Author: Joanne Dragun, M.D.

Not a fan of this new information, but I will share so we can be annoyed together. Last week a study was published by Dalhousie University in Canada about recovery time. No, not a hangover (although I guess that’s included). They found that at age 75 the body reaches a “tipping point” into frailty and stops being able to bounce back easily. Did we need a study to advise us that “our bodies can no longer easily recover from illness and injury”? I think we surmised that already, now there is evidence. Add in injuries and illness and the body logarithmically ages further. Sooo whats an aging body to do?

There is also evidence that being active, doing weight and balance training to avoid injuries, having a social network, being adaptable to change and sleep quality all factor in. How much do we consciously think about these issues? Usually we just plow through the day just expecting everything to be “normal”. Well we now know that we must take some responsibility if we hope to age well. Many reading this know how it takes just one tumble to derail plans and even travel. When you arrive for your medicare yearly wellness checkup, there is reason why so many questions are about falls.

I have seen many patients who present with what should be a treatable cancer, but are too frail to tolerate therapy. So may I suggest taking some steps now to be as strong and robust as you can?

Talk with your doctor about sleep. You are not Martha stewart who claims to sleep 4 hours. The body and mind need rest. Even a 20 min mid day nap is beneficial.

Exercise with light weights and walk. By the way, clear your place of throw rugs that can cause a trip. Stop wearing flip flops.

Talk with family and friends. Better, engage in activities that get you out and into a new environment several times a week.

As osteoporosis increases so does fracture risk, take vitamin D, calcium and again exercise.

Get hearing checked. You will feel less discombobulated if you can hear others and noises well.

Of course eat nutritious food, protein, drink a protein and electrolyte drink, and less alcohol.

Finally my best recommendation: ask your doctor for a script for physical therapy. I send patients all the time, not because they had a fall, or injury. But for “reconditioning” and balance. Insurance will cover and the engagement and instructions will be of great benefit.

You never were a wimp, don’t prove these researchers right. There are enough statistics impacting us, we don’t need frailty to be one as well.

Pearl: Most cancers do NOT show in blood work. New tests are developed (The Galleri test and Proteomics-based plasma test) detecting 18- 50 cancers in early stages. Find more @ myclevelandclinc.org. Cancers shed DNA into the bloodstream and these will be game changers for screening. Not yet FDA approved, but highly accurate. Expect more to come.

Free time? No such thing! There’s so much to do, be, manage, accomplish, develop, explore and if we take a break and actually stop, we either feel guilty or try to meditate. So why discuss something so amorphous and perhaps unattainable at the same time? Because I have one more activity for which to make time. (see how I avoided ending with a preposition? ) sounds weird. Okay, so here it is:

Practice continuous learning. This may take the form of lessons: tennis, golf, pickleball, bridge, hobbies in general. It may be familiarizing with new IT and websites at work (every office I am in is so very different I have a notebook earmarked, and they change the rules or programs every few months! I think it’s actually an ongoing cognitive test!). Most have continuing education credits to maintain licenses. Even something routine requires attention to the new- learning to literally navigate the snowy roads, and then big highway driving in Florida, even in the storms and dark. If you take a moment, you will discover so many ways that you are continuously learning, changing, becoming more self assured with this all happening through necessity, or serendipity. We actually rarely choose deliberately. Today I have a simple recommendation to add to your “to do” list. One that can actually improve your life.
Your health and wellness depends upon your own involvement. Always. Here is the recommendation: read about your health issue, disease, injury, cancer. There is a tremendous amount of info and people love to say “use caution when you search on line, lots of disinformation.” Many Docs roll their eyes and sigh when the patient shows up with a list of googled info. Ugh, one more thing to navigate. Allow me to weigh in. I am a big fan of more information. You would think having an oncologist in the family would negate the need to explore, “just follow this plan”. But with a relative recently diagnosed, my recommendation is the same, read (of course reputable websites such as MD Anderson, Cleveland clinic ,NIH, etc) but I don’t object to even anecdotal stories that allow the patient to hear others’ experiences.
A recent visit to another two oncologists came about because of this exploration, each offering unique perspectives and the Docs were patient in discussing. In my own practice, if there is a new trial or drug or procedure, I will tell the patient to wait and I will go on line and print out reputable info for them to digest further.
No one and I mean no one, even those of us dedicated to your life and wellness, will know everything and we are not intimidated by your questions.

For our own experience, this reading and questioning has led to some very cutting edge recommendations. One Doc said, “ Oh, we are thinking about starting that here” while other ideas are only in phase 1 trials (does this kill or harm the patient ?) therefore not ready for prime time.
So, crack the books in your “free time”. Become an expert in your own disease and dis-ease. Ask the questions. What have I recommended for a few years here? Be your own advocate, always. Also find physicians who listen, even if the protocol doesn’t apply to you, at least every option should be examined. You are not dying from your disease, you are living with it. That takes courage, knowledge, exploration and good use of your time. Read, ask questions, seek opinions, always be brave. All of your Docs are on your side and you have every right to explore and ask questions, even challenge. It’s the very best use of continuous learning that you can invest in (preposition end of sentence, Sister Mary Gabriel would tsk tsk). Yes, I am putting a lot on your shoulders, but they are broad, you are tough, and you deserve the best.

Patients with cancer take nothing for granted. Not their wellness, their activity, nutrition or their family, friends, work and even treatment. You know that giving thanks is a daily event. No complaints, fear or doubts. Just pure gratefulness. As I greet the patient in exam room 1, I respect their perspectives and strength. But nature has another plan. Enter the distraction.
Wild life in Florida is sometimes just wild… or comical. Take the turkeys (perfect timing!) Through the full length exam room windows, we see our share of pure joy. The baby raccoons creep by, the ducks in a row, always, the head of the watchful alligator guarding his pond, but the turkeys provide such light- heartedness. The window comes down to the ground – just right for them to see themselves and poke at their reflection. One even preened with full feathers spread- what gorgeous display. We get to enjoy the exact spacing of the multi colored feathers as God’s hand on a life is once again perfection. The family of five, watching out for each other, make their way back into the preserve, far from Thanksgiving dinner. They lift our spirits midway through a tough discussion, and the patient giggles and takes a pic. We are all grateful for the joyful moment.

Expressing gratefulness, keeping a gratitude journal, being thankful, gets into your psyche and lifts your spirit and now we know, even your immune system. So today is a perfect time to be reminded that health and well being is an internal force. While we can quickly offer thankfulness for friends, work, home, food, health and treatments, today, indulge me while I add to your already enlightened list, because……..trumpets! We can even be grateful for November’s exciting cancer research!

We Scorpios are always about the intensity, but how’s this for cancer treatment? Researchers in Brazil* are tapping Amazonian scorpions’ venom that appears to attack breast cancer cells as well as chemo taxol. Sting!

Since radiation treatments are my life, I am delighted by the increasing use of radio-pharmaceuticals being developed to increase intensity of dose targeting different molecules in the tumor. Look for increasing use in hematologic cancer like multiple myeloma, head and neck, liver cancer, sarcomas, lung, colorectal and gastric among others.

Sharing? How about taking tumor cells from the patient and fusing them with healthy dendritic cells from a donor, producing a personalized vaccine to activate the immune system for glioblastoma, melanoma and kidney cancer?(NIH and ASCO pubs).

Immune therapy is ubiquitous now but what about when it stops working and cancer outsmarts our bodies? No fear, scientists are studying MiTEs which can amplify immune response, converting tumor’s shield in the very weapon that defeats it. **

Trojan horse peptides are being used in drug conjugates offering a payload of a chemo drug, after it is absorbed by the cancer cell. (already in clinic: Lutathera)

Not to be outdone, Jersey in the house with Rutgers teaming with NIH to develop genetically engineered T cells to attack HPV positive metastatic cancers (head and neck, cervix, anal and esophageal) (presented at Society Immunotherapy of Cancer annual meeting November 2025).

How about the common occurrence of chemo-brain? Adding a statin may improve cognitive function and become a part of the protective tools of the trade.

Ok, so you get the idea that unseen forces are real, working toward your personal benefit and conspiring from centers around the globe (that do not even celebrate thanksgiving) to keep you strong and healthy. So let us toast to all the magical, yet untapped ways that our holidays not only are an opportunity for love and togetherness, but also for a future filled with hope.

God Blees you and your family and Happy Thanksgiving.

*http://www.sciencedaily,18 November 2025

** Cell.com. Weixmann Institute of Science

Yes, it’s that time. Don’t be a baby. Just go to the Doc or pharmacy and get a flu shot. Now is a perfect time so that benefits stay into spring. Hospital privileges require all Docs, but what’s in it for you? If you are immuno -compromised, an overwhelming infection is disaster. (28,000 deaths from flu in 23-24 season) If you are in groups, crowds, traveling or coming in and out of the centers and hospitals, you are exposed- even with a mask on, so please make your team’s job easier. It’s impossible to deliver the care you need and treatments if you are sick on top of having cancer.

Next issue, the covid booster. This Fall, federal health officials dropped universal recommendations, so its up to you and your Doc. Currently most pharmacies have one requirement: that you are over 65, or that you have an underlying health condition over age 6. These include: Cancer, cerebrovascular disease, chronic kidney disease, chronic liver disease, chronic lung disease including asthma and COPD, cystic fibrosis, dementia, heart disease and high blood pressure, hemoglobin blood disorders, HIV, Type 1 and 2 diabetes, disabilities (?), Immuno compromised, mental health disease, obesity, smoking, transplants (solid organ and blood stem cell) TB, substance abuse, pregnancy. (Did we forget anything?) The COVID vaccine can lower the risk of severe illness, reduce hospitalizations and reduce long COVID.

Here is an amazing finding published also last month…University of Florida and MD Anderson found that patients with advanced lung or melanoma cancer who received COVID m-RNA vaccine within 100 days of starting immunotherapy, lived significantly longer than those who did not. This is another major step in producing a universal cancer vaccine, revolutionizing all of cancer care. (Presented at 2025 European Society for Medical Oncology Congress in Berlin.) Trials are coming but real time effects are being seen.

So, talk with your Doc. Plan for at least the flu shot. Find out what other vaccines you need (shingles, pneumovax, etc) and just get it over with. Maybe they will give you a lollipop too.

Pearl: Confusion reigns as black box warning is coming off HRT for menopause symptoms. Find more at Breastcancer.org, “Does HRT increase breast cancer risk?” Here is my opinion: Short term use for severe symptoms. No one with BRCA mutation or with breast cancer should take, all of our therapies are “anti hormones” like tamoxifen, arimedex etc. We stop HRT in all women coming for breast cancer treatment. If you can tolerate the symptoms, especially if you are at risk for breast cancer, I am not recommending HRT. When you stop them, you the go thru menopause again anyway. Talk with you doctor of course. Turn the fan on.

Often speaking of the honor it is to champion our veterans in care, I experienced a wonderful privilege this week. My husband attended a Veterans Day event at Moorestown HS with our family, invited by our grandson. What was unique for this event was the youth and energy. The student counsel created and managed the festivities and their fresh, excited faces and greetings elevated the 56 Veterans with joy and enthusiasm. The powerful presentations and efforts to celebrate each Veteran by name and details, personalized this solemn day. My husband was very humbled and grateful.

I have concern that generations following will not appreciate our blessed freedom. Once the draft was discontinued, fewer families were engaged with any military interface. In every aspect of life, not cherishing, enriching, guarding and protecting risks loss.

How well this translates to our own mind and body. The most intimate example is our health- we must take a personal interest and not for granted. Losing focus, just expecting to be strong at every awakening, ignoring nutrition, drinking, smoking, injuries, ultimately take a toll often irreversible.

Protect and defend is more than a military phrase. Expecting rewards without the work is naive. Life expectancy with improved healthcare is going to increase. We cannot live 20 years in assisted living. Staying vibrant and strong for as long as possible should be our goal. Screening, proper diet, exercise, building relationships, using our minds (not losing them) will manifest a healthy longevity.

“Hey Doc, I got cancer over here, how’s this gonna help me now?” Well, by now you have read, here and elsewhere, about all the immune therapies- they tap into your own immune system so keeping it strong is the key to success with cancer. Betty said she started smoking again because of the stress! Harry is unmotivated and let himself go until he can’t get out of the wheelchair. Well, I have news for you. Cancer really is a chronic disease and new attention focused on even hard to treat tumors like GBM, triple negative breast cancer, hormone resistant prostate cancer are being managed with improved treatments and tumor genetics. Yes, you just may live to 100, so the phrase “Never give up!” applies to you too.

Not only this week, but everyday, we honor our military, veterans, those now serving and future courageous men and women. It takes work, courage, vision and fortitude. Give them something worthy to fight for. A proud, strong, healthy, vibrant country, who value sacrifice for personal and common good. Emulate their sacrifices in our own lives. Never forget. Never back-down, never surrender and never lose our precious freedom. Thank you to our amazing veterans. A grateful nation is behind you everyday, never taking you for granted.

Addendum: Thank you to my cherished family and friends who came to surprise and celebrate me on my birthday, I am humbled and grateful for you in our lives. Thank you Moorestown HS for honoring your students military families with such great enthusiasm.

This weekend I celebrate a milestone birthday. While I can reflect on the past year- its challenges, successes, seismic changes, remarkable and the unremarkable moments, it is frankly not where I put energy. By nature, I am not that introspective. Anticipating the new year is what brings me joy. That is why managing patients at a critical time in their lives is so fulfilling. I am not mired in the management, I am seeing a “new you”, unburdened by the clutches of disease. No the cancer may actually not be completely gone, the days may still be busy with testing. The office visits may be threateningly chaotic. But what I witness is the reclaimed power. The “I got this attitude”. The “I am here” bravado for your families and friends.

More than the work and caring for patients, I love the outcomes that drag and drive both of us to success. Some take this effort for granted (I never have, I know it is a honor). But some do ask, “How have you devoted your life to this career? Isn’t it tough?” Nope! I recognize the depth of gratitude I have to touch lives everyday. I have always said that it is a sacred privilege. I recall in medical school learning physical exam. I took my newly minted stethoscope, a prized possession in financial squeeze. I placed it on my friend’s back to listen to breath sounds. I can still vividly recall where I was and how I felt startled that people would allow and even welcome this intrusion. I never took it for granted. So, if I am indulging in retrospect, there is a great deal of respect included. Realizing that the life you choose each year, each day is the real gift.

And so, as a new year for me begins, I celebrate all of you having a birthday this year (wait, that is everyone!). Let us all be reborn with purpose, devotion, and love. Moving forward with faith that we will succeed through the challenges and have hope for a bright, joy filled new year and new you.

Pearl: As we leave prostate and breast cancer months, be aware that there are tools to aid decisions regarding treatment. Genetically testing the biopsy material aids in deciding if treatment is necessary, how aggressive the tumor is and what survival and recurrences are: For breast: Decision Rt for DCIS, For prostate, Decifer and for chemo benefit Oncodx. They take a few weeks to run, insurances pay now and always worth the wait before pulling trigger to treat. Now that’s a gift.

Today is Halloween!! I know, it comes around so quickly, every year, like a mammogram (see what I did there?!) I’d say I am taken by surprise but the candy on the counter tells the truth. The time change adds to the mysterious backdrop for the season. We’ve been watching the morning sunrise creep later until we are almost discombobulated. To re-tool my mind set, I just give in and enjoy the bright stars and constellations as consolation. The world is always providing, even in space, and as two almost sparkling “starry eyes” peer down, a cloud moves to expose the crescent sly smile of the moon. It was comical and comforting at the same time. Wouldn’t a charming smile in your mind be a great addition to the day? No spookiness, just delight.

As the sky finally lightens over the ocean, dark, threatening clouds are shielding the rising sun. You could just make out the light behind the fierceness, knowing there was brightness and relief just beyond. The hidden sun was glowing on the fringes, outlining and enhancing. I am reminded how the child’s mask hides the sweetness and impish trick or treat grin, only hidden for a brief moment, never giving in completely to the scary.

The season and spookiness is fun for only a short while. We crave normalcy, warmth, calm and peace. It’s hard to stay focused on the positive when darkness threatens. How can we navigate a new scary reality that creeps into our lives? Don’t ask me. Ask those for whom these developments are no longer new. Those who have managed, unmasked the fear, become fierce themselves in the battle.

Witnessing the bravery over the years, allow me to borrow their costume of courage for you. They have taught us…. do not allow cancer to be all consuming. It is an event. It is an insult. It is a pain and a problem, but it is not your life. It is something to manage not define and you are most capable. Cancer is inconvenient and causes doubt but you are fearless. In the days ahead, the new darkness will envelop us, but the sky will twinkle, reminding us that this is a normal transition- through your own life, through the seasons and through the unknown.

Wear your own cape of super powers. Believe that light will come again. Stand on the shoulders of those guiding your care and allow them to rescue. Smile in your mind and your heart, aware of the goodness shining around the edges. Use this Halloween to unmask your own sweet smile. You can do the amazing. Have faith in yourself. Oh, and face those tricksters with humor and courage and of course… be sure to allow yourself a little treat too!. Have a great weekend!

Pearl: Enjoy the new season! Mounting evidence that season of diagnosis and start of treatment influence prognosis. Summer and Autumn best and may be due to increased levels of vitamin D: for colorectal, prostate, lung, breast and melanoma. So get some sun and take that D3! ( pmc.ncbi.nih.gov)

It happens over coffee or wine. It happens at weddings and gatherings. It happens over text and emails, maybe facebook. It’s the whisper, “I have cancer” that seems, for it’s profound impact, to require a soft, quiet pronouncement. Of course as a cancer Doc, patients don’t whisper this life altering shift to me in the clinic. They offer their reports and scans, hopeful that their personal earthquake will stop. But with our family, friends and co-workers, it’s almost apologetic. They know that every conversation from this time forward will involve further exploration, explaining, self attention.

Just this week, Katie joined her mother and me, dropping a kiss on her Mom’s cheek, she whispered in my ear, “I have breast cancer” . Her mom nods her head, takes a sip of wine, and the discussion shifts. Good she is seeing someone I would recommend and starting radiation now. Taking it all in stride, an unplanned trajectory at a younger age. We discuss the plan and Katie’s spunk comes thru, “I’ll do this, but I won’t do that”. I am careful to encourage her independence in choices. Things are changing so rapidly in cancer treatments, my experience teaches me to not be dogmatic. Nothing is set in stone now.

Next month or even this week, someone will whisper to you, or a text will come from a mutual friend or relative. The best response is listening. Even as a physician, I cannot erase the pain this new dynamic is causing for the patient and family. I cannot placate and say that all will be well and cured (by now you know I almost never use that word, instead “managed” ) For some, the treatments will be quick, for others it will be a few years or even life long. Once the words are said out loud, allow it all to settle. Don’t dig for details. Don’t lend too much advice which can confuse or even destroy their faith in their care team which is critical to success. Recognize that their life just changed and the best you can do is to be an empathetic friend, because I have witnessed for many years, that role is critical to success.

Be there when they ring the bell to celebrate, because everyone, including the staff can shout, admire the courage and cheer them on to a brilliant future as survivor…… and the quiet, fear-filled whisper can be silenced.

Pearl: Exercise reduces development of breast cancer, improves survival and reduces side effects of treatment, so keep moving. Find more @ breastcancer.org

Twelve years of Catholic school training and a Polish Mother, Italian Father, all the sacraments and Masses, would surely imbue me with necessary requirements. I know of Docs who claim to be atheists, yet witness miracles daily…. none of their own doing! But for each of us, ultimate beliefs come from within. Signs abound and everyone of us has seen something amazing that encourages this concept.

A new book by French Mathematicians (Bonnassies and Bollore) says that science has become “God’s ally”. They distilled insights from 62 Nobel Prize winners and over 100 leading scientists to pin point discoveries that could prove God is real: “God, the science, the evidence”.

Kinda coulda saved them the effort….This week, for me, it was a beach walk. The terror in the Atlantic is bypassing us, thank goodness. Humberto grabbed Imelda’s hand and escorted her away, then the recent nor’easter flooded up and down the coast including almost all of St Augustine. The pile of seaweed on the shore is testament to the chaotic week, with lots of tumbled debris. The angry waves persisted and the sun was hesitant, but I was gifted for the effort. I encountered an intact sand dollar. What a find! It’s color for camouflage exactly matched the sand. He was still alive, not white and chalky. His tiny body tucked into a pin hole underneath. He (no idea if there are different sexes, how could you tell?) didn’t wriggle like a star fish. Yhew! What fascinated me about this precious piece is the symmetry. 3 identical slashes thru the shell on top, equidistant from an embossed 5 pointed “star” in the center and two lower and lateral. What or who could possibly come up with this concept? Underneath 5 more projections, equally spaced touching the slashes, carved into the shell each looking like leaves carefully drawn. Think I studied it? Pure perfection.

This find was enough for me this week. I did not need to help someone cure their cancer. I did not need to spectacularly avoid the car that flipped over ahead on the highway. I do not have to witness the several birds lining the pond of all shapes and sizes, yet all eerily equally spaced as if in school. No. I just needed the sand dollar to remind me that Someone else is in charge and my own believing is its own miracle.

Last week’s edition offered a brief mic drop. Published by ASTRO at the annual meeting and in March at ACRO, low dose radiation protocols were presented as a non-invasive alternative to medications and joint surgery. It is safe (very low dose, delivered over ten treatments to the joint- not impacting organs) and now, with longer followup and placebo trials, found to be effective. European countries have used this for some time and the presentation came form Korea, but I have treated these patients sporadically and find it very well tolerated, although I do not have the long term results regarding their pain improvement yet.

After 4 months, 70% of patient receiving a total of 3 gy ( the dose often used for just one treatment in cancers) met criteria. Meaningful improvements were detected in pain, stiffness and physical function.* 32.5 million US adults suffer when the cartilage breaks down and bones wear over time. If the joint is destroyed and cartilage gone, radiation will not repair. But I love the idea of trying a non -invasive approach if possible.

I have personally seen this used for shoulder, hands, wrists, hips and knees, I have not for spine. More will come as clinics add this management of benign disease to their plans of care. When Taylor completed her breast radiation, she returned a few weeks later for her knee. Walt had dupuytren’s contraction treated in the hand. Mark plays keyboard and guitar and enjoys his gigs post retirement, but the arthritis is crippling his ability to perform. If this could at least halt progression for a time, he would be delighted.

So I have decided to explore clinics close to home and may consider if the Radiation Oncologist offers this opportunity, before accepting a knee replacement. If you or your loved one has a question, contact your local cancer center dept. of Radiation Oncology and ask if they are treating patients with arthritis and request a consult. Bring your film disc and reports to see if you qualify. I will keep you posted on my own effort- our senior appendages need some TLC and even better if we can avoid a big surgery to keep up our own momentum.

*ASTRO news and publications, September 28, San Francisco