brook University and the Senior Vice President of Health Sciences, but the public health needs of the moment, particularly on Long Island which became an early epicenter for the disease, demanded his attention.
“Now that COVID hopefully is coming under control, it seems more logical” to retire this year, Kaushansky said in a wide-ranging interview about the pandemic, his career, and the medical school. In January, he stepped down as the dean, while he plans to retire as Senior Vice President of Health Sciences at the end of June.
Views on the Pandemic
Dr. Kenneth Kaushansky
Looking back at the immediate challenges in the first few months, Kaushansky said SBU did “extremely well” in caring for patients who were battling COVID-19 and was gratified by the school’s effort to catalog and understand the disease. “I’m very proud that we’ve been able to study this infection on all sorts of levels and make a real impact that has helped others,” he said.
Early on, as the medical team at Stony Brook met, Kaushansky urged the hospital to study COVID “to the hilt” and to “extract every little bit of data we can. We must keep all that data on all these patients.”
Indeed, Stony Brook has created a database that continues to grow of close to 10,000 people, which includes 3,000 inpatients, 4,000 who weren’t sick enough for hospital admission, and around 3,000 who thought they had the disease, but had other illnesses. “We’ve learned a ton from that, and it’s not just learning for learning’s sake,” Kaushansky said. The demand for the use of the database is so high that a steering committee is reviewing proposals.
Stony Brook had heard from doctors in Italy that COVID patients were having problems with blood clotting. This symptom was particularly meaningful to Kaushansky, who is a hematologist.
SBU studied the symptoms and “did a trial to see if aggressive anticoagulants would produce better outcomes” than the standard of care at the time, he said. “Our [intensive care unit] patients who were on this more aggressive anticoagulation protocols had half the mortality” of other patients, so the hospital “quickly adopted all of our care” to the more effective approach.
The hospital preemptively used biomarkers to determine who should and should not get aggressive anticoagulation. A subsequent study using the database confirmed the school’s early conclusion. Stony Brook published over 150 papers on the structure of the virus, clinical observations, sociological interventions, and a host of other areas, according to Kaushansky.
Carol Gomes, Chief Executive Officer of Stony Brook University Hospital, appreciated Kaushansky’s hands on approach, which included participating in daily calls as part of the hospital incident command center.
She likened Kaushansky to an orchestra leader, coordinating the research and patient care, making sure there was “no duplication of effort.”
Kaushansky believes federal research funding agencies and policy makers will recognize the importance of gathering information about this pandemic to treat future patients who might battle against variants and to provide a playbook for other health threats. “We really do need to prepare for the next one” as this is the third and deadliest of three coronaviruses, including SARS and MERS, he said.
Vaccines
As for vaccines, Kaushansky said Stony Brook was making it as “convenient as we can” to get a vaccination for health care workers. As of about a month ago, over 80 percent of Stony Brook’s health care workers had been vaccinated.
The black and brown communities have benefited from seeing leaders and role models receiving the vaccine. “This is beginning to erode the mistrust,” said Kaushansky, which developed as a byproduct of the infamous Tuskegee experiment, in which black men with syphilis did not receive penicillin despite its availability as an effective treatment.
Kaushansky added that a concern he’s heard from a range of people is that the vaccine was developed too quickly and that the side effects could be problematic. He cited the simultaneous steps doctors, pharmaceutical companies and others took to accelerate a process that didn’t leave out any of those steps.
Kaushansky participates in a group email interaction with prominent European hematologists. Looking at the data for the Astrazeneca vaccine, these researchers have calculated that anywhere from one in 500,000 to one in a million have developed blood clots.
“Not a single person on this mass email believes that they should stop the Astrazeneca vaccines for that kind of incident,” he said.
What He Helped Build
Kaushansky has been such a supporter of expanding the facilities and expertise at Stony Brook that he said the campus developed a joke about him.
“What’s the dean’s favorite bird?” he asked. “A crane.”
Fixtures on the campus for years, those cranes — the construction vehicles, not the birds — have changed the university, adding new teaching, research and clinical space on the campus.
That includes the Medical and Research Translational building and Bed Tower, which started in 2013 and opened in 2018, and the Hospital Pavilion, which has an additional 150 beds. Those extra beds were especially important a year after the pavilion opened, providing much-needed space for patients battling against COVID.
Gomes appreciated what Kaushansky built physically, as well as the interactive collaborations among different parts of the university. “An active collaboration and communication between researchers, clinicians and academics is a very different model” from the typical separation among those groups, she said. The work “reaped great rewards on the front end with the ability to collaborate to bring new ideas forward.”
As for the type of care patients received at Stony Brook, Kaushansky recalled a discussion over six years ago about central line infections. The data came from a 12 month period, starting six months prior to the meeting and going back to 18 months earlier.
“How are we going to know why all those central line infections occurred by looking at data” from so much earlier, Kaushansky recalled asking. The hospital created real time dashboards, which is an effort that has “paid huge dividends.”
Kaushansky cited the hospitals’ top 100 health grade for three years running. These grades assess whether patients survive a procedure, have complications or need to be readmitted.
“You’re going to get the best care possible when you come to Stony Brook,” Kaushansky said, as the top 100 rating puts Stony Brook in the top 2 percent of hospitals in the country.
Apart from the buildings Kaushansky helped develop, he’s proud of the program he helped build for medical school students.
About six years ago, Stony Brook instituted a new medical school curriculum that had translational pillars. The school starts students in the clinical realm considerably earlier than the classic program that involves two years of basic studies, followed by two years of clinical work.
Stony Brook provides basic science, followed by earlier exposure to the clinic, with a return to basic science after that
“It’s much more effective if you teach the basic science after the student has witnessed the clinical manifestation,” Kaushansky said. These approaches are part of translational pillars in areas such as cancer, physiology and infectious diseases.
As for what he’ll miss after he leaves, Kaushansky particularly appreciated the opportunity to speak with students. He used to hold a monthly breakfast with four or five students, where he learned about each student, their career goals and their medical journey.
A former colleague at the University of California at San Diego, John Carethers, who is the Chair in the Department of Internal Medicine at the University of Michigan, visited Kaushansky as a speaker twice at Stony Brook.
Carethers saw “first hand the wonderful impact he had on students — knowing their names, and providing wonderful advice,” he wrote in an email.
The Next Steps
For a decade, Kaushansky said he wanted to create a course about the future of medicine.
“There are a lot of great innovations in medicine that are fascinating from a scientific and clinical perspective,” Kaushansky said.
He will work on a course for use at Stony Brook in the main campus, the medical campus and for whichever program is interested in sharing these innovative medical and scientific steps in medicine.
He also plans to continue to be the lead editor of the primary textbook in hematology, called Williams Hematology. The textbook has gone through 10 editions.
Kaushansky and his wife Lauren, who is an author and education professor at Stony Brook, aren’t likely to remain on Long Island in the longer term. The couple has a getaway home in Santa Fe and may go there.
Kaushansky’s hobbies include wood working and running. He made a sofa when he was an undergraduate at UCLA, while his second significant work was a 16-foot sailboat he made as a second-year resident. He estimates he has made 40 pieces of furniture.
Kaushansky runs four miles a day four to six times a week. In 1990, he ran the Seattle Marathon which was the Goodwill Games Marathon, finishing in a time of around three hours and twenty-five minutes.
Culturally, Kaushansky hopes the school continues to embrace his focus on generosity.
“You’ve got to be generous with your time,” he said.
“No more can you say that you are too busy to talk. You have to be of a personality that takes pride and that gets the endorphins going from seeing the people you have brought, the people you have entrusted in leadership roles, succeed.”
Chris Pendergast passed away last October at the age of 71. Photo from SB
By Melissa Arnold
Each year, 5,000 people in America lose their lives to amyotrophic lateral sclerosis (ALS), a degenerative neurological disease that ultimately leads to a loss of muscle control throughout the body. Beloved Yankee first baseman Lou Gehrig and physicist Stephen Hawking were well-known for their public struggles with ALS, which often carries a hefty price tag because of the necessary medical care, home equipment and renovation.
Elizabeth Hashagen
The prognosis is unfortunately grim for all who are diagnosed with ALS, with most living less than five years after diagnosis. But some do achieve surprising longevity. Among them was Chris Pendergast, a Suffolk County educator and literal trailblazer who dedicated 27 years of his life to ALS awareness before his death last year.
In 1997, Pendergast founded ALS Ride for Life, a charitable organization known for its annual treks to raise awareness and funding for people with ALS, nicknamed “PALS.” The first Ride for Life in 1998 took more than two weeks as PALS in motorized wheelchairs journeyed from Manhattan to Washington, D.C.
These days, the organization has a more local focus and the ride itself is shorter, covering Long Island only. But regardless of the changes, it was always Pendergast leading the way.
Each year, Ride for Life hosts a benefit honoring those with ALS and others who have made major contributions in the search for a cure. This year’s benefit, held virtually on April 28, will honor Pendergast’s great legacy as the organization looks to the future.
“Chris would want us to have fun as we remember him and to keep on enjoying life,” said Ray Manzoni, chairman and president of Ride for Life. “We want to make sure that the arrow that Chris launched all those years ago continues to fly. He created so much hope, and we still have work to do.”
The event will feature appearances from an eclectic group of performers with a little something for everyone, Manzoni said. Emmy Award-winning anchor Elizabeth Hashagen of News 12 Long Island will emcee the evening. Performers will include musician Mike DelGuidice (on tour now with Billy Joel), comedian Bob Nelson and father-son Tik Tok duo Joe and Frank Mele.
Clinton Kelly
Also appearing for interviews and audience questions are former MLB pitcher and Yankees commentator David Cone; executive producer Elise Doganieri of the CBS reality hit “The Amazing Race,” and TV personality Clinton Kelly.
Kelly, who is best known for his long-running tenures on “What Not to Wear” and “The Chew,” grew up in Port Jefferson Station and graduated from Comsewogue High School. Later in life, he became friends with Christine Pendergast, Chris’ wife of nearly 50 years and a former physical education teacher at Comsewogue.
“[Christine] is a really special person and her marriage to Chris was truly inspirational,” said Kelly, who now hosts “Self-Made Mansions” on HGTV. “Beyond that, a close friend of my family passed away from ALS a few years ago. And so I am happy to bring attention to this disease in any way that I can, as well as raise funds for patient care. I’m hopeful that scientists can find a cure for this debilitating disease sooner than later.”
Chris’ son, 36-year-old Buddy Pendergast, was in the third grade when his father was diagnosed with ALS.
“As a family unit we were definitely put on an entirely different life path,” he recalled. “When my dad came to see that his progression was remarkably slower than other people with ALS, he very naturally turned his energy toward advocacy, just as he had in the past for other causes he was passionate about, particularly education and the environment.”
Mike Delguidice
To date, Ride for Life has raised more than $10 million in funding for research and support, and the organization’s efforts were instrumental to the creation of the Christopher Pendergast ALS Center of Excellence at Stony Brook University Hospital. But Buddy also admitted his dad would have mixed feelings about the benefit focusing on him this year.
“To be honest, he would have rather focused on other people instead … He was more compelled than anyone I’ve ever met to make a difference, even if it was just for a small community. Ride for Life became one of the most influential ALS organizations, and it’s very much like an extended family, not just one person,” he said. “It’s about remaining hopeful and optimistic in what the future holds. He envisioned a future where all of our hard work will pay off to make ALS a thing of the past.”
The 24th Annual Ride for Life Honoree Recognition Benefit will be held virtually beginning at 7 p.m. on April 28. The event is sponsored by TFCU, Symbio Research, Quontic Bank and The Rohlf Family. Individual tickets are $25, household watch party $100. To buy tickets, participate in raffles or donate to the cause, visit http://one.bidpal.net/alsrfl. To learn more about Chris and ALS Ride for Life, visit www.alsrideforlife.org. For further information, call 631-444-1292.
rapes have been found to reduce glucose levels. Pexels photo
Whole berries may reduce glucose levels the most
By David Dunaief, M.D.
Dr. David Dunaief
Type 2 diabetes is pervasive throughout the population, affecting adults, but also children and adolescents. Yet, even with its prevalence, many myths persist about managing diabetes.
Among these are: Fruit should be limited or avoided; Soy has detrimental effects with diabetes; Plant fiber provides too many carbohydrates; and Bariatric surgery is an alternative to lifestyle changes.
All of these statements are false. My goal is to help debunk these type 2 diabetes myths. Let’s look at the evidence.
Fruit
Fruit, whether whole fruit, fruit juice or dried fruit, has been long considered taboo for those with diabetes. This is only partially true. Yes, fruit juice and dried fruit should be avoided, because they do raise or spike glucose (sugar) levels. The same does not hold true for whole fresh or frozen fruit. Studies have demonstrated that patients with diabetes don’t experience a spike in sugar levels whether they limit the number of fruits consumed or have an abundance of fruit (1). In another study, whole fruit actually was shown to reduce the risk of type 2 diabetes (2).
In yet another study, researchers looked at the impacts of different types of whole fruits on glucose levels. They found that berries reduced glucose levels the most, but even bananas and grapes reduced these levels (3). That’s right, bananas and grapes, two fruits people associate with spiking sugar levels and increasing carbohydrate load. The only fruit that seemed to have a mildly negative impact on sugars was cantaloupe.
Whole fruit is not synonymous with sugar. One of the reasons for the beneficial effect is the fruits’ flavonoids, or plant micronutrients, but another is the fiber.
Fiber
We know fiber is important for reducing risk for a host of diseases and for managing their outcomes, and it is not any different for diabetes.
In the Nurses’ Health Study (NHS) and NHS II, two very large prospective observational studies, plant fiber was shown to help reduce the risk of type 2 diabetes (4). Researchers looked at lignans, a type of plant fiber, specifically examining the metabolites enterodiol and enterolactone. They found that patients with type 2 diabetes have substantially lower levels of these metabolites in their urine, compared to the control group without diabetes. There was a linear, or direct, relationship between the amount of metabolites and the reduction in risk for diabetes. The authors encourage patients to eat more of a plant-based diet to get this benefit.
Foods with lignans include flaxseed; sesame seeds; cruciferous vegetables, such as broccoli and cauliflower; and an assortment of fruits and whole grains (5). The researchers could not determine which plants contributed the greatest benefit. The researchers believe the effect results from antioxidant activity.
Soy and kidney function
In diabetes patients with nephropathy (kidney damage or disease), soy consumption showed improvements in kidney function (6). There were significant reductions in urinary creatinine levels and reductions of proteinuria (protein in the urine), both signs that the kidneys are beginning to function better.
This was a small randomized control trial over a four-year period with 41 participants. The control group’s diet consisted of 70 percent animal protein and 30 percent vegetable protein, while the treatment group’s diet consisted of 35 percent animal protein, 35 percent textured soy protein and 30 percent vegetable protein.
This is very important since diabetes patients are 20 to 40 times more likely to develop nephropathy than those without diabetes (7). It appears that soy protein may put substantially less stress on the kidneys than animal protein. However, those who have hypothyroidism should be cautious or avoid soy since it may suppress thyroid functioning.
Bariatric surgery
Bariatric surgery has grown in prevalence for treating severely obese (BMI>35 kg/m²) and obese (BMI >30 kg/m²) diabetes patients. In a meta-analysis of bariatric surgery involving 16 randomized control trials and observational studies, the procedure illustrated better results than conventional medicines over a 17-month follow-up period in treating HbA1C (three-month blood glucose measure), fasting blood glucose and weight loss (8). During this time period, 72 percent of those patients treated with bariatric surgery went into diabetes remission and had significant weight loss.
However, after 10 years without proper management involving lifestyle changes, only 36 percent remained in remission with diabetes, and a significant number regained weight. Thus, whether one chooses bariatric surgery or not, altering diet and exercise are critical to maintaining long-term benefits.
There is still a lot to be learned with diabetes, but our understanding of how to manage lifestyle modifications, specifically diet, is becoming clearer. The take-home message is: focus on a plant-based diet focused on fruits, vegetables, beans and legumes. And if you choose a medical approach, bariatric surgery is a viable option, but don’t forget that you need to make significant lifestyle changes to accompany the surgery in order to sustain its benefits.
References:
(1) Nutr J. 2013 Mar. 5;12:29. (2) Am J Clin Nutr. 2012 Apr.;95:925-933. (3) BMJ online 2013 Aug. 29. (4) Diabetes Care. online 2014 Feb. 18. (5) Br J Nutr. 2005;93:393–402. (6) Diabetes Care. 2008;31:648-654. (7) N Engl J Med. 1993;328:1676–1685. (8) Obes Surg. 2014;24:437-455.
Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.
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