It is so hard on all loved ones when a family member becomes ill. It makes you realize how precious life is and how important it is to maintain your health. With all major illnesses the first thing you need to do is take a deep breath and be thankful for all the wonderful people in your life and the professionals who are trying their best to help you and your spouse. Then you need to come up with a plan to maximize the outcomes.

The first thing to do is follow your physician’s orders. Yes, I said orders not recommendations or suggestions. When your husband was in the hospital the physician wrote orders to be followed by the nurses and staff. They weren’t maybes or suggestions but orders. There is no such thing as noncompliance in the hospital but there is such a thing with patients and physician orders. If you want the best outcome follow your physician’s orders. They will want him to follow a diet, exercise, rehabilitation program and medication regime. Noncompliance will decrease the chance for the best outcome. As physicians we want to see our patient’s quality of life to be the best it can be and it is so hard to witness noncompliance and see a worse outcome.

Vitamin D deficiency has been linked to cardiovascular disease for a long time. The studies on supplementation have been somewhat mixed in part due to study design. A study published on January 3 2018 (Med Clin) randomized cardiac patients to vitamin D supplementation and their usual medication or just their usual medication and the results were encouraging.

Among patients who had low levels of Vitamin D3 (<50nmol/L) almost 27% had major adverse cardiac events compared to 0% with vitamin D levels over 50nm0l/L. This was a prospective randomized study so it certainly demonstrates that there may be a huge benefit to Vitamin D3 supplementation for patients with coronary heart disease.

It is well established that vitamin D3 is necessary for bone and teeth health. It is also well established that the majority of Americans do not get enough Vitamin D3. We simply can’t make enough from sun exposure. The farther away from the equator we live, the less likely we are to be able to absorb enough of the suns rays. In winter it is particularly challenging and some studies have shown that it is nearly impossible even if we spent all day in the winter sun. In the summer we put sunscreen on and again it limits our exposure to the sun’s rays.

Supplementation is really the only way to get enough vitamin D3.It is such an important vitamin linked to good cardiovascular health, maintaining a good blood glucose level, supports the immune system and many more important functions.

Covitale-7 combines vitaminD3 with other ingredients to maximize health benefits. It supports the immune system, cardiovascular health, bone heath, anti-inflammatory, and supports good skin health. Available on

My Frienemy The Sun

My Frienemy The Sun

I have been watching a lot of astronomy shows lately and have come to the realization of how wonderful our sun is. Without its perfect rotation and location there would be no life on earth. Its warmth and energy help nourish and foster all life on earth. As humans, it is our primary source of Vitamin D. As with all things great and wonderful, too little or too much can harm us. We need to balance our exposure and a little common sense goes a long way.

It has been beaten into our heads that the sun is bad for us. That is not really true. Sunburn is bad for us but not sun exposure. So we faithfully put on our sunscreen to prevent sunburn, but by doing that we decrease the very vitamin that we can not get enough of from our food-Vitamin D.

Why is vitamin D so important? Without it our bone health is at jeopardy. We can develop brittle bones call osteomalacia in adults or rickets in children. Our immune system needs vitamin D to fight off diseases. Low vitamin D is linked to high cholesterol,obesity,heart disease,erectile dysfunction and cancer. The farther away you live from the equator the lower you Vitamin D level will be.

The National Health and Nutritional Examination Survey 2005-2006 found a large percentage of Americans were deficient in their levels of Vitamin D even at low levels. 41% on average at 20 ng/ml. If you have darker pigmented skin the deficiency rate goes up, African Americans were the most deficient at 82% and Hispanics had a 69% deficiency. Why is this? It is due to the lower level of the suns absorbency in darker skin.

There are a few foods that have vitamin D in them but it would be almost impossible to consume enough to compensate for the lack of sun exposure. How many pounds of mushrooms or quarts of milk a day can you really consume? It has only been the last 100 years or so that we have gone from an agricultural society to an industrial society. We are hard wired to get our vitamin D from the sun. So what do we do?

If we have a light complexion we have to use sunscreen because we may burn. Sun burn can lead to skin damage and skin cancer. But we can’t get enough vitamin D. If we have a darker complexion our skin has a harder time absorbing the sun rays so our vitamin D level in lower.

We pretty much have to take a nutritional supplement.

Nicotinamide (B3) has also been shown to improve skin health. It is a form of niacin that DOES NOT cause flushing or other annoying side effects. It helps form two important coenzymes NAD and NADP. These are of vital importance for energy production, DNA repair and regulation of cell cycle. It may help with Diabetes and high cholesterol and sun damaged skin.

Curcumin is the active ingredient in the spice turmeric. It is poorly absorbed unless pepper is added to it. It helps with general anti-inflammatory health possibly easing the pain of arthritis and it also helps regulate the cell cycle. Regulating the cell cycle is very important with maintaining good general health and fighting off disease.

Covitale-7 is the only product combining all of these ingredients into one easy to take product . You would have to take at least 6 pills a day to equal the effectiveness of Covitale-7. It is meant as a nutritional supplement to compliment a healthy life style.

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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.

Vitamin D: Are You Deficient?

Vitamin D: Are You Deficient?


Vitamin D is necessary for normal bodily functions but studies have shown that many of us are deficient in this vitamin. The more we learn about this vitamin the more evidence is mounting for its importance in the human body. It has long been known that Vitamin D is necessary for normal bone development. It is also important for our immune system and prevention of certain diseases. A deficiency in children can lead to rickets and deficiency in adults can lead to osteomalacia or osteoporosis.

At one time rickets was quite common which lead to the development of bowed legs in children. My grandmother grew up in poverty in Italy and developed rickets. As a child, I remember her bowed legs which, unfortunately for me, never seemed to slow her down. Nana had super powers of speed, reach and 360-degree vision. She wasn’t even 5 feet tall but I often envisioned her being able to fly effortlessly in the air and slam dunk with the best NBA athletes. My mother loved to tell a childhood story of witnessing my grandmother kicking my then 10-year-old uncle UP the stairs while Nana was wearing 6-inch stilettos. A difficult task which she handled with ease. In case you are wondering about child abuse in my family, this episode was more symbolic of my grandmother’s omnipotent parental power as her shoe did not touch him and he was laughing the entire way up the stairs.

Back to Vitamin D., there are only a few sources that humans can get vitamin D. Milk is fortified with it but if you are like me you would rather drink warm sewer water. My husband loves the stuff -good for him. He also golfs and gets plenty of Vitamin D from the sunshine as he never uses sunscreen and never burns. Sunshine promotes synthesis of Vitamin D from cholesterol in our skin. We should be able to get most of what we need from the sun but human lifestyles have changed dramatically in the last century. We no longer live outside for most of the day but are mainly inside dwellers. People who live in northern regions or have darker skin are also more prone to this deficiency.

Fatty fish, like tuna, sardines, mackerel, and salmon all have vitamin D but mercury in some of these fish can lead to concern particularly if you are pregnant. A teaspoon of cod liver oil can provide 440 IU. Which is particularly useful if you are trying to punish someone. An ounce of Caviar can provide 33 IU of Vitamin D particularly useful if you are trying to reward someone- like yourself. Egg yolks have about 40 IU and of course, the dreaded beef liver and some mushrooms can provide some Vitamin D.

Try to get some sunshine without burning during the day. Eat or drink what you can of vitamin rich foods and get your Vitamin D levels checked at your health care provider. If your levels are low you can easily add vitamin D3 supplements to your diet.

The Truth About Sunshine

The Truth About Sunshine

I grew up the sunshine state of California before all the worry about sunshine and cancer. I am pretty sure I never used sunblock although I remember the ad with the puppy pulling down the little girl’s panties to expose her white rump outlined by the red sunburn she had experienced from over exposure to the sun. I also never knew what a bike helmet was and seat belts were optional in my family. Come to think of it my parents might have had some ulterior motives, which I may have to discuss in my next blog or therapy session. The point is, we all survived.

Then came the onslaught from the government, physicians, and sunblock manufactures that sunlight was bad; SPF 50 was good. Well intentioned as most of this was, it was misdirected. Terribly misdirected. I know I am a cancer doctor and I am attacking the Holy Grail of modern medicine. How dare I? Well I can show you all kinds of well intentioned, misguided medical advice given over the years. How about cigarette smoking is good for you? I have the old ads to prove it. What about fen phen for weight loss? I am so glad I remained fat for that one. My point is that doctors and researchers are human, we make mistakes. Saying sunshine is bad for you is a BIG mistake.

Current literature is showing that in areas with the highest sunshine exposure have lower rates of cancer. This has been studied in many countries and they have all come up with the same conclusion sunshine is good for you. WOW what an insight. It makes sense otherwise we would be living underground like moles. But by limiting our sun exposure that’s exactly what we are doing.

The studies have shown that it is SUNBURN not SUNSHINE that is bad for us. Lets talk about melanoma. This is a devastating cancer that I have seen entirely too often. It is linked to genetic factors as well as SUNBURN. Sun burn may double the risk of melanoma but NON-BURNING sun exposure may reduce the risk of developing melanoma. Why is this? It has been linked to Vitamin D levels. As humans, we need vitamin D. One of our chief sources of vitamin D is the sun.

The more common forms of skin cancers are basal cell (BCC) and squamous cell carcinoma(SCC). Approximately 2.5 million cases are treated annually in the United States. We know that sunburn increases the risk of these cancers but sun exposure is more complicated with some studies showing increase and others not demonstrating this. The Final Recommendation Statement: Skin Cancer Counseling. US Prevention Services Task Force May 2012 stated that there was no association between cumulative sun exposure and either BCC or SCC . We do know,however, that the incidence of these cancers has risen by 17% from 1998 to 2012. Is it the aging of the population, the way we report these cancers (there is no registry), a more aware population going to their doctors? I don’t think anyone knows for sure.

So what can we do about decreasing our risk of BCC and SCC? A recent study published in the New England Journal of Medicine proved that by taking B3 at a certain dose twice a day decreased the development of these skin cancers and their precursors.

I will be talking more about sunshine, vitamins and ways to decrease your risk of cancer in future blogs. Yes, we can all eat better, weigh less, exercise more and I may discuss these issues in the future, but for now go out and enjoy the sunshine-just don’t get burned.