AN ANTON MEDIA GROUP SPECIAL
Healthy Living OCTOBER 14 - 20, 2020
BREAST CANCER AWARENESS MONTH
How To Treat Breast Cancer
Also inside: When to sign up for Medicare Dr. Marlene L. Levy
PhD, LCSW, DAIPM • CONTACT:
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Early Onset Alzheimer’s: A Love Story
“Ice Cream in the Cupboard engages the reader from the beginning. It compels one to keep turning the pages if for no other reason than to find out what troublesome behavior Carmen will exhibit next and how Moffett will deal with it.”
JAIME KING joins Indie “Ice Cream in the Cupboard’’ The book tells of a couple’s fractured life when the wife is diagnosed with earlyonset Alzheimer’s disease. Claudia Ferri (The Killing) and Dana ( Ashbrook (Twin Peaks) are plalying the couple. King will play a neurologist who tries to help the duo. BASED ON THE BOOK BY PAT MOFFETT
Available On
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How To Treat Breast Cancer Patients have more choices now than ever before
BY EMILY SAUCHELLI esauchelli@antonnews.com
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ccording to The American Cancer Society, the average risk of a woman developing invasive breast cancer is 13 percent and as a woman ages, the change of having breast cancer increases. Treatment options have advanced over time and the patients—no matter what age— have a variety of options at their disposal. There are three kinds of treatment pathways for women with breast cancer , which warrants a multi-disciplinary approach. The first being, surgery, the second, radiation oncology and the third, medical oncology. NYU Winthrop Hospital’s Perlmutter Cancer Center has a team of experts— who work together side-by-side to solve the puzzle that is breast cancer. When trying to treat breast cancer surgically, doctors have specific procedures. Dr. Shubhada Dhage is the director of breast surgical services and director of the breast health program at Perlmutter. She said there are two kinds of surgical procedures that can be used as methods to remove the cancer. “A patient can have what we call breast conservation, which means that we are conserving the breast and the patient can keep their breast and we removed only the tumor,” Dhage said. “The term for that is called lumpectomy. The other type of surgery a patient can have is called a mastectomy— when we remove the entire breast. We can do what’s called an oncoplastic lumpectomy to sort of reshape the breast to make sure that the contour of the breast looks good. We [can] do a lumpectomy or we do what’s called a nipple sparing mastectomy, where we try to hide the scar of a mastectomy and we keep the whole envelope of the breast.” There have been advancements in the way breast cancer surgery is performed now versus years ago. Dr. Dhage said today’s method is much more effective for the patient.
Dr. Nina D’Abreo, at the Perlmutter Cancer Center at NYU Winthrop Hospital, explains to a patient the pathology of breast cancer. (Photo courtesy of NYU Winthrop Hospital)
Dr. Shubhada Dhage.
(Photo courtesy of NYU Winthtrop Hospital)
“One way that has changed how we perform the surgery is before almost every patient had a long wire placed in the breast at the time of surgery in order to help a surgeon do [the] breast conservation or what we call lumpectomy,” she explained. “That patient’s day is somewhat longer. They have to undergo a procedure on the same day of surgery and it’s not as convenient. Now, we can place special markers in the breast, so that in the operating room, we can identify those markers either using a radar device or an ultrasound or a nuclear probe to identify exactly where the tumor is.” Dr. Amy Solan is a radiation oncologist at NYU Winthrop Hospital and said radiation is
Dr. Amy Solan.
(Photo courtesy of NYU Winthtrop Hospital)
performed after surgery—after a lumpectomy or after a mastectomy. “After a lumpectomy, we will need radiation to that breast to lower the risk of cancer coming back in the breast,” Solan explained. “Although, obviously there are exceptions. After a mastectomy, some patients do not need any radiation. Some patients we see have risk factors in the pathology, like positive lymph nodes or positive margins, large tumor size, things that may indicate a higher risk of cancer coming back either on the chest wall or in the nearby regional lymph nodes.” Dr. Solan said advancements in radiation treatments are becoming more of a reality
for patients. “Years ago, everybody would get 25 or 30 radiation treatments that are given on a daily basis,” Solan explained. “Now we’re doing our best to do shorter courses. [We do what] we call hypo-fractionation treatments. An example of the hypo-fractionated breast treatment might be 15 to 20 treatments to the whole breast.” According to Dr. Solan, the Perlmutter Cancer Center at NYU Winthrop Hospital is currently conducting a clinical trial to try and lessen the amount of treatments a patient would receive under radiation. “We have an open protocol where we’re treating just with
a single treatment for selected breast cancer patients,” Solan adds. “This is in conjunction with physicians at UT Southwestern Medical Center.” Dr. Nina D’Abreo is a medical oncologist and the medical director of the breast health program at Perlmutter. D’Abreo’s role involves not only treating the patients with breast cancer, but she also aides the patients after their treatment. “As [medical] director most of my function is to actually create processes within the program that allow [survivorship] this to happen,” she explains. “[Our breast health program] allows patients to have a seamless travel journey, right from diagnosis and then survivorship.” In terms of what a doctor’s role is in medical oncology, Dr. D’Abreo said medical oncologists work to treat the patients entire body. “We are the providers of what becomes systemic treatment,” she explained. “One way I look at it and I tell my patients, ‘think of it as a seed in the soil.’ The seed is the breast where the cancer is and radiation and surgery kind of work there. We treat the soil. We treat all of you, because cancer cells have a tendency to spread and go other places.” Dr. D’Abreo added that there are advancements being made in the medical oncology field. “The clinical trials that are ongoing are really trials to see how we can optimize or make cancer therapy better and minimize the use of chemotherapy, both in the setting of women with what we call early stage breast cancer before it has spread,” D’Abreo said. “But also in women with what we call metastatic or advanced breast cancer. It’s a list of trials, which are comparing either established drugs or drugs that are new in the market. [It’s] experimental in phase two or phase three trials, where we’re trying to make people live longer and to minimize side effects.”
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Advancements In Research
A look inside triple-negative breast cancer BY MALLORY WILSON
T
editorial@antonmediagroup.com
he Feinstein Institutes for Medical Research, the research arm of Northwell Health, is the location for 50 research labs and 2,500 clinical research studies. One of these research studies includes triple-negative breast cancer (TNBC). Dr. Annette T. Lee, an associate professor at the Feinstein Institutes for Medical Research has done quite a bit of research on cancer cells. Lee got her start working on the genetics of autoimmune diseases such as rheumatoid arthritis, lupus and inflammatory bowel disease at The Center for Genomics and Human Genetics as an assistant professor. Now, as an associate investigator and director of the Laboratory of Translational Genetics, she has
created her own area of research looking into the genetics of cancer. Triple-negative breast cancer got its name because the specific tumors associated with this type of cancer do not express the estrogen receptor, the progesterone receptor, and the human epidermal growth factor receptor. These three receptors are specifically the ones oncologists target when using chemotherapy. This makes triple-negative breast cancer especially hard to treat. “It’s not just cancer cells, it’s other types of normal cells that the tumor incorporates into itself,” Dr. Lee said. This type of breast cancer occurs more often in younger women who are Hispanic and African American and have the BRCA 1 mutation. “The statistics change year to year, but it is about 250,000 women who are diagnosed with breast cancer,” Lee
said. “Ten to 20 percent of those have triple-negative breast cancer.” The focus of Lee’s research, which started about 10 years ago, is to find out what makes triple-negative breast cancer so aggressive and to identify those tumors that have a high likelihood of recurring. Currently, Dr. Lee and her colleagues are collecting tumors and looking at all the cells to identify which cells are important and why they are important. To do this, they took tumor tissue from seven women who had triple-negative breast cancer who had a recurrence within five years of their first surgery and tissue from nine women who had triple-negative breast cancer and were cancer-free after five years. What they found after comparing the gene expression profiles of the
The Feinstein Institutes for Medical Research is located on Northern Boulevard in Manhasset. (Photo courtesy Feinstein Institutes for Medical Research)
women who had a recurrence and those who did not was that the tumors were very different. With this observation, they now know they need to find out what about these genes causes tumors to be more aggressive.
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“If you can identify what those genes are and what they do, then you can develop a targeted therapy or you can target those cells that over-express certain genes,” she explained. The metastatic levels and recurrence
HEALTHY LIVING • OCTOBER 14 - 20, 2020
levels of triple-negative breast cancer are very high. More than 50 percent of women develop a recurrence within five years. “Women don’t die from triple-negative breast cancer,” Dr. Lee explained.
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“If you just took the tumor out it for breast cancer, especially since would be fine, but what happens cancer is unique to each person, Dr. when you take the tumor out is that Lee hopes to her research will help her there are some tumor cells that are find out as much as possible. left behind that develop a new tumor “For this particular study, I would somewhere else.” feel complete if I knew which parIt is suggested that women start get- ticular cell in genes is the one that ting mammograms regularly after caused triple-negative breast cancer the age of 40, but if there is tumors to become metastatic a family history of breast and if I could prevent that cancer, earlier may be from happening,” Dr. better. Lee explained. “Just to Dr. Lee says she “Just to influence the influence the outcome chose this area outcome in just a small in just a small percentof study after she percentage of women, age of women, I would heard about other I would feel good that I feel good that I made doctors’ research a contribution to their made a contribution survival. and wanted to form ” to their survival.” a collaboration. All Even though you have Annette T. Lee, PhD of the research for this to be undergoing treatinvestigation is done at the ment at one of Northwell’s Feinstein Institutes. Everyone hospitals to be involved in the plays a role to help further the triple-negative breast cancer research, research. people can still help in other ways. To “We all work together,” she said. be involved with another investigation “The surgeons see the patients, the of Dr. Lee’s—the early-onset breast oncologists treat them with chemocancer investigation—you can request therapy and they want to help me find a saliva kit be mailed to you if you were new treatments. Even though we speak diagnosed under the age of 40. Once you complete the saliva kit you mail it different languages, we still have the back and Dr. Lee extracts the DNA and same goal.” completes an analysis on it, which will Although it can never be known whether a definitive cure will be found further help in her research.
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The Facts Of Medicare How the process works and when to enroll
What is not covered under Medicare Parts A and B? Medicare Part A and Part B does not cover the following: acupuncture, cosmetic surgery, dental exams, dentures, eye exams including prescription glasses, hearing aid exams and fittings, as well as long-term care—for those who are unable to perform the daily activities without assistance.
BY EMILY SAUCHELLI esauchelli@antonnews.com
What is Medicare? Medicare is health insurance for people ages 65 and older. However, there are some exceptions to that rule. Medicare also provides coverage for those with disabilities, who are under the age of 65, if they meet certain criteria. Medicare recognizes those who are under the age of 65 and have illnesses such as Amyotrophic Lateral Sclerosis (ALS) , a disability, or end stage renal disease—more commonly known as kidney failure. What does Medicare cover? There are three main parts that make up the Medicare system. Part A covers hospitalization. Part B covers outpatient procedures and doctor visits. There are penalties later on if you don’t elect a Part B plan when you start with Part A. Lastly, Part D is for prescription drug coverage. For Part D, it’s important to check which medications are covered and which are not under the plan you choose, so you can
Medicare starts enrollment on Oct. 15, 2020. plan accordingly. There is also is a choice between the traditional “fee for service” Medicare. This option pays for 80 percent of medical costs but you will still need a supplemental insurance plan to cover the remaining 20 percent of financial responsibilities. The second option is called managed Medicare. Managed Medicare
(Photo courtesy Unsplash)
plans are typically offered from private insurance companies. Some examples of managed Medicare insurers include UnitedHealthcare, or Aetna. But there are many others to choose from, so it’s important to find the right plan for you— that meets both your financial expectations as well as your health needs.
When can I sign up for Medicare? For those of you who are turning 65 this year, it is vital that you investigate your options. If you are already have either a “fee for service” Medicare plan or a managed Medicare plan, you have the ability to make any changes during the enrollment period. If you decide to make a change to your Medicare plans, your new plan will begin on Jan. 1, 2021. Open enrollment for Medicare begins Oct. 15 and ends Dec. 7. To learn more about Medicare, visit www.medicare.gov or call 1-800-633-4227.
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Congratulations to Our Nurses!
Congratulations to our nurses at St. Francis Hospital, The Heart Center®, for achieving the Magnet Recognition for Excellence in Nursing Care for the fourth consecutive time. Thank you for your leadership, care, and innovation that is the foundation of the tradition of excellence at St. Francis. We appreciate that your hearts are focused on exceptional patient care every day, enabling St. Francis to be recognized as the safest hospital on Long Island.
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Stroke Of Good Fortune Westbury man is a medical pioneer BY FRANK RIZZO
frizzo@antonmediagroup.com
Michael and Debbie Robbins at their Westbury apartment after his operation. (Photo courtesy of Northwell Health)
M
ichael Robbins opened his mouth, and no words came out. The Westbury business man and world traveler was in a Buenos Aires hotel room with his wife Diane this past February. They were getting ready to go downstairs and meet their tour group for dinner. “I was mid-sentence and I just stopped talking. I couldn’t say anything,” Robbins related. “My wife is a physical therapist and she’s very familiar with stroke patients and those types of scenarios. She realized right away that I was having a stroke.” Robbins was taken by ambulance to what he called “the best private hospital” in the Argentine capital. He spent six days and started recovering almost immediately, quickly regaining his speech. But it was a scary moment. And a battery of tests did not reveal the cause of this medical episode. The couple has been to every continent but Australia and Antarctica. They were in Argentina en route to the icy continent, scheduled to take a cruise from the resort city of Ushuaia. Located at the southernmost tip of South America, it is also known as the “End of the World.” Ironically, Robbins’ cardiologist, Dr. Jay Kugler, had recommended the
Antarctica tour after taking it himself in December. The couple had taken out trip insurance, and the tour operator, Tauck, flew a rescue nurse in from Houston. He accompanied them back to New York on a regular commercial flight. The experience has made Robbins reexamine his globetrotting ways. Asked if he would like to try again to reach Antarctica, he replied, “The fact that I had the stroke in February and they haven’t really identified any reason for why I had it makes me reticent to travel that far from good
hospitals. Not that I didn’t have good care in Buenos Aires.” He added, “Given that I’ve done a great deal of travel, I think I’m going to curtail it for the time being at my age.” Dr. Kugler, based in Great Neck and associated with Northwell Health, arranged to have Robbins wear a Holter monitor, an electrocardiography device to record the heart’s electrical activity. It looked for signs of arrhythmias or irregular heartbeats. One of these is labeled atrial fibrillation and is a leading cause of strokes.
The Medtronic Reveal LINQ II is a potential game changer in cardiac monitoring. (Medtronic photo) Though it can operate for hours at a time, the Holter can easily overlook irregularities that take place infrequently, as was suspected in Robbins’ case.
Globetrotter Robbins runs NexGen Enviro Systems based in Lindenhurst. According to its website, it provides “on-site solvent recycling, recovery and distillation capabilities.” Robbins said his firm helps companies, such as those involved in the defense industry, deal with solvents, many of which pose a danger to the environment and require special machinery to recycle and dispose of. “I import machinery from Italy,” he said. “When I bought the company 30 years ago and I started making trips to the factory, my wife and I would make side trips throughout Europe. We just expanded over the years to more exotic places.” He mentioned traveling throughout the north in India, from Shanghai to Beijing, Scandinavia, Russia, and much of southeast Asia and South America. Antarctica and Australia are the two continents left,
and Robbins said that he doesn’t know if he was up to doing them now. Australia involves spending up to 20 or more hours in flight, and potentially exposes one to a condition called deep vein thrombosis. This is a blood clot that typically forms in the legs and can be potentially fatal if it travels to the lungs. He and Diane lived in Jericho for 41 years and recently downsized to an apartment in Westbury. They also own a house in Boca Raton, FL. Robbins said that “When I look in the mirror I still think that I’m in my 40s and 50s,” but the stroke was sobering. He bikes when he’s in Florida, but he claims he’s “not a big exercise freak.” He and Diane have two sons, Jason (Michael’s business partner) and David, a urologist in North Miami, FL. They have three grandchildren, Olivia, Talia and Brandi.
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Little Device With Big Implications
After wearing the Holter for several months, he said, nothing unusual showed up. It was time for the next generation in heart monitors.
New And Improved
On July 7 of this year, the U.S. Food and Drug Administration (FDA) approved the Medtronic Reveal LINQ II, a small wireless cardiac monitor. The device is injected just under the skin and gives continuous feedback on infrequent heart rhythm problems. It has a battery life of between 4 and a half to 5 years and can be monitored remotely. On July 17, Robbins was at the Sandra Atlas Bass Heart Hospital at North Shore University Hospital, part of Northwell. He was going to be among the first patients in the world to have the LINQ II implanted. “I had to wait for it to come in by UPS,” he recalled. “I waited in the procedure room and was discussing travel and restaurants with all the medical staff in the room waiting for them to get it.” The device, he said, was the size of a paper clip, and inserting it took less than three minutes. “It’s nice to be a pioneer,” Robbins reflected. “They told me I didn’t even have to bring my wife to take me home. I went back to the dressing room and got dressed and I had to wait for the doctor to come in and explain how to hook up the monitor. You just plug it in and it starts up immediately.” There was no recovery period whatsoever, he said. “They told me to go about my business,” Robbins affirmed. “They gave me a card for airport security use, but no one is flying anyway so it doesn’t matter. And they told me we probably won’t get questions about [the device].” The procedure team was led by Laurence M. Epstein, MD, who is Northwell’s director of electrophysiology. Robbins, who had no known risk factors for the stroke, said, “I consider myself lucky to be alive—if my stroke didn’t happen in a large city during my travels things could have turned out differently. With the new cardiac monitoring device, I now have reassurance if I have an alarming heart symptom it will be picked up immediately.” According to Dr. Epstein, “The health system manages many thousands of patients with implanted cardiac devices through the Northwell Remote Monitoring Center. Specially trained technicians and nurses review the transmitted information and communicate with each patient’s physician. With the center in place, it allows us to quickly respond during the current coronavirus pandemic.”
BY FRANK RIZZO
frizzo@antonmediagroup.com
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r. Laurence Epstein used the word “game changer” often during an interview with Anton Media Group recently. The head of the electrophysiology unit at Northwell Health, he performed the first implant this past summer of the Medtronic LINQ II, a cardiac monitoring device of uncommon size and capability. His initial patient was Michael Robbins of Westbury, who suffered a stroke of undetermined origin. “It’s potentially a game changer,” he said of the device. “Right now, it’s an iteration of existing technology with improvements.” Existing cardiac monitors have different capabilities, but they all fail in one big way—in the crucial measurement of heart rhythm, they might miss very infrequent irregularities. The LINQ II, with an improved battery, provides wireless, remote monitoring for up to five years. “The other advantage is that the algorithms are much better at differentiating different arrhythmias,” Epstein observed. “We can also change the settings remotely without having to do [an invasive] procedure.” A press release noted that the device also registers “the frequency of premature ventricular contractions (PVCs) or extra beats from the lower chamber of the heart.” The remote setting, Epstein stated,“is going to be the game changer in the sense that right now the things we put in people like pacemakers and implantable defibrillators, when you need to reprogram them you have to come in for surgical procedures. This is proof that you can do it. You will start with this device, but I suspect it’s going to move to defibrillators and pacemakers in the future. That component is novel and may ultimately be a game changer when it gets applied to other devices.” As far as preventing strokes, the most crucial of arrhythmias is atrial fibrillation, he said, describing it as “when the upper chambers of the heart go crazy and blood clots therefore form. The heart is not actively squeezing, so blood can
Laurence M. Epstein, MD, Northwell Health’s director of electrophysiology, shows off the Medtronic LINQ II device. (Photo courtesy of Northwell Health)
pool in the pouches that are in the upper chambers and fly off and cause a stroke.” The device might also aid people who suffer mysterious fainting spells; detecting arrhythmias may lead to the proper detection and prevention. Robbins’ episode, Epstein said, “is called a cryptogenic stroke, when we don’t know why it occurs. One of the things that you want to know is if they’re having unknown episodes of atrial fibrillation.” He added, “Some people who have a-fib a very symptomatic— they get heart palpitations or they feel their heart rate increasing. The large number of patients with a-fib do not have symptoms. You want to know that in a person who had a stroke because it will change your patient management. You will put them on oral anticoagulants [blood thinners] like coumadin and new agents like eliquis or xarelto.” Epstein said the LINQ II, despite its size, has another attribute. “On the back it has this clear ceramic or sapphire, and down the road that is going to allow the company to place all kinds of sensors on it,” he pointed out. “Right now, it only monitors the electrical activity of the heart. It’s conceivable that this could be a platform that you can put on a glucose monitor for diabetes. You can put in an oxygen saturation monitor to monitor people’s respiratory status. There are things that could foretell heart failure so you can intervene before they have to come to the hospital. It’s a platform for many things that
may really change how we manage patients remotely. This is even more valuable in the COVID-19 era.” One of the baleful consequences of the pandemic, especially in its early stages, Epstein said, was that people were dying unnecessarily because they were not seeking medical care for things they were normally sick from. “The advice they were getting was ‘stay home, don’t go near hospitals.’ So we found that people were dying of heart attacks because they weren’t going to the hospital or were afraid to go there,” he said. “Or people were getting much sicker than they should have. Having a technology that allows you to monitor people remotely, especially in the COVID-19 era, is going to be hugely beneficial.” Electrophysiology, he said, started in the late ’80s, and “a lot of the stuff we do today has really evolved over the last few decades. I’ve been very fortunate that my career has spanned that and I got to play a part in helping to develop a lot of the stuff that just didn’t exist before, whether is was catheter ablation or implantable defibrillators and all the monitoring devices did not exist.” LINQ II, he stated, does not involve invasive surgery. “You make a teeny nick in the skin, and there’s this plunger device that injects it under the skin. So you really don’t need to be a surgeon to put this in. It’s really easy,” he said. Epstein noted that there has been progress made against heart disease in general with better outcomes and people living longer. He mentioned preventative things like diet and exercise, and the introduction of medicines that have lowered the rate of heart attacks. “The treatment for heart failure has dramatically evolved,” he concluded. “We’re putting in defibrillators that save people’s lives that were dropping dead previously. There are all kinds of new medications, whether it’s beta blockers, ace inhibitors and now entresto. All make a difference not only in terms of people’s length of life, but in their quality of life, which is really important.”
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Encouraging Healthy Eyes For Back-To-School Amid COVID-19
s the back-to-school season is in full swing, it is an ideal time to get your child’s eyes checked and focus on healthy vision habits. This takes on added importance given the pandemic, which has prompted many people to spend more time on digital devices and required a move to distance learning for millions of students nationwide. In fact, children now spend an average of 13 hours per day on digital devices, potentially contributing to digital eye strain and increasing the risk of nearsightedness among young people. Children may be especially at risk, as their still-developing eyes generally allow for more high-energy blue light to reach their retinas. Additionally, children may hold devices closer to their face, leading to a higher amount of potentially harmful blue light exposure. Good eye health is important for everyone and especially for students, in part because 80 percent of what children learn is through their eyes. With that in mind, here are three eye
health tips to consider. Reduce the risk of digital eye strain: Digital eye strain may be caused by prolonged use of computers, smartphones or tablets, potenDr. Scott Edmonds. tially causing (Photo courtesy of symptoms such UnitedHealthcare) as sore, tired, watery or dry eyes, headache, or sore neck, shoulder or back. To help reduce the risk, encourage your child to practice healthy vision habits by keeping computer screens at least 30 inches away from their eyes, resting their eyes every 20 minutes and blinking frequently to avoid dry eyes. Practice the 20/20/20 rule: every 20 minutes, take 20 seconds and look at something 20 feet away. Getting outside and away from digital screens may also reduce the risk of nearsightedness, which
affects 41 percent of Americans—up from 25 percent in 1970. Also, look for digital devices that include blue-light blocking technology or obtain glasses with premium anti-reflective coating, which may help prevent potentially harmful reflective glare and reduce the risk of digital eye strain. Look for warning signs of eye issues: The inability to see clearly may affect a child’s physical, emotional and social development, which in turn may affect academic and athletic performance and, ultimately, self-esteem. Unfortunately, sometimes children may not be aware and won’t complain if their vision isn’t normal, so it’s important to look for possible signs of vision problems. Red flags may include squinting while reading or watching television, difficulty hitting or catching a ball while playing sports, or issues watching 3D movies such as discomfort or dizziness. These potential warning signs may indicate an underlying vision problem that might require glasses or other treatments from an eye care professional.
Get a comprehensive eye exam: The American Optometric Association recommends that a child’s first comprehensive eye exam should occur between six months and 12 months, again at age three and before entering school at age five or six. It’s important to remember that a school’s vision screening is not a substitute for a comprehensive eye exam. Vision screenings at school usually focus on measuring acuity levels and might miss common conditions such as poor eye alignment, focusing problems and farsightedness. Plus, a comprehensive eye exam may uncover other health conditions not usually associated with the eyes, including diabetes and juvenile rheumatoid arthritis. As families plan health and safety strategies, including immunizations and the flu vaccine, considering these tips may help make sure your child is ready to learn–either in person or remotely. —Submitted by Dr. Scott Edmonds Chief Eye Care Officer, United Healthcare
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How Does Your Skin Look?
T
he skin is the window to the body and many systemic diseases manifest with specific skin findings. Many liver problems will manifest on the skin and an astute observer can diagnosis liver conditions by carefully examining the skin. Unfortunately, most skin findings are overlooked in the current medical era unless a person is specifically evaluated by a trained dermatologist. Therefore, a good understanding of the skin manifestations of liver disease will prepare the non-dermatologist for more accurate and improved diagnosis of liver disease. Yellow Skin Yellowing of the skin or jaundice is perhaps the best-known skin finding seen in liver disease. When liver disease, regardless of cause, leads to a rise in the levels of bilirubin in the blood, the skin can
THE SPECIALIST David Bernstein, MD
turn yellow. The higher the bilirubin in the blood, the deeper yellow a person’s skin may become. When people with liver dysfunction are unable to adequate produce clotting factors and/or have low platelet counts, easy bruising becomes common. Therefore, frequently noticed
ecchymotic areas so called “black and blues” may also be a sign of liver disease. Skin Findings Palmar erythema or “liver palms” is a nonspecific red discoloration of the palms and fingertips of the hands associated with liver disease. About 25 percent of people with cirrhosis will have this finding that has been attributed to abnormally high serum estradiol levels. One of the more interesting common skin findings in people with liver disease is called spider nevi or spider angiomas. These are anomalies in the small blood vessels, in which a central arteriole is surrounded by smaller blood vessels, which radiate from its center. This gives an appearance resembling spiders’ legs, hence the name. These are caused by a failure of the musculature surrounding the arteriole to contract. Spider
angiomas are classically in the upper chest. While spider angiomas do occur in healthy people, the presence of more than five “spiders” is highly suggestive of underlying liver disease. Nails Nails can show changes suggestive of liver disease. Terry’s nail is a physical finding in which affected nails have a bed that is white or pink with a distal transverse band that is pink to brown in color. The degree of pallor of the nail bed and the darkness of the distal band can predict how long the underlying disease has affected the patient. Of course, this is hard to determine if the patient comes to the office wearing nail polish. Rashes Liver disease does not lead to rashes, but rather rashes can be a manifestation of a systemic process. Hepatitis
B, however, can cause the development of recurrent papular eruptions and skin nodules. Hepatitis C has been associated with such skin conditions as lichen planus, cryoglobulinemia and porphyria cutanea tarda. Primary biliary cholangitis commonly causes xanthelasma, a yellowish deposit of cholesterol underneath the skin most commonly seen around the eyelids. Most interesting, hereditary hemochromatosis causes a bronzing of the skin and affected people look as though they have a suntan. This is diagnosed by looking at the non-sun exposed areas of the body to ensure that no tan lines are present. It is important to have one’s skin checked regularly, not just for the development of skin cancer, but also for skin changes that can be present in other systemic disease states such as liver disease.
Local Photographer Creates ‘Porchtraits’ Of Long Island Families Initiative raises funds for NYU Winthrop Hospital
A physician assistant (PA) in the Surgical Intensive Care Unit at NYU Winthrop Hospital, who went above and beyond the call of duty for COVID-19 patients, was the inspiration for a Garden City photographer to find her own way to give back. Paulina Vastardis, the sister of the PA, specializes in family and portrait photography. She joined a nationwide initiative, “Front Porch Project,” that takes socially distanced photos of families on their front porches, snapping the photographs at no cost to the families but instead accepting donations for good causes. In the case of Vastardis putting her talent to good work, she took ‘porchtraits’ of more than 100 Long Island families, who were at least a 10-foot distance from the camera, on their front porches. By doing so, she raised $5,000 for NYU Winthrop, which included donations from 10 additional families who contributed
help us get through this pandemic.” NYU Winthrop extends a warm thank you to Paulina, the families, and her sister.
Socially distanced “porchtrait” of local Follette family, taken by Garden City photographer, contributed to NYU Winthrop donation. (Photo courtesy of Paulina Vastardis)
without requesting photos in turn. The proceeds will help NYU Winthrop’s Surgical Intensive Care Unit. “I am so grateful to have used my talents for good, spending my days
photographing families around Long Island to raise money for the hospital,” Paulina Vastardis said. “I’ve created memories for those families, and we’ve all come together to help those who continue to
NYU Winthrop is the Long Island affiliate of NYU Langone Health and is ranked by U.S. News & World Report as one of the top-10 New York metro-area hospitals. The hospital, a 591-bed medical academic center and ACS Level 1 Trauma Center, features more than 75 divisions of specialty care, offering comprehensive inpatient and outpatient programs and services to address every stage of life. NYU Winthrop also has a Research Institute that conducts robust research and studies that are helping to shape the future of medicine. The hospital’s campus is also home to NYU Long Island School of Medicine. —Submitted by NYU Winthrop Hospital
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NYU Langone On List For “100 Best Companies”
NICU nurse educator recognized as “2020 Working Mother of the Year
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YU Langone Health has been named a Working Mother “100 Best Company” for its forward-thinking workplace programs including women’s advancement, parental leave, child care assistance and work flexibility. As part of the recognition, NYU Winthrop Hospital Neonatal Intensive Care Unit (NICU) nurse educator, Leticia Rios, RN, MSN, has been named NYU Langone Health’s “2020 Working Mother of the Year.” The honoree, a mother to a five-year-old daughter, works in NYU Winthrop’s NICU where she serves as a nurse educator for more than 120 nurses on current evidence-based practices to improve patient outcomes. She is also a volunteer for Birth Justice Warriors, a Long Island organization aimed at decreasing the disparity of maternal-infant health outcomes among minorities. “As the daughter of immigrant parents, academics were not supported when I was a young child,” Rios said. “I recognized the need to take control of my future and am now very proud to have achieved considerable milestones in my nursing career while not losing sight of my motherhood and parenting responsibilities.” Rios is currently pursuing a PhD at Adelphi University and utilizing NYU Langone’s tuition
NYU Winthrop NICU Nurse Educator Leticio Rios balances work, motherhood, and community initiatives to improve maternal-child outocmes in women of color. (Photo courtesy NYU Winthrop Hospital) reimbursement program. She received a master’s degree in nursing education from Long Island University, where she previously obtained her nursing degree. Rios juggled those milestones with being a mother to her daughter, Jordyn, which brought challenges to her as a woman of color. Ms. Rios experienced complications after her daughter’s delivery, along
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with difficulty receiving support to exclusively breastfeed. Recognizing that breastfeeding has the power to reduce the incidence of maternal and infant morbidity and mortality, she became an International Board Certified Lactation Consultant and established a business to increase the initiation and duration of breastfeeding in women of color. She facilitates the “Brownsville Baby Café,” now conducted via Zoom due to the pandemic, to provide breastfeeding support—and address food insecurity and access—to women in underserved communities and shelters. In addition, she educates staff in physician offices on how to become breastfeeding-friendly and has created networks to connect mothers with doulas, home-visiting programs, and midwives to reduce maternal and infant outcomes. Rios balances the professional development of NICU nurses and her passion for supporting underserved women with raising her daughter, striving to influence Jordyn’s trajectory and success for the future by exposing her to early childhood education. Jordyn this month began attending a “Gifted and Talented” school program, and excels at reading, gymnastics, swimming and ballet. —Submitted by NYU Winthrop Hospital
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The Horrors Of Early Onset Alzheimer’s
Ice Cream In the Cupboard film reflects disease’s reality BY DAVE GIL DE RUBIO
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dgilderubio@antonmediagroup.com
ccording to the Alzheimer’s Association, up to five percent of the more than five million Americans with Alzheimer’s suffer from early-onset familial Alzheimer’s disease (EOFAD), afflicting patients between the ages of 30 and 60. Its devastating impact is well familiar to Great Neck resident Pat Moffett, whose late wife Carmen started showing signs of EOFAD when she was only 53. Mood swings, forgetfulness and hostility led to an EOFAD diagnosis that drove Moffett to eventually institutionalize his spouse before she succumbed to the disease 14 years later in 2010. The pain and anguish are shared in Moffett’s self-published book Ice Cream In the Cupboard, an account of his and his family’s traumatic journey that was adapted into a 2019 film of the same name. For the father of five, both projects serve as a public service to those dealing with the horror of EOFAD. “The biggest takeaway [from the book and film] is that it’s possible to get this disease at a young age and it’s dangerous for the caregiver,” Moffett explained. “If that’s the case. I’d like for them to learn how to protect themselves. I want to make sure that caregivers realize that their lives could be in danger from either being hurt by the loved one or the fact that they’ll run themselves down and die on their own.” The film stars Dana Ashbrook (2017 Twin Peaks reboot) as Moffett, Claudia Ferri (AMC’s The Killing) as Carmen and Jaimie King (Pearl Harbor, Sin City) as Dr. Giselle Cohen, who first diagnosed Carmen with EOFAD. The movie opens with the future married couple meeting Carmen and Pat Moffett while Moffett was on a sales call, where he (Photo courtesy of Pat Moffett) mistakenly assumed Carmen was a secretary versus the office manager of the company he was visiting. his seat while his wife stormed off. After chasing The narrative eventually leads to his wife Carmen down and assuring local police everyhaving significant lapses in memory and lashing thing was okay after he caught up with her, the out about incidents that had happened years couple returned to their hotel room. ago. A number of scenarios were derived from “Carmen laid down in the bed while I went real-life anecdotes including a scene where out on the terrace and had four of the fastest Ferri’s Claudia mashes a plate of cake onto her cans of beer in my life,” Moffett recalled. “I husband before storming off. In reality, this was shaking from head to toe. I had no idea was adapted from a scenario where Moffett and what just happened. Carmen came out on the his wife, who had been bickering at the time, terrace, said she was starving and asked when I escaped for a romantic weekend getaway to her was going to feed her. She wanted to know if we Puerto Rican homeland where they were having were going to go out to dinner. I said I tried that dinner at a gorgeous seafood restaurant in San and that she threw food at me. She said she’d Juan. Dining on an outdoor veranda, Moffett was never do that to me and that I sometimes joke commenting on a number of vintage cars parked around too much. She also wanted to know outside when his spouse suddenly hit him with how I got all that [crap] on my shirt. My mouth a plate of steak and lobster forcefully enough to opened and I didn’t know what to say. We were knock the 6’3” Vietnam veteran backwards off on the first plane the next day. I never felt so
alone because something was happening to me that I couldn’t imagine happening to someone else. I had no idea what this was. Like everybody else, I thought you got Alzheimer’s when you were around 80.” Carmen was eventually diagnosed with EOFAD. As her condition deteriorated, the toll of being a caregiver started to take its toll on Moffett, his family and finances, as he had to cut back on his work hours and eventually had his spouse committed. “When they put Carmen into a full-time center for three weeks, the doctors told me to stop now because I was a mess,” he said. “I’d lost weight and my heart rate was not good at all. Carmen was beating up other patients in the Alzheimer’s daycare center I had her in. This ate up my savings—it was $600 a week for the daycare center so I could go to work. She was just punching out 90-year-old people where we could have been sued. Both the center and family of the Alzheimer’s patient can be sued. These people understood and knew the disease, so we didn’t have to deal with that. That was a very difficult time.” The film reflects the reality of EOFAD’s effects on the patient and their family in a way that’s led to it being positively received. It was one of 50 films chosen out of 6,500 entries at the 2019 Rhode Island International Film Festival, where it won Best Feature Film Narrative and the Best Feature Film Audience Award. While Moffett is proud of these accolades, he’s most satisfied by its portrayal of EOFAD. “The other films that have been done on Alzheimer’s—The Notebook, Still Alice, Away From Her—were excellent movies with terrific actors, but they missed the mark on the violent behavior,” he said. “I think they missed the mark because they barely have any agitation in them. That’s why I think Ice Cream in the Cupboard takes it up a notch in terms of what really goes on in that Alzheimer’s world when it comes to the violent behavior.” Ice Cream In the Cupboard can be viewed on Amazon Prime, Google Play, Xbox, YouTube and iTunes/Apple TV.
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