The Suffolk County Department of Health Services today issued an advisory to take precautions before recreating in the Nissequogue River and boat ramp parking area at/near the Nissequogue River State Park Marina in Kings Park. This advisory follows a recent NY-Alert notification of an effluent discharge from a manhole within the conveyance network in this area. Though the effluent has been treated, there is potential for elevated levels of pathogenic organisms to be present in this area.
Corrective actions to mitigate the discharge have been initiated and full repairs are scheduled for Friday, April 16, 2021.
Suffolk County Health officials are working closely with the NYSDEC, which has jurisdiction over the permitting, enforcement, and management of the Kings Park sewage treatment plant.
Residents and fisherman are advised to avoid contact with waters from this area of Nissequgoue River as well as the boat ramp parking lot until full repairs of the conveyance network are made. NYSDEC already prohibits the harvest of shellfish from this area at all times. Keep children and pets away from the area as well. If contact does occur, rinse off with clean water immediately. Seek medical attention if after exposure you experience nausea, vomiting or diarrhea; skin, eye or throat irritation, or allergic reactions or breathing difficulties.
More information is forthcoming as health officials learn more about the situation.
The Suffolk County Department of Health Services has paused dispensing of the Johnson and Johnson COVID-19 vaccine at its vaccination dispensing locations, following state and federal recommendations while the Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA) review data about an extremely rare type of blood clot that has been reported in six people who received that vaccine in the United States.
As of April 12, more than 6.8 million doses of the Johnson & Johnson (Janssen) vaccine have been administered in the U.S. CDC and FDA are reviewing data involving a rare and severe type of blood clot that was reported in six people after receiving the Johnson & Johnson vaccine. All six cases occurred among women between the ages of 18 and 48, and symptoms occurred six to 13 days after vaccination.
Suffolk County officials are not aware of any cases occurring among the approximately 2,000 residents who have received this vaccine through the County Health Department thus far. Those residents who received the Johnson & Johnson vaccine who develop severe headache, abdominal pain, leg pain or shortness of breath within three weeks after vaccination should contact their health care practitioners promptly.
“While this issue appears to be extremely rare, CDC and FDA are acting in a very cautious manner that underscores our commitment to vaccine safety,” said Dr. Gregson Pigott, Suffolk County Commissioner of Health Services. “We will be closely monitoring the federal review process and use that information to help guide our efforts here in Suffolk County in the days ahead.”
The Johnson & Johnson vaccine represents about 2% of the total supply of vaccines the Suffolk County Department of Health has received to date, so the pause is not expected to dramatically slow the pace of vaccinations dispensed by Suffolk County. As Suffolk County Department of Health Services does not maintain data on all vaccine providers in Suffolk County, other dispensers may have received and dispensed varying percentages of Johnson & Johnson vaccine in the community.
Residents who currently have appointments to receive the Johnson & Johnson vaccine should watch for a notification from their provider about canceling, postponing or rescheduling the appointment. If your appointment is cancelled, you can look for other vaccination appointments through the Vaccine Locator map, local pharmacies or your area.
CDC will convene a meeting of its Advisory Committee on Immunization Practices (ACIP) on April 14 to further review these cases and assess their potential significance. FDA will review that analysis as it also investigates the cases.
Meanwhile, until that process is complete, Suffolk County health officials will continue to dispense the allocations of Pfizer or Moderna vaccines that the county receives from New York State.
Walking may reduce the need for dialysis. METRO photo
Simple lifestyle changes can have an impact
By David Dunaief, M.D.
Dr. David Dunaief
On the heels of National Kidney Month in March, let’s look more closely at strategies for reducing chronic kidney disease (CKD). Those at highest risk for CKD include patients with diabetes, high blood pressure and those with first-degree relatives who have advanced disease. But those are only the ones at highest risk.
CKD is tricky because, similar to high blood pressure and dyslipidemia (high cholesterol), it tends to be asymptomatic, at least initially. Only in the advanced stages do symptoms become distinct, though there can be vague symptoms in moderate stages such as fatigue, malaise and loss of appetite.
What are the CKD stages?
CKD is classified into five stages based on the estimated glomerular filtration rate (eGFR), a way to determine kidney function. Stages 1 and 2 are the early stages, while stages 3a and 3b are the moderate stages, and finally stages 4 and 5 are the advanced stages. Stage 5 is end-stage renal disease, or kidney failure.
Who should be screened?
According to the U.S. Preventive Services Task Force and the American College of Physicians, those who are at highest risk should be screened including, as I mentioned above, patients with diabetes or hypertension (1)(2).
In an interview on Medscape.com, “Proteinuria: A Cheaper and Better Cholesterol?” two high-ranking nephrologists suggest that first-degree relatives to advanced CKD patients should also be screened and that those with vague symptoms of fatigue, malaise and/or decreased appetite may also be potential screening candidates (3). This broadens the asymptomatic population that may benefit from screening.
Slowing CKD progression
Fortunately, there are several options available, ranging from preventing CKD with specific exercise to slowing the progression with lifestyle changes and medications.
How much exercise?
Here we go again, preaching the benefits of exercise. But what if you don’t really like exercise? It turns out that the results of a study show that walking reduces the risk of death and the need for dialysis by 33 percent and 21 percent respectively (4). And although some don’t like formal exercise programs, most people agree that walking is enticing.
The most prevalent form of exercise in this study was walking. Even more intriguing, the results are based on a dose-response curve. In other words, those who walked more often saw greater results. So, the participants who walked one-to-two times per week had a significant 17 percent reduction in death and a 19 percent reduction in kidney replacement therapy, while those who walked at least seven times per week experienced a more impressive 59 percent reduction in death and a 44 percent reduction in the risk of dialysis. There were 6,363 participants for an average duration of 1.3 years.
How much protein to consume?
When it comes to CKD, more protein is not necessarily better, and may even be harmful. In a meta-analysis (a group of 10 randomized controlled trials) of Cochrane database studies, results showed that the risk of death or treatment with dialysis or kidney transplant was reduced by 32 percent in those who consumed less protein compared to unrestricted protein (5). According to the authors, as few as two patients would need to be treated for a year in order to prevent one from either dying or reaching the need for dialysis or transplant.
Sodium: How much is too much?
Good news! In a study, results showed that a modest sodium reduction in our diet may be sufficient to help prevent proteinuria (protein in the urine) (6). Here, less than 2000 mg was shown to be beneficial, something all of us can achieve.
Medications have a place
We routinely give certain medications, ACE inhibitors or ARBs, to patients who have diabetes to protect their kidneys. What about patients who do not have diabetes? ACEs and ARBs are two classes of anti-hypertensives — high blood pressure medications — that work on the RAAS system of the kidneys, responsible for blood pressure and water balance (7). Results of a study show that these medications reduced the risk of death significantly in patients with moderate CKD. Most of the patients were considered hypertensive.
However, there was a high discontinuation rate among those taking the medication. If you include the discontinuations and regard them as failures, then all who participated showed a 19 percent reduction in risk of death, which was significant. However, if you exclude discontinuations, the results are much more robust with a 63 percent reduction. To get a more realistic picture, this result, including both participants and dropouts, is probably close to what will occur in clinical practice unless the physician is a really good motivator or has very highly motivated patients.
While these two classes of medications, ACE inhibitors and ARBs, are good potential options for protecting the kidneys, they are not the only options. You don’t necessarily have to rely on drug therapies, and there is no downside to lifestyle modifications. Lowering sodium modestly, walking frequently, and lowering your protein consumption may all be viable options, with or without medication, since medication compliance was woeful. Screening for asymptomatic, moderate CKD may lack conclusive studies, but screening should occur in high-risk patients and possibly be on the radar for those with vague symptoms of lethargy as well as aches and pains. Of course, this is a discussion to have with your physician.
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.
April is Parkinson’s Disease Awareness Month and the American Parkinson Disease Association (APDA) Information and Referral Center at St Catherine of Siena Wellness Center in Suffolk Count is hard at work to raise awareness of Parkinson’s disease (PD), deliver vital programs and services in the community, and help local residents get involved and support a cause that is important to them. The APDA Information and Referral Center has a full roster of activities planned for the month (and beyond) and many ways for people to get involved. (For the safety of all involved, all events and programs are held virtually.)
The extensive health concerns and restrictions of the COVID-19 pandemic have been challenging for everyone, but for people with PD and their care partners who were already tackling the daily challenges of life with PD, the impact has been significant. Now more than ever, it is critical to support, engage and inform the PD community and raise awareness about this disease, and Parkinson’s Disease Awareness Month is a great time to shine a spotlight on this issue.
Over the past year, APDA has created extensive virtual programming to make sure that people living with PD have what they need during this difficult time. From online exercise programs to help keep people moving when they can’t get to their in-person fitness classes to educational webinars where they can ask PD experts their questions right from their own living rooms, and even virtual group singing and art programs — APDA has been there for them every step of the way.
For the month of April, the APDA Information and Referral Center at St Catherine of Siena Wellness Center will hold a Parkinson Disease Seminar, Loud and Lyrical Therapeutic Singing Group, APDA Press Program for those diagnosed 5 years or under, and Support groups for both those with Parkinson Disease and their Care-partners as well.
“Every nine minutes there is a new diagnosis of PD, which means that in April alone nearly 5,000 people in this country will learn they have PD,” states Julie Garofalo, RN Coordinator of APDA’s Information and Referral Center at St Catherine’s. “Here in Suffolk County, New York we are the boots on the ground – we are in the communities, providing the support, education, programs, and services people need to live their best lives. We’ve been able to maintain this support despite the pandemic thanks to virtual opportunities, and we look forward to seeing our PD community in person as soon as it is safe to do so.”
The support of the general public is crucial, and April is the perfect time to take action that can help the more than one million people in the United States coping with this chronic neurological movement disorder, and also fund research that will lead us to better treatments and ultimately, a cure. Visit www.apdaparkinson.org to learn more.
For more information about APDA programs, services and support in Suffolk County NY, contact the APDA Information and Referral Center at St Catherine of Siena Wellness Center at 631-862-3560 or [email protected]
About the American Parkinson Disease Association:
The American Parkinson Disease Association (APDA) is the largest grassroots network dedicated to fighting Parkinson’s disease (PD) and works tirelessly to help the more than 1 million Americans with PD live life to the fullest in the face of this chronic, neurological disorder. Founded in 1961, APDA has raised and invested more than $207 million to provide outstanding patient services and educational programs, elevate public awareness about the disease, and support research designed to unlock the mysteries of PD and ultimately put an end to this disease. To join us in the fight against Parkinson’s disease and to learn more about the support APDA provides nationally through our network of Chapters and Information & Referral (I&R) Centers, as well as our national Research Program and Centers for Advanced Research, please visit us at www.apdaparkinson.org.
Senator Mario R. Mattera will host a blood drive at the Smith Haven Mall, Moriches Road, Lake Grove on Thursday, April 8 from noon to 6 p.m. at the mall’s Center Court. “Due to the ongoing crisis, it is crucial that we all join together to help the New York Blood Center replenish their supply,” he said.
Donors with O-negative blood type, or “universal donors,” are especially encouraged to donate, as their blood is essential in emergency situations. A single donation can save up to three lives.
To schedule an appointment or for more information, visit mattera.nysenate.gov and click on the link on the home page or call 800-933-2566.
There are many fruits and vegetables that are beneficial for kidney health. METRO photo
Increasing fruits and vegetables may protect kidneys
By David Dunaief, M.D.
Dr. David Dunaief
Chronic kidney disease is on the rise in this country. Approximately 37 million U.S. adults have chronic kidney disease (CKD), with as many as 9 in 10 not aware they have it, according to the Centers for Disease Control and Prevention (CDC) (1). In this article, we will look beyond the more obvious causes of chronic kidney disease, like diabetes, smoking, aging, obesity and high blood pressure (2).
Why is early-stage CKD so important? It is associated with a 40 percent increased risk of developing cardiovascular events, such as heart attacks (3). It also significantly increases the risk of peripheral artery disease (PAD). Those with decreased kidney function have a 24 percent prevalence of PAD, compared to 3.7 percent in those with normal kidney function (4). Of course, it can lead ultimately to end-stage renal (kidney) disease, requiring dialysis and potentially a kidney transplant.
One of the problems with early-stage CKD is that it tends to be asymptomatic. However, there are simple tests, such as a basic metabolic panel and a urinalysis, that will indicate whether a patient may have mild chronic kidney disease. These indices for kidney function include an estimated glomerular filtration rate (eGFR), creatinine level and protein in the urine. While the other two indices have varying ranges depending on the laboratory used, a patient with an eGFR of 30 to 59 mL/minute/1.73 m2 is considered to have mild disease. The eGFR and the kidney function are inversely related, meaning as eGFR declines, the more severe the chronic kidney disease.
What can be done to stem early-stage CKD, before complications occur? There are several studies that have looked at medications and lifestyle modifications and their impacts on its prevention, treatment and reversal. Let’s look at the evidence.
Leveraging Medications
Allopurinol is usually thought of as a medication to prevent gout. However, in a randomized controlled trial, with 113 patients, results show that allopurinol may help to slow the progression of CKD, defined in this study as an eGFR less than 60 mL/min/1.73 m2 (5). The group using 100 mg of allopurinol showed significant improvement in eGFR levels (compared to the control group over a two-year period. The researchers concluded that allopurinol slowed CKD progression. Allopurinol also decreased cardiovascular risk by 71 percent.
Fibrates are a class of drug usually used to boost HDL (“good”) cholesterol levels and reduce triglyceride levels, another cholesterol marker. Fibrates have gotten negative press for not showing improvement in cardiovascular outcomes. However, in patients with mild to moderate CKD, a meta-analysis (a group of 10 studies) showed a 30 percent reduction in major cardiovascular events and a 40 percent reduction in the risk of cardiovascular mortality with the use of fibrates (6). This is important, since patients with CKD are mostly likely to die of cardiovascular disease.
The authors concluded that fibrates seem to have a much more powerful beneficial effect in CKD patients, as opposed to the general population. So, there may be a role for fibrates after all.
Diet’s impact
Fruits and vegetables may play a role in helping patients with CKD. In one study, the results showed that fruits and vegetables work as well as sodium bicarbonate in improving kidney function by reducing metabolic acidosis levels (7).
What is the significance of metabolic acidosis? It means that body fluids become acidic, and it is associated with chronic kidney disease. The authors concluded that both sodium bicarbonate and a diet including fruits and vegetables were renoprotective, helping to protect the kidneys from further damage in patients with CKD. Alkali diets are primarily plant-based, although not necessarily vegetarian or vegan diets. Animal products tend to cause an acidic environment. The study was one year in duration with 77 patients.
In the Nurses’ Health Study, results show that animal fat, red meat and sodium all negatively impact kidney function (8). The risk of protein in the urine, a potential indicator of CKD, increased by 72 percent in those participants who consumed the highest amounts of animal fat compared to the lowest, and by 51 percent in those who ate red meat at least twice a week. With higher amounts of sodium, there was a 52 percent increased risk of having lower levels of eGFR.
The most interesting part with sodium was that the difference between higher mean consumption and the lower mean consumption was not that large, 2.4 grams compared to 1.7 grams. In other words, the difference between approximately a teaspoon of sodium and three quarters of a teaspoon was responsible for the decrease in kidney function.
In my practice, when CKD patients follow a vegetable-rich, nutrient-dense diet, there are substantial improvements in kidney functioning. For instance, for one patient, his baseline eGFR was 54 mL/min/1.73 m2. After one month of lifestyle modifications, his eGFR improved by 9 points to 63 mL/min/1.73 m2, which is a return to “normal” functioning of the kidney. Note that this is an anecdotal story and not a study.
Therefore, it is important to have your kidney function checked with mainstream tests. If the levels are low, you should address the issue through medications and/or lifestyle modifications to manage and reverse early-stage CKD. Don’t wait until symptoms and complications occur. In my experience, it is much easier to treat and reverse a disease in its earlier stages, and CKD is no exception.
References:
(1) CDC.gov. (2) JAMA. 2004;291:844-850. (3) N Engl J Med. 2004;351:1296-1305. (4) Circulation. 2004;109:320–323. (5) Clin J Am Soc Nephrol. 2010 Aug;5:1388-1393. (6) J Am Coll Cardiol. 2012 Nov. 13;60:2061-2071. (7) Clin J Am Soc Nephrol. 2013;8:371-381. (8) Clin J Am Soc Nephrol. 2010; 5:836-843.
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.
Standing, from left, Angela Cammarata, Service Coordinator for St. Joseph’s Village, Pharmacist Amanda School, Legislator Nick Caracappa, Pharmacist Dan Gambhir, Pharmacist and Owner of Bell Mead Pharmacy Ruby Masson. Seated: St. Joseph’s Village resident Elyse Biederman.
St. Joseph’s Village resident Elyse Biederman gets her vaccine shot.
This week, Legislator Nick Caracappa helped residents of a senior housing community in his district get their first COVID vaccine. St. Joseph’s Village in Selden, which houses approximately 230 residents, is managed by Catholic Charities of Long Island. Legislator Caracappa coordinated with Bell Mead Pharmacy in East Setauket to have pharmacists on-site over a two-day period to administer 50+ Moderna vaccines.
“I was thrilled to be part of what was truly a community effort to get these folks vaccinated,” stated Legislator Nick Caracappa. “A special thank you goes to Ruby Masson, owner of Belle Mead Pharmacy and her friendly staff, Angela Cammarata, Service Coordinator for St. Joseph’s Village who arranged the appointment schedule for the residents, and Lynn Reddy from Catholic Charities for working collaboratively with my office to get this accomplished and help keep our senior population safe.”
Bringing together researchers and clinicians from six countries, including scientists scattered throughout the United States, a team of scientists co-led by Stony Brook University’s Michael Frohman linked mutations in a gene to congenital heart disease.
Frohman, Chair of the Department of Pharmacological Sciences in the Renaissance School of Medicine at SBU, has worked with the gene Phospholipidase D1 (or PLD1), for over 25 years. Researchers including Najim Lahrouchi and Connie Bezzina at the University of Amsterdam Heart Center linked this gene to congenital heart disease.
“The current study represents a seminal finding in that we provide a robust link between recessive genetic variants of PLD1 and a rather specific severe congenital heart defect comprising right-side valvular abnormalities,” Bezzina wrote in an email.
Michael Frohman at Glymur Falls in Iceland.
The international group collected information from 30 patients in 21 unrelated families and recently published their research in the Journal of Clinical Investigation.
A number of other genes are also involved in congenital heart disease, which is the most common type of birth defect. People with congenital heart disease have a range of symptoms, from those who can be treated with medication and/or surgery for pre-term infants to those who can’t survive.
The discovery of this genetic link and congenital heart disease suggests that PLD1 “needs to be screened in cases with this specific presentation as it has implications for reproductive counseling in affected families,” Bezzina explained.
Bezzina wrote that she had identified the first family with this genetic defect about five years ago.
“We had a strong suspicion that we had found the causal gene, but we needed confirmation and for that, we needed to identify additional families,” she said. “That took some time.
Bezzina described the collaboration with Frohman as “critical,” as she and Lahrouchi had been struggling to set up the PLD1 enzymatic assay in their lab, without any success. Lahrouchi identified Frohman as a leading expert in the study of PLD1 and the team reached out to him.
His work was instrumental in determining the effect of the mutations on the enzymatic activity of PLD1, Bezzina explained.
The timing in connecting with Frohman proved fortuitous, as Frohman had been collaborating with Michael Airola, Assistant Professor in the Department of Biochemistry & Cell Biology at Stony Brook University, on the structure of the PLD1 catalytic domain.
“Together, they immediately saw that the mutations found in the patients were located primarily in regions of the protein that are important for catalysis and this provided detailed insight into why the mutations caused the PLD1 enzyme to become non-functional,” Bezzina wrote.
These findings have implications for reproductive counseling, the scientists suggested.
A couple with an affected child who has a recessive variation of PLD1 could alert parents to the potential risk of having another child with a similar defect.
One of the variants the scientific team identified occurs in about two percent of Ashkenazi Jews, which means that 1 in 2,500 couples will have two carriers and a quarter of their conceptions will be homozygous recessive, which virtually guarantees congenital heart disease. This, however, is about three times less frequent than Tay-Sachs. “This has, in our view, clinical implications for assessing the risk of congenital heart defects among individuals of this ancestry,” said Bezzina.
The mutation probably arose among Ashkenazi Jews around 600 to 800 years ago. There are about 20 known disease mutations like Tay-Sachs in this population that are found only rarely in other groups.
Lahrouchi and Bezzina specialize in the genetics of congenital heart disease, which occurs worldwide in 7 out of every 1,000 live births.
With 56 coauthors, Frohman said this publication had the largest number of collaborators he’s ever had in a career that includes about 200 papers. While this is unusual for him, it’s not uncommon among papers in clinical research.
The lead researchers believed a comprehensive report with a uniform presentation of clinical data and biochemical analysis would provide a better resource for the field, so they brought together research from The Netherlands, the Czech Republic, Israel, France, Italy and the United States.
Previous research that involved Frohman revealed other patterns connected to the PLD1 gene.
About a dozen years ago, Frohman helped discover that mice lacking the PLD1 gene, or that were inhibited by a drug that blocked its function, had platelets that are less easily activated, which meant they were less able to form large blood clots.
These mice had better outcomes with strokes, heart attacks and pulmonary embolisms.
The small molecule inhibitor was protective for these conditions before strokes, but only provided a small amount of protection afterwards. Technical reasons made it difficult to use this inhibitor in clinical trials.
The primary work in Frohman’s lab explores the link between PLD1 and cancer. He has shown that loss of PLD1 decreases breast cancer tumor growth and metastasis.
As for what’s next, Frohman said he has a scientific focus and a translational direction. On the scientific front, he would like to know why the gene is required for heart development. He is launching into a set of experiments in which he can detect what might go wrong in animal models early in the development of the heart.
Clinically, he hopes to explore how one bad copy of the PLD1 gene combines with other genes that might contribute to cause enough difficulties to challenge the survival of a developing heart.
A resident of Old Field, Frohman lives with his wife Stella Tsirka, who is in the pharmacology department and is Vice Dean for Faculty Affairs in the Renaissance School of Medicine. The couple has two children, Dafni, who is a first-year medical student at Stony Brook and Evan, who is a lawyer clerking with a judge in Philadelphia.
Outside of work, Frohman, who earned MD and PhD degrees, enjoys hikes in parks, kayaking and biking.
Having a medical background helped him learn a “little bit about everything,” which gave him the opportunity to prepare for anything new, which included the medical implications of mutations in the PLD1 gene.
Bezzina hopes to continue to work with Frohman, on questions including how the mutation type affects disease severity. “An interplay with other predisposing genetic factors is very interesting to explore as that could also help us in dissecting the disease mechanism further,” she wrote.
In response to an easing of state regulations and their approach to patient care, area hospitals are relaxing restrictions about patient visitors.
Cheryl Miranda, director of Patient Experience at Huntington Hospital, has been planning the new visitation policy since the beginning of the month. Photo from Huntington Hospital
Starting this past Monday, Huntington Hospital will allow patients who do not have COVID-19 to have one visitor per day, between 2 p.m. and 6 p.m. St. Charles and St. Catherine of Siena hospitals also allow one COVID-19 negative visitor per day during those same hours.
Huntington Hospital is responding to the medical, emotional and personal need its patients have for the support of family and friends during whatever health challenges they face.
“There is nothing like having your loved one at your bedside, holding your hand,” said Cheryl Miranda, director of Patient Experience at Huntington Hospital, which is a part of Northwell Health.
Family also provides helpful information, helping medical professionals know whether a patient’s behavior is different from normal
“As a nurse, I’ve always felt that family is part of the caregiving circle,” Miranda said. “The family knows their loved one better than anyone. They will help us provide better care.”
St. Charles Hospital and St. Catherine of Siena started allowing one hospital visitor per COVID-negative patient per day starting about four weeks ago.
Stony Brook is making several changes to its visitation policy.
As of April 1, the hospital is allowing two visitors for patients in labor and delivery, for pediatric patients and for patients in end-of-life situations. This will increase from one to two.
Patients receiving same day surgical procedures will also be allowed a patient visitor until a procedure begins. The visitor is required to wait outside during the procedure and then can return during the patient’s release from the hospital.
Inpatient child psychiatry will also allow a visitor, as will cancer center and outpatient offices.
Approved visitors to Stony Brook must wear a mask that covers their nose and mouth the entire time, will have symptom checks, including thermal scanning, will not be allowed outside the patient’s room, must maintain six feet of distance and must wash their hands on entering and leaving the room.
Hospitals had generally restricted most or all patient visitors over various periods in the last year amid the pandemic to limit the spread of COVID-19. Nurses throughout Long Island and the world have used tablets, phones and other technology to help their patients connect with family members, enabling them to see spouses, siblings, children, grandchildren and friends from hospital beds that often had them feeling isolated during their health battles.
Allowing visitors, who are still required to wear masks, will help hospitalized patients feel more normal and receive the kind of support that can brighten their day while shortening their hospital visit.
A hospital employee will screen patients on their way into the hospital, asking them questions about any possible symptoms and taking their temperature.
Visitors who are COVID-19 positive can’t enter. Additionally, visitors who come in from out of the state or whom they believe necessitates a screening will have a rapid swab.
“We are not asking everyone to be tested,” Miranda said.
The hospital is spreading the word about its new patient visitor policy by changing its on-hold messages, is sharing information on TV sets and is telling families directly during virtual visits that one person at a time can come to the hospital.
Patients can determine who visits, which includes family members and friends.
“There is nothing like having your loved one at your bedside, holding your hand.”
— Cheryl Miranda
Miranda said the medical staff is well-prepared for an increase in visitors through the hospital.
“I don’t have to tell anybody in this building to follow precautions,” Miranda said. “We’ve all been through this for 13 months now and there isn’t anyone” who needs reminding about personal protective equipment, hand washing or social distancing.
Initially, Huntington Hospital workers will escort visitors to patient rooms, reminding them about safety policies.
During visits, patients and visitors are expected to wear masks. If a family member comes during mealtime or brings food, the patient can eat, but should do so at a safe distance.
Miranda, who has been at Huntington Hospital for 20 years, realizes the suffering patients and their families have endured during the pandemic.
“To tell someone they can’t be here is an awful, awful thing,” Miranda said. “My heart goes out to the families that haven’t been allowed to be here” and to the patients who “haven’t been able to have their loved ones at their side.”
Miranda has been planning this new visitation policy since the beginning of the month.
The hospital has learned numerous lessons about health care, including by providing virtual support for patients.
In addition to bereavement support groups, which have been particularly busy as families mark the one-year anniversary of the loss of a loved one, the hospital is adding a long-haul support group.
Starting on Thursday, April 8 at 2 p.m., Huntington Hospital will offer support to people who have a lingering cough, ongoing debilitating fatigue, body aches, joint pain, shortness of breath, loss of taste and smell, difficulty sleeping, headaches and brain fog.
People interested in joining that group can email Kacey Farber at [email protected].
Dr. Jean Cacciabaudo, associate medical director at Huntington Hospital and a cardiologist, will sit on the long haulers support meeting. Cacciabaudo, who had COVID-19 and has some long haulers symptoms, will attend not just for herself, but to provide the physician’s perspective.
Miranda said the bereavement support groups have helped family members amid a loss.
“It’s the beauty of humanity, when we reach out and help each other,” Miranda said. “There’s no magic solution for grief and loss. For some people, it’s just about remembering all the wonderful things they had when they had that person and sharing that with other people. It’s about not being isolated. That’s a big key.”
With all the focus on reducing sodium in our diets, the importance of consuming potassium gets short shrift.
More than 90 percent of people consume far too much sodium, with salt being the primary culprit (1). Sodium is insidious; it’s in foods that don’t even taste salty. Bread products are among the primary offenders. Other foods with substantial amounts of sodium are cold cuts and cured meats, cheeses, pizza, poultry, soups, pastas and, of course, snack foods. Processed foods and those prepared by restaurants are where most of our consumption occurs (2).
On the flip side, only about two percent of people get enough potassium from their diets (3). According to one study, we would need to consume about eight sweet potatoes or 10 bananas each day to reach appropriate levels.
Why is it important to reduce sodium and increase potassium? A high sodium-to-potassium ratio increases the risk of cardiovascular disease by 46 percent, according to the study, which looked at more than 12,000 Americans over almost 15 years (4). In addition, both may have significant impacts on blood pressure and cardiovascular disease.
To improve our overall health, we need to shift the sodium-to-potassium balance so that we consume more potassium and less sodium. Let’s look at the evidence.
Reduce your sodium
Two studies illustrate the benefits of reducing sodium in high blood pressure and normotensive (normal blood pressure) patients, ultimately preventing cardiovascular disease, including heart disease and stroke.
The first used the prestigious Cochrane review to demonstrate that blood pressure is reduced by a significant mean of −4.18 mm Hg systolic (top number) and −2.06 mm Hg diastolic (bottom number) involving both normotensive and hypertensive participants (5). When looking solely at hypertensive patients, the reduction was even greater, with a systolic blood pressure reduction of −5.39 mm Hg and a diastolic blood pressure reduction of −2.82 mm Hg.
This was a meta-analysis (a group of studies) that evaluated data from randomized clinical trials, the gold standard of studies. There were 34 trials reviewed with more than 3,200 participants. Salt was reduced from 9 to 12 grams per day to 5 to 6 grams per day. These levels were determined using 24-hour urine tests. The researchers believe there is a direct linear effect with salt reduction. In other words, the more we reduce the salt intake, the greater the effect of reducing blood pressure. The authors concluded that these effects on blood pressure will most likely result in a decrease in cardiovascular disease.
In the second study, a meta-analysis of 42 clinical trials, there was a similarly significant reduction in both systolic and diastolic blood pressures (6). This study included adults and children. Both demographics saw a reduction in blood pressure, though the effect was greater in adults. Interestingly, an increase in sodium caused a 24 percent increased risk of stroke incidence but, more importantly, a 63 percent increased risk of stroke mortality. The risk of mortality from heart disease was increased as well, by 32 percent.
In an epidemiology modeling study, the researchers projected that either a gradual or instantaneous reduction in sodium would save lives (7). For instance, a modest 40 percent reduction over 10 years in sodium consumed could prevent 280,000 premature deaths. These are only projections, but in combination with the above studies may be telling. The bottom line: decrease sodium intake by almost half and increase potassium intake from foods.
Increase your potassium
When we think of blood pressure, not enough attention is given to potassium. The typical American diet doesn’t contain enough of this mineral.
In a meta-analysis involving 32 studies, results showed that as the amount of potassium was increased, systolic blood pressure decreased significantly (8). When foods containing 3.5 to 4.7 grams of potassium were consumed, there was an impressive −7.16 mm Hg reduction in systolic blood pressure with high blood pressure patients. Anything more than this amount of potassium did not have any additional benefit. Increased potassium intake also reduced the risk of stroke by 24 percent. This effect was important.
The reduction in blood pressure was greater with increased potassium consumption than with sodium restriction, although there was no head-to-head comparison done. The good news is that potassium is easily attainable in the diet. Foods that are potassium-rich include bananas, sweet potatoes, almonds, raisins and green leafy vegetables such as Swiss chard.
Lowering sodium intake may have far-reaching benefits, and it is certainly achievable. First, consume less and give yourself a brief period to adapt — it takes about six weeks to retrain your taste buds, once you cut your sodium. You can also improve your odds by increasing your dietary potassium intake, which also has a substantial beneficial effect, striking a better sodium-to-potassium balance.
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.
The extensive health concerns and restrictions of the COVID-19 pandemic have been challenging for everyone, but for people with PD and their care partners who were already tackling the daily challenges of life with PD, the impact has been significant. Now more than ever, it is critical to support, engage and inform the PD community and raise awareness about this disease, and Parkinson’s Disease Awareness Month is a great time to shine a spotlight on this issue.
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