By Past President and Founding Member Myrna Felder
It is hard to recognize that Sandy Katz is no longer with us. From the 1993 founding of JALBCA, Sandy was there to pitch in whenever needed; serving as Co-President and as the Chair of the Annual Dinner. Her diligent work over the years laid the foundation for the great event that the Dinner has become. Starting at the Waters’ Edge Restaurant in Long Island City (until the event eventually outgrew that venue), reached by ferry from Manhattan on those balmy evenings, with cocktails on the veranda followed by a wonderful dinner-who can forget those so special get-togethers. Sandy lovingly attended to every detail – from the favors (do you still have your JALBCA umbrella?), to the seating arrangements to make sure everyone was comfortable, to the speeches which she tried (not always successfully) to keep to a minimum. It was always a fabulous evening as a result of Sandy’s efforts – typical of her special touch. I often offered her a lift home (we lived in adjoining buildings), but Sandy would not leave until the last guest departed – to make sure that everything was perfect from beginning to end.
In the more than a decade since she was first hospitalized for a brain tumor, Sandy refused to be deterred from attending and participating in WBASNY and JALBCA activities despite her illness – contributing to WBASNY’s Advisory Committee (consisting of the Past Presidents of WBASNY); attending Special Events; even flying down to Florida to attend the WBASNY Convention in St. Petersburg.
Her bravery and courage as she labored to overcome her disease was a model of dignity for all of us to follow.
Oh, how we will miss Sandy. But, oh how well she will be remembered!
On October 8, 2019, JALCA hosted a Breast Cancer Awareness Breakfast on Staten Island, at the Richmond County Supreme Court. The featured speaker was Tihesha Wilson, M.D., Chief of Breast Surgery at Richmond University Medical Center.
Dr. Wilson spoke about breast cancer statistics, risk factors, genetic testing, early detection by screening and breast self-examination, surgical treatment, reconstruction options, individualized treatment and respect for the needs of the patient and her family. She also answered audience questions. JALBCA thanks Dr. Wilson, our co-sponsors, the Staten Island Women’s Bar Association and the Staten Island Gender Fairness Committee, for a great program!
JALBCA was proud to co-sponsor the Bronx Women’s Bar Association 27th annual JALBCA Luncheon on October 18, 2019. JALBCA extends its thanks to long-term breast cancer survivor Victoria Pilotti, Ed.D., and Stephanie Bernik, M.D., F.A.C.S., Chief of Breast Surgery, Mount Sinai West. Dr. Pilotti described the challenges of her diagnosis and treatment in 2000. Dr. Bernick discussed the state of breast cancer diagnosis and treatment in 2019, including recent advances in screening, surgery to remove the breast cancer and reconstructive surgery options.
On October 21, 2019, JALBCA co-sponsored a seminar with Nassau County District Attorney Madeline Singas. This was a Breast Health Education Seminar which took place at the Nassau County District Court. JALBCA thanks Mary Solomon, Director of the ScanVan Project at Project Renewal (a long-time JALBCA grantee), for her engaging and informative presentation concerning the importance of early detection and treatment of breast cancer. Many judges, the Hon. Gail Prudenti, Dean of Hofstra School of Law, attorneys, including members of the D.A.’s office and court personnel attended the program.
By: Krisly M. Zamor
JALBCA’s informative, interactive and inspirational Treatment Beyond the Tumor 2.0 program at the Appellate Division, Second Department on October 22, 2019 was a smash hit! Co-sponsored by the Brooklyn Women’s Bar Association and SHARE, the program focused on the overlooked physical, mental and emotional toll often accompanying a breast cancer diagnosis and treatment. The program addressed treatments – including counseling, exercise, massage therapy and meditation – to aid patients with the physical and emotional side effects of breast cancer. It was followed by a networking reception where attendees shared personal stories of pain and triumphs over drinks and appetizers.
The evening started with an airing of JALBCA’s powerful new video, which shows the impact that JALBCA’s grantees have on people’s lives – please take four minutes to watch it at https://jalbca.org/JALBCAMainVideoFinal.mp4. Hon. Alan Scheinkman, Presiding Justice of the Appellate Division, Second Department, welcomed the attendees at the beautiful courthouse in Brooklyn and those viewing the webcast at Miller Zeiderman & Weiderkehr LLP in White Plains. (The webcast was co-sponsored by the Westchester Black Bar Association, the Westchester County Bar Association and the Westchester Women’s Bar Association.) JALBCA Co-President Hon. Saliann Scarpulla welcomed the audience on behalf of JALBCA and introduced moderator and JALBCA Board member Hon. Linda Capitti.
Judge Capitti introduced the program and discussed the importance of mental health services when facing a diagnosis of breast cancer, sharing her personal experience with the lack of mental and emotional support available to cancer patients. Judge Cappiti recounted her experience as a breast cancer survivor facing a recurrence 10 years after her initial diagnosis. She was “paralyzed by fear”. This paralysis impacted her mental and emotional health in a manner equally pertinent and concerning as the cancer itself. Unfortunately, during her search for mental health assistance, she found a formidable barrier to accessibility, namely, it was prohibitively expensive. These events opened her eyes to a truly overlooked issue — the need for psychological assistance for a successful and optimal recovery. To that end, this program sought to raise awareness of the issue and provide access to resources and options which have been created to meet the needs of survivors.
Judge Cappiti introduced the first speaker, Glenn Liebman, the CEO of the Mental Health Association in New York State, Inc. Liebman proudly shared the growth of the organization. With 26 affiliates across 52 counties, the organization is a trailblazer. It led the charge to introduce mental health initiatives in schools as well as trainings in general first aid for mental illness. Efforts such as these are critical because one in five adults in this country have a serious mental health issue and only one in two people who need mental health care receive it. Liebman also shared data from Britain, where eight in 10 women with breast cancer were not warned of potential long-term anxiety and depression.
To address the vital issue of mental health after a breast cancer diagnosis, Liebman recommended a few simple but critical steps for patients to include in their treatment. First, he explained, have a gatekeeper for your diagnosis; a strong advocate is important from the start of the process. Second, normalize conversations with your primary care doctor by asking about how you and your doctor plan to address or talk about mental health. As a care-manager for yourself, get your family and primary care doctor discussing these matters from the start. Lastly, the Collaborative Care Model, which is the integration of behavioral health and general medical services, has been shown to improve patient outcomes, save money, and reduce stigma related to mental health. For assistance in following the Model as part of your treatment and diagnosis or to learn more, email NYSCollaborativeCare@omh.ny.gov.
Liebman explained that Timothy’s Law requires symmetrical treatment of mental and physical health needs in New York State. There has been increased recognition statewide, facilitating these processes and introducing significant resources, including CHAMP – New York State’s Community Health Access to Addiction and Mental Healthcare Project (https://lac.org/community-health-access-to-addiction-and-mental-healthcare-project-champ/ or call the free CHAMP Helpline at 888-614-5400). However, insurance companies sometimes deny coverage, and Liebman spoke about appealing a denial of coverage in New York State. With a son afflicted by anxiety and depression just two weeks away from his 25th birthday, these issues are truly near and dear to Liebman’s heart. He welcomed the opportunity to speak with anyone who may be struggling with such terrible circumstances and/or afflictions and encouraged anyone to reach out to him at Gliebman@mhanys.org.
Judge Capitti then introduced Felicia Newsome, LMT, Managing Director, CATA Oncology Massage Training Program, who explained how massage can help the physical and emotional well-being of breast cancer patients. Newsome noted that it was important to distinguish her work in integrative medicine and integrative health from “alternative medicine.” She makes up a part of the treatment team, not acting as an alternative to it. She said she often heard from her clients: “When I got my diagnosis, I gasped and did not know how to exhale.” This is where her work comes in: helping clients exhale. She helps patients to better vocalize their needs when it comes to their treatment. This is critical because massage therapy comes with a variety of benefits. Generally, it helps with relieving stress and anxiety, improving sleep (which impairs decision-making), reducing pain, constipation and nausea. Post-surgery, massage therapy may improve recovery, reduce post-surgical pain and swelling as well as increase range of motion. Additionally, it may help with post-radiation treatment fatigue and improve peripheral neuropathy. There is not much that patients have control over, but in Newsome’s experience, this helps patients feel like they have control in actively participating in their own healing and that has made all the difference.
The next speaker, Bryan Molano (LMT, Element Natural Healing Arts), specializes in and spoke to lymphatic manual drainage, or LMD. First, “lymph” translates to clear water; it is a clear fluid of white blood cells, which carries viruses and cancerous cells out of the body. Its function is to move larger molecules back to the heart and also the immune surveillance system. Lymph nodes come in clusters in the neck, armpit and deep in the gut. A lymph node’s job is to cleanse the lymphatic fluid before it gets back into the heart. When unsuccessful, it causes a “traffic jam” or lymphedema. Post-surgery, one’s life may be affected by lymphedema. Lymphedema is extremely painful and often appears post-mastectomy and post-lobectomy. LMD is the lighter pressure method of massage used in treatment in an attempt to free up pathways and reduce swelling. It includes the contraction of smooth and skeletal muscle – both stimulated even more by targeted therapy. LMD helps prevent infection by moving the bacteria along. In wrapping up, Molano rebutted misconceptions of LMD as an inconclusive therapy. There have been tests that show its effectiveness, he stated. In controlled experiments, groups with LMD were seen to have an improved lymphatic flow. In fact, LMD participants’ pathway’s rhythm increased 15 to 20 times. Therefore, LMD is not merely a placebo effect.
Reprising her dynamic presentation from last year’s Treatment Beyond the Tumor program, Donna Wilson (RN, MSN, RRT, Personal Trainer, Clinical Fitness Specialist, Bendheim Integrative Medicine Center, Memorial Sloan Kettering Cancer Center) got everyone on their feet and active. Discussing the importance of exercise for breast cancer patients, Wilson emphasized that “all cancer patients should exercise through and after treatment.” Unfortunately, only a small percentage actually do. Wilson said that is because many physicians fail to prescribe movement as a critical part of treatment and recovery. This is important because chemotherapy causes loss of muscle mass and weight gain after treatment is highly correlated with a possible recurrence. Although simple exercises are easy enough to engage in on your own, Wilson advises that if anyone does go to a personal trainer, they should make sure the trainer has experience with recovering patients and is certified through the American Breast Cancer Society. “And don’t be afraid to lift weights!” she added. Lots of research says that it is appropriate, she explained; simply start off slow. In fact, Wilson is the captain and coach of a dragon boat team of breast cancer survivors: The Empire Dragons NYC. Out of 126 teams, Wilson’s came in seventh in a competition in Italy. Next year, they will be off to compete in France! With that as inspiration, Wilson had the group practice deep breathing exercises. After reprimanding us for our terrible postures, she led us through a quick, simple and easy circuit of exercises to improve mobility and health, including arm circles, chair squats and more.
To close out the program, Felicia Newsome led the group in a meditation exercise focused on breathing. Following a brief question and answer session, Justice Scarpulla thanked all the presenters for their engaging and informative presentations that focused on treating the whole person rather than just the tumor. She encouraged all attendees to join JALBCA and then invited attendees to enjoy a lovely reception in the lawyers’ lounge.
This program, in its second year, addressing the emotional and physical effects of breast cancer and treatments including mental health services, massage, exercise and meditation, was valuable and interesting for anyone who personally has been or knows anyone who has been affected by breast cancer – in other words, just about everyone! If you missed it, you can view the program at https://jalbca.org/JALBCATBT102219.mp4.
NOTE ABOUT AUTHOR: Krisly M. Zamor is a former JALBCA law student intern.
JALBCA was proud to join NY State Senator Jamaal Bailey and Bronx District Attorney Darcel Clark at Senator Bailey’s Survivor’s Day event for breast cancer and domestic violence survivors at the Butler United Methodist Church in the Bronx on October 27, 2019. JALBCA Executive Director Claire Gutekunst provided information on resources for people affected by breast cancer – and supplied the bright pink bracelets everyone is sporting in these photos.
On October 29, 2019, JALBCA co-sponsored Guided Meditation for Health and Healing, with the Richmond County Bar Association Wellness Committee and the Staten Island Women’s Bar Association, at Snug Harbor Cultural Center on Staten Island. Denise Danton Nizzare, NLP Center of NY Hypnosis and Meditation Leader and Yoga Alliance Certified Instructor, led the participants through a guided meditation.
The annual Breast Cancer Awareness Lunch took place at the Westchester County Courthouse in White Plains on October 30, 2019, closing out Breast Cancer Awareness Month. JALBCA and the Westchester Women’s Bar Association (WWBA) co-sponsored the luncheon. JALBCA thanks Alisan B. Goldfarb, MD, Assistant Clinical Professor at the Icahn School of Medicine at Mount Sinai Hospital, and Randy E. Stevens, MD, Director, Department of Radiation Oncology, White Plains Hospital Center for Cancer Care, for their interesting and informative presentations about breast health, early signs of disease, risk factors, and screening and treatment options.
On October 29, NYU Langone sponsored an updating program “Lymphedema Education Series: Updates in Research”, featuring Mei R. Fu, PhD, RN, FAAN. Dr. Fu is Associate Professor at NYU Rory Meyers College of Nursing, NYU.
Dr. Fu explained why exercise is helpful for lymphedema. She then discussed the effect of the vascular endothelial glycocalyx layer (EGL) on lymphedema. There is a lining in the capillary wall called the endothelial glycocalyx. The glycocalyx is hydrophobic and prevents the movement (reabsorption) of protein and fluid back into the venous side of the capillaries. This fluid then crosses into the interstitium. All interstitial fluid is reabsorbed by the lympathetic capillaries during homeostasis.
Lymphedema is an accumulation of lymph fluid in the interstitial spaces of the affected limb and areas. While primary lymphedema is a rare genetic condition, secondary lymphedema can occur when surgery or radiation therapy for cancer, such as breast cancer or melanoma, damages the lymphatic system. Dr. Fu reported that approximately 28%-40% of patients treated for gynecological cancer develop lymphedema. She explained that this is a lifetime condition, without a cure.
The symptom of lymphedema, for the most part, is inflammation, and patients are advised to “know your body”. That is, patients should seek a baseline and compare. The earlier a patient gets examined for lymphedema, the better. Other symptoms include: limitations in movement of limbs, swelling (e.g., of the hand, arm, breast or chest wall), arm firmness, arm tightness, arm heaviness, toughness or thickness of skin, stiffness, tenderness, hotness, redness, blistering, pain/aching/soreness, numbness, burning, stabbing, tingling, and fatigue. When a patient is able to get the fluid to move from the interstitial space, the inflammation decreases. Patients who have pain should report it. Also, since patients are concerned about cancer recurrence, they will want to rule out recurrence and then they can attend to managing the symptoms of lymphedema.
Dr. Fu next discussed fibrosis. This occurs when a patient has fluid in the interstitial area for a long time because of inflammation because the EGL layers do not work. Toughness results. At this point the patient needs to get physical therapy to manage lymph drainage.
Dr. Fu confirmed that inflammatory genes can be involved. She mentioned that some pre-surgery testing can be done to see if a patient has a proclivity for inflammation, in which case they can learn do to lymphatic exercises. She also described a complementary low-level laser therapy at NYU that is available for breast cancer-related lymphedema – this is the subject of a double-blind, randomized, placebo-controlled study. The laser is intended to break down fibrotic tissue, which in turn moves the fluid back to the lymphatic system.
Various surgical options are available for lymphedema. NYU Langone’s website indicates that surgical and laser treatments are used when severe secondary lymphedema has resulted from cancer treatments and does not improve with less invasive therapies.
Non-invasive therapies for lymphedema include manual lymphatic drainage (a specialized type of massage that helps mobilize built-up lymph through swollen and congested areas), compression therapy (which can include compression garments, multilayer bandages or a compression pump, which apply intermittent pressure on a timed cycle stimulating the flow of lymphatic fluid and reducing swelling), exercise, skin care and hygiene (to help decrease the risk of infection and prevent further swelling).
Dr. Fu identified the various available surgical procedures, as follows: lymph node transfer, lymphatico venous bypass (LVB), skin/subcutaneous tissue excision and liposuction. These accomplish different things. Lymph node transfer is a microsurgery that involves the transfer of lymph nodes to the damaged lymph node basin. In other words, healthy lymph nodes from an unaffected region are transplanted and can provide permanent new lymphatic drainage, though these new lymphatic channels do not begin to function until many months after surgery. LVB surgery, on the other hand, connects lymphatic vessels that lead to the veins in affected areas. In this intricate microsurgery performed with general anesthesia, blocked lymphatic vessels are surgically attached to small vessels called venules, which lead to larger veins. This can help drain stagnant lymph fluid. The connections that are made during LVB are very close to the surface of the skin, so it is a less invasive procedure than the lymph node transfer. Patients who have a bypass can usually go home the same day or the next day. The next technique involves the direct excision of lymphedematous tissues. Finally, liposuction involves the circumferential suction assisted excision of lymphedematous tissues.
As for laser techniques, the NYU Langone website refers to the use of low level laser therapy to remove lymph nodes. It can help improve the range of motion in an affected arm and lessen swelling and tightness. In this treatment, infrared lasers penetrate affected tissues impacting the cells causing inflammation, thereby reducing swelling and skin tightness. The procedure is performed in the hospital, and the patient can return home the same day.
Questions and Answers
The presentation was followed by a question-and-answer period. One audience member asked about the relationship between high blood pressure and lymphedema and Dr. Fu suggested that patients should not lift more than five pounds. Another person asked if she suggested that a sleeve be worn. The response was that, if there are no symptoms, then a sleeve is not needed. Another person questioned whether implants cause more lymphedema, and the response was in the negative. Finally, an attendee asked about radiation, which causes acute inflammation. Dr. Fu recommended that the patient do her lymphatic exercise while undergoing radiation.