Speaker 1: This is let's be clear with Shannon Doherty. Hi everyone,
Speaker 1: this is let's be clear with Shannon Doherty. Please welcome
Speaker 1: doctor Laurence Piro, Doctor Pierro. I brought you my best friend,
Speaker 1: and she was a stylish she was fantastic. I loved her.
Speaker 1: She taught me how to travel. We went to St.
Speaker 1: Barts every year, like we had a very very very tight,
Speaker 1: tight tight relationship. And she ended up getting cancer. I'm
Speaker 1: obviously not asking you to divulge anything, but her cancer,
Speaker 1: you know, was more advanced than mine at that time,
Speaker 1: and I remember her describing certain symptoms that she had
Speaker 1: and I would like two days later, by the way,
Speaker 1: just talking about it right now, thanks you. It gets
Speaker 1: me just talking about it. I'm starting to get those
Speaker 1: weird nice things that'll go away the minute I stopped
Speaker 1: talking about it. It's so bizarre, but you kept saying
Speaker 1: to me like, you cannot associate your cancer with hers.
Speaker 1: There are two different cancers. And if you look at
Speaker 1: her path, then you're going to walk her path like
Speaker 1: you have to walk your own path and she has
Speaker 1: to walk her own path. And when you first set
Speaker 1: me down and really had that conversation with me, I
Speaker 1: was like wow, Like I heard that, and then the
Speaker 1: pains like went away. It was all a mental thing.
Speaker 2: And I remember, actually the first time I said that
Speaker 2: to you was before you ever or at least before
Speaker 2: you ever verbalized anyway. Yeah, experienced some of the same things.
Speaker 2: I just knew to anticipate that, and I said that
Speaker 2: you cannot compare yourself. The minute I understood what her
Speaker 2: scenario was, I knew that you would look at that
Speaker 2: scenario and assume that that was your path. And because
Speaker 2: everybody does. I mean, fortunately many people are. Everybody's exceptional
Speaker 2: in some ways, but we're all very common in other ways.
Speaker 2: In terms of our human reactions. We're all very common
Speaker 2: because we're all part of the same you know, same community,
Speaker 2: of the same gene pool, the same organism. And so
Speaker 2: I knew that that would be a thing, and and
Speaker 2: it was, and each step of the way, you know,
Speaker 2: so that we had to keep repeating, especially because you
Speaker 2: were you know, you were a very good friend. So
Speaker 2: when you're a very good friend, you spend time talking.
Speaker 2: You know. It's kind of like support groups. I mean,
Speaker 2: support groups can be so great, but they have to
Speaker 2: be refereed carefully, and the composition of a support group
Speaker 2: has to be chosen carefully because you know, sometimes it
Speaker 2: can do damage and sort of help if it isn't
Speaker 2: you know, refereed carefully, and the people in the group
Speaker 2: are not common enough because if you're you know, if
Speaker 2: you're someone with adjuvant breast cancer and you know, with
Speaker 2: a eighty five or ninety percent chance of cure, and
Speaker 2: you're in a group with metastatic breast cancer patients, you know,
Speaker 2: you may be seeing, you know, a picture that is
Speaker 2: so frightening. You know that it's hard psychologically. So the sharing,
Speaker 2: the group share thing and the industry I think is
Speaker 2: very complicated, and especially in today's day of social media
Speaker 2: and all that, because anyone can reach out to you
Speaker 2: and share with you, and again you don't you're not
Speaker 2: really validating their data. I mean in this case of
Speaker 2: your friend, of course you were, but if someone meets
Speaker 2: you on the internet, you know, and is sharing data
Speaker 2: with you, you can't really validate their data. And we
Speaker 2: all leave pieces out of stories. I mean, even we're
Speaker 2: not talking about cancer, right if you're talking about, you know,
Speaker 2: your friend who did something to you one day about
Speaker 2: you know, what happened to a party or something like
Speaker 2: that people nate by nature tell their side of the story, right,
Speaker 2: So sometimes that leaves out a couple of beats that
Speaker 2: might change other people's view of it. But when they're
Speaker 2: telling their cancer story, they do the same thing. They
Speaker 2: sometimes leave out some beats because no one wants to
Speaker 2: be on the pathway that's leading to the bad outcome.
Speaker 2: Everyone wants to be on the pathway leading the good outcome,
Speaker 2: and so you sometimes leave things out, and therefore the
Speaker 2: person listening can't really adjudicate the story straightforwardly, right.
Speaker 1: And also there are you know people you said earlier,
Speaker 1: there are people that they're just like warriors when it
Speaker 1: comes to their protocols, and it doesn't matter. They just
Speaker 1: keep on a protocol. You know, I think there was
Speaker 1: only one protocol that I complained about. Every other protocol
Speaker 1: it didn't matter what that we were on together. Yeah,
Speaker 1: didn't matter what the side effects were, I was okay.
Speaker 1: And then there are other people like my friend who
Speaker 1: you know, blew through protocols incredibly incredibly quickly. It was
Speaker 1: like if if there was anything sort of uncomfortable. There
Speaker 1: are people that with a little bit of discomfort, they
Speaker 1: they don't want to stay on a protocol as opposed
Speaker 1: to realizing that like the more protocols you blow through,
Speaker 1: the less options you have because there's only so many protocols.
Speaker 1: What's really interesting to me is all the suggestions I think,
Speaker 1: and I've spoken to you about this, of that I
Speaker 1: get from people, you know, the chemo or this or
Speaker 1: that that is killing me Western medicine, that I need
Speaker 1: to be on you know, CBD, or I need to
Speaker 1: you know, uh, if I just go on a raw diet,
Speaker 1: or if I just do this, or I just do that.
Speaker 1: Oh my friend took you know, I remectin and they're
Speaker 1: completely cured of cancer. And I'm like, yeah, but they
Speaker 1: were also in a clinical trial, Like how are you saying,
Speaker 1: is that I remectin opposed to the clinical trial? Like,
Speaker 1: you know, it's such an interesting and I think a
Speaker 1: lot of people with cancer probably have this conversation with themselves,
Speaker 1: and I've had it with myself and I've had it
Speaker 1: with you. There's a vast amount of misinformation and just
Speaker 1: information in general that's really hard to sift through because
Speaker 1: there are so many stories and proclamations that this alternative
Speaker 1: medicine cured somebody of stage four cancer and so your
Speaker 1: brain has this very curious moment where it's like, well,
Speaker 1: should I be using a dewormer like they use on horses?
Speaker 1: Is that what's going to cure me? Like that was
Speaker 1: the latest one I got recently, And then you just
Speaker 1: start sort of knocking your head going stop it, you know,
Speaker 1: like science is science.
Speaker 2: There's so many levels to that. I mean, first of all,
Speaker 2: you one hundred percent right. I mean, on the surface
Speaker 2: of that kind of conversation, people cant say, well, gee,
Speaker 2: I don't know. My doctor treats me to like a statistic.
Speaker 2: He says, we're going on this protocol and it has,
Speaker 2: you know, forty two percent effectiveness. And yet I talk
Speaker 2: to this person and they're talking about this alternative stuff
Speaker 2: and they tell me about people that have been cured.
Speaker 2: But the reason that doctors don't talk about just people
Speaker 2: who've been cured because those are anecdotes. You have to
Speaker 2: study something in a disciplined way to find out if
Speaker 2: it's random or if it's an actual effect. And most
Speaker 2: of the alternative things are not studied that, and they're
Speaker 2: all driven by anecdotes and not to dismiss those, and
Speaker 2: they can feel empowering to a person who's in a
Speaker 2: bad situation. I get that, but at the end of
Speaker 2: the day, you're vulnerable, and when people are promising you
Speaker 2: things effectively, I mean they're effectively kind of promising this
Speaker 2: by saying this one person had this. I mean, they're
Speaker 2: hanging out there the possibility that that might be you.
Speaker 2: It's in some ways, you know, not intentionally, it's meaning
Speaker 2: to be helpful, but it's kind of praying on your
Speaker 2: vulnerability in some ways. And then if you choose not
Speaker 2: to do any of those things, because you just said
Speaker 2: I'm going to be sensible and you know, look at
Speaker 2: the data and all that. But then if you decide
Speaker 2: not to do those things and your outcome isn't good,
Speaker 2: then you self flagellate yourself. Well, maybe if I had
Speaker 2: done the Eye of Newt and all of that right,
Speaker 2: that you would have been okay. And so it also
Speaker 2: has that second layer of difficulty and judgment and all
Speaker 2: of that's difficult. You know, I didn't realize, despite a
Speaker 2: long career, I didn't realize just how humbled people get
Speaker 2: with suggestions until I took care of Farah Faucet and
Speaker 2: when I was on the journey with Pharah. You know,
Speaker 2: so many people strangers were writing or just left and
Speaker 2: right and whatever like with you, and she said, she
Speaker 2: just told all of them, just send this to my
Speaker 2: doctor and he'll sort this out. So you realize that
Speaker 2: besides eight thousand additional emails a day that I got,
Speaker 2: my office was filled to the ceiling with packages of
Speaker 2: bottles and pills and things and blankets and prayers and whatever,
Speaker 2: which is moving. To see how many people care. It
Speaker 2: was just beautiful moving, but it was a morass in
Speaker 2: terms of any patient if they were actually trying to
Speaker 2: sort out all of that stuff. But people don't fully
Speaker 2: realize is each time you have to open your thinking
Speaker 2: to another thing which might work, you're reliving your diagnosis,
Speaker 2: just reliving the whole initial process of the diagnosis and
Speaker 2: what might work. When you're having to tear into each
Speaker 2: of these individual suggests, and when it's thousands, it's overwhelming.
Speaker 1: So yeah, I mean that part doesn't bother me because
Speaker 1: I don't really like ever relive the diagnosis. But I
Speaker 1: think what I'm more worry about is I understand enough
Speaker 1: to look at some sort of suggestion that somebody gives
Speaker 1: me and either research it myself or have the conversation
Speaker 1: with you because a lot of times great you know,
Speaker 1: I believe in also natural medicine. I believe in homeopathic
Speaker 1: Like I think that's fantastical. Yeah, you just have to
Speaker 1: make sure that the properties that are in that homeopathic
Speaker 1: herb or whatever isn't counteracting what your normal cancer med
Speaker 1: is then doing. Like that's a big thing that people
Speaker 1: who give you the such suggestions don't realize, is that
Speaker 1: there is natural stuff out there, but it can literally
Speaker 1: kill essentially what your chemical medicine is on.
Speaker 2: That is, anything you're doing should be in addition to
Speaker 2: and not instead of right right. And then rule two
Speaker 2: is what are the drug interactions?
Speaker 1: Drug interaction?
Speaker 2: And I'll tell you I took care of a young
Speaker 2: man who was really an amazing, credible young man and scholar,
Speaker 2: and he unfortunately developed a very difficult cancer situation. And
Speaker 2: his girlfriend at the time of diagnosis and then they married.
Speaker 2: During the course of his care, someone and her family together,
Speaker 2: they decided he had a feeding tube at this particular
Speaker 2: point in his journey, and they decided that they would
Speaker 2: try to be helpful to him. They would stop feeding
Speaker 2: him the liquid diet that was the well balanced diet
Speaker 2: and all that, and they would feed him just like
Speaker 2: yogurt mixed with antioxidant berries and different things. And I
Speaker 2: always told this young man that if you know, if
Speaker 2: you are scared, you know, just call me and I
Speaker 2: will come. You know, just if you're scared of what's happening,
Speaker 2: just call and I will come. And so one day
Speaker 2: he called me and he said, I think I'm dying.
Speaker 2: I said why, and he said, because I'm bleeding from
Speaker 2: my nose, and I'm bleeding from my mouth, and I'm
Speaker 2: bleeding from everywhere. And you know, this was somebody in
Speaker 2: his twenties, right, and he had seen all these horror
Speaker 2: films where you know where that's what happens, and so
Speaker 2: he could only conclude that that meant he was dying.
Speaker 2: So I said, I'll be right there, and I drove
Speaker 2: there and I walked into the room and I looked
Speaker 2: at the scenario and it was interesting that something else
Speaker 2: I did which was kind of interesting. There was so
Speaker 2: much the room was so amped up, and I lifted
Speaker 2: up the sheet, you know, so his feet were there,
Speaker 2: and I asked the nurse. We had like around the
Speaker 2: clock nurs as. I said to the nurse, do you
Speaker 2: have some lotion here? And I was actually wearing was
Speaker 2: a summer and I was wearing like jeans and flip
Speaker 2: flops at a T shirt or something. I don't think the
Speaker 2: nurse knew I was the doctor.
Speaker 3: So I walked in the room and said, lift up
Speaker 3: the thing exposing and Feeta said, do you have lotion?
Speaker 3: And I think the nurse was so confused. So I
Speaker 3: just squirted some lotion on his feet and I started, actually,
Speaker 3: you know, massaging his feet because I knew he needed
Speaker 3: to calm down, you know, so we could sort this
Speaker 3: out because he was just petrified.
Speaker 2: Right, So well, I'm asking questions, Well, I'm just you know,
Speaker 2: putting this lotion on his feet and massaging his feet,
Speaker 2: which you know, if you're you ever get a foot massage, right,
Speaker 2: I mean, it makes your whole body just calm down,
Speaker 2: all the tension go away. So I'm asking questions, well,
Speaker 2: what about this and what about that? And what have
Speaker 2: you been feeding? Have you been taking these? And I'm
Speaker 2: asking of all the people in the room, and and
Speaker 2: that's when they told me that they had changed the diet.
Speaker 2: And I said, well, I said to him, listen, you
Speaker 2: have vitamin K deficiency from your diet. That is why
Speaker 2: you're bleeding and you're going to be fine. I sent
Speaker 2: his mother to the pharmacy to get some Vita McKay
Speaker 2: that I called in and prescribed you to the Via McKay.
Speaker 2: All the bleeding stopped and he was okay for that moment.
Speaker 2: I mean, he still had obviously cancer and cancer treating
Speaker 2: the rabbages of it. But the point is is that
Speaker 2: you know, a very very well meaning and well intentioned
Speaker 2: change in things without fully discussing it, you know, resulted
Speaker 2: in a very very scary moment for this this young man.
Speaker 1: That's poor thing. Which is a really interesting segue because
Speaker 1: I was going to talk to you about the fact that, like,
Speaker 1: maybe the white coat doesn't know everything, and then I
Speaker 1: hear that story and I'm like, maybe they do. You
Speaker 1: know what I'm saying, like, because you do understand, you know,
Speaker 1: drug interaction, and you do understand vitamin deficiency, and you
Speaker 1: do understand what somebody is needing and they're feeding to
Speaker 1: and you know, you do understand the different protocols and
Speaker 1: how they're going to help. So it's not necessarily segue.
Speaker 1: Isn't necessarily about that a white coach doesn't know everything,
Speaker 1: because I think they know quite a bit. I think
Speaker 1: it's more that it's okay, And it's what I love
Speaker 1: about our relationship, right, is that I've never felt as
Speaker 1: if I couldn't question something. I never looked at you
Speaker 1: and thought I just need to accept what he's saying
Speaker 1: to me and putting in front of me, keep my
Speaker 1: mouth shut and do what he says. I've always engaged
Speaker 1: with you and said like, hey, but I was just
Speaker 1: looking at this, and there's this and this and this
Speaker 1: and this as other additional data, and you're like, well, yes,
Speaker 1: but that data then comes with this data like you
Speaker 1: have to do a little bit more digging, or you
Speaker 1: have to do this or that. I don't think enough
Speaker 1: people have a healthy conversation with their doctor. And some doctors,
Speaker 1: not you, but some doctors I think make a patient
Speaker 1: feel as if they don't have the time for the questions.
Speaker 1: But I also think that the patients don't demand the time.
Speaker 1: And if a doctor doesn't know that you are needing
Speaker 1: that time desperately, then he's not going to give you
Speaker 1: that time because he's got fifty other patients to go see, right,
Speaker 1: So that it's perfectly okay to respectfully but strongly have
Speaker 1: a conversation and demand more time and do your own
Speaker 1: research and push back up against an opinion, because ultimately
Speaker 1: it is our lives and our bodies and our decision.
Speaker 1: So we have to be comfortable with everything and have
Speaker 1: no regrets going forward.
Speaker 2: So when the Internet came into being, prior.
Speaker 1: To now, everybody's a doctor. I mean, I have a
Speaker 1: freaking degree, don't you know they?
Speaker 2: Prior to the Internet, all medical knowledge was in medical books,
Speaker 2: and medical books were only sold in bookstores to doctor
Speaker 2: the medical people, so not only I think the Merks
Speaker 2: Manual or something like that was maybe the only real
Speaker 2: authoritative type of a book that lay people had. So
Speaker 2: the doctor was viewed as the keeper of all medical
Speaker 2: knowledge and there were no other vehicles. When the Internet
Speaker 2: came into being, I remember so vividly doctors being so
Speaker 2: inflamed because a patient would walk in with a print
Speaker 2: out of you know, seventy five pages and instead of saying,
Speaker 2: I have joint pains and rash, I think I have
Speaker 2: you know what is that? What is joyt pains and rash?
Speaker 2: Could it be lubas? Are going to be lying? They'd
Speaker 2: walk in and PLoP down seventy five pages and say
Speaker 2: I have a lime disease, and here's why, right when
Speaker 2: maybe they more likely had lucas or something. Doctors were
Speaker 2: so insulted by that they would grab the papers and
Speaker 2: throw them in the trash in front of the patient
Speaker 2: and say, this is what I think of the Internet
Speaker 2: boom like that. They were just enraged. And so I
Speaker 2: watched that going on, and I realized that I was
Speaker 2: living through a sea change and that medical knowledge was
Speaker 2: now going to be widely available to everyone, and people
Speaker 2: were not looking for me to be a professor. And
Speaker 2: you see, this is where the white coat comes in.
Speaker 2: That white coat is symbolic of somebody being a professor
Speaker 2: and a sign of authority. And I realized people didn't
Speaker 2: want me to be a professor and the keeper of authority.
Speaker 2: They wanted me they didn't want to be on my team.
Speaker 2: They wanted me to be on their team.
Speaker 1: That's craft what a beautiful way of saying it.
Speaker 2: And that's when I took off my white coat. And
Speaker 2: I've never put it back on because I think it's
Speaker 2: too strong of a symbol of an old time role
Speaker 2: for a doctor. And I think everybody's on their own journey,
Speaker 2: and as long as you accept responsibility for your decisions.
Speaker 2: I will go with you on your journey.
Speaker 4: Now.
Speaker 2: I'm going to try in every way I can to
Speaker 2: talk you into what I think is the best thing
Speaker 2: based on the data and everything I understand, and to
Speaker 2: tell you why. But at the end of the day,
Speaker 2: even if it's alternative or not not typical or not
Speaker 2: the best choice, I'll go on that journey with you
Speaker 2: as long as you understand that we're deviating. And I
Speaker 2: think one of the reasons why you and I have
Speaker 2: that relationship from the beginning is that I try always
Speaker 2: when I'm telling someone about what we should do, I
Speaker 2: try to always say, we have three options here, or
Speaker 2: four options here, or two whatever, so that even though
Speaker 2: I've already made up my mind based on the data
Speaker 2: so what I think would be best, I'm presenting the
Speaker 2: field of view of how I went through my decision
Speaker 2: making process, and I share my decision making process with you,
Speaker 2: as as you and I have done many times, right
Speaker 2: to say, so, here's the four paths. I like this
Speaker 2: one for this reason and that reason, I like this
Speaker 2: one for that reason whatever, And then I've ruled out
Speaker 2: these and these, and that leaves us here and between
Speaker 2: those two one spares hair in one doesen, so let's
Speaker 2: spare hair or whatever. How I mean, However, the situation is,
Speaker 2: and I think that you know, people doctor strutu comes,
Speaker 2: you know, grab the authority because it's kind of what
Speaker 2: the job teaches you to do. But if you actually
Speaker 2: give the authority over to the patient, they very quickly
Speaker 2: give it back to you.
Speaker 1: If you right, Yeah, well, because it's human nature, right,
Speaker 1: Like human nature is to want to be in control,
Speaker 1: and especially if you're sick, you want to feel like
Speaker 1: you have some semblance of control. So if you're given
Speaker 1: that control the way that you do it, you definitely
Speaker 1: give it back because you're because then you don't need
Speaker 1: to like fight for it exactly.
Speaker 2: And if you ever do want to really exert it,
Speaker 2: because in opposition to what his or her recommendation is
Speaker 2: for you, you know that they'll glad fully give it
Speaker 2: back to you, like you're handing it back saying, Okay,
Speaker 2: you've proven that you can handle the authority for me.
Speaker 2: But if I want my authority back, by the way,
Speaker 2: it's just on loan to you, So I'm going to
Speaker 2: take it back.
Speaker 1: Yeah.
Speaker 2: If I get to a different place and a different
Speaker 2: set of decisions.
Speaker 1: I also think that it's really unique about you as
Speaker 1: a doctor that I really encourage the listeners too. And
Speaker 1: it doesn't matter if you have breast cancer, any other
Speaker 1: kind of cancer, any sort of illness, or you're just
Speaker 1: you know, going to a general doctor. I really encourage
Speaker 1: you to, you know, get to know your doctor. Like
Speaker 1: doesn't mean you have to go to Italy with them,
Speaker 1: but that might be an extreme, but you know, engage
Speaker 1: and get to know and be very honest with your
Speaker 1: doctor about your lifestyle and everything else because at the
Speaker 1: end of the day, it allows more leeway in that relationship.
Speaker 1: And for instance, the infusions that I'm currently on right like,
Speaker 1: there came a point where I said, hey, I want
Speaker 1: to try something. I want to try not getting the
Speaker 1: anti nausea. I think it's prolonging my sickness. Once I
Speaker 1: get the infusion, I don't want fourteen days of feeling
Speaker 1: like I have to throw up for twelve days. I
Speaker 1: just want to throw up and get it over with.
Speaker 1: Maybe this will work, maybe it won't. And I remember
Speaker 1: there was a nurse who was very against it. And
Speaker 1: I waited for you, and I texted you and you
Speaker 1: came in. I go super early in the mornings. As
Speaker 1: you know, I'm a weirdo. I go at like six
Speaker 1: thirty seven o'clock in the morning, and you, you know,
Speaker 1: looked at me and said, if that's but you know
Speaker 1: me now, And that's the difference is that we now
Speaker 1: know each other and we have a shorthand.
Speaker 2: And you know that I know that you know your
Speaker 2: body like no one else. I've seen it over and
Speaker 2: over again. Well, I mean that's true of everybody, but
Speaker 2: you're like a you know, savant in that regard, and
Speaker 2: what you're wanting to do is completely anathetical. Like there's
Speaker 2: no reason to think taking a three day and a
Speaker 2: nausea injection is like prolonging the nausea. I mean, just
Speaker 2: like antithetical to traditional medical thinking. But I've seen time
Speaker 2: and time again you have weird reactions to medicines, and
Speaker 2: you figure it out for your own body, and when
Speaker 2: we do it, it works out. I'm like, that's again, Well,
Speaker 2: like I said to the nurse, she will take responsibility
Speaker 2: for this decision if it doesn't work out, Well, there's
Speaker 2: no there's no reason to hear.
Speaker 1: If you get very sick, you just have to like
Speaker 1: you have to come in We're going to have to
Speaker 1: get you in my d drip, like you have to
Speaker 1: stay hydrated. And I remember I called you and I
Speaker 1: was like, uh, I think it's working, Like I'm not
Speaker 1: as sick for as long.
Speaker 2: But we took we tried all different anti nausous, we
Speaker 2: tried steroids, we tried to check every everything. Yeah, and
Speaker 2: and and so why not because you have this instinct
Speaker 2: and you were right and most people know they But
Speaker 2: it's the same thing I always laugh about. You know,
Speaker 2: when patients I'll always have to get their blood drawn
Speaker 2: before the doctor's appointment, and some phlebotomists will insist that
Speaker 2: they're going to draw somewhere because it's the best vein,
Speaker 2: and the patient will say that vein doesn't work. I'm
Speaker 2: telling you that vein doesn't work. You need to go
Speaker 2: over here, and they won't listen to them because it's
Speaker 2: like I'm the phullbottomist and I know the right veins whatever,
Speaker 2: and listen. If a patient demonstrably tells you where to
Speaker 2: draw their blood, do it because they know their body.
Speaker 1: This is a tough one, Okay. When you try patients
Speaker 1: for years, does it take a toll on you when
Speaker 1: you lose them. The second part is or are you
Speaker 1: able to stay detached? And I know that that's a
Speaker 1: no from you.
Speaker 4: Right.
Speaker 2: So the thing about this topic that I feel so
Speaker 2: strongly about is that I have an obligation to bring
Speaker 2: the best knowledge, the best individualized thinking, the best strategic thinking,
Speaker 2: and all the best resources anywhere in the world to
Speaker 2: a patient's journey of healthcare, cancer treatment. But at the
Speaker 2: end of the day, their outcome is encoded in the universe,
Speaker 2: and so my job, above all else is to make
Speaker 2: sure that they have a journey that's closest to the
Speaker 2: journey they want to have, as close as I can
Speaker 2: make it. And that is where I derive my sense
Speaker 2: of gratitude and sense of joy from, is making sure
Speaker 2: or that as we go along that journey, after having
Speaker 2: brought all the best resources and the best you're thinking
Speaker 2: and all that. But you know, that's just the basic
Speaker 2: program to me, that I can make the experience as
Speaker 2: much what they want it to be as possible. And
Speaker 2: that includes the dying process. You know, you enter alone
Speaker 2: and you leave alone. You can't really help someone enter well,
Speaker 2: you can just try to catch them, but you can
Speaker 2: help someone fly away well. And everyone has very different
Speaker 2: ideas about what that process should be for them. But
Speaker 2: as a doctor, I think the most important thing is
Speaker 2: to listen to them and talk about it and try
Speaker 2: to even make that part of their journey. You know,
Speaker 2: if you think about the most vulnerable position that there
Speaker 2: is in the world is when you're flying away and
Speaker 2: if you don't have people around you who will listen
Speaker 2: to you and try to help you make it the
Speaker 2: way you want it to be. But a terrible, terrible
Speaker 2: tragedy and closure that is so I am thrilled that
Speaker 2: I've been able to treat people who've gotten care from diseases.
Speaker 2: I'm thrilled that I've been able to develop medicines that
Speaker 2: have cured some people and very much you know, prolonged
Speaker 2: the lives of other people. But I'm equally honored to
Speaker 2: have helped people die well, because it's one of the
Speaker 2: most intimate things you can do in life as a doctor.
Speaker 1: And in all your years of treating patients and being
Speaker 1: in the medical world, have you ever witnessed like a
Speaker 1: true miracle?
Speaker 2: Well, you know, that's a funny word. I certainly have
Speaker 2: seen people have responses that exceed anything you could see. Yeah,
Speaker 2: they seem miraculous. And I'm a big you know, I
Speaker 2: have a big spiritual presence as a person, you know,
Speaker 2: like I really very much, you know, part of me
Speaker 2: lives in that kind of spiritual existence. So I don't know.
Speaker 2: I mean, it's a complicated word for me, because when
Speaker 2: I think of miracle, I almost think of like somebody somewhere,
Speaker 2: you know, waving a wand and making magic and making
Speaker 2: something happen, you know. And I don't understand like what
Speaker 2: it looks like behind the behind the curtain, you know,
Speaker 2: of miracle making. So I don't know if things are
Speaker 2: really miracles. But I do know that I've seen unexpected results.
Speaker 2: I do know that a person harnessing their spiritual and
Speaker 2: creative and loving energy can change the course of disease,
Speaker 2: and people living in a dark and negative and uh
Speaker 2: you know, critical and unhappy place can change the course
Speaker 2: of disease. So I do believe that there are factors
Speaker 2: beyond our control, and whether they're all biologic and physiologic
Speaker 2: or where some of them are all so universe and spiritual,
Speaker 2: I personally believe very much in an order of the universe,
Speaker 2: and I believe that the universe, you know, that we
Speaker 2: are mindful people, and sometimes we allow our mindfulness to
Speaker 2: think that we know best for ourselves. But I'm quite
Speaker 2: well aware that there seems to be an order in
Speaker 2: the universe, and if you turn yourself over to the
Speaker 2: order in the universe, you often wind up in a
Speaker 2: way better place than you would have had you continue
Speaker 2: to plow forward your own, you know, limited thinking about
Speaker 2: where you belong. And so I try to always, you know,
Speaker 2: turn my will over to the universe and follow the
Speaker 2: clues to get to the place where I think maybe
Speaker 2: I'm supposed to belong. And I try to always you know,
Speaker 2: help patients, you know, on that same journey too.
Speaker 1: So with all the money pouring into cancer research, why
Speaker 1: is chemotherapy and actually is it still to go to
Speaker 1: treatment when it causes you know, obviously a lot of weakness,
Speaker 1: a lot of pain, a lot of side effects.
Speaker 2: Well, chemotherapy is largely derived from natural sources like the
Speaker 2: taxanes or other sorts of things, and some were chemically
Speaker 2: modified and some were synthesized, but they were all focused
Speaker 2: on kind of interfering with DNA or other critical pathways
Speaker 2: to make a cell die, and in fact they're very
Speaker 2: effective at doing that. But the necessary side effect is
Speaker 2: that other cells that are dividing can also de that
Speaker 2: causes the side effects. Right. So the side effects are
Speaker 2: caused by like a lot of times when people get
Speaker 2: mouth sores and ulcers or diarrhea, rectal pain, that sort
Speaker 2: of thing, it's because the mucosa lining of the bowel
Speaker 2: are cells that are always turning over, so they die
Speaker 2: more readily in response to chemotherapy. In fact, we've had
Speaker 2: an amazing you know revolution in two areas treatments, So
Speaker 2: in sequencing the human genome and identifying you know, mutations
Speaker 2: that are existing in cancers and then identifying drugs that
Speaker 2: affect those mutations. That's been miraculous at creating a non
Speaker 2: chemotherapy pathway. And immunotherapy has been an unbelievable breakthrough with
Speaker 2: drugs that you know, allow the immune system to see
Speaker 2: cancers in the way they were overlooking them before and
Speaker 2: now can actually kill them and clean them up. And
Speaker 2: they all have their other different side effects because you know,
Speaker 2: you can't you can't rev up the immune system to
Speaker 2: cancer cells without expecting that they might actually attack some
Speaker 2: other cells too, right, some of your good cells exactly,
Speaker 2: And it's so they're different side effects and chemotherapy with
Speaker 2: the side effects on the left. So whenever we're going
Speaker 2: to be manipulating with physiologic processes, we're going to get
Speaker 2: side effects. They're even vaccines now, you know, for cancer.
Speaker 2: And what was interesting to me is when one of
Speaker 2: the first vaccines that ever showed benefit to advance cancer patients,
Speaker 2: which is called provenge for or prostate cancer. It was
Speaker 2: interesting how little all anybody ever said was why don't
Speaker 2: we have a vaccine for cancer? And then the vaccine
Speaker 2: was developed, and how low the adoption rate was of
Speaker 2: it for a whole variety of reasons that are probably
Speaker 2: beyond the scope of this discussion. But there are many
Speaker 2: different lanes. There are huge breakthroughs, and you know, and
Speaker 2: cancer has become a chronic illness. You know, it used
Speaker 2: to be you know, pretty much your cured or it's
Speaker 2: a fatal illness in a fairly short period of time.
Speaker 2: And now people can live for years and years and
Speaker 2: sometimes decades with low grade cancer being manipulated from time
Speaker 2: to time with various pills or infusions.
Speaker 1: And immuno therapy. Like I know that you and I
Speaker 1: have discussed im therapy a lot. I always really liked
Speaker 1: the idea because sort of the way that I looked
Speaker 1: at it was, you know, it was it was basically
Speaker 1: like the Navy seals of cells going in and like
Speaker 1: just you know, killing all the the bad cells. But yes,
Speaker 1: they do sometimes knock off, you know, some other really
Speaker 1: good cells, someone like me.
Speaker 2: Your particular set of characteristics a breast cancer doesn't respond
Speaker 2: very well to immunotherapy, and then your particular markers. Beyond that,
Speaker 2: there are specifically markers that tell you if your cancer
Speaker 2: might be likely to be susceptible. So even if you
Speaker 2: have a cancer that's not that susceptible, if you show
Speaker 2: these immune markers that say it would be susceptible, then
Speaker 2: there might still be a chance. But your immune markers
Speaker 2: are even say your tumber wouldn't respond. Now that doesn't
Speaker 2: mean that with you know, other immunological advances that are
Speaker 2: coming down the lane, that's not an option. But that's
Speaker 2: not an option because there are some situations where cancers
Speaker 2: respond and when they have the markers that say they
Speaker 2: won't respond, and combinations sometimes work. So there's more stuff
Speaker 2: coming every single day there there we're understanding new ways
Speaker 2: to use these genetic defects and molecular markers, and every
Speaker 2: single day we're learning how to manipulate the immune system more.
Speaker 2: And there's these certain kind of immune system where we
Speaker 2: take T cells out and T cells out of your
Speaker 2: body immune cells, and we in the laboratory make them
Speaker 2: into warriors against your cancer and then fuse them back
Speaker 2: into you called you know, TILL cells, and there are
Speaker 2: other version of car T cells and all that. There's
Speaker 2: just a huge amount of research going on with that,
Speaker 2: and they're quite miraculous treatments in some cases and in
Speaker 2: other cases not. But we're learning how to empower them
Speaker 2: differently so that maybe in the cases where they're not effective,
Speaker 2: they will become so. And so that whole, that whole
Speaker 2: field I think is really really important. And if someone
Speaker 2: can live long we're in a in a remission or
Speaker 2: a partial mission for a period of time, that may
Speaker 2: be something that you know, really comes to roosts for
Speaker 2: their particular situation that isn't available today. And then you know,
Speaker 2: tons of these, like I said, molecular markers. And even
Speaker 2: as we talked about earlier in your case, we you know,
Speaker 2: we didn't think of her to express her. We didn't
Speaker 2: really think that much about that category as being anything important.
Speaker 2: But it turns out her to expressors respond to the
Speaker 2: drug addibody con you get this targeted her too. So
Speaker 2: and we had unbelievable results with your situation, and you know,
Speaker 2: to to talk about what you were mentioning earlier about
Speaker 2: our decision to stick with it. You know, the situation
Speaker 2: was that we you know, we had cancer in some
Speaker 2: critical places that if it were to get out of hand,
Speaker 2: it could cause us to lose precious time. Then we
Speaker 2: might not regain in terms of because when cancer is
Speaker 2: growing in an organ, it can cause that organ to dysfunction,
Speaker 2: and if that organ dysfunctions, they could be game over.
Speaker 2: And so you're always at this juncture where is the
Speaker 2: amount of cancer in that organ such that if we
Speaker 2: keep going on this when we're not sure if it's working,
Speaker 2: we're taking we're hoping that it's stable, like we're seeing
Speaker 2: the same amount of disease because we stopped it into
Speaker 2: stability and now we're going to turn around into response.
Speaker 2: But there's also the possibility that was like a brief
Speaker 2: pause and it's going to keep growing, and then if
Speaker 2: it keeps growing, are we going to get to that
Speaker 2: place where the tumor burdens so great that the organ
Speaker 2: dysfunctions and then we lose precious time or we're out
Speaker 2: of the game. And that's where we were talking about
Speaker 2: a little bit to some extent, not exactly that situation,
Speaker 2: but somewhat that situation. We were talking earlier about whether
Speaker 2: to stick with this treatment, and we had scans that
Speaker 2: were showing us not as much response as we would
Speaker 2: have expected. By that time. You were having a lot
Speaker 2: of side effects, but yet the tumor markers were going down,
Speaker 2: and so we said, look, we're going to assume that
Speaker 2: the tumor markers are telling us the story and the
Speaker 2: scans are lagging. And we turned out to be right.
Speaker 2: But we also had that challenge too, and are we
Speaker 2: getting enough brain penetration that it's really going to work
Speaker 2: there as well?
Speaker 1: Right?
Speaker 2: And that was really the more most concerning part to me,
Speaker 2: is that is that that scenario, like a little something
Speaker 2: showed up there and so we're like, does that mean
Speaker 2: it's failing? And it turns out no, it was. It
Speaker 2: was ultimately responded just a.
Speaker 1: Little bit more time.
Speaker 4: Yeah, are you hopeful for a cure?
Speaker 1: And if so, at like how far out? I mean?
Speaker 1: There are new amounts of different cancers right there. There
Speaker 1: are there are vaccines for some that you mentioned, there
Speaker 1: are kind of cures for.
Speaker 2: Some, they're definitely cures. Podgkin's disease is very careable, right.
Speaker 1: So the ones that are you know, extremely tough to
Speaker 1: cure lung cancer for instance.
Speaker 2: Right listen, melanoma just the answer to your question, my
Speaker 2: hopeful of a cure absolutely, I mean it would be. Yeah,
Speaker 2: you know, this is be a challenging business if you
Speaker 2: didn't have optimism. But you know, we're the ANSWER's Clinic
Speaker 2: is a you know, it's a very renowned center for
Speaker 2: many things, but chief among them melanoma and immunotherapy, and
Speaker 2: and us having played us instantial role in the opening
Speaker 2: and beginning of the field of immunotherapy. And there's a
Speaker 2: time period when when stage four melanoma was a universal death,
Speaker 2: nothing more than that, right and just and and stage
Speaker 2: four melanoma people can be of all the disease disappear
Speaker 2: and live for years, maybe being cured. I don't know,
Speaker 2: you know, if they're cured or if we just reduce
Speaker 2: the cells downs at such a low level and harnessed
Speaker 2: the immune system and whatever that they never come out again.
Speaker 2: But the point is is they can now live their
Speaker 2: whole and tiple life in some ways. And I mean
Speaker 2: that's we never thought that we would see that in
Speaker 2: a disease I don't know. I mean, like twenty years
Speaker 2: ago in melanoma or three years ago melano doctors would say,
Speaker 2: you know, like what's your favorite place in the world, Oh, Hawaiira,
Speaker 2: you should go there. You should go there, get your
Speaker 2: will set up before you go that. They literally said
Speaker 2: that to people with this kind of melanoma. And now
Speaker 2: people even with brain metastaites in melanoma, are you know,
Speaker 2: completely disease free for decades and therefore, you know, perhaps
Speaker 2: the cured. We're always you know, as a doctor, you
Speaker 2: don't want to hold out false hope, and so we're
Speaker 2: always hesitant to say that cure word, you know, in
Speaker 2: some situations, just because we don't want to be leading.
Speaker 2: But we are eternally hopeful.
Speaker 1: So we know that. Obviously, we just discussed that not
Speaker 1: all cancers are curable, but early detection is always the
Speaker 1: best chance you have. Is there a test that you
Speaker 1: recommend that it's comprehensive, and obviously that depends on the
Speaker 1: kind of cancer that you have, like for women breast cancer,
Speaker 1: I'm assuming it's a mammogram, right, it's the first place
Speaker 1: you start, right. What about for you know, other forms
Speaker 1: of cancer.
Speaker 2: Well, if you're a smoker, there's something called the screening
Speaker 2: lung CETA and those that have been shown to be
Speaker 2: effective in picking up early cancers. So that's if you're
Speaker 2: a non smoker, it's all more difficult because routine chest
Speaker 2: X rays don't necessarily show much benefit.
Speaker 1: And what about like prostate cancer.
Speaker 2: Prostate cancer, we have the p S a test and
Speaker 2: blood and it's a very sensitive test, and when that
Speaker 2: shows an increase, then people are able to get an
Speaker 2: MRI of the I think having you know, regular doctor
Speaker 2: visits and getting there's a whole kind of template of
Speaker 2: screening tests. You know, depending on your gender and both
Speaker 2: your signed gender at birth and your acquired gender and
Speaker 2: all of those you know, different things. It's there's a
Speaker 2: whole set of things that you can do from screening
Speaker 2: cts and PAP smears and HPV tests. I think one
Speaker 2: of the biggest preventative things people should be doing is
Speaker 2: getting HPV vaccinated if you're not. I mean, the HPV
Speaker 2: virus accounts for five percent of all the cancers in
Speaker 2: the world cervical cancer and women anal cancer, and men
Speaker 2: and women mouth cancer and men and women penal cancer,
Speaker 2: and men five percent of all the cancers in the
Speaker 2: world caused by a virus infection. That if you get
Speaker 2: vaccinated against the most common causing, most common cancer causing strains,
Speaker 2: you can prevent that, right, So that's incredibly you know important,
Speaker 2: you know, prevention item, I think, and in terms of
Speaker 2: overall prevention, I think, you know, achieving your ideal body
Speaker 2: weight is incredibly important because you know, body fat creates
Speaker 2: an inflammatory state that contributes to heart disease, diabetes, and cancer. So,
Speaker 2: you know, a lot of people like to focus on
Speaker 2: dietary composition and I love that and it's important, but
Speaker 2: the truth is, dietary composition it's not that important. If
Speaker 2: you have way too much body fat, I mean, get
Speaker 2: your body fat down because that's going to control the
Speaker 2: inflammatory condition. And then at that point then the value
Speaker 2: of your dietary composition becomes super important, right because you've
Speaker 2: eliminated that inflammatory thing. If you have this massive obesity
Speaker 2: inflammatory state, it almost doesn't matter how much kal you eat,
Speaker 2: you've got this inflammatory state that's totally pro cancer all
Speaker 2: the time, so that exercise seems to have an independent protective,
Speaker 2: you know component, separate from just it's a weight loss component.
Speaker 2: So I'd say, you know, exercise regularly. Look, we were
Speaker 2: meant to move, We were meant to move, and it
Speaker 2: changes that whole physiological structure. And then there are various
Speaker 2: anti inflammatory things that you can take and do you
Speaker 2: know from you know, turmeric, baby aspirin if you don't
Speaker 2: have reasons why you can't take aspirin and other kinds
Speaker 2: of things. So I think, you know, I think there's
Speaker 2: something to that whole anti inflammatory scenario for people in prevention.
Speaker 2: And you know there are you know, the other things
Speaker 2: from there, but yes, there are things that could be done.
Speaker 1: And being honest with yourself one with your doctor, like
Speaker 1: don't ignore signs. If something doesn't feel right, go have
Speaker 1: a conversation with your doctor. That seems to be a
Speaker 1: very important one to think.
Speaker 2: If you have anal bleeding, don't let somebody just chalk
Speaker 2: it up to hemorrhoids. Have somebody look look. And if
Speaker 2: you're having a colonoscopy, here's here's the most important to you.
Speaker 2: You're having a lenoscopy, you say to your doctor, I
Speaker 2: want you to be sure and examine my anus. Okay,
Speaker 2: Now that sounds like a strange thing to have to request,
Speaker 2: but the truth is is that a lot of times
Speaker 2: doctors just put the scope in and look and they
Speaker 2: don't they don't actually examine that area. And anal cancer
Speaker 2: is one of the things caused by HPV and it
Speaker 2: requires a visual exam and a finger exam, and you
Speaker 2: can completely miss the anal area with the scope right.
Speaker 2: And by the way, a lot of it is very
Speaker 2: embarrassing for a lot of women because they feel like
Speaker 2: if you get anal cancer, it means that you were
Speaker 2: having sex there. Women can get anal cancer never having
Speaker 2: had anal sex because vaginal secretions that are affected the
Speaker 2: HPV virus can pool in that area and infect that area.
Speaker 2: So don't let anybody embarrass you into not asking for
Speaker 2: the right exams and screen so you don't have that.
Speaker 2: So that's what happened.
Speaker 1: You heard it here, guys, Let's be clear.
Speaker 2: What a way I add. We started at the top
Speaker 2: and we handed at the bottom of the bottom.
Speaker 1: When they went high, I went left. Doctapiro, I love you,
Speaker 1: and you know your brain is impressive and you're a
Speaker 1: wealth of information, and I deeply appreciate our relationship as
Speaker 1: doctor patient, and I deeply appreciate our friendship, which is
Speaker 1: a total other side thing. Thank you so much.
Speaker 2: I love you as well. I do are you. You're
Speaker 2: amazing and every day your inspiration to me.
Speaker 1: Well, thank you. I know you're just you know, gonna
Speaker 1: keep plugging away until you know you want me to
Speaker 1: live to like ninety.
Speaker 2: I know that at least a couple of more trips
Speaker 2: to you Italy for sure.
Speaker 1: Sardinia is next, right.
Speaker 2: Exactly, we have to get to the places we missed exactly.
Speaker 1: All right, you guys, thank you so much much for
Speaker 1: listening in to Let's Be Clear with Shannon Doherty and
Speaker 1: with my very very very special guest, doctor Lawrence Piro
Speaker 1: of the Angelus Clinic. Check it out. It's a pretty
Speaker 1: phenomenal place. I know that a lot of my fans
Speaker 1: have actually contacted him, and I saw one in his
Speaker 1: waiting room, and it makes me very happy because I
Speaker 1: think he can answer a lot of questions and be
Speaker 1: the kind of provider, the care provider that so many
Speaker 1: of us need. All right, bye, thank you for listening
Speaker 1: to Li's Be Clear.