January 1, 2024 • 51 mins
Being a voice for people affected by cancer directly or indirectly is a calling Shannen takes seriously. Even if it means sharing her own prognosis and the difficult decisions she's had to make along the way.In this episode, she is joined by her good friend and world-renowned Oncologist Doctor Lawrence Piro who explains thecomplexities of Stage 4 Cancer and how he and Shannen plan to beat it one treatment at a time.
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Episode Transcript
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Speaker 1 (00:02):
This is let's be clear with Shannon Dorney. Hi, everyone,
this is Let's be clear with Shannon Doherty. I want
to thank you for listening to my podcast and for
your kind and encouraging words on social media. As you
may know, there are many people with me on this
cancer journey, and today I'm joined by someone instrumental in
(00:22):
my treatment. The Hollywood Reporter named him one of Hollywood's
top doctors. Please welcome doctor Lawrence Piro.
Speaker 2 (00:29):
Hey, Shannon, happy to be here. Hi.
Speaker 1 (00:32):
How are you.
Speaker 2 (00:33):
I'm good?
Speaker 1 (00:33):
How are you? I'm good. I had a very long day,
but nothing I would look forward to more than a
glass of wine and a conversation with you.
Speaker 2 (00:44):
Something we've done quite often and every time it's enjoyable
and unpredictable.
Speaker 1 (00:49):
Unpredictable it is a really, really good word for it.
Can you please, just for you know the people listening in,
tell us your full title, your specialty, and what hospitals
you're affiliated with.
Speaker 2 (01:03):
Well, I'm doctor Lawrence Pirerou. My title is CEO of
the Angels Clinic and Research Institute, which is an affiliate
of Cedar Sinai, which we started about twenty three years ago,
and I'm an medical oncologist, so kind of the overall
quarterback of the ecology team in terms of diagnosis and
(01:23):
planning treatment and coordinating all the treatments.
Speaker 1 (01:27):
And is your oncology specialty breast or a multitude of
different cancers.
Speaker 2 (01:34):
Well, it's a multitude of different cancers, and I've done
research in a number of different areas, but breast is
an area where I've treated in an extensive amount of
patients over my entire forty year career.
Speaker 1 (01:45):
And you are published, are you not?
Speaker 2 (01:47):
I am?
Speaker 1 (01:48):
Can you tell me a little bit about that.
Speaker 2 (01:50):
Well, I've been a researcher and a developer of treatments
from the beginning of my career. I was actually still
a fellow when published on the first which was a
drug that put a disease called harry sel leukemia into
remission in ninety eight percent of cases, and it was
a kind of a worldwide attention item because there was
(02:12):
almost nothing that would put that number of people into
a mission with a single treatment. So I was quite
a breakthrough and that spawned my career starting when I
was in my late twenties. That spawned my career in
investigative oncology and creating targeted treatments, and I was part
(02:34):
of the development team for all of the clinical trials
that led to the approval over Tuksan, which was the
first monocle and antibody ever used in Man and approved
as a drug. So we had a really great experience
with all that, and that of course opened up a
whole new field of drugs and now there are you know, many,
(02:54):
many and a lot of people actually got monocle antibodies
for COVID. I remember, yes, I'm sure that was a
fun thing to be involved with. And I have a
medium to large institute with a lot of oncologists doing
great work and doing research and all different kinds of things.
And I treat a wide variety of diseases because a
(03:15):
lot of times the relationship is the important thing.
Speaker 1 (03:20):
Yeah, So in other words, you're like no joke, You're
like the no joke doctor. So, just to give our
listeners a bit of history, I got diagnosed with breast
cancer in twenty fifteen. I went to a different oncologist
and had not a very successful sort of treatment in
(03:44):
the sense of nothing was really changing. I still had,
you know, a tumor in my breast. I still wasn't
getting surgery. I kind of was feeling a little bit lost.
The drug that this particular in college just had me
on put me in a menopause. I wasn't properly warned
about that. I was definitely feeling adrift, if you will,
(04:04):
in my sort of cancer journey, and I knew that
something needed to change. I just didn't know how to
change it. And most of the time, a lot of
patients feel as if they don't have the right to
ask for a better doctor or to change doctors, or
they're scared their insurance won't cover a new doctor, or
they feel like they can't change doctors. And I felt
(04:27):
that for a minute until I got a phone call
from my friend Chris, who said he was good friends
with a mutual friend of ours, David, and David really
wanted to introduce me to this oncologist that he said
saved his father's life with cancer and he felt very
strongly about and that meeting happened to be when I
(04:48):
met you. Do you want to tell us about it?
Speaker 2 (04:50):
Sure? Well, David Charvey called me and said, would I
be willing to have dinner over at Chris's house and
meet Shannon. She was going through a little cancer problem.
They thought if we'd met up, we might be a
good team, and so I said, yea, I'm sure, I'm
happy to. So we had dinner. You know, usually in
that kind of a situation, it's a it's kind of
(05:10):
a dance, you know, because you're like, it's like a
blind date. Two people who are invited to a get
social gathering for a purpose, and everyone kind of knows
the purpose, but you're supposed to act like you don't
know the purpose.
Speaker 1 (05:23):
It's so true, that great way of describing it.
Speaker 2 (05:25):
Yeah, So you usually dance around each other and like, well,
who's gonna who's going to reveal that they know the
purpose first and put it out on the table and
square it all up. And that, however, didn't play out
that night, because neither you nor I are kind of
beat around the bush people. So we just like jumped
right in. Yeah, and within five minutes we were pretty
(05:47):
connected and pretty sure that we understood one another and
pretty good, pretty sure that we'd be a great team together.
Speaker 1 (05:53):
Yeah. I felt like you understood why I was feeling
a bit lost, and you definitely had opinions on what
should change and what needed to get done immediately, And
I really respected the fact that you had like a
strong standpoint and you weren't intimidated by me by who
(06:17):
I am, but also more importantly by my personality. You
you know, you have just as bigger for personality as
I do. So we were able to really mesh on
that level. And I know that for me personally, I
kind of felt like, oh, I think that this is
somebody who is going to really be thoughtful with my care,
(06:38):
which was incredibly important to me. And he understands that
there's nothing more integral than me tackling this and getting better.
And you insisted that I come in like right away.
You were like, Okay, let's get started. I think we've
met on like a Friday or Saturday night and you're like, great,
we're getting you into the clinic on Monday. You were like,
(07:00):
let's go.
Speaker 2 (07:01):
Yeah. Well, you know, you you had there are a
lot of things going on in your situation that we
knew that we needed a change, and I wanted to
get changed right away because time was of the essence
for many reasons, not the least of which was you know,
there were delays and diagnosis, and then you'd been on
a form of therapy that didn't seem to be really
you know, anything getting the job done the way, and
(07:23):
you had a lot of side effects from it. So yeah,
I wanted to get started right away. And you know,
I said earlier that you know, sort of who I
choose to treat is guided in part by how important
the relationship is. And that is the most important thing,
because you know, everyone deserves world class self care and
that's required, but not sufficient. Everyone requires also a world
(07:48):
class patient experience because if you get even if you
get great care, if you get PTSD trying to get
the care, then the coalit of your life is not
good at all. And so that there are a lot
of things which affect that process, the patient experience. But
a big part of it is the doctor patient relationship.
And that's kind of a hackney term, you know, it
(08:10):
sounds so especially in our case, it sounds so like
official and a doctor patient relationship, but it is a
very important thing and it's about, you know, it's about
the patient believing that you're going to do everything for them,
that you're going to think about their case thoughtfully and
importantly individually. You're going to think about their individual case,
(08:33):
not just you know, what category you fit into you're
fit into this stage and this disease and third line
treatment or whatever, but actually your individual case and what
are the nuances for for example, we've chosen things at
times that you know, we're guided by efficacy against the cancer,
but also by whether it makes you lose hair or not,
(08:57):
because that sounds like super trivial hair versus cancer, but
it's not at all, because hair affects your view of yourself,
and your view your self effects your engagement with the
treatment and how much you believe in the treatment. It
affects one's ability to work in some cases. You work
in a business where you can't work much if you
(09:18):
look like you're sick. And so there's like so many
things that come into the factor of individualizing the treatment
or other side effects that you're willing to have or
not willing to have, not necessarily because they are visible
to other people, like hair, but they're important to you personally,
whoever the patient is. And some people can tolerate certain
kinds of side effects like they're charging to a war,
(09:42):
and other people are just completely debilitated by those side effects.
I don't think that most people realize that patients do
make choices almost as much by side effects as by efficacy,
not as much. I mean, there's always more power given
to efficacy as there should be, but it's a pretty
(10:02):
close balance because you know, especially in these days where
fortunately we have lots of treatments that if they can't
make you go into omission completely, they can keep you
in our mission for a long period of time with
a low level of cancer, and then there's going to
be another thing after that and another thing after that.
(10:23):
So it's a long journey. And if you are having
side effects that are just intolerable to you all through
that journey, then it's a long journey of miserable life.
And what people's goal is and of course should be,
and what the doctor's goal should be for you is
a lot if it's not curable, then a long journey
(10:43):
of the highest quality life.
Speaker 1 (10:46):
Yeah, I mean, I think quality of life is so
incredibly important because if your quality of life on a protocol,
on a treatment is very poor, then you definitely fall
into a depression, and that depression leads you to kind
of give up. And I you know, I know there's
no like science behind my particular kind of thinking that
(11:08):
you know, med speak for themselves and everything else. But
I do believe that mind over matters incredibly important. I
believe in the power of the brain and power of suggestion.
So if you're feeling really good, if you're in a
good place, and you're believing in your protocol and you're
okay with it and it's not totally working your quality
(11:29):
of life, then you're going to feel all sorts of
positive energy towards that protocol, which I think ends up
making the protocol work a little bit better. That's just
been my experience thus far on the protocols i've been on. Again,
I know that there's zero science behind that.
Speaker 2 (11:49):
Well, certainly, certainly, you know, there's lots of hormones and
signals that are released by the brain that you know
translate into a sense of well being, And if you
have a sense of well being on a treatment, you
know it may go better. I mean, in the case
of breast cancer, for example, there are studies that show
(12:09):
that you know, if you exercise during chemotherapy, that the
actual outcome of the chemotherapy may be better. The outcome
on the tumor may actually be better. So I think that,
as you know, indirect evidence that doing things with your
body or your mind may influence the milieu of your
body while you're getting the chemotherapy and change the outcome.
(12:30):
So I think what you say is you know, is
completely correct.
Speaker 1 (12:35):
So we I came into you know, your office on Monday,
and you had taken the weekend to access, you know,
all of my medical records, you know, with my authorisation obviously,
but so that you were completely on top of like
where I was at. Can you explain, because I don't
(12:55):
think a lot of people know, particularly with breast cancer,
like the her positive the her negative, But what is
the difference between that? People always ask me what I am,
and I'm like, I kind of don't remember.
Speaker 2 (13:10):
Well, you're a technically a strodener receptor positive progestion receptor
positive and her too negative. But it's a bit of
a complicated technicality, but there's the initial way that you
do that her testing and her is is one of
the genes that can be expressed in breast cancer, and
it's actually a target for treatments, some treatments that are
(13:31):
very very successful at helping in breast cancer, though it's
expression in the breast cancer can be associated with a
less good outcome. And you are her too negative, which
you know is a good prognostic indicator. But the way
that that test is initially done, it's done in kind
(13:52):
of a qualitative way. So they test the cells for
that expression, and you get sort of a one plus
or two plus or three plus, and a certain cutoff
of the pluses is considered negative in a certain kind
of positive. But if you're equivocal, meaning meaning that you're
in sort of a mid range, then we do a
more refined test, which is a quantitative test, and it's
(14:13):
a very accurate quantitative test. So you were in the
equivocal range, but when we then did the more complicated tests,
you were negative. So we're happy about that because you
know it's a better prognostics sign. However, fast forward many
years later in your treatment, when you're in that equivocal zone,
(14:36):
it's called HER too expressor, so you're expressing it even
though you're not technically positive. You're expressing it at a
low level. And so right when we were needing to
have another novel therapy in your case, a paper came
out that shows that patients who are HER two expressors
respond to one of the newer monocline line of body
(14:59):
drug conjugates that targets her too, and these people actually
respond well to it. So the fact that we had
all that data and we remember that data and we
access that data when we were having again to think
novelly and individually about you, because there were reasons why
going back onto chemotherapy wouldn't have been ideal at this
(15:20):
particular juncture, so we chose an antibody drug conjugate. Unfortunately
data had come out just in time. And you know,
that's something I've talked with you a lot about and
other people that you know, we know together, that I've treated.
You know, it's sort of in the beginning of my career,
we were all focused on you sort of pretty much
either cure something or you kind of limp along with it.
(15:45):
But there isn't a long period of being along with it,
you know, back in the day. Now there are so
many treatments that and since we've been able to sequence
the human genome and since we've you know, really unleashed
a lot of or unlocked the line of the secrets
that allow us unleash immunotherapy, which is the body's immune system,
(16:05):
you know, being repped up to fight the cancer. Now,
there are many different chapters to what we can do.
And so early on, if you achieved a partial remission
and we're limping along, it may not have affected your
overall survival even though you were in remission because because
it might not last that long. But now, if you
can achieve a partial remission that lasts for a decent
(16:28):
amount of time, in that time, developments are so fast
that something new may show up that might then give
you a much longer, more meaningful remission. So I always
say that, you know, it's important to think of each
therapy as a horse. And you want to ride in
a horse race, So you want to ride every horse
as long as it rides, and then you ride the
next horse as much as possible. When you hope by
(16:49):
the time you make a few laps, you know there's
altogether another set of horses to ride, you know, to
make the race that much longer.
Speaker 1 (17:06):
Somebody was asking me today and they were like, wow,
you know, like stage four breast cancer says like five years.
It's like, yeah, but that's like old data that you
have found on the internet, and things are different. I mean, yes,
there are people that have only survived five years. You know.
(17:27):
I think my best friend Dub was one of those.
But there are so many different things right now, and
you and I always talk about the fact that, like
we just need to squeeze out another three to five
years and then there's going to be you know, T
cell therapy, or there's gonna be this, or there's going
to be that, like whatever it is, there's going to
(17:47):
be a lot more options that will give another five years.
Then in those five years, there's a whole other, you know,
group of options, and then eventually there's going to be
a cure. So I always look at it as I'm
I'm the horse analogy is a really good one, Like
I'm constantly chasing I'm riding those horses so that I
get to the fresh set of horses, and I'm trying
(18:07):
to get the one that I'm on right now to
like last for as long as humanly im possible.
Speaker 2 (18:13):
And that's why I like that analogy, because when you're
the one riding the horse, which is the much more
difficult job than the one picking the horse, it gets
exhausting at times, but then you think, well, okay, this
is still working, right, Yeah, this is hard, but it's
still working, and we don't want to abandon that because
if we abandon it too early that one decision could
(18:35):
foreshorten a lot of other things, and then your timing
can be just exactly off for the introduction of new therapies,
like the fact that our timing was so fortunate of
you know, of finding this study about the Hurtwo expressors
and being able to put you on that.
Speaker 1 (18:53):
Right which the funny, I mean, the funny story behind
this is that I kind of bunt my head after
Ristmas party that I threw and I called you and
was like, and it was right after New Year's or
whatever when I called you and I was like, hey,
you know, over the holidays, I kind of hit my
head pretty badly, and I know that it was bleeding.
What do you think. I'm probably fine, right, Like, I
(19:15):
didn't die in my sleep, so I'm okay. And you're like, no,
you need to come in for a CT scan like
pronto and I did, and we found, you know, mets,
and I guess we can call Bob a tumor.
Speaker 2 (19:29):
He was a tumor, yeah, I mean, And that, interestingly
is my bigger concern with the way the trauma you had.
You know, there's something called a subdural humanitoma that is
a chronic slow oozing of blood that can present with
symptoms coming you know, a week or ten days after
the initial trauma. And some very famous people have died
(19:53):
with that sort of thing and if you don't evacuate
that blood quickly, and since you were having some symptoms
a little bit still at that time, that's what I
was concerned about, more so than a tumor in some ways,
because you know, you weren't exhibiting any signs which I mean,
you weren't having paralyzed and anything. You weren't having seizures.
You know, you were you know, dizzy, and I'm not
(20:14):
I'm not even still sure, you know, given the you know,
relatively small size of those things, of whether they were
definitely causing symptoms.
Speaker 1 (20:22):
Or not right, because what ended up happening is we
found some mets and we found one that was larger
than the others, and Dutch Piro said, you need to go, like,
get this. We're going to go get it removed immediately,
mainly because I want to, you know, study it, and
I want the pathology on it, and I want to
(20:42):
see is this is this breast cancer that's moved into
Like I need to know specifically the cancer that's there
that we're dealing with, so I know how to treat
it properly. And I think like six days later, I
was at Cedars. I'm getting my head cut open, and
(21:04):
a you know tumor that's Bob. By the way, I
named him Bob, no offense to any Bob's. He just
seemed like a Bob to me. You know, we got
almost all of him and the rest we handled with
brain radiation well.
Speaker 2 (21:17):
And the reason why it was so important to study
the tissue is that sometimes after you've had treatments for
long periods of time, the tumor's morph in their expressions,
so it may not have been expressing the same set
of determinants and markers that the original one had. But secondly,
and somewhat more importantly, chemotherapy does not penetrate well into
(21:41):
the brain, right.
Speaker 1 (21:42):
Because there's a blood brain barrier that it's got.
Speaker 2 (21:45):
To break through to sanctuary. And it's intended it's intended
to leologically because there are toxins. Chemotherapy is a form
of toxin, right, and their toxins all over in nature, right.
I mean the drug, the chemotherapy drug vin Christine comes
from it's a vinca alkaloid. It comes from the vinca plant,
(22:05):
which is a ground common groundcover. So if you were
back in your rooting days, when you were rooting around
in the four.
Speaker 1 (22:12):
It's actually just looking at that by the way plant
because it's also drought tolerant. If I and I was
quite attractive, Yeah, it's very attractive. I was looking at
it for my driveway.
Speaker 2 (22:24):
So if you were like rooting around in nature and
you were chewing on the vinca plant, you would be
getting some of the you know, sort of precursor molecule
of vin christine or the exact one. And so you
don't want that in your brain because your brains, your
you know, your central computers and operating zone. We don't
want toxins in there. So the blood brain barrier has
pumps that pump those things out, so it can't it
(22:46):
can't get there. And so as a result, however, therefore,
when we treat with chemotherapy, sometimes it doesn't penetrate, you know,
into the brain, and so there are other therapies that
do and certain chemos will penetrate into the into the brain.
And so again this is the whole individualizing of the
therapy thing. We need to choose something. I wanted to
see if the expressions of the tumor in your body
(23:09):
and the expressions of the tumoring the brain were the
same or not, And make sure that whatever we treated
you within your body would also treat the brain at
the same time, if possible. Even though we were giving
we removed the one and we were giving radiations the brain.
We don't want to treat the whole brain because that
has too much bad effect on normal brain tissue and
so and so we want only to treat those few spots.
(23:32):
And we didn't want any other brain tumors developed, if possible,
So we really wanted something to penetrate and bathe the brain,
you know, in that treatment. And therefore, if there were
seeds of cells that were ultimately destined to create other
brain tumor, spots of brain tumor, we would kill them
by using that treatment, and then they would manifest as
(23:55):
another spot of metastatic breast cancer.
Speaker 1 (23:58):
Right, But we also need did a treatment that didn't
just take care of the brain mets. We needed the
whole body. Like everything else that was going on. My
breast cancer was spread into my bones, so it was
very important that be kept under control. And we found
it when we did the pathology on Bob the tumor.
(24:20):
What was the difference of that pathology that allowed me
to be okay for this sort of new treatment that
he was talking about a second ago, that the papers
had just come out about it being a good alternative
for something like I was.
Speaker 2 (24:37):
It was also expressing her too. It was not her
too positive. It was in that expressor zone. It was
in that low level zone that this paper showed patients
respond to. And that was, you know, made me very
happy because we could treat both the body and the
brain with that, and this drug antibody conjugate penetrates into
the brain. So it is a perfect particularly good choice
(24:58):
and that has proved not only was that a reasonable
theory by which to choose a treatment, but that's proven
out to be a good result for you as we've had,
as we know, with some recent scans that let's just say,
it made us very happy.
Speaker 1 (25:11):
Made us very happy, yeah, which I think is really
interesting because you know, we scanned me quite often once
I went on this other treatment. You know, it didn't
it didn't really look like it was performing that well,
and I think it was after the fifth treatment that
you and I had a conversation about it, and the
conversation was maybe we should move to a different treatment,
(25:33):
and we sort of both sat with it and took
our time to think about it reconnected, and you know,
I think I started by saying I want to give
it more time, and you really sort of went back
and did research and then called me and said, actually,
I ordered a very specific test for you to get done,
which was for your tumor markers. And it's not something
(25:54):
that you get done every single month with your blood work.
It's specific that you have to order and I ordered it,
and your tumor markers were you know, they're cut in
half basically, so we know that it's working. And you said, so,
I feel comfortable with you staying on this as long
as you agree to get MRIs a little bit more
(26:15):
often because you wanted to stay on top of it.
And then after my seventh treatment, you came into my
infusion room and you were I mean, you came in
You're like, yes, you were, you know, you were I
don't want to say more excited than me, but you
were equally as joyous as me.
Speaker 2 (26:38):
And I almost never do that. And the reason I
almost never do that isn't because I'm not joyous. It's
because I fear if I do that, then every subsequent
time we have scans, if I don't walk in that way,
people will read and patients will read into it that
I'm really not joyous, and then they'll think whatever I'm saying,
you know that I really secretly, you know, upset because
(27:03):
we didn't get better results or something like that, you know,
And yeah, and that such an important part. We accidentally
tripped onto a zone of conversation. It's so important. It's
really so important as a doctor to realize that people
are watching every single move you make and every single world.
Speaker 1 (27:20):
So it's your eyebrot. So I'm like, what does that
mean exactly? But you and I have sort of we
have established the way of doing things because your clinic,
the Angelus Clinic in Los Angeles, is it's extraordinary in
the sense that you can go in, you can go
get a PET scan, you can go get an MRI,
(27:41):
you can go get a CT scan. And whereas traditionally
I know people that have had to wait ten days
for their results, at your clinic, you get the results
the same day. And most of your patients, you know,
wait for their scans. They wait there and then they
have an appointment with you or one of the other
doctors like whatever, and they get their results in person
(28:02):
the same day. And I chose to do it very
differently from the beginning with you, where I said I
don't want you, I don't want to know my results
in person. I let me go home and call me
with my results at whatever time works for you throughout
(28:23):
the day, whenever you have a moment, whenever you have
a break, whenever you know you're not seeing a patient,
if it's at night, doesn't really matter to me when
because I didn't want to monitor my reaction for you,
or for the nurse practitioner, or for anybody that was
in the room with me, for my mom, like whoever
it was, right I whatever you told me, good or bad.
(28:48):
I wanted to be alone so that I could have
an authentic, like true reaction for myself and not try
to put on a like game face for everyone. Because
there's nothing worse than getting bad news face to face,
and you feel like you have to make the person
giving you the bad news feel good. And I'm that person.
(29:11):
It feels like it's my responsibility to make sure everybody
is okay.
Speaker 2 (29:15):
You're the first person in my entire career whoever wanted
that format. No, No, it totally works, and it makes
subtle sense. And to be honest with you, which probably
you know is part of the underpinning of the closeness
of our friendship through all these many years, is that
I realize that I'm probably the same way like I
(29:36):
would probably you know, be the other person who had
wanted that way, because I realized that, you know, when
I hear something, whatever it is, I want to process
it personally to figure out how I feel about it
before I want to tell somebody else. Because the minute
you tell someone else whatever, if it's good news, you've
got a new job, you know, if it's bad news, whatever,
(29:58):
people are going to learn out their response. And it's
hard to hear other people's reaction, especially we're talking about
cancer and cancer results and all that when you're not
yet sure what your response is, because therefore you have
no defense or no ability to reformat their misguided reaction
to it. And often often the people in one's lives
(30:21):
have misguided reactions to data they don't you know, they're
getting bits and parts pieces of your story, and they
can be very misguided. And it's very hard to unhear something. Yeah,
and that is an underappreciated axiom. It's very hard to
unhear things. And if there's anything that in this conversation
(30:42):
we're having that people who are listening who are caregivers
or loved ones or people friends, people in the lives
of people who are going through the cancer journey, is
be very careful what you say because they can't unhear
what you say. There's such a desire of well meaning
(31:02):
people who care about someone to establish to you that
they understand what you're going through by saying, oh, well, yes,
you know, my sister had breast cancer too, or my
so and so had breast cancer too. Unfortunately, it often
leads most people when they're telling the story, don't think
about the punchline and whether the punch yeah, and they say, yeah,
(31:26):
well what happened to your sister? Says the patient, and
they said, well, yeah, she died three years ago, and like,
oh my right, I mean, and no one does that intentionally,
but it's mortifying because if you don't think about where
the story ends up before you choose to tell it
to this particular person. It's you know, it doesn't.
Speaker 1 (31:43):
Help that one all the time, all the time. And
you know, I know that the people are very you know,
well intentioned. It's like a way of connecting with me
and of saying, I know what you're going through, and
you know, I really like they always follow it up
with like I so admire, like you're journey, but it
is always sort of my mom, my grandmother, my sister,
(32:05):
my friend, they died, and I'm always like what do
I do with that information? It's a hard one. It
was I was being interviewed today and the woman interviewing
me her father is a doctor, and so I guess
she spoke to him about, you know, more in general
terms of like stage four you know, cancer, like I
(32:29):
have her knowledge of what I have and gave that
to her dad, and she kept on using the word
like terminal and like, you know, there is no cure,
like this is really bad, and I just I kind
of was like, based on what because your dad may
be a doctor, but he doesn't know my particular cancer.
He doesn't know where my tumor markers is. There are
(32:49):
so many things. But also I just kind of sat
there like huh, Like I don't know what you're getting at,
Like what do you are you looking for me to
break down and in this conversation because it's on camera
and that's going to be a great moment for you guys.
Like I couldn't figure out what the endgame was, except
that I think she was truly concerned and truly you know,
(33:11):
tried to come in with knowledge, but probably got fed
a bunch of stuff that perhaps she shouldn't have repeated
because I think I think it's very dangerous for other
people to have the conversation about your cancer besides your doctor.
I think it is an extremely dangerous conversation.
Speaker 2 (33:34):
Well, I always tell patients at the first diagnosis, I
say to them that they should tell all of their
friends who are going to wonder what they're supposed to
talk about with you. And they think, well, if I
don't talk about the cancer, they'll think that I'm afraid
(33:54):
in ignoring it. And if I do talk about the cancer,
then I might not say the right things. So they
don't know what to do. But they usually talk about
the cancer. They're call it how are you, How are
you doing? Are you okay? Do you need anything? Whatever?
All of which sounds nice, right, But if these are
the people who you talked about dropping your kids off
to school, and you know how the drop offline, you
(34:18):
know they should manage it better at the school, and
you know you want to meet to play, you know,
pick a ball, And I want to have a dinner
party this weekend. You know, do you want to come?
And what should we cook? Right instead? There? How are you?
Are you okay? Do you need anything?
Speaker 1 (34:33):
Like?
Speaker 2 (34:33):
It's just you become not normal, you become a cancer person. Yeah,
and you don't want to be a cancer person. So
I tell everyone, Tell your friends to talk about with
you everything that they always used to talk with you about,
and don't talk about cancer. And here's the clue. When
you want to talk about cancer, you'll tell them you'll
bring it up, and then then go for it. Then
(34:53):
I'm bringing it up, but I'm guiding you as to
what why I want to talk about? Do I want
to talk about how I'm feeling emotionally? Do I want
to talk about how sad that my personal life has
been influenced by cancer and this unfortunate thing my personal
life happened, or wheneverbody just take the lead and focus
on what they want to talk about. Don't put your
(35:14):
own stuff into it. And it's complicated, right because people
are not therapists and they're not aware of cancer and
they don't have the medical stuff. But this is so
important to the quality of life of a person with
cancer because when people are always making you a cancer person,
it just it attracts from your quality of life and
it changes yourself image of yourself, like I'm a cancer
(35:37):
person now, you know.
Speaker 1 (35:38):
And then you start feeling sick.
Speaker 2 (35:40):
Yeah, it feeds the beast, it really does.
Speaker 1 (35:45):
Versus I mean, I don't have many people that I
talk to cancer about. Like for me, I talk to
you about cancer because I think you're qualified to talk
to me about cancer. And everybody else where you getting
your information from, if it's from the internet, I literally
(36:05):
no desire to hear one word that comes from the internet,
not just about cancer, but pretty much about everything at
this point, but particularly about cancer. And so I want
to I want to speak to people that are, you know,
leading the charge in research. I want to. I want honesty.
I want, you know, hope where there's hope. I want
(36:29):
someone to be pragmatic where it's called for, Like, but
I don't want information that can't be verified or backed up.
And I also don't want to be a cancer person.
I want to you know, And I've often done some
very stupid, stupid things since being diagnosed because of my
(36:49):
desire to be normal, because I've like rejected the idea
that I'm a cancer in quote patient, Like, i have
cancer and I'm managing it. I'm managing it with you,
and I'm managing it with you know, doctor Ju and
like whoever else we need to bring in to help
in those moments. But I don't want it to define
(37:11):
my everyday life.
Speaker 2 (37:13):
Well so much so that you know, And we've always kept,
which I think is a super healthy and amazing way
to do it. We've always kept our lane separate. Yeah,
so when we're together as social aized friends, it's a
friend lane. When we're doing medical self to medical lane,
and you know, every once in a while those things
have to cross over, but it's extremely rare. And you,
(37:35):
for example, will never ask me anything medical when we're
doing something social, or if you have to, you'll say, look,
I'm really sorry for asking this right now when we're
having dinner, but just blah blah blah blah. It's some
little knit or whatever that you have to do.
Speaker 1 (37:47):
I've been to dinners with you. I've seen your phone.
I mean I haven't seen it, but like i've seen it.
How many you know you were inundated twenty four hours
a day, days a week. You do not get a
day off of you know, medical questions, and your patients
have your cell phone, and you know you've given full
(38:08):
access to yourself. So when I'm able to steal you
away and we go to dinner somewhere, I don't want
to do that. Like, if I have a question for you,
I'll text you during business hours or I'll come into
the clinic and I'll ask you. You know, we just
went to Italy together. You invited me on this amazing
yacht and with your family, and I got to go
(38:32):
to Italy with you, which was like bucket list. By
the way, you knew it was on my bucket list,
And when you called me, you said, like, it's kind
of bucket list, Shan, And I was like, I was
so excited.
Speaker 2 (38:46):
We had the best time, such.
Speaker 1 (38:47):
A good time, what an amazing went, an amazing trip.
Speaker 2 (38:51):
We made some amazing restaurant.
Speaker 1 (38:53):
So yeah, I wish i'd coordinated my outfits better with you.
But now I know what to expect.
Speaker 2 (38:59):
And she was is you know. I mean, it's just incredible,
like jumping off of every level of the yacht, even
the highest of like Shannon is fearless. I mean, she
truly is.
Speaker 1 (39:10):
I did injure myself.
Speaker 2 (39:11):
Well I know you did, but I was going to
skip over that. It wasn't It wasn't jumping off the boat, however,
it was.
Speaker 1 (39:20):
I mean that's the crazy thing, Like you jump off
like the highest points of this ginormous yacht and you
go to climb back on, and I got scared of
the of the jellyfish, so I went the long way.
Speaker 2 (39:35):
That was at night, I think, yeah.
Speaker 1 (39:37):
And the dangerous way, and that's when I gave myself
that that big bump on my leg.
Speaker 2 (39:42):
And that was really crazy too, because since it was night,
the crew had the bright light shining onto the sea,
and all of a sudden we can see all these
jellyfish floating around in there. That's, of course we never
saw during the day, and it was like, oh, did
she really just jump in there?
Speaker 1 (40:00):
Yeah, because they didn't see them when I did the jump.
It's like jumping in a shark infested waters like I
never would have done it had I known. But then
once I was swimming around, I was like, whoa, that's nuts.
I'm going to go the long way.
Speaker 2 (40:13):
You know, Southern Italy is number for seafood.
Speaker 1 (40:17):
I don't know.
Speaker 2 (40:18):
In this case, you were the seafood.
Speaker 1 (40:20):
I was seafood.
Speaker 2 (40:22):
Wow.
Speaker 1 (40:22):
Yeah, I mean we sort of did it fast forward
because I was going back to us meeting and you
sort of taking over my protocol and instantly saying, listen,
you gotta go get surgery, like that's the first thing.
Speaker 2 (40:37):
Are you surprised that we did a fast forward. Yeah.
We always start down a road and shortly turned down
a lane.
Speaker 1 (40:45):
Unpredictable is the word that you use to start with,
and that still matches and.
Speaker 2 (40:48):
There it goes, and that's the magic at all.
Speaker 1 (40:59):
So you said you got to get the tumor out
of your breast, like, let's like, that's the first thing.
And then once that's done, you're going to go on chemo,
You're going to get radiation, and we did. We did
all of that, and I made the decision at some
point to not take tomoxifen, which is you know, obviously
(41:20):
a drug that everybody recommends that you take because it
is a hormone blocker.
Speaker 2 (41:27):
And it was adgivant therapy, meaning that you had no
known cancer and it was being given. It would be
given to increase the chances that cancer not come back
by staying in your system and blocking the cell's ability
to grow. Estringe is a growth factor for cancer cells,
So tomoxism would block the estrogen to the cancer cell,
(41:49):
and hopefully any microscopic disease that maybe have been in
your body that's too small to show up on imaging
and that we didn't know about that maybe it would
kill that and increased the odds that it wouldn't come back.
That was the principle of adgement therapy of demoxmin.
Speaker 1 (42:06):
Which is a you know, solid argument, Like I look
back and I go, well, maybe how to do that?
Taking it? You know? I mean, I've had some people
in my life have sort of forced me to look
back like that, But I can't, right, because what good
is it? It doesn't do you.
Speaker 2 (42:22):
You make the best decision you can at the time
you make it, and in retrospect you often cannot remember
many of the factors that were influencing you. So when
you look back, you have an erroneous evaluation of your decision.
But at the time, you had been on estrogen blockade
before you ever had surgery, and it wasn't very effective
(42:46):
on shrinking your tumor, and you had a lot of
effects on your body that you didn't like. So those
two factors were influencing you to not choose to take
that drug at that time. And you were disease free,
and the balance of things to you at the time
seemed reasonable. And you did not make that lightly, and
you made it over and over again because I asked
(43:11):
you every single time for a year, are you sure
you don't want to do this? Issue? You want to
do this? So you were. You were resolute in your decision,
and you can't judge that decision, and no one else
can force you to because you made the best decision
you could at the time. And it's a it's an
erroneous set of analyzes when you look backwards.
Speaker 1 (43:29):
Yeah, I mean, I also think that I was fairly
certain it wasn't going to come back, because I believed
that the reason why I got cancer was because I
did IVF right. I met my husband at the time.
Later in years and you know, a multitude of things happen.
(43:50):
And so when it was time to have that decision,
we chose to have we needed IVF, and I did
a bunch of rounds of it, and I i, you know,
through a lot of other women that I knew that
did IVF that ended up getting breast cancer as well.
Sort of the numbers all started stacking up in my
(44:10):
head that if you know, you sort of have a
cell that's a little wonky and that's sitting on the
edge of maybe turning spreading cancer, blah blah blah, that
the all the hormones that you're pumping into your body
from IVF are only going to up that chance of it.
That was at least my thinking. So when I got
(44:32):
the you know, you're all clear remission after chemo and
all of that, I knew I wasn't doing IVF anymore
because I was already a menopause, so like there was
no need for it. I was pretty sure, you know,
I don't want to say that I made a very
uninformed decision, Like I am a researcher. I'm hardcore about
(44:53):
you know, backing up some of my data, certainly not
at your level and certainly not at doctor's levels, and
researchers levels. So my decision was at the time based
on sort of the facts that I knew that I
had investigated, and you, in fact, did keep on encouraging
me to take the demoxifin, and I was just like,
(45:15):
absolutely not.
Speaker 2 (45:16):
You're a resolute yeah, but also yes, you did research things.
But also there was another factor in there, which is,
even though you know, anyone who's sort of close to
menopause often goes into menopause with chemotherapy, sometimes people who
are not close to menopause go into it as well,
but then it sometimes returns, menstruation can return, and you
(45:39):
were still hopeful that it might return for you because
you still want.
Speaker 1 (45:43):
To have a baby, yeah, desperately.
Speaker 2 (45:45):
And I think that played a role in the demoxpin thing, which,
you know, people at this stage where you're at doesn't
seem like a factor, but that was a factor at
the time, this sort of hopefulness that maybe you could
still have a baby.
Speaker 1 (45:59):
Yeah. Yeah, I mean, thank you for reminding me of that,
because it did definitely play a huge role of you know,
wanting not only not only did I want a child
for myself, but I wanted it, you know, for my husband.
I wanted it for our marriage. I wanted, you know,
I wanted him to have that part of him self
fulfilled as well. So it seemed like a calculated risk
(46:23):
that wasn't too bad of one to take. Plus I
can't remember, you'll correct me. I think it's cervical cancer.
That there's a percentage of demoxifensity to increase. You'ine cancer,
thank you, And I was like, well, you know, that
just gave me one more reason to say no to it,
and yeah, and you're right, and I can't look back,
and so.
Speaker 2 (46:44):
Moving forward, I think, but I think also, don't forget
that cancer and cancer treatment you know, caused you to
look back at you know, your own life and to
be very philosophical. You know, it made you want to
have a child for another reason too, which is, you know,
to be able to part you know, the very many
things that you've learned in life and the many feelings
(47:05):
that you had into raising a human being, you know,
I mean, that's that's the ultimate diary, is to raise
a child and try to infuse their life with all
the wisdoms that you had and and helping them try
to avoid the mistakes that you made and that they're
(47:25):
going to not make some of their own of course
they will, but there's a you know, you were in
the spotlight since you were a young girl, and you've
lived a million lives when most people, you know, we're
just starting out or we're in the beginning of the careers.
You've already had two or three careers, and you know
(47:46):
fought your way, you know, in a Hollywood scene that
you know didn't necessarily you know, regard what you had
to say. And I mean, I've never met anybody as
well educated as you who was schooled on the set.
And I of course, as you know, many many people
were schooled on sets. But you have a you know
a level of comprehension and power of intelligence and use
(48:10):
of that intelligence, and you know, in a very incisive
way in cooking as well, for example, there are not
that many people who go on to be these amazing cooks.
And I mean everything you do is full tilt. That's
who you are, and that's how you make your decisions.
And so I actually find it very gratifying that you
(48:33):
research things and you you know, make your definitive decision,
because you see in medical decision making, people want shared
decisions with the physician, which I'm all about. I mean,
I'm all about that. I love that, as you know
and as all my patients know. But part and parcel
of shared decision making is accepting responsibility for the decision.
(48:54):
And you always do that. Sometimes people want share decision making,
and if it's not the right decision, then they want
to look to everyone else for you know, why the
wrong decision was made or whatever. But when you when
you're a person who really owns it, and like all
my patients do, but you are the you know, the
prime example of that of someone who you know, wants
(49:17):
to part, to stay in process, wants to know the data,
and once you make your decision, you own responsibility for
your decision. And I love that because that's that's just
the being a person of truth.
Speaker 1 (49:28):
Accountability I love nothing. Accountability is like my favorite thing.
So if I made a decision that put me in
a certain place, then I hold myself accountable like you
have to.
Speaker 2 (49:42):
I've seen that over and over and over again, and
everything you've said and done and even in stories we've
talked about about your career, Yes, and certain decisions that
you've made in response to things that happened or this
or that you've you know, you've always accepted responsibility for
those and you know, the thing is that even when
when things happened that weren't your responsibility, you will describe it,
(50:03):
but you're also not You've never been finger pointing of people.
Say that person did that.
Speaker 1 (50:09):
That's a new thing.
Speaker 2 (50:10):
As that person did that, you'll say what they did,
but you'll also understand the other factors that we're bearing
on the scenario. Yeah, and I've always respected.
Speaker 1 (50:19):
That for the most part. I think every you know,
there's always the exception to the rule where I point
the finger and go, you're bearing the full brunt of
this one because this is all on you.
Speaker 2 (50:32):
And when you do that, it's very believable because you
don't do that often.
Speaker 1 (50:35):
Doctor piro LP. Thank you so much for being on.
There is so much more for us to talk about.
So I'm going to have you on for another episode
and just keep digging and keep exploring because I just
I think you have so much to offer and this
conversation is incredibly important to a lot of people. So
(50:56):
thank you very much and I love you end Yeah,
see you soon.
This is let's be clear with Shannon Dorney. Hi, everyone,
this is Let's be clear with Shannon Doherty. I want
to thank you for listening to my podcast and for
your kind and encouraging words on social media. As you
may know, there are many people with me on this
cancer journey, and today I'm joined by someone instrumental in
(00:22):
my treatment. The Hollywood Reporter named him one of Hollywood's
top doctors. Please welcome doctor Lawrence Piro.
Speaker 2 (00:29):
Hey, Shannon, happy to be here. Hi.
Speaker 1 (00:32):
How are you.
Speaker 2 (00:33):
I'm good?
Speaker 1 (00:33):
How are you? I'm good. I had a very long day,
but nothing I would look forward to more than a
glass of wine and a conversation with you.
Speaker 2 (00:44):
Something we've done quite often and every time it's enjoyable
and unpredictable.
Speaker 1 (00:49):
Unpredictable it is a really, really good word for it.
Can you please, just for you know the people listening in,
tell us your full title, your specialty, and what hospitals
you're affiliated with.
Speaker 2 (01:03):
Well, I'm doctor Lawrence Pirerou. My title is CEO of
the Angels Clinic and Research Institute, which is an affiliate
of Cedar Sinai, which we started about twenty three years ago,
and I'm an medical oncologist, so kind of the overall
quarterback of the ecology team in terms of diagnosis and
(01:23):
planning treatment and coordinating all the treatments.
Speaker 1 (01:27):
And is your oncology specialty breast or a multitude of
different cancers.
Speaker 2 (01:34):
Well, it's a multitude of different cancers, and I've done
research in a number of different areas, but breast is
an area where I've treated in an extensive amount of
patients over my entire forty year career.
Speaker 1 (01:45):
And you are published, are you not?
Speaker 2 (01:47):
I am?
Speaker 1 (01:48):
Can you tell me a little bit about that.
Speaker 2 (01:50):
Well, I've been a researcher and a developer of treatments
from the beginning of my career. I was actually still
a fellow when published on the first which was a
drug that put a disease called harry sel leukemia into
remission in ninety eight percent of cases, and it was
a kind of a worldwide attention item because there was
(02:12):
almost nothing that would put that number of people into
a mission with a single treatment. So I was quite
a breakthrough and that spawned my career starting when I
was in my late twenties. That spawned my career in
investigative oncology and creating targeted treatments, and I was part
(02:34):
of the development team for all of the clinical trials
that led to the approval over Tuksan, which was the
first monocle and antibody ever used in Man and approved
as a drug. So we had a really great experience
with all that, and that of course opened up a
whole new field of drugs and now there are you know, many,
(02:54):
many and a lot of people actually got monocle antibodies
for COVID. I remember, yes, I'm sure that was a
fun thing to be involved with. And I have a
medium to large institute with a lot of oncologists doing
great work and doing research and all different kinds of things.
And I treat a wide variety of diseases because a
(03:15):
lot of times the relationship is the important thing.
Speaker 1 (03:20):
Yeah, So in other words, you're like no joke, You're
like the no joke doctor. So, just to give our
listeners a bit of history, I got diagnosed with breast
cancer in twenty fifteen. I went to a different oncologist
and had not a very successful sort of treatment in
(03:44):
the sense of nothing was really changing. I still had,
you know, a tumor in my breast. I still wasn't
getting surgery. I kind of was feeling a little bit lost.
The drug that this particular in college just had me
on put me in a menopause. I wasn't properly warned
about that. I was definitely feeling adrift, if you will,
(04:04):
in my sort of cancer journey, and I knew that
something needed to change. I just didn't know how to
change it. And most of the time, a lot of
patients feel as if they don't have the right to
ask for a better doctor or to change doctors, or
they're scared their insurance won't cover a new doctor, or
they feel like they can't change doctors. And I felt
(04:27):
that for a minute until I got a phone call
from my friend Chris, who said he was good friends
with a mutual friend of ours, David, and David really
wanted to introduce me to this oncologist that he said
saved his father's life with cancer and he felt very
strongly about and that meeting happened to be when I
(04:48):
met you. Do you want to tell us about it?
Speaker 2 (04:50):
Sure? Well, David Charvey called me and said, would I
be willing to have dinner over at Chris's house and
meet Shannon. She was going through a little cancer problem.
They thought if we'd met up, we might be a
good team, and so I said, yea, I'm sure, I'm
happy to. So we had dinner. You know, usually in
that kind of a situation, it's a it's kind of
(05:10):
a dance, you know, because you're like, it's like a
blind date. Two people who are invited to a get
social gathering for a purpose, and everyone kind of knows
the purpose, but you're supposed to act like you don't
know the purpose.
Speaker 1 (05:23):
It's so true, that great way of describing it.
Speaker 2 (05:25):
Yeah, So you usually dance around each other and like, well,
who's gonna who's going to reveal that they know the
purpose first and put it out on the table and
square it all up. And that, however, didn't play out
that night, because neither you nor I are kind of
beat around the bush people. So we just like jumped
right in. Yeah, and within five minutes we were pretty
(05:47):
connected and pretty sure that we understood one another and
pretty good, pretty sure that we'd be a great team together.
Speaker 1 (05:53):
Yeah. I felt like you understood why I was feeling
a bit lost, and you definitely had opinions on what
should change and what needed to get done immediately, And
I really respected the fact that you had like a
strong standpoint and you weren't intimidated by me by who
(06:17):
I am, but also more importantly by my personality. You
you know, you have just as bigger for personality as
I do. So we were able to really mesh on
that level. And I know that for me personally, I
kind of felt like, oh, I think that this is
somebody who is going to really be thoughtful with my care,
(06:38):
which was incredibly important to me. And he understands that
there's nothing more integral than me tackling this and getting better.
And you insisted that I come in like right away.
You were like, Okay, let's get started. I think we've
met on like a Friday or Saturday night and you're like, great,
we're getting you into the clinic on Monday. You were like,
(07:00):
let's go.
Speaker 2 (07:01):
Yeah. Well, you know, you you had there are a
lot of things going on in your situation that we
knew that we needed a change, and I wanted to
get changed right away because time was of the essence
for many reasons, not the least of which was you know,
there were delays and diagnosis, and then you'd been on
a form of therapy that didn't seem to be really
you know, anything getting the job done the way, and
(07:23):
you had a lot of side effects from it. So yeah,
I wanted to get started right away. And you know,
I said earlier that you know, sort of who I
choose to treat is guided in part by how important
the relationship is. And that is the most important thing,
because you know, everyone deserves world class self care and
that's required, but not sufficient. Everyone requires also a world
(07:48):
class patient experience because if you get even if you
get great care, if you get PTSD trying to get
the care, then the coalit of your life is not
good at all. And so that there are a lot
of things which affect that process, the patient experience. But
a big part of it is the doctor patient relationship.
And that's kind of a hackney term, you know, it
(08:10):
sounds so especially in our case, it sounds so like
official and a doctor patient relationship, but it is a
very important thing and it's about, you know, it's about
the patient believing that you're going to do everything for them,
that you're going to think about their case thoughtfully and
importantly individually. You're going to think about their individual case,
(08:33):
not just you know, what category you fit into you're
fit into this stage and this disease and third line
treatment or whatever, but actually your individual case and what
are the nuances for for example, we've chosen things at
times that you know, we're guided by efficacy against the cancer,
but also by whether it makes you lose hair or not,
(08:57):
because that sounds like super trivial hair versus cancer, but
it's not at all, because hair affects your view of yourself,
and your view your self effects your engagement with the
treatment and how much you believe in the treatment. It
affects one's ability to work in some cases. You work
in a business where you can't work much if you
(09:18):
look like you're sick. And so there's like so many
things that come into the factor of individualizing the treatment
or other side effects that you're willing to have or
not willing to have, not necessarily because they are visible
to other people, like hair, but they're important to you personally,
whoever the patient is. And some people can tolerate certain
kinds of side effects like they're charging to a war,
(09:42):
and other people are just completely debilitated by those side effects.
I don't think that most people realize that patients do
make choices almost as much by side effects as by efficacy,
not as much. I mean, there's always more power given
to efficacy as there should be, but it's a pretty
(10:02):
close balance because you know, especially in these days where
fortunately we have lots of treatments that if they can't
make you go into omission completely, they can keep you
in our mission for a long period of time with
a low level of cancer, and then there's going to
be another thing after that and another thing after that.
(10:23):
So it's a long journey. And if you are having
side effects that are just intolerable to you all through
that journey, then it's a long journey of miserable life.
And what people's goal is and of course should be,
and what the doctor's goal should be for you is
a lot if it's not curable, then a long journey
(10:43):
of the highest quality life.
Speaker 1 (10:46):
Yeah, I mean, I think quality of life is so
incredibly important because if your quality of life on a protocol,
on a treatment is very poor, then you definitely fall
into a depression, and that depression leads you to kind
of give up. And I you know, I know there's
no like science behind my particular kind of thinking that
(11:08):
you know, med speak for themselves and everything else. But
I do believe that mind over matters incredibly important. I
believe in the power of the brain and power of suggestion.
So if you're feeling really good, if you're in a
good place, and you're believing in your protocol and you're
okay with it and it's not totally working your quality
(11:29):
of life, then you're going to feel all sorts of
positive energy towards that protocol, which I think ends up
making the protocol work a little bit better. That's just
been my experience thus far on the protocols i've been on. Again,
I know that there's zero science behind that.
Speaker 2 (11:49):
Well, certainly, certainly, you know, there's lots of hormones and
signals that are released by the brain that you know
translate into a sense of well being, And if you
have a sense of well being on a treatment, you
know it may go better. I mean, in the case
of breast cancer, for example, there are studies that show
(12:09):
that you know, if you exercise during chemotherapy, that the
actual outcome of the chemotherapy may be better. The outcome
on the tumor may actually be better. So I think that,
as you know, indirect evidence that doing things with your
body or your mind may influence the milieu of your
body while you're getting the chemotherapy and change the outcome.
(12:30):
So I think what you say is you know, is
completely correct.
Speaker 1 (12:35):
So we I came into you know, your office on Monday,
and you had taken the weekend to access, you know,
all of my medical records, you know, with my authorisation obviously,
but so that you were completely on top of like
where I was at. Can you explain, because I don't
(12:55):
think a lot of people know, particularly with breast cancer,
like the her positive the her negative, But what is
the difference between that? People always ask me what I am,
and I'm like, I kind of don't remember.
Speaker 2 (13:10):
Well, you're a technically a strodener receptor positive progestion receptor
positive and her too negative. But it's a bit of
a complicated technicality, but there's the initial way that you
do that her testing and her is is one of
the genes that can be expressed in breast cancer, and
it's actually a target for treatments, some treatments that are
(13:31):
very very successful at helping in breast cancer, though it's
expression in the breast cancer can be associated with a
less good outcome. And you are her too negative, which
you know is a good prognostic indicator. But the way
that that test is initially done, it's done in kind
(13:52):
of a qualitative way. So they test the cells for
that expression, and you get sort of a one plus
or two plus or three plus, and a certain cutoff
of the pluses is considered negative in a certain kind
of positive. But if you're equivocal, meaning meaning that you're
in sort of a mid range, then we do a
more refined test, which is a quantitative test, and it's
(14:13):
a very accurate quantitative test. So you were in the
equivocal range, but when we then did the more complicated tests,
you were negative. So we're happy about that because you
know it's a better prognostics sign. However, fast forward many
years later in your treatment, when you're in that equivocal zone,
(14:36):
it's called HER too expressor, so you're expressing it even
though you're not technically positive. You're expressing it at a
low level. And so right when we were needing to
have another novel therapy in your case, a paper came
out that shows that patients who are HER two expressors
respond to one of the newer monocline line of body
(14:59):
drug conjugates that targets her too, and these people actually
respond well to it. So the fact that we had
all that data and we remember that data and we
access that data when we were having again to think
novelly and individually about you, because there were reasons why
going back onto chemotherapy wouldn't have been ideal at this
(15:20):
particular juncture, so we chose an antibody drug conjugate. Unfortunately
data had come out just in time. And you know,
that's something I've talked with you a lot about and
other people that you know, we know together, that I've treated.
You know, it's sort of in the beginning of my career,
we were all focused on you sort of pretty much
either cure something or you kind of limp along with it.
(15:45):
But there isn't a long period of being along with it,
you know, back in the day. Now there are so
many treatments that and since we've been able to sequence
the human genome and since we've you know, really unleashed
a lot of or unlocked the line of the secrets
that allow us unleash immunotherapy, which is the body's immune system,
(16:05):
you know, being repped up to fight the cancer. Now,
there are many different chapters to what we can do.
And so early on, if you achieved a partial remission
and we're limping along, it may not have affected your
overall survival even though you were in remission because because
it might not last that long. But now, if you
can achieve a partial remission that lasts for a decent
(16:28):
amount of time, in that time, developments are so fast
that something new may show up that might then give
you a much longer, more meaningful remission. So I always
say that, you know, it's important to think of each
therapy as a horse. And you want to ride in
a horse race, So you want to ride every horse
as long as it rides, and then you ride the
next horse as much as possible. When you hope by
(16:49):
the time you make a few laps, you know there's
altogether another set of horses to ride, you know, to
make the race that much longer.
Speaker 1 (17:06):
Somebody was asking me today and they were like, wow,
you know, like stage four breast cancer says like five years.
It's like, yeah, but that's like old data that you
have found on the internet, and things are different. I mean, yes,
there are people that have only survived five years. You know.
(17:27):
I think my best friend Dub was one of those.
But there are so many different things right now, and
you and I always talk about the fact that, like
we just need to squeeze out another three to five
years and then there's going to be you know, T
cell therapy, or there's gonna be this, or there's going
to be that, like whatever it is, there's going to
(17:47):
be a lot more options that will give another five years.
Then in those five years, there's a whole other, you know,
group of options, and then eventually there's going to be
a cure. So I always look at it as I'm
I'm the horse analogy is a really good one, Like
I'm constantly chasing I'm riding those horses so that I
get to the fresh set of horses, and I'm trying
(18:07):
to get the one that I'm on right now to
like last for as long as humanly im possible.
Speaker 2 (18:13):
And that's why I like that analogy, because when you're
the one riding the horse, which is the much more
difficult job than the one picking the horse, it gets
exhausting at times, but then you think, well, okay, this
is still working, right, Yeah, this is hard, but it's
still working, and we don't want to abandon that because
if we abandon it too early that one decision could
(18:35):
foreshorten a lot of other things, and then your timing
can be just exactly off for the introduction of new therapies,
like the fact that our timing was so fortunate of
you know, of finding this study about the Hurtwo expressors
and being able to put you on that.
Speaker 1 (18:53):
Right which the funny, I mean, the funny story behind
this is that I kind of bunt my head after
Ristmas party that I threw and I called you and
was like, and it was right after New Year's or
whatever when I called you and I was like, hey,
you know, over the holidays, I kind of hit my
head pretty badly, and I know that it was bleeding.
What do you think. I'm probably fine, right, Like, I
(19:15):
didn't die in my sleep, so I'm okay. And you're like, no,
you need to come in for a CT scan like
pronto and I did, and we found, you know, mets,
and I guess we can call Bob a tumor.
Speaker 2 (19:29):
He was a tumor, yeah, I mean, And that, interestingly
is my bigger concern with the way the trauma you had.
You know, there's something called a subdural humanitoma that is
a chronic slow oozing of blood that can present with
symptoms coming you know, a week or ten days after
the initial trauma. And some very famous people have died
(19:53):
with that sort of thing and if you don't evacuate
that blood quickly, and since you were having some symptoms
a little bit still at that time, that's what I
was concerned about, more so than a tumor in some ways,
because you know, you weren't exhibiting any signs which I mean,
you weren't having paralyzed and anything. You weren't having seizures.
You know, you were you know, dizzy, and I'm not
(20:14):
I'm not even still sure, you know, given the you know,
relatively small size of those things, of whether they were
definitely causing symptoms.
Speaker 1 (20:22):
Or not right, because what ended up happening is we
found some mets and we found one that was larger
than the others, and Dutch Piro said, you need to go, like,
get this. We're going to go get it removed immediately,
mainly because I want to, you know, study it, and
I want the pathology on it, and I want to
(20:42):
see is this is this breast cancer that's moved into
Like I need to know specifically the cancer that's there
that we're dealing with, so I know how to treat
it properly. And I think like six days later, I
was at Cedars. I'm getting my head cut open, and
(21:04):
a you know tumor that's Bob. By the way, I
named him Bob, no offense to any Bob's. He just
seemed like a Bob to me. You know, we got
almost all of him and the rest we handled with
brain radiation well.
Speaker 2 (21:17):
And the reason why it was so important to study
the tissue is that sometimes after you've had treatments for
long periods of time, the tumor's morph in their expressions,
so it may not have been expressing the same set
of determinants and markers that the original one had. But secondly,
and somewhat more importantly, chemotherapy does not penetrate well into
(21:41):
the brain, right.
Speaker 1 (21:42):
Because there's a blood brain barrier that it's got.
Speaker 2 (21:45):
To break through to sanctuary. And it's intended it's intended
to leologically because there are toxins. Chemotherapy is a form
of toxin, right, and their toxins all over in nature, right.
I mean the drug, the chemotherapy drug vin Christine comes
from it's a vinca alkaloid. It comes from the vinca plant,
(22:05):
which is a ground common groundcover. So if you were
back in your rooting days, when you were rooting around
in the four.
Speaker 1 (22:12):
It's actually just looking at that by the way plant
because it's also drought tolerant. If I and I was
quite attractive, Yeah, it's very attractive. I was looking at
it for my driveway.
Speaker 2 (22:24):
So if you were like rooting around in nature and
you were chewing on the vinca plant, you would be
getting some of the you know, sort of precursor molecule
of vin christine or the exact one. And so you
don't want that in your brain because your brains, your
you know, your central computers and operating zone. We don't
want toxins in there. So the blood brain barrier has
pumps that pump those things out, so it can't it
(22:46):
can't get there. And so as a result, however, therefore,
when we treat with chemotherapy, sometimes it doesn't penetrate, you know,
into the brain, and so there are other therapies that
do and certain chemos will penetrate into the into the brain.
And so again this is the whole individualizing of the
therapy thing. We need to choose something. I wanted to
see if the expressions of the tumor in your body
(23:09):
and the expressions of the tumoring the brain were the
same or not, And make sure that whatever we treated
you within your body would also treat the brain at
the same time, if possible. Even though we were giving
we removed the one and we were giving radiations the brain.
We don't want to treat the whole brain because that
has too much bad effect on normal brain tissue and
so and so we want only to treat those few spots.
(23:32):
And we didn't want any other brain tumors developed, if possible,
So we really wanted something to penetrate and bathe the brain,
you know, in that treatment. And therefore, if there were
seeds of cells that were ultimately destined to create other
brain tumor, spots of brain tumor, we would kill them
by using that treatment, and then they would manifest as
(23:55):
another spot of metastatic breast cancer.
Speaker 1 (23:58):
Right, But we also need did a treatment that didn't
just take care of the brain mets. We needed the
whole body. Like everything else that was going on. My
breast cancer was spread into my bones, so it was
very important that be kept under control. And we found
it when we did the pathology on Bob the tumor.
(24:20):
What was the difference of that pathology that allowed me
to be okay for this sort of new treatment that
he was talking about a second ago, that the papers
had just come out about it being a good alternative
for something like I was.
Speaker 2 (24:37):
It was also expressing her too. It was not her
too positive. It was in that expressor zone. It was
in that low level zone that this paper showed patients
respond to. And that was, you know, made me very
happy because we could treat both the body and the
brain with that, and this drug antibody conjugate penetrates into
the brain. So it is a perfect particularly good choice
(24:58):
and that has proved not only was that a reasonable
theory by which to choose a treatment, but that's proven
out to be a good result for you as we've had,
as we know, with some recent scans that let's just say,
it made us very happy.
Speaker 1 (25:11):
Made us very happy, yeah, which I think is really
interesting because you know, we scanned me quite often once
I went on this other treatment. You know, it didn't
it didn't really look like it was performing that well,
and I think it was after the fifth treatment that
you and I had a conversation about it, and the
conversation was maybe we should move to a different treatment,
(25:33):
and we sort of both sat with it and took
our time to think about it reconnected, and you know,
I think I started by saying I want to give
it more time, and you really sort of went back
and did research and then called me and said, actually,
I ordered a very specific test for you to get done,
which was for your tumor markers. And it's not something
(25:54):
that you get done every single month with your blood work.
It's specific that you have to order and I ordered it,
and your tumor markers were you know, they're cut in
half basically, so we know that it's working. And you said, so,
I feel comfortable with you staying on this as long
as you agree to get MRIs a little bit more
(26:15):
often because you wanted to stay on top of it.
And then after my seventh treatment, you came into my
infusion room and you were I mean, you came in
You're like, yes, you were, you know, you were I
don't want to say more excited than me, but you
were equally as joyous as me.
Speaker 2 (26:38):
And I almost never do that. And the reason I
almost never do that isn't because I'm not joyous. It's
because I fear if I do that, then every subsequent
time we have scans, if I don't walk in that way,
people will read and patients will read into it that
I'm really not joyous, and then they'll think whatever I'm saying,
you know that I really secretly, you know, upset because
(27:03):
we didn't get better results or something like that, you know,
And yeah, and that such an important part. We accidentally
tripped onto a zone of conversation. It's so important. It's
really so important as a doctor to realize that people
are watching every single move you make and every single world.
Speaker 1 (27:20):
So it's your eyebrot. So I'm like, what does that
mean exactly? But you and I have sort of we
have established the way of doing things because your clinic,
the Angelus Clinic in Los Angeles, is it's extraordinary in
the sense that you can go in, you can go
get a PET scan, you can go get an MRI,
(27:41):
you can go get a CT scan. And whereas traditionally
I know people that have had to wait ten days
for their results, at your clinic, you get the results
the same day. And most of your patients, you know,
wait for their scans. They wait there and then they
have an appointment with you or one of the other
doctors like whatever, and they get their results in person
(28:02):
the same day. And I chose to do it very
differently from the beginning with you, where I said I
don't want you, I don't want to know my results
in person. I let me go home and call me
with my results at whatever time works for you throughout
(28:23):
the day, whenever you have a moment, whenever you have
a break, whenever you know you're not seeing a patient,
if it's at night, doesn't really matter to me when
because I didn't want to monitor my reaction for you,
or for the nurse practitioner, or for anybody that was
in the room with me, for my mom, like whoever
it was, right I whatever you told me, good or bad.
(28:48):
I wanted to be alone so that I could have
an authentic, like true reaction for myself and not try
to put on a like game face for everyone. Because
there's nothing worse than getting bad news face to face,
and you feel like you have to make the person
giving you the bad news feel good. And I'm that person.
(29:11):
It feels like it's my responsibility to make sure everybody
is okay.
Speaker 2 (29:15):
You're the first person in my entire career whoever wanted
that format. No, No, it totally works, and it makes
subtle sense. And to be honest with you, which probably
you know is part of the underpinning of the closeness
of our friendship through all these many years, is that
I realize that I'm probably the same way like I
(29:36):
would probably you know, be the other person who had
wanted that way, because I realized that, you know, when
I hear something, whatever it is, I want to process
it personally to figure out how I feel about it
before I want to tell somebody else. Because the minute
you tell someone else whatever, if it's good news, you've
got a new job, you know, if it's bad news, whatever,
(29:58):
people are going to learn out their response. And it's
hard to hear other people's reaction, especially we're talking about
cancer and cancer results and all that when you're not
yet sure what your response is, because therefore you have
no defense or no ability to reformat their misguided reaction
to it. And often often the people in one's lives
(30:21):
have misguided reactions to data they don't you know, they're
getting bits and parts pieces of your story, and they
can be very misguided. And it's very hard to unhear something. Yeah,
and that is an underappreciated axiom. It's very hard to
unhear things. And if there's anything that in this conversation
(30:42):
we're having that people who are listening who are caregivers
or loved ones or people friends, people in the lives
of people who are going through the cancer journey, is
be very careful what you say because they can't unhear
what you say. There's such a desire of well meaning
(31:02):
people who care about someone to establish to you that
they understand what you're going through by saying, oh, well, yes,
you know, my sister had breast cancer too, or my
so and so had breast cancer too. Unfortunately, it often
leads most people when they're telling the story, don't think
about the punchline and whether the punch yeah, and they say, yeah,
(31:26):
well what happened to your sister? Says the patient, and
they said, well, yeah, she died three years ago, and like,
oh my right, I mean, and no one does that intentionally,
but it's mortifying because if you don't think about where
the story ends up before you choose to tell it
to this particular person. It's you know, it doesn't.
Speaker 1 (31:43):
Help that one all the time, all the time. And
you know, I know that the people are very you know,
well intentioned. It's like a way of connecting with me
and of saying, I know what you're going through, and
you know, I really like they always follow it up
with like I so admire, like you're journey, but it
is always sort of my mom, my grandmother, my sister,
(32:05):
my friend, they died, and I'm always like what do
I do with that information? It's a hard one. It
was I was being interviewed today and the woman interviewing
me her father is a doctor, and so I guess
she spoke to him about, you know, more in general
terms of like stage four you know, cancer, like I
(32:29):
have her knowledge of what I have and gave that
to her dad, and she kept on using the word
like terminal and like, you know, there is no cure,
like this is really bad, and I just I kind
of was like, based on what because your dad may
be a doctor, but he doesn't know my particular cancer.
He doesn't know where my tumor markers is. There are
(32:49):
so many things. But also I just kind of sat
there like huh, Like I don't know what you're getting at,
Like what do you are you looking for me to
break down and in this conversation because it's on camera
and that's going to be a great moment for you guys.
Like I couldn't figure out what the endgame was, except
that I think she was truly concerned and truly you know,
(33:11):
tried to come in with knowledge, but probably got fed
a bunch of stuff that perhaps she shouldn't have repeated
because I think I think it's very dangerous for other
people to have the conversation about your cancer besides your doctor.
I think it is an extremely dangerous conversation.
Speaker 2 (33:34):
Well, I always tell patients at the first diagnosis, I
say to them that they should tell all of their
friends who are going to wonder what they're supposed to
talk about with you. And they think, well, if I
don't talk about the cancer, they'll think that I'm afraid
(33:54):
in ignoring it. And if I do talk about the cancer,
then I might not say the right things. So they
don't know what to do. But they usually talk about
the cancer. They're call it how are you, How are
you doing? Are you okay? Do you need anything? Whatever?
All of which sounds nice, right, But if these are
the people who you talked about dropping your kids off
to school, and you know how the drop offline, you
(34:18):
know they should manage it better at the school, and
you know you want to meet to play, you know,
pick a ball, And I want to have a dinner
party this weekend. You know, do you want to come?
And what should we cook? Right instead? There? How are you?
Are you okay? Do you need anything?
Speaker 1 (34:33):
Like?
Speaker 2 (34:33):
It's just you become not normal, you become a cancer person. Yeah,
and you don't want to be a cancer person. So
I tell everyone, Tell your friends to talk about with
you everything that they always used to talk with you about,
and don't talk about cancer. And here's the clue. When
you want to talk about cancer, you'll tell them you'll
bring it up, and then then go for it. Then
(34:53):
I'm bringing it up, but I'm guiding you as to
what why I want to talk about? Do I want
to talk about how I'm feeling emotionally? Do I want
to talk about how sad that my personal life has
been influenced by cancer and this unfortunate thing my personal
life happened, or wheneverbody just take the lead and focus
on what they want to talk about. Don't put your
(35:14):
own stuff into it. And it's complicated, right because people
are not therapists and they're not aware of cancer and
they don't have the medical stuff. But this is so
important to the quality of life of a person with
cancer because when people are always making you a cancer person,
it just it attracts from your quality of life and
it changes yourself image of yourself, like I'm a cancer
(35:37):
person now, you know.
Speaker 1 (35:38):
And then you start feeling sick.
Speaker 2 (35:40):
Yeah, it feeds the beast, it really does.
Speaker 1 (35:45):
Versus I mean, I don't have many people that I
talk to cancer about. Like for me, I talk to
you about cancer because I think you're qualified to talk
to me about cancer. And everybody else where you getting
your information from, if it's from the internet, I literally
(36:05):
no desire to hear one word that comes from the internet,
not just about cancer, but pretty much about everything at
this point, but particularly about cancer. And so I want
to I want to speak to people that are, you know,
leading the charge in research. I want to. I want honesty.
I want, you know, hope where there's hope. I want
(36:29):
someone to be pragmatic where it's called for, Like, but
I don't want information that can't be verified or backed up.
And I also don't want to be a cancer person.
I want to you know, And I've often done some
very stupid, stupid things since being diagnosed because of my
(36:49):
desire to be normal, because I've like rejected the idea
that I'm a cancer in quote patient, Like, i have
cancer and I'm managing it. I'm managing it with you,
and I'm managing it with you know, doctor Ju and
like whoever else we need to bring in to help
in those moments. But I don't want it to define
(37:11):
my everyday life.
Speaker 2 (37:13):
Well so much so that you know, And we've always kept,
which I think is a super healthy and amazing way
to do it. We've always kept our lane separate. Yeah,
so when we're together as social aized friends, it's a
friend lane. When we're doing medical self to medical lane,
and you know, every once in a while those things
have to cross over, but it's extremely rare. And you,
(37:35):
for example, will never ask me anything medical when we're
doing something social, or if you have to, you'll say, look,
I'm really sorry for asking this right now when we're
having dinner, but just blah blah blah blah. It's some
little knit or whatever that you have to do.
Speaker 1 (37:47):
I've been to dinners with you. I've seen your phone.
I mean I haven't seen it, but like i've seen it.
How many you know you were inundated twenty four hours
a day, days a week. You do not get a
day off of you know, medical questions, and your patients
have your cell phone, and you know you've given full
(38:08):
access to yourself. So when I'm able to steal you
away and we go to dinner somewhere, I don't want
to do that. Like, if I have a question for you,
I'll text you during business hours or I'll come into
the clinic and I'll ask you. You know, we just
went to Italy together. You invited me on this amazing
yacht and with your family, and I got to go
(38:32):
to Italy with you, which was like bucket list. By
the way, you knew it was on my bucket list,
And when you called me, you said, like, it's kind
of bucket list, Shan, And I was like, I was
so excited.
Speaker 2 (38:46):
We had the best time, such.
Speaker 1 (38:47):
A good time, what an amazing went, an amazing trip.
Speaker 2 (38:51):
We made some amazing restaurant.
Speaker 1 (38:53):
So yeah, I wish i'd coordinated my outfits better with you.
But now I know what to expect.
Speaker 2 (38:59):
And she was is you know. I mean, it's just incredible,
like jumping off of every level of the yacht, even
the highest of like Shannon is fearless. I mean, she
truly is.
Speaker 1 (39:10):
I did injure myself.
Speaker 2 (39:11):
Well I know you did, but I was going to
skip over that. It wasn't It wasn't jumping off the boat, however,
it was.
Speaker 1 (39:20):
I mean that's the crazy thing, Like you jump off
like the highest points of this ginormous yacht and you
go to climb back on, and I got scared of
the of the jellyfish, so I went the long way.
Speaker 2 (39:35):
That was at night, I think, yeah.
Speaker 1 (39:37):
And the dangerous way, and that's when I gave myself
that that big bump on my leg.
Speaker 2 (39:42):
And that was really crazy too, because since it was night,
the crew had the bright light shining onto the sea,
and all of a sudden we can see all these
jellyfish floating around in there. That's, of course we never
saw during the day, and it was like, oh, did
she really just jump in there?
Speaker 1 (40:00):
Yeah, because they didn't see them when I did the jump.
It's like jumping in a shark infested waters like I
never would have done it had I known. But then
once I was swimming around, I was like, whoa, that's nuts.
I'm going to go the long way.
Speaker 2 (40:13):
You know, Southern Italy is number for seafood.
Speaker 1 (40:17):
I don't know.
Speaker 2 (40:18):
In this case, you were the seafood.
Speaker 1 (40:20):
I was seafood.
Speaker 2 (40:22):
Wow.
Speaker 1 (40:22):
Yeah, I mean we sort of did it fast forward
because I was going back to us meeting and you
sort of taking over my protocol and instantly saying, listen,
you gotta go get surgery, like that's the first thing.
Speaker 2 (40:37):
Are you surprised that we did a fast forward. Yeah.
We always start down a road and shortly turned down
a lane.
Speaker 1 (40:45):
Unpredictable is the word that you use to start with,
and that still matches and.
Speaker 2 (40:48):
There it goes, and that's the magic at all.
Speaker 1 (40:59):
So you said you got to get the tumor out
of your breast, like, let's like, that's the first thing.
And then once that's done, you're going to go on chemo,
You're going to get radiation, and we did. We did
all of that, and I made the decision at some
point to not take tomoxifen, which is you know, obviously
(41:20):
a drug that everybody recommends that you take because it
is a hormone blocker.
Speaker 2 (41:27):
And it was adgivant therapy, meaning that you had no
known cancer and it was being given. It would be
given to increase the chances that cancer not come back
by staying in your system and blocking the cell's ability
to grow. Estringe is a growth factor for cancer cells,
So tomoxism would block the estrogen to the cancer cell,
(41:49):
and hopefully any microscopic disease that maybe have been in
your body that's too small to show up on imaging
and that we didn't know about that maybe it would
kill that and increased the odds that it wouldn't come back.
That was the principle of adgement therapy of demoxmin.
Speaker 1 (42:06):
Which is a you know, solid argument, Like I look
back and I go, well, maybe how to do that?
Taking it? You know? I mean, I've had some people
in my life have sort of forced me to look
back like that, But I can't, right, because what good
is it? It doesn't do you.
Speaker 2 (42:22):
You make the best decision you can at the time
you make it, and in retrospect you often cannot remember
many of the factors that were influencing you. So when
you look back, you have an erroneous evaluation of your decision.
But at the time, you had been on estrogen blockade
before you ever had surgery, and it wasn't very effective
(42:46):
on shrinking your tumor, and you had a lot of
effects on your body that you didn't like. So those
two factors were influencing you to not choose to take
that drug at that time. And you were disease free,
and the balance of things to you at the time
seemed reasonable. And you did not make that lightly, and
you made it over and over again because I asked
(43:11):
you every single time for a year, are you sure
you don't want to do this? Issue? You want to
do this? So you were. You were resolute in your decision,
and you can't judge that decision, and no one else
can force you to because you made the best decision
you could at the time. And it's a it's an
erroneous set of analyzes when you look backwards.
Speaker 1 (43:29):
Yeah, I mean, I also think that I was fairly
certain it wasn't going to come back, because I believed
that the reason why I got cancer was because I
did IVF right. I met my husband at the time.
Later in years and you know, a multitude of things happen.
(43:50):
And so when it was time to have that decision,
we chose to have we needed IVF, and I did
a bunch of rounds of it, and I i, you know,
through a lot of other women that I knew that
did IVF that ended up getting breast cancer as well.
Sort of the numbers all started stacking up in my
(44:10):
head that if you know, you sort of have a
cell that's a little wonky and that's sitting on the
edge of maybe turning spreading cancer, blah blah blah, that
the all the hormones that you're pumping into your body
from IVF are only going to up that chance of it.
That was at least my thinking. So when I got
(44:32):
the you know, you're all clear remission after chemo and
all of that, I knew I wasn't doing IVF anymore
because I was already a menopause, so like there was
no need for it. I was pretty sure, you know,
I don't want to say that I made a very
uninformed decision, Like I am a researcher. I'm hardcore about
(44:53):
you know, backing up some of my data, certainly not
at your level and certainly not at doctor's levels, and
researchers levels. So my decision was at the time based
on sort of the facts that I knew that I
had investigated, and you, in fact, did keep on encouraging
me to take the demoxifin, and I was just like,
(45:15):
absolutely not.
Speaker 2 (45:16):
You're a resolute yeah, but also yes, you did research things.
But also there was another factor in there, which is,
even though you know, anyone who's sort of close to
menopause often goes into menopause with chemotherapy, sometimes people who
are not close to menopause go into it as well,
but then it sometimes returns, menstruation can return, and you
(45:39):
were still hopeful that it might return for you because
you still want.
Speaker 1 (45:43):
To have a baby, yeah, desperately.
Speaker 2 (45:45):
And I think that played a role in the demoxpin thing, which,
you know, people at this stage where you're at doesn't
seem like a factor, but that was a factor at
the time, this sort of hopefulness that maybe you could
still have a baby.
Speaker 1 (45:59):
Yeah. Yeah, I mean, thank you for reminding me of that,
because it did definitely play a huge role of you know,
wanting not only not only did I want a child
for myself, but I wanted it, you know, for my husband.
I wanted it for our marriage. I wanted, you know,
I wanted him to have that part of him self
fulfilled as well. So it seemed like a calculated risk
(46:23):
that wasn't too bad of one to take. Plus I
can't remember, you'll correct me. I think it's cervical cancer.
That there's a percentage of demoxifensity to increase. You'ine cancer,
thank you, And I was like, well, you know, that
just gave me one more reason to say no to it,
and yeah, and you're right, and I can't look back,
and so.
Speaker 2 (46:44):
Moving forward, I think, but I think also, don't forget
that cancer and cancer treatment you know, caused you to
look back at you know, your own life and to
be very philosophical. You know, it made you want to
have a child for another reason too, which is, you know,
to be able to part you know, the very many
things that you've learned in life and the many feelings
(47:05):
that you had into raising a human being, you know,
I mean, that's that's the ultimate diary, is to raise
a child and try to infuse their life with all
the wisdoms that you had and and helping them try
to avoid the mistakes that you made and that they're
(47:25):
going to not make some of their own of course
they will, but there's a you know, you were in
the spotlight since you were a young girl, and you've
lived a million lives when most people, you know, we're
just starting out or we're in the beginning of the careers.
You've already had two or three careers, and you know
(47:46):
fought your way, you know, in a Hollywood scene that
you know didn't necessarily you know, regard what you had
to say. And I mean, I've never met anybody as
well educated as you who was schooled on the set.
And I of course, as you know, many many people
were schooled on sets. But you have a you know
a level of comprehension and power of intelligence and use
(48:10):
of that intelligence, and you know, in a very incisive
way in cooking as well, for example, there are not
that many people who go on to be these amazing cooks.
And I mean everything you do is full tilt. That's
who you are, and that's how you make your decisions.
And so I actually find it very gratifying that you
(48:33):
research things and you you know, make your definitive decision,
because you see in medical decision making, people want shared
decisions with the physician, which I'm all about. I mean,
I'm all about that. I love that, as you know
and as all my patients know. But part and parcel
of shared decision making is accepting responsibility for the decision.
(48:54):
And you always do that. Sometimes people want share decision making,
and if it's not the right decision, then they want
to look to everyone else for you know, why the
wrong decision was made or whatever. But when you when
you're a person who really owns it, and like all
my patients do, but you are the you know, the
prime example of that of someone who you know, wants
(49:17):
to part, to stay in process, wants to know the data,
and once you make your decision, you own responsibility for
your decision. And I love that because that's that's just
the being a person of truth.
Speaker 1 (49:28):
Accountability I love nothing. Accountability is like my favorite thing.
So if I made a decision that put me in
a certain place, then I hold myself accountable like you
have to.
Speaker 2 (49:42):
I've seen that over and over and over again, and
everything you've said and done and even in stories we've
talked about about your career, Yes, and certain decisions that
you've made in response to things that happened or this
or that you've you know, you've always accepted responsibility for
those and you know, the thing is that even when
when things happened that weren't your responsibility, you will describe it,
(50:03):
but you're also not You've never been finger pointing of people.
Say that person did that.
Speaker 1 (50:09):
That's a new thing.
Speaker 2 (50:10):
As that person did that, you'll say what they did,
but you'll also understand the other factors that we're bearing
on the scenario. Yeah, and I've always respected.
Speaker 1 (50:19):
That for the most part. I think every you know,
there's always the exception to the rule where I point
the finger and go, you're bearing the full brunt of
this one because this is all on you.
Speaker 2 (50:32):
And when you do that, it's very believable because you
don't do that often.
Speaker 1 (50:35):
Doctor piro LP. Thank you so much for being on.
There is so much more for us to talk about.
So I'm going to have you on for another episode
and just keep digging and keep exploring because I just
I think you have so much to offer and this
conversation is incredibly important to a lot of people. So
(50:56):
thank you very much and I love you end Yeah,
see you soon.
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