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95 percent found incidentally are benign

By David Dunaief, M.D.

Dr. David Dunaief

More than 50 percent of people have thyroid nodules detectable by high-resolution ultrasound (1). Fortunately, most are benign. A small percent, 4 to 6.5 percent, are malignant, with the number varying depending on the study (2). Thyroid nodules are diagnosed more often incidentally on radiologic exams, such as CT scans of the chest, MRI scans, PET scans and ultrasounds of the carotid arteries in the neck, rather than as a consequence of symptoms (3).

There is a conundrum of what to do with a thyroid nodule, especially when it is found incidentally. It depends on the size. If it is over one centimeter, usually it is biopsied by fine needle aspiration (FNA) (4). While most are asymptomatic, if there are symptoms, these might include difficulty swallowing, difficulty breathing, hoarseness, pain in the lower portion of the neck and a goiter (5).

FNA biopsy is becoming more common. In a study evaluating several databases, there was a greater than 100 percent increase in thyroid FNAs performed over a five-year period from 2006 to 2011 (6). This resulted in a 31 percent increase in thyroidectomies, surgeries to remove the thyroid partially or completely.

However, the number of thyroid cancers diagnosed with the surgery did not rise in this same period. Though the number of cancers diagnosed has increased, the mortality rate has remained relatively stable over several decades at about 1,500 patients per year (7). Thyroid nodules in this study were least likely to be cancerous when the initial diagnosis was by incidental radiologic exam.

Evaluating borderline results

As much as 25 percent of FNA biopsies are indeterminate. We are going to look at two techniques to differentiate between benign and malignant thyroid nodules when FNA results are equivocal: a PET scan and a molecular genetics test.

A meta-analysis (a group of six studies) of PET scan results showed that it was least effective in resolving an unclear FNA biopsy. The PET scan was able to rule out patients who did not have malignancies, but did not do a good job of identifying those who did have cancer (8).

On the other hand, a molecular-based test was able to potentially determine whether an indeterminate thyroid nodule by FNA was malignant or benign (9).

Unlike in the PET scan study above, the researchers were able to not only rule out the majority of malignancies but also to rule them in. It was not perfect, but the percent of negative predictive value (ruled out) was 94 percent, and the positive predictive value (ruled in) was 74 percent. The combination test improved the predictive results of previous molecular tests by 65 to 69 percent. This is important to help decide whether or not the patient needs surgery to remove at least part of the thyroid.

Significance of calcification detected by ultrasound

Microcalcifications in the nodule can be detected on ultrasound. The significance of this may be that patients with microcalcifications are more likely to have malignant thyroid nodules than those without them, according to a small prospective study involving 170 patients (10). This does not mean necessarily that a patient has malignancy with calcifications, but there is a higher risk.

Good news

As I mentioned above, most thyroid nodules are benign. The results of one study go even further, showing that most asymptomatic benign nodules do not progress in size significantly after five years (11). The factors that did contribute to growth of about 11 percent of the nodules were age (<45 years old had more growth than >60 years old), multiple nodules, greater nodule volume at baseline and being male.

The authors’ suggestion is that, after the follow-up scan, the next ultrasound scan might be five years later instead of three years. However, they did discover thyroid cancer in 0.3 percent after five years.

Thyroid function may contribute to risk

In considering risk factors, it is important to note that those who had normal thyroid stimulating hormone (TSH) were less likely to have a malignant thyroid nodule than those who had high TSH, implying hypothyroidism. There was an almost 30 percent prevalence of cancer in the nodule if the TSH was greater than >5.5 mU/L (12).

Fortunately, most nodules are benign and asymptomatic, but the number of cancerous nodules found is growing. Why the death rate remains the same year over year for decades may have to do with the slow rate at which most thyroid cancers progress, especially two of the most common forms, follicular and papillary.

References:

(1) AACE 2013 Abstract 1048. (2) Thyroid. 2005;15(7):708. (3) uptodate.com. (4) AACE 2013 Abstract 1048. (5) thyroid.org. (6) AAES 2013 Annual Meeting. Abstract 36. (7) AACE 2013 Abstract 1048. (8) Cancer. 2011;117(20):4582-4594. (9) J Clin Endocrinol Metab. Online May 12, 2015. (10) Head Neck. 2008 Sep;30(9):1206-1210. (11) JAMA. 2015;313(9):926-935. (12) J Clin Endocrinol Metab. 2006;91(11):4295.

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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Senator Mario R. Mattera (2nd Senate District), in cooperation with the Middle Country Public Library, is hosting the Stony Brook Cancer Center’s Mobile Mammography Van at the library’s Selden location.  This no-cost breast cancer-screening event will be held from 9 am to 4 pm on Monday, December 6th at the library, which is located at 575 Middle Country Road.

Stony Brook University Cancer Center operates and staffs the mobile van, which is supported by more than $3 million in funding from the New York State Department of Health.  The van provides convenient access to screening services for all women in our area to ensure they get the information and services needed to protect themselves from breast cancer.

This event is for women 40 and older who have not had a mammogram in the past year. To help ensure proper coordination of the event, residents are being asked to schedule an appointment by calling 631-638-4135.

According to information provided by Stony Brook Cancer Center, most screenings are no cost to the patient since the cost of mammograms are covered by most insurance plans.  Any resident without insurance will be referred to the New York State Cancer Services Program.

“Thank you to the Stony Brook Cancer Center and the Middle Country Public Library for taking part in this important event.  Hopefully, this will help residents who may face challenges that prevent them from accessing this very important regular screening get the information they need to protect their health.  Early detection is the most critical protection in the fight against breast cancer and I hope everyone who needs this service will join us on December 6th,” stated Senator Mattera.

For more information on this important event, including eligibility requirements and directions to the library, please visit Senator Mattera’s website at mattera.nysenate.gov.

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Families opened their doors to each other during Thanksgiving, eager for a long-awaited reunion and hoping to keep out COVID-19. Stock photo

Despite the desire to relax, remove masks and go on with life, the pandemic, even prior to the emergence of a new, mutation-laden variant, has become a central concern among government and health care officials.

The stock market has felt the effects of concerns over the Omicron variant, hospitals are sending off some positive tests to check for the new variant, and the federal government is restricting travel from several countries in Africa.

While health care officials anticipate the inevitable presence of confirmed cases of Omicron in the United States and New York, they had already seen an increase in confirmed cases and had increased the need for treatment.

At St. Catherine of Siena Hospital in Smithtown, the hospital provided monoclonal antibody treatment for 32 people the Tuesday before Thanksgiving, according to St. Catherine Chief Medical Officer Dr. Mickel Khlat. That is up from an average of four to five a day just a few weeks earlier.

That increase comes not only from a rise in group activities indoors, but also from a reduction in the immunity conferred by vaccines that are less effective after six months.

Six weeks ago, unvaccinated patients represented 80% of those who received monoclonal antibody treatments, said Dr. Khlat. Recently, the percentage of vaccinated people who receive antibody treatment has risen to 50%.

“If you got the vaccine six or seven or eight months ago, your immunity is waning,” said Dr. Khlat.

Dr. Gregson Pigott explained that monoclonal antibody treatment could be lifesaving.

“The key is to seek treatment soon after a COVID diagnosis,” Dr. Pigott explained in an email.

The percentage of positive tests in Suffolk County has been rising at a rapid pace, mirroring the positive tests for the nation. The percentage of positive tests on a seven-day average reported on Tuesday, Nov. 29, was 5.3%. That is up from a seven-day average of 3.7% just two weeks earlier and 2.4% a month earlier, according to data from the Suffolk County Department of Health.

Dr. Susan Donelan, medical director of the Healthcare Epidemiology Department at Stony Brook Medicine, explained that this is likely a result of variable acceptance of vaccination opportunities, inconsistent or poor mask usage compliance, increased indoor activity, initiation of indoor heating and general pandemic fatigue.

At the same time, hospitals on Long Island and around the state are preparing and monitoring for the potential arrival of the Omicron variant, which the World Health Organization recently deemed a variant of concern in part because of the number of mutations to the spike protein. These mutations could alter the dynamic in the Stéphane Bancel indicated that vaccines may not be as effective against this variant.

Pigott suggested that too little is known to determine how effective the current vaccines would be against the new variant.

“We will learn more from the World Health Organization and the [Centers for Disease Control and Prevention] in the weeks to come,” Pigott explained in an email.

Dr. Adrian Popp, chair of Infection Control at Huntington Hospital/Northwell Health, said numerous mutations don’t necessarily mean this variant is any worse.

“It’s important to see what is the effect of these mutations,” Popp explained in an email. The answers to whether the strain is more virulent or if the vaccines are less effective are still unknown. The next few weeks could provide a clearer picture, Popp said.

Doctors urged residents to become vaccinated and, if eligible, get the booster.

“My message to the public is to still get the vaccine,” said Khlat. “I wouldn’t tell people to wait” until companies like Pfizer, Johnson & Johnson and Moderna develop vaccines or boosters for the latest variant. COVID is a “killer. I want everyone vaccinated as soon as possible.”

At the same time, hospitals are actively monitoring positive cases for the potential spread of the Omicron variant into the area.

Since the emergence of the new variant on Nov. 26, “Stony Brook’s labs have been hard at work in pursuit of an answer” to whether any patients have contracted the variant, Donelan explained in an email.

Stony Brook routinely sends 10 random samples of positive COVID swabs each week to the Wadsworth Virology lab for genomic sequencing. The hospital epidemiologist reviews the available electronic medical record of all positives to identify any patient who may have key characteristics, such as traveling in areas in which Omicron is more prevalent.

“Our lab is working directly with Wadsworth to facilitate rapid sequencing of any samples with high suspicion,” Donelan added.

Scientists are also trying to determine whether this variant has different symptoms and outcomes from the original virus.

The mRNA platforms from Pfizer and Moderna have the ability to pivot rapidly in the manufacturing process in response to changes in the genetic sequences of the virus.

Thanksgiving and holiday effects

With families coming together over Thanksgiving, health care professionals anticipate that the number of cases will rise.

“Thanksgiving gatherings, historically, have provided an annual springboard for cross-transmission of all sorts of respiratory viruses,” Donelan wrote. “This year shouldn’t be expected to be different.”

Pigott added that he would anticipate that the number of positive cases
would rise.

As for travel during the December holidays, Pigott advises people to practice prevention strategies that include washing their hands frequently, wearing masks in public indoor settings, keeping their distance as much as possible in public and when people don’t know the vaccination status of others.

Khlat suggested that people didn’t necessarily need to cancel any holiday travel plans because of the new variant. He urged people to “be smart” and make sure they wear masks on airplanes and remain aware of their surroundings.

“We can’t be prisoners,” he said. He also recommended that people stay home if they have symptoms like sniffles or a cough.

Khlat, who is planning to travel in January, will bring along hand sanitizer and may wear an n95 mask.

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Gov. Kathy Hochul. File photo by Julianne Mosher
State of Emergency to Trigger Use of Surge and Flex System and Expand Purchasing Ability
Department of Health Will Be Permitted to Limit Non-Essential, Non-Urgent Scheduled Hospital Procedures If Necessary to Ensure Capacity
New Omicron Variant Not Detected in New York State Yet, but Hochul Warns: ‘It’s Coming’

New York State Governor Kathy Hochul today announced urgent action to boost hospital capacity and address staffing shortages ahead of potential spikes in COVID-19 cases this upcoming winter. Through an Executive Order signed by Governor Hochul, the Department of Health will be allowed to limit non-essential, non-urgent procedures for in-hospitals or systems with limited capacity to protect access to critical health care services. Limited capacity is defined as below 10% staffed bed capacity, or as determined by the Department of Health based on regional and health care utilization factors.

The new protocols will begin on Friday, December 3, and will be re-assessed based on the latest COVID-19 data on January 15. The Executive Order will also enable New York State to acquire more quickly any critical supplies to combat the pandemic.

“We’ve taken extraordinary action to prevent the spread of COVID-19 and combat this pandemic. However, we continue to see warning signs of spikes this upcoming winter, and while the new Omicron variant has yet to be detected in New York State, it’s coming,” Governor Hochul said. “In preparation, I am announcing urgent steps today to expand hospital capacity and help ensure our hospital systems can tackle any challenges posed by the pandemic as we head into the winter months. The vaccine remains one of our greatest weapons in fighting the pandemic, and I encourage every New Yorker to get vaccinated, and get the booster if you’re fully vaccinated.”

The Hochul Administration continues to take comprehensive steps to prevent the spread of COVID-19, including mask protocols in health care and P-12 school settings, correctional facilities and detentions centers, public transportation and at transportation hubs, and implementation of the HERO Act which requires all employers to implement workplace safety plans in response to COVID-19.

The Administration continues to focus on boosting vaccination rates among New Yorkers, including bolstering the State’s network of vaccine access points, and working to expand testing supplies. That also includes acting on our comprehensive plan to vaccinate school-aged children 5-17, provide incentive programs, combat vaccine misinformation campaigns, increase vaccine awareness, deploy pop-up vaccines in targeted low-vaccination areas, and implement vaccine requirements for health care workers. On August 24, the vaccination rate among adults with one dose was 78.8%. Today, it is 90.2%.

Further, the Administration continues to ramp up booster shots and urges all New Yorkers to get the booster dose once fully vaccinated. As of November 24, over 2.2 million boosters and/or additional doses have been administered. Nearly 4,500 locations across are administering booster shots.

The Administration will continue to partner with local leaders to make vaccines, boosters and testing more widely available.

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Cool mist humidifiers add moisture to the air in the winter months. Stock photo
Mild dehydration can lead to decreased concentration, subdued  mood, fatigue and headaches

By David Dunaief, M.D.

Dr. David Dunaief

Dehydration typically gets attention during the summer months, when we spend more time outside in the heat. However, during the cooler winter months, it can also be troublesome. Dry heat quickly evaporates moisture in the air, making it hard to stay hydrated.

Complications and symptoms of dehydration can be mild to severe, ranging from constipation, mood changes, headaches and heart palpitations to heat stroke, migraines and heart attacks.

In addition, the dry air can make our throats and sinuses dry, making us uncomfortable and more susceptible to irritations and viruses.

Dehydration is simple to avoid, right? Not necessarily. We may be dehydrated before we’re thirsty. Let’s look at some of the consequences of dehydration and suggestions for avoiding it.

Tension-type migraines

In a review of studies published in the Handbook of Clinical Neurology, those who drank four cups more water had significantly fewer hours of migraine pain than those who drank less (1). Headache intensity decreased as well.

Heart palpitations

Heart palpitations are very common and are broadly felt as a racing heart rate, skipped beat, pounding sensation or fluttering. Dehydration and exercise are contributing factors (2). They occur mainly when we don’t hydrate prior to exercise. All we need to do is drink one glass of water prior to exercise and then drink during exercise to avoid palpitations. Though these symptoms are not usually life-threatening, they are anxiety producing for patients.

Heart attacks

The Adventist Health Study, an observational study, showed a dose-response curve for men (3). In other words, group one, which drank more than five glasses of water daily, had the least risk of death from heart disease than group two, which drank more than three glasses of water daily. Those in group three, which drank fewer than two glasses per day, saw the least amount of benefit, comparatively. For women, there was no difference between groups one and two; both fared better than group three.

The reason for this effect, according to the authors, may relate to blood or plasma viscosity (thickness) and fibrinogen, a substance that helps clots form.

Decreased concentration

In a study, mild dehydration resulted in decreased concentration, subdued mood, fatigue and headaches in women (4). In this small study the mean age of participants was 23, and they were neither athletes nor highly sedentary. Dehydration was caused by walking on a treadmill with or without taking a diuretic (water pill) prior to the exercise. The authors concluded that adequate hydration was needed, especially during and after exercise.

I would also suggest, from my practice experience, hydration prior to exercise.

Staying hydrated

Now we realize we need to stay hydrated, but how do we go about this? How much water we need to drink depends on circumstances, such as diet, activity levels, environment and other factors. It is not true necessarily that we all should be drinking eight glasses of water a day. 

In a review article, the authors analyzed the data, but did not find adequate studies to suggest that eight glasses is supported in the literature (5). It may actually be too much for some patients.

You may also get a significant amount of water from the foods in your diet. Nutrient-dense diets, like Mediterranean or Dietary Approaches to Stop Hypertension (DASH), have a plant-rich focus. A study notes that diets with a focus on fruits and vegetables increases water consumption (6). As you may know, 95 percent of the weights of many fruits and vegetables are attributed to water. An added benefit is an increased satiety level without eating calorically dense foods.

Remember that salty foods can be dehydrating, including breads and pastries, so try to avoid these.

Are caffeinated drinks dehydrating?

In a review, it was suggested that caffeinated coffee and tea don’t increase the risk of dehydration, even though caffeine is a mild diuretic (7). With moderate amounts of caffeinated beverages, the liquid has a more hydrating effect than its diuretic effect.

Keeping some humidity in the air

To reduce sinus inflammation and dry skin that you can experience with heated air, measure the humidity level in your home with a hygrometer and target keeping it between 30 and 50 percent (8). When the temperature outside drops below 10 degrees F, lower this to 25 percent.

Strategies for adding moisture to the air include using cool mist humidifiers, keeping the bathroom door open after you bathe or shower, and placing bowls of water strategically around your home, including on your stovetop when you cook. If you use a humidifier, take care to follow the manufacturer’s care instructions and clean it regularly.

It is important to stay hydrated to avoid complications — some are serious, but all are uncomfortable. Diet is a great way to ensure that you get the triple effect of high nutrients, increased hydration and sense of feeling satiated without calorie-dense foods. However, don’t go overboard with water consumption, especially if you have congestive heart failure or open-angle glaucoma (9).

References:

(1) Handb Clin Neurol. 2010;97:161-72. (2) my.clevelandclinic.org. (3) Am J Epidemiol 2002 May 1; 155:827-33. (4) J. Nutr. February 2012 142: 382-388. (5) AJP – Regu Physiol. 2002;283:R993-R1004. (6) Am J Lifestyle Med. 2011;5(4):316-319. (7) Exerc Sport Sci Rev. 2007;35(3):135-140. (8) epa.gov (9) Br J Ophthalmol. 2005:89:1298–1301.

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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Photo courtesy of Stony Brook Medicine

Stony Brook Medicine team performed a life-saving surgery on a Long Island football coach just a few days before the championship game to take place on Saturday, November 20.

Kyle Moodt, 38, a Bellport High School Varsity Assistant Football Coach, 5th grade general education teacher, father, and husband, battled debilitating headaches daily since July 2021. He and his wife Michelle have three children ages 3 (Emma), 5 (Brody) and 7 (Kayla), and live in Center Moriches.

The chronic headaches were isolated in one area, the front right side of his head. Kyle said “they were constant from wake up to bedtime. I’ve had two back surgeries in the past and I would probably take that sciatica pain over the headaches. The headaches never went away. It was hard to function with a headache all day long. Took a lot of Tylenol. At times, I would have to lay down whether I had practice or even in school. It was affecting my teaching in the classroom. I was teaching more from my desk than I have in most of my years. When I went home, after work, I was very tired. I felt like I wasn’t able to contribute to the household as much and more fell on my wife’s shoulders.”

Shortly after Kyle saw Stony Brook Medicine doctors, the medical team quickly identified that these were not normal headaches from reading a computed tomography (CT) and a computed tomography angiogram (CTA) scan. David Fiorella, MD, PhD, Neurointerventional Radiologist; Director, Stony Brook Cerebrovascular Center; and Co-Director, Stony Brook Cerebrovascular and Comprehensive Stroke Center and Michael Guido, MD, Neurologist; Director, Stony Brook Neurology Stroke Program; and Co-Director, Stony Brook Cerebrovascular and Comprehensive Stroke Center determined Kyle had a life-threatening malformation of the arteries in his brain. The diagnosis was arteriovenous fistula, or DAVF. This dangerous increased pressure in his head was a risk for fragile veins bursting which would cause a life-threatening brain bleed.

On November 11, Dr. Fiorella was able to use an angiogram to map out the malformation and make a treatment plan to allow him to be at the football team’s playoff game. And, subsequently treated Kyle’s complex brain malformation on November 16 through a small puncture site in his right wrist, performing a minimally invasive surgery that took less than one hour. The special procedure Kyle had was embolization of a dural fistual with a material Onyx. The goal of the procedure is to block off the abnormal arteries while preserving the normal arteries and veins.

Kyle is ecstatic. “Dr. Fiorella said I’m going to get this taken care of and I feel great 24 hours later after the successful surgery. It’s amazing. I don’t have brain fog. Had a good night’s sleep. I slept through the night. Woke up without a headache. I haven’t taken any medicine or Tylenol in 24 hours. The headaches that I’ve had for months are not there. Luckily, we were able to get to the bottom of this.”

“His angiogram showed the cure after the treatment and his MRI and MRA of his blood vessels indicated his brain is completely normal. He is neurologically perfect,” said Dr. Fiorella.

Kyle is grateful for Dr. Fiorella’s expertise and quality of care received at Stony Brook University Hospital. “About a year ago, he performed surgery on my father who had a stroke. I was very happy to know I was going to him for care. I remember, he put me, my mom, my brother, my sister at ease, talking and dealing with my father’s illness. So, if he’s confident, then I’m confident. And, they set the standards pretty high at Stony Brook.”

This positive outcome couldn’t be more timely as Kyle will not miss the opportunity to coach the offensive and defensive line as his Bellport Clippers face off against the Lindenhurst Bulldogs for the DII Suffolk County Championship at Stony Brook University’s Kenneth P. LaValle Stadium on Saturday at 7pm. Bellport last won a Suffolk title in 2010.

In sharing what it means for Stony Brook doctors to urgently treat Kyle with very little recovery time needed and getting him back to his “two families” touches him on a very emotional level. “Football is a passion of mine, but my main goal is the three kids I have at home. Definitely, I wanted to make sure that I would be able to make it to the game as the team gets ready for one of the biggest moments in their life but more importantly, family and my well-being came first. But the football team is family too. Some of these kids I’ve known since fifth grade. Some I played with their fathers or uncles as an offensive lineman for three years between 1998 and 2000. My parents are still very involved. Football brings the community together. We have all walks of races and socioeconomic backgrounds. My wife will cook for the lineman dinners at my house with 10 to 15 kids. We’re building a community and camaraderie between the team and this leads to our success. Kids care about each other. As coaches, we care about them too on and off the field. It’s why I love the district and where I am. It’s a big family affair.”

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Elevate your holiday meal by integrating healthy options
Dr. David Dunaief

This year, many of us are considering revising our Thanksgiving meal choices for the first time in generations. These past two years have provided a critical reminder of the importance of managing or reversing chronic diseases. This, coupled with a growing interest in plant-based eating, has prompted many to consider ways to reset the table, so to speak.

What can we do to turn Thanksgiving into a bonanza of good health? Phytochemicals (plant nutrients) called carotenoids have antioxidant and anti-inflammatory activity and are found mostly in fruits and vegetables. 

Carotenoids make up a family of more than 600 different substances, such as beta-carotene, alpha-carotene, lutein, zeaxanthin, lycopene and beta-cryptoxanthin (1).

Carotenoids help to prevent and potentially reverse diseases, such as breast cancer, amyotrophic lateral sclerosis (Lou Gehrig’s disease), age-related macular degeneration, and cardiovascular disease — heart disease and stroke. Foods that contain these substances are dark green leafy vegetables, as well as orange, yellow and red vegetables and fruits. 

A simple breast cancer study demonstrates their effects. We know that breast cancer risk is high among U.S.-born women, where the average lifetime risk of getting breast cancer is 12.8 percent (2).

In a meta-analysis of eighteen prospective studies, results show that women who consumed higher levels of carotenoids, such as alpha-carotene, beta-carotene, and lutein and zeaxanthin, had significantly reduced risk of developing estrogen-negative breast cancer (3).

Strategies for healthy holiday eating

Despite the knowledge that healthy eating has long-term positive effects, there are obstacles to healthy eating. Two critical factors are presentation and perception.

Vegetables are often prepared in either an unappetizing way — steamed to the point of no return — or smothered in cheese, negating their benefits, but clearing our consciences.

Many consider Thanksgiving a time to indulge and not think about the repercussions. Plant-based foods like whole grains, leafy greens and fruits are relegated to side dishes or afterthoughts. Why is it so important to change our mindsets? There are significant short-term consequences of gorging ourselves.

Not surprisingly, people tend to gain weight from Thanksgiving to New Year. This is when many gain the predominant amount of weight for the entire year. However, most do not lose the weight they gain during this time (4). If you can fend off weight gain during the holidays, think of the possibilities for the rest of the year.

Also, if you are obese and sedentary, you may already have heart disease. Overeating at a single meal increases your risk of heart attack over the near term, according to the American Heart Association (5). However, with a little Thanksgiving planning, you can reap significant benefits.

Here are some suggestions to get you thinking about ways to shift the heavy holiday meal paradigm:

Make healthy, plant-based dishes part of the main course. You don’t have to forgo signature dishes, but supplement tradition by adding mouthwatering vegetable-based dishes. One of my favorites is steamed “sweet” vegetables – cauliflower, broccoli, snap peas, onions and garlic. To make it sweet, I steam it in a splash of citrus-infused balsamic vinegar and add sliced apples before steaming. If you want to make this a primary dish, add diced tofu and/or garbanzo beans to make it more filling without overwhelming its delicate sweetness.

Improve vegetable options. Why would you serve vegetables without any seasoning? In my family, we season vegetables and make sauces to drizzle over them.

My 16-year-old nephew, who has never liked cooked vegetables, fell in love with my wife’s roasted Brussels sprouts and broccoli while on vacation this summer. He actually texted her a week later to ask for the recipes. Now, he makes them for himself. Good resources for appealing dishes can be found at PCRM.org, mouthwateringvegan.com, and many other resources.

Replace refined grains. A study in the American Journal of Clinical Nutrition, showed that replacing wheat or refined grains with whole wheat and whole grains significantly reduced central fat, or fat around the belly (6). Not only did participants lose subcutaneous fat found just below the skin, but also visceral adipose tissue, the fat that lines organs and causes chronic diseases such as cancer.

For even better results, consider substituting riced cauliflower or mashed cauliflower for rice or potatoes. You can purchase frozen riced cauliflower in many grocery stores now. Just be sure to get one that’s unsalted. If you prefer mashed, I have a simple recipe for mashed cauliflower here: www.medicalcompassmd.com/2021/01/09/mashed-cauliflower-recipe-vegan/

Create a healthy environment. Instead of putting out creamy dips, cheese platters and candies as snacks, choose whole grain brown rice crackers, baby carrots, cherry tomatoes and healthy dips like hummus and salsa. Help people choose wisely.

Offer healthy dessert options. Options might include dairy-free pumpkin pudding and fruit salad.

The goal should be to increase your nutrient-dense choices and decrease your empty-calorie foods. Instead of making Thanksgiving a holiday of regret, eating foods that cause weight gain, fatigue and that increase your risk for chronic diseases, promote everyone’s health, while maintaining the theme of a traditional festive meal.

References:

(1) Crit Rev Food Sci Nutr 2010;50(8):728–760. (2) SEER Cancer Statistics Review, 1975–2016, National Cancer Institute. (3) Am J Clin Nutr. 2012 Mar; 95(3): 713–725. (4) N Engl J Med 2000; 342:861-867. (5) www.heart.org. (6) Am J Clin Nutr 2010 Nov;92(5):1165-71.

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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Above, DeLorenzo (in blue) at a Multiple Sclerosis benefit in which she and a group of friends climbed the stairs at Rockefeller Center. Photo from C. DeLorenzo

By Daniel Dunaief

Her colleagues highlight the joy, passion and optimism she brings to her work, which can be the opposite of the way people she is eager to help feel. 

Dr. Christine DeLorenzo, Professor of Psychiatry and Biomedical Engineering at Stony Brook University, studies depression.

A disease with numerous symptoms that likely has a wide range of causes, depression presents an opportunity for Dr. DeLorenzo to bring not only a relentless energy to her work, but also an engineer’s perspective.

“Engineering is all about examining a complex problem and thinking, ‘I bet we can fix that,’” explained Dr. DeLorenzo in an email. “Biomedical engineering takes it to a new level.”

Indeed, Dr. DeLorenzo specializes in brain imaging, using positron emission tomography, among other techniques, to understand and differentiate the factors that might contribute to depression and to develop ways to treat specific subtypes of the mental health disease.

Dr. Ramin Parsey, who mentored Dr. DeLorenzo and is professor and Della Pietra Chair of Biomedical Imaging at Stony Brook, believes she will help define the subtypes of depression by imaging the brain.

For Dr. DeLorenzo, the abundance of discussion in the popular and scientific literature that currently attributes the progression of depression to a host of causes, from eating the wrong foods to not exercising enough to not getting the right amount of sleep, doesn’t offer much clarity.

“We see a million articles about what causes depression and they don’t all agree,” said Dr. DeLorenzo. “Depression is caused by a bunch of different things, which is not all that helpful when you’re the person suffering.”

In her brain studies, Dr. DeLorenzo has looked at inflammation and neurotransmitter systems. The goal of her work is to find “whatever is outside the normal range in the person with depression and treat” that potential cause, she said. High levels of inflammation might suggest an anti-inflammatory treatment.

When people receive a major depressive disorder diagnosis, they often are prescribed a selective serotonin reuptake inhibitor, or SSRI. This enables the neurotransmitter serotonin to remain in the brain for a longer period of time.

“It’s great that it works in a subset of people” for whom it is effective, Dr. DeLorenzo said. “We would like to know beforehand if we give this medication will it work for you, specifically.”

In one of her studies, Dr. DeLorenzo uses positron emission tomography, or PET scans, to search for signs of inflammation. She is looking for translocator proteins, which is a marker of inflammation. Reactive glial cells in the brain, which are an important supporting part of the nervous system that don’t have axons and dendrites like nerve cells, increase the production of these proteins during some depression and other disorders.

The level of these translocator proteins increase in glial cells when the brain is having an inflammatory response, which likely occurs in a subtype of depression as well as in other diseases.

Dr. DeLorenzo has a PET tracer that sticks to that protein and that gives off a signal to the camera, which enables her to quantify the inflammation.

At this point, she and her collaborators, including co-Principal Investigator Dr. Parsey and Dr. Stella Tsirka, Professor of Pharmacological Sciences at Stony Brook, are recruiting a collection of patients with depression. They are testing the idea that people with higher inflammation are better treated with an anti-inflammatory. They are using PET to see who has high or low inflammation prior to treatment. During the study, the researchers will determine if those with the highest inflammation had the best response.

Dr. Tsirka’s lab uses animal models to understand mechanisms of disease and experiment on treatment, while Dr. DeLorenzo uses neuro-imaging in human patients to understand and treat pathology.

“Our preclinical results certainly support the idea of the neuro-inflammation hypothesis of depression” and suggest potential ways to interfere with the process in preclinical models, Dr. Tsirka explained in an email.

Dr. Tsirka, who has been working for Dr. DeLorenzo for over three years, described her colleague as “enthusiastic, rational creative and hard working” and believed imaging could provide a way to verify efficient treatment of depression.

By understanding the biology of the brain, Dr. DeLorenzo hopes to address a range of questions that might affect the disease.

In other work, Dr. DeLorenzo is exploring the possibility that a disruption in glutamate leads to circadian and mood dysfunction in a subtype of depression.

In some studies with glutamate, researchers assessed mood before and after sleep deprivation. They found that sleep deprivation provided an antidepressant effect in about 40 percent of patients with Major Depressive Disorder.

A healthy person would typically become tired and angry after staying awake for 36 straight hours. Some people with this form of depression, however, see an improvement in their mood after staying up for so many hours.

“Something about sleep deprivation causes an antidepressant effect in some people,” Dr. DeLorenzo said. “We don’t know what that is.”

The antidepressant effect can be short lived, although about 10 percent of people have benefits that last as long as a few weeks.

To be sure, Dr. DeLorenzo cautioned that no one is “advocating just doing sleep deprivation” or even a continuous cycle of partial sleep deprivation.

Born and raised in Bay Ridge, Brooklyn, Dr. DeLorenzo earned her undergraduate and Master’s Degrees at Dartmouth College. She earned her PhD from Yale University, where she started her brain imaging work.

When Parsey left Columbia to join Stony Brook in 2012, Dr. DeLorenzo moved with him, even though her commute from Queens was three hours each way.

“She never complained” about her travels, Dr. Parsey marveled. In fact, Dr. DeLorenzo uses the commuting time to read papers and prepare emails.

Dr. Parsey admired Dr. DeLorenzo’s dedication to teaching and mentoring students in her lab. In her first summer, she took on 17 interns. “This is the kind of stuff that nobody else I know does,” Dr. Parsey marveled.

As for her work, Dr. DeLorenzo believes understanding sub-categories of mental health will follow the same pattern as cancer research. “Back in the day, we used to say, ‘Someone has cancer or a tumor.’ Now, we say that that tumor has this genetic marker, which is what we’re going to target when we treat it.”

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Deputy Chief Michael Presta with Huckleberry from Canine Companions. Photo by Julianne Mosher

By Julianne Mosher

[email protected]

Port Jefferson EMS has a new volunteer on staff — a golden lab named Huckleberry.

Known to his counterparts as “Huck,” the 2-year-old Canine Companions for Independence facility dog has been hired to respond to stressful situations and bring a sense of relief to those in need. 

Huck is ready for action in the Port Jefferson EMS car. Photo by Julianne Mosher

His handler Deputy Chief Michael Presta said that he became interested in adopting a facility dog when a friend — who is a police officer down in Maryland — told him about the program. Presta began researching Canine Companions and found that there are many different benefits to having a facility dog on premise. 

“A facility dog would be a dog that works in an educational, legal or some sort of clinical hospital health care setting,” he said. “For example, in the legal setting, they work as crime victim advocates for kids that have to testify and things like that, and it’s really kind of gained traction nationally in the education setting of the schools that have them.”

Presta added that hospitals like Mount Sinai and Calvary Hospital in the Bronx have facility dog programs, but Port Jefferson EMS is one of the first on Long Island within the health care industry.

“The dogs work with patients, work with people that are receiving PT, OT services, work with kids — anybody that’s really suffered any trauma,” he said. “And that’s what we’re using Huck for; we’re using him to really engage with the community’s vulnerable populations.”

Presta and his new furry friend will be working side by side engaging with children and adults affected by trauma who they deal with on a daily basis. 

“Not every solution in medicine is giving a medication or starting an IV,” he said. “Sometimes we can slow down work with the patients, and the dog is a great tool
for that.”

Since 1975, Canine Companions has bred, raised and expertly trained assistance dogs in over 40 commands designed to assist people with disabilities or to motivate and inspire clients with special needs. Huck can pull toy wagons, push drawers closed and retrieve all kinds of items. He has specific commands that allow him to interact with patients in a calm and appropriate way.

But it’s not just fun and games having him around. He has a lot of responsibilities while on call. “Right now, he responds in the car with me when I’m working clinically,” Presta said. 

Huck’s badge on the back of his harness.
Photo by Julianne Mosher

Not every opportunity is a good fit for Huck, Presta added. If a patient is extremely ill or isn’t a dog person, Huck usually stands back. But within the last few weeks — Huck just joined the team last month — he has calmed people in distress.

Presta said that while working with patients who have developmental disabilities, sometimes the lights, trucks and uniforms can be a sensory overload for them. 

That’s where Huck comes in.

“We’re hoping that the dog is going to be a great icebreaker tool to kind of break down that barrier,” the deputy chief said. “Establish a lot of communication and get them into the ambulance, get patients to the hospital.”

Port Jefferson EMS is a combination EMS agency of career and volunteer paramedics and EMTs providing 24/7/365 advanced life support ambulance service to the communities of Port Jefferson, Belle Terre, Mount Sinai and Miller Place. 

There is also a unique live-in program for Stony Brook University students where about 15 of them live on premise. They get free room and board in exchange for riding in the ambulance 24 hours a week.

“They get an immersive clinical experience,” Presta said. “They’re here all the time. They get a lot of clinical hours, which makes them really competitive for programs, and we get EMTs in the community here which is needed.”

And Presta said Huck has made friends with each and every one of them. 

“In addition to his role, he helps serve the 200 people in this organization,” he added. “We see some pretty gnarly things from time to time, so Huck is our de-facto licensed therapist here.”

Since his first tour in October, Huck is already off to an excellent start helping out others. 

“It’s been great for us,” Presta said. “He’s been really engaging with the community. We’re out in the village walking around, meeting people, talking to people from all walks of life and he really has been a great tool for us.”

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Pixabay photo

By Leah S. Dunaief

Leah Dunaief

Talk about mixed emotions. That’s what we feel when we are driving along and suddenly see a deer running out from among the trees. They are beautiful and graceful animals, and we stop the car and point them out to our small children in the back seat, who are thrilled at the sighting, perhaps recalling Bambi. But there is a lot more to the deer story here in suburbia. 

Long Island is home to more than 20,000 white-tailed deer, and that number has been exploding because there haven’t been many threats — until now. As long as they could find enough food and survive particularly harsh winters, the occasional highway collision and the short hunting season, they were largely untroubled. 

However, they have been a nuisance to residents because they devour flowers and vegetable gardens. And while they can be the innocent carriers of an infected tick, whose bite causes the miserable Lyme disease, they are gentle enough souls who leap out of sight as humans approach.

Now it turns out that they may be a more serious problem to us. A new study in Iowa found that the deer seem to be contracting the coronavirus from humans and spreading it to one another. This means the deer could become a reservoir for deadly mutations of the virus that could then possibly be passed back to humans. In that event, another vaccine would have to be developed to target the new variant in much the same way as flu shots are modified from year to year. 

Researchers were astonished at how widespread the infection was among the deer population there, estimated at 80%. Deer hunters and others who handle deer (as road kill) are being urged to take precautions to avoid transmission, like wearing rubber gloves and a mask.

Researchers don’t know exactly how the deer get infected by humans, but they suggest it might occur when people in Iowa feed deer in their backyards, or through sewage discharges or anything partially chewed by an infected human, like a “splotch of chewing tobacco” that then might be licked by a deer. 

The study of the deer was led by veterinary microbiologists from Penn State, according to an article in The New York Times on November 9, and they were able to make their analysis by examining the lymph nodes of dead deer. But they have not yet been able to determine whether the animals were sickened by the pathogen. They also are going to examine other wild animals, especially mice, that live in close proximity to humans, to see if they too might carry the virus. 

There is well established research that shows some pathogens do move back and forth between animals and humans, including those that cause yellow fever and West Nile. And we do know our dogs and cats can get COVID-19.

Also in the news is something called epizootic hemorrhagic disease, transmitted by the EHD virus that can kill deer within 36 hours of infection. This often-fatal disease is transmitted by biting midges. We call them “no-see-ums.” Deer do not catch it from each other, nor can humans be infected by either deer or midges. But stricken deer bleed to death, especially in late summer and early fall when midges are abundant.

While there is no treatment for EHD, the first frost kills the midges, ending the outbreak. The virus was first confirmed in New York in 2007 with small outbreaks in the state’s northern counties, according to Cornell University College of Veterinary Medicine. By 2020, the affected deer were found in the lower Hudson Valley, in other states along the eastern United States, and also in zoos.

“The dead deer do not serve as a source of infection for other animals because the virus is not long lived in dead animals,” according to the Cornell Wildlife Health Lab. Suffolk County has 139 cases reported and 8 confirmed as of last week.

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