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

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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

Thursday, July 11, 2019

A REVIEW OF TOXIC COMPOUNDS FROM EMERGENT FIRE ZONES





















© 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. Robert L. Bard, cancer diagnostic specialist (NYC)
After a decade past the 9/11 disaster, news broke of unique and advanced cases of CANCER arising in droves. A growing number of the same individuals exposed to the toxic fumes and plumes of hazardous particles in the danger zone have recently contracted aggressive cases of CANCER and were in immediate demand for medical care and desperate need for advanced research and support. 

This spike in cases can only come from ‘dormant’ cells or recurrence (usually with a vengeance) – such as cases of cancer tumors in the lung, liver, prostate, kidney, brain, skin and even the eye. To troubleshoot each case, it would be advantageous to take a crash course in toxicology and to recognize the chemical compounds that BATHED all responders during the event.  Understanding these chemicals can help us pursue their behaviors (on the body) and their long and short term effects.


TOXICOLOGY 101: A THREAT TO FIREFIGHTERS HEALTH
As part of our evaluation of all occupational illnesses contracted by first responders, we enter the world of TOXICOLOGY- the branch of science focused on the effects and detection of poisons.  It is also the discipline overlapping chemistry, biology and pharmacology- studying the adverse effects of chemical substances on living organisms.  In pursuit of first responders’ safety as far as chemical effects on the body, we connected with Professor David Purser of the Hartford Environmental Research (UK), a renowned toxicology expert who conducted major reviews on fire-exposed carcinogens published worldwide. “9/11 was unusual in that a major environmental hazard resulted from the dust cloud released as and after the Towers collapsed,” says Prof. Purser.  “The dust inhaled by responders at the time, and afterwards working at the site, has resulted in serious ongoing and developing health conditions and to this day. 

For fires in general, there is also increasing evidence and concern regarding FF exposure to carcinogens, especially from soot contamination to skin and clothing following attendance at incidents and during training.” An abstract from Prof. Purser’s latest presentation – “ Toxins Including Effects of Fire Retardants, During Fires and Post-Fire Investigation Activities” indicates a remarkable breakdown of some of the major toxins and carcinogenic compounds that the average firefighter would be exposed to.

Below is a list of common toxic elements found in active fires and post-fire investigations that first responders have been known to be exposed to.

• (2,3,7,8) Tetrachloro
..-dibenzodioxin
• Acrolein
• Aldehydes
• Asbestos
• Benz[A]Anthrene
• Benzene
• Benzo[A]Pyrene
• Carbon Fibre
• Carbon Monoxide
• Carbonyl Fluoride       (COF2)
• Ceramic
• Crotonaldehyde
• Dibenzofurans
• Dioxins
• Formaldehyde
• Furans
• Histone (H3.3)
• Hydrochloric Avid      (Hcl)
• Hydrogen Cyanide      (HCN)
• Hydrogen Fluoride      (HF)
• Isocyanates
• Metal Particulates
• Metals: Lead (Pb) & Cadmium (Cd)
• Nitrogen Oxides (Nox)
• Organic Irritants
• Phenol
• Phosphorous/Phosphate (P04)
• Polyaromatic Hydrocarbons
• Polychlorinated Biphenyls (Pcbs)
• Polycyclic Aromatic Hydrocarbon     – (Pahs)
• Styrene
• Sulfur Dioxide (SO2)

According to Prof. Purser’s presentation on “Fire Retardants and their Potential Impact on Fire Fighter Health” ** the highest and most active toxins threatening survival during or immediately after a fire are:

ASPHYXIANT GASES: CO, HCN, CO2 , low oxygen

IRRITANTS/ ACID GASES :  HCl, HBr, HF, COF2 , H3 PO4, SO2 , NOx

ORGANIC IRRITANTS:  acrolein, formaldehyde, crotonaldehyde, phenol, styrene

PARTICULATES: especially ultrafine particles + metals

These toxins are usually found within active fire zones- either inside the fire event itself or downwind plume in the form of residues and soot or lethal fragments activated at high temperatures or in airborne smoke.  These asphyxiant gases, irritants and particulates are the main causes of injury and death of fire victims exposed to high concentrations inside burning buildings.   Asphyxiant gases cause collapse with loss of consciousness during a fire, leading to death if exposure continues.  Irritants and smoke particulates cause pain to the eyes and lungs, with breathing difficulties, which inhibit escape during a fire and can lead to lung inflammation and edema within a few hours of rescue, which can also be fatal.  Those surviving may make a good recovery or suffer long term neurological or cardio-respiratory health effects, depending on the severity of the exposure. Those most at risk from these effects at the fire scene are building occupants and emergency responders not protected by breathing apparatus. 

Beyond the immediate fire zone, especially outside a burning building, or during wildfires, these toxic smoke products are considerably diluted by mixing with outside air, so are generally not immediately life-threatening.   The main hazards to unprotected persons exposed to the diluted smoke plume in the surrounding area are health risks from inhalation of smoke irritants and soot particulates, or from inhalation of mineral particles and fibers.  The immediate effects of exposure are mainly eye and throat irritation, with a sore throat and cough in some cases over a period of a few days, although persons with pre-existing respiratory or circulatory health conditions may be more severely affected.  Longer term health hazards following a single exposure may result from inhalation of sensitizers (such as isocyanates or formaldehyde), which can cause asthma, or from some mineral dusts and fibers, which may remain in the lungs. Health risks from exposure to carcinogens during a single incident are generally low, although the World Trade Center dust and some chemical fires may be exceptions.

Health risks to firefighters result mainly from repeated exposures to inhalation of smoke toxicants and contact with soot deposits.  These contain a wide variety of carcinogens, so that cumulative exposure over years may present an increased cancer risk.  The hazards arise from inhalation of smoke, soot or mineral fibers, but also from soot contamination of skin or clothing.   This can result in dermal, inhalation or oral ingestion, resulting in increased exposure to carcinogens, including dioxins and dibenzofurans, during post-fire activities. Halogenated fire retardants (especially chlorine and bromine systems), present possible increased health risks to fire victims and firefigthers during fires due to inhibition of combustion in the vapor phase resulting in inefficient combustion with an increase in yields of toxic carbon and nitrogen compounds, in addition to the formation of acid gases, dioxins and dibenzofurans under all fire conditions..**




Reference:
** Prof. David Purser's presentation on Toxic Hazards to Fire Fighters, Including Effects of Fire Retardants, During Fires and Post-Fire Investigation Activities  (NIST), Gaithersburgh MD on 9/30/2009    https://www.nist.gov/sites/default/files/documents/el/fire_research/4-Purser.pdf


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“IT ALL STARTS AT THE LUNGS" 
Historical Patterns of Carcinogenic Reactions from Environmental Disasters  by: Dr. Jesse Stoff


If you review the victims of  a disaster such as the radioactive fallout in CHERNOBYL, then compare it to the dust from the 911 catastrophe, you can find a similar behavior as far as how fatalities come to appear within a certain timeline. There’s the initial contamination that results in immediate illnesses- and then there’s a major wave of cancer cases that arise a decade later. These cancers are delineated on the CDC website and are occurring, undoubtedly, because of the mixture of toxins that people have been exposed to. The volume of these toxins are absorbed into their bodies since 9/11 (while working with the clean-up efforts) and can't get rid of them.

We are seeing patients with very unusual blood borne cancers that have had very unusual genetic profiles  -undoubtedly because of the unusual combination of carcinogenic toxins that people were exposed to that have been lingering in their system for so many years. We're also seeing a marked increase in Monoclonal Gammopathies (MGUS) and Myelofibrosis which is progressive damage to the bone marrow that itself can become a cancerous process. We're seeing many people suffering changes to the structure and functioning of their immune system even without yet developing a cancer but for those kinds of changes their risk of developing skyrockets. Also, because of the shifting in their immune system we see a significant increase in the level of different kinds of allergies (including environmental based) that have become more prevalent and worse than before the exposure to this kind of toxic material.

In essence, the destruction and suffering continues.



THE KILLER DUST
by Capt. Richard Marrone (9/11 Responder)

"It was just everywhere. The DUST was so thick it would dry your eyes out. You couldn't breathe. As EMS, that was a lot of what we were doing was just constantly cleaning people's eyes out. There's nothing you can do to get away from it. I know what was in those particulates--it was asbestos, it was concrete, it was human remains, metals and any possible contamination in a fire... it was all there. Nobody was protected. Even the firefighters who had self-contained breathing apparatus, you're only getting 15 or 20 minutes maximum on those cylinders, and there just wasn't enough to keep constantly replacing them. The police officers and EMS personnel were using surgical masks, which basically provided no protection whatsoever.  We mostly treated rescue workers on site due to the dust-- eyes and stuff like that. There really wasn't enough eye or respiratory protection, so anybody that became a patient post-collapse was due to the contamination and the toxins of 9/11."


RESPONDERS PULMONOLOGY REVIEW
Following the logical path of carcinogen, one would start from how environmental contaminants would make their way into the body; through the respiratory ports. As seen in the toxicology section of this article, these foreign substances range from particulates like metals and acids to microfragments to molecular-sized compounds whose behaviors vary from mild irritants to lethal poisons.  More often than not, these compounds can trigger cell mutations in our physiology as well as attack our very immune system to penetrate our defenses for tumors to grow.

Our responders’ health report brought us to interview  Pulmonary and Sleep Medicine Specialist Dr. Mayank Shukla (NYC) who helped identify the various diagnostics and screening procedures for first responders often start with a Pulmonary Function Test to study a patient’s airway size, and then a Bronchodilator Challenge Test to identify and distinguish between asthma and COPD.   Another protocol for patients exposed to airborne contaminants is examining airway resistance and looking for Upper Airway Resistance Syndrome (UARS), Sleep Apnea and other breathing disorders caused by an impairment of the airway size.

The concern for the responder’s air passage brings telltale signs of possible impending issues based on their condition that brings warning signs of what may lie ahead- in the lungs, the bloodstream etc.  There's another test which is available called NIOX designed for a patient to have allergy component or asthma that also is very sensitive, to look at the lung inflammation for these patients.

During airway inflammation, higher-than-normal levels of nitric oxide (NO) are released from epithelial cells of the bronchial wall. 4 The concentration of NO in exhaled breath, or fractional exhaled nitric oxide (FeNO), can help identify allergic/eosinophilic inflammation, and thereby support a diagnosis of asthma when other objective evidence is lacking. (See NIOX.com)

There are other testing available which helps us to do a direct visualization of the upper and lower levels. For example, there's the bronchoscopy for the lungs and air passages and then there's the laryngoscopy to visualize the nasal cavity, the sinus, sinusitis, the larynx, because many of these patients have acute or chronic laryngitis because getting exposed to the several toxins. Also, many of them have gastro esophageal reflux, so when you look at that endoscopy, you can realize that this patient have, you know, chronic inflammation of the, not only for a lower airway, but also with upper airway as well.





SPECIAL CONTRIBUTORS:

1) Professor David Purser CBE, Toxicologist from the Hartford Environmental Res. (Hatfield, UK)
2) Dr. Mayank Shukla - (www.drmayankshukla.com/) pulmonologist
3) Dr. Robert Bard - AngioFoundation.orgbardcancercenter.com/ contributing writer
4) Dr. Jesse Stoff - publisher for awarenessforacure.org/imofny.com contributing writer
5) Sal Banchitta- Ret FDNY / First Responders Cancer Awareness Sr. Ambassador
6) Captain Richard Marrone (ret. FDNY EMT / Vol. Long Island Firefighter 
6) Kevin P. Coughlin - 9/11 Photography, www.kevinpcoughlin.com/
7) NIOX.COM





Monday, May 27, 2019

ITALIAN CONTRIBUTIONS TO ADVANCED CANCER IMAGING & DIAGNOSTICS

By: Dr. Robert Bard (Cancer Imaging Historian)
Edited by: Prof. Rodolfo Campani

The record of cancer treatment advancements carry a significant debt to a community of Italian clinical pioneers- recognized for their extensive contribution to the screening, imaging and diagnostic innovations. Names such as Drs. Luigi Solbiati, Carlo Martinoli and Rodolfo Campani are some of the top names that helped to pave the movement for a much improved detection of cancer tumors and other subdermal disorders.

THE BIRTH OF MEDICAL RADIOLOGY
Since the German discovery of the X-Ray in 1890, scientists worldwide found the drive to mobilize diagnostic science into a non-invasive direction. Scanning technology carried the potential to save lives by enabling images of physiological issues underneath the skin non-invasively- or without any cutting. But it wasn't until 1977 that the results of radiologicical imaging advanced to the capacity of cancer detection as the Magnetic Resonance Imaging (MRI) was developed by Armenian-born Dr. Raymond Damadian who performed the first full body scan to diagnose cancer and refining the focus of modern radiology.

The Bracco Imaging Group (headquartered in Milan, Italy) established the first multinational healthcare group in 1927, and heavily supported many contributions to clinical diagnostic science including the launch of the advancement of CONTRAST agents for all imaging solutions. It is this material injected in the bloodstream that allowed a significant improvement in identifying tumor cells.

ITALIAN HISTORY OF TRACKING BLOOD FLOW
Leonardo Da Vinci detailed over 500 years ago about the way the blood flowed in and out of the heart and showed how the valves worked. It wasn't until 1960 that the medical community caught up to Da Vinci and confirmed all this time that he was remarkably correct! A jump to the 1990's became a pivotal period as European imaging has standardized the non-invasive ultrasound technology to be a major screening protocol for cancer investigation.

PROF. RODOLFO CAMPANI
One of the leading pioneers in this study was Professor Rodolfo Campani who started the first world study of ultrasound contrast agents in humans in Italy in 1990. The Scientific Journal of the Italian Society of Radiology "La Radiologia Medica" (reported in May 1993) presented the results of the 5 Italian experimentation centers under his coordination at the Institute of Radiology in the University of Pavia. He was credited for developing the first (non-radiation based) ultrasound contrast agent which are used to show BLOOD FLOW in tumors, elevating the power of the ultrasound to out-perform MRI's, X-rays and CT Scans. Implementation of this contrast was a generational leap in advantages because it made the tumor vascularity much more easily visible using the injectable and safe ultrasound contrast agent. Unlike the MRI contrasts (which contained heavy metals) the ultrasound contrast was comprised of air bubbles and microalbumin. In a 1994 journal, this contrast was first used in liver cancers where vascularity is highlighted inside the liver.

With this same time span, CARLO MARTINOLI, MD (Genoa) arose as another contributor to the widespread use of ultrasound technology by emphasizing the effects of ultrasound imaging of the musculoskeletal and peripheral nervous systems. He helped shape modern medical education to recognize and include the studies of ultrasound and musculoskeletal radiology and coauthored vital textbooks on the subject which are still in use today in over 22 countries.

PROFESSOR LUIGI SOLBIATI (Milan) specialized in the study of blood flow of cancers and published his discoveries about the major differences between malignant and benign tumor vessels. This study helped to shape the way non-invasive imaging protocols like the newer Doppler sonography & MRI diagnostic techniques identify cancers. He pioneered ultrasound-guided aspiration biopsies (1979), ethanol injection (1983), radiofrequency ablation with cool-tip electrodes (1995) and microwaves (2009) of solid tumors and fusion imaging for the guidance of interventional procedures (2003)

Modern studies confirm that metastasis (the spread of cancer to other areas of the body) and cell migration is mobilized by blood flow, and it is here that diagnostic protocols examine other clues as to the condition of the existing tumors. Digital ultrasound imaging with blood flow technology, the doppler blood flow, and the contrast enhanced blood flow was pioneered and developed by Rodolfo Campani and Luigi Solbiati (from Busto Arsizio/Varese) where they introduced worldwide the performance of the Doppler Ultrasound as a viable and more accurate technology for diagnosing tumors and assessing tumor response in many different areas.

(End of part 1)
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About the Author:
Robert L. Bard, MD, PC, DABR, FASLMS is internationally known and recognized as a leader in the field of 21st Century 3-D ULTRASONOGRAPHIC VOLUMETRIC DOPPLER IMAGING. Dr. Bard specializes in advanced 3-D sonography to detect cancers in numerous organs including the breast, prostate, skin, thyroid, melanoma and other areas. Dr. Bard’s images are used to accurately guide biopsies, target therapy and provide focused follow-up after treatment. As of Jan '18, Dr. Robert Bard spearheaded a partnership with a host of cancer educators, medical practitioners and non-profit foundations (allied under AwarenessforaCure.org) to form a public resource program to aid in the advancement of the public's understanding about self-preservation from cancer and other chronic diseases. EARLY DETECTION & PREVENTION is a global health movement that promotes a higher regard for "clean living" - from toxins and a toxic lifestyle. Our program consists of four main efforts: EDUCATION, COMMUNITY CONNECTION, CURRENT NEWS & CLINICAL RESOURCES. EARLY DETECTION & PREVENTION brings the empowerment of wellness through group seminars, videos and the distribution of current articles & newsletters published/shared to all the major cancer charities and their members. For more information or to subscribe to our EARLY CANCER DETECTION & PREVENTION PROGRAM newsletter, contact Bard Cancer Diagnostics today at: 212.355.7017 (www.BardCancerDiagnostics.com)- or email us at: bardcancercenter1@gmail.com

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Special thanks to the Columbia Association (FDNY) for their interest in exploring the history of cancer treatment and Italian solutionists.  5/14/2019 New Hyde Park, NY -- Chapter VP John Signorile introduces NYCRA's cancer advocates to present topics of awareness and available resources for checkups. In support of the Italian Heritage that the Columbia Association supports throughout its history, Dr. Bard produced this article as a gift to the organization and community it represents - uncovering the highly notable Italian contributors to cancer research. This archive study continues to expand in future volumes and issues.