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By Daniel Dunaief

Daniel Dunaief

America was reluctant to enter both World Wars and yet we won them both, at a tremendous cost to previous generations.

Today, as we continue to battle through the coronavirus, I’d like to think we will persevere. We don’t need political spin. We have plenty of that from both sides.

We need a sense of optimism, of shared purpose and of a keen belief that we will prevail through hard work and a readiness to innovate and adapt. We see so many horrific headlines about the number of people who test positive and who are threatening the capacity of health care systems in Florida and Texas, among others.

Even as we do everything we can to protect our health and the safety of our friends and family, we need to believe in ourselves and in our ability to work together. Defeating the virus takes more than ignoring it or claiming victory for political expediency.

Whoever wins this presidential election in this incredibly challenging year will have enormous work to do. 

Even a vaccine that is tested and produced in mass quantities by the early part of next year, which seems spectacularly optimistic but is still possible, doesn’t automatically put us back on the path to the world of 2019.

After all, the flu vaccine doesn’t eradicate the illness. It comes back with a vengeance some years. Some people who receive the shot still get sick, oftentimes with less severe symptoms.

We need to recognize that the world has changed. We’ve had time to process it and to adjust, even if we’re sick of the new rules. We need to use all the space we have to turn what seems like a nuisance and an inconvenience into a modern triumph.

The country can and should rethink everything from ways to attend sporting events to the specific needs of the home office. Maybe sports stadiums should remove seats, put picnic tables in front of patrons and make the game-time experience for fans look different because, for the foreseeable future, it will be.

Yes, I know, that will cost an incredible amount of money, but it would also give patrons a chance to enjoy their own space, instead of hoping for a time machine that brings us back to an era when we gave strangers a high five when our team scored.

Maybe waiters and waitresses can provide virtual personalized service, connecting through online services that deliver, via conveyor belt beneath those tables, contactless food to guests.

We need to renovate our homes to enjoy the new reality. Maybe we need virtual artwork we can add to our walls, that helps expand our small rooms and that changes at the flick of a switch. Maybe we also can figure out ways to create virtual assembly lines, where workers provide their part of a mechanized process from a distance, in a basement, workspace, or outside in their enclosed yards. It may not be as efficient, because someone might have to transport those parts, but those driving opportunities also create jobs for people who become a part of a new, virtual factory.

We may want to go back to the way things were, but we need to recognize the realities, and the opportunities, that come from moving forward. Moving on will require us to develop new ideas, create new jobs, and believe in ourselves. We have survived and thrived through challenges before, by pulling together, by innovating, and by tapping into the combination of ingenuity and hard work. People are prepared to put in the effort to earn their own version of the American Dream. We need innovations, new businesses, and inspirations that reignite the economy, while protecting our health.

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By Linda Toga, Esq.

Linda Toga, Esq.

With the COVID-19 pandemic on everyone’s mind, many people who have not engaged in estate planning have contacted me about how best to proceed with the development of an estate plan. 

It seems that the fear of the virus has made people understand the need for estate planning. However, even if you have a will or a trust, a power of attorney and/or a healthcare proxy, now is a good time to review your documents to confirm that they still express your wishes and meet your needs. Advanced planning is not something you think about once and forget. Successful planning requires that you periodically review and possibly revise your documents to reflect changes in your life circumstances. 

Some things to think about are:

Your beneficiaries: Have any of the beneficiaries named in your will or trust passed away? If so, you may want to name some new beneficiaries to share in your estate. Even if a beneficiary is still living, you should ask yourself if that person is still someone to whom you wish to leave a bequest. Relationships change over time. Are there new people in your life who are important to you? Are there beneficiaries named in your documents with whom you now have little or no contact, perhaps as the result of a divorce or relocation? Did you name a charity that no longer exists as a beneficiary? Are any of the beneficiaries now disabled? If you answered “yes” to any of these questions, you should consider making changes to your will or trust. 

The bequests: If you financial situation has changed since you created your estate plan and you can now make more generous bequests, you may want to revisit the size of bequests made to certain individuals. The converse is also true. If your estate is likely to be significantly smaller, perhaps you want to limit the bequests you are making either by removing some beneficiaries or decreasing the amount or percent of your estate going to each beneficiary. 

Your fiduciaries: The word fiduciaries refers to the people you have named as executor, trustee, agent and/or guardian in your estate planning documents. If any of the people you named as a fiduciary have passed, you should name a successor. If you named a sibling as an executor because your children were minor and now they are responsible adults, perhaps you want to name one of more of your children as the executor(s) of your estate.

Many clients revise their estate plans and name their children as agents on their powers of attorney or healthcare proxies when their children are older, more responsible and in a better position to make important decisions. This may be something you want to consider. If you named guardians to care for your children in the event you die when the children are still minors, it is very important to revisit this appointment. Perhaps your children have attained the age of majority and no longer need a guardian in which case the provision naming a guardian can be deleted. 

If a guardian may still be needed, you should consider the relationship the named guardian has with your children. Perhaps the person you named no longer has a good relationship with your children, or they have moved out of state and could only serve if your children are relocated. Has the guardian’s financial situation or living arrangements changed to the point that taking in and caring for your children will be overly burdensome? Since the guardian you name may be raising your children, all of these issues deserve serious thought. 

Although there are many issues to consider when reviewing your estate plan, the points mentioned above can provide a good starting point. Retaining an experienced estate planning attorney to review your documents with you and to discuss any changes you may want made will ensure that your estate plan will once again reflect your wishes. 

Linda M. Toga, Esq provides legal services in the areas of estate planning and administration, real estate, small business services and litigation. Call 631-444-5605 or email Ms. Toga at [email protected] to schedule a consultation. 

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GERD is a common condition in which the esophagus becomes irritated or inflamed because of acid backing up from the stomach. Stock photo
You may avoid medications by making simple changes

By David Dunaief, M.D.

Dr. David Dunaief

Wherever you look there is an advertisement for the treatment of heartburn or indigestion, both of which are related to reflux disease.

Reflux typically results in symptoms of heartburn and regurgitation, with stomach contents going backward up the esophagus. For some reason, the lower esophageal sphincter, the valve between the stomach and esophagus, inappropriately relaxes. No one is quite sure why it happens with some people and not others. Of course, a portion of reflux is physiologic (normal functioning), especially after a meal (1). As such, it typically doesn’t require medical treatment.

Gastroesophageal reflux disease (GERD), on the other hand, differs in that it’s long-lasting and more serious, affecting as much as 28 percent of the U.S. population (2). Can you understand why pharmaceutical firms give it so much attention?

GERD risk factors are diverse. They range from lifestyle — obesity, smoking cigarettes and diet — to medications, like calcium channel blockers and antihistamines. Other medical conditions, like hiatal hernia and pregnancy, also contribute (3). Diet issues include triggers like spicy foods, peppermint, fried foods and chocolate.

Smoking and Salt

One study showed that both smoking and salt consumption added to the risk of GERD significantly (4). Risk increased 70 percent in people who smoked. Surprisingly, people who used table salt regularly saw the same increased risk as seen with smokers.

Medications

The most common and effective medications for the treatment of GERD are H2 receptor blockers (e.g., Zantac and Tagamet), which partially block acid production, and proton pump inhibitors (e.g., Nexium and Prevacid), which almost completely block acid production (5). Both classes of medicines have two levels: over-the-counter and prescription strength. Here, I will focus on PPIs, for which more than 100 million prescriptions are written every year in the U.S. (6).

The most frequently prescribed PPIs include Prilosec (omeprazole), Protonix (pantoprazole), Nexium (esomeprazole), and Prevacid (lansoprazole). They have demonstrated efficacy for short-term use in the treatment of Helicobacter pylori-induced (bacteria overgrowth in the gut) peptic ulcers, GERD symptoms and complication prevention and gastric ulcer prophylaxis associated with NSAID use (aspirin, ibuprofen, etc.) as well as upper gastrointestinal bleeds.

However, they are often used long-term as maintenance therapy for GERD. PPIs used to be considered to have mild side effects. Unfortunately, evidence is showing that this may not be true. Most of the data in the package inserts is based on short-term studies lasting weeks, not years. The landmark study supporting long-term use approval was only one year, not 10 years. However, maintenance therapy usually continues over many years.

Side effects that have occurred after years of use are increased risk of bone fractures and calcium malabsorption; Clostridium difficile, a bacterial infection in the intestines; potential vitamin B12 deficiencies; and weight gain (7).

Bacterial infection risks

The FDA warned that patients who use PPIs may be at increased risk of a bacterial infection called C. difficile. This is a serious infection that occurs in the intestines and requires treatment with antibiotics. Unfortunately, it only responds to a few antibiotics and that number is dwindling. In the FDA’s meta-analysis, 23 of 28 studies showed increased risk of infection. Patients need to contact their physicians if they develop diarrhea when taking PPIs and the diarrhea doesn’t improve (8).

B12 deficiencies

Suppressing hydrochloric acid produced in the stomach may result in malabsorption issues if turned off for long periods of time. In a study where PPIs were associated with B12 malabsorption, it usually took at least three years’ duration to cause this effect. B12 was not absorbed properly from food, but the PPIs did not affect B12 levels from supplementation (9). Therefore, if you are taking a PPI chronically, it is worth getting your B12 and methylmalonic acid (a metabolite of B12) levels checked and discussing possible supplementation with your physician if you have a deficiency.

Lifestyle modifications

A number of modifications can improve GERD, such as raising the head of the bed about six inches, not eating prior to bedtime and obesity treatment, to name a few (10). In the same study already mentioned with smoking and salt, fiber and exercise both had the opposite effect, reducing the risk of GERD (5). This was a prospective (forward-looking) trial. The analysis by Journal Watch suggests that the fiber effect may be due to its ability to reduce nitric oxide production, a relaxant for the lower esophageal sphincter (11).

Obesity

In one study, obesity exacerbated GERD. What was interesting about the study is that researchers used manometry, which measures pressure, to show that obesity increases the pressure on the lower esophageal sphincter significantly (12). Intragastric (within the stomach) pressures were higher in both overweight and obese patients on inspiration and on expiration, compared to those with normal body mass index. This is yet another reason to lose weight.

Eating close to bedtime       

Though it may be simple, it is one of the most powerful modifications we can make to avoid GERD. A study that showed a 700 percent increased risk of GERD for those who ate within three hours of bedtime, compared to those who ate four hours or more prior to bedtime. Of note, this is 10 times the increased risk of the smoking effect (13). Therefore, it is best to not eat right before bed and to avoid “midnight snacks.”

Although there are a number of ways to treat GERD, the most comprehensive have to do with modifiable risk factors. Drugs have their place in the arsenal of choices, but lifestyle changes are the first — and most effective — approach in many instances. Consult your physician before stopping PPIs, since there may be rebound hyperacidity (high acid produced) if they are stopped abruptly.

References:

(1) Gastroenterol Clin North Am. 1996;25(1):75. (2) Gut. 2014 Jun; 63(6):871-80. (3) emedicinehealth.com. (4) Gut 2004 Dec.; 53:1730-1735. (5) Gastroenterology. 2008;135(4):1392. (6) Proton Pump Inhibitor, ClinCalc DrugStats Database, Version 20.0. Updated December 23, 2019. Accessed June 23, 2020. (7) World J Gastroenterol. 2009;15(38):4794–4798. (8) www.FDA.gov/safety/medwatch/safetyinformation. (9) Linus Pauling Institute; lpi.oregonstate.edu. (10) Arch Intern Med. 2006;166:965-971. (11) JWatch Gastro. Feb. 16, 2005. (12) Gastroenterology 2006 Mar.; 130:639-649. (13) Am J Gastroenterol. 2005 Dec.;100(12):2633-2636.

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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By Daniel Dunaief

Daniel Dunaief

This generation of college students have dealt with numerous shocks in their short lives. Most of them were born around the time of the terrorist attack on the World Trade Center. That event triggered several battles on foreign soil, led to the Department of Homeland Security, and created a world in which people took off their shoes at the airport and passed through metal detectors on the way in to concerts and sporting events.

As if that weren’t enough, this generation then had to deal with the 2008 financial crisis, when Lehman Brothers went bankrupt and when life, for many, became considerably more challenging amid a painful decline in the subprime housing market.

Through their upbringing, they also heard about mass shootings, some of which occurred at school. They practiced shelter-in-place and had nightmares about killers roaming the same hallways where artwork depicting students’ families and the alphabet adorned the walls.

The contentious 2016 presidential election brought two largely unpopular choices onto center stage. After a bitter election fight, the country didn’t have much time to heal, as the Democrats and Republicans transformed into the Montagues and Capulets.

Indeed, while each side dug in deeply, their respective media supporters expressed nonstop outrage and acted dumbfounded by the misdirection and apparent idiocy of the leaders and their minions across the aisle.

Then 2020 happened. The virus has killed over 120,000 Americans, crippled economies, led to mass layoffs and unemployment and turned the hug and the handshake into bygone gestures from six months ago that somehow seem even longer ago. With the killing of Minneapolis resident George Floyd, many protesters weathered the viral storm that had kept them inside for months to express outrage at a system where equal protection under the law seemed like a distant ideal.

Now, these same students face the possibility of returning to school. Some colleges have told their students to return earlier than normal, to forego visits to friend’s dorms, and to wear masks and social distance.

It seems likely that many of these colleges’ students, who have a familiar youth-inspired independent streak, will defy these new rules, much the same way many in the general public, including President Donald Trump (R), shun the idea of wearing masks.

If  I were running a college, and I’m glad I’m not because I’m struggling to provide sound  advice to two teenagers, I would triple and quadruple my medical staff. I would urge regular testing and I would make sure my college had the best possible treatments and plans ready.

Fortunately, the treatments for the virus have improved from the beginning, as the medical community has raced to provide relief to those battling draining and debilitating symptoms that have lasted for weeks or even months.

When people do contract the virus, as they inevitably will at some of these schools, I would urge students to rally around each other, their professors and anyone else who contracted COVID-19.

Unfortunately, this generation has had to grow up rapidly, to see ways each of them can play a role in helping each other. Students may not only become involved in the standard blood drives; they may urge their peers to check for antibodies and to donate convalescent plasma, which may help save lives and ameliorate the worst of the viral symptoms.

The modern college student doesn’t have to look to distant shores to find people overwhelmed and in need of their youthful energy and good intentions.

Many college students want to be relevant and contribute. They can and will have ample opportunities, with their antibodies, with their understanding and empathy, and with their ongoing resilience in the face of a lifetime of challenges.

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Deer tick. Stock photo

By Leah S. Dunaief

Leah Dunaief

Early Sunday morning, I had a close encounter with a tick. Now I know this is a bonanza season for ticks because we have had so much rain this past spring and there is lush greenery for the ticks to inhabit. Also, we have run articles cautioning readers about ticks and how the symptoms of Lyme disease so closely mimic those of COVID-19. I can advise you further that when you find a tick in bed with you that has already attached itself onto your person, you will experience shock and maybe even the creepy-crawlies.

Additionally, I could feel the lump, but because of its location, I could not see it. So since it was early and I was still more than half asleep, I tried to persuade myself that I could go back to sleep and we could deal with it later. But no, my brain was already on high alert and nudged me out of bed and to a full length mirror. 

Yep, it was a tick, tiny but unmistakable. Ech! What to do next? I have pulled them off my dogs many times over the years, but this one was smaller and out of reach. I googled “Tickssuck.org,” which told me not to slather it with Vaseline in order to smother it into releasing its hold on me, which I had done with the dogs. Instead it recommended getting tweezers, placing one tip under the head of the tick and carefully extract the beastie. Not wanting to wake the household, I found a smaller hand mirror, a pair of tweezers and a plastic bag to save the tick for diagnosis.

It was not pretty. I was in a convoluted position just to see the spot, and while one hand had to hold the mirror, the other could only fumble around with the tweezers. Somehow, after repeated stabs, I was able to yank the tick free, but I had left the head, the toxic part, still in my skin. I carefully, or so I thought, moved the tweezers toward the plastic bag only to have the tick slip out and fall onto the small bathroom rug at my feet. I uttered a not-so-nice word as I bent down to find the arachnid. After intense scrutiny, I could not find it. I carried the fluffy rug, carefully as you might imagine, out the front door and put it down in the sunlight. I saw nothing and was about to give up when I spied it and this time bagged it.

What did I do next? I sat down back inside my house and considered throwing up. Not a good idea in the living room. I considered going to a hospital emergency room but dismissed the thought in this time of real emergencies. I had the specimen, it was no longer attached, it would make a good story when everyone was awake, and I would wait until the beginning of the week to see a physician.

Monday morning, I tried to get an appointment. “When are you free in August?” I was asked sweetly by the receptionist. There ensued a lengthy exchange about 72 hours being critical for treatment, followed by a couple of phone calls back and forth throughout the day and finally a Tuesday slot. “Yes, it appears the head of the tick is still there, in the center of the red circle,” confirmed the physician who was good enough to squeeze me into his already overbooked schedule. “Would you like to wait until your body extrudes the head, which normally happens with a foreign substance in the skin, or would you like me to anesthetize the area and cut it out?” he asked. “Makes no difference.”

Well, it did make a difference to me, and I opted to wait. I left with two doxycycline and the warning to make sure the red spot doesn’t turn into a rash, to call immediately if it does for a full 21-day prescription, and an order for a blood test for Lyme after six weeks will have passed.

I share this with you to urge you every night to check yourself and your loved ones for ticks.

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Dairy may not be as beneficial as we have been led to believe. Stock Photo
Does calcium really reduce risk?

By David Dunaief, M.D.

Dr. David Dunaief

The prevalence of osteoporosis and low bone mass increase dramatically as we age. According to the Centers for Disease Control, over 48 percent of those ages 65 and older in the U.S. are affected by low bone mass, and 16.4 percent by osteoporosis (1).

Why do we care? Because they may lead to increased risk of fracture and, subsequently, lower mobility, which may have significant quality of life impacts (2). That is what we know. But what about what we think we know?

For decades we have been told that if we want strong bones, we need to consume dairy. This has been drilled into our brains since we were toddlers. Dairy has calcium and is fortified with vitamin D, so it could only be helpful, right? Not necessarily.

The data is mixed, but studies indicate that dairy may not be as beneficial as we have been led to believe. Even worse, it may be harmful. The operative word here is “may.” We will investigate this further. Vitamin D and calcium are good for us. But do supplements help prevent osteoporosis and subsequent fractures? Again, the data are mixed, but supplements may not be the answer for those who are not deficient.

Holes in the dairy paradigm

The results of a large, observational study involving men and women in Sweden showed that milk may be harmful (3). When comparing those who consumed three or more cups of milk daily to those who consumed less than one, there was a 93 percent increased risk of mortality in women between the ages of 39 and 74. There was also an indication of increased mortality based on dosage.

For every one glass of milk consumed there was a 15 percent increased risk of death in these women. There was a much smaller, but significant, 3 percent per glass increased risk of death in men. Women experienced a small, but significant, increased risk of hip fracture, but no increased risk in overall fracture risk. There was no increased risk of fracture in men, but there was no benefit either. There were higher levels of biomarkers that indicate oxidative stress and inflammation found in the urine.

This study was 20 years in duration and is eye-opening. We cannot make any decisive conclusions, only associations, since it is not a randomized controlled trial. But it does get you thinking. The researchers surmise that milk has high levels of D-galactose, a simple sugar that may increase inflammation and ultimately contribute to this potentially negative effect, whereas other foods have many-fold lower levels of this substance.

Ironically, the USDA recommends that, from 9 years of age through adulthood, we consume up to three servings of dairy per day (4). This is interesting, since the results from the previous study showed the negative effects at this recommended level of milk consumption. The USDA may want to rethink these guidelines.

Prior studies show milk may not be beneficial for preventing osteoporotic fractures. Specifically, in a meta-analysis that used data from the Nurses’ Health Study for women and the Health Professionals Follow-up Study for men, neither men nor women saw any benefit from milk consumption in preventing hip fractures (5).

Calcium disappointments

Unfortunately, it is not only milk that may not be beneficial. In a meta-analysis involving a group of observational studies, there was no statistically significant improvement in hip fracture risk in those men or women ingesting at least 300 mg of calcium from supplements and/or food on a daily basis (6).

The researchers did not differentiate the types of foods containing calcium. In a group of randomized controlled trials analyzed in the same study, those taking 800 to 1,600 mg of calcium supplements per day also saw no increased benefit in reducing nonvertebral fractures. In fact, in four clinical trials the researchers actually saw an increase in hip fractures among those who took calcium supplements. A weakness of the large multivaried meta-analyses is that vitamin D baseline levels, exercise and phosphate levels were not considered.

Vitamin D benefit

Finally, though the data is not always consistent for vitamin D, when it comes to fracture prevention, it appears it may be valuable. In a meta-analysis involving 11 randomized controlled trials, vitamin D supplementation resulted in a reduction in fractures (7). When patients were given a median dose of 800 IUs (ranging from 792 to 2,000 IUs) of vitamin D daily, there was a significant 14 percent reduction in nonvertebral fractures and an even greater 30 percent reduction in hip fractures in those 65 years and over. However, vitamin D in lower levels showed no significant ability to reduce fracture risk.

Just because something in medicine is a paradigm does not mean it’s correct. Milk may be an example of this. No definitive statement can be made about calcium, although even in randomized controlled trials with supplements, there seemed to be no significant benefit. Of course, the patients in these trials were not necessarily deficient in calcium or vitamin D.

In order to get benefit from vitamin D supplementation to prevent fracture, patients may need at least 800 IUs per day, which is the Institute of Medicine’s recommended amount for a relatively similar population as in the study.

Remember that studies, though imperfect, are better than tradition alone. Prevention and treatment therefore should be individualized, and deficiency in vitamin D or calcium should usually be treated, of course. Please, talk to your doctor before adding or changing any supplements.

References:

(1) cdc.gov (2) JAMA. 2001;285:785-795. (3) BMJ 2014;349:g6015. (4) health.gov. (5) JAMA Pediatr. 2014;168(1):54-60. (6) Am J Clin Nutr. 2007 Dec;86(6):1780-1790. (7) N Engl J Med. 2012 Aug. 2;367(5):481.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com. 

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METRO photo

By Daniel Dunaief

Daniel Dunaief

As we approach Father’s Day, I can’t help thinking that the creators of the alphabet hid important lessons in plain sight when they put the letters “n” and “o” between the letters “m” and “p.”

The letter “m” starts the Latin word “mater,” which means mother. The letter “p” starts the word
“pater,” which, also in Latin, means father.

Between mom and dad, then, resides the simple,
effective and important word “no.”

Parents who aren’t on the same page about decisions will find children who don’t believe a “no” ever means anything because they will run to the other parent to find someone who will render a “no” from the former parent meaningless.

Parents need the word “no” to unite them, bringing together the “m” and “p” that makes it possible to provide consistent parenting advice. When a “no” from dad is also a “no” from mom, children can’t divide and conquer with their parents.

Now, valuing and appreciating the word “no” doesn’t necessarily mean parents should say “no” to everything. In fact, when mom and dad agree on something for their children, they can and should celebrate the opportunities they urge their progeny to pursue.

When our children were young, we found ourselves falling into the repeated “no” pattern, mostly to protect our children. “Don’t go in the street, don’t put that toy in your mouth, don’t grab that dog’s tail, etc.” While all of those rules are valid and valuable, they also can create a culture of “no” that constantly reminds children of their limitations, giving them the equivalent of a Greek chorus of “no” that follows them around, preventing them from exploring the world or from considering opportunities and risks worth taking because they expect a giant “NO!” sign to appear in their closet, under their bed, at the entrance to their classroom or in the backyard.

My wife and I put considerable energy into redirecting our children, rather than giving them a negative answer. We suggested alternatives to their suggestion or even, at times, a compromise answer that wasn’t a negative so much as it was a reshaping of an impulse.

On an elemental level, the letters “n” and “o” also seem so apt for the world between mom and dad. After all, N for nitrogen represents 78 percent of the atmosphere while O for oxygen represents 21 percent, which means that, between the letter placeholder for mom and dad resides the letters for 99 percent of the atmosphere of the earth.

The elements nitrogen and oxygen also, like some families, exist in paired form as molecules instead of single elements. These molecules float around in the atmosphere as a duo, with a strong covalent bond keeping the orbiting electron shells full.

For children, saying “no” to their parents starts early as a way to fight back against the world of “no” while they drift into the world of the terrible twos or, in our children’s case, the threadbare threes. When these children are caught between their mother and father, they may find that their only defense against a disagreeable world is to hold up their own “no” shield.

That small word, however, is important to change the world as well, because children who can defend their “no” answer to parents can also refuse to accept problems they see in the world. Instead, they can defy policies or ideas that rankle them. Saying “no” to anything aids cognitive development and, as it turns out, is good preparation for parenting. It has to be true because it’s right there, hidden in place sight, in the alphabet.

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Pinot Grigio grapes come in a range of skin colors. METRO photo

By Bob Lipinski

Bob Lipinski

Pinot Grigio is the number one selling white wine from Italy and has been for many years. This fruity, easy-to-drink, dry to off-dry wine is made throughout the world with the bulk coming from Northern Italy.

The popular wine has been grown in Italy since the beginning of the nineteenth century, when it was first introduced in Piedmont. Cultivation of the grape moved eastwards over the decades and now finds its home in the Tre Venezie, a term used to describe the three contiguous northeastern regions of Friuli-Venezia Giulia, Veneto, and Trentino-Alto Adige. The Tre Venezie offers a combination of geography and climate well suited to producing high-quality grapes.

Pinot Grigio is a thin-skinned, medium acid white grape. The grape’s skin color ranges from a bluish gray to a delicate pink. During winemaking, the grapes are crushed releasing a clear juice, which is fermented minus the skins, which would otherwise add some color.

In some wine shops you can find examples of Pinot Grigio made with limited skin-contact, which are copper-colored. These wines have a greater depth of color and flavor. The Italian term for this copper-colored wine is ramato. Besides Pinot Grigio, another white wine that is made from pinkish-colored grapes is Gewürztraminer.

Grapes, like people, sometimes have alternate names; for example, Bill, Billy, Will, or Willie instead of William. Depending on their place of origin, grapes can have several or even sometimes over 100 different synonyms (names). An example is Pinot Grigio and Pinot Gris; same grape but different names depending on where it is grown. Other synonyms for Pinot Grigio are Grauer Burgunder and Ruländer (Austria and Germany).

This particular wine is pale straw-yellow in color, with light green reflections. It has a delicate aroma and flavor of apples, citrus (lemon, lime, tangerine), figs, kiwi, lychee, melon, nectarine, passion fruit, pears, watercress, and white peach. Its aftertaste is of almonds and hazelnuts.

Pinot Grigio can be paired with many types of cheese. Some of my favorites from Italy are Asiago, Bagozzo, Bel Paese, Burrata, Burrini, Fontina, Montasio, Mozzarella, Parmigiano-Reggiano, Pecorino, Robiola Piemonte, and Scamorza.

There are hundreds of brands of Pinot Grigio available in the U.S. coming from dozens of countries. Some recommended Italian Pinot Grigio brands are Alois Lageder, Eugenio Collavini, Dorigo, Barone Fini, Ronco delle Betulle, Ca’ Montini, Càvit, Ecco Domani, Elena Walch, Livio Felluga, Marco Felluga, Maso Canali, Jermann, J. Hofstätter, Santa Margherita, Santi, and Zonin.

Bob Lipinski is the author of 10 books, including “101: Everything You Need To Know About Whiskey” and “Italian Wine & Cheese Made Simple” (available on Amazon.com). He conducts training seminars on Wine, Spirits, and Food and is available for speaking engagements. He can be reached at www.boblipinski.com OR [email protected].

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Luna Moths are among the largest moth species in North America.

By John L. Turner

With a 65th birthday looming on the horizon for later this summer, I recently found myself, not surprisingly, thinking about “Bucket Lists” — lists comprising places to visit or things to do before “kicking the bucket.” It’s a concept made popular from the movie “The Bucket List,” starring Morgan Freeman and Jack Nicholson as two terminally ill older men living out their last desires, and the impending birth date — signaling a lifetime spanning two-thirds of a century — motivated me to develop “bucket list” priorities for the time I have left.

So I began to think about different types of bucket lists. Travel destinations with my family; bird trips; visits to major league baseball stadiums (been to about half of them) and, of course, the ultimate global nature bucket list — snorkeling with Whale Sharks in the coastal waters off Belize, witnessing the Wildebeest migration in the African Serengeti, sitting quietly near any one of our closest relatives — Chimpanzees, Gorillas, Bonobos, or Orangutans in the tropical forests of African and Asian countries — or walking in reverence amidst tens of millions of Monarch Butterflies at their winter roost in the highland fir forests of Mexico.

But there will be no exotic far-flung places for this article; this bucket list is more modest in scope, relating to natural phenomena that I long to see on Long Island. For a few of these, I’ve witnessed them many years ago but for others I await the first experience.

Here goes:

Seeing a Smooth Green Snake 

 Of the nearly dozen native snake species found on Long Island, undoubtedly the most beautiful is the Smooth Green Snake. It is a tropical lime green color on top and lemon yellow on its belly with a golden-colored eye. They are a bit wider than a pencil with adults reaching about two feet in length. You’d think such a brightly colored snake would stand out but laying motionless in grass they can disappear. I have never seen one on Long Island or anywhere else and would love to!

While on the subject of snakes I’d also love to see a Hognose Snake again and especially one performing its famous ‘death feign’ act. I’ve seen this behavior twice in my life, once on Long Island, but both experiences were decades ago. If disturbed the snake often but not always feigns its death by writhing spasmodically and rolling onto its back and abruptly “dies”. Adding to the convincing nature of the act the Hognose can even spill blood from its mouth by rupturing capillaries that line it. Of course, it’s all a ruse to stop a potential predator from attacking.

Finding an Ovenbird nest 

 In larger woodlands the Ovenbird sings out with its ringing teacher! teacher! song filling the spaces between and under the trees. With a little bit of luck you might find this songbird perched on a branch in the sub-canopy as it sings, its little warbler body shaking as song spills forth loudly. Despite years of searching on many a forest floor I’ve never found their “Dutch oven”-shaped nest which gives the bird its name. 

Twice in the Pine Barrens, once in Shoreham, the other in Riverhead, I’ve made a concerted effort to look for their nests, after observing nearby adults with food in their mouths. On my knees I very slowly and carefully inspected the forest floor starting where I thought, based on the bird’s behavior, the nest might be. Methodically, I spiraled outward in my search but, alas, despite half an hour of on-my-knees-searching came up empty.

Spotting a Giant Silk Moth 

Buck Moth

If you want to familiarize yourself with a remarkable, stunning, spectacular (fill in your own adjective here once you’ve seen what they look like) group of insects native to Long Island, check out photos of the following moth species: Luna, Cecropia, Polyphemus, Promethea, and Buck Moths. These are among the largest flying insects we have with wingspans as large as six inches. 

At one time they were common but no more. The host trees they depend upon as caterpillars are still relatively common to abundant on Long Island so its not a loss of food that explains their decline; widespread spraying of poisonous pesticides is the suspected cause for their significant drop.

The last of three live Luna Moths I’ve seen on Long Island was a decade ago. I’ve never seen a live Promethea or Cecropia and the last Polyphemus was six years ago — a ragged individual so beat up from bird strikes it was weakly fluttering along the asphalt in a shopping center parking lot. I scooped it out of harm’s way but it died later that day. 

Fortunately, the beautiful black, orange, and white Buck Moth, one of the iconic species of the Pine Barrens, is still common. Spared from spraying in its vast Pine Barrens forests, the Buck Moth can be observed during the day flying around the dwarf pines of Westhampton in the autumn as male moths seek out females to create the next generation.

Seeing a River Otter 

One of the bits of good news relating to Long Island wildlife is the sustained natural reintroduction of river otters, presumably from wandering individuals emigrating from Westchester and western Connecticut and island hopping to the North Fork via the island archipelago of Plum, Little Gull, Great Gull, and Fisher’s Islands. However the prospecting animals did it, they’re here now. And while I’ve seen wild otters in locations off Long Island and seen otter signs on Long Island, in the form of otter runs and scat (fishy poop) as close by as Frank Melville Memorial Park in Setauket, I’ve not seen one of these charismatic creatures here.

Observing a Mola mola  

Mola mola

This strange looking enormous fish (in fact it really doesn’t look like a fish) is often seen by fisherman and whale watchers afloat in the Atlantic Ocean in the summer. Also known as the ocean sunfish, they are world’s largest bony fish weighing in at more than one thousand pounds. They can dive deeply and after returning from cold ocean depth, they warm up by turning on their side to bask in the sun, showing off a flattened profile, a view that many (except me!) have enjoyed.

Do you have a nature-themed bucket list?

A resident of Setauket, John Turner is conservation chair of the Four Harbors Audubon Society, author of “Exploring the Other Island: A Seasonal Nature Guide to Long Island” and president of Alula Birding & Natural History Tours.

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METRO photo

By Leah S. Dunaief

Leah Dunaief

This is the year we all disappeared behind our masks. “Who is that masked man?” people would ask about the Lone Ranger, as he rode the range decades ago in every child’s imagination and kept the peace. Now they might ask the same question of us, masked men and women and children, as we peacefully go about our new freedoms of shopping and ordering meals for alfresco dining. We are not always immediately recognizable behind the variety of face coverings we see on the streets. The importance of wearing a mask has been accepted by almost everyone, and with good reason. An example of the benefits can be found in Japan.

According to Motoko Rich, a reporter for The New York Times, face coverings are common in Japan during flu and hay fever seasons, on crowded public transportation when commuters commonly have colds and even when women “don’t want to bother putting on makeup.” Mask sightings are routine.

Could that be the explanation for Japan’s surprisingly low number of victims of COVID-19 compared to other countries?

Initially, we Americans were advised not to wear masks, that they were unnecessary and should be saved for hospital workers. We all know what happened next. Cases of novel coronavirus spiked and the number of deaths exceeded the capacity of morgues and funeral homes for weeks. We were directed to shelter-in-place. Yet in Japan, which did not order a lockdown or massive testing or emphasize social distancing, and kept karaoke bars open and public transportation packed, terrible spikes in cases and deaths did not occur. The numbers there were 17,000 infections and 900 deaths. Yes, they have a smaller population, but in the United States, whose residents number two-and-one-half times that of Japan, some 1.9 million have fallen ill and 110,000 have died.

Eventually bars and businesses did close, and schools were shut early, as cultural and sports events were canceled, but note that none of those restrictions was mandatory. What the people did do was to nearly universally don masks. That response follows a cultural tradition of hundreds of years. Between the 17th and 19th centuries, mining workers used masks to prevent inhaling dust. The Japanese wore them during the 1918 flu epidemic and more recently during SARS and MERS outbreaks, as well as to protect against pollution and pollen. The country was “relatively unscathed,” during the epidemics, according to Motoko Rich.

Members of the scientific community weigh in on the matter. “I think there is definitely evidence coming out of COVID that Japan, as well as other countries which practice mask-wearing, tend to do much better in flattening the curve,” said  Akiko Iwasaki, a professor of immunobiology at Yale, as quoted in the NYT. 

Masks can block respiratory droplets that are emitted when people speak, cough or sneeze. Those droplets may carry the virus, even when the wearer has no symptoms, and hence transmit the disease if not captured by the mask.

The reporter goes on to emphasize that masks alone are not sufficient to prevent disease, that social distancing is also required. Even with masks, crowds are a danger for the spread of infection. It will be informative to learn the unintended health consequences of the many protests against racism, triggered by George Floyd’s death under the knee of a police officer, that have occurred over the past two weeks. Most of those protesters, crowded together, seemed to be wearing masks.

From my travels to Japan, I would add a couple of cultural differences to this story. We found the Japanese to bow rather than shake hands and to be a little physically distant with each other rather than hugging often. Their country is, for the most part, amazingly clean and uncluttered, and they seem fastidious about themselves. These traits would also argue in favor of less contagion when disease is present.

I would also like to predict that masks — designer, decorated, color coordinated, whatever — will be with us well after the pandemic ends.

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