The Centers for Disease Control and Prevention has recommended that people wear cloth face coverings in public settings where social distancing measures are difficult to maintain. Even as the world begins to unpause, wearing masks seems likely to continue.
Masks are designed not to prevent the wearer from getting ill, but to protect other people from getting the virus. Masks protect others from your germs when you cough or sneeze. They’re also an effective way to help people to avoid touching their faces.
Masks are exposed to the elements and germs each time they are worn, meaning they will require cleaning. Even though Harvard Health suggests COVID-19 may live more readily on hard surfaces than fabric, the CDC urges people to give cloth face masks the same level of care as regular laundry. Masks should be washed and dried often. The CDC offers these tips on how to clean most cloth and fabric masks.
• Fabric face masks should be washed depending on the frequency of use. More frequent use necessitates more frequent washing.
• A washing machine should be adequate for properly washing a face covering. Choose a warm setting for water temperature. Place masks in the dryer afterward.
• More delicate, hand-sewn masks may be washed by hand, suggests The Good Housekeeping Institute Cleaning Lab. Lather masks with soap and scrub them for at least 20 seconds with warm or hot water before placing in the dryer.
• For additional sanitation, iron masks on the cotton or linen setting for a few minutes to kill remaining germs.
• If masks are fortified with a filter, such as a coffee or HVAC filter, keep in mind that these filters are designed for single use. Paper filters should be replaced after each use. HVAC filters are washable, but manufacturers warn that their effectiveness decreases with each wash. Medium weight nonwoven interface used as filter material is typically washable.
Various health agencies do not condone using steam or microwaves to clean cloth face masks, as these sanitizing techniques are not as effective as regular laundering. Also, never microwave non-fabric dust or N95 respirator masks if you are using them. They can catch fire or be rendered useless.
Many seniors are embracing digital technology in this new world of social distancing.
By Linda Kolakowski
Linda Kolakowski
In the wake of the pandemic, many people who had formerly expected to move to a life plan retirement community, assisted living or other type of senior residence now have questions about whether a senior living community is still the right choice for them.
While it’s natural to have a level of uncertainty, even in the best of times, getting educated about the various living options available, what precautions are permanently in place, and what it was like to live in these communities during shelter in place times will help in the decision making process.
People are aging for a much longer period than years ago. In 2030, the expectation is that there will be twice as many 85-year-olds and three times as many people over 100 years of age than there are today, and they’re more active than previous generations. Trends indicate that more people want to be in communities with their friends, who become more like family members, as relatives may live far away. Retirement communities help people hold on to the community relationships we need in order to thrive at every age. Will these trends continue as we cope with the likes of COVID-19?
The Need for Community
One common experience across generations during COVID has been the need to have a community of sorts. Whether they found it through regular Zoom or Facetime calls with family, friends or work colleagues, the majority moved quickly to fill the void from social distancing measures and embraced digital technology. As the weather warmed, outdoor socially distant gatherings — fitness and other classes, bring your own sandwich picnics and other no touch activities became the norm in senior living communities.
While this certainly happened at all manners of senior living communities, it was not necessarily the case for seniors living on their own. Some seniors were able to enjoy the company and comforts of living with family members or had more mobile neighbors and friends to shop for them and otherwise help out. Others who were already isolated had neither the equipment nor technical know-how to connect with family and friends digitally.
Fear of infection closed down many senior centers, limited ride services and at home visits, and made trips to the supermarket and drug store overwhelming, if not impossible. Home maintenance also became a significant issue.
Residents of senior living communities like Jefferson’s Ferry had to curtail their activities, just like the rest of the population, but because of the array of services that come with living in a retirement community, they were able to get takeout meals, groceries, household items, laundry service, and even cocktails to go on the premises.
Staying Healthy
While there were health concerns, residents of many senior living communities also had ready access to the most up to date health information, as well as greater access to health care. Healthy residents overall remained healthy, thanks to senior living communities’ strict adherence to protocols and directives from local, state, and federal agencies that promote resident and employee safety and reduce the chance of exposure or transmission.
Feeling Good by Giving Back
Senior community residents across Long Island also came together in the spirit of giving back to make the best of a difficult situation.At Jefferson’s Ferry, the residents spearheaded fundraisers and made donations to provide free meals to the hardworking staff and otherwise demonstrated their gratitude with thank you notes and small gifts. Some residents made masks for their neighbors; others reached out to fellow residents with phone calls, or left treats and notes outside the doors of their neighbors to lift their spirits.
One Jefferson’s Ferry resident related her experience. “I can’t imagine having lived anywhere else during the ‘life during social distancing’ period. While most of my day is spent in my apartment, I converse regularly with friends by phone. I can have meals delivered, but often take the outdoor route to the Community Center. I’ll meet some masked neighbors along the way, pick up my mail and my takeout dinner in the café. If there is any kind of emergency or special need, I can just ‘push the button’ and a staff member will help me out.”
Another said, “It’s interesting and inspiring how Jefferson’s Ferry has continued to be a caring community, even in the midst of social distancing. We can still laugh at each other’s masks and hairdos, encourage one another when we get down, and remind each other that all the fun things we do together will resume someday.”
It’s Your Choice
At every stage of life, we all want to be able to exercise control and make choices.Equally important is making sure that access to services and health care remains viable and affordable as needs change over time. Talk to your friends, visit the senior communities in your area and ask a lot of questions. There are many terrific options out there. You will find the one that’s right for you.
Author Linda Kolakowski is the Vice President of Resident Life at Jefferson’s Ferry Life Plan Community in South Setauket.
Studies have shown that combined strength and endurance training may lower RHR in women. METRO photo
Certain types of exercise may lower RHR
By David Dunaief, M.D.
Dr. David Dunaief
How many of us regularly check our resting heart rate, or pulse, and what can we learn from it?
Resting heart rate is pretty important. In fact, it may play a role in longevity, heart disease — including heart failure, arrhythmias, heart attacks and sudden cardiac death — and even chronic kidney disease.
A “normal” resting heart rate is between 60 to 100 beats per minute (bpm). If your resting heart rate (RHR) is above 100 bpm, this is referred to as tachycardia, or a racing heartbeat, and it has potentially serious consequences. However, even normal RHRs can be stratified to identify risks for diseases. What I mean is that, even in the normal range, as your RHR increases, so do your potential risks. Actually, resting heart rate below approximately 70 bpm may be ideal.
The good news is that RHR is modifiable. Methods that may reduce your rate include medications, such as beta blockers, and lifestyle modifications, including meditation, dietary changes and exercise.
Impact on life span
Reducing RHR may be an important component in living a longer, healthier lifestyle. In the Copenhagen Male Study, a prospective study that followed 2,798 participants for 16 years, results showed that those with higher resting heart rates had a greater risk of death (1). There was a linear relationship between the risk of death and increasing RHR. Those who had a resting heart rate above 90 bpm were at a threefold greater risk of death, compared to those who had a RHR at or below 50 bpm. RHR was inversely related to the amount of physical activity.
Thus, the authors concluded that a “healthy” person with higher RHR may still have a shorter life span, with all other factors being equal, such as physical activity and blood pressure.
Predictor of Hypertension?
An analysis of 4,000 young adult participants in the 30-year CARDIA cohort study found that a 10 bpm higher RHR had a significant impact on future hypertension, or high blood pressure, experienced in middle age (2). This association was found with a 10 bpm increase in RHR among black and white men and white women. Interestingly, black women did not show the same association. The study authors hypothesize that this may suggest racial differences in sympathetic nervous activity impacts on hypertension among women. Of course, additional research will be necessary to delve deeper into this.
Heart disease mortality
In the Nord-Trondelag Health Study, a prospective observational study, those who had a higher RHR at the end of the study than they did at the beginning of the study 10 years prior were more likely to die from heart disease (3). In other words, as the RHR increased from less than 70 bpm to over 85 bpm, there was a 90 percent greater risk of heart disease, compared to those who maintained a RHR of less than 70 throughout the two measurements. This study involved 30,000 participants who were healthy volunteers at least 20 years old.
Heart attacks
In the Women’s Health Initiative, results showed a 26 percent decrease in the risk of cardiovascular events in those postmenopausal women who had a RHR below 62 bpm, compared to those who had a RHR above 76 bpm (4). Interestingly, these results were even more substantial in the subgroup of women who were newly postmenopausal, ranging in age from 50 to 64.
Effect on kidney function
I have written many times about chronic kidney disease. An interesting follow-up is resting heart rate and its impact on kidney function. In the Atherosclerosis Risk in Communities Study, results showed that the most severe form of chronic kidney disease, end-stage renal disease, was 98 percent more likely to occur in those with the highest RHR, compared to those with the lowest (5). There were approximately 13,000 participants in the study, with a 16-year follow-up.
The authors hypothesized that this negative effect on the kidney may be due to a loss of homeostasis in the autonomic (involuntary) nervous system, resulting in blood vessel dysfunction, such as increased inflammation and vasoconstriction (narrowing).
Lowering RHR
Studies have shown that combined strength and endurance training may lower RHR in women. METRO photo
A meta-analysis of controlled studies analyzed the effects of different types of exercise on RHR (6). Studies’ interventions included a range of exercises, such as high intensity interval training, including ball and team sports; endurance or strength training; yoga; qigong; and tai chi. Some studies’ participants were limited to one gender.
No surprise, analysis found that all interventions lowered RHR compared to control groups that did not exercise. The greatest results in lowering RHR were in endurance training, yoga, strength training (females only), and combined endurance and strength training (females only).
Can RHR be too low?
Is there a resting heart rate that is too low? Well, it depends on the context. If you are a marathoner or an athlete, then a RHR in the 40s may not be abnormal. For a healthy, physically active individual, it is not uncommon to have a resting heart rate in the 50s. However, if you are on medications that reduce your RHR and/or have a chronic disease, such as heart failure, it is probably not advisable to go much below 60 bpm.
Always ask your doctor about the appropriate resting heart rate for your particular situation.
Thus, resting heart rate is an easy and inexpensive biomarker to potentially determine risk stratification for disease and to increase longevity, even for those in the normal range. By monitoring and modifying RHR, we can use it as a tool for primary disease prevention.
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.
Exercise plays a crucial role in lowering blood pressure. Stock photo
Nighttime pressure readings may better predict cardiovascular events
By David Dunaief, M.D.
Dr. David Dunaief
Roughly 45 percent of adults in the U.S. have hypertension, or high blood pressure. That’s almost one in two adults, or 108 million people, of which 82 million do not have their hypertension con-trolled. If that isn’t scary enough, the Centers for Disease Control and Prevention (CDC) reports that almost a half-million people died in the U.S. in 2017 from complications of hypertension in 2017 (1).
Speaking of scary, the probability of complications, such as cardiovascular events and mortality, may have their highest incidence during nighttime sleeping hours.
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. Fortunately, hypertension is highly modifiable in terms of reducing the risk of cardiovascular disease and mortality (2). At least some of the risk factors are probably familiar to you. These include being significantly overweight or obese, smoking, poor diet, lack of exercise, family history, age, increased sodium, depression, low vitamin D, diabetes and too much alcohol (3).
Of course, antihypertensive (blood pressure) medications treat this disorder. In addition, some nonpharmacological approaches have benefits. These include lifestyle modifications with diet, exercise and potentially supplements.
Risk factors matter, but not equally
In an observational study involving 2,763 participants, 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 (4). Another risk factor with a significant impact was being at least modestly overweight (BMI >27.5 kg/m²), which put participants at 1.87 times increased risk. This surprisingly, albeit slightly, trumped cigarette smoking at 1.83 times increased risk.
The moral is that a freewheeling lifestyle can have a detrimental impact on blood pressure and cause at least stage 1 hypertension.
Hypertension complications are felt across gender, age and race
While the data show that more men than women have hypertension, 47 percent vs. 43 percent, and the prevalence of high blood pressure varies by race, the consequences of hypertension are felt across the spectrum of age, gender and race (1).
One of the most feared complications of hypertension is cardiovascular disease. In a study, isolated systolic (top number) 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 (5). 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, it was very large and had a 31-year duration.
Nighttime concerns
Measuring blood pressure in the clinic can be useful. However, in a meta-analysis (involving nine studies from Europe, South America and Asia), 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 (6).
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 (7). 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 (8). 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.
Eat your berries
Diet plays a role in controlling high blood pressure. In a study, blueberry powder (22 grams) in a 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 (9).
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.
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.
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.
Stony Brook University's COVID-19 testing site. Photo by Matthew Niegocki
As part of an awareness campaign, Suffolk County is trying to provide residents with updated information on testing locations, including sites in pharmacies that are free of charge.
Suffolk officials said this was in response to U.S. Centers for Disease Control Guidelines which were inexplicably changed Aug. 25 to say that individuals do not necessarily need to get tested for COVID-19 after coming in contact with someone who has tested positive. New York State officials have also spoken out against the change, arguing it flies in the face of what we currently understand about COVID-19.
Such sites are listed below:
Town of Brookhaven and East End
CVS Pharmacy, 6221 Route 25A, Wading River, NY 11792
CVS Pharmacy, 496 County Road 111 Building C, Manorville, NY 11949
Rite Aid, 803 Montauk Hwy Unit D, Shirley, NY
CVS Pharmacy, 29 Havenwood Drive, Shirley NY 11967
Walgreens, 1580 Route 112, Medford, NY 11763
CVS Pharmacy, 470 West Main Street, Patchogue, NY 11772
CVS Pharmacy, 1710 Route 112, Coram, NY 11727
CVS Pharmacy, 2315 Middle Country Road, Centereach, NY 11720
Rite Aid, 229 Independence Plaza, Selden, NY
CVS Pharmacy, 729 Portion Road, Ronkonkoma, NY 11779
Stony Brook Drive Through Testing Site, 100 Nicolls Rd, Stony Brook, NY 11794
Town of Smithtown
CVS Pharmacy, 977 Jericho Turnpike, Smithtown, NY 11725
CVS Pharmacy, 111 Terry Road, Smithtown, NY 11787
Town of Huntington and Western Suffolk
CVS Pharmacy, 520 Larkfield Road, East Northport, NY 11731
CVS Pharmacy, 2000 Jericho Turnpike, East Northport, NY 11731
CVS Pharmacy, 111 Depot Road, Huntington Station, NY 11746
CVS Pharmacy, 107 South Country Road, Bellport, NY 11713
CVS Pharmacy, 450 Main Street, Farmingdale, NY 11735
CVS Pharmacy, Candlewood Road and 5th Avenue, Brentwood, NY 11717
CVS Pharmacy, 311 Main Street, Center Moriches, NY 11934
CVS Pharmacy, 831 Connetquot Avenue, Islip Terrace, NY 11752
CVS Pharmacy, 105 Montauk Highway, West Sayville, NY 11782
Gov. Andrew Cuomo (D) said during a press conference Aug. 26 that New York would not adhere to the new guidance. He instead proclaimed that the CDC was following the bidding of President Donald Trump (R). He called the new health policy “political propaganda.”
Suffolk County Executive Steve Bellone (D) said in a release that the new CDC guidance is inconsistent with what has already helped stop the spread of COVID-19.
“From day one, we have prioritized access to testing, especially in our hard hit communities,” Bellone said in a release. “In light of the puzzling CDC guidance released this week, I am proud to stand with Governor Cuomo and others in the medical community to encourage our residents to continue to get tested. If we want to avoid a second wave and keep our infection rate below one percent, testing must be a top priority.”
For their part, federal health officials have told reporters the CDC’s change in testing policy was not based on politics and the change was made by CDC themselves. However, Trump has publicly said that he believed the reason the number of coronavirus cases continues to increase was because the U.S. has increased the number of tests it conducts.
Suffolk Commissioner of Health Services Dr. Gregson Pigott said testing is the best way to prevent a new wave of the virus come the end of summer.
“A robust testing program allows us to identify as many positive cases as possible, isolate those individuals and quarantine their close contacts, therefore slowing and containing the spread of COVID-19,” Pigott said in a release. “In order to protect public health and help prevent a second wave in the fall, we will continue to recommend everyone who is exposed to the virus gets tested.”
From left, Private First Class Alex Vroman of the New York Army National Guard and Josh Miller, MD, MPH, Assistant Dean for Clinical Integration and Medical Director of Diabetes Care for Stony Brook Medicine, at the coronavirus testing site on Stony Brook University’s campus, where more 48,000 people were tested from March through July. Photo from SBU
By Carol Gomes
Carol Gomes
The pandemic crisis has revealed who we are at Stony Brook Medicine, and we are truly “Stony Brook Strong.”
On Monday, March 2, Stony Brook University Hospital (SBUH) instituted our Hospital Incident Command System (HICS) to manage our response to the pandemic. Today, more than five months later, the system remains in place, operating seven days a week.
It is truly amazing how far we have come. At the height of the pandemic, on April 14, Stony Brook had 359 COVID-positive patients in the hospital. As of last Friday, we had only seven.
Now all our care sites are back in operation, using new safety and cleaning protocols. Our Emergency Departments remain open 24/7 for medical emergencies across Long Island, and we resumed elective procedures at SBUH effective June 1, after meeting state requirements.
From March through Aug. 2, SBUH treated 1,653 COVID-positive inpatients. The four hospitals in the Stony Brook Medicine hospital system formed the backbone of the response across Suffolk County, which had the lowest patient mortality rate across Downstate New York.
To manage the surge in patients, the hospital opened 300 additional inpatient beds, including 180 additional ICU beds. Stony Brook also collaborated with the New York State Department of Health to establish a drive-through coronavirus testing site on Stony Brook University’s campus, testing more than 48,000 people from March through July.
Adjacent to the testing site, Stony Brook set up a Field ER to care for patients referred from the hospital’s main Emergency Department. From March 24 to May 4, the site treated more than 1,885 patients.
Since the pandemic began, our Hospital Purchasing Department has been on top of the issue, scouring the nation and world for supplies. Over a three-month period, we received nearly 10 million gloves, more than 700,000 gowns, more than 750,000 surgical masks, more than 75,000 N95 respirators and nearly 30,000 face shields. We were one of the first hospitals in the nation to reprocess N95 respirators with Battelle Laboratories, with more than 8,000 masks reprocessed for future use if needed.
We know we must remain vigilant, as this pandemic is not yet over, and we face an uncertain future, with a possible second wave, for which we are well prepared. But we also know this much with certainty: we have successfully bent downward the curve of COVID-19 cases across Suffolk County.
Thank you for your continuing efforts to keep the coronavirus in check by following fundamental public health protocols: social distancing, masks and hand hygiene. Together, we will emerge from this pandemic even stronger than before, because together we are “Stony Brook Strong.”
Carol A. Gomes, MS, FACHE, CPHQ, is Chief Executive Officer at Stony Brook University Hospital.
Even over-the-counter medications carry risks and can lead to health problems. Stock photo
Use caution and follow the label instructions with NSAIDs and acetaminophen
By David Dunaief, M.D.
Dr. David Dunaief
Most of us keep a few stock items in our medicine cabinets as our “go-to’s” for pain relief, fever or inflammation.
In addition to aspirin, among these are usually other NSAIDs (non-steroidal anti-inflammatory drugs) and acetaminophen (Tylenol). Familiar NSAIDs include ibuprofen (Advil, Motrin) and naproxen sodium (Aleve). Over 70 million prescriptions for NSAIDs are written each year in the U.S., and Americans consume more than 30 billion doses, once over-the-counter (OTC) use is factored in (1).
According to a poll of these regular users of OTC NSAIDs, a substantial number — 60 percent — were unaware of their dangerous side effects (2). Acetaminophen is used frequently, as well. One quarter of Americans take it on a weekly basis.
Unfortunately, many think of these drugs as relatively benign. In fact, I find that until I specifically ask about their use, most patients don’t include them in a list of their medications.
The risks
Unfortunately, NSAIDs, according to the Centers for Disease Control and Prevention, are responsible for 7,600 deaths annually and 10 times that number in hospitalizations (3). These are not medications that should be taken lightly. NSAIDs increase the risk of several maladies, including heart attacks, gastrointestinal bleeds, exacerbation of diverticular disease, chronic arrhythmias (abnormal heartbeats) and erectile dysfunction. In some instances, the cardiovascular effects can be fatal.
These risks prompted the FDA to strengthen the warning labels on non-aspirin NSAID labels, advising that those taking NSAIDs should immediately seek medical attention if they experience chest pain, shortness of breath or trouble breathing, weakness in one part or side of their body, or slurred speech (4).
Adverse side effects of NSAIDs
In a case control (epidemiologic, retrospective) study using the UK Primary Care Database, chronic users of NSAIDs have a significantly increased risk of a serious arrhythmia (abnormal heartbeat) called atrial fibrillation (5). Patients were between 40 and 89 years of age.
Interestingly, chronic users were defined as patients who took NSAIDs for more than 30 days. Those patients who used NSAIDs more than 30 days had a 57 percent increased risk of atrial fibrillation. A Danish study reinforces these results after the first month of use (6). This is not very long to have such a substantial risk. For patients who used NSAIDs longer than one year, the risk increased to 80 percent. Caution should be used when prescribing NSAIDs or when taking them OTC. Atrial fibrillation is not an easy disease to treat.
NSAIDs also increase the risk of mortality in chronic users. Older patients who have heart disease or hypertension (high blood pressure) and are chronic NSAIDs users are at increased risk of death, according to an observational study (7). Compared to those who never or infrequently used them over about 2.5 years, chronic users had a greater than twofold increase in death due to cardiovascular causes. High blood pressure was not a factor, since the chronic users actually had lower blood pressure. Yet I have seen with my patients that NSAIDs can increase blood pressure.
Acetaminophen as an alternative?
Acetaminophen does not cause gastrointestinal bleeds, arrhythmias and deaths due to cardiovascular events that NSAIDs can. However, the Food & Drug Administration announced in 2011 that acetaminophen should not exceed 325 mg every four to six hours when used as a prescription combination pain reliever (4). The goal is to reduce and avoid severe injury to the liver, which can potentially cause liver failure.
There is an intriguing paradox with acetaminophen: Hospitals typically dispense regular-strength 325-mg doses of the drug, whereas OTC doses frequently are found in extra-strength 500-mg tablets, and often the suggested dose is two tablets, or 1 gram. Patients should not take more than 4 grams a day to lower their risk of liver damage. The 4 gram amount sounds like a significant quantity, but it translates into two pills of extra-strength Tylenol every six hours.
I have patients who have taken three pills at one time thinking that, since it is OTC, exceeding the dose is okay. Unfortunately, this is not true and can be dangerous.
The FDA’s recommendations for limiting the dose result from a conglomeration of data. For instance, one study that showed acute liver failure was due primarily to unintentional overdoses of acetaminophen (8). Accidental overdosing is more likely to occur when taking acetaminophen at the same time as a combination sinus, cough or cold remedy that also contains acetaminophen. Over-the-counter cold medications can contain acetaminophen.
In order to be aware of potentially adverse events, you have to be your own best advocate and read labels. Remember to tell your physician if you are taking OTC medications. If you are a chronic user of NSAIDs because of underlying inflammation, you may find an anti-inflammatory diet, which is usually plant-based, is an effective alternative.
References:
(1) Medscape.com, 2020 May 30 (emedicine.medscape.com/article/816117-overview). (2) J Rheumatol. 2005;32;2218-2224. (3) Annals of Internal Medicine, 1997;127:429-438. (4) fda.gov (5) Arch Intern Med. 2010;170(16):1450-1455. (6) BMJ 2011;343:d3450. (7) Am J Med. 2011 Jul;124(7):614-620. (8) Am J Gastroenterol. 2007;102:2459-2463.
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.
Owners of Huner’s Fitness Advantage in Port Jefferson said they believe they should be considered essential for the work they do helping people remain active and healthy. Photo from Huner’s Fitness Advantage website
After doing heavy lifting to ensure customer and employee safety, gyms can begin to reopen soon.
Suffolk County Executive Steve Bellone (D) announced a gradual gym reopening starting this Monday, Aug. 24. This comes after earlier this week Gov. Andrew Cuomo (D) said gyms can start to reopen once they receive guidance from local government.
Commercial gyms, such as Planet Fitness, LA Fitness, Retro Fitness and those that require a membership fee, along with indoor classes can restart next week.
Each fitness center will have to pass a county health inspection to make sure the gyms have sufficient procedures to protect staff and customers while following state guidelines established by Cuomo.
Hotel, office, higher education and residential gyms can reopen starting the following week, on Aug. 31.
On Thursday, Aug. 20, the county will host a virtual meeting with facility owners to review guidance, answer questions and provide any clarifications.
“With our infection rate holding steady at or below 1 percent and a robust testing system in place, we are confident we can reopen gyms in a way that is both safe and responsible,” Bellone said in a statement. “I want to remind our residents and gym owners that we are still in the midst of a pandemic.”
Bellone encouraged those attending gyms to wear a mask and follow all safety procedures.
Communal showers, whirlpools, saunas and steam rooms and water fountains and self-serve bars and samples must remain closed. According to the governor’s web site, individual showers and stalls can remain open as long as they are cleaned between use.
Classes are restricted to the most restrictive guidelines, which could either be six feet of distance in all directions from a participant, a limit of 33 percent capacity and no more than 50 people.
Gym owners also must provide sanitizing stations, acceptable face coverings, which exclude bandanas, buffs and gaiters and the limitation of physical contact activities including boxing and martial arts.
During each inspection, businesses will receive a gallon of NYS Clean hand sanitizer.
According to Cuomo, local health departments are required to inspect gyms prior to reopening or within two weeks of reopening, to ensure strict adherence to the state Department of Health guidance.
Indeed, the Suffolk County Department of Health Services will begin inspections on Monday, Aug. 24 for commercial and traditional gyms.
“New Yorkers must closely adhere to the guidelines and local health departments are required to strictly enforce them to help ensure gyms and fitness center reopen safely and protect the public health,” Cuomo said in a statement.
The Suffolk County Department of Economic Development and Planning will work with the Suffolk County Department of Labor, Licensing and Consumer Affairs and the Suffolk County Department of Health Services to create an online database of gyms and fitness centers within the county.
Before an inspection, gym owners will need to complete the affirmation for each location, which owners can find at the New York Forward website forward.ny.gov, that they reviewed and understood the state guidelines and will implement these protocols.
After owners attest to their safety plans, the county will schedule inspections. Suffolk will send out an email with the date and approximate time for an inspection.
Gym owners need to post a written safety plan describing the ways they are protecting employees and gym members from COVID-19.
Cuomo also requires that gyms use a MERV-13 or greater air-handling system. If the gym can’t operate at that level, the owners need to have a heating, ventilation and air conditioning professional document their inability to use such a system and adopt additional ventilation and mitigation protocols from the American Society of Heating, Refrigerating and Air-Conditioning Engineers and the U.S. Centers for Disease Control and Prevention.
Walking helps strengthen your joints, bones and muscles. METRO photo
Walking’s benefits extend beyond physical fitness
By David Dunaief, M.D.
Dr. David Dunaief
There is great emphasis on exercise in medicine and in society. We have heard it is good for us ever since we were children in gym class striving for the presidential fitness award.
The average reaction, unfortunately, is an aversion to exercise. As kids, many of us tried to get out of gym class, and as adults, we “want” to exercise, but we “don’t have time.” The result of this is a nation of couch potatoes. I once heard that the couch is the worst deep-fried food. It perpetuates inactivity, especially when watching TV. Even sleeping burns more calories.
I think part of the problem, generally, is that we don’t know what type of exercise is best and how long and frequently to do it. These days, for many who depend on gyms, dance studios and other exercise-related facilities for exercise are struggling to find meaningful substitutes.
Well, guess what? There is an easy way to get tremendous benefit with very little time involved. You don’t need expensive equipment, and you don’t have to join a gym. You can sharpen your wits with your feet.
Jane Brody has written in The New York Times’ Science Times about Esther Tuttle. Esther was 99 years old, sharp as a tack and was independently mobile, with no aids needed. She continued to stay active by walking in the morning for 30 minutes and then walking again in the afternoon. The skeptic might say that this is a nice story, but its value is anecdotal at best.
Well, evidence-based medicine backs up her claim that walking is a rudimentary and simple way to get exercise that shows incredible benefits. One mile of walking a day will help keep the doctor away.
Walking has a powerful effect on preserving brain function and even growing certain areas of the brain (1). Walking between six and nine miles a week, or just one mile a day, reduced the risk of cognitive impairment over 13 years and actually increased the amount of gray matter tissue in the brain over nine years.
Those participants who had an increase in brain tissue volume had a substantially reduced risk of developing cognitive impairment. Interestingly, the parts of the brain that grew included the hippocampus, involved with memory, and the frontal cortex, involved with short-term memory and executive decision making. There were 299 participants who had a mean age of 78 and were dementia free at the start of the trial. Imagine if you started earlier?
In yet another study, moderate exercise reduced the risk of mild cognitive impairment with exercise begun in mid-to-late life (2).
Even better news is that, if you’re pressed for time or if you’re building up your stamina, you can split a mile into two half-mile increments. How long does it take you to walk a half-mile? You’ll be surprised at how much better you will feel — and how much sharper your thinking is.
This is a terrific strategy to get you off the couch or away from your computer, another hazard for many of us working or schooling from home. Set an alarm for specific points throughout the day and use that as a prompt to get up and walk, even if only for 15 minutes. The miles will add up quickly.
In addition to the mental acuity benefits, this may also help with your psychological health, giving you a mental break from endless Zoom calls and your eyes a break from endless screens.
If you ratchet up the exercise to running, a study showed that mood also improves, mollifying anger (3). The act of running actually increases your serotonin levels, a hormone that, when low, can make people agitated or angry. So, exercise may actually help you get your aggressions out.
Walking has other benefits as well. We’ve all heard about the importance of doing weight-bearing exercise to prevent osteoporosis and osteoporotic fractures. The movie “WALL-E” even did a spoof on this, projecting a future where people lived in their movable recliners. The result was a human skeletal structure that had receded over the generations from lack of use. Although it was tongue-in-cheek, it wasn’t too far from the truth; if you don’t use them, bones weaken and break. Walking is a weight-bearing exercise that helps strengthen your joints, bones and muscles.
So, remember, use your feet to keep your mind sharp. Activities like walking will help you keep a positive attitude, preserve your bones and help increase the plasticity of your brain.
References:
(1) Neurology Oct 2010, 75 (16) 1415-1422. (2) Arch Neurol. 2010;67(1):80-86. (3) J Sport Exerc Psychol. 2010 Apr;32(2):253-261.
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.
It’s been a rough year for all of us, that’s for sure, but no one has felt the sting of the COVID-19 pandemic more keenly than those who have contracted the virus.
As of Aug. 6, more than 43,000 Suffolk County residents have tested positive for COVID-19, and many more have faced the virus without an official diagnosis. Its symptoms can vary widely, from mild fatigue and chills to flu-like illnesses or even respiratory distress requiring hospital care.
The virus is unpredictable, and dealing with symptoms along with a quarantine, lengthy recovery and uncertain long-term effects is daunting. It’s only natural that many will experience tough emotions along the way.
Stony Brook Medicine is now offering a virtual support group for past and present COVID-19 patients. The weekly sessions will give patients a space to discuss their experiences and feelings while learning healthy coping mechanisms.
The support group is hosted by the Mind-Body Clinical Research Center at the Stony Brook Renaissance School of Medicine. Under the direction of founder Dr. Adam Gonzalez, the center focuses on the integration of mental and physical health for overall wellbeing.
“We wanted to see what we could do to support these members of the community who had COVID-19 and shared that they were feeling anxious, isolated and afraid of transmitting the virus to others,” Gonzalez explained. “Our goal is to provide a telehealth platform for patients to come together and bolster one another, exchange information, and learn skills to cope with stress brought on by their illness.”
Leading the group is Jenna Palladino, a licensed clinical psychologist and clinical assistant professor of psychiatry. Palladino is hopeful that participants will feel comfortable opening up about their struggles with COVID-19 in the company of others who know what it’s like.
“Research supports the idea that sharing your story helps you to work through the emotions related to it. And talking to others experiencing similar feelings helps to normalize the experience,” Palladino said. “It’s important for people going through COVID-19 to know that they’re not alone.”
The initial group is expected to run for 12 weeks, covering topics like coping with isolation, deep breathing, managing anxiety, muscle relaxation and mindfulness, to name a few.
Palladino is also leaving plenty of room for participants to ask questions and discuss topics that interest them, allowing the group to better meet their specific needs and concerns.
Gonzalez added that the support group will act as a pilot program for researchers seeking to understand the experiences of people living with COVID-19. They’ll collect data at the beginning and end of the program to see how patients are doing, if the support group was beneficial and how it can be improved.
While the initial group is limited to 10 patients, Palladino and her team are prepared to quickly begin additional groups if there is an interest, she said.
The virtual COVID-19 support group will be held from 6 to 7 p.m. Thursdays via the free Microsoft Teams video conferencing platform. The group is limited to 10 participants at a time. Registration is required to attend by calling 631-632-8657. For more information and resources, visit www.stonybrookmedicine.edu/COVID19support.
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