03/02/14 12:00pm
03/02/2014 12:00 PM
Carrie Miller

Carrie Miller

The winter season tends to keep people indoors, depriving them of the sun’s vitamin D-filled rays. And recent studies have linked defi ciencies in vitamin D to a wide range of conditions — among them an increase in severe asthma reactions.

More than 25 million people in the U.S. suffer from asthma and close to 7 million of them are children, according to the National Institutes of Health.
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02/13/14 11:56am
02/13/2014 11:56 AM

Father Piotr Narkiewicz and Father Robert Kuznik shovel the front steps of St. Isidore’s Church during a snowstorm earlier this year. (Barbaraellen Koch photo)

I stepped outside, shovel in hand, and eyed my very snow-worthy Jeep.

But I was overconfident.

As I began to dig into the white stuff, I soon realized I had underestimated the 10 or 12 feet I had to remove in order to actually access my car. Being the overeager newbie reporter that I am, I had unwittingly offered to take photos of the freshly fallen snow, aptly timed as the first task of my morning — or so I thought. (more…)

01/26/14 9:00am
01/26/2014 9:00 AM

A healthy dose of skepticism and a grain of salt can do the body some good when it comes to medical information — particularly the findings of medical studies.

“A lot of times they are presented in a way that is sort of sensationalizing the results, so it’s not giving the public a true picture at all,” said Dr. Iris Granek, chair of the Department of Preventive Medicine at Stony Brook University School of Medicine.

Multiple factors can help determine how reliable a study is and whether it’s worth stocking up on vitamin E or scheduling time for an afternoon glass of green tea. Readers should go beyond the articles and get their hands on the study itself.

“Just because it is in a good peer-reviewed journal that’s famous doesn’t mean that the study is flawless,” Dr. Granek said. “No study is flawless.”

So even when the information comes from well-known publications like the Journal of the American Medical Association (JAMA) or the New England Journal of Medicine, it’s important to take a good, long look.

“People have to understand who was being studied — and this is not always reported by the media,” Dr. Granek said.

One of the best ways to determine if a study applies to you is seeing if you would fit into the study group itself. “A well-conducted small study that was done in a very specific population — it’s likely the results may not apply to you,” she said.

The best kind of study is a large, randomized, double-blind trial, which is known by research experts as the “golden standard” of clinical trials.

These studies split the target population randomly, with one group receiving treatment and the other receiving a placebo — neither knowing which they are getting. Both groups are followed and studied in the same way, so data is collected objectively, according to the National Institutes of Health.

Other types of trials are often not taken as seriously, Dr. Granek said.

The studies people should consider with the most skepticism, she said, are prevention studies — the idea that something is going to prevent a condition or disease.

“That really does take a long time to study, and in the end a measure may be doing harm, so that’s where I would be cautious — jumping on the bandwagon that something is preventive,” she said.

She said studies promoting aspirin were a good example. Aspirin had a positive effect in preventing heart attack in men and stroke in women — but also proved to have the negative effect of gastrointestinal bleeding.

“So there’s always weighing the benefit over potential risk in the long run,” the doctor said.

Before starting a daily regimen of any over-the-counter medications, Dr. Granek said, it’s important to consult with a physician first.

Got a health question or column idea? Email Carrie Miller at cmiller@timesreview.com. Follow her on twitter @carriemiller01.

01/19/14 3:00pm
01/19/2014 3:00 PM

WEDMD PHOTO | Coumadin, a blood thinner, can be difficult for doctor’s to prescribe effectively.

Blood clots can cause strokes, heart attacks or pulmonary embolism. But blood clotting can be beneficial, preventing or stopping bleeding during trauma.

Achieving a balance of both scenarios is critical.

For almost half a century, physicians treating patients with dangerous blood clots have had one type of oral medication to prescribe — the anticoagulant warfarin, more commonly known by the brand name Coumadin.

But health experts say it can be difficult to prescribe this drug effectively, as it easily interacts with a patient’s diet.

Within the past five years, the study of anticoagulants has become a hot topic in the medical field, sparking U.S. Food and Drug Administration approval of three new medications: Pradaxa (dabigatran etexilate), Xaralto (Rivaroxaban) and Eliquis (apixaban). Another option, Edoxaban, is awaiting FDA approval.

Patients and providers now have alternative treatment options, each with its own benefits.

“These new drugs have been shown to be as effective as warfarin, if not more effective, and they are remarkably safer when it comes to serious bleeding,” said Dr. Christian Ruff, a professor at Harvard Medical School who is helping to conduct clinical trials of Edoxaban, which involve over 21,000 patients from 46 countries.

While many people refer to anticoagulants as “blood thinners,” they do not actually thin the blood. Instead, they cause the blood to take longer to form a clot — something that’s undesirable in an emergency situation.

More than a third of patients at risk for a dangerous clotting event aren’t given the medication because of the fear of serious bleeding, Dr. Ruff said.

Warfarin, which costs pennies a pill, was initially created as a rat poison back in the 1940s. It was approved for human use in 1954 and, after suffering a heart attack while in office, President Eisenhower became one of the first patients to receive it, Dr. Ruff said.

The drug works by interfering with your body’s use of vitamin K, which creates clotting factors and prevents bleeding. But vitamin K is a naturally occurring nutrient present in many leafy green vegetables, Dr. Ruff said, and when ingested can affect the impact warfarin has on the body.

“It is certainly the most difficult and the most dangerous drug used in clinical practice,” he said.

The new medications inhibit clotting in different ways and are not dependent on vitamin K, enabling them to cut life-threatening bleeding by half compared to warfarin, Dr. Ruff said.

Researchers are still researching what they call an “antidote” to these new drugs — a treatment administered to reverse their clot-inhibiting effects in the event of an emergency.

“I think there’s been a bit of confusion about the reversal of these drugs, and the best thing to consider is prevention,” he said. “Would you rather cause double the amount of life-threatening bleeding and pray that you can reverse it or prevent half the amount of life-threatening bleeding in the first place?”

Dr. Ruff added that there is no true reversal agent for warfarin.

While the new options may ease a patient’s fear following a fall or accident, they can place added pressure on the budget, as the medications can be more expensive than warfarin, Dr. Ruff said.

“As more patients use these drugs, the volume goes up and the amount that companies charge per prescription will go down,” he said, adding that until then, the best option is what is affordable to a patient given the risks.

Got a health question or column idea? Email Carrie Miller at cmiller@timesreview.com. Follow her on twitter @carriemiller01.

01/12/14 12:00pm
01/12/2014 12:00 PM

The New Year brought about a welcome change for Medicare patients seeking mental health services.

Effective Jan. 1., Medicare coverage of mental health treatment is now in line with that available for other types of medical care — covering 80 percent of most fees and leaving only 20 percent up to the patient.

The change has been in the works for several years, thanks to the Medicare Improvements for Patients and Providers Act, which amended the Social Security Act in 2008.

Previously, patients seeking treatment such as psychotherapy from a clinical psychologist, Ph.D. or social worker were responsible for half the bill.

Medicare has been boosting its coverage for such services incrementally since 2008, covering to 55 percent in 2010, 60 percent in 2012 and 65 percent last year, according to the bill. Coverage will now remain at 80 percent.

Up to now, many patients seeking mental health services had to rely on supplemental coverage such as Medigap insurance to fill in the void, said Eric Hausman, Medicare consultant for the county Department for the Aging.

“The people who will be impacted most will be the people who don’t have other insurance aside from Medicare,” he said. “That’s a good change for them in terms of what they are paying out of pocket.”

With increased access to affordable care, patients who have thought about seeking mental services in the past should seriously consider utilizing care, he said.

Another recent change makes accessing care even easier: Medicare patients are now eligible for one free annual depression screening, which is now covered in full by Medicare, thanks to the passage of the Affordable Care Act, Mr. Hausman said.

“It’s at no cost as long as the doctor or provider accepts Medicare. This is a good way for somebody to get screened to see if they might need mental health counseling,” he said.

Once diagnosed, patients can access the affordable therapy they need — or be put on prescribed medication that has also only recently become available to Medicare patients, he said.

Before 2013, Medicare Part D, which covers prescription medications, did not cover many common psychological drugs such as benzodiazepine and barbiturates, Mr. Hausman said.

“Drugs like Valium and Xanax that people might take for anxiety, originally those classes of drugs were excluded from Medicare part D drug plans when it first started in 2006,” he said. “They started to cover those in 2013.”

The combined changes show that mental health treatment has become “better accepted and more recognized” in the field of medicine, he said.

Mr. Hausman said the best way to find a mental health provider in the area who accepts Medicare is to visit the Medicare website and use the “physician compare” tool, filling in the Zip code and type of provider.

He cautions, however, that even if a Medicare provider is listed, it does not necessarily mean he or she is able or willing to take on new Medicare patients.

“The best thing they can do is call and ask,” Mr. Hausman advised.

Got a health question or column idea? Email Carrie Miller at cmiller@timesreview.com. Follow her on twitter @carriemiller01.

01/05/14 10:00am
01/05/2014 10:00 AM
Peconic Bay in Riverhead

BARBARAELLEN KOCH FILE PHOTO | At Peconic Bay Medical Center in Riverhead, individuals dealing with epilepsy met recently to discuss their experiences.

Sitting around a conference table at Peconic Bay Medical Center on a recent Monday evening, a group of eight individuals met to discuss experiences with a somewhat common disorder — epilepsy.

A person who has two or more “unprovoked” seizures is considered to have epilepsy. While many factors, such as a high fever or lack of oxygen, can cause seizures, those happening without such causes are attributed to epilepsy.

One in 10 adults will suffer from a seizure sometime during their lives, according to the nonprofit Epilepsy Foundation, and epilepsy is the third most common neurologic disorder in the United States after Alzheimer’s disease and stroke.

Group members, ranging from sufferers’ aunts and grandmothers to those living with the disorder themselves, each gave advice based on their own experiences — offering fellow group members a common sentiment: “You’re not alone.”

“We’re out here on the East End, and it can feel like we are alone. It is very hard sometimes,” said Charlie Peterson, who has been dealing with epilepsy for most of his life.

He started the Riverhead group so people could seek support from local community members.

Learning from those immediately affected by epilepsy is often just as important as hearing from health professionals, he said.

In people with epilepsy, instead of the brain’s sending electrical energy in an orderly manner, brain cells keep firing, causing a surge of energy through the brain. This surge often results in a seizure, according to the nonprofit. More than six different types of seizures are commonly associated with epilepsy and can include convulsions, muscle spasms and altered consciousness, but they can also be just odd sensations and brief episodes of staring into space, according to the foundation.

A woman named Charlene was visiting the group for the first time, seeking information on how to help her 6-year-old grandson, who was recently diagnosed with epilepsy.

He had a pacemaker-like device implanted in his chest, a treatment known as vagus nerve stimulation, something most group members had experience with themselves. Those with the implant hold a magnet-like tool up to their chest to activate the treatment, which delivers electrical stimulation to the brain to help when they feel a seizure coming on.

“He calls it his magic wand, and keeps it in his pocket,” Charlene said, adding that her grandson has been having trouble getting the device out of his pocket in time to activate it.

A man named Patrick, who volunteers with a North Fork fire department, offered some advice, noting that the magnets can be altered and set into bracelets, so that all the boy would have to do would be to hold is hand to his heart.

Patrick himself had dealt with the very same issue, he said.

Other topics discussed during the meeting included medications, diet and surgery options, along with some of the personal challenges each person had dealt with in recent weeks.

The support group is free and open to all. For more information contact Mr. Peterson at 740-1476 or 728-2804.

Got a health question or column idea? Email Carrie Miller at cmiller@timesreview.com. Follow her on twitter @carriemiller01.

12/30/13 3:00pm
12/30/2013 3:00 PM
Peconic Bay in Riverhead

BARBARAELLEN KOCH FILE PHOTO | The entrance to Peconic Bay Medical Center in Riverhead.

Between opening up a new campus in Manorville in September and major changes in health care on the horizon, 2013 was a busy year for PBMC Health chief executive officer Andrew Mitchell.

Going into his 13th year on the job at the Riverhead-based facility, Mr. Mitchell has had to remain as flexible as ever as changing federal health care regulations dominated much of the industry in the past year.

Peconic Bay Medical Center CEO Andrew Mitchell.

But Mr. Mitchell was able to take a few minutes to fill the News-Review in on where the industry may be headed next year, while reflecting on what 2013 brought about for PBMC Health.

Q: Shortages in primary care have been reported nationwide. Do you believe that trend is affecting North Fork residents? If so how?

A: We’ve made major investments in primary care. We have numerous practice sites that are sponsored by the medical center all over the North and South forks and while we believe that primary care shortage is an issue, we are working diligently to ensure that residents have access to outstanding primary care physicians. We employ probably 15 or so primary care physicians who are distributed between the North and South forks.

Q: What types of outpatient care and/or facilities do you believe area residents are lacking most?

A: I don’t think it’s outpatient care they are lacking. I think the most significant issue is the lack of an advanced cardiac catheterization unit for East End residents. Patients who require cardiac catheterization, either on an emergency or elective basis, have to travel great distances to get that care, putting — quite frankly — their lives at risk.

When you look at the makeup of our population and the incidence of heart disease, it is absolutely the number one health issue for residents of the East End.

Q: Should area residents be more concerned than before about their likelihood of contracting a tick-borne disease?

A: No. I think virtually all of our primary care and infectious disease physicians are highly aware of the diseases associated with ticks and are very vigilant about monitoring patients for those potential diseases.

Q: The CDC calls antibiotic resistance ‘one of our most serious health threats.’ What steps is the hospital taking to ensure the safety of its patients?

A: It goes way beyond the hospital. We see ourselves today not as a hospital but as a fully integrated health system with ambulatory campuses, physician offices, home health agency, a skilled nursing facility — I could keep on going down the list. So antibiotic selection, antibiotic usage and the whole issue of antibiotic resistance is a focal point of the entire continuum of care of PBMC Health. Through our pharmacy and therapeutics committee and our quality management program, we look very carefully at the use of antibiotics, We look very carefully at their use in association with surgery and, since we are a health system, in the ambulatory and physician office environment as well.

Q: What concerns you most regarding the implementation of health care reform come January?

A: The change is happening very rapidly and implementation of health care reform has not always been happening according to the originally stated plan, so that requires health care systems like PBMC Health to adapt to the unplanned changes very quickly and to be very nimble in the current environment. So whether it’s the delayed implementation of the health care exchanges, the decision that small business doesn’t have to participate for another year — all those have an impact on the health system, and we need to make adjustments.

Changes being made by Medicare outside health care reform are happening just as dramatically and are causing us to make significant changes to the way we, and all hospitals, have to operate. That has to do with the so called “observation status” that has been created by Medicare.

Q: PBMC recently opened and continues to work on the Manorville campus. How will this advancement help handle the expected influx of patients with health care reform?

A: Health care reform is clearly changing the way the health care industry is proving care by incentivizing preventive and ambulatory care. So we think of the Manorville campus, The Gertrude & Louis Feil Campus, as our model ambulatory campus and we think it’s the wave of the future. I think one piece of really interesting data is that we’ve already seen volume levels that we anticipated in the third year of operation in what is now the third month.

It’s interesting; we’re seeing what’s clearly a national trend where convenience is very important to patients. What we’ve seen right out of the gate is a very, very high utilization of our urgent care center, where patients can walk in and get care without an appointment in an expeditious way – and not have to worry about taking a day off of work … I think in Manorville, because there was such a lack of physicians’ offices in the region, that what we’re really just seeing there is the actual demand from the community.

We plan to open more of these facilities in 2014.

Q: Are there any exciting changes or advancements planned for 2014?

A: We’re planning on continuing to expand our Manorville campus. Manorville has already been a success and it’s not even completed. We’ll be opening two more buildings on the campus in 2014 so it will be almost three- quarters completed next year. We’re looking to replicate that in other parts of the service area. We do have a multi-campus plan.

On the main campus we have some technology upgrades and program upgrades in surgery. We expect to open a surgical progressive care unit, another private room unit for higher acute surgical patients.

In 2014 we are going to focus our philanthropic initiatives around the growth of an endowment for the health system and we anticipate some major gifts that will allow us to build the surgical progressive care unit and upgrade our intensive care unit.

We’re also in the middle of a cosmetic remodeling of all the inpatient units. The private room inpatient units in the Kanas Center were received so well we are starting to replicate that appearance in the rest of the inpatient rooms.

cmiller@timesreview.com

12/22/13 12:00pm
12/22/2013 12:00 PM

KATHARINE SCHROEDER FILE PHOTO | Raspberry trifle for dessert.

Amid the distraction of all things holly and jolly, it’s easy to put health concerns on the back burner during the holidays. The season of thanks and generosity also happens to be a time of indulgence with lavish dinner spreads, delectable baked goods and lots of sweets. Considering all the temptations, it’s common to forget about the basics that maintain proper health the rest of the year. I’ve asked some area health experts to offer a few morsels of advice on staying well this holiday season — in both body and mind.

The biggest culprit in sabotaging diet and health during the holiday season is overindulgence, according to Dr. Alexis Hugelmeyer, medical director and family physician at The Suah Center in Riverhead.

“We actually see an increase in hospitalizations due to heart attacks, congestive heart failure and abnormal heart rhythm during the holiday season,” she said.

Devouring those rich holiday meals means you’re likely exposing yourself to high levels of sodium, or salt, which can drive up blood pressure. Combining high blood pressure with alcohol can lead to abnormal heart rhythm, Dr. Hugelmeyer said. Add in the stress of the season and the combination can prove too much for many unsuspecting adults.

Those with diabetes should be sure to monitor not only the sugary cocktails and homemade cranberry sauces but also carbohydrates from the meal’s previous courses. If you know that apple pie or sugar cookies will be too good to pass up, plan ahead and eat lightly during the main course.

“If you fall off track one day, that doesn’t mean your diet is ruined,” Dr. Hugelmeyer said. One of the best ways to stay the course is to give away leftovers, even if they make the perfect midnight snack. Pick up containers ahead of time and prepare doggie bags for friends and family — your waistline will thank you later.

The family cook should also consider serving the main meal earlier in the day. You want to enjoy dinner and dessert, but keep in mind that the body needs time to metabolize all those calories before bedtime, when digestion slows down.

You can also kickstart your metabolism by drinking a glass of water a few minutes before eating, which may minimize the urge to overeat, Dr. Hugelmeyer said.

Despite the joys the season brings, those planning and hosting holiday events can often become overwhelmed and stressed. Susan Dingle, a therapist and licensed clinical social worker in Southold, offered a few tips to deal with the emotional pitfalls that accompany holiday celebrations.

Strained family relationships can often flare up at the holidays and can make it feel like there’s an “elephant in the living room,” Ms. Dingle said. Conflict tends to lead to a breakdown in communication, which can spiral out of control and become a full-on family feud — and you do not want family tension to ruin the celebration.

“The most important thing is to not get caught in the middle of someone else’s dispute,” she said. “If the parties try to recruit you to their side, just assure them you love them both and trust they can work it out themselves.”

The loss of a loved one can be especially difficult to deal with during family-centered holidays, Ms. Dingle said. To work through those feelings — which can arise no matter how recently or long ago the loss occurred — she recommends accepting the sadness as part of the holiday.

“I would say honor the loss in some special way and be true to your feelings,” she said. “If we accept our feelings and not judge them, we’ll notice that the feelings do pass.”

Finally, don’t forget about yourself in all the holiday hoopla. Hosts often neglect their own well being, Ms. Dingle said.

“I have learned that the more people tune in to the intangible aspects of the holidays — the values of love, kindness and gratitude — the easier it is to deal with the stresses and disappointments,” she said.

Got a health question or column idea? Email Carrie Miller at cmiller@timesreview.com. Follow her on twitter @carriemiller01.