Wednesday, April 21, 2021

CHAGA MUSHROOM: Century Old Healing Solution for Complex Disorders

NYCRANEWS was fortunate to catch up to Debbie Falborn, Pediatric & Home Care Nurse from Sag Harbor, NY and a major wellness resource about the healing powers of chaga mushroom.  Since her  exciting tenure as co-owner of CHAGA ISLAND INC. (2016-2019), Debbie and partner Bridget LeRoy helped to bring "this  health secret of the east" to many with safe alternatives in anti-inflammatory and antiviral properties. 

We originally learned about Chaga mushroom and its medicinal qualities from our prior interview with Jim Hunt and his solutions to treat his own prostate cancer.  Debbie shared her experiences, her research and personal understanding about how this unique treatment solution works.  She employed her talents as a clinician (RN) and a health advisor to cancer patients who showed tremendous success using the mushroom for some of a wide range of health issues.


MEDICINAL PROPERTIES FROM A SINGLE MUSHROOM
I was introduced to Chaga Mushrooms many years ago by my sister who is also a registered nurse, but light years ahead of me with her background in Oriental medicine. I was in a car accident and I had a very bad neck injury – resulting in surgeries and subsequent traumas from it.  She introduced chaga to me, and immediately I felt amazing levels of improvement in my mobility, my neuropathy and other issues from my injury!  

Experts in Chinese medicine are well aware of chaga for their patients, as it has been around for thousands of years in other cultures like Scandinavia, Russia, China etc. Even an article from Sloan Kettering mentioned that chaga mushroom is being used in association with Covid, managing influenza type B like a Tamiflu/ They see it as a preventive to help your immune system and keeps you strong and healthy.

From all the global research, chaga mushroom has an exceptional amount of Betulinic acid which has been found to shrink tumors. It also provides the ability to detox, and many vital supportive nutrients like potassium, zinc, vitamin D- helpful supplements to complement our inactive lifestyle. The way I understand it, chaga mushroom has been recognized to actually change the mitochondria in the cancer cell, where its compounds can actually break down the outer shell up the cancer cell. 

Betulinic acid is a naturally occurring pentacyclic triterpenoid which has antiretroviral, antimalarial, and anti-inflammatory properties, as well as a more recently discovered potential as an anticancer agent, by inhibition of topoisomerase.


HOW DO YOU FIND IT?
There are specific suppliers online. You can search under “chaga chunks” or “chaga mushroom chunks”. It comes from very cold climates. It needs to be taken off LIVE WHITE BIRCH TREES. It can't be off dead trees - so people need to know where it comes from.  Some science that says that the chaga from Siberia was contaminated by Fukushima because it has to grow for a minimum of 15 years to be hard to stick. So it's a slow growing conch. It feels like wood and it never disintegrates when you cook it.  It will stay this property until all of the goodness is extracted out of it. And then you can just use it as a Tinder in the fire or throw it out. But slow brew it into a tea and it's very strong, very medicinal, and it's pretty remarkable stuff. 

GETTING THE WORD OUT
Years later, I formed a successful business around this with a friend (Bridget Leroy) whose son I helped recover from a very long bout with mono within just a few days with chaga mushroom tea. We started promoting Chaga Mushroom chunks in health fairs and farmers markets for weight loss, then for things like skin psoriasis.  But soon after, more and more (young) people started coming around searching for it based on their own research to manage cancer.  Most of them were quite verbal about their cancers and raved about their own findings and success with Chaga.  This helped to drive us to build up the entire distributorship and marketing to expand our community reach, and even expanded the product line to include bottling chaga tea.

The major audience for our chaga business was mainly those who were needing the strong medicinal version (needed more than just a pre bottled tea). They specifically needed the concentrate from the chunks to brew it themselves as part of their entire health program-- many of which involved special diets, other supplements and things tailored to people undergoing treatments or suffering cancers.

With my background as a registered nurse, I made suggestions based on their blood work and their current symptoms & diagnoses.  They integrated the chaga information I provided with those from their practitioners as part of a personal integrative health plan.  I would often check in with many of them from time to time to see how they were doing, and I found a lot of incredible success stories to attest to the efficacy of this tea.


JIM HUNT
Jim was one of those well researched shoppers at the farmer's market.  He may have sent his mom the first time and I believe she was a wellness or nutrition buff herself. We got to connect by phone at first about his medical history, his lifestyle, his family- and we put it all together towards some kind of a sensible plan alongside working with his physician.  His plan was his own and he did great- he's thriving and doing wonderfully.


WORKING THE BENEFITS OF THE MUSHROOM
During our video interview, Debbie showed us the actual chaga mushroom chunks, looking like dried dark meat in the palm of her hand.  

You start with four or five 2 inch cubes, fill up a Crock-Pot that should make enough tea to fill an eight quart crock pot twice.  A rule of thumb is to boil just however many that can fit in the cup of your hand. It gets to be the color of dark maple syrup, and you can drink it warm or cold.  People can sweeten it if they choose to.  I suggest a true stove top boil, better than microwave to get the most out of it. I suggest two cups a day.  Before I started working with so many cancer patients, I used this for DIABETES because it stabilizes blood sugar and blood pressure. 

There's different ways of extracting the benefit. Jim Hunt’s version was to brewed it, using four or five mushrooms in eight quarts of water, put it in the fridge then he took it to work every day in his cooler.  In order to get all of the properties out of the chaga mushroom, like the BETULINIC ACID, the POLYPHENOLS, the ANTIOXIDANTS and all the different properties that are in it, it has to leach out into the water. So the only way to make that happen is to slow brew it with a continual heat.  

Another way to use it is to grind it into a powder and make it into a tincture with alcohol. It sits for months, and you can put it under your tongue- like any other kind of a tincture.  But for most of the people that I've spoken to (those who are sick), they need the optimal benefit of the tea. And for that is definitely slow brewing it and drinking it out of a cup, like a cup of coffee or tea. That is definitely the best way to do it.


EPILOGUE
Debbie closed Chaga Island in early 2020- at the start of the Covid Pandemic due to the regulated shutdowns of all public gatherings.  She remains a recognized figure and an educational resource in the wellness community.  She continues to support patients as a private home care nurse, where chaga mushroom remains a major part of her arsenal in managing her patients.  

Monday, March 22, 2021

STRAIGHT TALK GOT ME TO VACCINATE


Op Ed: ABOUT GETTING THE SHOT
By: Leopoldo Gratzi, Ed.D

NYCRA-NEWS launched the "GET THE SHOT" campaign, kicked off with by Dr. Richard Schulder (R) and the many front line health responders who posted their vaccination selfies on Linkedin.  Contrary to the very program I designed to bring prevention and safety to the public, I write this segment confessing my (then) conflicted thoughts about the vaccine.  The barrage of pros and cons from the media who all drove their hardline versions of "convincing truths" constantly fed trepidation and confusion in me.  As a publisher of health news, I wrestled daily with my social responsibility vs. my fears fueled by the daily data overload.

Adding to my struggling lack of faith was the challenge of getting the vaccine for my elderly family members (back in January of this year). Long waits, broken websites and insane lines for appointments turned into dis-appointments with zero inventory certainly took all the desire out of getting vaccinated.


"CLEAR TALK FROM THE DOCS"
I became a medical publisher to offer Scientists, Doctors and Researchers an educational platform to impart their experience-based wisdom to the general public. After conducting enough interviews with medical professionals explaining in clear English WHY they trust the vaccine, I found great peace and personal value in their logic.  Their sensible guidance broke through my fears and questioning mind, such that this compelled me to share their viewpoints to others. But more than my public service, I also realized that I was gathering their views to quell my OWN resistance from getting the shot.

Front liners and essential workers are at the top of the list for the simple reason that their work does not lend itself the option to self-isolate.  If there was a group of people who understood infection, contamination and prevention, physicians make it their business to do their 'homework' on the vaccine- enough to personally support hoping to educate the skeptics, the nay-sayers and the fear-mongers.

I found the source of our divided community to stem from confusion  overwhelming flood of digital information vs. the the emotional and psychological tolls (from the pandemic) on the public. "I got the shot to get back to work, but I can empathize those who resist it -- it takes strength and a lot of  energy to TRUST anything (ie. the government) after a year of mask-wearing, half a million deaths and a life upside down!" - says Elizabeth Cristi, home health aide.

Speaking out to all public concerns, Dr. Stephen Chagares shared his own personal findings (through the use of 1st grade math) to verify why the vaccine is SAFE and NOT RUSHED- for himself, his family and for the community.  A talented educator to his patients, Dr. Chagares drives compelling statements with the help of reputable references to support herd immunity as a sound strategy for reversing the pandemic. "The very first recipients of the vaccine were healthcare personnel... the same people who treat and restore the ill. 


SPRING IS HERE
March 2021. US news reports 447 million doses have been administered at an estimated pace of 11 million doses a day- covering 1/4 of the US population. At least four companies are successfully manufacturing and distributing a tested and proven vaccine with more underway in the next few weeks. Appointments in vaccination sites are (now) happening on a next-day basis with no issues or delays.  Truly a different environment from January.

Sunday, 3/21 - Quietly sitting in the mandatory post-vaccination 15 minute waiting room, I reflected on how quickly and efficiently I got my shot (@ a CVS in Auburndale in Queens, NY).  With a strange calm, I first texted Dr. Chagares with a big smile underneath my double mask "I'm here because of your interview on the vaccine!" attaching my selfie (R), just like the ones my docs posted on social media. 

In closing, I see the vaccine resistance is a direct stand on our personal independence.  This is reflective on our cynicism and our unrelenting ability to question authority. But as a people, we also hold the ability to band together, self-motivate and shape our beliefs for the greater good- especially in times of crisis. Dr. Chagares and the many health responders who speak out or post their selfies getting the shot are clearly endorsing the return of our way of life and a healthy community.  If the pandemic challenge is earning public trust, "Straight Talk from the Docs" got one more subscriber to join the movement of social responsibility. 

This is US.


My Vaccination Debate - by: Anthony J. Carfang

I marvel at the wonders of modern medical science and its gifts to mankind.  However, I am even more amazed at the miraculous recuperative powers of the human body.  So much so that I absolutely hate to have anything foreign enter my system.  I avoid pills and supplements.  Until this year, I had never taken the flu shot! My logic about the flu shot was simple: 1) follow all the health protocols and sanitary precautions, 2) avoid people with flu symptoms.  I further reasoned that I would have time to seek care if I did catch the flu.  It worked for decades.

Those assumptions don't work for Covid.  Asymptomatic spread makes it impossible to avoid the virus, even by diligently following the protocols.  Further, I've seen friends and relatives progress from mild symptoms to hospitalization in a matter of hours.  

That made a vaccine believer out of me.


ABOUT THE WRITER

Anthony Carfang is a board member of Survivingbreastcancer.org, a nonprofit organization committed to supporting those who have been touched by breast cancer. Whether you are caring for someone who has been diagnosed, know someone who has breast cancer, have been diagnosed yourself or carry one of the gene mutations, we understand that a breast cancer diagnosis can be life changing and overwhelming. Out of the need to navigate the uncertainty and the strong desire for connection, support, and resources, survivingbreastcancer.org was born.




REFERENCES

1) “Operation Warp Speed selects billionaire scientist’s COVID-19 vaccine for monkey tests” https://www.sciencemag.org/news/2020/06/operation-warp-speed-selects-billionaire-scientist-s-covid-19-vaccine-monkey-tests

2) How were researchers able to develop COVID-19 vaccines so quickly? https://news.uchicago.edu/story/how-were-researchers-able-develop-covid-19-vaccines-so-quickly

3) “How did we develop a COVID-19 vaccine so quickly?”  https://www.medicalnewstoday.com/articles/how-did-we-develop-a-covid-19-vaccine-so-quickly

4) “Fact check: The vaccine for COVID-19 has been nearly 20 years in the making” https://www.usatoday.com/story/news/factcheck/2021/01/21/fact-check-covid-19-vaccine-nearly-20-years-making/3873247001/

5) “A Timeline of COVID-19 Vaccine Development”  https://www.biospace.com/article/a-timeline-of-covid-19-vaccine-development/

6) National Geographic: “COVID-19 requires the world to consider 'unconventional approaches'” https://www.nationalgeographic.com/science/article/to-make-a-coronavirus-vaccine-we-may-need-to-deliberately-infect-people

7) https://www.bloomberg.com/news/articles/2021-03-12/u-s-hits-100-million-dose-mark-three-months-into-vaccine-push


Tuesday, March 9, 2021

FUCOIDAN: Anti-Cancer Functions + Inhibitor of Covid-19?

By: Dr. Robert L. Bard & Adrian Barrios  (NY Cancer Resource Alliance writing team)

A natural health ingredient known as FUCOIDAN has joined our western fight against cancer  -native to the cold temperate seas of China, Japan, Korea. According to Memorial Sloan Kettering Cancer Center, "Fucoidan is a complex polysaccharide found in many species of brown seaweed (including Undaria pinnatifida and Cladosiphon okamuranus Tokida).... shown to slow blood clotting. Laboratory studies suggest that it can prevent the growth of cancer cells and has antiviral, neuroprotective, and immune-modulating effects."

In addition to its anticancer & anti-tumor components, Fucoidan has also shown effects as an antioxidant, anti-angiogenic, antiviral, and anticoagulant activities. [5]  These properties have captured the current interest of clinicians determined to produce treatment solutions for the complex symptoms of the CoronaVirus.  At the advent of public recognition of the drug REMDESEVIR (a widely popularized drug for its qualities as an immunomodulator), recent news headlines are highlighting major comparisons and competing statements with "the Seaweed extract to out-perform Remdesivir as a Covid inhibitor".  Also, Fucoidan has been compared to HEPARIN, an anticoagulant for its chemical composition of sulfated polysaccharide.

REMDESIVIR: Is recognized as the first approved drug to be effective against SARS-CoV-2. [8] In a clinical study (on 8/6/2020) by The National Institute of Allergy and Infectious Diseases (NIAID)- a branch of the NIH, tests for the efficacy of the antiviral Remdesivir + the interferon Beta-1a is underway a potential COVID-19 treatment.  "Laboratory studies suggest... type 1 interferon can inhibit SARS-CoV-2 and two closely related viruses, SARS-CoV and MERS-CoV. In addition, two small randomized controlled trials suggest that treatment with interferon beta may benefit patients with COVID-19." [6]

First isolated by Dr. Harvey Kylin in 1913 (Uppsala University, Sweden), Fucoidan has been known to come from different species of brown algae and seaweed, carrying different biochemical properties[0] Fucoidan's bioactivity has been linked to its anti-cancer properties including the induction of inflammation through the immune system, oxidative stress and stem cell mobilization[1].

The anti-cancer property of fucoidan has been demonstrated in vivo and in vitro in different types of cancers. For the Immune System, Fucoidan has been recognized to increase the number of natural killer cells and increase in the number of cytotoxic T-cells. Tests/Trials of fucoidan's effects on dendritic cells showed that the stimulation of CTLs was more effective in fucoidan-treated DCs which exerted a high level of specific lysis of breast cancer cells [2]. In addition, Fucoidan has also been known to carry (immunomodulatory) protective effects against the side effects from chemotherapies or radiation.

 

(Geographical distribution of Okinawa mozuku.)

ANTI-INFLAMMATION
Inflammation and immunity play important roles in the development of tumorigenesis [7]. Current epidemiological and preclinical results strongly support an anti-inflammatory approach to treating cancers. Several therapeutic agents targeting cancer-derived inflammatory responses and related signaling molecules, cytokines, transcription factors, and immune cells are being developed and tested [7.5]. Inflammation, cancer recurrence and cancer metastasis have a complicated relationship. Inflammatory responses play important roles in tumor development, including metastasis [9].

In mid-2018, an oral administration and absorption study of Mozuku fucoidan in 396 Japanese volunteers was performed. [10]. The results showed that fucoidan absorption in humans is extremely low; the fucoidan concentration after oral administration was approximately ten times higher in urine than in serum, confirming the intestinal absorption of Mozuku fucoidan in humans. The results indicated that volunteers living in Okinawa prefecture have the maximum value of urinary fucoidan, significantly higher estimated urinary excretion of fucoidan by place of residence, and significantly higher Mozuku fucoidan consumption habits compared with those living outside Okinawa prefecture. However, the biological mechanisms of fucoidan absorption across the intestinal tract need to be further investigated.


FROM THE SOURCE 

This section is directly sourced from an interview with Dr. Yoshiyuki Miyazaki at the NPO Research Institute of Fucoidan in Fukuoka, Japan.  Dr. Miyazaki received his PhD in Food Science and Biotechnology (2003) at Kyushu University.  He achieved a post-doctoral fellowship of JST, and then worked on basic research work on the immune regulation in infectious and allergic diseases at Saga University as associate professor (2004-2009). Since 2014, he started FUCOIDAN research on anti-cancer and immune regulatory effects to improve “Quality of Life” at NPO Research Institute of Fucoidan as chief researcher (2010-2011). After receiving a research fellowship (2014-2016), he assumed an associate professorship in the Laboratory of Bioactive Polysaccharide Analysis in Kyushu University where he performed research work on mechanisms in the regulation of intestinal immunity by fucoidan to enhance anti-tumor immunity (2016-present)

FUCOIDAN AND THE IMMUNE SYSTEM

Fucoidan is extracted using a special filtration membrane, and components with a molecular weight of 10,000 or less (impurities such as salts, heavy metals) are removed during the extraction process. As in the case of a research program from Keio University, synthesis of Fucoidan [1][2][3], is possible at the laboratory level, but has not yet been put to practical use.

We emphasize that the actual physiological action of Fucoidan is not "anti-cancer" that suppresses the growth of cancer cells with direct interaction, but "immune improvement" that is a host defense mechanism to prevent tumor growth. It is believed that Fucoidan activates the human body's natural immune mechanism that leads to the treatment of diseases that progress with a measurable decrease in immunity. I have studied on the mechanism of immune regulation by Fucoidan since 2010 as chief researcher in NPO Research Institute of Fucoidan, and now continuing in Laboratory of Bioactive Polysaccharide Analysis, Faculty of Agriculture in Kyushu University (2016. 4 - present, associate professor). Through 10 years of research, I have found unique and certain immuno-potentiating effects of Fucoidan. I hope that immune enhancement by Fucoidan may enhance the host resistance against SARS-CoV-2 and vaccine efficacy for Covid-19 treatment.

Fucoidan is not classified as a drug, therefore is not currently applied as a measurable treatment solution for the pandemic. (Development of vaccines for COVID-19 is desired to improve the current situation.) Fucoidan may, however be used as an effective supplement to immune enhancement in the vaccination.


EFFICACY & GLOBAL ACCEPTANCE

Some human trials have revealed useful physiological effects of Fucoidan improving medical treatment. However, in my opinion, there remains varied challenges in pharmaceutical approval of Fucoidan (due to the reasons described above)  unless mass-production of synthetic Fucoidan would be developed. Meanwhile, laboratory studies indicated success in synthesizing Fucoidan at the Keio University research program-- whereby the effects of oligofucosides, synthetic sulfated oligosaccharide with backbone structures of Fucoidan have been investigated on cancer cell growth [1][2] and influenza virus infection [3].

Currently, the scientific and medical communities have no conclusive evidence of therapeutic effects of Fucoidan on SARS-CoV-2. However, Fucoidan has been known to prevent dengue virus infection by direct interaction with viral envelope glycoprotein[4]. Furthermore, it was reported that Fucoidan possibly control influenza virus infection by augment immune responses, especially virus neutralizing antibody production[5]. In this context, we previously reported that Fucoidan derived from Undaria pinnatifida augmented immunoglobulin (IgA, IgG and IgM) production by mouse spleen lymphocytes[6]. So, we are believing that Fucoidan have sure physiological activities to reinforce vaccine efficacy.


ACTIVE COMPONENTS

Fucoidan is a natural ingredient with complex composition- whereby its pharmacological component is not a single chemical substance like a DRUG or MEDICINE. Fucoidan is a kind of polysaccharide, but similar polysaccharides have β-glucan derived from mushroom. A purified β-glucan preparation named "Lentinan" has uniform composition and is approved as a drug for gastric cancer in Japan. In contrast, "Fucoidan" cannot be expected to have medicinal action by single component like β-glucan, so it is used as a naturally occurring SUPPLEMENT like Kampo rather than pharmaceuticals.

The source plant of Fucoidan is not only Undaria pinnatifida but also Cladosiphon okamuranus Tokida-  the most major species of Mozuku Fucoidan (Okinawa mozuku in Japanese name).

Physiological properties of Fucoidan has had extensive presence in the health and wellness communities, where scientific information is accessible in many articles- including Therapies from Fucoidan; Multifunctional Marine Polymers[7]   A protective effect of Fucoidan against side effects from chemotherapy with FOLFOX or FOLFIRI has been investigated in the following report; Fucoidan reduces the toxicities of chemotherapy for patients with unresectable advanced or recurrent colorectal cancer[8]


GEOGRAPHIC SOURCING

I believe Fucoidan is related to brown algae habitat and food culture. In Japan, it can be seen that seaweed has been used for health since ancient times, since there is a description in "本草和名:Honzo Wamyo", the oldest existing drug dictionary in Japan compiled around the year 900 AD. In Japan, where the country faces the sea, a food culture that incorporates seafood into the diet takes root, and it is thought that aquaculture of seaweeds and the research have advanced.

Seaweeds are classified into three groups, "red algae", "green algae" and "brown algae", and Fucoidan is a component contained only in brown algae. Other plants do not have Fucoidan.

Among the brown algae, only Fucoidan contained in Mozuku (Cladosiphon okamuranus Tokida), Mekabu (Undaria pinnatifida), and Gagomecomb (Kjellmaniella crassifolia) has the Japan Health Food Authorization (JHFA)[9] quality standards and can be certified as conforming.  The association conducts work that contributes to the health promotion of the Japanese nationals, such as collecting and spreading information on food with health claims and operating JHFA and other certifications.

According to reports, response of Fucoidan appears to affect a higher rate of residents of the sourced area (Japan) than any other part of the globe.  The research team at "Station Biologique de Roscoff", research and educational institute for marine biology and oceanography in France, reported that Japanese can decompose some kinds of polysaccharides contained in seaweed, because their enterobacteria (Bacteroides plebeius) took up gene for degrading enzyme from other marine microorganisms (published in British scientific journal "Nature" at April 8, 2010). Even within Japan, there are regional differences as with food culture, so I believe it is highly possible that there will be regional differences in the effects of Fucoidan around the world.


References:

1) Systematic synthesis of sulfated oligofucosides and their effect on breast cancer MCF-7 cells (https://pubs.rsc.org/en/content/articlehtml/2014/cc/c4cc03544e)

2) Systematic synthesis of low-molecular weight Fucoidan derivatives and their effect on cancer cells (https://pubs.rsc.org/en/content/articlehtml/2015/ob/c5ob01634g)

3) Novel hemagglutinin-binding sulfated oligofucosides and their effect on influenza virus infection (https://pubs.rsc.org/en/content/articlehtml/2018/cc/c8cc03865a)

4) Structure and anti-dengue virus activity of sulfated polysaccharide from a marine alga (https://www.sciencedirect.com/science/article/pii/S0006291X08016562)

5) Supplementation of Elderly Japanese Men and Women with Fucoidan from Seaweed Increases Immune Responses to Seasonal Influenza Vaccination (https://academic.oup.com/jn/article/143/11/1794/4637681)

6) The enhancing effect of Fucoidan derived from Undaria pinnatifida on immunoglobulin production by mouse spleen lymphocytes

(https://www.tandfonline.com/doi/full/10.1080/09168451.2014.930323)

7) "Therapies from Fucoidan; Multifunctional Marine Polymers"

https://www.mdpi.com/1660-3397/9/10/1731/htm

8) Fucoidan reduces the toxicities of chemotherapy for patients with unresectable advanced or recurrent colorectal cancer  https://www.spandidos-publications.com/10.3892/ol.2011.254

9) JHFA is a certificate given to health foods that comply with voluntary food standard set by the Japan Health and Nutrition Food Association (JHNFA). JHNFA is a public interest incorporated foundation authorized by the Cabinet Office with the aim of promoting public health (http://www.jhnfa.org/english-info.html).




The above results show that fucoidan, whether through basic in vitro to in vivo research studies or clinical trials in humans, has been proven to produce effect of adjuvant therapy on cancer treatment. This allows molecular mechanisms in cancer research to be applied in adjuvant treatment, in line with the pursuit of translational medicine and the mindset of establishing a direct link between basic medical research and clinical application.

In conclusion, understanding the mechanisms underlying the anti-cancer effects of fucoidan, the advantages of combining fucoidan with therapeutic agents in the treatment of cancers, and the pharmacological limitations of fucoidan will aid the development of more informed approaches to treating cancers and may improve current clinical outcomes for cancer patients.


References:

0. 4. Kylin H. Biochemistry of sea algae. HZ Physiol. Chem. 1913;83:171–197. doi: 10.1515/bchm2.1913.83.3.171. [CrossRef] [Google Scholar]

1. Kwak J.Y. Fucoidan as a marine anticancer agent in preclinical development. Mar. Drugs. 2014;12:851–870. doi: 10.3390/md12020851. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

2. Hu Y., Cheng S.C., Chan K.T., Ke Y., Xue B., Sin F.W., Zeng C., Xie Y. Fucoidin enhances dendritic cell-mediated t-cell cytotoxicity against ny-eso-1 expressing human cancer cells. Biochem. Biophys. Res. Commun. 2010;392:329–334. doi: 10.1016/j.bbrc.2010.01.018. [PubMed] [CrossRef] [Google Scholar]


Main sources:

4. Fucoidan and Cancer: A Multifunctional Molecule with Anti-Tumor Potential   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4413214/

5. Fucoidan Extracted from Undaria pinnatifida: Source for Nutraceuticals/Functional Foods   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6164441/#B4-marinedrugs-16-00321

6. NIH clinical trial testing remdesivir plus interferon beta-1a for COVID-19 treatment begins    https://www.nih.gov/news-events/news-releases/nih-clinical-trial-testing-remdesivir-plus-interferon-beta-1a-covid-19-treatment-begins

7. Albrengues J, Shields MA, Ng D, Park CG, Ambrico A, Poindexter ME, Upadhyay P, Uyeminami DL, Pommier A, Küttner V, Bružas E, Maiorino L, Bautista C, Carmona EM, Gimotty PA, Fearon DT, Chang K, Lyons SK, Pinkerton KE, Trotman LC, Goldberg MS, Yeh JT, Egeblad M (2018) Neutrophil extracellular traps produced during inflammation awaken dormant cancer cells in mice. Science 361:1314–1315

7.5 Grivennikov SI, Greten FR, Karin M (2010) Immunity, Inflammation, and Cancer. Cell 140(6):883–899

8. FDA: Frequently Asked Questions on the Emergency Use Authorization for Remdesivir for Certain Hospitalized COVID-19 Patients -  https://www.fda.gov/media/137574/download

9. SpringerOpen: https://clintransmed.springeropen.com/articles/10.1186/s40169-019-0234-9 (open access)

10. Kadena K, Tomori M, Iha M, Nagamine T (2018) Absorption study of mozuku fucoidan in japanese volunteers. Mar Drugs 16:254. https://doi.org/10.3390/md16080254

11. https://www.mdpi.com/1660-3397/16/8/254  Posted by Awareness 4aCure at 11:24 AM   



Disclaimer & Copyright Notice: Copyright (c) 2021, IntermediaWorx inc. All Rights Reserved.  Additional copyrights shared by: The AngioFoundation (501c3) and the publishers of Prevention101.org  & The NY Cancer Resource Alliance [NYCRAlliance.org].  Contents in this article are provided publicly for informational purposes within non-commercial use and not for purposes of resale, distribution, commercial display or performance. Unless otherwise indicated on this web based page, no reproduction of any or all materials of this page is allowed without express/written permission from the publishers.  Additional permission may be required from third-parties who have provided limited permission for our publishers to use their content, whereas licenses for some of this Content may contain additional terms. When such Content licenses contain additional terms, we will make these terms available to you on those pages (which his incorporated herein by reference).The publishers/producers of this site and its contents such as videos, graphics, text, and other materials published are not intended to be a substitute for professional medical advice, diagnosis, or treatment. For any questions you may have regarding a medical condition, please always seek the advice of your physician or a qualified health provider. Do not postpone or disregard any professional medical advice over something you may have seen or read on this website. If you think you may have a medical emergency, call your doctor or 9-1-1 immediately.  This website does not support, endorse or recommend any specific products, tests, physicians, procedures, treatment opinions or other information that may be mentioned on this site. Referencing any content or information seen or published in this website or shared by other visitors of this website is solely at your own risk. The publishers/producers of this Internet web site reserves the right, at its sole discretion, to modify, disable access to, or discontinue, temporarily or permanently, all or any part of this Internet web site or any information contained thereon without liability or notice to you.

Thursday, February 11, 2021

TEXT2MD: PANDEMIC-FRIENDLY VIRTUAL HEALTHCARE

NYCRA NEWS recently interviewed Dr. Miguel Antonatos, board certified physician in internal medicine at a major medical center in Chicago, Illinois.. He completed his residency in 2011 at Morristown Memorial hospital in New Jersey (an affiliate of Mount Sinai in NYC) and has mostly worked as a hospital based physician for the last 10 years up to today throughout the pandemic.

Dr. Antonatos is the visionary founder of TEXT2MD.com.  He started with what he considered "a little idea using TELEMEDICINE with local patients". This idea took off quite well when more and more people started asking if he knew any home-based physicians- mostly for those with limited mobility, with frail parents or those who may be at highest risk for infections. He recognized  the many challenges for home-bound patients, making telemedicine and virtual healthcare a reality for so many.  Dr. Antonatos also appreciated the ability to serve so many more patients electronically even while on hospital duty or at home. 


INTERVIEW 1: THE NEW WORLD OF DIGITAL INTIMACY & FACE-TO-FACE CARE
Since 2018, I formalized a virtual Home-based physician and called it TEXT2MD.com using the the Medici platform.  This would allow me to schedule my patients starting with mostly text messaging, then we would work together through video conferencing.  I supported programs like weight loss, lifestyle management and men's health consults but I grew a following in so many other areas as a virtual primary care - especially with Covid making doctors' visits a problem for so many.

Part of healing is the ability to directly and closely interact with the patients.  Because of the way our world is today with cell phones being the everyone's social bridge,  my patients are greatly attracted to the comforts of text messaging their doctor.  It's (now) how they talk to their closest friends and family, so being part of this channel raises the appeal for a physician's connectivity.  Better than phone, text lets them remember everything, much like a grocery list or a note pad.

 Where patients are used to scheduling an appointment with the front desk or service for weeks down the road, a medical care platform like this is a more immediate and streamlined connection. It's private, safe and response-friendly during any part of the day, allowing the physician to answer any questions at any given moment, even while on hospital duty. This level of communication access quite priceless.  

As consultations go, I usually coordinate establishing a new patient with a video conference first. This face-to-face creates our people connection. Getting to know one another is critical when it comes to learning how to help the patient and video is very useful for that. Meanwhile earning the patient's trust is equally important, and video (again) is a great way to connect this way.  We can always schedule more video meetings, but after the first F2F consult, texting or emails are the way to go, including prescribing meds or recommending other diagnostic or treatment solutions.

Currently, TEXT2MD can to work with and prescribe medication for patients in 23 states and should have over 31 by the end of February.  We are working to build a complete national access by acquiring licenses in all 50 states. 


THE VIRTUAL HOUSE CALL: A SAFE ALTERNATIVE TO DOCTORS VISITS
Within the past several decades, the medical community has been put into overdrive to come up with new solutions (or modify existing ones) to implement safer, more efficient and cost-effective ways of working with the public. From the global demand for active medical personnel, to the rising wave of safety concerns that of the many at-risk patients, we face a great need to upgrade patient care. Elderly patients with chronic conditions or those with compromised immune systems may find it difficult (and even precarious) to travel to their doctors' office and sit in a waiting room next to strangers with unknown health conditions. Upgrading to an electronic doctor's visit or TELEMEDICINE is an available reality that addresses this concern. http://telemedscans.com/


RESEARCH ON IVERMECTIN (AND OTHER ALTERNATIVE MEDS)

Even before the beginning of the pandemic, I have conducted major research when the first cases in China started.  I followed the theories of this pandemic (and even had to get Chinese documents translated)- then followed it to Italy and joined the Italian society of critical care.  By the time we had our first cases in my hospital, I was a little more prepared than the rest of my colleagues.  Then, the treatment trend was mostly supplements like Vitamin C & Zinc and meds like Hydroxychloroquine to avoid ARDS and other pulmonary complications from Covid where patients end up in the ICU and get ventilated.  (We all followed this from areas like the New England Journal of Medicine).

By March of 2020, I learned about Australian research on Ivermectin and this opened more options for me towards the treatment of COVID.  After a while, I discontinued using Hydroxychloroquine based on a secondary therapy because it didn't  really show much improvement in patients. With more and more literature growing available,  I found the FLCCC (Front Line Critical Care Alliance) and found the data from Dr. Pierre Kory and Dr. Paul Marek to align with my experiences at the hospital as far as inducing high doses of Vitamin C to avoid complications.


Through TEXT2MD, I started implementing Ivermectin mostly through my tele-medicine sessions. Unfortunately most hospitals are not familiar with Ivermectin to apply it on their patients. I wasn't able to treat any patients in the hospital with this, but I definitely felt the necessity of Ivermectin for early therapy to avoid patients from ending up in the hospital where high risk patients increase their mortality dramatically up to 25%.

Since I started implementing Ivermectin for those with symptoms or prophylactically, I have only seen great success for COVID-19. So far we have supported almost 900 patients and we have ZERO hospitalization.  We follow up on every single patient with symptoms each day from the course of their treatment since day one, and not one of them has required hospital admission.  They improved dramatically after one or two doses.  Those who have had tougher symptoms, I follow them daily with the Ivermectin treatment schedule (I-MASK+) with aspirin at 325mg. daily.

Another drug being researched in Canada now is the use of Colchicine for outpatient treatment for COVID to decrease hospitalization rates.  That's something I'm looking to implement alongside the I-MASK+ protocol.  The thing about Colchicine is that you need to be careful.  For elderly patients, there are certain contradictions and side effects.  But definitely, for certain selected patients, colchicine could be a good adjunct treatment.  I have personally treated a few patients already with colchicine with much improvement of their symptoms.

As an out of the box thinker, I always seek out good research from the global stage. I seek out data and validated success to offer new possibilities for medications that can better help patients and areas safe to use.   If the research shows convincing proof of efficacy, I'm open to exploring it.  Ivermectin is just one story; it was widely used in Africa by millions of people resulting in very minimal side effects or complications and a very high rate of response.

EPILOGUE: NOTE FROM THE PUBLISHER
By: Dr. Robert L. Bard
NYCRA-NEWS and Prevention101.org reports on innovators in healthcare as part of our global mission to provide new options and current resources in support of complete wellness. We found the creative vision of the "digital house call" of Dr. Antonatos' plan to offer what might just be the framework to the future of home-based healthcare.  His effective use of TeleHealth and remote collaboration technology shows the potential of advancing the doctor-patient access, while also offering a safer and more affordable alternative to our current personalized care solutions.  Upon further review (during and beyond our interview), his business model of Text2MD appears to offer a streamlined model in time-management for all physicians.  

A year into the Covid pandemic, access to medical care continues to recover.  Even with the vaccine in our midst, patients and all healthcare workers alike continue the fear for contamination- such that TRUSTING in the return to our old patient care format does not seem possible.  This dilemma begs for new ideas, but our Covid era also calls for faster real-time medical response solutions. We support expanded education and the type of research employed by Dr. Antonatos about proven drugs like IVERMECTIN, COLCHICINE and the other solutions that bring significant results in other countries.   It is this type of expanded information gathering that raises the bar in the medical community and adding new answers to all health concerns- including our pandemic.   

This form of leadership reflects on the adage that "it takes a crisis to bring worlds and minds together to a solution that unites us all"



HEALTH & SAFETY MOVEMENT 2021: "GET THE SHOT" - NYCRA NEWS and PREVENTION101 continues its mission to share the viewpoints of experts, renowned educators and health advocates in the spirit of expanding public knowledge. For this series, we connect with healthcare worker Dr. Michael Schulder, a leading Northwell Health neurosurgeon in Manhasset, NY. He is one of the first to share his insights and his personal research on the safety and efficacy of the recently deployed Coronavirus vaccine. Dr. Schulder also addresses his views on public skepticism about the vaccine over some of the unknown factors of the coronavirus. He shares his confidence in the science and the preventive strategy of the vaccine as well as its social impact on the global stage.  See Feature article


PAVING MEDICAL HISTORY FROM THE FRONT LINES: THE ULTRASOUND MOVEMENT From a military call of duty in Thailand (1921) to a Post-9/11 First Responders Cancer Screening program to the first Covid-19 triage units in Italy, ultrasound imaging has evolved to support medical diagnostic needs of all FRONT LINES. Both Dr. Robert Bard and the many scanning benefits of ultrasound technology have dedicated an entire work history of responding to some of the highest demands in emergency scanning  (See Feature article)





MEDICAL IMAGING REVIEW: WHAT DOES A COVID LUNG LOOK LIKE? -
All research and testing programs undergo an evolutionary staging of its data-gathering and problem solving approach. In the case of testing for the physiological effects of Covid-19, researchers have employed standard medical diagnostic protocols from genetic/blood testing to biopsies to all available medical imaging devices) to gather all necessary data.  These protocols independently and in concert provide the necessary answers leading to treatment, prevention and early detection.  (See Feature article)


What's REALLY in the Air?  - Reviewing the Presence of SARS-Cov-2 Recent headlines show evidence of Coronavirus pathogens in hospital air supply and air passageways- creating a systemic hazard for the staff and patients under critical care. Reports showing "substantial controversy whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be transmitted through aerosols.Initiatives are in full swing from health departments and hospital safety leaders to advance sanitization measures and decontamination initiatives in hospitals. Agencies indicate that without adequate environmental controls, patients with airborne infectious disases will pose a risk to other patients and healthcare workers. Heating, Ventilation and Air Conditioning (HVAC)  expertise is essential for proper environmental management when planning control of airborne infectious disease outbreaks. (see feature).






Disclaimer & Copyright Notice: The materials provided on this website/web-based article are copyrighted and the intellectual property of the publishers/producers (The NY Cancer Resource Alliance/IntermediaWorx inc. and Bard Diagnostic Research & Educational Programs). It is provided publicly strictly for informational purposes within non-commercial use and not for purposes of resale, distribution, public display or performance. Unless otherwise indicated on this web based page, sharing, re-posting, re-publishing of this work is strictly prohibited without due permission from the publishers.  Also, certain content may be licensed from third-parties. The licenses for some of this Content may contain additional terms. When such Content licenses contain additional terms, we will make these terms available to you on those pages (which his incorporated herein by reference).The publishers/producers of this site and its contents such as videos, graphics, text, and other materials published are not intended to be a substitute for professional medical advice, diagnosis, or treatment. For any questions you may have regarding a medical condition, please always seek the advice of your physician or a qualified health provider. Do not postpone or disregard any professional medical advice over something you may have seen or read on this website. If you think you may have a medical emergency, call your doctor or 9-1-1 immediately.  This website does not support, endorse or recommend any specific products, tests, physicians, procedures, treatment opinions or other information that may be mentioned on this site. Referencing any content or information seen or published in this website or shared by other visitors of this website is solely at your own risk. The publishers/producers of this Internet web site reserves the right, at its sole discretion, to modify, disable access to, or discontinue, temporarily or permanently, all or any part of this Internet web site or any information contained thereon without liability or notice to you.

Saturday, January 23, 2021

THE PULSE OXIMETER + SMART WEB SEARCHING

 Does the Pulse Oximeter Belong in Your Home Health Monitoring Kit?
by: Dr. Robert L. Bard


Almost a year into the pandemic, we have seen waves of empty shelves of specific items due to panic shopping or the recent burst of proactive health trends. This reflects a significant part of "the Covid Culture"- comprising the demand for personal safety measures (beyond the holy trinity of masking, distancing and hand hygiene).  A large part of our population also subscribes to proactive health measures  in the home which includes a daily regimen of immune-boosting health supplements.  In addition, more and more drug store shelves continue to stock up on self-check devices including the hand-held infrared THERMOMETERS, BLOOD PRESSURE CUFFS, SPIROMETERS and THE PULSE OXIMETER.     


THE PULSE OXIMETER- is an electronic device that clips onto a patient’s finger to measure heart rate and oxygen saturation in his or her red blood cells—the device is useful in assessing patients with lung disease. 

According to a report from the Yalemedicine.org, "Pulse oximeters started to fly off store (and online) shelves when people learned that low oxygen saturation levels can be a sign of COVID-19.  The logic is that shortness of breath, a symptom of the disease, may not be easy—or even possible—for a person to reasonably self-assess. What’s more, doctors report that some COVID-19 patients suddenly develop a condition called “silent hypoxia,” where people look and feel comfortable—and don’t notice any shortness of breath—but their oxygen levels are dangerously low. It happens to patients both in the hospital and at home, but it is a particular problem in the latter case because the symptom may indicate severe COVID-19-related pneumonia, requiring a ventilator. That’s why some people may want or need to monitor their oxygen saturation levels at home." [1]

There are various schools of thought when it comes to this device. Physicians often use this as a preliminary for gathering a patient's vitals.  Though highly useful for its quick and portable data-grab, common belief is that the oximeter is not relied upon for more than this.  In fact, interviews with paramedics have recommended the use of the Capnograph vs. the Oximeter as a portable diagnostic for presence of lung disease and forms of congenital heart disease. [2]

The idea of home testing remains a valid protocol for wellness maintenance and prevention, and having a small arsenal of home testing devices (if used correctly) can certainly support this. Regular self-checks of one's circulatory performance strongly supports a lifestyle of safety and survivorship from the pandemic and disease in general.   But nothing tops primary monitoring like watching for coughs, shortness of breath, muscle pain and loss of taste and smell [1]. 


How to get a Proper OxySat Reading
 
In symptomatic patients, monitoring with HOME PULSE OXIMETRY is recommended (due to asymptomatic hypoxia). The limitations of home pulse oximeters should be recognized, and validated devices are preferred. Multiple readings should be taken over the course of the day, and a downward trend should be regarded as ominous. Baseline or ambulatory desaturation < 94% should prompt hospital admission.  The following guidance is suggested:

o Use the index or middle finger; avoid the toes or ear lobe 
o Only accept values associated with a strong pulse signal
 
o Observe readings for 30–60 seconds to identify the most common value
 
o Remove nail polish from the finger on which measurements are made
 
o Warm cold extremities prior to measurement 

[3] Source: FLCCC.net (Front Line Covid-19 Critical Care Alliance) / Contributor: Dr. Pierre Kory



The ARDS / Covid-19 Connection?
Acute Respiratory Distress Syndrome (aka: Acute Lung Injury / Noncardiac Pulmonary Edema) is a serious lung condition that causes low blood oxygen where fluid builds up inside the tiny air sacs of the lungs (alveoli).  This condition disables air from properly entering the lungs and moving enough oxygen into the bloodstream and throughout the body. [4]   
Experts from Yale Medicine state that "when the virus that causes coronavirus disease enters the body, it frequently attaches to cells in the upper airway... When this occurs, COVID-19 can lead to ARDS, typically setting in about eight days after the onset of initial symptoms. Certain risk factors increase the likelihood of the development of ARDS in people with COVID-19, including advanced age, diabetes, and high blood pressure". [5]





Covid-19 Resources: WHO (and HOW) to Believe 
"In our complex information age, what we choose to believe defines us." The explosion of materials about the Coronavirus pandemic has reshaped the relationship between digital media and public readership. Today's web searcher is inundated by a tsunami of information, such that selective and intelligent searching, fact-checking and source-validating (or vetting) has become a major necessity in the daily course of education through the web.  

The widely promoted prevention protocols (of masking, distance and hand hygiene) have conditioned us all toward proactive health consciousness- driving us to want to learn more and stay in touch with the current pandemic updates.  Public health agency sites like  CDC.govNIH.gov and the WHO.int are some of the top sources for these updates, offering a comprehensive list of resources and the latest proven information on personal safety, care, prevention and treatment solutions. 

Meanwhile, medical experts and societies have also joined this worldwide coalition for public awareness and info-sharing. One such association is the IDSA (Infectious Disease Society of America), a 50+ year old community of public health experts allied with major groups like the American Federation for Clinical Research (AFCR), the American Society for Clinical Investigation (ASCI), and the Association of American Physicians (AAP). The ISDA formed a branch called the Covid-19 Real-Time Learning Network, featuring a complete, well-maintained resource forum for the general public and the medical community. (see: link)  This type of institutional resourcing brought full access to expert information, empowering the proactive researcher to a wider level of understanding- from current health news, updates on Covid safety guidelines and infection prevention.




How Healthcare Pros Battle the Pandemic

Due to the many risks in outpatient care, I hope that my receiving the first dose and publicly promoting it will encourages cohorts, colleagues, patients and others to follow suit in registering to receive theirs.  Pfizer, Moderna and so many others are reputable Biotech/Pharm companies with a long history of success in their respective field.  This vaccine stands for so much today in the eye of public health and science. With the advancements in science, the opportunity to push forth with mRNA vaccines for other diseases and viruses sheds light on future health. With early work showing a 94/95% success rate, that demonstrates and presents an opportunity for those at risk for getting ill, or those at high risk due to comorbidities of getting ill a sense of hope and resolution.  The question will be- for how long? 

As for prevention and prophylaxis, constant hand washing and gloves have always been a part of my routine, however face masks will definitely become an everyday routine.  I have always been an advocate for overall wellness and health.  At present, I personally find comfort in taking daily multivitamins in addition to vitamin C, Vitamin D and Zinc, all of which “may help in supporting a healthy immune system.  I encourage others to be sure to consult with their pharmacist to discuss possible interactions and to consider taking as well.   

Image Source: Evan Ludin's Linkedin post



Additional Features:

HEALTH & SAFETY MOVEMENT 2021: "GET THE SHOT"
NYCRA NEWS and PREVENTION101 continues its mission to share the viewpoints of experts, renowned educators and health advocates in the spirit of expanding public knowledge. For this series, we connect with healthcare worker Dr. Michael Schulder, a leading Northwell Health neurosurgeon in Manhasset, NY. He is one of the first to share his insights and his personal research on the safety and efficacy of the recently deployed Coronavirus vaccine. Dr. Schulder also addresses his views on public skepticism about the vaccine over some of the unknown factors of the coronavirus. He shares his confidence in the science and the preventive strategy of the vaccine as well as its social impact on the global stage.  See Feature article

MEDICAL IMAGING REVIEW: WHAT DOES A COVID LUNG LOOK LIKE?
All research and testing programs undergo an evolutionary staging of its data-gathering and problem solving approach. In the case of testing for the physiological effects of Covid-19, researchers have employed standard medical diagnostic protocols from genetic/blood testing to biopsies to all available medical imaging devices) to gather all necessary data.  These protocols independently and in concert provide the necessary answers leading to treatment, prevention and early detection.  (See Feature article)



References

1) Yale Medicine: Should You Really Have a Pulse Oximeter at Home? By: K. Katella 5/8/2020 / https://www.yalemedicine.org/news/covid-pulse-oximeter

2) Capnography: Wikipedia source (link)

3) Front Line Covid-19 Critical Care Alliance / FAQ: https://covid19criticalcare.com/

4) Acute Respiratory Distress Syndrome: https://www.nhlbi.nih.gov/health-topics/acute-respiratory-distress-syndrome

5) Yale Medicine: What is the relationship between COVID-19 and ARDS? https://www.yalemedicine.org/conditions/ards



CONTRIBUTORS (in order of appearance)


ROBERT L. BARD, MD, PC, DABR, FASLMS
Advanced Imaging & Diagnostic Specialist & recipient of the 2020 nationally acclaimed Ellis Island Award for his lifetime achievement in advanced cancer diagnostic imaging. Dr. 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



PIERRE KORY, M.D., M.P.A.
Board Certified in Internal Medicine, Critical Care, and Pulmonary Medicine. He served as the Medical Director of the Trauma/ Life Support Center at the University of Wisconsin. Most recently, Dr. Kory joined the emergency volunteer team during the early COVID-19 pandemic in NYC at Mount Sinai Beth Israel Medical Center. He is also a founding member of the Front Line COVID-19 Critical Working Group. (www.covid19criticalcare.com/)



EVAN M. LUDIN, MS, OTR/L, CHT
Practices in the Commack community, specializing in orthopaedic rehabilitation and splinting for sports related injuries, as well as fabricating custom mold splints for post-op care and conservative management of CTS, DeQuervains, trigger finger, arthritis, wrist fractures, elbow & forearm fractures.  He works alongside many Stony Brook University MD's listed in "Top Docs" for 20 years, in addition to the many other Orthopaedic and Plastic Surgeons.  (www.Ludinhandtherapy.com)


Disclaimer & Copyright Notice: Copyright (c) 2021, IntermediaWorx inc. All Rights Reserved.  Additional copyrights shared by: The AngioFoundation (501c3) and the publishers of Prevention101.org  & The NY Cancer Resource Alliance [NYCRAlliance.org].  Contents in this article are provided publicly for informational purposes within non-commercial use and not for purposes of resale, distribution, commercial display or performance. Unless otherwise indicated on this web based page, no reproduction of any or all materials of this page is allowed without express/written permission from the publishers.  Additional permission may be required from third-parties who have provided limited permission for our publishers to use their content, whereas licenses for some of this Content may contain additional terms. When such Content licenses contain additional terms, we will make these terms available to you on those pages (which his incorporated herein by reference).The publishers/producers of this site and its contents such as videos, graphics, text, and other materials published are not intended to be a substitute for professional medical advice, diagnosis, or treatment. For any questions you may have regarding a medical condition, please always seek the advice of your physician or a qualified health provider. Do not postpone or disregard any professional medical advice over something you may have seen or read on this website. If you think you may have a medical emergency, call your doctor or 9-1-1 immediately.  This website does not support, endorse or recommend any specific products, tests, physicians, procedures, treatment opinions or other information that may be mentioned on this site. Referencing any content or information seen or published in this website or shared by other visitors of this website is solely at your own risk. The publishers/producers of this Internet web site reserves the right, at its sole discretion, to modify, disable access to, or discontinue, temporarily or permanently, all or any part of this Internet web site or any information contained thereon without liability or notice to you.