Wednesday, September 25, 2019

WHAT'S NEXT FOR ADVANCEMENTS IN IMMUNOLOGY?

Epilogue: 
CELLULAR WARFARE IN FULL SWING
By: Dr. Jesse Stoff  / Clinical Immunologist

Imagine having your own personal army of cells in your highly advanced defense system, working against outside invaders or abnormal cells where each cell type (over one hundred and eighty-seven recorded) carries their own dedicated function. This specialized team of cells work together to fulfill the complex mission of protecting the body from infection or illness each day. 

Our immunity or defense system works in three directives; the first is to (1) RECOGNIZE anything foreign and sound the alarm soon enough to thwart the invader. Molecules and cell surfaces that are identified as foreign are referred to as antigens and have the ability to elicit an immunogenic response. The second function is to (2) RESPOND to the alarm with enough of a counter attack to effectively neutralize the invader quickly. The third directive is to (3) REMEMBER what happened so that if the same situation were to arise again an effective response could be generated faster. The length and efficacy of the immune response depends upon the “intactness” of the underlying biochemistry.

During their lifetime, the cells of the immune system, based upon their experiences and exposures can change their cell surface antigens and their role in the immune response. More than any other organ or system in our body, the immune system is a dynamic system that can change. Like many other cells in our body, the cells of the immune system can be changed from the outside by drugs – Prednisone, Methotrexate, Humira, Remicade, and Plaquenil can suppress the immune system and thus, at least temporarily, help with certain inflammatory diseases, but they don’t heal or redirect the immune response.

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ENGINEERED KILLER T-CELLS COULD PROVIDE LONG-LASTING IMMUNITY AGAINST CANCER
UCLA researchers use stem cells to engineer cells that attack human tumors in mice 
Sarah C.P. Williams |

They’ve been called the “special forces” of the immune system: invariant natural killer T cells. Although there are relatively few of them in the body, they are more powerful than many other immune cells. In experiments with mice, UCLA researchers have shown they can harness the power of iNKT cells to attack tumor cells and treat cancer. The new method, described in the journal Cell Stem Cell, suppressed the growth of multiple types of human tumors that had been transplanted into the animals.  “What’s really exciting is that we can give this treatment just once and it increases the number of iNKT cells to levels that can fight cancer for the lifetime of the animal,” said Lili Yang, a member of the Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research at UCLA and the study’s senior author.

Scientists have hypothesized that iNKT cells could be a useful weapon against cancer because it has been shown that they are capable of targeting many types of cancer at once — a difference from most immune cells, which recognize and attack only one particular type of cancer cell at a time. But most people have very low quantities of iNKT cells; less than 0.1% of blood cells are iNKT cells in most cases.

Still, Yang and her colleagues knew that previous clinical studies have shown that cancer patients with naturally higher levels of iNKT cells generally live longer than those with lower levels of cells. “They are very powerful cells but they’re naturally present in such small numbers in the human blood that they usually can’t make a therapeutic difference,” said Yang, who also is a UCLA assistant professor of microbiology, immunology and molecular genetics and a member of the UCLA Jonsson Comprehensive Cancer Center. ­­

Lili Yang, UCLA Broad Stem Cell Research Center
The researchers’ goal was to create a therapy that would permanently boost the body’s ability to naturally produce more iNKT cells. They started with hematopoietic stem cells — cells found in the bone marrow that can duplicate themselves and can become all types of blood and immune cells, including iNKT cells. The researchers genetically engineered the stem cells so that they were programmed to develop into iNKT cells. 

They tested the resulting cells, called hematopoietic stem cell-engineered invariant natural killer T cells, or HSC-iNKT cells, on mice with both human bone marrow and human cancers — either multiple myeloma (a blood cancer) or melanoma (a solid tumor cancer) — and studied what happened to the mice’s immune systems, the cancers and the HSC-iNKT cells after they had integrated into the bone marrow.  They found that the stem cells differentiated normally into iNKT cells and continued to produce iNKT cells for the rest of the animals’ lives, which was generally about a year. “One advantage of this approach is that it’s a one-time cell therapy that can provide patients with a lifelong supply of iNKT cells,” Yang said. 

While mice without the engineered stem cell transplants had nearly undetectable levels of iNKT cells, in those that received engineered stem cell transplants, iNKT cells made up as much as 60% of the immune systems’ total T cell count. Plus, researchers found they could control those numbers by how they engineered the original hematopoietic stem cells. (See complete Press Release in: UCLA Newsroom)




This article is republished with the express consent of the UCLA NEWSROOM for the Journal of Modern Healing- produced by the NY Cancer Resource Alliance-for public use.  All distribution, sharing or re-posting of this article is only with the express permission of NYCRA ©2019- All Rights Reserved.    
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Sponsor:
CANCER PREVENTION can be closely aligned with EARLY DETECTION. But from the perspective of a lifestyle upgrade, it is greatly proven that smart nutrition, toxin prevention (smoking, alcohol, drug abuse control), Stress management and Immune system support are all main ingredients to the prevention of cancers. These same protocols, for those who recently underwent cancer treatment, are what medical experts and wellness professionals prescribe to STAY IN REMISSION.


About the Publisher:

JESSE STOFF, MD, HMD, FAAFP - Dr. Stoff is a highly credentialed medical expert specializing in Cancer Immunology and a publisher of current educational programs about Prevention, Wellness and medical texts about Onco-Immunology. As a senior clinical investigator for cancer treatment protocols, Dr. Stoff is dedicated to resolving the most challenging health issues of our time. He has spoken worldwide in some of the top medical conferences about his experiences and analyses on the study of human disease. His medical practice (INTEGRATIVE MEDICINE OF NY, Westbury, NY - www.IMOFNY.com) has been continually providing patients with the many comprehensive clinical options and modalities available- including "ONCO-IMMUNOLOGY", the science of battling cancer cells and reversing pre-cancerous conditions through a complete prevention program that has earned him great success in this field.  For more information, visit: www.Dr.JesseStoff.com



DISCLAIMER: All information provided in this article is intended as general public information and is not intended to treat or cure any disease or disorder. NYCRA, nor any individual or practitioner associated with the publishing of this article is not liable for any damages resulting from the use of the information on this article. As a visitor of this blogsite, you acknowledge and agree that any reliance on or use by you of any information available on this Internet web site shall be entirely at your own risk. In no event shall the owner or operator be liable for any direct, indirect, consequential or exemplary damages arising from the use or the performance of this Internet web site, even if the owner or operator has been advised of the possibility of such damages. While every attempt has been made to verify the information on this website, neither the owners, distributors, agents, publishers or their affiliates assume any responsibility or liability for any error, inaccuracies, omissions in the same, or related to results from use of these materials. No party is liable for any direct, incidental, consequential, indirect, or punitive damages arising out of your access to, or use of this blogsite and the contents herein.

Thursday, August 29, 2019

THE STRESS-CANCER CONNECTION EXPLAINED

CHRONIC STRESS & HORMONES
The risk of getting cancer is inversely related to the structure and function of the immune system. When the immune system is compromised, then that increases the risk of cancer. Depending upon what's compromising the immune system, that agent or agents can be triggers and/or promoters for the process of cancer itself. Usually that which suppresses the immune system and damages it is also a cancer initiator or promoter. The things that injure the immune system from poor nutrition include zinc deficiencies, Vitamin A deficiency, Vitamin D deficiency etc.  Infections like Epstein-Barr, cytomegalovirus, HIV all directly attack cells of the immune system and are oncogenic (viruses that can actually cause and initiate cancer, toxins and certain forms of trauma) specifically x-ray ionizing radiation.

So the way this all fits together comes from the endocrine system - a collection of organs that produce hormones. Hormones are substances that are produced by cell A, that act as some distance away on cell B. So for example, there is a part of the endocrine system called the autonomic nervous system and this is a very important balance in our body, and it's the balance that helps to maintain what's referred to as biochemical homeostasis, the balance between normal biology and fight or flight reactions.

When our body is under stress, and there are many different definitions of stress, one definition that I like is that the capacity to adapt has been exceeded, and the body can no longer compensate for what's going on. Then, the autonomic nervous system will kick in and their short term responsibility to produce substances called catecholamines. These are the fight or flight hormones, epinephrine, norepinephrine, metanephrines, etc. And these will generate a short term response.

When these biochemical substances kick in, they have an effect of stimulating the immune system because in the grand scheme of things, if we are in a fight or flight situation, there's a high risk of injury. And if we are injured, we want the immune system to be up-regulated. They up-regulate the immune system, so that if we get mauled by the saber-toothed tiger,  then we can heal from that mauling without dying of septic shock.  They're designed for a short term stressor.  In our current society, there are plenty of chronic stressors-  those that are not time limited to a few seconds or a few minutes, but actually can drag on for hours, days, months, and even years. When the body is under this sort of chronic stress, the body's ability to cope (let it be mental, emotional, physical, physiological)  has been exceeded, then the adrenal glands will produce a whole second set of hormones that have the opposite effect. These are cortisol and hydrocortisone. These are the hormones that have an anti-inflammatory effect and have the opposite effect of the catacholamines, and are designed to down-regulate the immune system.

As with everything else in our body, every system has a check and balance in it. If there's an up-regulation response of catacholamines, there's a down-regulation response with the adrenal hormones that are secreted by the cortex, the cortisols and the like, which down-regulate the immune system and are designed to reduce inflammation, which if you're only dealing with a saber- toothed tiger wound, reduces the inflammation and actually speeds the healing process up once the initial immune system has done its response.

As a society, we find people that have a up-regulated cortisol response chronically. And as a result of that, we see a blunting of the normal circadian cycles between cortisol and DHEA. And when this normal cycle is affected because of the chronic secretion of cortisol, what it does is, not only does it down-regulate the immune system, but it's a very important circadian cycle in our body, which affects mood, memory, focus, concentration, menstrual cycles and sleep, amongst many other things, so that when somebody is in a chronic stress, one of the symptoms that they will often complain about is poor sleep, okay? They have trouble falling asleep or trouble staying asleep. They restless this, that, and the other. And that is because this critical circadian cycle has been disrupted.

So the ways of dealing with this are many, but nonetheless the underlying biochemistry is the form of check and balance that the autonomic nervous system has in terms of up-regulating and down-regulating the immune response. Now, when somebody who's into chronic stress, and has high levels of circulating cortisol much longer and much higher than they're supposed to have, and there's production of DHEA is abnormally suppressed, and that of course throws off a whole bunch of other hormones, then that increases their risk of cancer, because the immune system cannot respond the way that it should, because it's being suppressed by the cortisol.




STRESS IS A CANCER PROMOTER
Does the cortisol cause cancer? The answer is at this point, NO.  So stress in and of itself biochemically does not cause cancer, but it is certainly a cancer promoter, in that if there is something that will trigger a cancer, and in our environment there's no shortage of things, you just need to have a glass of water, any place in Long Island you're exposed to six different carcinogens. But if you are exposed to something that is a cancer initiator, and your cortisol levels are running high, the immune system is suppressed because of stress, then that will increase the possibility of these abnormal cells that have been triggered by the initiator to progress into a tumor and a full blown cancer. So that's the connection, the way that that works biochemically.

And the biochemistry of all of this is very interesting. There is a direct correlation between stress and cancer, and PTSD and cancer.  Though stress and PTSD does not cause cancer, it's that they suppress the immune system, and to the excess and chronic production of cortisol, as a result of the normal stress response that has been exaggerated by the chronic and prolonged stress and PTSD situation.  To correct this, if you just go after trying to stimulate the immune system, you're going to have all kinds of wayward reactions and responses because now you have cortisol trying to down-regulate while you're trying to up-regulate, and it's just going to be a traffic jam, and gridlock, and nothing useful is going to happen. So you've got to look at that which is causing stress. So that has to be identified and ameliorated on every level possible that has been identified on.

Blood tests look at cortisol levels. You look at that whole pathway, look at how cholesterol is converted into pregnenolone, converted into DHEA, converted into testosterone, progesterone, estrogen, all the normal hormones and the balance of them, which is the heart of the endocrine system. And you can see, because all of these things would have an effect one way or the other in terms of the stress response and the immune response.

Typically what happens when somebody is in a chronic stress, we see a decrease in their level of pregnenolone or a decrease in the level of DHEA. Often testosterone levels are very low that they're undetectable (yes, women also produce testosterone from their adrenal glands). It happens to be one of the hormones that helps with bone density and osteoporosis. When a woman is under chronic stress, they are exposed to a higher risk of osteoporosis.  We conduct blood tests to identify these things, and there are supplements that you can take to balance its deficiency and help the body to reestablish a normal circadian cycle.  There is a time to take the cortisol, the hydrocortisone or the DHEA to to effectively and safely support a normal cortisol to DHEA curve.

STRESS & IRREGULAR SLEEP
But a very big piece that people don't pay adequate attention to is all the research that's gone on a circadian cycles looking at the sleep cycle in and of itself, and research has shown very important circadian cycles that kick in from approximately 9:00 at night to 3:00 in the morning, during which time the body can most efficiently repair damage, and the immune system can most efficiently repair itself, and take care of business. But people only go into that restorative cycle if they're actually sleeping, which is why people that work night shifts and swing shifts have a much higher incidence of severe and chronic disease.

There's a whole field of medicine called chronobiology, which would be fat textbooks, I own a couple. But the interesting thing is as they research different circadian cycles that every organ and every system has, it's very ... one of the fascinating things to me is how often the current research that they're doing at Harvard in their Department of Chronobiology, in such places as that, is how often their research about these cycles comes back and shows us the timing of the cycles. And of course, it's local time. The timing is set up by the sun, not by your habit, so that these cycles don't reset themselves, just because we have a habit of going to bed at 3:00 in the morning.

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ABOUT THE AUTHOR


JESSE STOFF, MD, HMD, FAAFP is a highly-credentialed medical expert studying all medical remedies in pursuit of resolving the most challenging health issues of our time. In many circles, he is recognized for his 35+ years of dedicated work in immunology and advanced clinical research in modern CANCER treatments. He has spoken worldwide in some of the most sought-after medical conferences about his experiences and analyses on the study of human disease. His integrative practice (INTEGRATIVE MEDICINE OF NY, Westbury, NY) has been continually providing all patients with the many comprehensive clinical options and modalities available- including "ONCO-IMMUNOLOGY", the science of battling cancer cells and reversing pre-cancerous conditions through a complete prevention program that has earned him great success in this field.  visit: www.Dr.JesseStoff.com


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Thursday, August 15, 2019

The Major Occupational Hazard of Post Traumatic Recall (PTSD) - part 1



INTRODUCTION:
High risk professions like law enforcement, military service, healthcare and emergency response are known to have exposure to some of the most extreme levels of trauma - both physically and psychologically.  They range in effects from manageable symptoms to crippling disorders.  Over time, most people overcome disturbing or traumatic experiences and continue to work and live their lives. But others who get affected by traumatic experiences may trigger a reaction that can last for months or even years. This is called Post-traumatic Stress Disorder, or PTSD. Proportionately, studies have shown a lower percentage of retirees from such challenging careers acquire PTSD (from 15-20%) while an estimated 30-40% who suffer from PTSD associated symptoms go undetected or do not register as full cases. A larger percentage ‘on the job’ might be able to maintain the expected work standards throughout their career and even make it to retirement without visible signs. But “POST traumatic recall” leading to fully blown PTSD occurs when repeated exposure to trauma compounds on the tolerance capacity that eventually, one’s coping ability collapses.  The individual may feel stages of grief, depression, anxiety, guilt or anger from uncontrollable issues like recurring flashbacks and nightmares. [1]


REVIEW OF POST TRAUMATIC RECALL (A field report by: Jessica Glynn, CSW)
PTSD can occur in all different extremes with at-risk professionals (like cops, responders and veterans). The trauma that they experience are above the ordinary that they could cause extreme flashbacks, anxiety and depression—heavily affecting their quality of life. The average civilian is also prone to this disorder starting with MICRO-TRAUMAS that can happen to everybody throughout any point in their lifetime.  Usually stemmed from childhood issues, micro-traumas actually shape the way an individual reacts to other people. As an example, child bullying may lead to developing a protective or defensive personality disorder.  Anytime they feel disrespected or embarrassed by others, feelings of extreme uncontrollable anger may arise without knowing the source of the hurt or why they're acting in that way.  This dilemma often causes problems in relationships.

Similarly, a first responder who experiences extreme traumas like horrendous disasters may stick with them in a much harsher way that could lead to flashbacks that are hallucinatory.  If gone unchecked or untreated, these symptoms (including auditory hallucinations) can get increasingly more intense and expand to other symptoms that can affect their daily functions.  A common way that anxiety can debilitate a sufferer is from recurrent lack of sleep disrupted by bad dreams triggered by the traumatic event.

Enduring trauma is different and unique for everyone. Some cases are event-specific (having intense auditory impact or visual intensity of a terrifying event) while other cases are contingent upon the tolerance of an individual. There are people who are more emotionally expressive than others- and that might help with if they talk about the trauma that they've been through. A latent emotional disorder like PTSD symptoms can come out over time just like anything that is suppressed or repressed. It could take some time for somebody who came back from combat or a first responder who has been in a traumatic event to show signs of disturbance. They could be holding it in and repeatedly thinking about it privately (or ruminating over it) allowing the disturbing memories to get more intense by the day.  This can often be a coping mechanism- protecting themselves from dark or negative feelings for a while, but eventually it builds up and can become symptomatic like flashbacks and anxiety, then leading to an eventual explosion.  Meanwhile, some people just have flashbacks right after the experience because of the way that everybody's brain processes differently. Others obsess over thoughts that keep popping up over and over again. It really just depends on the person.

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SIGNS AND SYMPTOMS

Not every traumatized person develops ongoing (chronic) or even short-term (acute) PTSD. Not everyone with PTSD has been through a dangerous event. Some experiences, like the sudden, unexpected death of a loved one, can also cause PTSD. Symptoms usually begin early, within 3 months of the traumatic incident, but sometimes they begin years afterward. Symptoms must last more than a month and be severe enough to interfere with relationships or work to be considered PTSD. The course of the illness varies. Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic. A doctor who has experience helping people with mental illnesses, such as a psychiatrist or psychologist, can diagnose PTSD.

To be diagnosed with PTSD, an adult must have all of the following for at least 1 month:
• At least one re-experiencing symptom
• At least one avoidance symptom
• At least two arousal and reactivity symptoms
• At least two cognition and mood symptoms

Re-experiencing symptoms include:
• Flashbacks/Bad dreams - reliving the trauma over and over, including physical symptoms like a racing heart or sweating
• Frightening thoughts

Re-experiencing symptoms may cause problems in a person’s everyday routine. The symptoms can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing symptoms.

Avoidance symptoms include:
• Staying away from places, events, or objects that are reminders of the traumatic experience
• Avoiding thoughts or feelings related to the traumatic event
• Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.


Arousal and reactivity symptoms include:
• Being easily startled
• Feeling tense or “on edge”
• Having difficulty sleeping
• Having angry outbursts

Arousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic events. These symptoms can make the person feel stressed and angry. They may make it hard to do daily tasks, such as sleeping, eating, or concentrating.





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HOW STRESS CAN MAKE YOU SICK
For our well-being, stress is so powerful that it can affect just about every function in our bodies right down to our cells. Stress can cause major weight gain, headaches, hair loss, dental problems, major fatigue, respiratory issues, digestive problems, psychological & focal disorders.  It is also known to affect the performance of our immune system - allowing for skin issues, colds, allergies and a host of chronic diseases. Stress management is important for more than psychological health; stress can greatly affect immune functioning, inflammation and even hormonal balance. Studies have shown that stress can reduce natural killer cell function. These are normally the cells that attack foreign invaders including viruses, bacteria and fungi. They are also the cells that patrol the body as the first line of defense against the development of cancer. 

Stress links to Cancer
When stressed, the body responds to physical, mental, or emotional pressure by releasing stress hormones (such as CORTISOL, EPINEPHRINE AND NOREPINEPHRINE) that increase blood pressure, speed heart rate, and raise blood sugar levels. When chronically elevated, these stress hormones can corrupt the performance (and even paralyze) our immune system which can lead to osteoporosis, weight gain (especially the dangerous visceral fat), high blood pressure, cardiovascular disease and cancer. These stress hormones are known to bind with cancer cells and stimulate angiogenesis, cell migration and invasion, leading to increased tumor growth and progression. Long term stress also increases blood supply that adds to the growth of cancerous tumors.

See complete article at IMMUNOLOGY TODAY
Also see video on "THE PITTS- 5 Elements that Affect the Immune System"



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TRANSCRANIAL NEURO-IMAGING FOR STRESS RELATED DISORDERS
By Dr. Robert L. Bard

Emotional traumas and stress influencers are scientifically aligned with anxiety, depression, behavioral disorders, drug/alcohol abuse and a wide list of physiological health issues.  These symptoms are typically diagnosed by mental health professionals through observational science and behavioral analysis.  But within the past 15 years, global advancements in transcranial imaging pioneered the ability to detect trauma-related issues in the brain through neurological imaging. Now, neurological stress can be identified clinically by monitoring chronic imbalance and changes in the neurochemical structure (or circuitry).  The shift in memory performance - specifically the hippocampus and the medial prefrontal cortex is one indicator of this imbalance whereby a stressful event can show images with signs of neuronal dysfunction.

Neuro-imaging measures brain thought activity which has known chemical tissue changes by observing the alterations in capillary blood vessels in the retina located in close proximity to the main emotional center of the anterior brain. Functional MRI (fMRI) is currently used to show brain chemical changes with cognitive commands such as “death vs freedom.” Most recognizable patterns with suicide occur in the anterior cingulate cortex of the brain which lies directly behind the globe and is vascularized by orbital branches of the anterior cerebral artery. Functional near infrared imaging (fNIR) devices show changes in brain oxygenation linked to suicide.

Another imaging innovation is the TRANSCRANIAL DOPPLER (TCD) - a type of sonogram that is a non‐invasive, non‐ionizing, inexpensive, portable and safe technique that uses a pulsed Doppler transducer for assessment of the blood flow in the anterior cerebral arterial circulation. This technology has been used to evaluate intracranial steno‐occlusive disease, subarachnoid hemorrhage, and extracranial diseases (including carotid artery disease and subclavian steal syndrome), detection of microembolic signals and acute strokes. [5] The Transcranial Doppler has been used to examine the mean speed of blood circulation of patients to validate and monitor treatment efficacy by tracking cranial blood vessels and vertebrobasilar flow vasospasm.  (See complete report from Military Medicine)

Another device used by imaging specialists to detect mental distress is through an EYE SONOGRAM or  Real Time Sonofluoroscopy of the orbital soft tissues of the eyes.  This process is performed in multiple scan planes with varying transducer configurations and frequencies.  Power and color Doppler use angle 0 degrees and PRF at 0.9 at the optic nerve head. 3D imaging of optic nerve and carotid, central retinal arteries and superficial posterior ciliary arteries performed in erect position before & after verbal communication and  orbital muscle tissue contractions may be observed as a precursor to visual changes in facial expression. Retinal arterial directional flow is also measured with peak systolic and diastolic values. Bulging of the optic nerve head is checked as increased intracranial pressure may be demonstrable in this condition. Other innovations such as the TRANSORBITAL DOPPLER, 3D/4D VESSEL DENSITY HISTOGRAM and the RETINAL OCT (optical coherence tomography) are also being explored in the pursuit of studying brain performance through the eyes.  An expanded review on these solutions will be available in part 2 of this report.

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CONTRIBUTORS /  EDITORIAL TEAM


ROBERT L. BARD, MD, PC, DABR, FASLMS - Advanced Imaging & Diagnostic Specialist
Having paved the way for the study of various cancers both clinically and academically, Dr. Robert Bard co-founded the 9/11 CancerScan program to bring additional diagnostic support to all first responders from Ground Zero. His main practice in midtown, NYC (Bard Diagnostic Imaging- www.CancerScan.com) uses the latest in digital Imaging technology has been also used to help guide biopsies and in many cases, even replicate much of the same reports of a clinical invasive biopsy. Imaging solutions such as high-powered Sonograms, Spectral Doppler, sonofluoroscopy, 3D/4D Image Reconstruction and the Spectral Doppler are safe, noninvasive, and does not use ionizing radiation. It is used as a complement to find anomalies and help diagnose the causes of pain, swelling and infection in the body’s internal organs while allowing the diagnostician the ability to zoom and ‘travel’ deep into the body for maximum exploration.

JESSE STOFF, MD, HMD, FAAFP - Cancer Immunologist / Publisher of Wellness Programs
Dr. Stoff is a highly-credentialed medical expert studying all medical remedies in pursuit of resolving the most challenging health issues of our time. In many circles, he is recognized for his 35+ years of dedicated work in immunology and advanced clinical research in modern CANCER treatments. He has spoken worldwide in some of the most sought-after medical conferences about his experiences and analyses on the study of human disease. His integrative practice (INTEGRATIVE MEDICINE OF NY, Westbury, NY) has been continually providing all patients with the many comprehensive clinical options and modalities available- including "ONCO-IMMUNOLOGY", the science of battling cancer cells and reversing pre-cancerous conditions through a complete prevention program that has earned him great success in this field.  For more information, visit: www.Dr.JesseStoff.com

JESSICA A. GLYNN, LMSW, CPC, CEC - Responders' Mental Health Program
As a therapist and coach, a lot of my work with clients is helping to manage symptoms of anxiety and panic- that which manifests in physical, often frightening and alarming ways. We can experience things like racing heartbeat, shortness of breath, numbness in arms and legs which can all make us feel like we are out control of our bodies and our surrounding world. When we have experienced a traumatic event in our lives, these feelings can be even more severe and heightened. The trauma and residually related fear is one that is very close to my heart and a reason I can provide empathy and understanding to clients that have been affected by the horrific day. When we work to process physical emotions that arise from trauma, the hope is that one day we can be less affected by it and live more presently to enjoy life’s fulfilling moments. I work with clients to slowly pull apart the physical emotions we experience from the thoughts that we are having and process them in a more self-aware and grounded way., visit her website- www.jagtheracoach.com

CHERI AMBROSE, Co-editor/outreach coordinator for NYCRA
Cheri is the associate editor for various publications such as PinkSmart News, the Journal for Modern Healing and First Responders Cancer News.  She is a patient advocate for many cancer-related programs and often contributes her time in cancer research fundraising events.  As the communications director for the NY Cancer Resource Alliance, she manages community outreach, partnership missions with other cancer foundations and research organizations and attends educational functions for cancer awareness. Her latest public projects include the launch of ImmunologyFirst.org and ImplantScan.org.  She stands as the current President of the male Breast Cancer Coalition (MaleBreastCancerCoalition.org).



** SIGNS AND SYMPTOMS segment is sourced from The National Institute of Mental Health website: www.nimh.nih.gov










References
1) https://www.rcpsych.ac.uk/mental-health/problems-disorders/post-traumatic-stress-disorder
2) https://www.psychologytoday.com/us/blog/cop-doc/201811/cops-and-ptsd
3) https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
4) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729089/
5) Transcranial Doppler: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2659960/
6) Transcranial Doppler 2: https://www.ncbi.nlm.nih.gov/pubmed/11725323
7) Design and Validation of an FPGA-Based Configurable Transcranial Doppler Neurofeedback System for Chronic Pain Patients https://europepmc.org/articles/pmc6069097
8) https://academic.oup.com/milmed/article/166/11/955/4819466
9) PTSD Diagnosis Aided By New Imaging Techniques  https://www.psychiatryadvisor.com/home/topics/anxiety/ptsd-trauma-and-stressor-related/ptsd-diagnosis-aided-by-new-imaging-techniques/
10) https://psychcentral.com/news/2014/12/02/imaging-studies-differentiate-ptsd-mild-brain-injury/78060.html
11) https://www.psychologytoday.com/us/blog/the-many-faces-anxiety-and-trauma/201904/how-do-we-diagnose-ptsd





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Wednesday, July 24, 2019

9/11 Asthma Cases & the Firefighters' Cough Continues to Plague First Responders

© Copyright 2019 - The Biofoundation for AngioGenesis R&D / IntermediaWorx inc. All Rights Reserved. Published for the NY Cancer Resource Alliance (NYCRA), AwarenessforaCure.org and HealthScanNYC.org

FOREWORD by: Dr. Jesse A. Stoff
Recently in the news, they're talking a lot about asbestos and asbestos-related cancers due to 9/11 exposure because when the Twin Towers collapsed, all the asbestos that was in there for insulation was aerosolized. And when you breathe that stuff in, in small particles that have been micronized from the explosion and compression phenomena, when those particles get lodged in the lungs, the body doesn't have a good way to excrete it.   Because lung tissue (unlike liver tissue for example) heals by scarring and not regeneration, when the lungs are exposed to chronic irritants that the body can't get rid of, chronic inflammation and irritation ultimately leads to the death of lung cells called pneumocytes.  That area of damage causes bronchiectasis and scar tissue formation which can lead to COPD and the diseases associated with that including cardiovascular problems and death.  [1] (source: Huntington Patch)


ASTHMA: A MAJOR PREVALENCE WITH FIRST 9/11 RESPONDERS
Fact: no two individuals are ever the same especially when it comes to the physiological effects of envrionmental health hazards- such as those from a disaster zone like Ground Zero. We have all seen countless cases of health issues appearing for the first time 10-15 years after 2001, and the same includes respiratory disorders like ASTHMA.

Where logic may dictate that  the giant plume of noxious dust should equate to a widepsread case of pulmonary issues within moments of contact, physicians have observed a variety of effects depending on body types (reflecting genetic makeup) or possibly a unique tolerance level that may actually resist or even 'hide' any symptoms until well past a decade from the exposure.  Others may even continue to show zero evidence of negative effects at all (or for now).

"THE TELLTALE COUGH"- EXPLAINED
According to Dr. Paul Schulster, (pulmonologist from Oceanside, NY) the COUGH can say a lot, but often misleads the patient as a "nothing" or a "simple little cough".  For firefighters, it is usually a telltale sign of various possible issues. The first syndrome often comes from a post-nasal drip. The second most common cause is from irritation, inflammation and bronchiospasm. Third is Gastroesophageal Reflux Disease. My 9/11-related patients that have GERD starts with that warning cough while others' coughs can trigger the asthma.  Finally, Irritative Cough Syndrome can also happen where one cough leads to another cough, irritating the airway, exacerbating another cough - and then another.

Having a cough here or a wheeze there is not enough for most first responders to raise the flag of alarm. Seasoned specialists like Dr. Schulster recognizes that unique and unusual symptoms or maladies do not reach the patient's consciousness for quite some time.  Ignoring or not paying more attention to these "little" anomalies tend to often be the norm.  These coughs may progressively grow worse over the years and then one day they begin to wheeze a little more than usual and wind up with advancing shortness of breath.  Once this becomes significant and finally enters their consciousness, only then will the thought of seeking medical help actually come to mind.













DIAGNOSTIC OPTIONS
Oftentimes, an exam from the pulmonologist starts with the CAT scans of the chest. The firefighters are being tracked for pulmonary nodules. They're referred to as sub-centimeter nodules, which are so small that you can't read it. "You don't really see them on a plain X-ray, chest X-rays, PA and lateral. A lot of these first responders already come to me with CAT scans from the past and have been followed by World Trade Center program and the FDNY doctors that are also pulmonary doctors"- states Dr. Schulster.

In a pulmonologist's tool kit exists certain standard pulmonary function examss- including the SPIROMETRY [2].  This test estimates the narrowing of your bronchial tubes by checking how much air you can exhale after a deep breath and how fast you can breathe out [5].   This allows us to  see the best way of determining the lung function in numbers, more or less, is a complete pulmonary function test.  Next is the METHACHOLINE CHALLENGE [3] - also known as an asthma trigger that, when inhaled, will cause mild constriction of your airways.  If you react to the methacholine, you likely have asthma. This test may be used even if your initial lung function test is normal. [5]   Another test used is THE COLD AIR CHALLENGE [4]. The  patients generally come with having had those in the past and most are positive for asthma. In the asthmatics. 

Inevitably, multiple poisons inhaled in 'the pile' trigger disorders that are obtained on a longterm basis. The isocyanates and the aldehyde may trigger the asthma, "but I'm not certain if we really know the specific cause of their 9/11 based asthma. There's a long list of toxins that irritate and inflame. The probable causes of Asthma are either chronic of acute inflammation. As they breathed in the 9/11 dust, they breathed in 30 of those toxins, causing inflammation in the airways which then led to chronic reactions."

The sub-centimeter nodules seems to be frequent with 9/11 responders. The good news is that most of them turn out to be benign.  One follows these nodules for a couple of years with images and CAT scans because they're often too small to really see on plain chest X-rays. And if they remain the same size, they get smaller over a few years, then they're considered benign. And then that's how we deal with it.

Concluding Dr. Schulster's interview, we found that identifying a chronic respiratory disorder like Asthma can be quite involved that there are various diagnostic solutions and treatment options available depending on its classification or severity. Especially in the case of a first responder's long-term exposure to toxic fumes, recognizing the source(s) of contamination can greatly help the physician establish the proper treatment strategy for the patient.


EXTRA: ASTHMA TREATMENT OPTIONS  
source: https://www.mayoclinic.org/diseases-conditions/asthma/diagnosis-treatment/drc-20369660
Prevention and long-term control are key in stopping asthma attacks before they start. Treatment usually involves learning to recognize your triggers, taking steps to avoid them and tracking your breathing to make sure your daily asthma medications are keeping symptoms under control. In case of an asthma flare-up, you may need to use a quick-relief inhaler, such as albuterol.

Medications
The right medications for you depend on a number of things — your age, symptoms, asthma triggers and what works best to keep your asthma under control. Preventive, long-term control medications reduce the inflammation in your airways that leads to symptoms. Quick-relief inhalers (bronchodilators) quickly open swollen airways that are limiting breathing. In some cases, allergy medications are necessary. Long-term asthma control medications, generally taken daily, are the cornerstone of asthma treatment. These medications keep asthma under control on a day-to-day basis and make it less likely you'll have an asthma attack.  See complete list of TREATMENT options and full descriptions @ MAYO CLINIC's website:
https://www.mayoclinic.org/diseases-conditions/asthma/diagnosis-treatment/drc-20369660

..................................................................................................................................................................

STAFF EDITOR 
JESSE STOFF, MD, HMD, FAAFP is a highly-credentialed medical expert studying all medical remedies in pursuit of resolving the most challenging health issues of our time. In many circles, he is recognized for his 35+ years of dedicated work in immunology and advanced clinical research in modern CANCER treatments. He has spoken worldwide in some of the most sought-after medical conferences about his experiences and analyses on the study of human disease. His integrative practice (INTEGRATIVE MEDICINE OF NY, Westbury, NY) has been continually providing all patients with the many comprehensive clinical options and modalities available- including "ONCO-IMMUNOLOGY", the science of battling cancer cells and reversing pre-cancerous conditions through a complete prevention program that has earned him great success in this field.  For more information, visit: www.Dr.JesseStoff.com


CONTRIBUTING 9/11 PHOTOGRAPHER
KEVIN P. COUGHLIN is a Pulitzer Prize-sharing photojournalist, writer, director of photography, pilot, and aerial cinematographer. He is the current executive photographer to New York Governor Andrew M. Cuomo. His photographs at Ground Zero following the September 11, 2001 attacks on the World Trade Center and while covering funerals and memorial services of fallen fire fighters, police officers, and emergency personnel killed as a result of the attacks are included in the 2002 Pulitzer Prize awarded to The New York Times for Public Service. In addition to The New York Times, his photographs have appeared in the New York Post, New York Daily News, Newsday, The Philadelphia Inquirer,  https://www.kevincoughlinphotography.com/


PROFESSIONAL INTERVIEWED IN THIS ARTICLE
PAUL L. SCHULSTER, MD PC is a practicing Pulmonary Disease Specialist in Oceanside, NY. Dr. Schulster graduated from University of Kentucky College of Medicine in 1972 and has been in practice for 47 years. He completed a residency at Queens Hospital Center. Dr. Schulster also specializes in Internal Medicine. Dr. Schulster also practices at South Nassau Community Hospital. One Healthy Way Oceanside NY. His private practice is located at: 442 Waukena Avenue, Oceanside, New York. 11572 |  (516) 599-8234



References:
1)The 9/11 Attacks are Still Going On with Asbestos Based Cancers- by: Jesse Stoffhttps://patch.com/new-york/huntington/9-11-attacks-are-still-going-asbestos-based-cancers
2) Spirometry: https://www.healthline.com/health/spirometry
3) Methacholine Challenge Test: https://www.lung.org/lung-health-and-diseases/lung-procedures-and-tests/methacholine-challenge-test.html
4) Cold Air Challenge: https://www.sciencedirect.com/science/article/abs/pii/S1526054205000941
5) Asthma/Mayo Clinic Report: https://www.mayoclinic.org/diseases-conditions/asthma/diagnosis-treatment/drc-20369660


Public Service Announcement from AwarenessforaCure.org

Thursday, July 18, 2019

CANCER TREATMENT OPTIONS: REVIEW

SOURCE: NIH National Cancer Institute 

 There are many types of cancer treatments. The types of treatment that you have will depend on the type of cancer you have and how advanced it is. Some people with cancer will have only one treatment. But most people have a combination of treatments, such as surgery with chemotherapy and/or radiation therapy. You may also have immunotherapy, targeted therapy, or hormone therapy. Clinical trials might also be an option for you. Clinical trials are research studies that involve people. Understanding what they are and how they work can help you decide if taking part in a trial is a good option for you. When you need treatment for cancer, you have a lot to learn and think about. It is normal to feel overwhelmed and confused. But, talking with your doctor and learning all you can about all your treatment options, including clinical trials, can help you make a decision you feel good about. Our Questions to Ask Your Doctor About Treatment may help.

Surgery: When used to treat cancer, surgery is a procedure in which a surgeon removes cancer from your body. Learn the different ways that surgery is used against cancer and what you can expect before, during, and after surgery.




Radiation Therapy: is a type of cancer treatment that uses high doses of radiation to kill cancer cells and shrink tumors. Learn about the types of radiation, why side effects happen, which ones you might have, and more.




Chemotherapy: is a type of cancer treatment that uses drugs to kill cancer cells. Learn how chemotherapy works against cancer, why it causes side effects, and how it is used with other cancer treatments.




Immunotherapy to Treat Cancer- helps your immune system fight cancer. Get information about the types of immunotherapy and what you can expect during treatment.




Targeted Therapy is a type of cancer treatment that targets the changes in cancer cells that help them grow, divide, and spread. Learn how targeted therapy works against cancer and about common side effects that may occur.

Hormone Therapy is a treatment that slows or stops the growth of breast and prostate cancers that use hormones to grow. Learn about the types of hormone therapy and side effects that may happen.

Stem Cell Transplants are procedures that restore blood-forming stem cells in cancer patients who have had theirs destroyed by very high doses of chemotherapy or radiation therapy. Learn about the types of transplants, side effects that may occur, and how stem cell transplants are used in cancer treatment.


Precision Medicine helps doctors select treatments that are most likely to help patients based on a genetic understanding of their disease. Learn about the role precision medicine plays in cancer treatment, including how genetic changes in a person's cancer are identified and used to select treatments.

Reflectance Confocal Microscopy (RCM)- The latest Imaging Advancement for Dermatologists


DR. MANU JAIN, Optical Imaging Specialist at Memorial Sloan Kettering Cancer Centre (MSKCC) Department of Dermatology provides great insight on the advantages of Reflectance Confocal Microscopy (RCM) for the diagnosis of skin cancers, in vivo.

RCM is a form of in vivo microscopy— “histopathology-like” diagnosis without doing a biopsy.  It offers several advantages over conventional light microscopy, including imaging of tissue in vivo and ability to provide bedside diagnosis. In addition to its applications in dermatology it can also be applied for oral cancers.  Meanwhile, we call this application ‘optical biopsy’.   Microscopy is actually what's paving the way for digital imaging in dermatology. Before this it was the naked eye and magnifying lens.

THE POWER OF LIGHT
As ultrasound is recognized for being non-invasive and radiation free, so is optical imaging – gathering cellular and nuclear epidermal and superficial dermal information through the use of LIGHT and laser.  It penetrates the skin to reach an estimated 200 micron in depth - good enough in dermatology to diagnose skin cancers like melanoma, basal cell carcinoma, and squamous cell carcinoma. Because most tumors that appear originates at the dermo-epidermal junction (around a hundred-micron depth from skin surface). In addition to morphological and cellular details, RCM also provides information on the dynamic phenomenon of the blood flow very clearly. 

Dr. Jain joined MSK four years ago, but this technology has been used primarily for research  prior to her joining in the USA. The engineering team at MSK (headed by Dr. Milind Rajadhyaksha) helped design this machine in collaboration with Caliber ID (Rochester, NY) 20+ years ago.  Few years ago, RCM acquired a category I current procedural terminology (CPT) reimbursement codes (96931–96936) by the US Centers for Medicare and Medicaid Services (CMS) [1]. However, there are limited expert readers of RCM in the US. To bridge this gap, Dr. Jain teaches and trains her residents in the dermatology and dermatopathology. She is has started her own annual CME accredited confocal courses at Memorial Sloan Kettering Cancer Center. She is also the Vice-president of recently formed American Confocal Group.

This innovation relies solely on reflectiveness of various tissue structures in the skin, illuminating and magnifying images by relying on the light planes. “Your skin is like a mirror and when you shine light on the mirror, whatever absorbs all the light becomes dark and whatever reflects all the light appears bright”.

"I think it could be interesting to explore the option of combining confocal microscopy with ultrasound because ultrasound can give us the doppler information and also the depth is a very good with ultrasound… which we miss with confocal microscopy.  So that would be really great. Like they have done with confocal and optical coherence tomography."

 Her professional focus is to teach RCM to dermatologists and dermatopathologists.  For the large institutions, it’s fairly affordable and cost-effective as it takes only 15 minutes or 20 minutes to do one lesion.  That means a patient gets scanned and diagnosed at the same time. This saves a lot of time for the patient at the end of the day because the patient doesn't have to wait for the biopsy report for week.

According to Dr. Jain's original bedside diagnosis study,, RCM has shown remarkable sensitivity (~90%) and specificity (~70%) in hands of a novice, within a short interval of 16 months [2] , for skin cancers..  Several studies reported RCM imaging to achieve sensitivity of 70–92% and specificity 84–88% for melanocytic lesions [3] and sensitivity of 100–92% and specificity 85–97% for non-melanocytic skin lesions . . "As an example, we’re examining a patient's new mole with confocal microscopy and if we are suspicious that it might be melanoma, we can use dermoscopy and confocal together to improve the accuracy of diagnosis. 

Although the sensitivity of RCM has not much changed over dermoscopy but the specificity is two times superior—translating into marked decrease in benign biopsies. 

RCM TECHNOLOGY DEVELOPMENT
Thanks to the developmental expertise of Dr. Milind Rajadhyaksha (member of the faculty of Memorial Sloan Kettering Cancer Center), the IN VIVO CONFOCAL MICROSCOPY is fast becoming the new standard in dermal non-invasive imaging.  Originally conceptualized with his mentors at MD Anderson (renowned physicist Dr. Robert Webb and dermatologist/laser pioneer Dr. Rox Anderson), the team sought better ways to detect skin cancers while reducing the need for biopsies in real time at the bed-side.  At the time, biopsy and pathology were the standard approach for detecting and diagnosing skin lesions.  The demand for advancing diagnostic imaging was a call from the 5 million+ new cases diagnosed in the US each year and another million cases detected in Europe, UK, Australia, other regions of the world.

Milind (as he prefers to be called) described how the RCM works in simplified terms: “We start with a bright light source… in our case it's a laser.  We focus the laser down to a very tiny spot inside the skin and we move the spot around in 2 dimensions so we create essentially a plane of illumination by moving that spot. Imagine having a flashlight which you point at a wall and now you move the flashlight back and forth, sideways and up and down until you can illuminate the entire wall.  Similarly, we ‘paint’ a single plane within tissue with focused laser spot and we collect light from each location that the spot illuminates and that we can use that to produce an image. You can essentially create an image or a picture of a single layer of cells or layer of tissue within skin.”

Milind states having built the original laboratory bench top portion in the early 1990’s and continued the expansion of the technology with MSKCC since 2005. He has been involved with advancing both the IN vivo (means directly on the patient) and the EX vivo microscope (referring to any fresh tissue that has been removed from the patient, ie. biopsy) to do faster imaging over large areas. Besides looking at skin cancers, this technology is set up over a mic top with a probe that can allow for imaging inside the oral cavity looking for oral cancers. “We've done a lot of work in imaging to guide treatment, surgeries and to guide laser ablations at Memorial for more than a decade.”

References:
1) Current Procedural Terminology, Professional Edition. Chicago IL: American Medical Association; 2016. The preliminary physician fee schedule for 2017 is available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1654-P.html