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

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Speaker 1: welcome to another episode of Let's Be Clear with Shannon Doherty.

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Speaker 1: So one of the main things about me doing this

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Speaker 1: podcast is that I really wanted to reach the cancer

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Speaker 1: community and have the opportunity to bring on incredibly special

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Speaker 1: doctors that I'm fortunate enough to have access to because

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Speaker 1: I live in Los Angeles, I go to Cedar Sinai,

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Speaker 1: so I have access to the best and currently I

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Speaker 1: have really good insurance.

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Speaker 2: That allows me to afford them.

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Speaker 1: And today I have on the exceptional brain surgeon, doctor Rachel,

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Speaker 1: who I adore And thank you for taking time out

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Speaker 1: of I know what is a very very very busy

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Speaker 1: schedule for you to drive all the way to Malibit

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Speaker 1: and hang out with me, and you brought me treat true.

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Speaker 3: Thanks so much for having me. It's a pleasure to

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Speaker 3: be Yeah.

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Speaker 1: So can you tell us you know your title exactly

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Speaker 1: what you do?

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Speaker 2: Just fill everybody in right.

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Speaker 3: So, I'm one of the brain tumor surgeons at theaters.

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Speaker 3: We have neurosurgeons have different subspecialties. I don't really do

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Speaker 3: like a lot of spine surgery or something some but

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Speaker 3: do mostly brain timber work. There are times in our

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Speaker 3: department we'll have like a chair who runs the department,

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Speaker 3: and then a clinical chief one's supposed to be like

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Speaker 3: a quality officer and things. So that's the kind of

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Speaker 3: thing that I do right now, besides the brain timor work.

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Speaker 3: I've been at Sedars for nineteen years. I hope I've

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Speaker 3: learned something by now.

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Speaker 1: I think you have. I'm pretty sure you have. I mean,

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Speaker 1: you did go into my brain, so I.

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Speaker 3: Swear if you learned a lot. Yes, that's true.

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Speaker 1: And so what got you started in this particular field?

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Speaker 1: And can you can you explain a little bit more

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Speaker 1: in depth of is it just on hology and surgery

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Speaker 1: that you do?

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Speaker 2: Is it more broad than that.

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Speaker 3: I became a neurse surgeon because I lost a bed. No.

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Speaker 2: I looked at your like, just say that, and you did.

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Speaker 3: It's the delivery.

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Speaker 2: Yeah.

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Speaker 3: My father was a doctor, and so I kind of

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Speaker 3: grew up in that house knowing that kind of stuff.

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Speaker 3: You would go on a lot of calls at night

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Speaker 3: and help people and stuff. It just became something that

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Speaker 3: I became interested in. And then you would, you know,

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Speaker 3: as a kid go into his pockets at the end

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Speaker 3: of the day, and I would find he was a

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Speaker 3: gaser neurologist, you know, yes, like bout stuff, and I

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Speaker 3: would try to picture of someone's colon. It was kind

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Speaker 3: of interesting and stuff like that. And so when I

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Speaker 3: was growing up, it just did a lot of stuff

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Speaker 3: for science and just it was kind of a natural pathway.

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Speaker 3: I didn't really decide to be a nerves surgeon toool

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Speaker 3: a lot later, but going to medical school seemed something

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Speaker 3: that was very natural for how I grew up.

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Speaker 1: Like I can't really imagine going through my dad's pockets

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Speaker 1: and seeing photos of colon's and stuff and thinking, well,

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Speaker 1: this is cool, this is what I need to get into,

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Speaker 1: and yet you did.

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Speaker 2: Yeah, what was it about it?

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Speaker 3: I guess it was just something that was both familiar

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Speaker 3: and then just something I gradually found interesting. I liked

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Speaker 3: science kind of stuff, and then who doesn't find the

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Speaker 3: brain fascinating? So I felt like when I was looking

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Speaker 3: at that stuff, here there's a ton with cardiothoracic surgery

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Speaker 3: that was starting to be replaced. That people were doing

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Speaker 3: more and more things and no VASc really from inside

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Speaker 3: the blood vessels like stents in the coronary arteries, and

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Speaker 3: now they can even replace a valve for some people

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Speaker 3: from inside that surgeons were becoming going to become more

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Speaker 3: and more obsolete, whereas there's still a lot of role

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Speaker 3: for brain termor surgeons. We haven't really fixed everything yet.

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Speaker 3: I don't know what's going to happen in my lifetime,

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Speaker 3: but we haven't really fixed everything yet that surgery is

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Speaker 3: still require.

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Speaker 1: I'm so fascinated by the conversation of like AI and

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Speaker 1: that what that role is, particularly in surgery. Is there

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Speaker 1: a role for AI and surgery probably some.

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Speaker 3: I mean, I think there's some part where the easier

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Speaker 3: targets with like AI, and it's interacted with neuroidiology, like

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Speaker 3: making sure we find all the abnormalities in the scan

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Speaker 3: and even having AI screen some of the scans and

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Speaker 3: trigger that to be read by a person as opposed

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Speaker 3: to put out answers more quickly when a scan is normal.

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Speaker 3: For surgery, it's a little harder. I mean, there are

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Speaker 3: robotic surgery platforms for other specialties that sometimes they'll use

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Speaker 3: that for a thoracic surgery or an abdominal surgery, but

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Speaker 3: there isn't a tremendous role for robotic surgery yet. And neurosurgery.

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Speaker 3: I mean, I have to be the robot. So some

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Speaker 3: of these things have you know, submillimeter accuracy and a

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Speaker 3: brain that's moving and pulsing as we operate. It's not

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Speaker 3: really clear that AI can pull all those things off yet.

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Speaker 1: I don't think I would want a robot cutting open

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Speaker 1: my brain I'm working on it. That would scare me

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Speaker 1: because there's you know, it's the human that I'm putting

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Speaker 1: my trust in, and the human that that's feeling the

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Speaker 1: compassion or the stress, the pressure, whatever it is to

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Speaker 1: ensure that you have the best result possible, whereas a

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Speaker 1: robot isn't they aren't programmed for that. For me, I

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Speaker 1: believe that a human is always going to go with

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Speaker 1: the extra mile to ensure that their patient has a

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Speaker 1: favorable outcome.

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Speaker 3: I think that makes a lot of sense. Probably a

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Speaker 3: lot of people would feel that way right that they

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Speaker 3: want that person there. And there are some of these

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Speaker 3: robotic surgeons like thoracic. The surgeon is in the room,

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Speaker 3: but they're not really right at the patient. They're far

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Speaker 3: away at a control console, and I don't know, it

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Speaker 3: just doesn't feel the same to me. Maybe I'm just

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Speaker 3: too old fashion, maybe I'm not used to it.

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Speaker 2: Yet Well then I'm old fashioned right there.

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Speaker 1: Yeah. That, and you have obviously incredibly stity hands. Do

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Speaker 1: you do something to protect them at all costs because

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Speaker 1: those hands are worth a lot of money.

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Speaker 3: Well, I don't do anything super risky with them. I

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Speaker 3: snowboard some and I used to wear a wrisk brace more.

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Speaker 3: But I think this, I don't try to do any

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Speaker 3: wild things anymore. So I don't really doing.

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Speaker 1: Double flips anymore, not taking the high.

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Speaker 3: I'm sure I never did double flips on purpose.

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Speaker 1: So.

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Speaker 2: Right, they're the mistake.

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Speaker 1: Oopsps oops, So we I think how we met was

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Speaker 1: very interesting because I fell down, as you know, like

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Speaker 1: a day or two days before Christmas, and doctor Piro

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Speaker 1: said you should go in for CT.

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Speaker 2: I did.

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Speaker 1: It showed some things in my brain. He was concerned.

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Speaker 1: He then said, you're going we need an MRI. I

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Speaker 1: did the MRI, and then it was kind of an

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Speaker 1: instant Okay, here's what's going on. You have met and

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Speaker 1: there's one that we feel we can operate on and

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Speaker 1: the others will radiate, and we want to operate mainly

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Speaker 1: to get the pathology correct.

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Speaker 2: Yes, and he had you already picked out. He's worked

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Speaker 2: with you before.

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Speaker 1: And he was like, this is the best, and you're

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Speaker 1: going to him and we set up.

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Speaker 2: I remember your office was like do you want to

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Speaker 2: come in? It's like, no, is there zoom? Is that possible?

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Speaker 1: And I'm so now used to zoom COVID and so

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Speaker 1: we zoomed and what was it like four or five

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Speaker 1: days later? I was getting operated on, right.

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Speaker 3: Yeah, well, fortunately we managed to get it set up

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Speaker 3: kind of quickly. And you're right when when doctor Piro calls,

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Speaker 3: I answer quickly, yeah, and we've known each other for

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Speaker 3: a while. It is yeah, different this world where there's

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Speaker 3: more and more of these you know, video possible visits

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Speaker 3: and things like that. Certainly with the pandemic. There's multiple

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Speaker 3: people that I've you know, met over a video and

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Speaker 3: then at surgery shook their hand finally and said it's

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Speaker 3: nice to meet you. It's kind of strange. Yeah.

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Speaker 1: I had friends that said, what do you mean you

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Speaker 1: haven't actually met him in person? Don't you want to

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Speaker 1: shake his hand in person before you say yes? And

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Speaker 1: don't you want to make sure that he's a kind,

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Speaker 1: compassionate person. And my response was no, all I care

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Speaker 1: about is this, like are his hands steady? Is he

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Speaker 1: the best is he going to, you know, take really

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Speaker 1: good care of me in a surgical way.

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Speaker 2: But then when I met.

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Speaker 1: You, you were very kind and very compassionate. And even

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Speaker 1: though I had psyched myself into believing that I was

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Speaker 1: not going to come out okay, I really did not

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Speaker 1: think that I would be fine. I was pretty sure

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Speaker 1: that I was going to die that really short time

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Speaker 1: period I had to go over everything with my estate

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Speaker 1: planner and my attorneys and make sure that my will

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Speaker 1: was in place and that my trust was secure, and

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Speaker 1: who got what I mean. It was a frantic time

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Speaker 1: going also through a separation. It was pretty nuts. And

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Speaker 1: that's how paranoid I was of dying. And then if

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Speaker 1: I didn't die, I would be paralyzed, and you were

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Speaker 1: I think you told me the worst that would happen

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Speaker 1: was maybe I would lose mobility of my right foot,

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Speaker 1: but that physical therapy would most likely fix it. And

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Speaker 1: then I asked you to please while you're in there

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Speaker 1: dissecting Bob the tumor that we took out, that you

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Speaker 1: took out, I asked you if you could please touch

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Speaker 1: the part of the brain that allowed me to instantly

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Speaker 1: speak six languages fluent and I gotta tell you.

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Speaker 3: Didn't do it.

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Speaker 2: Yeah, I'm not happy with you over that.

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Speaker 3: Yeah, and that is one of my failures. Definitely.

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Speaker 1: Is that like a real thing, because obviously it's something

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Speaker 1: that I saw in Gray's Anatomy, where I think it

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Speaker 1: was Emilia, who was also a brain surgeon, had to

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Speaker 1: get a very large tumor removed, and she woke up

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Speaker 1: speaking perfect German, and so that's where I got the

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Speaker 1: idea from.

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Speaker 3: And it's not that she had spoken German before.

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Speaker 1: I think she had spoken German before, yes, but I

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Speaker 1: so just assumed it didn't matter.

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Speaker 3: Well, sometimes that, unfortunately nurse or can do in a way.

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Speaker 3: So it's hard to give someone a new language. It's

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Speaker 3: hard to plug you into the matrix and really get

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Speaker 3: something new. That's disappointing. Yeah, sure, but once on, people

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Speaker 3: who grow up speaking a certain language, it's so rooted

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Speaker 3: in their brain as their primary language that if they

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Speaker 3: have some other language affecting things, other languages they learned

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Speaker 3: can turn down for a little bit. So I've had

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Speaker 3: a patient who grew up speaking French and English, and

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Speaker 3: you know, most of us are wired for our left

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Speaker 3: side of the brain to have most of language and memory.

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Speaker 3: Even totally left handed people still more than half of

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Speaker 3: them have language on the left hand side. It's just

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Speaker 3: something how the brain is wired. But this patient had

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Speaker 3: a brain to her on the right and he had

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Speaker 3: more like French language sites on the left side and

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Speaker 3: more English language sites on the right side. So when

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Speaker 3: they first did a surgery that that's kind of what happened.

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Speaker 3: He wasn't speaking because she was only speaking French, and

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Speaker 3: his wife was confused. That's what was going on, like

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Speaker 3: he never speaks French to me, but that language that

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Speaker 3: kind of turned down for a little bit as the

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Speaker 3: body had to heal.

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Speaker 2: Did he retain it?

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Speaker 3: M M. He just had to tap back into some

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Speaker 3: of these things to kind of reawaken these centers. So

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Speaker 3: sometimes we do these surgeries that have more of a

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Speaker 3: motor impact. That's w what we talk about, like physical

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Speaker 3: therapy to retrain that area of the brain and the

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Speaker 3: connections to get stronger. We try not to take an

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Speaker 3: away anything permanently, obviously, but sometimes if you're it kind

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Speaker 3: of depends on our risk benefit ratio. If we have

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Speaker 3: a tumor that looks like a Bolivian scene, we have

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Speaker 3: to carve it out. We have to take some risks

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Speaker 3: sometimes to take it out. Well next time, next time,

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Speaker 3: we don't want any next time.

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Speaker 2: I know we don't, we don't.

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Speaker 1: I do remember that when I when I woke up,

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Speaker 1: you were standing over me, and I believe the very

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Speaker 1: first question I asked you was what's wrong with me?

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Speaker 1: And you said nothing, and I couldn't believe it. And

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Speaker 1: then I think a little later, you know, I struggled

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Speaker 1: with my right hand of like holding a glass. A

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Speaker 1: good majority of that was because of the steroids, and

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Speaker 1: the steroids make me crazy. I do not do well

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Speaker 1: on steroids at all. So remember I kept on trying

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Speaker 1: to take myself off the steroids, and I guess the

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Speaker 1: brain would swell and then the right hand would get worse.

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Speaker 2: And now everything is obviously.

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Speaker 3: Great, terrific. Yeah, it's good to know, good job once

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Speaker 3: in a while.

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Speaker 1: That day, so I remember, also, didn't you ask me

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Speaker 1: what kind of music I wanted?

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Speaker 2: And I said, I'm going to be asleep, Like whatever

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Speaker 2: music makes you, you know, do the best job? What

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Speaker 2: did you do? You remember what you listened to?

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Speaker 1: Because I know I'm one of a lot of people,

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Speaker 1: so I don't expect you to know this answer.

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Speaker 2: But I'm just curious.

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Speaker 3: Couple. Well, I mean, so usually we asked a little

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Speaker 3: bit something what you might like to listen to that

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Speaker 3: helps call you as the anesthetic kicks in. Once you're

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Speaker 3: totally asleep, you can play whatever rave music we want

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Speaker 3: or something.

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Speaker 1: Is it?

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Speaker 2: So, I mean, what is your go to? Do you

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Speaker 2: like rock and roll? Do you like classical?

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Speaker 3: Sometimes it's like an old school hip hop playlist, like

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Speaker 3: has a lot less Snoop Dog or something like that,

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Speaker 3: just something to keep people moving. I mean, I think

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Speaker 3: there's like different philosophies. I know some surgeons who like

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Speaker 3: total silence in their operating room and don't want music

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Speaker 3: and they want the antithesiologists to listen to every single

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Speaker 3: little thing they have to say and stuff like that.

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Speaker 3: And that's fine for me. I feel like, you know,

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Speaker 3: obviously the music's not blaring, but I can concentrate and

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Speaker 3: it helps the other people in the room if it's

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Speaker 3: not total silence, you.

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Speaker 2: Know, right, it keeps the energy up.

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Speaker 3: Yeah, I think that's what it is, an energy and

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Speaker 3: a movement level. I think it works better for me.

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Speaker 1: You gave me a photo because I asked you, and

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Speaker 1: you gave me a photo of my brain. Can you

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Speaker 1: what was that surgery like for you? What was that

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Speaker 1: particular surgery that you did on me? What were the

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Speaker 1: reasons why we did it besides the pathology all of that,

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Speaker 1: and then you know, I can explain why I named

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Speaker 1: him Bob.

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Speaker 3: Oh good, I get to hear this finally. I've been

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Speaker 3: waiting so fortunately with your brain and there's only a

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Speaker 3: few spots, and some of them were tiny, so some

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Speaker 3: of them were ones that were really ideal for this

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Speaker 3: idea of focused radiation. Sometimes we'll say radiosurgery. It's almost

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Speaker 3: a gimmicky term though, like focused radiation as if to

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Speaker 3: replace surgery. But if we have a dot that's a

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Speaker 3: millimeter or two, sometimes we can't really find that at surgery,

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Speaker 3: so the radiation can target that based on the MRI

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Speaker 3: you had once. But theres a little bigger and there's

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Speaker 3: both this idea of it's a little bigger we can

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Speaker 3: eradicate it better with surgery. Well, a worry is that

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Speaker 3: sometimes when you stir up a metastasis, you kind of

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Speaker 3: leave little cells somewhere or can even if you're not

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Speaker 3: careful about it, spread tumor around. So we usually would

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Speaker 3: do at least some form of radiation afterwards, but we

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Speaker 3: and a couple other centers have been tinkering with the

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Speaker 3: idea of the radiation upfront, so you kind of like

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Speaker 3: almost like sterilize the tumor beforehand, so that even if

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Speaker 3: a cell escapes, it's been radiated and hopefully it won't

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Speaker 3: set up root. That can give doctor Puro tremendous on Collagi.

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Speaker 3: Is a tremendous advantage to have a sample of the

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Speaker 3: current disease. So if we take something out and we

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Speaker 3: analyze the receptors, we get to know a lot more, right,

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Speaker 3: And that's one of the things that probably I hope

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Speaker 3: has helped you and may help you more, is that

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Speaker 3: idea of like finding what them like their signature is

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Speaker 3: allowing targeted therapies and exactly your scenario. Not all guests work,

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Speaker 3: I mean, there's always a little bit of tinkering with

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Speaker 3: a regimen, but not all guessworks. Some like logical things

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Speaker 3: like this is a very patient directed, patient oriented treatment strategy.

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Speaker 1: Yes, So when you saw Bob, I named him because

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Speaker 1: I'm I don't know, I don't really view Bob's as

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Speaker 1: very scary.

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Speaker 2: Bob's are usually really nice.

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Speaker 1: And affable, so I didn't want Bob to be scary,

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Speaker 1: but you had to leave. You couldn't get all of

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Speaker 1: Bob out. Do you remember why that was?

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Speaker 3: There were a couple cells towards the motor area. So

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Speaker 3: for your scenario is a little complicated because it wasn't

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Speaker 3: totally on the surface of the brain, so we had

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Speaker 3: to kind of get to the area.

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Speaker 1: These are sort of the questions I didn't ask until now.

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Speaker 1: So I'm learning along with our listeners. I'm actually learning

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Speaker 1: about my own surgery because I do remember you just

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Speaker 1: send motor skills, and I remember looking at you also

330
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Speaker 1: and saying, stop if you're going to if it's going

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Speaker 1: to change me as me as the way that my

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Speaker 1: brain works, the way that I process speaking, mobility, all

333
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Speaker 1: of that. So, and obviously you were going to whether

334
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Speaker 1: I said something to you or not.

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Speaker 2: So it was not because I always.

336
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Speaker 1: Pictured Bob right at like the top of my head,

337
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Speaker 1: right here, just sitting on top of my brain.

338
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Speaker 2: But that's not the case.

339
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Speaker 3: Yeah, that's where the incision is. I have a prop

340
00:17:07,119 --> 00:17:10,639
Speaker 3: do you mind if I Yeah, So this is a

341
00:17:10,680 --> 00:17:13,600
Speaker 3: little model that I have. Sometimes you'll have a tumor

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Speaker 3: that's really on the surface that all we have to

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Speaker 3: do is really carve it out from here.

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Speaker 2: And that's what I thought mine was right, Not.

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Speaker 3: Quite so, yours was in between the two halves of

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Speaker 3: the brain, so we had to crawl around here. The

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00:17:24,119 --> 00:17:26,720
Speaker 3: safest route is to crawl around here and not touch

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Speaker 3: or take out any of this stuff and take it

349
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Speaker 3: out from the inside there.

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Speaker 1: So did you go horizontal and then just still kind

351
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Speaker 1: of cry this open a little bit to try to

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Speaker 1: get to Bob.

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Speaker 3: Well, sometimes we do different things for this scalp and

354
00:17:38,880 --> 00:17:42,040
Speaker 3: for the skull inside, so it can be very cosmetic

355
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Speaker 3: to do a horizontal or coronal incision like this because

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Speaker 3: things get all covered up and then underneath we do

357
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Speaker 3: what we need to do. So we fashioned a craniotomy.

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Speaker 3: That's where you make a window and the skull. We

359
00:17:54,200 --> 00:17:57,000
Speaker 3: can put the skull back on with little titanium bars

360
00:17:57,040 --> 00:17:59,360
Speaker 3: that don't set off metal detectors. It's not like we

361
00:17:59,720 --> 00:18:01,520
Speaker 3: use a big metal plate or anything. So you have

362
00:18:01,520 --> 00:18:03,760
Speaker 3: your own skull back on. But we can create a

363
00:18:03,800 --> 00:18:05,320
Speaker 3: window on the skull where we need to work and

364
00:18:05,359 --> 00:18:06,960
Speaker 3: it doesn't have to match the incision.

365
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Speaker 2: And that's what you did to me, right.

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Speaker 3: It feels good up there, right, it feels normal.

367
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Speaker 2: Yeah, no, it feels normal.

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Speaker 1: Sometimes the you know, when you go for the MRI,

369
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Speaker 1: they take the wand sure and right here beeps a

370
00:18:19,640 --> 00:18:20,040
Speaker 1: little bit?

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Speaker 3: Does it at touch?

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Speaker 2: It does attach? And I'm like, well, I have brain searchery.

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Speaker 1: Yeah, so you weren't able to get him completely out

374
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Speaker 1: because he was a little deeper in and wrapped around

375
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Speaker 1: where the mobility would be.

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Speaker 2: Can you explain that a little bit more?

377
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Speaker 3: Sure, So, our brains have different areas that have power

378
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Speaker 3: and neurons that function a certain way. So the brain

379
00:18:39,080 --> 00:18:41,679
Speaker 3: is largely mapped out. We know a lot where our

380
00:18:41,840 --> 00:18:45,479
Speaker 3: primary language center is, we know where our primary understanding is.

381
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Speaker 3: There's this part of the brain that has a lot

382
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Speaker 3: of motor function. It's kind of mapped out that our

383
00:18:50,760 --> 00:18:54,320
Speaker 3: face areas more this way, our hand areas more this way,

384
00:18:54,640 --> 00:18:57,320
Speaker 3: and our leg areas more this way. And so there

385
00:18:57,440 --> 00:19:00,280
Speaker 3: was a tiny layer. You know, we took out just

386
00:19:00,320 --> 00:19:02,159
Speaker 3: about everything, but there's a tiny layer right on that

387
00:19:02,200 --> 00:19:04,320
Speaker 3: motor area for the leg. And there's starting to look

388
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Speaker 3: like if we were too hard, we might have a

389
00:19:08,119 --> 00:19:10,560
Speaker 3: lot of legg or foot weakness. And sometimes we have

390
00:19:10,600 --> 00:19:13,160
Speaker 3: to decide exactly how much we want to tolerate, especially

391
00:19:13,200 --> 00:19:16,280
Speaker 3: since that site had been radiated already and things like that.

392
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Speaker 3: So I think that kind of allowed this idea of

393
00:19:18,600 --> 00:19:20,399
Speaker 3: can we do the maximal safe re section?

394
00:19:20,760 --> 00:19:23,360
Speaker 1: So obviously in order to get the rest of him,

395
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Speaker 1: I guess we radiated Bob and all the other mets

396
00:19:26,760 --> 00:19:31,280
Speaker 1: again after surgery, just to make sure that Bob was dead.

397
00:19:31,600 --> 00:19:34,600
Speaker 3: Yeah. I don't think Bob needed another dose, but you're right,

398
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Speaker 3: the other dots.

399
00:19:35,200 --> 00:19:38,080
Speaker 1: Yeah, their dots did, right. I'm so glad I did not.

400
00:19:39,000 --> 00:19:43,400
Speaker 1: I was scared enough. But knowing to that extent, which

401
00:19:43,400 --> 00:19:45,720
Speaker 1: is interesting because I'm sure that you have patients who

402
00:19:45,760 --> 00:19:50,119
Speaker 1: want to know every little detail. How is that for

403
00:19:50,240 --> 00:19:53,080
Speaker 1: you as a doctor to explain? Do you find that

404
00:19:53,160 --> 00:19:55,440
Speaker 1: it makes them more nervous?

405
00:19:56,080 --> 00:19:57,720
Speaker 3: Well, I think you're right. I think some people want

406
00:19:57,760 --> 00:20:01,359
Speaker 3: all the details. And my assumption is that they're asking

407
00:20:01,480 --> 00:20:04,280
Speaker 3: lots of these detailed questions. They're the type of person

408
00:20:04,359 --> 00:20:06,959
Speaker 3: that feels reassured by it, right. I think you're right.

409
00:20:07,119 --> 00:20:08,800
Speaker 3: Sometimes I kind of have to do a lot of

410
00:20:08,840 --> 00:20:11,680
Speaker 3: feeling out and not say too much. And once I've

411
00:20:11,720 --> 00:20:14,080
Speaker 3: had people where I talk a little bit about what

412
00:20:14,160 --> 00:20:16,280
Speaker 3: we have to do, like they say, stop, that's enough.

413
00:20:16,760 --> 00:20:18,480
Speaker 3: I don't. I don't want to know everything you do, right,

414
00:20:18,520 --> 00:20:20,200
Speaker 3: I just want to know, you know what's going to have,

415
00:20:20,359 --> 00:20:22,199
Speaker 3: what I'm going to feel. But the part when I'm asleep,

416
00:20:22,200 --> 00:20:24,800
Speaker 3: I don't want to know everything that happens. Everyone's different.

417
00:20:25,680 --> 00:20:30,399
Speaker 1: And for you, how many operations would you say you

418
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Speaker 1: do in one week?

419
00:20:32,440 --> 00:20:34,199
Speaker 3: It depends. I mean it could be as many as

420
00:20:34,240 --> 00:20:36,199
Speaker 3: seven or eight. And then there are weeks that I

421
00:20:36,240 --> 00:20:39,480
Speaker 3: have more administrative or teaching duties and it's less than that.

422
00:20:39,600 --> 00:20:44,800
Speaker 1: You know, And with those seven or eight, how many

423
00:20:44,840 --> 00:20:48,840
Speaker 1: are very high risk? Maybe sixty percent, seventy percent? And

424
00:20:48,920 --> 00:20:50,680
Speaker 1: what percentage was I of high risk?

425
00:20:51,760 --> 00:20:54,400
Speaker 3: You're pretty high risk. I mean there are people where

426
00:20:54,400 --> 00:20:56,600
Speaker 3: we have a tumor neuro language center that we have

427
00:20:56,640 --> 00:20:58,399
Speaker 3: to wake them up in the middle of surgery to

428
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Speaker 3: test language.

429
00:20:59,200 --> 00:21:00,480
Speaker 2: Well, I've seen that on Green anatomy.

430
00:21:00,880 --> 00:21:02,439
Speaker 3: Sure, there's a lot of stuff in there, some of

431
00:21:02,440 --> 00:21:04,800
Speaker 3: those stories, some of those things are real. It's true.

432
00:21:07,040 --> 00:21:09,679
Speaker 3: Fortunately we didn't have to do that for you. But

433
00:21:09,760 --> 00:21:12,480
Speaker 3: sometimes that obviously is a little bit element of risk.

434
00:21:12,520 --> 00:21:14,560
Speaker 3: And then there are probably things that some of my

435
00:21:15,000 --> 00:21:19,800
Speaker 3: colleagues perform more like like a craniotomy for a ruptured aneurysm,

436
00:21:19,880 --> 00:21:23,280
Speaker 3: that's higher risk of big blood loss and stuff. I

437
00:21:23,280 --> 00:21:25,480
Speaker 3: mean there's kind of sometimes the difference between like the

438
00:21:25,520 --> 00:21:28,119
Speaker 3: brain risk and then the risk to the overall medical

439
00:21:28,200 --> 00:21:33,120
Speaker 3: risk of the patient. So, I mean, your's had some risk,

440
00:21:33,200 --> 00:21:35,120
Speaker 3: but fortunately it wasn't the highest risk thing. And then

441
00:21:35,320 --> 00:21:37,080
Speaker 3: some of the things they do are kind of straightforward

442
00:21:37,280 --> 00:21:39,920
Speaker 3: or more straightforward if it's some tiny little benign to

443
00:21:40,000 --> 00:21:42,080
Speaker 3: run the surface of the brain, like I'm an ingioma,

444
00:21:42,400 --> 00:21:46,159
Speaker 3: or sometimes if people have a certain need for chemotherapy

445
00:21:46,240 --> 00:21:49,200
Speaker 3: and there's cerebrospinal fluor there's a port that I can

446
00:21:49,240 --> 00:21:52,359
Speaker 3: put in. That's a pretty simple surgery. So sometimes some

447
00:21:52,400 --> 00:21:54,040
Speaker 3: of those seven eight are not that hard.

448
00:22:03,040 --> 00:22:05,960
Speaker 1: Do you do anything before a surgery to get ready?

449
00:22:06,000 --> 00:22:10,840
Speaker 1: Do you meditate? Do you go back over the file

450
00:22:11,000 --> 00:22:14,959
Speaker 1: and all the X rays and like, what is your

451
00:22:15,080 --> 00:22:16,920
Speaker 1: routine before a surgery?

452
00:22:18,240 --> 00:22:23,800
Speaker 3: Well, I don't come in from the bar. I should Could.

453
00:22:23,600 --> 00:22:28,320
Speaker 1: You imagine if like your doctor wreaked a vodka.

454
00:22:28,760 --> 00:22:35,160
Speaker 3: There are stories about people, but you know, not at theater. No,

455
00:22:36,800 --> 00:22:39,320
Speaker 3: So yeah, I probably should meditate more, and I probably

456
00:22:39,359 --> 00:22:41,840
Speaker 3: should practice a little more mindfulipped I do feel like

457
00:22:42,200 --> 00:22:45,720
Speaker 3: I achieve that more by reviewing everything and making sure

458
00:22:45,760 --> 00:22:47,440
Speaker 3: I know all the ins and outs before I walk

459
00:22:47,480 --> 00:22:50,919
Speaker 3: into that room. That is more reassuring.

460
00:22:51,119 --> 00:22:54,720
Speaker 1: I think when you're operating, and I don't want this

461
00:22:54,840 --> 00:23:01,719
Speaker 1: to sound self important in any way, but I am

462
00:23:01,880 --> 00:23:05,280
Speaker 1: curious that when you operate on someone like me or

463
00:23:05,320 --> 00:23:07,800
Speaker 1: I'm sure some people that you've operated on that are

464
00:23:08,720 --> 00:23:14,080
Speaker 1: well known, is there an extra layer of pressure.

465
00:23:15,240 --> 00:23:19,439
Speaker 2: I know that you care about everybody's life, but like,

466
00:23:19,480 --> 00:23:20,560
Speaker 2: if you slip.

467
00:23:20,240 --> 00:23:24,679
Speaker 1: And do something, it's gonna come out that you were

468
00:23:24,720 --> 00:23:28,320
Speaker 1: my certain Is there any kind of a or do

469
00:23:28,359 --> 00:23:32,240
Speaker 1: you just really it's not about who the person is

470
00:23:32,440 --> 00:23:35,560
Speaker 1: in the sense of a name. It's about the fact

471
00:23:35,600 --> 00:23:38,680
Speaker 1: that you have a human there and it's your responsibility.

472
00:23:38,880 --> 00:23:40,520
Speaker 1: And I know that that's how you feel. But I'm

473
00:23:40,560 --> 00:23:42,000
Speaker 1: just curious about any added pressure.

474
00:23:43,040 --> 00:23:45,920
Speaker 3: Well, I mean there's some times some pressure. We just

475
00:23:45,960 --> 00:23:48,600
Speaker 3: try not to think about it too much. And you're right,

476
00:23:48,680 --> 00:23:52,280
Speaker 3: I'm thinking about you know, you in your career when

477
00:23:52,320 --> 00:23:55,880
Speaker 3: you're in that room, or I'm thinking about some CEO

478
00:23:55,920 --> 00:23:57,840
Speaker 3: and that person's career in the room, or I'm thinking

479
00:23:57,920 --> 00:24:02,120
Speaker 3: about someone as a mom has kids, and I kind

480
00:24:02,119 --> 00:24:04,520
Speaker 3: of have to both think about that a little in

481
00:24:04,560 --> 00:24:07,480
Speaker 3: the background, but try not to make it like overwhelm me. Right,

482
00:24:07,520 --> 00:24:10,000
Speaker 3: I'm there for a job that I've done many times before,

483
00:24:10,040 --> 00:24:13,000
Speaker 3: and I just have to put on my game face

484
00:24:13,040 --> 00:24:15,920
Speaker 3: and get that job done well. Make sure everybody's fine

485
00:24:15,960 --> 00:24:16,800
Speaker 3: no matter what the deal is.

486
00:24:17,040 --> 00:24:17,920
Speaker 2: You're so confident.

487
00:24:18,840 --> 00:24:21,159
Speaker 3: Maybe over maybe over, No, I don't think so.

488
00:24:21,200 --> 00:24:24,040
Speaker 1: It's like the perfect You're You're You're really honestly the

489
00:24:24,040 --> 00:24:26,239
Speaker 1: perfect balance. And I can tell you if ever I

490
00:24:26,280 --> 00:24:30,320
Speaker 1: need brain surgery again, it's it's always going to be you.

491
00:24:30,880 --> 00:24:31,760
Speaker 2: Let's hope I.

492
00:24:31,720 --> 00:24:34,199
Speaker 3: Don't, right, That's our other job is to do so

493
00:24:34,280 --> 00:24:36,200
Speaker 3: much surveillance. We keep you out of the operating room.

494
00:24:36,480 --> 00:24:37,919
Speaker 3: It's a little more fun for me than it is

495
00:24:37,960 --> 00:24:40,239
Speaker 3: for you.

496
00:24:40,560 --> 00:24:47,359
Speaker 1: Probably, yes, obviously, but as as we know, protocols stop working.

497
00:24:47,600 --> 00:24:52,360
Speaker 1: It's it's not anything wrong with the medicine. It's that

498
00:24:52,560 --> 00:24:58,080
Speaker 1: cancer changes. It's why I think there's not a cure yet,

499
00:24:58,800 --> 00:25:04,320
Speaker 1: because it's a living thing that's constantly changing and evolving.

500
00:25:04,400 --> 00:25:06,119
Speaker 2: And I can't.

501
00:25:05,880 --> 00:25:11,000
Speaker 1: Really even remember the particulars of my cancer, but I

502
00:25:11,080 --> 00:25:15,800
Speaker 1: know that whatever I was prior to the surgery, we

503
00:25:15,880 --> 00:25:20,159
Speaker 1: discovered that I had turned positive in one area. That

504
00:25:20,200 --> 00:25:22,359
Speaker 1: then allowed me to go on to a totally different

505
00:25:22,359 --> 00:25:26,760
Speaker 1: protocol that I wasn't eligible for prior, which really tells

506
00:25:26,760 --> 00:25:31,240
Speaker 1: you how important getting a sample of that tumor and

507
00:25:32,080 --> 00:25:36,719
Speaker 1: doing that pathology and really dissecting it can be incredibly helpful,

508
00:25:36,760 --> 00:25:38,400
Speaker 1: because all of a sudden you have a brand new

509
00:25:38,480 --> 00:25:41,320
Speaker 1: protocol that's open to you. But at the end of

510
00:25:41,359 --> 00:25:45,840
Speaker 1: the day, eventually a protocol will stop working. I don't

511
00:25:46,040 --> 00:25:48,200
Speaker 1: really know of anyone who's been on the same protocol

512
00:25:48,680 --> 00:25:52,760
Speaker 1: at stage four for twenty plus years. They eventually all

513
00:25:52,800 --> 00:25:55,679
Speaker 1: wear off. So at some point for somebody like me

514
00:25:55,840 --> 00:26:02,040
Speaker 1: who has a tendency to develop mets, there might be

515
00:26:02,119 --> 00:26:04,119
Speaker 1: some point where I have to see you again because

516
00:26:04,960 --> 00:26:08,640
Speaker 1: the radiation may not be able to handle it right.

517
00:26:08,720 --> 00:26:10,560
Speaker 3: There's a chance. I hope we can stay with that

518
00:26:10,600 --> 00:26:12,520
Speaker 3: off for a long time, but there's a chance me too.

519
00:26:12,760 --> 00:26:14,960
Speaker 3: Part of it is a lot of these frequent MRIs

520
00:26:15,000 --> 00:26:16,600
Speaker 3: like you've been being able to put up with and

521
00:26:16,640 --> 00:26:19,320
Speaker 3: do your counting and stuff, that hopefully we can find

522
00:26:19,359 --> 00:26:22,000
Speaker 3: little spots and pick them off before they need surgery.

523
00:26:22,280 --> 00:26:25,920
Speaker 3: But you're right, there's always some consideration for additional surgery.

524
00:26:26,080 --> 00:26:28,679
Speaker 3: And I agree with you. I mean, cancer has a reputation,

525
00:26:29,119 --> 00:26:31,400
Speaker 3: it has for a reason because it evolves and it

526
00:26:31,480 --> 00:26:34,560
Speaker 3: takes a therapy and just it takes one pocket of

527
00:26:34,600 --> 00:26:37,280
Speaker 3: cells that doesn't respond while that theory start to grow

528
00:26:37,320 --> 00:26:42,240
Speaker 3: and suddenly you need something different. It is that part

529
00:26:42,280 --> 00:26:46,320
Speaker 3: of current cancer care to really be both personalized but

530
00:26:46,400 --> 00:26:48,840
Speaker 3: also to update what we're looking at every now and

531
00:26:48,880 --> 00:26:51,440
Speaker 3: then that's sometimes we need another sample of something from

532
00:26:51,480 --> 00:26:54,800
Speaker 3: somewhere because if the black their signal changes a little bit,

533
00:26:54,840 --> 00:26:57,280
Speaker 3: like it did for you, and now you qualify for

534
00:26:57,480 --> 00:26:59,879
Speaker 3: a targeted therapy. We didn't think you qualified before. We

535
00:27:00,000 --> 00:27:03,600
Speaker 3: We've just changed everything, We just disrupted everything. It's great

536
00:27:03,600 --> 00:27:04,159
Speaker 3: that you had that.

537
00:27:04,720 --> 00:27:08,240
Speaker 1: And then obviously there's the incredible clinical trials that are

538
00:27:08,240 --> 00:27:14,399
Speaker 1: happening everywhere. Do you see for stage four patients that

539
00:27:14,480 --> 00:27:16,639
Speaker 1: it spreads more to organs or more to brains.

540
00:27:17,720 --> 00:27:19,879
Speaker 3: Everything's a little different. I mean, melanoma tends to have

541
00:27:19,920 --> 00:27:22,399
Speaker 3: some predilection for the brain. We think part of that

542
00:27:22,520 --> 00:27:25,760
Speaker 3: is because our skin actually has a common origin ast

543
00:27:25,840 --> 00:27:28,800
Speaker 3: site as our neural tissue, and so we think that's

544
00:27:28,960 --> 00:27:31,359
Speaker 3: part of the reason why there's some cancers that go

545
00:27:31,400 --> 00:27:36,280
Speaker 3: to the brain less frequently, like colon cancer or endometrial cancer.

546
00:27:36,320 --> 00:27:39,080
Speaker 3: Although as people are starting to survive better and better

547
00:27:39,080 --> 00:27:41,119
Speaker 3: for their primary tours. We're starting to see more of

548
00:27:41,160 --> 00:27:43,919
Speaker 3: those metastases than we used to see. You know, when

549
00:27:43,960 --> 00:27:47,200
Speaker 3: I started theaters at nineteen years ago, that was very uncommon,

550
00:27:47,240 --> 00:27:49,120
Speaker 3: But we're starting to see more of those things because

551
00:27:49,119 --> 00:27:51,600
Speaker 3: people survive longer from their primary cancer.

552
00:27:51,600 --> 00:27:55,520
Speaker 1: Right, I mean, cancer is just a whole other beast

553
00:27:55,600 --> 00:27:59,439
Speaker 1: to me. I didn't really have a lot of experience

554
00:27:59,520 --> 00:28:01,840
Speaker 1: with cancer, or not a lot of friends that had cancer,

555
00:28:02,520 --> 00:28:06,520
Speaker 1: and I was certainly, I thought incredibly healthy up until

556
00:28:06,520 --> 00:28:09,320
Speaker 1: twenty fifteen when I got diagnosed with cancer. To know

557
00:28:09,320 --> 00:28:13,639
Speaker 1: where the breast cancer spreads, sometimes people do have it

558
00:28:13,680 --> 00:28:16,159
Speaker 1: spread to the brain much faster than the organs. I

559
00:28:16,160 --> 00:28:18,440
Speaker 1: had a good friend that it spread to her organs

560
00:28:18,560 --> 00:28:25,160
Speaker 1: really quickly, where everything just started shutting down, and she

561
00:28:25,320 --> 00:28:27,560
Speaker 1: shut down. She just didn't want to keep going through it.

562
00:28:28,080 --> 00:28:32,960
Speaker 1: So when you go home because you people's lives in

563
00:28:32,960 --> 00:28:37,159
Speaker 1: your hands, does it impact the way that you view life?

564
00:28:37,320 --> 00:28:41,000
Speaker 1: From everything I've heard, you're a wonderful father, a wonderful husband.

565
00:28:41,480 --> 00:28:45,120
Speaker 1: Does it make you appreciate life more? Do you look

566
00:28:45,160 --> 00:28:48,920
Speaker 1: at things as being much more precious or do you

567
00:28:48,960 --> 00:28:51,240
Speaker 1: have to sometimes leave some of that behind in the

568
00:28:51,240 --> 00:28:54,480
Speaker 1: hospital and try to be as normal as possible.

569
00:28:55,680 --> 00:28:59,440
Speaker 3: Yeah, I think answer being some mixed moments. I think

570
00:28:59,480 --> 00:29:02,080
Speaker 3: I think some of it is, you know, when when

571
00:29:02,160 --> 00:29:05,080
Speaker 3: you see someone who how to particularly you know, hard time,

572
00:29:05,160 --> 00:29:07,080
Speaker 3: then you want to go home and just hug your

573
00:29:07,120 --> 00:29:08,640
Speaker 3: kids for a little bit and hug your wife for

574
00:29:08,680 --> 00:29:10,920
Speaker 3: a little bit. But you're right, I don't want to

575
00:29:10,920 --> 00:29:14,320
Speaker 3: totally expose the kids to every little thing on my

576
00:29:14,440 --> 00:29:18,800
Speaker 3: mind because I see some troublesome things and I want

577
00:29:18,800 --> 00:29:21,400
Speaker 3: them to be kids. They hear stuff sometimes, you know,

578
00:29:21,600 --> 00:29:23,880
Speaker 3: I'm on the phone with somebody and they're like screaming

579
00:29:23,880 --> 00:29:26,600
Speaker 3: in the background and something like that. But they I

580
00:29:26,680 --> 00:29:30,040
Speaker 3: try not to expose them to everything. But I think

581
00:29:30,040 --> 00:29:31,760
Speaker 3: that's part of the thing, maybe a little how I

582
00:29:31,760 --> 00:29:33,760
Speaker 3: grew up too, is like they're curious I have something

583
00:29:33,800 --> 00:29:35,239
Speaker 3: like this at home, like what is that? And what

584
00:29:35,280 --> 00:29:37,160
Speaker 3: picture do I have with me? And things like that.

585
00:29:37,800 --> 00:29:40,440
Speaker 3: It gets a little trick. I can't totally keep them

586
00:29:40,480 --> 00:29:42,040
Speaker 3: out of the loop, but I try to dispose them

587
00:29:42,080 --> 00:29:42,480
Speaker 3: to everything.

588
00:29:42,560 --> 00:29:44,760
Speaker 2: Yeah, are they fascinated by your job? Though?

589
00:29:45,320 --> 00:29:48,200
Speaker 3: Sometimes right now that what we usually say is like

590
00:29:48,320 --> 00:29:51,800
Speaker 3: dad takes out lumps out of someone's head to make

591
00:29:51,840 --> 00:29:54,400
Speaker 3: it like a little simple and sound a little more innocent.

592
00:29:54,480 --> 00:29:56,760
Speaker 2: Yeah, do you hope? Because I know a lot of

593
00:29:57,200 --> 00:30:02,120
Speaker 2: parents who are doctors or attorney they want their children

594
00:30:02,160 --> 00:30:05,000
Speaker 2: to follow in their footsteps. Do you feel that way

595
00:30:05,040 --> 00:30:05,400
Speaker 2: at all?

596
00:30:05,480 --> 00:30:08,360
Speaker 3: Or I don't know. I mean, I think the followed

597
00:30:08,400 --> 00:30:11,320
Speaker 3: in your dad's foods, see it did? I also felt

598
00:30:11,360 --> 00:30:14,520
Speaker 3: like my parents expected it of me. But I feel

599
00:30:14,520 --> 00:30:16,360
Speaker 3: like going into medicine the first place is a little

600
00:30:16,400 --> 00:30:18,959
Speaker 3: bit of a hard pathway unless one really really loves it,

601
00:30:19,560 --> 00:30:22,240
Speaker 3: and going in a nurse surgery even more so. So.

602
00:30:22,880 --> 00:30:26,520
Speaker 3: When I meet students sometimes I'll ask them if that's

603
00:30:26,960 --> 00:30:29,160
Speaker 3: basically the only thing on the planet that'll keep them

604
00:30:29,160 --> 00:30:31,440
Speaker 3: happy as a job, and if there's something else, you

605
00:30:31,480 --> 00:30:33,800
Speaker 3: probably should think about it, because it's just a hard

606
00:30:33,800 --> 00:30:37,720
Speaker 3: pathway and a hard life, you know, me answering phone

607
00:30:37,760 --> 00:30:39,840
Speaker 3: calls at mammoth and stuff like that. It's just one

608
00:30:39,880 --> 00:30:40,680
Speaker 3: of those things.

609
00:30:41,280 --> 00:30:43,160
Speaker 2: And where did you did you grow up here in

610
00:30:43,200 --> 00:30:44,160
Speaker 2: Los Angeles?

611
00:30:44,640 --> 00:30:47,120
Speaker 3: I grew up in Newport Beach. That's when doctor Marhide

612
00:30:47,120 --> 00:30:49,640
Speaker 3: grew up too. We went to rival high schools. That's funny,

613
00:30:50,440 --> 00:30:51,200
Speaker 3: it's entertaining.

614
00:30:52,680 --> 00:30:54,000
Speaker 2: Yeah, I asked what school you went to?

615
00:30:54,640 --> 00:30:57,920
Speaker 1: For all things that people normally ask before they get

616
00:30:58,000 --> 00:30:59,400
Speaker 1: brain surgery, and I didn't.

617
00:30:59,440 --> 00:31:01,200
Speaker 2: I didn't ask you anything.

618
00:31:01,280 --> 00:31:05,280
Speaker 3: I think, Yeah, I think once you knew Piro's recommendation,

619
00:31:05,400 --> 00:31:06,760
Speaker 3: you were fine.

620
00:31:06,920 --> 00:31:07,120
Speaker 2: Yeah.

621
00:31:07,160 --> 00:31:10,400
Speaker 1: I just also thank god it was so quick, so

622
00:31:10,520 --> 00:31:12,720
Speaker 1: quick of a turnaround, because I think if I had

623
00:31:12,960 --> 00:31:16,400
Speaker 1: had time to ruminate on it longer, I would.

624
00:31:16,160 --> 00:31:18,400
Speaker 2: Have had a lot more questions.

625
00:31:18,840 --> 00:31:22,760
Speaker 1: But you know, going through a separation when you're right

626
00:31:22,760 --> 00:31:26,200
Speaker 1: about to go into brain surgery, my thoughts were on that.

627
00:31:26,480 --> 00:31:29,440
Speaker 2: They weren't even on anything else.

628
00:31:29,560 --> 00:31:32,640
Speaker 1: So now I'm asking you all the questions that normally

629
00:31:32,680 --> 00:31:34,720
Speaker 1: people ask their brain surgeon.

630
00:31:35,120 --> 00:31:38,440
Speaker 3: Sometimes they do before Right, I went to a little

631
00:31:38,480 --> 00:31:40,680
Speaker 3: school up north called Stanford, and then I went to

632
00:31:40,760 --> 00:31:42,360
Speaker 3: U see San Diego for medical school.

633
00:31:42,520 --> 00:31:45,000
Speaker 2: God, I can't Stanford.

634
00:31:46,440 --> 00:31:50,840
Speaker 1: Somewhere just a little right, just Stanford, no big deal.

635
00:31:51,560 --> 00:31:55,480
Speaker 3: Beforehand, those weren't the questions, huh, No, it was.

636
00:31:56,480 --> 00:31:59,880
Speaker 1: I think it was looking in your eyes via zoom,

637
00:32:00,000 --> 00:32:05,160
Speaker 1: and you showed zero fear, and a lot of people

638
00:32:05,320 --> 00:32:06,240
Speaker 1: like doctors to.

639
00:32:06,280 --> 00:32:09,760
Speaker 2: Be very huggy, like my mom.

640
00:32:10,080 --> 00:32:12,600
Speaker 1: Right, she had an anaurysm, and then she just had

641
00:32:12,600 --> 00:32:16,880
Speaker 1: a new aniurysm, and one of your colleagues. Doctor Gonzales

642
00:32:17,240 --> 00:32:21,840
Speaker 1: did her last one, and he's perfect for her, and

643
00:32:21,880 --> 00:32:26,200
Speaker 1: he's a wonderful, amazing doctor. Also theaters, she has a

644
00:32:26,240 --> 00:32:29,280
Speaker 1: lot of questions and she really needs somebody like the

645
00:32:29,320 --> 00:32:34,280
Speaker 1: doctor to literally hold her hand, and she likes them

646
00:32:34,280 --> 00:32:37,040
Speaker 1: to be very warm and affectionate. Not that you aren't warm,

647
00:32:37,080 --> 00:32:41,960
Speaker 1: but I prefer my doctors to be much more analytical

648
00:32:43,000 --> 00:32:46,720
Speaker 1: and not distant. But I have a weird thing about

649
00:32:46,720 --> 00:32:49,240
Speaker 1: crossing over. Even though Pierro and I are very good friends,

650
00:32:50,280 --> 00:32:53,720
Speaker 1: when we go to dinner, we don't talk cancer. We

651
00:32:53,760 --> 00:32:56,800
Speaker 1: don't talk to medicine. And when I am in this

652
00:32:56,920 --> 00:33:02,240
Speaker 1: clinic as a patient, there's there's no hugging. No, there's

653
00:33:02,280 --> 00:33:05,080
Speaker 1: none of that, because now you're my doctor and I'm

654
00:33:05,080 --> 00:33:06,760
Speaker 1: a patient, and I just want you to give it

655
00:33:06,800 --> 00:33:07,000
Speaker 1: to me.

656
00:33:07,040 --> 00:33:09,960
Speaker 2: Strayed, and I don't want any emotion.

657
00:33:09,760 --> 00:33:12,880
Speaker 1: Whatsoever, because if somebody else has emotion, I'm going to

658
00:33:12,960 --> 00:33:15,200
Speaker 1: get emotional, and I don't like doing that in front

659
00:33:15,200 --> 00:33:16,600
Speaker 1: of people. It's just I don't get any of my

660
00:33:16,600 --> 00:33:19,960
Speaker 1: test results in person anymore. I like everything over the

661
00:33:20,000 --> 00:33:23,280
Speaker 1: phone so that I don't have to check myself and

662
00:33:23,600 --> 00:33:26,600
Speaker 1: monitor my reaction.

663
00:33:27,000 --> 00:33:28,280
Speaker 2: To the news.

664
00:33:28,760 --> 00:33:31,840
Speaker 1: I will put on a smiley face when somebody tells

665
00:33:31,880 --> 00:33:34,520
Speaker 1: me your cancer has spread, just to make sure that

666
00:33:34,600 --> 00:33:36,800
Speaker 1: the nurse standing next to my doctor doesn't feel bad

667
00:33:36,800 --> 00:33:39,280
Speaker 1: for me, because I don't like the pity. I don't

668
00:33:39,360 --> 00:33:41,200
Speaker 1: like the sad look. I don't like any of that.

669
00:33:42,040 --> 00:33:44,040
Speaker 1: And also I don't want to get wrapped up.

670
00:33:43,960 --> 00:33:45,680
Speaker 2: Into those emotions.

671
00:33:46,000 --> 00:33:49,360
Speaker 1: For me, it's very hard, and lately I've had a

672
00:33:49,360 --> 00:33:52,040
Speaker 1: lot more of those emotions, which has thrown me off

673
00:33:52,600 --> 00:33:55,120
Speaker 1: because I'm going to go to an interesting that you

674
00:33:55,160 --> 00:33:57,240
Speaker 1: said about that I'm getting my MRIs always on time,

675
00:33:57,280 --> 00:34:00,800
Speaker 1: because you called me and you had a conversation with me,

676
00:34:00,880 --> 00:34:04,320
Speaker 1: and you said you need to go get your MRIs

677
00:34:04,360 --> 00:34:09,800
Speaker 1: more often. And I pushed back and was like, no,

678
00:34:10,160 --> 00:34:14,040
Speaker 1: I think I think that this is okay and for

679
00:34:14,200 --> 00:34:17,200
Speaker 1: most people, and I think even for myself, I should listen.

680
00:34:17,320 --> 00:34:20,000
Speaker 2: And I did. I started ramping it up a lot more.

681
00:34:20,719 --> 00:34:24,680
Speaker 1: But I have a weird ability to know when a

682
00:34:24,719 --> 00:34:26,000
Speaker 1: protocol has stopped working.

683
00:34:26,280 --> 00:34:27,200
Speaker 2: There's just something.

684
00:34:27,280 --> 00:34:32,000
Speaker 1: There's there's a twitch that happens, there's a feeling in

685
00:34:32,000 --> 00:34:36,200
Speaker 1: my bones, there's I just get I get a little off,

686
00:34:36,880 --> 00:34:41,120
Speaker 1: and I instantly know, Okay, the protocol is no longer working,

687
00:34:41,600 --> 00:34:44,880
Speaker 1: and a couple of days later, I'll go for the

688
00:34:45,000 --> 00:34:47,759
Speaker 1: MRI and the PET and sure enough it'll be a

689
00:34:47,880 --> 00:34:53,879
Speaker 1: super tiny spot. I think now, because I've started considering

690
00:34:53,920 --> 00:34:56,880
Speaker 1: that a lot more, and I go more often and

691
00:34:56,880 --> 00:35:02,960
Speaker 1: get the MRIs, my mentality is slowly changing. So before

692
00:35:03,000 --> 00:35:06,040
Speaker 1: where I wanted my doctors to just be very concise

693
00:35:06,120 --> 00:35:11,760
Speaker 1: and straightforward with me, I am finding that I'm getting

694
00:35:11,800 --> 00:35:14,799
Speaker 1: more scared and more aware of what's going on in

695
00:35:14,800 --> 00:35:18,640
Speaker 1: my body. I'm wanting more conversations with my doctors. I'm

696
00:35:18,680 --> 00:35:23,520
Speaker 1: wanting my test a lot more often because maybe it's

697
00:35:23,560 --> 00:35:27,040
Speaker 1: the reality. Maybe I was able to push reality off

698
00:35:27,080 --> 00:35:30,640
Speaker 1: a little bit and say, if anybody can beat it,

699
00:35:30,640 --> 00:35:32,960
Speaker 1: it's me, and it's fine, and I'm just going to

700
00:35:33,080 --> 00:35:35,759
Speaker 1: keep on these protocols and eventually they'll have another one

701
00:35:35,760 --> 00:35:38,240
Speaker 1: and another one and another one. But when you start

702
00:35:38,280 --> 00:35:42,440
Speaker 1: going through protocols a little bit faster because your cancer

703
00:35:42,480 --> 00:35:49,600
Speaker 1: is getting more aggressive or whatever the reason, you, you

704
00:35:49,760 --> 00:35:53,840
Speaker 1: definitely just start checking in more and getting more fearful.

705
00:35:54,040 --> 00:35:55,560
Speaker 2: It's really so.

706
00:35:55,640 --> 00:35:58,440
Speaker 1: Now, if I had brain surgery with you, well, now

707
00:35:58,480 --> 00:36:00,000
Speaker 1: I don't need to ask you, because I've asked you,

708
00:36:00,280 --> 00:36:02,160
Speaker 1: but I would have I would be a lot more

709
00:36:02,719 --> 00:36:05,160
Speaker 1: I think attentive at this point in time in my life,

710
00:36:06,360 --> 00:36:08,480
Speaker 1: do you find it easier to deal with the people

711
00:36:08,520 --> 00:36:11,560
Speaker 1: that are more like me? Are the ones who ask

712
00:36:11,640 --> 00:36:13,080
Speaker 1: a lot of questions?

713
00:36:14,560 --> 00:36:17,799
Speaker 3: I think in the middle somewhere, I mean, I think,

714
00:36:17,960 --> 00:36:20,680
Speaker 3: I think sometimes people hang on to too many questions

715
00:36:20,719 --> 00:36:23,680
Speaker 3: and sometimes like unimportant questions. So I don't know, there's

716
00:36:23,719 --> 00:36:25,960
Speaker 3: someone coming up with a surgery with a benign tumor,

717
00:36:26,000 --> 00:36:28,560
Speaker 3: that's you know, asking exactly how long she's going to

718
00:36:28,600 --> 00:36:30,880
Speaker 3: be off from work, and like, you know, can I

719
00:36:30,920 --> 00:36:33,120
Speaker 3: do this like eight months, eight weeks from surgery?

720
00:36:33,360 --> 00:36:33,640
Speaker 2: I don't.

721
00:36:33,680 --> 00:36:35,680
Speaker 3: I don't know those things, right. We have to get

722
00:36:35,680 --> 00:36:37,960
Speaker 3: you through the process to know those things and see

723
00:36:38,000 --> 00:36:40,239
Speaker 3: how you're recovering. Stuff like That's it can get tough

724
00:36:40,239 --> 00:36:43,120
Speaker 3: when we're focusing on you know, steps like very very

725
00:36:43,160 --> 00:36:45,400
Speaker 3: far away. I know that sometimes that's the people's like

726
00:36:45,520 --> 00:36:49,319
Speaker 3: kind of control are almost like a soothing mechanism. But

727
00:36:49,400 --> 00:36:50,920
Speaker 3: sometimes all we can do is get to that one

728
00:36:51,000 --> 00:36:52,719
Speaker 3: next step and then see where it goes from there.

729
00:36:52,880 --> 00:36:55,640
Speaker 1: Well, yeah, I mean people want to people want to

730
00:36:55,640 --> 00:36:59,160
Speaker 1: feel like they're going to be normal very quickly, but.

731
00:37:00,760 --> 00:37:03,800
Speaker 2: You just you never know what can happen.

732
00:37:04,320 --> 00:37:07,600
Speaker 1: And by the way, just as a side note, I

733
00:37:07,640 --> 00:37:11,240
Speaker 1: do do my MRIs on schedule sometimes if I feel

734
00:37:12,080 --> 00:37:15,600
Speaker 1: Sometimes if I feel something off, I will go before

735
00:37:15,640 --> 00:37:18,080
Speaker 1: I'm supposed to go in because I want to catch it.

736
00:37:18,080 --> 00:37:22,480
Speaker 1: It's quickly as humanly possible, So like I'm scheduling for

737
00:37:22,520 --> 00:37:24,440
Speaker 1: another one quickly, so.

738
00:37:25,920 --> 00:37:29,320
Speaker 2: Just because I'm like, well, why not? Now I understand now.

739
00:37:29,160 --> 00:37:32,240
Speaker 1: It's but again, it's that reality is sort of sinking

740
00:37:32,239 --> 00:37:34,799
Speaker 1: in a little bit more. Where you go? God, why

741
00:37:34,800 --> 00:37:37,479
Speaker 1: do I want to wait until something gets bigger? Why

742
00:37:37,520 --> 00:37:40,680
Speaker 1: not make radiation a little bit easier? It's smaller, Like

743
00:37:40,880 --> 00:37:45,240
Speaker 1: get in there, get it handled quicker, change your protocol quicker,

744
00:37:46,000 --> 00:37:49,120
Speaker 1: or you know, sign up for a clinical trial and

745
00:37:49,200 --> 00:37:58,880
Speaker 1: have a chance of actually getting into a clinical trial quicker.

746
00:38:00,560 --> 00:38:04,560
Speaker 1: There are questions for you, sir, oh my, after brain surgery,

747
00:38:04,680 --> 00:38:07,279
Speaker 1: how quickly can you tell if someone is going to

748
00:38:07,280 --> 00:38:11,200
Speaker 1: have lasting problems like loss of mobility or memory or etc.

749
00:38:12,200 --> 00:38:16,399
Speaker 3: You should know something basically instantly, like as we wake

750
00:38:16,440 --> 00:38:18,440
Speaker 3: you up from surgery, we start to know what's going

751
00:38:18,480 --> 00:38:21,359
Speaker 3: on that by that first night, you know, first twenty

752
00:38:21,440 --> 00:38:25,200
Speaker 3: four hours, if you're doing well and you're speaking well,

753
00:38:25,239 --> 00:38:28,600
Speaker 3: moving well, usually that means that everything's going to be fine.

754
00:38:29,400 --> 00:38:31,680
Speaker 3: So the dangerous things happen early for.

755
00:38:31,719 --> 00:38:35,359
Speaker 1: You mentally to know that you're waking up and you're

756
00:38:35,400 --> 00:38:38,560
Speaker 1: going to a very difficult surgery, but you still have to,

757
00:38:39,400 --> 00:38:44,120
Speaker 1: you know, put on a happier face, perhaps for your children,

758
00:38:44,200 --> 00:38:47,640
Speaker 1: or if you lose a patient during surgery and you

759
00:38:47,719 --> 00:38:50,839
Speaker 1: still how do you handle that?

760
00:38:52,120 --> 00:38:54,560
Speaker 3: Well. I don't know if I have perfect answers to that,

761
00:38:54,640 --> 00:38:57,680
Speaker 3: but I think that some things compartmentalize themselves a little bit,

762
00:38:57,840 --> 00:39:00,480
Speaker 3: like the times that I have a surgery first thing

763
00:39:00,520 --> 00:39:02,360
Speaker 3: in morning, after check in so early, it's not like

764
00:39:02,400 --> 00:39:04,520
Speaker 3: I can take the kids to school or something anyway,

765
00:39:04,840 --> 00:39:07,560
Speaker 3: So the times I do are naturally a day like today,

766
00:39:07,560 --> 00:39:09,560
Speaker 3: we're not clearly not operating right now, and I could

767
00:39:09,600 --> 00:39:11,799
Speaker 3: take the kids to school and kind of be more

768
00:39:11,840 --> 00:39:15,160
Speaker 3: the regular person for a little bit. I mean, right

769
00:39:15,160 --> 00:39:18,120
Speaker 3: when there are things that happen at surgery, it's particularly tough.

770
00:39:18,320 --> 00:39:20,920
Speaker 3: I also think there's a part where some amount of

771
00:39:20,920 --> 00:39:24,799
Speaker 3: that decompression at work before I go home, first of all,

772
00:39:24,960 --> 00:39:28,239
Speaker 3: might help keep me out of a car accident or something, right,

773
00:39:28,400 --> 00:39:30,520
Speaker 3: and second, just try not to bring it all into

774
00:39:30,520 --> 00:39:35,080
Speaker 3: the house, like to be at work and reflective and

775
00:39:35,160 --> 00:39:37,919
Speaker 3: you know what happened today, what can we do better

776
00:39:37,960 --> 00:39:41,000
Speaker 3: next time? And try to make those processes happen, you know,

777
00:39:41,120 --> 00:39:43,800
Speaker 3: right afterwards, in early, so that it doesn't try to

778
00:39:43,920 --> 00:39:46,040
Speaker 3: roll over and everything, and it rolls over a little,

779
00:39:46,120 --> 00:39:48,399
Speaker 3: but try to limit the effect of it.

780
00:39:49,560 --> 00:39:51,960
Speaker 1: When a patient is sent to you, do you get

781
00:39:51,960 --> 00:39:54,680
Speaker 1: them at stage one or does that usually mean that

782
00:39:54,680 --> 00:39:56,719
Speaker 1: they're further advanced?

783
00:39:57,160 --> 00:40:01,080
Speaker 3: Right, So most people are sent to me when they

784
00:40:01,160 --> 00:40:04,640
Speaker 3: know they have a brain metastasis, right, So none of

785
00:40:04,640 --> 00:40:06,640
Speaker 3: those people are going to be stage one. But we

786
00:40:06,680 --> 00:40:09,959
Speaker 3: also treat primary brain tumors called gliomas. They're more less

787
00:40:09,960 --> 00:40:13,000
Speaker 3: common than metastases, but sometimes people might have a lower

788
00:40:13,040 --> 00:40:15,560
Speaker 3: grade or a higher grade glioma, and that's the tumor

789
00:40:15,600 --> 00:40:18,799
Speaker 3: that started in the brain itself. There are a lot

790
00:40:18,800 --> 00:40:22,799
Speaker 3: of patients who don't have benign brain tumors if they

791
00:40:22,960 --> 00:40:26,680
Speaker 3: have a glioma as an adult. That's more common in children.

792
00:40:27,280 --> 00:40:29,960
Speaker 3: But also there's a common tumor not of the brain itself,

793
00:40:29,960 --> 00:40:33,360
Speaker 3: with the coverings of the brain. The meningis and meningiomas

794
00:40:33,400 --> 00:40:36,680
Speaker 3: are fairly common tumors and are usually benign. So there's

795
00:40:36,719 --> 00:40:39,440
Speaker 3: kind of this variety of depending on what the pathology is.

796
00:40:40,840 --> 00:40:42,920
Speaker 2: And the most important question that I can think to

797
00:40:42,960 --> 00:40:47,719
Speaker 2: ask you, when you made that decision, you looked at

798
00:40:47,719 --> 00:40:49,319
Speaker 2: my brain? Did it just wow you?

799
00:40:49,880 --> 00:40:52,560
Speaker 3: It was amazing? It was amazing. In fact, do you

800
00:40:52,600 --> 00:40:54,879
Speaker 3: remember one of the times you made fun of me, No,

801
00:40:55,120 --> 00:40:57,200
Speaker 3: that I gave you a picture of your brain. Yes,

802
00:40:57,400 --> 00:41:00,560
Speaker 3: and it was only printed on a regular paper. You said,

803
00:41:01,040 --> 00:41:03,839
Speaker 3: this is not it was enough hoppy. So then I

804
00:41:03,880 --> 00:41:07,480
Speaker 3: had to do the photo for the real photo.

805
00:41:08,280 --> 00:41:15,080
Speaker 1: My I cannot believe you brought me that. Oh you

806
00:41:15,120 --> 00:41:18,840
Speaker 1: know you're gonna have to explain all of this. This happened,

807
00:41:20,040 --> 00:41:20,680
Speaker 1: that's wild.

808
00:41:20,760 --> 00:41:23,280
Speaker 2: What is this? Did you like leave a cotton swad?

809
00:41:24,040 --> 00:41:24,279
Speaker 1: No?

810
00:41:24,280 --> 00:41:26,399
Speaker 3: No, no, I didn't leave something. So sometimes we use

811
00:41:26,480 --> 00:41:30,080
Speaker 3: these cotton nois, these cotton patties to try and protect

812
00:41:30,360 --> 00:41:32,239
Speaker 3: various areas of the brain. This one is really like

813
00:41:32,280 --> 00:41:34,799
Speaker 3: they open the dura that coverings the brain, and this

814
00:41:34,880 --> 00:41:37,040
Speaker 3: is to keep it hydrated. But this is so like

815
00:41:37,080 --> 00:41:39,719
Speaker 3: if there's a big vein here, we don't accidentally touch

816
00:41:39,760 --> 00:41:41,120
Speaker 3: it and or interfere, and then we take that stuff

817
00:41:41,120 --> 00:41:44,239
Speaker 3: out afterwards, you don't have any extra surprises in there.

818
00:41:44,480 --> 00:41:46,719
Speaker 2: Have you ever left something in a brain and you'll

819
00:41:46,760 --> 00:41:47,800
Speaker 2: never adminish, you know.

820
00:41:48,920 --> 00:41:51,160
Speaker 3: But you know, obviously that's part of what we have

821
00:41:51,239 --> 00:41:53,719
Speaker 3: to be cautious about. And that's why to people in

822
00:41:53,719 --> 00:41:56,040
Speaker 3: the operator that help us, like help count these little

823
00:41:56,040 --> 00:41:58,920
Speaker 3: cottonoids and make sure we know and we have everything

824
00:41:58,920 --> 00:42:00,560
Speaker 3: that we started with that jazz.

825
00:42:00,920 --> 00:42:02,879
Speaker 1: I only asked that question because once again I saw

826
00:42:02,880 --> 00:42:05,120
Speaker 1: it on grease anatomy Great and they were doing the

827
00:42:05,200 --> 00:42:06,840
Speaker 1: counting and they came up short.

828
00:42:07,200 --> 00:42:09,319
Speaker 3: Yes, you know, you're actually one of those people who

829
00:42:09,320 --> 00:42:13,279
Speaker 3: hasn't really asked for much. We have patients, you know,

830
00:42:13,880 --> 00:42:16,520
Speaker 3: call with billions of questions or asked for like several

831
00:42:16,560 --> 00:42:18,600
Speaker 3: refills of pain medicine. You're not that type of person

832
00:42:18,600 --> 00:42:20,680
Speaker 3: who's really asked for a whole lot of things.

833
00:42:21,080 --> 00:42:24,120
Speaker 1: No, I got off the pain meds immediately pretty much,

834
00:42:24,360 --> 00:42:26,920
Speaker 1: and I, you know, unfortunately, kept on trying to take

835
00:42:26,960 --> 00:42:31,239
Speaker 1: myself off the steroids, and you kept telling me to

836
00:42:31,280 --> 00:42:33,399
Speaker 1: go back on, like brain swelling is a real thing

837
00:42:33,440 --> 00:42:38,800
Speaker 1: after brain surgery. But uh, yeah, I'm not a big

838
00:42:38,920 --> 00:42:43,360
Speaker 1: pain pill person. It's I don't I don't like to

839
00:42:43,360 --> 00:42:45,400
Speaker 1: feel out of control, which is also some of the

840
00:42:45,440 --> 00:42:46,399
Speaker 1: fear of being put under.

841
00:42:47,000 --> 00:42:49,920
Speaker 2: I'm one of those that I'm a control freak.

842
00:42:50,120 --> 00:42:52,920
Speaker 1: I like to know everything that's happening in the moment,

843
00:42:53,719 --> 00:42:57,280
Speaker 1: and I kind of feel that with pain pills, it doles.

844
00:42:57,719 --> 00:43:02,360
Speaker 1: It just doles my ability to be quick and processed quickly,

845
00:43:03,080 --> 00:43:07,080
Speaker 1: and I don't like that at all. Has cancer ever

846
00:43:07,640 --> 00:43:11,760
Speaker 1: touched you personally with family member I loved one of friends?

847
00:43:13,480 --> 00:43:16,880
Speaker 3: Actually yes, I mean my my father died from glioblastoma.

848
00:43:16,920 --> 00:43:19,759
Speaker 3: I'm malignant brain TURMR. You would think that would be

849
00:43:19,880 --> 00:43:22,319
Speaker 3: my interesting story how I got into it, But it

850
00:43:22,320 --> 00:43:26,040
Speaker 3: was when I was already a neurosurgeon. But then it

851
00:43:26,080 --> 00:43:28,480
Speaker 3: was this thing that was odd. It was kind of

852
00:43:28,480 --> 00:43:30,239
Speaker 3: like I didn't realize I've been working, you know, more

853
00:43:30,280 --> 00:43:32,279
Speaker 3: than a decade in her surgery to rally all these

854
00:43:32,320 --> 00:43:34,359
Speaker 3: troops around me and try to help my dad. But

855
00:43:34,800 --> 00:43:36,440
Speaker 3: you know, he was eighty four, so it's like a

856
00:43:36,440 --> 00:43:39,520
Speaker 3: lot tougher for a lot of treatments when you're that age.

857
00:43:39,719 --> 00:43:41,960
Speaker 2: But you didn't do that, No, No.

858
00:43:41,880 --> 00:43:43,520
Speaker 3: I had one of my buddies to do it. That right,

859
00:43:43,600 --> 00:43:45,560
Speaker 3: that'd be too much. And even if it weren't too

860
00:43:45,640 --> 00:43:47,960
Speaker 3: much for me me, I mean that's considered a conflicted.

861
00:43:47,560 --> 00:43:50,320
Speaker 2: Seaters, right, What pressure on your buddy.

862
00:43:50,640 --> 00:43:52,280
Speaker 3: Yeah, a lot of pressure on my buddies.

863
00:43:52,320 --> 00:43:56,920
Speaker 1: It's true that. I mean I would if I had,

864
00:43:57,560 --> 00:43:59,520
Speaker 1: you know, a buddy or a family member or somebody

865
00:43:59,520 --> 00:44:01,360
Speaker 1: that will get camp because it's the conflict of interest

866
00:44:01,360 --> 00:44:05,080
Speaker 1: with somebody that I would definitely want someone closer to

867
00:44:05,160 --> 00:44:07,799
Speaker 1: me operating on, like my mother for instance. But at

868
00:44:07,800 --> 00:44:11,320
Speaker 1: the same time, wow, what pressure.

869
00:44:11,520 --> 00:44:14,600
Speaker 3: Yeah, it's definitely some pressure on them, that's true.

870
00:44:14,840 --> 00:44:18,319
Speaker 2: Have you ever canceled a scheduled surgery because you didn't

871
00:44:18,360 --> 00:44:20,880
Speaker 2: feel physically or emotionally at your best?

872
00:44:21,520 --> 00:44:25,920
Speaker 3: Hmm. I can't say that I've done that, per se.

873
00:44:27,719 --> 00:44:30,640
Speaker 3: The closest I came to that actually was a patient

874
00:44:30,719 --> 00:44:34,719
Speaker 3: still remembers that they needed what's called a ventriculo peraitual

875
00:44:34,800 --> 00:44:38,360
Speaker 3: shunt or a VP shunt. I did postpone one because

876
00:44:38,360 --> 00:44:41,840
Speaker 3: my wife was in labor, and so forever they always

877
00:44:41,920 --> 00:44:44,920
Speaker 3: remember when the twins were born, because my wife was

878
00:44:44,920 --> 00:44:46,640
Speaker 3: in labor. I brought her in and then, you know,

879
00:44:46,719 --> 00:44:49,160
Speaker 3: things calmed down. I did the surgery I think a

880
00:44:49,280 --> 00:44:53,080
Speaker 3: day later or something, but they remember.

881
00:44:52,760 --> 00:44:58,560
Speaker 1: That that's a pretty good reason to postpone. So you

882
00:44:58,640 --> 00:45:00,800
Speaker 1: never postponed for like, you know, just woke up and

883
00:45:00,840 --> 00:45:02,920
Speaker 1: said I'm not feeling this today.

884
00:45:04,280 --> 00:45:07,840
Speaker 3: I think not as simple as that, you know, I

885
00:45:07,880 --> 00:45:10,680
Speaker 3: think just have to even I've had a little ache

886
00:45:10,760 --> 00:45:12,560
Speaker 3: or something, I have to find a way to do

887
00:45:12,640 --> 00:45:15,160
Speaker 3: the job. That's what's funny. Someone who was just saying

888
00:45:15,160 --> 00:45:19,560
Speaker 3: something about calling out sick, and then you know, sometimes

889
00:45:19,600 --> 00:45:21,879
Speaker 3: it feels like it's a neurosurgeon. I can't call on sick.

890
00:45:22,120 --> 00:45:25,680
Speaker 3: I can call and dismembered. But whoever's there is sicker

891
00:45:25,719 --> 00:45:28,480
Speaker 3: than I am. So I need to, you know, get

892
00:45:28,520 --> 00:45:30,400
Speaker 3: it going. I think, you know, I've had a virus

893
00:45:30,520 --> 00:45:32,960
Speaker 3: or something, and if it's super bad and it happens

894
00:45:33,000 --> 00:45:34,920
Speaker 3: to hit on a day of surgery, I guess I

895
00:45:34,920 --> 00:45:37,040
Speaker 3: would have to do something. But I think fortunately, you know,

896
00:45:37,080 --> 00:45:38,719
Speaker 3: I don't operate every single day of the week, so

897
00:45:38,800 --> 00:45:41,560
Speaker 3: sometimes it hits on a day when I'm not that

898
00:45:41,680 --> 00:45:42,520
Speaker 3: busy or something.

899
00:45:43,239 --> 00:45:48,480
Speaker 1: Is there any anything that you would say to people

900
00:45:49,480 --> 00:45:53,040
Speaker 1: like me that are looking at having brain mets or

901
00:45:53,080 --> 00:45:57,719
Speaker 1: a tumor going in a surgery that would possibly help

902
00:45:57,800 --> 00:46:01,040
Speaker 1: them the questions that they should ask. I have the

903
00:46:01,200 --> 00:46:07,880
Speaker 1: utmost respect for doctors because the education, the how hard

904
00:46:07,920 --> 00:46:13,200
Speaker 1: they work, their work ethic is absolutely insane to me.

905
00:46:13,440 --> 00:46:16,160
Speaker 1: So I have nothing but respect for all doctors. But

906
00:46:16,920 --> 00:46:19,640
Speaker 1: that doesn't mean that I think every doctor that you

907
00:46:19,760 --> 00:46:21,839
Speaker 1: meet is the right doctor for you, and I do

908
00:46:21,920 --> 00:46:24,760
Speaker 1: believe in getting a second third opinion.

909
00:46:25,360 --> 00:46:27,480
Speaker 3: Well, I think you're right. It's always reasonable to have

910
00:46:27,480 --> 00:46:30,359
Speaker 3: a second opinion. It can't really hurt. I think that

911
00:46:30,760 --> 00:46:34,520
Speaker 3: it's different. If you're in Kansas City, there's kind of

912
00:46:34,560 --> 00:46:36,840
Speaker 3: only one place to go for some of like brain tumors,

913
00:46:36,920 --> 00:46:39,160
Speaker 3: but in a lot of these cities there are multiple places.

914
00:46:39,200 --> 00:46:41,960
Speaker 3: Sometimes I make the comment that in New York people

915
00:46:42,000 --> 00:46:43,680
Speaker 3: tend to stick in their burrow and they won't really

916
00:46:43,719 --> 00:46:46,720
Speaker 3: go to these other hospitals per se. But in Los Angeles,

917
00:46:46,760 --> 00:46:48,440
Speaker 3: one of the tricky things that you can if you're

918
00:46:48,480 --> 00:46:50,960
Speaker 3: tricky about it, you can schedule three in person visits

919
00:46:51,040 --> 00:46:53,360
Speaker 3: at academic centers in the same day if you schedule

920
00:46:53,400 --> 00:46:56,680
Speaker 3: it right. It's just tricky, and maybe too many opinions

921
00:46:56,800 --> 00:46:58,760
Speaker 3: is bad. I mean, it's hard to get six people

922
00:46:58,800 --> 00:47:03,240
Speaker 3: to agree on anything. So I've had people see six surgeons. Yeah,

923
00:47:03,440 --> 00:47:05,359
Speaker 3: the plant's not going to be the same from all

924
00:47:05,400 --> 00:47:08,600
Speaker 3: of them, But that second opinion's pretty reasonable. I think

925
00:47:08,640 --> 00:47:13,600
Speaker 3: that sometimes people will ask questions about their surgery and

926
00:47:13,640 --> 00:47:16,600
Speaker 3: things but it's fair to ask, you know, how many

927
00:47:16,600 --> 00:47:18,800
Speaker 3: times have you done this before or how regularly do

928
00:47:18,800 --> 00:47:21,960
Speaker 3: you perform this surgery? Right there is someone out in

929
00:47:22,000 --> 00:47:25,760
Speaker 3: the valley that says they do complex brain, complex, spine, complex,

930
00:47:26,120 --> 00:47:28,759
Speaker 3: baskular surgery, all of those things that one person, and

931
00:47:28,760 --> 00:47:31,600
Speaker 3: they're not attached to a big hospital. But I think

932
00:47:31,640 --> 00:47:34,799
Speaker 3: that some people that's suspicious and some people they don't

933
00:47:34,800 --> 00:47:38,200
Speaker 3: really pick up on that, right, Like at our academic

934
00:47:38,200 --> 00:47:41,399
Speaker 3: medical center. Those are three different people. Yeah, nobody can

935
00:47:41,440 --> 00:47:43,680
Speaker 3: do all that, but I don't think everyone picks up

936
00:47:43,680 --> 00:47:44,560
Speaker 3: on this stuff.

937
00:47:45,160 --> 00:47:48,160
Speaker 1: That would that would be a red flag for me.

938
00:47:48,520 --> 00:47:50,400
Speaker 3: Yeah, well, you're smart about this stuff.

939
00:47:50,520 --> 00:47:50,880
Speaker 2: I know that.

940
00:47:51,760 --> 00:47:56,120
Speaker 1: You know, you follow up with me and you will

941
00:47:56,760 --> 00:47:59,799
Speaker 1: call me and you will text me and say you know, hey,

942
00:47:59,840 --> 00:48:02,600
Speaker 1: I you know this was the result in your MRI,

943
00:48:02,760 --> 00:48:04,080
Speaker 1: and I think we need to do this and this

944
00:48:04,160 --> 00:48:08,040
Speaker 1: and this, and you know you're you're definitely not shy

945
00:48:08,400 --> 00:48:11,839
Speaker 1: about putting your opinion out there. But do you which

946
00:48:11,920 --> 00:48:13,839
Speaker 1: I deeply appreciate, by the way, I want to say,

947
00:48:13,840 --> 00:48:15,920
Speaker 1: thank you, You're welcome. Do you have a lot of

948
00:48:15,960 --> 00:48:18,280
Speaker 1: hope for the future of cancer treatment?

949
00:48:20,040 --> 00:48:22,000
Speaker 3: I do? I mean I think that a lot of

950
00:48:21,680 --> 00:48:25,600
Speaker 3: our different techniques are getting better over time. I mean,

951
00:48:25,840 --> 00:48:28,480
Speaker 3: surgeries are getting a little bit less invasive, a little

952
00:48:28,520 --> 00:48:31,040
Speaker 3: bit risk less risk, and we're kind of balancing better

953
00:48:31,520 --> 00:48:33,279
Speaker 3: who we take to surgery and what we do. I

954
00:48:33,320 --> 00:48:36,560
Speaker 3: think there's a lot of an older philosophy in medicine

955
00:48:36,600 --> 00:48:39,520
Speaker 3: of the MRI has to look perfect. But once in

956
00:48:39,520 --> 00:48:41,160
Speaker 3: a while, if the m RY looks perfect and the

957
00:48:41,160 --> 00:48:44,360
Speaker 3: patient's doing a lot worse, are we're really accomplishing the

958
00:48:44,480 --> 00:48:46,840
Speaker 3: right task. Now that we have more and more treatments

959
00:48:46,840 --> 00:48:50,279
Speaker 3: for whatever kind of pocket of cells we have, and

960
00:48:50,360 --> 00:48:55,239
Speaker 3: clearly the whole idea of chemotherapy, targeted therapy, immunotherapy is

961
00:48:55,280 --> 00:48:59,560
Speaker 3: all changing dramatically. We have agents coming up, you know,

962
00:48:59,680 --> 00:49:02,880
Speaker 3: fast and faster and things that didn't exist before. So

963
00:49:02,920 --> 00:49:04,879
Speaker 3: I think there's a lot of hope. I mean, it's

964
00:49:04,920 --> 00:49:08,200
Speaker 3: hard to really search for that elusive cure because the

965
00:49:08,200 --> 00:49:11,120
Speaker 3: cure implies also like one treatment fits all, and all

966
00:49:11,160 --> 00:49:13,520
Speaker 3: these cancer are a little different, and all these molecular

967
00:49:13,600 --> 00:49:16,160
Speaker 3: signature is a little different. But there are more and people,

968
00:49:16,280 --> 00:49:18,680
Speaker 3: more and more people going into a long term remission.

969
00:49:19,280 --> 00:49:22,560
Speaker 3: The difference with the word remission being disease is quiet.

970
00:49:22,600 --> 00:49:26,200
Speaker 3: We're still watching we shouldn't be so arrogant to say

971
00:49:26,360 --> 00:49:29,440
Speaker 3: you're fine, you can go live your life. But you know,

972
00:49:29,480 --> 00:49:31,000
Speaker 3: we hope you get more and more people to the

973
00:49:31,040 --> 00:49:33,240
Speaker 3: point where they can come off therapies and just be watched.

974
00:49:35,200 --> 00:49:37,680
Speaker 1: Yeah, it's you know, it's very interesting. I have so

975
00:49:37,800 --> 00:49:42,560
Speaker 1: many people that happened recently where everybody tells me that, oh,

976
00:49:42,600 --> 00:49:46,160
Speaker 1: there's this place and they're curing, and then they're curing

977
00:49:46,239 --> 00:49:48,200
Speaker 1: cancer and they don't take insurance.

978
00:49:48,239 --> 00:49:49,520
Speaker 2: But it's amazing.

979
00:49:49,640 --> 00:49:54,120
Speaker 1: And then you when you start delving into some of

980
00:49:54,160 --> 00:49:59,239
Speaker 1: them are just scams and the others are their results

981
00:49:59,840 --> 00:50:04,560
Speaker 1: are are favorable for a completely different cancer. Yeah, and

982
00:50:04,600 --> 00:50:07,480
Speaker 1: you're like, well, okay, I get that maybe they helped

983
00:50:07,520 --> 00:50:11,480
Speaker 1: this person with pancreatic cancer, but my cancer is different.

984
00:50:11,520 --> 00:50:14,719
Speaker 1: So that three phase targeted therapy that this person has

985
00:50:14,760 --> 00:50:17,200
Speaker 1: all of a sudden come up with may not actually

986
00:50:18,000 --> 00:50:20,960
Speaker 1: do a thing on me. Or you know, like immunotherapy

987
00:50:21,040 --> 00:50:24,319
Speaker 1: doesn't work on my particular cancer as of right now

988
00:50:24,400 --> 00:50:29,279
Speaker 1: because of the negative positive all of that stuff that

989
00:50:29,360 --> 00:50:31,000
Speaker 1: I'm still not ever clear on.

990
00:50:31,239 --> 00:50:32,520
Speaker 3: It's tricky, it is.

991
00:50:32,560 --> 00:50:35,640
Speaker 1: It's really tricky. People always ask me which which kind

992
00:50:35,640 --> 00:50:36,360
Speaker 1: of have and I'm.

993
00:50:36,160 --> 00:50:36,400
Speaker 3: Like, I.

994
00:50:37,960 --> 00:50:40,520
Speaker 1: Don't know. I'll put you on the phone with my doctor.

995
00:50:40,560 --> 00:50:42,520
Speaker 1: He'll explain it better than better than me.

996
00:50:43,480 --> 00:50:47,040
Speaker 2: All right, well are you going? Do you have to

997
00:50:47,040 --> 00:50:48,240
Speaker 2: go to the hospital.

998
00:50:47,840 --> 00:50:50,480
Speaker 3: Now, I should go to the hospital. Have patience to

999
00:50:50,480 --> 00:50:53,200
Speaker 3: see later, yeah, jack Ob Yeah.

1000
00:50:52,920 --> 00:50:54,880
Speaker 2: All right, Well, thank you.

1001
00:50:55,480 --> 00:51:00,839
Speaker 1: I honestly am really happy that I met you and

1002
00:51:02,040 --> 00:51:05,319
Speaker 1: that based off of that Zoom meeting, you've filled me

1003
00:51:05,640 --> 00:51:08,520
Speaker 1: with as much confidence as I was ever going to

1004
00:51:08,560 --> 00:51:12,720
Speaker 1: have going into that surgery, and that you didn't overcomplicate

1005
00:51:12,760 --> 00:51:16,839
Speaker 1: it for me, because it's way more fun finding everything.

1006
00:51:16,520 --> 00:51:19,200
Speaker 3: Out now, it's way more fun.

1007
00:51:19,600 --> 00:51:21,399
Speaker 2: Dodgor two, thank you so much for being here.

1008
00:51:21,800 --> 00:51:23,319
Speaker 3: Thank you very much, great to be here.

1009
00:51:23,560 --> 00:51:26,880
Speaker 1: All right, guys, that is the wonderful, amazing doctor Rachel

1010
00:51:27,280 --> 00:51:28,400
Speaker 1: at Cedar SINAI.

1011
00:51:29,480 --> 00:51:29,960
Speaker 2: I don't know.

1012
00:51:30,040 --> 00:51:33,000
Speaker 1: If you've got anything going on with the brain, Please

1013
00:51:33,040 --> 00:51:36,640
Speaker 1: go to doctor two if you can get into him,

1014
00:51:37,280 --> 00:51:40,400
Speaker 1: he's wonderful. If not, I'm sure they have amazing recommendations.

1015
00:51:40,520 --> 00:51:45,160
Speaker 1: And I hope that I hope that we were able

1016
00:51:45,200 --> 00:51:49,279
Speaker 1: to either soothe or answer questions that anybody had and

1017
00:51:49,400 --> 00:51:52,600
Speaker 1: always feel free to go in the Let's Be Clear Pod,

1018
00:51:52,800 --> 00:51:55,959
Speaker 1: Instagram and send me questions because I have no fear

1019
00:51:55,960 --> 00:51:59,680
Speaker 1: about harassing this incredibly busy man with text messages to

1020
00:51:59,719 --> 00:52:01,040
Speaker 1: try to answer some questions.

1021
00:52:01,200 --> 00:52:02,160
Speaker 2: You don't mind that, do you.

1022
00:52:02,160 --> 00:52:03,960
Speaker 3: You don't mind at all. You don't do that enough.

1023
00:52:04,040 --> 00:52:06,560
Speaker 3: You don't play the brain Turmor card. Actually made one,

1024
00:52:06,560 --> 00:52:09,120
Speaker 3: though I'm not promising he's gonna get you out of tickets.

1025
00:52:09,160 --> 00:52:14,799
Speaker 2: But no, oh, keep doing well. I'm here for you.

1026
00:52:14,960 --> 00:52:19,760
Speaker 2: This is unbelievable. I'm pulling this card.

1027
00:52:20,120 --> 00:52:20,760
Speaker 3: You should plug.

1028
00:52:21,040 --> 00:52:22,239
Speaker 2: I should pull it, do you know?

1029
00:52:22,640 --> 00:52:27,920
Speaker 1: I I'm very odd about telling people who are listening

1030
00:52:27,920 --> 00:52:30,319
Speaker 1: in when I pull a cancer card, because some people

1031
00:52:30,360 --> 00:52:33,480
Speaker 1: are like they get upset about it. But I do

1032
00:52:33,680 --> 00:52:38,879
Speaker 1: remember I was at this very busy kind of when

1033
00:52:39,000 --> 00:52:41,839
Speaker 1: everything first started going on with me, and it's when

1034
00:52:41,960 --> 00:52:46,520
Speaker 1: things progressed and gotten to stage four, and I was

1035
00:52:46,560 --> 00:52:49,279
Speaker 1: trying to find a way to come to terms with

1036
00:52:49,320 --> 00:52:53,960
Speaker 1: it and to have a sense of humor. And as

1037
00:52:54,040 --> 00:52:57,279
Speaker 1: this wonderful woman Jan recently said to me, she said,

1038
00:52:57,320 --> 00:53:01,560
Speaker 1: you seem like you are holding hands with cancer and

1039
00:53:02,480 --> 00:53:07,200
Speaker 1: it's an interesting way to go through your journey with it.

1040
00:53:07,640 --> 00:53:11,720
Speaker 1: And I guess I was holding hands with humor and cancer.

1041
00:53:12,960 --> 00:53:15,520
Speaker 2: And we went to this restaurant in.

1042
00:53:15,440 --> 00:53:19,960
Speaker 1: Santa Monica called Wally's and they were packed, but they

1043
00:53:20,000 --> 00:53:22,959
Speaker 1: have this dish there with truffles and I just.

1044
00:53:23,719 --> 00:53:24,399
Speaker 2: Was craving it.

1045
00:53:25,000 --> 00:53:29,560
Speaker 1: And we sat down and I think it took the

1046
00:53:29,600 --> 00:53:31,359
Speaker 1: waiter a really long time to come over.

1047
00:53:31,760 --> 00:53:35,080
Speaker 2: They were packed, so I was totally understanding.

1048
00:53:35,120 --> 00:53:38,120
Speaker 1: But then he stopped by and he said, and they

1049
00:53:38,160 --> 00:53:39,400
Speaker 1: know who I am there because I've been there a

1050
00:53:39,400 --> 00:53:42,400
Speaker 1: bunch and it was all in the press about, you know,

1051
00:53:42,560 --> 00:53:45,280
Speaker 1: going to stage four. And he said, I'm so sorry,

1052
00:53:45,320 --> 00:53:47,880
Speaker 1: we're so slammed, but I'm going to get right to you.

1053
00:53:47,920 --> 00:53:50,359
Speaker 1: And I said, it's okay, it's not like I you know,

1054
00:53:50,640 --> 00:53:53,160
Speaker 1: I'm on a time schedule or anything with cancer.

1055
00:53:53,400 --> 00:53:54,799
Speaker 3: Oh man.

1056
00:53:54,960 --> 00:53:56,920
Speaker 1: And he stopped and he looked at me and I

1057
00:53:56,960 --> 00:53:58,400
Speaker 1: started laughing and I went.

1058
00:53:58,320 --> 00:54:02,360
Speaker 2: I'm so sorry. I didn't mean that. I'm just playing

1059
00:54:02,360 --> 00:54:02,640
Speaker 2: with you.

1060
00:54:02,680 --> 00:54:04,520
Speaker 3: And he goes, oh my god, I'll take your order.

1061
00:54:04,400 --> 00:54:05,880
Speaker 1: Right now, and I'm no, no, no, no, no, I'd be

1062
00:54:05,960 --> 00:54:09,160
Speaker 1: mad if you took my order. Like I'm just trying

1063
00:54:09,200 --> 00:54:12,080
Speaker 1: to find the humor. I'm trying to figure out how

1064
00:54:12,120 --> 00:54:17,120
Speaker 1: to make it normal from me, where where I can

1065
00:54:17,280 --> 00:54:21,839
Speaker 1: make jokes, and maybe the jokes is I know it's

1066
00:54:21,840 --> 00:54:25,200
Speaker 1: to help me and relax my anxiety about having cancer.

1067
00:54:25,280 --> 00:54:28,360
Speaker 1: But it's also to relax other people's anxiety who just

1068
00:54:28,480 --> 00:54:31,000
Speaker 1: read stuff randomly about me and then see me and

1069
00:54:31,040 --> 00:54:33,440
Speaker 1: they're like, oh, you know, like this weekend, I was

1070
00:54:33,440 --> 00:54:36,600
Speaker 1: at this amazing event. People are like, oh my god,

1071
00:54:36,640 --> 00:54:38,319
Speaker 1: you look so good. Now I know what I look

1072
00:54:38,400 --> 00:54:39,880
Speaker 1: like compared to what I used to look like.

1073
00:54:40,080 --> 00:54:43,960
Speaker 2: You know. So I know that a large.

1074
00:54:43,719 --> 00:54:46,880
Speaker 1: Group of people assume that once you start getting to

1075
00:54:46,960 --> 00:54:50,960
Speaker 1: my stage of cancer, they really start deteriorating way fast.

1076
00:54:51,800 --> 00:54:56,160
Speaker 1: So my brand of humor and sometimes mentioning cancer is

1077
00:54:56,200 --> 00:54:59,520
Speaker 1: to also make them feel a little bit more comfortable

1078
00:54:59,520 --> 00:55:02,440
Speaker 1: with it so that people don't tiptoe around me. And

1079
00:55:02,480 --> 00:55:05,960
Speaker 1: once I start being self deprecating about myself and about cancer,

1080
00:55:06,520 --> 00:55:10,200
Speaker 1: I feel as if that wall has been taken down

1081
00:55:10,239 --> 00:55:13,359
Speaker 1: and now everybody can just go on in a normal way.

1082
00:55:13,880 --> 00:55:17,280
Speaker 2: So instead of doing the cancer card, I actually prefer

1083
00:55:17,320 --> 00:55:21,160
Speaker 2: the brain. It's different, it is different, and it's far better.

1084
00:55:21,680 --> 00:55:23,759
Speaker 2: I'm into this card. So thank you, thank you.

1085
00:55:23,800 --> 00:55:25,920
Speaker 1: All right, I'm gonna let you go to work. Thank you,

1086
00:55:25,960 --> 00:55:28,239
Speaker 1: doctor Chu, and thank you everybody for tuning into let's

1087
00:55:28,280 --> 00:55:30,000
Speaker 1: be clear. Rishanna adorerty to see you next time,