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Members of Mather Hospital’s leadership team break ground on a new ambulatory surgery center in Port Jefferson Station Nov. 22. Photo by Kevin Redding

With construction officially underway in a secluded lot on Route 112, North Shore residents are one step closer to an efficient and cost-effective surgery center that will provide in-and-out care to its patients while eliminating many of the hassles associated with visits to the hospital.

On Nov. 22, staff from John T. Mather Memorial Hospital and 19 community surgeons stood on the site in hard hats and broke ground on what will be the freestanding Port Jefferson Ambulatory Surgery Center in Port Jefferson Station. The outpatient facility will feature six operating rooms equipped to handle procedures in orthopedics, ophthalmology, pain management, general surgery, neurosurgery and otolaryngology. The project, which cost approximately $12 million and has been in the planning stages for about five years, will be far less expensive to run than a hospital, which means cost savings for patients and the health care system overall. It will also open up more space at Mather for patients that require a more complex procedure and a lengthier hospital stay.

“…at the surgery center, you seem to be able to get in and out more efficiently and that saves you personal time, saves money, and saves cancellations. It just makes the overall patient experience so much better.”

— Michael Fracchia

Those involved in the project said they hoped for the facility’s doors to officially open in the summer of 2017. For now, though, they’re just pleased things are finally moving forward.

“As we’ve been saying — at long last,” Kenneth Roberts, chief executive officer of Mather Hospital, said during the groundbreaking. “We’ve been working on this project for a long time now, so we’re very happy to see it finally getting pushed forward.”

During an indoor celebration after the groundbreaking ceremony, Mather’s Director of Orthopedic Surgery Michael Fracchia said he was excited about what the center will mean for the community.

“People love these types of facilities because they can get in-and-out service and it’s truly less intrusive on their lives,” Fracchia said. “If you have something done in a hospital, it’s always an all-day event, no matter what it is. But at the surgery center, you seem to be able to get in and out more efficiently and that saves you personal time, saves money, and saves cancellations. It just makes the overall patient experience so much better.”

Fracchia said the facility will be able to run more efficiently because it won’t need the sort of complex technologies often found in hospitals. A patient might need an intensive care unit or an MRI or CT scan, he said, and while these are wonderful technologies, they’re also expensive and require maintenance. By eliminating these systems, the surgical centers can treat more patients at a quicker pace.

“We want to provide more care,” said Brian McGinley, orthopedic surgeon and president of the project. “We can potentially do more while maintaining our inpatient surgery at Mather. The community will have access here, rather than having to go to Nassau County or into the city.”

McGinley said that while planning the project, the team interviewed many companies that specialize in developing ambulatory service centers around the country. They found a fitting partner in Pinnacle III, a company based in Colorado that has successfully facilitated the opening of comparable facilities nationwide. This will be the first Pinnacle III facility in New York State.

In a press release, Robert Carrera, the CEO/president of Pinnacle III, said the company is excited to partner with and assist the local physicians as well as Mather Hospital in bringing high quality and cost-effective services to the Port Jefferson area.

The doctors all agreed on the project’s mission: to provide cost-effective quality health care to as many people on the North Shore as possible.

“You come in here, you drive in, you get taken care of and you don’t have to go through all the hoops that you would at a hospital,” Port Jefferson-based general surgeon Nicholas Craig said. “The doctors have all been in the community for a long time. We not only work here, we live here, so you get taken care of by people who care about their community … and when you care about your community, you care about the people in your community, and that’s what this is all about.”

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By David Dunaief, M.D.

David Dunaief, M.D.
David Dunaief, M.D.

Many of us give thanks for our health on Thanksgiving. Well, let’s follow through with this theme. While eating healthy may be furthest from our minds during a holiday, it is so important. Instead of making Thanksgiving a holiday of regret, eating foods that cause weight gain and fatigue, as well as increase your risk for chronic diseases, you can reverse this trend while staying in the traditional theme of what it means to enjoy a festive meal.

What can we do to turn Thanksgiving into a bonanza of good health? Phytochemicals (plant nutrients) called carotenoids have antioxidant and anti-inflammatory activity and are found mostly in fruits and vegetables. Carotenoids make up a family of greater than 600 different substances, such as beta-carotene, alpha-carotene, lutein, zeaxanthin, lycopene and beta-cryptoxanthin (1).

Carotenoids help to prevent and potentially reverse diseases, such as breast cancer; amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease; age-related macular degeneration; and cardiovascular disease — heart disease and stroke. Foods that contain these substances are orange, yellow and red vegetables and fruits and dark green leafy vegetables. Examples include sweet potato, acorn squash, summer squash, spaghetti squash, green beans, carrots, cooked pumpkin, spinach, kale, papayas, tangerines, tomatoes and Brussels sprouts.

Acorn squash contains carotenoids, which help to prevent breast cancer, Lou Gehrig’s disease, age-related macular degeneration and cardiovascular disease.
Acorn squash contains carotenoids, which help to prevent breast cancer, Lou Gehrig’s disease, age-related macular degeneration and cardiovascular disease.

Let’s look at the evidence.

Breast cancer effect

We know that breast cancer risk is high among women, especially on Long Island. The risk for a woman getting breast cancer is 12.4 percent in her lifetime (2). Therefore, we need to do everything within reason to reduce that risk. In a meta-analysis (a group of eight prospective or forward-looking studies), results show that women who were in the second to fifth quintile blood levels of carotenoids, such as alpha-carotene, beta-carotene and lutein and zeaxanthin, had significantly reduced risk of developing breast cancer (3). Thus, there was an inverse relationship between carotenoid levels and breast cancer risk. Even modest amounts of carotenoids potentially can have a resounding effect in preventing breast cancer.

ALS: Lou Gehrig’s disease

ALS is a disabling and feared disease. Unfortunately, there are no effective treatments for reversing it. Therefore, we need to work double-time in trying to prevent its occurrence. In a meta-analysis of five prestigious observational studies, including The Nurses’ Health Study and the Health Professionals Follow-Up Study, results showed that people with the greatest amount of carotenoids in their blood from foods such as spinach, kale and carrots had a decreased risk of developing ALS and/or delayed the onset of the disease (4). This study involved over one million people with more than 1,000 who developed ALS.

Those who were in the highest carotenoid level quintile had a 25 percent reduction in risk, compared to those in the lowest quintile. This difference was even greater for those who had high carotenoid levels and did not smoke; they achieved a 35 percent reduction. According to the authors, the beneficial effects may be due to antioxidant activity and more efficient function of the power source of the cell, the mitochondrion. This is a good way to prevent a horrible disease while improving your overall health.

Positive effects of healthy eating

Despite the knowledge that healthy eating has long-term positive effects, there are several obstacles to healthy eating. Two critical factors are presentation and perception. Presentation is glorious for traditional dishes, like turkey, gravy and stuffing with lots of butter and creamy sauces. However, vegetables are usually prepared in either an unappetizing way — steamed to the point of no return, so they cannot compete with the main course, or smothered in cheese, negating their benefits, but clearing our consciences.

Many consider Thanksgiving a time to indulge and not think about the repercussions. Plant-based foods like whole grains, leafy greens and fruits are relegated to side dishes or afterthoughts. Why is it so important to change our mind-sets? Believe it or not, there are significant short-term consequences of gorging ourselves. Not surprisingly, people tend to gain weight from Thanksgiving to New Year. This is when most gain the predominant amount of weight for the entire year.

However, people do not lose the weight they gain during this time (5). If you can fend off weight gain during the holidays, just think of the possibilities for the rest of the year. Also, if you are obese and sedentary, you may already have heart disease. Overeating at a single meal increases your risk of heart attack over the near term, according to the American Heart Association (6). However, with a little Thanksgiving planning, you can reap significant benefits.

What strategies should you employ for the best outcomes?

• Make healthy, plant-based dishes part of the main course. I am not suggesting that you forgo signature dishes, but add to tradition by making mouthwatering vegetable-based main dishes for the holiday.

• Improve the presentation of vegetable dishes. Most people don’t like grilled chicken without any seasoning. Why should vegetables be different? In my family, we make sauces for vegetables, like a peanut sauce using mostly rice vinegar and infusing a teaspoon of toasted sesame oil. Good resources for appealing dishes can be found at www.pcrm.org, EatingWell magazine, www.wholefoodsmarket.com and many other resources.

• Replace refined grains with whole grains. A study in the American Journal of Clinical Nutrition showed that replacing wheat or refined grains with whole wheat and whole grains significantly reduced central fat, or fat around the belly (7). Not only did participants lose subcutaneous fat found just below the skin but also visceral adipose tissue, the fat that lines organs and causes chronic diseases such as cancer.

• Create a healthy environment. Instead of putting out creamy dips, processed crackers and candies as snacks prior to the meal, put out whole grain brown rice crackers, baby carrots, cherry tomatoes and healthy dips like hummus and salsa. Help people choose wisely.

• Offer more healthy dessert options, like dairy-free pumpkin pudding and fruit salad. The goal should be to increase your nutrient-dense choices and decrease your empty-calorie foods. You don’t have to be perfect, but improvements during this time period have a tremendous impact — they set the tone for the new year and put you on a path to success. Why not turn this holiday into an opportunity to de-stress, rest and reverse or prevent chronic disease by consuming plenty of carotenoid-containing foods.

References: (1) Crit Rev Food Sci Nutr 2010;50(8):728–760. (2) SEER Cancer Statistics Review, 1975–2009, National Cancer Institute. (3) J Natl Cancer Inst 2012;104(24):1905-1916. (4) Ann Neurol 2013;73:236–245. (5) N Engl J Med 2000; 342:861-867. (6) www.heart.org. (7) Am J Clin Nutr 2010 Nov; 92(5):1165-1171.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

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Vitamin D levels may play an important role in the treatment of multiple sclerosis.

By David Dunaief, M.D.

David Dunaief, M.D.
David Dunaief, M.D.

Medicine has made great strides in the treatment of multiple sclerosis over the last few decades. Multiple sclerosis (MS) is an autoimmune disease where there is underlying inflammation and the immune system attacks its own tissue. This causes demyelination, or breakdown of the myelin sheath, a protective covering on the nerves in the central nervous system (CNS). The result is a number of debilitating effects, such as cognitive impairment, numbness and weakness in the limbs, fatigue, memory problems, inflammation of the optic nerve causing vision loss and eye pain (optic neuritis) and mobility difficulties.

There are several forms of MS. The two most common are relapsing-remitting and primary-progressive. Relapsing-remitting has intermittent flare-ups and occurs about 85 to 90 percent of the time. Primary-progressive (steady) occurs about 10 percent of the time. Relapsing-remitting may eventually become secondary-progressive MS, which is much harder to control, although dietary factors may play a role.

Diagnosis and progression

MS is diagnosed in several ways. The ophthalmologist may be the first to diagnose the disease with a retinal exam (looking at the back of the eye). If you have eye pain or sudden vision loss in one eye, it is important to see your ophthalmologist. Another tool in diagnosis is an MRI of the CNS. This looks for lesions caused by the breakdown of the myelin sheath. The MRI can also be used to determine the risk of progression from a solitary CNS lesion to a full-blown MS diagnosis. This is accomplished by examining the corpus callosum, a structure deep within the brain, according to a presentation at the European Neurologic Society (1). Approximately half of patients with one isolated lesion will progress to clinically definite MS within six years. An MRI may be able to predict changes in this portion of the brain within two years. Patients with a family history of MS should discuss this diagnostic with a neurologist.

Medication

Interferon beta is the mainstay of treatment for MS for good reason. Data shows that it reduces recurrence in relapsing-remitting MS and also the number of brain lesions.However, in a study, interferon beta failed to stop the progression to disability in the long term (2). Many MS patients will experience disability over 20 years. Ultimately, what does this mean? Patients should continue therapy; however, they should have realistic expectations. This study was retrospective, looking back at previously collected data — not the strongest of studies.

In an RCT, higher levels of vitamin D in the blood showed a trend toward reduced disability in timed tandem walking and in disability accumulation.

Vitamin D impact

Vitamin D may play a key role in reducing flare-ups in relapsing-remitting MS. There have been several studies that showed this benefit with vitamin D supplements and/or with interferon beta. In one study, interferon beta had very interesting results showing that it may help increase the absorption of vitamin D from the sun (3). This was a randomized controlled trial (RCT), the gold standard of studies, involving 178 patients. The study’s authors suggest that interferon beta’s effectiveness at reducing the frequency of relapsing-remitting MS flare-ups may have to do with its effect on the metabolizing of vitamin D. In those who did not have higher blood levels of vitamin D, interferon beta actually increased the risk of flare-ups.

Physicians should monitor blood levels of vitamin D to make sure they are adequate. It may be beneficial for MS patients to get 15 to 20 minutes of sun exposure without sunscreen per day. However, patients with a history of high risk of skin cancer should not be in the sun without protective clothing and sunscreen.

In a prospective (forward-looking) observational study, patients with higher levels of vitamin D, even in those without interferon beta treatment, had reduced risk of relapsing-remitting MS flare-ups (4). The patients with higher levels had 40 ng/ml, and those with lower levels had 20 ng/ml. Patients’ blood samples were assessed every eight weeks for a mean duration of 1.7 years. The relationship with vitamin D was linear — as the blood level increased two-fold, the risk of flare-ups decreased by 27 percent.

In an RCT, higher levels of vitamin D in the blood showed a trend toward reduced disability in timed tandem walking and in disability accumulation (5). The results did not reach statistical significance, but approached it. A much larger RCT needs to be performed to test for significance.

Diet and lifestyle

Interestingly, a study found that caffeine, alcohol and fish — fatty or lean — intake may result in delay of secondary progression of relapsing-remitting MS (6). This observational study involved 1,372 patients. The reduction in risk of disability was as follows: Moderate daily alcohol intake resulted in a 39 percent reduction; daily coffee consumption showed a 40 percent reduction; and fish two or more times a week showed a 40 percent reduction.

All of these results were compared to patients who did not consume these items. However, the same effect was not shown in primary-progressive MS patients: Fatty fish actually increased risk of progression, compared to lean fish. With MS, vitamin D blood levels may be critically important. They are one of the easier fixes, although it may take higher doses of vitamin D supplementation to reach sufficient levels, once low.

While food (fish with bones, for example) provides vitamin D, it falls short of the amount needed by an MS patient. Interferon beta and vitamin D supplementation may have added effects. Lifestyle changes or additions also have tantalizingly appealing possibilities.

References: (1) Abstract O-293; June 2012. (2) JAMA. 2012;308:247-256. (3) Neurology. 2012;79:208-210. (4) Neurology. 2012;79:254-260. (5) J Neurol Neurosurg Psychiatry. 2012;83(5):565-571. (6) Eur J Neurol. 2012 Apr;19(4):616-624.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

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Nurses from St. Catherine of Siena Medical Center and St. Charles Hospital have a new contract. File photo by Alex Petroski

The final hurdle was cleared to avoid a work stoppage for nurses at two North Shore hospitals.

Registered nurses from St. Catherine of Siena Medical Center in Smithtown and St. Charles Hospital in Port Jefferson voted overwhelmingly to approve a new contract Nov. 10 — they had been working without a contract since March 2015.

The New York State Nurses Association identified inefficient staffing, health benefits and a pay increase as the key issues they wanted addressed during negotiations, and according to a statement, all three were achieved. Additional nurses will be added to shifts at both hospitals, nurses will receive a three percent pay increase and an increase in health benefits, according to a statement from the union.

After about 18-months of negotiations, the NYSNA and hospital administration from both facilities reached a tentative agreement for a new contract to avoid a work stoppage Nov. 5, and the Nov. 10 vote made it official.

“Nurses at St. Catherine are always willing to stand up for safe patient care.”

— Tammy Miller

“The nurses at St. Charles Hospital are happy to ratify an agreement that protects both nurses and patients,” Tracy Kosciuk, RN and president of the local bargaining unit at St. Charles Hospital, said in a statement. “The issues were so important to our nurses that we took a strike vote that overwhelmingly passed, by a vote of 96 percent, and we were willing to hold a two-day strike. We are grateful to have a union behind us to speak up and educate the community on these important issues, and we look forward to working with the community in the future.”

Kosciuk, who has been at the hospital for nearly three decades, said in a phone interview last week that the tentative agreement was reached in part thanks to a “marathon” negotiating session that spanned from the afternoon Nov. 4 until about 9 a.m. Nov. 5. Nurses at both hospitals, who are among about 40,000 in New York State represented by the NYSNA, had voted to authorize the union to give notice of a strike in October, though that never manifested.

“I’m happy with what we were able to retain in regards to nurse-patient ratio with the intensive care unit,” Kosciuk said. Typically six nurses are staffed for shifts in the ICU, though Lorraine Incarnato, a nurse at St. Catherine’s in the ICU for nearly 30 years, said, during a picket outside of the hospital in April, she frequently worked shifts with five or even four nurses on duty.

“It’s causing a lot of friction between administration and staff,” Incarnato said in April. “When you have staff working always short [staffed], always extra, and then knowing that there’s not the respect factor there, they’re unhappy. Unhappy staff doesn’t keep patients happy. We try to put on a really happy face, because the patients come first.”

Administration members from both hospitals were also glad to avoid a work stoppage.

Nurses and their supporters picket outside St. Charles Hospital on April 8, calling for higher staffing levels and encouraging passing drivers to honk in solidarity. Photo by Giselle Barkley
Nurses and their supporters picket outside St. Charles Hospital on April 8, calling for higher staffing levels and encouraging passing drivers to honk in solidarity. Photo by Giselle Barkley

“We are pleased to have reached a fair settlement and I’d like to commend both bargaining teams who worked very hard to reach this agreement,” Executive Vice President and Chief Administrative Officer at St. Charles Jim O’Connor said in a statement prior to the vote. “St. Charles Hospital is proud of our professional nursing staff and the high quality of care they provide to the members of our community.”

Leadership from St. Catherine of Siena expressed a similar sentiment.

“We are pleased to have reached a tentative agreement which is subject to ratification by NYSNA members at our hospital,” St. Catherine’s Executive Vice President and Chief Administrative Officer Paul J. Rowland said in a statement last week.

The more-than-a-year-and-a-half negotiating session featured pickets at both hospitals, with nurses frustrated by inadequate staffing and seeking better health benefits and a pay increase in their next contract.

“All of these issues affect retention and recruitment,” Tammy Miller, a nurse at St. Catherine of Siena, said in a statement in October. “Keeping and attracting experienced nurses are essential to quality care.”

Miller was proud of the efforts put forth by the union and nursing staff since their contract expired.

“Nurses at St. Catherine are always willing to stand up for safe patient care,” she said in a statement after the vote.

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By Dr. David Dunaief

Prostate cancer is the second most common cancer in men, after skin cancer. The American Cancer Society estimates that, in 2016, there will be almost 190,000 new prostate cancer diagnoses in the United States and just over 26,000 deaths (1). What better time to discuss prostate cancer prevention than in “Movember,” a month dedicated to raising awareness of men’s health issues?

The best way to avoid prostate cancer is through lifestyle modifications, which means garnering knowledge about both detrimental and beneficial approaches. There are a host of things that may increase your risk and others that may decrease your likelihood of prostate cancer. Your genetics or family history do not mean you can’t alter gene expression with the choices you make.

What may increase the risk of prostate cancer? Contributing factors include obesity, animal fat and supplements, such as vitamin E and selenium. Equally as important, factors that may reduce risk include vegetables, especially cruciferous, tomato sauce or cooked tomatoes, soy and even coffee.

Vitamin E and selenium

In the SELECT trial, a randomized clinical trial (RCT), a dose of 400 mg of vitamin E actually increased the risk of prostate cancer by 17 percent (2). Though significant, this is not a tremendous clinical effect. It does show that vitamin E should not be used for prevention of prostate cancer. Interestingly, in this study, selenium may have helped to reduce the mortality risk in the selenium plus vitamin E arm, but selenium trended toward a slight increased risk when taken alone. Therefore, I would not recommend that men take selenium or vitamin E for prevention.

Obesity

Obesity showed conflicting results, prompting the study authors to analyze the results further. According to a review of the literature, obesity may slightly decrease the risk of nonaggressive prostate cancer, however increase risk of aggressive disease (3). Don’t think this means that obesity has protective effects. It’s quite the contrary. The authors attribute the lower incidence of nonaggressive prostate cancer to the possibility that it is more difficult to detect the disease in obese men, since larger prostates make biopsies less effective. What the results tell us is that those who are obese have a greater risk of dying from prostate cancer when it is diagnosed.

Animal fat, red meat and processed meats

It seems there is a direct effect between the amount of animal fat we consume and incidence of prostate cancer. In the Health Professionals Follow-up Study, a large observational study, those who consumed the highest amount of animal fat had a 63 percent increased risk, compared to those who consumed the least. Here is the kicker: It was not just the percent increase that was important, but the fact that it was an increase in advanced or metastatic prostate cancer (4). Also, in this study, red meat had an even greater, approximately 2.5-fold, increased risk of advanced disease. If you are going to eat red meat, I recommend decreased frequency, like lean meat once every two weeks or once a month.

In another large, prospective (forward-looking) observational study, the authors concluded that red and processed meats increase the risk of advanced prostate cancer through heme iron, barbecuing/grilling and nitrate/nitrite content (5).

Omega-3s paradox

When we think of omega-3 fatty acids or fish oil, we think “protective” or “beneficial.” However, these may increase the risk of prostate cancer, according to one epidemiological study (6). This study, called the Prostate Cancer Prevention Trial, involving a seven-year follow-up period, showed that docosahexaenoic acid (DHA), a form of omega-3 fatty acid, increased the risk of high-grade disease 2.5-fold. This finding was unexpected.

However, this does not mean that men should cut back on fish consumption; the effects of omega-3s on heart disease prevention are significant, and heart disease is far more prevalent. Also, this is only one study finding. If you choose to eat fish, salmon or sardines in water with no salt are among the best choices.

Lycopene — found in tomato sauce

Tomato sauce has been shown to potentially reduce the risk of prostate cancer. However, uncooked tomatoes have not shown beneficial effects. This may be because, in order to release lycopene, the tomatoes need to be cooked (7). It is believed that lycopene, which is a type of carotenoid found in tomatoes, is central to this benefit.

In a prospective (forward-looking) study involving 47,365 men who were followed for 12 years, the risk of prostate cancer was reduced by 16 percent (8). The primary source of lycopene in this study was tomato sauce. When the authors looked at tomato sauce alone, they saw a reduction in risk of 23 percent when comparing those who consumed at least two servings a week to those who consumed less than one serving a month. The reduction in severe, or metastatic, prostate cancer risk was even greater, at 35 percent. There was a statistically significant reduction in risk with a very modest amount of tomato sauce.

In the Health Professionals Follow-Up Study, the results were similar, with a 21 percent reduction in the risk of prostate cancer (9). Again, tomato sauce was the predominant food responsible for this effect. This was another large observational study with 47,894 participants. Although tomato sauce may be beneficial, many brands are loaded with salt. I recommend to patients that they either make their own sauce or purchase a sauce with no salt, such as one made by Eden Organics.

Vegetable effect

Vegetables, especially cruciferous vegetables, reduce the risk of prostate cancer significantly. In a case-control study (comparing those with and without disease), participants who consumed at least three servings of cruciferous vegetables per week, versus those who consumed less than one per week, saw a 41 percent reduction in prostate cancer risk (10). What’s even more impressive is the effect was twice that of tomato sauce, yet the intake was similarly modest. Cruciferous vegetables include broccoli, cauliflower, bok choy, kale and arugula, to name a few.

Where does coffee fit in?

Surprisingly, coffee may reduce the risk of prostate cancer. It was recently shown in the Health Professionals Follow-Up Study, where there was a dose-response curve. In other words, the more coffee consumed, the lower the risk. Even those who consumed one to three cups a day saw a 30 percent reduction in the risk of lethal prostate cancers, whether the coffee was caffeinated or decaffeinated (11). Coffee contains bioactive compounds, such as phenolic acids, which have antioxidant effects.

There is a caveat. Although, in this study, more was better, that is not always true in many other studies. Therefore, I would not recommend drinking more than three cups per day, because of other potentially detrimental effects. I think it is apt to finish with two thoughts. Aaron Katz, M.D., from Columbia University Medical Center, had it right when he mentioned that lifestyle modification was important. He was talking about those with early-stage prostate cancer. However, the same philosophy can be applied to prevention of prostate cancer. My goal in writing this article was to arm you with the knowledge you need to start protecting yourself or your loved ones today.

References: (1) www.cancer.org. (2) JAMA. 2011; 306: 1549-1556. (3) Epidemiol Rev. 2007;29:88. (4) J Natl Cancer Inst. 1993;85(19):1571. (5) Am J Epidemiol. 2009;170(9):1165. (6) Am J Epidemiol. 2011 Jun 15;173(12):1429-1439. (7) Exp Biol Med (Maywood). 2002; 227:914-919. (8) J Natl Cancer Inst. 2002;94(5):391. (9) Exp Biol Med (Maywood). 2002; 227:852-859; Int. J. Cancer. 2007;121: 1571–1578. (10) J Natl Cancer Inst. 2000;92(1):61. (11) J Natl Cancer Inst. 2011;103:876-884.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For more information, visit www.medicalcompassmd.com or consult your personal physician.

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Raffaella Sordella. Photo from the laboratory of Raffaella Sordella

By Daniel Dunaief

Raffaella Sordella, whose lyrical name reflects her upbringing in Italy, takes the fight against cancer personally. That’s because she underwent surgery for a tumor in her pancreas a few years ago when she, her husband Manuel Barriola and their young daughters Victoria and Alicia were living in Boston.

“The past few years I have made friends with many people who share firsthand experience with cancer,” she recalled in an email. “I have witnessed their strength and courage and they have been an incredible source of inspiration for our work, especially at times when the glass looked half-empty.”

Indeed, while she fought cancer herself, Sordella and the lab she leads as an associate professor at Cold Spring Harbor Laboratory battle against the deadly disease every day. Recently, she made a discovery about a gene that has been among the most studied and carefully combed genetic regions of the human genome. A tumor suppressor gene, p53 protects against tumor growth. An increasing number of findings, however, point toward the possibility of p53 mutants that promote tumors.

In research published in eLife, Sordella found just such a mutant. Looking at a variation in which the gene is truncated, or cut short, a range of cancers can develop and can cause greater threats to a patient’s health. “Despite four decades and all these papers, this is completely new,” Sordella said.

As many as 10 to 15 percent of tumors of the pancreas, ovaries, melanoma, head and neck and small cell lung carcinoma have this truncated version of p53, according to Sordella. “If you have these mutations, your colon cancer tends to become more metastatic,” she said.

Sordella and her colleagues studied the signaling pathway that regulates the activity of this gene. They have found a path that may become a target for drugs. Her lab is in discussions with a pharmaceutical company to start clinical trials. Sordella suggested that this type of finding addresses the notion of individualized medicine, in which doctors and scientists search for the specific genetic regions that contribute to cancer, looking for ways to block them, turn them off or slow them down.

In this truncated version of p53, the genes are active in the mitochondria, or the powerhouse of the cell, where the energy molecule adenosine triphosphate, or ATP, is produced. Sordella is studying how this mutant p53 can affect metabolism.

“The result is exciting because it was so unexpected,” Scott Lowe, the chair of the Cancer Biology & Genetics Program at the Memorial Sloan Kettering Cancer Center, wrote in an email. “The current work shows that these mutations can act as an ‘accelerator’ of tumorigenesis as well.” Lowe was a co-author on the study, who described his lab’s contributions as providing human data on the prevalence of truncated mutations in p53 in human tumors.

Researchers have dedicated considerable effort to understanding the tumor microenvironment. They are seeking to understand what a cancer might need from its immediate surroundings. Scientists studying other diseases, such as fibrosis, tissue chronic injuries, Alzheimer’s and Parkinson’s are also dedicating considerable resources to understanding the microenvironment. The recent discovery has encouraged Sordella and her colleagues to explore the role of cancer cell metabolism, cancer cells and their interaction with the tumor microenvironment, while also exploring the druggability of downstream pathways. This form of the gene is interacting with cyclophilin D, which is an inner pore permeability regulatory. Cyclophilin D, as a result, could become the target for future drug treatments.

Lowe suggested that the “current study raises the possibility that cancers with truncating mutations in p53 would be susceptible to agents that block cyclophilin D,” but added that it “should be clear that this will require much further testing.” Still, he concluded that it “is exciting as the possibility of this approach was not previously appreciated.”

Sordella came upon the discovery of the role of this form of the gene by chance. The focus of her lab is to understand the mechanism of resistance in small cell lung cancers. She generated a model in which there was resistance to a particular inhibitor. When she conducted an expression profile, she found a shift in the molecular weight of p53. Cloning and sequencing the gene demonstrated an alternative splicing, or cutting, that nobody had described.

Sordella credits partners including Edward Kastenhuber, Marc Ladanyi and Lowe at Sloan Kettering with assisting in the analysis of the gene. Sordella appreciates the financial support of Swim Across America, an organization that raises money for cancer research and that has supported her research for several years. Swim Across America takes “great pride in each new finding as these are the building blocks for achieving the ultimate goal,” Daniel Cavallo III, the beneficiary chair of the Nassau-Suffolk Chapter of Swim Across America, wrote in an email. “All you need to do is speak with Dr. Sordella for a short time and it is so clearly evident just how passionate she is about her work,” Cavallo said. “Her hard work, dedication and commitment to the cause are extraordinary — this along with her achievements are part of why we continue to fund her research.”

As a child, Sordella said she had an interest in becoming a physicist. After witnessing the suffering and strain cancer inflicted on her family, including an uncle and grandfather who succumbed to the disease when she was 13, Sordella decided that battling this disease would be her mission. Her family, she said, instilled in her the sense of finding purpose beyond the accumulation of wealth and has established a foundation with the goal of caring for the elderly and promoting education. She hopes her work contributes to her family’s legacy. “Hopefully one day soon, I will be able to celebrate with them a new great victory in the fight against cancer,” she said.

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'I Spy A Dragon Fly' by Rita Swanteson will be on view at the Port Jefferson Village Center through Nov. 17. Image from Mac Titmus

By Rita J. Egan

The North Shore Art Guild is exhibiting for a cause. From Nov. 3 to 27, the organization will present Artists United in the Fight Against Cancer, at the Port Jefferson Village Center. The exhibition will benefit the Stony Brook Cancer Center’s Art Therapy Program. Mac Titmus, president of The North Shore Art Guild, said 30 percent of the event sales will go toward the program. With a decline in federal and state funding, the raised funds will help the cancer center avoid cuts in the program.

‘Street Artist,’ oil on canvas by Joe Miller
‘Street Artist,’ oil on canvas by Joe Miller

The center offers therapeutic programs to provide relief from pain, fatigue, boredom and stress for both children and adult patients. Titmus said the guild invited both members and nonmembers to submit work for the exhibit demonstrating the theme Through the Eyes of a Child. The guild president said when it comes to shows such as this one the group looks for a broad theme for the artists to work with. “We always try to think of a theme that is going to inspire the artists, and being that this is something to do with young children in the oncology unit, we try to visualize how the world would look through the eyes of a child,” he said.

The show, juried by local accomplished artist Linda Louis, will feature 98 pieces from 67 artists. According to Titmus, the artwork was chosen from 118 submissions, and the selection represents a mixture of mediums including watercolors, acrylics, photography, mixed media and more.

Healing through art therapy

Stephanie Condra, a licensed creative arts therapist who works with oncologists and bone marrow transplant patients at Stony Brook, said art therapy is instrumental in allowing patients to express their feelings during treatment and hospitalization as well as providing important coping skills. “It can be very psychotherapeutic in nature. It can do a lot of processing of thoughts and feelings of fear and anxiety and anger, as well as actively in the moment give something very positive to focus on,” she said. According to the therapist, in addition to creating art, this type of therapy provides other creative choices including working with a patient using guided visualization, playing music or even talking in imagery and metaphor. Condra said patients can experience a lot of anxiety when it comes to their treatment and future. “I think that’s one of the great benefits of art therapy, that they get much more of a choice and control in what is going on in that moment, when a lot feels out of control with the treatment.”

Finding the words through art

Joan Alpers, director of Child Life Services at Stony Brook Children’s Hospital, agrees with the benefits for patients when given a choice with art, and she said therapists who work with pediatric patients also offer games and playing with objects. “It’s both providing different kind of choices to people where choices of course are being taken away, and it’s also providing the opportunity to kind of normalize an experience, where, of course, necessarily medicine and medical protocol take first stage.”

Alpers said communicating through art is an important tool when it comes to pediatric patients. “Sometimes what happens is children just don’t have the words for things. They just don’t have the capacity to tell us how they are feeling or what’s going on or put it in words. But they certainly can make us a picture or show us in their play,” she said.

Children stand in front of one of the art pieces that will be on view at the PJVC through Nov. 27.

In addition to the guild’s exhibit on the second floor of the Village Center, Alpers and Condra said on the third floor artwork from pediatric patients will be on display in the hope that art lovers will be able to relate to the need for such a program. “Kids are filled with life even when they are sick, and kids want to paint and make and do, even while they are dealing with their treatments for cancer and devastating illnesses,” said Alpers, adding, “A lot of the work that we’ll show from the kids is bright and airy and beautiful, because that’s what kids need to be and do in order to create hope, in order to make a pleasant day out of a difficult day.”

Making a difference

Titmus said even though cancer can be a difficult subject, the guild has a goal in addition to raising money when visitors come to the exhibit. “We’re hoping that they understand a little bit more about art therapy,” he said. The art guild president said the goal is to donate $20,000 to the cause. In addition to the funds raised with event sales, the guild, which includes 140 members, has already begun raising money for the art therapy program through private donations and sponsorships by reaching out to local businesses and corporations. Artists also paid an entrance free of $10 for members and $20 for nonmembers to be considered as part of the show, and these fees will also go toward the donation.

The exhibit, which is presented in cooperation with Stony Brook Cancer Center, the Village of Port Jefferson and the Port Jefferson Conservancy, will feature a reception on Nov. 12 from 4 to 7 p.m. where many of the artists will be on hand. Raffles will be sold to raise additional funds and among the prizes are four one-day passes to Disney World and a chef’s dinner from Ruvo East in Port Jefferson. Both Condra and Alpers feel that events such as this help patients by acknowledging their journeys, something that is important to those suffering from cancer. “When they hear that there are people in their own community that are there behind them, I think that’s extremely valuable and extremely important in terms of their care, their hope and their resilience,” Alpers said.

The Port Jefferson Village Center, 101A E. Broadway, Port Jefferson is open seven days a week from 9 a.m. to 9 p.m. except holidays. For more information, call 631-802-2165 or visit www.northshoreartguild.com.

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Statin users tend to neglect dietary guidance.

By David Dunaief, M.D.

High cholesterol affects a great number of Americans and cuts across many demographics, affecting young and old and those in between. When we think of hyperlipidemia (high cholesterol), what do you think is the mainstay of medical treatment? If you said “statins” you would be correct.

Do statins deserve this central role in treatment? They have been convincingly shown in studies to significantly lower cholesterol, and they play an important role for those who have cardiovascular disease. However, should we be using statins as liberally as we have? Well, guidelines for the treatment of high cholesterol, released in November 2013, suggest that we should. In fact, if followed, these guidelines would increase the use of this medication, especially in those over the age of 60. Some in the medical community have even joked that statins might as well be put in the drinking water.

This is a medication that patients may be on for life. I don’t know about you, but that thought sends chills down my spine. We know all medications have pros and cons. Statins are no exception; they have been mired in controversy. For one thing, they have side effects. These include possibly increasing the risks of diabetes, myalgias (muscle pain), hepatic (liver) toxicity, kidney disorders and negatively affecting memory.

Statins also may reduce the benefits of exercise, and they may not be as effective in women as they are in men. Because statins are such effective cholesterol-lowering medications, does this mean that patients on these drugs may become complacent with their diets? A new study indicates that this is exactly what might be happening. Let’s look at the evidence.

Statins have been mired in controversy. Stock photo
Statins have been mired in controversy. 

Diet complacency

The “S” in statins does not stand for “superimmune to eating anything.” In a study published in JAMA Internal Medicine, results show that those who are taking statins tend to eat more calories and fats and, ultimately, increase their [body mass index] by gaining weight compared to those who were not taking statins (1).

In fact, in this study that used 11 years of NHANES data, results showed that there were a 14 percent increase in fat intake and an almost 10 percent increase in overall calorie intake among statin users. This resulted in a BMI that rose by 1.3 percent in those on statins, while in nonusers over the same period BMI only rose by 0.4 percent.

In other words, if you took an average male who was 5 feet 9 inches and weighed 200 lb, the difference between statin users and nonusers would be the difference between obesity and being just below obesity. Those on statins were consuming about 200 extra calories a day. This increase in calorie consumption occurred after they were placed on statins. Their weight also increased by 6.6 to 11 lb. This is especially concerning to the researchers, since the guidelines for statin use call for a prudent diet to help reduce fat and calorie intake with the ultimate goal of reducing weight.

However, the opposite was found to have happened — users consumed more calories and gained more weight. This is an observational study with over 27,000 participants, therefore no firm conclusions can be made. However, statins are not a license to gorge at the all-you-can-eat buffet line. We already know that statins may increase the risk of diabetes. Why worsen this risk with dietary indiscretions that are harmful to your BMI?

As an aside, the authors note that this increased calorie and fat consumption may be a contributing reason for the increased risk of diabetes with statins, but it’s too early to tell.

Impact on women

We tend to clump data together from trials that focus predominantly on one demographic, in this case men, and apply the results broadly to both men and women. However, in a May 5, 2014, New York Times article, “A New Women’s Issue: Statins,” some in the medical community, including the editor of JAMA, focus attention on this tendency, noting that this may be a mistake (2).

According to the dissenters, the thought process is that women have been underrepresented in statin trials, and cholesterol may not play the same role in women as it does in men. Yet almost half of the patients treated with statins are women. These physicians were referring to the use of statins in primary prevention, or in those who have high cholesterol but who do not have documented heart disease.

Lest you think their views are based solely on opinion or anecdotal data from clinical experience, this data on women was from the JUPITER trial, which looked at almost 7,000 initially healthy female participants (3). Statins did benefit women by reducing the occurrence of chest pain and reducing the number of stent placements and bypass surgeries, but they did not reach the primary end points of showing statistical significance in reducing the occurrence of a first heart attack, stroke or death.

The caveat is that there were not a large number of cardiovascular events — heart attacks, strokes or death — that occurred in either the treatment group or the control group. These results were in women over the age of 60. This may give slight pause when prescribing statins. By no means do I think these physicians are advocating to not give women statins, just that we may want to weigh the benefits and risks on a case-by-case basis.

Tamping down exercise benefits

If exercise is beneficial for lowering cardiovascular disease risk and so are statins, the logical presumption might be that the two together would create a synergistic effect that is greater than the two alone — or at least an added benefit from combining the two. Unfortunately, what seems straightforward is not always the case.

In a small, yet randomized controlled trial, participants who were put on statins and monitored for cardiopulmonary exercise saw a blunted aerobic effect compared to the control group, which exercised without the medication (4). In the treatment group, there was a marginal 1.5 percent improvement with aerobic exercise, while the control group experienced a much more robust 10 percent gain.

The reason for this disappointing discrepancy is that statins seem to interrupt the enzymes that are responsible for making the mitochondria (the powerhouse or energy source for the cell) more efficient. The most troubling aspect of this trial is that the participants chosen were out-of-shape, overweight individuals in need of aerobic exercise.

Whether or not a patient, male or female, is placed on cholesterol-lowering medication, one thing is clear: There is a strong need to make sure that lifestyle modifications are always emphasized to help reduce the risk of cardiovascular disease to its lowest levels. But the quandary becomes what to do with statins and exercise. And statins, as powerful and effective as they may be, still do have side effects, may reduce exercise benefits and may not have the same effects for women. Thus, they may not be appropriate for everyone. A healthy diet and exercise, however, are appropriate for all.

References: (1) JAMA Intern Med. online April 24, 2014. (2) nytimes.com. (3) N Engl J Med. 2008 Nov 20;359(21):2195-2207. (4) J Am Coll Cardiol. 2013;62(8):709-714.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

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Celina Wilson, left, of Bridge of Hope Resource Center, and Zachary Jacobs, right, of Stony Brook Children’s Hospital, address community members who attended an educational forum at Port Jefferson high school Oct. 19. Photos by Alex Petroski

Port Jefferson high school played host to an educational forum on the ongoing addiction problem facing the community Oct. 19.

The forum, entitled The Adolescent Brain: Preventing High-Risk Behaviors, was presented by Bridge of Hope Resource Center, a Port Jefferson Station nonprofit created in 1998 with the goal of improving the lives of individuals in the community and is a strong advocate in the fight against addiction. Speakers featured a former Brookhaven National Lab scientist who specializes in addiction and the human brain, a doctor in the field of adolescent medicine at Stony Brook Children’s Hospital and the founder and president of the nonprofit.

Suffolk County has statistically been one of the greatest areas of concern in New York for heroin and opioid deaths in recent years, according to the Centers for Disease Control and Prevention. Suffolk County Police Commissioner Tim Sini said the county has had more than 100 opioid-related overdoses for several consecutive years.

The issue is not just in New York. According to the CDC, from 2005 to 2014, drug overdose deaths have risen by 144 percent to 2,300 deaths in New York and 58 percent to 47,055 deaths in the nation.

Dr. Joanne Fowler has studied how the human brain changes as a result of drug use since the late 1980s at stops including Brookhaven National Lab. She shared some of her decades of findings with those in attendance.

“When you think about addiction, it’s a really complex problem, and you have many, many factors that play into it,” she said. “Addiction, I would call, the loss of control of a behavior even though it’s causing a lot of problems to the individual. It’s a very destructive behavior that the individual can’t stop even though they want to stop.”

Fowler said the age in which an individual begins a behavior, like using drugs, can play a large roll in addiction because the part of the brain susceptible to addiction takes time to mature.

“The frontal cortex is a very important part of the brain,” she said. “It matures very slowly, so you really don’t have a mature frontal cortex until your early twenties.”

Dr. Zachary Jacobs, who works as a counselor for children at Stony Brook, discussed some risk factors for children and adolescents that could lead down a path of addiction, and some are out of a parent’s control.

“We’ve heard a lot about what parents and family can do, and I’m here to say despite your best efforts, it still might not be enough,” he said. “Despite a strong family, great, open communication, sometimes adolescents are just going to become their own individuals that disagree with family and societal norms … peers become so much more important than family, I’m sorry to say that.”

He recommended open communication and education as a means to combat potentially addictive, hazardous behaviors in children and adolescents to at least avoid issues with addiction, but total prevention is not that simple, he said.

Celina Wilson started Bridge of Hope Resource Center. She is the mother of three children, and she identified several risk factors parents should look for as potential signs of addiction. Insecurity pertaining to body image or loneliness, stress, life-changing events such as a divorce or death in the family, bullying, failure or rejection, depression, academic challenges, failure in competitive sports, a need for acceptance and several others were the factors Wilson suggested parents should be wary of and could be the root of later addiction.

“We have to help our teens better understand the world,” Wilson said. “We have to explain and review risks with them as much as possible.”

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St. Charles Hospital nurses and other staff wear pink bracelets as a sign of support for Desiree Bielski-Stoff, who is battling breast cancer. Photo from Bielski-Stoff

By Rebecca Anzel

Registered nurse at St. Charles Hospital in Port Jefferson Desiree Bielski-Stoff knows what a lump feels like — she had a small one removed from her left breast when she was 20. Since then, she performed self-examinations regularly and, coupled with her medical knowledge, thought she was “pretty good” at self-assessment.

In September, Bielski-Stoff, who is now 37, was diagnosed with breast cancer. Less than a month later, she had a double mastectomy at Memorial Sloan Kettering Cancer Center in Manhattan.

Bielski-Stoff waits to enter the operating room before her double mastectomy Oct. 4. Photo from Bielski-Stoff
Bielski-Stoff waits to enter the operating room before her double mastectomy Oct. 4. Photo from Bielski-Stoff

“I was looking for something like that mass in my left breast, something I could feel,” she said. “It wasn’t like a lighted sign going ‘Bling Bling, you have cancer — you have a mass in your breast,’ and I think that’s what we think we’re supposed to be looking for.”

October is national Breast Cancer Awareness Month, and Bielski-Stoff has been sharing her story with friends and family in the hopes they will not have to go through what she experienced. Every two minutes, a woman in the U.S. is diagnosed with breast cancer, a disease that kills more than 40,000 women each year, according to Right at Home, a senior care organization.

On average, women develop breast cancer at age 61. Bielski-Stoff’s diagnosis rattled her family, friends and coworkers. She has worked at the hospital since 2004.

“It’s eye-opening for all of us — I’m her age, you know? You never know,” Kim Audiino, an emergency room nurse at St. Charles Hospital and friend of Bielski-Stoff, said. “I think people need to open their eyes and be more alert about checking themselves.”

Bielski-Stoff was getting dressed after taking a shower in August when out of the corner of her eye, she noticed her right breast collapsed when she lifted her arm. Her first thought, she said, was that it was due to the 10 pounds she recently lost for her sister’s upcoming wedding. Bielski-Stoff conducted a brief self-exam, finding nothing out of the ordinary — nothing was swollen and she did not feel any lumps.

She showed her gynecologist that Wednesday. Bielski-Stoff said the doctor cocked her head, commented that it looked like a dimple and gave her a script for a mammogram and an ultrasound. The doctor told her it was probably nothing but she wanted to be on the safe side.

Her appointment was Sept. 7 at St. Charles with Dr. Jane Marie Testa, a doctor her coworkers recommended after Bielski-Stoff insisted she wanted to see the best. George, her husband, had asked if she wanted him to go with her, but she said no — she did not want to make it a big deal.

“I remember driving there and pulling up in the parking lot and thinking, either this is going to go in a good way or it’s not,” Bielski-Stoff said, “like, this could be the last time I feel normal.”

The tests took a few hours. When they were over, Testa came in and said she wanted to show Bielski-Stoff a few things with the ultrasound. There was a spot on her left breast the doctor wanted to take a sample of, and one on her right. Then Testa hovered over another spot on her right breast and said she was sorry — it was cancer.

There was no question about what it was, Bielski-Stoff said. It was a classic presentation of a cancerous mass. It was irregularly shaped and had vascularity and calcifications. Questions were flying through her mind about whether her life was over, if she would be in pain and if she was going to be okay, she said.

“The feeling that comes over you when somebody says cancer is just, I started crying,” Bielski-Stoff said. “I thought, ‘How do I absorb this right now. It was everything all at once — fear, a lot of fear.”

Her sister’s wedding was that weekend, so she booked the biopsies for the following Wednesday. Then she set about trying to find a surgeon.

Bielski-Stoff’s insurance company told her there was only one in network near her, so she turned to her coworkers at St. Charles for advice. With the help of her supervisor and the head of human resources, Bielski-Stoff learned the doctors at Memorial Sloan Kettering were covered.

The surgeon gave her two options: either Bielski-Stoff could get a lumpectomy with radiation or she could get a mastectomy. She opted for a double mastectomy.

“I have to live with this. This is what I can live with,” she said about her decision. “I’m young, 37. I can’t spend the rest of my life panicking that I’m getting cancer again.”

“The feeling that comes over you when somebody says cancer is just, I started crying. I thought, ‘How do I absorb this right now. It was everything all at once — fear, a lot of fear.”

— Desiree Bielski-Stoff

Her surgery was Oct. 3. Two weeks later, all the drains were out and she was sore but doing well. The support from her friends at St. Charles helped her through the experience, she said. They visited her every day, bringing her flowers and food, watching movies with her, checking her dressings, helping her bathe and delivering her medicine from the pharmacy.

“We were pretty much her nanny 24/7 while her husband was working,” Audiino said. “She was never alone, and she had more care than anyone I’ve seen because she’s so well-known and well-liked. We love her to pieces.”

Audiino and another friend, Colleen Miller, raised just about $600 selling over 150 pink bracelets around the hospital. Her Facebook page is littered with pictures of coworkers wearing their bracelets — some say Faith, others say Hope and Survivor. The funds paid for the hotel room Bielski-Stoff’s husband stayed in the night before her surgery.

St. Charles is letting employees donate their vacation time to Bielski-Stoff. She has exhausted hers between her cancer experience and working on the hospital’s negotiating team.

“All of us at St. Charles wish Desiree the best of health — I am very proud of our staff for supporting Desiree during this difficult time,” Jim O’Connor, executive vice president and chief administrative officer at St. Charles, said in an email. “Their gesture also brings awareness to this important health issue and the need for screening and early detection.”

Others have been doing what they can to show their support as well. A former patient’s family drove to her house from the North Shore to drop off supermarket gift cards, and her sister set up a GoFundMe account.

Bielski-Stoff said this experience has been traumatic because it feels like she does not just have cancer, but all her friends and family do. Her diagnosis has made the people around her aware of the importance of conducting self-examinations and going to a doctor regularly.

“It made me have a different look on life and it definitely opened my eyes to making sure that I take care of myself and my children, and that all of my friends keep up with checking for themselves,” Miller, a nursing assistant at St. Charles, said. “In the meantime, we all have to be ‘Dezzy strong,’ as I call it, and be there for her while she’s recovering.”

Bielski-Stoff found out on Halloween she’ll need four months of chemotherapy. 

“That’s going to change me as well and make the fight a little bit harder,” she said.

Bielski-Stoff’s friend Jimmy Bonacasa is hosting a fundraiser for her at the Harbor Crab in Patchogue Sunday, Nov. 13, from 4 to 8 p.m. There is a suggested donation of $20.

This version was updated Nov. 1 to include Bielski-Stoff’s treatment plan.

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