WEBVTT - Let’s Be Surgical…with Dr. Chu 0:00:02.560 --> 0:00:08.039 This is Let's Be Clear with Shannon Doherty. Hi, everyone, 0:00:08.080 --> 0:00:11.879 welcome to another episode of Let's Be Clear with Shannon Doherty. 0:00:12.039 --> 0:00:14.840 So one of the main things about me doing this 0:00:14.920 --> 0:00:18.599 podcast is that I really wanted to reach the cancer 0:00:18.640 --> 0:00:24.560 community and have the opportunity to bring on incredibly special 0:00:24.800 --> 0:00:29.319 doctors that I'm fortunate enough to have access to because 0:00:29.360 --> 0:00:33.280 I live in Los Angeles, I go to Cedar Sinai, 0:00:33.800 --> 0:00:37.360 so I have access to the best and currently I 0:00:37.360 --> 0:00:39.159 have really good insurance. 0:00:39.080 --> 0:00:41.640 That allows me to afford them. 0:00:42.200 --> 0:00:48.280 And today I have on the exceptional brain surgeon, doctor Rachel, 0:00:48.520 --> 0:00:54.880 who I adore And thank you for taking time out 0:00:54.880 --> 0:00:57.280 of I know what is a very very very busy 0:00:57.320 --> 0:01:00.000 schedule for you to drive all the way to Malibit 0:01:00.600 --> 0:01:03.520 and hang out with me, and you brought me treat true. 0:01:04.200 --> 0:01:06.320 Thanks so much for having me. It's a pleasure to 0:01:06.319 --> 0:01:07.000 be Yeah. 0:01:07.000 --> 0:01:10.679 So can you tell us you know your title exactly 0:01:10.680 --> 0:01:11.440 what you do? 0:01:11.480 --> 0:01:13.320 Just fill everybody in right. 0:01:14.000 --> 0:01:16.320 So, I'm one of the brain tumor surgeons at theaters. 0:01:16.319 --> 0:01:19.720 We have neurosurgeons have different subspecialties. I don't really do 0:01:19.800 --> 0:01:21.840 like a lot of spine surgery or something some but 0:01:22.240 --> 0:01:25.440 do mostly brain timber work. There are times in our 0:01:25.480 --> 0:01:28.520 department we'll have like a chair who runs the department, 0:01:28.560 --> 0:01:30.840 and then a clinical chief one's supposed to be like 0:01:30.880 --> 0:01:32.960 a quality officer and things. So that's the kind of 0:01:32.959 --> 0:01:35.559 thing that I do right now, besides the brain timor work. 0:01:36.480 --> 0:01:38.920 I've been at Sedars for nineteen years. I hope I've 0:01:38.959 --> 0:01:39.839 learned something by now. 0:01:40.240 --> 0:01:43.520 I think you have. I'm pretty sure you have. I mean, 0:01:43.640 --> 0:01:46.039 you did go into my brain, so I. 0:01:46.000 --> 0:01:48.160 Swear if you learned a lot. Yes, that's true. 0:01:48.880 --> 0:01:52.640 And so what got you started in this particular field? 0:01:52.760 --> 0:01:56.360 And can you can you explain a little bit more 0:01:56.360 --> 0:02:01.800 in depth of is it just on hology and surgery 0:02:01.840 --> 0:02:02.400 that you do? 0:02:03.080 --> 0:02:04.800 Is it more broad than that. 0:02:07.200 --> 0:02:12.680 I became a neurse surgeon because I lost a bed. No. 0:02:13.520 --> 0:02:16.120 I looked at your like, just say that, and you did. 0:02:16.320 --> 0:02:17.079 It's the delivery. 0:02:17.120 --> 0:02:17.320 Yeah. 0:02:17.760 --> 0:02:19.520 My father was a doctor, and so I kind of 0:02:19.520 --> 0:02:21.440 grew up in that house knowing that kind of stuff. 0:02:21.480 --> 0:02:24.799 You would go on a lot of calls at night 0:02:25.080 --> 0:02:26.840 and help people and stuff. It just became something that 0:02:26.840 --> 0:02:29.480 I became interested in. And then you would, you know, 0:02:29.520 --> 0:02:31.080 as a kid go into his pockets at the end 0:02:31.120 --> 0:02:32.560 of the day, and I would find he was a 0:02:32.600 --> 0:02:35.400 gaser neurologist, you know, yes, like bout stuff, and I 0:02:35.400 --> 0:02:37.360 would try to picture of someone's colon. It was kind 0:02:37.400 --> 0:02:40.720 of interesting and stuff like that. And so when I 0:02:40.800 --> 0:02:43.160 was growing up, it just did a lot of stuff 0:02:43.200 --> 0:02:45.520 for science and just it was kind of a natural pathway. 0:02:45.520 --> 0:02:47.200 I didn't really decide to be a nerves surgeon toool 0:02:47.200 --> 0:02:49.639 a lot later, but going to medical school seemed something 0:02:49.639 --> 0:02:51.200 that was very natural for how I grew up. 0:02:51.600 --> 0:02:55.280 Like I can't really imagine going through my dad's pockets 0:02:55.280 --> 0:02:59.160 and seeing photos of colon's and stuff and thinking, well, 0:02:59.240 --> 0:03:01.400 this is cool, this is what I need to get into, 0:03:02.120 --> 0:03:02.880 and yet you did. 0:03:03.480 --> 0:03:05.239 Yeah, what was it about it? 0:03:05.520 --> 0:03:08.040 I guess it was just something that was both familiar 0:03:08.080 --> 0:03:10.960 and then just something I gradually found interesting. I liked 0:03:11.120 --> 0:03:13.519 science kind of stuff, and then who doesn't find the 0:03:13.560 --> 0:03:16.800 brain fascinating? So I felt like when I was looking 0:03:16.800 --> 0:03:19.360 at that stuff, here there's a ton with cardiothoracic surgery 0:03:19.360 --> 0:03:22.480 that was starting to be replaced. That people were doing 0:03:22.520 --> 0:03:25.280 more and more things and no VASc really from inside 0:03:25.320 --> 0:03:28.920 the blood vessels like stents in the coronary arteries, and 0:03:28.960 --> 0:03:31.280 now they can even replace a valve for some people 0:03:31.600 --> 0:03:34.160 from inside that surgeons were becoming going to become more 0:03:34.200 --> 0:03:36.520 and more obsolete, whereas there's still a lot of role 0:03:36.600 --> 0:03:39.480 for brain termor surgeons. We haven't really fixed everything yet. 0:03:39.480 --> 0:03:40.800 I don't know what's going to happen in my lifetime, 0:03:40.800 --> 0:03:43.360 but we haven't really fixed everything yet that surgery is 0:03:43.360 --> 0:03:44.000 still require. 0:03:44.400 --> 0:03:47.280 I'm so fascinated by the conversation of like AI and 0:03:47.680 --> 0:03:52.160 that what that role is, particularly in surgery. Is there 0:03:52.200 --> 0:03:55.960 a role for AI and surgery probably some. 0:03:56.040 --> 0:03:59.520 I mean, I think there's some part where the easier 0:03:59.520 --> 0:04:02.800 targets with like AI, and it's interacted with neuroidiology, like 0:04:03.000 --> 0:04:05.600 making sure we find all the abnormalities in the scan 0:04:05.680 --> 0:04:09.440 and even having AI screen some of the scans and 0:04:09.520 --> 0:04:11.920 trigger that to be read by a person as opposed 0:04:11.960 --> 0:04:14.840 to put out answers more quickly when a scan is normal. 0:04:15.000 --> 0:04:16.680 For surgery, it's a little harder. I mean, there are 0:04:17.200 --> 0:04:21.520 robotic surgery platforms for other specialties that sometimes they'll use 0:04:21.520 --> 0:04:24.479 that for a thoracic surgery or an abdominal surgery, but 0:04:24.520 --> 0:04:28.760 there isn't a tremendous role for robotic surgery yet. And neurosurgery. 0:04:28.800 --> 0:04:31.240 I mean, I have to be the robot. So some 0:04:31.320 --> 0:04:34.160 of these things have you know, submillimeter accuracy and a 0:04:34.400 --> 0:04:37.360 brain that's moving and pulsing as we operate. It's not 0:04:37.400 --> 0:04:40.360 really clear that AI can pull all those things off yet. 0:04:40.720 --> 0:04:48.200 I don't think I would want a robot cutting open 0:04:48.240 --> 0:04:50.599 my brain I'm working on it. That would scare me 0:04:50.640 --> 0:04:54.040 because there's you know, it's the human that I'm putting 0:04:54.080 --> 0:04:58.000 my trust in, and the human that that's feeling the 0:04:58.120 --> 0:05:01.919 compassion or the stress, the pressure, whatever it is to 0:05:02.720 --> 0:05:06.479 ensure that you have the best result possible, whereas a 0:05:06.600 --> 0:05:10.480 robot isn't they aren't programmed for that. For me, I 0:05:10.480 --> 0:05:12.960 believe that a human is always going to go with 0:05:13.040 --> 0:05:16.960 the extra mile to ensure that their patient has a 0:05:17.000 --> 0:05:17.960 favorable outcome. 0:05:18.080 --> 0:05:20.400 I think that makes a lot of sense. Probably a 0:05:20.440 --> 0:05:22.080 lot of people would feel that way right that they 0:05:22.120 --> 0:05:25.240 want that person there. And there are some of these 0:05:25.320 --> 0:05:28.400 robotic surgeons like thoracic. The surgeon is in the room, 0:05:28.400 --> 0:05:30.160 but they're not really right at the patient. They're far 0:05:30.200 --> 0:05:32.400 away at a control console, and I don't know, it 0:05:32.440 --> 0:05:34.320 just doesn't feel the same to me. Maybe I'm just 0:05:34.720 --> 0:05:36.600 too old fashion, maybe I'm not used to it. 0:05:36.560 --> 0:05:38.719 Yet Well then I'm old fashioned right there. 0:05:39.720 --> 0:05:43.719 Yeah. That, and you have obviously incredibly stity hands. Do 0:05:43.760 --> 0:05:47.239 you do something to protect them at all costs because 0:05:47.279 --> 0:05:48.880 those hands are worth a lot of money. 0:05:49.880 --> 0:05:55.800 Well, I don't do anything super risky with them. I 0:05:56.839 --> 0:05:59.360 snowboard some and I used to wear a wrisk brace more. 0:05:59.440 --> 0:06:01.920 But I think this, I don't try to do any 0:06:01.920 --> 0:06:04.320 wild things anymore. So I don't really doing. 0:06:04.440 --> 0:06:07.119 Double flips anymore, not taking the high. 0:06:07.480 --> 0:06:09.600 I'm sure I never did double flips on purpose. 0:06:09.520 --> 0:06:09.839 So. 0:06:11.320 --> 0:06:12.200 Right, they're the mistake. 0:06:12.760 --> 0:06:17.279 Oopsps oops, So we I think how we met was 0:06:17.400 --> 0:06:22.440 very interesting because I fell down, as you know, like 0:06:22.520 --> 0:06:27.479 a day or two days before Christmas, and doctor Piro 0:06:27.680 --> 0:06:29.440 said you should go in for CT. 0:06:29.920 --> 0:06:30.479 I did. 0:06:30.640 --> 0:06:34.640 It showed some things in my brain. He was concerned. 0:06:34.800 --> 0:06:37.000 He then said, you're going we need an MRI. I 0:06:38.320 --> 0:06:40.080 did the MRI, and then it was kind of an 0:06:40.160 --> 0:06:44.640 instant Okay, here's what's going on. You have met and 0:06:44.800 --> 0:06:49.400 there's one that we feel we can operate on and 0:06:49.440 --> 0:06:52.599 the others will radiate, and we want to operate mainly 0:06:52.640 --> 0:06:55.279 to get the pathology correct. 0:06:55.400 --> 0:06:58.240 Yes, and he had you already picked out. He's worked 0:06:58.320 --> 0:06:58.920 with you before. 0:06:59.000 --> 0:07:01.719 And he was like, this is the best, and you're 0:07:01.760 --> 0:07:03.600 going to him and we set up. 0:07:03.839 --> 0:07:05.640 I remember your office was like do you want to 0:07:05.680 --> 0:07:11.120 come in? It's like, no, is there zoom? Is that possible? 0:07:11.120 --> 0:07:15.040 And I'm so now used to zoom COVID and so 0:07:16.080 --> 0:07:19.760 we zoomed and what was it like four or five 0:07:19.840 --> 0:07:23.720 days later? I was getting operated on, right. 0:07:23.600 --> 0:07:25.440 Yeah, well, fortunately we managed to get it set up 0:07:25.480 --> 0:07:29.440 kind of quickly. And you're right when when doctor Piro calls, 0:07:29.440 --> 0:07:32.720 I answer quickly, yeah, and we've known each other for 0:07:32.760 --> 0:07:37.160 a while. It is yeah, different this world where there's 0:07:37.280 --> 0:07:41.000 more and more of these you know, video possible visits 0:07:41.000 --> 0:07:44.280 and things like that. Certainly with the pandemic. There's multiple 0:07:44.320 --> 0:07:48.080 people that I've you know, met over a video and 0:07:48.120 --> 0:07:50.960 then at surgery shook their hand finally and said it's 0:07:51.000 --> 0:07:53.080 nice to meet you. It's kind of strange. Yeah. 0:07:53.200 --> 0:07:56.000 I had friends that said, what do you mean you 0:07:56.080 --> 0:07:59.440 haven't actually met him in person? Don't you want to 0:07:59.440 --> 0:08:02.680 shake his hand in person before you say yes? And 0:08:02.800 --> 0:08:04.960 don't you want to make sure that he's a kind, 0:08:05.040 --> 0:08:08.520 compassionate person. And my response was no, all I care 0:08:08.560 --> 0:08:12.520 about is this, like are his hands steady? Is he 0:08:12.600 --> 0:08:16.120 the best is he going to, you know, take really 0:08:16.120 --> 0:08:18.360 good care of me in a surgical way. 0:08:18.680 --> 0:08:19.960 But then when I met. 0:08:19.760 --> 0:08:24.840 You, you were very kind and very compassionate. And even 0:08:24.960 --> 0:08:30.000 though I had psyched myself into believing that I was 0:08:30.080 --> 0:08:33.720 not going to come out okay, I really did not 0:08:33.960 --> 0:08:37.240 think that I would be fine. I was pretty sure 0:08:37.280 --> 0:08:41.120 that I was going to die that really short time 0:08:41.160 --> 0:08:44.439 period I had to go over everything with my estate 0:08:44.480 --> 0:08:47.360 planner and my attorneys and make sure that my will 0:08:47.440 --> 0:08:49.400 was in place and that my trust was secure, and 0:08:49.440 --> 0:08:52.640 who got what I mean. It was a frantic time 0:08:53.080 --> 0:08:57.079 going also through a separation. It was pretty nuts. And 0:08:58.280 --> 0:09:03.440 that's how paranoid I was of dying. And then if 0:09:03.520 --> 0:09:06.600 I didn't die, I would be paralyzed, and you were 0:09:07.440 --> 0:09:10.720 I think you told me the worst that would happen 0:09:10.880 --> 0:09:14.240 was maybe I would lose mobility of my right foot, 0:09:14.880 --> 0:09:20.520 but that physical therapy would most likely fix it. And 0:09:20.559 --> 0:09:24.360 then I asked you to please while you're in there 0:09:24.400 --> 0:09:27.240 dissecting Bob the tumor that we took out, that you 0:09:27.280 --> 0:09:31.480 took out, I asked you if you could please touch 0:09:31.520 --> 0:09:34.000 the part of the brain that allowed me to instantly 0:09:34.040 --> 0:09:41.520 speak six languages fluent and I gotta tell you. 0:09:39.760 --> 0:09:40.400 Didn't do it. 0:09:40.600 --> 0:09:43.520 Yeah, I'm not happy with you over that. 0:09:43.679 --> 0:09:47.080 Yeah, and that is one of my failures. Definitely. 0:09:47.679 --> 0:09:50.160 Is that like a real thing, because obviously it's something 0:09:50.160 --> 0:09:53.440 that I saw in Gray's Anatomy, where I think it 0:09:53.480 --> 0:09:57.800 was Emilia, who was also a brain surgeon, had to 0:09:57.840 --> 0:10:00.800 get a very large tumor removed, and she woke up 0:10:01.440 --> 0:10:05.360 speaking perfect German, and so that's where I got the 0:10:05.400 --> 0:10:06.120 idea from. 0:10:06.760 --> 0:10:08.520 And it's not that she had spoken German before. 0:10:08.600 --> 0:10:10.720 I think she had spoken German before, yes, but I 0:10:10.840 --> 0:10:12.800 so just assumed it didn't matter. 0:10:13.840 --> 0:10:17.200 Well, sometimes that, unfortunately nurse or can do in a way. 0:10:17.600 --> 0:10:19.800 So it's hard to give someone a new language. It's 0:10:19.800 --> 0:10:21.800 hard to plug you into the matrix and really get 0:10:21.840 --> 0:10:27.960 something new. That's disappointing. Yeah, sure, but once on, people 0:10:27.960 --> 0:10:31.480 who grow up speaking a certain language, it's so rooted 0:10:31.480 --> 0:10:33.760 in their brain as their primary language that if they 0:10:33.800 --> 0:10:36.960 have some other language affecting things, other languages they learned 0:10:37.320 --> 0:10:40.160 can turn down for a little bit. So I've had 0:10:40.160 --> 0:10:43.920 a patient who grew up speaking French and English, and 0:10:44.559 --> 0:10:46.520 you know, most of us are wired for our left 0:10:46.520 --> 0:10:48.800 side of the brain to have most of language and memory. 0:10:48.880 --> 0:10:52.040 Even totally left handed people still more than half of 0:10:52.040 --> 0:10:53.640 them have language on the left hand side. It's just 0:10:53.679 --> 0:10:56.320 something how the brain is wired. But this patient had 0:10:56.360 --> 0:10:58.000 a brain to her on the right and he had 0:10:58.080 --> 0:11:01.079 more like French language sites on the left side and 0:11:01.160 --> 0:11:04.040 more English language sites on the right side. So when 0:11:04.040 --> 0:11:06.520 they first did a surgery that that's kind of what happened. 0:11:06.520 --> 0:11:08.640 He wasn't speaking because she was only speaking French, and 0:11:08.679 --> 0:11:11.240 his wife was confused. That's what was going on, like 0:11:11.280 --> 0:11:14.079 he never speaks French to me, but that language that 0:11:14.160 --> 0:11:15.520 kind of turned down for a little bit as the 0:11:15.520 --> 0:11:16.320 body had to heal. 0:11:16.720 --> 0:11:17.679 Did he retain it? 0:11:18.240 --> 0:11:21.040 M M. He just had to tap back into some 0:11:21.120 --> 0:11:23.560 of these things to kind of reawaken these centers. So 0:11:23.600 --> 0:11:26.080 sometimes we do these surgeries that have more of a 0:11:26.120 --> 0:11:28.120 motor impact. That's w what we talk about, like physical 0:11:28.160 --> 0:11:30.200 therapy to retrain that area of the brain and the 0:11:30.200 --> 0:11:33.600 connections to get stronger. We try not to take an 0:11:33.640 --> 0:11:37.880 away anything permanently, obviously, but sometimes if you're it kind 0:11:37.880 --> 0:11:40.400 of depends on our risk benefit ratio. If we have 0:11:40.440 --> 0:11:42.640 a tumor that looks like a Bolivian scene, we have 0:11:42.679 --> 0:11:44.360 to carve it out. We have to take some risks 0:11:44.360 --> 0:11:48.160 sometimes to take it out. Well next time, next time, 0:11:48.640 --> 0:11:49.640 we don't want any next time. 0:11:49.840 --> 0:11:51.400 I know we don't, we don't. 0:11:51.600 --> 0:11:53.840 I do remember that when I when I woke up, 0:11:54.240 --> 0:11:58.720 you were standing over me, and I believe the very 0:11:58.760 --> 0:12:01.040 first question I asked you was what's wrong with me? 0:12:02.600 --> 0:12:07.240 And you said nothing, and I couldn't believe it. And 0:12:07.360 --> 0:12:10.560 then I think a little later, you know, I struggled 0:12:10.600 --> 0:12:13.120 with my right hand of like holding a glass. A 0:12:13.160 --> 0:12:17.160 good majority of that was because of the steroids, and 0:12:17.240 --> 0:12:20.600 the steroids make me crazy. I do not do well 0:12:20.600 --> 0:12:23.480 on steroids at all. So remember I kept on trying 0:12:23.559 --> 0:12:26.760 to take myself off the steroids, and I guess the 0:12:26.760 --> 0:12:29.480 brain would swell and then the right hand would get worse. 0:12:30.080 --> 0:12:32.480 And now everything is obviously. 0:12:32.200 --> 0:12:35.520 Great, terrific. Yeah, it's good to know, good job once 0:12:35.559 --> 0:12:36.000 in a while. 0:12:36.120 --> 0:12:40.480 That day, so I remember, also, didn't you ask me 0:12:40.520 --> 0:12:41.800 what kind of music I wanted? 0:12:42.520 --> 0:12:45.560 And I said, I'm going to be asleep, Like whatever 0:12:45.679 --> 0:12:49.040 music makes you, you know, do the best job? What 0:12:49.080 --> 0:12:50.800 did you do? You remember what you listened to? 0:12:51.200 --> 0:12:53.120 Because I know I'm one of a lot of people, 0:12:53.160 --> 0:12:54.800 so I don't expect you to know this answer. 0:12:54.840 --> 0:12:55.679 But I'm just curious. 0:12:55.800 --> 0:12:58.520 Couple. Well, I mean, so usually we asked a little 0:12:58.520 --> 0:13:00.160 bit something what you might like to listen to that 0:13:00.200 --> 0:13:02.719 helps call you as the anesthetic kicks in. Once you're 0:13:02.760 --> 0:13:06.280 totally asleep, you can play whatever rave music we want 0:13:06.360 --> 0:13:06.760 or something. 0:13:06.880 --> 0:13:07.080 Is it? 0:13:07.120 --> 0:13:08.840 So, I mean, what is your go to? Do you 0:13:08.880 --> 0:13:10.800 like rock and roll? Do you like classical? 0:13:11.200 --> 0:13:13.719 Sometimes it's like an old school hip hop playlist, like 0:13:13.760 --> 0:13:15.640 has a lot less Snoop Dog or something like that, 0:13:15.840 --> 0:13:18.160 just something to keep people moving. I mean, I think 0:13:18.200 --> 0:13:21.280 there's like different philosophies. I know some surgeons who like 0:13:21.559 --> 0:13:25.480 total silence in their operating room and don't want music 0:13:25.520 --> 0:13:28.800 and they want the antithesiologists to listen to every single 0:13:28.800 --> 0:13:30.440 little thing they have to say and stuff like that. 0:13:30.559 --> 0:13:32.880 And that's fine for me. I feel like, you know, 0:13:33.120 --> 0:13:36.160 obviously the music's not blaring, but I can concentrate and 0:13:36.280 --> 0:13:38.040 it helps the other people in the room if it's 0:13:38.040 --> 0:13:39.360 not total silence, you. 0:13:39.280 --> 0:13:40.760 Know, right, it keeps the energy up. 0:13:40.880 --> 0:13:42.599 Yeah, I think that's what it is, an energy and 0:13:42.640 --> 0:13:44.520 a movement level. I think it works better for me. 0:13:54.440 --> 0:13:58.440 You gave me a photo because I asked you, and 0:13:58.480 --> 0:14:02.600 you gave me a photo of my brain. Can you 0:14:03.760 --> 0:14:07.000 what was that surgery like for you? What was that 0:14:07.040 --> 0:14:10.080 particular surgery that you did on me? What were the 0:14:10.160 --> 0:14:13.920 reasons why we did it besides the pathology all of that, 0:14:14.080 --> 0:14:16.319 and then you know, I can explain why I named 0:14:16.400 --> 0:14:16.800 him Bob. 0:14:17.679 --> 0:14:19.800 Oh good, I get to hear this finally. I've been 0:14:19.840 --> 0:14:23.040 waiting so fortunately with your brain and there's only a 0:14:23.040 --> 0:14:25.200 few spots, and some of them were tiny, so some 0:14:25.280 --> 0:14:28.720 of them were ones that were really ideal for this 0:14:28.840 --> 0:14:33.240 idea of focused radiation. Sometimes we'll say radiosurgery. It's almost 0:14:33.240 --> 0:14:35.800 a gimmicky term though, like focused radiation as if to 0:14:35.880 --> 0:14:38.560 replace surgery. But if we have a dot that's a 0:14:38.560 --> 0:14:41.560 millimeter or two, sometimes we can't really find that at surgery, 0:14:41.920 --> 0:14:44.440 so the radiation can target that based on the MRI 0:14:45.320 --> 0:14:47.880 you had once. But theres a little bigger and there's 0:14:47.920 --> 0:14:50.280 both this idea of it's a little bigger we can 0:14:50.400 --> 0:14:55.600 eradicate it better with surgery. Well, a worry is that 0:14:55.640 --> 0:14:58.560 sometimes when you stir up a metastasis, you kind of 0:14:58.600 --> 0:15:01.880 leave little cells somewhere or can even if you're not 0:15:01.960 --> 0:15:05.640 careful about it, spread tumor around. So we usually would 0:15:05.680 --> 0:15:09.920 do at least some form of radiation afterwards, but we 0:15:10.160 --> 0:15:11.800 and a couple other centers have been tinkering with the 0:15:11.800 --> 0:15:14.040 idea of the radiation upfront, so you kind of like 0:15:14.080 --> 0:15:17.560 almost like sterilize the tumor beforehand, so that even if 0:15:17.560 --> 0:15:20.880 a cell escapes, it's been radiated and hopefully it won't 0:15:20.880 --> 0:15:24.760 set up root. That can give doctor Puro tremendous on Collagi. 0:15:24.840 --> 0:15:27.640 Is a tremendous advantage to have a sample of the 0:15:27.680 --> 0:15:30.480 current disease. So if we take something out and we 0:15:30.520 --> 0:15:33.240 analyze the receptors, we get to know a lot more, right, 0:15:33.280 --> 0:15:35.280 And that's one of the things that probably I hope 0:15:35.320 --> 0:15:37.480 has helped you and may help you more, is that 0:15:37.760 --> 0:15:40.120 idea of like finding what them like their signature is 0:15:40.160 --> 0:15:44.640 allowing targeted therapies and exactly your scenario. Not all guests work, 0:15:44.720 --> 0:15:47.000 I mean, there's always a little bit of tinkering with 0:15:47.320 --> 0:15:51.040 a regimen, but not all guessworks. Some like logical things 0:15:51.080 --> 0:15:55.400 like this is a very patient directed, patient oriented treatment strategy. 0:15:55.920 --> 0:16:00.640 Yes, So when you saw Bob, I named him because 0:16:01.000 --> 0:16:04.160 I'm I don't know, I don't really view Bob's as 0:16:04.320 --> 0:16:04.960 very scary. 0:16:05.880 --> 0:16:08.239 Bob's are usually really nice. 0:16:08.000 --> 0:16:12.160 And affable, so I didn't want Bob to be scary, 0:16:12.560 --> 0:16:15.640 but you had to leave. You couldn't get all of 0:16:15.680 --> 0:16:18.720 Bob out. Do you remember why that was? 0:16:18.960 --> 0:16:21.120 There were a couple cells towards the motor area. So 0:16:21.720 --> 0:16:25.560 for your scenario is a little complicated because it wasn't 0:16:26.000 --> 0:16:28.160 totally on the surface of the brain, so we had 0:16:28.160 --> 0:16:29.600 to kind of get to the area. 0:16:29.720 --> 0:16:32.200 These are sort of the questions I didn't ask until now. 0:16:32.280 --> 0:16:35.280 So I'm learning along with our listeners. I'm actually learning 0:16:35.320 --> 0:16:37.480 about my own surgery because I do remember you just 0:16:37.520 --> 0:16:39.680 send motor skills, and I remember looking at you also 0:16:39.800 --> 0:16:45.320 and saying, stop if you're going to if it's going 0:16:45.360 --> 0:16:48.000 to change me as me as the way that my 0:16:48.040 --> 0:16:51.600 brain works, the way that I process speaking, mobility, all 0:16:51.640 --> 0:16:54.800 of that. So, and obviously you were going to whether 0:16:54.840 --> 0:16:56.000 I said something to you or not. 0:16:56.360 --> 0:16:58.120 So it was not because I always. 0:16:57.800 --> 0:17:00.960 Pictured Bob right at like the top of my head, 0:17:01.040 --> 0:17:03.720 right here, just sitting on top of my brain. 0:17:03.800 --> 0:17:04.760 But that's not the case. 0:17:04.840 --> 0:17:07.119 Yeah, that's where the incision is. I have a prop 0:17:07.119 --> 0:17:10.639 do you mind if I Yeah, So this is a 0:17:10.680 --> 0:17:13.600 little model that I have. Sometimes you'll have a tumor 0:17:13.640 --> 0:17:15.280 that's really on the surface that all we have to 0:17:15.280 --> 0:17:16.800 do is really carve it out from here. 0:17:16.880 --> 0:17:18.760 And that's what I thought mine was right, Not. 0:17:18.840 --> 0:17:22.000 Quite so, yours was in between the two halves of 0:17:22.000 --> 0:17:24.080 the brain, so we had to crawl around here. The 0:17:24.119 --> 0:17:26.720 safest route is to crawl around here and not touch 0:17:26.800 --> 0:17:28.359 or take out any of this stuff and take it 0:17:28.359 --> 0:17:29.440 out from the inside there. 0:17:29.920 --> 0:17:32.880 So did you go horizontal and then just still kind 0:17:32.880 --> 0:17:35.359 of cry this open a little bit to try to 0:17:35.400 --> 0:17:36.000 get to Bob. 0:17:36.480 --> 0:17:38.800 Well, sometimes we do different things for this scalp and 0:17:38.880 --> 0:17:42.040 for the skull inside, so it can be very cosmetic 0:17:42.119 --> 0:17:45.480 to do a horizontal or coronal incision like this because 0:17:45.560 --> 0:17:48.600 things get all covered up and then underneath we do 0:17:48.680 --> 0:17:51.640 what we need to do. So we fashioned a craniotomy. 0:17:51.800 --> 0:17:54.199 That's where you make a window and the skull. We 0:17:54.200 --> 0:17:57.000 can put the skull back on with little titanium bars 0:17:57.040 --> 0:17:59.360 that don't set off metal detectors. It's not like we 0:17:59.720 --> 0:18:01.520 use a big metal plate or anything. So you have 0:18:01.520 --> 0:18:03.760 your own skull back on. But we can create a 0:18:03.800 --> 0:18:05.320 window on the skull where we need to work and 0:18:05.359 --> 0:18:06.960 it doesn't have to match the incision. 0:18:07.720 --> 0:18:09.920 And that's what you did to me, right. 0:18:10.040 --> 0:18:11.720 It feels good up there, right, it feels normal. 0:18:11.840 --> 0:18:12.960 Yeah, no, it feels normal. 0:18:13.440 --> 0:18:16.120 Sometimes the you know, when you go for the MRI, 0:18:16.280 --> 0:18:19.600 they take the wand sure and right here beeps a 0:18:19.640 --> 0:18:20.040 little bit? 0:18:20.160 --> 0:18:20.800 Does it at touch? 0:18:20.880 --> 0:18:22.840 It does attach? And I'm like, well, I have brain searchery. 0:18:22.880 --> 0:18:24.760 Yeah, so you weren't able to get him completely out 0:18:24.800 --> 0:18:28.680 because he was a little deeper in and wrapped around 0:18:28.760 --> 0:18:29.879 where the mobility would be. 0:18:29.920 --> 0:18:31.160 Can you explain that a little bit more? 0:18:31.160 --> 0:18:35.479 Sure, So, our brains have different areas that have power 0:18:35.560 --> 0:18:39.040 and neurons that function a certain way. So the brain 0:18:39.080 --> 0:18:41.679 is largely mapped out. We know a lot where our 0:18:41.840 --> 0:18:45.479 primary language center is, we know where our primary understanding is. 0:18:45.760 --> 0:18:48.640 There's this part of the brain that has a lot 0:18:48.680 --> 0:18:50.719 of motor function. It's kind of mapped out that our 0:18:50.760 --> 0:18:54.320 face areas more this way, our hand areas more this way, 0:18:54.640 --> 0:18:57.320 and our leg areas more this way. And so there 0:18:57.440 --> 0:19:00.280 was a tiny layer. You know, we took out just 0:19:00.320 --> 0:19:02.159 about everything, but there's a tiny layer right on that 0:19:02.200 --> 0:19:04.320 motor area for the leg. And there's starting to look 0:19:04.359 --> 0:19:08.080 like if we were too hard, we might have a 0:19:08.119 --> 0:19:10.560 lot of legg or foot weakness. And sometimes we have 0:19:10.600 --> 0:19:13.160 to decide exactly how much we want to tolerate, especially 0:19:13.200 --> 0:19:16.280 since that site had been radiated already and things like that. 0:19:16.359 --> 0:19:18.600 So I think that kind of allowed this idea of 0:19:18.600 --> 0:19:20.399 can we do the maximal safe re section? 0:19:20.760 --> 0:19:23.360 So obviously in order to get the rest of him, 0:19:23.720 --> 0:19:26.240 I guess we radiated Bob and all the other mets 0:19:26.760 --> 0:19:31.280 again after surgery, just to make sure that Bob was dead. 0:19:31.600 --> 0:19:34.600 Yeah. I don't think Bob needed another dose, but you're right, 0:19:34.640 --> 0:19:35.320 the other dots. 0:19:35.200 --> 0:19:38.080 Yeah, their dots did, right. I'm so glad I did not. 0:19:39.000 --> 0:19:43.400 I was scared enough. But knowing to that extent, which 0:19:43.400 --> 0:19:45.720