Focus On Health - June 3, 2021 by TBR News Media

MAY 27, 2021 • ARTS & LIFESTYLES • PAGE B13

Focus on Health Making sense of migraines How to reach a healthy blood pressure

Alcohol & COVID-19 Food’s important role in overall health A SUPPLEMENT TO TIMES BEACON RECORD NEWS MEDIA • MAY 27, 2021

PAGE B14 • ARTS & LIFESTYLES • MAY 27, 2021

FOCUS ON HEALTH

Did you start You're not alone drinking more and help is available during COVID?

PORT JEFFERSON DERMATOLOGY Peter A. Klein, MD Adam J. Korzenko, MD Brett M. Dolgin, DO * Wil D. Tutrone, MD Vanita Srivastava, DO * Renee Fruchter, MD

s COVID hit and stay-at-home orders A began, alcohol sales and consumption skyrocketed. Nielsen reported a 54%

Nights And Weekends Available We provide outstanding dermatologic care to patients with diseases of the skin, hair, and nails. All care is provided by a physician who is board-certified in Dermatology * Dr. Dolgin and Dr. Srivastava are pleased to offer Botox and fillers. Please call for more information.

increase in national sales of alcohol for the week ending March 21, 2020, compared with the year prior; online sales increased 262% from 2019. In several national surveys, more than half of adult respondents said that they were drinking more frequently — often daily — and many said that they were having more drinks at each sitting, with about a third engaging in potentially dangerous binge drinking. The jump in alcohol use was largest among women and not surprisingly, people of all ages cited increased stress, anxiety and grief coupled with increased alcohol availability and boredom as contributing factors. As the world returns to “normal” and day drinking memes on social media begin to fade, some of those who have become accustomed to a 3 p.m. drink or who have increased the number of glasses of wine or beer they consume with dinner will have a hard time going back.

How do you know if you’re drinking too much?

New office location opening June 2021 631.928.7922 6 Medical Drive, Suite D Port Jefferson Station, NY 11776 631.475.8249 100 Hospital Road, Suite 116 Patchogue, NY 11772

NEW 631.223.4599 400 West Main Street, Suite 211 Babylon, NY 11702

www.portjeffdermatology.com ©24220

According to the federal government’s Dietary Guidelines for Americans, moderate alcohol consumption is defined as having up to one drink per day for women and up to two drinks per day for men. This definition refers to the amount consumed on any single day and is not intended as an average over several days. The Dietary Guidelines, however, also say that people who don’t usually drink alcohol shouldn’t take that as a green light to start. The Dietary Guidelines define a one alcoholic drink equivalent as containing 14 g (0.6 fl oz) of pure alcohol, which includes 12 fluid ounces of regular beer (5% alcohol), 5 fluid ounces of wine (12% alcohol), or 1.5 fluid ounces of 80 proof distilled spirits (40% alcohol). In comparison to moderate alcohol consumption, high-risk drinking is the consumption of four or more drinks on any day or eight or more drinks per week for women and five or more drinks on any day or 15 or more drinks per week for men. Binge drinking is the consumption within about two hours of four or more drinks for women and five or more drinks for men.

Excessive alcohol consumption, which includes binge drinking, high-risk drinking, and any drinking by pregnant women or those under 21 years of age comes with significant risks. Excessive drinking increases the risk of many chronic diseases BY JEFFREY L. REYNOLDS and violence and, over time, can impair short- and longterm cognitive function. Binge drinking is associated with a wide range of health and social problems, including sexually transmitted diseases, unintended pregnancy, accidental injuries, and violent crime. As scary as all that can be, there’s a ton of help available both in our local communities and online, where trained professionals can help you assess your drinking and if need be, help you come up with strategies to cut-back or quit. At FCA, we operate two state licensed outpatient treatment centers, two recovery centers and recovery coaching (Call 516-7460350 or visit FCALI.org). LICADD runs a 24-hour assessment and referral hotline at 631-979-1700 as does Response at 631-7517500 and Project Hope at 1-844-863-9314. There are also a number of free or lowcost addiction recovery smartphone apps that give consumers 24/7 access to selfhelp and tracking tools, 12-step programs, motivational tools, and reminders. Sober Grid, SoberTool, Nomo, WEconnect, rTribe, and 24 Hours a Day are just a few of the popular resources. Alcoholics Anonymous and other 12-step programs have meetings online, along with a host of other online sobriety support groups. Of these, Self-Management and Recovery Training (SMART), Loosid, LifeRing, Club Soda, Women for Sobriety, and Tempest are among the top-rated. Emerging from COVID and returning to normal is going to look different for everyone. If it’s proving to be challenging for you or someone you love, pick up the phone, fire up your computer and reach out for help today. You are not alone. Dr. Reynolds is the President/CEO of Family and Children’s Association (FCA), one of Long Island’s oldest and largest nonprofits providing addiction prevention, treatment and recovery services.

MAY 27, 2021 • ARTS & LIFESTYLES • PAGE B15

FOCUS ON HEALTH

8 ways to reach a healthy blood pressure

o take care of your heart, it’s important to know and track your blood pressure. Millions of Americans have high blood pressure, also called hypertension, but many don’t realize it or aren’t keeping it at a healthy level. For most adults, healthy blood pressure is 120/80 millimeters of mercury or less. Blood pressure consistently above 130/80 millimeters of mercury increases your risk for heart disease, kidney disease, eye damage, dementia and stroke. Your doctor might recommend lowering your blood pressure if it’s between 120/80 and 130/80 and you have other risk factors for heart or blood vessel disease. High blood pressure is often “silent,” meaning it doesn’t usually cause symptoms but can damage your body, especially your heart over time. Having poor heart health also increases the risk of severe illness from COVID-19. While you can’t control everything that increases your risk for high blood pressure – it runs in families, often increases with age and varies by race and ethnicity – there are things you can do. Consider these tips from experts with the National Heart, Lung, and Blood Institute’s (NHLBI) The Heart Truth program:

#1: KNOW YOUR NUMBERS Everyone ages 3 and older should get their blood pressure checked by a health care provider at least once a year. Expert advice: 30 minutes before your test, don’t exercise, drink caffeine or smoke cigarettes. Right before, go to the bathroom. During the test, rest your arm on a table at the level of your heart and put your feet flat on the floor. Relax and don’t talk. #2: EAT HEALTHY Follow a heart-healthy eating plan, such as NHLBI’s Dietary Approaches to Stop Hypertension (DASH). For example, use herbs for flavor instead of salt and add one fruit or vegetable to every meal. #3: MOVE MORE Get at least 2 1/2 hours of physical activity each week to help lower and control blood pressure. To ensure you’re reducing your sitting throughout the day and getting active, try breaking your activity up. Do 10 minutes of exercise, three times a day or one 30-minute session on five separate days each week. Any amount of physical activity is better than none and all activity counts. #4: HAVE A HEALTHY PREGNANCY High blood pressure during pregnancy can harm the mother and baby. It also increases a woman’s risk of having high blood

pressure later in life. Talk to your health care provider about high blood pressure. Ask if your blood pressure is normal and track it during and after pregnancy. If you’re planning to become pregnant, start monitoring it now. #5: MANAGE STRESS Stress can increase your blood pressure and make your body store more fat. Reduce stress with meditation, relaxing activities or support from a counselor or online group. #6: STOP SMOKING The chemicals in tobacco smoke can harm your heart and blood vessels. Seek out resources, such as smoke free hotlines and text message programs, that offer free support and information. #7: AIM FOR A HEALTHY WEIGHT If you’re overweight, losing just 3-5% of your weight can improve blood pressure. If you weigh 200 pounds, that’s a loss of 6 to 10 pounds. To lose weight, ask a friend or family member for help or to join a weight

loss program with you. Social support can help keep you motivated. #8: WORK WITH YOUR DOCTOR Get help setting your target blood pressure. Write down your numbers every time you get your blood pressure checked. Ask if you should monitor your blood pressure from home. Take all prescribed medications as directed and keep up your healthy lifestyle. If seeing a doctor worries you, ask to have your blood pressure taken more than once during a visit to get an accurate reading. To find more information about high blood pressure as well as resources for tracking your numbers, visit nhlbi.nih.gov/hypertension.

TIMES BEACON RECORD NEWS MEDIA EDITOR AND PUBLISHER Leah S. Dunaief GENERAL MANAGER Johness Kuisel MANAGING EDITOR Rita J. Egan EDITOR Julianne Mosher LEISURE & SUPPLEMENTS EDITOR Heidi Sutton ADVERTISING DIRECTOR Kathleen Gobos ACCOUNT EXECUTIVES Elizabeth Bongiorno Robin Lemkin Minnie Yancey ART/PRODUCTION DIRECTOR Beth Heller Mason ART DEPARTMENT Janet Fortuna Sharon Nicholson CLASSIFIEDS & SUBSCRIPTION DIRECTOR Sheila Murray CLASSIFIEDS Joann Brady BUSINESS MANAGER Sandi Gross CIRCULATION & LEGALS MANAGER Courtney Biondo COPY EDITOR John Broven SPECIAL PROJECTS MANAGER Kathryn Mandracchia INTERNET STRATEGY DIRECTOR Rob Alfano --------------------------------------------Subscription $59 year/ $99 two years

--------------------------------------------Times Beacon Record Newspapers are published every Thursday. Address: P.O. Box 707, Setauket, NY 11733; telephone: 631-7517744; email address: desk@ tbrnewsmedia.com; fax: 631751-4165; website: www. tbrnewsmedia.com. Entire contents copyright 2021.

PAGE B16 • ARTS & LIFESTYLES • MAY 27, 2021

Luxury Independent Living in a beautiful community Daily Tours available! Walk-ins welcome! Call or stop by to learn more!

Assisted Living and Memory Care Apartments opening soon! Live the lifestyle you’ve always wanted at

The Chelsea Features and amenities include: • Exclusive two-year rate lock for Founding Members • Gorgeous newly-constructed building • Private studios and one bedroom apartments • Safe, secure private Memory Care studios 26150

Be sure to schedule your private tour today by calling (631) 309-2749!

1 Meadow Lane, Yaphank, NY 11980 P (631) 309-2749 • ChelseaForYou.com

Reserve Your Apartment Today!

MAY 27, 2021 • ARTS & LIFESTYLES • PAGE B17

FOCUS ON HEALTH

SO MUCH MORE THAN A HEADACHE

Making sense of

migraines BY MELISSA ARNOLD

ust about everyone knows the throbbing Jcomes discomfort of a headache, whether it after a long day of work, too little

sleep or an oncoming cold. It’s also likely that you’ve heard someone say they have a migraine when the pain becomes severe. But the truth is that migraine is more than just a bad headache, and the term has taken on a variety of meanings, not all of them accurate. According to the American Migraine Foundation, migraine is an incurable brain disease that affects approximately 40 million people in the United States — that’s 1 in 4 households. In the majority of those cases, at least one close relative has migraines as well, but it’s still uncertain what causes the disease. Migraine can come with a wide range of neurological symptoms that differ from person to person and day to day. These symptoms exist on a spectrum from sporadic to chronic, mild to incapacitating, and some people can even experience trouble speaking, weakness and numbness in ways that mimic a stroke. “Migraine is more than just pain. While the pain is often moderate to severe, one sided and throbbing, there are other characteristics,” said headache specialist Dr. Noah Rosen, director of the Northwell Headache Center in Great Neck. “The individual must also have either sensitivity to light and noise or nausea to meet the full definition. This can worsen with movement, and many people also develop associated skin or hair sensitivity. Many people may also experience changes in mood, energy level and appetite. About 20% of migraine patients may also have aura with their migraines, which is a brief, fully

reversible neurological deficit. Auras can cause visual changes, sensation changes and sometimes weakness.” For Cat Charrett-Dykes, migraines have been a regular part of her life since she was 13 years old. She would see sparkles and spots and go through bouts of nausea and vomiting, all while feeling like a knife was stabbing through her head. At school, she had trouble reading and finding the right words. “I felt like Dorothy in ‘The Wizard of Oz.’ Some of my siblings also had migraine occasionally, but not to the same degree,” said Charrett-Dykes, who lives in Holtsville. The attacks were relatively easy to tame until after the birth of her first child. Then, as is common, her migraines became more severe and frequent. She saw countless healthcare providers, who couldn’t agree on a diagnosis: They suggested she had anxiety, allergies, epilepsy. One even asked if her ponytail was too tight. Unfortunately, getting a proper diagnosis and care can be a problem in the migraine community. The World Health Organization reports that more than half of all people with migraine haven’t seen a doctor for their condition in at least a year. Many more have never been formally diagnosed. While seeing a

neurologist can be useful, not all neurologists are experts in headache disorders. “Only about 700 people in the country are certified headache specialists, and the field of headache medicine is not yet formally recognized by the federal government, so there are limits on the field’s growth despite how common the condition is,” Rosen explained. “During my time as a resident physician I was seeing severely disabled patients with headache disorders end up in the emergency room, yet I had almost no education in that area, in part because of how underserved the condition is. It is often ignored, stigmatized and mistreated.” Charrett-Dykes waited decades to find someone who understood her. “It wasn’t until 2003 that I was finally diagnosed. As soon as the physician’s assistant walked into the room, he took one look at me and turned off the lights,” she recalled. “No one had ever done that before. He said, ‘You have migraines, don’t you? I know that face. My wife has migraines, too.’ It was such a relief.” Still, a diagnosis is only the beginning of the migraine journey. Treatment is focused on identifying the person’s unique triggers — perhaps certain foods, scents, strenuous activity, or an irregular schedule — along with the precise combination of medications and other options to help ease their symptoms. There is no magic bullet, and finding treatment that helps can be challenging. “Trigger identification and avoidance is a great thing to try, but not always possible. Raising the ‘threshold’ required to set off a migraine can be done with pharmacological or non-pharmacological approaches,” Rosen said. “Of the medications that are available now, some are preventive and some are acute (or abortive). The preventive treatments help avoid getting the headache in the first place. Healthy habits like regulating sleep, diet, hydration and stress can reduce frequency, as can some vitamin supplements, complementary practices like acupuncture, biofeedback, mindfulness and regular cardiovascular exercise.” The process of trial and error is exhausting for many people with migraine, including Nancy Harris-Bonk of Albany, who’s tried countless doctors and medications since her first migraine attack as a young teen. At one point, she was taking the highest dose of oxycodone allowed under a doctor’s care and still having 25 or more migraine days each month. “I just wasn’t recovering, so I went online and started looking for answers,” said Bonk, whose episodic migraines turned chronic

after a fall left her with a traumatic brain injury. “I was able to make contact with someone else who had migraine attacks, and it opened a door for me. I learned that I wasn’t alone and that there were treatment options. It made me want to help educate others about migraine disease and how to live with it.” Downstate, Charrett-Dykes had similar goals. She founded Chronic Migraine Awareness, Inc. (CMA) in 2009, a simple chat group that later grew into a multifaceted nonprofit connecting people with resources, specialists, and one another. CMA’s main Facebook group now has 12,000 members around the world, with several smaller groups for specific demographics and topics. They also provide care packages for people with migraine, support caregivers, and lead advocacy efforts. Bonk eventually qualified for Social Security Disability Insurance, freeing her up to focus on her well-being while acting as a resource for others. She still has about 15 migraine days a month, but medication changes and a knowledgeable healthcare team have made life a lot more manageable, she said. She serves on the board of CMA and works with the National Headache Foundation’s Patient Leadership Council; the Coalition for Headache and Migraine Patients (CHAMP); and Migraine.com. "Learning all you can about migraine disease, knowing what it is and what it isn’t, can make a big difference when it comes to seeking care and advocating for yourself,” Bonk said. “Forming connections with others who have similar experiences is important so we know we're not alone. This disease can leave us feeling isolated, frustrated and overwhelmed … talking with others who are going through a similar journey is validating and a great comfort. ” While each of these organizations has a unique focus, they all share a desire to increase knowledge and awareness of migraine disease. “The pain of migraine is not like other pain and should not be treated like that. It needs to be discussed and not just treated,” Rosen said. “The stigma of people with migraine having a low pain tolerance is also nonsense. I have been impressed on a daily basis by the strength, resilience and resourcefulness of these patients.” June is Migraine and Headache Awareness Month. To learn more, visit www.migraine. com. To connect with others, visit CMA’s website at www.chronicmigraineawareness. org. The Northwell Headache Center has several locations on Long Island and telehealth appointments are available. For information, call 516-325-7000 or visit www. northwell.edu/neurosciences/our-centers/ headache-center.

Lovelier Legs

PAGE B18 • ARTS & LIFESTYLES • MAY 27, 2021

Jerry G. Ninia, MD, RVT, FACPh Fellow American College of Surgeons

We provide office-based treatment for Varicose Veins and Spider Veins

SAFE HOME MODIFICATIONS Falls at home CAN be prevented!

Specializing in: • Injection-Compression Sclerotherapy • Foam Sclerotherapy • Ultrasound - Guided Sclerotherapy • Ambulatory Phlebectomy

Uniquely Effective For: Replacing vein stripping. Expert Spider Vein Treatment Now Offering: VenaSeal TM

Varicose Vein Center MOST MEDICAL INSURANCE ACCEPTED

PORT JEFFERSON • 405 East Main Street

American College of Phlebology

Call for an appointment 631–474–1414 or email us at info@mdvein.com Visit Our Website at www.mdvein.com

We are here for you and ready to serve you. We are following CDC Guidelines.

Offering exclusive 3D digital fitting technology

Most insurance accepted

Plans accepted

• Contact lenses• Eye exams • Designer frames for the whole family • Prescriptions filled • On-site lab

2194 Nesconset Highway • Stony Brook • (631) 246-5468 Andrew N. Polan, F.N.A.O. stonybrookvisionworld.com

Like us on Facebook Varicose Vein Center

Ask about our 160-point “Safe Home” assessment to see which areas of your home have the greatest risk of falls.

631-509-3885

Plus ELVeS™ (Endo Laser Vein System) The latest procedure for minimally invasive vein treatment.

Now Accepting Medicare Patients

Grab bars Handrails Ramps Stairlifts Bathrooms and more!

MAY 27, 2021 • ARTS & LIFESTYLES • PAGE B19

FOCUS ON HEALTH

Food's important role in overall health

utrition is a popular topic of N conversation, particularly among those embarking on a weight loss or maintenance

plan. Individuals carefully study food macros and pore over various diets to get the most out of the foods they eat. When the end goal is simply looking good, it may be easy to forget about the other benefits of nutritious diets, including their link to overall health. A close relationship exists between nutritional status and health. Experts at Tufts Health Plan recognize that good nutrition can help reduce the risk of developing many diseases, including heart disease, stroke, diabetes, and some cancers. The notion of “you are what you eat” still rings true. The World Health Organization indicates better nutrition means stronger immune systems, fewer illnesses and better overall health. However, according to the National Resource Center on Nutrition, Physical

Activity, and Aging, one in four older Americans suffers from poor nutrition. And this situation is not exclusive to the elderly. A report examining the global burden of chronic disease published in The Lancet found poor diet contributed to 11 million deaths worldwide — roughly 22 percent of deaths among adults — and poor quality of life. Low intake of fruits and whole grains and high intake of sodium are the leading risk factors for illness in many countries. Common nutrition problems can arise when one favors convenience and routine over balanced meals that truly fuel the body.

Improving nutrition

Guidelines regarding how many servings of each food group a person should have each day may vary slightly by country, but they share many similarities. The U.S. Department of Agriculture once followed a “food pyramid” guide, but has since switched

to the MyPlate resource, which emphasizes how much of each food group should cover a standard 9-inch dinner plate. Food groups include fruits, vegetables, grains, proteins, and dairy. The USDA dietary guidelines were updated for its 2020-2025 guide. Recommendations vary based on age and activity levels, but a person eating 2,000 calories a day should eat 2 cups of whole fruits; 2 1⁄2 cups of colorful vegetables; 6 ounces of grains, with half of them being whole grains; 5 1⁄2 ounces of protein, with a focus on lean proteins; and 3 cups of lowfat dairy. People should limit their intake of sodium, added sugars and saturated fats. As a person ages he or she generally needs fewer calories because of less activity. Children may need more calories because they are still growing and tend to be very active.

When the end goal is simply looking good, it may be easy to forget about the other benefits of nutritious diets.

Those who are interested in preventing illness and significantly reducing premature mortality from leading diseases should carefully evaluate the foods they eat, choosing well-balanced, low-fat, nutritionally dense options that keep saturated fat and sodium intake to a minimum.

WELCOME home

Everyone deserves happiness in their life — especially today’s seniors. That’s why Amber Court Assisted Living works hard every day to create a safe, healthy, and joyful home for the wonderful people we call family. Discover the Amber Court difference. Schedule your visit today. 26170

MEDICAID OPTIONS AVAILABLE

888.929.4929 | AmberCourtAL.com ASSISTED LIVING COMMUNITIES

SMITHTOWN

BROOKLYN

WESTBURY

PELHAM GARDENS

ELIZABETH

HARBORVIEW

130 Lake Avenue South, Nesconset, NY 11767 | 631.636.0620

PAGE B20 • ARTS & LIFESTYLES • MAY 27, 2021

“ P R E P L A N N I N G YO U R F U N E RA L N OW I S M O R E I M P O RTA N T T H A N E V E R .” P E T E R G . M O LO N E Y & F. DA N I E L M O LO N E Y J R . , OW N E R S

As you grow older, you don’t want to worry about how your family will manage your end-of-life plans. Taking control now takes the pressure off them later – and you can rest assured your preferences will be honored. Our planning tool kit is exactly what you need to get started. Start today. Peace of mind tomorrow.

Mail In the Coupon Below to Request Your Free Planning Tool Kit OR VISIT US ONLINE AT MOLONEYFH.COM/PLANNINGTOOLKIT

MAIL TO: 132 RONKONKOMA AVENUE · LAKE RONKONKOMA, NEW YORK 11779

Name

Serving all of Long Island with locations in: Bohemia, Central Islip, Holbrook, Lake Ronkonkoma, Center Moriches, Port Jefferson Station, and Hauppauge.

Phone

Address FREE PLANNING TOOL KIT OF COURSE, THERE IS NO COST OR OBLIGATION

24210

(631) 588-1515

MAY 27, 2021 • ARTS & LIFESTYLES • PAGE B21

FOCUS ON HEALTH BY JULIE FREEDMAN

VIGIL

he shriek of the pager cut through my half-sleep. Willing myself to sit up on the plastic mattress, I pressed my thumbs along my eyebrows to clear a fleeting dream. It was 2:00 a.m. The emergency room had a new patient for me. She was 71 years old and recently diagnosed with amyotrophic lateral sclerosis, or ALS. She was having trouble breathing. After a near-lifetime of dutiful function, the neurons that moved her muscles had simply started to die. Even those muscles we never think about — her diaphragm or the ribbons that lifted her ribs to expand her lungs — had become unreliable. I switched on the fluorescent, call-room light and found my clogs. Eleanor had a fever. The pneumonia on her X-ray looked like smudged They had been living close to this chalk across both lower lungs. The ER physician had started BIPAP — Bilevel edge for some time. It had become Positive Airway Pressure — strapping normal for her to strap on a mask a cushioned plastic mask tightly over to breathe. Bill said they wanted to her face, forcing oxygenated air into return home as soon as possible. He her mouth. We call this “non-invasive” could handle everything, he assured ventilation, but it is not comfortable. me, seeming a little irritated by my Her vital signs conjured a grim picture hovering at Eleanor’s bedside. They — heart racing, breathing fast — but had no illusions, he explained, deftly the woman wearing the mask gave a untangling the tangle of wires lying different impression, despite the odd across his wife’s chest. They knew her way the machine was ironing out her disease was progressive, and fatal, but cheeks with each breath. She was calm. they still had things under control. She was still gardening, he said, Her unstrained eyes were the chalky blue of flax blossoms. She was feeling with an edge of pride. He showed me better, she mouthed. Actually, she was a picture of sunlight, caught in the bowls of tulips. Not that hungry. Could she eat When we intubate life wasn’t messy. It had something? been messy even before Her husband, Bill, at someone, we the day Eleanor admitted her bedside, was calm to him that she could too. He was tall and affect a strange not get her fingers to trim and moved with a transformation. The button her blouse. Bill’s youthful quickness. His patient becomes a retirement money never neatly-tucked shirt made me suddenly aware of my chimera, part woman quite stretched enough. There were grandchildren own pajama-like hospital and part machine. to scramble after three scrubs. Since Eleanor’s diagnosis, Bill explained, they had days a week. They were sweet kids, but been managing everything at home. Bill didn’t have the patience. Eleanor He was a retired electrician, so he was did, though. She gave me a stretchedcomfortable with all of the medical out smile from behind the mask. She equipment. They even had a BIPAP was hungry, he reminded me. Was there a sandwich somewhere she could have? unit there for nighttime.

I wasn’t reassured. Her heart was working like she was running up stairs, just to lie still. A patient with weak respiratory muscles and pneumonia in both lungs might soon need the more “invasive” kind of breathing support, a mechanical ventilator. A ventilator blows air into a patient’s lungs through a tube we insert directly into her trachea. Bill and Eleanor hoped to avoid a ventilator, but she would accept it if necessary, at least for a time. To use a ventilator, we would need to sedate and paralyze her, which meant that Eleanor’s stomach should stay empty. So, no sandwich for now. Over the next two hours, I sat at the ICU nurses’ station across from Eleanor’s room, propped awake by a familiar anxiety, the prickly weight of my own hesitation. If Eleanor’s breathing muscles tired out before the antibiotics took hold, she could quickly worsen. Not intubating her early might endanger her, but it is my nature as a doctor to try to avoid aggressive interventions. I tend to see their burdens in the foreground. When we intubate someone, we affect a strange transformation. The patient becomes a chimera, part woman and part machine. We lose the expression in her face. The ventilator’s

vocabulary of alarms replaces her voice. Her family’s eyes track the cardiac monitor. They touch her skin without knowing if she can feel it. We lose all of the small, animal ways we read each other. A mechanical ventilator can save a life, but when a patient dies despite using one, I struggle to accept what we have done. I was not impartial here. I wanted to get Eleanor back to her tulips and their brief season, but I really did not want to intubate her. So I watched, tracking the cursive of Eleanor’s heart rhythm on the monitor. Eventually, she closed her eyes, her breathing more even, and I returned to my plastic mattress to sleep too. In the morning, Eleanor smiled brightly when I walked in the room, the only plastic on her face the slender oxygen tubing. Could she finally have breakfast? I was grateful, not sure she grasped the fate she had outrun. Yes to breakfast. Yes, she could. She returned home the following day. Three months later, Eleanor was back in the hospital with another pneumonia. This one was milder, just some stray sketch lines on her X-ray. At home, she could walk only a few steps now. A truck brought steel oxygen tanks to their house each week. Bill had been half-lifting her, wrapping her arm across his shoulders, to pivot to a portable toilet at her bedside. He had learned some simple cooking because she could no longer manage that, and was getting pretty good at roast chicken. Despite his efforts, Eleanor had lost weight. The space between the bones of her forearm was a furrow under my fingers. Each day though, she spent time in their garden. There was a shady spot for her wheelchair. Eleanor did not seem to defy her medical numbers this time. She looked weary as her heart jogged along. Her thin shoulders kept slumping leftward despite the pillows that the nurses had tucked around her. I was at her bedside on her third hospital day when she took a sip of water and started to choke. VIGIL continued on page B22

PAGE B22 • ARTS & LIFESTYLES • MAY 27, 2021

VIGIL

Continued from page B21 She coughed again and again, a flash of the pale blue of her eyes each time, then finally recovered. She began to cry. “I’m sorry. I’m sorry,” she said. She shouldn’t be like this, she explained. Anger ridged her quiet voice. She was supposed to make cookies with her smallest granddaughter. The girl was four. What would she remember? This being lifted to the toilet, this fragility, it did not suit her. She was a mother and a grandmother. She stirred thick dough and weeded and bound her family together. Except that now, she did not. I had focused on her vital signs. I was missing her suffering. I sat and held her papery hand and told her that none of this was her fault. The next day, Eleanor was stable enough to return home. Busy with other patients, I sped by her room for a quick hug, taking in the sharp ridge of her shoulder against my chest. Two months later, she returned. At home, she was in bed all the time. Her neurologist had actually sent two hospice nurses to the house a few weeks before. They set up an array of syringes and tablets in the dining room. Bill sent them away again after only two days. He didn’t like how they did things. Those nurses had brought morphine. They had started to teach Bill to administer it. That had scared them both. “We don’t believe in morphine,” Bill told me. Eleanor, watery-eyed behind her oxygen mask, nodded agreement. She pointed to a spiral-bound notebook and I handed it to her. In shaky letters, all capital, she wrote, “I WANT CONTROL.” It’s not often that patients tell me that they “don’t believe” in a medication, but morphine can spark intense reactions. I fell silent, trying to resolve what it was they did not believe in. Eleanor’s thin legs barely rippled the hospital blankets. Breathing itself was work. Both she and Bill knew she was dying. What did "control" mean for her now? The pharmacology of morphine is complex. It is an essential medicine at the end of life. It relieves pain, and, because there are opiate receptors in the lungs, also soothes the drowning feeling that comes with end-stage respiratory illness. I remembered Eleanor choking on that thread of

water. If she felt that again, morphine would help. But it is an imprecise drug. It causes sedation as it relieves physical suffering. Was this the loss of control she feared? It can also cause euphoria, restlessness, hallucinations, and, at high doses, death. My training taught me to show it due respect: start with low doses, lower still for someone frail, then assess for effect. Medical ethics teaches that intention matters. If I give a reasonable dose of morphine with the intention to relieve suffering, and I cause an unwanted outcome — sedation or agitation, or even death — I am still keeping my oath not to harm. This is the “doctrine of double effect,” derived from the teachings of 13th-century Catholic theologian Thomas Aquinas. It offers a clear enough theory, but it never really sets me at ease. If I give a drug and a bad thing happens, my patients and their families experience that bad thing. I have hurt them, and Aquinas does not offer much comfort. To be clear, morphine relieves suffering almost all of the time. Patients usually welcome that relief, but I’ve also spoken with grieving family members who look back on someone’s death from a long, terrible illness, convinced that morphine was the thing that killed her. These conversations play in my mind when I care for a dying patient in the hospital. I am aware of the family’s eyes on my hands, of how my words might replay in their heads, that they will relive my patient’s last moments again and again. In this sense, the family becomes my patient too. Eleanor’s words on that notebook page were wildly impossible: she did not have control. They seemed like a request for relief that I was not trained to give, spiritual or existential. Eleanor and Bill had faced her illness by asserting control in the face of the uncontrollable. They voiced acceptance, but they were defiant. All along, they had been letting out rope, in stepwise retreat, giving up the gardening, the cooking, the not needing help. With each retreat, they had established another defensive position, and now she was staked out at just remaining awake. Eleanor’s cardiac monitor alarmed in shrill tones as her heartbeat became briefly irregular, then quieted. I dropped the subject of morphine for the moment. I could not

find words to resolve Eleanor’s desire for control with how near she was to death. I didn’t want to push anything on them that they might later look back on as a violation. A few hours later, Eleanor was struggling. There was sweat on the sides of her nose. I tentatively asked her if she would accept some morphine to help ease her breathing. She nodded. I ordered a small dose, and returned to the room with the nurse while she gave it. I talked with Bill and with Laura, their daughter, consciously modeling a sense of calm routine. The drug helped. Eleanor’s face relaxed. She even gave a hint of a smile. That evening, Eleanor was mostly peaceful. When she did become uncomfortable, she received more morphine, and was able to rest. The next morning, Bill asked me about bringing her home. She wanted to see her garden. He wanted her there too. As we talked, Eleanor began to cough, nearly silently. Her shoulders jerked. She lurched her hand clumsily for Bill’s wrist. Her nurse gave morphine. Ten minutes later, she was still breathing fast, grunting, heavy eyelids startling open with each cough. Bill sat down, then stood again, then sat. He reached to adjust her monitor wire, her oxygen cannula, then stopped, suddenly unsure of where to put his hands. Laura reached for Eleanor’s shoulder. I asked her nurse for another dose of morphine. A few minutes passed. Eleanor’s breathing quieted and she leaned her face into a pillow. Bill let out a long breath, then turned to me. He began to ask about the logistics of ambulance transportation home. Suddenly, Laura nudged her father. Eleanor’s eyes had closed, and her breathing pattern had changed. With each inhalation, she lifted her chin up and forward, like a swimmer reaching for the surface of the water. Bill called her name. She didn’t answer. Suddenly, she was gone from in front of us. Bill looked at me, eyes flashing something that might have been anger. My own heart pounded. I knew the morphine doses had been appropriate. Still, I worried he might hold me accountable if these were her final moments. Willing myself calm, I encouraged them to stand close to her, to hold her hands and touch her hair and talk to her. After a few minutes, I left them alone.

An hour passed. I crept back to her room, but hesitated before parting the polyester curtain. My patients are usually strangers to me, but Eleanor was not. It was an accidental gift of my call schedule that had let me care for her through her three hospitalizations, to watch over her and her family, even in this interrupted way. I was afraid I had failed them anyway. Gathering a breath, I went in. More family members had arrived, seven in all. At the center of this crowd, awake and laughing, was Eleanor. She had spent fifteen minutes beyond the reach of their voices, and then woke up to find them staring at her. She had jokingly asked for lipstick so she could face the occasion more glamorously. They were almost giddy with relief. But relief for what? Relief that she had not died, certainly, but she would soon and they all knew it. They now knew what her death could be like. They had had their dress rehearsal, and, in the extinction of that mystery, it was like they no longer feared it. Suddenly, they had these minutes, and maybe hours or even days, and each one was a gift. Eleanor was too fragile to send home. Laura and Bill would instead stay with her overnight. She struggled briefly that evening, but by sunrise, she was mostly dozing. A few hours later, her breathing slowed. Again, she reached her chin upward for air. Again, she was beyond the reach of her family’s voices. I counted to 20 after one breath ended before the next one came. And then, none came. Bill wept. “My girl,” he said, taking her hand. Julie Freedman is a hospitalist and palliative care physician at a community hospital in the San Francisco Bay Area. She received her medical degree from Harvard University and trained in internal medicine at the University of California, San Francisco. She believes that we need narrative almost as we need shelter: We build stories around ourselves in the face of serious illness. Understanding, and sometimes entering, these stories is an essential part of caring for patients. On the other hand, after this last year, she is thinking it might also be lovely to become a florist. She is on Twitter @jfreedmanmd. * This article was first published in the Spring 2021 Intima: A Journal of Narrative Medicine (theintima.org) and is reprinted with permission.

MAY 27, 2021 • ARTS & LIFESTYLES • PAGE B23

FOCUS ON HEALTH

The best ages to spay or neuter pets

nimal overpopulation is a concern that affects the well-being of pets. The ASPCA says letting animals reproduce unchecked can lead to pet homelessness that results in millions of healthy cats and dogs being euthanized in the United States each year. In addition to helping to control homelessness, spaying and neutering companion animals may have medical and behavioral benefits. As valuable as spaying and neutering can be, the procedures are not without potential complications. Responsible pet owners must weight the pros and cons of spaying and neutering with a qualified animal professional. The ASPCA says it is generally considered safe for kittens as young as eight weeks old to be spayed or neutered. Doing so can help avoid the start of urine spraying and eliminate the chances for cats to go into heat and become pregnant. Did you know that female kittens can enter their first heat as young as four months? Or that most do so by

the time they reach six months old? A domestic cat can live around 12 to 15 years. A cat that has an average of four kittens per litter, three times per year for 15 years can produce a total of 180 kittens over a lifetime. Spaying a cat early on can prevent overpopulation and offer other benefits. Spaying and neutering has been shown to reduce risk for testicular cancer and some prostate problems. Sterilization also can protect against uterine infections and breast tumors in many female pets. These procedures may also help prevent animals from roaming to find mates or reduce aggression problems. Many veterinarians now recommend female and male dogs be spayed or neutered between the ages of six to nine months. Some vets say puppies can be neutered as young as eight weeks old as long as they are healthy. In fact, it has become the norm for rescue puppies to be neutered prior to being placed with adoptive families. Those who would

like to follow the American Animal Hospital Association Canine Life Stage Guidelines should have small-breed dogs (under 45 pounds projected adult body weight) neutered or spayed at six months of age or prior to the first heat. Large-breed dogs should be sterilized after growth stops, which is usually between nine and 15 months of age. Some research has pointed out that early neutering may lead to certain medical conditions that may be preventable by waiting until a pup or kitten is a little older before having him or her go under the knife. Researchers at the University of California, Davis, conducted a study on golden retrievers in 2013 that found early neutering and spaying appeared to increase the risk of diseases, such as cranial cruciate ligament rupture, hemangiosarcoma, mast cell tumors, lymphosarcoma, and hip dysplasia. Working with a veterinarian can help pet owners make informed decisions about the appropriate age for a pet’s sterilization.

OPEN 7 DAYS A WEEK LIKE HAVING A LAWYER IN THE FAMILY Our 55+ ﬁve star reviews speak for themselves “Professional & personal service! A real pro.” “Admirable work ethic, very responsive” “Meticulous, intelligent, caring person & lawyer.”

• Acupuncture • Dentistry • Digital X-Rays • Ultrasound & Endoscopy • Laboratory w/Stat Results Surgeries (Routine & Emergency): • Specialty Surgery • Foreign Body Surgery SCHEDULE YO UR PET’S SPAY • Bloat Surgery & NEUTER • Splenectomy Surgery APPOINTMEN TODAY

“You will not regret hiring Mark to represent you!”

ANIMAL HEALTH & WELLNESS VETERINARY OFFICE, PC

READ MORE FIVE-STAR REVIEWS AT NORTHSHOREINJURYLAWYER.COM Attorney Advertising

Comprehensive Veterinary Care

STEVEN TEMPLETON, D.V.M. & ASSOCIATES 150 Main St., East Setauket 631.751.2200 • www.animalhealthwellness.com

Mark T. Freeley, Esq 144 Woodbury Road • Woodbury, NY 11797 PH: 631-495-9435 • In home & virtual consults available

We are still providing emergency care, sick care, and preventative care including vaccines. Call for hours and appointment.

PAGE B24 • ARTS & LIFESTYLES • MAY 27, 2021

Screening is safe. Don’t delay your colonoscopy. Timely screenings can reduce cancer risk by 90%.* Our Direct Access Colonoscopy program is as safe and convenient as ever. Skip the office visit and set up your colonoscopy with one phone call. We’re taking every precaution to keep you safe with COVID-19 testing for all patients, enhanced cleaning protocols and full personal protective gear.

*American College of Gastroenterology

Direct Access Colonoscopy Program We make scheduling simple. One phone call and one appointment.

631.975.COLO (631.975.2656) Mather Gastroenterology • 631.978.7700 70 North Country Rd., Suite 101 Port Jefferson, NY 11777 harborviewmedicalservices.com

24200