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Speaker 1: This is Let's Be Clear with Shannon Doherty. Hi everyone,

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Speaker 1: I'm back with a new episode of Let's Be Clear

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Speaker 1: with Shannon Doherty. As I have mentioned before, it's important

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Speaker 1: for me to use this podcast platform to connect with

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Speaker 1: the cancer community in a very personal and honest way.

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Speaker 1: And what better way to do that than to hear

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Speaker 1: from the experts who are caring for me and can

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Speaker 1: speak to this complicated disease with experience and knowledge. Today,

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Speaker 1: I'm really happy to welcome one of those experts, my friend,

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Speaker 1: doctor Amin Marhati from Cedar SINAI. Welcome, Hey Shannon, Hi Doc,

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Speaker 1: good to see you now. I said your last name correctly, right, Yes.

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Speaker 2: You did, Mahi Marhati HAUGHTI.

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Speaker 1: So, can you tell us a little your radiation on collegist?

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Speaker 2: Yes?

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Speaker 1: And I think a lot of people don't necessarily know

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Speaker 1: the difference between you know, a regular on collegeist, a

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Speaker 1: radiation on colleges, a cardiologists on collegists. There's so many

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Speaker 1: different subcategories. Can you explain like your specific job?

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Speaker 2: Definitely, So when someone is diagnosed with cancer, I mean

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Speaker 2: there's obviously the work up to cancer, which would involve

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Speaker 2: like a radiologist, a pathologist. Sometimes like a surgeon to

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Speaker 2: do a biopsy. But then when someone has a diagnosis

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Speaker 2: of cancer, there's a there's three main specialties that sort

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Speaker 2: of are involved in the treatment of that. The main

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Speaker 2: one is a medical oncologist. That's what doctor Lawrence Piro

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Speaker 2: is my fav Love that guy, and he's a wonderful

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Speaker 2: medical oncologist that's taken care of you for many years.

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Speaker 2: And he they sort of work as the quarterback. But

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Speaker 2: then another full specialty is radiation oncology, and so I'm

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Speaker 2: involved more on the treatment side. You know, He's involved

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Speaker 2: more in kind of the management and restaging and ordering

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Speaker 2: the tests and labs and things like that. But my

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Speaker 2: role is the majority of cancer's breast, lung, colon, et

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Speaker 2: cetera involves some form of radiation therapy, especially when it

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Speaker 2: spreads to the brain or you know, bone, things like that.

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Speaker 2: What we do is we are experts in utilizing focused

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Speaker 2: radiation and delivering it properly to tumors and trying to

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Speaker 2: minimize the damage around it. So that's what my role

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Speaker 2: is as a radiation on collogs, which is different than

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Speaker 2: a radiologist who interprets images.

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Speaker 1: Okay, so you mentioned focused radiation. I met you because

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Speaker 1: I had mets in my brain. I don't remember, was

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Speaker 1: it like five or six?

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Speaker 2: Yeah, well it was initially six and then three more

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Speaker 2: and so we did pinpoint radiation on all of this.

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Speaker 2: One of them was surgically removed so we can get tissue,

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Speaker 2: and we rated that just before doctor Chu got the

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Speaker 2: tumor out. And we did that mainly does this sort

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Speaker 2: of get the tissue and do more analysis and more

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Speaker 2: kind of testing to see if there's anything further we

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Speaker 2: can learn about your tumor. But then we did pinpoint

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Speaker 2: radiation to the rest and that's a procedure called radio surgery.

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Speaker 2: So the reason they call that radio surgery is because

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Speaker 2: this is delivery all the radiation in one shot. Radiation

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Speaker 2: when it hits your tissue, if you give a little

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Speaker 2: bit of radiation, it causes a little bit of damage

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Speaker 2: to the DNA of the tumor cells, and the tumor

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Speaker 2: cells will then gradually die off. If you're treating like

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Speaker 2: a large area, you do little bits at a time,

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Speaker 2: like over twenty five thirty sessions which you had, you know,

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Speaker 2: to your chest well, and that's when you're treating a

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Speaker 2: large area, you have to give the normal tissue a

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Speaker 2: chance to heal itself and fix itself. So you do

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Speaker 2: little bits of radiation at a time when it's to

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Speaker 2: larger areas, but when you're trying to treat it like

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Speaker 2: a distinct tumor, you do all of it at once.

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Speaker 2: You sort of condense that radiation because then you're using

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Speaker 2: radiation to just obliterate everything in its path. So that

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Speaker 2: what you had had to your brain was radio surgery,

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Speaker 2: and that what you had had to your chestwall and

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Speaker 2: then subsequently your rib was what's called fractioning radiation, meaning

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Speaker 2: chopped up into several small fractions.

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Speaker 1: Gotcha. So in my case, I'm hoping that people who

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Speaker 1: are listening saw my Instagram where I posted the bit

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Speaker 1: of getting fitted for you know, the mask which I

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Speaker 1: then took home was going to wear for Halloween, but

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Speaker 1: I didn't go out for Halloween. Plus a little scary

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Speaker 1: to put that mask back on. And we did that

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Speaker 1: so that the mask holds goes over your head, holds

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Speaker 1: everything in place. You guys, lock me in so that

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Speaker 1: there's minimal movement.

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Speaker 2: Yes, that it's an amazing process. Well for you. If

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Speaker 2: you recall, we did a mapping session where we made

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Speaker 2: the mask and then got a quick scan and then

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Speaker 2: there was like ten days of doing calculations and planning.

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Speaker 2: When you came back for the treatment, each treatment was like,

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Speaker 2: you know, ten minutes or so, right, it was quick,

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Speaker 2: and so patients they kind of get up and they like, oh,

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Speaker 2: that's it, right, but they don't realize, you know, what's

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Speaker 2: under the hook, so to speak. It's like there is

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Speaker 2: a team of people that you know. It starts with

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Speaker 2: me the radiation on colleges, I see you, I determine

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Speaker 2: what I want to treat, how much I want to treat,

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Speaker 2: et cetera. We go through the planning process and we

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Speaker 2: have a team of physicist who all have PhDs and

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Speaker 2: medical physics that are behind the scenes calibrating the machine,

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Speaker 2: doing calculations, and these are the kind of things that

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Speaker 2: patients don't always see what's going on behind the scene.

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Speaker 2: And this is where where Cedars Sinai excels because they

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Speaker 2: don't cut any corners on when it comes to like

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Speaker 2: the physics team or the quality of the equipment and

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Speaker 2: doing the quality checks and making sure everything is as

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Speaker 2: precise as it should be. And then the end result

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Speaker 2: is you lying there and getting a tumors out and

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Speaker 2: then going home.

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Speaker 1: Right, you make it sound really easy, just lying there

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Speaker 1: just like that. But yeahs as a person who is

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Speaker 1: you know, very claust tophobic, the mask and you've got

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Speaker 1: this lollipop stick that you know is in your mouth,

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Speaker 1: and the whole thing is to not move because if

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Speaker 1: you do move, if you get antsy, or if you stop,

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Speaker 1: it puts more time onto it. And I did make

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Speaker 1: it a little bit of a competition where I was like,

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Speaker 1: I want to be the one person who moves the least.

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Speaker 2: Yeah, And I was like standing there like, okay, so

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Speaker 2: someone check your pulse. And also I was wondering where

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Speaker 2: my ice cream went.

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Speaker 1: Now that's right, now I know where it was, and

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Speaker 1: then stuck that pompsicle. Yeah, it's like they all take that,

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Speaker 1: thank you. Yeah.

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Speaker 2: But you know what's interesting is the way we monitor

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Speaker 2: your movement because the machine is delivering radiation, we don't

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Speaker 2: want you to like kind of jerk this way or

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Speaker 2: you know, we use this optical surface tracking where it's

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Speaker 2: a device that basically monitors your motion within less than

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Speaker 2: a millimeter, so if you move a little bit, it

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Speaker 2: has its feedback loop to the treatment machine, where you know,

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Speaker 2: it just shuts down instantaneously, so like if you're out

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Speaker 2: of position, we get you back into position before we

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Speaker 2: deliver this very high dose of precise radiation. You know,

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Speaker 2: I mean you're an actress, right, you get multiple takes.

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Speaker 2: Sometimes we only get one.

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Speaker 1: Take, right, Yeah, you guys have to do it perfect

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Speaker 1: first time, which is a lot of pressure. It's a

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Speaker 1: lot of pressure, and you know you're again there's the

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Speaker 1: whole teams. It's a huge amount of work that in

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Speaker 1: treating literally just one person.

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Speaker 2: And that's what a lot of people don't realize. You know,

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Speaker 2: there are so many people involved in just delivering that

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Speaker 2: one Just take one of the little numors retreating you know,

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Speaker 2: you just kind of see you know, like Ty and Marty,

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Speaker 2: like the texts at the end, and then like you know,

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Speaker 2: the sim therapist, you see me, and then there's a

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Speaker 2: whole slew of other people and everyone has to be

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Speaker 2: one hundred percent precise all the time. And then we

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Speaker 2: have to do that day in and day out for hundreds,

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Speaker 2: if not thousands. I've treated over four thousand women with

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Speaker 2: breast cancer in my career, and like, imagine that kind

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Speaker 2: of pressure, like try to be precise, but we have

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Speaker 2: so many checks and balances in place. We have such

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Speaker 2: a high quality physics department, things like that, and it's

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Speaker 2: really teamwork at its finest.

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Speaker 1: Yeah, it's one of the things that I really love

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Speaker 1: about Sedars. And that's not to say there aren't other

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Speaker 1: amazing hospitals, but Sedars you really understand that everybody who

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Speaker 1: works there, the entire team, oh, has been thoroughly checked out, vetted.

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Speaker 1: They follow certain protocols that you're sort of getting the

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Speaker 1: absolute best of the best. Yeah, and you can go

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Speaker 1: in feeling pretty confident because radiation can be a very

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Speaker 1: scary thing, especially when it's to your brain. Of course, Oh, absolutely,

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Speaker 1: Like I was petrified of you know. It's not of you, No,

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Speaker 1: you made me feel very confident, but of you know,

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Speaker 1: is it going to change who I am? Like that?

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Speaker 1: That was, as you know, a big concern of mine,

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Speaker 1: not just with you, but with brain surgery with doctor

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Speaker 1: Chwo of are you going to zap something? Is it

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Speaker 1: going to change who I am? Am? I not going

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Speaker 1: to think as quickly, and particularly with the surgery, there

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Speaker 1: was that concern as well. Of course, doctor Chuo ignored

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Speaker 1: me when I asked him to like touch the part

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Speaker 1: of the brain that made me speak eight fluent languages.

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Speaker 1: He ignored me and didn't do it. Shame on you,

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Speaker 1: doctor Chu. One thing I asked of you. Yeah, I

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Speaker 1: mean it is a very scary thing. And you do

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Speaker 1: all sorts of radiation for all sorts of different cancers.

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Speaker 2: Correct, Yeah, more or less, mostly breast and lung sort of,

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Speaker 2: particularly because those two spread to the brain a lot.

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Speaker 1: I have a question because this is I've actually been

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Speaker 1: wondering this for myself. Is there a certain amount of

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Speaker 1: times that you can do the pinpoint radiation? Like is

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Speaker 1: there a certain number and then it's up and then

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Speaker 1: you have to do overall brain radiation.

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Speaker 2: It's a great question. It's a topic of evolving debate.

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Speaker 2: We live in an era fortunately where you know, women

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Speaker 2: with breast cancer in particular are living a lot longer

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Speaker 2: because of all these wonderful therapies. And in the old

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Speaker 2: days they didn't have that much success, so they would

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Speaker 2: just sort of go crazy with like whole brain radiation

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Speaker 2: and cause a lot of side effects. But the thinking

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Speaker 2: has shifted now to being more pinpoint and precise. And

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Speaker 2: to answer your question, is there a number like meteors

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Speaker 2: like you've had nine total? The answer to that question

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Speaker 2: is how big are they? Like if you had like

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Speaker 2: ten of them that were like thirty milimeters each. In

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Speaker 2: my difficult and yours fortunately have all been very small,

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Speaker 2: so we can sort of keep going without causing problems.

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Speaker 2: And I've you know, in the past, there have been

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Speaker 2: times where I've had to do one that was like

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Speaker 2: close to the other, I ran into some problem, you know,

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Speaker 2: like it would cause some degree of side effects. But

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Speaker 2: having many small ones is the best case scenario because

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Speaker 2: then you can sort of keep going and have less

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Speaker 2: side effects, so to speak.

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Speaker 1: So what size becomes not small?

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Speaker 2: Oh? Good question. So for single shot radio surgery, when

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Speaker 2: you're delivering all the radiation at once, that's the most

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Speaker 2: intense treatment, that's the most effective, but it also could

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Speaker 2: potentially have the most side effects if you're doing a

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Speaker 2: big area is roughly three centimeters thirty millimeters. When you

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Speaker 2: get into a fifty centimeter tumor like I did this

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Speaker 2: morning before I came here, then you have to take

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Speaker 2: that one dose of radiation and chop it out into like,

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Speaker 2: let's say, five sessions, and if it gets it's even bigger,

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Speaker 2: and then you have to include a lot of your

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Speaker 2: normal brain in the treatment field. Then it's like up

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Speaker 2: to thirty sessions, and it's less effect. When you do

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Speaker 2: thirty sessions, you're delivering more radiation to a larger area,

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Speaker 2: but you're doing it in a way that allows the

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Speaker 2: normal brain to sort of safely regenerate itself, and but

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Speaker 2: you know, not perfectly, but enough so that you can

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Speaker 2: get away with doing that treatment, right, So smaller, the

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Speaker 2: fewer treatments you get, the more effective and the safer.

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Speaker 1: Okay, let's say you know, I had these five or

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Speaker 1: six and then mets and we did however many treatments

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Speaker 1: we did, and then those mets come back and the

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Speaker 1: drugs aren't working, and I have to have pinpoint radiation again,

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Speaker 1: and then the same thing happens in three months. I

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Speaker 1: have to come back, and you know, you just keep

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Speaker 1: on that cycle. As long as they're small, you can

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Speaker 1: just keep doing the absolutely.

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Speaker 2: Yeah, and it would be in your particular case. And

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Speaker 2: this is this is what something good educationally for people

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Speaker 2: who might be listening the routine staging, the getting the

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Speaker 2: brain EMRI every three four months. You know, getting the

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Speaker 2: pet CT and catching things relatively early makes all the difference.

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Speaker 2: Because I can't tell you how many times I've had

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Speaker 2: patients who had one or two treated and they're like, oh,

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Speaker 2: let's go to you know, Barbados or something. I just

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Speaker 2: disappear off the grid. They come back two years later

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Speaker 2: and they have one that's like a little bit bigger.

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Speaker 2: Then I have to send him a doctor chew and

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Speaker 2: then he tells them about the language thing, and it

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Speaker 2: becomes a whole big mess.

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Speaker 1: You know. Is no, I'm not not going to let

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Speaker 1: you speak multiple languages so easily.

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Speaker 2: But I think it's But that's the the advantage that

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Speaker 2: people in let's call it Western medicine. When you live

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Speaker 2: in a metropolitan area like LA and have access to

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Speaker 2: wonderful doctors like doctor Piro and wonderful imaging centers where

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Speaker 2: you can get your scans in relatively quick fashion, you

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Speaker 2: can stay on top of it. And and that's a

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Speaker 2: thing like patients who are motivated about, you know, their health,

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Speaker 2: they're motivated about you know, quote unquote beating cans so

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Speaker 2: to speak. They're the ones that are just they listen

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Speaker 2: to their doctors, they're on top of things. They do

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Speaker 2: their restage and says, they do their blood work when

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Speaker 2: they're supposed to, you know, and and sometimes even in

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Speaker 2: cases like that it might not be enough. But to

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Speaker 2: give yourself and other patients the best fighting chance, just

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Speaker 2: you just have to kind of follow the routine, you know.

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Speaker 1: Yeah, I mean, I think what's unfortunate is that not

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Speaker 1: every insurance company support scans every three months, you know, Like, yeah,

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Speaker 1: I know that. It was tricky for me in the

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Speaker 1: beginning as well, and it becomes easier. This is what's

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Speaker 1: really sad, is it becomes a lot easier to get

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Speaker 1: it every three months the worst you are. So once

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Speaker 1: you're enter stage four, they're like, oh, okay, yeah, you

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Speaker 1: might need a scan every three months, but you kind

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Speaker 1: of want it before then. Like even every six months

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Speaker 1: is a much healthier, you know, way as opposed to

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Speaker 1: the once a year. So a few things I'm going

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Speaker 1: to have to work on in the future advocating for.

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Speaker 1: I mean, it is a good thing for us to

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Speaker 1: just remind all of you guys listening to press your

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Speaker 1: doctor too, because if you're feeling anything weird, if you've

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Speaker 1: got headaches and you have cancer or anything just really

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Speaker 1: really you can request. You can say I think there's

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Speaker 1: something going on and I need an MRI, I need

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Speaker 1: whatever it is. Your pet scans and do go in

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Speaker 1: for your blood test because those it's amazing how much

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Speaker 1: your blood tells you, Like I didn't even know, oh yeah,

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Speaker 1: really how much my blood was telling my doctors about me.

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Speaker 2: You know, Sit tight, because I would say in the

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Speaker 2: next few years, there's going to be even more tests

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Speaker 2: that analyze your blood and look for circulating tumor cells

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Speaker 2: and circulating tumor DNA and things like that. Genetic testing

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Speaker 2: is going to have a more profound component. We're at

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Speaker 2: sort of an inflection point in cancer care where we're

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Speaker 2: going to be less reliant on imaging and like MRIs

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Speaker 2: and cat skins and petskins, and more reliant on blood

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Speaker 2: work and genetic testing and molecular testing to understand what

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Speaker 2: direction things are going. The technology is there, like, you know,

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Speaker 2: there's this one test that was developed out of Cleveland

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Speaker 2: Clinic called the Gallery test, where it's like a blood

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Speaker 2: test that tells you if your tumor is proliferating or not,

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Speaker 2: you know, And it's relatively in a fledgling state, but

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Speaker 2: the science is developing, the data is accumulating. You now

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Speaker 2: have artificial intelligence that's helping you analyze this information. And

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Speaker 2: I think we're moving towards a new frontier. You know,

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Speaker 2: everyone likes to say that in cancer care, like everything,

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Speaker 2: every new drug or whatever, it is a new frontier, right,

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Speaker 2: but nothing really has been until now. I think this

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Speaker 2: way to analyze your blood and your DNA and your

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Speaker 2: molecular profile, it's really going to take off in the

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Speaker 2: next few years.

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Speaker 1: I mean, that's really exciting to hear. And you mentioned

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Speaker 1: Cleveland Clinic and I just read a whole release from

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Speaker 1: them recently about their clinical trial that's currently happening on

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Speaker 1: breast cancer vaccine, and I found that to be absolutely

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Speaker 1: fascinating that finally there might be a vaccine for breast

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Speaker 1: cancer and that it can apparently work on people who

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Speaker 1: have you know, had it, are in remission, get the

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Speaker 1: vaccine and it's possibly you know, obviously a lot more

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Speaker 1: clinical trial has to be done in order to determine

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Speaker 1: what all it can do. But I agree with you,

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Speaker 1: it's a very exciting time. And although I always say

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Speaker 1: I can't believe the cancer has been around for what

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Speaker 1: a hundred years and there's not a cure yet, there's

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Speaker 1: not a vaccine, there's nothing.

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Speaker 2: I'm going to give you my take on what you

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Speaker 2: just said, I know that there's a lot of information

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Speaker 2: online and a lot of people are like, oh, you know,

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Speaker 2: they're trying to withhold the here. You know, like the

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Speaker 2: people think that the industry is trying really not to

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Speaker 2: find that. That's actually not true. I think that the

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Speaker 2: person you don't think that either, But there's a lot

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Speaker 2: of people who just sort of look superficially online and

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Speaker 2: get some information. Here is why it's really hard to

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Speaker 2: find a cure for most types of cancers. The reason

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Speaker 2: is because you have a tumor that formed. You know,

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Speaker 2: what is a tumor exactly, it's a portion of your breast.

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Speaker 2: You know, a portion within the duct of your breast

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Speaker 2: developed an abnormality as it was growing. You know, your

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Speaker 2: ducks replenish themselves and they have to go through the

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Speaker 2: process of cell division to make more cells and more

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Speaker 2: ducts and more lobules and things like that. Somewhere along

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Speaker 2: the way, due to X, Y and Z factors. No

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Speaker 2: one knows exactly there was a mutation in the DNA

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Speaker 2: of your tumor cell. Now, the human cell in general,

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Speaker 2: it's like, if you think about it, it's built to survive.

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Speaker 2: That's why humans have made it so long. Evolutionarily, you

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Speaker 2: have a cell that is just constantly dividing and growing

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Speaker 2: and growing. So you have to think of the human

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Speaker 2: cell as having its footstuck on the accelerator, so it

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Speaker 2: doesn't want to stop growing. So every cell in our

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Speaker 2: body inherently could be a cancer cell. It just doesn't

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Speaker 2: want to stop growing. But we have these big breaks

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Speaker 2: that are sitting on top of it as well. I'm oversimplifying,

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Speaker 2: of course, but when you get a mutation and the

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Speaker 2: big proteins that sit on top of it, the break,

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Speaker 2: so to speak, then cells kind of grow unchecked. But

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Speaker 2: then what happens is, Okay, you might find the ability

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Speaker 2: to treat one type of mutation, but tumor cells go

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Speaker 2: through evolution, they evolve, and then you might get a

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Speaker 2: drug like inher To or percepted or something that might

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Speaker 2: knock out ninety nine point ninety nine percent of your

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Speaker 2: tumor cells and be an effective therapy, but it's that

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Speaker 2: point oh oh one percent that might be behind that's

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Speaker 2: resistant to that particular therapy, and then that grows and

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Speaker 2: you have to find a different treatment. And people can

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Speaker 2: only tolerate certain types of treatment, certain amounts, and so

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Speaker 2: in my opinion, the best way to address that is

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Speaker 2: catching it as early as possible because over time, these

364
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Speaker 2: cells go through you know, evolution at a lightening pace

365
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Speaker 2: and they become resistant. They have this biology where they

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Speaker 2: become resistant to treatment.

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Speaker 1: You know, thank you, because that's a brilliant way of

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Speaker 1: explaining it in a way that someone like me who

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Speaker 1: does not have a medical degree, although on occasion I

370
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Speaker 1: like to pretend I do for me to understand, because

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Speaker 1: when you really break it down to how you did,

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Speaker 1: of course, you know the cell is constantly mutating and

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Speaker 1: growing and changing and becoming something different. So finding a

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Speaker 1: cure that also can adjust to that mutation is incredibly hard.

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Speaker 1: I mean, I would imagine it's like you could find

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Speaker 1: one thing that would cure it under this particular condition,

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Speaker 1: but then it's already mutated, so then that doesn't even work.

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Speaker 1: It's much like the protocols that we're on, right. So

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Speaker 1: I've actually had protocols that have last me I think

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00:20:00,680 --> 00:20:03,919
Speaker 1: a pretty good amount of time, all things considered, But

381
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Speaker 1: eventually my body stopped it. Maybe the cells mutated whatever

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Speaker 1: they change, where that particular pill was no longer impacting it.

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Speaker 2: If I recall it's mina while since I looked at

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Speaker 2: your char but when you were originally.

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Speaker 1: You don't look at it every day.

386
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Speaker 2: Just sometimes I'm just like, gee.

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Speaker 1: My favor, it's not true. You guys.

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Speaker 2: You no. I look, I look at the tumor treated,

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Speaker 2: and I'm like.

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Speaker 1: Yeah, I got it. You know, you took care of Bob.

391
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Speaker 2: We can start Navy by Bob, by Bob. When you

392
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Speaker 2: were initially diagnosed, I recall your tumor was estrogen receptor

393
00:20:43,720 --> 00:20:47,800
Speaker 2: positive and her too negative. Now to the viewers and

394
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Speaker 2: people who are diagnosed with breast cancer, they hear that

395
00:20:50,760 --> 00:20:53,919
Speaker 2: and they're like, I mean, there's many layers to what

396
00:20:53,960 --> 00:20:58,320
Speaker 2: that could mean. In the most simplistic way, esergen receptor

397
00:20:58,359 --> 00:21:02,760
Speaker 2: positive means that your particular breast cancer was expressing estrogen receptors,

398
00:21:02,840 --> 00:21:07,359
Speaker 2: meaning to some degree estrogen was fueling your tumor growth.

399
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Speaker 2: Then the her too, which is a gene that they

400
00:21:10,600 --> 00:21:13,280
Speaker 2: you know that's involved in breast cancer treatment and diagnosis

401
00:21:13,280 --> 00:21:18,160
Speaker 2: and stuff, yours did not express the hurto receptor pathway.

402
00:21:18,200 --> 00:21:21,480
Speaker 2: And then over time in twenty eighteen or twenty or

403
00:21:21,520 --> 00:21:25,000
Speaker 2: something like that, when your tumor involved, it eventually did,

404
00:21:25,760 --> 00:21:28,879
Speaker 2: which suggests that you were able to successfully, doctor Piro,

405
00:21:29,080 --> 00:21:32,760
Speaker 2: was to eradicate all of the tumors that you had,

406
00:21:32,760 --> 00:21:35,359
Speaker 2: there was a little bit left behind that developed its

407
00:21:35,440 --> 00:21:40,600
Speaker 2: own molecular kind of evolution and its own resistance, and

408
00:21:40,680 --> 00:21:42,680
Speaker 2: that's what started to grow. And that's what came into

409
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Speaker 2: your brain, as we confirmed when doctor Chu took out

410
00:21:45,359 --> 00:21:49,000
Speaker 2: that one spot and we looked at it. Because cancer

411
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Speaker 2: in your living, breathing example of cancer, how it evolves

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Speaker 2: and how we change our strategy to address it.

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Speaker 1: So I mean, yes, by the way, I one of

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Speaker 1: my favorite things I probably once a month, I'm going

415
00:22:05,560 --> 00:22:08,479
Speaker 1: to really sounds strange right now, is I look at

416
00:22:08,520 --> 00:22:12,119
Speaker 1: the picture of my brain opened up that doctor Chru

417
00:22:12,280 --> 00:22:15,600
Speaker 1: said to me. I he actually printed it out and

418
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Speaker 1: gave it to me because he knows I'm like a

419
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Speaker 1: weird nerd that way. And I look at it and

420
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Speaker 1: I actually, when I got done with brain surgery and

421
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Speaker 1: I got home, I showed it to as many people

422
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Speaker 1: as I possibly could, and some were horrified by it

423
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Speaker 1: and some enjoyed it like I do. But I mean,

424
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Speaker 1: I just think it's it's it's to me, it's so

425
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Speaker 1: fascinating that you know radiation works the way that it does,

426
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Speaker 1: and it's you hear the word radiation, right, and you

427
00:22:41,600 --> 00:22:43,480
Speaker 1: think of like noble, you think of like all these

428
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Speaker 1: crazy things. So you get very, very very scared of radiation.

429
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Speaker 1: But because you're doing pinpoint, and you with me and

430
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Speaker 1: with all your patients, you were very careful. You didn't

431
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Speaker 1: you didn't laugh at me or sort of ignore the

432
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Speaker 1: fact that I was concerned about having more bald spots

433
00:23:04,400 --> 00:23:07,200
Speaker 1: and patches and that radiation can cause the hair loss.

434
00:23:07,480 --> 00:23:11,239
Speaker 1: You were equally as concerned, at least in front of

435
00:23:11,280 --> 00:23:15,000
Speaker 1: me about Listen, I'm going to get every little met

436
00:23:15,040 --> 00:23:20,080
Speaker 1: that I can, and I will do it trying to

437
00:23:20,280 --> 00:23:23,359
Speaker 1: not get your hair at the same time, like I

438
00:23:23,880 --> 00:23:26,320
Speaker 1: hear you, I respect the fact that you really want

439
00:23:26,400 --> 00:23:30,359
Speaker 1: to keep your hair. Thank you. It's a weird, but

440
00:23:30,760 --> 00:23:32,000
Speaker 1: it's growing underneath this.

441
00:23:32,040 --> 00:23:33,960
Speaker 2: By the way, I totally so you are going to

442
00:23:34,000 --> 00:23:35,840
Speaker 2: grow a third ear? Is that okay? I hope that

443
00:23:35,840 --> 00:23:39,040
Speaker 2: doesn't bother you. It's a third ear? Just back here.

444
00:23:39,160 --> 00:23:43,480
Speaker 1: Can I hear thousands of feet away, because I'll take.

445
00:23:43,320 --> 00:23:46,199
Speaker 2: It you bring up. I do want to make a

446
00:23:46,200 --> 00:23:48,000
Speaker 2: comment about what you just said, because you and I

447
00:23:48,240 --> 00:23:50,159
Speaker 2: we had dialogue. Of course, I told you about what

448
00:23:50,240 --> 00:23:54,320
Speaker 2: to expect what we're doing. One of the big disconnects

449
00:23:54,320 --> 00:23:57,840
Speaker 2: and healthcare in general, from doctor to patient, just patients

450
00:23:57,920 --> 00:24:01,639
Speaker 2: trying to navigate the healthcare system is there's too much information.

451
00:24:01,720 --> 00:24:04,720
Speaker 2: And one thing that in my eighteen years at SED

452
00:24:04,920 --> 00:24:07,720
Speaker 2: Sinai and my training at UCLA before that, one thing

453
00:24:07,800 --> 00:24:12,280
Speaker 2: I've always always made important to me is patients nodding

454
00:24:12,359 --> 00:24:14,639
Speaker 2: their head at you and sounding like they understand what

455
00:24:14,680 --> 00:24:18,520
Speaker 2: you're talking about. They almost never do, and it's really important,

456
00:24:18,760 --> 00:24:21,200
Speaker 2: you know, I have these you know, we just hired

457
00:24:21,200 --> 00:24:23,960
Speaker 2: like three or four young doctors who are physician scientists,

458
00:24:23,960 --> 00:24:27,639
Speaker 2: and they're absolutely brilliant. They are like like one smarter

459
00:24:27,760 --> 00:24:29,520
Speaker 2: than the next. I'm like, wow, you guys are like,

460
00:24:29,760 --> 00:24:32,160
Speaker 2: you know, it's a new era of just like smart

461
00:24:32,160 --> 00:24:35,720
Speaker 2: people to go into medicine. And you know, as young

462
00:24:35,800 --> 00:24:39,199
Speaker 2: doctors in particular, they feel compelled and this is not

463
00:24:39,320 --> 00:24:41,479
Speaker 2: right around this is actually probably more right than anything

464
00:24:41,880 --> 00:24:45,760
Speaker 2: to give you all the information. It's almost like a

465
00:24:45,840 --> 00:24:48,760
Speaker 2: checklist where they have to just kind of explain everything.

466
00:24:48,760 --> 00:24:51,320
Speaker 2: And what I've noticed is I started out doing that

467
00:24:51,359 --> 00:24:54,159
Speaker 2: in my career as well, until I realized that it

468
00:24:54,200 --> 00:24:57,479
Speaker 2: became detrimental to a patient. Until like The core of

469
00:24:57,560 --> 00:24:59,760
Speaker 2: what I wanted to convey to them to help them

470
00:24:59,800 --> 00:25:03,520
Speaker 2: make a decision was at the very last of a

471
00:25:03,600 --> 00:25:06,680
Speaker 2: two hour clinic visit where they were poked and prodded

472
00:25:06,680 --> 00:25:08,919
Speaker 2: by nurses and had an memory done. It was the

473
00:25:08,960 --> 00:25:10,560
Speaker 2: last two seconds where I was like, Oh, by the way,

474
00:25:10,560 --> 00:25:12,560
Speaker 2: it might do this and that, you know. And I

475
00:25:13,040 --> 00:25:15,560
Speaker 2: have been as I've gotten further into my career, I

476
00:25:15,600 --> 00:25:18,399
Speaker 2: have focused more on simplifying it. I don't know if

477
00:25:18,400 --> 00:25:21,840
Speaker 2: you ever saw that movie with Denzel Washington was called Philadelphia.

478
00:25:21,880 --> 00:25:23,800
Speaker 2: He was like a lawyer with Tom Hanks or something. Yeah,

479
00:25:23,840 --> 00:25:26,159
Speaker 2: and he goes. He kept saying, explain it to me

480
00:25:26,200 --> 00:25:27,600
Speaker 2: like I'm a six year old, or explain it to

481
00:25:27,600 --> 00:25:29,560
Speaker 2: me like I'm a ten year old. And that line

482
00:25:29,600 --> 00:25:32,800
Speaker 2: always resonated with me because not to try to insult

483
00:25:32,800 --> 00:25:35,959
Speaker 2: the intelligence of my patients, but I do cancer all day,

484
00:25:35,960 --> 00:25:39,399
Speaker 2: every day. I know what is going on or what

485
00:25:39,480 --> 00:25:42,280
Speaker 2: to expect, but you don't, or other patients don't.

486
00:25:42,359 --> 00:25:55,440
Speaker 1: Yeah, I think it's also it's overwhelming. And you go

487
00:25:55,480 --> 00:25:58,639
Speaker 1: in there and you're already nervous because you are getting poked.

488
00:25:58,720 --> 00:26:01,360
Speaker 1: You know, you're getting your blood drawn, getting an MRI done,

489
00:26:01,520 --> 00:26:03,959
Speaker 1: You're scared because you have cancer, or you're scared because

490
00:26:04,040 --> 00:26:07,040
Speaker 1: you hear the word radiation or surgery, whatever it is.

491
00:26:07,640 --> 00:26:12,040
Speaker 1: So then if there's so much information coming at you,

492
00:26:13,640 --> 00:26:16,720
Speaker 1: I think it can drown out your own questions. And

493
00:26:17,119 --> 00:26:20,479
Speaker 1: I always encourage people to, you know, write down a

494
00:26:20,560 --> 00:26:24,480
Speaker 1: list of questions beforehand and make sure that they check

495
00:26:24,520 --> 00:26:27,000
Speaker 1: that list off, and to also not be intimidated by

496
00:26:27,000 --> 00:26:29,640
Speaker 1: the white coat, which is something I find a lot

497
00:26:29,680 --> 00:26:32,640
Speaker 1: of people are that I speak to, oh that are sick,

498
00:26:32,760 --> 00:26:34,879
Speaker 1: is that they kind of feel they don't have the

499
00:26:35,000 --> 00:26:38,800
Speaker 1: right to question the doctor or ask for special things.

500
00:26:39,000 --> 00:26:41,520
Speaker 1: And I'm always like, oh God, I wish you all

501
00:26:41,560 --> 00:26:43,920
Speaker 1: could go to my doctors, you know, because I've never

502
00:26:44,000 --> 00:26:46,480
Speaker 1: felt that way. I've always felt like I could push

503
00:26:46,560 --> 00:26:51,280
Speaker 1: back and that I could question. I could say, you know, well,

504
00:26:51,760 --> 00:26:53,320
Speaker 1: I don't want to get an aria this month. I

505
00:26:53,359 --> 00:26:55,720
Speaker 1: want to get them every three months instead, And there's

506
00:26:55,760 --> 00:26:59,040
Speaker 1: a dialogue about like why that choice is that choice?

507
00:26:59,600 --> 00:27:02,520
Speaker 2: It takes a lot of experience to get to get

508
00:27:02,520 --> 00:27:05,119
Speaker 2: to that point as as a doctor, to value that

509
00:27:05,320 --> 00:27:07,200
Speaker 2: or to you know, because you're in your head, you're

510
00:27:07,359 --> 00:27:10,760
Speaker 2: you're the expert, and you're trying to impart your areation

511
00:27:11,040 --> 00:27:14,240
Speaker 2: to everyone which comes from a good place. Obviously. Obviously,

512
00:27:14,280 --> 00:27:16,800
Speaker 2: you know, I very very rarely meet a doctor who's

513
00:27:16,840 --> 00:27:19,639
Speaker 2: just out there doing it for you know, for kicks

514
00:27:19,720 --> 00:27:21,880
Speaker 2: or to try to be famous or you know, make

515
00:27:21,960 --> 00:27:24,680
Speaker 2: money or whatever. And most of them, the vast majority

516
00:27:24,680 --> 00:27:27,080
Speaker 2: of them, really just want you to get back, you know,

517
00:27:27,119 --> 00:27:30,040
Speaker 2: they want to take care of you. But the approach

518
00:27:30,080 --> 00:27:32,800
Speaker 2: can certainly fluctuate, and it takes a lot of experience.

519
00:27:32,840 --> 00:27:35,760
Speaker 2: And that one thing I like to do is I

520
00:27:36,119 --> 00:27:39,160
Speaker 2: like to not overload my patients with unnecessary, too much

521
00:27:39,200 --> 00:27:41,480
Speaker 2: information that's not necessarily relevant. But I also like to

522
00:27:41,480 --> 00:27:44,000
Speaker 2: give them my cell phone because what I find is

523
00:27:44,040 --> 00:27:47,160
Speaker 2: that when they leave my office, there's so much anxiety,

524
00:27:47,200 --> 00:27:49,960
Speaker 2: and there's so much uncertainty, and there's so much misinformation

525
00:27:50,040 --> 00:27:53,280
Speaker 2: out there that sometimes just like a little text message

526
00:27:53,359 --> 00:27:57,160
Speaker 2: or a little you know, two second conversation can sort

527
00:27:57,200 --> 00:28:01,280
Speaker 2: of reset them a little bit and take them to

528
00:28:01,359 --> 00:28:04,399
Speaker 2: a place of like, Okay, now I got now that

529
00:28:04,440 --> 00:28:07,280
Speaker 2: little bit of information clicks to me. You know, when

530
00:28:07,320 --> 00:28:10,040
Speaker 2: I started out in my career, you know, I was

531
00:28:10,080 --> 00:28:12,560
Speaker 2: focused on my career. I got a job at Cedars,

532
00:28:12,600 --> 00:28:14,199
Speaker 2: I was stoked to work there, stoked to live in

533
00:28:14,320 --> 00:28:16,959
Speaker 2: La and whatever. And then I remember one day there

534
00:28:17,000 --> 00:28:19,679
Speaker 2: was one very poignant moment women with breast cancer who

535
00:28:19,720 --> 00:28:22,320
Speaker 2: had a brain met that I treated. I remember like

536
00:28:22,400 --> 00:28:24,720
Speaker 2: I did my whole spiel with her. I recommended this,

537
00:28:24,960 --> 00:28:27,760
Speaker 2: did that, whatever, And then you know, she went off

538
00:28:27,800 --> 00:28:29,359
Speaker 2: and I went home and I always stopped by this

539
00:28:29,520 --> 00:28:32,600
Speaker 2: Bristol farms on the way home from Cedars as I

540
00:28:32,600 --> 00:28:36,040
Speaker 2: was grabbing ie tea or whatever, and I saw her

541
00:28:36,040 --> 00:28:38,160
Speaker 2: there with her daughter. I saw her, and she didn't

542
00:28:38,160 --> 00:28:40,560
Speaker 2: see me, and she was just there having a laugh

543
00:28:40,600 --> 00:28:43,240
Speaker 2: with her daughter. They were picking something and going home

544
00:28:43,280 --> 00:28:47,160
Speaker 2: to make dinner or something. And at that instant, I

545
00:28:47,240 --> 00:28:51,440
Speaker 2: was like, Okay, my job is about giving her more

546
00:28:51,520 --> 00:28:54,440
Speaker 2: days like that, more moments like that. It's about nothing else.

547
00:28:54,680 --> 00:28:57,280
Speaker 2: It's not about me, It's not about Cedars, not about

548
00:28:57,440 --> 00:29:00,640
Speaker 2: anything other than that woman sitting there is enjoying a

549
00:29:00,800 --> 00:29:03,840
Speaker 2: day with their daughter, you know, and give her more

550
00:29:03,840 --> 00:29:07,680
Speaker 2: of those. However you can whatever, use your knowledge and expertise,

551
00:29:07,680 --> 00:29:10,880
Speaker 2: and the best way you can to maximize that and

552
00:29:10,960 --> 00:29:11,800
Speaker 2: everything else.

553
00:29:11,600 --> 00:29:14,480
Speaker 1: Is hotter Ihan, My god, that's such a beautiful way

554
00:29:14,520 --> 00:29:17,600
Speaker 1: of looking at it. As you know, you guys are yes,

555
00:29:17,640 --> 00:29:20,800
Speaker 1: you're taking care of us, but you're also giving people

556
00:29:20,840 --> 00:29:26,560
Speaker 1: more time and more precious moments. You know, when we're gone,

557
00:29:26,720 --> 00:29:30,760
Speaker 1: their children, their loved ones, their friends will be so

558
00:29:30,960 --> 00:29:35,240
Speaker 1: deeply appreciative that they got that extra that extra laugh,

559
00:29:35,360 --> 00:29:39,880
Speaker 1: that extra cry, that extra whatever it was. That's a

560
00:29:40,520 --> 00:29:41,600
Speaker 1: that's very beautiful.

561
00:29:41,640 --> 00:29:44,400
Speaker 2: You know. I coached just recently, I coached my daughter's

562
00:29:44,480 --> 00:29:46,560
Speaker 2: junior high volleyball team. You know, I just kind of

563
00:29:46,600 --> 00:29:47,920
Speaker 2: did it on the side, and it was fun. It

564
00:29:47,960 --> 00:29:50,960
Speaker 2: was great, great experience. There was one thing I kept

565
00:29:51,000 --> 00:29:52,960
Speaker 2: emphasizing with them. It was there was a it was

566
00:29:52,960 --> 00:29:55,880
Speaker 2: a quote that I saw on a Michael Jordan documentary.

567
00:29:57,520 --> 00:29:59,640
Speaker 2: It was called The Last Dance whatever is Michael Jordan's

568
00:29:59,640 --> 00:30:03,320
Speaker 2: Ten Parts documentary. But some guy talked about how Michael

569
00:30:03,360 --> 00:30:06,760
Speaker 2: Jordan wasn't the best in the world because he dribbled

570
00:30:06,760 --> 00:30:09,320
Speaker 2: better than anyone, or he shot the ball better than anyone,

571
00:30:09,440 --> 00:30:12,800
Speaker 2: or he you know, did whatever, played defense better than anyone.

572
00:30:13,440 --> 00:30:15,920
Speaker 2: He was the best there was because he was always

573
00:30:16,040 --> 00:30:19,440
Speaker 2: present in the moment. So when I was coaching these young,

574
00:30:19,520 --> 00:30:22,480
Speaker 2: you know, seventh and eighth grade girls, I was like, listen,

575
00:30:22,720 --> 00:30:24,840
Speaker 2: look around you. You know, here we are playing a

576
00:30:24,880 --> 00:30:27,240
Speaker 2: game against you know, whoever here you are in the

577
00:30:27,280 --> 00:30:29,560
Speaker 2: gym is the last time you might might be together.

578
00:30:30,360 --> 00:30:33,880
Speaker 2: Just be present in the moment, because the moment is everything.

579
00:30:33,920 --> 00:30:36,240
Speaker 2: The moment is what will stick with you. Don't think

580
00:30:36,280 --> 00:30:39,360
Speaker 2: about what's ahead of you, don't think about what's behind you.

581
00:30:39,600 --> 00:30:43,160
Speaker 2: Be present, and that, I think is what's important to

582
00:30:43,320 --> 00:30:46,080
Speaker 2: cancer patients, people who are going through it. And I

583
00:30:46,120 --> 00:30:50,400
Speaker 2: always tell I always tell people this. I I live

584
00:30:50,440 --> 00:30:53,400
Speaker 2: my life, you know, as much as I'm capable of,

585
00:30:53,520 --> 00:30:55,400
Speaker 2: as much as I'm able to to the fullest, because

586
00:30:55,760 --> 00:30:58,600
Speaker 2: I'm surrounded by people like you, by other patients who

587
00:30:59,360 --> 00:31:02,400
Speaker 2: you know, vague go through something hard. They've they've gone

588
00:31:02,440 --> 00:31:05,320
Speaker 2: to the abyss and stared at it, you know, wherever

589
00:31:05,400 --> 00:31:09,760
Speaker 2: that quote moves from, and they realize that, Okay, you

590
00:31:09,800 --> 00:31:13,440
Speaker 2: know what. You know, life is limited. It's limited for everyone,

591
00:31:13,800 --> 00:31:17,120
Speaker 2: but people like you, they realize it more, they embrace

592
00:31:17,160 --> 00:31:20,400
Speaker 2: it more. And I am fortunate enough to be surrounded

593
00:31:20,400 --> 00:31:23,080
Speaker 2: by that every single day, so that when you know,

594
00:31:23,400 --> 00:31:24,960
Speaker 2: my buddy calls me up and says, let's go to

595
00:31:25,040 --> 00:31:27,800
Speaker 2: Kansas City, you know for the Chiefs game. Sure, let's

596
00:31:27,840 --> 00:31:29,719
Speaker 2: you know, like you take advantage of every moment. You know,

597
00:31:30,120 --> 00:31:33,120
Speaker 2: someone says let's have a big fiftieth birthday party or whatever, like,

598
00:31:33,560 --> 00:31:35,360
Speaker 2: go for it. Let's just you know, go out and

599
00:31:35,440 --> 00:31:37,840
Speaker 2: have some fun, that sort of thing, because that's what

600
00:31:37,840 --> 00:31:38,640
Speaker 2: life's about. It's that.

601
00:31:39,320 --> 00:31:44,160
Speaker 1: So let's say for those people out there who are not,

602
00:31:44,560 --> 00:31:48,800
Speaker 1: you know, as fortunate as I have been to have

603
00:31:48,840 --> 00:31:52,960
Speaker 1: a doctor like you, who you know, you cared, you listened.

604
00:31:53,400 --> 00:31:55,720
Speaker 1: You didn't you know, think that I was vain for

605
00:31:55,800 --> 00:31:59,680
Speaker 1: asking about my hair. You talked me through that whole

606
00:32:00,160 --> 00:32:03,280
Speaker 1: mapping mask process. I mean you saw me. I was crying.

607
00:32:03,360 --> 00:32:06,320
Speaker 1: I was just hyperventilating. You know, you talked me through.

608
00:32:06,840 --> 00:32:08,880
Speaker 1: You were kind enough to shoot video because I asked

609
00:32:08,920 --> 00:32:12,960
Speaker 1: you to. You basically held my hand through the entire

610
00:32:13,000 --> 00:32:15,880
Speaker 1: experience and knew how to talk to me and explain

611
00:32:16,000 --> 00:32:18,480
Speaker 1: things to me. Gave me your cell phone number, allowed

612
00:32:18,520 --> 00:32:22,959
Speaker 1: me to, you know, infiltrate your private time with your

613
00:32:23,000 --> 00:32:26,320
Speaker 1: own family after hours, to answer questions that popped up

614
00:32:26,360 --> 00:32:28,959
Speaker 1: in my head, because that happens a lot. You go in,

615
00:32:29,120 --> 00:32:31,360
Speaker 1: you think that you've got your list of questions, you

616
00:32:31,400 --> 00:32:33,719
Speaker 1: get overwhelmed, you leave, and then you don't see your

617
00:32:33,760 --> 00:32:36,480
Speaker 1: doctor again until it's time for radiation or surgery or

618
00:32:36,520 --> 00:32:39,680
Speaker 1: whatever it is so the fact that you allow, you know,

619
00:32:39,720 --> 00:32:43,440
Speaker 1: your patience to text you is a you know, very

620
00:32:43,520 --> 00:32:48,760
Speaker 1: rare thing from some that I know. But for those

621
00:32:48,800 --> 00:32:53,200
Speaker 1: people that don't have a doctor like you in their life,

622
00:32:53,280 --> 00:32:56,480
Speaker 1: what would be sort of your biggest suggestion when they

623
00:32:56,560 --> 00:33:00,680
Speaker 1: go in to meet their radiation oncologists? But what are

624
00:33:00,720 --> 00:33:03,000
Speaker 1: the things that they should be asking about? What are

625
00:33:03,040 --> 00:33:04,600
Speaker 1: the things that they should be looking for? And I

626
00:33:04,640 --> 00:33:08,560
Speaker 1: know that that answer changes does constantly because it's you know,

627
00:33:08,600 --> 00:33:10,160
Speaker 1: what kind of a cancer are you dealing with? How

628
00:33:10,200 --> 00:33:12,120
Speaker 1: big are the mets where? You know, is it in

629
00:33:12,160 --> 00:33:15,040
Speaker 1: your brain? Is it in your lungs? Like is it

630
00:33:15,080 --> 00:33:17,440
Speaker 1: in your breast? For you, it's a it's a hard one,

631
00:33:17,480 --> 00:33:19,280
Speaker 1: but I'm going to impress it. I'm going to ask it.

632
00:33:19,400 --> 00:33:23,880
Speaker 2: So specifically about women who have you know, breast cancer,

633
00:33:24,000 --> 00:33:28,920
Speaker 2: any cancer that spread to the brain. The most important

634
00:33:28,920 --> 00:33:31,800
Speaker 2: thing to understand is what's your experience with like the

635
00:33:31,920 --> 00:33:35,000
Speaker 2: long term effects and the long term outcomes, because sometimes

636
00:33:35,480 --> 00:33:39,080
Speaker 2: that will vary depending on where the little tumor spots are. Again,

637
00:33:39,160 --> 00:33:41,320
Speaker 2: this goes back to what I was saying earlier. Sometimes,

638
00:33:41,440 --> 00:33:44,000
Speaker 2: you know, doctors and healthcare providers in general, they feel

639
00:33:44,040 --> 00:33:47,120
Speaker 2: compelled to kind of go through that laundry list of

640
00:33:47,160 --> 00:33:49,400
Speaker 2: like these twenty things that can happen. And that's the

641
00:33:49,440 --> 00:33:52,200
Speaker 2: part I've noticed scarest patients the most. And sometimes it

642
00:33:52,240 --> 00:33:53,800
Speaker 2: has to be said. Sometimes you have to go through

643
00:33:53,960 --> 00:33:56,120
Speaker 2: like you know, you know, when a surgeon says you

644
00:33:56,200 --> 00:33:58,240
Speaker 2: might not wake up, you know, I mean it's happened before.

645
00:33:58,280 --> 00:33:58,920
Speaker 2: I mean it's rare.

646
00:33:59,680 --> 00:34:00,959
Speaker 1: I always like hearing that.

647
00:34:01,040 --> 00:34:04,600
Speaker 2: Yeah, it's always like, sign here, take a crocabol and

648
00:34:04,760 --> 00:34:08,319
Speaker 2: have an IC. The most important thing to say is

649
00:34:08,360 --> 00:34:10,799
Speaker 2: how camp like some of those laundry list questions is

650
00:34:11,120 --> 00:34:14,080
Speaker 2: making sure to understand how common or uncommon they are,

651
00:34:14,880 --> 00:34:18,759
Speaker 2: and have them really drill down and emphasize what they

652
00:34:18,800 --> 00:34:20,800
Speaker 2: really expect to happen. Just tell me what you really

653
00:34:20,840 --> 00:34:22,920
Speaker 2: think is going to happen, and like, let's leave the

654
00:34:22,960 --> 00:34:25,400
Speaker 2: fluff out and focus in on what I can do

655
00:34:25,520 --> 00:34:28,200
Speaker 2: to prevent it. Are there things I can do? Maybe

656
00:34:28,239 --> 00:34:30,840
Speaker 2: there's certain diets, or there's certain you know, preventive measures

657
00:34:30,880 --> 00:34:33,720
Speaker 2: I can take to limit the swelling that you might cause,

658
00:34:33,800 --> 00:34:37,399
Speaker 2: or what you know, things of that nature. I think

659
00:34:37,440 --> 00:34:40,440
Speaker 2: are important is to just be deliberate and to be

660
00:34:40,520 --> 00:34:43,720
Speaker 2: focused on the most important aspects of your care because

661
00:34:43,800 --> 00:34:45,520
Speaker 2: you have a limited amount of time with your doctor,

662
00:34:45,560 --> 00:34:47,439
Speaker 2: you have a limited of time to the treatment. It's

663
00:34:47,480 --> 00:34:49,759
Speaker 2: important to be finite. I think.

664
00:34:50,960 --> 00:34:54,759
Speaker 1: I think that's amazing advice. And then that after the

665
00:34:54,880 --> 00:34:58,240
Speaker 1: radiation was very interesting for me. You know, the first

666
00:34:58,239 --> 00:35:03,200
Speaker 1: time I got radiation done for for just the breast wall, yes,

667
00:35:03,280 --> 00:35:05,200
Speaker 1: I was like a little tired, but I don't think

668
00:35:05,200 --> 00:35:07,960
Speaker 1: it impacted me as much. And maybe it's age, or

669
00:35:07,960 --> 00:35:10,200
Speaker 1: maybe it's because it was in the brain, but you

670
00:35:10,280 --> 00:35:13,960
Speaker 1: were very conscious of saying, listen, you're going to be tired,

671
00:35:14,000 --> 00:35:16,360
Speaker 1: and it doesn't hit you right away. I feel like

672
00:35:16,400 --> 00:35:21,839
Speaker 1: it built up and the fatigue got much worse later on.

673
00:35:21,960 --> 00:35:25,000
Speaker 2: That's a great question, and there's a very specific reason

674
00:35:25,040 --> 00:35:27,239
Speaker 2: for why you get tired after radiation, and it's a

675
00:35:27,239 --> 00:35:30,560
Speaker 2: good thing. So when you radiate a particular tissue, your

676
00:35:30,600 --> 00:35:33,200
Speaker 2: body doesn't know how to respond to it, so it's

677
00:35:33,239 --> 00:35:35,800
Speaker 2: immune system starts going a little bit crazy, like thinking

678
00:35:35,840 --> 00:35:39,640
Speaker 2: it has like a foreign invader. So that tiredness is

679
00:35:39,680 --> 00:35:42,560
Speaker 2: your immune system ramping up to deal with it, and

680
00:35:42,560 --> 00:35:47,640
Speaker 2: that's good in the following sense, there's no better weapon

681
00:35:47,719 --> 00:35:50,839
Speaker 2: that you have for fighting your cancer than your own

682
00:35:50,840 --> 00:35:54,759
Speaker 2: immune system. It's the one that knows what's normal and

683
00:35:54,840 --> 00:35:57,000
Speaker 2: abnormal in your body. It knows how to interpret that

684
00:35:57,360 --> 00:35:59,600
Speaker 2: and what radiation does. And frankly, this is part of

685
00:35:59,640 --> 00:36:04,160
Speaker 2: how is an effective anti cancer treatment is it ramps

686
00:36:04,239 --> 00:36:07,200
Speaker 2: up your own immune system. So the radiation causes the

687
00:36:07,200 --> 00:36:09,359
Speaker 2: same type of tiredness as like when you have a flu.

688
00:36:09,840 --> 00:36:12,080
Speaker 2: Your body is battling off like a virus or a

689
00:36:12,080 --> 00:36:15,160
Speaker 2: bacteria or something, and it's doing that because your immune

690
00:36:15,160 --> 00:36:17,120
Speaker 2: system is ramp up. That's why you're tired.

691
00:36:17,360 --> 00:36:20,640
Speaker 1: And so that explains why because you're getting more and

692
00:36:20,719 --> 00:36:24,960
Speaker 1: more radiation after so many treatments, you just it keeps growing.

693
00:36:25,120 --> 00:36:27,960
Speaker 1: That's fatigue because it's just really fighting all of it.

694
00:36:28,120 --> 00:36:30,600
Speaker 2: Your immune system keeps going, which is amazing.

695
00:36:30,680 --> 00:36:32,960
Speaker 1: For a while, I think I was also you know,

696
00:36:33,040 --> 00:36:38,400
Speaker 1: I mean I did surgery as well. Yeah, radiation I have,

697
00:36:38,800 --> 00:36:44,000
Speaker 1: I have almost like a guinea pig. So but what

698
00:36:44,080 --> 00:36:49,239
Speaker 1: I also found interesting for my particular case was that

699
00:36:49,280 --> 00:36:54,040
Speaker 1: we did radiate Bob. For those of you who don't

700
00:36:54,080 --> 00:36:56,480
Speaker 1: know who Bob is because we've now or I've at

701
00:36:56,560 --> 00:36:59,239
Speaker 1: least mentioned him two or three times, Bob was the

702
00:36:59,360 --> 00:37:05,680
Speaker 1: bigger tumor that we decided to remove because then we

703
00:37:05,719 --> 00:37:09,760
Speaker 1: could study its pathology, and in studying its pathology, it's

704
00:37:09,920 --> 00:37:13,440
Speaker 1: you know, molecular makeup and everything else. It allowed the

705
00:37:13,520 --> 00:37:16,160
Speaker 1: doctors to come up with the right plan to see

706
00:37:16,200 --> 00:37:19,279
Speaker 1: if it had changed, if it had changed, did it

707
00:37:19,360 --> 00:37:22,200
Speaker 1: become you know, was there any her two negative prospects

708
00:37:22,200 --> 00:37:24,120
Speaker 1: in there, like whatever it happened, how.

709
00:37:24,239 --> 00:37:26,320
Speaker 2: Is it sensitive to certain drugs versus others?

710
00:37:26,360 --> 00:37:28,000
Speaker 1: You know, we have that type, so we could do

711
00:37:28,040 --> 00:37:32,920
Speaker 1: a better treatment plan. But we radiated Bob first, and

712
00:37:33,120 --> 00:37:36,319
Speaker 1: that was I call them seeds. It was so that

713
00:37:36,440 --> 00:37:40,560
Speaker 1: during surgery, like there's little cancer seeds that could have

714
00:37:40,600 --> 00:37:42,239
Speaker 1: spilled out. Can you explain that?

715
00:37:42,560 --> 00:37:44,919
Speaker 2: So there's two different approaches when you have a brain

716
00:37:45,040 --> 00:37:48,640
Speaker 2: metastasis or brain met for short, Bob wasn't a very

717
00:37:48,680 --> 00:37:51,799
Speaker 2: accessible area, you know, so when when doctor Chew went

718
00:37:51,800 --> 00:37:54,000
Speaker 2: in there, it wasn't you know, he made a small

719
00:37:54,080 --> 00:37:56,520
Speaker 2: decision in your skull, and you know, he was able

720
00:37:56,560 --> 00:37:59,120
Speaker 2: to open the tentorium and just kind of go right

721
00:37:59,160 --> 00:38:00,759
Speaker 2: to where he needs to and take it out. And

722
00:38:00,880 --> 00:38:04,760
Speaker 2: sometimes when you're surgically removing a tumor, little tiny tumor

723
00:38:04,800 --> 00:38:07,120
Speaker 2: cells might just sort of kind of stick to the

724
00:38:07,280 --> 00:38:10,440
Speaker 2: edges and they might seed along where the incision is.

725
00:38:10,880 --> 00:38:14,080
Speaker 2: So that's why we give radio surgery after the fact.

726
00:38:14,080 --> 00:38:17,880
Speaker 2: But then the radio surgery after you remove Bob, you know,

727
00:38:17,920 --> 00:38:20,120
Speaker 2: it's a little bit more difficult because you don't have

728
00:38:20,160 --> 00:38:23,960
Speaker 2: a discernible target. You know, sometimes things can shift and

729
00:38:24,000 --> 00:38:25,400
Speaker 2: things like that, you know, and yours was at a

730
00:38:25,440 --> 00:38:27,480
Speaker 2: place where it could have shifted a little bit. So

731
00:38:27,520 --> 00:38:30,280
Speaker 2: we thought it was better, let's just radiate Bob now.

732
00:38:31,000 --> 00:38:33,640
Speaker 2: And you know, so that way we kind of sterilized

733
00:38:34,080 --> 00:38:39,400
Speaker 2: Bob's edges. Bob's edges, Sorry, Bob is on. We've we

734
00:38:39,520 --> 00:38:42,800
Speaker 2: sliced and diced Bob. Bob is sitting in paraffin box somewhere.

735
00:38:43,200 --> 00:38:45,440
Speaker 2: We took care of Bob.

736
00:38:45,600 --> 00:38:47,680
Speaker 1: I was like, can you guys please give me Bob.

737
00:38:48,080 --> 00:38:49,719
Speaker 2: We could give you like a little like his head

738
00:38:49,840 --> 00:38:54,440
Speaker 2: or something like that. No, but but then that sterilizes

739
00:38:54,480 --> 00:38:57,080
Speaker 2: the edges. So when we remove it, the edges were

740
00:38:57,120 --> 00:38:59,680
Speaker 2: sort of dead, so it doesn't seed along the area

741
00:38:59,719 --> 00:39:02,399
Speaker 2: that we've surgically removed. And now we know a year

742
00:39:02,480 --> 00:39:06,040
Speaker 2: later that you know, it was successful in eradicating there,

743
00:39:06,080 --> 00:39:08,080
Speaker 2: So it didn't Bob didn't regrowth.

744
00:39:07,719 --> 00:39:11,400
Speaker 1: But it didn't kill all of Bob. It was like

745
00:39:11,440 --> 00:39:13,879
Speaker 1: you said, just the edges, so that when doctor Chu

746
00:39:14,000 --> 00:39:16,440
Speaker 1: removed as much of it as he could, yeah, it

747
00:39:16,480 --> 00:39:21,200
Speaker 1: was still alive enough tissue in order to see the pathology.

748
00:39:21,320 --> 00:39:22,279
Speaker 1: Does that make any sense?

749
00:39:22,320 --> 00:39:25,160
Speaker 2: Absolutely yes, because the things that we were looking at

750
00:39:25,239 --> 00:39:28,480
Speaker 2: kind of in a molecular aspect would take more than

751
00:39:28,680 --> 00:39:30,480
Speaker 2: you know, a few days to change, you know, in

752
00:39:31,000 --> 00:39:33,799
Speaker 2: the body. So we were able to get enough information

753
00:39:34,040 --> 00:39:37,480
Speaker 2: to make the necessary changes we needed, you know, to assess,

754
00:39:37,680 --> 00:39:39,960
Speaker 2: so to speak. You know, if you'd kind of radiated

755
00:39:40,000 --> 00:39:42,000
Speaker 2: Bob and waited like five or six weeks, there might

756
00:39:42,000 --> 00:39:43,719
Speaker 2: have been some changes, it might have transformed in a

757
00:39:43,760 --> 00:39:46,799
Speaker 2: way where the information wouldn't have been as useful. But

758
00:39:47,280 --> 00:39:49,640
Speaker 2: this approach was was ultimately the best for you, just

759
00:39:49,680 --> 00:39:53,120
Speaker 2: for that specific reason. So sometimes as an oncologist like

760
00:39:53,160 --> 00:39:57,080
Speaker 2: doctor Pirol, you're sort of giving, using your best clinical judgment,

761
00:39:57,480 --> 00:39:59,839
Speaker 2: what responds in what scenario. And that's why I think

762
00:40:00,520 --> 00:40:03,799
Speaker 2: having gray hair is really important on cology because you

763
00:40:03,800 --> 00:40:06,120
Speaker 2: can read the information in a medical journal. You can

764
00:40:06,200 --> 00:40:09,239
Speaker 2: read the statistics and the outcomes and things like that

765
00:40:09,320 --> 00:40:12,840
Speaker 2: other people's experiences, but when you do several thousand of

766
00:40:12,880 --> 00:40:16,560
Speaker 2: them yourself, that just gives you a much better perspective

767
00:40:16,560 --> 00:40:19,040
Speaker 2: of like, no, when I tried this, this worked and

768
00:40:19,080 --> 00:40:20,840
Speaker 2: that didn't work. When I tried that, that worked and

769
00:40:20,880 --> 00:40:24,239
Speaker 2: this didn't work. And so experience I think is really important.

770
00:40:24,400 --> 00:40:26,399
Speaker 2: Some of your listeners might be hearing this and saying, oh,

771
00:40:26,440 --> 00:40:28,239
Speaker 2: my doctors are really young and just came out, but

772
00:40:28,719 --> 00:40:32,240
Speaker 2: they I'm sure have the training and experience of their

773
00:40:32,400 --> 00:40:35,480
Speaker 2: mentors and people that can help guide them as well,

774
00:40:35,600 --> 00:40:39,600
Speaker 2: you know. So I do think that clinical experience is

775
00:40:39,719 --> 00:40:42,640
Speaker 2: very valuable in guiding this type of decision making because

776
00:40:43,040 --> 00:40:46,320
Speaker 2: a lot of it is just to some degree, relying

777
00:40:46,360 --> 00:40:49,560
Speaker 2: on chance and relying on hope that something works.

778
00:40:49,280 --> 00:40:52,400
Speaker 1: You know, right. I like my doctors to have some

779
00:40:52,520 --> 00:40:56,359
Speaker 1: surgical clinical research experience. I want to cover it all.

780
00:41:04,680 --> 00:41:07,960
Speaker 1: I also think that people have to be extremely careful,

781
00:41:07,960 --> 00:41:11,000
Speaker 1: because I know that this happened to me, of digging

782
00:41:11,040 --> 00:41:15,080
Speaker 1: for too much information on everything. Because there's a lot

783
00:41:15,280 --> 00:41:19,160
Speaker 1: of chat rooms that are wonderful right where people can

784
00:41:19,760 --> 00:41:24,920
Speaker 1: support each other, But it can also be a really

785
00:41:25,000 --> 00:41:29,719
Speaker 1: dark path because somebody will say, oh, well, I have

786
00:41:29,800 --> 00:41:32,920
Speaker 1: the same thing as you have, you know, stage four cancer,

787
00:41:34,239 --> 00:41:39,400
Speaker 1: but their body could respond to a medicine that yours doesen't.

788
00:41:39,480 --> 00:41:43,160
Speaker 1: They could you know, have shutting of hair much more

789
00:41:43,280 --> 00:41:46,560
Speaker 1: than you or much less. So you have to be

790
00:41:46,640 --> 00:41:49,200
Speaker 1: really careful with those chat rooms and when you're looking

791
00:41:49,239 --> 00:41:52,520
Speaker 1: for the information. Yet it's I think, is it helpful

792
00:41:52,600 --> 00:41:57,239
Speaker 1: for your patients at least to be somewhat knowledgeable.

793
00:41:58,320 --> 00:42:00,399
Speaker 2: It is helpful for them to be knowledgeable, of course,

794
00:42:00,840 --> 00:42:04,280
Speaker 2: but sometimes people sort of go down the wormhole, and

795
00:42:04,640 --> 00:42:07,120
Speaker 2: sometimes even if you tell them no, this is not

796
00:42:07,239 --> 00:42:09,239
Speaker 2: the case, they still don't believe you because they saw

797
00:42:09,239 --> 00:42:11,880
Speaker 2: it in some chat room. Here's a good way to

798
00:42:11,920 --> 00:42:14,799
Speaker 2: think about that. If you're in a classroom and you

799
00:42:14,880 --> 00:42:17,480
Speaker 2: lean over to you know, person next to you and say, hey,

800
00:42:17,920 --> 00:42:20,319
Speaker 2: I saw so and so kissing so and so, and

801
00:42:20,320 --> 00:42:22,680
Speaker 2: then that person turns, the next person says, I saw

802
00:42:22,760 --> 00:42:25,480
Speaker 2: so and so kissing so and so, and two other

803
00:42:25,480 --> 00:42:28,080
Speaker 2: people are, you know, and it keeps going around, and

804
00:42:28,160 --> 00:42:31,040
Speaker 2: just within one classroom, it might come back to you

805
00:42:31,080 --> 00:42:36,239
Speaker 2: as like, you know, so and so was on de Yeah,

806
00:42:36,280 --> 00:42:38,400
Speaker 2: I tried. I tried to weave in and I know

807
00:42:38,480 --> 00:42:41,719
Speaker 2: two in a reference there. But my point is, in

808
00:42:41,760 --> 00:42:45,080
Speaker 2: a very short amount of time, misinformation, just in a

809
00:42:45,239 --> 00:42:48,600
Speaker 2: small classroom, small table full of people can just spread

810
00:42:48,680 --> 00:42:50,800
Speaker 2: like that, you know, and so I always try to

811
00:42:50,840 --> 00:42:52,920
Speaker 2: tell people like, look, you know the Fourth House and

812
00:42:52,960 --> 00:42:56,200
Speaker 2: breast cancer patients that I've treated in my career, here's

813
00:42:56,280 --> 00:42:58,799
Speaker 2: my experience, here's what I tend to see. You know,

814
00:42:58,920 --> 00:43:01,200
Speaker 2: you might read on a room that it causes this

815
00:43:01,360 --> 00:43:03,640
Speaker 2: or that and that and this, but at the same time,

816
00:43:03,840 --> 00:43:05,480
Speaker 2: you know, it's a different era. You know, these are

817
00:43:05,600 --> 00:43:08,720
Speaker 2: women that were probably treated in the nineties or two

818
00:43:09,080 --> 00:43:12,719
Speaker 2: different period of time under different circumstances. So I do

819
00:43:12,840 --> 00:43:15,279
Speaker 2: my best to try to reel them in, you know,

820
00:43:15,719 --> 00:43:17,960
Speaker 2: as best as I can. But it is good to

821
00:43:18,000 --> 00:43:22,000
Speaker 2: be informed. It's not good to let information online consume

822
00:43:22,080 --> 00:43:24,840
Speaker 2: you and guide you down the wrong path, so to speak.

823
00:43:25,040 --> 00:43:27,319
Speaker 1: Yeah, I think you know. I did visit a few

824
00:43:27,400 --> 00:43:32,360
Speaker 1: chat rooms right in the beginning because I was obviously curious,

825
00:43:32,560 --> 00:43:37,480
Speaker 1: and I found it disruptive for me, just because it

826
00:43:37,760 --> 00:43:41,880
Speaker 1: did feel like a game of telephone. But there were

827
00:43:41,920 --> 00:43:44,279
Speaker 1: other chatrooms that I went into and it felt like

828
00:43:44,320 --> 00:43:47,600
Speaker 1: a sisterhood and like a family, all supporting each other.

829
00:43:47,600 --> 00:43:50,239
Speaker 1: And I was like, well, that's really beautiful because we

830
00:43:50,320 --> 00:43:52,600
Speaker 1: all need that, we all need the love and support,

831
00:43:52,880 --> 00:43:56,359
Speaker 1: especially when you're facing something like cancer, whatever cancer you have,

832
00:43:56,440 --> 00:43:59,640
Speaker 1: it's such a difficult disease. But there are, you know,

833
00:43:59,719 --> 00:44:05,239
Speaker 1: some excellent published papers out there to give you the

834
00:44:05,320 --> 00:44:08,719
Speaker 1: kind of knowledge and information that you need in order

835
00:44:08,760 --> 00:44:12,000
Speaker 1: to go in and feel like you've got a little

836
00:44:12,040 --> 00:44:13,719
Speaker 1: bit of a handle on your own disease, because I

837
00:44:13,800 --> 00:44:15,920
Speaker 1: think that that's the biggest thing, is that cancer is

838
00:44:16,040 --> 00:44:20,000
Speaker 1: still somewhat unknown. Of course to the individual who gets

839
00:44:20,000 --> 00:44:23,680
Speaker 1: it that they need to feel armed with knowledge.

840
00:44:23,760 --> 00:44:26,360
Speaker 2: Yes, absolutely, I'm going to add a little grain of

841
00:44:26,440 --> 00:44:28,080
Speaker 2: salt to what you said. I always had a lot

842
00:44:28,120 --> 00:44:31,200
Speaker 2: of patients, and I'd say you're definitely on the higher

843
00:44:31,280 --> 00:44:33,719
Speaker 2: end of the spectrum in terms of being able to

844
00:44:33,800 --> 00:44:36,759
Speaker 2: process this information. You're a pretty intelligent young lady. And

845
00:44:37,080 --> 00:44:41,520
Speaker 2: you also you're getting the right information from the right places.

846
00:44:41,560 --> 00:44:46,759
Speaker 2: I mean, that's like the top two percentile of my experience.

847
00:44:47,080 --> 00:44:51,240
Speaker 2: Usually it's like everything in between. Again, the vast majority

848
00:44:51,239 --> 00:44:53,799
Speaker 2: of patients, they understand the information you're sharing with them.

849
00:44:54,080 --> 00:44:56,480
Speaker 2: If they bring something up that they learn from the outside,

850
00:44:56,600 --> 00:44:59,000
Speaker 2: you know, it's easy to just sort of put it

851
00:44:59,040 --> 00:45:01,759
Speaker 2: into the proper content ext firm. But not everyone can

852
00:45:01,800 --> 00:45:06,320
Speaker 2: pull up medical literature papers and recent publications and process

853
00:45:06,320 --> 00:45:07,680
Speaker 2: that the way you do. And I know you've brought

854
00:45:07,680 --> 00:45:09,040
Speaker 2: it up with me a couple of times in the past.

855
00:45:09,080 --> 00:45:11,239
Speaker 2: I'm like, oh, wow, that's pretty impressive. You know, I

856
00:45:11,280 --> 00:45:13,760
Speaker 2: wish they were all like you, but you're the exception,

857
00:45:14,000 --> 00:45:17,799
Speaker 2: not the rule. But yes, it's always important to arm

858
00:45:17,800 --> 00:45:20,759
Speaker 2: yourself with whatever information you can, allow it to be

859
00:45:20,800 --> 00:45:24,080
Speaker 2: filtered properly. It's usually very helpful if you talk to

860
00:45:24,120 --> 00:45:26,799
Speaker 2: other people with the same condition that you have. I

861
00:45:26,880 --> 00:45:29,479
Speaker 2: found those chat room to be very helpful because, yeah,

862
00:45:29,840 --> 00:45:31,360
Speaker 2: very often sometimes there are in my own pace and

863
00:45:31,360 --> 00:45:33,320
Speaker 2: it's like, oh doctor, you know, like you know, they'll

864
00:45:33,520 --> 00:45:35,879
Speaker 2: make that connection and things like that. But I do

865
00:45:35,920 --> 00:45:39,600
Speaker 2: think it's incredibly important to find support as long as

866
00:45:39,640 --> 00:45:42,080
Speaker 2: you take with a grain of salt that sometimes the

867
00:45:42,080 --> 00:45:45,279
Speaker 2: information or the treatment they got might not pertain to

868
00:45:45,400 --> 00:45:48,400
Speaker 2: their circumstance. You know, you're very good at that, and

869
00:45:48,480 --> 00:45:49,359
Speaker 2: others aren't. You know.

870
00:45:49,960 --> 00:45:52,760
Speaker 1: Well, you know, I learned that through I had doctor

871
00:45:52,800 --> 00:45:55,240
Speaker 1: piro On and we talked about one of my best

872
00:45:55,239 --> 00:46:00,440
Speaker 1: friends who passed away from stage four breast cancer. Like me,

873
00:46:00,640 --> 00:46:03,440
Speaker 1: it didn't she didn't have brain mets, hers had spread

874
00:46:03,440 --> 00:46:08,279
Speaker 1: to her organs, and when she first got sick. I

875
00:46:08,360 --> 00:46:11,840
Speaker 1: really associated everything that she was going through with myself

876
00:46:11,880 --> 00:46:14,959
Speaker 1: in the beginning. So then when she had all these

877
00:46:15,000 --> 00:46:17,719
Speaker 1: pains and that meant that it had spread, all of

878
00:46:17,760 --> 00:46:20,360
Speaker 1: a sudden, I got pains and it had spread. Doctor

879
00:46:20,360 --> 00:46:25,160
Speaker 1: Parro was very on top of me about not associating

880
00:46:25,840 --> 00:46:30,040
Speaker 1: my experience with hers, because he said, night and day

881
00:46:30,239 --> 00:46:33,960
Speaker 1: two very different things. Yes, stage four breast cancer, yours

882
00:46:34,000 --> 00:46:36,319
Speaker 1: is in your bones, hers is in her organs. Like

883
00:46:36,680 --> 00:46:40,880
Speaker 1: there's two different treatments, there's two different This is incredibly different,

884
00:46:41,239 --> 00:46:43,760
Speaker 1: and you cannot associate. And even if you have someone

885
00:46:43,800 --> 00:46:47,680
Speaker 1: who who you find where it did travel into their

886
00:46:47,680 --> 00:46:49,920
Speaker 1: bones and they have brain mets, it's still going to

887
00:46:49,920 --> 00:46:54,359
Speaker 1: be different because we're all individuals, and although we can

888
00:46:54,800 --> 00:46:58,360
Speaker 1: hug and support each other as much as humanly possible,

889
00:46:58,880 --> 00:47:02,560
Speaker 1: you still have to keep a little bit of disassociation,

890
00:47:02,800 --> 00:47:03,600
Speaker 1: I guess.

891
00:47:04,080 --> 00:47:07,080
Speaker 2: And what's worse is that, you know, I'm sure that

892
00:47:07,440 --> 00:47:11,040
Speaker 2: doctors like doctor Piro, myself and others, you know, if

893
00:47:11,080 --> 00:47:14,520
Speaker 2: you're describing a circumstance from another patient to us, unless

894
00:47:14,520 --> 00:47:17,600
Speaker 2: we treated that patient, we don't know the details. We

895
00:47:17,640 --> 00:47:20,680
Speaker 2: don't know the molecular basis of their tumor or where

896
00:47:20,719 --> 00:47:23,040
Speaker 2: it has spread. It's also really hard for us to

897
00:47:23,040 --> 00:47:25,440
Speaker 2: say no, that doesn't apply to you because of X,

898
00:47:25,520 --> 00:47:28,120
Speaker 2: Y and Z, because we haven't had a chance to

899
00:47:28,160 --> 00:47:30,880
Speaker 2: read through their chart and say that. So sometimes I

900
00:47:31,320 --> 00:47:35,319
Speaker 2: see doctors sometimes get frustrated trying to kind of tell

901
00:47:35,320 --> 00:47:37,439
Speaker 2: them it doesn't really apply it because they don't have

902
00:47:37,840 --> 00:47:40,400
Speaker 2: the information to kind of say whether it does or doesn't,

903
00:47:40,440 --> 00:47:43,200
Speaker 2: you know, and that. But that's an important point. And

904
00:47:44,000 --> 00:47:46,640
Speaker 2: you know, I've seen a lot of people spiral with

905
00:47:47,480 --> 00:47:49,080
Speaker 2: having information and others like that.

906
00:47:49,320 --> 00:47:51,319
Speaker 1: Yeah, I mean, and it's not just the person with

907
00:47:51,360 --> 00:47:55,320
Speaker 1: the cancer that spirals, it's everybody else. It happened to

908
00:47:55,360 --> 00:47:59,319
Speaker 1: me very very very recently where a woman said to

909
00:47:59,360 --> 00:48:01,840
Speaker 1: me that her dad is a doctor, and so she

910
00:48:02,000 --> 00:48:05,560
Speaker 1: spoke to her father and you know, how did it

911
00:48:05,640 --> 00:48:09,840
Speaker 1: feel or how does it feel that I have stage

912
00:48:09,960 --> 00:48:13,680
Speaker 1: four terminal cancer and my time is limited? And I

913
00:48:13,880 --> 00:48:16,880
Speaker 1: was like, whoa, And she's like, well, my dad explained.

914
00:48:16,880 --> 00:48:19,880
Speaker 1: I mean, like to me, it's like, first off, your

915
00:48:19,960 --> 00:48:25,560
Speaker 1: dad doesn't know anything about my particular like the broad strokes. Sure,

916
00:48:25,800 --> 00:48:28,400
Speaker 1: just what I've told people and what's out there in

917
00:48:28,440 --> 00:48:32,399
Speaker 1: the public, but he doesn't know my exact pathology, and

918
00:48:32,600 --> 00:48:34,480
Speaker 1: he doesn't know my treatment plan. Like there are so

919
00:48:34,560 --> 00:48:39,800
Speaker 1: many variables that go into each person's individual cancer. That

920
00:48:39,800 --> 00:48:44,280
Speaker 1: that's why associating your cancer with somebody else's or assuming

921
00:48:44,320 --> 00:48:48,719
Speaker 1: that you know everything, it's impossible because it just is.

922
00:48:48,840 --> 00:48:52,520
Speaker 1: It's like the people who tell me, hey, and you know,

923
00:48:52,600 --> 00:48:54,560
Speaker 1: God bless them because they're just trying to help me.

924
00:48:54,680 --> 00:48:59,200
Speaker 1: But you shouldn't be on any of these pharmaceutical drugs,

925
00:48:59,480 --> 00:49:02,000
Speaker 1: that's what's giving you cancer. Go on a vegan diet

926
00:49:02,120 --> 00:49:05,759
Speaker 1: or do this. And I'm like, yeah, sure, let me

927
00:49:05,880 --> 00:49:09,120
Speaker 1: just you know, not get infusions and see how fast

928
00:49:09,200 --> 00:49:14,040
Speaker 1: everything spreads while I try some experimental all natural which listen,

929
00:49:14,160 --> 00:49:19,400
Speaker 1: everybody can do what they want individually. But there's a

930
00:49:19,560 --> 00:49:21,720
Speaker 1: lot of misinformation about cancer.

931
00:49:22,280 --> 00:49:24,520
Speaker 2: You bring up a very good point, and it leads

932
00:49:24,600 --> 00:49:26,440
Speaker 2: me to one of my favorite quotes. I tell my

933
00:49:26,520 --> 00:49:28,480
Speaker 2: residents and fellows this all the time. You know, there's

934
00:49:28,520 --> 00:49:32,200
Speaker 2: three types of lies in this world. There's lies, there's

935
00:49:32,280 --> 00:49:37,160
Speaker 2: damn lies, and there's cancer statistics. The reason I say that,

936
00:49:37,200 --> 00:49:40,839
Speaker 2: and what I mean by that is, you know, very

937
00:49:40,880 --> 00:49:43,680
Speaker 2: often and patients are very focused on this, understandably, of course,

938
00:49:43,680 --> 00:49:45,920
Speaker 2: but they're very focused on how much longer do I

939
00:49:45,960 --> 00:49:46,319
Speaker 2: have to live?

940
00:49:46,400 --> 00:49:46,600
Speaker 1: Doc?

941
00:49:46,719 --> 00:49:49,040
Speaker 2: And I'm like, or what are the chances that I'll

942
00:49:49,080 --> 00:49:52,319
Speaker 2: be cured? And you know, my favorite answer sometimes is

943
00:49:52,320 --> 00:49:55,960
Speaker 2: like somewhere between zero and one hundred percent, because it's

944
00:49:56,239 --> 00:49:59,120
Speaker 2: really and I think that's where the experience comes in.

945
00:49:59,160 --> 00:50:02,839
Speaker 2: And I assured doctor Hero feels the same. You know. See,

946
00:50:02,880 --> 00:50:05,040
Speaker 2: you've seen it all over the years. You're like, you

947
00:50:05,080 --> 00:50:07,040
Speaker 2: see someone that thought they were going to be completely

948
00:50:07,120 --> 00:50:09,600
Speaker 2: cured and al lujah and go have a big party,

949
00:50:09,640 --> 00:50:11,520
Speaker 2: and then you know, two months later it comes back,

950
00:50:11,520 --> 00:50:14,319
Speaker 2: you know, crazy fashion. Or you see people where it's

951
00:50:14,400 --> 00:50:17,799
Speaker 2: quote unquote stage four terminal. All the buzzwords that I

952
00:50:17,800 --> 00:50:20,719
Speaker 2: think don't really apply in today's era of cancer care.

953
00:50:21,200 --> 00:50:23,880
Speaker 2: You see them living many, many, many many years with

954
00:50:23,960 --> 00:50:27,920
Speaker 2: no evidence of disease. Right, It's really hard to predict

955
00:50:27,960 --> 00:50:31,720
Speaker 2: what's going to happen on an individual basis. It's really

956
00:50:31,800 --> 00:50:34,759
Speaker 2: hard to try to tell people, hey, you know, I

957
00:50:34,760 --> 00:50:37,880
Speaker 2: mean there are some circumstances where the disease might not

958
00:50:37,960 --> 00:50:40,800
Speaker 2: be responding to X, Y and Z, and it continues

959
00:50:40,840 --> 00:50:43,640
Speaker 2: to progress where you can start to have a sense that, Okay,

960
00:50:43,640 --> 00:50:46,400
Speaker 2: this is not going in a good direction. In the

961
00:50:46,520 --> 00:50:50,920
Speaker 2: absence of that, in the absence of any discernible progression,

962
00:50:51,680 --> 00:50:55,360
Speaker 2: just living as a statistic living as like, oh I'm terminal,

963
00:50:55,440 --> 00:50:58,960
Speaker 2: Like you know, it's never. It doesn't make sense to me.

964
00:50:59,160 --> 00:51:00,840
Speaker 2: I don't think that's the right way to think about it.

965
00:51:00,840 --> 00:51:02,799
Speaker 2: I think the right way to think about it it's

966
00:51:02,880 --> 00:51:06,560
Speaker 2: highly variable. Do what you can with your doctors and

967
00:51:06,600 --> 00:51:08,640
Speaker 2: do what they offer you to the best that you can.

968
00:51:08,719 --> 00:51:11,520
Speaker 2: Be an advocate for yourself as a patient as you

969
00:51:11,600 --> 00:51:14,080
Speaker 2: are and as most of my patients are. Try to

970
00:51:14,160 --> 00:51:16,160
Speaker 2: learn as much as you can. Learn what your options are,

971
00:51:16,280 --> 00:51:18,319
Speaker 2: learn what would happen if it progresses, you know, but

972
00:51:19,120 --> 00:51:23,040
Speaker 2: there's no certainty in what in what this experience is, right,

973
00:51:23,239 --> 00:51:26,000
Speaker 2: which is good because you know it gives people hope

974
00:51:26,040 --> 00:51:29,160
Speaker 2: to you know, you know, I never you always want people,

975
00:51:29,800 --> 00:51:33,880
Speaker 2: even in dire circumstances, you know, you always want people

976
00:51:33,880 --> 00:51:36,560
Speaker 2: to have some semblance of hope. I saw this quote once,

977
00:51:36,640 --> 00:51:38,040
Speaker 2: I remember where I saw it, but it was like,

978
00:51:38,400 --> 00:51:41,960
Speaker 2: when you have health, we have health, you have hope,

979
00:51:42,320 --> 00:51:45,480
Speaker 2: and when you have hope, you have everything. You know,

980
00:51:45,560 --> 00:51:47,920
Speaker 2: that's really all you need is just a little bit

981
00:51:47,920 --> 00:51:49,839
Speaker 2: of hope. But you know, I don't want to you know,

982
00:51:49,960 --> 00:51:51,920
Speaker 2: you don't want to mislead people, but you also want

983
00:51:51,920 --> 00:51:55,120
Speaker 2: to say look, a lot of possibilities with what you have,

984
00:51:55,239 --> 00:51:58,160
Speaker 2: with your condition, with your response to treatment. Hang in there,

985
00:51:58,239 --> 00:52:01,359
Speaker 2: keep moving forward, be present, and every moment live your

986
00:52:01,360 --> 00:52:03,520
Speaker 2: life as best as you can. You know, let us

987
00:52:03,560 --> 00:52:05,279
Speaker 2: worry about the treatments and stuff like that, and just

988
00:52:05,360 --> 00:52:07,280
Speaker 2: keep moving forward. Every day is a gift.

989
00:52:07,840 --> 00:52:10,520
Speaker 1: Every day is a gift, And there are so many

990
00:52:12,280 --> 00:52:18,040
Speaker 1: new things in the works that I think hope is

991
00:52:18,239 --> 00:52:24,320
Speaker 1: always there. It's so important because listen, I can die today.

992
00:52:24,480 --> 00:52:27,040
Speaker 1: I could die in twenty years, I don't know. I

993
00:52:27,080 --> 00:52:30,120
Speaker 1: could die walking outside of my house and you know,

994
00:52:30,200 --> 00:52:32,360
Speaker 1: a tree falling on me or a bus hitting me

995
00:52:32,520 --> 00:52:36,000
Speaker 1: or whatever, or I can die of cancer. But all

996
00:52:36,040 --> 00:52:39,879
Speaker 1: I can do is live each day in as much

997
00:52:39,920 --> 00:52:43,440
Speaker 1: of a positive manner with a lot of hope as

998
00:52:43,520 --> 00:52:46,839
Speaker 1: I can, and embrace it and be like, wow, you know,

999
00:52:47,000 --> 00:52:48,880
Speaker 1: I get to wake up again today and what do

1000
00:52:48,920 --> 00:52:52,360
Speaker 1: I get to do? And I believe that that positivity

1001
00:52:52,480 --> 00:52:56,840
Speaker 1: that you bring into your life. I think it helps

1002
00:52:56,880 --> 00:52:59,480
Speaker 1: with your hear it does, buddy, I think it helps

1003
00:52:59,520 --> 00:53:00,520
Speaker 1: you fight the cancer.

1004
00:53:00,719 --> 00:53:03,160
Speaker 2: It does kind of matter well well. Also, when you're

1005
00:53:03,160 --> 00:53:05,400
Speaker 2: not as stressed out and anxious, you're not releasing as

1006
00:53:05,480 --> 00:53:07,960
Speaker 2: much cortisol which gy have an effect. And I'm a

1007
00:53:07,960 --> 00:53:10,560
Speaker 2: big believer, you know, not to sound like hope or anything,

1008
00:53:10,600 --> 00:53:14,360
Speaker 2: but I believe that there is this energy in the world,

1009
00:53:14,360 --> 00:53:19,520
Speaker 2: in the universe that manifesting positivity, you know, can have

1010
00:53:19,560 --> 00:53:23,440
Speaker 2: this ripple effect somewhere in your world, you know, so

1011
00:53:23,480 --> 00:53:26,480
Speaker 2: to speak. And but again it always it goes back

1012
00:53:26,520 --> 00:53:29,440
Speaker 2: to what the Michael Jordan quote, being present in the moment.

1013
00:53:29,760 --> 00:53:32,120
Speaker 2: Like you, you don't know what tomorrow is going to bring.

1014
00:53:32,200 --> 00:53:33,839
Speaker 2: You don't know what you know five days from now

1015
00:53:33,920 --> 00:53:36,080
Speaker 2: is going to bring. All you know is the day

1016
00:53:36,080 --> 00:53:37,640
Speaker 2: in front of you is a gift and you want

1017
00:53:37,680 --> 00:53:40,239
Speaker 2: to enjoy it and maximize it to the best of

1018
00:53:40,239 --> 00:53:42,920
Speaker 2: your ability, enjoy it as best as you can. And

1019
00:53:43,040 --> 00:53:47,319
Speaker 2: you know, hopefully there's always hope. You have hope a lot.

1020
00:53:47,360 --> 00:53:50,840
Speaker 2: Hopefully all the patients who have cancer stage four cancer

1021
00:53:51,360 --> 00:53:53,919
Speaker 2: that are listening to this, they have hope too. There's

1022
00:53:54,000 --> 00:53:58,000
Speaker 2: always something that you know, you can turn over a

1023
00:53:58,040 --> 00:54:01,640
Speaker 2: stone and it might lead to something that might add days,

1024
00:54:01,760 --> 00:54:04,640
Speaker 2: you know, add weeks, years to your life. You just

1025
00:54:04,719 --> 00:54:07,520
Speaker 2: don't know. You just have to keep moving forward.

1026
00:54:12,040 --> 00:54:15,040
Speaker 1: So we met, if I recall how we met, it

1027
00:54:15,160 --> 00:54:18,600
Speaker 1: was from doctor Piro. Yes, as we said, he's my

1028
00:54:18,960 --> 00:54:21,560
Speaker 1: you know, general oncologist. I guess I'm gonna call it

1029
00:54:21,600 --> 00:54:25,560
Speaker 1: like that. You obviously have to work in tandem with

1030
00:54:25,760 --> 00:54:30,160
Speaker 1: the general on collegist, but does that always go smoothly?

1031
00:54:30,360 --> 00:54:32,560
Speaker 2: No? No, never.

1032
00:54:32,920 --> 00:54:35,480
Speaker 1: That response was amazing. That was very candid.

1033
00:54:35,680 --> 00:54:39,080
Speaker 2: I'm gonna put I'm gonna say something nice about doctor Piro.

1034
00:54:39,239 --> 00:54:40,879
Speaker 2: This is why I respect him and me. I work

1035
00:54:40,880 --> 00:54:42,279
Speaker 2: with a lot of different on colleagues, and a lot

1036
00:54:42,320 --> 00:54:44,200
Speaker 2: of them are like you know, some of them are

1037
00:54:44,239 --> 00:54:46,480
Speaker 2: on the cover of magazine, or some of them are

1038
00:54:46,520 --> 00:54:48,960
Speaker 2: like you know, our big name people that you know

1039
00:54:50,120 --> 00:54:52,920
Speaker 2: don't maybe they don't like to hear other perspectives as

1040
00:54:53,320 --> 00:54:58,200
Speaker 2: their own. You know, someone like doctor Piro, who is

1041
00:54:58,239 --> 00:55:01,799
Speaker 2: a very well established, very well afected oncologists. What I've

1042
00:55:01,840 --> 00:55:06,799
Speaker 2: always appreciated about him in particular, you know, is he

1043
00:55:06,920 --> 00:55:09,680
Speaker 2: will ask everyone, hey, this is the circumstance, this is

1044
00:55:09,719 --> 00:55:12,600
Speaker 2: the clinical situation. What do you think He's not like

1045
00:55:12,640 --> 00:55:14,520
Speaker 2: calling me up saying hey, I want you to do

1046
00:55:14,640 --> 00:55:16,840
Speaker 2: this and that for Shannon or this person or you

1047
00:55:16,880 --> 00:55:20,760
Speaker 2: know that person. Not at all. Very collegial, very open minded,

1048
00:55:21,000 --> 00:55:24,560
Speaker 2: very open to discussion. Doctor Giuliano, who I think you know.

1049
00:55:24,600 --> 00:55:27,399
Speaker 2: He's also he's got this whole dot g oh yeah,

1050
00:55:27,520 --> 00:55:32,640
Speaker 2: doctor G. He's he has this army of you know,

1051
00:55:32,800 --> 00:55:37,880
Speaker 2: young surgeons, young radiologists, young pathologists, young just this whole

1052
00:55:37,960 --> 00:55:41,359
Speaker 2: team of people around him. He's always trying to learn something.

1053
00:55:41,400 --> 00:55:43,919
Speaker 2: Every tumor board we have on Thursday, he's always trying

1054
00:55:43,920 --> 00:55:46,400
Speaker 2: to learn something new. He's always trying to hear your perspective,

1055
00:55:46,640 --> 00:55:48,880
Speaker 2: what are you bringing the table, what is your experience?

1056
00:55:49,400 --> 00:55:53,120
Speaker 2: And it's wonderful to be surrounded by people like that. Now,

1057
00:55:53,800 --> 00:55:57,160
Speaker 2: they're not always like that. There are definitely some people

1058
00:55:57,360 --> 00:55:59,400
Speaker 2: that are like, Nope, this is the way to do it,

1059
00:55:59,440 --> 00:56:02,640
Speaker 2: and you're all wrong, right, Like, there's definitely egos involved,

1060
00:56:02,680 --> 00:56:05,600
Speaker 2: But I don't see that where I work, fortunately, and

1061
00:56:05,680 --> 00:56:08,239
Speaker 2: I think it's it's lovely when you can all be like,

1062
00:56:08,280 --> 00:56:10,880
Speaker 2: you know, listen, sometimes you might disagree. I'll disagree with

1063
00:56:10,920 --> 00:56:14,719
Speaker 2: colleagues and we'll have playful discussions. But sometimes you're like,

1064
00:56:14,800 --> 00:56:16,880
Speaker 2: you know, I don't know, you don't know, let's just

1065
00:56:16,920 --> 00:56:19,440
Speaker 2: sort of do the best, make the best decision that

1066
00:56:19,480 --> 00:56:20,840
Speaker 2: we can for the patient.

1067
00:56:21,000 --> 00:56:23,480
Speaker 1: Do you really tell patients that it's not working?

1068
00:56:24,800 --> 00:56:28,400
Speaker 2: Yes, very honest with patients. Oh yeah, So it just

1069
00:56:28,400 --> 00:56:29,879
Speaker 2: didn't work. When did you do this? Now?

1070
00:56:30,040 --> 00:56:33,440
Speaker 1: So how do you how do you how do you approach.

1071
00:56:33,120 --> 00:56:36,080
Speaker 2: That right to the point, really right to the well.

1072
00:56:38,560 --> 00:56:41,040
Speaker 1: The band aid off, by the way, I'm an advocate

1073
00:56:41,080 --> 00:56:41,319
Speaker 1: of that.

1074
00:56:41,480 --> 00:56:45,560
Speaker 2: No, of course, I'm always going to be empathetic to

1075
00:56:45,680 --> 00:56:48,759
Speaker 2: anyone sitting in front of me that's undergoing cancer care.

1076
00:56:48,760 --> 00:56:52,600
Speaker 2: I'm always going to be sensitive. But you got to

1077
00:56:52,640 --> 00:56:54,840
Speaker 2: get right to the point, you know, And I do

1078
00:56:54,880 --> 00:56:56,920
Speaker 2: a lot. A lot of my friends, you know, have

1079
00:56:57,040 --> 00:56:59,399
Speaker 2: relatives that call me up and hey, what does this mean?

1080
00:56:59,480 --> 00:57:02,600
Speaker 2: Or and he told me this or whatever. Sometimes they

1081
00:57:02,680 --> 00:57:04,600
Speaker 2: might not have had the full picture, and like you

1082
00:57:04,600 --> 00:57:07,080
Speaker 2: will see their report or their image or their MRI

1083
00:57:07,239 --> 00:57:10,320
Speaker 2: and be like, ooh, that's not good. And you say, okay,

1084
00:57:10,440 --> 00:57:13,239
Speaker 2: this means that, and it's bad. It's not you know,

1085
00:57:13,239 --> 00:57:16,160
Speaker 2: it's not it's not something that responds. It's not something

1086
00:57:16,200 --> 00:57:19,160
Speaker 2: that moves in a good direction. And you know, and

1087
00:57:19,240 --> 00:57:22,760
Speaker 2: you this, we tried this treatment. It didn't work, So

1088
00:57:22,760 --> 00:57:26,439
Speaker 2: we're going to try something else. And on occasion, there's

1089
00:57:26,520 --> 00:57:28,840
Speaker 2: not much else we can try that's meaningful.

1090
00:57:28,840 --> 00:57:30,840
Speaker 1: Right, I mean, like, that's got to have that's got

1091
00:57:30,880 --> 00:57:33,440
Speaker 1: to be much harder conversation is when there isn't something

1092
00:57:33,440 --> 00:57:33,919
Speaker 1: else to.

1093
00:57:33,800 --> 00:57:36,280
Speaker 2: Try, it is And I think that in a time

1094
00:57:36,440 --> 00:57:39,000
Speaker 2: like that, when you share that information with a patient,

1095
00:57:39,040 --> 00:57:40,960
Speaker 2: you know, maybe once a week. You know, for me,

1096
00:57:41,520 --> 00:57:44,120
Speaker 2: when you have to say something like that to a patient,

1097
00:57:44,640 --> 00:57:47,479
Speaker 2: there's just like this dark cloak that goes over your head.

1098
00:57:47,840 --> 00:57:51,360
Speaker 2: And that's where me, as as they're providing doctor in

1099
00:57:51,400 --> 00:57:54,680
Speaker 2: that circumstance, I have to take a step back. Understand

1100
00:57:54,760 --> 00:57:59,560
Speaker 2: they're not absorbing the information from me properly that they're

1101
00:58:00,120 --> 00:58:03,040
Speaker 2: I don't want them to make a decision based on

1102
00:58:03,160 --> 00:58:07,040
Speaker 2: something that was so emotionally reactive, something that you know,

1103
00:58:07,040 --> 00:58:09,520
Speaker 2: where their life is flashing before their eyes. And that's

1104
00:58:09,560 --> 00:58:11,720
Speaker 2: why I give my cell phone because they'll gather their

1105
00:58:11,720 --> 00:58:14,480
Speaker 2: thoughts a day or two later. I always say, you know,

1106
00:58:14,840 --> 00:58:18,120
Speaker 2: to my residence people I work with, they're there to

1107
00:58:18,160 --> 00:58:22,640
Speaker 2: see you as an oncologist. First, it's always important to

1108
00:58:22,760 --> 00:58:25,960
Speaker 2: get them to a point where they're making decisions that

1109
00:58:26,000 --> 00:58:27,480
Speaker 2: you think are going to help me help them, or

1110
00:58:27,480 --> 00:58:31,080
Speaker 2: that might give them a few more days, weeks, months, years,

1111
00:58:31,080 --> 00:58:33,800
Speaker 2: you know what I'm saying. So I think it's important

1112
00:58:33,800 --> 00:58:36,680
Speaker 2: and circumstances like that to always follow up, make sure

1113
00:58:36,720 --> 00:58:40,040
Speaker 2: they're not overwhelmed, make sure they've thought about it, you know,

1114
00:58:40,240 --> 00:58:42,960
Speaker 2: and then say, Okay, we can try X, we can

1115
00:58:42,960 --> 00:58:45,760
Speaker 2: try Y, we can try Z. But it's hard. No, No,

1116
00:58:45,800 --> 00:58:48,320
Speaker 2: it's hard. And you do as an oncologist and I'm

1117
00:58:48,360 --> 00:58:52,280
Speaker 2: a very I feel relationships and feel friendships, and my

1118
00:58:52,400 --> 00:58:54,640
Speaker 2: patients mean a lot to me on a personal level.

1119
00:58:54,680 --> 00:58:57,240
Speaker 2: But you do have to detach yourself sometimes, not like

1120
00:58:57,320 --> 00:58:59,120
Speaker 2: in a I'm not there for your sort of way,

1121
00:58:59,160 --> 00:59:00,840
Speaker 2: but you have to go home home and shake it off.

1122
00:59:00,880 --> 00:59:04,000
Speaker 1: And how do you do that? Because I mean, you know,

1123
00:59:04,560 --> 00:59:07,800
Speaker 1: you have wife, you have kids, like, you have a family,

1124
00:59:07,840 --> 00:59:11,520
Speaker 1: and you can't sort of take home that darkness all

1125
00:59:11,520 --> 00:59:14,800
Speaker 1: the time because that would impact you know, your home life,

1126
00:59:14,840 --> 00:59:17,280
Speaker 1: your family. How do you shake that off?

1127
00:59:17,480 --> 00:59:19,880
Speaker 2: My wife? My wife talks about this all the time.

1128
00:59:19,960 --> 00:59:22,960
Speaker 2: So like, you know, there's always that first hour or two,

1129
00:59:23,080 --> 00:59:24,160
Speaker 2: like you know, it might you know, I might not

1130
00:59:24,160 --> 00:59:26,000
Speaker 2: work till midnight or something, but I might come home

1131
00:59:26,040 --> 00:59:29,240
Speaker 2: at five o'clock and just need like an hour to

1132
00:59:29,240 --> 00:59:33,320
Speaker 2: to just be like turn on Sports Center, go to

1133
00:59:33,360 --> 00:59:35,840
Speaker 2: dinner with a friend, or do something and just kind

1134
00:59:35,840 --> 00:59:38,880
Speaker 2: of like decompressed. I never I never take it home

1135
00:59:38,920 --> 00:59:42,040
Speaker 2: and put it on them of course, you know, because

1136
00:59:42,080 --> 00:59:44,120
Speaker 2: again it goes back to what we're saying. Really, you know, life,

1137
00:59:44,240 --> 00:59:46,640
Speaker 2: every every day's a gift, even for me, you know,

1138
00:59:47,200 --> 00:59:50,080
Speaker 2: even though my days are numbered just like everyone else's.

1139
00:59:50,120 --> 00:59:51,480
Speaker 2: You know, you have to take you have you have

1140
00:59:51,520 --> 00:59:53,360
Speaker 2: to make sure you're present in the moment and then

1141
00:59:53,640 --> 00:59:57,720
Speaker 2: enjoying every day that you can. But absorbing that and

1142
00:59:57,760 --> 01:00:00,200
Speaker 2: passing it on to other people's not a good It

1143
01:00:00,240 --> 01:00:03,200
Speaker 2: doesn't help anyone, and especially doesn't help your own patient.

1144
01:00:03,640 --> 01:00:05,960
Speaker 2: You know, they're coming to you for help, They're coming

1145
01:00:05,960 --> 01:00:08,560
Speaker 2: to you to help guide them, and you got to

1146
01:00:08,600 --> 01:00:11,240
Speaker 2: be strong. So I always joke that like I'm holding

1147
01:00:11,240 --> 01:00:12,920
Speaker 2: it all in and just one day I'll let it

1148
01:00:12,920 --> 01:00:15,560
Speaker 2: all out, you know, like you know, run off the antarctica,

1149
01:00:15,960 --> 01:00:18,840
Speaker 2: you know, starting to you know, you know, be friends

1150
01:00:18,840 --> 01:00:20,680
Speaker 2: with like a polar bear or something, and just get

1151
01:00:20,680 --> 01:00:21,040
Speaker 2: a hug.

1152
01:00:21,280 --> 01:00:25,560
Speaker 1: This is why I do not I do not let

1153
01:00:25,600 --> 01:00:30,680
Speaker 1: anyone in the medical field give me good news or

1154
01:00:30,840 --> 01:00:35,640
Speaker 1: bad news in person, because for me, it puts an

1155
01:00:35,640 --> 01:00:40,480
Speaker 1: instant barrier between us where they can have their own reaction.

1156
01:00:40,600 --> 01:00:43,640
Speaker 1: They don't have to monitor their facial you know, reaction.

1157
01:00:44,280 --> 01:00:46,000
Speaker 1: They can just say it to me on the phone,

1158
01:00:46,080 --> 01:00:48,560
Speaker 1: and then I don't have to monitor my reaction because,

1159
01:00:50,400 --> 01:00:53,440
Speaker 1: like the first time and second time that it was

1160
01:00:53,480 --> 01:00:57,360
Speaker 1: told to me in person, I felt like I had

1161
01:00:57,400 --> 01:01:01,600
Speaker 1: to be really strong in front of everybody and help

1162
01:01:01,680 --> 01:01:03,720
Speaker 1: them through it. Not that they were asking me and

1163
01:01:03,760 --> 01:01:06,800
Speaker 1: not that they weren't professional, but I still could see

1164
01:01:06,840 --> 01:01:09,000
Speaker 1: like something a little different in their face, and I

1165
01:01:09,160 --> 01:01:12,520
Speaker 1: had to reassure them that, like, oh, I'm not upset

1166
01:01:12,560 --> 01:01:15,040
Speaker 1: by this news, like not at all. Don't worry about it.

1167
01:01:15,080 --> 01:01:17,240
Speaker 1: I'm going to go home. I'm going to have a

1168
01:01:17,320 --> 01:01:20,640
Speaker 1: dance party, like and meanwhile, you know, all I want

1169
01:01:20,680 --> 01:01:23,800
Speaker 1: to do is cry and like figure my shit out,

1170
01:01:23,880 --> 01:01:25,480
Speaker 1: but I wouldn't do it in front of someone.

1171
01:01:25,920 --> 01:01:30,080
Speaker 2: Human beings are complicated. It comes out in many different ways.

1172
01:01:30,600 --> 01:01:32,720
Speaker 2: You have to let people sort of walk their path.

1173
01:01:32,800 --> 01:01:35,440
Speaker 2: You have to let them go through the stages of

1174
01:01:35,480 --> 01:01:38,560
Speaker 2: whatever it is they go through, and you fortunately have

1175
01:01:38,680 --> 01:01:42,080
Speaker 2: this wonderful platform. I love that you're doing this in

1176
01:01:42,160 --> 01:01:44,760
Speaker 2: such a way where you're bringing in all your doctors

1177
01:01:44,800 --> 01:01:46,880
Speaker 2: and the people. You're trying to educate people on kind

1178
01:01:46,880 --> 01:01:49,560
Speaker 2: of what the experience, what your experience has been, and

1179
01:01:49,600 --> 01:01:52,440
Speaker 2: you've sort of run the table in terms of different

1180
01:01:52,560 --> 01:01:55,439
Speaker 2: kinds of breast cancer therapy. You sort of had it all,

1181
01:01:55,480 --> 01:01:59,040
Speaker 2: you know, and so I'm very grateful that you sitting

1182
01:01:59,040 --> 01:02:01,240
Speaker 2: here in front of me looking as great you do,

1183
01:02:01,360 --> 01:02:03,880
Speaker 2: with things being as controlled as they are, God blessed.

1184
01:02:03,880 --> 01:02:07,440
Speaker 2: That's that's amazing, you know again, you know, but no,

1185
01:02:07,560 --> 01:02:11,440
Speaker 2: not everyone experiences that, and as an oncologist, you just

1186
01:02:11,520 --> 01:02:13,320
Speaker 2: have to do what's best for them.

1187
01:02:13,800 --> 01:02:15,840
Speaker 1: All right, I'm going to wrap this up. I guess,

1188
01:02:15,960 --> 01:02:19,120
Speaker 1: you know. One of those things that people always want

1189
01:02:19,480 --> 01:02:22,200
Speaker 1: to know is like, have you seen miracles? But I

1190
01:02:22,240 --> 01:02:25,720
Speaker 1: think for me I need to define really quickly in

1191
01:02:25,760 --> 01:02:28,280
Speaker 1: my head what a miracle is. Yes, I'm a highly

1192
01:02:28,280 --> 01:02:30,600
Speaker 1: spiritual human being. I believe in God, so I do

1193
01:02:30,680 --> 01:02:34,680
Speaker 1: believe in miracles. Have you seen, you know, the worst

1194
01:02:34,680 --> 01:02:36,480
Speaker 1: of the worst. Didn't think it was ever going to

1195
01:02:36,480 --> 01:02:39,640
Speaker 1: be better, but something changed?

1196
01:02:40,120 --> 01:02:45,040
Speaker 2: So the answer is absolutely yes. Now again, doesn't you know?

1197
01:02:45,120 --> 01:02:48,480
Speaker 2: Common things happen commonly, right, you know? And I know

1198
01:02:48,560 --> 01:02:50,400
Speaker 2: everyone wants an answer, they want to know what's going

1199
01:02:50,440 --> 01:02:52,400
Speaker 2: to happen with me? I don't know, like you know,

1200
01:02:52,760 --> 01:02:55,880
Speaker 2: you think you know sometimes you can guess, but seeing

1201
01:02:55,920 --> 01:02:59,640
Speaker 2: the most dire circumstances, you know, switch to a better

1202
01:02:59,680 --> 01:03:03,680
Speaker 2: direct where many months or years or you know, longer

1203
01:03:03,680 --> 01:03:07,760
Speaker 2: than that was added. I have seen. Sometimes there's luck involved,

1204
01:03:07,800 --> 01:03:11,120
Speaker 2: sometimes there's you know, the human body is sort of

1205
01:03:11,160 --> 01:03:15,280
Speaker 2: this kind of this enigmatic thing, and sometimes things take

1206
01:03:15,320 --> 01:03:18,440
Speaker 2: a turn that you don't expect as a professional that

1207
01:03:18,520 --> 01:03:21,760
Speaker 2: you haven't seen many times or ever in your past.

1208
01:03:22,360 --> 01:03:25,120
Speaker 2: And again you have to just always take one day

1209
01:03:25,120 --> 01:03:27,560
Speaker 2: at a time and have hope and have faith that

1210
01:03:27,640 --> 01:03:30,000
Speaker 2: you know you're moving in the right direction and that

1211
01:03:30,600 --> 01:03:32,160
Speaker 2: as long as you do everything you can. You know,

1212
01:03:32,440 --> 01:03:34,640
Speaker 2: when I played football in high school, they always coach

1213
01:03:34,720 --> 01:03:36,800
Speaker 2: use to always say leave it all on the field.

1214
01:03:37,080 --> 01:03:39,400
Speaker 2: You know, when you're out there playing you might win,

1215
01:03:39,520 --> 01:03:42,320
Speaker 2: you might lose. I tell my volleyball girls is too, like,

1216
01:03:42,520 --> 01:03:44,720
Speaker 2: just just leave it all in the court, don't leave

1217
01:03:44,800 --> 01:03:47,920
Speaker 2: anything behind. You don't want to leave any stone unturned.

1218
01:03:47,960 --> 01:03:50,320
Speaker 2: You don't want to have any regrets about trying this

1219
01:03:50,520 --> 01:03:52,640
Speaker 2: or not doing that. And that applies to life, it

1220
01:03:52,640 --> 01:03:55,800
Speaker 2: applies to your cancer journey. Leave it all out there

1221
01:03:55,840 --> 01:03:58,480
Speaker 2: and then you can just move on in peace in life.

1222
01:03:59,160 --> 01:04:01,040
Speaker 1: I mean, I agree with that, and I think that

1223
01:04:02,040 --> 01:04:05,240
Speaker 1: I think that's beautiful. I kind of look at you know,

1224
01:04:05,280 --> 01:04:07,480
Speaker 1: I'm I'm not gonna say what it is. I'm on

1225
01:04:07,560 --> 01:04:12,840
Speaker 1: a new uh you know, cancer infusion, and you know,

1226
01:04:12,880 --> 01:04:15,240
Speaker 1: after four treatments, we didn't really see a difference, and

1227
01:04:15,280 --> 01:04:18,240
Speaker 1: everybody wanted me to switch and yeah, and I just

1228
01:04:18,320 --> 01:04:20,600
Speaker 1: kind of was like, we're going to keep going with

1229
01:04:20,640 --> 01:04:24,400
Speaker 1: this and see and you know, yeah, after the sixth

1230
01:04:24,400 --> 01:04:27,640
Speaker 1: seventh treatment, we really saw it breaking down the blood

1231
01:04:27,640 --> 01:04:31,440
Speaker 1: brain barrier. Do I call that a miracle? Yeah? For me,

1232
01:04:31,760 --> 01:04:34,120
Speaker 1: that happens to be a miracle right now. That like

1233
01:04:34,480 --> 01:04:36,960
Speaker 1: I sort of rolled the dice and said let's keep going.

1234
01:04:37,440 --> 01:04:39,480
Speaker 1: And doctor Piro and I, you know, after he looked

1235
01:04:39,480 --> 01:04:43,240
Speaker 1: at the tumor markers, he felt comfortable with that decision.

1236
01:04:44,720 --> 01:04:47,800
Speaker 1: And that it's actually breaking that blood brain barrier is

1237
01:04:48,520 --> 01:04:51,120
Speaker 1: a miracle of that drug and a miracle of you know,

1238
01:04:51,240 --> 01:04:54,280
Speaker 1: maybe God intervening and being like I'm going to give

1239
01:04:54,280 --> 01:04:54,920
Speaker 1: her a break.

1240
01:04:55,240 --> 01:04:55,440
Speaker 2: You know.

1241
01:04:56,440 --> 01:04:58,920
Speaker 1: You know, sometimes you're looking for miracles in all the

1242
01:04:58,960 --> 01:05:02,560
Speaker 1: wrong places and they're right there in front of your face.

1243
01:05:03,000 --> 01:05:03,560
Speaker 2: This is true.

1244
01:05:03,840 --> 01:05:07,400
Speaker 1: Well, I feel like we could easily do a whole

1245
01:05:07,480 --> 01:05:12,840
Speaker 1: nother anytime podcast, a whole another episode. You're wonderful. I

1246
01:05:12,880 --> 01:05:15,760
Speaker 1: just love you and for all of you guys listening,

1247
01:05:15,880 --> 01:05:20,800
Speaker 1: remember to go on Let's Be Clear pod on Instagram,

1248
01:05:21,400 --> 01:05:25,560
Speaker 1: send us any questions that you have, and I promise,

1249
01:05:26,120 --> 01:05:28,600
Speaker 1: if I have to drive to seaters with all of

1250
01:05:28,600 --> 01:05:33,520
Speaker 1: my computers and mics and all of that stuff, I'll

1251
01:05:33,560 --> 01:05:37,360
Speaker 1: do it and we'll answer your guys questions. So thank you,

1252
01:05:37,880 --> 01:05:44,320
Speaker 1: Thank you, doctor MARHARDI thank you very much, and I

1253
01:05:44,400 --> 01:05:47,240
Speaker 1: adore you, and I really appreciate everything that you do

1254
01:05:47,520 --> 01:05:51,120
Speaker 1: and how fantastic you are with your patients and all

1255
01:05:51,160 --> 01:05:54,720
Speaker 1: of your advice and your expertise. It's deeply appreciated.

1256
01:05:54,800 --> 01:05:55,640
Speaker 2: Thank you for having me.

1257
01:05:56,400 --> 01:05:59,320
Speaker 1: Thanks all right, you guys, tune in next week to

1258
01:06:00,040 --> 01:06:01,760
Speaker 1: other episode of Let's Be Cule. We Shouldn't a Door

1259
01:06:01,800 --> 01:06:10,880
Speaker 1: to Buy mm hm