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Residents on Long Island and elsewhere can’t call their doctor’s offices and ask to receive all of the same treatment that sent President Donald Trump (R) from the Walter Reed National Military Medical Center back to the White House and the campaign trail.

Dr. Luis Marcos said SBU was planning to participate in the second Regeneron trial, but a general lack of COVID patients scrapped that idea. Photo from SBU

After officials said he tested positive for COVID-19 Oct. 2, the president received a combination of the antiviral drug Remdesivir, an antibody cocktail from Regeneron, and the steroid dexamethasone.

Remdesivir has become more widely used in hospitals on Long Island.

The last two months, “all patients admitted to the hospital may qualify for Remdesivir according to the clinical judgment of your doctor,” said Dr. Luis Marcos, Associate Professor of Clinical Medicine at Renaissance School of Medicine at Stony Brook University.

The patient population that is most likely to benefit from Remdesivir includes residents who are over 60, have diabetes with hypertension and have been admitted to the hospital with mild pneumonia.

Patients who have liver disease or kidney failure may not be prescribed the intravenous drug.

Typically, Remdesivir, like other antiviral drugs, benefits patients who have contracted COVID-19 within a week, because the medicine stops the replication of the virus.

Patients who received Remdesivir after an infection that lasted more than 10 days may not benefit as much because the drug won’t reverse damage done to the lungs.

The side effects of antivirals typically last one to two days.

Dexamethasone is also available and used in hospitals including Huntington Hospitals and Stony Brook.

As a steroid, dexamethasone has “multiple side effects,” said Dr. Michael Grosso, Chief Medical Officer at Huntington Hospital. “It is only given when the benefit is expected to significantly outweigh the risk and so there’s going to be that assessment in every case,” Dr. Grosso said.

Patients with diabetes are likely to experience “more trouble with their blood sugar control if they’re receiving dexamethasone,” Grosso added.

Dexamethasone can also produce sleeplessness and, in some cases, psychiatric disturbances, doctors added.

The monoclonal antibody cocktail from Regeneron the president received has had limited use, mostly through clinical trials and in compassionate care cases. It has not received approval from the Food and Drug Administration, although it has applied for emergency use authorization.

Stony Brook was planning to participate in the second trial of Regeneron, with Dr. Bettina Fries, Chief of the Division of Infectious Diseases, as the principal investigator and Dr. Marcos as the co-principal investigator. The hospital did not participate because it didn’t have enough cases.

Marcos said the cocktail of antibodies block the virus actively causing inflammation.

The good news with the Regeneron treatment is that the side effects appear minimal, Marcos said.

Regeneron is unlikely to reverse the damage in the lungs caused by the virus. In managing patient care, doctors try to slow or stop the progression of pneumonia from the virus.

Marcos said patients who are asymptomatic or have minor symptoms shouldn’t race to take the more widely available Remdesivir or Dexamethasone because 99% of patients with COVID infection do not have pneumonia. Those patients with a mild upper respiratory infection may not need anything but Tylenol.

Patients who are developing more severe symptoms can come to the hospital to determine the best medical response.

“If you have fever or you don’t feel that great, of course, come to the Emergency Room, we can evaluate you, and decide what to do next. For mild, mild cases, I don’t think we should be using Remdesivir,” Grosso said.

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With the approaching emotions of the holidays, Suffolk County residents may face persistent and unwanted changes in their lives, from not seeing a cherished family member to remaining confined to the same house where they work, live, eat and study. Between now and the end of the year, TBR News Media will feature stories about the impact of the ongoing pandemic on mental health. The articles will explore how to recognize signs of mental health strain and will provide advice to help get through these difficult times. This week, the article focuses on youth.

In a normal year, when school is out, the number of referrals Dr. Sharon Skariah, Director of Child Adolescent Psychiatry at South Oaks Hospital in Amityville, declines during the summer.

Dr. Sharon Skariah says parents should recognize their own issues in order to help their children. Photo by Sharon Skariah

That’s not the case this year, as children continued to seek help for mental health challenges caused by the loss of a parent, the loss of financial or health security and the decline in social contact amid social distancing.

“We’ve been seeing significant anxiety and depression,” Skariah said. “Part of that is the prolonged time that [children] have been out of school.”

Skariah expects that the ongoing pandemic losses and restrictions will likely continue to cause those figures to increase.

Several mental health professionals shared their dos and don’ts for parents with grieving children.

Grieving Dos

For starters, Skariah suggests that parents should recognize their own anxiety and depression.

“If they find that they are themselves overwhelmed with the chaos of the pandemic, they should be aware that their own anxiety and mood can play a role in their children’s behavior,” she said.

Dr. Meghan Downey, clinical psychologist and Director of Northwell Health’s OnTrackNY, urged people to maintain a routine.

“Often, a holiday can exacerbate our stress levels,” Downey said. “Changes to our routine can increase stress. Continuing with the same sleep wake routine, normal eating and [finding time] for joy and relaxation provide a good foundation for managing grief.”

Based on prior group traumatic events, like the 9/11 terrorist attacks and the SARS virus, Skariah said the restoration of order happens over time and depends on personal and predisposing factors.

She urged families to be genuine and open and actively listen to what children say. Downey suggests children need to feel that they are allowed to mourn.

A support network can and should consider showing empathy, care and concern. Approaching people when they are calm, rather than in a distressed state, can provide some mental health relief.

People who are experiencing grief also can benefit from staying connected, even through holiday letters, phone calls, or a card, Downey said.

When Downey gives presentations to children and educators in school, she advises people working with young children to allow them to play death, to display their emotions through play.

Grieving Don’ts

Telling children platitudes like “time heals all wounds” may not be helpful for someone who is “acutely grieving,” Skariah said.

Downey added that telling children that a loved one is “sleeping” or that they should “stop crying, other people might get upset” provides mixed and confusing messages.

Telling children that “at least [the person who died is] not in pain anymore, they are in a better place” often doesn’t help and distracts people from feeling their emotional intensity, Downey said.

Downey cautioned youths, and their adult guardians, to manage over-indulgent behavior, such as with food or with excess spending.

While those indulgences provide temporary relief, they can also contribute to feelings of guilt, which can exacerbate grief, Downey cautioned.

Bradley Lewis, Administrative Manager for School Based Mental Health Services for South Oaks Hospital, said he has received numerous requests during the pandemic for support related to COVID-19.

Lewis said Downey’s presentations to some of the 11 school districts went beyond the thought of death, but include losses in other areas, like access to friends, senior awards dinners, and graduations.

“A lot of families appreciated the opportunity to learn more about grief and loss, to understand the different types of grief their children might be going through,” Lewis said.

With parents, Lewis urges parents to “end the stigma of mental health,” he said.

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The Miller Place Inn has temporarily closed to weddings after receiving a call from the NYSLA. Photo from the Miller Place Inn

By Julianne Mosher and Kyle Barr

The well-known wedding and event venue Miller Place Inn has been issued a hefty fine for hosting an event that led to around 270 individuals having to quarantine across Long Island.

Suffolk County Executive Steve Bellone (D) said Oct. 13 a notorious Sweet 16 party was hosted at the venue Sept. 25. The event involved 81 people, including 49 students and 32 adults, which is over the state-mandated limit. That party has now led to 334 people having been notified by the Suffolk County Department of Health for contact tracing. Of that number, 183 of those people were affiliated with schools, while 151 were non-school specific. The county executive said the people affected were spread throughout the county.

“It was the first time the health department has taken a course of action against a business.”

— Steve Bellone

The county DHS has identified 37 positive cases in connection to the Sweet 16 party, of which 29 of the positive cases were those who attended, seven were household contacts, and one case was a close contact of an individual who attended.

State law restricts all non essential gatherings to 50 or fewer people or 50 percent capacity, whichever one of those is less. 

“It was the first time the health department has taken a course of action against a business,” Bellone said on a conference call with reporters, citing that businesses before have largely complied with COVID restrictions when confronted by officials. The Inn has received previous warnings, he said.

The Inn was fined $10,000 for violations of the New York state executive orders, as well as $2,000 for violations of the Suffolk County sanitary code. The county exec said the determination that the Inn was at fault based on the “comprehensive contact tracing investigation.” Though he noted not everyone at the party was wearing masks, the primary violation was breaking the mass gathering rules.

Christopher Regina, a co-owner of the Inn, said in a phone interview after Bellone’s announcement that they were made aware Oct. 8 they were in violation of the guidelines. They thought they were allowed to operate at 50% of their fire marshal cap of 250 persons. He said, along with implementing air filtration measures, they were “operating safely” with less than 125.

“At no time before that did we know we were operating in the wrong,” he said.

On Friday, Oct. 9, the Inn announced it would be closing down after what they said was a warning call from the New York State Liquor Authority over reported COVID violations. Miller Place Inn owners Donna Regina, during an interview Friday, expressed that she was aware of “a group of teens [who] tested positive somewhere.”

“At no time before that did we know we were operating in the wrong.”

— Christopher Regina

The event has become notorious in the past few weeks, as the Sweet 16 was reported to have directly led to the Sachem school district having to temporarily shut down the high school.

Though the county executive said there is no dictionary definition for a so-called superspreader event, “Based on our experience in dealing with this pandemic for seven months now, this is a superspreader event without question.”

On Friday, a spokesperson from the New York State Liquor Authority told TBR News Media they had issued a warning to the Inn about complaints. A spokesperson for the SLA did not immediately respond to a request for comment over if they will take any action against the venue.

Bellone said that people need to be mindful of the consequences of mass gatherings so no more clusters pop up. 

“We need to make sure as we move into the colder weather, as we move towards winter, that we cannot have these types of activities that could cause a superspreader event like this,” he said. “We are entering a period of time where it is dangerous. We know as people move indoors they shut the windows, shut the doors and when inside that’s the real possibility for a second wave of cases happening.”

 

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Gurwin centenarians enjoy a celebratory birthday at a High Tea party. Photo from Gurwin

The Gurwin Jewish ~ Fay J. Lindner Residences assisted living community in Commack honored seven residents last week who reached or passed the century mark.

Sally B., 100, is one of the most recent Fay J. Lindner residents to reach the centenarian milestone. Photo from Gurwin Jewish

The milestone birthday celebration ­— a socially-distanced tea party — provided an opportunity for residents and staff alike to wish each centenarian well, and learn a bit about their lives. Adorned in top hats, tiaras and other festive attire, the residents were happy to spend the afternoon with some of their favorite staff members and fellow centenarians.

The group of seven — aged 100 to 104 — includes a Holocaust survivor, a retired New City policeman, aircraft engineer, teacher and homemaker, among others. Displaying vibrant energy throughout the festivities, the distinguished group proved that age is just a number.

Some chatted with guests, answering questions, providing advice and expressing wishes for health for everyone; others enjoyed mixing and mingling, sharing past experiences and memorable lifetime events. The honored guests were showered with affection by members of Gurwin staff who offered speeches, snapped photos, and even serenaded them with a personally penned tribute song.

Michael Letter, Administrator/Chief Operating Officer of the community, spoke with fondness for the residents and gratitude to staff during an opening speech, saying “Today’s event is a celebration of the lives, legacy and longevity of our inspirational centenarians. I feel very privileged to know them all and am grateful to our staff that provides the nurturing care that enables our extraordinary residents to stay engaged connected and thrive.”

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Ask your doctor before starting gluten withdrawal. Stock photo

By David Dunaief, M.D.

Dr. David Dunaief

A quick trip to the grocery store or a restaurant will confirm what you already know: gluten-free is a “thing.” Pizza, pasta, bread, and even breadcrumb-encrusted products have been reformulated, and everyday products, like frozen vegetables, have been relabeled with splashy language promising “gluten-free.” The marketers are on board: gluten-free diets are hot.

“Gluten-free” is not necessarily synonymous with healthy. Still, we keep hearing how more people feel better without gluten. Is this a placebo effect? What is myth and what is reality in terms of gluten? In this article I will try to distill what we know about gluten and gluten-free diets, who may benefit and who may not.

Why gluten-free?

Gluten is a plant protein found mainly in wheat, rye and barley. While more popular recently, going gluten-free is not a fad, since we know that patients who suffer from celiac disease, an autoimmune disease, benefit tremendously when gluten is removed (1). In fact, it is the main treatment.

But what about people who don’t have celiac disease? There seems to be a spectrum of physiological reaction to gluten, from intolerance to gluten (sensitivity) to gluten tolerance (insensitivity). Obviously, celiac disease is the extreme of intolerance, but even these patients may be asymptomatic.

Then, there is nonceliac gluten sensitivity (NCGS), referring to those in the middle portion of the spectrum (2). The prevalence of NCGS is half that of celiac disease, according to the NHANES data from 2009-2010 (3). However, many disagree with this assessment, indicating that it is much more prevalent and that its incidence is likely to rise (4). The term was not even coined until 2011.

Celiac disease vs. gluten sensitivity

Both may present intestinal symptoms, such as bloating, gas, cramping and diarrhea, as well as extraintestinal (outside the gut) symptoms, including gait ataxia (gait disturbance), malaise, fatigue and attention deficit disorder (5). Surprisingly, they both may have the same results with serological (blood) tests.

The first line of testing includes anti-gliadin antibodies and tissue transglutaminase. These measure a reaction to gluten; however, they don’t have to be positive for there to be a reaction to gluten. HLA–DQ phenotype testing is the second line of testing and is more specific for celiac disease.

What is unique to celiac disease is a histological change in the small intestine, with atrophy of the villi (small fingerlike projections) contributing to gut permeability, what might be called “leaky gut.” Biopsy of the small intestine is the most definitive way to diagnose celiac disease. Though the research has mainly focused on celiac disease, there is some evidence that shows NCGS has potential validity, especially in irritable bowel syndrome.

Before we look at the studies, what does it mean when a food says it’s “gluten-free”? The FDA requires that “gluten-free” labeled foods have no more than 20 parts per million of gluten (6). Effective October 13, 2020, new FDA guidelines go into effect for proving fermented foods, such as sauerkraut and yogurt, and hydrolyzed ingredients found in many packaged products meet the same criteria.

Irritable bowel syndrome

Irritable bowel syndrome (IBS) is a nebulous disease diagnosed through exclusion, and the treatments are not obvious. That is why the results from a 34-patient, randomized controlled trial, the gold standard of studies, showing that a gluten-free diet significantly improved symptoms in IBS patients, is so important (7). Patients were given a muffin and bread on a daily basis.

Of course, one group was given gluten-free products and the other given products with gluten, though the texture and taste were identical. In six weeks, many of those who were gluten-free saw the pain associated with bloating and gas mostly resolve; they had significant improvement in stool composition, such that they were not suffering from diarrhea, and their fatigue diminished. In one week, those in the gluten group were in substantially more discomfort than those in the gluten-free group.

As part of a well-written editorial in Medscape by David Johnson, M.D., a professor of gastroenterology, questioned whether this beneficial effect from the IBS trial was due to gluten withdrawal or to withdrawal of fermentable sugars because of the elimination of some grains themselves (8). In other words, gluten may be just one part of the picture. He believes that nonceliac gluten sensitivity is a valid concern.

Antibiotics

The microbiome in the gut may play a pivotal role in whether a person develops celiac disease. In an observational study using data from the Swedish Prescribed Drug Register, results indicate that those who were given antibiotics within the last year had a 40 percent greater chance of developing celiac disease and a 90 percent greater risk of developing gut inflammation (9). The researchers believe that this results from a misbalance in the microbiota, or flora, of the gastrointestinal tract from antibiotic use.

Not everyone will benefit from a gluten-free diet. In fact, most of us will not. Ultimately, people who may benefit are those who have celiac disease and those who have symptomatic gluten sensitivity. Also, patients who have positive serological tests, including tissue transglutaminase or anti-gliadin antibodies, are good candidates for gluten-free diets.

There is a downside to a gluten-free diet: potential development of macronutrient and micronutrient deficiencies. Therefore, it is wise to ask your doctor before starting gluten withdrawal. The research in patients with gluten sensitivity is relatively recent, and most gluten research relates to celiac disease. Hopefully, we will see broader studies in the future.

References:

(1) Am J Gastroenterol. 2013;108:656-676. (2) Gut 2013;62:43–52. (3) Scand J Gastroenterol. (4) Neurogastroenterol Motil. 2013 Nov;25(11):864-871. (5) medscape.com. (6) fda.gov. (7) Am J Gastroenterol. 2011; 106(3):508-514. (8) medscape.com. (9) BMC Gastroenterol. 2013:13(109).

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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Eszter Boros, assistant professor in the College of Arts and Sciences Department of Chemistry at Stony Brook University, was recently named a 2020 Moore Inventor Fellow, an honor that is given to researchers who look to enable breakthroughs that accelerate progress over the next fifty years. It is hosted through the Gordon and Betty Moore Foundation.

The fellowship supports scientist-inventors who create new tools and technologies with a high potential to accelerate progress in the Foundation’s areas of interest: scientific discovery, environmental conservation and patient care. Boros was nominated for the fellowship based on the commercial potential of her research, combining a radioactive targeted molecular probe and therapeutic that has the potential to provide pre-operative nuclear imaging and subsequent radiotherapeutic intervention for incurable prostate cancer.

Specifically, Boros is developing radioactive theranostics that can be injected into the human body and used both as a diagnostic, to detect and localize disease, and also as a therapeutic, to treat the disease. Her invention, which enables the highly selective capture of radioactive metal ions, such as those of the element scandium, paves the way for the application of scandium radioisotopes in the non-invasive, early diagnosis and targeted radiotherapy of cancers.

“I am so excited and pleased Eszter is selected as a Moore Inventors Fellow, Stony Brook’s first,” said Nicole S. Sampson, dean of the College of Arts and Sciences and SUNY distinguished professor of Chemistry. “She is truly a Renaissance woman, combining fundamental inorganic chemistry and metal radiochemistry with modern imaging methods to provide personalized medical  treatments of cancer and microbial infections.”

This year, the Moore Foundation received nearly 200 nominations, from which five fellows were selected. Each fellow receives a total of $825,000 over three years to drive their invention forward, which includes $50,000 per year from their home institution as a commitment to these outstanding individuals.

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Dr. Deborah Birx and Dr. Maurie McInnis at Stony Brook University’s Wang Center on Wednesday. Photo by Julianne Mosher

The head of the White House’s Coronavirus Task Force visited Stony Brook University this week to talk to faculty, students and administrators about college life during the pandemic.

On Wednesday, Oct. 7, Dr. Deborah Birx met in a private roundtable talk with SBU representatives to gauge how everyone feels returning to campus, as part of a several-month-long tour of colleges across the country. The meeting lasted more than two hours, president of the university Dr. Maurie McInnis said, deeming it a successful discussion.

“We want to find a pathway forward for other universities, and when we want to use what we have learned to make it available to others.”

— Dr. Deborah Birx

“She was excited about what we’ve been doing on campus and at the hospital,” McInnis said. “We also learned an enormous amount from her about what we can expect in the fall.”

The roundtable went over time, and so Birx only gave about 15 minutes to assembled reporters.

With recent news of many colleges across the state struggling to stay open with an uptick in COVID-19 cases on their campus, Birx praised the university for how they initially handled the pandemic back in March, up until now.

She added that she was particularly excited to visit Stony Brook because the university and hospital “stood out at one of the most difficult times in March, April and May in a really open, transparent and careful way.”

“I was listening to the research activities that they started from day one,” she said. “And it thrilled my heart to hear from them that their number one thing was collecting data and collecting information in real time.”

Birx said the university’s research was fundamental in the beginning, by comparing and trying to understand how to find solutions with better care for patients.

“That’s why we have medical research institutions,” she said. “I think you could really see the strength of that here.”

She commended staff for their “months of planning” by implementing social distancing throughout the campus with signs, stickers on the floor and seating placed six-feet-apart from each other — things she hopes other colleges and universities will follow.

“We want to find a pathway forward for other universities, and when we want to use what we have learned to make it available to others,” she said. “It’s been really a privilege to be here.”

Reporters asked the head of the president’s coronavirus task force about President Donald Trump (R) testing positive for COVID-19, his trip to Walter Reed National Military Medical Center and his most recent return to the White House, especially his apparent eschewing of wearing a mask for photo ops despite being contagious.

Birx replied, “We have been on the road, so I’ve been very concerned about what’s happening in the rest of America.” She added she would not question the judgement of the Walter Reed doctors, and she is “very proud of the physicians, between the Navy and the army, that are caring for him.”

During her visit, she asked for insight from students, asking them for their comments and concerns for the remainder of the school year.

“Meeting with students and really understanding what the university did to make sure that the students and the community were safe, I think really needs to constantly be applauded,” Dr. Birx said. “And I think understanding what’s happening with the commuting students and ensuring that they’re safe, has also been really important.”

Birx asked students for insight regarding communication with family members during holiday gatherings this upcoming season.

“I think there are still people waiting for the epidemic to look like it looked before,” she said. “It’s not going to look like that. It’s not going to be a workplace driven epidemic. It is going to be what we’ve seen across the south — where it involves family members, social occasions and spreading silently in communities before and outside of the workplace.”

But she also mentioned what she’s anticipating, and her own, personal, concerns.

“I feel like at this moment, in many of the areas of the Northeast county by county, we still don’t have enough what we would call ‘eyes on the epidemic,’” she said. “What do I mean by that? Really active surveillance sites so that we can see early infections before we see hospitalizations, so we can do community mitigation.”

By having eyes on the virus, it can be more easily contained especially among non-sick asymptomatic individuals.

“I think working with the county, the university can use their data and their ability to translate information to be in regular communication with the community about where the virus is and where it isn’t,” Birx said.

“We’ve demonstrated that we can learn, live and work together safely,” McInnis said.

But before Birx left, she gave one big piece of advice for heading into the fall season. “Please get your flu shot.”

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Not so fast! Soy milk may have a negative impact on the thyroid. METRO photo
Use extreme caution when taking supplements

By David Dunaief, M.D.

Dr. David Dunaief

Hypothyroidism can cause weight gain and low energy, but diagnosing and treating it can be tricky. The thyroid is a butterfly-shaped organ at the base of the neck, and it is responsible for maintaining our metabolism. The prefix “hypo,” derived from Greek, means “under” (1). Therefore, hypothyroidism indicates an underactive thyroid and results in slowing of the metabolism.

Blood tests determine if a person has hypothyroidism. Items that are tested include thyroid stimulating hormone (TSH), which is usually increased, thyroxine (free T4) and triiodothyronine (free T3 or T3 uptake). Both of these last two may be suppressed, or lowered (2).

There are two types of primary hypothyroidism: subclinical and overt. In the overt (more obvious) type, classic symptoms include weight gain, fatigue, thinning hair, cold intolerance, dry skin and depression, as well as the changes in all three thyroid hormones on blood tests mentioned above.

In the subclinical, there may be less obvious or vague symptoms and only changes in the TSH. The subclinical can progress to the overt stage rapidly in some cases (3). Subclinical is substantially more common than overt; its prevalence may be as high as 10 percent of the U.S. population (4).

The most common type of hypothyroidism is Hashimoto’s thyroiditis, where antibodies attack thyroid gland tissues (5). Several blood tests are useful to determine if a patient has Hashimoto’s: thyroid peroxidase (TPO) antibodies and antithyroglobulin antibodies.

Medications

Levothyroxine and Armour Thyroid are two main medications for hypothyroidism. The difference is that Armour Thyroid converts T4 into T3, while levothyroxine does not. Therefore, one medication may be more appropriate than the other, depending on the circumstance. T3 can also be given with levothyroxine, which is similar to using Armour Thyroid.

What about supplements?

A study tested 10 different thyroid support supplements; the results were downright disappointing, if not a bit scary (6). Of the supplements tested, 90 percent contained actual medication, some to levels higher than what are found in prescription medications. These supplements could cause toxic effects. There is a narrow therapeutic window when it comes to the appropriate medication dosage for treating hypothyroidism, and it is sensitive. Therefore, if you are going to consider using supplements, check with your doctor and tread very lightly.

Soy impact

In a randomized controlled trial, the treatment group that received higher amounts of soy supplementation had a threefold greater risk of conversion from subclinical hypothyroidism to overt hypothyroidism than those who received considerably less supplementation (7). According to this small, yet well-designed, study, soy has a negative impact on the thyroid. Therefore, those with hypothyroidism may want to minimize or avoid soy.

The reason that soy may have this negative impact was illustrated in a study involving rat thyrocytes (thyroid cells) (8). Researchers found that soy isoflavones, especially genistein, which are usually beneficial, may contribute to autoimmune thyroid disease, such as Hashimoto’s thyroiditis. They also found that soy may inhibit the absorption of iodide in the thyroid.

Weight loss

Wouldn’t it be nice if the silver lining of hypothyroidism is that, with medication to treat the disease, we were guaranteed to lose weight? In a retrospective study, results showed that only about half of those treated with medication for hypothyroidism lost weight (9). This was a small study, and we need a large randomized controlled trial to test it further.

WARNING: The FDA has a black box warning on thyroid medications — they should never be used as weight loss drugs (10). They could put a patient in a hyperthyroid state or worse, with potentially catastrophic results.

Coffee

Taking levothyroxine and coffee together may decrease the absorption of levothyroxine significantly, according to one study (11). It did not seem to matter whether they were taken together or an hour apart. This was a very small study involving only eight patients. Still, I recommend avoiding coffee for several hours after taking the medication.

Vegetables

There is a theory that vegetables, specifically cruciferous ones such as cauliflower, cabbage and broccoli, may exacerbate hypothyroidism. In one animal study, results suggested that very high intake of these vegetables reduces thyroid functioning (12). This study was done over 30 years ago, and it has not been replicated.

Importantly, this may not be the case in humans. In the recently published Adventist Health Study-2, results showed that those who had a vegan-based diet were less likely to develop hypothyroidism than those who ate an omnivore diet (13). And those who added lactose and eggs to the vegan diet also had a small increased risk of developing hypothyroidism. However, this trial did not focus on raw cruciferous vegetables, where additional study is much needed.

There are two take-home points, if you have hypothyroid issues: Try to avoid soy products, and don’t think supplements that claim to be thyroid support and good for you are harmless because they are over the counter and “natural.” In my clinical experience, an anti-inflammatory, vegetable-rich diet helps improve quality of life issues, especially fatigue and weight gain, for those with Hashimoto’s thyroiditis.

References:

(1) dictionary.com. (2) nlm.nih.gov. (3) Endocr Pract. 2005;11:115-119. (4) Arch Intern Med. 2000;160:526-534. (5) mayoclinic.org. (6) Thyroid. 2013;23:1233-1237. (7) J Clin Endocrinol Metab. 2011 May;96:1442-1449. (8) Exp Biol Med (Maywood). 2013;238:623-630. (9) American Thyroid Association. 2013;Abstract 185. (10) FDA.gov. (11) Thyroid. 2008;18:293-301. (12) Crit Rev Food Sci Nutr. 1983;18:123-201. (13) Nutrients. 2013 Nov. 20;5:4642-4652.

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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Comsewogue Public Library, 170 Terryville Road, Port Jefferson Station hosts a flu shot clinic on Thursday, Oct. 8 from 11 a.m. to 2 p.m. A pharmacist from Genoa Health will be on-site to administer flu shots. The event will be held outdoors, weather permitting. Bring your insurance card. Open to all. Questions? Call 631-928-1212 and ask for Adult Services.

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Patients arriving at the Fortunato Breast Health Center use sanitizing gel before being given a mask and having their temperature taken.

Early detection is crucial in diagnosing and treating breast cancer. But screenings in the time of the COVID-19 pandemic have become more complicated, with many screening centers closing for a time and patients fearful to come into a hospital or clinic setting. Mather Hospital’s Fortunato Breast Health Center has responded with strict safety protocols designed to protect patients and staff.

Above, patients are socially distanced from Fortunato Breast Health Center staff when checking in for a screening.

“As always with breast cancer and other cancers, your best bet is to have an early diagnosis,” said Breast Center Co-Medical Director Michelle Price, MD. “The importance of early detection cannot be overstated. Therefore, we have adapted protocols so that we can continue to provide expert care in the setting of the COVID-19 pandemic.”

The Breast Center recommends that women receive their first screening mammography at age 40 and continue annual screening every year thereafter. Many professional societies involved with the diagnosis and treatment of breast cancer also continue to recommend annual screening mammography starting at age 40, including the Society for Breast Imaging, American College of Radiology and National Comprehensive Cancer Network. In some high-risk situations, screening may begin even earlier.

Strict safety protocols have been implemented at the Breast Center in response to the COVID-19 pandemic. Dr. Price said this includes all staff and patients wearing masks at all times, everyone undergoing temperature checks when they arrive at the Breast Center, patients completing a COVID screening questionnaire about possible exposure to the virus, and the use of sanitizing gel.

“We no longer routinely have patients use waiting rooms, to minimize personal interactions,” said Dr. Price. “When patients arrive, they first call from their car, and are brought in one at a time for a streamlined experience.”

Where patients once routinely filled out a medical history form to provide information, the technologist now interviews the patient and records the pertinent data. This change eliminates the need for patients to handle a pen and paper.

Fortunato Breast Health Center Co-Medical Directors Michelle Price, MD, and Joseph Carrucciu, MD, with a 3D mammography unit in a photo taken prior to the COVID-19 pandemic.

“We have a socially distant protocol where the patient has very limited contact with anyone else, providing maximal safety. The technologist brings the patient to the mammography room, where she is provided a gown to change in to privately. When ready, the technologist enters the room and performs the mammogram. When the study is complete, the patient is again given privacy to get dressed, and she is escorted out of the department by the technologist. As has always been the case, the imaging equipment is thoroughly disinfected between patients. People seem very satisfied with what we have done from the point of safety protocols. It’s a similar setup they’ve experienced at other doctors’ offices,” said Dr. Price who stressed the importance of continuing with annual mammograms despite the pandemic.

“Early in the pandemic, non-urgent medical care was postponed, but now the situation has changed,” she said. “The current consensus is that screening should continue if it can be done safely. We have implemented protocols to maximize safety for patients and staff alike. Early detection of breast cancer offers us the best chance for successful treatment.”

The Fortunato Breast Center uses advanced 3D mammography that is designed to make screening more comfortable. The 3D mammography also offers sharper, clearer images for improved diagnostic accuracy all while providing the lowest radiation dose of all FDA approved mammography systems.

Fortunato Breast Center radiologists are specialists who only read breast imaging studies and look back as far as possible at a patient’s history of breast images for any subtle changes or abnormalities in order to provide the most accurate reading.

Should a patient have a breast cancer diagnosis, the Breast Center’s compassionate nurse navigators provide personal guidance with scheduling appointments for tests and follow-up procedures, getting prescriptions, insurance questions, and any other help patients may need. The Breast Center’s nurse navigators provide support throughout every step of the patients’ journey to recovery.

The Breast Center offers no cost or discounted mammography screenings for those individuals with low income and no health insurance. For more information, visit www. matherhospital.org/breasthealth or call 631-476-2771.

All photos courtesy of Mather Hospital

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