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Aaron Sasson. Photo courtesy of Stony Brook Medicine

By Daniel Dunaief

Thanks to the efforts of Stony Brook University School of Medicine’s Chief of Surgical Oncology Aaron Sasson and numerous doctors and researchers at Stony Brook, Long Island has its first National Pancreas Foundation Center.

A nonprofit organization, the National Pancreas Foundation goes through an extensive screening process to designate such centers around the country, recognizing those that focus on multidisciplinary treatment of pancreatic cancer. The NPF offers this distinction to those institutions that treat the whole patient and that offer some of the best outcomes and improved quality of life for people suffering with a disease who have an 8 percent survival rate five years after diagnosis.

Sasson appreciates the team effort at the medical school. “As opposed to one person leading this, there are many people here who are required to have an interest in pancreatic cancer,” he said. “We are not only looking to build a great infrastructure for the treatment of pancreatic cancer, but we’re also looking to build a team for research on pancreatic cancer.”

Sasson highlighted the research efforts led by Yusuf Hannun, the director of the Cancer Center at SBU, who has helped attract a “tremendous number of scientists” to engage in research into this disease.

The recognition by the NPF helps the university recruit physicians who are clinically interested in developing ways to improve the outcome for patients.

Pancreatic cancer presents particular challenges complicated by its biological aggressiveness, its difficulty to detect and by the many subtypes of this disease. “It’s similar to lung and breast cancer,” Sasson said. “There are many facets of those cancers. You can’t lump them all together.”

Researchers and clinicians are still trying to understand pancreatic cancer in greater detail. Once they have done that, they can advance to treating the possible subtypes.

Numerous researchers at SBU have developed collaborations with scientists at Cold Spring Harbor Laboratory. David Tuveson, the director of the National Cancer Institute-designated Cancer Center, has engaged in collaborations with SBU scientists in his work on organoids, which are model human organs grown in a lab. Scientists use organoids to test drugs and molecular pathways involved in pancreatic cancer.

Members of the Long Island community can take comfort in the continuing dedication of the numerous staff members committed to finding a cure. “Residents of Suffolk County and Long Island should be proud of what Stony Brook has been able to accomplish,” Sasson said.

Stony Brook University has been involved in several clinical efforts. The university developed a drug called CPI-613, for which Rafael Pharmaceuticals is in the early stage of clinical trials in combination with other drugs.

In early stages, the treatment increases the vulnerability of cancer cells to numerous other drugs. Newark, New Jersey-based Rafael Pharmaceuticals is testing this treatment in pancreatic cancer and in acute myeloid leukemia.

At SBU facilities, Sasson explained that researchers and clinicians are taking a multidisciplinary approach in their work. One study, he said, is exploring the effects of a kind of radiation therapy for a subpopulation of pancreatic cancer that combines expertise in radiology, gastroenterology, pathology and medical and surgical oncology.

Sasson himself is interested in screening and biomarkers. At least half of his work is related to pancreatic cancer. When he thinks about people who have battled pancreatic cancer, several patients come to mind. He had a patient who was about 80 at the time of his diagnosis. His primary doctor told him to get his affairs in order.

“We operated on him and he lived another six or seven years,” Sasson recalls. “He was grateful to see his grandchildren graduate and to see his great-grandbabies being born.”

While every patient is unlikely to have the same outcome, Sasson said surrendering to the disease and preparing for the inevitable may not be the only option, as there may be other courses of action.

Another patient had advanced pancreatic cancer for 18 months before Sasson met her. She had received no treatment and yet the cancer didn’t progress, which is “almost unheard of and unbelievable.” In fact, the case defied medical expectations so dramatically that the doctors conducted two more biopsies to confirm that she had pancreatic cancer. “She did well for many years despite having advanced pancreatic cancer.”

In another case, a patient was receiving surveillance for lung cancer every three months. In between those visits, he had developed metastatic pancreatic cancer. This patient example and the previous one show the range of cancer progression.

The value of having an integrated clinical and research program is that scientists can look for subtle clues and signals amid the reality of cancer with a wide range of outcomes. Indeed, scientists attend the weekly tumor board meeting, so they can learn about the clinical aspects of the disease. Doctors also attend research collaborations so they can hear about developments in the lab.

Rather than dictating how researchers and clinicians should collaborate, Sasson hopes to facilitate an environment that sparks these partnerships.

Sasson joined Stony Brook Medical School almost three years ago. He said he is “impressed with the caliber of physicians.” It took time to get the critical mass and organization for pancreatic cancer to match the number of basic science investigators.

“I’m hopeful for the progress we’ll be able to make to treat this terrible disease,” he said.

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District Attorney Tim Sini (D). File photo by Victoria Espinoza

By Fr. Francis Pizzarelli

Father Frank Pizzarelli

Recently District Attorney Tim Sini (D) announced a new initiative to combat the drug epidemic ravaging Suffolk County. The Comprehensive Addiction Recovery and Education Program, or CARE Program, allows nonviolent defendants with substance abuse disorders a full dismissal of chargers if the person successfully completes a 90-day treatment program. It was designed by prosecutors, defense attorneys and court officials.

This initiative is definitely a positive step in the right direction. As someone who has provided outpatient and residential treatment for addictions for more than 25 years, I am deeply concerned that this effort lacks substance and appropriate resources for those struggling with substance abuse and mental health issues.

Many of our judges have already been open to alternative sentencing for nonviolent drug offenders. 

There are some important facts that seem to always get buried when this important issue is raised. These are facts that the public should know. 

First and foremost, we do not have nearly enough detox and/or residential treatment beds.

And insurance no longer covers a full 28-day stay in a residential treatment program. At best, most will only cover 7 to 11 days. That is unconscionable. More tragically, many insurance companies tell those battling chronic addiction “try outpatient treatment first — fail at this then we will pay for residential care.”

A growing number of young men and women are trying outpatient treatment first and are failing in record numbers. They are dying! What is very disturbing is that few to no voices are crying out about this horrific human atrocity.

Evidence-based treatment grounded in competent research states that the chronic opioid and heroin addict needs long-term residential treatment if long-term recovery is the hope for outcome.

Presently in Suffolk County we have two programs that provide more than three months of care. Only one program is not insurance based.

So the CARE initiative is a great step forward. Let’s not set those struggling with addictions within the criminal justice system up for failure because we lack the comprehensive and competent resources to make the CARE Program an effective tool on one’s road to recovery and wellness.

Unfortunately, outpatient programs have very limited success with chronic drug abusers. Do some enter and sustain health recovery? Yes, but a growing number fail.

As one local religious leader, I have presided at way too many funerals for young people who have died senselessly around addiction. In the past three weeks, I have had three young adults with tremendous potential lose their lives because of overdosing on heroin. I have talked with many of my colleagues in religion who are burying a record number of young people within their own faith traditions. 

Actions speak louder than words. The violence of our silence is contributing to this national health crisis. Change and transformation is possible. I live among these miracles everyday.

Fr. Pizzarelli, SMM, LCSW-R, ACSW, DCSW, is the director of Hope House Ministries in Port Jefferson.

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The first question that must be answered is whether you are determined a resident of New York. Stock photo

By Nancy Burner, Esq.

Nancy Burner, Esq.

We have seen many clients considered “snowbirds,” those who maintain a residence in New York but travel down south during our harsh winters. For our snowbird clients who want to create estate planning documents and plan for possible care needed in the future, it is important to determine if you should see an attorney in New York or elsewhere. 

The first question that must be answered is whether you are determined a resident of New York or of the other state you are visiting. Some factors to determine residency include the amount of time spent in each state, your mailing address, which state your driver’s license is held, where your car is registered, where you are registered to vote and where you file your income taxes.

Once you determine which state is your primary residence, there are other considerations to be examined regarding your estate plan. Snowbirds should consider where they plan on living in the future and where they think they will likely receive care. There may be a possibility that you move down south upon retirement but you plan to move back to New York to be with family members when you are in need of assistance. Since most clients do not have a plan set in stone, they should have estate planning documents, which may include Medicaid asset protection, that would cover them in either state.

Because the laws governing estate planning and Medicaid benefits differ from state to state, it is advisable that you have your documents reviewed by an attorney in both states to ensure that they comply with the laws in both places. For example, there is an additional signature required on a last will and testament in Florida that is not required in New York. Complying with Florida law when executing a last will and testament will not invalidate the document if it is probated in New York. This will avoid any issues or delay in administration if your will is probated in Florida. 

Additional examples of differences in the law are for powers of attorney and advance directives, including health care proxy and living will documents. Since these are state-specific laws, they often have different terminology that can be confusing when moving between locations. 

For a health care proxy in New York the person named to make your medical decisions is called your “agent.” In Florida the term for the agent acting as your health care proxy is a “surrogate.” In Florida the term used under the law to name the default agent appointed is “proxy.” This could cause unnecessary confusion and should be addressed by your estate planning attorney. 

The language and powers listed in your power of attorney will also differ by state. This becomes especially important when your agent is assisting in long-term care planning. You should make sure that your power of attorney includes all of the possible powers your agent may need should you need long-term care whether it is by privately paying or applying for Medicaid to cover your care costs. This may include: the power to prepare, sign and amend a trust agreement; allow for transfers of assets to your agent; and enter into contracts for caregivers or home health care services. 

For our snowbird clients it is important to consider where you are likely to receive care in the future. We recommend that you have your estate planning documents reviewed by an elder law and estate planning attorney in New York and your warm winter destination. 

Nancy Burner, Esq. practices elder law and estate planning from her East Setauket office.

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Flatbread with Ricotta, Swiss Chard and Scallion Topping

By Barbara Beltrami

One of the nice things about the influx of immigrants in recent years is that they’ve brought with them cultures that we were formerly unfamiliar with and have added a whole new dimension to our own culture and cuisine. 

For years, we’ve accepted and taken for granted the cuisines that western European and British immigrants brought with them and actually integrated them into what we now think of as basic American cuisine. But now dishes from regions in the Far and Near East as well as the Caribbean, Mexico and Central and South America have also assumed dynamic roles in our basic American cuisine. 

A good example is flatbread. Acting as the base for a limitless number of toppings, it makes a great light meal, tasty appetizer and healthful snack.

Basic Flatbread

YIELD: Makes approximately 20 pieces

INGREDIENTS:

2¼ ounces active dry yeast

1¾ cup flour

1 teaspoon coarse salt

¾ cup warm (100 F) water

2 teaspoons olive oil

DIRECTIONS:

In a large mixing bowl, combine yeast, flour and salt. Slowly add water and mix until dough starts to form a ball. Coat hands and a flat surface with flour and knead dough until it feels smooth and elastic. Place dough in oil-coated large bowl; cover with a clean damp linen or cotton towel; and let sit in a warm place about one hour or until doubled in size. Remove from bowl to floured surface and punch and knead gently. Separate dough into golf ball size pieces. With a rolling pin flatten each piece into a ⅛-inch-thick disk. Heat an ungreased skillet over medium setting and cook disk until dough begins to bubble, about one minute, flip it and cook other side. Serve warm with olives, olive oil, hummus, tzatziki or baba ghanoush or top with other ingredients in this column and broil.

Tomato, Feta, Chickpea and Kalamata Olive Topping

YIELD: Makes approximately 6 to 8 servings

INGREDIENTS:

One 15½-ounce can chickpeas, rinsed, drained and lightly mashed

2 large garden tomatoes, sliced thin

2 garlic cloves, minced

½ cup chopped fresh parsley

1 cup pitted chopped Kalamata olives

¹/₃ cup extra virgin olive oil

Juice of half a lemon

Freshly ground black pepper

DIRECTIONS:

Preheat broiler. Arrange first five ingredients on flatbread; drizzle with olive oil and lemon juice; sprinkle with black pepper; and place on a broiler pan rack and broil until topping starts to bubble, 5 to 10 minutes. Serve hot or warm with hard or soft cold drinks and spinach salad.

Ricotta, Swiss Chard and Scallion Topping

Flatbread with Ricotta, Swiss Chard and Scallion Topping

YIELD: Makes approximately 6 to 8 servings

INGREDIENTS:

1 bunch Swiss chard, cleaned, washed and chopped

1 teaspoon salt

Freshly ground black pepper

1 bunch scallions, cleaned, washed and sliced thin

1 cup fresh ricotta

¼ cup extra virgin olive oil 

Grated zest of half a lemon

Coarse salt and freshly ground black pepper

DIRECTIONS:

In a large covered skillet over medium heat, cook Swiss chard with salt, pepper and one cup water until limp and tender. When cool enough to handle, squeeze or press out all liquid and divide and spread evenly on flatbreads. Top with scallions and ricotta. Broil until bubbly, 5 to 10 minutes, remove, drizzle with oil and sprinkle with lemon zest and salt and pepper. Serve hot or warm with tomato and onion salad and cold drinks.

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One of Rick Mundy’s Adirondack paintings, ‘These Mountains 1'

By Irene Ruddock 

Rick Mundy is an award-winning watercolor artist who specializes in realistic paintings of Long Island, the Adirondacks, the Caribbean Islands, New York City, Africa and Alaska. He is noted as being one of the top art businesses on Long Island and has been published in Art Business News, The New York Times, Boater’s Digest and the Encyclopedia of Living Artists.

I recently visited Mundy’s Setauket studio to get a sneak peak of the artist’s upcoming exhibit featuring 60 watercolor paintings at the Bayard Cutting Arboretum in Great River. An artist reception is scheduled for Sept. 2 and again on Sept. 23 from 1:30 to 3:30 p.m. 

I am amazed by the vast variety and creativity of your portfolio. How do you think of all these ideas? 

Painting is a celebration of the creative spirit and all that is beautiful in nature. As a teacher of biology, I learned more about nature, which is a recurring theme in my paintings. It is fun and exciting and I can’t stop myself once I get an idea! I like to paint in themes and in a series, and I most often do a diptych or a triptych. 

When did you first decide to become an artist and was there an artist who encouraged you? 

I enjoyed art since I was a child being inspired by John Nagy and winning a few contests, but later I apprenticed with the watercolorist Andrew Stasky who encouraged me to paint in transparent watercolor — where the light travels through many layers of paint to the viewer creating a fresh, clean painting.

‘These Mountains 111’ by Rick Mundy

Your new exhibit sounds stunning with a 360º view of the Adirondacks that includes a series of eight paintings. What is it about the mountains that attracts you so?

 I was an outdoor guide licensed by the NYS Department of Environmental Conservation for decades. The Adirondacks possess the calm of a woodland pond, the roar of a gorge in the spring and have ever-changing personalities from season to season. I know practically every trail in the mountains — its waterfalls, rocks and special ledges to stop for lunch! I enjoy going higher and deeper into the mountain where, in my mind, I compose the essence of the scene I want to paint — moving water, rocks, wildlife. I don’t photograph or sketch much; instead I develop the ideas in my mind so that these paintings are not actual places —they are created in my painting.

How has your extensive mountain climbing influenced your philosophy of life in other ways? 

I feel that nature feeds the soul. Being at one with nature, not fearful, but calm with the knowledge of the beauty that nature can deliver. Knowing Mother Nature is in charge and respecting her vastness. She will show you great things, but she is in charge. 

‘Royal Adornments’ by Rick Mundy

You are showing three rooms of paintings — Long Island, Adirondacks and the third titled ‘Well, … certainly different.’ Can you give us a hint about that? 

The Long Island paintings are all about the special beauty of the island’s beaches, boatyards, barrier islands, etc. In the last room, I exhibit my African collection including royal hair combs, animal skins and beading; my tropical mosaics, which look like Tiffany glass; my floral Gingko paintings; and some cityscapes.

What kind of presentation are you planning at your art receptions?

I am going to show examples of sketches and notes that I worked from, even the ones that didn’t deliver the look I wanted. It will show how the Adirondack paintings, which took two and a half years to complete, finally evolved.

What would you like the viewer to take away from this exhibit? 

I would like people to see in my paintings something in nature that they may have missed or wish to experience. I especially want to share with the viewers all the beauty I have witnessed. 

View Rick Mundy’s exhibit at the Bayard Cutting Arboretum, 440 Montauk Highway, Great River from Aug. 30 to Sept. 30. The arboretum is open Thursday to Sunday from 11 a.m. to 4 p.m. For parking fees and restaurant information visit www.BayardCuttingArboretum.com. Visit Rick Mundy’s website at www.rickmundywatercolors.com.

All images courtesy of Rick Mundy

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From left, Charlie Hunnam and Rami Malek in a scene from ‘Papillon’. Photo courtesy of Bleeker Street

By Kyle Barr

Here’s a question when it comes to remakes: Should a film stand on its own two feet or should we as an audience come down harder on its mistakes than we would an original film?

“Papillon,” the 1973 movie directed by Franklin J. Schaffner and starring Steve McQueen and Dustin Hoffman, is based on Henri Charrière’s autobiography of the same name. I’ve never read the book, and I’ve never seen the original movie. Hell, it might be a great movie, but too often people would rather compare films to each other than consider them on their own merits.

A film is a film before it is a remake, and it should be taken as such. If so, then there is a problem when a remake such as “Papillon” is missing key pieces of character motivation that makes one wonder if it was assumed from the original movie.

“Papillon” starts in early 1930s France, as the titular Papillon (Charlie Hunnam), a safecracker working for the local mob, gets framed for a murder he didn’t commit by a local mob boss for whom he worked. He is sentenced to life in prison at Devil’s Island in French Guiana, a place known for its abject brutality and harsh conditions. Anyone sentenced to Devil’s Island is exiled, never able to return to France. On the way there Papillon meets Louis Dega (Rami Malek), a convicted counterfeiter to whom he offers protection in exchange for money, all the while thinking of escape.

Though Papillon and Dega initially dislike each other, it is their commitment to their friendship that drives the plot of the movie, and both actors play across each other very well. This friendship is despite attempts by Warden Barrot (Yorick van Wageningen) to break Papillon’s spirit through a long stay in solitary.

Director Michael Noer does a pretty good job at really setting the tone of the film. Everything at the prison colony is dirty, bloody and hard. Every actor involved is well tuned to his role. Malek does well as a stoic man seemingly numb to other people’s problems, that is until he starts to form a bond with Papillon. 

Hunnam has never really had a problem falling into character, and here he plays the hard-bitten man with a heart of gold as well as he has for nearly every film and show since “Sons of Anarchy.”

Yet there is a clear lifelessness to the whole affair. We start the film in France, end up in French Guiana, and yet we never hear a single person try to affect even an attempt at a French accent. It takes the occasional sight of the tricolor French flag to remind us that, yes, these people are French, with French guards and French prisoners. It’s enough to question whether Hollywood still thinks Americans will laugh at anything French as if every line is a nasal-sounding comic’s routine. 

What’s worse is Papillon, the character, never makes you care enough about his plight. He is a rough man, willing to beat any man into roadkill just to get enough money to escape, but he stops just short of killing anybody. It seems the film is trying to tell us that is something to admire. He spends enough time in solitary confinement and suffers so that we may admire him in a Christ-like sort of way, but much like the real prison system, it seems we are supposed to root for someone’s morality just because they will do anything to attain some form of “justice” just short of the original sin. 

Perhaps it would be different if I saw the original film; then perhaps I would understand what character Papillon is trying to be. Perhaps in that film they comment about his violent nature, but there’s not enough here for any kind of real understanding.

The movie is good enough, but it’s still sad to see so much effort go into the set and costume design as well as the character’s portrayals only to see it wasted on what Hollywood must be thinking is just another remake.

Rated R for language, violence, nudity and some sexual material,“Papillon” is now playing in local theaters.

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Photo courtesy of Kent Animal Shelter

MEET AVA!

The stories Ava could tell if she could talk. At only 1 year old this sweet but shy girl has had a rough start to life. Rescued from South Carolina, she’s now safe at Kent Animal Shelter looking for a home and family with lots of love and patience to help her come out of her shell. Could that be with you? Ava has beautiful brown eyes, a light and dark brown coat and a brown nose. She is spayed, microchipped and up to date on vaccines.

Kent Animal Shelter is located at 2259 River Road in Calverton. The adoption center is open from 10 a.m. to 4 p.m. every day. For more information on Ava and other adoptable pets at Kent, call 631-727-5731. 

Update: Ava has been adopted!

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By Matthew Kearns, DVM

This time of year (actually throughout the summer and fall) we have an uptick in ear infections. To call every dog or cat that comes in with itchy ears an ear infection is misleading. Otitis externa means “inflammation” (not infection) of the external ear canal. The bacteria and yeast we treat with medications fall into the category of “normal flora,” or organisms found in low numbers in healthy ear canals. 

Usually some other trigger is involved and the normal flora overgrow. Parasitic infections (ear mites), pets that swim a lot/get water in their ears, or ear trauma (plucking hair, etc.) are triggers for acute, or nonrecurring problems that are easy to treat. 

Chronic, recurrent infections are almost always secondary to allergies. I actually consulted with a veterinary dermatologist and she estimated that between 80 and 90 percent of all recurrent otitis externa in dogs is related to allergies.    

The anatomy of the ear plays a role in predisposing patients to ear infections. The normal canine and feline external ear canal have and “L” shape, with both a vertical and horizontal component to it leading to a greater distance from the opening of the ear canal to the ear drum. Additionally, clearing the healthy ear canal occurs through a slow process called migration. 

The ear canal contains epithelial cells (those similar to skin), ceruminous cells and apocrine cells (cells that produce earwax). Epithelial cells will turn over, or be replaced every few days and, along with a small amount of earwax, migrate toward the entrance of the canal. Once at the entrance a good shake of the head sends it out to the world. If the lining of the ear canal becomes inflamed, it narrows due to swelling (most likely due to some sort of food or environmental/seasonal allergy) and excessive ear wax is produced. This combination not only overwhelms the ear’s ability to clear the wax, it also leads to a warm, dark and moist environment and allows the normal bacteria and yeast to go crazy.

Certain breeds such as Labrador retrievers, golden retrievers, cocker spaniels, shar-peis and mixed breeds of this type have predisposing factors such as hair in the ears, floppy ears, narrow ear canals or a combination. 

Now, this does not mean that every member of these breeds is guaranteed to have chronic ear infections, rather it means that if you have a member of these breeds and they have even low-grade allergies, the ears can spiral out of control quickly. We are also starting to encounter antibiotic strains of bacteria (such as Staphylococcus) in chronic recurrent otitis in veterinary medicine.  

The main point of all of this is if your pet has chronic, recurrent ear infections, it is important to look for an underlying allergy and treat the allergy. Sometimes it can be a veterinary-approved prescription diet or sometimes the newer, safer allergy medications. Remember to discuss this with your veterinarian.

Dr. Kearns practices veterinary medicine from his Port Jefferson office and is pictured with his son Matthew and his dog Jasmine.

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RENAISSANCE DOG Long Island Museum educators, from left, Lisa Unander, Emma Backfish, Beth Chiarelli, Kristin Cuomo and Jessica Pastore, pose with artist and star of the day, Dagger II, aka DogVinci, at the Stony Brook museum’s Summer Thursday event on Aug. 16. Dagger painted a work of art and then attendees created their own masterpieces to take home. Join the museum for its final Summer Thursday event of the year, a free outdoor screening of “Back to the Future,” on Sept. 6. For more information, call 631-751-0066 or visit www.longislandmuseum.org.

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