Speaker 1: This is Let's Be Clear with Shannon Doherty. Hi everyone,
Speaker 1: I'm back with a new episode of Let's Be Clear
Speaker 1: with Shannon Doherty. As I have mentioned before, it's important
Speaker 1: for me to use this podcast platform to connect with
Speaker 1: the cancer community in a very personal and honest way.
Speaker 1: And what better way to do that than to hear
Speaker 1: from the experts who are caring for me and can
Speaker 1: speak to this complicated disease with experience and knowledge. Today,
Speaker 1: I'm really happy to welcome one of those experts, my friend,
Speaker 1: doctor Amin Marhati from Cedar SINAI. Welcome, Hey Shannon, Hi Doc,
Speaker 1: good to see you now. I said your last name correctly, right, Yes.
Speaker 2: You did, Mahi Marhati HAUGHTI.
Speaker 1: So, can you tell us a little your radiation on collegist?
Speaker 2: Yes?
Speaker 1: And I think a lot of people don't necessarily know
Speaker 1: the difference between you know, a regular on collegeist, a
Speaker 1: radiation on colleges, a cardiologists on collegists. There's so many
Speaker 1: different subcategories. Can you explain like your specific job?
Speaker 2: Definitely, So when someone is diagnosed with cancer, I mean
Speaker 2: there's obviously the work up to cancer, which would involve
Speaker 2: like a radiologist, a pathologist. Sometimes like a surgeon to
Speaker 2: do a biopsy. But then when someone has a diagnosis
Speaker 2: of cancer, there's a there's three main specialties that sort
Speaker 2: of are involved in the treatment of that. The main
Speaker 2: one is a medical oncologist. That's what doctor Lawrence Piro
Speaker 2: is my fav Love that guy, and he's a wonderful
Speaker 2: medical oncologist that's taken care of you for many years.
Speaker 2: And he they sort of work as the quarterback. But
Speaker 2: then another full specialty is radiation oncology, and so I'm
Speaker 2: involved more on the treatment side. You know, He's involved
Speaker 2: more in kind of the management and restaging and ordering
Speaker 2: the tests and labs and things like that. But my
Speaker 2: role is the majority of cancer's breast, lung, colon, et
Speaker 2: cetera involves some form of radiation therapy, especially when it
Speaker 2: spreads to the brain or you know, bone, things like that.
Speaker 2: What we do is we are experts in utilizing focused
Speaker 2: radiation and delivering it properly to tumors and trying to
Speaker 2: minimize the damage around it. So that's what my role
Speaker 2: is as a radiation on collogs, which is different than
Speaker 2: a radiologist who interprets images.
Speaker 1: Okay, so you mentioned focused radiation. I met you because
Speaker 1: I had mets in my brain. I don't remember, was
Speaker 1: it like five or six?
Speaker 2: Yeah, well it was initially six and then three more
Speaker 2: and so we did pinpoint radiation on all of this.
Speaker 2: One of them was surgically removed so we can get tissue,
Speaker 2: and we rated that just before doctor Chu got the
Speaker 2: tumor out. And we did that mainly does this sort
Speaker 2: of get the tissue and do more analysis and more
Speaker 2: kind of testing to see if there's anything further we
Speaker 2: can learn about your tumor. But then we did pinpoint
Speaker 2: radiation to the rest and that's a procedure called radio surgery.
Speaker 2: So the reason they call that radio surgery is because
Speaker 2: this is delivery all the radiation in one shot. Radiation
Speaker 2: when it hits your tissue, if you give a little
Speaker 2: bit of radiation, it causes a little bit of damage
Speaker 2: to the DNA of the tumor cells, and the tumor
Speaker 2: cells will then gradually die off. If you're treating like
Speaker 2: a large area, you do little bits at a time,
Speaker 2: like over twenty five thirty sessions which you had, you know,
Speaker 2: to your chest well, and that's when you're treating a
Speaker 2: large area, you have to give the normal tissue a
Speaker 2: chance to heal itself and fix itself. So you do
Speaker 2: little bits of radiation at a time when it's to
Speaker 2: larger areas, but when you're trying to treat it like
Speaker 2: a distinct tumor, you do all of it at once.
Speaker 2: You sort of condense that radiation because then you're using
Speaker 2: radiation to just obliterate everything in its path. So that
Speaker 2: what you had had to your brain was radio surgery,
Speaker 2: and that what you had had to your chestwall and
Speaker 2: then subsequently your rib was what's called fractioning radiation, meaning
Speaker 2: chopped up into several small fractions.
Speaker 1: Gotcha. So in my case, I'm hoping that people who
Speaker 1: are listening saw my Instagram where I posted the bit
Speaker 1: of getting fitted for you know, the mask which I
Speaker 1: then took home was going to wear for Halloween, but
Speaker 1: I didn't go out for Halloween. Plus a little scary
Speaker 1: to put that mask back on. And we did that
Speaker 1: so that the mask holds goes over your head, holds
Speaker 1: everything in place. You guys, lock me in so that
Speaker 1: there's minimal movement.
Speaker 2: Yes, that it's an amazing process. Well for you. If
Speaker 2: you recall, we did a mapping session where we made
Speaker 2: the mask and then got a quick scan and then
Speaker 2: there was like ten days of doing calculations and planning.
Speaker 2: When you came back for the treatment, each treatment was like,
Speaker 2: you know, ten minutes or so, right, it was quick,
Speaker 2: and so patients they kind of get up and they like, oh,
Speaker 2: that's it, right, but they don't realize, you know, what's
Speaker 2: under the hook, so to speak. It's like there is
Speaker 2: a team of people that you know. It starts with
Speaker 2: me the radiation on colleges, I see you, I determine
Speaker 2: what I want to treat, how much I want to treat,
Speaker 2: et cetera. We go through the planning process and we
Speaker 2: have a team of physicist who all have PhDs and
Speaker 2: medical physics that are behind the scenes calibrating the machine,
Speaker 2: doing calculations, and these are the kind of things that
Speaker 2: patients don't always see what's going on behind the scene.
Speaker 2: And this is where where Cedars Sinai excels because they
Speaker 2: don't cut any corners on when it comes to like
Speaker 2: the physics team or the quality of the equipment and
Speaker 2: doing the quality checks and making sure everything is as
Speaker 2: precise as it should be. And then the end result
Speaker 2: is you lying there and getting a tumors out and
Speaker 2: then going home.
Speaker 1: Right, you make it sound really easy, just lying there
Speaker 1: just like that. But yeahs as a person who is
Speaker 1: you know, very claust tophobic, the mask and you've got
Speaker 1: this lollipop stick that you know is in your mouth,
Speaker 1: and the whole thing is to not move because if
Speaker 1: you do move, if you get antsy, or if you stop,
Speaker 1: it puts more time onto it. And I did make
Speaker 1: it a little bit of a competition where I was like,
Speaker 1: I want to be the one person who moves the least.
Speaker 2: Yeah, And I was like standing there like, okay, so
Speaker 2: someone check your pulse. And also I was wondering where
Speaker 2: my ice cream went.
Speaker 1: Now that's right, now I know where it was, and
Speaker 1: then stuck that pompsicle. Yeah, it's like they all take that,
Speaker 1: thank you. Yeah.
Speaker 2: But you know what's interesting is the way we monitor
Speaker 2: your movement because the machine is delivering radiation, we don't
Speaker 2: want you to like kind of jerk this way or
Speaker 2: you know, we use this optical surface tracking where it's
Speaker 2: a device that basically monitors your motion within less than
Speaker 2: a millimeter, so if you move a little bit, it
Speaker 2: has its feedback loop to the treatment machine, where you know,
Speaker 2: it just shuts down instantaneously, so like if you're out
Speaker 2: of position, we get you back into position before we
Speaker 2: deliver this very high dose of precise radiation. You know,
Speaker 2: I mean you're an actress, right, you get multiple takes.
Speaker 2: Sometimes we only get one.
Speaker 1: Take, right, Yeah, you guys have to do it perfect
Speaker 1: first time, which is a lot of pressure. It's a
Speaker 1: lot of pressure, and you know you're again there's the
Speaker 1: whole teams. It's a huge amount of work that in
Speaker 1: treating literally just one person.
Speaker 2: And that's what a lot of people don't realize. You know,
Speaker 2: there are so many people involved in just delivering that
Speaker 2: one Just take one of the little numors retreating you know,
Speaker 2: you just kind of see you know, like Ty and Marty,
Speaker 2: like the texts at the end, and then like you know,
Speaker 2: the sim therapist, you see me, and then there's a
Speaker 2: whole slew of other people and everyone has to be
Speaker 2: one hundred percent precise all the time. And then we
Speaker 2: have to do that day in and day out for hundreds,
Speaker 2: if not thousands. I've treated over four thousand women with
Speaker 2: breast cancer in my career, and like, imagine that kind
Speaker 2: of pressure, like try to be precise, but we have
Speaker 2: so many checks and balances in place. We have such
Speaker 2: a high quality physics department, things like that, and it's
Speaker 2: really teamwork at its finest.
Speaker 1: Yeah, it's one of the things that I really love
Speaker 1: about Sedars. And that's not to say there aren't other
Speaker 1: amazing hospitals, but Sedars you really understand that everybody who
Speaker 1: works there, the entire team, oh, has been thoroughly checked out, vetted.
Speaker 1: They follow certain protocols that you're sort of getting the
Speaker 1: absolute best of the best. Yeah, and you can go
Speaker 1: in feeling pretty confident because radiation can be a very
Speaker 1: scary thing, especially when it's to your brain. Of course, Oh, absolutely,
Speaker 1: Like I was petrified of you know. It's not of you, No,
Speaker 1: you made me feel very confident, but of you know,
Speaker 1: is it going to change who I am? Like that?
Speaker 1: That was, as you know, a big concern of mine,
Speaker 1: not just with you, but with brain surgery with doctor
Speaker 1: Chwo of are you going to zap something? Is it
Speaker 1: going to change who I am? Am? I not going
Speaker 1: to think as quickly, and particularly with the surgery, there
Speaker 1: was that concern as well. Of course, doctor Chuo ignored
Speaker 1: me when I asked him to like touch the part
Speaker 1: of the brain that made me speak eight fluent languages.
Speaker 1: He ignored me and didn't do it. Shame on you,
Speaker 1: doctor Chu. One thing I asked of you. Yeah, I
Speaker 1: mean it is a very scary thing. And you do
Speaker 1: all sorts of radiation for all sorts of different cancers.
Speaker 2: Correct, Yeah, more or less, mostly breast and lung sort of,
Speaker 2: particularly because those two spread to the brain a lot.
Speaker 1: I have a question because this is I've actually been
Speaker 1: wondering this for myself. Is there a certain amount of
Speaker 1: times that you can do the pinpoint radiation? Like is
Speaker 1: there a certain number and then it's up and then
Speaker 1: you have to do overall brain radiation.
Speaker 2: It's a great question. It's a topic of evolving debate.
Speaker 2: We live in an era fortunately where you know, women
Speaker 2: with breast cancer in particular are living a lot longer
Speaker 2: because of all these wonderful therapies. And in the old
Speaker 2: days they didn't have that much success, so they would
Speaker 2: just sort of go crazy with like whole brain radiation
Speaker 2: and cause a lot of side effects. But the thinking
Speaker 2: has shifted now to being more pinpoint and precise. And
Speaker 2: to answer your question, is there a number like meteors
Speaker 2: like you've had nine total? The answer to that question
Speaker 2: is how big are they? Like if you had like
Speaker 2: ten of them that were like thirty milimeters each. In
Speaker 2: my difficult and yours fortunately have all been very small,
Speaker 2: so we can sort of keep going without causing problems.
Speaker 2: And I've you know, in the past, there have been
Speaker 2: times where I've had to do one that was like
Speaker 2: close to the other, I ran into some problem, you know,
Speaker 2: like it would cause some degree of side effects. But
Speaker 2: having many small ones is the best case scenario because
Speaker 2: then you can sort of keep going and have less
Speaker 2: side effects, so to speak.
Speaker 1: So what size becomes not small?
Speaker 2: Oh? Good question. So for single shot radio surgery, when
Speaker 2: you're delivering all the radiation at once, that's the most
Speaker 2: intense treatment, that's the most effective, but it also could
Speaker 2: potentially have the most side effects if you're doing a
Speaker 2: big area is roughly three centimeters thirty millimeters. When you
Speaker 2: get into a fifty centimeter tumor like I did this
Speaker 2: morning before I came here, then you have to take
Speaker 2: that one dose of radiation and chop it out into like,
Speaker 2: let's say, five sessions, and if it gets it's even bigger,
Speaker 2: and then you have to include a lot of your
Speaker 2: normal brain in the treatment field. Then it's like up
Speaker 2: to thirty sessions, and it's less effect. When you do
Speaker 2: thirty sessions, you're delivering more radiation to a larger area,
Speaker 2: but you're doing it in a way that allows the
Speaker 2: normal brain to sort of safely regenerate itself, and but
Speaker 2: you know, not perfectly, but enough so that you can
Speaker 2: get away with doing that treatment, right, So smaller, the
Speaker 2: fewer treatments you get, the more effective and the safer.
Speaker 1: Okay, let's say you know, I had these five or
Speaker 1: six and then mets and we did however many treatments
Speaker 1: we did, and then those mets come back and the
Speaker 1: drugs aren't working, and I have to have pinpoint radiation again,
Speaker 1: and then the same thing happens in three months. I
Speaker 1: have to come back, and you know, you just keep
Speaker 1: on that cycle. As long as they're small, you can
Speaker 1: just keep doing the absolutely.
Speaker 2: Yeah, and it would be in your particular case. And
Speaker 2: this is this is what something good educationally for people
Speaker 2: who might be listening the routine staging, the getting the
Speaker 2: brain EMRI every three four months. You know, getting the
Speaker 2: pet CT and catching things relatively early makes all the difference.
Speaker 2: Because I can't tell you how many times I've had
Speaker 2: patients who had one or two treated and they're like, oh,
Speaker 2: let's go to you know, Barbados or something. I just
Speaker 2: disappear off the grid. They come back two years later
Speaker 2: and they have one that's like a little bit bigger.
Speaker 2: Then I have to send him a doctor chew and
Speaker 2: then he tells them about the language thing, and it
Speaker 2: becomes a whole big mess.
Speaker 1: You know. Is no, I'm not not going to let
Speaker 1: you speak multiple languages so easily.
Speaker 2: But I think it's But that's the the advantage that
Speaker 2: people in let's call it Western medicine. When you live
Speaker 2: in a metropolitan area like LA and have access to
Speaker 2: wonderful doctors like doctor Piro and wonderful imaging centers where
Speaker 2: you can get your scans in relatively quick fashion, you
Speaker 2: can stay on top of it. And and that's a
Speaker 2: thing like patients who are motivated about, you know, their health,
Speaker 2: they're motivated about you know, quote unquote beating cans so
Speaker 2: to speak. They're the ones that are just they listen
Speaker 2: to their doctors, they're on top of things. They do
Speaker 2: their restage and says, they do their blood work when
Speaker 2: they're supposed to, you know, and and sometimes even in
Speaker 2: cases like that it might not be enough. But to
Speaker 2: give yourself and other patients the best fighting chance, just
Speaker 2: you just have to kind of follow the routine, you know.
Speaker 1: Yeah, I mean, I think what's unfortunate is that not
Speaker 1: every insurance company support scans every three months, you know, Like, yeah,
Speaker 1: I know that. It was tricky for me in the
Speaker 1: beginning as well, and it becomes easier. This is what's
Speaker 1: really sad, is it becomes a lot easier to get
Speaker 1: it every three months the worst you are. So once
Speaker 1: you're enter stage four, they're like, oh, okay, yeah, you
Speaker 1: might need a scan every three months, but you kind
Speaker 1: of want it before then. Like even every six months
Speaker 1: is a much healthier, you know, way as opposed to
Speaker 1: the once a year. So a few things I'm going
Speaker 1: to have to work on in the future advocating for.
Speaker 1: I mean, it is a good thing for us to
Speaker 1: just remind all of you guys listening to press your
Speaker 1: doctor too, because if you're feeling anything weird, if you've
Speaker 1: got headaches and you have cancer or anything just really
Speaker 1: really you can request. You can say I think there's
Speaker 1: something going on and I need an MRI, I need
Speaker 1: whatever it is. Your pet scans and do go in
Speaker 1: for your blood test because those it's amazing how much
Speaker 1: your blood tells you, Like I didn't even know, oh yeah,
Speaker 1: really how much my blood was telling my doctors about me.
Speaker 2: You know, Sit tight, because I would say in the
Speaker 2: next few years, there's going to be even more tests
Speaker 2: that analyze your blood and look for circulating tumor cells
Speaker 2: and circulating tumor DNA and things like that. Genetic testing
Speaker 2: is going to have a more profound component. We're at
Speaker 2: sort of an inflection point in cancer care where we're
Speaker 2: going to be less reliant on imaging and like MRIs
Speaker 2: and cat skins and petskins, and more reliant on blood
Speaker 2: work and genetic testing and molecular testing to understand what
Speaker 2: direction things are going. The technology is there, like, you know,
Speaker 2: there's this one test that was developed out of Cleveland
Speaker 2: Clinic called the Gallery test, where it's like a blood
Speaker 2: test that tells you if your tumor is proliferating or not,
Speaker 2: you know, And it's relatively in a fledgling state, but
Speaker 2: the science is developing, the data is accumulating. You now
Speaker 2: have artificial intelligence that's helping you analyze this information. And
Speaker 2: I think we're moving towards a new frontier. You know,
Speaker 2: everyone likes to say that in cancer care, like everything,
Speaker 2: every new drug or whatever, it is a new frontier, right,
Speaker 2: but nothing really has been until now. I think this
Speaker 2: way to analyze your blood and your DNA and your
Speaker 2: molecular profile, it's really going to take off in the
Speaker 2: next few years.
Speaker 1: I mean, that's really exciting to hear. And you mentioned
Speaker 1: Cleveland Clinic and I just read a whole release from
Speaker 1: them recently about their clinical trial that's currently happening on
Speaker 1: breast cancer vaccine, and I found that to be absolutely
Speaker 1: fascinating that finally there might be a vaccine for breast
Speaker 1: cancer and that it can apparently work on people who
Speaker 1: have you know, had it, are in remission, get the
Speaker 1: vaccine and it's possibly you know, obviously a lot more
Speaker 1: clinical trial has to be done in order to determine
Speaker 1: what all it can do. But I agree with you,
Speaker 1: it's a very exciting time. And although I always say
Speaker 1: I can't believe the cancer has been around for what
Speaker 1: a hundred years and there's not a cure yet, there's
Speaker 1: not a vaccine, there's nothing.
Speaker 2: I'm going to give you my take on what you
Speaker 2: just said, I know that there's a lot of information
Speaker 2: online and a lot of people are like, oh, you know,
Speaker 2: they're trying to withhold the here. You know, like the
Speaker 2: people think that the industry is trying really not to
Speaker 2: find that. That's actually not true. I think that the
Speaker 2: person you don't think that either, But there's a lot
Speaker 2: of people who just sort of look superficially online and
Speaker 2: get some information. Here is why it's really hard to
Speaker 2: find a cure for most types of cancers. The reason
Speaker 2: is because you have a tumor that formed. You know,
Speaker 2: what is a tumor exactly, it's a portion of your breast.
Speaker 2: You know, a portion within the duct of your breast
Speaker 2: developed an abnormality as it was growing. You know, your
Speaker 2: ducks replenish themselves and they have to go through the
Speaker 2: process of cell division to make more cells and more
Speaker 2: ducts and more lobules and things like that. Somewhere along
Speaker 2: the way, due to X, Y and Z factors. No
Speaker 2: one knows exactly there was a mutation in the DNA
Speaker 2: of your tumor cell. Now, the human cell in general,
Speaker 2: it's like, if you think about it, it's built to survive.
Speaker 2: That's why humans have made it so long. Evolutionarily, you
Speaker 2: have a cell that is just constantly dividing and growing
Speaker 2: and growing. So you have to think of the human
Speaker 2: cell as having its footstuck on the accelerator, so it
Speaker 2: doesn't want to stop growing. So every cell in our
Speaker 2: body inherently could be a cancer cell. It just doesn't
Speaker 2: want to stop growing. But we have these big breaks
Speaker 2: that are sitting on top of it as well. I'm oversimplifying,
Speaker 2: of course, but when you get a mutation and the
Speaker 2: big proteins that sit on top of it, the break,
Speaker 2: so to speak, then cells kind of grow unchecked. But
Speaker 2: then what happens is, Okay, you might find the ability
Speaker 2: to treat one type of mutation, but tumor cells go
Speaker 2: through evolution, they evolve, and then you might get a
Speaker 2: drug like inher To or percepted or something that might
Speaker 2: knock out ninety nine point ninety nine percent of your
Speaker 2: tumor cells and be an effective therapy, but it's that
Speaker 2: point oh oh one percent that might be behind that's
Speaker 2: resistant to that particular therapy, and then that grows and
Speaker 2: you have to find a different treatment. And people can
Speaker 2: only tolerate certain types of treatment, certain amounts, and so
Speaker 2: in my opinion, the best way to address that is
Speaker 2: catching it as early as possible because over time, these
Speaker 2: cells go through you know, evolution at a lightening pace
Speaker 2: and they become resistant. They have this biology where they
Speaker 2: become resistant to treatment.
Speaker 1: You know, thank you, because that's a brilliant way of
Speaker 1: explaining it in a way that someone like me who
Speaker 1: does not have a medical degree, although on occasion I
Speaker 1: like to pretend I do for me to understand, because
Speaker 1: when you really break it down to how you did,
Speaker 1: of course, you know the cell is constantly mutating and
Speaker 1: growing and changing and becoming something different. So finding a
Speaker 1: cure that also can adjust to that mutation is incredibly hard.
Speaker 1: I mean, I would imagine it's like you could find
Speaker 1: one thing that would cure it under this particular condition,
Speaker 1: but then it's already mutated, so then that doesn't even work.
Speaker 1: It's much like the protocols that we're on, right. So
Speaker 1: I've actually had protocols that have last me I think
Speaker 1: a pretty good amount of time, all things considered, But
Speaker 1: eventually my body stopped it. Maybe the cells mutated whatever
Speaker 1: they change, where that particular pill was no longer impacting it.
Speaker 2: If I recall it's mina while since I looked at
Speaker 2: your char but when you were originally.
Speaker 1: You don't look at it every day.
Speaker 2: Just sometimes I'm just like, gee.
Speaker 1: My favor, it's not true. You guys.
Speaker 2: You no. I look, I look at the tumor treated,
Speaker 2: and I'm like.
Speaker 1: Yeah, I got it. You know, you took care of Bob.
Speaker 2: We can start Navy by Bob, by Bob. When you
Speaker 2: were initially diagnosed, I recall your tumor was estrogen receptor
Speaker 2: positive and her too negative. Now to the viewers and
Speaker 2: people who are diagnosed with breast cancer, they hear that
Speaker 2: and they're like, I mean, there's many layers to what
Speaker 2: that could mean. In the most simplistic way, esergen receptor
Speaker 2: positive means that your particular breast cancer was expressing estrogen receptors,
Speaker 2: meaning to some degree estrogen was fueling your tumor growth.
Speaker 2: Then the her too, which is a gene that they
Speaker 2: you know that's involved in breast cancer treatment and diagnosis
Speaker 2: and stuff, yours did not express the hurto receptor pathway.
Speaker 2: And then over time in twenty eighteen or twenty or
Speaker 2: something like that, when your tumor involved, it eventually did,
Speaker 2: which suggests that you were able to successfully, doctor Piro,
Speaker 2: was to eradicate all of the tumors that you had,
Speaker 2: there was a little bit left behind that developed its
Speaker 2: own molecular kind of evolution and its own resistance, and
Speaker 2: that's what started to grow. And that's what came into
Speaker 2: your brain, as we confirmed when doctor Chu took out
Speaker 2: that one spot and we looked at it. Because cancer
Speaker 2: in your living, breathing example of cancer, how it evolves
Speaker 2: and how we change our strategy to address it.
Speaker 1: So I mean, yes, by the way, I one of
Speaker 1: my favorite things I probably once a month, I'm going
Speaker 1: to really sounds strange right now, is I look at
Speaker 1: the picture of my brain opened up that doctor Chru
Speaker 1: said to me. I he actually printed it out and
Speaker 1: gave it to me because he knows I'm like a
Speaker 1: weird nerd that way. And I look at it and
Speaker 1: I actually, when I got done with brain surgery and
Speaker 1: I got home, I showed it to as many people
Speaker 1: as I possibly could, and some were horrified by it
Speaker 1: and some enjoyed it like I do. But I mean,
Speaker 1: I just think it's it's it's to me, it's so
Speaker 1: fascinating that you know radiation works the way that it does,
Speaker 1: and it's you hear the word radiation, right, and you
Speaker 1: think of like noble, you think of like all these
Speaker 1: crazy things. So you get very, very very scared of radiation.
Speaker 1: But because you're doing pinpoint, and you with me and
Speaker 1: with all your patients, you were very careful. You didn't
Speaker 1: you didn't laugh at me or sort of ignore the
Speaker 1: fact that I was concerned about having more bald spots
Speaker 1: and patches and that radiation can cause the hair loss.
Speaker 1: You were equally as concerned, at least in front of
Speaker 1: me about Listen, I'm going to get every little met
Speaker 1: that I can, and I will do it trying to
Speaker 1: not get your hair at the same time, like I
Speaker 1: hear you, I respect the fact that you really want
Speaker 1: to keep your hair. Thank you. It's a weird, but
Speaker 1: it's growing underneath this.
Speaker 2: By the way, I totally so you are going to
Speaker 2: grow a third ear? Is that okay? I hope that
Speaker 2: doesn't bother you. It's a third ear? Just back here.
Speaker 1: Can I hear thousands of feet away, because I'll take.
Speaker 2: It you bring up. I do want to make a
Speaker 2: comment about what you just said, because you and I
Speaker 2: we had dialogue. Of course, I told you about what
Speaker 2: to expect what we're doing. One of the big disconnects
Speaker 2: and healthcare in general, from doctor to patient, just patients
Speaker 2: trying to navigate the healthcare system is there's too much information.
Speaker 2: And one thing that in my eighteen years at SED
Speaker 2: Sinai and my training at UCLA before that, one thing
Speaker 2: I've always always made important to me is patients nodding
Speaker 2: their head at you and sounding like they understand what
Speaker 2: you're talking about. They almost never do, and it's really important,
Speaker 2: you know, I have these you know, we just hired
Speaker 2: like three or four young doctors who are physician scientists,
Speaker 2: and they're absolutely brilliant. They are like like one smarter
Speaker 2: than the next. I'm like, wow, you guys are like,
Speaker 2: you know, it's a new era of just like smart
Speaker 2: people to go into medicine. And you know, as young
Speaker 2: doctors in particular, they feel compelled and this is not
Speaker 2: right around this is actually probably more right than anything
Speaker 2: to give you all the information. It's almost like a
Speaker 2: checklist where they have to just kind of explain everything.
Speaker 2: And what I've noticed is I started out doing that
Speaker 2: in my career as well, until I realized that it
Speaker 2: became detrimental to a patient. Until like The core of
Speaker 2: what I wanted to convey to them to help them
Speaker 2: make a decision was at the very last of a
Speaker 2: two hour clinic visit where they were poked and prodded
Speaker 2: by nurses and had an memory done. It was the
Speaker 2: last two seconds where I was like, Oh, by the way,
Speaker 2: it might do this and that, you know. And I
Speaker 2: have been as I've gotten further into my career, I
Speaker 2: have focused more on simplifying it. I don't know if
Speaker 2: you ever saw that movie with Denzel Washington was called Philadelphia.
Speaker 2: He was like a lawyer with Tom Hanks or something. Yeah,
Speaker 2: and he goes. He kept saying, explain it to me
Speaker 2: like I'm a six year old, or explain it to
Speaker 2: me like I'm a ten year old. And that line
Speaker 2: always resonated with me because not to try to insult
Speaker 2: the intelligence of my patients, but I do cancer all day,
Speaker 2: every day. I know what is going on or what
Speaker 2: to expect, but you don't, or other patients don't.
Speaker 1: Yeah, I think it's also it's overwhelming. And you go
Speaker 1: in there and you're already nervous because you are getting poked.
Speaker 1: You know, you're getting your blood drawn, getting an MRI done,
Speaker 1: You're scared because you have cancer, or you're scared because
Speaker 1: you hear the word radiation or surgery, whatever it is.
Speaker 1: So then if there's so much information coming at you,
Speaker 1: I think it can drown out your own questions. And
Speaker 1: I always encourage people to, you know, write down a
Speaker 1: list of questions beforehand and make sure that they check
Speaker 1: that list off, and to also not be intimidated by
Speaker 1: the white coat, which is something I find a lot
Speaker 1: of people are that I speak to, oh that are sick,
Speaker 1: is that they kind of feel they don't have the
Speaker 1: right to question the doctor or ask for special things.
Speaker 1: And I'm always like, oh God, I wish you all
Speaker 1: could go to my doctors, you know, because I've never
Speaker 1: felt that way. I've always felt like I could push
Speaker 1: back and that I could question. I could say, you know, well,
Speaker 1: I don't want to get an aria this month. I
Speaker 1: want to get them every three months instead, And there's
Speaker 1: a dialogue about like why that choice is that choice?
Speaker 2: It takes a lot of experience to get to get
Speaker 2: to that point as as a doctor, to value that
Speaker 2: or to you know, because you're in your head, you're
Speaker 2: you're the expert, and you're trying to impart your areation
Speaker 2: to everyone which comes from a good place. Obviously. Obviously,
Speaker 2: you know, I very very rarely meet a doctor who's
Speaker 2: just out there doing it for you know, for kicks
Speaker 2: or to try to be famous or you know, make
Speaker 2: money or whatever. And most of them, the vast majority
Speaker 2: of them, really just want you to get back, you know,
Speaker 2: they want to take care of you. But the approach
Speaker 2: can certainly fluctuate, and it takes a lot of experience.
Speaker 2: And that one thing I like to do is I
Speaker 2: like to not overload my patients with unnecessary, too much
Speaker 2: information that's not necessarily relevant. But I also like to
Speaker 2: give them my cell phone because what I find is
Speaker 2: that when they leave my office, there's so much anxiety,
Speaker 2: and there's so much uncertainty, and there's so much misinformation
Speaker 2: out there that sometimes just like a little text message
Speaker 2: or a little you know, two second conversation can sort
Speaker 2: of reset them a little bit and take them to
Speaker 2: a place of like, Okay, now I got now that
Speaker 2: little bit of information clicks to me. You know, when
Speaker 2: I started out in my career, you know, I was
Speaker 2: focused on my career. I got a job at Cedars,
Speaker 2: I was stoked to work there, stoked to live in
Speaker 2: La and whatever. And then I remember one day there
Speaker 2: was one very poignant moment women with breast cancer who
Speaker 2: had a brain met that I treated. I remember like
Speaker 2: I did my whole spiel with her. I recommended this,
Speaker 2: did that, whatever, And then you know, she went off
Speaker 2: and I went home and I always stopped by this
Speaker 2: Bristol farms on the way home from Cedars as I
Speaker 2: was grabbing ie tea or whatever, and I saw her
Speaker 2: there with her daughter. I saw her, and she didn't
Speaker 2: see me, and she was just there having a laugh
Speaker 2: with her daughter. They were picking something and going home
Speaker 2: to make dinner or something. And at that instant, I
Speaker 2: was like, Okay, my job is about giving her more
Speaker 2: days like that, more moments like that. It's about nothing else.
Speaker 2: It's not about me, It's not about Cedars, not about
Speaker 2: anything other than that woman sitting there is enjoying a
Speaker 2: day with their daughter, you know, and give her more
Speaker 2: of those. However you can whatever, use your knowledge and expertise,
Speaker 2: and the best way you can to maximize that and
Speaker 2: everything else.
Speaker 1: Is hotter Ihan, My god, that's such a beautiful way
Speaker 1: of looking at it. As you know, you guys are yes,
Speaker 1: you're taking care of us, but you're also giving people
Speaker 1: more time and more precious moments. You know, when we're gone,
Speaker 1: their children, their loved ones, their friends will be so
Speaker 1: deeply appreciative that they got that extra that extra laugh,
Speaker 1: that extra cry, that extra whatever it was. That's a
Speaker 1: that's very beautiful.
Speaker 2: You know. I coached just recently, I coached my daughter's
Speaker 2: junior high volleyball team. You know, I just kind of
Speaker 2: did it on the side, and it was fun. It
Speaker 2: was great, great experience. There was one thing I kept
Speaker 2: emphasizing with them. It was there was a it was
Speaker 2: a quote that I saw on a Michael Jordan documentary.
Speaker 2: It was called The Last Dance whatever is Michael Jordan's
Speaker 2: Ten Parts documentary. But some guy talked about how Michael
Speaker 2: Jordan wasn't the best in the world because he dribbled
Speaker 2: better than anyone, or he shot the ball better than anyone,
Speaker 2: or he you know, did whatever, played defense better than anyone.
Speaker 2: He was the best there was because he was always
Speaker 2: present in the moment. So when I was coaching these young,
Speaker 2: you know, seventh and eighth grade girls, I was like, listen,
Speaker 2: look around you. You know, here we are playing a
Speaker 2: game against you know, whoever here you are in the
Speaker 2: gym is the last time you might might be together.
Speaker 2: Just be present in the moment, because the moment is everything.
Speaker 2: The moment is what will stick with you. Don't think
Speaker 2: about what's ahead of you, don't think about what's behind you.
Speaker 2: Be present, and that, I think is what's important to
Speaker 2: cancer patients, people who are going through it. And I
Speaker 2: always tell I always tell people this. I I live
Speaker 2: my life, you know, as much as I'm capable of,
Speaker 2: as much as I'm able to to the fullest, because
Speaker 2: I'm surrounded by people like you, by other patients who
Speaker 2: you know, vague go through something hard. They've they've gone
Speaker 2: to the abyss and stared at it, you know, wherever
Speaker 2: that quote moves from, and they realize that, Okay, you
Speaker 2: know what. You know, life is limited. It's limited for everyone,
Speaker 2: but people like you, they realize it more, they embrace
Speaker 2: it more. And I am fortunate enough to be surrounded
Speaker 2: by that every single day, so that when you know,
Speaker 2: my buddy calls me up and says, let's go to
Speaker 2: Kansas City, you know for the Chiefs game. Sure, let's
Speaker 2: you know, like you take advantage of every moment. You know,
Speaker 2: someone says let's have a big fiftieth birthday party or whatever, like,
Speaker 2: go for it. Let's just you know, go out and
Speaker 2: have some fun, that sort of thing, because that's what
Speaker 2: life's about. It's that.
Speaker 1: So let's say for those people out there who are not,
Speaker 1: you know, as fortunate as I have been to have
Speaker 1: a doctor like you, who you know, you cared, you listened.
Speaker 1: You didn't you know, think that I was vain for
Speaker 1: asking about my hair. You talked me through that whole
Speaker 1: mapping mask process. I mean you saw me. I was crying.
Speaker 1: I was just hyperventilating. You know, you talked me through.
Speaker 1: You were kind enough to shoot video because I asked
Speaker 1: you to. You basically held my hand through the entire
Speaker 1: experience and knew how to talk to me and explain
Speaker 1: things to me. Gave me your cell phone number, allowed
Speaker 1: me to, you know, infiltrate your private time with your
Speaker 1: own family after hours, to answer questions that popped up
Speaker 1: in my head, because that happens a lot. You go in,
Speaker 1: you think that you've got your list of questions, you
Speaker 1: get overwhelmed, you leave, and then you don't see your
Speaker 1: doctor again until it's time for radiation or surgery or
Speaker 1: whatever it is so the fact that you allow, you know,
Speaker 1: your patience to text you is a you know, very
Speaker 1: rare thing from some that I know. But for those
Speaker 1: people that don't have a doctor like you in their life,
Speaker 1: what would be sort of your biggest suggestion when they
Speaker 1: go in to meet their radiation oncologists? But what are
Speaker 1: the things that they should be asking about? What are
Speaker 1: the things that they should be looking for? And I
Speaker 1: know that that answer changes does constantly because it's you know,
Speaker 1: what kind of a cancer are you dealing with? How
Speaker 1: big are the mets where? You know, is it in
Speaker 1: your brain? Is it in your lungs? Like is it
Speaker 1: in your breast? For you, it's a it's a hard one,
Speaker 1: but I'm going to impress it. I'm going to ask it.
Speaker 2: So specifically about women who have you know, breast cancer,
Speaker 2: any cancer that spread to the brain. The most important
Speaker 2: thing to understand is what's your experience with like the
Speaker 2: long term effects and the long term outcomes, because sometimes
Speaker 2: that will vary depending on where the little tumor spots are. Again,
Speaker 2: this goes back to what I was saying earlier. Sometimes,
Speaker 2: you know, doctors and healthcare providers in general, they feel
Speaker 2: compelled to kind of go through that laundry list of
Speaker 2: like these twenty things that can happen. And that's the
Speaker 2: part I've noticed scarest patients the most. And sometimes it
Speaker 2: has to be said. Sometimes you have to go through
Speaker 2: like you know, you know, when a surgeon says you
Speaker 2: might not wake up, you know, I mean it's happened before.
Speaker 2: I mean it's rare.
Speaker 1: I always like hearing that.
Speaker 2: Yeah, it's always like, sign here, take a crocabol and
Speaker 2: have an IC. The most important thing to say is
Speaker 2: how camp like some of those laundry list questions is
Speaker 2: making sure to understand how common or uncommon they are,
Speaker 2: and have them really drill down and emphasize what they
Speaker 2: really expect to happen. Just tell me what you really
Speaker 2: think is going to happen, and like, let's leave the
Speaker 2: fluff out and focus in on what I can do
Speaker 2: to prevent it. Are there things I can do? Maybe
Speaker 2: there's certain diets, or there's certain you know, preventive measures
Speaker 2: I can take to limit the swelling that you might cause,
Speaker 2: or what you know, things of that nature. I think
Speaker 2: are important is to just be deliberate and to be
Speaker 2: focused on the most important aspects of your care because
Speaker 2: you have a limited amount of time with your doctor,
Speaker 2: you have a limited of time to the treatment. It's
Speaker 2: important to be finite. I think.
Speaker 1: I think that's amazing advice. And then that after the
Speaker 1: radiation was very interesting for me. You know, the first
Speaker 1: time I got radiation done for for just the breast wall, yes,
Speaker 1: I was like a little tired, but I don't think
Speaker 1: it impacted me as much. And maybe it's age, or
Speaker 1: maybe it's because it was in the brain, but you
Speaker 1: were very conscious of saying, listen, you're going to be tired,
Speaker 1: and it doesn't hit you right away. I feel like
Speaker 1: it built up and the fatigue got much worse later on.
Speaker 2: That's a great question, and there's a very specific reason
Speaker 2: for why you get tired after radiation, and it's a
Speaker 2: good thing. So when you radiate a particular tissue, your
Speaker 2: body doesn't know how to respond to it, so it's
Speaker 2: immune system starts going a little bit crazy, like thinking
Speaker 2: it has like a foreign invader. So that tiredness is
Speaker 2: your immune system ramping up to deal with it, and
Speaker 2: that's good in the following sense, there's no better weapon
Speaker 2: that you have for fighting your cancer than your own
Speaker 2: immune system. It's the one that knows what's normal and
Speaker 2: abnormal in your body. It knows how to interpret that
Speaker 2: and what radiation does. And frankly, this is part of
Speaker 2: how is an effective anti cancer treatment is it ramps
Speaker 2: up your own immune system. So the radiation causes the
Speaker 2: same type of tiredness as like when you have a flu.
Speaker 2: Your body is battling off like a virus or a
Speaker 2: bacteria or something, and it's doing that because your immune
Speaker 2: system is ramp up. That's why you're tired.
Speaker 1: And so that explains why because you're getting more and
Speaker 1: more radiation after so many treatments, you just it keeps growing.
Speaker 1: That's fatigue because it's just really fighting all of it.
Speaker 2: Your immune system keeps going, which is amazing.
Speaker 1: For a while, I think I was also you know,
Speaker 1: I mean I did surgery as well. Yeah, radiation I have,
Speaker 1: I have almost like a guinea pig. So but what
Speaker 1: I also found interesting for my particular case was that
Speaker 1: we did radiate Bob. For those of you who don't
Speaker 1: know who Bob is because we've now or I've at
Speaker 1: least mentioned him two or three times, Bob was the
Speaker 1: bigger tumor that we decided to remove because then we
Speaker 1: could study its pathology, and in studying its pathology, it's
Speaker 1: you know, molecular makeup and everything else. It allowed the
Speaker 1: doctors to come up with the right plan to see
Speaker 1: if it had changed, if it had changed, did it
Speaker 1: become you know, was there any her two negative prospects
Speaker 1: in there, like whatever it happened, how.
Speaker 2: Is it sensitive to certain drugs versus others?
Speaker 1: You know, we have that type, so we could do
Speaker 1: a better treatment plan. But we radiated Bob first, and
Speaker 1: that was I call them seeds. It was so that
Speaker 1: during surgery, like there's little cancer seeds that could have
Speaker 1: spilled out. Can you explain that?
Speaker 2: So there's two different approaches when you have a brain
Speaker 2: metastasis or brain met for short, Bob wasn't a very
Speaker 2: accessible area, you know, so when when doctor Chew went
Speaker 2: in there, it wasn't you know, he made a small
Speaker 2: decision in your skull, and you know, he was able
Speaker 2: to open the tentorium and just kind of go right
Speaker 2: to where he needs to and take it out. And
Speaker 2: sometimes when you're surgically removing a tumor, little tiny tumor
Speaker 2: cells might just sort of kind of stick to the
Speaker 2: edges and they might seed along where the incision is.
Speaker 2: So that's why we give radio surgery after the fact.
Speaker 2: But then the radio surgery after you remove Bob, you know,
Speaker 2: it's a little bit more difficult because you don't have
Speaker 2: a discernible target. You know, sometimes things can shift and
Speaker 2: things like that, you know, and yours was at a
Speaker 2: place where it could have shifted a little bit. So
Speaker 2: we thought it was better, let's just radiate Bob now.
Speaker 2: And you know, so that way we kind of sterilized
Speaker 2: Bob's edges. Bob's edges, Sorry, Bob is on. We've we
Speaker 2: sliced and diced Bob. Bob is sitting in paraffin box somewhere.
Speaker 2: We took care of Bob.
Speaker 1: I was like, can you guys please give me Bob.
Speaker 2: We could give you like a little like his head
Speaker 2: or something like that. No, but but then that sterilizes
Speaker 2: the edges. So when we remove it, the edges were
Speaker 2: sort of dead, so it doesn't seed along the area
Speaker 2: that we've surgically removed. And now we know a year
Speaker 2: later that you know, it was successful in eradicating there,
Speaker 2: So it didn't Bob didn't regrowth.
Speaker 1: But it didn't kill all of Bob. It was like
Speaker 1: you said, just the edges, so that when doctor Chu
Speaker 1: removed as much of it as he could, yeah, it
Speaker 1: was still alive enough tissue in order to see the pathology.
Speaker 1: Does that make any sense?
Speaker 2: Absolutely yes, because the things that we were looking at
Speaker 2: kind of in a molecular aspect would take more than
Speaker 2: you know, a few days to change, you know, in
Speaker 2: the body. So we were able to get enough information
Speaker 2: to make the necessary changes we needed, you know, to assess,
Speaker 2: so to speak. You know, if you'd kind of radiated
Speaker 2: Bob and waited like five or six weeks, there might
Speaker 2: have been some changes, it might have transformed in a
Speaker 2: way where the information wouldn't have been as useful. But
Speaker 2: this approach was was ultimately the best for you, just
Speaker 2: for that specific reason. So sometimes as an oncologist like
Speaker 2: doctor Pirol, you're sort of giving, using your best clinical judgment,
Speaker 2: what responds in what scenario. And that's why I think
Speaker 2: having gray hair is really important on cology because you
Speaker 2: can read the information in a medical journal. You can
Speaker 2: read the statistics and the outcomes and things like that
Speaker 2: other people's experiences, but when you do several thousand of
Speaker 2: them yourself, that just gives you a much better perspective
Speaker 2: of like, no, when I tried this, this worked and
Speaker 2: that didn't work. When I tried that, that worked and
Speaker 2: this didn't work. And so experience I think is really important.
Speaker 2: Some of your listeners might be hearing this and saying, oh,
Speaker 2: my doctors are really young and just came out, but
Speaker 2: they I'm sure have the training and experience of their
Speaker 2: mentors and people that can help guide them as well,
Speaker 2: you know. So I do think that clinical experience is
Speaker 2: very valuable in guiding this type of decision making because
Speaker 2: a lot of it is just to some degree, relying
Speaker 2: on chance and relying on hope that something works.
Speaker 1: You know, right. I like my doctors to have some
Speaker 1: surgical clinical research experience. I want to cover it all.
Speaker 1: I also think that people have to be extremely careful,
Speaker 1: because I know that this happened to me, of digging
Speaker 1: for too much information on everything. Because there's a lot
Speaker 1: of chat rooms that are wonderful right where people can
Speaker 1: support each other, But it can also be a really
Speaker 1: dark path because somebody will say, oh, well, I have
Speaker 1: the same thing as you have, you know, stage four cancer,
Speaker 1: but their body could respond to a medicine that yours doesen't.
Speaker 1: They could you know, have shutting of hair much more
Speaker 1: than you or much less. So you have to be
Speaker 1: really careful with those chat rooms and when you're looking
Speaker 1: for the information. Yet it's I think, is it helpful
Speaker 1: for your patients at least to be somewhat knowledgeable.
Speaker 2: It is helpful for them to be knowledgeable, of course,
Speaker 2: but sometimes people sort of go down the wormhole, and
Speaker 2: sometimes even if you tell them no, this is not
Speaker 2: the case, they still don't believe you because they saw
Speaker 2: it in some chat room. Here's a good way to
Speaker 2: think about that. If you're in a classroom and you
Speaker 2: lean over to you know, person next to you and say, hey,
Speaker 2: I saw so and so kissing so and so, and
Speaker 2: then that person turns, the next person says, I saw
Speaker 2: so and so kissing so and so, and two other
Speaker 2: people are, you know, and it keeps going around, and
Speaker 2: just within one classroom, it might come back to you
Speaker 2: as like, you know, so and so was on de Yeah,
Speaker 2: I tried. I tried to weave in and I know
Speaker 2: two in a reference there. But my point is, in
Speaker 2: a very short amount of time, misinformation, just in a
Speaker 2: small classroom, small table full of people can just spread
Speaker 2: like that, you know, and so I always try to
Speaker 2: tell people like, look, you know the Fourth House and
Speaker 2: breast cancer patients that I've treated in my career, here's
Speaker 2: my experience, here's what I tend to see. You know,
Speaker 2: you might read on a room that it causes this
Speaker 2: or that and that and this, but at the same time,
Speaker 2: you know, it's a different era. You know, these are
Speaker 2: women that were probably treated in the nineties or two
Speaker 2: different period of time under different circumstances. So I do
Speaker 2: my best to try to reel them in, you know,
Speaker 2: as best as I can. But it is good to
Speaker 2: be informed. It's not good to let information online consume
Speaker 2: you and guide you down the wrong path, so to speak.
Speaker 1: Yeah, I think you know. I did visit a few
Speaker 1: chat rooms right in the beginning because I was obviously curious,
Speaker 1: and I found it disruptive for me, just because it
Speaker 1: did feel like a game of telephone. But there were
Speaker 1: other chatrooms that I went into and it felt like
Speaker 1: a sisterhood and like a family, all supporting each other.
Speaker 1: And I was like, well, that's really beautiful because we
Speaker 1: all need that, we all need the love and support,
Speaker 1: especially when you're facing something like cancer, whatever cancer you have,
Speaker 1: it's such a difficult disease. But there are, you know,
Speaker 1: some excellent published papers out there to give you the
Speaker 1: kind of knowledge and information that you need in order
Speaker 1: to go in and feel like you've got a little
Speaker 1: bit of a handle on your own disease, because I
Speaker 1: think that that's the biggest thing, is that cancer is
Speaker 1: still somewhat unknown. Of course to the individual who gets
Speaker 1: it that they need to feel armed with knowledge.
Speaker 2: Yes, absolutely, I'm going to add a little grain of
Speaker 2: salt to what you said. I always had a lot
Speaker 2: of patients, and I'd say you're definitely on the higher
Speaker 2: end of the spectrum in terms of being able to
Speaker 2: process this information. You're a pretty intelligent young lady. And
Speaker 2: you also you're getting the right information from the right places.
Speaker 2: I mean, that's like the top two percentile of my experience.
Speaker 2: Usually it's like everything in between. Again, the vast majority
Speaker 2: of patients, they understand the information you're sharing with them.
Speaker 2: If they bring something up that they learn from the outside,
Speaker 2: you know, it's easy to just sort of put it
Speaker 2: into the proper content ext firm. But not everyone can
Speaker 2: pull up medical literature papers and recent publications and process
Speaker 2: that the way you do. And I know you've brought
Speaker 2: it up with me a couple of times in the past.
Speaker 2: I'm like, oh, wow, that's pretty impressive. You know, I
Speaker 2: wish they were all like you, but you're the exception,
Speaker 2: not the rule. But yes, it's always important to arm
Speaker 2: yourself with whatever information you can, allow it to be
Speaker 2: filtered properly. It's usually very helpful if you talk to
Speaker 2: other people with the same condition that you have. I
Speaker 2: found those chat room to be very helpful because, yeah,
Speaker 2: very often sometimes there are in my own pace and
Speaker 2: it's like, oh doctor, you know, like you know, they'll
Speaker 2: make that connection and things like that. But I do
Speaker 2: think it's incredibly important to find support as long as
Speaker 2: you take with a grain of salt that sometimes the
Speaker 2: information or the treatment they got might not pertain to
Speaker 2: their circumstance. You know, you're very good at that, and
Speaker 2: others aren't. You know.
Speaker 1: Well, you know, I learned that through I had doctor
Speaker 1: piro On and we talked about one of my best
Speaker 1: friends who passed away from stage four breast cancer. Like me,
Speaker 1: it didn't she didn't have brain mets, hers had spread
Speaker 1: to her organs, and when she first got sick. I
Speaker 1: really associated everything that she was going through with myself
Speaker 1: in the beginning. So then when she had all these
Speaker 1: pains and that meant that it had spread, all of
Speaker 1: a sudden, I got pains and it had spread. Doctor
Speaker 1: Parro was very on top of me about not associating
Speaker 1: my experience with hers, because he said, night and day
Speaker 1: two very different things. Yes, stage four breast cancer, yours
Speaker 1: is in your bones, hers is in her organs. Like
Speaker 1: there's two different treatments, there's two different This is incredibly different,
Speaker 1: and you cannot associate. And even if you have someone
Speaker 1: who who you find where it did travel into their
Speaker 1: bones and they have brain mets, it's still going to
Speaker 1: be different because we're all individuals, and although we can
Speaker 1: hug and support each other as much as humanly possible,
Speaker 1: you still have to keep a little bit of disassociation,
Speaker 1: I guess.
Speaker 2: And what's worse is that, you know, I'm sure that
Speaker 2: doctors like doctor Piro, myself and others, you know, if
Speaker 2: you're describing a circumstance from another patient to us, unless
Speaker 2: we treated that patient, we don't know the details. We
Speaker 2: don't know the molecular basis of their tumor or where
Speaker 2: it has spread. It's also really hard for us to
Speaker 2: say no, that doesn't apply to you because of X,
Speaker 2: Y and Z, because we haven't had a chance to
Speaker 2: read through their chart and say that. So sometimes I
Speaker 2: see doctors sometimes get frustrated trying to kind of tell
Speaker 2: them it doesn't really apply it because they don't have
Speaker 2: the information to kind of say whether it does or doesn't,
Speaker 2: you know, and that. But that's an important point. And
Speaker 2: you know, I've seen a lot of people spiral with
Speaker 2: having information and others like that.
Speaker 1: Yeah, I mean, and it's not just the person with
Speaker 1: the cancer that spirals, it's everybody else. It happened to
Speaker 1: me very very very recently where a woman said to
Speaker 1: me that her dad is a doctor, and so she
Speaker 1: spoke to her father and you know, how did it
Speaker 1: feel or how does it feel that I have stage
Speaker 1: four terminal cancer and my time is limited? And I
Speaker 1: was like, whoa, And she's like, well, my dad explained.
Speaker 1: I mean, like to me, it's like, first off, your
Speaker 1: dad doesn't know anything about my particular like the broad strokes. Sure,
Speaker 1: just what I've told people and what's out there in
Speaker 1: the public, but he doesn't know my exact pathology, and
Speaker 1: he doesn't know my treatment plan. Like there are so
Speaker 1: many variables that go into each person's individual cancer. That
Speaker 1: that's why associating your cancer with somebody else's or assuming
Speaker 1: that you know everything, it's impossible because it just is.
Speaker 1: It's like the people who tell me, hey, and you know,
Speaker 1: God bless them because they're just trying to help me.
Speaker 1: But you shouldn't be on any of these pharmaceutical drugs,
Speaker 1: that's what's giving you cancer. Go on a vegan diet
Speaker 1: or do this. And I'm like, yeah, sure, let me
Speaker 1: just you know, not get infusions and see how fast
Speaker 1: everything spreads while I try some experimental all natural which listen,
Speaker 1: everybody can do what they want individually. But there's a
Speaker 1: lot of misinformation about cancer.
Speaker 2: You bring up a very good point, and it leads
Speaker 2: me to one of my favorite quotes. I tell my
Speaker 2: residents and fellows this all the time. You know, there's
Speaker 2: three types of lies in this world. There's lies, there's
Speaker 2: damn lies, and there's cancer statistics. The reason I say that,
Speaker 2: and what I mean by that is, you know, very
Speaker 2: often and patients are very focused on this, understandably, of course,
Speaker 2: but they're very focused on how much longer do I
Speaker 2: have to live?
Speaker 1: Doc?
Speaker 2: And I'm like, or what are the chances that I'll
Speaker 2: be cured? And you know, my favorite answer sometimes is
Speaker 2: like somewhere between zero and one hundred percent, because it's
Speaker 2: really and I think that's where the experience comes in.
Speaker 2: And I assured doctor Hero feels the same. You know. See,
Speaker 2: you've seen it all over the years. You're like, you
Speaker 2: see someone that thought they were going to be completely
Speaker 2: cured and al lujah and go have a big party,
Speaker 2: and then you know, two months later it comes back,
Speaker 2: you know, crazy fashion. Or you see people where it's
Speaker 2: quote unquote stage four terminal. All the buzzwords that I
Speaker 2: think don't really apply in today's era of cancer care.
Speaker 2: You see them living many, many, many many years with
Speaker 2: no evidence of disease. Right, It's really hard to predict
Speaker 2: what's going to happen on an individual basis. It's really
Speaker 2: hard to try to tell people, hey, you know, I
Speaker 2: mean there are some circumstances where the disease might not
Speaker 2: be responding to X, Y and Z, and it continues
Speaker 2: to progress where you can start to have a sense that, Okay,
Speaker 2: this is not going in a good direction. In the
Speaker 2: absence of that, in the absence of any discernible progression,
Speaker 2: just living as a statistic living as like, oh I'm terminal,
Speaker 2: Like you know, it's never. It doesn't make sense to me.
Speaker 2: I don't think that's the right way to think about it.
Speaker 2: I think the right way to think about it it's
Speaker 2: highly variable. Do what you can with your doctors and
Speaker 2: do what they offer you to the best that you can.
Speaker 2: Be an advocate for yourself as a patient as you
Speaker 2: are and as most of my patients are. Try to
Speaker 2: learn as much as you can. Learn what your options are,
Speaker 2: learn what would happen if it progresses, you know, but
Speaker 2: there's no certainty in what in what this experience is, right,
Speaker 2: which is good because you know it gives people hope
Speaker 2: to you know, you know, I never you always want people,
Speaker 2: even in dire circumstances, you know, you always want people
Speaker 2: to have some semblance of hope. I saw this quote once,
Speaker 2: I remember where I saw it, but it was like,
Speaker 2: when you have health, we have health, you have hope,
Speaker 2: and when you have hope, you have everything. You know,
Speaker 2: that's really all you need is just a little bit
Speaker 2: of hope. But you know, I don't want to you know,
Speaker 2: you don't want to mislead people, but you also want
Speaker 2: to say look, a lot of possibilities with what you have,
Speaker 2: with your condition, with your response to treatment. Hang in there,
Speaker 2: keep moving forward, be present, and every moment live your
Speaker 2: life as best as you can. You know, let us
Speaker 2: worry about the treatments and stuff like that, and just
Speaker 2: keep moving forward. Every day is a gift.
Speaker 1: Every day is a gift, And there are so many
Speaker 1: new things in the works that I think hope is
Speaker 1: always there. It's so important because listen, I can die today.
Speaker 1: I could die in twenty years, I don't know. I
Speaker 1: could die walking outside of my house and you know,
Speaker 1: a tree falling on me or a bus hitting me
Speaker 1: or whatever, or I can die of cancer. But all
Speaker 1: I can do is live each day in as much
Speaker 1: of a positive manner with a lot of hope as
Speaker 1: I can, and embrace it and be like, wow, you know,
Speaker 1: I get to wake up again today and what do
Speaker 1: I get to do? And I believe that that positivity
Speaker 1: that you bring into your life. I think it helps
Speaker 1: with your hear it does, buddy, I think it helps
Speaker 1: you fight the cancer.
Speaker 2: It does kind of matter well well. Also, when you're
Speaker 2: not as stressed out and anxious, you're not releasing as
Speaker 2: much cortisol which gy have an effect. And I'm a
Speaker 2: big believer, you know, not to sound like hope or anything,
Speaker 2: but I believe that there is this energy in the world,
Speaker 2: in the universe that manifesting positivity, you know, can have
Speaker 2: this ripple effect somewhere in your world, you know, so
Speaker 2: to speak. And but again it always it goes back
Speaker 2: to what the Michael Jordan quote, being present in the moment.
Speaker 2: Like you, you don't know what tomorrow is going to bring.
Speaker 2: You don't know what you know five days from now
Speaker 2: is going to bring. All you know is the day
Speaker 2: in front of you is a gift and you want
Speaker 2: to enjoy it and maximize it to the best of
Speaker 2: your ability, enjoy it as best as you can. And
Speaker 2: you know, hopefully there's always hope. You have hope a lot.
Speaker 2: Hopefully all the patients who have cancer stage four cancer
Speaker 2: that are listening to this, they have hope too. There's
Speaker 2: always something that you know, you can turn over a
Speaker 2: stone and it might lead to something that might add days,
Speaker 2: you know, add weeks, years to your life. You just
Speaker 2: don't know. You just have to keep moving forward.
Speaker 1: So we met, if I recall how we met, it
Speaker 1: was from doctor Piro. Yes, as we said, he's my
Speaker 1: you know, general oncologist. I guess I'm gonna call it
Speaker 1: like that. You obviously have to work in tandem with
Speaker 1: the general on collegist, but does that always go smoothly?
Speaker 2: No? No, never.
Speaker 1: That response was amazing. That was very candid.
Speaker 2: I'm gonna put I'm gonna say something nice about doctor Piro.
Speaker 2: This is why I respect him and me. I work
Speaker 2: with a lot of different on colleagues, and a lot
Speaker 2: of them are like you know, some of them are
Speaker 2: on the cover of magazine, or some of them are
Speaker 2: like you know, our big name people that you know
Speaker 2: don't maybe they don't like to hear other perspectives as
Speaker 2: their own. You know, someone like doctor Piro, who is
Speaker 2: a very well established, very well afected oncologists. What I've
Speaker 2: always appreciated about him in particular, you know, is he
Speaker 2: will ask everyone, hey, this is the circumstance, this is
Speaker 2: the clinical situation. What do you think He's not like
Speaker 2: calling me up saying hey, I want you to do
Speaker 2: this and that for Shannon or this person or you
Speaker 2: know that person. Not at all. Very collegial, very open minded,
Speaker 2: very open to discussion. Doctor Giuliano, who I think you know.
Speaker 2: He's also he's got this whole dot g oh yeah,
Speaker 2: doctor G. He's he has this army of you know,
Speaker 2: young surgeons, young radiologists, young pathologists, young just this whole
Speaker 2: team of people around him. He's always trying to learn something.
Speaker 2: Every tumor board we have on Thursday, he's always trying
Speaker 2: to learn something new. He's always trying to hear your perspective,
Speaker 2: what are you bringing the table, what is your experience?
Speaker 2: And it's wonderful to be surrounded by people like that. Now,
Speaker 2: they're not always like that. There are definitely some people
Speaker 2: that are like, Nope, this is the way to do it,
Speaker 2: and you're all wrong, right, Like, there's definitely egos involved,
Speaker 2: But I don't see that where I work, fortunately, and
Speaker 2: I think it's it's lovely when you can all be like,
Speaker 2: you know, listen, sometimes you might disagree. I'll disagree with
Speaker 2: colleagues and we'll have playful discussions. But sometimes you're like,
Speaker 2: you know, I don't know, you don't know, let's just
Speaker 2: sort of do the best, make the best decision that
Speaker 2: we can for the patient.
Speaker 1: Do you really tell patients that it's not working?
Speaker 2: Yes, very honest with patients. Oh yeah, So it just
Speaker 2: didn't work. When did you do this? Now?
Speaker 1: So how do you how do you how do you approach.
Speaker 2: That right to the point, really right to the well.
Speaker 1: The band aid off, by the way, I'm an advocate
Speaker 1: of that.
Speaker 2: No, of course, I'm always going to be empathetic to
Speaker 2: anyone sitting in front of me that's undergoing cancer care.
Speaker 2: I'm always going to be sensitive. But you got to
Speaker 2: get right to the point, you know, And I do
Speaker 2: a lot. A lot of my friends, you know, have
Speaker 2: relatives that call me up and hey, what does this mean?
Speaker 2: Or and he told me this or whatever. Sometimes they
Speaker 2: might not have had the full picture, and like you
Speaker 2: will see their report or their image or their MRI
Speaker 2: and be like, ooh, that's not good. And you say, okay,
Speaker 2: this means that, and it's bad. It's not you know,
Speaker 2: it's not it's not something that responds. It's not something
Speaker 2: that moves in a good direction. And you know, and
Speaker 2: you this, we tried this treatment. It didn't work, So
Speaker 2: we're going to try something else. And on occasion, there's
Speaker 2: not much else we can try that's meaningful.
Speaker 1: Right, I mean, like, that's got to have that's got
Speaker 1: to be much harder conversation is when there isn't something
Speaker 1: else to.
Speaker 2: Try, it is And I think that in a time
Speaker 2: like that, when you share that information with a patient,
Speaker 2: you know, maybe once a week. You know, for me,
Speaker 2: when you have to say something like that to a patient,
Speaker 2: there's just like this dark cloak that goes over your head.
Speaker 2: And that's where me, as as they're providing doctor in
Speaker 2: that circumstance, I have to take a step back. Understand
Speaker 2: they're not absorbing the information from me properly that they're
Speaker 2: I don't want them to make a decision based on
Speaker 2: something that was so emotionally reactive, something that you know,
Speaker 2: where their life is flashing before their eyes. And that's
Speaker 2: why I give my cell phone because they'll gather their
Speaker 2: thoughts a day or two later. I always say, you know,
Speaker 2: to my residence people I work with, they're there to
Speaker 2: see you as an oncologist. First, it's always important to
Speaker 2: get them to a point where they're making decisions that
Speaker 2: you think are going to help me help them, or
Speaker 2: that might give them a few more days, weeks, months, years,
Speaker 2: you know what I'm saying. So I think it's important
Speaker 2: and circumstances like that to always follow up, make sure
Speaker 2: they're not overwhelmed, make sure they've thought about it, you know,
Speaker 2: and then say, Okay, we can try X, we can
Speaker 2: try Y, we can try Z. But it's hard. No, No,
Speaker 2: it's hard. And you do as an oncologist and I'm
Speaker 2: a very I feel relationships and feel friendships, and my
Speaker 2: patients mean a lot to me on a personal level.
Speaker 2: But you do have to detach yourself sometimes, not like
Speaker 2: in a I'm not there for your sort of way,
Speaker 2: but you have to go home home and shake it off.
Speaker 1: And how do you do that? Because I mean, you know,
Speaker 1: you have wife, you have kids, like, you have a family,
Speaker 1: and you can't sort of take home that darkness all
Speaker 1: the time because that would impact you know, your home life,
Speaker 1: your family. How do you shake that off?
Speaker 2: My wife? My wife talks about this all the time.
Speaker 2: So like, you know, there's always that first hour or two,
Speaker 2: like you know, it might you know, I might not
Speaker 2: work till midnight or something, but I might come home
Speaker 2: at five o'clock and just need like an hour to
Speaker 2: to just be like turn on Sports Center, go to
Speaker 2: dinner with a friend, or do something and just kind
Speaker 2: of like decompressed. I never I never take it home
Speaker 2: and put it on them of course, you know, because
Speaker 2: again it goes back to what we're saying. Really, you know, life,
Speaker 2: every every day's a gift, even for me, you know,
Speaker 2: even though my days are numbered just like everyone else's.
Speaker 2: You know, you have to take you have you have
Speaker 2: to make sure you're present in the moment and then
Speaker 2: enjoying every day that you can. But absorbing that and
Speaker 2: passing it on to other people's not a good It
Speaker 2: doesn't help anyone, and especially doesn't help your own patient.
Speaker 2: You know, they're coming to you for help, They're coming
Speaker 2: to you to help guide them, and you got to
Speaker 2: be strong. So I always joke that like I'm holding
Speaker 2: it all in and just one day I'll let it
Speaker 2: all out, you know, like you know, run off the antarctica,
Speaker 2: you know, starting to you know, you know, be friends
Speaker 2: with like a polar bear or something, and just get
Speaker 2: a hug.
Speaker 1: This is why I do not I do not let
Speaker 1: anyone in the medical field give me good news or
Speaker 1: bad news in person, because for me, it puts an
Speaker 1: instant barrier between us where they can have their own reaction.
Speaker 1: They don't have to monitor their facial you know, reaction.
Speaker 1: They can just say it to me on the phone,
Speaker 1: and then I don't have to monitor my reaction because,
Speaker 1: like the first time and second time that it was
Speaker 1: told to me in person, I felt like I had
Speaker 1: to be really strong in front of everybody and help
Speaker 1: them through it. Not that they were asking me and
Speaker 1: not that they weren't professional, but I still could see
Speaker 1: like something a little different in their face, and I
Speaker 1: had to reassure them that, like, oh, I'm not upset
Speaker 1: by this news, like not at all. Don't worry about it.
Speaker 1: I'm going to go home. I'm going to have a
Speaker 1: dance party, like and meanwhile, you know, all I want
Speaker 1: to do is cry and like figure my shit out,
Speaker 1: but I wouldn't do it in front of someone.
Speaker 2: Human beings are complicated. It comes out in many different ways.
Speaker 2: You have to let people sort of walk their path.
Speaker 2: You have to let them go through the stages of
Speaker 2: whatever it is they go through, and you fortunately have
Speaker 2: this wonderful platform. I love that you're doing this in
Speaker 2: such a way where you're bringing in all your doctors
Speaker 2: and the people. You're trying to educate people on kind
Speaker 2: of what the experience, what your experience has been, and
Speaker 2: you've sort of run the table in terms of different
Speaker 2: kinds of breast cancer therapy. You sort of had it all,
Speaker 2: you know, and so I'm very grateful that you sitting
Speaker 2: here in front of me looking as great you do,
Speaker 2: with things being as controlled as they are, God blessed.
Speaker 2: That's that's amazing, you know again, you know, but no,
Speaker 2: not everyone experiences that, and as an oncologist, you just
Speaker 2: have to do what's best for them.
Speaker 1: All right, I'm going to wrap this up. I guess,
Speaker 1: you know. One of those things that people always want
Speaker 1: to know is like, have you seen miracles? But I
Speaker 1: think for me I need to define really quickly in
Speaker 1: my head what a miracle is. Yes, I'm a highly
Speaker 1: spiritual human being. I believe in God, so I do
Speaker 1: believe in miracles. Have you seen, you know, the worst
Speaker 1: of the worst. Didn't think it was ever going to
Speaker 1: be better, but something changed?
Speaker 2: So the answer is absolutely yes. Now again, doesn't you know?
Speaker 2: Common things happen commonly, right, you know? And I know
Speaker 2: everyone wants an answer, they want to know what's going
Speaker 2: to happen with me? I don't know, like you know,
Speaker 2: you think you know sometimes you can guess, but seeing
Speaker 2: the most dire circumstances, you know, switch to a better
Speaker 2: direct where many months or years or you know, longer
Speaker 2: than that was added. I have seen. Sometimes there's luck involved,
Speaker 2: sometimes there's you know, the human body is sort of
Speaker 2: this kind of this enigmatic thing, and sometimes things take
Speaker 2: a turn that you don't expect as a professional that
Speaker 2: you haven't seen many times or ever in your past.
Speaker 2: And again you have to just always take one day
Speaker 2: at a time and have hope and have faith that
Speaker 2: you know you're moving in the right direction and that
Speaker 2: as long as you do everything you can. You know,
Speaker 2: when I played football in high school, they always coach
Speaker 2: use to always say leave it all on the field.
Speaker 2: You know, when you're out there playing you might win,
Speaker 2: you might lose. I tell my volleyball girls is too, like,
Speaker 2: just just leave it all in the court, don't leave
Speaker 2: anything behind. You don't want to leave any stone unturned.
Speaker 2: You don't want to have any regrets about trying this
Speaker 2: or not doing that. And that applies to life, it
Speaker 2: applies to your cancer journey. Leave it all out there
Speaker 2: and then you can just move on in peace in life.
Speaker 1: I mean, I agree with that, and I think that
Speaker 1: I think that's beautiful. I kind of look at you know,
Speaker 1: I'm I'm not gonna say what it is. I'm on
Speaker 1: a new uh you know, cancer infusion, and you know,
Speaker 1: after four treatments, we didn't really see a difference, and
Speaker 1: everybody wanted me to switch and yeah, and I just
Speaker 1: kind of was like, we're going to keep going with
Speaker 1: this and see and you know, yeah, after the sixth
Speaker 1: seventh treatment, we really saw it breaking down the blood
Speaker 1: brain barrier. Do I call that a miracle? Yeah? For me,
Speaker 1: that happens to be a miracle right now. That like
Speaker 1: I sort of rolled the dice and said let's keep going.
Speaker 1: And doctor Piro and I, you know, after he looked
Speaker 1: at the tumor markers, he felt comfortable with that decision.
Speaker 1: And that it's actually breaking that blood brain barrier is
Speaker 1: a miracle of that drug and a miracle of you know,
Speaker 1: maybe God intervening and being like I'm going to give
Speaker 1: her a break.
Speaker 2: You know.
Speaker 1: You know, sometimes you're looking for miracles in all the
Speaker 1: wrong places and they're right there in front of your face.
Speaker 2: This is true.
Speaker 1: Well, I feel like we could easily do a whole
Speaker 1: nother anytime podcast, a whole another episode. You're wonderful. I
Speaker 1: just love you and for all of you guys listening,
Speaker 1: remember to go on Let's Be Clear pod on Instagram,
Speaker 1: send us any questions that you have, and I promise,
Speaker 1: if I have to drive to seaters with all of
Speaker 1: my computers and mics and all of that stuff, I'll
Speaker 1: do it and we'll answer your guys questions. So thank you,
Speaker 1: Thank you, doctor MARHARDI thank you very much, and I
Speaker 1: adore you, and I really appreciate everything that you do
Speaker 1: and how fantastic you are with your patients and all
Speaker 1: of your advice and your expertise. It's deeply appreciated.
Speaker 2: Thank you for having me.
Speaker 1: Thanks all right, you guys, tune in next week to
Speaker 1: other episode of Let's Be Cule. We Shouldn't a Door
Speaker 1: to Buy mm hm