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