WEBVTT - Let's Answer Your Questions...with Dr. Ray Chu 0:00:02.520 --> 0:00:08.319 This is let's be clear, who's Shannon Dohrney. Hello, Let's 0:00:08.360 --> 0:00:11.239 be clear listeners, this is not a super familiar voice. 0:00:11.240 --> 0:00:14.240 My name is Rache. I'm a brain to resurgeon. Remember 0:00:14.480 --> 0:00:17.400 me probably when being on a guest in Shannon's podcast 0:00:17.480 --> 0:00:20.319 earlier this year. It's definitely hard for us to be 0:00:20.400 --> 0:00:23.319 without her, to be without her light, and I feel 0:00:23.360 --> 0:00:26.599 for you, folks. But here we get to try to 0:00:26.600 --> 0:00:31.000 put on further this this tradition she started of being 0:00:31.160 --> 0:00:35.960 upfront with information and explaining things to people. I'm honored 0:00:35.960 --> 0:00:38.480 to have been part of Shannon's treatment team as a resurgeon, 0:00:38.920 --> 0:00:43.360 and so I'm your guest host today, and so this 0:00:43.400 --> 0:00:45.960 is a good time to put some more information out there. 0:00:46.120 --> 0:00:49.640 With a breast cancer aware this month, So I've been 0:00:49.640 --> 0:00:53.400 giving some questions from listeners and readers about cancer and 0:00:53.440 --> 0:00:56.800 I'm going to do my best to answer them. So 0:00:57.000 --> 0:00:59.200 someone wrote in what's the difference between stage three and 0:00:59.280 --> 0:01:04.360 stage four? So cancers to the body are staged, and 0:01:04.400 --> 0:01:08.600 it generally involves the idea of how far outside the 0:01:08.720 --> 0:01:11.480 organ of origin things are. So like a lung cancer 0:01:11.760 --> 0:01:14.560 that spreads to the other lung or lymphotes outside the 0:01:14.640 --> 0:01:18.039 lung or to other organs. Stage four generally means like 0:01:18.080 --> 0:01:20.679 a totally different organ, like a lung cancer that spreads 0:01:20.760 --> 0:01:23.440 the liver, or breast cancer that spreads to the brain. 0:01:23.640 --> 0:01:25.760 That's usually the difference between the stage three and a 0:01:25.800 --> 0:01:29.640 stage four. Someone asks what does a cancer look like 0:01:30.240 --> 0:01:32.600 when you operate on them, So they all actually look 0:01:32.640 --> 0:01:36.480 a little bit different, and sometimes even for a breast cancer, 0:01:36.520 --> 0:01:38.440 they can look a little different. It depends a little 0:01:38.440 --> 0:01:42.360 bit on how aggressively something is growing. Sometimes things are 0:01:42.480 --> 0:01:46.520 pretty vascular and growing and really pushing brain around a lot, 0:01:46.720 --> 0:01:48.000 and once in a while you have ones that are 0:01:48.040 --> 0:01:50.760 a little bit more slower growing and encapsulated and kind 0:01:50.800 --> 0:01:54.480 of round. You typically can tell the cells look very different, 0:01:54.520 --> 0:01:56.680 doesn't look like normal brain at all. When you see 0:01:56.680 --> 0:02:00.520 a tumor and it has some color and texture differences. 0:02:00.600 --> 0:02:03.520 Sometimes a tumor can be a little bit firmer than 0:02:03.600 --> 0:02:07.360 regular brain, so you can carve out that pathway, that 0:02:07.480 --> 0:02:12.040 line between the brain tumor and the normal brain. Rarely 0:02:12.080 --> 0:02:14.320 there can be hemorrhage associated with it, So sometimes you 0:02:14.360 --> 0:02:17.120 can operate within this blood clot and then you find 0:02:17.240 --> 0:02:22.760 tumor tissue to remove. Sometimes a tumor can be cystic. 0:02:23.200 --> 0:02:26.880 Sometimes the cells can create some fluid and you want 0:02:26.919 --> 0:02:28.799 to take all that out, and sometimes there's a little 0:02:28.800 --> 0:02:31.520 bit of a wall to be removed. Sometimes really it 0:02:31.600 --> 0:02:33.840 just makes fluid that pushes on the normal brain. So 0:02:34.280 --> 0:02:37.120 we use all these kinds of differences to try to 0:02:37.160 --> 0:02:40.320 help us remove everything we can. Most of the time 0:02:40.320 --> 0:02:43.360 when we're there at surgery, between things we use to 0:02:43.440 --> 0:02:47.840 help us, like MRI guidance and an operating microscope. We 0:02:47.919 --> 0:02:51.040 use this big microscope that offers a lot of illumination 0:02:51.160 --> 0:02:54.679 and a lot of magnification. We can see the edge 0:02:54.680 --> 0:02:57.720 of the tumor. There are always a few cells left 0:02:57.880 --> 0:03:00.360 behind that we can't see that there are actually smaller 0:03:00.360 --> 0:03:03.160 than you can see in the microscope. So typically people 0:03:03.200 --> 0:03:07.200 need some amount of radiation around the surgery. Sometimes we 0:03:07.240 --> 0:03:10.680 do that afterwards. Sometimes if it's a very small spot, 0:03:10.800 --> 0:03:12.440 we think our targeting is better if we do a 0:03:12.520 --> 0:03:17.079 small doser radiation beforehand and then do surgery. Also, if 0:03:17.320 --> 0:03:20.600 we're at surgery and any cells escape if someone already 0:03:20.680 --> 0:03:22.800 had radiation, we think that those cells as not really 0:03:22.840 --> 0:03:27.880 that viable, not that alive, So sometimes we would take 0:03:27.880 --> 0:03:30.200 all that into account that there's cells there. But one 0:03:30.400 --> 0:03:32.600 part of the question is is can you see cells 0:03:32.639 --> 0:03:35.120 spread in the brain. You really can't see the exact cells. 0:03:35.160 --> 0:03:37.240 They have to be large enough to be a tumor. 0:03:38.080 --> 0:03:42.360 Sometimes we use other adjuncts at surgery, like there's not 0:03:42.680 --> 0:03:48.200 as many interopreative MRIs like tak an MRI in surgery, 0:03:48.240 --> 0:03:52.440 and really you can't operate inside an MRI safely right. 0:03:52.560 --> 0:03:55.160 Many surgical tools are some type of metal, and even 0:03:55.160 --> 0:03:58.360 if you choose one that doesn't create a lot of 0:03:58.440 --> 0:04:02.400 magnetic signal, kind of dangerous to do that. But sometimes 0:04:02.480 --> 0:04:04.680 we use an ultrasound because you can use an ultrasound 0:04:04.760 --> 0:04:07.840 right on the brain itself and see as you're working 0:04:07.920 --> 0:04:11.040 that you took all the tumor out. So those are 0:04:11.040 --> 0:04:12.440 some of the things we use to make sure we 0:04:13.360 --> 0:04:16.440 do our best job. Someone asks how long does it 0:04:16.440 --> 0:04:20.279 take for cancer to metastasize, so they offer the spread 0:04:20.360 --> 0:04:23.800 of timing days, weeks, months, or year. So most cancers 0:04:23.800 --> 0:04:26.440 don't spread in days. So it is rare that we 0:04:26.440 --> 0:04:29.760 can find someone that has had a new diagnosis of 0:04:29.760 --> 0:04:32.040 a cancer and they'll have several sites of the disease 0:04:32.560 --> 0:04:34.760 at the same time, but it usually still would be 0:04:34.839 --> 0:04:37.480 something over time has spread to that not usually days. 0:04:37.720 --> 0:04:41.120 I've definitely seen people where it can be diagnosed with 0:04:41.240 --> 0:04:43.880 a cancer like a breast cancer and a brain metastis. 0:04:43.920 --> 0:04:46.720 At the same time, I've also seen people where it 0:04:46.720 --> 0:04:50.039 can be more than five or more years since they're 0:04:50.200 --> 0:04:54.080 cancer diagnosis before something happens. There's a lot we think 0:04:54.080 --> 0:04:56.240 that has to do with how much people fall up 0:04:56.240 --> 0:04:58.960 with their doctor and get appropriate scans and things and 0:04:59.120 --> 0:05:03.919 appropriate treatment, and we usually can find little changes happening 0:05:04.000 --> 0:05:07.479 before there's widespread disease. That once in a while it's 0:05:07.520 --> 0:05:10.520 people who don't quite keep up all the imaging or 0:05:10.960 --> 0:05:13.640 kind of disappear a little bit from the oncologists and 0:05:13.760 --> 0:05:16.640 start taking some strange therapies that sometimes they can come 0:05:16.680 --> 0:05:19.159 back with a lot of things going on. But it 0:05:19.240 --> 0:05:22.560 is part of why for a lot of cancer you 0:05:22.680 --> 0:05:26.599 really use the term remission. Like when people have had 0:05:26.680 --> 0:05:28.640 a lot of treatment and things are quiet and we 0:05:28.720 --> 0:05:32.480 still watch them with some visits and scans, they can 0:05:32.480 --> 0:05:35.480 be in a remission. And for many of these cancers, 0:05:35.520 --> 0:05:37.520 it's hard to use the word cure. Care would imply 0:05:37.960 --> 0:05:40.039 we shake your hand and give you a U and 0:05:40.080 --> 0:05:42.080 say go live your life. Don't get another test again. 0:05:42.480 --> 0:05:45.200 I mean, we do worry that things can rear their 0:05:45.240 --> 0:05:48.000 ugliheads again. So sometimes I even have people, you know 0:05:48.040 --> 0:05:51.760 that I've been following for more than a decade, just 0:05:52.279 --> 0:05:56.039 making sure that they stay out of trouble. See, does 0:05:56.080 --> 0:05:58.719 weight have anything to do with the likeli of getting cancer? 0:05:58.760 --> 0:06:01.800 I'm not aware of some that's super clear for that. 0:06:01.880 --> 0:06:05.359 I mean, we do think of both how people respond 0:06:05.400 --> 0:06:08.799 to a disease and its treatments might have a little 0:06:08.800 --> 0:06:11.200 bit to do with health, you know, like some amount 0:06:11.279 --> 0:06:14.880 of focus on exercise and diet. It's not really that 0:06:14.920 --> 0:06:17.480 there's something as simple as a tumor starvation diet. I've 0:06:17.480 --> 0:06:20.320 had someone before where the spouse the patient on the 0:06:20.320 --> 0:06:22.919 tumor strivation diet. The only thing starving was the patient. 0:06:22.920 --> 0:06:24.520 The pumber can find a way to grow, So it's 0:06:24.520 --> 0:06:27.880 not as simple as the diet. Sometimes in the Internet 0:06:27.920 --> 0:06:31.000 people even talk about, oh, sugar feeds cancer, And there's 0:06:31.040 --> 0:06:34.440 a little bit to that. I mean in your bloodstream. Also, 0:06:34.720 --> 0:06:37.640 your body makes glucose to feed the brain, right, it 0:06:37.680 --> 0:06:40.719 doesn't your brain doesn't run on protein purely, so you 0:06:40.760 --> 0:06:44.520 can't really eliminate sugar from everything. And clearly it's one 0:06:44.560 --> 0:06:47.480 thing to say, you know, nobody needs three slices of 0:06:47.560 --> 0:06:51.200 chocolate cake to day, but sugar from fruits it is 0:06:51.240 --> 0:06:54.000 always going to be a part of a good diet. 0:06:54.200 --> 0:06:57.000 And so sometimes too, when people are going through surgeries 0:06:57.000 --> 0:06:58.919 and treatments, they deserve a treat here and there. You know, 0:06:59.000 --> 0:07:02.200 to deny someone all twreats doesn't always help quality of life. 0:07:02.240 --> 0:07:04.880 Part of our goal should be quality of life, not 0:07:05.000 --> 0:07:08.799 just pure quantity of belief. There's a question about itchy 0:07:08.880 --> 0:07:11.360 nipples as a sign of breast cancer. Well, I'm going 0:07:11.440 --> 0:07:13.440 to be the best one to go into all of 0:07:13.440 --> 0:07:15.679 those as a neurosurgeon, but I haven't heard that one before. 0:07:15.840 --> 0:07:19.040 That's a big warning sign. Note Okay, someone asks what 0:07:19.160 --> 0:07:21.240 is the best case scenario when a patient goes to 0:07:21.240 --> 0:07:24.040 you to get a tumor removed? So many times what 0:07:24.080 --> 0:07:27.480 we look at is this distinction between a solitary brain 0:07:27.520 --> 0:07:32.000 metasis or several brain fantast disease. And while Shannon actually 0:07:32.040 --> 0:07:34.360 had a couple spots there, a lot of them are 0:07:34.440 --> 0:07:37.880 very small. There was one major one, and so sometimes 0:07:37.880 --> 0:07:41.440 we think if there's one major metastasis and we perform surgery, 0:07:41.960 --> 0:07:44.240 that we're attacking like the major side of disease in 0:07:44.280 --> 0:07:47.720 the body. There is this part too that taking some 0:07:47.840 --> 0:07:51.760 tumor out from the current disease state really helps. To 0:07:51.800 --> 0:07:55.040 the hero on cologist dart Piro, it really helps give 0:07:55.120 --> 0:07:57.920 us both an idea for sure that we're seeing tumor. 0:07:58.560 --> 0:08:00.240 Also it gets another chance for us to look the 0:08:00.320 --> 0:08:03.320 molecular signas to their tumor case. It changes the idea 0:08:03.320 --> 0:08:07.800 of any targeted therapy or immuni therapy. So with her, 0:08:08.000 --> 0:08:10.680 fortunately we were able to remove that safely and she 0:08:10.720 --> 0:08:12.760 did well with surgery. She was pretty tough. She's been 0:08:12.800 --> 0:08:15.520 through a few surgeries, so she is pretty tough. And 0:08:15.560 --> 0:08:17.560 then we're able to treat the other tiny sites with 0:08:17.720 --> 0:08:20.800 radiation and she spawned well to that. So in Sham's case, 0:08:20.800 --> 0:08:23.679 there was this big advantage that we took with surgery 0:08:23.680 --> 0:08:26.640 that her brain was quiet for a long time, and 0:08:26.760 --> 0:08:29.480 really what we thought was going on with her is 0:08:29.520 --> 0:08:32.760 that she had systemic disease. That was the problem. I 0:08:32.800 --> 0:08:37.880 remember actually when we did our podcast together. Neurologically, she 0:08:37.920 --> 0:08:42.480 was doing great, her brain was terrific, she was speaking well, 0:08:42.559 --> 0:08:44.600 she was thoughtful, but she said I kind of have 0:08:44.679 --> 0:08:47.480 this new pain and that they were kind of working 0:08:47.480 --> 0:08:49.080 that up and it was that worry, that sign that 0:08:49.120 --> 0:08:50.959 something else is going on on the body. The pain 0:08:51.200 --> 0:08:54.040 was on the body, her brain was doing fine. There 0:08:54.080 --> 0:08:56.640 is that advantage in the brain that most of the time, 0:08:56.679 --> 0:09:00.559 between surgery and radiation we can control metallic disease. It 0:09:00.559 --> 0:09:03.400 doesn't always happen exactly the same and the rest of 0:09:03.440 --> 0:09:06.840 the body, and so sometimes looking again at that molecular 0:09:06.840 --> 0:09:11.280 signature helps guide us onto the next step. Once in 0:09:11.320 --> 0:09:13.079 a while. It's that thing that we think of the 0:09:14.280 --> 0:09:18.439 removing a solitary brain metastasis is kind of like resetting 0:09:18.440 --> 0:09:20.680 the clock. Like if you took all the people with 0:09:20.800 --> 0:09:25.000 lung cancer with and without brain metastases, clearly the survival 0:09:25.040 --> 0:09:27.920 would be different. But we think that if we have 0:09:28.000 --> 0:09:31.560 someone with really one metastas that we can remove safely 0:09:31.880 --> 0:09:36.319 and give focused radiation to the edges there, we kind 0:09:36.320 --> 0:09:39.360 of reset the prognosis clocked, almost as if they didn't 0:09:39.360 --> 0:09:42.640 have that metastasis in the first place. And then clearly 0:09:42.640 --> 0:09:44.760 when you have someone with several metastasy, you don't have 0:09:44.800 --> 0:09:49.200 that advantage. Sometimes when we operate on people with several metastases, 0:09:49.400 --> 0:09:52.520 we operate on one or two of the largest ones 0:09:52.960 --> 0:09:55.800 that might be hard to treat with radiation or ones 0:09:55.840 --> 0:09:58.840 that are very symptomatic. For example, there could be one 0:09:58.840 --> 0:10:01.040 really pressing on the most area and with like a 0:10:01.120 --> 0:10:03.599 lot of swelling. That someone has weakness, and if we 0:10:03.640 --> 0:10:05.840 can take that out, we can make them stronger. So 0:10:06.360 --> 0:10:09.800 we plan those surgeries to help quality of life, but 0:10:09.880 --> 0:10:12.920 it may not always change their prognosis if they're multiple 0:10:12.920 --> 0:10:17.719 metastasies different than that solitary scenario. Those are some of 0:10:17.760 --> 0:10:19.959 the ways we look at try to make the best 0:10:20.160 --> 0:10:30.760 of a situation for a patient and keep them healthy. 0:10:35.640 --> 0:10:37.959 Someone asked, how soon can you tell of a surgery 0:10:38.080 --> 0:10:41.720 was a success? In general, you know a lot about 0:10:41.920 --> 0:10:44.960 surgery within the first twenty four hours, so you know, 0:10:45.000 --> 0:10:47.160 if I would know if a patient is neurologically worse 0:10:47.280 --> 0:10:49.800 or not, that if things like brain swelling or bleeding 0:10:50.040 --> 0:10:52.679 or even stroke, which is a risk of surgery. It's 0:10:52.679 --> 0:10:55.199 an uncommon risk. I mean, when you tinker with the 0:10:55.280 --> 0:10:59.079 brain for surgery, a stroke can happen about one percent 0:10:59.120 --> 0:11:02.079 of the time you perform kind of surgery. We would 0:11:02.080 --> 0:11:04.719 know that generally in the first twenty four hours. There 0:11:04.800 --> 0:11:07.360 is partly a different sun of success in terms of 0:11:07.400 --> 0:11:09.400 like does a tumor grow back in things, but usually 0:11:09.400 --> 0:11:13.160 between surgery and focus radiation, we can prevent a tumor 0:11:13.200 --> 0:11:15.720 from coming back at that. One side part of our 0:11:15.840 --> 0:11:18.840 job later with multiple rain and arize is to look 0:11:18.880 --> 0:11:20.560 at the rest of the brain to make sure there 0:11:20.559 --> 0:11:23.880 are no other sense. Okay, someone asks, are there natural 0:11:23.880 --> 0:11:27.319 foods that keep cancer away? Well, it's a little bit unclear. 0:11:27.840 --> 0:11:30.240 There are some studies that you'll see that talk about 0:11:30.520 --> 0:11:33.360 either the rate of cancer or the response to cancer 0:11:33.400 --> 0:11:35.960 and evolvays some things, but it's not really clear enough 0:11:35.960 --> 0:11:39.760 that there's a particular food that does that. Now, clearly 0:11:40.080 --> 0:11:44.720 there's probably a part of us as Americans eating like 0:11:44.920 --> 0:11:48.160 regular food and you know, fresh fruits and vegetables and 0:11:48.280 --> 0:11:52.079 things that are from cooking, and there's probably an amount 0:11:52.160 --> 0:11:54.520 of processed foods that we're a little bit not in 0:11:54.600 --> 0:11:57.719 control of exactly what's in there and sugar content and 0:11:57.760 --> 0:12:00.840 stuff like that. But I wouldn't as necessarily say that 0:12:00.880 --> 0:12:06.880 there's one super particular thing that people should tank see. 0:12:07.200 --> 0:12:09.520 When breast cancers be on the point of treatment, what 0:12:09.640 --> 0:12:12.120 does a patient actually die from It can depend, so 0:12:13.000 --> 0:12:16.280 it's a little bit more rare for people to succumb 0:12:16.320 --> 0:12:20.800 to brain metastases. Usually we can control them between surgery 0:12:21.160 --> 0:12:25.440 and radiation and sometimes Now there are targeted agents for 0:12:25.520 --> 0:12:27.840 breast cancer, a number of different targeted medicines that can 0:12:27.840 --> 0:12:30.120 get into the brain a little bit or when people 0:12:30.200 --> 0:12:35.480 qualify for immunotherapy, right, so chemotherapy being medicines that hurt 0:12:35.520 --> 0:12:39.240 tumor cells a little bit different than immunotherapy, medicine to 0:12:39.240 --> 0:12:42.200 stimulate your immune system to fight the tumor better. Not 0:12:42.320 --> 0:12:45.000 all cancers have a good signal that they would respond 0:12:45.040 --> 0:12:49.640 to immunotherapy, but they can. And then even if therapy 0:12:49.720 --> 0:12:52.080 can get into the brain, sometimes we even use it 0:12:52.120 --> 0:12:55.439 on primary brain tumors, so sometimes that can be the 0:12:55.720 --> 0:13:00.800 stuff that really helps fight things. I guess the second 0:13:00.800 --> 0:13:02.880 part of that is the cancer is the cancer yourself. 0:13:02.920 --> 0:13:06.880 For organ failure, so not most people really die pure 0:13:07.040 --> 0:13:09.959 organ failure. So real organ failure we're like your kidney 0:13:10.000 --> 0:13:13.160 shutting down, your liver shutting down. Happens when people have 0:13:13.200 --> 0:13:16.520 some type of an infection and you know, bloodstream infection 0:13:16.600 --> 0:13:21.560 called sepsis. Most of the time, when breast cancer patients 0:13:21.600 --> 0:13:23.959 start to peter out, it's that the disease is growing 0:13:24.000 --> 0:13:25.840 and just taking a toll on their body for their 0:13:25.920 --> 0:13:29.319 energy reserves. And making them sick. It can be some 0:13:29.480 --> 0:13:33.960 organ involvement. It's not usually totally organ failure. Can you 0:13:34.000 --> 0:13:36.360 tell when someone only has a few weeks left to live? 0:13:37.080 --> 0:13:39.080 Yes and no. I mean sometimes you get a sense 0:13:39.120 --> 0:13:42.640 on someone who really feels that their energy is very 0:13:42.640 --> 0:13:45.360 depleted and they don't feel well. They haven't responded to 0:13:45.360 --> 0:13:49.400 the therapy. Once a while, when people have limited ability 0:13:49.480 --> 0:13:53.200 to speak, they can still tell you what they want 0:13:53.240 --> 0:13:55.520 and feel like they're going through. When people sometimes just 0:13:55.600 --> 0:13:58.080 gradually want to do less and eat less than that 0:13:58.080 --> 0:13:59.880 can be a sign they know there are things going 0:13:59.920 --> 0:14:02.480 on that are not going in the right direction. But 0:14:02.600 --> 0:14:06.599 sometimes it's hard. Like humans, we have this weakness in prognostication. 0:14:06.679 --> 0:14:09.480 We can't always pull the future out Like I want 0:14:09.840 --> 0:14:12.880 my crystal ball to be working, but it's really well, 0:14:12.920 --> 0:14:14.920 like a crystal ball that has some cracks in it. 0:14:15.080 --> 0:14:19.120 Things like that. See, cancer treatment can weaken the body 0:14:19.120 --> 0:14:20.960 of the immune system, So how do we know whether 0:14:20.960 --> 0:14:23.240 it's doing more good than harm. Well, some of that 0:14:23.360 --> 0:14:26.720 is and really seeing people and try to balance the 0:14:26.840 --> 0:14:31.000 quality of life. So more and more it's the priority 0:14:31.120 --> 0:14:33.240 to make sure people have a good quality of life 0:14:33.240 --> 0:14:37.760 and not really just you hammering them with treatments to 0:14:37.800 --> 0:14:42.440 get more quantity of life. So as people are fatigued 0:14:42.640 --> 0:14:46.680 or have different medical side effects from treatment, sometimes we 0:14:46.720 --> 0:14:49.040 will dose reduce the treatment. And sometimes even if the 0:14:49.080 --> 0:14:53.360 treatment was roughly working, if it's hurting someone more than 0:14:53.360 --> 0:14:55.480 it's helping, we may have to change that. So it's 0:14:55.520 --> 0:14:58.480 a lot of contact with a good doctor and making 0:14:58.480 --> 0:15:00.720 sure we stay in touch about side of and things. 0:15:01.600 --> 0:15:05.320 Should someone with cancer exercise, absolutely so, we both think 0:15:05.320 --> 0:15:08.720 that that's good for your mental health, but the whole 0:15:08.720 --> 0:15:12.400 idea of just oxygenation and stimulating the good cells in 0:15:12.440 --> 0:15:15.360 the body, right, We think that exercise and movement is 0:15:15.680 --> 0:15:18.680 good for the immune system and helping you fight the tumor. 0:15:18.760 --> 0:15:22.240 In general, there's no disease that I know of where 0:15:22.480 --> 0:15:26.080 strict bed rests for prolonged times is good and lots 0:15:26.080 --> 0:15:29.600 and lots of bedrests put you at risk for other problems. 0:15:29.760 --> 0:15:32.400 So when people are in the hospital after surgery it 0:15:32.440 --> 0:15:35.480 can't walk around very well. We do various things to 0:15:35.520 --> 0:15:39.920 stimulate their blood from being too thick and getting blood clots. 0:15:39.920 --> 0:15:41.920 There are squeezers we put on the legs are rarely 0:15:41.920 --> 0:15:45.200 if it's days later. Some people even need light blood 0:15:45.200 --> 0:15:48.000 thinner to make sure they don't develop these blood clots 0:15:48.000 --> 0:15:50.640 and things like that. When you're under prolonged bed rest, 0:15:50.760 --> 0:15:53.640 then there are risks for blood clots and it can 0:15:53.680 --> 0:15:58.160 be dangerous. Also cancer in general, we think cancervations are 0:15:58.160 --> 0:16:00.280 a little more prone to blood clots than others, even 0:16:00.320 --> 0:16:02.480 more so, like strict bed rest can be a risk 0:16:02.640 --> 0:16:07.840 for cancervations. As it true you qualify for lifetime disability 0:16:07.880 --> 0:16:10.560 if you're diagnosed with cancer, I'm unaware of that being 0:16:10.640 --> 0:16:13.440 the case. I think there are definitely people with different 0:16:13.440 --> 0:16:16.680 insurance policies, and then there's a part where it can 0:16:16.720 --> 0:16:22.320 depend where you are in your cancer course. Certainly someone 0:16:22.360 --> 0:16:26.120 has more and more metastics than unable to work in 0:16:26.160 --> 0:16:28.680 things like that. There's things that for disability, but not 0:16:28.760 --> 0:16:32.560 an automatic you know, the first sign of cancer, it 0:16:32.640 --> 0:16:37.200 is not an automatic lifetime disability. Do I think anything 0:16:37.200 --> 0:16:40.080 about deodorant in cases of breast cancer. I haven't heard 0:16:40.080 --> 0:16:42.960 that one either. I haven't heard any breast cancer oncologists 0:16:43.200 --> 0:16:46.120 recommend that everyone stops deodorant. I don't know that that's 0:16:46.160 --> 0:16:49.760 the one. I certainly appreciate it when patient's were deodorant. 0:16:50.920 --> 0:16:53.280 Do you think the metal insides women's brass could potentially 0:16:53.280 --> 0:16:55.200 be a factor causing breast cancer. That one's a tough 0:16:55.200 --> 0:16:56.880 one for me. I'm not sure I would call myself 0:16:56.880 --> 0:16:58.920 the expert in that, but I'm unaware of any type 0:16:58.960 --> 0:17:01.600 of recall, and you know, this country is pretty safe 0:17:01.640 --> 0:17:03.120 with that stuff, so I think if there are any 0:17:03.160 --> 0:17:06.960 real evidence for that, it would be something that'd be 0:17:07.040 --> 0:17:10.720 changed pretty quickly. Also, you know, I assume they're talking 0:17:10.720 --> 0:17:13.280 more like the underwire than like the class and stuff 0:17:13.280 --> 0:17:15.240 like that, which sometimes the classes are in the back. 0:17:15.320 --> 0:17:17.359 But I'm not aware of anything that says that the 0:17:17.400 --> 0:17:20.919 metal has anything to do with it. So once in 0:17:20.920 --> 0:17:24.679 a while we meet patients that have a couple of 0:17:24.960 --> 0:17:28.359 preset ideas in their head about what cancer is like 0:17:29.200 --> 0:17:31.560 and what to do or not to do. Sometimes you're 0:17:31.600 --> 0:17:35.560 worry that people with mentastass might feel that there's nothing 0:17:35.560 --> 0:17:39.000 that can be done. But we're better and better at 0:17:39.040 --> 0:17:42.240 this over the years, and even since I started at 0:17:42.320 --> 0:17:45.320 Cedar Sina twenty years ago, things are different than before, 0:17:46.280 --> 0:17:49.520 so things are more treatable. We have better tools at surgery, 0:17:49.680 --> 0:17:56.840 have better treatments, more targeted agents and immunotherapy. So it 0:17:56.880 --> 0:17:59.000 wasn't like that when I started that. We had people 0:17:59.440 --> 0:18:01.840 brame my task diase around for a long period of time, 0:18:02.280 --> 0:18:04.159 but now there are there are people that I have 0:18:04.240 --> 0:18:07.280 even past ten years with a diagnosis or brain metast disease. 0:18:07.800 --> 0:18:11.200 It's different than it used to be. Sometimes we meet 0:18:11.200 --> 0:18:14.680 people that are a little bit reluctant for different treatments 0:18:14.760 --> 0:18:17.280 like radiation. So people are scared by the dea of 0:18:17.320 --> 0:18:20.440 radiation and probably more than scared by the idea of 0:18:20.560 --> 0:18:23.439 radiation or their brain. Part of what we do for 0:18:23.560 --> 0:18:28.000 target radiation is that we focus really tightly around the 0:18:28.040 --> 0:18:32.280 tumor target, and then we distribute the beams of radiation 0:18:32.760 --> 0:18:35.800 around multiple parts of the brain such that each part 0:18:35.800 --> 0:18:38.439 of the brain can tolerate the dose. So it's kind 0:18:38.480 --> 0:18:41.719 of like if you have two flashlights focus on a target. 0:18:41.760 --> 0:18:44.200 It's more intense at the center, but if you do 0:18:44.280 --> 0:18:47.520 that thousands of times, you get this intensity at the 0:18:47.560 --> 0:18:49.480 tumor site, but the rest of the brain gets very 0:18:49.480 --> 0:18:51.640 little radiation at all, And so we do to try 0:18:51.680 --> 0:18:54.199 to make it safe. I mean, clearly, there's always a 0:18:54.200 --> 0:18:57.119 little bit of risk with things like radiation, but we 0:18:57.200 --> 0:18:59.360 try to limit that risk as much as possible, keep 0:18:59.560 --> 0:19:02.439 the brain as healthy as possible. It is better than 0:19:02.480 --> 0:19:04.159 it used to be that we can target these things 0:19:04.600 --> 0:19:08.199 more precisely, really the sub millimeter accuracy than we used to. 0:19:09.760 --> 0:19:13.320 Sometimes we meet patients that are very reluctant to treatment, 0:19:13.400 --> 0:19:16.800 and there are lots of people out there with stories 0:19:17.200 --> 0:19:20.840 on chemotherapy. I think that some of these stories are 0:19:20.880 --> 0:19:25.399 really older stories. I think it's tricky to go on 0:19:25.440 --> 0:19:27.520 the internet sometimes, not that I don't want people to read. 0:19:27.520 --> 0:19:30.280 I always appreciate what people read, just we have to 0:19:30.440 --> 0:19:32.480 take everything with a grain of salt. And on the 0:19:32.480 --> 0:19:34.920 Internet it's a lot harder to tell what your source 0:19:34.920 --> 0:19:37.679 of information is. You know, in a store, it's very 0:19:37.720 --> 0:19:39.840 easy to tell the difference between the Wall Street Journal 0:19:39.840 --> 0:19:42.240 and the National Enquirer. But on the Internet it's different. 0:19:42.320 --> 0:19:46.119 So sometimes we're really just reading some one person's particular 0:19:46.720 --> 0:19:49.720 response to all the stuff, and you know, rarely people 0:19:49.800 --> 0:19:52.800 aren't even telling you all the things and telling you 0:19:53.320 --> 0:19:56.160 the total truth. Right, So generally get a little bit 0:19:56.320 --> 0:19:59.879 better information from curated sites like them American Cancer Society 0:20:00.400 --> 0:20:03.359 or our website I think has good information. Sometimes we 0:20:03.440 --> 0:20:05.480 want to gauge that and really weigh the source of 0:20:05.520 --> 0:20:09.200 the information. Even your favorite restaurant has a bad review somewhere, 0:20:09.840 --> 0:20:13.000 that doesn't mean that you don't like it anymore. And 0:20:13.040 --> 0:20:15.320 then I think the one difference too is that the 0:20:15.400 --> 0:20:18.920 chemotherapies have gotten better. So really in this umbrella of 0:20:19.000 --> 0:20:23.000 chemotherapy are more and more targeted therapies. As we do 0:20:23.119 --> 0:20:26.840 more testing and find more molecular signatures of these cancers, 0:20:27.119 --> 0:20:30.560 sometimes we can find a particular driver that we can 0:20:30.600 --> 0:20:33.800 develop a drug to. So some targeted therapies will take 0:20:33.800 --> 0:20:36.000 advantage of that hurt to our cells and get into 0:20:36.040 --> 0:20:39.760 them in a certain way because of that. One example 0:20:39.760 --> 0:20:41.720 for a breast cancer is people that are hurt too 0:20:41.880 --> 0:20:44.919 positive that there are targeted agents for that that this 0:20:45.320 --> 0:20:47.960 her too positive is a different little different than a 0:20:47.960 --> 0:20:51.120 triple negative breast cancer, and we can use different treatments 0:20:51.119 --> 0:20:54.560 for some of these people. I think another major improvement 0:20:54.560 --> 0:20:57.000 over time has been this idea of immunit therapy. So 0:20:57.400 --> 0:21:01.480 immunotherapy is medicine to emulate your immune system or fight 0:21:01.520 --> 0:21:04.320 a tumor better. There's a lot of tumors that try 0:21:04.359 --> 0:21:07.560 to hide from the immune system, and primary brain temors 0:21:07.640 --> 0:21:11.040 can hide from the immune system by both down regulating 0:21:11.240 --> 0:21:14.800 signals that our immune sysm uses to detect foreign things 0:21:14.840 --> 0:21:18.320 like tumors, and it also sends out signals to suppress 0:21:18.359 --> 0:21:21.320 your immune cells. But the goal of immuni therapy is 0:21:21.359 --> 0:21:26.240 medicine to try to stimulate that to reverse itself. I 0:21:26.280 --> 0:21:30.119 guess I should clarify. There is like medicine immune therapy, 0:21:30.200 --> 0:21:36.240 there's also cellular imunotherapy like vaccines. Vaccines oftentimes are taking 0:21:36.280 --> 0:21:39.680 tumor proteins and stimulating them with your immute white blood 0:21:39.680 --> 0:21:42.320 cells to fight them better. But it's a little harder 0:21:42.640 --> 0:21:45.640 to do all that stuff. It requires to recent surgery. 0:21:45.720 --> 0:21:49.600