Speaker 1: This is Let's Be Clear with Shannon Doherty. Hi, everyone,
Speaker 1: welcome to another episode of Let's Be Clear with Shannon Doherty.
Speaker 1: So one of the main things about me doing this
Speaker 1: podcast is that I really wanted to reach the cancer
Speaker 1: community and have the opportunity to bring on incredibly special
Speaker 1: doctors that I'm fortunate enough to have access to because
Speaker 1: I live in Los Angeles, I go to Cedar Sinai,
Speaker 1: so I have access to the best and currently I
Speaker 1: have really good insurance.
Speaker 2: That allows me to afford them.
Speaker 1: And today I have on the exceptional brain surgeon, doctor Rachel,
Speaker 1: who I adore And thank you for taking time out
Speaker 1: of I know what is a very very very busy
Speaker 1: schedule for you to drive all the way to Malibit
Speaker 1: and hang out with me, and you brought me treat true.
Speaker 3: Thanks so much for having me. It's a pleasure to
Speaker 3: be Yeah.
Speaker 1: So can you tell us you know your title exactly
Speaker 1: what you do?
Speaker 2: Just fill everybody in right.
Speaker 3: So, I'm one of the brain tumor surgeons at theaters.
Speaker 3: We have neurosurgeons have different subspecialties. I don't really do
Speaker 3: like a lot of spine surgery or something some but
Speaker 3: do mostly brain timber work. There are times in our
Speaker 3: department we'll have like a chair who runs the department,
Speaker 3: and then a clinical chief one's supposed to be like
Speaker 3: a quality officer and things. So that's the kind of
Speaker 3: thing that I do right now, besides the brain timor work.
Speaker 3: I've been at Sedars for nineteen years. I hope I've
Speaker 3: learned something by now.
Speaker 1: I think you have. I'm pretty sure you have. I mean,
Speaker 1: you did go into my brain, so I.
Speaker 3: Swear if you learned a lot. Yes, that's true.
Speaker 1: And so what got you started in this particular field?
Speaker 1: And can you can you explain a little bit more
Speaker 1: in depth of is it just on hology and surgery
Speaker 1: that you do?
Speaker 2: Is it more broad than that.
Speaker 3: I became a neurse surgeon because I lost a bed. No.
Speaker 2: I looked at your like, just say that, and you did.
Speaker 3: It's the delivery.
Speaker 2: Yeah.
Speaker 3: My father was a doctor, and so I kind of
Speaker 3: grew up in that house knowing that kind of stuff.
Speaker 3: You would go on a lot of calls at night
Speaker 3: and help people and stuff. It just became something that
Speaker 3: I became interested in. And then you would, you know,
Speaker 3: as a kid go into his pockets at the end
Speaker 3: of the day, and I would find he was a
Speaker 3: gaser neurologist, you know, yes, like bout stuff, and I
Speaker 3: would try to picture of someone's colon. It was kind
Speaker 3: of interesting and stuff like that. And so when I
Speaker 3: was growing up, it just did a lot of stuff
Speaker 3: for science and just it was kind of a natural pathway.
Speaker 3: I didn't really decide to be a nerves surgeon toool
Speaker 3: a lot later, but going to medical school seemed something
Speaker 3: that was very natural for how I grew up.
Speaker 1: Like I can't really imagine going through my dad's pockets
Speaker 1: and seeing photos of colon's and stuff and thinking, well,
Speaker 1: this is cool, this is what I need to get into,
Speaker 1: and yet you did.
Speaker 2: Yeah, what was it about it?
Speaker 3: I guess it was just something that was both familiar
Speaker 3: and then just something I gradually found interesting. I liked
Speaker 3: science kind of stuff, and then who doesn't find the
Speaker 3: brain fascinating? So I felt like when I was looking
Speaker 3: at that stuff, here there's a ton with cardiothoracic surgery
Speaker 3: that was starting to be replaced. That people were doing
Speaker 3: more and more things and no VASc really from inside
Speaker 3: the blood vessels like stents in the coronary arteries, and
Speaker 3: now they can even replace a valve for some people
Speaker 3: from inside that surgeons were becoming going to become more
Speaker 3: and more obsolete, whereas there's still a lot of role
Speaker 3: for brain termor surgeons. We haven't really fixed everything yet.
Speaker 3: I don't know what's going to happen in my lifetime,
Speaker 3: but we haven't really fixed everything yet that surgery is
Speaker 3: still require.
Speaker 1: I'm so fascinated by the conversation of like AI and
Speaker 1: that what that role is, particularly in surgery. Is there
Speaker 1: a role for AI and surgery probably some.
Speaker 3: I mean, I think there's some part where the easier
Speaker 3: targets with like AI, and it's interacted with neuroidiology, like
Speaker 3: making sure we find all the abnormalities in the scan
Speaker 3: and even having AI screen some of the scans and
Speaker 3: trigger that to be read by a person as opposed
Speaker 3: to put out answers more quickly when a scan is normal.
Speaker 3: For surgery, it's a little harder. I mean, there are
Speaker 3: robotic surgery platforms for other specialties that sometimes they'll use
Speaker 3: that for a thoracic surgery or an abdominal surgery, but
Speaker 3: there isn't a tremendous role for robotic surgery yet. And neurosurgery.
Speaker 3: I mean, I have to be the robot. So some
Speaker 3: of these things have you know, submillimeter accuracy and a
Speaker 3: brain that's moving and pulsing as we operate. It's not
Speaker 3: really clear that AI can pull all those things off yet.
Speaker 1: I don't think I would want a robot cutting open
Speaker 1: my brain I'm working on it. That would scare me
Speaker 1: because there's you know, it's the human that I'm putting
Speaker 1: my trust in, and the human that that's feeling the
Speaker 1: compassion or the stress, the pressure, whatever it is to
Speaker 1: ensure that you have the best result possible, whereas a
Speaker 1: robot isn't they aren't programmed for that. For me, I
Speaker 1: believe that a human is always going to go with
Speaker 1: the extra mile to ensure that their patient has a
Speaker 1: favorable outcome.
Speaker 3: I think that makes a lot of sense. Probably a
Speaker 3: lot of people would feel that way right that they
Speaker 3: want that person there. And there are some of these
Speaker 3: robotic surgeons like thoracic. The surgeon is in the room,
Speaker 3: but they're not really right at the patient. They're far
Speaker 3: away at a control console, and I don't know, it
Speaker 3: just doesn't feel the same to me. Maybe I'm just
Speaker 3: too old fashion, maybe I'm not used to it.
Speaker 2: Yet Well then I'm old fashioned right there.
Speaker 1: Yeah. That, and you have obviously incredibly stity hands. Do
Speaker 1: you do something to protect them at all costs because
Speaker 1: those hands are worth a lot of money.
Speaker 3: Well, I don't do anything super risky with them. I
Speaker 3: snowboard some and I used to wear a wrisk brace more.
Speaker 3: But I think this, I don't try to do any
Speaker 3: wild things anymore. So I don't really doing.
Speaker 1: Double flips anymore, not taking the high.
Speaker 3: I'm sure I never did double flips on purpose.
Speaker 1: So.
Speaker 2: Right, they're the mistake.
Speaker 1: Oopsps oops, So we I think how we met was
Speaker 1: very interesting because I fell down, as you know, like
Speaker 1: a day or two days before Christmas, and doctor Piro
Speaker 1: said you should go in for CT.
Speaker 2: I did.
Speaker 1: It showed some things in my brain. He was concerned.
Speaker 1: He then said, you're going we need an MRI. I
Speaker 1: did the MRI, and then it was kind of an
Speaker 1: instant Okay, here's what's going on. You have met and
Speaker 1: there's one that we feel we can operate on and
Speaker 1: the others will radiate, and we want to operate mainly
Speaker 1: to get the pathology correct.
Speaker 2: Yes, and he had you already picked out. He's worked
Speaker 2: with you before.
Speaker 1: And he was like, this is the best, and you're
Speaker 1: going to him and we set up.
Speaker 2: I remember your office was like do you want to
Speaker 2: come in? It's like, no, is there zoom? Is that possible?
Speaker 1: And I'm so now used to zoom COVID and so
Speaker 1: we zoomed and what was it like four or five
Speaker 1: days later? I was getting operated on, right.
Speaker 3: Yeah, well, fortunately we managed to get it set up
Speaker 3: kind of quickly. And you're right when when doctor Piro calls,
Speaker 3: I answer quickly, yeah, and we've known each other for
Speaker 3: a while. It is yeah, different this world where there's
Speaker 3: more and more of these you know, video possible visits
Speaker 3: and things like that. Certainly with the pandemic. There's multiple
Speaker 3: people that I've you know, met over a video and
Speaker 3: then at surgery shook their hand finally and said it's
Speaker 3: nice to meet you. It's kind of strange. Yeah.
Speaker 1: I had friends that said, what do you mean you
Speaker 1: haven't actually met him in person? Don't you want to
Speaker 1: shake his hand in person before you say yes? And
Speaker 1: don't you want to make sure that he's a kind,
Speaker 1: compassionate person. And my response was no, all I care
Speaker 1: about is this, like are his hands steady? Is he
Speaker 1: the best is he going to, you know, take really
Speaker 1: good care of me in a surgical way.
Speaker 2: But then when I met.
Speaker 1: You, you were very kind and very compassionate. And even
Speaker 1: though I had psyched myself into believing that I was
Speaker 1: not going to come out okay, I really did not
Speaker 1: think that I would be fine. I was pretty sure
Speaker 1: that I was going to die that really short time
Speaker 1: period I had to go over everything with my estate
Speaker 1: planner and my attorneys and make sure that my will
Speaker 1: was in place and that my trust was secure, and
Speaker 1: who got what I mean. It was a frantic time
Speaker 1: going also through a separation. It was pretty nuts. And
Speaker 1: that's how paranoid I was of dying. And then if
Speaker 1: I didn't die, I would be paralyzed, and you were
Speaker 1: I think you told me the worst that would happen
Speaker 1: was maybe I would lose mobility of my right foot,
Speaker 1: but that physical therapy would most likely fix it. And
Speaker 1: then I asked you to please while you're in there
Speaker 1: dissecting Bob the tumor that we took out, that you
Speaker 1: took out, I asked you if you could please touch
Speaker 1: the part of the brain that allowed me to instantly
Speaker 1: speak six languages fluent and I gotta tell you.
Speaker 3: Didn't do it.
Speaker 2: Yeah, I'm not happy with you over that.
Speaker 3: Yeah, and that is one of my failures. Definitely.
Speaker 1: Is that like a real thing, because obviously it's something
Speaker 1: that I saw in Gray's Anatomy, where I think it
Speaker 1: was Emilia, who was also a brain surgeon, had to
Speaker 1: get a very large tumor removed, and she woke up
Speaker 1: speaking perfect German, and so that's where I got the
Speaker 1: idea from.
Speaker 3: And it's not that she had spoken German before.
Speaker 1: I think she had spoken German before, yes, but I
Speaker 1: so just assumed it didn't matter.
Speaker 3: Well, sometimes that, unfortunately nurse or can do in a way.
Speaker 3: So it's hard to give someone a new language. It's
Speaker 3: hard to plug you into the matrix and really get
Speaker 3: something new. That's disappointing. Yeah, sure, but once on, people
Speaker 3: who grow up speaking a certain language, it's so rooted
Speaker 3: in their brain as their primary language that if they
Speaker 3: have some other language affecting things, other languages they learned
Speaker 3: can turn down for a little bit. So I've had
Speaker 3: a patient who grew up speaking French and English, and
Speaker 3: you know, most of us are wired for our left
Speaker 3: side of the brain to have most of language and memory.
Speaker 3: Even totally left handed people still more than half of
Speaker 3: them have language on the left hand side. It's just
Speaker 3: something how the brain is wired. But this patient had
Speaker 3: a brain to her on the right and he had
Speaker 3: more like French language sites on the left side and
Speaker 3: more English language sites on the right side. So when
Speaker 3: they first did a surgery that that's kind of what happened.
Speaker 3: He wasn't speaking because she was only speaking French, and
Speaker 3: his wife was confused. That's what was going on, like
Speaker 3: he never speaks French to me, but that language that
Speaker 3: kind of turned down for a little bit as the
Speaker 3: body had to heal.
Speaker 2: Did he retain it?
Speaker 3: M M. He just had to tap back into some
Speaker 3: of these things to kind of reawaken these centers. So
Speaker 3: sometimes we do these surgeries that have more of a
Speaker 3: motor impact. That's w what we talk about, like physical
Speaker 3: therapy to retrain that area of the brain and the
Speaker 3: connections to get stronger. We try not to take an
Speaker 3: away anything permanently, obviously, but sometimes if you're it kind
Speaker 3: of depends on our risk benefit ratio. If we have
Speaker 3: a tumor that looks like a Bolivian scene, we have
Speaker 3: to carve it out. We have to take some risks
Speaker 3: sometimes to take it out. Well next time, next time,
Speaker 3: we don't want any next time.
Speaker 2: I know we don't, we don't.
Speaker 1: I do remember that when I when I woke up,
Speaker 1: you were standing over me, and I believe the very
Speaker 1: first question I asked you was what's wrong with me?
Speaker 1: And you said nothing, and I couldn't believe it. And
Speaker 1: then I think a little later, you know, I struggled
Speaker 1: with my right hand of like holding a glass. A
Speaker 1: good majority of that was because of the steroids, and
Speaker 1: the steroids make me crazy. I do not do well
Speaker 1: on steroids at all. So remember I kept on trying
Speaker 1: to take myself off the steroids, and I guess the
Speaker 1: brain would swell and then the right hand would get worse.
Speaker 2: And now everything is obviously.
Speaker 3: Great, terrific. Yeah, it's good to know, good job once
Speaker 3: in a while.
Speaker 1: That day, so I remember, also, didn't you ask me
Speaker 1: what kind of music I wanted?
Speaker 2: And I said, I'm going to be asleep, Like whatever
Speaker 2: music makes you, you know, do the best job? What
Speaker 2: did you do? You remember what you listened to?
Speaker 1: Because I know I'm one of a lot of people,
Speaker 1: so I don't expect you to know this answer.
Speaker 2: But I'm just curious.
Speaker 3: Couple. Well, I mean, so usually we asked a little
Speaker 3: bit something what you might like to listen to that
Speaker 3: helps call you as the anesthetic kicks in. Once you're
Speaker 3: totally asleep, you can play whatever rave music we want
Speaker 3: or something.
Speaker 1: Is it?
Speaker 2: So, I mean, what is your go to? Do you
Speaker 2: like rock and roll? Do you like classical?
Speaker 3: Sometimes it's like an old school hip hop playlist, like
Speaker 3: has a lot less Snoop Dog or something like that,
Speaker 3: just something to keep people moving. I mean, I think
Speaker 3: there's like different philosophies. I know some surgeons who like
Speaker 3: total silence in their operating room and don't want music
Speaker 3: and they want the antithesiologists to listen to every single
Speaker 3: little thing they have to say and stuff like that.
Speaker 3: And that's fine for me. I feel like, you know,
Speaker 3: obviously the music's not blaring, but I can concentrate and
Speaker 3: it helps the other people in the room if it's
Speaker 3: not total silence, you.
Speaker 2: Know, right, it keeps the energy up.
Speaker 3: Yeah, I think that's what it is, an energy and
Speaker 3: a movement level. I think it works better for me.
Speaker 1: You gave me a photo because I asked you, and
Speaker 1: you gave me a photo of my brain. Can you
Speaker 1: what was that surgery like for you? What was that
Speaker 1: particular surgery that you did on me? What were the
Speaker 1: reasons why we did it besides the pathology all of that,
Speaker 1: and then you know, I can explain why I named
Speaker 1: him Bob.
Speaker 3: Oh good, I get to hear this finally. I've been
Speaker 3: waiting so fortunately with your brain and there's only a
Speaker 3: few spots, and some of them were tiny, so some
Speaker 3: of them were ones that were really ideal for this
Speaker 3: idea of focused radiation. Sometimes we'll say radiosurgery. It's almost
Speaker 3: a gimmicky term though, like focused radiation as if to
Speaker 3: replace surgery. But if we have a dot that's a
Speaker 3: millimeter or two, sometimes we can't really find that at surgery,
Speaker 3: so the radiation can target that based on the MRI
Speaker 3: you had once. But theres a little bigger and there's
Speaker 3: both this idea of it's a little bigger we can
Speaker 3: eradicate it better with surgery. Well, a worry is that
Speaker 3: sometimes when you stir up a metastasis, you kind of
Speaker 3: leave little cells somewhere or can even if you're not
Speaker 3: careful about it, spread tumor around. So we usually would
Speaker 3: do at least some form of radiation afterwards, but we
Speaker 3: and a couple other centers have been tinkering with the
Speaker 3: idea of the radiation upfront, so you kind of like
Speaker 3: almost like sterilize the tumor beforehand, so that even if
Speaker 3: a cell escapes, it's been radiated and hopefully it won't
Speaker 3: set up root. That can give doctor Puro tremendous on Collagi.
Speaker 3: Is a tremendous advantage to have a sample of the
Speaker 3: current disease. So if we take something out and we
Speaker 3: analyze the receptors, we get to know a lot more, right,
Speaker 3: And that's one of the things that probably I hope
Speaker 3: has helped you and may help you more, is that
Speaker 3: idea of like finding what them like their signature is
Speaker 3: allowing targeted therapies and exactly your scenario. Not all guests work,
Speaker 3: I mean, there's always a little bit of tinkering with
Speaker 3: a regimen, but not all guessworks. Some like logical things
Speaker 3: like this is a very patient directed, patient oriented treatment strategy.
Speaker 1: Yes, So when you saw Bob, I named him because
Speaker 1: I'm I don't know, I don't really view Bob's as
Speaker 1: very scary.
Speaker 2: Bob's are usually really nice.
Speaker 1: And affable, so I didn't want Bob to be scary,
Speaker 1: but you had to leave. You couldn't get all of
Speaker 1: Bob out. Do you remember why that was?
Speaker 3: There were a couple cells towards the motor area. So
Speaker 3: for your scenario is a little complicated because it wasn't
Speaker 3: totally on the surface of the brain, so we had
Speaker 3: to kind of get to the area.
Speaker 1: These are sort of the questions I didn't ask until now.
Speaker 1: So I'm learning along with our listeners. I'm actually learning
Speaker 1: about my own surgery because I do remember you just
Speaker 1: send motor skills, and I remember looking at you also
Speaker 1: and saying, stop if you're going to if it's going
Speaker 1: to change me as me as the way that my
Speaker 1: brain works, the way that I process speaking, mobility, all
Speaker 1: of that. So, and obviously you were going to whether
Speaker 1: I said something to you or not.
Speaker 2: So it was not because I always.
Speaker 1: Pictured Bob right at like the top of my head,
Speaker 1: right here, just sitting on top of my brain.
Speaker 2: But that's not the case.
Speaker 3: Yeah, that's where the incision is. I have a prop
Speaker 3: do you mind if I Yeah, So this is a
Speaker 3: little model that I have. Sometimes you'll have a tumor
Speaker 3: that's really on the surface that all we have to
Speaker 3: do is really carve it out from here.
Speaker 2: And that's what I thought mine was right, Not.
Speaker 3: Quite so, yours was in between the two halves of
Speaker 3: the brain, so we had to crawl around here. The
Speaker 3: safest route is to crawl around here and not touch
Speaker 3: or take out any of this stuff and take it
Speaker 3: out from the inside there.
Speaker 1: So did you go horizontal and then just still kind
Speaker 1: of cry this open a little bit to try to
Speaker 1: get to Bob.
Speaker 3: Well, sometimes we do different things for this scalp and
Speaker 3: for the skull inside, so it can be very cosmetic
Speaker 3: to do a horizontal or coronal incision like this because
Speaker 3: things get all covered up and then underneath we do
Speaker 3: what we need to do. So we fashioned a craniotomy.
Speaker 3: That's where you make a window and the skull. We
Speaker 3: can put the skull back on with little titanium bars
Speaker 3: that don't set off metal detectors. It's not like we
Speaker 3: use a big metal plate or anything. So you have
Speaker 3: your own skull back on. But we can create a
Speaker 3: window on the skull where we need to work and
Speaker 3: it doesn't have to match the incision.
Speaker 2: And that's what you did to me, right.
Speaker 3: It feels good up there, right, it feels normal.
Speaker 2: Yeah, no, it feels normal.
Speaker 1: Sometimes the you know, when you go for the MRI,
Speaker 1: they take the wand sure and right here beeps a
Speaker 1: little bit?
Speaker 3: Does it at touch?
Speaker 2: It does attach? And I'm like, well, I have brain searchery.
Speaker 1: Yeah, so you weren't able to get him completely out
Speaker 1: because he was a little deeper in and wrapped around
Speaker 1: where the mobility would be.
Speaker 2: Can you explain that a little bit more?
Speaker 3: Sure, So, our brains have different areas that have power
Speaker 3: and neurons that function a certain way. So the brain
Speaker 3: is largely mapped out. We know a lot where our
Speaker 3: primary language center is, we know where our primary understanding is.
Speaker 3: There's this part of the brain that has a lot
Speaker 3: of motor function. It's kind of mapped out that our
Speaker 3: face areas more this way, our hand areas more this way,
Speaker 3: and our leg areas more this way. And so there
Speaker 3: was a tiny layer. You know, we took out just
Speaker 3: about everything, but there's a tiny layer right on that
Speaker 3: motor area for the leg. And there's starting to look
Speaker 3: like if we were too hard, we might have a
Speaker 3: lot of legg or foot weakness. And sometimes we have
Speaker 3: to decide exactly how much we want to tolerate, especially
Speaker 3: since that site had been radiated already and things like that.
Speaker 3: So I think that kind of allowed this idea of
Speaker 3: can we do the maximal safe re section?
Speaker 1: So obviously in order to get the rest of him,
Speaker 1: I guess we radiated Bob and all the other mets
Speaker 1: again after surgery, just to make sure that Bob was dead.
Speaker 3: Yeah. I don't think Bob needed another dose, but you're right,
Speaker 3: the other dots.
Speaker 1: Yeah, their dots did, right. I'm so glad I did not.
Speaker 1: I was scared enough. But knowing to that extent, which
Speaker 1: is interesting because I'm sure that you have patients who
Speaker 1: want to know every little detail. How is that for
Speaker 1: you as a doctor to explain? Do you find that
Speaker 1: it makes them more nervous?
Speaker 3: Well, I think you're right. I think some people want
Speaker 3: all the details. And my assumption is that they're asking
Speaker 3: lots of these detailed questions. They're the type of person
Speaker 3: that feels reassured by it, right. I think you're right.
Speaker 3: Sometimes I kind of have to do a lot of
Speaker 3: feeling out and not say too much. And once I've
Speaker 3: had people where I talk a little bit about what
Speaker 3: we have to do, like they say, stop, that's enough.
Speaker 3: I don't. I don't want to know everything you do, right,
Speaker 3: I just want to know, you know what's going to have,
Speaker 3: what I'm going to feel. But the part when I'm asleep,
Speaker 3: I don't want to know everything that happens. Everyone's different.
Speaker 1: And for you, how many operations would you say you
Speaker 1: do in one week?
Speaker 3: It depends. I mean it could be as many as
Speaker 3: seven or eight. And then there are weeks that I
Speaker 3: have more administrative or teaching duties and it's less than that.
Speaker 1: You know, And with those seven or eight, how many
Speaker 1: are very high risk? Maybe sixty percent, seventy percent? And
Speaker 1: what percentage was I of high risk?
Speaker 3: You're pretty high risk. I mean there are people where
Speaker 3: we have a tumor neuro language center that we have
Speaker 3: to wake them up in the middle of surgery to
Speaker 3: test language.
Speaker 2: Well, I've seen that on Green anatomy.
Speaker 3: Sure, there's a lot of stuff in there, some of
Speaker 3: those stories, some of those things are real. It's true.
Speaker 3: Fortunately we didn't have to do that for you. But
Speaker 3: sometimes that obviously is a little bit element of risk.
Speaker 3: And then there are probably things that some of my
Speaker 3: colleagues perform more like like a craniotomy for a ruptured aneurysm,
Speaker 3: that's higher risk of big blood loss and stuff. I
Speaker 3: mean there's kind of sometimes the difference between like the
Speaker 3: brain risk and then the risk to the overall medical
Speaker 3: risk of the patient. So, I mean, your's had some risk,
Speaker 3: but fortunately it wasn't the highest risk thing. And then
Speaker 3: some of the things they do are kind of straightforward
Speaker 3: or more straightforward if it's some tiny little benign to
Speaker 3: run the surface of the brain, like I'm an ingioma,
Speaker 3: or sometimes if people have a certain need for chemotherapy
Speaker 3: and there's cerebrospinal fluor there's a port that I can
Speaker 3: put in. That's a pretty simple surgery. So sometimes some
Speaker 3: of those seven eight are not that hard.
Speaker 1: Do you do anything before a surgery to get ready?
Speaker 1: Do you meditate? Do you go back over the file
Speaker 1: and all the X rays and like, what is your
Speaker 1: routine before a surgery?
Speaker 3: Well, I don't come in from the bar. I should Could.
Speaker 1: You imagine if like your doctor wreaked a vodka.
Speaker 3: There are stories about people, but you know, not at theater. No,
Speaker 3: So yeah, I probably should meditate more, and I probably
Speaker 3: should practice a little more mindfulipped I do feel like
Speaker 3: I achieve that more by reviewing everything and making sure
Speaker 3: I know all the ins and outs before I walk
Speaker 3: into that room. That is more reassuring.
Speaker 1: I think when you're operating, and I don't want this
Speaker 1: to sound self important in any way, but I am
Speaker 1: curious that when you operate on someone like me or
Speaker 1: I'm sure some people that you've operated on that are
Speaker 1: well known, is there an extra layer of pressure.
Speaker 2: I know that you care about everybody's life, but like,
Speaker 2: if you slip.
Speaker 1: And do something, it's gonna come out that you were
Speaker 1: my certain Is there any kind of a or do
Speaker 1: you just really it's not about who the person is
Speaker 1: in the sense of a name. It's about the fact
Speaker 1: that you have a human there and it's your responsibility.
Speaker 1: And I know that that's how you feel. But I'm
Speaker 1: just curious about any added pressure.
Speaker 3: Well, I mean there's some times some pressure. We just
Speaker 3: try not to think about it too much. And you're right,
Speaker 3: I'm thinking about you know, you in your career when
Speaker 3: you're in that room, or I'm thinking about some CEO
Speaker 3: and that person's career in the room, or I'm thinking
Speaker 3: about someone as a mom has kids, and I kind
Speaker 3: of have to both think about that a little in
Speaker 3: the background, but try not to make it like overwhelm me. Right,
Speaker 3: I'm there for a job that I've done many times before,
Speaker 3: and I just have to put on my game face
Speaker 3: and get that job done well. Make sure everybody's fine
Speaker 3: no matter what the deal is.
Speaker 2: You're so confident.
Speaker 3: Maybe over maybe over, No, I don't think so.
Speaker 1: It's like the perfect You're You're You're really honestly the
Speaker 1: perfect balance. And I can tell you if ever I
Speaker 1: need brain surgery again, it's it's always going to be you.
Speaker 2: Let's hope I.
Speaker 3: Don't, right, That's our other job is to do so
Speaker 3: much surveillance. We keep you out of the operating room.
Speaker 3: It's a little more fun for me than it is
Speaker 3: for you.
Speaker 1: Probably, yes, obviously, but as as we know, protocols stop working.
Speaker 1: It's it's not anything wrong with the medicine. It's that
Speaker 1: cancer changes. It's why I think there's not a cure yet,
Speaker 1: because it's a living thing that's constantly changing and evolving.
Speaker 2: And I can't.
Speaker 1: Really even remember the particulars of my cancer, but I
Speaker 1: know that whatever I was prior to the surgery, we
Speaker 1: discovered that I had turned positive in one area. That
Speaker 1: then allowed me to go on to a totally different
Speaker 1: protocol that I wasn't eligible for prior, which really tells
Speaker 1: you how important getting a sample of that tumor and
Speaker 1: doing that pathology and really dissecting it can be incredibly helpful,
Speaker 1: because all of a sudden you have a brand new
Speaker 1: protocol that's open to you. But at the end of
Speaker 1: the day, eventually a protocol will stop working. I don't
Speaker 1: really know of anyone who's been on the same protocol
Speaker 1: at stage four for twenty plus years. They eventually all
Speaker 1: wear off. So at some point for somebody like me
Speaker 1: who has a tendency to develop mets, there might be
Speaker 1: some point where I have to see you again because
Speaker 1: the radiation may not be able to handle it right.
Speaker 3: There's a chance. I hope we can stay with that
Speaker 3: off for a long time, but there's a chance me too.
Speaker 3: Part of it is a lot of these frequent MRIs
Speaker 3: like you've been being able to put up with and
Speaker 3: do your counting and stuff, that hopefully we can find
Speaker 3: little spots and pick them off before they need surgery.
Speaker 3: But you're right, there's always some consideration for additional surgery.
Speaker 3: And I agree with you. I mean, cancer has a reputation,
Speaker 3: it has for a reason because it evolves and it
Speaker 3: takes a therapy and just it takes one pocket of
Speaker 3: cells that doesn't respond while that theory start to grow
Speaker 3: and suddenly you need something different. It is that part
Speaker 3: of current cancer care to really be both personalized but
Speaker 3: also to update what we're looking at every now and
Speaker 3: then that's sometimes we need another sample of something from
Speaker 3: somewhere because if the black their signal changes a little bit,
Speaker 3: like it did for you, and now you qualify for
Speaker 3: a targeted therapy. We didn't think you qualified before. We
Speaker 3: We've just changed everything, We just disrupted everything. It's great
Speaker 3: that you had that.
Speaker 1: And then obviously there's the incredible clinical trials that are
Speaker 1: happening everywhere. Do you see for stage four patients that
Speaker 1: it spreads more to organs or more to brains.
Speaker 3: Everything's a little different. I mean, melanoma tends to have
Speaker 3: some predilection for the brain. We think part of that
Speaker 3: is because our skin actually has a common origin ast
Speaker 3: site as our neural tissue, and so we think that's
Speaker 3: part of the reason why there's some cancers that go
Speaker 3: to the brain less frequently, like colon cancer or endometrial cancer.
Speaker 3: Although as people are starting to survive better and better
Speaker 3: for their primary tours. We're starting to see more of
Speaker 3: those metastases than we used to see. You know, when
Speaker 3: I started theaters at nineteen years ago, that was very uncommon,
Speaker 3: But we're starting to see more of those things because
Speaker 3: people survive longer from their primary cancer.
Speaker 1: Right, I mean, cancer is just a whole other beast
Speaker 1: to me. I didn't really have a lot of experience
Speaker 1: with cancer, or not a lot of friends that had cancer,
Speaker 1: and I was certainly, I thought incredibly healthy up until
Speaker 1: twenty fifteen when I got diagnosed with cancer. To know
Speaker 1: where the breast cancer spreads, sometimes people do have it
Speaker 1: spread to the brain much faster than the organs. I
Speaker 1: had a good friend that it spread to her organs
Speaker 1: really quickly, where everything just started shutting down, and she
Speaker 1: shut down. She just didn't want to keep going through it.
Speaker 1: So when you go home because you people's lives in
Speaker 1: your hands, does it impact the way that you view life?
Speaker 1: From everything I've heard, you're a wonderful father, a wonderful husband.
Speaker 1: Does it make you appreciate life more? Do you look
Speaker 1: at things as being much more precious or do you
Speaker 1: have to sometimes leave some of that behind in the
Speaker 1: hospital and try to be as normal as possible.
Speaker 3: Yeah, I think answer being some mixed moments. I think
Speaker 3: I think some of it is, you know, when when
Speaker 3: you see someone who how to particularly you know, hard time,
Speaker 3: then you want to go home and just hug your
Speaker 3: kids for a little bit and hug your wife for
Speaker 3: a little bit. But you're right, I don't want to
Speaker 3: totally expose the kids to every little thing on my
Speaker 3: mind because I see some troublesome things and I want
Speaker 3: them to be kids. They hear stuff sometimes, you know,
Speaker 3: I'm on the phone with somebody and they're like screaming
Speaker 3: in the background and something like that. But they I
Speaker 3: try not to expose them to everything. But I think
Speaker 3: that's part of the thing, maybe a little how I
Speaker 3: grew up too, is like they're curious I have something
Speaker 3: like this at home, like what is that? And what
Speaker 3: picture do I have with me? And things like that.
Speaker 3: It gets a little trick. I can't totally keep them
Speaker 3: out of the loop, but I try to dispose them
Speaker 3: to everything.
Speaker 2: Yeah, are they fascinated by your job? Though?
Speaker 3: Sometimes right now that what we usually say is like
Speaker 3: dad takes out lumps out of someone's head to make
Speaker 3: it like a little simple and sound a little more innocent.
Speaker 2: Yeah, do you hope? Because I know a lot of
Speaker 2: parents who are doctors or attorney they want their children
Speaker 2: to follow in their footsteps. Do you feel that way
Speaker 2: at all?
Speaker 3: Or I don't know. I mean, I think the followed
Speaker 3: in your dad's foods, see it did? I also felt
Speaker 3: like my parents expected it of me. But I feel
Speaker 3: like going into medicine the first place is a little
Speaker 3: bit of a hard pathway unless one really really loves it,
Speaker 3: and going in a nurse surgery even more so. So.
Speaker 3: When I meet students sometimes I'll ask them if that's
Speaker 3: basically the only thing on the planet that'll keep them
Speaker 3: happy as a job, and if there's something else, you
Speaker 3: probably should think about it, because it's just a hard
Speaker 3: pathway and a hard life, you know, me answering phone
Speaker 3: calls at mammoth and stuff like that. It's just one
Speaker 3: of those things.
Speaker 2: And where did you did you grow up here in
Speaker 2: Los Angeles?
Speaker 3: I grew up in Newport Beach. That's when doctor Marhide
Speaker 3: grew up too. We went to rival high schools. That's funny,
Speaker 3: it's entertaining.
Speaker 2: Yeah, I asked what school you went to?
Speaker 1: For all things that people normally ask before they get
Speaker 1: brain surgery, and I didn't.
Speaker 2: I didn't ask you anything.
Speaker 3: I think, Yeah, I think once you knew Piro's recommendation,
Speaker 3: you were fine.
Speaker 2: Yeah.
Speaker 1: I just also thank god it was so quick, so
Speaker 1: quick of a turnaround, because I think if I had
Speaker 1: had time to ruminate on it longer, I would.
Speaker 2: Have had a lot more questions.
Speaker 1: But you know, going through a separation when you're right
Speaker 1: about to go into brain surgery, my thoughts were on that.
Speaker 2: They weren't even on anything else.
Speaker 1: So now I'm asking you all the questions that normally
Speaker 1: people ask their brain surgeon.
Speaker 3: Sometimes they do before Right, I went to a little
Speaker 3: school up north called Stanford, and then I went to
Speaker 3: U see San Diego for medical school.
Speaker 2: God, I can't Stanford.
Speaker 1: Somewhere just a little right, just Stanford, no big deal.
Speaker 3: Beforehand, those weren't the questions, huh, No, it was.
Speaker 1: I think it was looking in your eyes via zoom,
Speaker 1: and you showed zero fear, and a lot of people
Speaker 1: like doctors to.
Speaker 2: Be very huggy, like my mom.
Speaker 1: Right, she had an anaurysm, and then she just had
Speaker 1: a new aniurysm, and one of your colleagues. Doctor Gonzales
Speaker 1: did her last one, and he's perfect for her, and
Speaker 1: he's a wonderful, amazing doctor. Also theaters, she has a
Speaker 1: lot of questions and she really needs somebody like the
Speaker 1: doctor to literally hold her hand, and she likes them
Speaker 1: to be very warm and affectionate. Not that you aren't warm,
Speaker 1: but I prefer my doctors to be much more analytical
Speaker 1: and not distant. But I have a weird thing about
Speaker 1: crossing over. Even though Pierro and I are very good friends,
Speaker 1: when we go to dinner, we don't talk cancer. We
Speaker 1: don't talk to medicine. And when I am in this
Speaker 1: clinic as a patient, there's there's no hugging. No, there's
Speaker 1: none of that, because now you're my doctor and I'm
Speaker 1: a patient, and I just want you to give it
Speaker 1: to me.
Speaker 2: Strayed, and I don't want any emotion.
Speaker 1: Whatsoever, because if somebody else has emotion, I'm going to
Speaker 1: get emotional, and I don't like doing that in front
Speaker 1: of people. It's just I don't get any of my
Speaker 1: test results in person anymore. I like everything over the
Speaker 1: phone so that I don't have to check myself and
Speaker 1: monitor my reaction.
Speaker 2: To the news.
Speaker 1: I will put on a smiley face when somebody tells
Speaker 1: me your cancer has spread, just to make sure that
Speaker 1: the nurse standing next to my doctor doesn't feel bad
Speaker 1: for me, because I don't like the pity. I don't
Speaker 1: like the sad look. I don't like any of that.
Speaker 1: And also I don't want to get wrapped up.
Speaker 2: Into those emotions.
Speaker 1: For me, it's very hard, and lately I've had a
Speaker 1: lot more of those emotions, which has thrown me off
Speaker 1: because I'm going to go to an interesting that you
Speaker 1: said about that I'm getting my MRIs always on time,
Speaker 1: because you called me and you had a conversation with me,
Speaker 1: and you said you need to go get your MRIs
Speaker 1: more often. And I pushed back and was like, no,
Speaker 1: I think I think that this is okay and for
Speaker 1: most people, and I think even for myself, I should listen.
Speaker 2: And I did. I started ramping it up a lot more.
Speaker 1: But I have a weird ability to know when a
Speaker 1: protocol has stopped working.
Speaker 2: There's just something.
Speaker 1: There's there's a twitch that happens, there's a feeling in
Speaker 1: my bones, there's I just get I get a little off,
Speaker 1: and I instantly know, Okay, the protocol is no longer working,
Speaker 1: and a couple of days later, I'll go for the
Speaker 1: MRI and the PET and sure enough it'll be a
Speaker 1: super tiny spot. I think now, because I've started considering
Speaker 1: that a lot more, and I go more often and
Speaker 1: get the MRIs, my mentality is slowly changing. So before
Speaker 1: where I wanted my doctors to just be very concise
Speaker 1: and straightforward with me, I am finding that I'm getting
Speaker 1: more scared and more aware of what's going on in
Speaker 1: my body. I'm wanting more conversations with my doctors. I'm
Speaker 1: wanting my test a lot more often because maybe it's
Speaker 1: the reality. Maybe I was able to push reality off
Speaker 1: a little bit and say, if anybody can beat it,
Speaker 1: it's me, and it's fine, and I'm just going to
Speaker 1: keep on these protocols and eventually they'll have another one
Speaker 1: and another one and another one. But when you start
Speaker 1: going through protocols a little bit faster because your cancer
Speaker 1: is getting more aggressive or whatever the reason, you, you
Speaker 1: definitely just start checking in more and getting more fearful.
Speaker 2: It's really so.
Speaker 1: Now, if I had brain surgery with you, well, now
Speaker 1: I don't need to ask you, because I've asked you,
Speaker 1: but I would have I would be a lot more
Speaker 1: I think attentive at this point in time in my life,
Speaker 1: do you find it easier to deal with the people
Speaker 1: that are more like me? Are the ones who ask
Speaker 1: a lot of questions?
Speaker 3: I think in the middle somewhere, I mean, I think,
Speaker 3: I think sometimes people hang on to too many questions
Speaker 3: and sometimes like unimportant questions. So I don't know, there's
Speaker 3: someone coming up with a surgery with a benign tumor,
Speaker 3: that's you know, asking exactly how long she's going to
Speaker 3: be off from work, and like, you know, can I
Speaker 3: do this like eight months, eight weeks from surgery?
Speaker 2: I don't.
Speaker 3: I don't know those things, right. We have to get
Speaker 3: you through the process to know those things and see
Speaker 3: how you're recovering. Stuff like That's it can get tough
Speaker 3: when we're focusing on you know, steps like very very
Speaker 3: far away. I know that sometimes that's the people's like
Speaker 3: kind of control are almost like a soothing mechanism. But
Speaker 3: sometimes all we can do is get to that one
Speaker 3: next step and then see where it goes from there.
Speaker 1: Well, yeah, I mean people want to people want to
Speaker 1: feel like they're going to be normal very quickly, but.
Speaker 2: You just you never know what can happen.
Speaker 1: And by the way, just as a side note, I
Speaker 1: do do my MRIs on schedule sometimes if I feel
Speaker 1: Sometimes if I feel something off, I will go before
Speaker 1: I'm supposed to go in because I want to catch it.
Speaker 1: It's quickly as humanly possible, So like I'm scheduling for
Speaker 1: another one quickly, so.
Speaker 2: Just because I'm like, well, why not? Now I understand now.
Speaker 1: It's but again, it's that reality is sort of sinking
Speaker 1: in a little bit more. Where you go? God, why
Speaker 1: do I want to wait until something gets bigger? Why
Speaker 1: not make radiation a little bit easier? It's smaller, Like
Speaker 1: get in there, get it handled quicker, change your protocol quicker,
Speaker 1: or you know, sign up for a clinical trial and
Speaker 1: have a chance of actually getting into a clinical trial quicker.
Speaker 1: There are questions for you, sir, oh my, after brain surgery,
Speaker 1: how quickly can you tell if someone is going to
Speaker 1: have lasting problems like loss of mobility or memory or etc.
Speaker 3: You should know something basically instantly, like as we wake
Speaker 3: you up from surgery, we start to know what's going
Speaker 3: on that by that first night, you know, first twenty
Speaker 3: four hours, if you're doing well and you're speaking well,
Speaker 3: moving well, usually that means that everything's going to be fine.
Speaker 3: So the dangerous things happen early for.
Speaker 1: You mentally to know that you're waking up and you're
Speaker 1: going to a very difficult surgery, but you still have to,
Speaker 1: you know, put on a happier face, perhaps for your children,
Speaker 1: or if you lose a patient during surgery and you
Speaker 1: still how do you handle that?
Speaker 3: Well. I don't know if I have perfect answers to that,
Speaker 3: but I think that some things compartmentalize themselves a little bit,
Speaker 3: like the times that I have a surgery first thing
Speaker 3: in morning, after check in so early, it's not like
Speaker 3: I can take the kids to school or something anyway,
Speaker 3: So the times I do are naturally a day like today,
Speaker 3: we're not clearly not operating right now, and I could
Speaker 3: take the kids to school and kind of be more
Speaker 3: the regular person for a little bit. I mean, right
Speaker 3: when there are things that happen at surgery, it's particularly tough.
Speaker 3: I also think there's a part where some amount of
Speaker 3: that decompression at work before I go home, first of all,
Speaker 3: might help keep me out of a car accident or something, right,
Speaker 3: and second, just try not to bring it all into
Speaker 3: the house, like to be at work and reflective and
Speaker 3: you know what happened today, what can we do better
Speaker 3: next time? And try to make those processes happen, you know,
Speaker 3: right afterwards, in early, so that it doesn't try to
Speaker 3: roll over and everything, and it rolls over a little,
Speaker 3: but try to limit the effect of it.
Speaker 1: When a patient is sent to you, do you get
Speaker 1: them at stage one or does that usually mean that
Speaker 1: they're further advanced?
Speaker 3: Right, So most people are sent to me when they
Speaker 3: know they have a brain metastasis, right, So none of
Speaker 3: those people are going to be stage one. But we
Speaker 3: also treat primary brain tumors called gliomas. They're more less
Speaker 3: common than metastases, but sometimes people might have a lower
Speaker 3: grade or a higher grade glioma, and that's the tumor
Speaker 3: that started in the brain itself. There are a lot
Speaker 3: of patients who don't have benign brain tumors if they
Speaker 3: have a glioma as an adult. That's more common in children.
Speaker 3: But also there's a common tumor not of the brain itself,
Speaker 3: with the coverings of the brain. The meningis and meningiomas
Speaker 3: are fairly common tumors and are usually benign. So there's
Speaker 3: kind of this variety of depending on what the pathology is.
Speaker 2: And the most important question that I can think to
Speaker 2: ask you, when you made that decision, you looked at
Speaker 2: my brain? Did it just wow you?
Speaker 3: It was amazing? It was amazing. In fact, do you
Speaker 3: remember one of the times you made fun of me, No,
Speaker 3: that I gave you a picture of your brain. Yes,
Speaker 3: and it was only printed on a regular paper. You said,
Speaker 3: this is not it was enough hoppy. So then I
Speaker 3: had to do the photo for the real photo.
Speaker 1: My I cannot believe you brought me that. Oh you
Speaker 1: know you're gonna have to explain all of this. This happened,
Speaker 1: that's wild.
Speaker 2: What is this? Did you like leave a cotton swad?
Speaker 1: No?
Speaker 3: No, no, I didn't leave something. So sometimes we use
Speaker 3: these cotton nois, these cotton patties to try and protect
Speaker 3: various areas of the brain. This one is really like
Speaker 3: they open the dura that coverings the brain, and this
Speaker 3: is to keep it hydrated. But this is so like
Speaker 3: if there's a big vein here, we don't accidentally touch
Speaker 3: it and or interfere, and then we take that stuff
Speaker 3: out afterwards, you don't have any extra surprises in there.
Speaker 2: Have you ever left something in a brain and you'll
Speaker 2: never adminish, you know.
Speaker 3: But you know, obviously that's part of what we have
Speaker 3: to be cautious about. And that's why to people in
Speaker 3: the operator that help us, like help count these little
Speaker 3: cottonoids and make sure we know and we have everything
Speaker 3: that we started with that jazz.
Speaker 1: I only asked that question because once again I saw
Speaker 1: it on grease anatomy Great and they were doing the
Speaker 1: counting and they came up short.
Speaker 3: Yes, you know, you're actually one of those people who
Speaker 3: hasn't really asked for much. We have patients, you know,
Speaker 3: call with billions of questions or asked for like several
Speaker 3: refills of pain medicine. You're not that type of person
Speaker 3: who's really asked for a whole lot of things.
Speaker 1: No, I got off the pain meds immediately pretty much,
Speaker 1: and I, you know, unfortunately, kept on trying to take
Speaker 1: myself off the steroids, and you kept telling me to
Speaker 1: go back on, like brain swelling is a real thing
Speaker 1: after brain surgery. But uh, yeah, I'm not a big
Speaker 1: pain pill person. It's I don't I don't like to
Speaker 1: feel out of control, which is also some of the
Speaker 1: fear of being put under.
Speaker 2: I'm one of those that I'm a control freak.
Speaker 1: I like to know everything that's happening in the moment,
Speaker 1: and I kind of feel that with pain pills, it doles.
Speaker 1: It just doles my ability to be quick and processed quickly,
Speaker 1: and I don't like that at all. Has cancer ever
Speaker 1: touched you personally with family member I loved one of friends?
Speaker 3: Actually yes, I mean my my father died from glioblastoma.
Speaker 3: I'm malignant brain TURMR. You would think that would be
Speaker 3: my interesting story how I got into it, But it
Speaker 3: was when I was already a neurosurgeon. But then it
Speaker 3: was this thing that was odd. It was kind of
Speaker 3: like I didn't realize I've been working, you know, more
Speaker 3: than a decade in her surgery to rally all these
Speaker 3: troops around me and try to help my dad. But
Speaker 3: you know, he was eighty four, so it's like a
Speaker 3: lot tougher for a lot of treatments when you're that age.
Speaker 2: But you didn't do that, No, No.
Speaker 3: I had one of my buddies to do it. That right,
Speaker 3: that'd be too much. And even if it weren't too
Speaker 3: much for me me, I mean that's considered a conflicted.
Speaker 2: Seaters, right, What pressure on your buddy.
Speaker 3: Yeah, a lot of pressure on my buddies.
Speaker 1: It's true that. I mean I would if I had,
Speaker 1: you know, a buddy or a family member or somebody
Speaker 1: that will get camp because it's the conflict of interest
Speaker 1: with somebody that I would definitely want someone closer to
Speaker 1: me operating on, like my mother for instance. But at
Speaker 1: the same time, wow, what pressure.
Speaker 3: Yeah, it's definitely some pressure on them, that's true.
Speaker 2: Have you ever canceled a scheduled surgery because you didn't
Speaker 2: feel physically or emotionally at your best?
Speaker 3: Hmm. I can't say that I've done that, per se.
Speaker 3: The closest I came to that actually was a patient
Speaker 3: still remembers that they needed what's called a ventriculo peraitual
Speaker 3: shunt or a VP shunt. I did postpone one because
Speaker 3: my wife was in labor, and so forever they always
Speaker 3: remember when the twins were born, because my wife was
Speaker 3: in labor. I brought her in and then, you know,
Speaker 3: things calmed down. I did the surgery I think a
Speaker 3: day later or something, but they remember.
Speaker 1: That that's a pretty good reason to postpone. So you
Speaker 1: never postponed for like, you know, just woke up and
Speaker 1: said I'm not feeling this today.
Speaker 3: I think not as simple as that, you know, I
Speaker 3: think just have to even I've had a little ache
Speaker 3: or something, I have to find a way to do
Speaker 3: the job. That's what's funny. Someone who was just saying
Speaker 3: something about calling out sick, and then you know, sometimes
Speaker 3: it feels like it's a neurosurgeon. I can't call on sick.
Speaker 3: I can call and dismembered. But whoever's there is sicker
Speaker 3: than I am. So I need to, you know, get
Speaker 3: it going. I think, you know, I've had a virus
Speaker 3: or something, and if it's super bad and it happens
Speaker 3: to hit on a day of surgery, I guess I
Speaker 3: would have to do something. But I think fortunately, you know,
Speaker 3: I don't operate every single day of the week, so
Speaker 3: sometimes it hits on a day when I'm not that
Speaker 3: busy or something.
Speaker 1: Is there any anything that you would say to people
Speaker 1: like me that are looking at having brain mets or
Speaker 1: a tumor going in a surgery that would possibly help
Speaker 1: them the questions that they should ask. I have the
Speaker 1: utmost respect for doctors because the education, the how hard
Speaker 1: they work, their work ethic is absolutely insane to me.
Speaker 1: So I have nothing but respect for all doctors. But
Speaker 1: that doesn't mean that I think every doctor that you
Speaker 1: meet is the right doctor for you, and I do
Speaker 1: believe in getting a second third opinion.
Speaker 3: Well, I think you're right. It's always reasonable to have
Speaker 3: a second opinion. It can't really hurt. I think that
Speaker 3: it's different. If you're in Kansas City, there's kind of
Speaker 3: only one place to go for some of like brain tumors,
Speaker 3: but in a lot of these cities there are multiple places.
Speaker 3: Sometimes I make the comment that in New York people
Speaker 3: tend to stick in their burrow and they won't really
Speaker 3: go to these other hospitals per se. But in Los Angeles,
Speaker 3: one of the tricky things that you can if you're
Speaker 3: tricky about it, you can schedule three in person visits
Speaker 3: at academic centers in the same day if you schedule
Speaker 3: it right. It's just tricky, and maybe too many opinions
Speaker 3: is bad. I mean, it's hard to get six people
Speaker 3: to agree on anything. So I've had people see six surgeons. Yeah,
Speaker 3: the plant's not going to be the same from all
Speaker 3: of them, But that second opinion's pretty reasonable. I think
Speaker 3: that sometimes people will ask questions about their surgery and
Speaker 3: things but it's fair to ask, you know, how many
Speaker 3: times have you done this before or how regularly do
Speaker 3: you perform this surgery? Right there is someone out in
Speaker 3: the valley that says they do complex brain, complex, spine, complex,
Speaker 3: baskular surgery, all of those things that one person, and
Speaker 3: they're not attached to a big hospital. But I think
Speaker 3: that some people that's suspicious and some people they don't
Speaker 3: really pick up on that, right, Like at our academic
Speaker 3: medical center. Those are three different people. Yeah, nobody can
Speaker 3: do all that, but I don't think everyone picks up
Speaker 3: on this stuff.
Speaker 1: That would that would be a red flag for me.
Speaker 3: Yeah, well, you're smart about this stuff.
Speaker 2: I know that.
Speaker 1: You know, you follow up with me and you will
Speaker 1: call me and you will text me and say you know, hey,
Speaker 1: I you know this was the result in your MRI,
Speaker 1: and I think we need to do this and this
Speaker 1: and this, and you know you're you're definitely not shy
Speaker 1: about putting your opinion out there. But do you which
Speaker 1: I deeply appreciate, by the way, I want to say,
Speaker 1: thank you, You're welcome. Do you have a lot of
Speaker 1: hope for the future of cancer treatment?
Speaker 3: I do? I mean I think that a lot of
Speaker 3: our different techniques are getting better over time. I mean,
Speaker 3: surgeries are getting a little bit less invasive, a little
Speaker 3: bit risk less risk, and we're kind of balancing better
Speaker 3: who we take to surgery and what we do. I
Speaker 3: think there's a lot of an older philosophy in medicine
Speaker 3: of the MRI has to look perfect. But once in
Speaker 3: a while, if the m RY looks perfect and the
Speaker 3: patient's doing a lot worse, are we're really accomplishing the
Speaker 3: right task. Now that we have more and more treatments
Speaker 3: for whatever kind of pocket of cells we have, and
Speaker 3: clearly the whole idea of chemotherapy, targeted therapy, immunotherapy is
Speaker 3: all changing dramatically. We have agents coming up, you know,
Speaker 3: fast and faster and things that didn't exist before. So
Speaker 3: I think there's a lot of hope. I mean, it's
Speaker 3: hard to really search for that elusive cure because the
Speaker 3: cure implies also like one treatment fits all, and all
Speaker 3: these cancer are a little different, and all these molecular
Speaker 3: signature is a little different. But there are more and people,
Speaker 3: more and more people going into a long term remission.
Speaker 3: The difference with the word remission being disease is quiet.
Speaker 3: We're still watching we shouldn't be so arrogant to say
Speaker 3: you're fine, you can go live your life. But you know,
Speaker 3: we hope you get more and more people to the
Speaker 3: point where they can come off therapies and just be watched.
Speaker 1: Yeah, it's you know, it's very interesting. I have so
Speaker 1: many people that happened recently where everybody tells me that, oh,
Speaker 1: there's this place and they're curing, and then they're curing
Speaker 1: cancer and they don't take insurance.
Speaker 2: But it's amazing.
Speaker 1: And then you when you start delving into some of
Speaker 1: them are just scams and the others are their results
Speaker 1: are are favorable for a completely different cancer. Yeah, and
Speaker 1: you're like, well, okay, I get that maybe they helped
Speaker 1: this person with pancreatic cancer, but my cancer is different.
Speaker 1: So that three phase targeted therapy that this person has
Speaker 1: all of a sudden come up with may not actually
Speaker 1: do a thing on me. Or you know, like immunotherapy
Speaker 1: doesn't work on my particular cancer as of right now
Speaker 1: because of the negative positive all of that stuff that
Speaker 1: I'm still not ever clear on.
Speaker 3: It's tricky, it is.
Speaker 1: It's really tricky. People always ask me which which kind
Speaker 1: of have and I'm.
Speaker 3: Like, I.
Speaker 1: Don't know. I'll put you on the phone with my doctor.
Speaker 1: He'll explain it better than better than me.
Speaker 2: All right, well are you going? Do you have to
Speaker 2: go to the hospital.
Speaker 3: Now, I should go to the hospital. Have patience to
Speaker 3: see later, yeah, jack Ob Yeah.
Speaker 2: All right, Well, thank you.
Speaker 1: I honestly am really happy that I met you and
Speaker 1: that based off of that Zoom meeting, you've filled me
Speaker 1: with as much confidence as I was ever going to
Speaker 1: have going into that surgery, and that you didn't overcomplicate
Speaker 1: it for me, because it's way more fun finding everything.
Speaker 3: Out now, it's way more fun.
Speaker 2: Dodgor two, thank you so much for being here.
Speaker 3: Thank you very much, great to be here.
Speaker 1: All right, guys, that is the wonderful, amazing doctor Rachel
Speaker 1: at Cedar SINAI.
Speaker 2: I don't know.
Speaker 1: If you've got anything going on with the brain, Please
Speaker 1: go to doctor two if you can get into him,
Speaker 1: he's wonderful. If not, I'm sure they have amazing recommendations.
Speaker 1: And I hope that I hope that we were able
Speaker 1: to either soothe or answer questions that anybody had and
Speaker 1: always feel free to go in the Let's Be Clear Pod,
Speaker 1: Instagram and send me questions because I have no fear
Speaker 1: about harassing this incredibly busy man with text messages to
Speaker 1: try to answer some questions.
Speaker 2: You don't mind that, do you.
Speaker 3: You don't mind at all. You don't do that enough.
Speaker 3: You don't play the brain Turmor card. Actually made one,
Speaker 3: though I'm not promising he's gonna get you out of tickets.
Speaker 2: But no, oh, keep doing well. I'm here for you.
Speaker 2: This is unbelievable. I'm pulling this card.
Speaker 3: You should plug.
Speaker 2: I should pull it, do you know?
Speaker 1: I I'm very odd about telling people who are listening
Speaker 1: in when I pull a cancer card, because some people
Speaker 1: are like they get upset about it. But I do
Speaker 1: remember I was at this very busy kind of when
Speaker 1: everything first started going on with me, and it's when
Speaker 1: things progressed and gotten to stage four, and I was
Speaker 1: trying to find a way to come to terms with
Speaker 1: it and to have a sense of humor. And as
Speaker 1: this wonderful woman Jan recently said to me, she said,
Speaker 1: you seem like you are holding hands with cancer and
Speaker 1: it's an interesting way to go through your journey with it.
Speaker 1: And I guess I was holding hands with humor and cancer.
Speaker 2: And we went to this restaurant in.
Speaker 1: Santa Monica called Wally's and they were packed, but they
Speaker 1: have this dish there with truffles and I just.
Speaker 2: Was craving it.
Speaker 1: And we sat down and I think it took the
Speaker 1: waiter a really long time to come over.
Speaker 2: They were packed, so I was totally understanding.
Speaker 1: But then he stopped by and he said, and they
Speaker 1: know who I am there because I've been there a
Speaker 1: bunch and it was all in the press about, you know,
Speaker 1: going to stage four. And he said, I'm so sorry,
Speaker 1: we're so slammed, but I'm going to get right to you.
Speaker 1: And I said, it's okay, it's not like I you know,
Speaker 1: I'm on a time schedule or anything with cancer.
Speaker 3: Oh man.
Speaker 1: And he stopped and he looked at me and I
Speaker 1: started laughing and I went.
Speaker 2: I'm so sorry. I didn't mean that. I'm just playing
Speaker 2: with you.
Speaker 3: And he goes, oh my god, I'll take your order.
Speaker 1: Right now, and I'm no, no, no, no, no, I'd be
Speaker 1: mad if you took my order. Like I'm just trying
Speaker 1: to find the humor. I'm trying to figure out how
Speaker 1: to make it normal from me, where where I can
Speaker 1: make jokes, and maybe the jokes is I know it's
Speaker 1: to help me and relax my anxiety about having cancer.
Speaker 1: But it's also to relax other people's anxiety who just
Speaker 1: read stuff randomly about me and then see me and
Speaker 1: they're like, oh, you know, like this weekend, I was
Speaker 1: at this amazing event. People are like, oh my god,
Speaker 1: you look so good. Now I know what I look
Speaker 1: like compared to what I used to look like.
Speaker 2: You know. So I know that a large.
Speaker 1: Group of people assume that once you start getting to
Speaker 1: my stage of cancer, they really start deteriorating way fast.
Speaker 1: So my brand of humor and sometimes mentioning cancer is
Speaker 1: to also make them feel a little bit more comfortable
Speaker 1: with it so that people don't tiptoe around me. And
Speaker 1: once I start being self deprecating about myself and about cancer,
Speaker 1: I feel as if that wall has been taken down
Speaker 1: and now everybody can just go on in a normal way.
Speaker 2: So instead of doing the cancer card, I actually prefer
Speaker 2: the brain. It's different, it is different, and it's far better.
Speaker 2: I'm into this card. So thank you, thank you.
Speaker 1: All right, I'm gonna let you go to work. Thank you,
Speaker 1: doctor Chu, and thank you everybody for tuning into let's
Speaker 1: be clear. Rishanna adorerty to see you next time,