April 29, 2024 • 46 mins
Expert Oncologist Dr. Lawrence Piro guides Shannen every step of the way on her cancer journey, so we had to bring him back for another episode full of amazing advice and lots of HOPE! What should you be asking your doctor TODAY? Why is it important NOT to compare your cancer journey to others? And what he says is SO important to help lower your chances of a cancer diagnosis.
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Episode Transcript
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Speaker 1 (00:02):
This is let's be clear with Shannon Doherty. Hi everyone,
this is let's be clear with Shannon Doherty. Please welcome
doctor Laurence Piro, Doctor Pierro. I brought you my best friend,
and she was a stylish she was fantastic. I loved her.
She taught me how to travel. We went to St.
(00:22):
Barts every year, like we had a very very very tight,
tight tight relationship. And she ended up getting cancer. I'm
obviously not asking you to divulge anything, but her cancer,
you know, was more advanced than mine at that time,
and I remember her describing certain symptoms that she had
(00:45):
and I would like two days later, by the way,
just talking about it right now, thanks you. It gets
me just talking about it. I'm starting to get those
weird nice things that'll go away the minute I stopped
talking about it. It's so bizarre, but you kept saying
to me like, you cannot associate your cancer with hers.
(01:08):
There are two different cancers. And if you look at
her path, then you're going to walk her path like
you have to walk your own path and she has
to walk her own path. And when you first set
me down and really had that conversation with me, I
was like wow, Like I heard that, and then the
(01:29):
pains like went away. It was all a mental thing.
Speaker 2 (01:33):
And I remember, actually the first time I said that
to you was before you ever or at least before
you ever verbalized anyway. Yeah, experienced some of the same things.
I just knew to anticipate that, and I said that
you cannot compare yourself. The minute I understood what her
scenario was, I knew that you would look at that
(01:55):
scenario and assume that that was your path. And because
everybody does. I mean, fortunately many people are. Everybody's exceptional
in some ways, but we're all very common in other ways.
In terms of our human reactions. We're all very common
because we're all part of the same you know, same community,
of the same gene pool, the same organism. And so
(02:18):
I knew that that would be a thing, and and
it was, and each step of the way, you know,
so that we had to keep repeating, especially because you
were you know, you were a very good friend. So
when you're a very good friend, you spend time talking.
You know. It's kind of like support groups. I mean,
support groups can be so great, but they have to
(02:41):
be refereed carefully, and the composition of a support group
has to be chosen carefully because you know, sometimes it
can do damage and sort of help if it isn't
you know, refereed carefully, and the people in the group
are not common enough because if you're you know, if
you're someone with adjuvant breast cancer and you know, with
(03:02):
a eighty five or ninety percent chance of cure, and
you're in a group with metastatic breast cancer patients, you know,
you may be seeing, you know, a picture that is
so frightening. You know that it's hard psychologically. So the sharing,
the group share thing and the industry I think is
very complicated, and especially in today's day of social media
(03:26):
and all that, because anyone can reach out to you
and share with you, and again you don't you're not
really validating their data. I mean in this case of
your friend, of course you were, but if someone meets
you on the internet, you know, and is sharing data
with you, you can't really validate their data. And we
all leave pieces out of stories. I mean, even we're
(03:48):
not talking about cancer, right if you're talking about, you know,
your friend who did something to you one day about
you know, what happened to a party or something like
that people nate by nature tell their side of the story, right,
So sometimes that leaves out a couple of beats that
might change other people's view of it. But when they're
telling their cancer story, they do the same thing. They
(04:09):
sometimes leave out some beats because no one wants to
be on the pathway that's leading to the bad outcome.
Everyone wants to be on the pathway leading the good outcome,
and so you sometimes leave things out, and therefore the
person listening can't really adjudicate the story straightforwardly, right.
Speaker 1 (04:30):
And also there are you know people you said earlier,
there are people that they're just like warriors when it
comes to their protocols, and it doesn't matter. They just
keep on a protocol. You know, I think there was
only one protocol that I complained about. Every other protocol
it didn't matter what that we were on together. Yeah,
(04:50):
didn't matter what the side effects were, I was okay.
And then there are other people like my friend who
you know, blew through protocols incredibly incredibly quickly. It was
like if if there was anything sort of uncomfortable. There
are people that with a little bit of discomfort, they
(05:10):
they don't want to stay on a protocol as opposed
to realizing that like the more protocols you blow through,
the less options you have because there's only so many protocols.
What's really interesting to me is all the suggestions I think,
and I've spoken to you about this, of that I
get from people, you know, the chemo or this or
(05:34):
that that is killing me Western medicine, that I need
to be on you know, CBD, or I need to
you know, uh, if I just go on a raw diet,
or if I just do this, or I just do that.
Oh my friend took you know, I remectin and they're
completely cured of cancer. And I'm like, yeah, but they
(05:55):
were also in a clinical trial, Like how are you saying,
is that I remectin opposed to the clinical trial? Like,
you know, it's such an interesting and I think a
lot of people with cancer probably have this conversation with themselves,
and I've had it with myself and I've had it
with you. There's a vast amount of misinformation and just
(06:21):
information in general that's really hard to sift through because
there are so many stories and proclamations that this alternative
medicine cured somebody of stage four cancer and so your
(06:41):
brain has this very curious moment where it's like, well,
should I be using a dewormer like they use on horses?
Is that what's going to cure me? Like that was
the latest one I got recently, And then you just
start sort of knocking your head going stop it, you know,
like science is science.
Speaker 2 (07:02):
There's so many levels to that. I mean, first of all,
you one hundred percent right. I mean, on the surface
of that kind of conversation, people cant say, well, gee,
I don't know. My doctor treats me to like a statistic.
He says, we're going on this protocol and it has,
you know, forty two percent effectiveness. And yet I talk
to this person and they're talking about this alternative stuff
(07:23):
and they tell me about people that have been cured.
But the reason that doctors don't talk about just people
who've been cured because those are anecdotes. You have to
study something in a disciplined way to find out if
it's random or if it's an actual effect. And most
of the alternative things are not studied that, and they're
all driven by anecdotes and not to dismiss those, and
(07:47):
they can feel empowering to a person who's in a
bad situation. I get that, but at the end of
the day, you're vulnerable, and when people are promising you
things effectively, I mean they're effectively kind of promising this
by saying this one person had this. I mean, they're
hanging out there the possibility that that might be you.
It's in some ways, you know, not intentionally, it's meaning
(08:10):
to be helpful, but it's kind of praying on your
vulnerability in some ways. And then if you choose not
to do any of those things, because you just said
I'm going to be sensible and you know, look at
the data and all that. But then if you decide
not to do those things and your outcome isn't good,
then you self flagellate yourself. Well, maybe if I had
done the Eye of Newt and all of that right,
(08:31):
that you would have been okay. And so it also
has that second layer of difficulty and judgment and all
of that's difficult. You know, I didn't realize, despite a
long career, I didn't realize just how humbled people get
with suggestions until I took care of Farah Faucet and
(08:53):
when I was on the journey with Pharah. You know,
so many people strangers were writing or just left and
right and whatever like with you, and she said, she
just told all of them, just send this to my
doctor and he'll sort this out. So you realize that
besides eight thousand additional emails a day that I got,
(09:17):
my office was filled to the ceiling with packages of
bottles and pills and things and blankets and prayers and whatever,
which is moving. To see how many people care. It
was just beautiful moving, but it was a morass in
terms of any patient if they were actually trying to
sort out all of that stuff. But people don't fully
(09:41):
realize is each time you have to open your thinking
to another thing which might work, you're reliving your diagnosis,
just reliving the whole initial process of the diagnosis and
what might work. When you're having to tear into each
of these individual suggests, and when it's thousands, it's overwhelming.
Speaker 1 (10:02):
So yeah, I mean that part doesn't bother me because
I don't really like ever relive the diagnosis. But I
think what I'm more worry about is I understand enough
to look at some sort of suggestion that somebody gives
me and either research it myself or have the conversation
(10:25):
with you because a lot of times great you know,
I believe in also natural medicine. I believe in homeopathic
Like I think that's fantastical. Yeah, you just have to
make sure that the properties that are in that homeopathic
herb or whatever isn't counteracting what your normal cancer med
(10:46):
is then doing. Like that's a big thing that people
who give you the such suggestions don't realize, is that
there is natural stuff out there, but it can literally
kill essentially what your chemical medicine is on.
Speaker 2 (11:00):
That is, anything you're doing should be in addition to
and not instead of right right. And then rule two
is what are the drug interactions?
Speaker 1 (11:09):
Drug interaction?
Speaker 2 (11:10):
And I'll tell you I took care of a young
man who was really an amazing, credible young man and scholar,
and he unfortunately developed a very difficult cancer situation. And
his girlfriend at the time of diagnosis and then they married.
During the course of his care, someone and her family together,
(11:33):
they decided he had a feeding tube at this particular
point in his journey, and they decided that they would
try to be helpful to him. They would stop feeding
him the liquid diet that was the well balanced diet
and all that, and they would feed him just like
yogurt mixed with antioxidant berries and different things. And I
(11:55):
always told this young man that if you know, if
you are scared, you know, just call me and I
will come. You know, just if you're scared of what's happening,
just call and I will come. And so one day
he called me and he said, I think I'm dying.
I said why, and he said, because I'm bleeding from
(12:16):
my nose, and I'm bleeding from my mouth, and I'm
bleeding from everywhere. And you know, this was somebody in
his twenties, right, and he had seen all these horror
films where you know where that's what happens, and so
he could only conclude that that meant he was dying.
So I said, I'll be right there, and I drove
there and I walked into the room and I looked
(12:38):
at the scenario and it was interesting that something else
I did which was kind of interesting. There was so
much the room was so amped up, and I lifted
up the sheet, you know, so his feet were there,
and I asked the nurse. We had like around the
clock nurs as. I said to the nurse, do you
have some lotion here? And I was actually wearing was
a summer and I was wearing like jeans and flip
(13:01):
flops at a T shirt or something. I don't think the
nurse knew I was the doctor.
Speaker 3 (13:05):
So I walked in the room and said, lift up
the thing exposing and Feeta said, do you have lotion?
And I think the nurse was so confused. So I
just squirted some lotion on his feet and I started, actually,
you know, massaging his feet because I knew he needed
to calm down, you know, so we could sort this
out because he was just petrified.
Speaker 2 (13:23):
Right, So well, I'm asking questions, Well, I'm just you know,
putting this lotion on his feet and massaging his feet,
which you know, if you're you ever get a foot massage, right,
I mean, it makes your whole body just calm down,
all the tension go away. So I'm asking questions, well,
what about this and what about that? And what have
you been feeding? Have you been taking these? And I'm
asking of all the people in the room, and and
(13:44):
that's when they told me that they had changed the diet.
And I said, well, I said to him, listen, you
have vitamin K deficiency from your diet. That is why
you're bleeding and you're going to be fine. I sent
his mother to the pharmacy to get some Vita McKay
that I called in and prescribed you to the Via McKay.
All the bleeding stopped and he was okay for that moment.
(14:07):
I mean, he still had obviously cancer and cancer treating
the rabbages of it. But the point is is that
you know, a very very well meaning and well intentioned
change in things without fully discussing it, you know, resulted
in a very very scary moment for this this young man.
Speaker 1 (14:26):
That's poor thing. Which is a really interesting segue because
I was going to talk to you about the fact that, like,
maybe the white coat doesn't know everything, and then I
hear that story and I'm like, maybe they do. You
know what I'm saying, like, because you do understand, you know,
(14:49):
drug interaction, and you do understand vitamin deficiency, and you
do understand what somebody is needing and they're feeding to
and you know, you do understand the different protocols and
how they're going to help. So it's not necessarily segue.
Isn't necessarily about that a white coach doesn't know everything,
(15:10):
because I think they know quite a bit. I think
it's more that it's okay, And it's what I love
about our relationship, right, is that I've never felt as
if I couldn't question something. I never looked at you
and thought I just need to accept what he's saying
(15:33):
to me and putting in front of me, keep my
mouth shut and do what he says. I've always engaged
with you and said like, hey, but I was just
looking at this, and there's this and this and this
and this as other additional data, and you're like, well, yes,
but that data then comes with this data like you
(15:55):
have to do a little bit more digging, or you
have to do this or that. I don't think enough
people have a healthy conversation with their doctor. And some doctors,
not you, but some doctors I think make a patient
feel as if they don't have the time for the questions.
(16:15):
But I also think that the patients don't demand the time.
And if a doctor doesn't know that you are needing
that time desperately, then he's not going to give you
that time because he's got fifty other patients to go see, right,
So that it's perfectly okay to respectfully but strongly have
(16:37):
a conversation and demand more time and do your own
research and push back up against an opinion, because ultimately
it is our lives and our bodies and our decision.
So we have to be comfortable with everything and have
no regrets going forward.
Speaker 2 (16:57):
So when the Internet came into being, prior.
Speaker 1 (17:01):
To now, everybody's a doctor. I mean, I have a
freaking degree, don't you know they?
Speaker 2 (17:07):
Prior to the Internet, all medical knowledge was in medical books,
and medical books were only sold in bookstores to doctor
the medical people, so not only I think the Merks
Manual or something like that was maybe the only real
authoritative type of a book that lay people had. So
(17:29):
the doctor was viewed as the keeper of all medical
knowledge and there were no other vehicles. When the Internet
came into being, I remember so vividly doctors being so
inflamed because a patient would walk in with a print
out of you know, seventy five pages and instead of saying,
(17:50):
I have joint pains and rash, I think I have
you know what is that? What is joyt pains and rash?
Could it be lubas? Are going to be lying? They'd
walk in and PLoP down seventy five pages and say
I have a lime disease, and here's why, right when
maybe they more likely had lucas or something. Doctors were
(18:11):
so insulted by that they would grab the papers and
throw them in the trash in front of the patient
and say, this is what I think of the Internet
boom like that. They were just enraged. And so I
watched that going on, and I realized that I was
living through a sea change and that medical knowledge was
(18:33):
now going to be widely available to everyone, and people
were not looking for me to be a professor. And
you see, this is where the white coat comes in.
That white coat is symbolic of somebody being a professor
and a sign of authority. And I realized people didn't
want me to be a professor and the keeper of authority.
(18:54):
They wanted me they didn't want to be on my team.
They wanted me to be on their team.
Speaker 1 (19:00):
That's craft what a beautiful way of saying it.
Speaker 2 (19:02):
And that's when I took off my white coat. And
I've never put it back on because I think it's
too strong of a symbol of an old time role
for a doctor. And I think everybody's on their own journey,
and as long as you accept responsibility for your decisions.
I will go with you on your journey.
Speaker 4 (19:20):
Now.
Speaker 2 (19:20):
I'm going to try in every way I can to
talk you into what I think is the best thing
based on the data and everything I understand, and to
tell you why. But at the end of the day,
even if it's alternative or not not typical or not
the best choice, I'll go on that journey with you
as long as you understand that we're deviating. And I
(19:41):
think one of the reasons why you and I have
that relationship from the beginning is that I try always
when I'm telling someone about what we should do, I
try to always say, we have three options here, or
four options here, or two whatever, so that even though
I've already made up my mind based on the data
(20:03):
so what I think would be best, I'm presenting the
field of view of how I went through my decision
making process, and I share my decision making process with you,
as as you and I have done many times, right
to say, so, here's the four paths. I like this
one for this reason and that reason, I like this
one for that reason whatever, And then I've ruled out
these and these, and that leaves us here and between
(20:24):
those two one spares hair in one doesen, so let's
spare hair or whatever. How I mean, However, the situation is,
and I think that you know, people doctor strutu comes,
you know, grab the authority because it's kind of what
the job teaches you to do. But if you actually
give the authority over to the patient, they very quickly
give it back to you.
Speaker 1 (20:45):
If you right, Yeah, well, because it's human nature, right,
Like human nature is to want to be in control,
and especially if you're sick, you want to feel like
you have some semblance of control. So if you're given
that control the way that you do it, you definitely
give it back because you're because then you don't need
(21:06):
to like fight for it exactly.
Speaker 2 (21:08):
And if you ever do want to really exert it,
because in opposition to what his or her recommendation is
for you, you know that they'll glad fully give it
back to you, like you're handing it back saying, Okay,
you've proven that you can handle the authority for me.
But if I want my authority back, by the way,
it's just on loan to you, So I'm going to
take it back.
Speaker 1 (21:28):
Yeah.
Speaker 2 (21:28):
If I get to a different place and a different
set of decisions.
Speaker 1 (21:31):
I also think that it's really unique about you as
a doctor that I really encourage the listeners too. And
it doesn't matter if you have breast cancer, any other
kind of cancer, any sort of illness, or you're just
you know, going to a general doctor. I really encourage
you to, you know, get to know your doctor. Like
doesn't mean you have to go to Italy with them,
(21:52):
but that might be an extreme, but you know, engage
and get to know and be very honest with your
doctor about your lifestyle and everything else because at the
end of the day, it allows more leeway in that relationship.
And for instance, the infusions that I'm currently on right like,
(22:15):
there came a point where I said, hey, I want
to try something. I want to try not getting the
anti nausea. I think it's prolonging my sickness. Once I
get the infusion, I don't want fourteen days of feeling
like I have to throw up for twelve days. I
just want to throw up and get it over with.
Maybe this will work, maybe it won't. And I remember
(22:36):
there was a nurse who was very against it. And
I waited for you, and I texted you and you
came in. I go super early in the mornings. As
you know, I'm a weirdo. I go at like six
thirty seven o'clock in the morning, and you, you know,
looked at me and said, if that's but you know
(22:59):
me now, And that's the difference is that we now
know each other and we have a shorthand.
Speaker 2 (23:04):
And you know that I know that you know your
body like no one else. I've seen it over and
over again. Well, I mean that's true of everybody, but
you're like a you know, savant in that regard, and
what you're wanting to do is completely anathetical. Like there's
no reason to think taking a three day and a
nausea injection is like prolonging the nausea. I mean, just
(23:27):
like antithetical to traditional medical thinking. But I've seen time
and time again you have weird reactions to medicines, and
you figure it out for your own body, and when
we do it, it works out. I'm like, that's again, Well,
like I said to the nurse, she will take responsibility
for this decision if it doesn't work out, Well, there's
no there's no reason to hear.
Speaker 1 (23:47):
If you get very sick, you just have to like
you have to come in We're going to have to
get you in my d drip, like you have to
stay hydrated. And I remember I called you and I
was like, uh, I think it's working, Like I'm not
as sick for as long.
Speaker 2 (24:01):
But we took we tried all different anti nausous, we
tried steroids, we tried to check every everything. Yeah, and
and and so why not because you have this instinct
and you were right and most people know they But
it's the same thing I always laugh about. You know,
when patients I'll always have to get their blood drawn
before the doctor's appointment, and some phlebotomists will insist that
(24:23):
they're going to draw somewhere because it's the best vein,
and the patient will say that vein doesn't work. I'm
telling you that vein doesn't work. You need to go
over here, and they won't listen to them because it's
like I'm the phullbottomist and I know the right veins whatever,
and listen. If a patient demonstrably tells you where to
draw their blood, do it because they know their body.
Speaker 1 (24:56):
This is a tough one, Okay. When you try patients
for years, does it take a toll on you when
you lose them. The second part is or are you
able to stay detached? And I know that that's a
no from you.
Speaker 4 (25:11):
Right.
Speaker 2 (25:12):
So the thing about this topic that I feel so
strongly about is that I have an obligation to bring
the best knowledge, the best individualized thinking, the best strategic thinking,
and all the best resources anywhere in the world to
a patient's journey of healthcare, cancer treatment. But at the
(25:37):
end of the day, their outcome is encoded in the universe,
and so my job, above all else is to make
sure that they have a journey that's closest to the
journey they want to have, as close as I can
make it. And that is where I derive my sense
of gratitude and sense of joy from, is making sure
(26:00):
or that as we go along that journey, after having
brought all the best resources and the best you're thinking
and all that. But you know, that's just the basic
program to me, that I can make the experience as
much what they want it to be as possible. And
that includes the dying process. You know, you enter alone
(26:21):
and you leave alone. You can't really help someone enter well,
you can just try to catch them, but you can
help someone fly away well. And everyone has very different
ideas about what that process should be for them. But
as a doctor, I think the most important thing is
to listen to them and talk about it and try
(26:42):
to even make that part of their journey. You know,
if you think about the most vulnerable position that there
is in the world is when you're flying away and
if you don't have people around you who will listen
to you and try to help you make it the
way you want it to be. But a terrible, terrible
tragedy and closure that is so I am thrilled that
(27:07):
I've been able to treat people who've gotten care from diseases.
I'm thrilled that I've been able to develop medicines that
have cured some people and very much you know, prolonged
the lives of other people. But I'm equally honored to
have helped people die well, because it's one of the
most intimate things you can do in life as a doctor.
Speaker 1 (27:30):
And in all your years of treating patients and being
in the medical world, have you ever witnessed like a
true miracle?
Speaker 2 (27:41):
Well, you know, that's a funny word. I certainly have
seen people have responses that exceed anything you could see. Yeah,
they seem miraculous. And I'm a big you know, I
have a big spiritual presence as a person, you know,
like I really very much, you know, part of me
(28:03):
lives in that kind of spiritual existence. So I don't know.
I mean, it's a complicated word for me, because when
I think of miracle, I almost think of like somebody somewhere,
you know, waving a wand and making magic and making
something happen, you know. And I don't understand like what
it looks like behind the behind the curtain, you know,
(28:27):
of miracle making. So I don't know if things are
really miracles. But I do know that I've seen unexpected results.
I do know that a person harnessing their spiritual and
creative and loving energy can change the course of disease,
and people living in a dark and negative and uh
(28:47):
you know, critical and unhappy place can change the course
of disease. So I do believe that there are factors
beyond our control, and whether they're all biologic and physiologic
or where some of them are all so universe and spiritual,
I personally believe very much in an order of the universe,
and I believe that the universe, you know, that we
(29:09):
are mindful people, and sometimes we allow our mindfulness to
think that we know best for ourselves. But I'm quite
well aware that there seems to be an order in
the universe, and if you turn yourself over to the
order in the universe, you often wind up in a
way better place than you would have had you continue
(29:31):
to plow forward your own, you know, limited thinking about
where you belong. And so I try to always, you know,
turn my will over to the universe and follow the
clues to get to the place where I think maybe
I'm supposed to belong. And I try to always you know,
help patients, you know, on that same journey too.
Speaker 1 (29:50):
So with all the money pouring into cancer research, why
is chemotherapy and actually is it still to go to
treatment when it causes you know, obviously a lot of weakness,
a lot of pain, a lot of side effects.
Speaker 2 (30:05):
Well, chemotherapy is largely derived from natural sources like the
taxanes or other sorts of things, and some were chemically
modified and some were synthesized, but they were all focused
on kind of interfering with DNA or other critical pathways
to make a cell die, and in fact they're very
(30:27):
effective at doing that. But the necessary side effect is
that other cells that are dividing can also de that
causes the side effects. Right. So the side effects are
caused by like a lot of times when people get
mouth sores and ulcers or diarrhea, rectal pain, that sort
of thing, it's because the mucosa lining of the bowel
are cells that are always turning over, so they die
(30:50):
more readily in response to chemotherapy. In fact, we've had
an amazing you know revolution in two areas treatments, So
in sequencing the human genome and identifying you know, mutations
that are existing in cancers and then identifying drugs that
affect those mutations. That's been miraculous at creating a non
(31:13):
chemotherapy pathway. And immunotherapy has been an unbelievable breakthrough with
drugs that you know, allow the immune system to see
cancers in the way they were overlooking them before and
now can actually kill them and clean them up. And
they all have their other different side effects because you know,
(31:34):
you can't you can't rev up the immune system to
cancer cells without expecting that they might actually attack some
other cells too, right, some of your good cells exactly,
And it's so they're different side effects and chemotherapy with
the side effects on the left. So whenever we're going
to be manipulating with physiologic processes, we're going to get
side effects. They're even vaccines now, you know, for cancer.
(31:57):
And what was interesting to me is when one of
the first vaccines that ever showed benefit to advance cancer patients,
which is called provenge for or prostate cancer. It was
interesting how little all anybody ever said was why don't
we have a vaccine for cancer? And then the vaccine
was developed, and how low the adoption rate was of
(32:18):
it for a whole variety of reasons that are probably
beyond the scope of this discussion. But there are many
different lanes. There are huge breakthroughs, and you know, and
cancer has become a chronic illness. You know, it used
to be you know, pretty much your cured or it's
a fatal illness in a fairly short period of time.
(32:38):
And now people can live for years and years and
sometimes decades with low grade cancer being manipulated from time
to time with various pills or infusions.
Speaker 1 (32:52):
And immuno therapy. Like I know that you and I
have discussed im therapy a lot. I always really liked
the idea because sort of the way that I looked
at it was, you know, it was it was basically
like the Navy seals of cells going in and like
just you know, killing all the the bad cells. But yes,
they do sometimes knock off, you know, some other really
(33:15):
good cells, someone like me.
Speaker 2 (33:18):
Your particular set of characteristics a breast cancer doesn't respond
very well to immunotherapy, and then your particular markers. Beyond that,
there are specifically markers that tell you if your cancer
might be likely to be susceptible. So even if you
have a cancer that's not that susceptible, if you show
these immune markers that say it would be susceptible, then
(33:42):
there might still be a chance. But your immune markers
are even say your tumber wouldn't respond. Now that doesn't
mean that with you know, other immunological advances that are
coming down the lane, that's not an option. But that's
not an option because there are some situations where cancers
respond and when they have the markers that say they
won't respond, and combinations sometimes work. So there's more stuff
(34:06):
coming every single day there there we're understanding new ways
to use these genetic defects and molecular markers, and every
single day we're learning how to manipulate the immune system more.
And there's these certain kind of immune system where we
take T cells out and T cells out of your
body immune cells, and we in the laboratory make them
(34:29):
into warriors against your cancer and then fuse them back
into you called you know, TILL cells, and there are
other version of car T cells and all that. There's
just a huge amount of research going on with that,
and they're quite miraculous treatments in some cases and in
other cases not. But we're learning how to empower them
differently so that maybe in the cases where they're not effective,
(34:51):
they will become so. And so that whole, that whole
field I think is really really important. And if someone
can live long we're in a in a remission or
a partial mission for a period of time, that may
be something that you know, really comes to roosts for
their particular situation that isn't available today. And then you know,
tons of these, like I said, molecular markers. And even
(35:13):
as we talked about earlier in your case, we you know,
we didn't think of her to express her. We didn't
really think that much about that category as being anything important.
But it turns out her to expressors respond to the
drug addibody con you get this targeted her too. So
and we had unbelievable results with your situation, and you know,
(35:35):
to to talk about what you were mentioning earlier about
our decision to stick with it. You know, the situation
was that we you know, we had cancer in some
critical places that if it were to get out of hand,
it could cause us to lose precious time. Then we
might not regain in terms of because when cancer is
(35:56):
growing in an organ, it can cause that organ to dysfunction,
and if that organ dysfunctions, they could be game over.
And so you're always at this juncture where is the
amount of cancer in that organ such that if we
keep going on this when we're not sure if it's working,
we're taking we're hoping that it's stable, like we're seeing
(36:19):
the same amount of disease because we stopped it into
stability and now we're going to turn around into response.
But there's also the possibility that was like a brief
pause and it's going to keep growing, and then if
it keeps growing, are we going to get to that
place where the tumor burdens so great that the organ
dysfunctions and then we lose precious time or we're out
(36:39):
of the game. And that's where we were talking about
a little bit to some extent, not exactly that situation,
but somewhat that situation. We were talking earlier about whether
to stick with this treatment, and we had scans that
were showing us not as much response as we would
have expected. By that time. You were having a lot
of side effects, but yet the tumor markers were going down,
(37:01):
and so we said, look, we're going to assume that
the tumor markers are telling us the story and the
scans are lagging. And we turned out to be right.
But we also had that challenge too, and are we
getting enough brain penetration that it's really going to work
there as well?
Speaker 1 (37:19):
Right?
Speaker 2 (37:19):
And that was really the more most concerning part to me,
is that is that that scenario, like a little something
showed up there and so we're like, does that mean
it's failing? And it turns out no, it was. It
was ultimately responded just a.
Speaker 1 (37:37):
Little bit more time.
Speaker 4 (37:38):
Yeah, are you hopeful for a cure?
Speaker 1 (37:53):
And if so, at like how far out? I mean?
There are new amounts of different cancers right there. There
are there are vaccines for some that you mentioned, there
are kind of cures for.
Speaker 2 (38:08):
Some, they're definitely cures. Podgkin's disease is very careable, right.
Speaker 1 (38:12):
So the ones that are you know, extremely tough to
cure lung cancer for instance.
Speaker 2 (38:18):
Right listen, melanoma just the answer to your question, my
hopeful of a cure absolutely, I mean it would be. Yeah,
you know, this is be a challenging business if you
didn't have optimism. But you know, we're the ANSWER's Clinic
is a you know, it's a very renowned center for
many things, but chief among them melanoma and immunotherapy, and
(38:40):
and us having played us instantial role in the opening
and beginning of the field of immunotherapy. And there's a
time period when when stage four melanoma was a universal death,
nothing more than that, right and just and and stage
four melanoma people can be of all the disease disappear
(39:02):
and live for years, maybe being cured. I don't know,
you know, if they're cured or if we just reduce
the cells downs at such a low level and harnessed
the immune system and whatever that they never come out again.
But the point is is they can now live their
whole and tiple life in some ways. And I mean
that's we never thought that we would see that in
a disease I don't know. I mean, like twenty years
(39:25):
ago in melanoma or three years ago melano doctors would say,
you know, like what's your favorite place in the world, Oh, Hawaiira,
you should go there. You should go there, get your
will set up before you go that. They literally said
that to people with this kind of melanoma. And now
people even with brain metastaites in melanoma, are you know,
completely disease free for decades and therefore, you know, perhaps
(39:46):
the cured. We're always you know, as a doctor, you
don't want to hold out false hope, and so we're
always hesitant to say that cure word, you know, in
some situations, just because we don't want to be leading.
But we are eternally hopeful.
Speaker 1 (40:05):
So we know that. Obviously, we just discussed that not
all cancers are curable, but early detection is always the
best chance you have. Is there a test that you
recommend that it's comprehensive, and obviously that depends on the
kind of cancer that you have, like for women breast cancer,
I'm assuming it's a mammogram, right, it's the first place
(40:26):
you start, right. What about for you know, other forms
of cancer.
Speaker 2 (40:30):
Well, if you're a smoker, there's something called the screening
lung CETA and those that have been shown to be
effective in picking up early cancers. So that's if you're
a non smoker, it's all more difficult because routine chest
X rays don't necessarily show much benefit.
Speaker 1 (40:48):
And what about like prostate cancer.
Speaker 2 (40:51):
Prostate cancer, we have the p S a test and
blood and it's a very sensitive test, and when that
shows an increase, then people are able to get an
MRI of the I think having you know, regular doctor
visits and getting there's a whole kind of template of
screening tests. You know, depending on your gender and both
your signed gender at birth and your acquired gender and
(41:14):
all of those you know, different things. It's there's a
whole set of things that you can do from screening
cts and PAP smears and HPV tests. I think one
of the biggest preventative things people should be doing is
getting HPV vaccinated if you're not. I mean, the HPV
virus accounts for five percent of all the cancers in
(41:36):
the world cervical cancer and women anal cancer, and men
and women mouth cancer and men and women penal cancer,
and men five percent of all the cancers in the
world caused by a virus infection. That if you get
vaccinated against the most common causing, most common cancer causing strains,
you can prevent that, right, So that's incredibly you know important,
(42:01):
you know, prevention item, I think, and in terms of
overall prevention, I think, you know, achieving your ideal body
weight is incredibly important because you know, body fat creates
an inflammatory state that contributes to heart disease, diabetes, and cancer. So,
you know, a lot of people like to focus on
(42:21):
dietary composition and I love that and it's important, but
the truth is, dietary composition it's not that important. If
you have way too much body fat, I mean, get
your body fat down because that's going to control the
inflammatory condition. And then at that point then the value
of your dietary composition becomes super important, right because you've
eliminated that inflammatory thing. If you have this massive obesity
(42:44):
inflammatory state, it almost doesn't matter how much kal you eat,
you've got this inflammatory state that's totally pro cancer all
the time, so that exercise seems to have an independent protective,
you know component, separate from just it's a weight loss component.
So I'd say, you know, exercise regularly. Look, we were
meant to move, We were meant to move, and it
(43:06):
changes that whole physiological structure. And then there are various
anti inflammatory things that you can take and do you
know from you know, turmeric, baby aspirin if you don't
have reasons why you can't take aspirin and other kinds
of things. So I think, you know, I think there's
something to that whole anti inflammatory scenario for people in prevention.
(43:31):
And you know there are you know, the other things
from there, but yes, there are things that could be done.
Speaker 1 (43:36):
And being honest with yourself one with your doctor, like
don't ignore signs. If something doesn't feel right, go have
a conversation with your doctor. That seems to be a
very important one to think.
Speaker 2 (43:49):
If you have anal bleeding, don't let somebody just chalk
it up to hemorrhoids. Have somebody look look. And if
you're having a colonoscopy, here's here's the most important to you.
You're having a lenoscopy, you say to your doctor, I
want you to be sure and examine my anus. Okay,
Now that sounds like a strange thing to have to request,
(44:09):
but the truth is is that a lot of times
doctors just put the scope in and look and they
don't they don't actually examine that area. And anal cancer
is one of the things caused by HPV and it
requires a visual exam and a finger exam, and you
can completely miss the anal area with the scope right.
And by the way, a lot of it is very
(44:32):
embarrassing for a lot of women because they feel like
if you get anal cancer, it means that you were
having sex there. Women can get anal cancer never having
had anal sex because vaginal secretions that are affected the
HPV virus can pool in that area and infect that area.
So don't let anybody embarrass you into not asking for
(44:52):
the right exams and screen so you don't have that.
So that's what happened.
Speaker 1 (44:57):
You heard it here, guys, Let's be clear.
Speaker 2 (45:03):
What a way I add. We started at the top
and we handed at the bottom of the bottom.
Speaker 1 (45:08):
When they went high, I went left. Doctapiro, I love you,
and you know your brain is impressive and you're a
wealth of information, and I deeply appreciate our relationship as
doctor patient, and I deeply appreciate our friendship, which is
(45:29):
a total other side thing. Thank you so much.
Speaker 2 (45:34):
I love you as well. I do are you. You're
amazing and every day your inspiration to me.
Speaker 1 (45:40):
Well, thank you. I know you're just you know, gonna
keep plugging away until you know you want me to
live to like ninety.
Speaker 2 (45:48):
I know that at least a couple of more trips
to you Italy for sure.
Speaker 1 (45:53):
Sardinia is next, right.
Speaker 2 (45:54):
Exactly, we have to get to the places we missed exactly.
Speaker 1 (45:58):
All right, you guys, thank you so much much for
listening in to Let's Be Clear with Shannon Doherty and
with my very very very special guest, doctor Lawrence Piro
of the Angelus Clinic. Check it out. It's a pretty
phenomenal place. I know that a lot of my fans
have actually contacted him, and I saw one in his
(46:21):
waiting room, and it makes me very happy because I
think he can answer a lot of questions and be
the kind of provider, the care provider that so many
of us need. All right, bye, thank you for listening
to Li's Be Clear.
This is let's be clear with Shannon Doherty. Hi everyone,
this is let's be clear with Shannon Doherty. Please welcome
doctor Laurence Piro, Doctor Pierro. I brought you my best friend,
and she was a stylish she was fantastic. I loved her.
She taught me how to travel. We went to St.
(00:22):
Barts every year, like we had a very very very tight,
tight tight relationship. And she ended up getting cancer. I'm
obviously not asking you to divulge anything, but her cancer,
you know, was more advanced than mine at that time,
and I remember her describing certain symptoms that she had
(00:45):
and I would like two days later, by the way,
just talking about it right now, thanks you. It gets
me just talking about it. I'm starting to get those
weird nice things that'll go away the minute I stopped
talking about it. It's so bizarre, but you kept saying
to me like, you cannot associate your cancer with hers.
(01:08):
There are two different cancers. And if you look at
her path, then you're going to walk her path like
you have to walk your own path and she has
to walk her own path. And when you first set
me down and really had that conversation with me, I
was like wow, Like I heard that, and then the
(01:29):
pains like went away. It was all a mental thing.
Speaker 2 (01:33):
And I remember, actually the first time I said that
to you was before you ever or at least before
you ever verbalized anyway. Yeah, experienced some of the same things.
I just knew to anticipate that, and I said that
you cannot compare yourself. The minute I understood what her
scenario was, I knew that you would look at that
(01:55):
scenario and assume that that was your path. And because
everybody does. I mean, fortunately many people are. Everybody's exceptional
in some ways, but we're all very common in other ways.
In terms of our human reactions. We're all very common
because we're all part of the same you know, same community,
of the same gene pool, the same organism. And so
(02:18):
I knew that that would be a thing, and and
it was, and each step of the way, you know,
so that we had to keep repeating, especially because you
were you know, you were a very good friend. So
when you're a very good friend, you spend time talking.
You know. It's kind of like support groups. I mean,
support groups can be so great, but they have to
(02:41):
be refereed carefully, and the composition of a support group
has to be chosen carefully because you know, sometimes it
can do damage and sort of help if it isn't
you know, refereed carefully, and the people in the group
are not common enough because if you're you know, if
you're someone with adjuvant breast cancer and you know, with
(03:02):
a eighty five or ninety percent chance of cure, and
you're in a group with metastatic breast cancer patients, you know,
you may be seeing, you know, a picture that is
so frightening. You know that it's hard psychologically. So the sharing,
the group share thing and the industry I think is
very complicated, and especially in today's day of social media
(03:26):
and all that, because anyone can reach out to you
and share with you, and again you don't you're not
really validating their data. I mean in this case of
your friend, of course you were, but if someone meets
you on the internet, you know, and is sharing data
with you, you can't really validate their data. And we
all leave pieces out of stories. I mean, even we're
(03:48):
not talking about cancer, right if you're talking about, you know,
your friend who did something to you one day about
you know, what happened to a party or something like
that people nate by nature tell their side of the story, right,
So sometimes that leaves out a couple of beats that
might change other people's view of it. But when they're
telling their cancer story, they do the same thing. They
(04:09):
sometimes leave out some beats because no one wants to
be on the pathway that's leading to the bad outcome.
Everyone wants to be on the pathway leading the good outcome,
and so you sometimes leave things out, and therefore the
person listening can't really adjudicate the story straightforwardly, right.
Speaker 1 (04:30):
And also there are you know people you said earlier,
there are people that they're just like warriors when it
comes to their protocols, and it doesn't matter. They just
keep on a protocol. You know, I think there was
only one protocol that I complained about. Every other protocol
it didn't matter what that we were on together. Yeah,
(04:50):
didn't matter what the side effects were, I was okay.
And then there are other people like my friend who
you know, blew through protocols incredibly incredibly quickly. It was
like if if there was anything sort of uncomfortable. There
are people that with a little bit of discomfort, they
(05:10):
they don't want to stay on a protocol as opposed
to realizing that like the more protocols you blow through,
the less options you have because there's only so many protocols.
What's really interesting to me is all the suggestions I think,
and I've spoken to you about this, of that I
get from people, you know, the chemo or this or
(05:34):
that that is killing me Western medicine, that I need
to be on you know, CBD, or I need to
you know, uh, if I just go on a raw diet,
or if I just do this, or I just do that.
Oh my friend took you know, I remectin and they're
completely cured of cancer. And I'm like, yeah, but they
(05:55):
were also in a clinical trial, Like how are you saying,
is that I remectin opposed to the clinical trial? Like,
you know, it's such an interesting and I think a
lot of people with cancer probably have this conversation with themselves,
and I've had it with myself and I've had it
with you. There's a vast amount of misinformation and just
(06:21):
information in general that's really hard to sift through because
there are so many stories and proclamations that this alternative
medicine cured somebody of stage four cancer and so your
(06:41):
brain has this very curious moment where it's like, well,
should I be using a dewormer like they use on horses?
Is that what's going to cure me? Like that was
the latest one I got recently, And then you just
start sort of knocking your head going stop it, you know,
like science is science.
Speaker 2 (07:02):
There's so many levels to that. I mean, first of all,
you one hundred percent right. I mean, on the surface
of that kind of conversation, people cant say, well, gee,
I don't know. My doctor treats me to like a statistic.
He says, we're going on this protocol and it has,
you know, forty two percent effectiveness. And yet I talk
to this person and they're talking about this alternative stuff
(07:23):
and they tell me about people that have been cured.
But the reason that doctors don't talk about just people
who've been cured because those are anecdotes. You have to
study something in a disciplined way to find out if
it's random or if it's an actual effect. And most
of the alternative things are not studied that, and they're
all driven by anecdotes and not to dismiss those, and
(07:47):
they can feel empowering to a person who's in a
bad situation. I get that, but at the end of
the day, you're vulnerable, and when people are promising you
things effectively, I mean they're effectively kind of promising this
by saying this one person had this. I mean, they're
hanging out there the possibility that that might be you.
It's in some ways, you know, not intentionally, it's meaning
(08:10):
to be helpful, but it's kind of praying on your
vulnerability in some ways. And then if you choose not
to do any of those things, because you just said
I'm going to be sensible and you know, look at
the data and all that. But then if you decide
not to do those things and your outcome isn't good,
then you self flagellate yourself. Well, maybe if I had
done the Eye of Newt and all of that right,
(08:31):
that you would have been okay. And so it also
has that second layer of difficulty and judgment and all
of that's difficult. You know, I didn't realize, despite a
long career, I didn't realize just how humbled people get
with suggestions until I took care of Farah Faucet and
(08:53):
when I was on the journey with Pharah. You know,
so many people strangers were writing or just left and
right and whatever like with you, and she said, she
just told all of them, just send this to my
doctor and he'll sort this out. So you realize that
besides eight thousand additional emails a day that I got,
(09:17):
my office was filled to the ceiling with packages of
bottles and pills and things and blankets and prayers and whatever,
which is moving. To see how many people care. It
was just beautiful moving, but it was a morass in
terms of any patient if they were actually trying to
sort out all of that stuff. But people don't fully
(09:41):
realize is each time you have to open your thinking
to another thing which might work, you're reliving your diagnosis,
just reliving the whole initial process of the diagnosis and
what might work. When you're having to tear into each
of these individual suggests, and when it's thousands, it's overwhelming.
Speaker 1 (10:02):
So yeah, I mean that part doesn't bother me because
I don't really like ever relive the diagnosis. But I
think what I'm more worry about is I understand enough
to look at some sort of suggestion that somebody gives
me and either research it myself or have the conversation
(10:25):
with you because a lot of times great you know,
I believe in also natural medicine. I believe in homeopathic
Like I think that's fantastical. Yeah, you just have to
make sure that the properties that are in that homeopathic
herb or whatever isn't counteracting what your normal cancer med
(10:46):
is then doing. Like that's a big thing that people
who give you the such suggestions don't realize, is that
there is natural stuff out there, but it can literally
kill essentially what your chemical medicine is on.
Speaker 2 (11:00):
That is, anything you're doing should be in addition to
and not instead of right right. And then rule two
is what are the drug interactions?
Speaker 1 (11:09):
Drug interaction?
Speaker 2 (11:10):
And I'll tell you I took care of a young
man who was really an amazing, credible young man and scholar,
and he unfortunately developed a very difficult cancer situation. And
his girlfriend at the time of diagnosis and then they married.
During the course of his care, someone and her family together,
(11:33):
they decided he had a feeding tube at this particular
point in his journey, and they decided that they would
try to be helpful to him. They would stop feeding
him the liquid diet that was the well balanced diet
and all that, and they would feed him just like
yogurt mixed with antioxidant berries and different things. And I
(11:55):
always told this young man that if you know, if
you are scared, you know, just call me and I
will come. You know, just if you're scared of what's happening,
just call and I will come. And so one day
he called me and he said, I think I'm dying.
I said why, and he said, because I'm bleeding from
(12:16):
my nose, and I'm bleeding from my mouth, and I'm
bleeding from everywhere. And you know, this was somebody in
his twenties, right, and he had seen all these horror
films where you know where that's what happens, and so
he could only conclude that that meant he was dying.
So I said, I'll be right there, and I drove
there and I walked into the room and I looked
(12:38):
at the scenario and it was interesting that something else
I did which was kind of interesting. There was so
much the room was so amped up, and I lifted
up the sheet, you know, so his feet were there,
and I asked the nurse. We had like around the
clock nurs as. I said to the nurse, do you
have some lotion here? And I was actually wearing was
a summer and I was wearing like jeans and flip
(13:01):
flops at a T shirt or something. I don't think the
nurse knew I was the doctor.
Speaker 3 (13:05):
So I walked in the room and said, lift up
the thing exposing and Feeta said, do you have lotion?
And I think the nurse was so confused. So I
just squirted some lotion on his feet and I started, actually,
you know, massaging his feet because I knew he needed
to calm down, you know, so we could sort this
out because he was just petrified.
Speaker 2 (13:23):
Right, So well, I'm asking questions, Well, I'm just you know,
putting this lotion on his feet and massaging his feet,
which you know, if you're you ever get a foot massage, right,
I mean, it makes your whole body just calm down,
all the tension go away. So I'm asking questions, well,
what about this and what about that? And what have
you been feeding? Have you been taking these? And I'm
asking of all the people in the room, and and
(13:44):
that's when they told me that they had changed the diet.
And I said, well, I said to him, listen, you
have vitamin K deficiency from your diet. That is why
you're bleeding and you're going to be fine. I sent
his mother to the pharmacy to get some Vita McKay
that I called in and prescribed you to the Via McKay.
All the bleeding stopped and he was okay for that moment.
(14:07):
I mean, he still had obviously cancer and cancer treating
the rabbages of it. But the point is is that
you know, a very very well meaning and well intentioned
change in things without fully discussing it, you know, resulted
in a very very scary moment for this this young man.
Speaker 1 (14:26):
That's poor thing. Which is a really interesting segue because
I was going to talk to you about the fact that, like,
maybe the white coat doesn't know everything, and then I
hear that story and I'm like, maybe they do. You
know what I'm saying, like, because you do understand, you know,
(14:49):
drug interaction, and you do understand vitamin deficiency, and you
do understand what somebody is needing and they're feeding to
and you know, you do understand the different protocols and
how they're going to help. So it's not necessarily segue.
Isn't necessarily about that a white coach doesn't know everything,
(15:10):
because I think they know quite a bit. I think
it's more that it's okay, And it's what I love
about our relationship, right, is that I've never felt as
if I couldn't question something. I never looked at you
and thought I just need to accept what he's saying
(15:33):
to me and putting in front of me, keep my
mouth shut and do what he says. I've always engaged
with you and said like, hey, but I was just
looking at this, and there's this and this and this
and this as other additional data, and you're like, well, yes,
but that data then comes with this data like you
(15:55):
have to do a little bit more digging, or you
have to do this or that. I don't think enough
people have a healthy conversation with their doctor. And some doctors,
not you, but some doctors I think make a patient
feel as if they don't have the time for the questions.
(16:15):
But I also think that the patients don't demand the time.
And if a doctor doesn't know that you are needing
that time desperately, then he's not going to give you
that time because he's got fifty other patients to go see, right,
So that it's perfectly okay to respectfully but strongly have
(16:37):
a conversation and demand more time and do your own
research and push back up against an opinion, because ultimately
it is our lives and our bodies and our decision.
So we have to be comfortable with everything and have
no regrets going forward.
Speaker 2 (16:57):
So when the Internet came into being, prior.
Speaker 1 (17:01):
To now, everybody's a doctor. I mean, I have a
freaking degree, don't you know they?
Speaker 2 (17:07):
Prior to the Internet, all medical knowledge was in medical books,
and medical books were only sold in bookstores to doctor
the medical people, so not only I think the Merks
Manual or something like that was maybe the only real
authoritative type of a book that lay people had. So
(17:29):
the doctor was viewed as the keeper of all medical
knowledge and there were no other vehicles. When the Internet
came into being, I remember so vividly doctors being so
inflamed because a patient would walk in with a print
out of you know, seventy five pages and instead of saying,
(17:50):
I have joint pains and rash, I think I have
you know what is that? What is joyt pains and rash?
Could it be lubas? Are going to be lying? They'd
walk in and PLoP down seventy five pages and say
I have a lime disease, and here's why, right when
maybe they more likely had lucas or something. Doctors were
(18:11):
so insulted by that they would grab the papers and
throw them in the trash in front of the patient
and say, this is what I think of the Internet
boom like that. They were just enraged. And so I
watched that going on, and I realized that I was
living through a sea change and that medical knowledge was
(18:33):
now going to be widely available to everyone, and people
were not looking for me to be a professor. And
you see, this is where the white coat comes in.
That white coat is symbolic of somebody being a professor
and a sign of authority. And I realized people didn't
want me to be a professor and the keeper of authority.
(18:54):
They wanted me they didn't want to be on my team.
They wanted me to be on their team.
Speaker 1 (19:00):
That's craft what a beautiful way of saying it.
Speaker 2 (19:02):
And that's when I took off my white coat. And
I've never put it back on because I think it's
too strong of a symbol of an old time role
for a doctor. And I think everybody's on their own journey,
and as long as you accept responsibility for your decisions.
I will go with you on your journey.
Speaker 4 (19:20):
Now.
Speaker 2 (19:20):
I'm going to try in every way I can to
talk you into what I think is the best thing
based on the data and everything I understand, and to
tell you why. But at the end of the day,
even if it's alternative or not not typical or not
the best choice, I'll go on that journey with you
as long as you understand that we're deviating. And I
(19:41):
think one of the reasons why you and I have
that relationship from the beginning is that I try always
when I'm telling someone about what we should do, I
try to always say, we have three options here, or
four options here, or two whatever, so that even though
I've already made up my mind based on the data
(20:03):
so what I think would be best, I'm presenting the
field of view of how I went through my decision
making process, and I share my decision making process with you,
as as you and I have done many times, right
to say, so, here's the four paths. I like this
one for this reason and that reason, I like this
one for that reason whatever, And then I've ruled out
these and these, and that leaves us here and between
(20:24):
those two one spares hair in one doesen, so let's
spare hair or whatever. How I mean, However, the situation is,
and I think that you know, people doctor strutu comes,
you know, grab the authority because it's kind of what
the job teaches you to do. But if you actually
give the authority over to the patient, they very quickly
give it back to you.
Speaker 1 (20:45):
If you right, Yeah, well, because it's human nature, right,
Like human nature is to want to be in control,
and especially if you're sick, you want to feel like
you have some semblance of control. So if you're given
that control the way that you do it, you definitely
give it back because you're because then you don't need
(21:06):
to like fight for it exactly.
Speaker 2 (21:08):
And if you ever do want to really exert it,
because in opposition to what his or her recommendation is
for you, you know that they'll glad fully give it
back to you, like you're handing it back saying, Okay,
you've proven that you can handle the authority for me.
But if I want my authority back, by the way,
it's just on loan to you, So I'm going to
take it back.
Speaker 1 (21:28):
Yeah.
Speaker 2 (21:28):
If I get to a different place and a different
set of decisions.
Speaker 1 (21:31):
I also think that it's really unique about you as
a doctor that I really encourage the listeners too. And
it doesn't matter if you have breast cancer, any other
kind of cancer, any sort of illness, or you're just
you know, going to a general doctor. I really encourage
you to, you know, get to know your doctor. Like
doesn't mean you have to go to Italy with them,
(21:52):
but that might be an extreme, but you know, engage
and get to know and be very honest with your
doctor about your lifestyle and everything else because at the
end of the day, it allows more leeway in that relationship.
And for instance, the infusions that I'm currently on right like,
(22:15):
there came a point where I said, hey, I want
to try something. I want to try not getting the
anti nausea. I think it's prolonging my sickness. Once I
get the infusion, I don't want fourteen days of feeling
like I have to throw up for twelve days. I
just want to throw up and get it over with.
Maybe this will work, maybe it won't. And I remember
(22:36):
there was a nurse who was very against it. And
I waited for you, and I texted you and you
came in. I go super early in the mornings. As
you know, I'm a weirdo. I go at like six
thirty seven o'clock in the morning, and you, you know,
looked at me and said, if that's but you know
(22:59):
me now, And that's the difference is that we now
know each other and we have a shorthand.
Speaker 2 (23:04):
And you know that I know that you know your
body like no one else. I've seen it over and
over again. Well, I mean that's true of everybody, but
you're like a you know, savant in that regard, and
what you're wanting to do is completely anathetical. Like there's
no reason to think taking a three day and a
nausea injection is like prolonging the nausea. I mean, just
(23:27):
like antithetical to traditional medical thinking. But I've seen time
and time again you have weird reactions to medicines, and
you figure it out for your own body, and when
we do it, it works out. I'm like, that's again, Well,
like I said to the nurse, she will take responsibility
for this decision if it doesn't work out, Well, there's
no there's no reason to hear.
Speaker 1 (23:47):
If you get very sick, you just have to like
you have to come in We're going to have to
get you in my d drip, like you have to
stay hydrated. And I remember I called you and I
was like, uh, I think it's working, Like I'm not
as sick for as long.
Speaker 2 (24:01):
But we took we tried all different anti nausous, we
tried steroids, we tried to check every everything. Yeah, and
and and so why not because you have this instinct
and you were right and most people know they But
it's the same thing I always laugh about. You know,
when patients I'll always have to get their blood drawn
before the doctor's appointment, and some phlebotomists will insist that
(24:23):
they're going to draw somewhere because it's the best vein,
and the patient will say that vein doesn't work. I'm
telling you that vein doesn't work. You need to go
over here, and they won't listen to them because it's
like I'm the phullbottomist and I know the right veins whatever,
and listen. If a patient demonstrably tells you where to
draw their blood, do it because they know their body.
Speaker 1 (24:56):
This is a tough one, Okay. When you try patients
for years, does it take a toll on you when
you lose them. The second part is or are you
able to stay detached? And I know that that's a
no from you.
Speaker 4 (25:11):
Right.
Speaker 2 (25:12):
So the thing about this topic that I feel so
strongly about is that I have an obligation to bring
the best knowledge, the best individualized thinking, the best strategic thinking,
and all the best resources anywhere in the world to
a patient's journey of healthcare, cancer treatment. But at the
(25:37):
end of the day, their outcome is encoded in the universe,
and so my job, above all else is to make
sure that they have a journey that's closest to the
journey they want to have, as close as I can
make it. And that is where I derive my sense
of gratitude and sense of joy from, is making sure
(26:00):
or that as we go along that journey, after having
brought all the best resources and the best you're thinking
and all that. But you know, that's just the basic
program to me, that I can make the experience as
much what they want it to be as possible. And
that includes the dying process. You know, you enter alone
(26:21):
and you leave alone. You can't really help someone enter well,
you can just try to catch them, but you can
help someone fly away well. And everyone has very different
ideas about what that process should be for them. But
as a doctor, I think the most important thing is
to listen to them and talk about it and try
(26:42):
to even make that part of their journey. You know,
if you think about the most vulnerable position that there
is in the world is when you're flying away and
if you don't have people around you who will listen
to you and try to help you make it the
way you want it to be. But a terrible, terrible
tragedy and closure that is so I am thrilled that
(27:07):
I've been able to treat people who've gotten care from diseases.
I'm thrilled that I've been able to develop medicines that
have cured some people and very much you know, prolonged
the lives of other people. But I'm equally honored to
have helped people die well, because it's one of the
most intimate things you can do in life as a doctor.
Speaker 1 (27:30):
And in all your years of treating patients and being
in the medical world, have you ever witnessed like a
true miracle?
Speaker 2 (27:41):
Well, you know, that's a funny word. I certainly have
seen people have responses that exceed anything you could see. Yeah,
they seem miraculous. And I'm a big you know, I
have a big spiritual presence as a person, you know,
like I really very much, you know, part of me
(28:03):
lives in that kind of spiritual existence. So I don't know.
I mean, it's a complicated word for me, because when
I think of miracle, I almost think of like somebody somewhere,
you know, waving a wand and making magic and making
something happen, you know. And I don't understand like what
it looks like behind the behind the curtain, you know,
(28:27):
of miracle making. So I don't know if things are
really miracles. But I do know that I've seen unexpected results.
I do know that a person harnessing their spiritual and
creative and loving energy can change the course of disease,
and people living in a dark and negative and uh
(28:47):
you know, critical and unhappy place can change the course
of disease. So I do believe that there are factors
beyond our control, and whether they're all biologic and physiologic
or where some of them are all so universe and spiritual,
I personally believe very much in an order of the universe,
and I believe that the universe, you know, that we
(29:09):
are mindful people, and sometimes we allow our mindfulness to
think that we know best for ourselves. But I'm quite
well aware that there seems to be an order in
the universe, and if you turn yourself over to the
order in the universe, you often wind up in a
way better place than you would have had you continue
(29:31):
to plow forward your own, you know, limited thinking about
where you belong. And so I try to always, you know,
turn my will over to the universe and follow the
clues to get to the place where I think maybe
I'm supposed to belong. And I try to always you know,
help patients, you know, on that same journey too.
Speaker 1 (29:50):
So with all the money pouring into cancer research, why
is chemotherapy and actually is it still to go to
treatment when it causes you know, obviously a lot of weakness,
a lot of pain, a lot of side effects.
Speaker 2 (30:05):
Well, chemotherapy is largely derived from natural sources like the
taxanes or other sorts of things, and some were chemically
modified and some were synthesized, but they were all focused
on kind of interfering with DNA or other critical pathways
to make a cell die, and in fact they're very
(30:27):
effective at doing that. But the necessary side effect is
that other cells that are dividing can also de that
causes the side effects. Right. So the side effects are
caused by like a lot of times when people get
mouth sores and ulcers or diarrhea, rectal pain, that sort
of thing, it's because the mucosa lining of the bowel
are cells that are always turning over, so they die
(30:50):
more readily in response to chemotherapy. In fact, we've had
an amazing you know revolution in two areas treatments, So
in sequencing the human genome and identifying you know, mutations
that are existing in cancers and then identifying drugs that
affect those mutations. That's been miraculous at creating a non
(31:13):
chemotherapy pathway. And immunotherapy has been an unbelievable breakthrough with
drugs that you know, allow the immune system to see
cancers in the way they were overlooking them before and
now can actually kill them and clean them up. And
they all have their other different side effects because you know,
(31:34):
you can't you can't rev up the immune system to
cancer cells without expecting that they might actually attack some
other cells too, right, some of your good cells exactly,
And it's so they're different side effects and chemotherapy with
the side effects on the left. So whenever we're going
to be manipulating with physiologic processes, we're going to get
side effects. They're even vaccines now, you know, for cancer.
(31:57):
And what was interesting to me is when one of
the first vaccines that ever showed benefit to advance cancer patients,
which is called provenge for or prostate cancer. It was
interesting how little all anybody ever said was why don't
we have a vaccine for cancer? And then the vaccine
was developed, and how low the adoption rate was of
(32:18):
it for a whole variety of reasons that are probably
beyond the scope of this discussion. But there are many
different lanes. There are huge breakthroughs, and you know, and
cancer has become a chronic illness. You know, it used
to be you know, pretty much your cured or it's
a fatal illness in a fairly short period of time.
(32:38):
And now people can live for years and years and
sometimes decades with low grade cancer being manipulated from time
to time with various pills or infusions.
Speaker 1 (32:52):
And immuno therapy. Like I know that you and I
have discussed im therapy a lot. I always really liked
the idea because sort of the way that I looked
at it was, you know, it was it was basically
like the Navy seals of cells going in and like
just you know, killing all the the bad cells. But yes,
they do sometimes knock off, you know, some other really
(33:15):
good cells, someone like me.
Speaker 2 (33:18):
Your particular set of characteristics a breast cancer doesn't respond
very well to immunotherapy, and then your particular markers. Beyond that,
there are specifically markers that tell you if your cancer
might be likely to be susceptible. So even if you
have a cancer that's not that susceptible, if you show
these immune markers that say it would be susceptible, then
(33:42):
there might still be a chance. But your immune markers
are even say your tumber wouldn't respond. Now that doesn't
mean that with you know, other immunological advances that are
coming down the lane, that's not an option. But that's
not an option because there are some situations where cancers
respond and when they have the markers that say they
won't respond, and combinations sometimes work. So there's more stuff
(34:06):
coming every single day there there we're understanding new ways
to use these genetic defects and molecular markers, and every
single day we're learning how to manipulate the immune system more.
And there's these certain kind of immune system where we
take T cells out and T cells out of your
body immune cells, and we in the laboratory make them
(34:29):
into warriors against your cancer and then fuse them back
into you called you know, TILL cells, and there are
other version of car T cells and all that. There's
just a huge amount of research going on with that,
and they're quite miraculous treatments in some cases and in
other cases not. But we're learning how to empower them
differently so that maybe in the cases where they're not effective,
(34:51):
they will become so. And so that whole, that whole
field I think is really really important. And if someone
can live long we're in a in a remission or
a partial mission for a period of time, that may
be something that you know, really comes to roosts for
their particular situation that isn't available today. And then you know,
tons of these, like I said, molecular markers. And even
(35:13):
as we talked about earlier in your case, we you know,
we didn't think of her to express her. We didn't
really think that much about that category as being anything important.
But it turns out her to expressors respond to the
drug addibody con you get this targeted her too. So
and we had unbelievable results with your situation, and you know,
(35:35):
to to talk about what you were mentioning earlier about
our decision to stick with it. You know, the situation
was that we you know, we had cancer in some
critical places that if it were to get out of hand,
it could cause us to lose precious time. Then we
might not regain in terms of because when cancer is
(35:56):
growing in an organ, it can cause that organ to dysfunction,
and if that organ dysfunctions, they could be game over.
And so you're always at this juncture where is the
amount of cancer in that organ such that if we
keep going on this when we're not sure if it's working,
we're taking we're hoping that it's stable, like we're seeing
(36:19):
the same amount of disease because we stopped it into
stability and now we're going to turn around into response.
But there's also the possibility that was like a brief
pause and it's going to keep growing, and then if
it keeps growing, are we going to get to that
place where the tumor burdens so great that the organ
dysfunctions and then we lose precious time or we're out
(36:39):
of the game. And that's where we were talking about
a little bit to some extent, not exactly that situation,
but somewhat that situation. We were talking earlier about whether
to stick with this treatment, and we had scans that
were showing us not as much response as we would
have expected. By that time. You were having a lot
of side effects, but yet the tumor markers were going down,
(37:01):
and so we said, look, we're going to assume that
the tumor markers are telling us the story and the
scans are lagging. And we turned out to be right.
But we also had that challenge too, and are we
getting enough brain penetration that it's really going to work
there as well?
Speaker 1 (37:19):
Right?
Speaker 2 (37:19):
And that was really the more most concerning part to me,
is that is that that scenario, like a little something
showed up there and so we're like, does that mean
it's failing? And it turns out no, it was. It
was ultimately responded just a.
Speaker 1 (37:37):
Little bit more time.
Speaker 4 (37:38):
Yeah, are you hopeful for a cure?
Speaker 1 (37:53):
And if so, at like how far out? I mean?
There are new amounts of different cancers right there. There
are there are vaccines for some that you mentioned, there
are kind of cures for.
Speaker 2 (38:08):
Some, they're definitely cures. Podgkin's disease is very careable, right.
Speaker 1 (38:12):
So the ones that are you know, extremely tough to
cure lung cancer for instance.
Speaker 2 (38:18):
Right listen, melanoma just the answer to your question, my
hopeful of a cure absolutely, I mean it would be. Yeah,
you know, this is be a challenging business if you
didn't have optimism. But you know, we're the ANSWER's Clinic
is a you know, it's a very renowned center for
many things, but chief among them melanoma and immunotherapy, and
(38:40):
and us having played us instantial role in the opening
and beginning of the field of immunotherapy. And there's a
time period when when stage four melanoma was a universal death,
nothing more than that, right and just and and stage
four melanoma people can be of all the disease disappear
(39:02):
and live for years, maybe being cured. I don't know,
you know, if they're cured or if we just reduce
the cells downs at such a low level and harnessed
the immune system and whatever that they never come out again.
But the point is is they can now live their
whole and tiple life in some ways. And I mean
that's we never thought that we would see that in
a disease I don't know. I mean, like twenty years
(39:25):
ago in melanoma or three years ago melano doctors would say,
you know, like what's your favorite place in the world, Oh, Hawaiira,
you should go there. You should go there, get your
will set up before you go that. They literally said
that to people with this kind of melanoma. And now
people even with brain metastaites in melanoma, are you know,
completely disease free for decades and therefore, you know, perhaps
(39:46):
the cured. We're always you know, as a doctor, you
don't want to hold out false hope, and so we're
always hesitant to say that cure word, you know, in
some situations, just because we don't want to be leading.
But we are eternally hopeful.
Speaker 1 (40:05):
So we know that. Obviously, we just discussed that not
all cancers are curable, but early detection is always the
best chance you have. Is there a test that you
recommend that it's comprehensive, and obviously that depends on the
kind of cancer that you have, like for women breast cancer,
I'm assuming it's a mammogram, right, it's the first place
(40:26):
you start, right. What about for you know, other forms
of cancer.
Speaker 2 (40:30):
Well, if you're a smoker, there's something called the screening
lung CETA and those that have been shown to be
effective in picking up early cancers. So that's if you're
a non smoker, it's all more difficult because routine chest
X rays don't necessarily show much benefit.
Speaker 1 (40:48):
And what about like prostate cancer.
Speaker 2 (40:51):
Prostate cancer, we have the p S a test and
blood and it's a very sensitive test, and when that
shows an increase, then people are able to get an
MRI of the I think having you know, regular doctor
visits and getting there's a whole kind of template of
screening tests. You know, depending on your gender and both
your signed gender at birth and your acquired gender and
(41:14):
all of those you know, different things. It's there's a
whole set of things that you can do from screening
cts and PAP smears and HPV tests. I think one
of the biggest preventative things people should be doing is
getting HPV vaccinated if you're not. I mean, the HPV
virus accounts for five percent of all the cancers in
(41:36):
the world cervical cancer and women anal cancer, and men
and women mouth cancer and men and women penal cancer,
and men five percent of all the cancers in the
world caused by a virus infection. That if you get
vaccinated against the most common causing, most common cancer causing strains,
you can prevent that, right, So that's incredibly you know important,
(42:01):
you know, prevention item, I think, and in terms of
overall prevention, I think, you know, achieving your ideal body
weight is incredibly important because you know, body fat creates
an inflammatory state that contributes to heart disease, diabetes, and cancer. So,
you know, a lot of people like to focus on
(42:21):
dietary composition and I love that and it's important, but
the truth is, dietary composition it's not that important. If
you have way too much body fat, I mean, get
your body fat down because that's going to control the
inflammatory condition. And then at that point then the value
of your dietary composition becomes super important, right because you've
eliminated that inflammatory thing. If you have this massive obesity
(42:44):
inflammatory state, it almost doesn't matter how much kal you eat,
you've got this inflammatory state that's totally pro cancer all
the time, so that exercise seems to have an independent protective,
you know component, separate from just it's a weight loss component.
So I'd say, you know, exercise regularly. Look, we were
meant to move, We were meant to move, and it
(43:06):
changes that whole physiological structure. And then there are various
anti inflammatory things that you can take and do you
know from you know, turmeric, baby aspirin if you don't
have reasons why you can't take aspirin and other kinds
of things. So I think, you know, I think there's
something to that whole anti inflammatory scenario for people in prevention.
(43:31):
And you know there are you know, the other things
from there, but yes, there are things that could be done.
Speaker 1 (43:36):
And being honest with yourself one with your doctor, like
don't ignore signs. If something doesn't feel right, go have
a conversation with your doctor. That seems to be a
very important one to think.
Speaker 2 (43:49):
If you have anal bleeding, don't let somebody just chalk
it up to hemorrhoids. Have somebody look look. And if
you're having a colonoscopy, here's here's the most important to you.
You're having a lenoscopy, you say to your doctor, I
want you to be sure and examine my anus. Okay,
Now that sounds like a strange thing to have to request,
(44:09):
but the truth is is that a lot of times
doctors just put the scope in and look and they
don't they don't actually examine that area. And anal cancer
is one of the things caused by HPV and it
requires a visual exam and a finger exam, and you
can completely miss the anal area with the scope right.
And by the way, a lot of it is very
(44:32):
embarrassing for a lot of women because they feel like
if you get anal cancer, it means that you were
having sex there. Women can get anal cancer never having
had anal sex because vaginal secretions that are affected the
HPV virus can pool in that area and infect that area.
So don't let anybody embarrass you into not asking for
(44:52):
the right exams and screen so you don't have that.
So that's what happened.
Speaker 1 (44:57):
You heard it here, guys, Let's be clear.
Speaker 2 (45:03):
What a way I add. We started at the top
and we handed at the bottom of the bottom.
Speaker 1 (45:08):
When they went high, I went left. Doctapiro, I love you,
and you know your brain is impressive and you're a
wealth of information, and I deeply appreciate our relationship as
doctor patient, and I deeply appreciate our friendship, which is
(45:29):
a total other side thing. Thank you so much.
Speaker 2 (45:34):
I love you as well. I do are you. You're
amazing and every day your inspiration to me.
Speaker 1 (45:40):
Well, thank you. I know you're just you know, gonna
keep plugging away until you know you want me to
live to like ninety.
Speaker 2 (45:48):
I know that at least a couple of more trips
to you Italy for sure.
Speaker 1 (45:53):
Sardinia is next, right.
Speaker 2 (45:54):
Exactly, we have to get to the places we missed exactly.
Speaker 1 (45:58):
All right, you guys, thank you so much much for
listening in to Let's Be Clear with Shannon Doherty and
with my very very very special guest, doctor Lawrence Piro
of the Angelus Clinic. Check it out. It's a pretty
phenomenal place. I know that a lot of my fans
have actually contacted him, and I saw one in his
(46:21):
waiting room, and it makes me very happy because I
think he can answer a lot of questions and be
the kind of provider, the care provider that so many
of us need. All right, bye, thank you for listening
to Li's Be Clear.
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Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations.
3. Crime Junkie
If you can never get enough true crime... Congratulations, you’ve found your people.