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Chadwick Boseman

Left, Dr. Daniel Jamorabo, gastroenterologist at Stony Brook Medicine and assistant professor of medicine in the Division of Gastroenterology and Hepatology at Stony Brook University’s Renaissance School of Medicine. Right, Dr. David Purow, chairman of Medicine-Gastroenterology at Huntington Hospital. Left by Stony Brook Medicine/Jeanne Neville; right from Northwell Health

No one rushes to make a reservation at a pre-colonoscopy restaurant with a cleansing and well-reviewed special of the day. 

In fact, for most people, the preparation for a potentially lifesaving diagnostic procedure is somewhere between unpleasant and unpalatable.

That, however, may have changed as the U.S. Food and Drug Administration recently approved another incremental improvement in the colonoscopy preparation that could make the preparation and the procedure — which can detect early signs of cancer — less bothersome.

Manufactured by Sebela Pharmaceuticals, Suflave is a low-volume preparation that tastes like a lemon-lime sports drink. It should be available in August.

“Patients really like” Suflave, with about 80 percent finding it palatable, said Dr. Daniel Jamorabo, a gastroenterologist at Stony Brook Medicine and assistant professor of medicine in the Division of Gastroenterology and Hepatology at Stony Brook University’s Renaissance School of Medicine. 

Jamorabo called it a “wonderful addition to the bowel preparations that are out there.”

Jamorabo said the ingredients in most preparations are the same: the difference in the Suflave preparation seems connected to the flavor.

The thinking in the gastrointestinal community is that “we need to find a preparation” that is more pleasant, said Dr. David Purow, chairman of Medicine-Gastroenterology at Huntington Hospital. “That will capture more people who are somewhat reluctant to have a colonoscopy.”

Colonoscopies are a “necessary screening procedure,” Purow added, and health care professionals in the field don’t want the discomfort during preparation to discourage people from getting the procedure.

Indeed, doctors have a much higher success rate with patients when they detect evidence of colon cancer early.

Getting it right

Doctors suggested that the success of preparing for a colonoscopy varies.

Jamorabo estimated that around 10% of patients may not take all the steps necessary to have the screening.

In those circumstances, these patients have to reschedule the procedure and go through drinking fluids that clear out their systems more effectively.

Gastroenterologists urged people to ask questions if they don’t understand any of the steps they need to take to prepare.

For some patients, the COVID-19 pandemic delayed their routine colonoscopy visits, as people stayed away from hospitals and medical care facilities during periods of highest viral infection.

Jamorabo added that colon cancers have started to show up in younger people.

In 2018, the American Cancer Society recommended lowering the age for screenings from 50 to 45.

“It’s showing up more” in people under 50, said Jamorabo. “It may even go lower.”

Doctors discovered stage three colon cancer in late actor Chadwick Boseman before he was 40.

“We don’t know yet” why it’s causing cancer in younger people, Jamorabo added, but “it’s not rare. It’s been going on for a couple of years. We can’t write it off as some statistical anomaly.”

Early symptoms

People can and should be on the lookout for symptoms that might indicate colon cancer.

Unintentional weight loss, such as losing 10 pounds or more in three to four months without changing diet or exercise regimen, could indicate a problem.

Blood in the stool, changes in bowel habits and ongoing constipation could also require medical attention.

More subtle signs, such as fatigue, shortness of breath or decreased appetite, could indicate that people are losing blood in their stool.

As for the overlap between COVID and colon cancer, Jamorabo believes that the ongoing inflammation from the SARS-CoV2 virus could predispose people to cancer.

“I don’t think enough time has elapsed” to know if there’s a link between the virus and colon cancer, he added.

With anxiety building over big-picture issues like global warming and an intensely divided population, people are likely increasingly worried about the state of the world.

“Most gastroenterologists are probably busier than they’ve ever been,” Purow said. “Some of that is probably due to the times in which we are living.”

Stress and anxiety can cause gastrointestinal symptoms that manifest in different ways.

Even with less concern about the pandemic, doctors are still seeing more people with alcoholic liver disease, as some turned to alcohol to relieve their ongoing anxiety.

“We’re trying to expand our network of dietitians and mental health professionals that we’re working with,” said Purow.

Information is power

An important tool in preventing colon cancer involves tracking the colon’s health through colonoscopies.

Having Suflave on the market could “lower the dread” of having a colonoscopy, Jamorabo noted. “We need to make the logistics of the preparation easier.”

Viola Davis in a scene from the movie. Photo from Netflix

Reviewed by Jeffrey Sanzel

August Wilson, one of the foremost American dramatists, created the ten-play cycle The Pittsburgh Plays. The pieces explored different elements of the African-American experience, each work set in a different decade. The second play (and third chronologically) was Ma Rainey’s Black Bottom. Inspired by blues singer Ma Rainey, it was set in a fictional recording session in Chicago. It opened on Broadway in 1984, receiving strong press and running for 276 performances.  

Netflix now offers an excellent film that enhances the stage production. George C. Wolfe has skillfully and sensitively directed a screenplay by Ruben Santiago-Hudson. Santiago-Hudson has wisely drawn the majority of the script from Wilson but has opened it up, most notably with a prologue showing Ma Rainey’s southern performance roots and the shift of African Americans from south to north in the Great Migration.  

The action shifts to the studio where the musicians await the arrival of Ma Rainey. The artists smoke, drink, and banter, and philosophize. But what seems like random chatter is a reflection of social injustice then and now. The men offer stories and anecdotes, with this slice of life elevated by Wilson’s honest and poetic words and exceptional performances.

Serving as the leader is guitarist and trombonist Cutler (Colman Domingo); Toledo (Glynn Turman) is the pianist and eldest of the group; Slow Drag (Michael Potts) plays double bass and Levee Green (Chadwick Boseman) is the rebellious trumpeter with big dreams. This quartet offer a glimpse into the challenges of being both black and musicians in the Chicago of the 20’s. The studio is run by Mel Sturdyvant (Jonny Coyne), whose mercenary tactics are slowly revealed. Irvin (Jeremy Shamos) is Ma’s anxious manager.

Ma Rainey (Viola Davis) arrives an hour late, setting off various complications. She is accompanied by her girlfriend, Dussie Mae (Taylour Paige), who has eyes for Levee, as well as her stuttering nephew, Sylvester (Dusan Brown), who she insists introduce the recording of “Black Bottom.”

What ensues is a battle of wills that represent issues of both music and race. While Ma appears to be difficult, it is really a matter of survival. She knows that she is being used by these white men, and they only cater to her as far as their needs. Viola Davis, possibly the finest actor working today, completely loses herself in Ma Rainey’s frustration and triumph. It is a flawless and mesmerizing performance of a woman who understands the nature of an unfair world.  

The film also marked the final performance of Chadwick Boseman, who sadly died of colon cancer at the age of forty-three. His performance is nothing less than brilliant, bouncing between Levee’s energetic and monomaniacal determination to create his own band and his inner demons. These lead to clashes with both Ma and his fellow musicians. His relating of his mother’s rape and his father’s revenge is one of the most chilling and raw moments in this or any film. 

The entire cast deliver dimensional and wholly present performances, easily drawing us into this world where they face both petty and large demands at every turn. Their stories take different shapes, some metaphoric and others brutally and vividly real. There is not a false or wasted moment. It builds to a harrowing climax and an equally brutal and telling coda. 

Ma Rainey’s Black Bottom celebrates the power of the blues, chronicling an important part of African American history. It is a reminder of art and of exploitation, of defiance and disappointment. It is also an exceptional film. Rated R, the film is currently streaming on Netflix.

Photos courtesy of Netflix

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Thanos (Josh Brolin) in a scene from ‘Avengers: Infinity War’. Photo courtesy of Marvel Studios

By Kyle Barr

Marvel movies tread a line between being formulaic comic-book style action movies and surprisingly nuanced examinations of real world problems with real emotional heart. Some do better than others with that. 

A scene from ‘Avengers: Infinity War’

“Captain America: The Winter Soldier” was as much a condemnation of modern government surveillance as it was a spy-style action thriller. “Black Panther” was an exploration of afro-futurism and a condemnation of isolationist policies as much as it was a high-tech, high-flying romp. 

That’s not a bad thing, and in fact the formula has grown to the point it’s now expected that Marvel movies cannot have their introspection without the action, and visa versa.

So what extra edge does “Avengers: Infinity War,” directed by the brothers Anthony and Joe Russo, have to set it apart from its contemporaries in the action genre? Well, to avoid spoilers, the most I can say is that it flips the genre formula where “heroes learn a lesson and win the day” on its head. 

 

In this movie, written by Christopher Markus and Stephen McFeely, the main villain is also the main character. Thanos, played with such subtle menace and intelligence by Josh Brolin, searches the universe for the infinity stones, glowing rocks that control an element of existence, from time to reality. Superheroes from Earth and beyond must find a way to stop him before he commits the biggest act of genocide the universe has ever seen.

Unlike a normal Marvel movie, it is the villain whose decisions drive the plot. In most Marvel movies, the main characters need to learn, grow and change in order to win the day. In “Avengers: Infinity War,” even if a character learns a lesson and even if they make the right decision, it doesn’t necessarily mean they win.

Being that this is the most recent big crossover Marvel movie, it is impossible to list the characters and actors who play them without leaving out a number of characters who all make contributions to the plot. Many of these actors have been in their roles for so many years it seems it would be hard at this point for any of them to not play their characters effortlessly. 

A scene from ‘Avengers: Infinity War’

Chadwick Boseman of this year’s “Black Panther” remains great as the stoic and noble King T’Challa. Robert Downey Jr. adds an extra edge of fear and foreboding to the character that really takes the performance above the usual I’m-too-smart-for you sarcasm of old Iron Man. 

If there were to be a weak link, it would have to be Mark Ruffalo as Bruce Banner/The Hulk, who can’t seem to make an emotional impact compared to the other characters. His jokes land largely flat, and he doesn’t seem to be as invested as the rest of the cast. Another small disappointment is Eitri, the weaponsmith dwarf played by Peter Dinklage, who despite having an interesting play upon the “Dwarf” character, seems stiff and his performance seems almost phoned in.

Although it’s been a conflict built up to through 19 films so far, the ferociousness with how the plot develops is breathtaking. Again, trying to resist spoiling the plot is hard, but none of the characters come out of this movie clean. 

Thanos’ race to find the infinity stones takes place both on Earth and across the stars, but nearly every character plays off of the emotional conclusions of their own separate movies. For those who have been keeping up with every new Marvel release, you might feel as if you’re watching family members being repeatedly punched in the gut. 

If you haven’t been a hard-core Marvel fanatic, it might seem overwhelming. All of these characters have a backstory, and while some of them are meeting for the first time, several have long and troubled histories together like a big screen version of a soap opera. The movie tries to avoid info dumps (though it still has to go and explain what the heck the big colorful space rocks are) so people going into this as their first Marvel movie might have a hard time understanding what’s happening.

A scene from ‘Avengers: Infinity War’

The film ends on a very deep and somber note. Of course that is in anticipation for “Avengers: Infinity War Part 2” to be released in May of next year. The sequel now has quite the task of concluding what happens at the end of Part 1, and one could be skeptical to see how they might manage to pull it off. 

Isn’t it strange how we got here? It has been a decade of nothing but Marvel fever. When the idea for a shared film universe was still new there were quite a few people who were waiting for the bubble to burst. They waited for the first movie that was bad enough to let the whole thing crumble.

Of course that didn’t happen. For now, “Avengers: Infinity War” is the real deal. There are few good movie series like what Marvel has done that combine real emotional heart with comic book action gravitas. As long as they stay good, they still deserve an audience.

“Avengers: Infinity War,” rated PG-13 for sci-fi violence and action, language and some crude references, is now playing in local theaters.