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Research at Montefiore seeks to advance treatment of pancreatic cancer

Research at Montefiore seeks to advance treatment of pancreatic cancer

By: Mehroz Baig

Ron, a 79-year-old Bronx man, remembers the day a CAT scan revealed something was seriously wrong with his health.

“While the tech was doing the scan, she had this look on her face,” he said. “She said, ‘excuse me,’ and went and got the doctor.” The scan  eventually showed he had developed pancreatic cancer.

Ron asked for his last name to be withheld because he hasn’t told much of his family or his friends that he was diagnosed with pancreatic cancer in August 2010 and he doesn’t want them to worry.

Ron is a small figure who walks fast wearing a white, short-brimmed hat covering a head of light gray hair and a black sports jacket. His health has put many restraints on his life: as he puts it, his plumbing isn’t what it used to be. But he maintains a sense of humor. He talks about the nurses who take care of him and says that he likes to joke with them.

“They feel bad for everyone that has to be treated,” he says. “When I kid around, you get a rapport with them, you become friends.”

Pancreatic cancer can occur in two forms: one attacks the part of the pancreas that creates enzymes which make regulatory hormones, like insulin to control glucose levels in blood, explains Dr. Steven Libutti, director of the Montefiore-Einstein Center for Cancer Care. This cancer is called pancreatic neuroendocrine cancer.  This is is the kind of cancer that Ron has. The second form of pancreatic cancer is called pancreatic adenocarcinoma, which attacks the part of the pancreas responsible for helping the body digest foods. Adenocarcinoma occurs more frequently and is more deadly.

“Life expectancy for pancreatic adenocarcinomas is often measured in months whereas life expectancy for pancreatic neuroendocrine carcinoma can be measured in years,” Libutti said.

Libutti , who is also associate director for clinical services at the Albert Einstein Cancer Center, says that although pancreatic neuroendocrine cancer is less prevalent, it is increasing.

“Part of it may be we have better means of diagnosing or detecting them and part of it may be that they actually are increasing in incidence,” Libutti said.

The National Cancer Institute estimates that in 2010, there were approximately 43,000 new cases of pancreatic cancer in the United States. That same year, there were 36,800 deaths by pancreatic cancer in the U.S. The data was not split between the two types of pancreatic cancers. According to the New York State Department of Health, there were 2,768 cases of pancreatic cancer diagnosed in 2007. That same year in New York, there were 2,280 deaths from pancreatic cancer.

Libutti is heading the most recent venture in cancer treatment and detection at Montefiore and Albert Einstein Cancer Center. Through a partnership with four other institutions in Texas, Libutti and his team applied for a grant from the National Cancer Institute to research the use of nanotechnology to diagnose and treat pancreatic neuroendocrine cancer and ovarian cancer. In September, the team was granted a $16 million, five-year grant to pursue this technology.

Nanoparticles are tiny particles, smaller than the diameter of a human hair. “The idea is that nanomedicines can be engineered to have unique properties that might allow them to help in the development of therapeutics that can be targeted to tumors as opposed to having a general effect on the entire body,” Libutti said.

Imagine a cancer tumor having a zip code, Libutti says. His goal with this research is to design an agent that can read that zip code. Once the agent is injected into the body, it would go directly to the zip code where the tumor lives. Once that is accomplished, the agent can be sent with medicine to kill the tumor or some other substance that would allow doctors to see the tumor more clearly.

Currently, there are various treatment options for people who are diagnosed with pancreatic neuroendocrine cancer: surgery is usually the first option. If a person is not able to have surgery, either due to medical conditions or because the patient chooses not to, other options include octreotide injections or sunitinib pills, both medicines that slow the growth of neuroendocrine tumors. “Traditional chemotherapy doesn’t work for endocrine cancers,” Libutti said.

Libutti points out that the concept for this research is not new. Doctors use iodine, for example, to diagnose and treat thyroid cancer. There isn’t a naturally occurring substance that responds to pancreatic cancer tumors the way iodine does to thyroid cancer. Libutti’s research aims to fill that void by creating something that will serve the same purpose that iodine does for thyroid cancer.

Dr. Steven Libutti in Lab

Steven K. Libutti, director of Montefiore-Einstein Center for Cancer Care, is investigating nanoparticles for imaging and treating pancreatic tumors as part of a national five-institution research project funded by the NCI. Pictured in the lab with Dr. Libutti is Mijung Kwon, a senior scientist at Einstein. (Photo Credit: Albert Einstein College of Medicine)

Libutti says that if the research is successful, his team could have a working form of nanomedicine ready to use in seven to ten years. Although the Einstein-Montefiore investigators are focusing on the pancreatic neuroendocrine cancer, the research could produce a substance that would also be useful for pancreatic adenocarcinoma as well as ovarian cancer.  These cancers are not linked but they were chosen because of the expertise and interests of the investigating teams.

“My question would be, is this something that they’d be able to detect early?” asked Kristen Angell, affiliate coordinator at the Pancreatic Cancer Action Network’s chapter in Connecticut. Angell’s father was diagnosed with the deadly pancreatic adenocarcinoma in April of last year and was given a year to live. Angell was her father’s caretaker during the last year of his life and says that early detection of adenocarcinoma is crucial to fighting this disease.

Angell points to the progress that’s been made in breast cancer and says she hopes the same efforts can be directed towards pancreatic cancer.

In the meantime, Ron continues his treatment with Dr. Libutti. Although he hadn’t felt too much pain in the beginning, he says he recently started getting an ache on the right side of his body, which he hopes to address with the nurse the next time he is at the hospital. Ron’s pancreatic tumors have spread to his liver, and while the treatment is meant to slow their growth, it is too early to tell what, if any progress has been made.

Since October 2010, Ron has been going to Montefiore for blood work every two weeks, a shot every month, and periodic CAT scans. Having survived a heart attack, prostate cancer seventeen years ago, and now living with a pacemaker, Ron simply did not think that he could survive a major cancer surgery and opted for the second treatment option of monthly injections that slow the growth of the cancerous tumors.

“I’m like an old car,” he jokes.

Ron has found ways to cope with his health: he maintains a strict diet, donates to children’s organizations and prays.

“I got to church a lot,” Ron says, “more so in the last couple of years when my health started deteriorating. I’ve lived my life. I want to live more but it’s in God’s hands.”

(Click on the interactive below to see pancreatic cancer cases and deaths for all five New York boroughs from 1976 to 2007.)

Posted in Former Featured, Front Page, HealthComments (0)

An Ex-Addict Pushes a Message of Hope and Healing

By Amanda Staab

Reinaldo Daniel Diaz had to hit rock bottom before he could turn his life around and  stop his addiction. Now, he is an active member of the Bronx community, reaching out to as many young people as he can. Photo by Amanda Staab

Reinaldo Daniel Diaz had to hit rock bottom before he could turn his life around and stop his addiction. Now, he is an active member of the Bronx community, reaching out to as many young people as he can. Photo by Amanda Staab

On a recent cold and windy Friday night in the Bronx, rumors spread on the street about a gang initiation week about to start. While some residents were afraid to leave their homes after dark, one man opened the doors to a local church and invited the community to come together in song.

Reinaldo Daniel Diaz, a 40-year-old man with a robust frame and a big smile, took center stage alongside his seven teen backup singers, and the crowd joined in, singing “Healing rain is falling down. I’m not afraid,” a gospel song by Michael W. Smith.

La Iglesia Evangelio de Amor church on Van Nest Avenue was packed with kids and adults, all of them standing in rows and clapping to the beat, some of them closing their eyes and gently shaking their heads. The happy clamor echoed outside, and even more people came in and took a look around.

The focus of the event, though, was not the religion or the music. It was the young people of the Bronx.

“We want to show them that you can be part of a community without being part of a gang,” said Diaz, once he came down from the stage.

Diaz, commonly called Danny within the community, is a substance abuse counselor who has been organizing similar events up to three times a month at local churches, schools, and youth prisons. He began this work a year and a half ago through LifeCause, a grassroots organization he started from his parents’ basement in Soundview.

“I live right in the midst of this war zone, which I call the Bronx, New York City, and we’re fighting for the lives of our kids, to give them a shot,” he said.

LifeCause aims to raise awareness among young African-Americans and Hispanics about HIV and AIDS, gangs, substance abuse, domestic violence, and any other issue that disproportionately affects those communities. Since he started, Diaz has recruited approximately 12 kids who either met him through the various congregations he visits or at the events LifeCause sponsors.

In addition to acting out real-life scenarios in skits and helping distribute free AIDS tests, Diaz’s team tries to reach out to other teens and talk to them about the issues and whatever else they may be facing. The goal, said Diaz, is to send a message to the young people that they can persevere despite difficult circumstances.

“The dream is to let this movement, so to speak, LifeCause affect these kids and, hopefully, they’ll affect others and their families,” said Diaz. The group not only addresses awareness and prevention, but also what the kids are doing to prepare for a successful future.

“We try to get them involved in GED courses,” said Diaz. “We try to get them involved in jobs. We bring them back into community, help them get connected with other youth, other churches, and with other people who are striving to do the same thing.”

Though local churches and other community groups sometimes help host events, Diaz funds most LifeCause events entirely on his own, with his own money. Though he’s not a rich man – he makes little more than $40,000 salary – Diaz manages to make it work.

“This is not an overnight thing,” said Diaz. “I’ve been just saving and buying, saving and buying.” Little by little, he has accumulated tables, chairs, and sound equipment. This past summer, his parents and sister helped him purchase a concert-grade stage for LifeCause events.

Diaz and his team are careful about their methods. They don’t lecture. They try to break the issues down and present them in music, skits, or games, any way that will get through to the kids.

“We tell them how it is,” said Carlos Aristy, 21, who’s known Diaz for years and started helping him write and act out skits about drug abuse and gang violence. “This is real life. This is what they go through.”

Aristy was raised by his grandmother in Hunts Point. At a very young age, he had witnessed exactly how drug addiction can destroy a person’s life. While his peers hung out on the street, Aristy used that example to keep him motivated in school. He managed to graduate high school on time, but dropped out of college after only one year. After talking it out with Diaz, Aristy said he was inspired to go back to school, and now he plans to start at Bronx Community College in January to pursue a degree in digital arts.

While he’s in college, Aristy said he plans to continue helping Diaz. He said his experiences with the group have opened his eyes. The event that moved him most was two months ago. Diaz and his crew visited a Bronx youth prison, where Aristy noticed a small kid, a nine-year-old boy, sitting in the back of the room full of teenagers.

“I was like, ‘We really got to hit the community,’” said Aristy.

LifeCause also organized and sponsored several block parties this past summer with music, raffles, basketball, and even free haircuts. Local churches hosted the events, which also included health information and free HIV tests.

“Our goal is to make it so normal for a person to want to get tested or to want to implement a coping strategy or a condom negotiation strategy,” said Diaz. He’s also organized conferences for pastors, so that they can raise awareness about health concerns with their own parishioners.

LifeCause hosted a block party outside the Rock of Salvation Church at 1179 Hoe Ave. last October. Photo courtesy of LifeCause

LifeCause hosted a block party outside the Rock of Salvation Church at 1179 Hoe Ave. last October. Photo courtesy of LifeCause

“There are issues that need to be spoken about in church,” said Diaz. “People may not readily want to hear what the doctor has to say. They may trust the pastor.”

Diaz and his LifeCause team are praised by members of the community. “He’s great at what he does,” said Albie Sanabria, the youth minister at Crossway Church on Bruckner Boulevard who met Diaz at an event a year ago. “He loves people. I see the joy when he deals with people, even on the street.”

Diaz wasn’t always hitting the sidewalks and passing out pamphlets on HIV. He openly talks about the years he was a drug addict, lost on the streets.

“I came up in the city, and even though I had great parents, somewhere along the cracks, I was traumatized,” he said. Diaz said that he was sexually abused when he was four years old by a family friend who used to babysit him. He kept it a secret, but the effects carried into his adolescence.

“I started to act out,” he said. “I started to be very angry and wanting to hurt myself, and slowly but surely, I began to medicate.” Diaz got hooked on alcohol and drugs. He started with nicotine and moved on to marijuana, then cocaine.

Diaz dropped out of high school as a junior and began hitting the clubs. He eventually worked at a few, stocking the bars and collecting bottles during parties. For nearly three years, this kept him and his drug business busy. The extra money also helped him fuel his own habit.

By the time he was 20, Diaz hadn’t acknowledged the trauma of his past. He buried who he really was under a shell, he said, and it felt horrible. His addiction isolated him, and he was losing relationships. Diaz would be gone from home for days at a time, and his parents had no idea where he was. When he did sometimes return, he said his mother would hide her face and cry when she saw him.

“I was in the grips of addiction where all that was important for me was the next high,” said Diaz. It wasn’t until he found himself reeking of urine and smoking crack alone beneath the staircase of a Morrisania project that he thought he might have hit rock bottom. That’s when, he said, he asked for a sign from God.

“I decided to give him a chance,” said Diaz, “because I had lost a lot, lost relationships, lost family, was losing my home. The turn-around comes when you begin to lose everything and you become aware of it.”

Two days later, Diaz made his way home to tell his parents everything. His family had been praying for him and asking close friends to keep him in their thoughts. That afternoon, his older sister, Elizabeth Diaz, asked him to go with her to her church, a place where people had gone for help with problems similar to his.

As children, the two siblings had been very close. Diaz said every time someone offered him a candy, he always asked for another for his sister. He never left her out. As a teenager, Diaz wrote a rap with a friend that haunted his sister while she witnessed his decline. “‘There’s more to life than this,’” she said the hook went. “‘There’s more to life than this.’ That’s what comes to my mind when I think about those days.”

The church she took him to was the Love Gospel Assembly on the Grand Concourse  in the heart of the Bronx.  Diaz, hard and streetwise, took a seat in the back next to his sister. To his surprise, he recognized a prostitute he knew standing a few pews ahead with her hands up in the air, singing.

“I look at this woman, and I see the tracks, the heroin tracks on her arms, and I couldn’t believe that she was beautiful, clean, and she had tears in her eyes, but she was smiling,” said Diaz. “I was like, ‘How can she be smiling and crying at the same time?’ I didn’t understand, and then it hit me that she was experiencing something that I wanted.”

The pastor stopped the service in the middle and announced that God wanted  him to ask if there was anyone in the pews who needed to approach the altar and receive a blessing. Diaz’s sister looked over at him and told him to go.

“I challenged Danny that afternoon,” she said. “I said, ‘Danny, what’s it going to be? If you’re a real man, you’re going to go up there.’” Reluctantly, Diaz walked to the front of the church. The pastor placed a hand on Diaz’s forehead.

“It was like God stopped everything that he had to do in heaven just for me in that very moment and made himself real to me in that very moment,” said Diaz, who previously hadn’t been much of a believer. The blessing was his first experience with God, he said, and what made him really change his life.

That same pastor, the late Bishop Gerald Julius Kaufman, helped Diaz find a rehabilitation center, and when Diaz made it through the 18-month program, Kaufman hired him as a janitor for the church.

“That place made it happen for me,” said Diaz. Focusing on his new job and avoiding old acquaintances helped him stay clean. On his lunch breaks, said Diaz, he volunteered at the church’s kitchen, which served about 400 meals to the homeless every weekday. He was taking his apron off, getting ready to return to work, when a woman, a social worker who also attended the church, approached him.

She asked him to have a seat with her on the white marble stairs leading to the first floor. She told him that she could see his potential and that he could do whatever he wanted with his life. “You know what happened that day?” Diaz paused and started again a bit softer. “I believed her.”

The woman suggested he start with his GED, and he did. He went on to apply to Fordham University, but the admissions counselor there told him he might have a better chance getting in somewhere else. Just as he was walking back toward the subway and about to give up, his cousin told him, over the phone, about the college’s Higher Education Opportunity Program, run by the state to give economically and educationally disadvantaged students a chance at college. Diaz turned around and ran to the program director’s office and asked for a chance to prove himself. He said he also promised the director that if he did make the cut, he would stay in the city to reinvest in the young people who were just like him.

“When she saw that I was serious, she gave me a chance, she gave me a shot,” said Diaz. He was admitted and enrolled at the age of 24. Diaz graduated in four years, and that’s when he started his work as a substance abuse counselor in the Bronx.

Diaz is now helping recovering addicts through his job at the Next Steps program, run by Albert Einstein College of Medicine on 161st Street. “It’s the fulfillment of who I was born to be,” said Diaz. “I really feel that this is my purpose and calling in life. Anything that I do with it almost feels like part of a puzzle is coming together.”

In the future, Diaz plans to develop a program through LifeCause that would help at-risk teens or young people already abusing drugs or dealing with other issues get back on track and get access to education and jobs. For now, he is also taking night classes, working toward a dual master’s degree in social work and theology at Fordham.

His aim, though, is not be a pastor with a single congregation. Instead, Diaz said he would like to continue spending his weekends reaching out to as many young people as he can by walking the streets and organizing various LifeCause events.

“He’s a leader,” said Diaz’s sister. “He’s always been a leader, and to see him lead is really a beautiful thing.” He’s dynamic and creative, she said, and knows how to motivate people.

His team members value the way Diaz has used his experiences to inspire others. “He’ll look at something, and he’ll say, ‘I want to do this, this, and that,’” said Adam Olazabal, 20, who volunteers as security for LifeCause events whenever he can. “He’ll come up with a little idea, and as he goes on, the idea will keep growing… and you’ll see it.”

Because he spends his own money to fund events, Diaz lives in a few rooms in his parents’ basement. The space that might otherwise serve as a bedroom is filled with folding tables, tents, a collapsible stage, sound equipment, and boxes upon boxes of HIV tests.

Diaz has managed to carve out a corner for his office, a small desk with a computer that is surrounded by shelves overflowing with books on health and religion.

“My thing now is reading up on gangs, homelessness, and all types of social ills that I address,” said Diaz, “things that help me sharpen my skills.” A thick book with Billy Graham’s smiling face on it was turned toward Diaz as he sat. He said he also tries to follow the examples of Martin Luther King, Jr., Malcolm X, Mother Teresa, and Gandhi.

Like some leaders from the past, Diaz believes his faith and his responsibility to his community go hand in hand. To explain it, he paraphrased words from the Bible: “Do away with your religious rites and your religious ceremony. That’s not important. Be just. Do what’s right by your brother.”

Though he grew up in Soundview, Diaz does most of his work in Morrisania, a section in the Bronx, he said, that really needs help. “Morrisania has one of the highest rates of everything,” said Diaz. He then listed diabetes, HIV infections, and gang violence. “It’s an epicenter.”

Poverty and an overall lack of resources and opportunities necessary to succeed, said Diaz, have held back several Bronx neighborhoods. And, many times, those who actually do make it, don’t come back to help.

“When people usually get it together, let’s say, they want to get out,” said Diaz. “To them, that means success. Nobody wants to stay. Nobody wants to reinvest within the community.”

Olazabal, who met Diaz at the church on Grand Concourse, grew up in Bronx projects and said he’s seen much of the same.

“Everybody feels they’ve done enough,” he said. “Everybody thinks, ‘Well, you know, I’ve already put my part in, so let me let the next person do whatever I didn’t really finish.’ That’s how a lot of things never get done. That’s how there are a lot of gaps.”

The young man said Diaz is different and he believes in what the LifeCause founder is trying to do. After all, Olazabal himself is another example of Diaz’s success. He recently took the GED exam, after Diaz helped him register. Olazabal, who’s been in and out of trouble, now plans on going to college, and he’s considering a career in music or carpentry.

Though Diaz himself is a success story, he has kept his promise and stayed to be a positive force in the Bronx. Again, he referred to the Bible:  “He said you are the salt of the city. He said you are the preservative of the city. If you leave, the city will rot, the city will go and be no more. In other words, the city needs you.” Then, he took a breath. “Powerful,” he said, and let out a bellowing laugh.

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