Surgical Oncology (BREAST CANCER) with Donna-Marie Manasseh
Oh, hey, to you're brother-in-law who so much more chill since he stopped drinking and started making ceramics alley board and you're listening to another episode of all, jeez, so man, woman child, pumpkin, whoever you are, if you open this to listen to it, congratulations. You're not fearless. None of us are fearless, especially in the face of really scary stuff, but you are empowered and curious, and quite frankly, a responsible person. I don't care how many water bottles you have in your car or that you said jeans through the wash with gum in the pocket. You're on it. You're about get so informed. And I haven't great news. This episode is uplifting as it really as the vote is so good that I'm bleeping the cuss words so that you'll make sure to send it to your moms and daughters and brothers. Maybe it'll show your uncle how to work the podcast app because breast cancer affects. All we might be at risk for it. We might love people who are and this all gist is amazing. She made me feel so much less scared and more hopeful and more empowered. But before we hop into it just some nuts and a couple of bolts. Okay. Thank you to everyone who donates to the patriots dot com. Allergies page, which helps me pain editor and lets me prioritize making these episodes every week and thanks to everyone who gets themselves some goods at all. Ogies merch dot com. There's hats and pins and shirts. There's backpacks and thank you for telling friends about it either in person, maybe over a game of pinochle or online every time you tag all Gs in tweet or Graham. I'm so happy to see the word spreads. So thank you for that. And thank you for rating and subscribing that keeps allergies up in the charts, which delights me not only because I'm a petty baby who's. Happy that this type dream didn't fail, but also because that's just how more people discover it, which means they discover these all adjusts and these cool science stories. And you know I'm a creep, I read your reviews every single one of them every week. And I present a just plucked one from the review patch of itunes. So this week I wanna shout out a couple of people. So thank you too. Dear g seventy two who says that they imagined that I'm really ferry flying around the country in order to sprinkle knowledge dust. I like that I'm into the visual. I like the vibe, Sarah stabler k. also thank you for your review, which started look mom here on a podcast kind of. So I did want to show you offer that. Okay, so thank you to everyone who left reviews. I read each and every one of them this week. Thank you. Okay. Surgical oncology, two words, what do they mean? It means being a tumor hunter and it's bad ass. So surgery comes from the ancient Greek for handwork who. New and college also, Greek is derived from tumor or mass. So this surgical oncologist is the chief of breast cancer surgery at my monitors, medical centers, breast center in the borough park neighborhood of Brooklyn, New York. I don't know my way around Brooklyn, but I thought if you're on the east coast, that would mean something to you, but she graduated from Harvard Medical School. She's been working in this field for twenty two years. She is in word a boss. So I happen to be New York, and I got myself there with my little recording kit. And I let the nurses in the waiting room know that I was there to see this doctor. And as I took a seat next to this tidy stack of magazines and started leafing through them a patient and her husband were leaving the office and he was carrying this folder of paperwork, and we made eye contact and she gave me kind of a sympathetic smile. And it was the first of many times. I tried not to cry during this. I had litter. Really not even gotten past the waiting room door to interview this doctor. So I have never had breast cancer. I've never had a scare and I know women, my age and younger who have been diagnosed tube treated who are marching on and we all see the October breast cancer awareness marketing. And I wanted to talk to someone who does this all twelve months out of the year to learn about her life and her work. She's passionate, she's inspiring. She so so funny. She's not only approachable as this like sparkling, amazing human, but she makes it very scary topic approachable to we talked about boobs and boobs touched on boobs. Also heads up the term women is used a lot to discuss breast cancer patients. But of course, breast cancer happens to men to non binary patients, trans patients as well, and we talk about that too. So you'll hear about different kinds of breast tissue who should get screened. Then genetics deodorants making your body less hospitable to the asshole tumors. And most importantly learn about why being your own advocate might save your life and others. So fling your bra or someone else's across the room and get cozy for a heartwarming boob, honking chat with surgical oncologist, Dr, Donna Marie, Manasseh. Now. So you have been a doctor, you are a surgical oncologist? Yes. Right. Yes, that's correct. So you deal with breast health and breast cancer matters of that nature. Everything breast at all times. All breasts read all the time. How did you, how did you choose this field of medicine. And how did you choose medicine in general? When did you know? Like pretty good doctor. So I'll start with when did I choose medicine? My father would tell you I was to to use AOL too. I will say I was about five still really early. Yeah. My father was a mechanic, a very good one. And I wanted to be a mechanic. My mother said, nail the human body was the next best thing, but I love working with my hands. I always had this guardian angel complex, you know, coming in and swooping in and trying to save someone. I wanted to do that with my hands. And so I think that's where my choice in being a doctor came in at about ten, my aunt head heart disease. So I thought about heart surgery for a very long time. All the heart things you can buy, try to eat up everything they had to do with the heart, but felt at about. I'd say the middle of my residency or. Actually slightly just before my residency, I spent time with a surgical in college is someone who deals with all types of cancer in the body. And I just felt that his connection with patients and just that relationship you have with a cancer. Patient was really special specifically breasts. Unfortunately, came to me because the woman who would have been my mother-in-law was diagnosed with breast cancer. During the time I was in research and I had a very, very close relationship with her and just felt that joined that time that about two weeks before she died. He came to me that that's what I should do, and I spoke to her about, and she's said, because exactly what you should do. Just to know when you hear that soft kind of sparkly chime. That denotes times during the interview that I thought I was going to lose it and start crying, but kept it together in front of the stranger breast surgeries, unique. Unlike other surgeries where you see a medical specialist, they send you to the surgeon and then after that, the sort of like you're fine. I'll see you later with breasts. It's a, it's a lifelong relationship. We are the ones after woman gets a mammogram. That kind of starts steering the ship. We have the individual have surgery. We recommend the medical colleges. We recommend the next steps. And even though the team effort is continuing of care that happens and is an attachment that happens between the surgeon and the patient that I think is very unique to breast surgery versus other types of surgery and with other kinds of cancers, is it monitored for the span of your life? Like breast cancer is breast cancer a little bit tricky that way it depends. So other cancers for the most part are monitored for a very long time depending on how earlier stage was depending if you're an early stage, you would be treated, and the expectation would be if everything is okay in five years, depending on the cancer that you would not need to follow up, things that are later stage. Unfortunately, that may spread. We want to keep a closer eye on for a longer period of time, and that's actually a good thing because it means that we can treat something. So before we die further, let's just had a quick. Segment. So please pretend that I'm wearing a beige nineteen eighty suit and a wide tie. And I'm talking into a game show microphone as I run through breast anatomy in like four seconds, so you may know them as the milk producing glands. They're the Lobule Buell's and there are about twenty to forty of them making up each lobe. How many lobes in abreast if you said that adult females have about fifteen to twenty you on a few more seconds of this segment. These are passages connecting the lobes and the nipple the ducks. Now lymphatic vessels help flush things out and fight infections. And that Strom, ah, is on deck as the fatty tissue and ligaments that surrounded all ya'll that okay, but we all know our breast is not just a collection of milk. Plumbing, breast is different. If you go into. The whole nature of breast is not just a physical thing. There's a whole social political background to breasts. Breasts have very different meaning than say your colon. And so I think because of that, there's a longer life long relationship even though for most breast cancers that are early stage after five years, you're pretty much okay. But most women don't want to break that bond because either they think we're their good luck charm or, you know, it's a very touchy subject. The breasts women identify their breasts very unique ways from sexual to feeding their children to I part of their identity in some way. It's kind of what makes us a woman versus a man in some respects to some people. And I think because of that relationship when you're taking care of that part of someone's body, they cling to you longer and feel, you know, just in case, let me just. You to see this person. So I think that's what makes it a little bit more unique. Do you think treating breast cancer or addressing breast cancer is different in America because of our cultural relation to the breast where it is breast are so sexualize like you can't show a female nipple on Instagram, but like you could show just dozens of male nipples, one picture, right. Do you do you think that hinders our helps away that you're able to do outreach in treatment? It's good question. I probably would say a little bit of both. I think that it helps because previously, in decades, a lot of women died from this disease because of the tremendous fear associated with what we did for women with breast cancer. Decades ago, we would remove an entire breast and disfigure a woman. Actually, today we have so many options for treating breast surgery rest cancer, including even if we do remove the breast, the reconstruction options are incredible. I always challenge my mail interns to tell me which one do they. Is really not, and they always get it wrong. Which is, which is I'm glad I have great plastic surgeons. But I think because how we see the breasts and on our way we are in this country. I think earlier decades. It was a hindrance. I think today because women are much more empowered and women are much more independent, not defying themselves just by that particular area. I think that it helps because we speak up a lot more. The reason breast cancer has so many options is because we've done so much research. The reason we've been able to do so much research is because we have so many advocacy groups that raise money for research, and the reason we have so many advocacy groups is because we are talking about breasts. We are not going to sit quiet and say in the corner, I don't want to deal with this. I don't want to dress this. We tend to pull the sisterhood together and say, I'm here if you need it, it's not a dirty little secret anymore. And in that vein, how important is. Getting the word out about self exams. So I'm big advocate of self exam fact when I do my my little outreach programs, I always make the following statement that if you look at the literature, it will tell you doing a monthly self exam is useless. It's not going to help you find anything. It's not gonna hasn't been proven to change survival, whether you do it or not. And I say from a common sense perspective, when you do a mammogram, you're not guaranteed because your mammograms negative that that until you're next mammogram happens that you'll have cancer. You can have a cancer anytime after that mammogram, and the only way you're gonna find it is if you actually examine yourself, I always tell women, self exam is very cheap. You could use your hand use somebody else's head. Don't really care who does it, don't care what you do it, but just haven't done because you will find something. In fact, people do come in that have felt something and will say, I just had a mammogram because mammograms are not made by God. Basically, they're not perfect. And so use all the tools that you have in. General for your health to try to diagnose things as earliest possible because cancer is best treated earlier. It is. And so if you do a mammogram, you feel something don't say mammogram was negative. I'm good. No, something's not right. And you only figure that out if you examine yourself, some women aren't comfortable with their breasts, and I say, get a spouse, get a girlfriend on here, get the dog. I don't care get somebody to examine you. And if they feel something is just off, see a healthcare provider and and hopefully will tell you it's nothing they ought to have an app for that. I think there should be enough. I'm I'm trying to work on the app but can't figure out the hands part of it. There's no hands on phones yet. I mean, like task rabbit, just come over, just come on over just pal page, and then let me know if you're late sending them urgency text message to me. He good. No, no. Can you break down some stats? Like, what are we at currently with how many people get breast cancer. You know what our survival rates like and also how is that changed since you started practicing? So if you look at the statistics, like the American Cancer Society puts out still over toward fifty thousand women per year diagnosed with breast cancer while in the US in the US. Unfortunately about forty thousand still die of the disease. It's tricky because what people don't recognize that breast cancer is made up of very different types of breast cancer. It's not just one type of breast cancer. There's a spectrum. So remember those different things that make up a boob. So different types of tumors can occur depending on the location in the breast. So a ductile carcinoma may start in docked and a lobby lobster carcinoma in a lobe, some have not spread to the surrounding breast tissue, but others called invasive have, which is why early detection is clutch. So how does this cancer even start though? Well, Dr monas- he is incredibly gifted at explaining things in understandable terms, and she's also it's deadly, hilarious. And so the incidents of breast cancer has increased more so because technology's better at picking up the smallest little detail. And in our bodies, they're probably cancer cells circulating all the time because remember a cancer cell is a normal cell that just went a little quirky immune system, you know, quirky funky. So just just a little wacky. So the police otherwise known as your immune system go around and take care of them when they don't take care of them or worse when those cells recruit the police to their side. So now you have dirty cops. Then the then the they take over and the cancer cells grow the not foreign invaders. They're actually your own cells. And so these cells as they circulate if they get destroyed great, if they don't, they grow. And so if we're picking up some of these cells that are actually really, really early like haven't figured out how to invade. But on a mammogram, they show up and on my biopsy, it shows up. Now I'm treating you as a cancer patient. Whereas before mammogram is believe it or not. Some of these we didn't pick up and may not have done anything so because of better awareness and early detection. We're seeing more cancer patients, but better prognosis for them if treated early. But the problem is, once we know about it, we don't know exactly which ones really will do something or which ones won't we're not there yet. I think we will get there, but. For now, we have to go with what we have, and we can't just assume somebody has something that's probably going to be an issue and God forbid something later. Right? Can you break down? Let's have lump one. Oh one. Okay. Boob lumps Yagi down because I know that you can have a fiber. You can have a sis- have a tumor like, and I know that there's probably a lot of confusion if people feel something like, what are we dealing with and how do you tell the difference in what should someone now? So the base basic rule number one is a few which I told my high school girls to do if you examine yourself regularly be familiar with your breasts, anything different than what you're used to feeling is a problem, a problem that needs to be investigated. There is no, this is exactly how cancer presents. There are many different ways it can present. Sometimes it presents with a lump or mass sometimes at lump or mass feels like what we think should be benign, but it's not big just because of the features of the cancer. Sometimes it presents with the breast being read and there's no mass sometime. It presents with the nipple being and anyone is usually an outy. Sometimes it doesn't present what anything at all. So I always tell women, the best thing to do is to be familiar with what you used to feeling like. And if the breasts just feels different and do it around the time of the middle of your cycle. So not because your breasts get lumpy during the cycle, but do the time when is the middle, you're more likely to feel if there's any kind of a change PS if you're ever like, why do by boobs hurt? Sometimes why we boobs, why? Okay. I just looked it up and they are in cahoots with your ovaries. Clearly they're making mischief. They're making hormones, so estrogens like, oh my God. Let's along these ducks. Let's have a baby and progesterone as like, hell, yes, I'm on board. I'm going to increase the number and size of these lobby oils so we can get ready to feed this baby. We're going to have an after AVI relation. Progesterone is ready to party, makes blood vessels and large fill with blue. Did these things are engorged their tender, swollen ovaries or like, do you love this? And you're like, no. I'm literally studying abroad in Portugal for a year. I'm not having a baby maybe ever. Definitely not this month in your over his like, okay, I'll try again in another twenty days until menopause. And that's while your breasts change throughout the month. Also, there are benign cysts and fibrous aids. But if you notice anything that's off get it, checked doctor's orders, and you can have things like cysts and benign stuff for sure, but it's better to have someone investigated improved that that's what it is instead of saying, it's probably that and letting it sit. Now you were talking about cells ago wacky. Yup. And and kinda don't get caught in time. Right. So how much do you think lifestyle or or just like stress management or nutrition is a factor in trying to stave off cancers particularly breast cancer. So if you consider that the immune SIS. Adam is what we use to fight off cancers and other evil spirits in our body. Then the then stress and all the things that we're talking about nutrition actually affect that. So sitting here in New York, it's hard for me to tell everybody, try not to be stressed children, but it really does play an incredible role. In fact, if we were able to live like Buddhist and not be stressed. We would eliminate the three top killers of humans cardiac disease cancers. So even when you think of mental health disease Alzheimer's, these things are all kind of have some degree of stress because what stressed tells your body is you need to be a constant state of activity and aiding concentrated activity when she's gonna wear itself out or not be as good. And so think about it as your immune system gets worn out and can't look. I can't do you. Miss me gets basically burned out and so we can't protect you in any particular way. Nutrition is as far as I'm concerned, I'm also Jamaican. So nutrition is everything we, we are not at the point yet in in medical science to say, oh, you can treat this cancer with bananas. However, we do know that fried foods. Red meat there, certain things, pork that a certain things that are infl-, inflammatory foods, things that make your body stay in an inflamed state. I'll definitely go further into this on a future Rheumatology episode on inflammatory disease, but quick rundown of foods to avoid according to a Harvard University medical site, refined carbohydrates, like white bread, pastries, pasta all of the things you eat when you're sad, French fries and other fried foods, soda and other sugar, sweetened beverages, red meat, and processed meat like hotdogs and sausage. Also, margarine shortening lard. Now we all see these items and they're like in the notify bad for you call him because we've heard for years and their calorie dense. So it's easy to say cough. I make my own choices. I don't care about the calories, but when you look at it from a well. Well, my tissues hate this in an impairs, my ability to clean my body of cancer standpoint. Well, then, yeah, that's a whole new ballgame. So that's a good point dock that inflamed sate basically is creating a fertile soil for bad wacky cells to continue to grow. That's where nutrition comes in. And I think if if you look at some of the chemo therapeutics the drugs, we used to treat some of these cancers. Some of them have come from trees like the Pacific you tree is a tree that we use to create one of our chemo drugs and it's very effective. So Dr Manasseh is talking about the chemotherapy drug with a brand name Taxol. Cute fund quick history. So in the early nineteen sixties a thirty two year old botanist named Arthur barklay collected samples in the forest of Washington state to be screened for possible anticancer properties grabbed some bark from conifer that was otherwise like pretty useless to the lumber industry. Nobody cared about it now to doctors. Dr. Wallich Dr. Muny found that among thirty thousand botanical samples, the Pacific you had a negative effect on tumor growth which is positive effect on your boobs. So later a doctor by the name of Dr Susan band Horwitz figured out exactly why it worked. So the active compounds cause cancer cells to rip apart their own DNA and they die. Now, after decades of testing, the medicine was approved by the FDA in nineteen ninety four. It's known generically as Paclitaxel, I think, and it can also treat ovarian cancer lung cancer, cervical cancer, pancreatic cancer. So that's just one way a plant can save a life. So another reason to believe in the words of Clive Owen first. So you can extrapolate to think that if I eat enough broccoli, if I need certain a good fruits and vegetables diet plant based diet that I'll get the benefits of some of those items instead of being. An inflammatory state. Now you're an anti inflammatory state. So even if you have a cancer cell floating around in your body, it won't grow. That's the difference. I think in breast cancer health, and I think cancer in general, we were first attacking the cancer cells. I think we've switched to fixing the soil. Oh, that's so interesting school, right? Yes. That's something that you've seen changed a lot since you've been in practice? Absolutely. I think it's a wonderful time for cancer medicine right now, the amount of discoveries with respect to how we look at the disease with respect to the treatment of this disease has changed more in the past. I'd say, fifteen years in the past century. That's crazy. What do you owe that to a couple of things? I think technology is one we can't. We don't have the technology to be able to look at these cancers in a specific way. We now can look at the genetics of cancer and target therre. Purpose for that. I think as I said before, the advocacy is a big deal. You need funding and money to fund these research items and to develop these technologies. And I think Coleman is a perfect example has raised a ton of money along with many other organizations, research foundation, etc. And these funds go specifically to research which then allow people to develop the ideas they have until look it and understand the cancer cells and what they're doing and develop ways to treat them. And so because we've gotten so good at trying to finally understand what it's doing, we now can kind of figure out, oh, hey, this drug that we developed may be good for this situation. And how do you feel about kind of genetic screening like the Biard CA? Is it not RCA one and two? How does that impact the decisions that you make an also the prophylactic like like double mastectomies or or partial hysterectomies? Like how much do you see people just saying, you know what? I've got the gene. I lost someone on my. Family, like, let's go. So I'll tell you a story, but I, I'll say, I'm a big advocate, knowing your genetic health, I think more information is always better. I think in order for you to to survive and live, well, it's all about knowledge and information. And so what we used to say is if you have the right family history, meaning either your certain heritage Ashkenazi Jewish heritage or if you have a number of women in your family with breast cancer young age, you're a potential candidate for having this Jane. Let's check you now. I think what we would more say is personally, I think almost every woman should probably be tested if possible. That's kind of hard to do, but I think somebody in the family's gotta be that index person, right? Somebody's gonna be that first person. We haven't caught up from an insurance coverage perspective to allow that to happen. Unfortunately, there are those things out there like twenty three and me, and those type of genetic type stuff, which is which I think is important. But I think it's more important for for listeners to recognize that if you find something on that test in these to be evaluated because nothing's perfect. And I think if it came back positive, you need to see geneticist and check it. But the story I'll tell you, which will probably leave an imprint is a young woman. That's one of my favorite stories is a young woman who she's probably about twenty nine and her aunt got breast cancer on. It's probably like in her mid fifties, sixties with somebody really young, but being empowered and who she was, she encouraged her father, the ons brother to be tested. Because, hey, your sisters got breast cancer, and it's the only person in the family by the way you need to be tested and they're falls like, yeah, yeah, yeah. And ultimately, he gets tested and low and behold, he happens to carry the gene. So she decides. Leads me and my sister have to be tested. And she also ultimately has the gene. Now she is, I said, an twenty's. She's been getting imaging like the Mirai and such to keep an eye on things. In about two years later, we find something on her MRI this little something. Thank God was a stage zero, very, very early cancer. Rupe boy, if she had not done that any of the things I just told you, this young woman would have presented in her thirties with an invasive cancer does, but it's also great, right? Because because she was in power with the information, she, we started screening her, she's twenty something years old. We were not going to screen her for anything. She had one aunt with breast cancer. She was not going to be screened for anything, and I love seeing because I say you saved your own life just gonna drop another one of these bad boys. Right? And so it's so I think when it comes to the genetic question, I think more information is good. I think people get scared by information because they don't wanna know, but the problem I always tell them is that eventually you will know. I not know when you can do something that's so true. Right. That's true for everything from car repairs. Every car repair in particular? No. Please keep starting. Please keep starting. Yeah, exactly. And now what about can you tell me a little bit about really quick about imaging? What imaging methods do you recommend? I know mammograms are supposed to start with your forty. I'm like, going out nowadays, is it better to do is is a better to mammograms, like, what are you? What do you suggest? So we have three modalities for imaging breasts mammogram, ultrasound and MRI right now, the recommendation is mammograms, average risk person started age forty. I don't care what any other news media says. That's what you do, and I'll tell you why believe that strongly when the literature backs it up, but I'll tell you why, but mammograms is what you start with. If your breasts are dense, which is determined by the mammogram, so you can go fill yourself people. But really it's dictated by a mammogram, not by your exam. Then we add an ultrasound. So now you're getting an ultrasound and mammogram. Because it's just two ways of looking at the breasts. The mammogram kind of looks at a picture of the breast, looks at the architecture. Ultrasounds looks for anything that's cystic or solid. And then we have what's called an MRI which we use more cautiously. We don't use as a screening tool unless you have a gene or strong family history or revaluate something, and that looks more at the activity that's in the breast itself. So the average person average risk. It's a mammogram ultrasound starting at age. Forty. Okay. People have said in the news that mammograms, why do we need to get a mammogram that they always telling my breasts were Dan, so they're not gonna see anything problem is a mammogram, even if it doesn't see something for every person it's much better than me examining you. Okay. By the time I feel something the mass is now a larger mass. A mammogram can pick this up before it gets to a certain size in some cases. So even if it's fifty percent in the worst case scenario at picking something up fifty. Percent is better than zero, right? You take away a mammogram. We're now back into nineteen fifties and seventies before the mammogram started mammograms. Side note were invented in the mid nineteen sixties, and then in nineteen seventy six machines became more widely available for routine screenings. Now, also, I am neither a lawyer nor a doctor, but opinions on this topic vary in when it comes to your own health and screening schedule. This is a free podcast that can neither diagnose nor treat diseases. So please consult your own healthcare provider. But yes, back to the old time days when doctors diagnosed things by observing leeches and consulting oracles and looking to the sky to ask ravens who is in danger, right? It's crazy to think that there was. I mean, I realized that there was a time before mammograms. There was a time before like electricity. I still like to think that the even in the seventies seventies eighties, actually people still questioning it because. Again, it's it's technology. That's far it's uncomfortable. It's not fun, but in the same sense, and I joke with people that I talked to my outreach because I say, if I we didn't have a mammogram. If I said, I have a test like a pick up a cancer, fifty percent of the time. People be clamoring for it, right? They'll be climbing for if I said you can't get it. No, no, no, I need it. I need it. Do you know what I made? So if we have something else comes along that's better by all means. Let's compare mammogram to that, but if we don't have anything else except for my right and left hand. I'm going with the mammogram for sure, even though I'm good with the right left hand, I'm still going with them. No. Do you have any tips for making a mammogram? Just a breezy vaca- of a doctor's appointment, just so fun. Absolutely. What I do my own is I actually schedule a dinner right afterwards and shopping. I often will tell my patients to take and I'm an I'm little. So those comfortable thing in the world. But I often say take an Advil or Motrin. The kind of preempted if you will and then have planned. I always have fun with a friend of mine. She happens to be my radiologist, so it makes it easy. A friend of mine. We're going to dinner afterwards and we're going shopping that we have something to look forward to after because it's uncomfortable. It's not gonna be able to do. And the reality is if the technician eases up on you, she's not compressing the tissue enough to be able to see when he's a happen. So going back the way a mammogram works is a compresses, the breast tissue and everything that's breasts kind of spreads out and things that are not like a cancer won't. Oh, so they don't compress it enough. Then things are going to look like they're cancers when they're not, they need to compress it. So that's something is they can see, so treat your boobs like a Panini or a Turkey burger in a George Foreman grill. It's just better squished. Tender juicy, delicious taste of real foods just minute. So I'm in the machine saying compress away now because you're not getting a second chance. And then I need to go get my wine and dinner. So that's what I do. So you need to do something to slightly annoy your radiologist. So she has a less tender touch with you, like just piss her off just just enough just enough. So show Mr. she gets it in your good, good. That's great advice to something fun after after you. I think you absolutely have to. I think I should do that for my tax. Appoint everything. Anything that's hard to. I mean, if you think about, if you remember when you're a kid, when you got vaccinated, they gave you a lollipop toy, right? Why should that change? Because I'm forty something years old. So I mean, I think I should not change it all. That's such good advice works for me. It works. And so those are the imaging modalities. Can you run me through a couple of the top therapies? Like, let's say that you get a diagnosis which you know two hundred and forty. Five thousand women are an men a year. Because it doesn't just affect women doesn't just affect, you know, it affects men non binary. So many people what? What are the plans of attack that you have? So it's good. It's I can tell you there's a tremendous list of the plans of attacks. I'll put them in categories to make it easy. There's three ways we attack this. Sometimes we use one way of us two ways. We use all three one is surgery, so getting it out to is some kind of drug therapy. Okay. And three is some kind of radiation therapy. And depending one, basically the specifics of the tumor the tumor tells us what it's going to do and we give it an answer back onto, make sure it doesn't do what it plans to do. This is like the worst version of call and response in country music or a rap, battle involving one person who just obviously sucks. So if you have a really early cancer, let's say a noninvasive cancer that was picked up on a mammogram, very tiny. Most times you can get away with just surgery. Sometimes we might give you radiation to that area. If we saved the breast tissue, and sometimes we give you a pill, if you go down the path of an invasive cancer, which means it can spread from the breast. Now we're not just protecting the breast tissue, but we're protecting the other parts of your body. So how likely it is to do that dictates what we do in terms of drug therapy because surgery and radiation can only go to the local area. Drug therapy goes through your entire body. Oh, good. So there any cells anywhere your body that we can't see today, the drug therapy presumably eliminates it and now in your surgery because you're a surgeon, I am proud one where like you're in your in, love it, Ned on on your scrubbing up. You got a mask. You're like, I think if you're ever in a job that is also a Halloween costume, like you're winning. That's great. That's right. That's right. And so what is it like for you when you're like, okay, it surgery day and getting in there. Do you have like a routine, like a music? You listen to pump you up? Is it how often are you in surgery? Is it like every day, once a week? Do you do it like what is that like? So surgery for me is the point of it all. It's me doing battle with this disease that's trying to take someone's life. I often I operate on on Mondays, Mondays and Fridays Caisley Thursdays, but us is about two to three times a week depending on what's going on and depending on what the needs are. But on Monday morning dredging I'm going to work and I get to put my pajamas on. I said, it's my favorite outfit in the world. If if if it were up to me, I'd be wearing scrubs and clogs all the time. It's my favorite thing, so soft. So it's just it's it. It's it. First of all, I'm a little bit taller wearing clogs. That's even better risk rub hat. So it's just it's just the best thing. But I think it's a privilege and an honor to be that intimate with somebody. I think everyone identify with the fear of going to sleep and putting your life in people's hands, and I take that extremely seriously. I, my ritual is to create the sink. I asked for guidance of my hands and wisdom to do what I know that I've been give. The talent to do. And thankfully today we can see the cancers on our imaging, but we don't have these big gnarly cancers that were taking out. So I'm usually taking out what looks to me mostly like normal breast tissue, but I know we take the picture of it. I'll see this cancer and I snapped at it usually and say, you're out and you know, and put this patient back to what I called an empowered state. She's kicked cancers button. I was there to help my second favourite part of this whole experience is going out to the family and getting my hug. That's my favorite, especially when the spouse is six feet. I'm I'm five, two of them lucky and his guy sixty something just grabs me. And just because you feel in that moment, the intimacy of the human experience of what just happened for me. It, you know, it's what I do. I've been doing it for a number of years, but for this person they have not. And there was something that was threatening them and we just took care of it. Wow. Do people ever asked to keep it actually funny, not the cancers. The benign stuff I take out, they wanna see, but the cancers that I've never gotten asked that nine stuff, they wanna see it. I see what it looks like somebody's, I'll we can't give it to them for sure, but we may take a picture of something, but rarely, you know, we, we can't. We can't get people by ports of, you know, you're here with mine a minute. Wait, exactly. Yeah. But now it's mine. So. And so to you. I mean, you must get updates on stories from people all the time. I mean, I imagine that it's kind of like you have this big growing family. Yes. Right? Yeah. Did you anticipate that when you started this job, did you realize like, oh, I'm going to have hundreds of people in my life who I feel like really connected to an invested in. Yeah, no, not not at all, especially because as a as a youngster, I was more kind of like to myself and I had maybe one or two really close friends, but I wasn't the person who had like a horde of best friends and family and with my patients idea. One other one of my favorite stories is there was a young woman that I diagnosed the week of my thirty four th birthday, and she was thirty four years old. And of course she comes in attractive and you know, just full of life, etc. And she felt this mass and there there may time when you examine somebody your heart just drop into your into your stomach and you just know. And she was coming in with a full thought that this was going to be like a or something. So. Her mindset was different. And basically we treated her and we became actually really good friends. And one day she sent me a picture and I'm looking at the picture and this was like four or five years after her diagnosis look at the picture and trying to figure it out and you think figure it out, but it just didn't make sense with her and it was an ultrasound of twins. And so I like in tears are just kind of like, you know, I'm somewhat a part of that. I mean, she has. She now has two beautiful boys or ten years old, but just that whole process, she had gone through and being a part of that process. She is family. Anytime she comes near this area, we try to get together and I look at those boys and like, you know, just how our whole relationship started is just amazing. It's it's an incredible experience that I would do over and over again. There are a lot of patients that are older that will call me their daughter and my staff will say, I think your mother's outside like, no, my mother's in Florida. No, this my daughter knows my, it's it's really, really cool. It really is. I think that's that's a cool part that I just did not intimidate, but I absolutely love. I mean, just in this interview, I've already had to try not to cry like five times lost it like, have you ever like? How do you compartmentalize and not just be like, oh, go to motions because I, it's what you do is so touching like any is so so when it comes to and we've had a couple patients that really will grab you. I'm sorry, I keep telling you stories. I love it. It's a waste of the way I work. We had this one couple recently. They're traveling from abroad, but they happened to be here for work and young woman actually fully pregnant probably like a week from delivering. And unfortunately, he had a the president feel right to her and she was rushed to us and sure enough. It was going to be positive and she actually was very strong like, Nope, it's good, I understand, but her husband started to just break down. I can do women cry. Can't do men cry because the power of what's happening becomes real, and he just talks about how we've known each other and you need to save her for seventeen years. Exactly. And so what I do in those situations is number one, I have to remember that when somebody looks at me, they look at me as you're going to help me. So if you're on a sinking ship and the guard shows up and starts crying, you kinda get a little nervous. So so I have to tell myself that number of times because these things are, I'm a very emotional person naturally because I think you have to be in this field, but I think it's more important that that patient needs to know that it will. She's not worried I'm not going to be worried and I try to relate that now. I'm not made of stone. I will step out if it gets too much. And that was one case where I said, I'll be right back. I'll give you a minute and I walked into a room with my PA and the two, which is kind of like, okay, let's try to keep it together because this a human experience, you know, you have this. This should be the best time of their lives. They're having a baby in about a week or two, and I just told her that she has cancer in her breast. It's it's surreal. Right. And now what do you do to kind of. Compress. Do you think about work a lot when you're off work, or do you have like a very compartmentalized life where you're like? I'm off work. I'm home and with the family with my pet parakeet. I don't know if you have a pet barricaded up, but you know what I mean? Or do you think about work in read articles lot when you're not at work, where's that line for you? So I have never seen this job as work. That's number one. Oh, well, yeah, it. It's something I really enjoy from a physical perspective, an intellectual perspective. So reading about these things is is actually very enjoyable to me. So I, yeah, I will read outside of work to figure out what was going on with my patients, etc. Also like to write and try to write down and capture these human experiences. And as you can tell by that back wall, I love photography. That's all mine. Yeah, yeah. So on the wall behind me were about a dozen framed enlarged photos that looked like professional posters of gorgeous flowers and birds and sunsets, things you wanna stare towards in breathe deeply at and next to her pictures on a hook, hung her freshly pressed lab coat which is embroidered with her name over the breast pocket, and the juxtaposition of science and art and purpose in pastime formed kind of a scene that would always be too on the nose for an indie film. But it was real and I loved it. That is my go-to device. When it really really hits the fan. I just grabbed my camera and I go somewhere and I also have probably one of the most incredible husbands in the world who has had his own set of tragedies and has developed basically the strongest emotional quotient I can. I can think of an is really good at being humorous when he. Needs to be an and quiet when he doesn't cut our German shepherd. But he really does kind of like, let's go for a ride. He really does how to read me. So having that and having, I think a strong support per family in a support system I think is true for any job you're in. If you're having a tough day, I'll either call my sister who will make the crack me up something my nephews did, or I'll call a friend of mine or you know, having that, I think it's very important for everybody. And so that's how I kind of keep it together if you will. And how do you recommend that your patients keep together if someone's newly diagnosed, what is the best thing they can do for themselves to really beat it? Like what's the best course of action they can take what's the best mentality to have to laugh. I try to make them what really. Yeah, humor is the biggest thing you naturally feel really good when you laugh because thankfully in we have a disease process that is actually for the most part, very, very, very treatable. Knock on wood. I've run across few cases where we really can't do anything at all. And usually it's because. Unfortunately, somebody was so scared that they took a long time to be seen diagnosed for women who are getting their mammograms regularly. Usually it's a very good outcome. It's rare. In fact, it kind of shocks us sometimes really bad. So I tell them, listen, look, this sucks for sure. No one's debating that, but you are going to be okay. I've been doing this long enough to know that and you need to find moments of pure joy and you whatever that is for you go and do you know, and try to keep the humor if you can, but also pay the piper. When you feel upset, you need to acknowledge that this is something that's affecting your mortality and it's important to whether you want to write it down, but pick that thing that makes you happy. My sister often says, because I asked her, how does she always stay happy? Because she, she seems to be happy all the time is she seeks. She craves joy like she's craving water. So in every moment, what's the thing that's gonna make me happy right now, and if you do that little moments, turn into big moments. Turn into a lifetime. That's such good advice. Yeah, she's good at that. She's really, really good at that, and she's got started. She's gonna do some ten guys something since I've sat down to edit. This episode. The last few days I keep asking myself where or how can I find joy and foof boy, Howdy is hard, but it works. What do you recommend for partners of people who have been diagnosed? So for caregivers, I often recommend one. We have a lot of support groups in sure there's tons of online things you can go to, but the simple things are to just really be there for the person. Don't feel like you have to constantly try to help or talk about it. Sometimes you distract them. Let's go do something else. Let's try to do something that we just wanted to do or let's continue, nothing. Nothing things have changed with the not finalize. We're not doing a will. This is not a death sentence. Let's try to just create a new reality for our selves and just be there for the person. And sometimes the person won't wanna talk about anything. Sometimes they don't talk about the cancer diagnosis at all, you know. So I think being there for the person for whatever they need is the best thing that you can do and saying. Look here if you need me, that's all I can do. And how do you feel about October? I've always been curious about this because it's like October, it's breast cancer awareness month and you're like, I can see that it's a great everything from like Delta Airlines to like Pepsi or whatever it was like pink, pink, pink pink, but like, but then you look, what about the other eleven months? I thought I'm like, okay. I guess it isn't that, but just not right. You know, I I love up Tober because I was calling my rockstar, once. Let's use you. I do a lot of talks love October for what it symbolizes if you think about how breast cancer was viewed in this country prior to Betty Ford coming out and saying, I had breast cancer and I just cannot stress enough how necessary it is for women to take the time out of their active lives and take an interest in their own health and their own body. Early detection. Is the secret Edith bunker coming on television and saying it. Women's were scared. They didn't say anything about breast cancer. We didn't talk about it. That's so great. It is right because we're not that our generation don't like that and that fear lead to death, plain simple, straightforward lead to death because you didn't tell anybody anyone see your doctor, I think because it's in your face which Tober that's actually when we see more patients for mammograms, because people start thinking a little because it's right in front of you and people start thinking about a little bit more. So I think the advocacy in the awareness that happens Tober is necessary with that said, I often tell patients breast cancer just doesn't happen in October. We talk outside of October, and you need to be evaluated outside of October. Some of my patients are sick of October because they're tired of the pink, the tide of the emphasis. But I have to remind them that there are a lot of women out there who have not been your in your shoes or yet to be in your shoes. And that's Tober four. It's not just to celebrate the survivors. I think it's more to celebrate the ones who will become survey. Drivers. God, that's I think that there are a lot. It is with two hundred and fifty thousand people diagnosis here. There's so many people out there that don't know that this into become their costs. I know exactly exactly. Have you seen anything change, you know, shifting in terms of awareness for patients who are men or who are trans or who are non binary, like having it be less of a of a woman's issue necessarily and having it be more of a could happen to anyone. So we're trying to infect when we do our talks. We try to mention that a lot more increase our readiness and for the trans population in particular, it's actually relatively new issue. It's funny because we were talking about this this morning in our conference because these individuals are taking estrogen and what we know about breast cancer is estrogen as a malt. So it gets concerning when someone's actively taking estrogen for good reasons. We don't want them to now increase the risk of something that could be bad. So it's. A relatively new area, but I think it applies to anyone across the board male or female. If you feel something on your body that was not there before, evaluate it, I don't care what you are. Anybody can get a cancer. Anybody can get cancer anywhere on their body. If it's something that's not normal for you, it doesn't hurt to to see somebody for them to say that's nothing. Rather do that then say, how long has this been here? Right. And plus if you get a mammogram, you can go out to dinner afterwards and get a toy. Don't you have to get the toy? You can't just do the didn't lollipop or the toy. Remember the lineup and the toy, don't forget the toy. The toys important toy is very important. So figure out where you're gonna go towards the toy shopping documents. He is a treasure. Okay. Getting back to hormones and how how do hormones affect breast cancer? Because I know a lot of people now since the seventies sixties more people are on birth control. You know, more people might be taking hormonal therapies for other reasons. I'm on a hormone patch because I have ovaries that are like we're out before forty. So how, how does hormone therapy effect that like, what do we need to know about that? So that's a controversial topic, but the lemon short of it is we know when we're not know the exact mechanism of how estrogen directly causes a breast cancer. We know that women get it more than men and women have more estrogen than men. We know from some hormonal studies on Homer replacement therapy that some women may be at an increased risk. I have women who take home placement therapy for most of their lives and never get a breast cancer. I have women who never take it and do get breast cancer. I think you have to do good nutrition, good health, which means exercising, walking at least thirty minutes a day, low stress if it possible. And those things. Build an immune system and build an environment where things cannot develop. So you may take estrogen and alter, let's say the cellular structures, and now it's ready to go out and conquer the world. But if the soil is not good for it, if the soil is to healthy for it, it won't. It won't thri. Right. So I think the home on story is going to be that for the most part is probably safe. I think moderation is the key to anything. If anyone is menopausal and they take hormone replacement therapy, I always say, take a break. If you can reassess take the lowest dose possible as human beings. We were not designed to take hormones or have hormones in our body forever has got to be a reason for that. But with that said, you want to not bite someone's head off and you want to live comfortably and continue to have a good sex life then take it. And so I think it's important to look at life as a holistic. Approach, right? You want to be healthy that's mental physical, sexually, and spiritually. That's what you want. And the way you do that is a multifactorial process is not okay. I'm not gonna take a hormone and I'm good with breast cancer. That's not going to happen because you may have the genetics that allow that to happen. Your mom may have eaten something that allows that to happen, you may have lived near God knows what you may be too stressed out. I have these patients who are great with nutrition and exercise all the time, but stressed out of their mind. We if that's gonna you know what I mean? So that's good. Point beer, be fallen down a thought, spiral just evaluating my whole life. And how has your work changed in terms of breast implants? Because I know that I'm sure that in the seventies before that that maybe wasn't around as much as a surgeon, do you have to kind of advise patients differently if they've had them to in terms of their screening and any kind of surgical answers to it. So luckily the way. Screenings done, weakened screen women with breast implants easily. It's just a different technique that we use in the past. Like when I was starting implants, were placed in the breast tissue, specifically the reason that was dangerous because it would block some of the tissue from being seen on a mammogram for the most part today, I think almost one hundred percent. The implants are now placed behind the muscle or behind the tissue so that you can see all the tissue that you need to the needs to be seen on a mammogram. So for the most part, they're not put into the what we call the breast tissues. Specifically, if you're wondering how long have we as a species had boob implants? Well, then we have the same brain. So I looked up and in the early nineteen, hundreds doctors were very creative and resourceful using all kinds of items as surgical breast implants from like ox cartilage to ground up rubber to wool, too. Formaldehyde polymers strips of tape wound in a ball like yarn. They also used ivory and glass orbs as breast implants. There were like, it looked like boop put where boob is. Now, silicone was also injected just free Ballin around the breast tissue, and then in the early nineteen sixties, DOW Chemical patented, silicone breast implants, and there were sailing ones after that. Now there have been all kinds of studies about the psychology of getting breast implants, and I won't go into it because that's a whole other field of study, but you can always see the Calogero episode we already did. If you're struggling with anybody issues and you wanna fortify, perhaps your self acceptance. Now as a person who fills out an a. Cup only when I'm just bloated from teriyaki bender. I can tell you that pulling back the curtain to reveal cultural beauty sickness is helpful in accepting yourself. But from a medical standpoint, how does the dock feel about them. Think for women who lose their breasts to cancer or to prevention. The some of the implants are incredible. You can't tell. I mean, I'll examine a patient like, wow, this feels really good, felt this really some good stuff you've got going on here. Which ones are those? Those are like the silicone silicone gel ones those. I mean, if you ever get, I don't have a pair of my office, but if you ever get a chance, you have a girlfriend say, hey, look. I don't mean to be weird, but I've been instructed by document SE because I think I think again, knowledge is power and people have a fear of if I remove my breast, what is that gonna look like? Often we'll send them to my plastic surgeons who are incredible credible people, and those let them feel the implants and say, this is what it feels like. Right. So I think it's, I think it's important. I like implants, and it's funny because it's funny because the as wannabe Bs and CS and the season dis want to go back to Bs and as and I'm like, it's incredible. You know, I had a gynecologist on gynecology episode Dr. Phillip our Bank, and she said how I'm like, yeah. Very few people really find that their breasts are. They're either too big too small. There's no better lesson nuclear teacher daughter, then love your body. Everybody's oops. I was like groups. I think it's an image thing. I think in Europe, I think they love their boobs in here. We don't as much. I don't. We just don't know a thing. Yeah, I don't know what we think everyone else, and that's what I'm saying. I think you need to pull your friend assign say, look, let me see your see yours medicine. Okay. Mine are much better. I'm happier now. The thing is maybe we just don't see. I don't think. I think that's what it is we gotta show. Yes, he more on TV. All right. And then you can make an assessment you say, minor, actually. Great. I always tell my patients, you know, if they're happy and they're healthy, then they're fine. They're great. They're great. They're healthy boobs. So then that's the best can we do a rapid fire round with some. Sure, sure. So questions, listeners who donate to patriotic get to ask you question. Okay. Okay. Anna Thompson, monster note. Does the make up or shape of your breasts factor into your risk of getting cancer? No, absolutely. Not. The only thing that make up and shape does is it affects maybe how the mammogram may look. So if your breasts are more dense, you need a mammogram and ultrasound. We still can pick things up on a mammogram, but not as easily as if your breasts were fattier. Okay. Oh, it's so weird that some could be fattier and some can be denser. Yeah, and that's. And that's somewhat familiar. That's somewhat genetic. The all the women in your family have similar breast issue. Important. Okay. Here's my pitch. Set all of your family reunions on European beaches, like happy, unashamed, mood, lizards, you know the drill, send me a postcard. Here's Karl wants to know. I've heard aluminum, deodorant contributes to press no God, no people where your Dorota please, where you're the older it. We get that question all the time. Like please wear deodorant. It does not. There's no evidence to suggest that it does increase your risk of breast cancer. If it really drives you nuts us, something that does not have aluminum, Tom's of Maine, for example, but you'd have to apply it many times I've tried and you just need to apply many times, but please wear deodorant, right. And I know that those crystal rocks worked for like one day and then the next they just don't. They just don't. So please people as a New Yorker, New Yorker yet at least where you do over it side note, I did fact check this and according to cancer, dot org quote, there are no strong epidemiological studies in the medical literature that link breast cancer risk and anti per sprint us and very little scientific evidence to support this claim. So there you have it also, can I tell you the weirdest story. You know what? I'm going to save it. I'm going to save it for my secret. At the end of this episode. Also, if you've never listened to the very end of the episodes after the credits, I tell you a secret. So if you turn off the show during the credits every week, woo Hoy. Okay. Back to rapid-fire, Becca wants to know as the unhappy owner of a set of lumpy boobs. Ultrasounds on these jerks twice a year. Is there anything else I could do to stay healthy? Is the six months between squeezes too much time, so, yeah, anything she can do to keep them healthy and between? I don't call them jerks. They're happy and healthy. They're, they're, they're your friend. The girls, they don't mean to be disruptive. Lumpy is is not a bad thing. It's just the type of breast tissue. In fact, then the lumpy or the more they sit up nicely for you. Fatty breasts tend to go down. So let's yeah, that's why I want to twenty year old. They're up here when as you age, they become fattier and they go look at your toes for a minute. So that's, that's the difference. So be happy that they are the way they are? No six months is not is doing it every day or shorter than that is not is not necessary. It hasn't been proven to find anything earlier. I think the things we talked about exercise nutrition, providing a a safe environment for your cells so that nothing grows a good soil is the best thing you can do in terms of prevention. I really do. That's good to know. I hadn't even thought about that. You know, let's see. Jane NS wants to know how have we not developed a better way to screen for cancer, then putting our boobs into a honk honk machine. Yeah, we just haven't. It's it's. It's a good thought. I think in the future we will probably be better at that. There's been a number of attempts at looking at your blood to see if there's anything that we can pick up like a marker to say, hey, this person needs to be screened specifically, technology's not there. However, I would encourage everyone to donate to the Komen's of the world's the breast cancer research foundation, so that people have enough funding to do research to find those things to make better honk Kong makes a, that's what you want better, honk, honk machines. Charlotte milling wants to know, is there a link between gynecological abnormalities people met experience earlier in life like endometriosis or PCS, and the propensity to develop Brent's breast cancer. So they're, they're, they're a lot of disruptions that can occur. We, we know things like ovarian cancer or associated with an increased risk of breast. Cancer, things that increase a hormonal state can also increase your risk of breast cancer. And so these are things we that we potentially monitor for, but anything more specific than that, we don't really highlight as specific problem. Natasha Behar's wants to know. I've seen so many sexist objectified breast cancer awareness campaigns. What is the professional opinion on this? Is any awareness, good? Or could there be negative downstream effects of bad campaigns? So awareness, I think is always good. I think people can get overwhelmed by the pink pink washing is what we call it washing. Think washing. My partner often shows a slide where he's show bunch of those pink tennis balls. He came across a slide that I guess it was the gun club of America where you can get a gun with the pink handle and his favourite was Kentucky Fried chicken's pink bucket. You can get your right. You can get cancer while you're preventing cancer. So don't even write chicken. It's not it's great tasting trust me, but it's unfortunately one of those foods we try to avoid. So that term pink washing, especially refers to companies whose products do not help prevent cancer in the first place. But they make a big show about donations and awareness after they cost cancer, sometimes spending more money on marketing, their pink products than is actually donated to the cause. So you may have to read the fine print. The literally a few years ago, dick sporting goods was caught just with the teeny tiny disclaimer on their site saying that some of the companies selling the pink items that are hawking, don't even donate to a charity. It's like having a cool party. And then some friend of a friend invites capitalism who liked spills hot sauce on the carpet, and then insults the host and clogs the toilet before leaves. But you can get overwhelmed by it met. I think if you remember the spirit of what it is and it's good that we're overwhelmed by it because there was a time where nobody spoke about it at all. And I think in October is a celebration of those of those times and that we will never go back to that that we are here, and we're proud and that knowing about breast cancer and there's still some women out there who fear it and don't say anything, they still come into my office you. That's what that month is four. Yeah. Mercersburg wants to know how do you feel about marijuana as a substitute for chemo? And I'm wondering if it is, she means the substitute or something that helps you through chemo. I hope she means it helps you through chemo. Okay. Meaning the side effects, I believe that especially with side effects from chemotherapy, you need to do whatever it takes to be able to get through chemotherapy. Marijuana has many positive effects which respect nausea, control appetite. And if that's the thing that works for you, then please, by all means because the most important thing is says, I said is to be healthy and to be able to continue eating. And if you're nauseous and not eating, even though we're treating you the soil once again is not being fed well, God, so bad things can take an opportunity. So if the weed makes you crave chicken fingers, maybe maybe hold back and just try to eat more broccoli. Try. Okay. Try also my patients, they have the c- cards, so they technically allowed to do whatever they want right now. And I said, no, because of the card you're not to do. But yeah, I mean, yeah, just try to make smart food choices. I think today. Especially we have a lot more healthy options at tastes. Good, right. I think people just jump for something because it's convenient, but if it's if you clear your pantry of the bad stuff and put something in, that's really, really good. I think you'll choose that. And are there any movies where breast cancer or breast cancer patient is depicted that you feel like get it right, or get it really wrong? Well, not a movie, but there was a famous seen in sex in the city that I love. And what is it? It's the one where one of the characters and I am bad on her name's right now, but PS looked it up and it was Samantha, you look. So pretty today fix. I have cancer. Basically. She had had chemotherapy in breast cancer, very, very sexy woman who, obviously, you're seeing the effects of of the treatment and she was giving a speech if you wanna see the face of breast cancer look around to with this wig on and her younger boyfriend very handsome guy was in the audience, and she starts talking and there's a lot of women in the audience, and she starts sweating because of the lights and the hot flash. Che's from what she therapy. She was getting and fine. She said, oh, exit polls away. Goff. And this woman who was very nervous about the way she looked and everything. The whole crowd just cheered. And stood up and started pulling their wings off. And I think that's what I always believed about breast cancer. It's very empowering if you have the right support and the right right people around you to to help show you. This can be a very impounding disease. You kicked cancers, but more if you're in the fight, you're fighting cancers, but you're getting up every day and doing it no matter whether you're somebody who's stage four with disease that's going to be there or somebody that we've treated and disease no longer there. You're still getting up every day to fight this thing and you need to be empowered by that because not everybody can do that. Right? And so that probably is a scene that still sticks in my mind as portraying a very powerful person because this woman was dealing with had a very difficult time. She her sexuality is being -ffected the way she looked was being affected. And finally that when that one moment she basically said, screw it, I'm going to be who I am and you know, screw you cancer, which I think is a good thing. Then. Is a good thing. Do you have any patients that are like, I know that it's a battle. I know I'm fighting, but some days I'm just like, oh, I'm not a warrior, like my patients every every ethnic you not human if you don't do that. But I think that's why I say you have to pay the piper. Sometimes those moments are gonna come and to pretend that twenty four, seven, you're fine. I think is you're kidding yourself, and it will come at a moment where you're not expected the middle of a shopping mall. For example, you need to recognize that you just almost fell off of a cliff. And in that moment, realized that someone gave you a parachute, do. But I think you need to do both. I really do. I think you'd be kidding yourself if you're not. I think one of the things that's trickiest for my patients is they go through treatment. They get through everything and then we say, fine. Things are great. I'll see you in three months or six months and they're like, well way, we'll, we'll wait a minute. Why Where're you going, you know, because now we put them on a survivorship track and they're not ready mentally and emotionally because now no one's okay. Now, what do I do my waiting for the next bomb to go off its human, but that's where we're working on trying to empower these patients through survivorship planning. Now you're survivor is one of the things we need to pay attention to. These are some of the side effects that can happen, but you're still hours, you know, you still have family member and we want to make sure you're okay. And I always do a segment about debunking flimflam. Is there any myths, any major myths or misconceptions that you're like? If I could tell the world like megaphone? Not true. Do this instead, anything else that comes to your mind that you're just like a amid. Th- about breast cancer that you're like. That mammograms cause breast cancer? Oh, no, yeah. They think the radiation in mammograms will give you breast cancer, the radiation mammograms equivalent to the radiation of flying back and forth to California. Three times it's not gonna cause cancer. I think that that is the reason that's one of the midst that I hate. And I, you'll hear me give an hour lecture on is because it's the one two we had that actually can pick this up as early as possible when we come up with something via blood test via x, Ray vision, glasses, whatever you want, then fine. We can debunk mammograms. But right now it is the one thing that made a difference between the nineteen eighties seventies and eighties and the women that are so empowered today to yell and scream about why we don't need mammograms. So that would be the one and two more questions. I always ask what what about your job sucks the most? What is the hardest part of your job? The most tedious part, the part that you don't look forward to the part you're that you're like, oh, fine. The most tedious part of my job. So I from my charts that I have do the electronic medical record. You mean aside from that? I just wish I could just dictate it and it just comes out and it's like it's done. Aside from that, I think. No, no, I actually it's a stupid thing to say, but actually like most parts of my job for sure. Because remember I'm seeing people who are at their worst moment in time and the little things that may annoy me. The things that I don't like that. I'm very upset about if a patient doesn't get treated properly. And I mean from my custodian, all the way up this patient walks into our doors. They are a family member and they're to be treated as such. And I am lucky to be an institution where that happens. But occasionally you get somebody who just not thinking about why this person's here that will send me through the roof. Really? Yeah, because this is a very vulnerable time for a person. It really is. Even if I tell you you're gonna be fine, and we make jokes, etc. I just told you you have cancer, that's never as a human, never going to cause shudders down your back. It's never not going to have. It's always going to be something that creates that feeling. And for anyone here today, the brush somebody off or not recognized the importance of that really does bug me. You know, you have to have some humanity. This person is sitting here with a life threatening diagnosis, even though thankfully we can take care of it. You just never know. You know here staff was very nice to me in the way to your. Yes, the good. So I don't have to fire anybody. Good. What is last question? What is the thing that you love the most about your top, what you love about your show? What is I know that that's hard to pick for you? I love. I love it. It's a hard one. I love the hug. I love the hug from my patients, especially after I've done surgery, and I see them for that first time post operative Lii and say, welcome to being cancer free and it just. Grapping. Oh, no, you're making me growing over. They do, and, and that's what I'm just like. They just grabbed me. And it's funny because I think I give a good vibe that I'm a hugger 'cause I am very big hugger. They kind of like lean in and then they just grabbed me and whispered my ear. Thank you. I think that is that is worth every everything that I've ever done is in that moment, everything. So after holding it together and trying not to cry this entire time, most of the time out of just pure inspiration in hope. I finally just broke and my mascara was not where it started on. Sorry, we wonder that that that is that is that is my favorite moment, for sure. I mean, are you kind of glad you didn't become a mechanic? I do tinker once in a while, but I am. I mean, you know, when your car's not working. So if I tell you, you know what? I can fix it for five dollars. I think people would do. But yeah, I think my mom was right. For sure. This is much better than being mechanic. I've been keeping the right job. Thank you so much doing this. Anytime you're you're my favorite surgical oncology, I well, you're always going on. Well, yes. Pleasure. So remember to ask smart people stupid questions because it just might save your life. Were somebody else's Dr? Mun ASI is at the my monitors, a medical center in Brooklyn, New York, and for more resources, cancer dot org, breast cancer, dot org are all there. So so many sites were resources to reach out to Susan G Komen is the largest nonprofit that deals with breast cancer awareness and research, and they deal with community health, global outrage public policy. Again, that's Komen dot org, but you may have your preferred charities. Also, the third week of October is specifically male breast cancer awareness week. So now you're aware of that too. Consult your own healthcare advisors in providers. If you have questions about screening and treatment and share your stories, this episode is dedicated to everyone of all genders who has had or has been affected by breast cancer and the amazing folks. Who are out there working toward a cure and helping patients. My aunt Norma pretty much my second mom, Kathy, and Stephen remorse has grammar all survivors and my cousin just this last week was diagnosed. She personally echoes Dr Manasseh, she says, get a baseline mammogram at forty, and she added that. If you have dense breasts, ask about three d. mammograms, she undergoes surgery this week, so please keep McKesson in your thoughts. If you can. She's tough cookie, and we love her very, very much. Thank you to Bonnie Dutch and Shannon. Feltus. Thanks to everyone at patriot part of your support. This month goes toward a donation to breast cancer research. Thank you, Steven remorse for adding this altogether and also for the amazing Allah geology, bonus episode, you hosted this past week, you killed it. Thank you, Erin. Talbert loved your mom Kathy and to Hannah Lippo or admonition the allergies Facebook group. Thank you. Didn't Nick the war burn who. Wrote and performed the theme song, and is it a band called islands? Oh, also Steven Ray Morris hosts the per cast and see drastic, right? I figured everyone who listens to this podcast listens to his already, but if you don't, you gotta check that out really quick before we get to the secret. I wanted to plug to friends things. These aren't ads. They don't even know him doing it, but I just think they're cool. And I feel like all Ogies listeners would be so up in this, but on October twentieth in New York. At caveat NYC in the afternoon, they're doing a deep dive with a deep ocean expert, and they're Skyping to people on the research vessel Felker for alive QNA. It's going to be bananas and it's hosted by science Friday, and also by two dollar gist. Our favorite squid scientists, Sarah mcinulty. So caveat NYC has tickets. They're like fifteen bucks or something, and it's October twentieth. And then also if you wanted to SICOM for a living to science communication, you want to start a podcast or two videos or write books about science, and you're not quite sure where to start or if this is your deal. If you can get yourself to the west coast November seconds before I have friends CARA, Santa, Maria, Sara, Curtis, and Jason Goldman, they're awesome, and they run this camp called SICOM camp. It's SICOM camp dot com. And they have lectures, s'mores, horseback riding seminars, workshops. It's all about science communication with some of the best people in the world who do it who all gather there. So I just wanted to tell you guys about it so that it didn't pass and you guys didn't say Allie. Why didn't you tell me about it? I always go on. I love it, and it's been so helpful for me too. So those are two things that my friends are doing. I just want to tell you about, okay, so, oh, I promised you a secret at the very end. All right. Okay. So we're talking about crystals deodorant. I was talking to someone about this a while ago about how, but don't those crystals. Just stop working spontaneously. Also, what's with these magic crystals. They're just a big hunk of mineral salts. And when you get them wet or you rub them on your damp armpits, it gives you a layer of salt on your. Pin in the bacteria that would normally cause you to smell like pepperoni in a hot car. Can't grow on your armpits. So that's why you don't smoke. You still sweat, but you won't smile. I guess, because the bacteria flora can't survive in a salty environment like that. So there you go, but I've heard of people using them and they just kind of stopped working for them. Maybe the bacteria, flora changes or maybe they're not getting it wet enough, whatever. And I was talking to this woman about it. And I said, yeah, like what? If you're like dancing with the governor and then all the sudden it stops working and you smell terrible. She was like, that's so weird because that happened to me. I was using crystals Yoder and it stopped working. She was at the governor's ball dancing and she realized she smelled bad. And I was like, that's really weird. I don't know where I got what if you were dancing with the governor, but it happened to you at the governor's ball anyway. Thanks for listening. Please take care of yourself. All of you kiddo. Alright, Brian. Pachyderms. Dozy while gene. Meteorology. And so I think it's important to look at life as a holistic approach, right? You want to be healthy that's mental physical, sexually, and spiritually. That's what you want.