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