1:06

Hello everybody , welcome to

1:09

the second part of our

1:11

podcast episode about

1:13

Brad's and my

1:16

discussion about our initial cancer

1:19

treatment phase . The previous episode

1:21

we talked a lot about my cancer

1:23

treatment and some philosophical

1:26

conversations , and now we

1:28

will start right off by

1:30

talking with Brad about

1:32

his story . So

1:35

let's go , Brad , your turn .

1:38

Yeah , no problem . Okay , I

1:40

will launch into my story because

1:42

I was treated . Once I was finally

1:44

a diagnosed

1:46

and then admitted to the hospital with

1:49

the hemoptysis coughing

1:51

up lots of blood from

1:53

the burst cancerous tumor in my left

1:55

lung , I was treated extremely aggressively

1:58

with a bolus

2:00

of chemo drugs . It

2:02

took , I don't know , maybe two

2:04

or four days for them to finally figure out what was going

2:06

on . But they realized

2:09

that the cancer they thought was

2:11

indolent and more

2:13

or less confined to my skin or

2:15

just underneath it , had

2:17

been sneaky and gotten into one of my organs

2:20

and had poked a hole in

2:22

my left lung . So they hit me with a bolus

2:24

of chemo drugs

2:27

. I think they called it CHOP

2:29

.

2:30

And .

2:30

I forget what all is in there .

2:32

You may have a better idea than I do at

2:34

this point , but I think there was cycloph

2:38

and oncovin or something like

2:40

that , and maybe a couple

2:42

of other things too yes

2:44

, chop capital

2:46

c , capital capital O

2:49

, and capital P stands

2:51

for agents cyclophosphamide

2:53

or cytoxan , doxorubicin

2:57

or adriamycin , vincristin

3:00

, which used

3:02

to be called oncovin , and

3:05

a steroid

3:07

to P is prednisolone .

3:09

Okay , yeah , and then so

3:11

that really knocked me for

3:13

a loop . What happened was that

3:15

my left lung basically completely collapsed

3:17

, partly due to the

3:20

hole in it because of the cancerous tumor

3:22

, but in a way , the cancer had been the only thing

3:24

keeping my lung together at

3:26

that point , it would seem so

3:28

. When the cancer receded , I

3:30

was coughing up all of those dead

3:33

cells that had been

3:35

in my lung that were killed , I

3:37

suppose , by the chemo and drugs . I

3:40

was having great difficulty breathing , I

3:42

was coughing a lot and

3:45

had to be on an oxygen tube

3:49

, and ended up staying in the hospital

3:51

for 19 days after I

3:53

was admitted in the cancer ward

3:55

. It was quite yeah , it was

3:57

a very aggressive form of

4:00

treatment , because they realized , in

4:02

a way , maybe they overreacted in some

4:04

sense and didn't take

4:06

into account what the blast

4:09

of chemo that they were giving

4:11

me would actually do . But

4:13

I don't know , maybe that was exactly

4:16

what was needed at that time . Since I survived

4:18

, I've just kind of accepted the

4:20

aggressiveness of that initial treatment as

4:23

okay , that's how it had to

4:25

be right . Once they realized

4:28

that the cancer was much more insidious , and

4:30

indeed life-threatening , than they had first

4:32

thought it to be , they

4:34

felt like the best thing to do was

4:37

finally to treat this thing before

4:40

it invades any other vital

4:42

organs . Let's say , but

4:45

yeah , in the process I was super

4:47

sick and in the hospital for

4:49

quite some time .

4:51

I wondered Brad , two things

4:53

. One is , for somebody who has never

4:55

really been sick , being

4:57

in the hospital for three weeks the

5:00

first time around with major

5:02

health issues was probably super

5:04

duper scary . And

5:07

the second comment is

5:09

I wonder if another

5:11

reason why I wanted you to be treated

5:13

the first time as an inpatient is

5:16

because of the tumor lysis occurrence

5:19

, which is the

5:21

heavy duty chemotherapy

5:23

needed to treat the tumor , is killing

5:26

the cancer cells so quickly

5:28

that those cancer

5:31

cells die and release

5:33

all that toxin in

5:35

your system which

5:37

we need to support you with , to

5:40

help you , as you said in your poem

5:43

, piss out your chemotherapy

5:46

but also your debris

5:49

from the cancer cells if that make

5:51

sense , and the electrolyte

5:54

abnormalities and organ damage that

5:56

could occur from that . they had to support

5:58

you through that . They've been monitoring your

6:01

blood volumes and

6:03

your ins and outs , fluid-wise , etc

6:05

.

6:07

That was my impression at the time . It was like , oh

6:09

yeah , I absolutely need to stay in the

6:11

hospital after they hit me with that

6:13

bolus of chemo Although

6:15

I will say that the hospitalist at

6:18

the time was European and

6:21

he said I'm in Europe , you might

6:23

just have been sent home after

6:25

that and recover there , just fine

6:27

. I was like , ok , maybe , but here

6:30

we are in North America , so that information

6:32

doesn't help me at all . But now I wonder

6:34

maybe he was onto something . But

6:37

yeah , I I do think I was in

6:39

pretty rough shape , I

6:41

gotta say . And yeah , it was overwhelming

6:44

to feel like , yeah

6:47

, everything in my body had suddenly just

6:49

changed in a way that I couldn't

6:51

really understand and had a hard time

6:53

accepting . I was

6:55

in a lot of pain . I

6:58

was coughing up a lot of gray

7:01

junk from my

7:03

lung that was those dead

7:05

cells that you're talking about about

7:14

as well as peeing bright red urine into the tankard very copiously and

7:16

simultaneously horrendously constipated from all the painkillers

7:19

I was on . It was

7:21

quite something , it was a

7:24

real . I was plunged

7:26

into cancer treatment at the deep end

7:28

, I'll just put it that way . And

7:30

yeah , I didn't know if I would survive even

7:33

that initial blast

7:36

. By and large . Yeah , I

7:38

came out of it okay . There was some question

7:40

of what to do with my left lung , that

7:43

there was a possibility that

7:45

they might want to drain the fluid , sort

7:48

of surgically , like put in a

7:50

drainage tube into my body somewhere

7:52

. But the people from internal

7:55

medicine came and had a look at me and

7:57

they said , no , you're not in

7:59

good enough shape for us to do that . You

8:01

know , my immune system had kind of taken a hit

8:04

. I suppose they

8:06

thought that an opportunistic infection

8:08

might really give me a lot of damage , that

8:11

an opportunistic infection might really do me a lot

8:13

of damage . The

8:16

pulmonologist at the time said that the

8:18

best thing to do is just to try to let the left lung

8:20

reinflate itself slowly . I

8:23

did a lot of breathing exercises

8:25

, breathing into a device

8:27

that measured how much air I could emit

8:31

, the force in which I was able to breathe out

8:33

.

8:34

Was that an incentive aerometer

8:36

?

8:39

Maybe . So there were a lot of

8:41

devices deployed

8:44

to figure that out and actually later on that

8:46

became really important . Going in for the stem

8:48

cell transplant was whether

8:50

my lung had properly re-inflated

8:53

and had resumed its functions

8:55

, and thankfully it had . I have no

8:57

, from what I can tell

8:59

, I have no residual lung damage

9:02

from that whole event

9:04

. So I think my pulmonologist

9:06

was very wise to say

9:08

yeah , we're not going to . There's

9:10

no magic bullet here . To use another favorite

9:13

American saying in

9:15

medical terms , there's no silver

9:18

bullet or what have you . It's just like your

9:20

lung will want to heal itself , whether you

9:22

believe it or not . You

9:25

need to help it in certain ways by trying your

9:27

best to like walk around , get some exercise

9:29

, learn how to breathe

9:32

again , and I was functioning

9:34

with one lung for a while

9:36

and I did need oxygen , even when they sent

9:38

me home after those

9:40

19 days . But

9:43

yeah , he was right , and

9:45

so my left lung was just fine as far as anyone

9:48

could tell . And it was funny because my medical

9:50

teams were sort of blaming each other

9:52

for that lung

9:54

disaster before they knew what was going

9:56

on . My oncologist thought

9:58

that my pulmonologist had

10:01

actually punctured a hole in my lung when they

10:03

did the bronchoscopy Just

10:06

before my tumor burst

10:08

. They wanted to find out

10:10

what was causing the opacity in my left lung

10:12

and why I was

10:14

coughing so much . So they sent a bronchoscope

10:17

down into my lung to have a look at things

10:19

and they didn't find anything , because your lungs are apparently

10:22

just a labyrinth where

10:24

it's actually very hard to locate like

10:26

a single tumor , even though it's pretty big . And

10:29

they weren't even looking for a tumor anyway . They

10:31

just had no idea what it was about . So

10:34

they were blaming each other , the oncologists

10:36

were blaming the pulmonologists

10:38

, and the pulmonologist said he has cancer , maybe

10:40

you should have treated that , and

10:43

I guess the pulmonologists were right . So

10:45

anyway , that was the first dose

10:48

of chemotherapy that I got

10:50

in the hospital with a burst

10:52

lung tumor and

10:55

they let me recover from that at

10:57

home for a while . It took a while for

10:59

me to get into shape

11:01

again to

11:03

go back in because they knew my cancer was still

11:05

there . But

11:08

I'll pause . You look like you have a question coming

11:10

.

11:11

Yeah , how do you know ? There's

11:14

a few things going through my head . One is

11:16

you were exercising quite a bit

11:18

, and I think

11:20

that may have done a great

11:23

benefit to your body , because you went

11:25

into this , relatively

11:27

speaking , as fit as you can

11:29

.

11:30

Yeah .

11:31

I think that may have helped

11:33

you to tolerate the setback you

11:35

had .

11:36

Yeah , it certainly made good that I stopped smoking

11:38

10 years or so before all of this

11:40

happened . Yeah , I smoked

11:42

as a teenager . I

11:45

always thought , oh , maybe my cancer because

11:47

I used to smoke . But nobody

11:49

made that connection and I wasn't one cancer

11:51

anyways . But yeah , I was kind of

11:53

in the best shape of my life as cancer

11:55

was forming in my body . It was almost as

11:57

if I was in training to

12:00

survive cancer . I didn't know it

12:02

at the time , but it's almost as if that

12:04

was happening .

12:05

Isn't that weird how things work out that

12:07

way . Sometimes in hindsight , you

12:10

wonder if , at some deeper level

12:12

, you sort of knew that

12:15

this is what you had to do yeah

12:17

, I think it's .

12:19

I think it's definitely an open question . I mean , what

12:21

had happened in my personal

12:23

and professional life at that point was

12:25

I had kind of because I was in

12:27

a very stressful job . I I was chair

12:29

of the English department at

12:33

Sacramento State University for three years

12:35

and I kind of let my health slide

12:37

. I was eating too

12:39

much , I was drinking too much coffee , I

12:42

was drinking too much alcohol as

12:44

well , and so I really

12:46

, yeah , I kind of let myself become

12:49

less healthy . I was exercising

12:51

during that period , but not as much as I

12:53

was when I finally got

12:55

relieved of my duties as chair

12:57

or where I declined to stand

13:00

for reelection I'll put it that way Because

13:02

the job had been really awful , stressful

13:04

and frustrating and all kinds

13:07

of difficult . So after

13:09

that I was like , okay , I need to get

13:11

myself in better shape , because I really , because

13:13

of the job pressures , I ignored

13:16

my physical well-being for three

13:18

years essentially . So

13:21

I threw myself into that as a reaction

13:23

to the three-year

13:25

period of having to go to all these

13:27

committee meetings with HR

13:30

and all the other nonsense that goes with

13:32

campus leadership position . But

13:34

yeah , maybe on some deeper level I

13:37

thought my body thought run

13:39

for your life run Forrest , run Forrest

13:41

, go movie , something

13:45

along those lines . But

13:47

in my mind I did have a

13:49

good reason for getting it , cancer

13:52

notwithstanding .

13:54

But that's also a change . In the

13:56

field of oncology they call it pre-em

13:59

. Most of us are familiar with the fact

14:01

that rehabilitation after treatment

14:04

can help and they're moving up more

14:06

and more to during treatment

14:09

for those who are , like weeks , admitted

14:11

for a stem cell transplant as

14:13

well as before the treatment

14:15

starts , to optimize your body , your

14:18

system , to be able to withstand

14:20

and tolerate yeah and

14:23

hopefully build up some reserve before

14:26

the treatment starts , which is a

14:28

very interesting . We used to say

14:30

, when you're undergoing treatment , to stay in bed . Those

14:33

stem cell transplant patients just rest

14:35

. Also , how was it for

14:37

you to see the chemo bags

14:39

coming into the room and just see them

14:41

being ? Some

14:44

people have a very visual

14:46

of how it's flowing through your bloodstream

14:49

very visual of how it's flowing through your bloodstream

14:51

, and so I don't know if you remember

14:53

that moment . For

14:56

many people , that's a moment that they'll never

14:58

forget .

15:05

And other people . It's like I've repressed it or

15:07

I don't remember . I

15:10

don't really remember it . In that first 19-day stay particularly

15:13

, I was hooked up to an IV anyway , because

15:16

they needed to pump

15:19

fluids into me , so

15:21

I was hooked up to something . What they eventually

15:23

did , though , is they had to place a catheter

15:26

, a PICC line , in my arm , so

15:28

that was my first kind of initiation

15:30

really into into chemotherapy

15:33

. They placed a PICC line in my arm

15:35

, and it was one

15:38

of my least favorite experiences I've ever

15:40

had . I was there fully

15:42

conscious while the nurse installed this

15:44

thing , and , yeah

15:46

, my wife was there and she read the comic

15:49

british fiction to me while I suffered

15:52

through this little mini ordeal wait

15:55

, brad , because some might not know what

15:57

a pick line is .

15:59

a pick line p , I , c

16:01

, c is a peripherally inserted

16:03

central catheter

16:06

that some people

16:08

need to use if

16:11

the fluids that get

16:13

infused through it are too

16:15

toxic for the small peripheral

16:17

veins and or

16:19

the small peripheral veins

16:21

are not easily accessible

16:24

anymore due to

16:26

previous chemotherapy

16:30

or diseases that affect

16:32

the ability to catalyze

16:35

. A big line is a sort of central

16:37

line that continues

16:39

to have a piece hanging outside

16:41

of your body . It's not hidden

16:44

. You can shower with it , you can

16:46

swim with it .

16:48

Yeah , I was hooked up to an

16:51

IV with liquids in it for quite

16:53

some time and so when the chemo drugs finally

16:55

came I was just good , let's

16:57

go Like , are you

16:59

finally going to treat this cancer buddy , like

17:02

I was . By that point I was a little

17:04

frustrated with my initial

17:06

oncologist who had incorrectly

17:09

assumed that the cancer was very

17:11

slow moving and not especially

17:14

threatening . So , yeah

17:16

, I didn't have really strong feelings

17:18

about the chemo itself when it

17:20

started . I will say that

17:22

, yeah , later on I

17:24

actually

17:27

kind of enjoyed the

17:29

later chemotherapy sessions . The

17:32

first one was so bad and

17:34

I had so many unpleasant side

17:37

effects of being hammered with this huge bolus

17:39

of chemo that going back in

17:42

for the second one was psychologically

17:44

challenging . But it was a breeze actually

17:47

Compared to the first one . The second

17:49

one was like I don't know , getting

17:52

a nice infusion

17:55

of new blood or something

17:57

. It was completely benign

17:59

and these treatments were

18:01

basically I was in the hospital for four

18:04

nights consecutively

18:07

and they would infuse me with various

18:09

things for various lengths of time and

18:12

then I'd go home and

18:14

I was neutropenic for part of that time

18:16

at home so I could socialize

18:19

, didn't go into restaurants and so forth , but

18:21

but yeah , it soon became kind

18:23

of a routine where I would bring my computer

18:25

into the hospital . I had

18:28

a writing academic project

18:30

that I was hammering away on , so

18:32

I'd bring books , I'd bring music

18:35

, I'd have stuff to entertain

18:37

me , and it became

18:39

a little bit of a yeah

18:41

, almost like a nice little spa

18:43

vacation in the cancer ward

18:46

by the end of that summer of chemo

18:48

met in the cancer ward by the end of

18:50

that summer of chemo , Some

18:53

patients would actually literally come in their suitcases

18:55

all kinds of stuff keep themselves

18:57

comfortable and entertained .

19:00

Interesting to see once they learn

19:02

what they really need in the room . The

19:05

story also aligns with the

19:08

tumor lysis that you read . When the tumor lysis theory , when

19:10

the tumor bulk is the biggest in

19:12

the beginning , the tumor lysis

19:15

phenomenon and the related side effects

19:18

are also the worst , and

19:20

so the fact that your next treatments were

19:23

better tolerated goes along

19:25

with the theory that your tumor bulk is decreasing

19:28

. Goes along with the theory , and it can . Tumor bulk is decreasing

19:30

, so you're mostly dealing with this

19:33

and the side effects of chemo itself

19:35

.

19:36

Yeah , which by

19:38

my sixth cycle , sixth

19:41

and final cycle in that summer

19:43

, I didn't notice many

19:45

side effects at all . I will say

19:47

that as my left lung reinflated

19:50

, I did start to become more active again and

19:53

I even played soccer two more times

19:55

before I realized that running

19:57

was going to be challenging because my joints

19:59

started to really hurt and to this

20:02

day I still can't really run the

20:04

way I used to . I bike , I walk

20:06

, but sort of the impact on my knees

20:08

in particular of running is too , is

20:11

too painful these days , and I gather

20:13

that chemotherapy has something to do with that , that

20:16

it somehow robbed my joints

20:18

of some of their strength . I don't know exactly

20:20

how to put it , but

20:23

that's just my experience of things . So I

20:25

had to shift the way I exercised . So

20:28

I had to shift the way I exercised . So , yeah , I now

20:30

ride my bike or do stationary

20:32

bike riding , take

20:35

short walks fairly

20:37

frequently and lift very light

20:39

weights . But yeah , I still

20:41

feel really invested

20:44

in my modest exercise

20:46

routine that

20:51

I kind of hit upon as I transitioned out of that summer of chemo into the transplant

20:54

mentality . But we'll deal with that

20:56

in a later episode .

20:59

Yes , we will . I like your

21:01

observation

21:03

, and maybe one

21:05

possible explanation for

21:08

the fact that you have

21:10

more pain with

21:13

running and so you had to change your exercise

21:15

regimen is that cancer

21:17

treatments , in particular chemotherapy

21:19

, can accelerate your

21:22

aging process

21:24

and potentially

21:27

maybe it can accelerate your osteoarthritic

21:30

disease

21:33

process . Running really

21:35

puts a strain on

21:37

your knees and your ankles

21:40

, your joints and people with osteoarthritis

21:43

really have a hard time running

21:46

. And so it's interesting that you changed

21:48

your physical activity

21:51

level to offload

21:53

your joints . So that's an interesting

21:55

observation . I think you're very observant

21:58

of your bodily changes .

22:00

I mean , it was pretty clear I love

22:02

playing soccer and I played it for my

22:05

whole life . Basically , I played one great final game

22:07

where I felt great , and then the next week I came back and I was like , oh yeah , I played one great final game where I felt

22:09

great , and then next week I came back and I was

22:11

like , oh no , I can't do this

22:13

at all . And that was

22:16

that Because I would have kept going , for

22:18

sure if I'd been able to , but

22:20

it was just too painful .

22:22

But you're very creative . I

22:24

think you go on .

22:26

Yeah , I feel better with a

22:28

modest but regular

22:30

exercise regimen . Yeah

22:33

, I have adapted . I've had

22:35

to adapt .

22:38

And maybe this is a plug for me to add

22:40

for individuals who've never exercised

22:42

before but would like to exercise

22:45

, or those who have exercised before but

22:47

are now , after cancer treatment

22:49

, concerned about how

22:51

to resume exercise in a safe

22:53

way . Please discuss that

22:56

with your healthcare providers . There are different

22:58

ways to be supported through

23:00

this the physical therapist

23:02

, the personal trainer , exercise

23:05

physiologists , summer cover , insurance

23:09

. Don't hesitate to ask

23:11

for help . Brad , did

23:13

you tell us how many cycles of

23:15

that inpatient chemotherapy you got

23:17

for urinary treatments ?

23:20

Six .

23:21

Six Okay .

23:26

Yeah , so that was every three weeks . Yeah , I think

23:28

it was after the initial treatment and the kind

23:30

of semi-catastrophic side effects

23:32

. We waited longer than that , but , yeah

23:34

, once I went back in for my second one

23:37

and it was tolerable , then

23:39

, yeah , I was in every three weeks for that four-day

23:42

stay in the hospital and they

23:44

were prepping me for at that point was

23:46

supposed to be an autologous stem

23:48

cell transplant where I'd be my own donor . But

23:52

and maybe this is a way of looping back

23:54

to our earlier discussions

23:56

the aggressive chemotherapy they gave me

23:58

seemed to make my

24:00

slow-moving cancer come back really

24:03

fast which it did and

24:05

so I was suddenly no longer a candidate

24:08

for the autologous stem

24:10

cell transplant and I needed a donor

24:12

in a big hurry . So , yeah , they

24:15

did not knock my cancer into any

24:17

type of lasting remission .

24:20

But then , by the way , this whole ordeal and six

24:23

cycles every three weeks or so

24:25

it's almost six months

24:27

ongoing . That

24:29

put a big number in your life , your family

24:32

life , your personal life your work , life

24:34

I mean everything Be a

24:37

doctor , thank you .

24:39

I mean , my job was such that , as

24:41

it happened , I was on sabbatical when

24:43

I was diagnosed . Wow , after

24:45

12 years of teaching , I finally got the

24:48

sabbatical .

24:49

You got your treatment during your sabbatical

24:51

.

24:52

Yep .

24:53

Oh my , isn't it creepy how that

24:55

all worked out . Yeah , but

24:58

you wonder if there's some higher

25:01

power who was trying to protect you

25:03

, or a subconscious

25:05

effort on your behalf . Wow

25:07

.

25:08

Yeah , if I'd gotten my sabbatical in my seventh

25:10

year , as you're supposed to . That's what sabbatical

25:13

means , right ? The thing you get every seven

25:15

years .

25:16

Yeah .

25:17

I wouldn't have been in that situation . But at

25:19

a California State School you're lucky to get any

25:22

kind of sabbatical at all . But

25:24

yeah , I was writing a research project

25:26

that eventually was published like

25:28

nine years later . But yeah

25:31

, so since I wasn't teaching that

25:33

semester , I made cancer my full-time

25:35

job . Even before I

25:38

was treated I was writing a way

25:40

to say are there any clinical trials

25:42

out there for my first

25:44

cancer ? There didn't seem to be any . But

25:48

yeah , I was fortunate . I mean I never

25:50

caught again . I had to retire early

25:52

because of all my medical problems . But

25:55

yeah , I'm glad I was on sabbatical

25:57

that semester because it was certainly

25:59

an all-consuming

26:01

struggle

26:03

. Once my tumor burst , we

26:06

had just entered into a whole new world

26:08

.

26:09

Yes , in terms of your burst

26:11

tumor , given

26:13

your diagnosis with an indolent lymphoma

26:17

of your skin . I just

26:19

had a random thought that

26:21

ties into our discussion

26:24

of earlier this episode or

26:26

maybe it was the prior episode about

26:28

clonal selection . Maybe

26:30

somehow your tumor

26:33

started mutating very early and

26:35

spontaneously , before

26:37

you started cancer treatment

26:40

, and develop some aggressive

26:42

clones that spread

26:44

to your lung .

26:46

Yeah , that's the big question , that no one

26:49

really knows what turned

26:51

my allegedly slow-moving

26:54

endocrine cancer into a malignant

26:56

, fast-moving cancer . No

26:59

one ever really explained it to me and the doctors

27:01

weren't going to say , oh yeah , all those chemo

27:03

treatments we gave you , they've

27:05

kind of just roused the cancer into

27:07

an even more menacing state . They wouldn't

27:10

quite cop to that and

27:12

I don't know that's necessarily what happened anyway

27:15

. But yeah , I

27:17

will underline again in this

27:19

episode how unusual

27:22

and rare my form of T-cell

27:24

non-Hodgkin's lymphoma was

27:26

. It didn't manifest in

27:28

any of the normal ways that they were

27:30

expecting and in

27:33

a way that's why I felt it was important

27:35

to switch oncologists . After

27:49

my first bolus of chemo , my wife met a woman at the gym whose

27:51

husband also had an extremely rare form of lymphoma and

27:59

they got to talking and so my wife heard about this different

28:01

oncologist at the same hospital

28:03

, by the way , but we switched

28:06

to him and he's been my oncologist ever since

28:08

. So in a way , yeah

28:14

, my cancer was unusual and certainly didn't present normally to start with , but at

28:16

least I got in to see the best person at that institution who could give me

28:18

, ultimately , I think , what was the best advice

28:20

for how to go forward with the treatments and

28:23

I got second opinions about

28:26

this at various times , but

28:29

none of the second opinions made me reevaluate

28:32

the care available at my home

28:34

institution . So I

28:36

was lucky to be living very close

28:38

to an excellent hospital , at the

28:41

first rate cancer

28:44

center and a stem cell transplant

28:46

program , so I

28:48

had pretty good wraparound care in that regard

28:50

. But yeah , my , my cancer was very

28:53

weird . Eventually

28:56

I met the husband of the woman my

28:58

wife had met and we sort

29:00

of chatted about our rare cancers and discussed

29:02

whether we should wear T-shirts saying

29:05

my cancer is more rare than your

29:07

cancer or something

29:09

like that .

29:11

Yes and

29:14

both . Beyond that , I think

29:16

every tumor has the potential to behave

29:18

in a very unique way that

29:20

might fall into patterns but still

29:22

is unique for one person . So

29:25

I think it always needs

29:27

that human , personalized touch

29:30

in terms of treatment decision-making . Artificial

29:33

intelligence may be able to enhance

29:36

treatment decision-making

29:38

, but I don't believe it can ever fully

29:40

replace it , but

29:43

that's a story for another day . Another thing to comment

29:45

on is that you went

29:48

to get multiple second opinions

29:51

. That's a topic on its own

29:53

. Perhaps also let us know in the comments

29:55

if you would like us to elaborate

29:58

. Not everybody has the

30:00

courage , opportunity , energy

30:02

and time to do so . Some

30:04

cancer treatments need urgent treatment

30:07

, not allowing fertility preservation either

30:09

. It can

30:12

be a whole ordeal to pursue

30:14

a second opinion to find

30:16

somebody who has your expertise

30:18

, somebody

30:23

who has your expertise , and to deal with the political implications If

30:25

you're seeing somebody in the same practice or

30:27

a competitor of

30:29

your current oncologist

30:31

. Please note , you're never obligated

30:34

to explain

30:36

why you're pursuing a

30:38

second opinion . Another dynamic

30:41

that comes into play is that you

30:43

need to find somebody with whom you click , somebody

30:45

you trust , because it's really

30:48

sort of a relationship that you need to grow

30:50

and foster , and

30:52

if a trust is not there

30:55

. It really impacts

30:57

everything , including your peace of mind

30:59

and comfort

31:01

about the treatment decisions you make

31:04

. Lastly

31:07

, I wanted to add something

31:09

about expectations . It

31:11

is becoming more and more common

31:13

that treatment

31:15

has been turned

31:18

into an algorithm , meaning

31:20

it's not so much that

31:22

you will get a total

31:25

different treatment approach if

31:27

you seek out opinion

31:29

, because cancer treatments

31:32

are evolving so quickly

31:34

. There are algorithms

31:36

set up at national level

31:38

that are constantly

31:40

reviewed by a

31:42

large panel of experts

31:45

to see if it needs to be updated

31:47

to allow all of us to

31:49

give the latest and greatest treatment

31:51

to our patients , even if

31:53

we don't necessarily have the

31:55

time to keep up with the

31:58

literature . In particular , this is the case

32:00

for community docs who treat

32:02

multiple different tumor types and may not

32:05

have the time

32:07

to delve into updating

32:09

themselves constantly on each specific

32:12

tumor type . These

32:14

algorithms have been set up to

32:17

prioritize survival prioritize

32:26

survival and , where survival is the same , agents will be prioritized that favor

32:29

tolerability and affordability . Furthermore , in terms

32:31

of expectations , it's important to look

32:33

at the relationship how you click with the

32:35

other doctor , as well as research

32:38

studies . Every cancer

32:43

center may have access to different types

32:46

of research studies , which you can

32:48

find online

32:51

in a website that I will put in the comments

32:53

clinicaltrialsgov

32:55

. That will allow you

32:57

to see if there's

33:00

any studies particular to

33:02

your situation that

33:04

may necessitate

33:06

you to travel elsewhere

33:08

. Wow

33:17

, brett , I think for today , maybe

33:19

this episode is enough . I

33:21

think we have a lot of thoughts

33:24

. I will put some links in

33:26

the description to expand

33:28

on some of the things we talked about here

33:30

, and then the next episode we

33:32

can continue to elaborate

33:35

on what we talked about today , maybe start

33:37

talking about the recurrences that both

33:39

you and I experienced

33:41

. What do you think ?

33:43

Brad Sounds good .

33:46

I'm very grateful for our discussion today

33:48

, Brad , and I'm sending you a big yeah

33:52

, no , these conversations have been fantastic

33:54

.

33:55

Your training and medical knowledge is extremely

33:58

interesting to me , as well as

34:00

your personal story . There's a lot to think about and a lot to talk about . I'm me as well as your personal story . So

34:03

there's a lot to think about and a lot to talk about

34:05

. I'm enjoying it as well .