Surgery is a very effect treatment for common skin cancers such as basal cell carcinoma and squamous cell carcinoma. The surgery can consist of a simple removal of the skin cancer or a more involved procedure such a Mohs surgery. If the tumor is small and not aggressive in nature and is in a location where cosmesis is not of concern, then a simple excision should suffice. The tissue should then be sent to an outside pathologist who will review the specimen and report on if the entire tumor was removed with adequate margins.( a margin is the area around the tumor that we want to see no cancer cells just normal skin cells).

This form of treatment is very effective as well as cost saving. What I have noted in recent years is the increased, often unnecessary, usage of Mohs surgery. This is a microsurgery in which the dermatologist looks under a microscope to make sure the margins are adequate. Whereas this is very effective, it is much costlier and is often not needed. For example, if you have a skin cancer on your arm or leg a simple excision is more than adequate for control of this cancer. Mohs surgery may add up to an additional $1,000 in medical costs and the outcome will be the same.

If on the other hand you have a skin cancer in the middle of your face Mohs surgery makes more sense. The margin status can be obtained while you are in the office. This often results in smaller margins and the cosmetic result should be improved. Unfortunately, sometimes large portions of skin will still have to be removed to get adequate margins. We have all seen people with huge scars on their face, nose and ears from these surgeries. Is that the only course of treatment?  No. 

Radiation therapy is often a good choice for skin cancers. It can spare normal tissue and the cosmesis is often excellent with the outcome similar to surgery. The treatment uses radiation that does not penetrate the skin very deeply. You would go for daily treatments and the side effects are mainly redness and skin irritation over the radiated fields. Whatever area is being treated remains intact such as an ear or a nose. The redness rapidly clears and leaves the skin soft. It often looks smooth, young and wrinkle free. I have had numerous patients ask me (jokingly) for treatment to the other side of their face since the skin looks so good.

If you are diagnosed with a skin cancer and you are concerned about the cosmesis ask for a Radiation Oncology consultation. I can not tell you if you would be a good candidate or not without seeing you but I can tell you after over 25 years of treating skin cancer with radiation therapy, the results are excellent and patient satisfaction very high.

It doesn’t hurt to get a second opinion and it may save a big part of your nose (or ear).

Michelle Haessler M.D.

Board Certified Radiation Oncologist

Adopt a Dog Month And How It Can Help You Fight Cancer

Adopt a Dog Month And How It Can Help You Fight Cancer

I have always loved dogs and always will. October is National Adopt a Dog Month sponsored by the American Humane Society, so what better time to talk about how dogs can help your health. I grew up with dogDogs give us love. Proven scientifically although I don’t know why they spent the research money, I could have told them that

Its adopt a dog month. Go out and save a life. For every dog you save you save 2or 3 dogs. The one you adopted and if you adopted from a rescue organization you opened up a spot there for them to take in another dog from a shelter- which opens up a spot at the shelter. So 3 dogs saved. Oh, and don’t forget about adopting a cat.s. My first dog as a child was “Candy” a tough little cocker spaniel. She was a sweet, ornery little thing. My most vivid memory of her was coming home to find my Italian grandmother stuck in our recliner unable to get out of the recliner because Candy decided she didn’t want her to. Every time my little grandmother tried to get out of the chair it was a battle of wills- a snippy little cocker spaniel and an equally snippy little Sicilian Grandma. Candy won.  Great memories.

Since that time, I have had many dogs who have lived long and wonderful lives. Most have been rescues. I recently looked at the statistics for euthanasia of shelter dogs over the last few decades and was pleasantly surprised to see that fewer dogs are being euthanized due to the efforts of shelters, rescue groups and heightened public awareness. I currently have two rescue Siberian Huskies. I never expected to own one Husky, let alone two, but what wonderful dogs. They both have interesting stories of abandonment and abuse, as most rescues do, but it never ceases to amaze me how they have adjusted and enhanced my life seemingly forgetting their past.

What can dogs do for you and your health and cancer?

  1. Dogs can smell cancer. This doesn’t surprise me as their sense of smell is so much greater than ours. This has been proven scientifically and is currently being researched as to how to benefit patients
  2. Dogs can give us companionship. This is very important on the dark days that we all have. They can lift depression and give us hope and the will to live.
  3. Dogs have health benefits like lowering our blood pressure
  4. Dogs provide endless entertainment and love.
  5. Dogs give us purpose.
  6. They provide exercise. You need to walk them. Take care of them. Throw a ball for them. All of this uses calories and provides exercise. Exercise is very important to fight cancer.
  7. Dogs give us love. Proven scientifically although I don’t know why they spent the research money, I could have told them that.
  8. Its adopt a dog month. Go out and save a life. For every dog you save you save 2or 3 dogs. The one you adopted and if you adopted from a rescue organization you opened up a spot there for them to take in another dog from a shelter- which opens up a spot at the shelter. So 3 dogs saved. Oh, and don’t forget about adopting a cat.


What You Can Do To Improve Your Odds Of Surviving Breast Cancer

What You Can Do To Improve Your Odds Of Surviving Breast Cancer

Cancer. What a horrible word. It is one we all dread hearing. It is one, as a physician, we all hate saying. The word itself is not a death sentence even though at first sound it may appear to be. After you have had the diagnosis, after you have decided on a treatment course and after you have had a big cry. What can you do to help improve your survival odds?

There are many things you can do to be proactive. Many of these things are lifestyle changes and these are often not what we want to hear but are based on science. We all wish we could do what we want, eat what we want and remain healthy. But health requires work and so does improving your odds against cancer. MIND, BODY, SPIRIT.

MIND (set)  is important. I have read skeptics who have said that cancer cells don’t hear meditation and prayer, but your body does. If you can get into a more relaxed state your body responds. If you are upset living without sleep-your body responds with various stress hormones. As difficult as it may be at this time in your life your need to regroup gather all of your strength for the fight ahead. Your family and friends all want to help you. Let them know what you need. A shoulder to cry on, prayers or someone to go to a movie with.

A good friend of mine is a psychologist and gave me the best advice, which I have shared with my patients over the years. When you are stressed get out of the house. Do something. Go for a walk. Go to the mall Just get out of the house. See a comedy. Laugh. The sillier, the better. And whatever you do NEVER I mean NEVER listen to Country and Western music. Nothing good can come from listening to some poor fool who is singing about having his pickup truck being repossessed, losing the woman of his dreams and his dog all in the same day.

BODY, Okay, here comes the lifestyle changes nobody likes. They are based on science so don’t scoff. We all know we need to do these things but it REALLY matters if you have cancer. It can definitely improve your odds of survival.

  1. Maintain a good body weight. Studies have shown being overweight increases your chances of developing many cancers. Having excess fat means your estrogen levels will be increased. Some breast cancers are fueled by estrogen.
  2. Eat a low-fat diet. Fat can convert to hormones. We want to decrease this as much as possible
  3. Exercise- even a walk around the block helps. Start slowly then increase in intensity. Exercise decreases your hormone levels.
  4. STOP SMOKING, need I say more.
  5. Take vitamin supplement. A study run by the US government showed that on average 41.6% of American are deficient on vitamin D. If you are dark skinned it is even worse since darker skinned people cannot absorb UVB light as well which means less Vitamin D.82.2% of African American are deficient of vitamin D and 69.2% of Hispanics. It doesn’t matter what ethnic group you belong to if you have a darker complexion then you have a higher incidence of deficiency.
  6. 107 countries participated in a study looking at how close the country was to the equator, less UVB light and lower vitamin D levels, and the incidence in breast cancer. It was demonstrated that the farther away from the equator the country was (lower vitamin D levels) the higher the incidence of breast cancer.
  7. Curcumin has been shown to have anti-tumor properties such as cell inhibition and apoptosis.


Many studies have shown that breast cancer patients with higher levels of vitamin D have a higher survival rate.

  1. British Journal of Cancer 2014 analyzed 30 prospective studies and found high blood levels of vitamin D were associated with a decrease risk of cancer mortality.
  2. Roswell Park Cancer Institute studied over 1,000 premenopausal women and found that higher levels of vitamin D decreased the odds of having triple negative breast cancer (an aggressive form of breast cancer) by 64%
  3. A meta-analysis published in Anticancer Research Journal 2014 showed the highest levels of vitamin D compared to the lowest levels of Vitamin D had HALF the death rate from their cancer.

SPIRIT, I truly believe we all have a spirit and this will help you through the challenges ahead. I have seen this over and over in my practice. I have witnessed people who survived but should not have. I have no medical reason for them to be alive but they are. I have seen such heartbreaking tragedy that I could not wait to get to my car to scream. But through it all there was such strength and love that I could not imagine a world with people not having a spirit. You can believe in a Higher Being or not, and you can believe that we have a spirit or not,  but I chose to.

I have co-founded The Ola Kino Company, which developed Covitale-7, to help my patients with their fight against cancer and to decrease the incidence of cancer. Its ingredients are supported by hundreds of research papers, so I highly recommend it. Even if you chose not to use our product, the above recommendations will help you with your battle with breast cancer and I wish you all the best in your life.



The Cost of Cancer Care

The Cost of Cancer Care

As an oncologist, I try not to think about the cost of treating a patient with cancer. What I want is a good outcome. If my husband was diagnosed with cancer, I would want the best care at any cost. Wouldn’t we all? Unfortunately, there are limited resources. I am not rich; my family is not rich and even if we were money doesn’t buy health. The cost of cancer care is staggering. The results are often less than amazing. Health care is the number one reason for bankruptcy in our country.

Ten years ago, the average cost of chemotherapy was $5,000 a month. It is now $10,000 a month with the average cost of one year of chemotherapy at $100,000. 11 out of 12 chemotherapy agents cost over $10,000 a month. The new class of cancer treatment drugs are predicted to add $50 billion dollars a year to cancer costs. The American Society of Clinical Oncology predicts by the year 2020 the annual cost of cancer care will reach $207 Billion dollars in the U.S.

This is not to imply that all cancer treatment costs are chemotherapy related by any means.   There are other costs such as surgery, radiation therapy, hospitalization, support services, medication etc. None of this is cheap.  Per the Medical Expenditure Panel Survey, the average cost of cancer care per patient was $85,201 in 2010-2011.

The financial burden on a family is enormous. With higher deductibles and higher copays the average family , will find it more and more difficult to afford cancer care. It is bad enough to have the physical and emotional stresses that a diagnosis of cancer brings but then add the financial burden to this.

What can you do as a patient who has been recently diagnosed with cancer?

  1. Advocate for yourself or get someone to be your advocate-become active in your treatment plan. Take notes. Write down questions.
  2. Keep copies of your medical records. Yes, these are yours to request. I always offered copies of records to my patients and told them to keep a copy for themselves and offer a copy to all new doctors. Records can be hard to get sometimes and this speeds up the process. What records: All consults, Pathology reports, Radiology Reports, Operative Notes, Hospitalization discharge summaries, Histories and Physicals and records of any other procedure you may have had done. Keep them forever.
  3. Request that your case be presented at a Cancer Conference. This is where a number of cancer specialists sit down and discuss your case and treatment options. There is no charge for this. Every person with cancer is unique and if you are told you are not then go somewhere else
  4. Get a second opinion if you have any doubt at all. Your Oncologist should be glad to set this up for you. It doesn’t mean you are going to get your care elsewhere, just that you want someone else to look over your case. If your doctor does not want to do this-run to another doctor.
  5. Ask a lot of questions. What are the side effects of treatment? What is the outcome? What is the difference in Progression Free Survival and Overall Survival? Why do I need this treatment? If I don’t get this treatment what will happen? What are the costs of this treatment vs other treatments? What is my life expectancy with and without treatment?


If you have not been diagnoses with cancer , what can you do?  There is no way to prevent cancer but you can decrease your risk.

  1. Stop smoking. Yes, it’s hard. Get over it.
  2. Don’t be around smokers. Keep them out of your house and car.
  3. Check for Radon
  4. Even if it’s ½ hour walk. A study has shown that exercise may be as advantageous as chemotherapy for breast cancer patients. I am NOT saying refuse chemotherapy. Take chemotherapy if that is what your Oncologist recommends but think of the added benefit if you exercise.
  5. Eat properly. We all know what that means. Yes its hard. I am guilty. But I keep trying and so should you.
  6. Try to maintain a decent weight. I grew up with Twiggy as the national standard of beauty. I am of Italian descent- Sophia Loren, Gina Lollobrigida -Ok so I don’t quite look like them, but Italians are curvy-MOST women are curvy. Even though Twiggy is beautiful in her own way, there is no way I could ever look like that. We won’t go into my body image problems as I don’t want to bring a tear to your eyes. Needless to say, whatever your body type try to maintain a decent weight. A few pounds overweight-OK-100 pounds overweight not OK.
  7. Back on the weight thing. Weight really does matter. Several cancers are linked to increased weight. An example is Uterine cancer. Being obese may increase your risk over six times the average and 40% of all uterine cancers are directly related to obesity.

In addition to the above, ingredients in CoVitale-7 have been shown to decrease the incidence of certain cancers. A study in the New England Journal of Medicine 2015 showed that taking nicotinamide twice a day at a certain dose decreased the incidence of non-melanomatous skin cancers by 23%. A study in the Journal of Clinical Oncology showed that patients with colon cancer or breast cancer had better outcomes if their D3 levels were maintained. An aggressive form of prostate cancer has been linked to low D3 levels. These references can be seen on our website, After years of being a Board Certified Oncologist, I co-founded The Ola Kino Company, which has developed CoVitale-7. Look at the website and look at the references and judge for yourself.

Cancer: The Unwanted Guest

Cancer: The Unwanted Guest

Who wants Cancer?

Not me. Not anyone I know of. Yet, cancer has touched everyone. Do you know anyone who has not had a family member, friend, work associate or neighbor without cancer? Probably not , because if you live long enough one in three women and one in two men will develop it. As physicians, we are trained to diagnose and treat illness. As an oncologist, I have spent twenty-five years seeing miraculous cures and heartbreaking tragedies in patients who developed cancer.

I remember an older patient who had developed brain metastasis. His life expectancy was on average 6 months. He wasn’t sure if he wanted treatment but eventually he decided to have brain radiation therapy to improve his quality of life. He did well but we did not see him again and we assumed he had passed away. About two years later one of our nurses came rushing into the department and said” look who’s here in the waiting room”. I couldn’t believe it, here he was volunteering to transport patients to their appointments. He was cancer free!!!

I pulled out his chart and reviewed it. Was the diagnosis wrong? Had we made a mistake? No, he had brain metastasis. I reviewed the MRI and plain as day he had multiple cancerous lesions in his brain. He said he was really happy he had the brain radiation and I was too. I was also dumbfounded. This is not supposed to happen but it did. Whereas, I would love to take credit for this miraculous cure, I know there had to be some kind of divine intervention. These wonderful things do happen but unfortunately it is rare. Better to never get the disease or at least lower our risk of cancer whenever possible

About ten years ago I treated a 19-year-old patient with metastatic melanoma. I see very few young patients since cancer in this age group is uncommon. I remember her well. She was fair complexioned , light reddish blonde hair and the sweetest smile. She looked like a typical high school cheerleader and come to think of it, I think she had been. A beautiful young girl with her whole life ahead of her or at least, it should have been. I treated her back with radiation to help ease her pain and I thought, why should a nineteen-year-old have back pain, let alone metastatic cancer? I don’t have these answers, although, I wish I did. I treated her and the treatment helped ease her pain. She passed away about 6 months later.

When I think about her, I still feel so sad for such a loss. I saw her mother about 2 years later as she had been diagnosed with early stage breast cancer. She had a good prognosis and did quite well, but I can’t help to think how unfair life can be.

Physicians in this country are historically not trained in the prevention of disease. The training has improved in this regard recently and most physicians try very hard to instill in their patient’s life style changes that will help them lead a better quality of life but time is short and compliance is low. When physicians have a roomful of sick patients needing care, priorities are very clear-try to make these patient’s health better. When a patient is confronted with a prime rib dinner or a triple chocolate anything—well, we are all human.

We can all eat better. I love chocolate. I remember when I was pregnant; I desired Cheetos and ginger snaps. Together. I could not stand the smell of chocolate nor could I eat garlic. I was hoping that my dread for chocolate would continue post- partum but no. After giving birth, the love of Cheetos with ginger snaps remained and of course my love of chocolate returned. Garlic, the one healthy thing on the list, remained repugnant to me.

Physicians are human too. We can all live better lifestyles to improve our health. One easy way is to get enough sunshine, not burn, and to try to keep our Vitamin D3 levels high. My next blog will discuss D3 levels how important and easy they are to achieve.