Speaker 1: This is let's be clear with Shannon Dorney. Hi, everyone,
Speaker 1: this is Let's be clear with Shannon Doherty. I want
Speaker 1: to thank you for listening to my podcast and for
Speaker 1: your kind and encouraging words on social media. As you
Speaker 1: may know, there are many people with me on this
Speaker 1: cancer journey, and today I'm joined by someone instrumental in
Speaker 1: my treatment. The Hollywood Reporter named him one of Hollywood's
Speaker 1: top doctors. Please welcome doctor Lawrence Piro.
Speaker 2: Hey, Shannon, happy to be here. Hi.
Speaker 1: How are you.
Speaker 2: I'm good?
Speaker 1: How are you? I'm good. I had a very long day,
Speaker 1: but nothing I would look forward to more than a
Speaker 1: glass of wine and a conversation with you.
Speaker 2: Something we've done quite often and every time it's enjoyable
Speaker 2: and unpredictable.
Speaker 1: Unpredictable it is a really, really good word for it.
Speaker 1: Can you please, just for you know the people listening in,
Speaker 1: tell us your full title, your specialty, and what hospitals
Speaker 1: you're affiliated with.
Speaker 2: Well, I'm doctor Lawrence Pirerou. My title is CEO of
Speaker 2: the Angels Clinic and Research Institute, which is an affiliate
Speaker 2: of Cedar Sinai, which we started about twenty three years ago,
Speaker 2: and I'm an medical oncologist, so kind of the overall
Speaker 2: quarterback of the ecology team in terms of diagnosis and
Speaker 2: planning treatment and coordinating all the treatments.
Speaker 1: And is your oncology specialty breast or a multitude of
Speaker 1: different cancers.
Speaker 2: Well, it's a multitude of different cancers, and I've done
Speaker 2: research in a number of different areas, but breast is
Speaker 2: an area where I've treated in an extensive amount of
Speaker 2: patients over my entire forty year career.
Speaker 1: And you are published, are you not?
Speaker 2: I am?
Speaker 1: Can you tell me a little bit about that.
Speaker 2: Well, I've been a researcher and a developer of treatments
Speaker 2: from the beginning of my career. I was actually still
Speaker 2: a fellow when published on the first which was a
Speaker 2: drug that put a disease called harry sel leukemia into
Speaker 2: remission in ninety eight percent of cases, and it was
Speaker 2: a kind of a worldwide attention item because there was
Speaker 2: almost nothing that would put that number of people into
Speaker 2: a mission with a single treatment. So I was quite
Speaker 2: a breakthrough and that spawned my career starting when I
Speaker 2: was in my late twenties. That spawned my career in
Speaker 2: investigative oncology and creating targeted treatments, and I was part
Speaker 2: of the development team for all of the clinical trials
Speaker 2: that led to the approval over Tuksan, which was the
Speaker 2: first monocle and antibody ever used in Man and approved
Speaker 2: as a drug. So we had a really great experience
Speaker 2: with all that, and that of course opened up a
Speaker 2: whole new field of drugs and now there are you know, many,
Speaker 2: many and a lot of people actually got monocle antibodies
Speaker 2: for COVID. I remember, yes, I'm sure that was a
Speaker 2: fun thing to be involved with. And I have a
Speaker 2: medium to large institute with a lot of oncologists doing
Speaker 2: great work and doing research and all different kinds of things.
Speaker 2: And I treat a wide variety of diseases because a
Speaker 2: lot of times the relationship is the important thing.
Speaker 1: Yeah, So in other words, you're like no joke, You're
Speaker 1: like the no joke doctor. So, just to give our
Speaker 1: listeners a bit of history, I got diagnosed with breast
Speaker 1: cancer in twenty fifteen. I went to a different oncologist
Speaker 1: and had not a very successful sort of treatment in
Speaker 1: the sense of nothing was really changing. I still had,
Speaker 1: you know, a tumor in my breast. I still wasn't
Speaker 1: getting surgery. I kind of was feeling a little bit lost.
Speaker 1: The drug that this particular in college just had me
Speaker 1: on put me in a menopause. I wasn't properly warned
Speaker 1: about that. I was definitely feeling adrift, if you will,
Speaker 1: in my sort of cancer journey, and I knew that
Speaker 1: something needed to change. I just didn't know how to
Speaker 1: change it. And most of the time, a lot of
Speaker 1: patients feel as if they don't have the right to
Speaker 1: ask for a better doctor or to change doctors, or
Speaker 1: they're scared their insurance won't cover a new doctor, or
Speaker 1: they feel like they can't change doctors. And I felt
Speaker 1: that for a minute until I got a phone call
Speaker 1: from my friend Chris, who said he was good friends
Speaker 1: with a mutual friend of ours, David, and David really
Speaker 1: wanted to introduce me to this oncologist that he said
Speaker 1: saved his father's life with cancer and he felt very
Speaker 1: strongly about and that meeting happened to be when I
Speaker 1: met you. Do you want to tell us about it?
Speaker 2: Sure? Well, David Charvey called me and said, would I
Speaker 2: be willing to have dinner over at Chris's house and
Speaker 2: meet Shannon. She was going through a little cancer problem.
Speaker 2: They thought if we'd met up, we might be a
Speaker 2: good team, and so I said, yea, I'm sure, I'm
Speaker 2: happy to. So we had dinner. You know, usually in
Speaker 2: that kind of a situation, it's a it's kind of
Speaker 2: a dance, you know, because you're like, it's like a
Speaker 2: blind date. Two people who are invited to a get
Speaker 2: social gathering for a purpose, and everyone kind of knows
Speaker 2: the purpose, but you're supposed to act like you don't
Speaker 2: know the purpose.
Speaker 1: It's so true, that great way of describing it.
Speaker 2: Yeah, So you usually dance around each other and like, well,
Speaker 2: who's gonna who's going to reveal that they know the
Speaker 2: purpose first and put it out on the table and
Speaker 2: square it all up. And that, however, didn't play out
Speaker 2: that night, because neither you nor I are kind of
Speaker 2: beat around the bush people. So we just like jumped
Speaker 2: right in. Yeah, and within five minutes we were pretty
Speaker 2: connected and pretty sure that we understood one another and
Speaker 2: pretty good, pretty sure that we'd be a great team together.
Speaker 1: Yeah. I felt like you understood why I was feeling
Speaker 1: a bit lost, and you definitely had opinions on what
Speaker 1: should change and what needed to get done immediately, And
Speaker 1: I really respected the fact that you had like a
Speaker 1: strong standpoint and you weren't intimidated by me by who
Speaker 1: I am, but also more importantly by my personality. You
Speaker 1: you know, you have just as bigger for personality as
Speaker 1: I do. So we were able to really mesh on
Speaker 1: that level. And I know that for me personally, I
Speaker 1: kind of felt like, oh, I think that this is
Speaker 1: somebody who is going to really be thoughtful with my care,
Speaker 1: which was incredibly important to me. And he understands that
Speaker 1: there's nothing more integral than me tackling this and getting better.
Speaker 1: And you insisted that I come in like right away.
Speaker 1: You were like, Okay, let's get started. I think we've
Speaker 1: met on like a Friday or Saturday night and you're like, great,
Speaker 1: we're getting you into the clinic on Monday. You were like,
Speaker 1: let's go.
Speaker 2: Yeah. Well, you know, you you had there are a
Speaker 2: lot of things going on in your situation that we
Speaker 2: knew that we needed a change, and I wanted to
Speaker 2: get changed right away because time was of the essence
Speaker 2: for many reasons, not the least of which was you know,
Speaker 2: there were delays and diagnosis, and then you'd been on
Speaker 2: a form of therapy that didn't seem to be really
Speaker 2: you know, anything getting the job done the way, and
Speaker 2: you had a lot of side effects from it. So yeah,
Speaker 2: I wanted to get started right away. And you know,
Speaker 2: I said earlier that you know, sort of who I
Speaker 2: choose to treat is guided in part by how important
Speaker 2: the relationship is. And that is the most important thing,
Speaker 2: because you know, everyone deserves world class self care and
Speaker 2: that's required, but not sufficient. Everyone requires also a world
Speaker 2: class patient experience because if you get even if you
Speaker 2: get great care, if you get PTSD trying to get
Speaker 2: the care, then the coalit of your life is not
Speaker 2: good at all. And so that there are a lot
Speaker 2: of things which affect that process, the patient experience. But
Speaker 2: a big part of it is the doctor patient relationship.
Speaker 2: And that's kind of a hackney term, you know, it
Speaker 2: sounds so especially in our case, it sounds so like
Speaker 2: official and a doctor patient relationship, but it is a
Speaker 2: very important thing and it's about, you know, it's about
Speaker 2: the patient believing that you're going to do everything for them,
Speaker 2: that you're going to think about their case thoughtfully and
Speaker 2: importantly individually. You're going to think about their individual case,
Speaker 2: not just you know, what category you fit into you're
Speaker 2: fit into this stage and this disease and third line
Speaker 2: treatment or whatever, but actually your individual case and what
Speaker 2: are the nuances for for example, we've chosen things at
Speaker 2: times that you know, we're guided by efficacy against the cancer,
Speaker 2: but also by whether it makes you lose hair or not,
Speaker 2: because that sounds like super trivial hair versus cancer, but
Speaker 2: it's not at all, because hair affects your view of yourself,
Speaker 2: and your view your self effects your engagement with the
Speaker 2: treatment and how much you believe in the treatment. It
Speaker 2: affects one's ability to work in some cases. You work
Speaker 2: in a business where you can't work much if you
Speaker 2: look like you're sick. And so there's like so many
Speaker 2: things that come into the factor of individualizing the treatment
Speaker 2: or other side effects that you're willing to have or
Speaker 2: not willing to have, not necessarily because they are visible
Speaker 2: to other people, like hair, but they're important to you personally,
Speaker 2: whoever the patient is. And some people can tolerate certain
Speaker 2: kinds of side effects like they're charging to a war,
Speaker 2: and other people are just completely debilitated by those side effects.
Speaker 2: I don't think that most people realize that patients do
Speaker 2: make choices almost as much by side effects as by efficacy,
Speaker 2: not as much. I mean, there's always more power given
Speaker 2: to efficacy as there should be, but it's a pretty
Speaker 2: close balance because you know, especially in these days where
Speaker 2: fortunately we have lots of treatments that if they can't
Speaker 2: make you go into omission completely, they can keep you
Speaker 2: in our mission for a long period of time with
Speaker 2: a low level of cancer, and then there's going to
Speaker 2: be another thing after that and another thing after that.
Speaker 2: So it's a long journey. And if you are having
Speaker 2: side effects that are just intolerable to you all through
Speaker 2: that journey, then it's a long journey of miserable life.
Speaker 2: And what people's goal is and of course should be,
Speaker 2: and what the doctor's goal should be for you is
Speaker 2: a lot if it's not curable, then a long journey
Speaker 2: of the highest quality life.
Speaker 1: Yeah, I mean, I think quality of life is so
Speaker 1: incredibly important because if your quality of life on a protocol,
Speaker 1: on a treatment is very poor, then you definitely fall
Speaker 1: into a depression, and that depression leads you to kind
Speaker 1: of give up. And I you know, I know there's
Speaker 1: no like science behind my particular kind of thinking that
Speaker 1: you know, med speak for themselves and everything else. But
Speaker 1: I do believe that mind over matters incredibly important. I
Speaker 1: believe in the power of the brain and power of suggestion.
Speaker 1: So if you're feeling really good, if you're in a
Speaker 1: good place, and you're believing in your protocol and you're
Speaker 1: okay with it and it's not totally working your quality
Speaker 1: of life, then you're going to feel all sorts of
Speaker 1: positive energy towards that protocol, which I think ends up
Speaker 1: making the protocol work a little bit better. That's just
Speaker 1: been my experience thus far on the protocols i've been on. Again,
Speaker 1: I know that there's zero science behind that.
Speaker 2: Well, certainly, certainly, you know, there's lots of hormones and
Speaker 2: signals that are released by the brain that you know
Speaker 2: translate into a sense of well being, And if you
Speaker 2: have a sense of well being on a treatment, you
Speaker 2: know it may go better. I mean, in the case
Speaker 2: of breast cancer, for example, there are studies that show
Speaker 2: that you know, if you exercise during chemotherapy, that the
Speaker 2: actual outcome of the chemotherapy may be better. The outcome
Speaker 2: on the tumor may actually be better. So I think that,
Speaker 2: as you know, indirect evidence that doing things with your
Speaker 2: body or your mind may influence the milieu of your
Speaker 2: body while you're getting the chemotherapy and change the outcome.
Speaker 2: So I think what you say is you know, is
Speaker 2: completely correct.
Speaker 1: So we I came into you know, your office on Monday,
Speaker 1: and you had taken the weekend to access, you know,
Speaker 1: all of my medical records, you know, with my authorisation obviously,
Speaker 1: but so that you were completely on top of like
Speaker 1: where I was at. Can you explain, because I don't
Speaker 1: think a lot of people know, particularly with breast cancer,
Speaker 1: like the her positive the her negative, But what is
Speaker 1: the difference between that? People always ask me what I am,
Speaker 1: and I'm like, I kind of don't remember.
Speaker 2: Well, you're a technically a strodener receptor positive progestion receptor
Speaker 2: positive and her too negative. But it's a bit of
Speaker 2: a complicated technicality, but there's the initial way that you
Speaker 2: do that her testing and her is is one of
Speaker 2: the genes that can be expressed in breast cancer, and
Speaker 2: it's actually a target for treatments, some treatments that are
Speaker 2: very very successful at helping in breast cancer, though it's
Speaker 2: expression in the breast cancer can be associated with a
Speaker 2: less good outcome. And you are her too negative, which
Speaker 2: you know is a good prognostic indicator. But the way
Speaker 2: that that test is initially done, it's done in kind
Speaker 2: of a qualitative way. So they test the cells for
Speaker 2: that expression, and you get sort of a one plus
Speaker 2: or two plus or three plus, and a certain cutoff
Speaker 2: of the pluses is considered negative in a certain kind
Speaker 2: of positive. But if you're equivocal, meaning meaning that you're
Speaker 2: in sort of a mid range, then we do a
Speaker 2: more refined test, which is a quantitative test, and it's
Speaker 2: a very accurate quantitative test. So you were in the
Speaker 2: equivocal range, but when we then did the more complicated tests,
Speaker 2: you were negative. So we're happy about that because you
Speaker 2: know it's a better prognostics sign. However, fast forward many
Speaker 2: years later in your treatment, when you're in that equivocal zone,
Speaker 2: it's called HER too expressor, so you're expressing it even
Speaker 2: though you're not technically positive. You're expressing it at a
Speaker 2: low level. And so right when we were needing to
Speaker 2: have another novel therapy in your case, a paper came
Speaker 2: out that shows that patients who are HER two expressors
Speaker 2: respond to one of the newer monocline line of body
Speaker 2: drug conjugates that targets her too, and these people actually
Speaker 2: respond well to it. So the fact that we had
Speaker 2: all that data and we remember that data and we
Speaker 2: access that data when we were having again to think
Speaker 2: novelly and individually about you, because there were reasons why
Speaker 2: going back onto chemotherapy wouldn't have been ideal at this
Speaker 2: particular juncture, so we chose an antibody drug conjugate. Unfortunately
Speaker 2: data had come out just in time. And you know,
Speaker 2: that's something I've talked with you a lot about and
Speaker 2: other people that you know, we know together, that I've treated.
Speaker 2: You know, it's sort of in the beginning of my career,
Speaker 2: we were all focused on you sort of pretty much
Speaker 2: either cure something or you kind of limp along with it.
Speaker 2: But there isn't a long period of being along with it,
Speaker 2: you know, back in the day. Now there are so
Speaker 2: many treatments that and since we've been able to sequence
Speaker 2: the human genome and since we've you know, really unleashed
Speaker 2: a lot of or unlocked the line of the secrets
Speaker 2: that allow us unleash immunotherapy, which is the body's immune system,
Speaker 2: you know, being repped up to fight the cancer. Now,
Speaker 2: there are many different chapters to what we can do.
Speaker 2: And so early on, if you achieved a partial remission
Speaker 2: and we're limping along, it may not have affected your
Speaker 2: overall survival even though you were in remission because because
Speaker 2: it might not last that long. But now, if you
Speaker 2: can achieve a partial remission that lasts for a decent
Speaker 2: amount of time, in that time, developments are so fast
Speaker 2: that something new may show up that might then give
Speaker 2: you a much longer, more meaningful remission. So I always
Speaker 2: say that, you know, it's important to think of each
Speaker 2: therapy as a horse. And you want to ride in
Speaker 2: a horse race, So you want to ride every horse
Speaker 2: as long as it rides, and then you ride the
Speaker 2: next horse as much as possible. When you hope by
Speaker 2: the time you make a few laps, you know there's
Speaker 2: altogether another set of horses to ride, you know, to
Speaker 2: make the race that much longer.
Speaker 1: Somebody was asking me today and they were like, wow,
Speaker 1: you know, like stage four breast cancer says like five years.
Speaker 1: It's like, yeah, but that's like old data that you
Speaker 1: have found on the internet, and things are different. I mean, yes,
Speaker 1: there are people that have only survived five years. You know.
Speaker 1: I think my best friend Dub was one of those.
Speaker 1: But there are so many different things right now, and
Speaker 1: you and I always talk about the fact that, like
Speaker 1: we just need to squeeze out another three to five
Speaker 1: years and then there's going to be you know, T
Speaker 1: cell therapy, or there's gonna be this, or there's going
Speaker 1: to be that, like whatever it is, there's going to
Speaker 1: be a lot more options that will give another five years.
Speaker 1: Then in those five years, there's a whole other, you know,
Speaker 1: group of options, and then eventually there's going to be
Speaker 1: a cure. So I always look at it as I'm
Speaker 1: I'm the horse analogy is a really good one, Like
Speaker 1: I'm constantly chasing I'm riding those horses so that I
Speaker 1: get to the fresh set of horses, and I'm trying
Speaker 1: to get the one that I'm on right now to
Speaker 1: like last for as long as humanly im possible.
Speaker 2: And that's why I like that analogy, because when you're
Speaker 2: the one riding the horse, which is the much more
Speaker 2: difficult job than the one picking the horse, it gets
Speaker 2: exhausting at times, but then you think, well, okay, this
Speaker 2: is still working, right, Yeah, this is hard, but it's
Speaker 2: still working, and we don't want to abandon that because
Speaker 2: if we abandon it too early that one decision could
Speaker 2: foreshorten a lot of other things, and then your timing
Speaker 2: can be just exactly off for the introduction of new therapies,
Speaker 2: like the fact that our timing was so fortunate of
Speaker 2: you know, of finding this study about the Hurtwo expressors
Speaker 2: and being able to put you on that.
Speaker 1: Right which the funny, I mean, the funny story behind
Speaker 1: this is that I kind of bunt my head after
Speaker 1: Ristmas party that I threw and I called you and
Speaker 1: was like, and it was right after New Year's or
Speaker 1: whatever when I called you and I was like, hey,
Speaker 1: you know, over the holidays, I kind of hit my
Speaker 1: head pretty badly, and I know that it was bleeding.
Speaker 1: What do you think. I'm probably fine, right, Like, I
Speaker 1: didn't die in my sleep, so I'm okay. And you're like, no,
Speaker 1: you need to come in for a CT scan like
Speaker 1: pronto and I did, and we found, you know, mets,
Speaker 1: and I guess we can call Bob a tumor.
Speaker 2: He was a tumor, yeah, I mean, And that, interestingly
Speaker 2: is my bigger concern with the way the trauma you had.
Speaker 2: You know, there's something called a subdural humanitoma that is
Speaker 2: a chronic slow oozing of blood that can present with
Speaker 2: symptoms coming you know, a week or ten days after
Speaker 2: the initial trauma. And some very famous people have died
Speaker 2: with that sort of thing and if you don't evacuate
Speaker 2: that blood quickly, and since you were having some symptoms
Speaker 2: a little bit still at that time, that's what I
Speaker 2: was concerned about, more so than a tumor in some ways,
Speaker 2: because you know, you weren't exhibiting any signs which I mean,
Speaker 2: you weren't having paralyzed and anything. You weren't having seizures.
Speaker 2: You know, you were you know, dizzy, and I'm not
Speaker 2: I'm not even still sure, you know, given the you know,
Speaker 2: relatively small size of those things, of whether they were
Speaker 2: definitely causing symptoms.
Speaker 1: Or not right, because what ended up happening is we
Speaker 1: found some mets and we found one that was larger
Speaker 1: than the others, and Dutch Piro said, you need to go, like,
Speaker 1: get this. We're going to go get it removed immediately,
Speaker 1: mainly because I want to, you know, study it, and
Speaker 1: I want the pathology on it, and I want to
Speaker 1: see is this is this breast cancer that's moved into
Speaker 1: Like I need to know specifically the cancer that's there
Speaker 1: that we're dealing with, so I know how to treat
Speaker 1: it properly. And I think like six days later, I
Speaker 1: was at Cedars. I'm getting my head cut open, and
Speaker 1: a you know tumor that's Bob. By the way, I
Speaker 1: named him Bob, no offense to any Bob's. He just
Speaker 1: seemed like a Bob to me. You know, we got
Speaker 1: almost all of him and the rest we handled with
Speaker 1: brain radiation well.
Speaker 2: And the reason why it was so important to study
Speaker 2: the tissue is that sometimes after you've had treatments for
Speaker 2: long periods of time, the tumor's morph in their expressions,
Speaker 2: so it may not have been expressing the same set
Speaker 2: of determinants and markers that the original one had. But secondly,
Speaker 2: and somewhat more importantly, chemotherapy does not penetrate well into
Speaker 2: the brain, right.
Speaker 1: Because there's a blood brain barrier that it's got.
Speaker 2: To break through to sanctuary. And it's intended it's intended
Speaker 2: to leologically because there are toxins. Chemotherapy is a form
Speaker 2: of toxin, right, and their toxins all over in nature, right.
Speaker 2: I mean the drug, the chemotherapy drug vin Christine comes
Speaker 2: from it's a vinca alkaloid. It comes from the vinca plant,
Speaker 2: which is a ground common groundcover. So if you were
Speaker 2: back in your rooting days, when you were rooting around
Speaker 2: in the four.
Speaker 1: It's actually just looking at that by the way plant
Speaker 1: because it's also drought tolerant. If I and I was
Speaker 1: quite attractive, Yeah, it's very attractive. I was looking at
Speaker 1: it for my driveway.
Speaker 2: So if you were like rooting around in nature and
Speaker 2: you were chewing on the vinca plant, you would be
Speaker 2: getting some of the you know, sort of precursor molecule
Speaker 2: of vin christine or the exact one. And so you
Speaker 2: don't want that in your brain because your brains, your
Speaker 2: you know, your central computers and operating zone. We don't
Speaker 2: want toxins in there. So the blood brain barrier has
Speaker 2: pumps that pump those things out, so it can't it
Speaker 2: can't get there. And so as a result, however, therefore,
Speaker 2: when we treat with chemotherapy, sometimes it doesn't penetrate, you know,
Speaker 2: into the brain, and so there are other therapies that
Speaker 2: do and certain chemos will penetrate into the into the brain.
Speaker 2: And so again this is the whole individualizing of the
Speaker 2: therapy thing. We need to choose something. I wanted to
Speaker 2: see if the expressions of the tumor in your body
Speaker 2: and the expressions of the tumoring the brain were the
Speaker 2: same or not, And make sure that whatever we treated
Speaker 2: you within your body would also treat the brain at
Speaker 2: the same time, if possible. Even though we were giving
Speaker 2: we removed the one and we were giving radiations the brain.
Speaker 2: We don't want to treat the whole brain because that
Speaker 2: has too much bad effect on normal brain tissue and
Speaker 2: so and so we want only to treat those few spots.
Speaker 2: And we didn't want any other brain tumors developed, if possible,
Speaker 2: So we really wanted something to penetrate and bathe the brain,
Speaker 2: you know, in that treatment. And therefore, if there were
Speaker 2: seeds of cells that were ultimately destined to create other
Speaker 2: brain tumor, spots of brain tumor, we would kill them
Speaker 2: by using that treatment, and then they would manifest as
Speaker 2: another spot of metastatic breast cancer.
Speaker 1: Right, But we also need did a treatment that didn't
Speaker 1: just take care of the brain mets. We needed the
Speaker 1: whole body. Like everything else that was going on. My
Speaker 1: breast cancer was spread into my bones, so it was
Speaker 1: very important that be kept under control. And we found
Speaker 1: it when we did the pathology on Bob the tumor.
Speaker 1: What was the difference of that pathology that allowed me
Speaker 1: to be okay for this sort of new treatment that
Speaker 1: he was talking about a second ago, that the papers
Speaker 1: had just come out about it being a good alternative
Speaker 1: for something like I was.
Speaker 2: It was also expressing her too. It was not her
Speaker 2: too positive. It was in that expressor zone. It was
Speaker 2: in that low level zone that this paper showed patients
Speaker 2: respond to. And that was, you know, made me very
Speaker 2: happy because we could treat both the body and the
Speaker 2: brain with that, and this drug antibody conjugate penetrates into
Speaker 2: the brain. So it is a perfect particularly good choice
Speaker 2: and that has proved not only was that a reasonable
Speaker 2: theory by which to choose a treatment, but that's proven
Speaker 2: out to be a good result for you as we've had,
Speaker 2: as we know, with some recent scans that let's just say,
Speaker 2: it made us very happy.
Speaker 1: Made us very happy, yeah, which I think is really
Speaker 1: interesting because you know, we scanned me quite often once
Speaker 1: I went on this other treatment. You know, it didn't
Speaker 1: it didn't really look like it was performing that well,
Speaker 1: and I think it was after the fifth treatment that
Speaker 1: you and I had a conversation about it, and the
Speaker 1: conversation was maybe we should move to a different treatment,
Speaker 1: and we sort of both sat with it and took
Speaker 1: our time to think about it reconnected, and you know,
Speaker 1: I think I started by saying I want to give
Speaker 1: it more time, and you really sort of went back
Speaker 1: and did research and then called me and said, actually,
Speaker 1: I ordered a very specific test for you to get done,
Speaker 1: which was for your tumor markers. And it's not something
Speaker 1: that you get done every single month with your blood work.
Speaker 1: It's specific that you have to order and I ordered it,
Speaker 1: and your tumor markers were you know, they're cut in
Speaker 1: half basically, so we know that it's working. And you said, so,
Speaker 1: I feel comfortable with you staying on this as long
Speaker 1: as you agree to get MRIs a little bit more
Speaker 1: often because you wanted to stay on top of it.
Speaker 1: And then after my seventh treatment, you came into my
Speaker 1: infusion room and you were I mean, you came in
Speaker 1: You're like, yes, you were, you know, you were I
Speaker 1: don't want to say more excited than me, but you
Speaker 1: were equally as joyous as me.
Speaker 2: And I almost never do that. And the reason I
Speaker 2: almost never do that isn't because I'm not joyous. It's
Speaker 2: because I fear if I do that, then every subsequent
Speaker 2: time we have scans, if I don't walk in that way,
Speaker 2: people will read and patients will read into it that
Speaker 2: I'm really not joyous, and then they'll think whatever I'm saying,
Speaker 2: you know that I really secretly, you know, upset because
Speaker 2: we didn't get better results or something like that, you know,
Speaker 2: And yeah, and that such an important part. We accidentally
Speaker 2: tripped onto a zone of conversation. It's so important. It's
Speaker 2: really so important as a doctor to realize that people
Speaker 2: are watching every single move you make and every single world.
Speaker 1: So it's your eyebrot. So I'm like, what does that
Speaker 1: mean exactly? But you and I have sort of we
Speaker 1: have established the way of doing things because your clinic,
Speaker 1: the Angelus Clinic in Los Angeles, is it's extraordinary in
Speaker 1: the sense that you can go in, you can go
Speaker 1: get a PET scan, you can go get an MRI,
Speaker 1: you can go get a CT scan. And whereas traditionally
Speaker 1: I know people that have had to wait ten days
Speaker 1: for their results, at your clinic, you get the results
Speaker 1: the same day. And most of your patients, you know,
Speaker 1: wait for their scans. They wait there and then they
Speaker 1: have an appointment with you or one of the other
Speaker 1: doctors like whatever, and they get their results in person
Speaker 1: the same day. And I chose to do it very
Speaker 1: differently from the beginning with you, where I said I
Speaker 1: don't want you, I don't want to know my results
Speaker 1: in person. I let me go home and call me
Speaker 1: with my results at whatever time works for you throughout
Speaker 1: the day, whenever you have a moment, whenever you have
Speaker 1: a break, whenever you know you're not seeing a patient,
Speaker 1: if it's at night, doesn't really matter to me when
Speaker 1: because I didn't want to monitor my reaction for you,
Speaker 1: or for the nurse practitioner, or for anybody that was
Speaker 1: in the room with me, for my mom, like whoever
Speaker 1: it was, right I whatever you told me, good or bad.
Speaker 1: I wanted to be alone so that I could have
Speaker 1: an authentic, like true reaction for myself and not try
Speaker 1: to put on a like game face for everyone. Because
Speaker 1: there's nothing worse than getting bad news face to face,
Speaker 1: and you feel like you have to make the person
Speaker 1: giving you the bad news feel good. And I'm that person.
Speaker 1: It feels like it's my responsibility to make sure everybody
Speaker 1: is okay.
Speaker 2: You're the first person in my entire career whoever wanted
Speaker 2: that format. No, No, it totally works, and it makes
Speaker 2: subtle sense. And to be honest with you, which probably
Speaker 2: you know is part of the underpinning of the closeness
Speaker 2: of our friendship through all these many years, is that
Speaker 2: I realize that I'm probably the same way like I
Speaker 2: would probably you know, be the other person who had
Speaker 2: wanted that way, because I realized that, you know, when
Speaker 2: I hear something, whatever it is, I want to process
Speaker 2: it personally to figure out how I feel about it
Speaker 2: before I want to tell somebody else. Because the minute
Speaker 2: you tell someone else whatever, if it's good news, you've
Speaker 2: got a new job, you know, if it's bad news, whatever,
Speaker 2: people are going to learn out their response. And it's
Speaker 2: hard to hear other people's reaction, especially we're talking about
Speaker 2: cancer and cancer results and all that when you're not
Speaker 2: yet sure what your response is, because therefore you have
Speaker 2: no defense or no ability to reformat their misguided reaction
Speaker 2: to it. And often often the people in one's lives
Speaker 2: have misguided reactions to data they don't you know, they're
Speaker 2: getting bits and parts pieces of your story, and they
Speaker 2: can be very misguided. And it's very hard to unhear something. Yeah,
Speaker 2: and that is an underappreciated axiom. It's very hard to
Speaker 2: unhear things. And if there's anything that in this conversation
Speaker 2: we're having that people who are listening who are caregivers
Speaker 2: or loved ones or people friends, people in the lives
Speaker 2: of people who are going through the cancer journey, is
Speaker 2: be very careful what you say because they can't unhear
Speaker 2: what you say. There's such a desire of well meaning
Speaker 2: people who care about someone to establish to you that
Speaker 2: they understand what you're going through by saying, oh, well, yes,
Speaker 2: you know, my sister had breast cancer too, or my
Speaker 2: so and so had breast cancer too. Unfortunately, it often
Speaker 2: leads most people when they're telling the story, don't think
Speaker 2: about the punchline and whether the punch yeah, and they say, yeah,
Speaker 2: well what happened to your sister? Says the patient, and
Speaker 2: they said, well, yeah, she died three years ago, and like,
Speaker 2: oh my right, I mean, and no one does that intentionally,
Speaker 2: but it's mortifying because if you don't think about where
Speaker 2: the story ends up before you choose to tell it
Speaker 2: to this particular person. It's you know, it doesn't.
Speaker 1: Help that one all the time, all the time. And
Speaker 1: you know, I know that the people are very you know,
Speaker 1: well intentioned. It's like a way of connecting with me
Speaker 1: and of saying, I know what you're going through, and
Speaker 1: you know, I really like they always follow it up
Speaker 1: with like I so admire, like you're journey, but it
Speaker 1: is always sort of my mom, my grandmother, my sister,
Speaker 1: my friend, they died, and I'm always like what do
Speaker 1: I do with that information? It's a hard one. It
Speaker 1: was I was being interviewed today and the woman interviewing
Speaker 1: me her father is a doctor, and so I guess
Speaker 1: she spoke to him about, you know, more in general
Speaker 1: terms of like stage four you know, cancer, like I
Speaker 1: have her knowledge of what I have and gave that
Speaker 1: to her dad, and she kept on using the word
Speaker 1: like terminal and like, you know, there is no cure,
Speaker 1: like this is really bad, and I just I kind
Speaker 1: of was like, based on what because your dad may
Speaker 1: be a doctor, but he doesn't know my particular cancer.
Speaker 1: He doesn't know where my tumor markers is. There are
Speaker 1: so many things. But also I just kind of sat
Speaker 1: there like huh, Like I don't know what you're getting at,
Speaker 1: Like what do you are you looking for me to
Speaker 1: break down and in this conversation because it's on camera
Speaker 1: and that's going to be a great moment for you guys.
Speaker 1: Like I couldn't figure out what the endgame was, except
Speaker 1: that I think she was truly concerned and truly you know,
Speaker 1: tried to come in with knowledge, but probably got fed
Speaker 1: a bunch of stuff that perhaps she shouldn't have repeated
Speaker 1: because I think I think it's very dangerous for other
Speaker 1: people to have the conversation about your cancer besides your doctor.
Speaker 1: I think it is an extremely dangerous conversation.
Speaker 2: Well, I always tell patients at the first diagnosis, I
Speaker 2: say to them that they should tell all of their
Speaker 2: friends who are going to wonder what they're supposed to
Speaker 2: talk about with you. And they think, well, if I
Speaker 2: don't talk about the cancer, they'll think that I'm afraid
Speaker 2: in ignoring it. And if I do talk about the cancer,
Speaker 2: then I might not say the right things. So they
Speaker 2: don't know what to do. But they usually talk about
Speaker 2: the cancer. They're call it how are you, How are
Speaker 2: you doing? Are you okay? Do you need anything? Whatever?
Speaker 2: All of which sounds nice, right, But if these are
Speaker 2: the people who you talked about dropping your kids off
Speaker 2: to school, and you know how the drop offline, you
Speaker 2: know they should manage it better at the school, and
Speaker 2: you know you want to meet to play, you know,
Speaker 2: pick a ball, And I want to have a dinner
Speaker 2: party this weekend. You know, do you want to come?
Speaker 2: And what should we cook? Right instead? There? How are you?
Speaker 2: Are you okay? Do you need anything?
Speaker 1: Like?
Speaker 2: It's just you become not normal, you become a cancer person. Yeah,
Speaker 2: and you don't want to be a cancer person. So
Speaker 2: I tell everyone, Tell your friends to talk about with
Speaker 2: you everything that they always used to talk with you about,
Speaker 2: and don't talk about cancer. And here's the clue. When
Speaker 2: you want to talk about cancer, you'll tell them you'll
Speaker 2: bring it up, and then then go for it. Then
Speaker 2: I'm bringing it up, but I'm guiding you as to
Speaker 2: what why I want to talk about? Do I want
Speaker 2: to talk about how I'm feeling emotionally? Do I want
Speaker 2: to talk about how sad that my personal life has
Speaker 2: been influenced by cancer and this unfortunate thing my personal
Speaker 2: life happened, or wheneverbody just take the lead and focus
Speaker 2: on what they want to talk about. Don't put your
Speaker 2: own stuff into it. And it's complicated, right because people
Speaker 2: are not therapists and they're not aware of cancer and
Speaker 2: they don't have the medical stuff. But this is so
Speaker 2: important to the quality of life of a person with
Speaker 2: cancer because when people are always making you a cancer person,
Speaker 2: it just it attracts from your quality of life and
Speaker 2: it changes yourself image of yourself, like I'm a cancer
Speaker 2: person now, you know.
Speaker 1: And then you start feeling sick.
Speaker 2: Yeah, it feeds the beast, it really does.
Speaker 1: Versus I mean, I don't have many people that I
Speaker 1: talk to cancer about. Like for me, I talk to
Speaker 1: you about cancer because I think you're qualified to talk
Speaker 1: to me about cancer. And everybody else where you getting
Speaker 1: your information from, if it's from the internet, I literally
Speaker 1: no desire to hear one word that comes from the internet,
Speaker 1: not just about cancer, but pretty much about everything at
Speaker 1: this point, but particularly about cancer. And so I want
Speaker 1: to I want to speak to people that are, you know,
Speaker 1: leading the charge in research. I want to. I want honesty.
Speaker 1: I want, you know, hope where there's hope. I want
Speaker 1: someone to be pragmatic where it's called for, Like, but
Speaker 1: I don't want information that can't be verified or backed up.
Speaker 1: And I also don't want to be a cancer person.
Speaker 1: I want to you know, And I've often done some
Speaker 1: very stupid, stupid things since being diagnosed because of my
Speaker 1: desire to be normal, because I've like rejected the idea
Speaker 1: that I'm a cancer in quote patient, Like, i have
Speaker 1: cancer and I'm managing it. I'm managing it with you,
Speaker 1: and I'm managing it with you know, doctor Ju and
Speaker 1: like whoever else we need to bring in to help
Speaker 1: in those moments. But I don't want it to define
Speaker 1: my everyday life.
Speaker 2: Well so much so that you know, And we've always kept,
Speaker 2: which I think is a super healthy and amazing way
Speaker 2: to do it. We've always kept our lane separate. Yeah,
Speaker 2: so when we're together as social aized friends, it's a
Speaker 2: friend lane. When we're doing medical self to medical lane,
Speaker 2: and you know, every once in a while those things
Speaker 2: have to cross over, but it's extremely rare. And you,
Speaker 2: for example, will never ask me anything medical when we're
Speaker 2: doing something social, or if you have to, you'll say, look,
Speaker 2: I'm really sorry for asking this right now when we're
Speaker 2: having dinner, but just blah blah blah blah. It's some
Speaker 2: little knit or whatever that you have to do.
Speaker 1: I've been to dinners with you. I've seen your phone.
Speaker 1: I mean I haven't seen it, but like i've seen it.
Speaker 1: How many you know you were inundated twenty four hours
Speaker 1: a day, days a week. You do not get a
Speaker 1: day off of you know, medical questions, and your patients
Speaker 1: have your cell phone, and you know you've given full
Speaker 1: access to yourself. So when I'm able to steal you
Speaker 1: away and we go to dinner somewhere, I don't want
Speaker 1: to do that. Like, if I have a question for you,
Speaker 1: I'll text you during business hours or I'll come into
Speaker 1: the clinic and I'll ask you. You know, we just
Speaker 1: went to Italy together. You invited me on this amazing
Speaker 1: yacht and with your family, and I got to go
Speaker 1: to Italy with you, which was like bucket list. By
Speaker 1: the way, you knew it was on my bucket list,
Speaker 1: And when you called me, you said, like, it's kind
Speaker 1: of bucket list, Shan, And I was like, I was
Speaker 1: so excited.
Speaker 2: We had the best time, such.
Speaker 1: A good time, what an amazing went, an amazing trip.
Speaker 2: We made some amazing restaurant.
Speaker 1: So yeah, I wish i'd coordinated my outfits better with you.
Speaker 1: But now I know what to expect.
Speaker 2: And she was is you know. I mean, it's just incredible,
Speaker 2: like jumping off of every level of the yacht, even
Speaker 2: the highest of like Shannon is fearless. I mean, she
Speaker 2: truly is.
Speaker 1: I did injure myself.
Speaker 2: Well I know you did, but I was going to
Speaker 2: skip over that. It wasn't It wasn't jumping off the boat, however,
Speaker 2: it was.
Speaker 1: I mean that's the crazy thing, Like you jump off
Speaker 1: like the highest points of this ginormous yacht and you
Speaker 1: go to climb back on, and I got scared of
Speaker 1: the of the jellyfish, so I went the long way.
Speaker 2: That was at night, I think, yeah.
Speaker 1: And the dangerous way, and that's when I gave myself
Speaker 1: that that big bump on my leg.
Speaker 2: And that was really crazy too, because since it was night,
Speaker 2: the crew had the bright light shining onto the sea,
Speaker 2: and all of a sudden we can see all these
Speaker 2: jellyfish floating around in there. That's, of course we never
Speaker 2: saw during the day, and it was like, oh, did
Speaker 2: she really just jump in there?
Speaker 1: Yeah, because they didn't see them when I did the jump.
Speaker 1: It's like jumping in a shark infested waters like I
Speaker 1: never would have done it had I known. But then
Speaker 1: once I was swimming around, I was like, whoa, that's nuts.
Speaker 1: I'm going to go the long way.
Speaker 2: You know, Southern Italy is number for seafood.
Speaker 1: I don't know.
Speaker 2: In this case, you were the seafood.
Speaker 1: I was seafood.
Speaker 2: Wow.
Speaker 1: Yeah, I mean we sort of did it fast forward
Speaker 1: because I was going back to us meeting and you
Speaker 1: sort of taking over my protocol and instantly saying, listen,
Speaker 1: you gotta go get surgery, like that's the first thing.
Speaker 2: Are you surprised that we did a fast forward. Yeah.
Speaker 2: We always start down a road and shortly turned down
Speaker 2: a lane.
Speaker 1: Unpredictable is the word that you use to start with,
Speaker 1: and that still matches and.
Speaker 2: There it goes, and that's the magic at all.
Speaker 1: So you said you got to get the tumor out
Speaker 1: of your breast, like, let's like, that's the first thing.
Speaker 1: And then once that's done, you're going to go on chemo,
Speaker 1: You're going to get radiation, and we did. We did
Speaker 1: all of that, and I made the decision at some
Speaker 1: point to not take tomoxifen, which is you know, obviously
Speaker 1: a drug that everybody recommends that you take because it
Speaker 1: is a hormone blocker.
Speaker 2: And it was adgivant therapy, meaning that you had no
Speaker 2: known cancer and it was being given. It would be
Speaker 2: given to increase the chances that cancer not come back
Speaker 2: by staying in your system and blocking the cell's ability
Speaker 2: to grow. Estringe is a growth factor for cancer cells,
Speaker 2: So tomoxism would block the estrogen to the cancer cell,
Speaker 2: and hopefully any microscopic disease that maybe have been in
Speaker 2: your body that's too small to show up on imaging
Speaker 2: and that we didn't know about that maybe it would
Speaker 2: kill that and increased the odds that it wouldn't come back.
Speaker 2: That was the principle of adgement therapy of demoxmin.
Speaker 1: Which is a you know, solid argument, Like I look
Speaker 1: back and I go, well, maybe how to do that?
Speaker 1: Taking it? You know? I mean, I've had some people
Speaker 1: in my life have sort of forced me to look
Speaker 1: back like that, But I can't, right, because what good
Speaker 1: is it? It doesn't do you.
Speaker 2: You make the best decision you can at the time
Speaker 2: you make it, and in retrospect you often cannot remember
Speaker 2: many of the factors that were influencing you. So when
Speaker 2: you look back, you have an erroneous evaluation of your decision.
Speaker 2: But at the time, you had been on estrogen blockade
Speaker 2: before you ever had surgery, and it wasn't very effective
Speaker 2: on shrinking your tumor, and you had a lot of
Speaker 2: effects on your body that you didn't like. So those
Speaker 2: two factors were influencing you to not choose to take
Speaker 2: that drug at that time. And you were disease free,
Speaker 2: and the balance of things to you at the time
Speaker 2: seemed reasonable. And you did not make that lightly, and
Speaker 2: you made it over and over again because I asked
Speaker 2: you every single time for a year, are you sure
Speaker 2: you don't want to do this? Issue? You want to
Speaker 2: do this? So you were. You were resolute in your decision,
Speaker 2: and you can't judge that decision, and no one else
Speaker 2: can force you to because you made the best decision
Speaker 2: you could at the time. And it's a it's an
Speaker 2: erroneous set of analyzes when you look backwards.
Speaker 1: Yeah, I mean, I also think that I was fairly
Speaker 1: certain it wasn't going to come back, because I believed
Speaker 1: that the reason why I got cancer was because I
Speaker 1: did IVF right. I met my husband at the time.
Speaker 1: Later in years and you know, a multitude of things happen.
Speaker 1: And so when it was time to have that decision,
Speaker 1: we chose to have we needed IVF, and I did
Speaker 1: a bunch of rounds of it, and I i, you know,
Speaker 1: through a lot of other women that I knew that
Speaker 1: did IVF that ended up getting breast cancer as well.
Speaker 1: Sort of the numbers all started stacking up in my
Speaker 1: head that if you know, you sort of have a
Speaker 1: cell that's a little wonky and that's sitting on the
Speaker 1: edge of maybe turning spreading cancer, blah blah blah, that
Speaker 1: the all the hormones that you're pumping into your body
Speaker 1: from IVF are only going to up that chance of it.
Speaker 1: That was at least my thinking. So when I got
Speaker 1: the you know, you're all clear remission after chemo and
Speaker 1: all of that, I knew I wasn't doing IVF anymore
Speaker 1: because I was already a menopause, so like there was
Speaker 1: no need for it. I was pretty sure, you know,
Speaker 1: I don't want to say that I made a very
Speaker 1: uninformed decision, Like I am a researcher. I'm hardcore about
Speaker 1: you know, backing up some of my data, certainly not
Speaker 1: at your level and certainly not at doctor's levels, and
Speaker 1: researchers levels. So my decision was at the time based
Speaker 1: on sort of the facts that I knew that I
Speaker 1: had investigated, and you, in fact, did keep on encouraging
Speaker 1: me to take the demoxifin, and I was just like,
Speaker 1: absolutely not.
Speaker 2: You're a resolute yeah, but also yes, you did research things.
Speaker 2: But also there was another factor in there, which is,
Speaker 2: even though you know, anyone who's sort of close to
Speaker 2: menopause often goes into menopause with chemotherapy, sometimes people who
Speaker 2: are not close to menopause go into it as well,
Speaker 2: but then it sometimes returns, menstruation can return, and you
Speaker 2: were still hopeful that it might return for you because
Speaker 2: you still want.
Speaker 1: To have a baby, yeah, desperately.
Speaker 2: And I think that played a role in the demoxpin thing, which,
Speaker 2: you know, people at this stage where you're at doesn't
Speaker 2: seem like a factor, but that was a factor at
Speaker 2: the time, this sort of hopefulness that maybe you could
Speaker 2: still have a baby.
Speaker 1: Yeah. Yeah, I mean, thank you for reminding me of that,
Speaker 1: because it did definitely play a huge role of you know,
Speaker 1: wanting not only not only did I want a child
Speaker 1: for myself, but I wanted it, you know, for my husband.
Speaker 1: I wanted it for our marriage. I wanted, you know,
Speaker 1: I wanted him to have that part of him self
Speaker 1: fulfilled as well. So it seemed like a calculated risk
Speaker 1: that wasn't too bad of one to take. Plus I
Speaker 1: can't remember, you'll correct me. I think it's cervical cancer.
Speaker 1: That there's a percentage of demoxifensity to increase. You'ine cancer,
Speaker 1: thank you, And I was like, well, you know, that
Speaker 1: just gave me one more reason to say no to it,
Speaker 1: and yeah, and you're right, and I can't look back,
Speaker 1: and so.
Speaker 2: Moving forward, I think, but I think also, don't forget
Speaker 2: that cancer and cancer treatment you know, caused you to
Speaker 2: look back at you know, your own life and to
Speaker 2: be very philosophical. You know, it made you want to
Speaker 2: have a child for another reason too, which is, you know,
Speaker 2: to be able to part you know, the very many
Speaker 2: things that you've learned in life and the many feelings
Speaker 2: that you had into raising a human being, you know,
Speaker 2: I mean, that's that's the ultimate diary, is to raise
Speaker 2: a child and try to infuse their life with all
Speaker 2: the wisdoms that you had and and helping them try
Speaker 2: to avoid the mistakes that you made and that they're
Speaker 2: going to not make some of their own of course
Speaker 2: they will, but there's a you know, you were in
Speaker 2: the spotlight since you were a young girl, and you've
Speaker 2: lived a million lives when most people, you know, we're
Speaker 2: just starting out or we're in the beginning of the careers.
Speaker 2: You've already had two or three careers, and you know
Speaker 2: fought your way, you know, in a Hollywood scene that
Speaker 2: you know didn't necessarily you know, regard what you had
Speaker 2: to say. And I mean, I've never met anybody as
Speaker 2: well educated as you who was schooled on the set.
Speaker 2: And I of course, as you know, many many people
Speaker 2: were schooled on sets. But you have a you know
Speaker 2: a level of comprehension and power of intelligence and use
Speaker 2: of that intelligence, and you know, in a very incisive
Speaker 2: way in cooking as well, for example, there are not
Speaker 2: that many people who go on to be these amazing cooks.
Speaker 2: And I mean everything you do is full tilt. That's
Speaker 2: who you are, and that's how you make your decisions.
Speaker 2: And so I actually find it very gratifying that you
Speaker 2: research things and you you know, make your definitive decision,
Speaker 2: because you see in medical decision making, people want shared
Speaker 2: decisions with the physician, which I'm all about. I mean,
Speaker 2: I'm all about that. I love that, as you know
Speaker 2: and as all my patients know. But part and parcel
Speaker 2: of shared decision making is accepting responsibility for the decision.
Speaker 2: And you always do that. Sometimes people want share decision making,
Speaker 2: and if it's not the right decision, then they want
Speaker 2: to look to everyone else for you know, why the
Speaker 2: wrong decision was made or whatever. But when you when
Speaker 2: you're a person who really owns it, and like all
Speaker 2: my patients do, but you are the you know, the
Speaker 2: prime example of that of someone who you know, wants
Speaker 2: to part, to stay in process, wants to know the data,
Speaker 2: and once you make your decision, you own responsibility for
Speaker 2: your decision. And I love that because that's that's just
Speaker 2: the being a person of truth.
Speaker 1: Accountability I love nothing. Accountability is like my favorite thing.
Speaker 1: So if I made a decision that put me in
Speaker 1: a certain place, then I hold myself accountable like you
Speaker 1: have to.
Speaker 2: I've seen that over and over and over again, and
Speaker 2: everything you've said and done and even in stories we've
Speaker 2: talked about about your career, Yes, and certain decisions that
Speaker 2: you've made in response to things that happened or this
Speaker 2: or that you've you know, you've always accepted responsibility for
Speaker 2: those and you know, the thing is that even when
Speaker 2: when things happened that weren't your responsibility, you will describe it,
Speaker 2: but you're also not You've never been finger pointing of people.
Speaker 2: Say that person did that.
Speaker 1: That's a new thing.
Speaker 2: As that person did that, you'll say what they did,
Speaker 2: but you'll also understand the other factors that we're bearing
Speaker 2: on the scenario. Yeah, and I've always respected.
Speaker 1: That for the most part. I think every you know,
Speaker 1: there's always the exception to the rule where I point
Speaker 1: the finger and go, you're bearing the full brunt of
Speaker 1: this one because this is all on you.
Speaker 2: And when you do that, it's very believable because you
Speaker 2: don't do that often.
Speaker 1: Doctor piro LP. Thank you so much for being on.
Speaker 1: There is so much more for us to talk about.
Speaker 1: So I'm going to have you on for another episode
Speaker 1: and just keep digging and keep exploring because I just
Speaker 1: I think you have so much to offer and this
Speaker 1: conversation is incredibly important to a lot of people. So
Speaker 1: thank you very much and I love you end Yeah,
Speaker 1: see you soon.