SENSIBLE ADVANTAGES OF ULTRASOUND IMAGING FOR BURNS AND DERMAL TRAUMAS

Written by: Dr. Robert L. Bard of the Bard Diagnostic Imaging Center

For most emergency responders and physicians, identifying the degree of any burn or dermal trauma cases starts with a visual assessment.  With professional training and enough experience, the professional eye can differentiate between first, second and third degree burns to initiate the proper treatment process. First-degree burns commonly show redness, and swelling only on the outermost skin layer; second-degree burns show surface injury to the underlying layer with blistering and Third-degree burns affect up to the deep layers of the skin.

As standard practices continue to evolve, diagnosing any advanced burns are now calling for new considerations for the prevention of burn-related complications.  As more and more after-effects from high degree burns have left patients with lasting (and sometimes fatal) results, it may no longer be enough to drive a treatment protocol based on surface topical healing. 

BURN SCANNING TECHNOLOGY: ASSURANCE AGAINST COMPLICATIONS

Second and third-degree burns may show blisters and red skin but with today’s many non-invasive subdermal technologies, you can now identify the depth of the burn and what the injury truly means under the skin. Identifying the exact DEPTH of the internal injury as well as monitoring (visually) its internal impact/effect on the body may uncover and predict other potential health issues such as:

-        Scarring and unrecoverable dead tissues

-        Damage to Nerve endings /neuropathy

-        Inflammation

-        Temporary to permanent loss of skin

-        Damage to underlying bones, muscles and tendons

-        Bacterial infections (from the broken skin) like tetanus

-        Internal Shock

-        Hypovolemia (low blood volume/ unusual blood loss from a burn)

According to Image 1A, high resolution sonogram used a standard probe for skin imaging showing the black area, which is just below the white line of the surface and the black fluid corresponds to the blister seen on the specimen of the burned area. Now below it you see the skin with the first vertical blue dotted line and it goes to the fascial plain white line, which shows swelling of the tissues. The normal skin measures 1.3 millimeters or thin as a dime and the depth of the burn itself measured is twice that, 2.6 millimeters. So we have a way of seeing the fluid. We have a way of checking the depth of the burn, which is clinically difficult because the eyes cannot see below the skin.   You can see the blister is basically gone because that's the tiny black area above the tissue line- showing almost no fluid left (represented In the blackish area)

Upon review of Day 9 diagram, see "burn healing" on the left side of this diagram where it says dermis on day 9, you can see the bottom white line under the lettering dermis, which shows the bottom of the skin, which last time was 1.3 millimeters. Then to the right of that the dermis tissue is starting to have the red and blue healing blood vessels that's coming in marked by the red arrow. And then to the right of that where it says decreased vascularity, the larger blood vessels have not yet come in, but at least we know the skin has viable feeding blood flow. So it's more likely than not to heal.

** These images are scanned with the GE Ultrasound Voluson E8.  Any machine over 15 megahertz can be used on burns- however, devices with higher the resolution improves the scan experience to get the best data.

REVIEW OF THE BLOOD FLOW INNOVATION

Today’s imaging devices cover a wide range of functions on the market carrying specific features to fit their many users specific needs.  This scan was generated by the General Electric Voluson E8 system which uses an 18 mhz probe outputting 1/10 of a millimeter of resolution.  The benefit of using this GE 3D Doppler system enables the ability to measure the depth of the burn as well as identify and record the exact amount of fluid in the surface of the burn, which is the blister. 

For many diagnostic applications, the real-time scanning ability of VASCULAR ULTRASOUND has greatly advanced the way injuries are read, identified and managed.  Vascular ultrasound uses sound waves to evaluate the body's circulatory system.  It also helps identify blockages in the arteries and veins and detect blood clots.  This innovation is not radiation based, leaving no harmful side effects and out-performs many of today’s current counterparts including accuracy in scanning soft tissues that does not appear in x-rays. 

BLOOD FLOW technology is the “diagnostician’s storyteller”.  It allows you to see which part of the skin is alive by the indication of active blood flow through the area- versus the skin that is dead or dying with no blood flow. In cases of burns, the margin of injury can extend once the burn has been completely cooled down. Since vascular ultrasound is safe sound waves, you can conduct frequent scans to monitor healing and progress every hour/every day until resolution.

The paradigm of studying blood flow allows any diagnostician to review whether the tissue is curing or not.  In the case of performing a possible skin graft, the blood flow around an injury gives more data as far as the behavior of the burn or injury as well as the condition of healthy tissue to attach to the burn.

Any inflammatory skin disease is caused by inflammatory blood vessels, which is not evident by the naked eye. This scanning modality allows you to quantify the degree of inflammation and the response to all the new treatments available. Where widely accepted optical technologies work well,  they are limited to 1/2 of a millimeter depth, so they are surface only.

SKIN LIFE VS. SCARS 

If the tissue doesn't heal with normal skin, it will scar. The scar tissue appears as black in ultrasound imaging, almost like the fluid- but with zero blood flow.  Any kind of trauma can result in healing tissue or dead tissue, which will either get infected or scar down. Imaging can also show if the area is getting inflamed as it indicates irregular volume of the blood vessels resulting in cellulitis or the inflamed skin.

Scar tissue is dead skin.  Doppler Imaging can be useful as it shows the thickness of the scar to determine if it can be treated, either with steroids, laser or any of a number of current scar treatment technologies.  The depth and the hardness of the scar determines which option to use and all these can be resolved by the various ultrasound technologies. Ultrasound is the new ‘weapon of choice’ to show depth, thickness of the scar, type of scar, how hard or elastic it is  (also see elastography).  It also allows the surgeon to clearly identify the margins you wish to attach the graph to.  

[IMAGE 2] In this image, we have a burn that came from a charcoal grill. This burn leaves a white coating (surface singe) to the red skin. (A) This white surface outline with the black arrows is the ash from the grill or the burning surface. The small yellow circle is the blister that immediately broke from the heat. So the blister burst and opened up causing the teardrop-shaped opening in the skin, which could get infected. 

Diagram B shows the two yellow arrows pointing to the white area, it's got a top white, a medium dark, and a bottom white area.  That's the appearing ash visible only on the surface but not penetrating deep (thus it is not a third-degree burn). Upon further interactive review of the burn, it was only surface ash from the surface of the charcoal grill which was easily removable. On the same image (B), we are also looking at external tendon, 1 mm wide. 

Diagram C indicates the blood vessels and the normal tissue on the side of the burn. Though the burn goes deep into the skin, it is not a complete third-degree burn in the whole area (B). Comparing B and C, the injury to the burned tissue is marked by the red arrow on top and also the tendon that raises the finger pushes 1 mm wide is completely unaffected by the dark burn area. Now below that since we weren't sure if it was a third-degree burn or we wanted to see if there was viable skin next to it, we did the blood flow technology which shows the micro vessels or the capillaries that are in the adjacent skin, so if you ever needed to graft it you'd have normal skin and also the fact that you have normal skin in the red area means that the burn in that area is a first degree or not really burned at all.

“IT’S ALL ABOUT THE PROBES”

The GE Doppler scanner can go deeper under the skin - at an estimated 5x the resolution than the average ultrasound probe (at 1/10mm resolution). The higher the megahertz, the deeper and sharper the image (like 70mhz has 1/50 of a millimeter resolution).  Such a probe is much better for imaging tendons and skin and the regular 18 or 20 megahertz (such as the GE) that we use routinely use has 1/10 of a millimeter resolution. You have better detail for seeing tendons and blood vessels.

Overall, each probe determines a specific depth, the width & range of the scan, the level of blood flow while the hardware & diagnostic software itself communicates with the probe to translate all data into recognizable images in real time.

PRE-OPERATIVE (AND RISK REDUCTION) PROTOCOL

Among its many uses, cosmetic surgeons can benefit from dermal imaging by mapping the nerves and the arteries before cutting. Also, you can find the dead skin as compared to the normal skin for doing reconstructive surgery. 

Emergency departments can more easily treat nerve trauma, burns, tendon injuries with the help of visual analysis of any affected area.  As an example,  you can see if the tendon is partly or completely torn with ultrasound more easily and effectively. you are able to move the finger because it won't be any movement of the torn part. If you move the tendon when you open up the finger from a closed fist position.

ABOUT THE AUTHOR-

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.

References

https://www.cdc.gov/masstrauma/factsheets/public/burns.pdf’’

https://stanfordhealthcare.org/medical-conditions/skin-hair-and-nails/burns/stages.html

https://www.intechopen.com/books/hot-topics-in-burn-injuries/burn-etiology-and-pathogenesis

  

https://www.healthline.com/health/burns#complications

https://www.radiologyinfo.org/en/info.cfm?pg=vascularus

Disclaimer & Copyright Notice: The materials provided on this website 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.

PREHOSPITAL DIAGNOSTICS; THE EMERGENCY RESPONDERS’ “DIGITAL ANGEL”

By Dr. Robert Bard | Edited by: The RightWriters research staff | October 25, 2019

The saying “you can’t take it with you” is often applied to points of wisdom about letting go of your worldly possessions at the twilight of your years. In the case of emergency response, an ambulance rig is designed to simulate an ER on wheels, packing a range of life support equipment, devices and drugs for all critical rescue situations.  This includes essentials like breathing and airway clearing devices to scanning & monitoring equipment to dressing & bandaging materials.

Stories from many seasoned EMT or paramedics may include rare rescue situations that fall short of having more advanced resources and on-the-spot access to medical expertise that could have changed the course of the rescue when racing to the ER took too long.  Modern solutions to this dilemma include the expansion of field care through advanced Point-of-Care Ultrasound use and integration of TeleMedicine.  These innovations help rescuers immediately identify complex trauma including any possible ‘land mines’ through portable digital imaging technology while saving valuable time when it comes to file transfers of the patient’s condition electronically to the critical care professionals at the end of the ride.

PRE-HOSPITAL ULTRASOUND USE BY EUROPEAN RESPONDERS

Pre-hospital ultrasound has many clinical applications that may reduce morbidity and potentially improve outcomes for patients with life-threating conditions [3].  Worldwide, responders have adopted the use of a portable non-invasive, non-radiation ultrasound in their rescue rig.   For example, in Germany, the use of ultrasound in the field has focused on the FAST exam and cardiac sonography for non-traumatic patients since 2002–2003.  French prehospital clinicians have adopted ultrasound in certain areas as well, including SAMU (Service d'Aide Médicale d'Urgence). The Italian EMS system began incorporating ultrasound into prehospital care in 2005. [2]

Pre-hospital ultrasound is employed in this setting to differentiate reversible causes of pulseless electrical activity (PEA), assess for pericardial, intraperitoneal, and pleural fluid in trauma, and to differentiate between pulmonary edema and emphysema. In the USA, the focus on rapid transport and limiting on-scene time may have contributed to slower adoption of prehospital ultrasound into clinical algorithms. There is less experience in the routine use of ultrasound on ground ambulances. [2]

THE ERA OF TELEMEDICINE

By: Elizabeth Banchitta

With the combined use of remote portable ultrasound and telemedicine, the rescue unit raises the chances of the patient’s survival exponentially while significantly reducing the risks of complications during critical care. Telemedicine is the practice of medicine using technology to deliver care at a distance.  [4] Current communications technology and file-sharing allows medical doctors to consult EMTs and Paramedics to work with their patients remotely (through HIPAA compliant conferencing platforms) and software.  This revolutionary upgrade is true evidence of improving public health (and survivorship) and a significant cost reduction in medical care.

CONCEPTS REALIZED FOR A GLOBAL UPGRADE IN EMERGENT RESPONSE

On August of 1985, Mayor Ed Koch pushed a city policy to implement EMS medical control - a communications center where responders have advisory access to a medical doctor.  This originally was intended to eliminate unnecessary ambulance transports. This allowed the responder to determine and/or refuse medical attention on calls that were not actual life-threatening situation.  Koch’s idea was to keep ambulances available for the ‘real’ emergencies “and is not a free taxi service to the ER”. (NYT 7)

2019- Koch’s communications program is still technically in place, but its directives have been reshaped as TELEMED, TELEHEALTH or INTEL Communications- geared to be more about immediate access to doctors' medical guidance and data transmitting.  For the many incidences (such as heavy traffic) where time is truly of the essence, where a patient’s life is slipping away faster than the rig could cut through city streets, arming the responder with higher performance equipment and communication protocols with the ER docs has become the growing trend- or at least the sensible modern concept in motion.

Medical Control is a recorded line between the mobile unit and the hospital personnel awaiting the ‘delivery’. Thanks to TELEMED, they're there to help the responder interpret data collected and transmitted to them. Based on their findings, they may direct the rig to a specific hospital with the appropriate resources to best treat the patient. This also decreases the amount of time that will be spent on the patient running tests in the ER that could have been done during transport. For many cases, time is of the essence. TeleMed also helps responders administer certain tasks to keep patients stable from a life-or-death situation.  TeleMed also facilitates calls for a second opinion or orders allowing emergency personnel to administer additional doses of medication. There have been countless situations where ambulances are caught in terrible traffic or unforeseen road blocks that meant needing to act fast on a patient’s increasingly critical situation.  Having the doctor “present and available” (virtually) gives the responder real-time instructions on what to do.

For the sake of response time, New York City is probably one of the most densely populated areas with the highest number of hospitals and level 1 trauma centers.  But this is not the case for many areas in the country.  There are regions that experience up to an hour drive to the hospital making a patient's “golden hour” much more difficult to achieve. EMS refers to the golden hour as the time from when the incident happened to the time that the patient gets definitive care at the hospital. Getting the ball rolling by identifying exactly what is wrong with the patient during longer transport times can increase the possibilities of survival. This is where the need for additional life support technology is at its highest. 

A growing number of EMT’s in the country are allowed (and trained) to take glucose for unconscious or altered mental status patients. Some have CT Scans for possible strokes and CPAP for patients suffering from CHF or other respiratory failures. Resources like the use of EKG’s on patients that are experiencing chest pain or having heart attacks. Where proximity defines the standards, these devices and protocols may not apply for responders and units everywhere. Many of these devices are part of a “pilot program” and does not apply to all towns.  

The idea of a portable hi-powered PreHospital ultrasound that can identify traumas (including a transcranial Doppler to detect oxygen and blood flow in the brain) is something that the military and helivacs are equipped with now- and to integrate that with our com link to the doctor is such a vital game-changer as far as upgrades go!  To use that travel time to see what's going on so much earlier and transmit this data over to the doctor can be a powerful addition to the emergency response. Also, by having access to the doctor to interpret this data helps make crucial decisions such as ‘which hospital, precinct or resources would be best for handling this? Or do they need a trauma or a stroke center? Some places have certain staff members on call 24 seven whereas other hospitals do not. These are the additional directives that can change the overall direction of patient care.

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PREHOSPITAL ULTRASOUND: EMERGING TECHNOLOGY FOR EMS

by: Dean Meehach   5/15/2019  - Source: EMS1.com 

Point of care ultrasound for prehospital
applications. (Photo/Greg Friese)

Clinical applications for field ultrasound to assess, treat and monitor critically ill patients
Prehospital ultrasound is a form of medical imaging that is portable, non-invasive, painless, and does not expose the patient to ionizing radiation. With proper training and education, prehospital providers can use ultrasound to obtain immediate anatomical, diagnostic, and functional information on their patients.  In recent years, ultrasound devices have decreased in size and cost while producing images of enhanced quality.   For example, prehospital focused abdominal sonography for trauma (FAST) exams have the potential to provide valuable information in abdominal trauma with high reliability leading to more appropriate transport destination decisions. In addition, field ultrasound images can be transmitted enroute to the emergency department to facilitate further evaluation by ED physicians and trauma surgeons to expedite care ... READ MORE

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Next issue: TELEMED FOR COLLABORATION BETWEEN PROVIDERS

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.

ELIZABETH BANCHITTA, Technical Contributor / EMT

Elizabeth is a New York State certified EMT-B and a two-time recipient of the St. Catherine's of Siena Award for excellence of written and verbal communication to receiving hospitals. She is the current President of GiveKindness* Organization (a partner of Quinnipiac University, Hofstra University and Farmingdale State College) dedicated to implementing Annual Food Drives for Island Harvest Food Pantry and fundraising for Sloan Kettering Cancer Center. She is currently a graduating student (with honors) of Farmingdale State College with concentrations in Bioscience and Chemistry.  She is also a current volunteer in the NY Cancer Resource Alliance as a communications assistant to the president and an assistant publisher of the monthly newsletter and educational awareness quarterly magazine-The Journal of Modern Healing.

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).

References:

1) https://www.health.ny.gov/professionals/ems/pdf/9814

2) https://www.sonosite.com/education/sonosite-institute

3) Int J Emerg Med. 2008 Dec; 1(4): 253–259. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657261/

4) Jems.com: Point-of-Care Ultrasound in the Prehospital Setting as the patient is being transported to the nearest hospital. https://www.jems.com/2018/02/01/point-of-care-ultrasound-in-the-prehospital-setting/

 5) What’s the difference between telemedicine and telehealth? https://www.aafp.org/media-center/kits/telemedicine-and-telehealth.html

6) https://www.healthleadersmedia.com/innovation/4-ways-telemedicine-changing-healthcare

7) Ambulances, Under A New Policy, Pick Up Only Emergency Patients, NYT: 8/1985-

https://www.nytimes.com/1985/08/15/nyregion/ambulances-under-a-new-policy-pick-up-only-emergency-patients.html

Also see: (Coming soon: Part 2) TELEMED FOR COLLABORATION BETWEEN PROVIDERS



Disclaimer & Copyright Notice: The materials provided on this website are copyrighted and the intellectual property of the publishers/producers (The AngioFoundation / the NY Cancer Resource Alliance /  IntermediaWorx inc). 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.

Awareness TRULY Saves Lives- “Yes, Men Get Breast Cancer too”

Written by: Darleen Garza / TheRightWriters editorial staff

Ten years ago, if you inquired about male breast cancer at your annual physical, most doctors would likely dismiss your fears by responding about “how incredibly RARE, or improbable it was to contract this”.  This lack of public information is a common testimony from many male breast cancer survivors- the same dilemma that is now recognized as a main contributor to the expansion of this silent epidemic.

The term “RARE” is often misleading and alluding to something reversible and of little concern. When it comes to any health disorder, the limited numbers of cases showing are only the ones reported but are often skewed due to the ‘real’ count that would constitute a baseline- from the individuals that have not come forward to be counted.  According to the CDC, for any disease to capture EPIDEMIC proportions, it must “rises above the expected level, or baseline… where there is a [sudden] increase in the number of cases in that population in that area.”

BEYONCÉ'S DAD BRINGS "NEW AMMO" TO MALE BREAST CANCER BATTLE

Survivor Michael Singer (L) gives appreciation to Mathew Knowles (R) at
Dr. Oz show for going public with his breast cancer- bringing global
awareness & advocacy

Recent data reflecting actual cases about male breast cancer has finally reached the tipping point in the visibility scale as more news coverage from advocacy groups and victims finally ‘going public’ have filled the media.  Thanks to survivors like Mathew Knowles (music producer and father of Beyoncé) who elected to publicize his breast cancer significantly contributed to public awareness, identifying this issue as a serious threat to public health. 

“One of our main objectives at the Male Breast Cancer Coalition is to publish all survivor stories to alert the men at large that this is not a cancer to ignore… it’s not so RARE or IMPOSSIBLE to contact,” states Cheri Ambrose, president. “Learning about Mr. Knowles’ story from the newspapers and Good Morning America, and then sharing airtime with him at Dr. Oz was such a powerful sign of support to our advocacy mission because he elected to use his own story and his celebrity to get people to pay attention. This is the kind of generosity that can truly save a lot of lives just on pure awareness alone!” (See: Dr. Oz episode w/ Mathew Knowles interview)

In an October interview with the American Heart Association News, Mathew Knowles shared his new mission of advocacy and awareness hoping to save more lives from a disease that has now captured headlines as a global health alert. He detailed his rare gene mutation called BRCA2 as what the medical community identifies as the main cause for this cancer and possibly others. Sharing the entire road of discovering the first symptoms to having undergone a mastectomy on his right breast, Mr. Knowles has forged a national commitment to speaking out about breast cancer in men.   "My opportunity is to help people have awareness of the BRCA gene (mutation) and of male breast cancer…things happens for a reason. I'm grateful for this opportunity to save myself, hopefully save my family and hopefully impact the world in an extremely positive way."

“GET CHECKED NOW!”

The First Responders Cancer Resource was established in 2017 by a partnership between 9/11 survivors and medical experts in conventional and advanced cancer care. Their flagship catch-phrase “GET CHECKED NOW!” was partly designed for the many potential cancer targets in the firefighter community who needs to take a more proactive stance at annual exams and awareness about how cancer truly performs. Ms. Ambrose and the many ambassadors of MBCC adopted this tagline because of a similar dilemma among men who are either slow to act when it comes to finding anomalies like lumps on the chest area.  

Click to enlarge and print

“By now, we all know that dealing with cancer has everything to do with TIME… the sooner you detect it, the better the likelihood of reversing the problem,” states cancer imaging expert Dr. Robert Bard. “Where women have been conditioned to do self-exams regularly, finding irregularities (like lumps under the nipple or abnormal discharge) are not often part of a man’s health regimen.  Meanwhile, the medical community has a defined set of factors that help identify an increase in risks for breast cancer including age (60+), exposure to estrogen, obesity and liver diseases as this increases female hormones in men. The good news is that technologically, we have much more than the conventional mammograms… the cancer imaging community is equipped with new innovations such as the high-speed Advanced 3D Ultrasound that’s far more accurate and completely comfortable especially for men.”

Where the stigma of men having breasts and getting mammograms often sits awkwardly with the typical male ego, more and more victims are now sharing their stories at the MBCC website (and throughout mainstream media) with the hopes of waking up the men to GET CHECKED and accept this disease a major reality.  According to the American Cancer Society, 1 in 800 men will be diagnosed in their lifetime… and an estimated 500 men will die of breast cancer this year. From a recent interview, Dr. Stephen Chagares (breast surgeon) detailed how Male Breast Cancer is often identified and points to early detection for the best chance at survival.  “It’s either spotting a mass somewhere in the chest area or a strange discharge or a bloody nipple drainage… it’s better if you find these symptoms at an early enough stage but unfortunately it becomes actual breast cancer because they’re not identified until longer down the road.”

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Special thanks to the MALE BREAST CANCER COALITION

Disclaimer & Copyright Notice: The materials provided on this website 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.

WHAT'S NEXT FOR ADVANCEMENTS IN IMMUNOLOGY?

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

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

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

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

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ENGINEERED KILLER T-CELLS COULD PROVIDE LONG-LASTING IMMUNITY AGAINST CANCER
UCLA researchers use stem cells to engineer cells that attack human tumors in mice 
Sarah C.P. Williams | September 23, 2019 | Original distribution: UCLA Newsroom

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

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

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

Lili Yang, UCLA Broad Stem Cell Research Center

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

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

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

Original distribution: UCLA Newsroom

This article is republished with the express consent of the UCLA NEWSROOM for the Journal of Modern Healing- produced by the NY Cancer Resource Alliance-for public use.  All distribution, sharing or re-posting of this article is only with the express permission of NYCRA ©2019- All Rights Reserved.    

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CANCER PREVENTION can be closely aligned with EARLY DETECTION. But from the perspective of a lifestyle upgrade, it is greatly proven that smart nutrition, toxin prevention (smoking, alcohol, drug abuse control), Stress management and Immune system support are all main ingredients to the prevention of cancers. These same protocols, for those who recently underwent cancer treatment, are what medical experts and wellness professionals prescribe to STAY IN REMISSION.

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

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THE STRESS-CANCER CONNECTION EXPLAINED

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

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

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

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

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

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

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




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

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

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

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


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

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

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ABOUT THE AUTHOR

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

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