WEBVTT NOTE duration: "01:51:39.477" NOTE Confidence: 0.9956942 00:00:00.560 --> 00:00:02.080 Great. Good evening, everyone. It's NOTE Confidence: 0.9956942 00:00:02.080 --> 00:00:03.040 really nice to see you NOTE Confidence: 0.9956942 00:00:03.040 --> 00:00:03.540 tonight. NOTE Confidence: 0.97671944 00:00:04.240 --> 00:00:05.680 So, before we get started, NOTE Confidence: 0.97671944 00:00:05.680 --> 00:00:06.799 I'd love to do a NOTE Confidence: 0.97671944 00:00:06.879 --> 00:00:08.000 get a quick sense of NOTE Confidence: 0.97671944 00:00:08.000 --> 00:00:09.119 who is in the room, NOTE Confidence: 0.97671944 00:00:09.119 --> 00:00:10.000 if you are willing and NOTE Confidence: 0.97671944 00:00:10.000 --> 00:00:11.200 if you are comfortable. So NOTE Confidence: 0.97671944 00:00:11.200 --> 00:00:12.160 by a quick show of NOTE Confidence: 0.97671944 00:00:12.160 --> 00:00:13.759 hands, how many of you NOTE Confidence: 0.97671944 00:00:13.759 --> 00:00:14.500 are patients? NOTE Confidence: 0.951416 00:00:17.825 --> 00:00:18.325 Both. NOTE Confidence: 0.9581299 00:00:18.704 --> 00:00:20.404 Yep. Wonderful. Thank you. NOTE Confidence: 0.9985623 00:00:20.864 --> 00:00:22.565 And how many are caregivers, NOTE Confidence: 0.9985623 00:00:22.864 --> 00:00:24.485 family members, or supporters? NOTE Confidence: 0.9698181 00:00:26.945 --> 00:00:27.744 How many of you are NOTE Confidence: 0.9698181 00:00:27.744 --> 00:00:28.724 health care providers? NOTE Confidence: 0.99960047 00:00:30.410 --> 00:00:31.370 And how many are here NOTE Confidence: 0.99960047 00:00:31.370 --> 00:00:32.970 from the pharmaceutical or research NOTE Confidence: 0.99960047 00:00:32.970 --> 00:00:33.470 industry? NOTE Confidence: 0.992513 00:00:34.490 --> 00:00:35.850 Great. Thank you. We have NOTE Confidence: 0.992513 00:00:35.850 --> 00:00:36.350 representation NOTE Confidence: 0.9602051 00:00:36.729 --> 00:00:37.550 from everyone. NOTE Confidence: 0.9985962 00:00:38.170 --> 00:00:39.370 So thank you. It's really NOTE Confidence: 0.9985962 00:00:39.370 --> 00:00:41.210 meaningful for me, to see NOTE Confidence: 0.9985962 00:00:41.210 --> 00:00:42.170 all of these groups here NOTE Confidence: 0.9985962 00:00:42.170 --> 00:00:42.670 together. NOTE Confidence: 0.99886066 00:00:43.050 --> 00:00:44.430 I think, as NOTE Confidence: 0.983667 00:00:44.954 --> 00:00:47.274 Deepika and Raghav said, this NOTE Confidence: 0.983667 00:00:47.274 --> 00:00:48.894 is really a shared journey. NOTE Confidence: 0.99553955 00:00:49.434 --> 00:00:50.475 And I'm honored to be NOTE Confidence: 0.99553955 00:00:50.475 --> 00:00:51.914 here as the division chief NOTE Confidence: 0.99553955 00:00:51.914 --> 00:00:53.354 of GI oncology at Yale NOTE Confidence: 0.99553955 00:00:53.354 --> 00:00:54.714 Cancer Center. And in my NOTE Confidence: 0.99553955 00:00:54.714 --> 00:00:55.214 role, NOTE Confidence: 0.9951172 00:00:55.515 --> 00:00:56.475 I spend a lot of NOTE Confidence: 0.9951172 00:00:56.475 --> 00:00:57.914 time thinking about how we NOTE Confidence: 0.9951172 00:00:57.914 --> 00:00:58.894 advance treatments NOTE Confidence: 0.99311525 00:00:59.510 --> 00:01:01.050 and how we improve outcomes. NOTE Confidence: 0.99459136 00:01:01.910 --> 00:01:03.350 But evenings like this are NOTE Confidence: 0.99459136 00:01:03.350 --> 00:01:05.430 really a powerful reminder of NOTE Confidence: 0.99459136 00:01:05.430 --> 00:01:06.650 what truly matters, NOTE Confidence: 0.986921 00:01:07.030 --> 00:01:08.470 and it's really the people, NOTE Confidence: 0.986921 00:01:08.470 --> 00:01:09.270 all of you who are NOTE Confidence: 0.986921 00:01:09.270 --> 00:01:09.910 in the room who are NOTE Confidence: 0.986921 00:01:09.910 --> 00:01:10.870 at the center of what NOTE Confidence: 0.986921 00:01:10.870 --> 00:01:11.370 matters. NOTE Confidence: 0.939798 00:01:12.095 --> 00:01:12.735 And I wanna take a NOTE Confidence: 0.939798 00:01:12.735 --> 00:01:14.495 moment to thank doctor Raghav NOTE Confidence: 0.939798 00:01:14.495 --> 00:01:16.435 Sundar and doctor Deepak Gakarki NOTE Confidence: 0.939798 00:01:16.575 --> 00:01:18.095 and and others certainly for NOTE Confidence: 0.939798 00:01:18.095 --> 00:01:19.075 helping to, NOTE Confidence: 0.9996745 00:01:19.775 --> 00:01:21.534 initiate this and plan this NOTE Confidence: 0.9996745 00:01:21.534 --> 00:01:22.034 event. NOTE Confidence: 0.99401855 00:01:23.935 --> 00:01:25.075 So bringing a community NOTE Confidence: 0.99934894 00:01:25.375 --> 00:01:27.680 like this together takes incredible NOTE Confidence: 0.99934894 00:01:27.740 --> 00:01:28.240 dedication. NOTE Confidence: 0.9988281 00:01:29.020 --> 00:01:30.780 It reflects on their deep NOTE Confidence: 0.9988281 00:01:30.780 --> 00:01:32.720 commitment to patients and families NOTE Confidence: 0.98083496 00:01:33.020 --> 00:01:34.940 navigating this journey. And while NOTE Confidence: 0.98083496 00:01:34.940 --> 00:01:35.900 I have not a had NOTE Confidence: 0.98083496 00:01:35.900 --> 00:01:36.860 a chance to meet all NOTE Confidence: 0.98083496 00:01:36.860 --> 00:01:37.995 of you personally, I hope NOTE Confidence: 0.98083496 00:01:38.075 --> 00:01:38.875 to be able to talk NOTE Confidence: 0.98083496 00:01:38.875 --> 00:01:39.694 with you later. NOTE Confidence: 0.9920726 00:01:39.995 --> 00:01:40.715 I want you to know NOTE Confidence: 0.9920726 00:01:40.715 --> 00:01:42.475 that your experiences really shape NOTE Confidence: 0.9920726 00:01:42.475 --> 00:01:43.675 and inform the work that NOTE Confidence: 0.9920726 00:01:43.675 --> 00:01:44.415 we do. NOTE Confidence: 0.99975586 00:01:44.875 --> 00:01:45.775 So survivorship NOTE Confidence: 0.99522984 00:01:46.075 --> 00:01:47.675 is not just about the NOTE Confidence: 0.99522984 00:01:47.675 --> 00:01:49.195 end of a treatment or NOTE Confidence: 0.99522984 00:01:49.195 --> 00:01:50.095 reaching a milestone. NOTE Confidence: 1 00:01:50.910 --> 00:01:52.850 It's about the entire experience NOTE Confidence: 0.99492186 00:01:53.390 --> 00:01:54.510 and the strength that it NOTE Confidence: 0.99492186 00:01:54.510 --> 00:01:56.210 takes to face that uncertainty, NOTE Confidence: 0.99698895 00:01:57.230 --> 00:01:59.310 the resilience on difficult days, NOTE Confidence: 0.99698895 00:01:59.310 --> 00:02:00.910 and the courage to keep NOTE Confidence: 0.99698895 00:02:00.910 --> 00:02:01.730 moving forward. NOTE Confidence: 0.9491061 00:02:02.445 --> 00:02:03.425 So I want to acknowledge NOTE Confidence: 0.9491061 00:02:03.565 --> 00:02:05.165 that this journey is certainly NOTE Confidence: 0.9491061 00:02:05.165 --> 00:02:06.305 not easy easy. NOTE Confidence: 0.9992676 00:02:06.765 --> 00:02:08.285 I can certainly imagine that. NOTE Confidence: 0.9992676 00:02:08.285 --> 00:02:08.785 Gastroesophageal NOTE Confidence: 0.999163 00:02:09.245 --> 00:02:11.005 cancers can bring physical and NOTE Confidence: 0.999163 00:02:11.005 --> 00:02:12.065 emotional challenges. NOTE Confidence: 0.98429364 00:02:12.605 --> 00:02:14.285 There are moments that feel NOTE Confidence: 0.98429364 00:02:14.285 --> 00:02:14.785 overwhelming. NOTE Confidence: 0.9907715 00:02:15.490 --> 00:02:16.790 But what I've seen something, NOTE Confidence: 0.9733015 00:02:17.169 --> 00:02:19.169 that's very power powerful is NOTE Confidence: 0.9733015 00:02:19.169 --> 00:02:20.770 that people find strength they NOTE Confidence: 0.9733015 00:02:20.770 --> 00:02:21.910 didn't know they had. NOTE Confidence: 0.994439 00:02:22.770 --> 00:02:24.210 Families show up for each NOTE Confidence: 0.994439 00:02:24.210 --> 00:02:25.910 other in incredible ways, NOTE Confidence: 1 00:02:26.450 --> 00:02:27.110 and individuals NOTE Confidence: 0.9986165 00:02:27.410 --> 00:02:29.385 continue to build meaningful lives NOTE Confidence: 0.9986165 00:02:29.385 --> 00:02:30.584 even in the face of NOTE Confidence: 0.9986165 00:02:30.584 --> 00:02:31.405 this uncertainty. NOTE Confidence: 0.9914551 00:02:32.745 --> 00:02:33.785 So here at Yale, we're NOTE Confidence: 0.9914551 00:02:33.785 --> 00:02:35.005 deeply committed NOTE Confidence: 1 00:02:35.465 --> 00:02:36.285 to really NOTE Confidence: 0.9863661 00:02:36.665 --> 00:02:38.925 growing and evolving our survivorship NOTE Confidence: 0.9863661 00:02:39.145 --> 00:02:40.185 program, and I think this NOTE Confidence: 0.9863661 00:02:40.185 --> 00:02:41.385 is one part of that NOTE Confidence: 0.9863661 00:02:41.385 --> 00:02:43.225 specifically in GI oncology, and NOTE Confidence: 0.9863661 00:02:43.225 --> 00:02:44.185 we hope that you can NOTE Confidence: 0.9863661 00:02:44.185 --> 00:02:45.730 be part of that. We're NOTE Confidence: 0.9863661 00:02:45.730 --> 00:02:46.930 fortunate to have a wide NOTE Confidence: 0.9863661 00:02:46.930 --> 00:02:48.290 range of resources that you'll NOTE Confidence: 0.9863661 00:02:48.290 --> 00:02:49.910 hear about tonight that include NOTE Confidence: 0.98611885 00:02:50.210 --> 00:02:52.290 nutrition and physical therapy and NOTE Confidence: 0.98611885 00:02:52.290 --> 00:02:54.370 symptom management and mental health NOTE Confidence: 0.98611885 00:02:54.370 --> 00:02:56.150 support and integrative medicine NOTE Confidence: 0.9902344 00:02:56.690 --> 00:02:58.290 and access to trials and NOTE Confidence: 0.9902344 00:02:58.290 --> 00:02:58.950 new therapies. NOTE Confidence: 0.99810714 00:03:01.085 --> 00:03:02.444 But just as importantly, we NOTE Confidence: 0.99810714 00:03:02.444 --> 00:03:03.965 recognize that there's no one NOTE Confidence: 0.99810714 00:03:03.965 --> 00:03:05.885 size fits all approach. Just NOTE Confidence: 0.99810714 00:03:05.885 --> 00:03:07.185 as we talk about precision NOTE Confidence: 0.99810714 00:03:07.245 --> 00:03:08.685 medicine, there really should be NOTE Confidence: 0.99810714 00:03:08.685 --> 00:03:09.905 precision survivorship. NOTE Confidence: 0.9806685 00:03:11.005 --> 00:03:12.285 So another quick show of NOTE Confidence: 0.9806685 00:03:12.285 --> 00:03:13.405 hands. How many of you NOTE Confidence: 0.9806685 00:03:13.405 --> 00:03:15.000 feel that your needs have NOTE Confidence: 0.9806685 00:03:15.240 --> 00:03:16.840 changed over the time of NOTE Confidence: 0.9806685 00:03:16.840 --> 00:03:17.580 your journey? NOTE Confidence: 0.9995117 00:03:20.120 --> 00:03:20.620 Thanks. NOTE Confidence: 0.9845042 00:03:21.240 --> 00:03:22.760 So that's exactly why we're NOTE Confidence: 0.9845042 00:03:22.760 --> 00:03:24.919 focusing on tailoring survivorship care, NOTE Confidence: 0.9845042 00:03:24.919 --> 00:03:25.720 to meet you where you're NOTE Confidence: 0.9845042 00:03:25.720 --> 00:03:26.460 at now, NOTE Confidence: 0.9809946 00:03:27.665 --> 00:03:28.544 not just where you were NOTE Confidence: 0.9809946 00:03:28.544 --> 00:03:29.905 at diagnosis or where you NOTE Confidence: 0.9809946 00:03:29.905 --> 00:03:30.885 were during treatment. NOTE Confidence: 0.99853516 00:03:31.505 --> 00:03:32.645 So to the caregivers, NOTE Confidence: 0.9963823 00:03:33.264 --> 00:03:34.725 you are a really essential NOTE Confidence: 0.9963823 00:03:34.785 --> 00:03:36.065 part of this journey. Your NOTE Confidence: 0.9963823 00:03:36.065 --> 00:03:36.565 presence NOTE Confidence: 0.9918213 00:03:36.945 --> 00:03:38.385 and support matter more than NOTE Confidence: 0.9918213 00:03:38.385 --> 00:03:39.605 you probably hear. NOTE Confidence: 0.99880147 00:03:39.905 --> 00:03:41.345 And to our patients, you NOTE Confidence: 0.99880147 00:03:41.345 --> 00:03:42.680 are not defined by your NOTE Confidence: 0.99880147 00:03:42.680 --> 00:03:43.180 diagnosis. NOTE Confidence: 0.99816895 00:03:43.800 --> 00:03:45.640 So tonight's about community and NOTE Confidence: 0.99816895 00:03:45.640 --> 00:03:46.140 connection. NOTE Confidence: 0.99021405 00:03:46.520 --> 00:03:47.480 I encourage you to talk NOTE Confidence: 0.99021405 00:03:47.480 --> 00:03:48.680 with one another, talk with NOTE Confidence: 0.99021405 00:03:48.680 --> 00:03:49.340 your neighbor. NOTE Confidence: 0.97881526 00:03:49.800 --> 00:03:51.080 Please come up and introduce NOTE Confidence: 0.97881526 00:03:51.080 --> 00:03:52.380 yourself to all of us. NOTE Confidence: 0.97881526 00:03:52.520 --> 00:03:54.520 Ask questions, share your experience, NOTE Confidence: 0.97881526 00:03:54.520 --> 00:03:55.640 and more importantly, we want NOTE Confidence: 0.97881526 00:03:55.640 --> 00:03:56.380 your ideas. NOTE Confidence: 0.99469864 00:03:56.805 --> 00:03:57.765 So thank you for being NOTE Confidence: 0.99469864 00:03:57.765 --> 00:03:59.125 here, allowing us to be NOTE Confidence: 0.99469864 00:03:59.125 --> 00:04:00.185 part of your journey, NOTE Confidence: 0.9894409 00:04:00.485 --> 00:04:01.785 and it's really a privilege NOTE Confidence: 0.9894409 00:04:01.925 --> 00:04:02.885 for all of us as NOTE Confidence: 0.9894409 00:04:02.885 --> 00:04:04.805 medical providers to walk alongside NOTE Confidence: 0.9894409 00:04:04.805 --> 00:04:06.645 you. We're committed not just NOTE Confidence: 0.9894409 00:04:06.645 --> 00:04:07.845 to treating your cancer, but NOTE Confidence: 0.9894409 00:04:07.845 --> 00:04:09.205 to supporting your life beyond NOTE Confidence: 0.9894409 00:04:09.205 --> 00:04:10.165 it. So thank you so NOTE Confidence: 0.9894409 00:04:10.165 --> 00:04:11.625 much. I'm excited for tonight. NOTE Confidence: 0.78782827 00:04:20.640 --> 00:04:22.000 Thanks, doctor Coon. So that NOTE Confidence: 0.78782827 00:04:22.000 --> 00:04:22.400 really, NOTE Confidence: 0.98168945 00:04:22.800 --> 00:04:23.300 touching, NOTE Confidence: 0.92875534 00:04:23.760 --> 00:04:26.345 opening remarks. So I'm hoping NOTE Confidence: 0.92875534 00:04:26.345 --> 00:04:27.225 for this to be an NOTE Confidence: 0.92875534 00:04:27.225 --> 00:04:27.725 interactive NOTE Confidence: 0.9211914 00:04:28.585 --> 00:04:30.205 session and not really have NOTE Confidence: 0.9998372 00:04:30.745 --> 00:04:31.884 too many didactic NOTE Confidence: 0.97475857 00:04:32.185 --> 00:04:33.485 talks and things like that. NOTE Confidence: 0.97475857 00:04:33.705 --> 00:04:35.305 And, would really encourage all NOTE Confidence: 0.97475857 00:04:35.305 --> 00:04:36.025 of you to reach out NOTE Confidence: 0.97475857 00:04:36.025 --> 00:04:36.845 to us and, NOTE Confidence: 0.9950684 00:04:37.384 --> 00:04:39.404 share your experiences, ask questions. NOTE Confidence: 0.9987793 00:04:40.349 --> 00:04:41.089 More importantly, NOTE Confidence: 0.97216797 00:04:41.469 --> 00:04:41.949 while we NOTE Confidence: 0.97778744 00:04:42.830 --> 00:04:43.629 like I said, this is NOTE Confidence: 0.97778744 00:04:43.629 --> 00:04:44.830 kind of the start of NOTE Confidence: 0.97778744 00:04:44.830 --> 00:04:45.710 the way we're trying to NOTE Confidence: 0.97778744 00:04:45.710 --> 00:04:46.990 set up this program. I'm NOTE Confidence: 0.97778744 00:04:46.990 --> 00:04:48.110 really hoping that some of NOTE Confidence: 0.97778744 00:04:48.110 --> 00:04:49.629 you will help us walk NOTE Confidence: 0.97778744 00:04:49.629 --> 00:04:51.150 the next generation of patients NOTE Confidence: 0.97778744 00:04:51.150 --> 00:04:52.765 that are coming through Yale NOTE Confidence: 0.97778744 00:04:52.765 --> 00:04:53.885 through this journey. We know NOTE Confidence: 0.97778744 00:04:53.885 --> 00:04:55.005 how scary some of these NOTE Confidence: 0.97778744 00:04:55.005 --> 00:04:56.285 things are when you first NOTE Confidence: 0.97778744 00:04:56.285 --> 00:04:57.645 hear about this diagnosis of NOTE Confidence: 0.97778744 00:04:57.645 --> 00:04:59.245 cancer, when you first hear NOTE Confidence: 0.97778744 00:04:59.245 --> 00:05:01.085 about what chemotherapy is and NOTE Confidence: 0.97778744 00:05:01.085 --> 00:05:03.165 surgery and radiation and all NOTE Confidence: 0.97778744 00:05:03.165 --> 00:05:04.525 these big scary words and NOTE Confidence: 0.97778744 00:05:04.525 --> 00:05:06.045 what it means, but also NOTE Confidence: 0.97778744 00:05:06.045 --> 00:05:08.080 why each part of it NOTE Confidence: 0.97778744 00:05:08.080 --> 00:05:09.520 actually plays an important role NOTE Confidence: 0.97778744 00:05:09.520 --> 00:05:10.880 in getting through what is NOTE Confidence: 0.97778744 00:05:10.880 --> 00:05:12.800 truly devastating cancer, not just NOTE Confidence: 0.97778744 00:05:12.800 --> 00:05:13.760 for yourself, but for your NOTE Confidence: 0.97778744 00:05:13.760 --> 00:05:14.960 family and for everything else. NOTE Confidence: 0.97778744 00:05:14.960 --> 00:05:15.460 And, NOTE Confidence: 0.9639235 00:05:16.160 --> 00:05:17.360 so for this group here, NOTE Confidence: 0.9639235 00:05:17.360 --> 00:05:18.800 I'm really hoping that you NOTE Confidence: 0.9639235 00:05:18.800 --> 00:05:20.000 all can continue to join NOTE Confidence: 0.9639235 00:05:20.000 --> 00:05:21.520 us and grow this this NOTE Confidence: 0.9639235 00:05:21.520 --> 00:05:23.205 community that we're growing. The NOTE Confidence: 0.9639235 00:05:23.205 --> 00:05:24.404 other aspect of this, and NOTE Confidence: 0.9639235 00:05:24.404 --> 00:05:25.945 some of you have also NOTE Confidence: 0.9639235 00:05:26.005 --> 00:05:27.544 have experiences, is the NOTE Confidence: 0.96621954 00:05:28.404 --> 00:05:29.685 rapid change in the way NOTE Confidence: 0.96621954 00:05:29.685 --> 00:05:31.365 we're treating our patients. Even NOTE Confidence: 0.96621954 00:05:31.365 --> 00:05:32.645 how some of you who NOTE Confidence: 0.96621954 00:05:32.645 --> 00:05:33.604 have gone through this cancer NOTE Confidence: 0.96621954 00:05:33.604 --> 00:05:34.885 journey ten, fifteen years ago NOTE Confidence: 0.96621954 00:05:34.885 --> 00:05:35.845 and the way we're thinking NOTE Confidence: 0.96621954 00:05:35.845 --> 00:05:37.525 about it now, our cure NOTE Confidence: 0.96621954 00:05:37.525 --> 00:05:38.345 rates, our NOTE Confidence: 0.9873657 00:05:39.410 --> 00:05:41.110 rates of reducing side effects, NOTE Confidence: 0.9873657 00:05:41.169 --> 00:05:42.550 trying to get things precise, NOTE Confidence: 0.9873657 00:05:42.690 --> 00:05:44.290 not just trying to hit NOTE Confidence: 0.9873657 00:05:44.290 --> 00:05:45.570 everyone with the same drugs NOTE Confidence: 0.9873657 00:05:45.570 --> 00:05:46.550 and the same treatments. NOTE Confidence: 0.9897313 00:05:46.930 --> 00:05:48.370 That's kind of the biggest NOTE Confidence: 0.9897313 00:05:48.370 --> 00:05:49.990 advances that we're making, and NOTE Confidence: 0.9897313 00:05:50.050 --> 00:05:51.650 that's where, again, we want NOTE Confidence: 0.9897313 00:05:51.650 --> 00:05:52.690 you to be a part NOTE Confidence: 0.9897313 00:05:52.690 --> 00:05:53.729 of this journey with us. NOTE Confidence: 0.9897313 00:05:53.729 --> 00:05:55.085 And as we try to NOTE Confidence: 0.9897313 00:05:55.085 --> 00:05:56.305 advance these different NOTE Confidence: 0.99825615 00:05:56.925 --> 00:05:58.365 aspects of fighting this really NOTE Confidence: 0.99825615 00:05:58.365 --> 00:05:59.265 deadly cancer. NOTE Confidence: 0.98765236 00:06:00.125 --> 00:06:01.485 And while I said I NOTE Confidence: 0.98765236 00:06:01.485 --> 00:06:02.845 don't have I'm not gonna NOTE Confidence: 0.98765236 00:06:02.845 --> 00:06:03.805 make this didactic. I do NOTE Confidence: 0.98765236 00:06:03.805 --> 00:06:04.845 have a few slides to NOTE Confidence: 0.98765236 00:06:04.845 --> 00:06:05.585 just set NOTE Confidence: 0.99464846 00:06:05.885 --> 00:06:07.085 just set the stage. But NOTE Confidence: 0.99464846 00:06:07.085 --> 00:06:08.125 before we start, I just NOTE Confidence: 0.99464846 00:06:08.125 --> 00:06:09.085 wanted to give a bit NOTE Confidence: 0.99464846 00:06:09.085 --> 00:06:10.150 of context of the kind NOTE Confidence: 0.99464846 00:06:10.150 --> 00:06:11.449 of talks we're gonna have. NOTE Confidence: 0.9691976 00:06:12.150 --> 00:06:12.949 I I will give a NOTE Confidence: 0.9691976 00:06:12.949 --> 00:06:13.910 little bit of an outline NOTE Confidence: 0.9691976 00:06:13.910 --> 00:06:14.650 of what NOTE Confidence: 0.9705514 00:06:15.110 --> 00:06:16.150 this cancer is gonna be NOTE Confidence: 0.9705514 00:06:16.150 --> 00:06:17.190 like. We do have doctor NOTE Confidence: 0.9705514 00:06:17.190 --> 00:06:18.310 Boffa here who's gonna talk NOTE Confidence: 0.9705514 00:06:18.310 --> 00:06:19.750 about the surgical aspects of NOTE Confidence: 0.9705514 00:06:19.750 --> 00:06:20.630 it. A lot of you NOTE Confidence: 0.9705514 00:06:20.630 --> 00:06:21.830 here have been operated, have NOTE Confidence: 0.9705514 00:06:21.830 --> 00:06:23.255 been seen by him. We NOTE Confidence: 0.9705514 00:06:23.255 --> 00:06:25.014 have doctor Du from radiation NOTE Confidence: 0.9705514 00:06:25.014 --> 00:06:26.214 oncology who's gonna talk about NOTE Confidence: 0.9705514 00:06:26.214 --> 00:06:27.735 the radiation side of things. NOTE Confidence: 0.9705514 00:06:27.735 --> 00:06:28.395 And then NOTE Confidence: 0.9597455 00:06:28.695 --> 00:06:30.375 probably the most important component NOTE Confidence: 0.9597455 00:06:30.375 --> 00:06:31.654 of this is everyone else NOTE Confidence: 0.9597455 00:06:31.654 --> 00:06:33.014 who's helping support. We're gonna NOTE Confidence: 0.9597455 00:06:33.014 --> 00:06:34.235 have Scott, NOTE Confidence: 0.94447607 00:06:34.615 --> 00:06:36.455 Capoza and Natalie Smith from NOTE Confidence: 0.94447607 00:06:36.455 --> 00:06:38.055 physio physical therapy as well NOTE Confidence: 0.94447607 00:06:38.055 --> 00:06:39.200 as nutrition talking to you NOTE Confidence: 0.94447607 00:06:39.200 --> 00:06:41.279 about the equally important aspects NOTE Confidence: 0.94447607 00:06:41.279 --> 00:06:42.560 of staying healthy through this NOTE Confidence: 0.94447607 00:06:42.560 --> 00:06:43.460 cancer journey. NOTE Confidence: 0.99609375 00:06:44.000 --> 00:06:44.480 And, NOTE Confidence: 0.9804001 00:06:44.960 --> 00:06:46.320 again, we're not gonna have NOTE Confidence: 0.9804001 00:06:46.320 --> 00:06:47.600 lots of slides. Many of NOTE Confidence: 0.9804001 00:06:47.600 --> 00:06:48.640 us don't even have slides, NOTE Confidence: 0.9804001 00:06:48.640 --> 00:06:49.520 and we're just gonna have NOTE Confidence: 0.9804001 00:06:49.520 --> 00:06:50.160 a little bit of a NOTE Confidence: 0.9804001 00:06:50.160 --> 00:06:51.455 chat and then, talk to NOTE Confidence: 0.9804001 00:06:51.455 --> 00:06:52.035 you about NOTE Confidence: 0.9204644 00:06:52.414 --> 00:06:53.775 and then most importantly is NOTE Confidence: 0.9204644 00:06:53.775 --> 00:06:54.995 we're gonna have two, NOTE Confidence: 0.9449515 00:06:56.014 --> 00:06:57.055 people talking to you about NOTE Confidence: 0.9449515 00:06:57.055 --> 00:06:58.095 their own cancer journeys, and NOTE Confidence: 0.9449515 00:06:58.095 --> 00:06:59.134 they're both very special. We NOTE Confidence: 0.9449515 00:06:59.134 --> 00:07:00.815 spoke about Deepika who's gone NOTE Confidence: 0.9449515 00:07:00.815 --> 00:07:01.854 through this journey. We also NOTE Confidence: 0.9449515 00:07:01.854 --> 00:07:03.300 have doctor Derek Yac who's NOTE Confidence: 0.9449515 00:07:03.460 --> 00:07:04.819 also a physician and also NOTE Confidence: 0.9449515 00:07:04.819 --> 00:07:06.659 survived esophageal cancer, and they're NOTE Confidence: 0.9449515 00:07:06.659 --> 00:07:07.960 gonna give you both their NOTE Confidence: 0.9449515 00:07:08.020 --> 00:07:09.220 aspects of the story their NOTE Confidence: 0.9449515 00:07:09.220 --> 00:07:11.300 journey. But, hopefully, in future NOTE Confidence: 0.9449515 00:07:11.300 --> 00:07:12.180 versions, I'll have some of NOTE Confidence: 0.9449515 00:07:12.180 --> 00:07:13.220 you come down and have NOTE Confidence: 0.9449515 00:07:13.220 --> 00:07:14.819 this take this, role as NOTE Confidence: 0.9449515 00:07:14.819 --> 00:07:15.319 well. NOTE Confidence: 0.97280484 00:07:16.020 --> 00:07:16.900 Again, it's meant to be NOTE Confidence: 0.97280484 00:07:16.900 --> 00:07:17.860 direct it's meant to be NOTE Confidence: 0.97280484 00:07:17.860 --> 00:07:19.695 interactive, so please stop us NOTE Confidence: 0.97280484 00:07:19.695 --> 00:07:21.375 and ask questions or share NOTE Confidence: 0.97280484 00:07:21.375 --> 00:07:22.275 your own experiences. NOTE Confidence: 0.9859619 00:07:23.455 --> 00:07:24.415 With that, I'm gonna get NOTE Confidence: 0.9859619 00:07:24.415 --> 00:07:24.915 started. NOTE Confidence: 0.9949544 00:07:26.095 --> 00:07:27.455 So one of the things NOTE Confidence: 0.9949544 00:07:27.455 --> 00:07:27.955 that NOTE Confidence: 0.99384767 00:07:28.415 --> 00:07:29.794 I would like to bring, NOTE Confidence: 0.96185017 00:07:30.495 --> 00:07:31.775 to context is this thing NOTE Confidence: 0.96185017 00:07:31.775 --> 00:07:33.830 about stomach cancer and esophageal NOTE Confidence: 0.96185017 00:07:33.830 --> 00:07:35.030 cancer and the diet the NOTE Confidence: 0.96185017 00:07:35.030 --> 00:07:37.050 dichotomy that sometimes is created. NOTE Confidence: 0.96185017 00:07:37.270 --> 00:07:38.790 This actually is very different NOTE Confidence: 0.96185017 00:07:38.790 --> 00:07:40.310 from the view of who NOTE Confidence: 0.96185017 00:07:40.310 --> 00:07:41.350 you're meeting and what you're NOTE Confidence: 0.96185017 00:07:41.350 --> 00:07:42.870 meeting them for. For someone NOTE Confidence: 0.96185017 00:07:42.870 --> 00:07:44.150 like doctor Buffa or doctor NOTE Confidence: 0.96185017 00:07:44.150 --> 00:07:45.805 Du who think of the NOTE Confidence: 0.96185017 00:07:45.805 --> 00:07:47.165 specific region that they need NOTE Confidence: 0.96185017 00:07:47.165 --> 00:07:48.205 to treat from a surgical NOTE Confidence: 0.96185017 00:07:48.205 --> 00:07:50.705 perspective, radiation perspective, the esophagus NOTE Confidence: 0.96185017 00:07:50.765 --> 00:07:52.225 and stomach kind of make NOTE Confidence: 0.96185017 00:07:52.365 --> 00:07:53.405 a big difference on how NOTE Confidence: 0.96185017 00:07:53.405 --> 00:07:54.605 they're gonna approach it. But NOTE Confidence: 0.96185017 00:07:54.605 --> 00:07:56.045 for an oncologist my like NOTE Confidence: 0.96185017 00:07:56.045 --> 00:07:57.645 myself, actually, a lot of NOTE Confidence: 0.96185017 00:07:57.645 --> 00:07:59.430 esophageal cancers behave like stomach NOTE Confidence: 0.96185017 00:07:59.430 --> 00:08:00.470 cancers. It depends on the NOTE Confidence: 0.96185017 00:08:00.470 --> 00:08:02.490 histological subtype. And NOTE Confidence: 0.96765137 00:08:02.870 --> 00:08:03.750 I think of it more NOTE Confidence: 0.96765137 00:08:03.750 --> 00:08:04.870 of the the biology of NOTE Confidence: 0.96765137 00:08:04.870 --> 00:08:05.830 the cancer. And so for NOTE Confidence: 0.96765137 00:08:05.830 --> 00:08:06.949 today, we're gonna talk about NOTE Confidence: 0.96765137 00:08:06.949 --> 00:08:08.410 gastric esophageal cancers. NOTE Confidence: 0.96812266 00:08:08.789 --> 00:08:09.990 The problem with the data NOTE Confidence: 0.96812266 00:08:09.990 --> 00:08:10.870 that we see here is NOTE Confidence: 0.96812266 00:08:10.870 --> 00:08:12.310 that even the data is NOTE Confidence: 0.96812266 00:08:12.310 --> 00:08:13.910 split up between esophageal and NOTE Confidence: 0.96812266 00:08:13.910 --> 00:08:15.110 stomach cancer. You can see NOTE Confidence: 0.96812266 00:08:15.110 --> 00:08:17.325 that esophagus over here is NOTE Confidence: 0.96812266 00:08:17.325 --> 00:08:18.605 number seven and stomachs over NOTE Confidence: 0.96812266 00:08:18.605 --> 00:08:20.125 here at number five. But NOTE Confidence: 0.96812266 00:08:20.125 --> 00:08:21.185 if you add gastroesophageal NOTE Confidence: 0.9939662 00:08:21.565 --> 00:08:23.325 cancers of point six and NOTE Confidence: 0.9939662 00:08:23.325 --> 00:08:24.145 point four, NOTE Confidence: 0.9991821 00:08:24.525 --> 00:08:26.044 we have one million people NOTE Confidence: 0.9991821 00:08:26.044 --> 00:08:27.105 dying from gastroesophageal NOTE Confidence: 0.98800576 00:08:27.565 --> 00:08:28.764 cancers every year. That's even NOTE Confidence: 0.98800576 00:08:28.764 --> 00:08:30.205 more than colorectal cancer. That's, NOTE Confidence: 0.98800576 00:08:30.205 --> 00:08:31.185 like, number two NOTE Confidence: 0.9808722 00:08:31.780 --> 00:08:33.220 cause of death with upper NOTE Confidence: 0.9808722 00:08:33.220 --> 00:08:34.179 GI cancer. So this is NOTE Confidence: 0.9808722 00:08:34.179 --> 00:08:35.780 a really, really serious cancer, NOTE Confidence: 0.9808722 00:08:35.780 --> 00:08:37.220 and the journey that we're NOTE Confidence: 0.9808722 00:08:37.220 --> 00:08:38.260 fighting here for all of NOTE Confidence: 0.9808722 00:08:38.260 --> 00:08:40.020 you is something that there NOTE Confidence: 0.9808722 00:08:40.020 --> 00:08:40.900 are a lot of problems NOTE Confidence: 0.9808722 00:08:40.900 --> 00:08:41.860 that we have not really NOTE Confidence: 0.9808722 00:08:41.860 --> 00:08:43.395 solved. We're getting there, but NOTE Confidence: 0.9808722 00:08:43.554 --> 00:08:44.915 that's kind of the sets NOTE Confidence: 0.9808722 00:08:44.915 --> 00:08:46.035 the stage on the tone NOTE Confidence: 0.9808722 00:08:46.035 --> 00:08:47.335 of what we're dealing with. NOTE Confidence: 0.9808722 00:08:47.475 --> 00:08:48.755 It is an Asian predominant NOTE Confidence: 0.9808722 00:08:48.755 --> 00:08:49.955 illness, which means the number NOTE Confidence: 0.9808722 00:08:49.955 --> 00:08:51.155 of patients being diagnosed with NOTE Confidence: 0.9808722 00:08:51.155 --> 00:08:52.515 these cancers tend to be NOTE Confidence: 0.9808722 00:08:52.515 --> 00:08:53.875 heavier in the United States. NOTE Confidence: 0.9808722 00:08:53.875 --> 00:08:54.915 But I mean, tend to NOTE Confidence: 0.9808722 00:08:54.915 --> 00:08:55.875 be heavier in Asia, but NOTE Confidence: 0.9808722 00:08:55.875 --> 00:08:56.915 we still have a lot NOTE Confidence: 0.9808722 00:08:56.915 --> 00:08:58.110 of people in the United NOTE Confidence: 0.9808722 00:08:58.110 --> 00:08:59.230 States and other parts of NOTE Confidence: 0.9808722 00:08:59.230 --> 00:09:00.350 the world who are suffering NOTE Confidence: 0.9808722 00:09:00.350 --> 00:09:01.250 from this cancer. NOTE Confidence: 0.98554146 00:09:02.670 --> 00:09:04.450 We also know that with NOTE Confidence: 0.98554146 00:09:04.510 --> 00:09:06.030 this being a global population, NOTE Confidence: 0.98554146 00:09:06.030 --> 00:09:07.790 that movement and where you NOTE Confidence: 0.98554146 00:09:07.790 --> 00:09:08.990 come from may affect the NOTE Confidence: 0.98554146 00:09:08.990 --> 00:09:10.270 risk of getting these sort NOTE Confidence: 0.98554146 00:09:10.270 --> 00:09:10.850 of cancers. NOTE Confidence: 0.9550781 00:09:11.634 --> 00:09:12.774 And most importantly NOTE Confidence: 0.96003836 00:09:13.315 --> 00:09:14.595 is if you read Google NOTE Confidence: 0.96003836 00:09:14.595 --> 00:09:15.554 and AI and stuff like NOTE Confidence: 0.96003836 00:09:15.554 --> 00:09:16.274 that, some people will be NOTE Confidence: 0.96003836 00:09:16.274 --> 00:09:17.475 like, oh, gastric cancer is NOTE Confidence: 0.96003836 00:09:17.475 --> 00:09:18.434 coming down. It's not an NOTE Confidence: 0.96003836 00:09:18.434 --> 00:09:20.434 important cancer. What is true NOTE Confidence: 0.96003836 00:09:20.434 --> 00:09:22.274 is that, actually, as we NOTE Confidence: 0.96003836 00:09:22.274 --> 00:09:23.954 have a growing and larger NOTE Confidence: 0.96003836 00:09:23.954 --> 00:09:24.454 population, NOTE Confidence: 0.9935547 00:09:24.800 --> 00:09:26.319 the burden of this illness NOTE Confidence: 0.9935547 00:09:26.319 --> 00:09:27.279 is gonna go up over NOTE Confidence: 0.9935547 00:09:27.279 --> 00:09:28.319 the next twenty to five NOTE Confidence: 0.9935547 00:09:28.480 --> 00:09:29.839 thirty years. So we are NOTE Confidence: 0.9935547 00:09:29.839 --> 00:09:31.379 gonna be dealing with this NOTE Confidence: 0.9371745 00:09:31.679 --> 00:09:32.959 in a big way. And NOTE Confidence: 0.9371745 00:09:32.959 --> 00:09:33.459 especially, NOTE Confidence: 0.9835205 00:09:36.079 --> 00:09:37.279 in in many parts of NOTE Confidence: 0.9835205 00:09:37.279 --> 00:09:38.735 the world, we're actually looking NOTE Confidence: 0.9835205 00:09:38.735 --> 00:09:39.695 for these cancers more, and NOTE Confidence: 0.9835205 00:09:39.695 --> 00:09:40.735 we're picking up more of NOTE Confidence: 0.9835205 00:09:40.735 --> 00:09:41.395 this stuff. NOTE Confidence: 0.9520459 00:09:43.295 --> 00:09:44.815 And sorry. I just talk NOTE Confidence: 0.9520459 00:09:44.815 --> 00:09:46.335 about that. But what is NOTE Confidence: 0.9520459 00:09:46.335 --> 00:09:47.934 most scary for us is NOTE Confidence: 0.9520459 00:09:47.934 --> 00:09:49.554 we are seeing a striking NOTE Confidence: 0.9520459 00:09:49.615 --> 00:09:51.054 number of folks getting diagnosed NOTE Confidence: 0.9520459 00:09:51.054 --> 00:09:52.175 with this cancer at younger, NOTE Confidence: 0.9520459 00:09:52.175 --> 00:09:53.610 younger age. Some of you NOTE Confidence: 0.9520459 00:09:53.610 --> 00:09:54.910 here are in that group. NOTE Confidence: 0.9520459 00:09:55.130 --> 00:09:56.570 Deepika got her cancer at NOTE Confidence: 0.9520459 00:09:56.570 --> 00:09:57.790 the age of twenty something. NOTE Confidence: 0.85908204 00:09:58.170 --> 00:09:58.670 Nonsmoker. NOTE Confidence: 0.97850037 00:09:59.130 --> 00:10:01.050 Nothing that has a risk NOTE Confidence: 0.97850037 00:10:01.050 --> 00:10:02.010 factor for this, and we NOTE Confidence: 0.97850037 00:10:02.010 --> 00:10:03.790 have no way to explain NOTE Confidence: 0.97850037 00:10:03.929 --> 00:10:04.429 why NOTE Confidence: 0.9726931 00:10:05.095 --> 00:10:06.054 young people are getting these NOTE Confidence: 0.9726931 00:10:06.054 --> 00:10:07.255 GI cancers. There's lots of NOTE Confidence: 0.9726931 00:10:07.255 --> 00:10:09.015 hypothesis floating around there. We NOTE Confidence: 0.9726931 00:10:09.015 --> 00:10:09.735 at Yale are doing a NOTE Confidence: 0.9726931 00:10:09.735 --> 00:10:10.775 lot of research trying to NOTE Confidence: 0.9726931 00:10:10.775 --> 00:10:11.975 figure this out. There's no NOTE Confidence: 0.9726931 00:10:11.975 --> 00:10:13.175 clear answers, but this is NOTE Confidence: 0.9726931 00:10:13.175 --> 00:10:14.934 the scariest part about what NOTE Confidence: 0.9726931 00:10:14.934 --> 00:10:15.735 we are seeing. This is NOTE Confidence: 0.9726931 00:10:15.735 --> 00:10:17.515 an epidemic in GI cancers NOTE Confidence: 0.9726931 00:10:17.654 --> 00:10:18.635 of young onset. NOTE Confidence: 0.97302246 00:10:20.170 --> 00:10:21.130 Here at Yale, we do NOTE Confidence: 0.97302246 00:10:21.130 --> 00:10:23.070 have a large team with, NOTE Confidence: 0.99487305 00:10:23.770 --> 00:10:24.910 surgeons, oncologists, NOTE Confidence: 0.9995117 00:10:25.290 --> 00:10:25.790 radiation, NOTE Confidence: 0.97391766 00:10:26.410 --> 00:10:28.429 supportive care, palliative care. NOTE Confidence: 0.9991455 00:10:28.970 --> 00:10:29.850 And so you can see NOTE Confidence: 0.9991455 00:10:29.850 --> 00:10:30.670 that it takes NOTE Confidence: 0.9783906 00:10:31.290 --> 00:10:32.565 an army of folks to NOTE Confidence: 0.9783906 00:10:32.565 --> 00:10:33.765 help fight this cancer. But NOTE Confidence: 0.9783906 00:10:33.765 --> 00:10:35.045 more importantly, which is not NOTE Confidence: 0.9783906 00:10:35.045 --> 00:10:35.765 on the slide, is the NOTE Confidence: 0.9783906 00:10:35.765 --> 00:10:37.065 army of folks at home NOTE Confidence: 0.9783906 00:10:37.205 --> 00:10:38.485 helping all of us fight NOTE Confidence: 0.9783906 00:10:38.485 --> 00:10:40.005 this cancer, which is gonna NOTE Confidence: 0.9783906 00:10:40.005 --> 00:10:40.885 be an important part of NOTE Confidence: 0.9783906 00:10:40.885 --> 00:10:41.385 this. NOTE Confidence: 0.9566406 00:10:43.205 --> 00:10:44.885 Another part that's pretty exciting NOTE Confidence: 0.9566406 00:10:44.885 --> 00:10:45.605 at this point of time NOTE Confidence: 0.9566406 00:10:45.605 --> 00:10:46.405 is the fact that we NOTE Confidence: 0.9566406 00:10:46.405 --> 00:10:48.184 are actually helping having more NOTE Confidence: 0.9572584 00:10:48.699 --> 00:10:50.059 therapeutic options for our patients. NOTE Confidence: 0.9572584 00:10:50.059 --> 00:10:50.779 A lot of you, we NOTE Confidence: 0.9572584 00:10:50.779 --> 00:10:52.139 have talked about this concept NOTE Confidence: 0.9572584 00:10:52.139 --> 00:10:53.740 of precision oncology where we're NOTE Confidence: 0.9572584 00:10:53.740 --> 00:10:54.620 trying to find the right NOTE Confidence: 0.9572584 00:10:54.620 --> 00:10:55.820 targets and the right drugs NOTE Confidence: 0.9572584 00:10:55.820 --> 00:10:57.179 to the right patients. And NOTE Confidence: 0.9572584 00:10:57.179 --> 00:10:58.179 that's something that we have NOTE Confidence: 0.9572584 00:10:58.179 --> 00:10:59.259 a lot of focus at NOTE Confidence: 0.9572584 00:10:59.259 --> 00:11:00.240 here trying to, NOTE Confidence: 0.9669073 00:11:01.100 --> 00:11:02.220 without going into too much NOTE Confidence: 0.9669073 00:11:02.220 --> 00:11:04.079 of the semantics is we NOTE Confidence: 0.9669073 00:11:04.235 --> 00:11:05.995 straightaway profile all the tumors NOTE Confidence: 0.9669073 00:11:05.995 --> 00:11:07.195 and from the patients that NOTE Confidence: 0.9669073 00:11:07.195 --> 00:11:08.315 we get, get the right NOTE Confidence: 0.9669073 00:11:08.315 --> 00:11:10.075 biomarkers to straightaway decide on NOTE Confidence: 0.9669073 00:11:10.075 --> 00:11:11.675 what is the right treatment NOTE Confidence: 0.9669073 00:11:11.675 --> 00:11:12.875 strategies that will be best NOTE Confidence: 0.9669073 00:11:12.875 --> 00:11:13.535 for them. NOTE Confidence: 0.9755232 00:11:15.515 --> 00:11:17.035 And we do have multiple NOTE Confidence: 0.9755232 00:11:17.035 --> 00:11:18.449 clinical trials and a lot NOTE Confidence: 0.9755232 00:11:18.449 --> 00:11:19.809 of research that is kicking NOTE Confidence: 0.9755232 00:11:19.809 --> 00:11:21.569 off within this place. And NOTE Confidence: 0.9755232 00:11:21.569 --> 00:11:23.009 we encourage you to ask NOTE Confidence: 0.9755232 00:11:23.009 --> 00:11:24.050 more about this and be NOTE Confidence: 0.9755232 00:11:24.050 --> 00:11:25.189 a part of this journey. NOTE Confidence: 0.94240755 00:11:25.889 --> 00:11:27.569 And with that, I'm gonna NOTE Confidence: 0.94240755 00:11:27.569 --> 00:11:30.129 introduce doctor Boffa, who's here. NOTE Confidence: 0.94240755 00:11:30.129 --> 00:11:31.329 So doctor Boffa is gonna NOTE Confidence: 0.94240755 00:11:31.329 --> 00:11:32.449 talk to talk to us NOTE Confidence: 0.94240755 00:11:32.449 --> 00:11:33.269 about the surgical NOTE Confidence: 0.9293213 00:11:33.934 --> 00:11:34.675 aspects of, NOTE Confidence: 0.99392366 00:11:35.615 --> 00:11:37.695 this cancer. Doctor Buffa, please. NOTE Confidence: 0.99392366 00:11:37.695 --> 00:11:38.195 Great. NOTE Confidence: 0.9595308 00:11:39.375 --> 00:11:40.575 Well, thank you guys for NOTE Confidence: 0.9595308 00:11:40.575 --> 00:11:42.755 coming. I don't have slides. NOTE Confidence: 0.9595308 00:11:42.815 --> 00:11:44.255 I could act some things NOTE Confidence: 0.9595308 00:11:44.255 --> 00:11:46.175 out or I you guys NOTE Confidence: 0.9595308 00:11:46.175 --> 00:11:46.675 probably NOTE Confidence: 0.9849935 00:11:48.179 --> 00:11:49.380 know more about the the NOTE Confidence: 0.9849935 00:11:49.460 --> 00:11:50.740 this experience than I do. NOTE Confidence: 0.9849935 00:11:50.740 --> 00:11:52.040 I I will say that, NOTE Confidence: 0.9991862 00:11:53.940 --> 00:11:55.400 there's been quite an evolution NOTE Confidence: 0.9991862 00:11:55.700 --> 00:11:56.200 in NOTE Confidence: 0.98327637 00:11:56.660 --> 00:11:59.220 the surgery for esophageal cancer. NOTE Confidence: 0.98327637 00:11:59.220 --> 00:12:00.834 And, you know, not too NOTE Confidence: 0.98327637 00:12:00.834 --> 00:12:01.654 long ago, NOTE Confidence: 0.99821776 00:12:02.035 --> 00:12:03.315 thirty or forty years ago, NOTE Confidence: 0.99821776 00:12:03.315 --> 00:12:04.595 there really wasn't a great NOTE Confidence: 0.99821776 00:12:04.595 --> 00:12:06.035 option. I mean, there there NOTE Confidence: 0.99821776 00:12:06.035 --> 00:12:07.495 really wasn't a way to NOTE Confidence: 0.998291 00:12:07.875 --> 00:12:09.014 make a new esophagus NOTE Confidence: 0.9886719 00:12:09.315 --> 00:12:11.095 out of the existing plumbing. NOTE Confidence: 0.9718262 00:12:11.929 --> 00:12:13.290 And that really is the NOTE Confidence: 0.9718262 00:12:13.290 --> 00:12:14.750 challenge is how do you, NOTE Confidence: 0.9916705 00:12:15.690 --> 00:12:17.209 how do you reconstruct somebody? NOTE Confidence: 0.9916705 00:12:17.209 --> 00:12:17.929 How do you get rid NOTE Confidence: 0.9916705 00:12:17.929 --> 00:12:19.929 of everything that is involved NOTE Confidence: 0.9916705 00:12:19.929 --> 00:12:20.670 in cancer NOTE Confidence: 0.90478516 00:12:21.290 --> 00:12:21.790 and, NOTE Confidence: 0.99902344 00:12:22.250 --> 00:12:23.149 then restore NOTE Confidence: 0.99077815 00:12:23.529 --> 00:12:24.970 the anatomy so that they NOTE Confidence: 0.99077815 00:12:24.970 --> 00:12:26.635 could, so that people can NOTE Confidence: 0.99077815 00:12:26.635 --> 00:12:28.475 return to an acceptable quality NOTE Confidence: 0.99077815 00:12:28.475 --> 00:12:29.915 of life. And it it's NOTE Confidence: 0.99077815 00:12:29.915 --> 00:12:31.135 challenging. And NOTE Confidence: 0.9863959 00:12:31.755 --> 00:12:33.535 right now, our best option NOTE Confidence: 0.9863959 00:12:33.675 --> 00:12:35.115 for most patients is to NOTE Confidence: 0.9863959 00:12:35.115 --> 00:12:36.335 take part of the stomach. NOTE Confidence: 0.9863959 00:12:36.555 --> 00:12:37.595 And so we get rid NOTE Confidence: 0.9863959 00:12:37.595 --> 00:12:38.870 of about, for most patients, NOTE Confidence: 0.9863959 00:12:38.870 --> 00:12:39.670 we get rid of about NOTE Confidence: 0.9863959 00:12:39.670 --> 00:12:41.030 two thirds of the esophagus NOTE Confidence: 0.9863959 00:12:41.030 --> 00:12:41.750 and a third of the NOTE Confidence: 0.9863959 00:12:41.750 --> 00:12:43.030 stomach and make a tube NOTE Confidence: 0.9863959 00:12:43.030 --> 00:12:43.929 out of the, NOTE Confidence: 0.99191624 00:12:44.630 --> 00:12:45.670 stomach and pull it up NOTE Confidence: 0.99191624 00:12:45.670 --> 00:12:47.050 through the chest. And, NOTE Confidence: 0.99677736 00:12:47.590 --> 00:12:48.470 we're able to do that NOTE Confidence: 0.99677736 00:12:48.470 --> 00:12:50.070 minimally invasively. That's sort of NOTE Confidence: 0.99677736 00:12:50.070 --> 00:12:52.250 an innovation that happened maybe NOTE Confidence: 0.95532227 00:12:52.635 --> 00:12:53.775 twenty years ago, NOTE Confidence: 0.9667969 00:12:55.035 --> 00:12:56.235 and has just gotten better NOTE Confidence: 0.9667969 00:12:56.235 --> 00:12:56.895 and better, NOTE Confidence: 0.9727376 00:12:57.275 --> 00:12:58.495 over time. But, NOTE Confidence: 0.99975586 00:12:59.355 --> 00:13:00.175 it's definitely NOTE Confidence: 0.9836426 00:13:00.554 --> 00:13:01.835 an operation that if you NOTE Confidence: 0.9836426 00:13:01.835 --> 00:13:03.355 can avoid it, you, you NOTE Confidence: 0.9836426 00:13:03.355 --> 00:13:04.795 know, you should avoid it. NOTE Confidence: 0.9836426 00:13:04.795 --> 00:13:06.335 And so I think that NOTE Confidence: 0.9534389 00:13:07.050 --> 00:13:09.050 where the biggest areas for NOTE Confidence: 0.9534389 00:13:09.050 --> 00:13:11.870 innovation are are finding people NOTE Confidence: 0.9534389 00:13:12.170 --> 00:13:13.710 where it's earlier because NOTE Confidence: 0.97368306 00:13:14.090 --> 00:13:16.330 unlike, say, pancreatic cancer, where NOTE Confidence: 0.97368306 00:13:16.330 --> 00:13:17.210 if you have a small NOTE Confidence: 0.97368306 00:13:17.210 --> 00:13:18.090 tumor in the middle of NOTE Confidence: 0.97368306 00:13:18.090 --> 00:13:18.825 your pancreas, NOTE Confidence: 0.99375767 00:13:19.465 --> 00:13:21.145 there's not a radically different NOTE Confidence: 0.99375767 00:13:21.145 --> 00:13:22.585 operation that we can do. NOTE Confidence: 0.99375767 00:13:22.585 --> 00:13:23.865 But finding it really early NOTE Confidence: 0.99375767 00:13:23.865 --> 00:13:25.804 in the esophagus, there's actually NOTE Confidence: 0.99375767 00:13:25.945 --> 00:13:26.745 there are a lot of NOTE Confidence: 0.99375767 00:13:26.745 --> 00:13:28.505 options. And so, you know, NOTE Confidence: 0.99375767 00:13:28.505 --> 00:13:29.625 when we think of, like, NOTE Confidence: 0.99375767 00:13:29.625 --> 00:13:30.905 AI and what it's gonna NOTE Confidence: 0.99375767 00:13:30.905 --> 00:13:32.025 do for us, I I NOTE Confidence: 0.99375767 00:13:32.025 --> 00:13:33.449 really think that there's very NOTE Confidence: 0.99375767 00:13:33.449 --> 00:13:33.949 few NOTE Confidence: 0.9448353 00:13:34.569 --> 00:13:36.649 esophageal cancer and gastric cancer NOTE Confidence: 0.9448353 00:13:36.649 --> 00:13:38.730 in particular have a real NOTE Confidence: 0.9448353 00:13:38.730 --> 00:13:39.230 unique, NOTE Confidence: 0.9793701 00:13:39.689 --> 00:13:41.209 potential to find the right NOTE Confidence: 0.9793701 00:13:41.209 --> 00:13:42.410 people because a lot of NOTE Confidence: 0.9793701 00:13:42.410 --> 00:13:43.069 the symptoms, NOTE Confidence: 0.97302246 00:13:44.009 --> 00:13:45.129 that people have and a NOTE Confidence: 0.97302246 00:13:45.129 --> 00:13:46.649 lot of the conditions that NOTE Confidence: 0.97302246 00:13:46.649 --> 00:13:48.825 lead to esophageal cancer are NOTE Confidence: 0.97302246 00:13:48.825 --> 00:13:50.765 really common. You know, heartburn, NOTE Confidence: 0.98542434 00:13:51.385 --> 00:13:52.825 reflux, you know, who doesn't NOTE Confidence: 0.98542434 00:13:52.825 --> 00:13:53.945 or who hasn't had that NOTE Confidence: 0.98542434 00:13:53.945 --> 00:13:55.065 at one time or another. NOTE Confidence: 0.98542434 00:13:55.065 --> 00:13:56.425 And so you can't give NOTE Confidence: 0.98542434 00:13:56.425 --> 00:13:57.865 everybody an upper endoscopy, you NOTE Confidence: 0.98542434 00:13:57.865 --> 00:13:59.145 know, every six months. And NOTE Confidence: 0.98542434 00:13:59.145 --> 00:14:00.345 so how do you use NOTE Confidence: 0.98542434 00:14:00.345 --> 00:14:01.325 this to really NOTE Confidence: 0.9654635 00:14:01.899 --> 00:14:03.260 find the people? Because if NOTE Confidence: 0.9654635 00:14:03.260 --> 00:14:04.140 if you find it really NOTE Confidence: 0.9654635 00:14:04.140 --> 00:14:05.740 early, there's there's a lot NOTE Confidence: 0.9654635 00:14:05.740 --> 00:14:07.020 more options and that are NOTE Confidence: 0.9654635 00:14:07.020 --> 00:14:08.380 a lot easier on patients. NOTE Confidence: 0.9654635 00:14:08.380 --> 00:14:08.880 So, NOTE Confidence: 0.9960205 00:14:10.940 --> 00:14:12.800 it's I think we're constantly NOTE Confidence: 0.9960205 00:14:13.020 --> 00:14:15.115 trying to understand ways of NOTE Confidence: 0.9573364 00:14:15.495 --> 00:14:17.274 making this less impactful. NOTE Confidence: 0.9917399 00:14:17.654 --> 00:14:18.774 And and I would say NOTE Confidence: 0.9917399 00:14:18.774 --> 00:14:19.274 that, NOTE Confidence: 0.9981445 00:14:20.214 --> 00:14:21.495 there's not a lot of NOTE Confidence: 0.9981445 00:14:21.495 --> 00:14:23.495 operations that I personally do NOTE Confidence: 0.9981445 00:14:23.495 --> 00:14:24.454 that I don't think you NOTE Confidence: 0.9981445 00:14:24.454 --> 00:14:26.475 can have done somewhere else. NOTE Confidence: 0.9814812 00:14:26.820 --> 00:14:27.700 I think some of the NOTE Confidence: 0.9814812 00:14:27.700 --> 00:14:29.940 esophageal cancer operations, we just NOTE Confidence: 0.9814812 00:14:29.940 --> 00:14:30.980 have such a great team NOTE Confidence: 0.9814812 00:14:30.980 --> 00:14:31.800 here, and, NOTE Confidence: 0.97784424 00:14:32.580 --> 00:14:34.020 we've we've been doing this NOTE Confidence: 0.97784424 00:14:34.020 --> 00:14:35.060 a long time. And I NOTE Confidence: 0.97784424 00:14:35.060 --> 00:14:35.800 think that, NOTE Confidence: 0.9998047 00:14:36.340 --> 00:14:38.360 the difference between our outcomes NOTE Confidence: 0.9705034 00:14:38.740 --> 00:14:40.020 and and a lot of NOTE Confidence: 0.9705034 00:14:40.020 --> 00:14:41.935 other places' outcomes are not NOTE Confidence: 0.9705034 00:14:41.935 --> 00:14:43.375 me. It's just we have NOTE Confidence: 0.9705034 00:14:43.375 --> 00:14:44.415 a great team. You know? NOTE Confidence: 0.9705034 00:14:44.415 --> 00:14:45.075 Our nurses, NOTE Confidence: 0.98939943 00:14:45.615 --> 00:14:47.135 you know, it's not easy NOTE Confidence: 0.98939943 00:14:47.135 --> 00:14:48.435 to recover from an esophageectomy. NOTE Confidence: 0.963839 00:14:48.895 --> 00:14:50.415 They you know? Our nurses NOTE Confidence: 0.963839 00:14:50.415 --> 00:14:51.455 will kick your butt and NOTE Confidence: 0.963839 00:14:51.455 --> 00:14:52.575 get you up and moving NOTE Confidence: 0.963839 00:14:52.575 --> 00:14:53.855 and do everything that needs NOTE Confidence: 0.963839 00:14:53.855 --> 00:14:54.895 to happen to keep you NOTE Confidence: 0.963839 00:14:54.895 --> 00:14:55.350 safe. NOTE Confidence: 0.97718185 00:14:56.230 --> 00:14:57.509 But whenever I whenever I NOTE Confidence: 0.97718185 00:14:57.509 --> 00:14:59.029 hear somebody, you know, is NOTE Confidence: 0.97718185 00:14:59.029 --> 00:14:59.990 seeing us as a second NOTE Confidence: 0.97718185 00:14:59.990 --> 00:15:01.430 or third opinion and is NOTE Confidence: 0.97718185 00:15:01.430 --> 00:15:03.110 choosing somewhere else, I I NOTE Confidence: 0.97718185 00:15:03.110 --> 00:15:03.990 just say, you know, our NOTE Confidence: 0.97718185 00:15:03.990 --> 00:15:05.029 nurses that you're you're not NOTE Confidence: 0.97718185 00:15:05.110 --> 00:15:05.829 I don't care what you NOTE Confidence: 0.97718185 00:15:05.829 --> 00:15:07.029 think about me, but our NOTE Confidence: 0.97718185 00:15:07.029 --> 00:15:08.389 nurses are so great and NOTE Confidence: 0.97718185 00:15:08.389 --> 00:15:10.235 our PAs, and they just NOTE Confidence: 0.97718185 00:15:10.235 --> 00:15:11.535 spend so much time NOTE Confidence: 0.998291 00:15:12.395 --> 00:15:13.675 trying to make this very NOTE Confidence: 0.998291 00:15:13.675 --> 00:15:14.575 difficult journey, NOTE Confidence: 0.8680827 00:15:15.595 --> 00:15:17.215 more manageable. So, NOTE Confidence: 0.9528198 00:15:19.275 --> 00:15:20.795 I'm happy to answer any NOTE Confidence: 0.9528198 00:15:20.795 --> 00:15:22.955 questions about anything if anybody NOTE Confidence: 0.9528198 00:15:22.955 --> 00:15:23.695 has any, NOTE Confidence: 0.99497765 00:15:24.590 --> 00:15:25.870 about things that are new, NOTE Confidence: 0.99497765 00:15:25.870 --> 00:15:26.670 things that, NOTE Confidence: 0.95452476 00:15:27.150 --> 00:15:28.190 you could say, why is NOTE Confidence: 0.95452476 00:15:28.190 --> 00:15:29.310 it that x, y, or NOTE Confidence: 0.95452476 00:15:29.310 --> 00:15:30.930 z? I'll I'll answer anything. NOTE Confidence: 0.9194743 00:15:31.550 --> 00:15:32.270 I mean, don't ask me NOTE Confidence: 0.9194743 00:15:32.270 --> 00:15:33.630 about my taxes or anything NOTE Confidence: 0.9194743 00:15:33.630 --> 00:15:34.590 like that. I'm not I NOTE Confidence: 0.9194743 00:15:34.590 --> 00:15:35.710 I I'm not at liberty NOTE Confidence: 0.9194743 00:15:35.710 --> 00:15:36.930 to disclose that, but NOTE Confidence: 0.9916992 00:15:37.800 --> 00:15:38.300 yeah. NOTE Confidence: 0.38659668 00:15:42.165 --> 00:15:42.745 I was NOTE Confidence: 0.46917725 00:15:43.685 --> 00:15:44.265 fifty nine. NOTE Confidence: 0.6828613 00:15:45.925 --> 00:15:46.485 And within NOTE Confidence: 0.9917806 00:15:47.125 --> 00:15:48.665 oh, sorry. Within, NOTE Confidence: 0.98807466 00:15:49.445 --> 00:15:50.805 let's see. That was September NOTE Confidence: 0.98807466 00:15:50.805 --> 00:15:52.085 of twenty three that she NOTE Confidence: 0.98807466 00:15:52.085 --> 00:15:53.225 had the surgery. NOTE Confidence: 0.9943034 00:15:54.000 --> 00:15:55.600 And the following year, I NOTE Confidence: 0.9943034 00:15:55.600 --> 00:15:56.740 could hear my husband NOTE Confidence: 0.9637207 00:15:57.360 --> 00:15:59.540 making sounds that concerned me. NOTE Confidence: 0.9946289 00:16:00.240 --> 00:16:00.740 And, NOTE Confidence: 0.9996745 00:16:01.200 --> 00:16:02.260 he was diagnosed NOTE Confidence: 0.9177246 00:16:03.040 --> 00:16:04.880 about a year and about NOTE Confidence: 0.9177246 00:16:04.880 --> 00:16:06.900 fifteen months later. Immediately, NOTE Confidence: 0.9757865 00:16:07.884 --> 00:16:09.345 surgery was not an option. NOTE Confidence: 0.9757865 00:16:09.404 --> 00:16:11.665 Is there some criteria that, NOTE Confidence: 0.9757865 00:16:11.725 --> 00:16:12.865 I mean, other than NOTE Confidence: 0.7064616 00:16:13.644 --> 00:16:14.464 he was age NOTE Confidence: 0.9481337 00:16:14.845 --> 00:16:16.285 eighty five at that point NOTE Confidence: 0.9481337 00:16:16.285 --> 00:16:17.964 versus her fifty nine, do NOTE Confidence: 0.9481337 00:16:17.964 --> 00:16:19.985 you consider age an immediate NOTE Confidence: 0.9481337 00:16:20.045 --> 00:16:21.425 exclusion for surgery? NOTE Confidence: 0.95043945 00:16:22.444 --> 00:16:24.330 No. So what what I NOTE Confidence: 0.95043945 00:16:24.330 --> 00:16:25.150 would say NOTE Confidence: 0.8623047 00:16:25.930 --> 00:16:27.230 is really any NOTE Confidence: 0.9964425 00:16:28.090 --> 00:16:29.850 person that takes care of NOTE Confidence: 0.9964425 00:16:29.850 --> 00:16:30.750 cancer patients, NOTE Confidence: 0.98211914 00:16:31.690 --> 00:16:32.890 the first job is to NOTE Confidence: 0.98211914 00:16:32.890 --> 00:16:34.010 say, what's gonna get you NOTE Confidence: 0.98211914 00:16:34.010 --> 00:16:35.450 into trouble? And it's one NOTE Confidence: 0.98211914 00:16:35.450 --> 00:16:36.890 of three things. It's either NOTE Confidence: 0.98211914 00:16:36.890 --> 00:16:38.350 the tumor we can see, NOTE Confidence: 0.9958089 00:16:38.725 --> 00:16:40.085 it's the tumor we can't NOTE Confidence: 0.9958089 00:16:40.085 --> 00:16:40.585 see, NOTE Confidence: 0.9969727 00:16:41.045 --> 00:16:43.205 or it's something unrelated to NOTE Confidence: 0.9969727 00:16:43.205 --> 00:16:44.645 tumor. So if somebody has NOTE Confidence: 0.9969727 00:16:44.645 --> 00:16:46.025 a lot of medical problems, NOTE Confidence: 0.99822444 00:16:46.725 --> 00:16:48.245 honestly, the cancer may not NOTE Confidence: 0.99822444 00:16:48.245 --> 00:16:49.445 be the front of the NOTE Confidence: 0.99822444 00:16:49.445 --> 00:16:49.945 stove. NOTE Confidence: 0.99902344 00:16:50.645 --> 00:16:52.165 If it's contained in the NOTE Confidence: 0.99902344 00:16:52.165 --> 00:16:52.665 esophagus, NOTE Confidence: 0.96994853 00:16:53.139 --> 00:16:54.660 then it's usually the tumor NOTE Confidence: 0.96994853 00:16:54.660 --> 00:16:55.699 we can see and we NOTE Confidence: 0.96994853 00:16:55.699 --> 00:16:56.199 go NOTE Confidence: 0.95911324 00:16:56.579 --> 00:16:58.660 big on trying to get NOTE Confidence: 0.95911324 00:16:58.660 --> 00:16:59.779 that taken care of. And NOTE Confidence: 0.95911324 00:16:59.779 --> 00:17:00.660 it can be surgery, it NOTE Confidence: 0.95911324 00:17:00.660 --> 00:17:01.480 can be radiation, NOTE Confidence: 0.9977722 00:17:02.019 --> 00:17:03.380 but that's attacking it where NOTE Confidence: 0.9977722 00:17:03.380 --> 00:17:04.280 we can see. NOTE Confidence: 0.9836968 00:17:04.900 --> 00:17:05.859 If it's spread to a NOTE Confidence: 0.9836968 00:17:05.859 --> 00:17:07.080 bunch of lymph nodes NOTE Confidence: 0.9998169 00:17:07.445 --> 00:17:08.965 or it has spread to NOTE Confidence: 0.9998169 00:17:08.965 --> 00:17:09.945 a vital organ, NOTE Confidence: 0.97169363 00:17:10.725 --> 00:17:12.825 you're much more at risk NOTE Confidence: 0.97169363 00:17:12.965 --> 00:17:14.165 for the cancer we can't NOTE Confidence: 0.97169363 00:17:14.165 --> 00:17:15.365 see. And so the the NOTE Confidence: 0.97169363 00:17:15.445 --> 00:17:16.725 what I will tell patients NOTE Confidence: 0.97169363 00:17:16.725 --> 00:17:17.925 is it's kind of like NOTE Confidence: 0.97169363 00:17:17.925 --> 00:17:19.045 if your house is on NOTE Confidence: 0.97169363 00:17:19.045 --> 00:17:20.505 fire because of the furnace, NOTE Confidence: 0.9889664 00:17:21.150 --> 00:17:22.109 you don't risk your life NOTE Confidence: 0.9889664 00:17:22.109 --> 00:17:22.670 to get rid of the NOTE Confidence: 0.9889664 00:17:22.670 --> 00:17:24.030 furnace. You you put out NOTE Confidence: 0.9889664 00:17:24.109 --> 00:17:25.230 you treat the whole house, NOTE Confidence: 0.9889664 00:17:25.230 --> 00:17:26.830 and that's your priority. And NOTE Confidence: 0.9889664 00:17:26.830 --> 00:17:29.230 so that's really the the NOTE Confidence: 0.9889664 00:17:29.230 --> 00:17:29.730 issue. NOTE Confidence: 0.9899205 00:17:30.109 --> 00:17:31.550 But age, you know, in NOTE Confidence: 0.9899205 00:17:31.550 --> 00:17:32.750 the United States, if you NOTE Confidence: 0.9899205 00:17:32.750 --> 00:17:33.810 make it to eighty, NOTE Confidence: 0.9892126 00:17:34.484 --> 00:17:36.405 on average, people live another NOTE Confidence: 0.9892126 00:17:36.405 --> 00:17:38.005 nine years. So once you NOTE Confidence: 0.9892126 00:17:38.005 --> 00:17:39.045 make it to eighty, you've NOTE Confidence: 0.9892126 00:17:39.045 --> 00:17:39.925 actually gone over a lot NOTE Confidence: 0.9892126 00:17:39.925 --> 00:17:41.045 of hurdles. So I've definitely NOTE Confidence: 0.9892126 00:17:41.045 --> 00:17:41.785 done esophagectomies NOTE Confidence: 0.9985026 00:17:42.244 --> 00:17:43.465 on people in their eighties. NOTE Confidence: 0.9780939 00:17:46.859 --> 00:17:48.059 It is funny that people NOTE Confidence: 0.9780939 00:17:48.059 --> 00:17:49.340 interpret it that way. On NOTE Confidence: 0.9780939 00:17:49.340 --> 00:17:49.840 average NOTE Confidence: 0.9235026 00:17:58.700 --> 00:17:59.679 I just wonder NOTE Confidence: 0.8540344 00:18:00.554 --> 00:18:02.234 about that up because it NOTE Confidence: 0.8540344 00:18:02.234 --> 00:18:03.534 was at the very same. NOTE Confidence: 0.9970703 00:18:05.034 --> 00:18:05.534 Yeah. NOTE Confidence: 0.97772217 00:18:39.910 --> 00:18:41.290 Yeah. I think that, NOTE Confidence: 0.98940706 00:18:42.230 --> 00:18:42.869 so I have a lot NOTE Confidence: 0.98940706 00:18:42.869 --> 00:18:44.150 of sayings. They kind of NOTE Confidence: 0.98940706 00:18:44.150 --> 00:18:44.890 are my, NOTE Confidence: 0.94125086 00:18:45.750 --> 00:18:46.790 my way of kind of NOTE Confidence: 0.94125086 00:18:46.790 --> 00:18:49.190 framing things. And so I NOTE Confidence: 0.94125086 00:18:49.190 --> 00:18:49.690 think, NOTE Confidence: 0.9723162 00:18:50.150 --> 00:18:52.035 doing high risk surgery is NOTE Confidence: 0.9723162 00:18:52.035 --> 00:18:53.575 very reasonable. I mean, sometimes, NOTE Confidence: 0.9723162 00:18:53.635 --> 00:18:54.435 we you know, that's just NOTE Confidence: 0.9723162 00:18:54.435 --> 00:18:55.155 what we do, and a NOTE Confidence: 0.9723162 00:18:55.155 --> 00:18:56.115 lot of what I do NOTE Confidence: 0.9723162 00:18:56.115 --> 00:18:57.095 is high risk. NOTE Confidence: 0.9992676 00:18:57.555 --> 00:18:59.015 I think doing surgery NOTE Confidence: 0.9946289 00:18:59.315 --> 00:19:00.215 that you're not NOTE Confidence: 0.965198 00:19:01.315 --> 00:19:02.595 confident is gonna help the NOTE Confidence: 0.965198 00:19:02.595 --> 00:19:04.675 person is also reasonable because NOTE Confidence: 0.965198 00:19:04.675 --> 00:19:06.115 sometimes there is no other NOTE Confidence: 0.965198 00:19:06.115 --> 00:19:07.480 option. I just don't do NOTE Confidence: 0.965198 00:19:07.480 --> 00:19:08.679 those in the same patient. NOTE Confidence: 0.965198 00:19:08.679 --> 00:19:09.720 So if I'm not a NOTE Confidence: 0.965198 00:19:09.720 --> 00:19:10.840 hundred if I'm not really NOTE Confidence: 0.965198 00:19:10.840 --> 00:19:11.960 sure so I if I'm NOTE Confidence: 0.965198 00:19:11.960 --> 00:19:13.000 gonna do a big surgery, NOTE Confidence: 0.965198 00:19:13.000 --> 00:19:14.700 I better be pretty confident NOTE Confidence: 0.965198 00:19:14.919 --> 00:19:15.419 that NOTE Confidence: 0.98864746 00:19:15.799 --> 00:19:17.160 that I'm gonna help them NOTE Confidence: 0.98864746 00:19:17.160 --> 00:19:17.660 because, NOTE Confidence: 0.98791504 00:19:18.359 --> 00:19:19.660 you know, it's otherwise, NOTE Confidence: 0.9544922 00:19:20.200 --> 00:19:21.580 there there are other consequences. NOTE Confidence: 0.99853516 00:19:25.615 --> 00:19:26.014 Yeah. NOTE Confidence: 0.96139157 00:19:26.734 --> 00:19:27.534 I think I'll add to NOTE Confidence: 0.96139157 00:19:27.534 --> 00:19:29.375 doctor Buffet's comment about this NOTE Confidence: 0.96139157 00:19:29.375 --> 00:19:30.975 fact that couple of things NOTE Confidence: 0.96139157 00:19:30.975 --> 00:19:32.434 about surgery. One is NOTE Confidence: 0.99119735 00:19:35.720 --> 00:19:37.480 the key for surgery still NOTE Confidence: 0.99119735 00:19:37.480 --> 00:19:39.080 remains one of the main NOTE Confidence: 0.99119735 00:19:39.080 --> 00:19:40.040 ways in which we can NOTE Confidence: 0.99119735 00:19:40.040 --> 00:19:41.100 cure the cancer. NOTE Confidence: 0.9539264 00:19:41.400 --> 00:19:42.760 But one of the key NOTE Confidence: 0.9539264 00:19:42.760 --> 00:19:44.460 things about the surgery is NOTE Confidence: 0.9539264 00:19:44.520 --> 00:19:45.880 doctor Boffa, the surgeon, has NOTE Confidence: 0.9539264 00:19:45.880 --> 00:19:46.840 to be able to take NOTE Confidence: 0.9539264 00:19:46.840 --> 00:19:48.359 everything out, and the first NOTE Confidence: 0.9539264 00:19:48.359 --> 00:19:49.800 patient has to survive taking NOTE Confidence: 0.9539264 00:19:49.800 --> 00:19:51.175 everything out. There's no point NOTE Confidence: 0.9539264 00:19:51.175 --> 00:19:52.375 in taking out fifty percent NOTE Confidence: 0.9539264 00:19:52.375 --> 00:19:53.655 of the cancer, sixty percent NOTE Confidence: 0.9539264 00:19:53.655 --> 00:19:55.015 of the cancer, eighty percent. NOTE Confidence: 0.9539264 00:19:55.015 --> 00:19:56.395 It's hundred or nothing. NOTE Confidence: 0.98466796 00:19:56.775 --> 00:19:57.815 Lots of studies have shown NOTE Confidence: 0.98466796 00:19:57.815 --> 00:19:59.255 that even if ninety five NOTE Confidence: 0.98466796 00:19:59.255 --> 00:20:01.095 percent is taken out, it's NOTE Confidence: 0.98466796 00:20:01.095 --> 00:20:02.295 the remaining five percent that NOTE Confidence: 0.98466796 00:20:02.295 --> 00:20:03.675 will take life. And often, NOTE Confidence: 0.96522844 00:20:04.100 --> 00:20:05.300 the ninety five percent sort NOTE Confidence: 0.96522844 00:20:05.300 --> 00:20:06.420 of surgeries are the ones NOTE Confidence: 0.96522844 00:20:06.420 --> 00:20:08.020 that actually have poorer outcomes NOTE Confidence: 0.96522844 00:20:08.020 --> 00:20:09.780 and you actually do worse NOTE Confidence: 0.96522844 00:20:09.780 --> 00:20:11.460 than not doing surgery at NOTE Confidence: 0.96522844 00:20:11.460 --> 00:20:12.660 all and just going through NOTE Confidence: 0.96522844 00:20:12.660 --> 00:20:13.720 chemo or radiation. NOTE Confidence: 0.92645675 00:20:14.180 --> 00:20:15.380 And so that's kind of NOTE Confidence: 0.92645675 00:20:15.380 --> 00:20:17.080 why it's always a multidisciplinary NOTE Confidence: 0.96605587 00:20:17.994 --> 00:20:19.355 discussion between the surgeons, the NOTE Confidence: 0.96605587 00:20:19.355 --> 00:20:21.375 radiation, and the medical oncologist NOTE Confidence: 0.96605587 00:20:21.515 --> 00:20:23.515 on what is the best NOTE Confidence: 0.96605587 00:20:23.515 --> 00:20:25.934 approach for each individual patient, NOTE Confidence: 0.96605587 00:20:25.994 --> 00:20:27.755 not just can I cut NOTE Confidence: 0.96605587 00:20:27.755 --> 00:20:28.635 that tumor out, but how NOTE Confidence: 0.96605587 00:20:28.635 --> 00:20:29.674 does that fit within the NOTE Confidence: 0.96605587 00:20:29.674 --> 00:20:30.554 rest of the body? How NOTE Confidence: 0.96605587 00:20:30.554 --> 00:20:31.855 are the other medical conditions? NOTE Confidence: 0.96605587 00:20:31.914 --> 00:20:32.875 Are there ways in which NOTE Confidence: 0.96605587 00:20:32.875 --> 00:20:34.450 we can shrink the tumor NOTE Confidence: 0.96605587 00:20:34.450 --> 00:20:35.250 down so that we can NOTE Confidence: 0.96605587 00:20:35.250 --> 00:20:36.630 get it to surgery? The NOTE Confidence: 0.96605587 00:20:36.769 --> 00:20:36.850 the NOTE Confidence: 0.99609375 00:20:37.570 --> 00:20:38.850 we always get the surgeons NOTE Confidence: 0.99609375 00:20:38.850 --> 00:20:40.470 involved because we know that NOTE Confidence: 0.95926857 00:20:40.929 --> 00:20:42.369 surgery is often the only NOTE Confidence: 0.95926857 00:20:42.369 --> 00:20:43.730 way to cure the cancer. NOTE Confidence: 0.95926857 00:20:43.730 --> 00:20:45.570 There are emerging ways in NOTE Confidence: 0.95926857 00:20:45.570 --> 00:20:46.529 which we can try and NOTE Confidence: 0.95926857 00:20:46.529 --> 00:20:47.730 avoid the surgery, but that's NOTE Confidence: 0.95926857 00:20:47.730 --> 00:20:49.755 still very carefully thought through. NOTE Confidence: 0.95926857 00:20:49.755 --> 00:20:51.275 It's not something we just NOTE Confidence: 0.95926857 00:20:51.275 --> 00:20:52.234 throw out of the bat NOTE Confidence: 0.95926857 00:20:52.234 --> 00:20:53.275 and be like, okay. Don't NOTE Confidence: 0.95926857 00:20:53.275 --> 00:20:54.795 do surgery and you're cured NOTE Confidence: 0.95926857 00:20:54.795 --> 00:20:55.675 from your cancer. That's a NOTE Confidence: 0.95926857 00:20:55.675 --> 00:20:57.115 very, very carefully thought through NOTE Confidence: 0.95926857 00:20:57.115 --> 00:20:58.895 this decision that's very individualized. NOTE Confidence: 0.935791 00:20:59.195 --> 00:20:59.695 And, NOTE Confidence: 0.9682002 00:21:01.115 --> 00:21:02.555 if you've made that decision NOTE Confidence: 0.9682002 00:21:02.555 --> 00:21:03.835 to not offer surgery, it's NOTE Confidence: 0.9682002 00:21:03.835 --> 00:21:05.140 not a flippant, oh, we NOTE Confidence: 0.9682002 00:21:05.140 --> 00:21:05.940 think you're too old for NOTE Confidence: 0.9682002 00:21:05.940 --> 00:21:06.900 it, and therefore, we're not NOTE Confidence: 0.9682002 00:21:06.900 --> 00:21:07.859 offering it to you. It's NOTE Confidence: 0.9682002 00:21:07.859 --> 00:21:08.900 it's a very thought through NOTE Confidence: 0.9682002 00:21:08.900 --> 00:21:10.340 decision because at the end NOTE Confidence: 0.9682002 00:21:10.340 --> 00:21:11.380 of the day, the other NOTE Confidence: 0.9682002 00:21:11.380 --> 00:21:13.300 rule about cancer treatment in NOTE Confidence: 0.9682002 00:21:13.300 --> 00:21:14.260 general is we know we're NOTE Confidence: 0.9682002 00:21:14.260 --> 00:21:15.880 dealing with a deadly disease, NOTE Confidence: 0.9682002 00:21:16.100 --> 00:21:17.140 but the rule is do NOTE Confidence: 0.9682002 00:21:17.140 --> 00:21:18.734 no harm first. The last NOTE Confidence: 0.9682002 00:21:18.734 --> 00:21:20.035 thing we wanna do is NOTE Confidence: 0.9682002 00:21:20.175 --> 00:21:21.295 do something that's gonna end NOTE Confidence: 0.9682002 00:21:21.295 --> 00:21:22.494 up shortening life or making NOTE Confidence: 0.9682002 00:21:22.494 --> 00:21:24.175 things worse than we know NOTE Confidence: 0.9682002 00:21:24.175 --> 00:21:25.135 the cancer's bad and we NOTE Confidence: 0.9682002 00:21:25.135 --> 00:21:25.935 know it's gonna do bad NOTE Confidence: 0.9682002 00:21:25.935 --> 00:21:26.895 things. But if we do NOTE Confidence: 0.9682002 00:21:26.895 --> 00:21:28.175 something that makes things worse, NOTE Confidence: 0.9682002 00:21:28.175 --> 00:21:29.135 that's the worst thing to NOTE Confidence: 0.9682002 00:21:29.135 --> 00:21:30.415 do. And so that's a NOTE Confidence: 0.9682002 00:21:30.415 --> 00:21:32.130 very nuanced decision, and it's NOTE Confidence: 0.9682002 00:21:32.130 --> 00:21:33.410 hard in an audience to NOTE Confidence: 0.9682002 00:21:33.410 --> 00:21:35.270 go through specific sort of NOTE Confidence: 0.9728597 00:21:35.890 --> 00:21:37.890 decisions. But it's not something NOTE Confidence: 0.9728597 00:21:37.890 --> 00:21:38.390 we NOTE Confidence: 0.9473315 00:21:38.770 --> 00:21:40.609 just often very flippantly rule NOTE Confidence: 0.9473315 00:21:40.609 --> 00:21:41.410 out and say there's no NOTE Confidence: 0.9473315 00:21:41.410 --> 00:21:42.930 surgery. We we do think NOTE Confidence: 0.9473315 00:21:42.930 --> 00:21:44.145 these things through. And this NOTE Confidence: 0.9473315 00:21:44.145 --> 00:21:45.585 is not just Yale. Most NOTE Confidence: 0.9473315 00:21:45.585 --> 00:21:46.785 groups would think this stuff NOTE Confidence: 0.9473315 00:21:46.785 --> 00:21:48.065 through before we say that NOTE Confidence: 0.9473315 00:21:48.065 --> 00:21:49.665 we're ruling a certain treatment NOTE Confidence: 0.9473315 00:21:49.665 --> 00:21:50.484 option out. NOTE Confidence: 0.9144043 00:21:52.225 --> 00:21:53.765 Other questions for doctor Buffa? NOTE Confidence: 0.9652507 00:21:56.960 --> 00:21:58.800 Well, we heard about radiation, NOTE Confidence: 0.9652507 00:21:58.800 --> 00:21:59.300 and NOTE Confidence: 0.9699707 00:21:59.840 --> 00:22:01.119 while there may be side NOTE Confidence: 0.9699707 00:22:01.119 --> 00:22:02.160 effects from radiation, it's still NOTE Confidence: 0.9699707 00:22:02.160 --> 00:22:03.359 a very, very important part NOTE Confidence: 0.9699707 00:22:03.359 --> 00:22:04.400 and a curative part NOTE Confidence: 0.99053955 00:22:05.200 --> 00:22:06.740 very curative part of, NOTE Confidence: 0.946704 00:22:07.920 --> 00:22:09.359 gastric esophageal cancer treatment. And NOTE Confidence: 0.946704 00:22:09.359 --> 00:22:10.480 with that, I'm gonna invite NOTE Confidence: 0.946704 00:22:10.480 --> 00:22:11.600 doctor Du to give us NOTE Confidence: 0.946704 00:22:11.600 --> 00:22:12.320 a talk. But thank you, NOTE Confidence: 0.946704 00:22:12.320 --> 00:22:13.434 doctor Buffa. Yeah. NOTE Confidence: 0.97635907 00:22:19.255 --> 00:22:20.635 Thank you, doctor Sundar. NOTE Confidence: 0.9987703 00:22:21.015 --> 00:22:21.895 My name is Kevin Du. NOTE Confidence: 0.9987703 00:22:21.895 --> 00:22:23.115 I'm a radiation oncologist NOTE Confidence: 0.9627511 00:22:23.415 --> 00:22:26.155 treating, GI cancers, including esophageal NOTE Confidence: 0.9627511 00:22:26.375 --> 00:22:27.494 cancers. And, NOTE Confidence: 0.9807129 00:22:29.650 --> 00:22:30.869 I oh, thank you. NOTE Confidence: 0.9318034 00:22:31.330 --> 00:22:32.150 I I've been NOTE Confidence: 0.984092 00:22:32.450 --> 00:22:34.130 I I think what I'll NOTE Confidence: 0.984092 00:22:34.210 --> 00:22:35.810 I did I think I'm NOTE Confidence: 0.984092 00:22:35.810 --> 00:22:36.770 one of the few people NOTE Confidence: 0.984092 00:22:36.770 --> 00:22:38.130 maybe to to put together NOTE Confidence: 0.984092 00:22:38.130 --> 00:22:39.490 a slide deck, but I'm NOTE Confidence: 0.984092 00:22:39.490 --> 00:22:40.690 going to try not to NOTE Confidence: 0.984092 00:22:40.690 --> 00:22:42.044 use it too much. And, NOTE Confidence: 0.984092 00:22:42.524 --> 00:22:44.125 I'm realizing as I'm sitting NOTE Confidence: 0.984092 00:22:44.125 --> 00:22:45.024 here in the room, NOTE Confidence: 0.9677469 00:22:45.884 --> 00:22:48.125 surrounded by esophageal cancer patients. NOTE Confidence: 0.9677469 00:22:48.125 --> 00:22:49.004 And, you know, as a NOTE Confidence: 0.9677469 00:22:49.004 --> 00:22:50.684 cancer doctor, I always think NOTE Confidence: 0.9677469 00:22:50.684 --> 00:22:52.605 of that, I learn more NOTE Confidence: 0.9677469 00:22:52.605 --> 00:22:53.424 from my patients, NOTE Confidence: 0.9941406 00:22:53.804 --> 00:22:54.304 actually, NOTE Confidence: 0.9900716 00:22:54.764 --> 00:22:56.470 than than I can teach NOTE Confidence: 0.9900716 00:22:56.470 --> 00:22:56.970 them. NOTE Confidence: 0.9943197 00:22:57.509 --> 00:22:59.590 So, I would actually maybe NOTE Confidence: 0.9943197 00:22:59.590 --> 00:23:00.869 like to start with, the NOTE Confidence: 0.9943197 00:23:00.869 --> 00:23:02.070 comment you made, which I NOTE Confidence: 0.9943197 00:23:02.070 --> 00:23:03.350 think is very important when NOTE Confidence: 0.9943197 00:23:03.350 --> 00:23:04.789 we think about how long NOTE Confidence: 0.9943197 00:23:04.789 --> 00:23:06.809 term wellness after radiation treatment, NOTE Confidence: 0.9486084 00:23:07.269 --> 00:23:09.109 which is that, radiation was NOTE Confidence: 0.9486084 00:23:09.109 --> 00:23:09.609 torture. NOTE Confidence: 0.885791 00:23:10.435 --> 00:23:11.795 You know? And and that's, NOTE Confidence: 0.9394531 00:23:12.195 --> 00:23:12.935 that's very, NOTE Confidence: 0.980127 00:23:13.395 --> 00:23:15.475 that's very important to to NOTE Confidence: 0.980127 00:23:15.475 --> 00:23:16.935 think about and talk about. NOTE Confidence: 0.9723145 00:23:17.315 --> 00:23:18.675 How many patients in this NOTE Confidence: 0.9723145 00:23:18.675 --> 00:23:20.295 room have have had radiation? NOTE Confidence: 0.9614258 00:23:21.155 --> 00:23:22.115 So a good number of NOTE Confidence: 0.9614258 00:23:22.115 --> 00:23:22.615 patients. NOTE Confidence: 0.99438477 00:23:23.955 --> 00:23:24.960 Is there is there pretty NOTE Confidence: 0.99438477 00:23:24.960 --> 00:23:26.320 much agreement that it was NOTE Confidence: 0.99438477 00:23:26.320 --> 00:23:26.640 torture? NOTE Confidence: 0.901062 00:23:28.240 --> 00:23:29.760 Yeah. Okay. Yeah. Yeah. And NOTE Confidence: 0.901062 00:23:29.760 --> 00:23:31.140 still yeah. Yeah. NOTE Confidence: 0.9821167 00:23:32.000 --> 00:23:33.540 So this is where, NOTE Confidence: 0.9808268 00:23:34.480 --> 00:23:35.440 I can talk a little NOTE Confidence: 0.9808268 00:23:35.440 --> 00:23:37.359 bit about radiation, the role NOTE Confidence: 0.9808268 00:23:37.359 --> 00:23:39.460 in treatment of esophageal cancer. NOTE Confidence: 0.9907837 00:23:40.125 --> 00:23:41.805 And, I think it's very NOTE Confidence: 0.9907837 00:23:41.805 --> 00:23:43.244 important to talk about this NOTE Confidence: 0.9907837 00:23:43.244 --> 00:23:44.285 concept that, NOTE Confidence: 0.8938802 00:23:45.805 --> 00:23:47.085 in when we talk about NOTE Confidence: 0.8938802 00:23:47.085 --> 00:23:48.385 first do no harm, NOTE Confidence: 0.9980469 00:23:49.405 --> 00:23:49.905 that NOTE Confidence: 0.97218156 00:23:50.685 --> 00:23:51.645 a lot of our cancer NOTE Confidence: 0.97218156 00:23:51.645 --> 00:23:53.405 treatments can cause harm, and NOTE Confidence: 0.97218156 00:23:53.405 --> 00:23:54.365 we need to help our NOTE Confidence: 0.97218156 00:23:54.365 --> 00:23:55.320 patients with this. NOTE Confidence: 0.9984538 00:23:55.799 --> 00:23:56.679 So the first thing to NOTE Confidence: 0.9984538 00:23:56.679 --> 00:23:58.220 think about is that, NOTE Confidence: 0.96606445 00:23:59.240 --> 00:24:00.119 you know, as you know, NOTE Confidence: 0.96606445 00:24:00.119 --> 00:24:01.980 we think a lot about NOTE Confidence: 0.8872884 00:24:03.080 --> 00:24:05.159 radiation treatment as, I would NOTE Confidence: 0.8872884 00:24:05.159 --> 00:24:05.659 say, NOTE Confidence: 0.9761393 00:24:06.279 --> 00:24:07.820 even though there are significant NOTE Confidence: 0.9761393 00:24:08.039 --> 00:24:09.320 side effects that we do NOTE Confidence: 0.9761393 00:24:09.320 --> 00:24:10.700 think about it as a NOTE Confidence: 0.9886998 00:24:11.025 --> 00:24:12.625 precision treatment and a carefully NOTE Confidence: 0.9886998 00:24:12.625 --> 00:24:13.605 delivered treatment. NOTE Confidence: 0.96069336 00:24:14.145 --> 00:24:14.645 And, NOTE Confidence: 0.99263823 00:24:15.505 --> 00:24:16.785 we use a lot of NOTE Confidence: 0.99263823 00:24:16.785 --> 00:24:17.665 what we learned in the NOTE Confidence: 0.99263823 00:24:17.665 --> 00:24:19.105 past century with, NOTE Confidence: 0.9963379 00:24:19.505 --> 00:24:20.484 physics, biology, NOTE Confidence: 0.9785822 00:24:20.785 --> 00:24:22.545 computer technology to really try NOTE Confidence: 0.9785822 00:24:22.545 --> 00:24:24.299 to separate out the therapeutic NOTE Confidence: 0.9785822 00:24:24.299 --> 00:24:24.799 index, NOTE Confidence: 0.99440694 00:24:25.659 --> 00:24:27.260 that is the side effects NOTE Confidence: 0.99440694 00:24:27.260 --> 00:24:29.119 from the effectiveness of radiation NOTE Confidence: 0.99440694 00:24:29.260 --> 00:24:29.760 treatment. NOTE Confidence: 0.9654338 00:24:30.940 --> 00:24:32.619 This is an example, though, NOTE Confidence: 0.9654338 00:24:32.619 --> 00:24:34.140 of what a radiation treatment NOTE Confidence: 0.9654338 00:24:34.140 --> 00:24:34.880 looks like, NOTE Confidence: 0.9461263 00:24:36.385 --> 00:24:37.665 generated by AI, by the NOTE Confidence: 0.9461263 00:24:37.665 --> 00:24:38.785 way, not not one of NOTE Confidence: 0.9461263 00:24:38.785 --> 00:24:39.445 my patients. NOTE Confidence: 0.9841797 00:24:40.225 --> 00:24:41.345 But you can tell in NOTE Confidence: 0.9841797 00:24:41.345 --> 00:24:42.625 the red colors, and I NOTE Confidence: 0.9841797 00:24:42.625 --> 00:24:43.585 don't know if any of NOTE Confidence: 0.9841797 00:24:43.585 --> 00:24:45.425 your radiation doctors have shown NOTE Confidence: 0.9841797 00:24:45.425 --> 00:24:47.045 you your own radiation plans. NOTE Confidence: 0.99251884 00:24:47.425 --> 00:24:48.645 But, you know, we customize NOTE Confidence: 0.99251884 00:24:48.705 --> 00:24:50.645 these radiation plans based on NOTE Confidence: 0.99251884 00:24:50.830 --> 00:24:52.530 an individual patient's anatomy. NOTE Confidence: 0.9899414 00:24:53.070 --> 00:24:54.430 But you can see that, NOTE Confidence: 0.97436523 00:24:55.550 --> 00:24:56.510 a lot of a lot NOTE Confidence: 0.97436523 00:24:56.510 --> 00:24:56.910 of the, NOTE Confidence: 0.9818217 00:24:58.030 --> 00:24:58.990 a lot of times we're NOTE Confidence: 0.9818217 00:24:58.990 --> 00:25:00.350 treating very large areas of NOTE Confidence: 0.9818217 00:25:00.350 --> 00:25:01.090 the esophagus. NOTE Confidence: 0.9760132 00:25:02.109 --> 00:25:03.890 And, that leads to NOTE Confidence: 0.9735884 00:25:04.205 --> 00:25:05.484 a lot of the, side NOTE Confidence: 0.9735884 00:25:05.484 --> 00:25:07.984 effects during treatment, including sometimes NOTE Confidence: 0.9735884 00:25:08.125 --> 00:25:08.625 hospitalizations NOTE Confidence: 0.74853516 00:25:09.085 --> 00:25:09.585 because, NOTE Confidence: 0.9341634 00:25:09.885 --> 00:25:11.105 of difficulty swallowing, NOTE Confidence: 0.92822266 00:25:12.285 --> 00:25:13.505 and, weight loss. NOTE Confidence: 0.98291016 00:25:14.205 --> 00:25:14.605 And, NOTE Confidence: 0.99262154 00:25:15.165 --> 00:25:16.445 and then in addition, you NOTE Confidence: 0.99262154 00:25:16.445 --> 00:25:17.825 know, we're aiming right NOTE Confidence: 0.9609863 00:25:18.359 --> 00:25:20.119 between the lungs, and we're NOTE Confidence: 0.9609863 00:25:20.119 --> 00:25:22.140 aiming right behind the heart. NOTE Confidence: 0.98498535 00:25:22.680 --> 00:25:23.880 So the heart and lungs NOTE Confidence: 0.98498535 00:25:23.880 --> 00:25:26.059 are very important vital organs. NOTE Confidence: 0.94873047 00:25:26.840 --> 00:25:27.160 And, NOTE Confidence: 0.9995117 00:25:27.960 --> 00:25:29.500 the exposure of radiation NOTE Confidence: 0.99670994 00:25:29.880 --> 00:25:31.320 to these organs is really NOTE Confidence: 0.99670994 00:25:31.320 --> 00:25:32.280 where a lot of the NOTE Confidence: 0.99670994 00:25:32.280 --> 00:25:33.375 side effects come from in NOTE Confidence: 0.99670994 00:25:33.375 --> 00:25:35.315 the long term, from radiation NOTE Confidence: 0.99670994 00:25:35.375 --> 00:25:35.875 treatment. NOTE Confidence: 0.96181643 00:25:36.655 --> 00:25:37.935 The good news is that NOTE Confidence: 0.96181643 00:25:37.935 --> 00:25:39.855 over time, and, I guess, NOTE Confidence: 0.96181643 00:25:39.855 --> 00:25:41.535 I would say that, certainly NOTE Confidence: 0.96181643 00:25:41.535 --> 00:25:42.755 in the last ten years, NOTE Confidence: 0.97436523 00:25:43.215 --> 00:25:45.615 our computer technology has actually NOTE Confidence: 0.97436523 00:25:45.615 --> 00:25:46.115 advanced NOTE Confidence: 0.99850464 00:25:47.119 --> 00:25:49.119 greatly. So the radiation treatment NOTE Confidence: 0.99850464 00:25:49.119 --> 00:25:50.100 that we give NOTE Confidence: 0.99902344 00:25:50.800 --> 00:25:51.300 now NOTE Confidence: 0.976237 00:25:51.600 --> 00:25:53.140 is a lot more precise. NOTE Confidence: 0.976237 00:25:53.359 --> 00:25:53.859 And, NOTE Confidence: 0.99295896 00:25:54.640 --> 00:25:55.840 not only that, but we've NOTE Confidence: 0.99295896 00:25:55.840 --> 00:25:58.240 learned from previous experience to NOTE Confidence: 0.99295896 00:25:58.240 --> 00:25:59.920 really try to reduce the NOTE Confidence: 0.99295896 00:25:59.920 --> 00:26:01.840 dose of radiation exposure to NOTE Confidence: 0.99295896 00:26:01.840 --> 00:26:03.585 the heart, to the lungs, NOTE Confidence: 0.9998915 00:26:04.045 --> 00:26:05.005 in order to try to NOTE Confidence: 0.9998915 00:26:05.005 --> 00:26:06.385 mitigate some of these NOTE Confidence: 0.84472656 00:26:06.685 --> 00:26:07.825 long term issues. NOTE Confidence: 0.63305664 00:26:09.805 --> 00:26:10.305 So, NOTE Confidence: 0.99365234 00:26:11.005 --> 00:26:11.505 ultimately, NOTE Confidence: 0.9991455 00:26:12.445 --> 00:26:13.825 you know, after radiation, NOTE Confidence: 0.99869794 00:26:14.525 --> 00:26:15.645 weight loss is a very NOTE Confidence: 0.99869794 00:26:15.645 --> 00:26:16.145 important NOTE Confidence: 0.9760742 00:26:16.710 --> 00:26:18.230 thing to think about, and, NOTE Confidence: 0.9760742 00:26:18.710 --> 00:26:19.910 I'm really pleased that we NOTE Confidence: 0.9760742 00:26:19.910 --> 00:26:21.910 have our nutritionist here to NOTE Confidence: 0.9760742 00:26:21.910 --> 00:26:23.290 talk to you about this. NOTE Confidence: 0.9832519 00:26:23.669 --> 00:26:25.609 You know, we actually think, NOTE Confidence: 0.99820966 00:26:26.390 --> 00:26:27.850 that early nutritionist NOTE Confidence: 0.98339844 00:26:28.230 --> 00:26:28.730 intervention, NOTE Confidence: 0.98890907 00:26:29.350 --> 00:26:30.630 having a meeting with a NOTE Confidence: 0.98890907 00:26:30.630 --> 00:26:31.690 registered dietitian NOTE Confidence: 0.92944336 00:26:32.605 --> 00:26:33.105 improves, NOTE Confidence: 0.98154294 00:26:33.725 --> 00:26:35.244 how patients get through treatment NOTE Confidence: 0.98154294 00:26:35.244 --> 00:26:37.184 and also survival after treatment. NOTE Confidence: 0.9170619 00:26:37.965 --> 00:26:39.744 Weight loss is associated with NOTE Confidence: 0.9170619 00:26:39.965 --> 00:26:40.865 poor outcomes. NOTE Confidence: 0.9797045 00:26:41.404 --> 00:26:43.105 And so every single patient NOTE Confidence: 0.9797045 00:26:43.325 --> 00:26:44.205 that I see in my NOTE Confidence: 0.9797045 00:26:44.205 --> 00:26:45.885 clinic sees a nutritionist. We NOTE Confidence: 0.9797045 00:26:45.885 --> 00:26:47.085 have a nutritious come to NOTE Confidence: 0.9797045 00:26:47.085 --> 00:26:48.065 our clinic and NOTE Confidence: 0.9861857 00:26:48.440 --> 00:26:49.400 meet with them in our NOTE Confidence: 0.9861857 00:26:49.400 --> 00:26:51.160 clinic rooms, and that's very NOTE Confidence: 0.9861857 00:26:51.160 --> 00:26:52.280 important. And, NOTE Confidence: 0.98547363 00:26:52.680 --> 00:26:53.820 I I would recommend, NOTE Confidence: 0.9858127 00:26:55.080 --> 00:26:56.359 you know, that this is NOTE Confidence: 0.9858127 00:26:56.359 --> 00:26:57.640 an essential part of, NOTE Confidence: 0.9983724 00:26:58.119 --> 00:26:59.340 recovering from radiation. NOTE Confidence: 0.8970703 00:27:00.215 --> 00:27:00.715 Deconditioning, NOTE Confidence: 0.7470703 00:27:01.095 --> 00:27:01.595 fatigue. NOTE Confidence: 0.99820966 00:27:02.295 --> 00:27:03.275 It's been demonstrated NOTE Confidence: 0.9626953 00:27:03.655 --> 00:27:06.395 that, after chemotherapy and radiation, NOTE Confidence: 0.9582723 00:27:06.775 --> 00:27:08.555 patients actually lose muscle mass, NOTE Confidence: 0.9582723 00:27:08.855 --> 00:27:09.355 sarcopenia, NOTE Confidence: 0.9972331 00:27:09.734 --> 00:27:10.635 they call it. NOTE Confidence: 0.9910458 00:27:11.494 --> 00:27:12.535 As you can imagine, if NOTE Confidence: 0.9910458 00:27:12.535 --> 00:27:14.055 you lose muscle mass, you NOTE Confidence: 0.9910458 00:27:14.055 --> 00:27:16.019 get weaker. It's harder to NOTE Confidence: 0.9910458 00:27:16.019 --> 00:27:17.380 get back into shape, harder NOTE Confidence: 0.9910458 00:27:17.380 --> 00:27:18.659 to recover, harder to get NOTE Confidence: 0.9910458 00:27:18.659 --> 00:27:20.019 back to your normal activities NOTE Confidence: 0.9910458 00:27:20.019 --> 00:27:21.240 and your daily routine, NOTE Confidence: 0.99750435 00:27:22.100 --> 00:27:23.619 easier to just feel like NOTE Confidence: 0.99750435 00:27:23.619 --> 00:27:24.840 sitting around all day. NOTE Confidence: 0.97021484 00:27:25.539 --> 00:27:25.940 And, NOTE Confidence: 0.9433594 00:27:26.340 --> 00:27:26.840 so, NOTE Confidence: 0.98966473 00:27:27.220 --> 00:27:28.419 this is something that has NOTE Confidence: 0.98966473 00:27:28.419 --> 00:27:28.919 been NOTE Confidence: 0.9682617 00:27:29.545 --> 00:27:30.365 more and more, NOTE Confidence: 0.99902344 00:27:30.665 --> 00:27:31.165 that NOTE Confidence: 0.89127606 00:27:32.585 --> 00:27:33.565 mild to moderate NOTE Confidence: 0.911155 00:27:34.025 --> 00:27:36.425 exercise, regimented exercise has been NOTE Confidence: 0.911155 00:27:36.425 --> 00:27:37.705 shown to be important in NOTE Confidence: 0.911155 00:27:37.705 --> 00:27:38.205 cancer NOTE Confidence: 0.99121094 00:27:38.505 --> 00:27:39.005 recovery. NOTE Confidence: 0.9747925 00:27:39.545 --> 00:27:40.585 And, the way I talk NOTE Confidence: 0.9747925 00:27:40.585 --> 00:27:41.385 to my patients about it, NOTE Confidence: 0.9747925 00:27:41.385 --> 00:27:42.425 it's really about building up NOTE Confidence: 0.9747925 00:27:42.425 --> 00:27:43.950 muscle mass. You know? Nutrition, NOTE Confidence: 0.9885254 00:27:44.490 --> 00:27:44.990 exercise, NOTE Confidence: 0.9736328 00:27:45.850 --> 00:27:47.290 trying to get back into NOTE Confidence: 0.9736328 00:27:47.290 --> 00:27:48.890 shape after all this, NOTE Confidence: 0.954895 00:27:49.369 --> 00:27:51.130 torture. You know? And, NOTE Confidence: 0.97952706 00:27:51.610 --> 00:27:52.990 and this is very important, NOTE Confidence: 0.97952706 00:27:53.210 --> 00:27:53.950 for recovery. NOTE Confidence: 0.984375 00:27:57.335 --> 00:27:57.835 Something NOTE Confidence: 0.9733887 00:27:58.215 --> 00:27:58.715 which, NOTE Confidence: 0.99016315 00:27:59.575 --> 00:28:00.775 you know, I think is NOTE Confidence: 0.99016315 00:28:00.775 --> 00:28:02.375 very important about what you NOTE Confidence: 0.99016315 00:28:02.375 --> 00:28:03.575 shared, which is that your NOTE Confidence: 0.99016315 00:28:03.575 --> 00:28:04.695 family had and, by the NOTE Confidence: 0.99016315 00:28:04.695 --> 00:28:05.755 way, I'm really sorry NOTE Confidence: 0.9392578 00:28:06.615 --> 00:28:07.815 about what your family has NOTE Confidence: 0.9392578 00:28:07.815 --> 00:28:10.080 gone through. It's it's heartbreaking. NOTE Confidence: 0.96839905 00:28:11.580 --> 00:28:12.859 But one thing which really NOTE Confidence: 0.96839905 00:28:12.859 --> 00:28:14.460 resonated was this idea of NOTE Confidence: 0.96839905 00:28:14.460 --> 00:28:16.220 a, of needing a feeding NOTE Confidence: 0.96839905 00:28:16.220 --> 00:28:16.720 tube NOTE Confidence: 0.6907552 00:28:17.340 --> 00:28:18.240 after a treatment. NOTE Confidence: 0.9674656 00:28:19.580 --> 00:28:21.820 Sometimes after radiation, there can NOTE Confidence: 0.9674656 00:28:21.820 --> 00:28:23.440 be, what are called esophageal NOTE Confidence: 0.9674656 00:28:23.660 --> 00:28:25.335 strictures. So this is something NOTE Confidence: 0.9674656 00:28:25.335 --> 00:28:26.455 that can happen even a NOTE Confidence: 0.9674656 00:28:26.455 --> 00:28:28.135 few months after radiation is NOTE Confidence: 0.9674656 00:28:28.135 --> 00:28:29.575 over, where there can be NOTE Confidence: 0.9674656 00:28:29.575 --> 00:28:31.175 enough scar tissue that the NOTE Confidence: 0.9674656 00:28:31.175 --> 00:28:32.395 esophagus narrows NOTE Confidence: 0.84765625 00:28:32.855 --> 00:28:33.335 and, NOTE Confidence: 0.9676615 00:28:33.815 --> 00:28:35.575 and and constricts and makes NOTE Confidence: 0.9676615 00:28:35.575 --> 00:28:37.355 difficult, swallowing difficult. NOTE Confidence: 0.88549805 00:28:38.799 --> 00:28:39.279 So, NOTE Confidence: 0.9697998 00:28:39.600 --> 00:28:41.440 I would encourage if, folks NOTE Confidence: 0.9697998 00:28:41.440 --> 00:28:43.279 are having difficulty with this, NOTE Confidence: 0.9353977 00:28:43.600 --> 00:28:46.179 that, a speech language pathology NOTE Confidence: 0.9353977 00:28:46.320 --> 00:28:48.019 consultation is very important, NOTE Confidence: 0.9987488 00:28:48.799 --> 00:28:49.919 to try to learn how NOTE Confidence: 0.9987488 00:28:49.919 --> 00:28:51.059 to swallow better. NOTE Confidence: 0.89697266 00:28:51.855 --> 00:28:52.675 And then also, NOTE Confidence: 0.98714775 00:28:53.055 --> 00:28:55.055 we have excellent endoscopists who NOTE Confidence: 0.98714775 00:28:55.055 --> 00:28:55.715 can actually, NOTE Confidence: 0.9756483 00:28:56.255 --> 00:28:57.695 with an endoscopy, go in NOTE Confidence: 0.9756483 00:28:57.695 --> 00:28:58.995 and open up the stricture, NOTE Confidence: 0.9756483 00:28:59.055 --> 00:29:00.435 break up the scar tissue, NOTE Confidence: 0.98335636 00:29:00.815 --> 00:29:01.775 to try to open that NOTE Confidence: 0.98335636 00:29:01.775 --> 00:29:03.395 up and make swallowing easier. NOTE Confidence: 0.98335636 00:29:03.660 --> 00:29:05.580 So that's another, important thing. NOTE Confidence: 0.98335636 00:29:05.580 --> 00:29:06.940 This is probably the the NOTE Confidence: 0.98335636 00:29:06.940 --> 00:29:08.540 most common long term side NOTE Confidence: 0.98335636 00:29:08.540 --> 00:29:10.160 effect of radiation. Actually, NOTE Confidence: 0.9982639 00:29:10.540 --> 00:29:12.060 about five percent of patients NOTE Confidence: 0.9982639 00:29:12.060 --> 00:29:13.440 can can see this. NOTE Confidence: 0.9794573 00:29:14.220 --> 00:29:15.900 And then, the lungs are NOTE Confidence: 0.9794573 00:29:15.900 --> 00:29:16.720 very important. NOTE Confidence: 0.94638294 00:29:17.445 --> 00:29:18.485 You know, as I'm talking NOTE Confidence: 0.94638294 00:29:18.485 --> 00:29:19.684 about, trying to get back NOTE Confidence: 0.94638294 00:29:19.684 --> 00:29:20.825 to physical activity, NOTE Confidence: 0.7850952 00:29:21.445 --> 00:29:23.065 sometimes there can be a NOTE Confidence: 0.7850952 00:29:23.125 --> 00:29:23.865 a a inflammation NOTE Confidence: 1 00:29:24.485 --> 00:29:26.105 of the lungs from radiation NOTE Confidence: 1 00:29:26.245 --> 00:29:26.745 treatment. NOTE Confidence: 0.9885254 00:29:27.284 --> 00:29:28.485 These pictures are actually not NOTE Confidence: 0.9885254 00:29:28.485 --> 00:29:30.645 from esophageal cancer patient. They're NOTE Confidence: 0.9885254 00:29:30.645 --> 00:29:31.845 actually from a lung cancer NOTE Confidence: 0.9885254 00:29:31.845 --> 00:29:32.250 patient. NOTE Confidence: 0.81901044 00:29:33.130 --> 00:29:33.370 I I actually, NOTE Confidence: 0.9864502 00:29:35.210 --> 00:29:36.650 fortunately, I think with how NOTE Confidence: 0.9864502 00:29:36.650 --> 00:29:37.870 we're reducing the NOTE Confidence: 0.98746747 00:29:38.250 --> 00:29:40.170 the, the lung exposure to NOTE Confidence: 0.98746747 00:29:40.170 --> 00:29:40.670 radiation NOTE Confidence: 0.95458984 00:29:41.290 --> 00:29:42.010 these days, NOTE Confidence: 0.99991864 00:29:42.410 --> 00:29:43.850 this is not something that NOTE Confidence: 0.99991864 00:29:43.850 --> 00:29:45.050 I have really seen in NOTE Confidence: 0.99991864 00:29:45.050 --> 00:29:45.710 my patients. NOTE Confidence: 0.99902344 00:29:46.415 --> 00:29:47.635 However, about NOTE Confidence: 0.9541391 00:29:49.215 --> 00:29:50.975 twenty percent of patients may NOTE Confidence: 0.9541391 00:29:50.975 --> 00:29:52.335 have an inflammation of lungs, NOTE Confidence: 0.9541391 00:29:52.335 --> 00:29:53.375 about five percent, NOTE Confidence: 0.99853516 00:29:53.775 --> 00:29:54.515 very severe NOTE Confidence: 0.78564453 00:29:55.215 --> 00:29:55.715 fibrosis NOTE Confidence: 0.9958496 00:29:56.015 --> 00:29:57.135 or scar tissue in the NOTE Confidence: 0.9958496 00:29:57.135 --> 00:29:57.635 lungs. NOTE Confidence: 0.9930013 00:29:59.179 --> 00:30:00.080 If that happens, NOTE Confidence: 0.86083984 00:30:00.539 --> 00:30:02.700 steroids may be needed. And, NOTE Confidence: 0.89375 00:30:03.100 --> 00:30:04.380 I I would say that, NOTE Confidence: 0.9664612 00:30:04.940 --> 00:30:06.700 antioxidant therapy has been shown NOTE Confidence: 0.9664612 00:30:06.700 --> 00:30:08.299 to help to mitigate the NOTE Confidence: 0.9664612 00:30:08.299 --> 00:30:10.000 scar tissue effect with radiation. NOTE Confidence: 0.9664612 00:30:10.140 --> 00:30:10.640 So, NOTE Confidence: 0.9719904 00:30:11.179 --> 00:30:12.559 many times, I may recommend NOTE Confidence: 0.9719904 00:30:12.620 --> 00:30:14.160 for my patients a combination NOTE Confidence: 0.9719904 00:30:14.220 --> 00:30:14.720 of NOTE Confidence: 0.86450195 00:30:15.475 --> 00:30:17.335 of, of medications to help NOTE Confidence: 0.9399763 00:30:18.195 --> 00:30:19.554 improve and soften up the NOTE Confidence: 0.9399763 00:30:19.554 --> 00:30:20.294 scar tissue. NOTE Confidence: 0.8742676 00:30:21.635 --> 00:30:22.294 And then, NOTE Confidence: 0.9963379 00:30:22.595 --> 00:30:23.335 very importantly, NOTE Confidence: 0.9547991 00:30:23.875 --> 00:30:25.794 cardiac toxicity. So we know NOTE Confidence: 0.9547991 00:30:25.794 --> 00:30:26.835 actually that, NOTE Confidence: 0.99921876 00:30:27.235 --> 00:30:29.220 the more radiation the heart NOTE Confidence: 0.9484253 00:30:30.179 --> 00:30:31.860 sees, actually, the the, NOTE Confidence: 0.94124347 00:30:32.419 --> 00:30:33.780 the the poorer the patient NOTE Confidence: 0.94124347 00:30:33.780 --> 00:30:34.280 does. NOTE Confidence: 0.9637402 00:30:34.659 --> 00:30:36.260 And so, again, these days, NOTE Confidence: 0.9637402 00:30:36.260 --> 00:30:37.559 now that we're very cognizant NOTE Confidence: 0.9637402 00:30:37.620 --> 00:30:38.580 of this, we really try NOTE Confidence: 0.9637402 00:30:38.580 --> 00:30:40.520 to reduce the radiation exposure NOTE Confidence: 0.9637402 00:30:40.580 --> 00:30:42.600 to the to the, heart, NOTE Confidence: 0.97946507 00:30:43.700 --> 00:30:46.095 about, one percent serious cardiac NOTE Confidence: 0.97946507 00:30:46.095 --> 00:30:47.535 events in patients after, NOTE Confidence: 0.9926758 00:30:47.935 --> 00:30:49.395 after radiation treatment. NOTE Confidence: 0.93188477 00:30:49.855 --> 00:30:50.095 And, NOTE Confidence: 0.929718 00:30:51.215 --> 00:30:52.975 this is again where, not NOTE Confidence: 0.929718 00:30:52.975 --> 00:30:55.295 just in, treating esophageal cancer, NOTE Confidence: 0.929718 00:30:55.295 --> 00:30:57.295 but across the board, cardio NOTE Confidence: 0.929718 00:30:57.295 --> 00:30:57.795 oncology NOTE Confidence: 0.99139404 00:30:58.300 --> 00:31:00.000 is actually a very important NOTE Confidence: 0.99139404 00:31:00.060 --> 00:31:01.260 thing for any, NOTE Confidence: 0.9820801 00:31:01.660 --> 00:31:03.660 cancer survivor to think about. NOTE Confidence: 0.9820801 00:31:03.660 --> 00:31:05.100 And we have an excellent, NOTE Confidence: 0.8913439 00:31:05.420 --> 00:31:07.740 cardio oncology programs, cardiologists who NOTE Confidence: 0.8913439 00:31:07.740 --> 00:31:08.240 specialize NOTE Confidence: 0.9913737 00:31:08.700 --> 00:31:11.100 in, taking care of cancer NOTE Confidence: 0.9913737 00:31:11.100 --> 00:31:11.600 survivors. NOTE Confidence: 0.95410156 00:31:13.095 --> 00:31:14.775 This is something where, the NOTE Confidence: 0.95410156 00:31:14.775 --> 00:31:16.375 primary effect of radiation is NOTE Confidence: 0.95410156 00:31:16.375 --> 00:31:18.054 really in terms of a NOTE Confidence: 0.95410156 00:31:18.054 --> 00:31:19.495 long term change to the NOTE Confidence: 0.95410156 00:31:19.495 --> 00:31:20.875 blood vessels of the heart, NOTE Confidence: 0.9756775 00:31:21.575 --> 00:31:23.655 similar to how, high blood NOTE Confidence: 0.9756775 00:31:23.655 --> 00:31:24.955 pressure, high cholesterol, NOTE Confidence: 0.99161786 00:31:25.495 --> 00:31:26.775 you know, it can all NOTE Confidence: 0.99161786 00:31:26.775 --> 00:31:28.260 affect the blood vessels of NOTE Confidence: 0.99161786 00:31:28.260 --> 00:31:28.840 the heart. NOTE Confidence: 0.9875488 00:31:29.300 --> 00:31:29.940 And so, NOTE Confidence: 0.9168213 00:31:30.340 --> 00:31:32.200 these are modifiable risk factors. NOTE Confidence: 0.9168213 00:31:32.500 --> 00:31:34.900 And, being as, up on, NOTE Confidence: 0.9562613 00:31:35.460 --> 00:31:37.380 making sure you're exercising, good NOTE Confidence: 0.9562613 00:31:37.380 --> 00:31:39.140 diets, low cholesterol, your blood NOTE Confidence: 0.9562613 00:31:39.140 --> 00:31:40.035 pressure is under NOTE Confidence: 0.9827104 00:31:40.515 --> 00:31:41.795 control. All that is very, NOTE Confidence: 0.9827104 00:31:41.795 --> 00:31:43.875 very important for esophageal cancer NOTE Confidence: 0.9827104 00:31:43.875 --> 00:31:44.375 survivors. NOTE Confidence: 0.9276123 00:31:46.675 --> 00:31:47.795 And then, of course, the NOTE Confidence: 0.9276123 00:31:47.795 --> 00:31:48.295 psychosocial NOTE Confidence: 0.8984375 00:31:49.075 --> 00:31:49.575 burden. NOTE Confidence: 0.96643066 00:31:50.355 --> 00:31:51.015 You know, NOTE Confidence: 0.898291 00:31:51.555 --> 00:31:52.995 I think going back to NOTE Confidence: 0.898291 00:31:52.995 --> 00:31:54.375 this idea of being tortured, NOTE Confidence: 0.9520671 00:31:55.430 --> 00:31:57.270 these are things that folks NOTE Confidence: 0.9520671 00:31:57.270 --> 00:31:58.570 need to recover from. NOTE Confidence: 0.85595703 00:31:58.950 --> 00:31:59.270 And, NOTE Confidence: 0.96407473 00:31:59.990 --> 00:32:02.070 sometimes patients really may need NOTE Confidence: 0.96407473 00:32:02.070 --> 00:32:04.250 help, with recovering from this. NOTE Confidence: 0.96407473 00:32:04.310 --> 00:32:05.430 And, again, that's where we NOTE Confidence: 0.96407473 00:32:05.430 --> 00:32:07.210 have a excellent psycho oncology NOTE Confidence: 0.7182617 00:32:07.670 --> 00:32:08.410 team here, NOTE Confidence: 0.92510986 00:32:08.975 --> 00:32:10.355 folks who can actually, NOTE Confidence: 0.756958 00:32:11.695 --> 00:32:12.335 help with, NOTE Confidence: 0.95406085 00:32:12.735 --> 00:32:14.335 guiding patients toward a better NOTE Confidence: 0.95406085 00:32:14.335 --> 00:32:14.835 recovery. NOTE Confidence: 0.9675293 00:32:15.375 --> 00:32:15.875 And, NOTE Confidence: 0.9475431 00:32:16.335 --> 00:32:17.375 all of you here today NOTE Confidence: 0.9475431 00:32:17.375 --> 00:32:18.655 as well talking about your NOTE Confidence: 0.9475431 00:32:18.655 --> 00:32:19.155 experiences, NOTE Confidence: 0.9338989 00:32:19.775 --> 00:32:21.295 a very important thing, to NOTE Confidence: 0.9338989 00:32:21.295 --> 00:32:22.355 think about afterwards. NOTE Confidence: 0.8796387 00:32:23.700 --> 00:32:24.919 So, ultimately, NOTE Confidence: 0.9574788 00:32:25.620 --> 00:32:26.580 I would say as I'm NOTE Confidence: 0.9574788 00:32:26.580 --> 00:32:27.940 running out of time or NOTE Confidence: 0.9574788 00:32:27.940 --> 00:32:28.760 past time, NOTE Confidence: 0.99902344 00:32:29.539 --> 00:32:30.039 that NOTE Confidence: 0.9343262 00:32:31.140 --> 00:32:32.440 we do think about NOTE Confidence: 0.9428168 00:32:33.220 --> 00:32:34.740 long term follow-up and care NOTE Confidence: 0.9428168 00:32:34.740 --> 00:32:36.179 as being very important in NOTE Confidence: 0.9428168 00:32:36.179 --> 00:32:36.919 my field. NOTE Confidence: 0.96836346 00:32:38.595 --> 00:32:40.915 If you are noticing new NOTE Confidence: 0.96836346 00:32:40.915 --> 00:32:43.235 difficulty swallowing, weight loss, shortness NOTE Confidence: 0.96836346 00:32:43.235 --> 00:32:43.895 of breath, NOTE Confidence: 0.9998372 00:32:44.355 --> 00:32:45.655 chest pain, fatigue, NOTE Confidence: 0.96648973 00:32:46.755 --> 00:32:48.995 emotional distress, you know, these NOTE Confidence: 0.96648973 00:32:48.995 --> 00:32:50.835 are all reasons and things NOTE Confidence: 0.96648973 00:32:50.835 --> 00:32:51.875 that we talk about when NOTE Confidence: 0.96648973 00:32:51.875 --> 00:32:53.309 we see you after the NOTE Confidence: 0.96648973 00:32:53.309 --> 00:32:54.990 treatment. And, we have a NOTE Confidence: 0.96648973 00:32:54.990 --> 00:32:56.510 team here to help. You NOTE Confidence: 0.96648973 00:32:56.510 --> 00:32:57.010 know, NOTE Confidence: 0.97780246 00:32:57.470 --> 00:32:58.590 I'm not an expert in NOTE Confidence: 0.97780246 00:32:58.590 --> 00:32:59.789 all of these things, but NOTE Confidence: 0.97780246 00:32:59.789 --> 00:33:00.990 I know who the experts NOTE Confidence: 0.97780246 00:33:00.990 --> 00:33:03.010 are, and, your doctors NOTE Confidence: 0.9987305 00:33:03.470 --> 00:33:05.090 know who the experts are. NOTE Confidence: 0.9691051 00:33:05.710 --> 00:33:06.669 Make sure you talk to NOTE Confidence: 0.9691051 00:33:06.669 --> 00:33:08.485 your doctors about these things. NOTE Confidence: 0.9691051 00:33:08.485 --> 00:33:10.645 They're very important, and, there NOTE Confidence: 0.9691051 00:33:10.645 --> 00:33:11.605 are things we can do NOTE Confidence: 0.9691051 00:33:11.605 --> 00:33:12.185 to help. NOTE Confidence: 0.9423625 00:33:14.725 --> 00:33:16.965 So, I'll just finish I'll NOTE Confidence: 0.9423625 00:33:16.965 --> 00:33:18.325 I'll actually skip over this NOTE Confidence: 0.9423625 00:33:18.325 --> 00:33:19.145 part, and NOTE Confidence: 0.93098956 00:33:20.700 --> 00:33:22.220 maybe turn this, open it NOTE Confidence: 0.93098956 00:33:22.220 --> 00:33:23.619 up for any comments, NOTE Confidence: 0.9941406 00:33:24.059 --> 00:33:24.559 questions. NOTE Confidence: 0.984375 00:33:24.860 --> 00:33:25.360 Yeah. NOTE Confidence: 0.2401123 00:33:27.260 --> 00:33:27.760 Is NOTE Confidence: 0.97685176 00:33:30.220 --> 00:33:31.440 there any way to distinguish NOTE Confidence: 0.97685176 00:33:31.500 --> 00:33:33.280 whether it's, caused by NOTE Confidence: 0.9271973 00:33:34.105 --> 00:33:35.625 the radiation or the immuno NOTE Confidence: 0.9271973 00:33:35.784 --> 00:33:37.565 Yeah. Yeah. I think, so, NOTE Confidence: 0.9243326 00:33:37.945 --> 00:33:39.644 doctor Yock, as you know, NOTE Confidence: 0.98380536 00:33:39.945 --> 00:33:41.625 I'm I'm very familiar with NOTE Confidence: 0.98380536 00:33:41.625 --> 00:33:43.164 your with your, care. NOTE Confidence: 0.9871826 00:33:44.184 --> 00:33:45.565 This is something where, NOTE Confidence: 0.96691895 00:33:46.985 --> 00:33:48.445 you you had immunotherapy NOTE Confidence: 0.8417969 00:33:49.250 --> 00:33:49.750 after, NOTE Confidence: 0.93652344 00:33:50.130 --> 00:33:51.350 after your surgery. NOTE Confidence: 0.9862584 00:33:51.890 --> 00:33:53.650 And that's actually an important NOTE Confidence: 0.9862584 00:33:53.650 --> 00:33:54.390 part of, NOTE Confidence: 0.98950195 00:33:54.770 --> 00:33:56.130 what doctor Raga was talking NOTE Confidence: 0.98950195 00:33:56.130 --> 00:33:57.510 about in terms of newer, NOTE Confidence: 0.9660034 00:33:57.970 --> 00:33:59.510 more innovative, more effective, NOTE Confidence: 0.999312 00:33:59.970 --> 00:34:01.890 cancer treatments for esophageal cancers NOTE Confidence: 0.999312 00:34:01.890 --> 00:34:03.570 that are shown to improve NOTE Confidence: 0.999312 00:34:03.570 --> 00:34:04.070 outcomes. NOTE Confidence: 0.97580296 00:34:04.610 --> 00:34:06.215 So So immunotherapy by itself NOTE Confidence: 0.97580296 00:34:06.215 --> 00:34:07.434 can also cause pneumonitis. NOTE Confidence: 0.98620605 00:34:07.815 --> 00:34:08.635 And so, NOTE Confidence: 0.99420166 00:34:09.094 --> 00:34:10.315 I would say that, NOTE Confidence: 0.99467075 00:34:10.935 --> 00:34:12.214 you know, when when a NOTE Confidence: 0.99467075 00:34:12.214 --> 00:34:13.734 patient gets pneumonitis that I've NOTE Confidence: 0.99467075 00:34:13.734 --> 00:34:14.775 treated, the first thing that NOTE Confidence: 0.99467075 00:34:14.775 --> 00:34:16.295 the medical oncologist or the NOTE Confidence: 0.99467075 00:34:16.295 --> 00:34:17.700 surgeon does is call me NOTE Confidence: 0.99467075 00:34:17.859 --> 00:34:18.980 and say, does this look NOTE Confidence: 0.99467075 00:34:18.980 --> 00:34:20.280 like radiation pneumonitis? NOTE Confidence: 0.99214363 00:34:21.219 --> 00:34:22.180 The things we look for NOTE Confidence: 0.99214363 00:34:22.180 --> 00:34:24.020 in radiation pneumonitis are really, NOTE Confidence: 0.99214363 00:34:24.339 --> 00:34:25.800 is the inflammation NOTE Confidence: 1 00:34:26.339 --> 00:34:27.400 in our field NOTE Confidence: 0.93151855 00:34:28.020 --> 00:34:28.839 of radiation, NOTE Confidence: 0.99053484 00:34:29.540 --> 00:34:30.900 or is it really distant NOTE Confidence: 0.99053484 00:34:30.900 --> 00:34:32.339 and outside of where we've NOTE Confidence: 0.99053484 00:34:32.339 --> 00:34:33.405 exposed to radiation? NOTE Confidence: 0.97409666 00:34:34.665 --> 00:34:35.705 And, you know, there's all NOTE Confidence: 0.97409666 00:34:35.705 --> 00:34:37.005 these things that we can, NOTE Confidence: 0.91733396 00:34:38.105 --> 00:34:39.625 think about in terms of, NOTE Confidence: 0.99780273 00:34:40.025 --> 00:34:41.565 how focal, how patchy, NOTE Confidence: 0.9625651 00:34:41.865 --> 00:34:43.245 you know, how their inflammation NOTE Confidence: 0.9625651 00:34:43.465 --> 00:34:43.965 tracks, NOTE Confidence: 0.9975586 00:34:44.825 --> 00:34:45.565 and things NOTE Confidence: 0.97875977 00:34:45.865 --> 00:34:47.145 about how the how it NOTE Confidence: 0.97875977 00:34:47.145 --> 00:34:48.719 looks on the CT scan. NOTE Confidence: 0.82714844 00:34:49.200 --> 00:34:49.700 So, NOTE Confidence: 0.9921875 00:34:50.560 --> 00:34:51.060 ultimately, NOTE Confidence: 0.9393921 00:34:51.760 --> 00:34:52.980 I would say that, NOTE Confidence: 0.8895874 00:34:55.760 --> 00:34:57.119 many times as a judgment NOTE Confidence: 0.8895874 00:34:57.119 --> 00:34:58.400 call whether or not it's NOTE Confidence: 0.8895874 00:34:58.400 --> 00:34:59.619 from, immunotherapy NOTE Confidence: 0.9619629 00:35:00.080 --> 00:35:02.180 or drug or from radiation. NOTE Confidence: 0.95700073 00:35:03.635 --> 00:35:04.675 I I think in your NOTE Confidence: 0.95700073 00:35:04.675 --> 00:35:05.795 case, we did think about NOTE Confidence: 0.95700073 00:35:05.795 --> 00:35:06.675 it as more of an NOTE Confidence: 0.95700073 00:35:06.675 --> 00:35:07.175 immunotherapy NOTE Confidence: 0.9995117 00:35:07.875 --> 00:35:08.375 reaction. NOTE Confidence: 0.9786784 00:35:08.915 --> 00:35:10.275 I would say that, this NOTE Confidence: 0.9786784 00:35:10.275 --> 00:35:11.474 is also very important in NOTE Confidence: 0.9786784 00:35:11.474 --> 00:35:12.994 terms of modern radiation and NOTE Confidence: 0.9786784 00:35:12.994 --> 00:35:14.755 how we, reduce the lung NOTE Confidence: 0.9786784 00:35:14.755 --> 00:35:16.140 dose, which is that as NOTE Confidence: 0.9786784 00:35:16.140 --> 00:35:17.660 we start stacking on all NOTE Confidence: 0.9786784 00:35:17.660 --> 00:35:19.440 these treatments that increase inflammation NOTE Confidence: 0.9786784 00:35:19.500 --> 00:35:20.400 like immunotherapy, NOTE Confidence: 0.99768066 00:35:21.579 --> 00:35:23.020 trying to reduce the lung NOTE Confidence: 0.99768066 00:35:23.020 --> 00:35:25.180 exposure to radiation with radiation NOTE Confidence: 0.99768066 00:35:25.180 --> 00:35:26.940 really becomes more important as NOTE Confidence: 0.99768066 00:35:26.940 --> 00:35:27.440 well. NOTE Confidence: 0.89127606 00:35:29.255 --> 00:35:30.235 Any other questions? NOTE Confidence: 0.9698181 00:35:31.415 --> 00:35:32.695 I will add to what NOTE Confidence: 0.9698181 00:35:32.695 --> 00:35:33.735 doctor Du said, NOTE Confidence: 0.95988584 00:35:34.135 --> 00:35:35.835 about this. While we're talking NOTE Confidence: 0.95988584 00:35:35.975 --> 00:35:36.855 a fair bit about the NOTE Confidence: 0.95988584 00:35:36.855 --> 00:35:38.235 side effects and, NOTE Confidence: 0.9968872 00:35:39.495 --> 00:35:40.935 the the complications that we're NOTE Confidence: 0.9968872 00:35:40.935 --> 00:35:42.155 dealing with with NOTE Confidence: 0.8808594 00:35:42.549 --> 00:35:43.690 radiation that NOTE Confidence: 0.8967285 00:35:44.390 --> 00:35:45.769 the reason we subject NOTE Confidence: 0.9752308 00:35:46.150 --> 00:35:47.349 or ask you to be NOTE Confidence: 0.9752308 00:35:47.349 --> 00:35:48.950 subjected to the radiation is NOTE Confidence: 0.9752308 00:35:48.950 --> 00:35:49.450 because, NOTE Confidence: 0.98095703 00:35:50.950 --> 00:35:51.450 if NOTE Confidence: 0.9803409 00:35:51.989 --> 00:35:53.269 it often does one of NOTE Confidence: 0.9803409 00:35:53.269 --> 00:35:54.630 two things. Right? One is NOTE Confidence: 0.9803409 00:35:54.630 --> 00:35:56.315 if you can't get surgery, NOTE Confidence: 0.9803409 00:35:56.535 --> 00:35:58.474 then the only directed treatment NOTE Confidence: 0.9803409 00:35:58.535 --> 00:35:59.895 to the esophagus is gonna NOTE Confidence: 0.9803409 00:35:59.895 --> 00:36:01.035 be radiation. Otherwise, NOTE Confidence: 0.96643454 00:36:01.575 --> 00:36:02.855 all the drugs that medical NOTE Confidence: 0.96643454 00:36:02.855 --> 00:36:04.775 oncologists give, systemic therapies, all NOTE Confidence: 0.96643454 00:36:04.775 --> 00:36:05.895 just go everywhere, and we NOTE Confidence: 0.96643454 00:36:05.895 --> 00:36:06.775 just hope it gets to NOTE Confidence: 0.96643454 00:36:06.775 --> 00:36:08.135 the esophagus. Right? But if NOTE Confidence: 0.96643454 00:36:08.135 --> 00:36:09.094 you wanna really get to NOTE Confidence: 0.96643454 00:36:09.094 --> 00:36:10.454 the esophagus and kill everything NOTE Confidence: 0.96643454 00:36:10.454 --> 00:36:12.300 off there, radiation tends to NOTE Confidence: 0.96643454 00:36:12.300 --> 00:36:13.739 still be one of the NOTE Confidence: 0.96643454 00:36:13.739 --> 00:36:15.420 most important components to the NOTE Confidence: 0.96643454 00:36:15.420 --> 00:36:17.340 treatment there. And therein goes NOTE Confidence: 0.96643454 00:36:17.340 --> 00:36:18.700 back this balance of risks NOTE Confidence: 0.96643454 00:36:18.700 --> 00:36:19.760 and benefits. And NOTE Confidence: 0.98291016 00:36:20.540 --> 00:36:21.420 at least in this sort NOTE Confidence: 0.98291016 00:36:21.420 --> 00:36:23.020 of situation, if surgery is NOTE Confidence: 0.98291016 00:36:23.020 --> 00:36:24.239 not a curative option, NOTE Confidence: 0.979272 00:36:25.075 --> 00:36:27.395 generally speaking, just chemotherapy or NOTE Confidence: 0.979272 00:36:27.395 --> 00:36:28.835 systemic therapy is not a NOTE Confidence: 0.979272 00:36:28.835 --> 00:36:30.035 cure will not cure the NOTE Confidence: 0.979272 00:36:30.035 --> 00:36:31.395 cancer. You kind of need NOTE Confidence: 0.979272 00:36:31.395 --> 00:36:33.155 the radiation in there to NOTE Confidence: 0.979272 00:36:33.155 --> 00:36:34.035 give you that shot of NOTE Confidence: 0.979272 00:36:34.035 --> 00:36:35.315 long term control and cure, NOTE Confidence: 0.979272 00:36:35.315 --> 00:36:36.835 and that's kind of why NOTE Confidence: 0.979272 00:36:36.835 --> 00:36:38.035 we have this balance of NOTE Confidence: 0.979272 00:36:38.035 --> 00:36:39.395 the benefits and risks of NOTE Confidence: 0.979272 00:36:39.395 --> 00:36:39.895 radiation. NOTE Confidence: 0.9499512 00:36:40.380 --> 00:36:42.219 We subject we ask you NOTE Confidence: 0.9499512 00:36:42.219 --> 00:36:43.660 to be subjected to this NOTE Confidence: 0.9499512 00:36:43.660 --> 00:36:44.859 stuff is because of that NOTE Confidence: 0.9499512 00:36:44.859 --> 00:36:45.359 benefit. NOTE Confidence: 0.95986074 00:36:45.739 --> 00:36:47.500 Or the alternative is if NOTE Confidence: 0.95986074 00:36:47.500 --> 00:36:48.539 you're using the chemo and NOTE Confidence: 0.95986074 00:36:48.539 --> 00:36:50.059 radiation to get the tumors NOTE Confidence: 0.95986074 00:36:50.059 --> 00:36:51.200 to get you to surgery, NOTE Confidence: 0.95986074 00:36:51.260 --> 00:36:52.299 which is also a cure. NOTE Confidence: 0.95986074 00:36:52.299 --> 00:36:53.579 So very often, the radiation NOTE Confidence: 0.95986074 00:36:53.579 --> 00:36:54.940 is very much trying to NOTE Confidence: 0.95986074 00:36:54.940 --> 00:36:55.815 get you to that cure NOTE Confidence: 0.95986074 00:36:55.815 --> 00:36:56.775 that we are aiming for, NOTE Confidence: 0.95986074 00:36:56.775 --> 00:36:58.614 and that kinda sets the NOTE Confidence: 0.95986074 00:36:58.614 --> 00:37:00.295 context to why then we NOTE Confidence: 0.95986074 00:37:00.295 --> 00:37:01.175 may still have to deal NOTE Confidence: 0.95986074 00:37:01.175 --> 00:37:02.214 with the side effects from NOTE Confidence: 0.95986074 00:37:02.214 --> 00:37:02.954 it, but NOTE Confidence: 0.9831261 00:37:03.494 --> 00:37:05.175 that that's the background to NOTE Confidence: 0.9831261 00:37:05.175 --> 00:37:06.295 this. Right? Yeah. I think NOTE Confidence: 0.9831261 00:37:06.295 --> 00:37:08.135 that's a very fair point. NOTE Confidence: 0.9831261 00:37:08.375 --> 00:37:09.415 Thank you for coming to NOTE Confidence: 0.9831261 00:37:09.415 --> 00:37:11.355 the defense of radiation, doctor NOTE Confidence: 0.9831261 00:37:11.370 --> 00:37:11.770 Sundar. NOTE Confidence: 0.96337306 00:37:12.810 --> 00:37:14.430 I I think this is NOTE Confidence: 0.96337306 00:37:14.490 --> 00:37:15.690 really interesting. You know, we NOTE Confidence: 0.96337306 00:37:15.690 --> 00:37:17.210 use radiation to help make NOTE Confidence: 0.96337306 00:37:17.210 --> 00:37:19.310 doctor Boffa's surgery more successful NOTE Confidence: 0.96337306 00:37:19.370 --> 00:37:20.830 many times. You know? Sometimes NOTE Confidence: 0.96337306 00:37:21.050 --> 00:37:22.570 if, you're only able to NOTE Confidence: 0.96337306 00:37:22.570 --> 00:37:23.745 get ninety five percent of NOTE Confidence: 0.96337306 00:37:23.745 --> 00:37:25.065 the tumor, as you were NOTE Confidence: 0.96337306 00:37:25.065 --> 00:37:25.805 saying earlier, NOTE Confidence: 0.998291 00:37:26.105 --> 00:37:26.844 with surgery, NOTE Confidence: 0.9998047 00:37:27.385 --> 00:37:28.825 radiation can help convert that NOTE Confidence: 0.9998047 00:37:28.825 --> 00:37:30.425 to a hundred percent. Right? NOTE Confidence: 0.9473758 00:37:30.825 --> 00:37:32.685 Sometimes, if a patient may, NOTE Confidence: 0.9473758 00:37:32.825 --> 00:37:34.265 because of other reasons, not NOTE Confidence: 0.9473758 00:37:34.265 --> 00:37:35.864 be eligible for a big NOTE Confidence: 0.9473758 00:37:35.864 --> 00:37:37.005 thoracic surgery, NOTE Confidence: 0.9585405 00:37:37.830 --> 00:37:39.270 Radiation can be a curative NOTE Confidence: 0.9585405 00:37:39.270 --> 00:37:40.870 treatment just by itself with NOTE Confidence: 0.9585405 00:37:40.870 --> 00:37:41.370 chemotherapy. NOTE Confidence: 0.99645996 00:37:42.470 --> 00:37:43.350 You know, we're not as NOTE Confidence: 0.99645996 00:37:43.350 --> 00:37:44.330 good as surgery. NOTE Confidence: 0.9879761 00:37:44.870 --> 00:37:46.890 The complete response rates with NOTE Confidence: 0.9879761 00:37:46.950 --> 00:37:47.450 chemoradiation NOTE Confidence: 0.9734497 00:37:48.070 --> 00:37:49.510 range from thirty to fifty NOTE Confidence: 0.9734497 00:37:49.510 --> 00:37:50.570 percent of patients. NOTE Confidence: 0.98598635 00:37:51.614 --> 00:37:53.055 Although, for those thirty to NOTE Confidence: 0.98598635 00:37:53.055 --> 00:37:54.175 fifty percent of patients, if NOTE Confidence: 0.98598635 00:37:54.175 --> 00:37:55.395 they have a complete response, NOTE Confidence: 0.9600342 00:37:56.015 --> 00:37:57.135 we may actually be able NOTE Confidence: 0.9600342 00:37:57.135 --> 00:37:58.815 to avoid a a big NOTE Confidence: 0.9600342 00:37:58.815 --> 00:38:00.975 surgery, and, sometimes that actually NOTE Confidence: 0.9600342 00:38:00.975 --> 00:38:02.735 improves patients' quality of life NOTE Confidence: 0.9600342 00:38:02.735 --> 00:38:04.355 to to keep their esophagus. NOTE Confidence: 0.99343693 00:38:05.580 --> 00:38:06.540 You know, that's an active NOTE Confidence: 0.99343693 00:38:06.540 --> 00:38:07.820 area of research in my NOTE Confidence: 0.99343693 00:38:07.820 --> 00:38:09.180 field, which is how can NOTE Confidence: 0.99343693 00:38:09.180 --> 00:38:10.320 we, one, NOTE Confidence: 0.9863933 00:38:10.780 --> 00:38:12.140 as I've been talking about, NOTE Confidence: 0.9863933 00:38:12.140 --> 00:38:14.480 make radiation safer, more tolerable, NOTE Confidence: 0.9556441 00:38:14.940 --> 00:38:16.380 less long term side effects. NOTE Confidence: 0.9556441 00:38:16.380 --> 00:38:17.500 But two, also, how can NOTE Confidence: 0.9556441 00:38:17.500 --> 00:38:18.780 we convert how can we NOTE Confidence: 0.9556441 00:38:18.780 --> 00:38:20.625 get more complete responses, more NOTE Confidence: 0.9556441 00:38:20.625 --> 00:38:21.525 cures with, NOTE Confidence: 0.9493408 00:38:21.985 --> 00:38:23.125 chemotherapy radiation, NOTE Confidence: 0.83813477 00:38:23.425 --> 00:38:23.925 potentially, NOTE Confidence: 0.9862305 00:38:24.305 --> 00:38:25.685 combining it with all the, NOTE Confidence: 0.967951 00:38:25.985 --> 00:38:27.185 new drugs that are coming NOTE Confidence: 0.967951 00:38:27.185 --> 00:38:28.945 out? So these are important NOTE Confidence: 0.967951 00:38:28.945 --> 00:38:29.445 questions, NOTE Confidence: 0.9946167 00:38:29.825 --> 00:38:30.864 and we think about the NOTE Confidence: 0.9946167 00:38:30.864 --> 00:38:33.285 combination of surgery, chemotherapy, radiation, NOTE Confidence: 0.9946167 00:38:33.344 --> 00:38:34.305 and trying to find that NOTE Confidence: 0.9946167 00:38:34.305 --> 00:38:35.880 right balance of side effects. NOTE Confidence: 0.96536535 00:38:37.880 --> 00:38:39.079 Thanks, doctor Lu. That's great. NOTE Confidence: 0.96536535 00:38:39.079 --> 00:38:40.440 Any other questions for doctor NOTE Confidence: 0.96536535 00:38:40.440 --> 00:38:40.940 Lu? NOTE Confidence: 0.9753418 00:38:41.960 --> 00:38:43.160 If not, we'll move on. NOTE Confidence: 0.9753418 00:38:43.160 --> 00:38:44.200 Thank you, doctor Lu. And NOTE Confidence: 0.9753418 00:38:44.200 --> 00:38:45.160 we'll we'll move on to NOTE Confidence: 0.9753418 00:38:45.160 --> 00:38:45.739 the next NOTE Confidence: 0.94357824 00:38:47.319 --> 00:38:48.359 part which we have been NOTE Confidence: 0.94357824 00:38:48.359 --> 00:38:50.085 focusing very bit about and NOTE Confidence: 0.94357824 00:38:50.244 --> 00:38:51.445 which actually will play a NOTE Confidence: 0.94357824 00:38:51.445 --> 00:38:52.645 big role here is actually NOTE Confidence: 0.94357824 00:38:52.645 --> 00:38:54.085 the whole idea that you NOTE Confidence: 0.94357824 00:38:54.085 --> 00:38:55.305 need more than just, NOTE Confidence: 0.92763674 00:38:56.565 --> 00:38:58.085 drugs and surgery to try NOTE Confidence: 0.92763674 00:38:58.085 --> 00:38:59.445 and to fight this cancer. NOTE Confidence: 0.92763674 00:38:59.445 --> 00:39:01.125 And so we're gonna have, NOTE Confidence: 0.961069 00:39:01.925 --> 00:39:04.420 Scott Kapoza from physical physiotherapy NOTE Confidence: 0.961069 00:39:04.560 --> 00:39:05.760 as well as Natalie Smith NOTE Confidence: 0.961069 00:39:05.760 --> 00:39:07.360 from nutrition giving us a NOTE Confidence: 0.961069 00:39:07.360 --> 00:39:08.800 little bit about how we NOTE Confidence: 0.961069 00:39:08.800 --> 00:39:10.239 support our patients through this NOTE Confidence: 0.961069 00:39:10.239 --> 00:39:10.739 journey, NOTE Confidence: 0.99658203 00:39:11.040 --> 00:39:11.940 Scott and Natalie. NOTE Confidence: 0.79174805 00:39:13.760 --> 00:39:14.260 Alright. NOTE Confidence: 0.982666 00:39:17.075 --> 00:39:17.575 Sure. NOTE Confidence: 0.9859064 00:39:19.474 --> 00:39:21.234 Alright. So we also said NOTE Confidence: 0.9859064 00:39:21.234 --> 00:39:22.434 we weren't gonna do a NOTE Confidence: 0.9859064 00:39:22.434 --> 00:39:22.934 PowerPoint, NOTE Confidence: 0.99768066 00:39:23.395 --> 00:39:24.674 but to keep us on NOTE Confidence: 0.99768066 00:39:24.674 --> 00:39:25.895 track, we did. NOTE Confidence: 0.9871732 00:39:27.395 --> 00:39:28.434 To start off, my name NOTE Confidence: 0.9871732 00:39:28.434 --> 00:39:29.635 is Natalie Smith. I'm an NOTE Confidence: 0.9871732 00:39:29.635 --> 00:39:30.855 oncology certified dietitian. NOTE Confidence: 0.9633345 00:39:31.739 --> 00:39:32.880 I've been working in oncology NOTE Confidence: 0.9633345 00:39:33.020 --> 00:39:34.219 for a little over twelve NOTE Confidence: 0.9633345 00:39:34.219 --> 00:39:34.719 years. NOTE Confidence: 0.99139696 00:39:35.500 --> 00:39:36.620 For the first ten years NOTE Confidence: 0.99139696 00:39:36.620 --> 00:39:37.500 of my career, I was NOTE Confidence: 0.99139696 00:39:37.500 --> 00:39:39.420 really managing active treatment patients NOTE Confidence: 0.99139696 00:39:39.420 --> 00:39:40.719 that were going through concurrent NOTE Confidence: 0.99139696 00:39:40.780 --> 00:39:41.280 chemoradiation NOTE Confidence: 0.9970215 00:39:41.660 --> 00:39:42.400 for esophageal, NOTE Confidence: 0.9876302 00:39:43.580 --> 00:39:45.120 colon, breast, ovarian, NOTE Confidence: 0.99741906 00:39:45.935 --> 00:39:46.815 a lot of head and NOTE Confidence: 0.99741906 00:39:46.815 --> 00:39:47.555 neck patients, NOTE Confidence: 0.96293944 00:39:48.175 --> 00:39:49.875 tongue cancer, base of tongue. NOTE Confidence: 0.97509766 00:39:50.494 --> 00:39:52.255 So the experience I've I've NOTE Confidence: 0.97509766 00:39:52.255 --> 00:39:53.375 had really helps me in NOTE Confidence: 0.97509766 00:39:53.375 --> 00:39:54.835 this survivorship realm, NOTE Confidence: 0.98275596 00:39:55.135 --> 00:39:56.255 which we're gonna go into NOTE Confidence: 0.98275596 00:39:56.255 --> 00:39:57.455 the specifics of what we NOTE Confidence: 0.98275596 00:39:57.455 --> 00:39:59.234 do and where we fit, NOTE Confidence: 0.98275596 00:39:59.455 --> 00:40:00.915 in your treatment journey. NOTE Confidence: 0.9880371 00:40:02.219 --> 00:40:02.719 Also, NOTE Confidence: 0.97436523 00:40:03.340 --> 00:40:04.540 really, we me and Scott NOTE Confidence: 0.97436523 00:40:04.540 --> 00:40:05.900 try to educate patients on NOTE Confidence: 0.97436523 00:40:05.900 --> 00:40:07.200 the importance of the credentials NOTE Confidence: 0.97436523 00:40:07.260 --> 00:40:08.860 after our name. So, obviously, NOTE Confidence: 0.97436523 00:40:08.860 --> 00:40:10.880 nowadays, everybody's a nutrition professional NOTE Confidence: 0.97436523 00:40:10.940 --> 00:40:12.780 online. So it's really important NOTE Confidence: 0.97436523 00:40:12.780 --> 00:40:13.980 when you're watching videos, when NOTE Confidence: 0.97436523 00:40:13.980 --> 00:40:15.920 you're getting oncology information, NOTE Confidence: 0.9980469 00:40:16.385 --> 00:40:17.765 especially nutrition information, NOTE Confidence: 0.9498698 00:40:18.065 --> 00:40:19.285 physical therapy information. NOTE Confidence: 0.99890137 00:40:19.585 --> 00:40:20.785 You're getting it from people NOTE Confidence: 0.99890137 00:40:20.785 --> 00:40:22.565 with the right credentials. So NOTE Confidence: 0.99244523 00:40:22.944 --> 00:40:24.944 CSO is that certified specialist NOTE Confidence: 0.99244523 00:40:24.944 --> 00:40:26.244 in oncology for dietitians. NOTE Confidence: 0.9780939 00:40:26.545 --> 00:40:27.585 I think there's twenty of NOTE Confidence: 0.9780939 00:40:27.585 --> 00:40:28.785 us in Connecticut, and twelve NOTE Confidence: 0.9780939 00:40:28.785 --> 00:40:29.820 of us are at Yale. NOTE Confidence: 0.9780939 00:40:30.060 --> 00:40:31.100 So you have a really NOTE Confidence: 0.9780939 00:40:31.100 --> 00:40:31.980 good chance of meeting a NOTE Confidence: 0.9780939 00:40:31.980 --> 00:40:33.739 CSO here. So I'll let NOTE Confidence: 0.9780939 00:40:33.739 --> 00:40:34.880 Scott introduce himself. NOTE Confidence: 0.86067706 00:40:35.500 --> 00:40:36.780 Thanks, Adam. Yeah. I'm I'm NOTE Confidence: 0.86067706 00:40:36.780 --> 00:40:38.080 Scott. Are you on? NOTE Confidence: 0.9993164 00:40:39.180 --> 00:40:40.400 I think I'm on now. NOTE Confidence: 0.95625186 00:40:40.940 --> 00:40:42.300 I'm Scott Capoza. I'm a NOTE Confidence: 0.95625186 00:40:42.300 --> 00:40:43.739 I'm a physical therapist here NOTE Confidence: 0.95625186 00:40:43.739 --> 00:40:44.864 as Natalie said. NOTE Confidence: 0.9635511 00:40:45.505 --> 00:40:47.185 I got my start at NOTE Confidence: 0.9635511 00:40:47.185 --> 00:40:49.185 Smilow in survivorship back when NOTE Confidence: 0.9635511 00:40:49.185 --> 00:40:51.025 the survivorship clinic first opened NOTE Confidence: 0.9635511 00:40:51.025 --> 00:40:52.485 back in two thousand six. NOTE Confidence: 0.9635511 00:40:52.785 --> 00:40:54.625 So the survivorship clinic actually NOTE Confidence: 0.9635511 00:40:54.625 --> 00:40:55.125 predates NOTE Confidence: 0.94679356 00:40:55.744 --> 00:40:57.765 the Smilow Cancer Hospital building. NOTE Confidence: 0.9482422 00:40:58.980 --> 00:41:00.260 And and that's how I NOTE Confidence: 0.9482422 00:41:00.260 --> 00:41:01.719 got my start. And, NOTE Confidence: 0.9963379 00:41:02.580 --> 00:41:04.120 when we started our survivorship NOTE Confidence: 0.9963379 00:41:04.340 --> 00:41:05.620 program back in two thousand NOTE Confidence: 0.9963379 00:41:05.620 --> 00:41:06.120 six, NOTE Confidence: 0.9979655 00:41:06.739 --> 00:41:07.640 it was a multidisciplinary NOTE Confidence: 0.94820464 00:41:08.260 --> 00:41:10.180 approach because we recognized that NOTE Confidence: 0.94820464 00:41:10.180 --> 00:41:11.219 that the needs of cancer NOTE Confidence: 0.94820464 00:41:11.219 --> 00:41:12.520 survivors are complex. NOTE Confidence: 0.9964464 00:41:13.135 --> 00:41:14.415 And so you needed a NOTE Confidence: 0.9964464 00:41:14.415 --> 00:41:14.915 multidisciplinary NOTE Confidence: 1 00:41:15.455 --> 00:41:15.955 approach NOTE Confidence: 0.9906277 00:41:16.415 --> 00:41:18.275 to address the nutritional concerns NOTE Confidence: 0.9906277 00:41:18.415 --> 00:41:20.015 of of cancer survivors, of NOTE Confidence: 0.9906277 00:41:20.015 --> 00:41:20.915 the psychosocial NOTE Confidence: 0.99869794 00:41:21.855 --> 00:41:23.315 concerns of survivors NOTE Confidence: 0.9715712 00:41:23.695 --> 00:41:25.455 as well as the the NOTE Confidence: 0.9715712 00:41:25.455 --> 00:41:27.555 medical concerns of survivors NOTE Confidence: 0.96761066 00:41:27.935 --> 00:41:28.755 and the physical NOTE Confidence: 0.9978841 00:41:29.210 --> 00:41:30.269 aspects of that. NOTE Confidence: 0.99658203 00:41:31.049 --> 00:41:31.789 And so NOTE Confidence: 0.98525393 00:41:32.329 --> 00:41:33.549 so I worked in survivorship NOTE Confidence: 0.95744556 00:41:33.849 --> 00:41:35.529 for for years, and I NOTE Confidence: 0.95744556 00:41:35.529 --> 00:41:36.569 would see these patients and NOTE Confidence: 0.95744556 00:41:36.569 --> 00:41:37.769 I would say, oh, you NOTE Confidence: 0.95744556 00:41:37.769 --> 00:41:39.609 need physical therapy because you NOTE Confidence: 0.95744556 00:41:39.609 --> 00:41:41.390 have neuropathy from your chemotherapy, NOTE Confidence: 0.95744556 00:41:41.529 --> 00:41:42.395 or or you have range NOTE Confidence: 0.95744556 00:41:42.395 --> 00:41:43.495 of motion restrictions NOTE Confidence: 0.9901123 00:41:43.795 --> 00:41:45.415 because of radiation therapy. NOTE Confidence: 0.98915166 00:41:45.795 --> 00:41:46.675 And then we were I NOTE Confidence: 0.98915166 00:41:46.675 --> 00:41:48.035 found that we were referring NOTE Confidence: 0.98915166 00:41:48.035 --> 00:41:49.395 out because we didn't have NOTE Confidence: 0.98915166 00:41:49.395 --> 00:41:51.335 a certified specialist in oncology NOTE Confidence: 0.98915166 00:41:51.475 --> 00:41:52.935 here at Smilo. NOTE Confidence: 0.98165894 00:41:53.235 --> 00:41:54.114 And so I went ahead NOTE Confidence: 0.98165894 00:41:54.114 --> 00:41:55.415 and I got board certification. NOTE Confidence: 0.98165894 00:41:55.555 --> 00:41:56.835 And so as you were NOTE Confidence: 0.98165894 00:41:56.835 --> 00:41:57.335 saying, NOTE Confidence: 0.9996745 00:41:57.660 --> 00:41:58.640 there are currently NOTE Confidence: 0.9683431 00:41:59.020 --> 00:42:00.239 six board certified, NOTE Confidence: 0.9996745 00:42:01.420 --> 00:42:01.920 oncology NOTE Confidence: 0.9841181 00:42:02.460 --> 00:42:03.660 physical therapists in the state NOTE Confidence: 0.9841181 00:42:03.660 --> 00:42:04.780 of Connecticut, and two of NOTE Confidence: 0.9841181 00:42:04.780 --> 00:42:06.559 them are here at Smilo. NOTE Confidence: 0.9841181 00:42:06.619 --> 00:42:08.140 So, again, I feel like NOTE Confidence: 0.9841181 00:42:08.140 --> 00:42:08.940 we do a pretty good NOTE Confidence: 0.9841181 00:42:08.940 --> 00:42:10.480 job of having highly qualified NOTE Confidence: 0.9841181 00:42:10.700 --> 00:42:11.599 people here. NOTE Confidence: 0.948673 00:42:14.565 --> 00:42:15.605 But what what we wanna NOTE Confidence: 0.948673 00:42:15.765 --> 00:42:16.725 where we wanna start and, NOTE Confidence: 0.948673 00:42:16.725 --> 00:42:18.485 actually, again, doctor Du, wherever NOTE Confidence: 0.948673 00:42:18.485 --> 00:42:19.145 you want. NOTE Confidence: 0.99853516 00:42:19.445 --> 00:42:20.325 Thank you so much for NOTE Confidence: 0.99853516 00:42:20.325 --> 00:42:21.225 laying the groundwork NOTE Confidence: 0.9694336 00:42:21.525 --> 00:42:22.645 for all the work that NOTE Confidence: 0.9694336 00:42:22.645 --> 00:42:24.325 that Natalie and I and NOTE Confidence: 0.9694336 00:42:24.325 --> 00:42:25.785 and our social work colleagues, NOTE Confidence: 0.98695594 00:42:26.325 --> 00:42:28.160 do, as far as what NOTE Confidence: 0.98695594 00:42:28.160 --> 00:42:28.800 we do, NOTE Confidence: 0.99399036 00:42:29.120 --> 00:42:30.800 to help our patients, you NOTE Confidence: 0.99399036 00:42:30.800 --> 00:42:32.980 know, after surgery, after chemotherapy, NOTE Confidence: 0.99399036 00:42:33.200 --> 00:42:34.660 after radiation therapy. NOTE Confidence: 0.9728516 00:42:35.840 --> 00:42:37.540 But I think it is, NOTE Confidence: 0.9449917 00:42:38.400 --> 00:42:40.239 important to, you know, first NOTE Confidence: 0.9449917 00:42:40.239 --> 00:42:41.760 talk about actually, if we NOTE Confidence: 0.9449917 00:42:41.760 --> 00:42:43.585 can go, yeah, of what NOTE Confidence: 0.9449917 00:42:43.585 --> 00:42:44.325 is survivorship. NOTE Confidence: 0.97279096 00:42:45.745 --> 00:42:46.945 And because you might be NOTE Confidence: 0.97279096 00:42:46.945 --> 00:42:47.985 wondering, well, what does that NOTE Confidence: 0.97279096 00:42:47.985 --> 00:42:50.465 even mean? And, really, you NOTE Confidence: 0.97279096 00:42:50.465 --> 00:42:51.505 know, we like to go NOTE Confidence: 0.97279096 00:42:51.505 --> 00:42:52.545 by this definition from the NOTE Confidence: 0.97279096 00:42:52.545 --> 00:42:54.325 Nasdaq National Cancer Institute, NOTE Confidence: 0.9982422 00:42:55.029 --> 00:42:56.150 which talks about the health NOTE Confidence: 0.9982422 00:42:56.150 --> 00:42:57.609 and well-being of a person, NOTE Confidence: 0.9934082 00:42:58.230 --> 00:42:59.670 with cancer from the time NOTE Confidence: 0.9934082 00:42:59.670 --> 00:43:01.109 of diagnosis to the end NOTE Confidence: 0.9934082 00:43:01.109 --> 00:43:02.549 of their life. And this NOTE Confidence: 0.9934082 00:43:02.549 --> 00:43:03.049 includes NOTE Confidence: 0.9980469 00:43:03.430 --> 00:43:04.569 the physical aspects, NOTE Confidence: 0.99902344 00:43:05.509 --> 00:43:06.250 the mental NOTE Confidence: 0.9995117 00:43:06.630 --> 00:43:07.130 aspects, NOTE Confidence: 1 00:43:07.704 --> 00:43:08.444 the emotional, NOTE Confidence: 0.9913009 00:43:09.305 --> 00:43:10.825 the social, and we could NOTE Confidence: 0.9913009 00:43:10.825 --> 00:43:11.625 probably have a whole another NOTE Confidence: 0.9913009 00:43:11.625 --> 00:43:12.984 talk about the financial concerns NOTE Confidence: 0.9913009 00:43:12.984 --> 00:43:13.964 at the same time. NOTE Confidence: 0.99658203 00:43:14.825 --> 00:43:16.765 But knowing that survivorship NOTE Confidence: 0.9645299 00:43:17.145 --> 00:43:18.425 is through the balance of NOTE Confidence: 0.9645299 00:43:18.425 --> 00:43:20.265 this patient's of everybody's life NOTE Confidence: 0.9645299 00:43:20.265 --> 00:43:21.565 is really, really important. NOTE Confidence: 0.98620605 00:43:21.890 --> 00:43:23.810 And, again, it's not just NOTE Confidence: 0.98620605 00:43:23.810 --> 00:43:24.310 one NOTE Confidence: 0.99088544 00:43:24.850 --> 00:43:26.290 thing, and it is very NOTE Confidence: 0.99088544 00:43:26.290 --> 00:43:26.790 unique. NOTE Confidence: 0.98999023 00:43:27.170 --> 00:43:29.090 Everybody's survivorship needs are unique NOTE Confidence: 0.98999023 00:43:29.090 --> 00:43:30.450 to the person. And so NOTE Confidence: 0.98999023 00:43:30.450 --> 00:43:31.170 that's one of the things NOTE Confidence: 0.98999023 00:43:31.170 --> 00:43:32.370 that Natalie and I say NOTE Confidence: 0.98999023 00:43:32.370 --> 00:43:33.330 so often is that we NOTE Confidence: 0.98999023 00:43:33.330 --> 00:43:34.610 try to meet our patients NOTE Confidence: 0.98999023 00:43:34.610 --> 00:43:35.590 where they're at. NOTE Confidence: 0.9547119 00:43:36.290 --> 00:43:36.950 And, again, NOTE Confidence: 0.9921124 00:43:37.385 --> 00:43:38.344 you know, you might even NOTE Confidence: 0.9921124 00:43:38.344 --> 00:43:40.265 be wondering, you know, who's NOTE Confidence: 0.9921124 00:43:40.265 --> 00:43:41.325 a cancer survivor? NOTE Confidence: 0.9783796 00:43:42.265 --> 00:43:43.065 I can't tell you the NOTE Confidence: 0.9783796 00:43:43.065 --> 00:43:44.025 number of patients that I NOTE Confidence: 0.9783796 00:43:44.025 --> 00:43:44.905 work with who are still NOTE Confidence: 0.9783796 00:43:44.905 --> 00:43:46.585 in after treatment. They're still NOTE Confidence: 0.9783796 00:43:46.585 --> 00:43:48.184 getting chemotherapy or they're still NOTE Confidence: 0.9783796 00:43:48.184 --> 00:43:50.105 in radiation therapy, and they NOTE Confidence: 0.9783796 00:43:50.105 --> 00:43:51.325 say, am I a survivor? NOTE Confidence: 0.9937744 00:43:52.070 --> 00:43:53.210 I'm still in treatment. NOTE Confidence: 0.99118876 00:43:54.950 --> 00:43:56.710 And, again, I like this NOTE Confidence: 0.99118876 00:43:56.710 --> 00:43:58.550 definition from the National Cancer NOTE Confidence: 0.99118876 00:43:58.550 --> 00:43:59.050 Institute NOTE Confidence: 0.99658203 00:43:59.670 --> 00:44:00.410 that says NOTE Confidence: 0.9409877 00:44:00.950 --> 00:44:02.869 anybody diagnosed with cancer from NOTE Confidence: 0.9409877 00:44:02.869 --> 00:44:03.530 the moment NOTE Confidence: 1 00:44:04.614 --> 00:44:05.355 of diagnosis NOTE Confidence: 0.9947917 00:44:05.655 --> 00:44:06.535 and through the balance of NOTE Confidence: 0.9947917 00:44:06.535 --> 00:44:07.515 his or her life NOTE Confidence: 0.97857666 00:44:07.895 --> 00:44:09.114 is a cancer survivor. NOTE Confidence: 0.99990237 00:44:10.055 --> 00:44:11.495 And the way that I NOTE Confidence: 0.99990237 00:44:11.495 --> 00:44:13.035 like to frame this is NOTE Confidence: 0.8604492 00:44:14.135 --> 00:44:15.594 you gotta survive the words NOTE Confidence: 0.8015137 00:44:16.535 --> 00:44:17.435 you have cancer NOTE Confidence: 0.9899089 00:44:18.069 --> 00:44:18.890 pointed at you. NOTE Confidence: 0.97387695 00:44:19.510 --> 00:44:21.190 So from that moment on, NOTE Confidence: 0.97387695 00:44:21.190 --> 00:44:22.250 you're a survivor. NOTE Confidence: 0.9965376 00:44:22.710 --> 00:44:23.430 But I think for the NOTE Confidence: 0.9965376 00:44:23.430 --> 00:44:25.030 context of our conversation this NOTE Confidence: 0.9965376 00:44:25.030 --> 00:44:25.530 evening, NOTE Confidence: 0.99560547 00:44:26.069 --> 00:44:26.809 we're gonna NOTE Confidence: 0.9970703 00:44:27.190 --> 00:44:28.410 refer to survivorship NOTE Confidence: 1 00:44:28.950 --> 00:44:29.609 in the NOTE Confidence: 0.93721515 00:44:30.069 --> 00:44:32.809 post active treatment phase, so NOTE Confidence: 0.93721515 00:44:32.869 --> 00:44:33.369 post NOTE Confidence: 0.9995117 00:44:33.864 --> 00:44:34.364 surgery, NOTE Confidence: 0.9895223 00:44:34.985 --> 00:44:37.165 post chemotherapy, and post radiation NOTE Confidence: 0.9895223 00:44:37.305 --> 00:44:38.505 as far as the the NOTE Confidence: 0.9895223 00:44:38.505 --> 00:44:39.325 what's next. NOTE Confidence: 0.98579836 00:44:40.025 --> 00:44:41.225 I think it too. Scott NOTE Confidence: 0.98579836 00:44:41.225 --> 00:44:42.344 and I always laugh because NOTE Confidence: 0.98579836 00:44:42.344 --> 00:44:43.545 every clinic we run because NOTE Confidence: 0.98579836 00:44:43.545 --> 00:44:45.305 we see patients every Wednesday NOTE Confidence: 0.98579836 00:44:45.305 --> 00:44:46.265 for a full day clinic, NOTE Confidence: 0.98579836 00:44:46.265 --> 00:44:47.385 and we kind of rotate NOTE Confidence: 0.98579836 00:44:47.385 --> 00:44:48.505 around to the different cancer NOTE Confidence: 0.98579836 00:44:48.505 --> 00:44:49.930 centers. And the number of NOTE Confidence: 0.98579836 00:44:49.930 --> 00:44:51.050 patients that look at us NOTE Confidence: 0.98579836 00:44:51.050 --> 00:44:51.930 and look like they need NOTE Confidence: 0.98579836 00:44:51.930 --> 00:44:52.969 to leave because they're like, NOTE Confidence: 0.98579836 00:44:52.969 --> 00:44:53.770 I don't think I belong NOTE Confidence: 0.98579836 00:44:53.770 --> 00:44:55.290 here. They always start the NOTE Confidence: 0.98579836 00:44:55.290 --> 00:44:56.730 visit saying, I don't think NOTE Confidence: 0.98579836 00:44:56.730 --> 00:44:57.930 I belong here. I don't NOTE Confidence: 0.98579836 00:44:57.930 --> 00:44:59.290 know what this is. But NOTE Confidence: 0.98579836 00:44:59.450 --> 00:45:00.489 and at the end, they NOTE Confidence: 0.98579836 00:45:00.489 --> 00:45:01.785 say, I am so glad NOTE Confidence: 0.98579836 00:45:01.785 --> 00:45:03.224 I came. Like, thank you NOTE Confidence: 0.98579836 00:45:03.224 --> 00:45:04.444 so much for this conversation. NOTE Confidence: 0.98257035 00:45:05.065 --> 00:45:07.244 We round robin. So myself, NOTE Confidence: 0.98257035 00:45:07.305 --> 00:45:08.185 I meet with the patient NOTE Confidence: 0.98257035 00:45:08.185 --> 00:45:09.385 for thirty minutes. Scott meets NOTE Confidence: 0.98257035 00:45:09.385 --> 00:45:10.425 with them for thirty minutes, NOTE Confidence: 0.98257035 00:45:10.425 --> 00:45:11.545 the social worker for thirty NOTE Confidence: 0.98257035 00:45:11.545 --> 00:45:12.825 minutes, the APRN for thirty NOTE Confidence: 0.98257035 00:45:12.825 --> 00:45:14.025 minutes. So it's a long NOTE Confidence: 0.98257035 00:45:14.025 --> 00:45:16.270 visit, but they feel, like, NOTE Confidence: 0.96173966 00:45:16.650 --> 00:45:18.010 lighter. They feel like they NOTE Confidence: 0.96173966 00:45:18.010 --> 00:45:19.369 were heard. We're really like NOTE Confidence: 0.96173966 00:45:19.369 --> 00:45:20.989 a therapeutic listening clinic. NOTE Confidence: 0.9575698 00:45:21.849 --> 00:45:23.290 But it's so interesting because NOTE Confidence: 0.9575698 00:45:23.290 --> 00:45:24.329 everybody sits down there like, NOTE Confidence: 0.9575698 00:45:24.329 --> 00:45:25.050 I don't really think I NOTE Confidence: 0.9575698 00:45:25.050 --> 00:45:25.770 should be here. I'm like, NOTE Confidence: 0.9575698 00:45:25.770 --> 00:45:26.410 no. No. No. No. I NOTE Confidence: 0.9575698 00:45:26.410 --> 00:45:27.530 think you should be. So NOTE Confidence: 0.9575698 00:45:27.530 --> 00:45:28.430 we'll get to it. NOTE Confidence: 0.99316406 00:45:29.645 --> 00:45:30.145 And, NOTE Confidence: 0.98151505 00:45:31.244 --> 00:45:32.525 and so, again, when we NOTE Confidence: 0.98151505 00:45:32.525 --> 00:45:33.185 talk about NOTE Confidence: 0.97772217 00:45:33.565 --> 00:45:35.585 survivorship and, you know, NOTE Confidence: 0.9845215 00:45:36.125 --> 00:45:37.825 not just us as providers, NOTE Confidence: 0.9845215 00:45:37.885 --> 00:45:39.825 but as the loved ones NOTE Confidence: 0.99731445 00:45:40.285 --> 00:45:41.825 of survivors, the friends NOTE Confidence: 0.9178467 00:45:42.210 --> 00:45:42.950 of survivors. NOTE Confidence: 0.9387207 00:45:43.330 --> 00:45:44.530 You know, so often, you NOTE Confidence: 0.9387207 00:45:44.530 --> 00:45:46.130 might ask your person, how NOTE Confidence: 0.9387207 00:45:46.130 --> 00:45:47.109 are you doing? And NOTE Confidence: 0.9836426 00:45:47.969 --> 00:45:49.410 as a survivor, the survivor NOTE Confidence: 0.9836426 00:45:49.410 --> 00:45:50.530 might say, oh, I'm doing NOTE Confidence: 0.9836426 00:45:50.530 --> 00:45:51.030 okay. NOTE Confidence: 0.99636006 00:45:51.969 --> 00:45:52.930 But we know that that's NOTE Confidence: 0.99636006 00:45:52.930 --> 00:45:53.890 only the tip of the NOTE Confidence: 0.99636006 00:45:53.890 --> 00:45:54.390 iceberg. NOTE Confidence: 0.9943685 00:45:55.155 --> 00:45:56.275 We know that there's so NOTE Confidence: 0.9943685 00:45:56.275 --> 00:45:57.715 much more that's going on NOTE Confidence: 0.9943685 00:45:57.715 --> 00:45:59.175 under the level of water. NOTE Confidence: 0.99658203 00:46:00.435 --> 00:46:01.175 And so NOTE Confidence: 0.9985645 00:46:01.475 --> 00:46:02.835 we're not gonna get into NOTE Confidence: 0.9985645 00:46:02.835 --> 00:46:04.675 all of these concerns tonight. NOTE Confidence: 0.9985645 00:46:04.675 --> 00:46:06.195 We're really gonna focus just NOTE Confidence: 0.9985645 00:46:06.195 --> 00:46:08.135 on two aspects of survivorship NOTE Confidence: 0.9985645 00:46:08.275 --> 00:46:09.735 that we see so commonly NOTE Confidence: 0.9643809 00:46:10.100 --> 00:46:12.020 in our clinic and that NOTE Confidence: 0.9643809 00:46:12.020 --> 00:46:14.420 we as, as oncology specialists NOTE Confidence: 0.9643809 00:46:14.420 --> 00:46:15.940 within our our scope of NOTE Confidence: 0.9643809 00:46:15.940 --> 00:46:16.440 practice, NOTE Confidence: 0.9864032 00:46:17.380 --> 00:46:19.300 we'd we address. So we're NOTE Confidence: 0.9864032 00:46:19.300 --> 00:46:21.780 gonna focus mostly tonight on NOTE Confidence: 0.9864032 00:46:21.780 --> 00:46:22.680 fear of recurrence NOTE Confidence: 0.94873047 00:46:23.140 --> 00:46:23.800 and fatigue. NOTE Confidence: 0.99625653 00:46:24.260 --> 00:46:25.885 But, again, these are some NOTE Confidence: 0.99625653 00:46:25.885 --> 00:46:26.385 other, NOTE Confidence: 0.99986047 00:46:26.844 --> 00:46:29.005 you know, common concerns that NOTE Confidence: 0.99986047 00:46:29.005 --> 00:46:29.744 we hear NOTE Confidence: 0.97248787 00:46:30.045 --> 00:46:31.244 from our folks that we NOTE Confidence: 0.97248787 00:46:31.244 --> 00:46:32.605 see in survivorship, and I NOTE Confidence: 0.97248787 00:46:32.605 --> 00:46:33.885 think the survivors that are NOTE Confidence: 0.97248787 00:46:33.885 --> 00:46:34.844 in this room could probably NOTE Confidence: 0.97248787 00:46:34.924 --> 00:46:35.964 are probably all nodding your NOTE Confidence: 0.97248787 00:46:35.964 --> 00:46:37.424 head and saying, yes. NOTE Confidence: 0.9770738 00:46:38.260 --> 00:46:39.380 Probably have all experienced that NOTE Confidence: 0.9770738 00:46:39.380 --> 00:46:40.600 at one point or another. NOTE Confidence: 0.9770738 00:46:40.660 --> 00:46:42.100 Mhmm. And we usually start NOTE Confidence: 0.9770738 00:46:42.100 --> 00:46:43.220 the visit by saying, well, NOTE Confidence: 0.9770738 00:46:43.220 --> 00:46:44.660 how are you doing? And NOTE Confidence: 0.9770738 00:46:44.660 --> 00:46:45.780 I would say fifty percent NOTE Confidence: 0.9770738 00:46:45.780 --> 00:46:46.900 of people probably tear up NOTE Confidence: 0.9770738 00:46:46.900 --> 00:46:48.600 in that question. Right? Because NOTE Confidence: 0.9770738 00:46:48.660 --> 00:46:49.860 you're just on this treadmill NOTE Confidence: 0.9770738 00:46:49.860 --> 00:46:51.060 of treatment. Right? Like, you NOTE Confidence: 0.9770738 00:46:51.060 --> 00:46:51.880 get the diagnosis. NOTE Confidence: 0.982666 00:46:52.515 --> 00:46:53.555 You start you go to NOTE Confidence: 0.982666 00:46:53.555 --> 00:46:54.055 surgery, NOTE Confidence: 0.7833659 00:46:54.355 --> 00:46:55.974 maybe radiation, chemo. NOTE Confidence: 0.9744237 00:46:56.275 --> 00:46:57.075 You come up for a NOTE Confidence: 0.9744237 00:46:57.075 --> 00:46:58.674 breath. Right? And then you NOTE Confidence: 0.9744237 00:46:58.674 --> 00:46:59.795 you see us in clinic, NOTE Confidence: 0.9744237 00:46:59.795 --> 00:47:01.154 and we say, well, how NOTE Confidence: 0.9744237 00:47:01.154 --> 00:47:02.355 are you doing? And, you NOTE Confidence: 0.9744237 00:47:02.355 --> 00:47:03.555 know, and the caregiver might NOTE Confidence: 0.9744237 00:47:03.555 --> 00:47:04.295 get tearful. NOTE Confidence: 0.9835254 00:47:04.835 --> 00:47:06.270 We're not asking about the NOTE Confidence: 0.9835254 00:47:06.270 --> 00:47:08.190 cancer or right. We're asking, NOTE Confidence: 0.9835254 00:47:08.190 --> 00:47:09.310 how are you doing emotionally? NOTE Confidence: 0.9835254 00:47:09.310 --> 00:47:10.350 How are you doing physically? NOTE Confidence: 0.9835254 00:47:10.350 --> 00:47:11.489 How are you doing nutritionally? NOTE Confidence: 0.98476774 00:47:11.870 --> 00:47:12.670 And that brings out a NOTE Confidence: 0.98476774 00:47:12.670 --> 00:47:13.469 lot of emotion. And I NOTE Confidence: 0.98476774 00:47:13.469 --> 00:47:14.270 think that's what we love NOTE Confidence: 0.98476774 00:47:14.270 --> 00:47:15.150 about the clinic is it's NOTE Confidence: 0.98476774 00:47:15.150 --> 00:47:15.969 such a real NOTE Confidence: 0.98890907 00:47:16.350 --> 00:47:17.790 face to face. Like, it's NOTE Confidence: 0.98890907 00:47:17.790 --> 00:47:19.469 a caring clinic that you NOTE Confidence: 0.98890907 00:47:19.469 --> 00:47:20.430 feel like you can land NOTE Confidence: 0.98890907 00:47:20.430 --> 00:47:21.550 in kind of an uncertain NOTE Confidence: 0.98890907 00:47:21.550 --> 00:47:22.005 time. NOTE Confidence: 0.97627515 00:47:23.525 --> 00:47:25.045 So I love that, like, NOTE Confidence: 0.97627515 00:47:25.045 --> 00:47:26.404 you guys got the doctor NOTE Confidence: 0.97627515 00:47:26.404 --> 00:47:28.404 Boffa's perspective with the surgery, NOTE Confidence: 0.97627515 00:47:28.404 --> 00:47:29.525 you know, the visual of, NOTE Confidence: 0.97627515 00:47:29.525 --> 00:47:30.565 like, you know, taking part NOTE Confidence: 0.97627515 00:47:30.565 --> 00:47:31.944 of the stomach, the esophagus, NOTE Confidence: 0.97627515 00:47:32.005 --> 00:47:33.285 pulling that up, right, using NOTE Confidence: 0.97627515 00:47:33.285 --> 00:47:35.440 the plumbing. So we I NOTE Confidence: 0.97627515 00:47:35.440 --> 00:47:37.620 kinda break survivorship for nutrition NOTE Confidence: 0.97627515 00:47:37.680 --> 00:47:38.500 and for PT NOTE Confidence: 0.9961286 00:47:38.800 --> 00:47:40.160 into, like, acute and long NOTE Confidence: 0.9961286 00:47:40.160 --> 00:47:40.980 term survivorship NOTE Confidence: 0.9266881 00:47:41.280 --> 00:47:42.560 con you know, concerns or NOTE Confidence: 0.9266881 00:47:42.560 --> 00:47:43.700 conditions. So NOTE Confidence: 0.967334 00:47:44.160 --> 00:47:45.940 the acute phase is really, NOTE Confidence: 0.9720023 00:47:46.239 --> 00:47:47.360 okay. What are these short NOTE Confidence: 0.9720023 00:47:47.360 --> 00:47:49.614 term concerns that patients typically NOTE Confidence: 0.9720023 00:47:49.675 --> 00:47:51.035 have? And I listed out NOTE Confidence: 0.9720023 00:47:51.035 --> 00:47:53.114 kind of very common things NOTE Confidence: 0.9720023 00:47:53.114 --> 00:47:54.635 that I see very often NOTE Confidence: 0.9720023 00:47:54.635 --> 00:47:55.455 in the gastroesophageal, NOTE Confidence: 1 00:47:57.035 --> 00:47:57.535 population. NOTE Confidence: 0.98860675 00:47:58.234 --> 00:47:59.775 So, obviously, when NOTE Confidence: 0.98183095 00:48:00.090 --> 00:48:02.250 anatomy changes, right, things are NOTE Confidence: 0.98183095 00:48:02.250 --> 00:48:05.290 removed, shortened, lengthened, stretched, whatever NOTE Confidence: 0.98183095 00:48:05.290 --> 00:48:07.370 we're doing, right, you're probably NOTE Confidence: 0.98183095 00:48:07.370 --> 00:48:08.090 not gonna be able to NOTE Confidence: 0.98183095 00:48:08.090 --> 00:48:09.450 eat the same way after NOTE Confidence: 0.98183095 00:48:09.450 --> 00:48:11.150 that you did before. So NOTE Confidence: 0.98183095 00:48:11.370 --> 00:48:12.330 if you're eating like my NOTE Confidence: 0.98183095 00:48:12.330 --> 00:48:13.950 husband who used to bartend NOTE Confidence: 0.98183095 00:48:14.010 --> 00:48:15.370 and he takes two minutes NOTE Confidence: 0.98183095 00:48:15.370 --> 00:48:16.224 to eat his full dinner, NOTE Confidence: 0.98183095 00:48:16.224 --> 00:48:18.145 you know, you have to NOTE Confidence: 0.98183095 00:48:18.145 --> 00:48:19.984 then slow down, chew your NOTE Confidence: 0.98183095 00:48:19.984 --> 00:48:21.185 food. Right? You might have NOTE Confidence: 0.98183095 00:48:21.185 --> 00:48:22.325 to modify the texture. NOTE Confidence: 0.9935397 00:48:23.105 --> 00:48:24.805 There's something called dumping syndrome NOTE Confidence: 0.9935397 00:48:24.864 --> 00:48:26.065 that I think a lot NOTE Confidence: 0.9935397 00:48:26.065 --> 00:48:27.204 of patients aren't NOTE Confidence: 0.9867666 00:48:27.505 --> 00:48:29.185 aware of. Right? There's early NOTE Confidence: 0.9867666 00:48:29.185 --> 00:48:30.704 and late dumping syndrome. So, NOTE Confidence: 0.9867666 00:48:30.704 --> 00:48:31.505 you know, if you're feeling NOTE Confidence: 0.9867666 00:48:31.505 --> 00:48:33.260 really sweaty after drinking a NOTE Confidence: 0.9867666 00:48:33.260 --> 00:48:34.380 milkshake and you need to NOTE Confidence: 0.9867666 00:48:34.380 --> 00:48:35.340 lie down and you feel NOTE Confidence: 0.9867666 00:48:35.340 --> 00:48:36.300 like you're gonna throw up, NOTE Confidence: 0.9867666 00:48:36.300 --> 00:48:36.800 like, NOTE Confidence: 0.96783024 00:48:37.100 --> 00:48:38.300 these things we hear so NOTE Confidence: 0.96783024 00:48:38.300 --> 00:48:40.060 often. So sometimes patients come NOTE Confidence: 0.96783024 00:48:40.060 --> 00:48:41.020 in, and they're like, yeah. NOTE Confidence: 0.96783024 00:48:41.020 --> 00:48:42.380 Yeah. I'm dealing with this. NOTE Confidence: 0.96783024 00:48:42.380 --> 00:48:43.500 And I say, well, that's NOTE Confidence: 0.96783024 00:48:43.500 --> 00:48:45.040 this. And they say, oh, NOTE Confidence: 0.96783024 00:48:45.125 --> 00:48:46.325 okay. What do I do? NOTE Confidence: 0.96783024 00:48:46.325 --> 00:48:47.444 Alright. That's when we go NOTE Confidence: 0.96783024 00:48:47.444 --> 00:48:48.344 through the strategies. NOTE Confidence: 0.9975586 00:48:48.645 --> 00:48:49.145 Right? NOTE Confidence: 0.98696953 00:48:50.724 --> 00:48:52.265 Altering meal and snack patterns. NOTE Confidence: 0.98696953 00:48:52.325 --> 00:48:53.765 Okay. Maybe you never ate NOTE Confidence: 0.98696953 00:48:53.765 --> 00:48:55.204 breakfast, which I see all NOTE Confidence: 0.98696953 00:48:55.204 --> 00:48:56.484 the time. Now you need NOTE Confidence: 0.98696953 00:48:56.484 --> 00:48:57.765 to start eating breakfast before NOTE Confidence: 0.98696953 00:48:57.765 --> 00:48:58.805 you start your day. Right? NOTE Confidence: 0.98696953 00:48:58.805 --> 00:48:59.559 Maybe you need to pack NOTE Confidence: 0.98696953 00:48:59.559 --> 00:49:00.599 some snacks in your car. NOTE Confidence: 0.98696953 00:49:00.599 --> 00:49:01.400 Maybe we need to come NOTE Confidence: 0.98696953 00:49:01.400 --> 00:49:02.520 up with some smoothies or NOTE Confidence: 0.98696953 00:49:02.520 --> 00:49:03.559 or shakes that you can NOTE Confidence: 0.98696953 00:49:03.559 --> 00:49:04.700 drink while you're working. NOTE Confidence: 0.9633933 00:49:06.119 --> 00:49:08.039 Meeting basic nutrition needs in NOTE Confidence: 0.9633933 00:49:08.039 --> 00:49:09.880 the beginning right after treatment NOTE Confidence: 0.9633933 00:49:09.880 --> 00:49:11.640 completion is so important because, NOTE Confidence: 0.9633933 00:49:11.640 --> 00:49:12.380 as mentioned, NOTE Confidence: 0.99856335 00:49:12.924 --> 00:49:14.045 weight loss is such a NOTE Confidence: 0.99856335 00:49:14.045 --> 00:49:15.885 common side effect of treatment NOTE Confidence: 0.99856335 00:49:15.885 --> 00:49:16.704 to the esophagus. NOTE Confidence: 0.9902886 00:49:17.325 --> 00:49:19.085 And we know that maintaining NOTE Confidence: 0.9902886 00:49:19.085 --> 00:49:21.325 weight, maintaining strength, lean body NOTE Confidence: 0.9902886 00:49:21.325 --> 00:49:22.605 mass is so important for NOTE Confidence: 0.9902886 00:49:22.605 --> 00:49:23.825 tolerance and recovery. NOTE Confidence: 1 00:49:24.285 --> 00:49:24.780 So NOTE Confidence: 0.98489696 00:49:25.100 --> 00:49:26.060 my goal is to really NOTE Confidence: 0.98489696 00:49:26.060 --> 00:49:27.260 go through what's your diet NOTE Confidence: 0.98489696 00:49:27.260 --> 00:49:28.300 recall, what are you eating, NOTE Confidence: 0.98489696 00:49:28.300 --> 00:49:29.260 what are you drinking, what's NOTE Confidence: 0.98489696 00:49:29.260 --> 00:49:30.940 your weight trend been, and NOTE Confidence: 0.98489696 00:49:30.940 --> 00:49:32.460 I go through specifics of NOTE Confidence: 0.98489696 00:49:32.460 --> 00:49:33.500 how many calories do you NOTE Confidence: 0.98489696 00:49:33.500 --> 00:49:34.380 need in a day to NOTE Confidence: 0.98489696 00:49:34.380 --> 00:49:35.580 put some weight on. You NOTE Confidence: 0.98489696 00:49:35.580 --> 00:49:36.780 know? And then Scott comes NOTE Confidence: 0.98489696 00:49:36.780 --> 00:49:37.660 in and talks about all NOTE Confidence: 0.98489696 00:49:37.660 --> 00:49:38.880 the exercise piece. NOTE Confidence: 0.9335022 00:49:40.454 --> 00:49:42.055 So regaining weight if lost NOTE Confidence: 0.9335022 00:49:42.055 --> 00:49:42.954 weight through treatment. NOTE Confidence: 0.9879325 00:49:43.255 --> 00:49:45.335 Again, modifying textures. Maybe you NOTE Confidence: 0.9879325 00:49:45.335 --> 00:49:46.775 no longer can tolerate tomatoes NOTE Confidence: 0.9879325 00:49:46.775 --> 00:49:47.974 or tomato sauce. It's too NOTE Confidence: 0.9879325 00:49:47.974 --> 00:49:49.914 acidic. It burns going down. NOTE Confidence: 0.9879325 00:49:50.055 --> 00:49:50.555 Right? NOTE Confidence: 0.9708116 00:49:51.510 --> 00:49:53.510 Manage feeding tubes. So we NOTE Confidence: 0.9708116 00:49:53.510 --> 00:49:55.110 manage g tubes or j NOTE Confidence: 0.9708116 00:49:55.110 --> 00:49:56.469 tubes, which are placed in NOTE Confidence: 0.9708116 00:49:56.469 --> 00:49:57.450 the small intestine. NOTE Confidence: 0.99271226 00:49:58.390 --> 00:49:59.989 So some patients have this NOTE Confidence: 0.99271226 00:49:59.989 --> 00:50:00.790 for a short period of NOTE Confidence: 0.99271226 00:50:00.790 --> 00:50:01.989 time. Some have it long NOTE Confidence: 0.99271226 00:50:01.989 --> 00:50:04.310 term. So dietitians, especially oncology NOTE Confidence: 0.99271226 00:50:04.310 --> 00:50:05.910 dietitians, are well trained in NOTE Confidence: 0.99271226 00:50:05.910 --> 00:50:07.244 this realm as well. NOTE Confidence: 0.97078997 00:50:08.344 --> 00:50:09.465 And then a speech language NOTE Confidence: 0.97078997 00:50:09.465 --> 00:50:10.585 pathologist, which I know is NOTE Confidence: 0.97078997 00:50:10.585 --> 00:50:12.125 mentioned, but it's so important, NOTE Confidence: 0.9780931 00:50:12.665 --> 00:50:13.705 to include that as part NOTE Confidence: 0.9780931 00:50:13.705 --> 00:50:15.484 of the team to strengthen NOTE Confidence: 0.9780931 00:50:15.545 --> 00:50:17.145 muscles that are weakened. Maybe NOTE Confidence: 0.9780931 00:50:17.145 --> 00:50:18.344 you're not eating food throughout NOTE Confidence: 0.9780931 00:50:18.344 --> 00:50:19.545 treatment and you're relying on NOTE Confidence: 0.9780931 00:50:19.545 --> 00:50:21.180 a feeding tube. The speech NOTE Confidence: 0.9780931 00:50:21.180 --> 00:50:22.780 language pathologist is so important NOTE Confidence: 0.9780931 00:50:22.780 --> 00:50:23.760 along with a dietitian, NOTE Confidence: 0.98324424 00:50:24.140 --> 00:50:25.980 a PT, your oncology team NOTE Confidence: 0.98324424 00:50:25.980 --> 00:50:27.420 to make sure that you're NOTE Confidence: 0.98324424 00:50:27.420 --> 00:50:29.260 practicing and getting those muscles NOTE Confidence: 0.98324424 00:50:29.260 --> 00:50:30.320 back that you lost. NOTE Confidence: 0.9793396 00:50:31.260 --> 00:50:32.780 And food fears is a NOTE Confidence: 0.9793396 00:50:32.780 --> 00:50:34.295 huge, huge component. NOTE Confidence: 0.98347443 00:50:34.675 --> 00:50:35.875 I would say probably not NOTE Confidence: 0.98347443 00:50:35.875 --> 00:50:37.015 as common in gastroesophageal NOTE Confidence: 0.88549805 00:50:37.474 --> 00:50:37.974 patients, NOTE Confidence: 0.99519855 00:50:38.594 --> 00:50:39.974 but breast, colon, NOTE Confidence: 0.8796387 00:50:40.355 --> 00:50:40.855 prostate, NOTE Confidence: 0.9867136 00:50:41.395 --> 00:50:43.555 everybody is so afraid to NOTE Confidence: 0.9867136 00:50:43.555 --> 00:50:45.655 eat any food after diagnosis NOTE Confidence: 0.9867136 00:50:45.795 --> 00:50:46.994 because they worry that there NOTE Confidence: 0.9867136 00:50:46.994 --> 00:50:48.454 was something they did NOTE Confidence: 0.95703125 00:50:49.080 --> 00:50:50.440 specifically that caused. I see NOTE Confidence: 0.95703125 00:50:50.440 --> 00:50:51.660 so many heads nodding. NOTE Confidence: 0.9660832 00:50:52.360 --> 00:50:53.800 But they're so afraid that NOTE Confidence: 0.9660832 00:50:53.800 --> 00:50:55.580 they ate or did something NOTE Confidence: 0.9660832 00:50:55.719 --> 00:50:57.100 from nutrition perspective NOTE Confidence: 0.9958496 00:50:57.400 --> 00:50:58.440 that they shouldn't have done. NOTE Confidence: 0.9958496 00:50:58.440 --> 00:50:59.660 So then they get fearful NOTE Confidence: 0.9958496 00:50:59.719 --> 00:51:00.460 of anything, NOTE Confidence: 0.99890953 00:51:00.945 --> 00:51:02.225 and then they're worried about NOTE Confidence: 0.99890953 00:51:02.225 --> 00:51:03.505 putting anything in their body. NOTE Confidence: 0.99890953 00:51:03.505 --> 00:51:04.965 So there's a lot of, NOTE Confidence: 0.998291 00:51:05.265 --> 00:51:06.165 like, mental, NOTE Confidence: 0.9836426 00:51:06.785 --> 00:51:08.885 psychosocial component of this, but NOTE Confidence: 0.9836426 00:51:08.945 --> 00:51:10.725 food fears is a huge, NOTE Confidence: 0.9836426 00:51:10.785 --> 00:51:12.305 huge conversation that I have NOTE Confidence: 0.9836426 00:51:12.305 --> 00:51:13.364 with a lot of patients. NOTE Confidence: 0.92429423 00:51:16.969 --> 00:51:18.170 And so, again, from the NOTE Confidence: 0.92429423 00:51:18.170 --> 00:51:19.609 physical perspective in the short NOTE Confidence: 0.92429423 00:51:19.609 --> 00:51:20.109 term, NOTE Confidence: 0.97620344 00:51:20.890 --> 00:51:22.250 again, we wanna make sure NOTE Confidence: 0.97620344 00:51:22.250 --> 00:51:23.210 that we're first of all, NOTE Confidence: 0.97620344 00:51:23.210 --> 00:51:25.049 we're minimizing weight loss. So, NOTE Confidence: 0.97620344 00:51:25.049 --> 00:51:26.910 again, you're having these conversations NOTE Confidence: 0.97620344 00:51:26.969 --> 00:51:28.489 with the Natalie about, you NOTE Confidence: 0.97620344 00:51:28.489 --> 00:51:30.010 know, proper nutrition and how NOTE Confidence: 0.97620344 00:51:30.010 --> 00:51:31.869 to get quality calories NOTE Confidence: 0.9965123 00:51:32.545 --> 00:51:34.145 back into them. At the NOTE Confidence: 0.9965123 00:51:34.145 --> 00:51:34.965 same time, NOTE Confidence: 0.9543101 00:51:35.265 --> 00:51:37.364 I wanna combat weight loss NOTE Confidence: 0.9543101 00:51:37.425 --> 00:51:38.785 with shrink training. So again, NOTE Confidence: 0.9543101 00:51:38.785 --> 00:51:39.985 thank you for talking about NOTE Confidence: 0.9543101 00:51:39.985 --> 00:51:40.485 sarcopenia NOTE Confidence: 0.96451145 00:51:41.425 --> 00:51:42.625 and how that is a NOTE Confidence: 0.96451145 00:51:42.625 --> 00:51:44.065 real concern, that muscle the NOTE Confidence: 0.96451145 00:51:44.065 --> 00:51:45.265 loss of muscle mass is NOTE Confidence: 0.96451145 00:51:45.265 --> 00:51:46.165 a real concern. NOTE Confidence: 0.9929231 00:51:46.830 --> 00:51:47.590 The way that I look NOTE Confidence: 0.9929231 00:51:47.590 --> 00:51:49.150 at that is, you know, NOTE Confidence: 0.9929231 00:51:49.150 --> 00:51:50.430 it can be anything as NOTE Confidence: 0.9929231 00:51:50.430 --> 00:51:52.270 functional as, you know, you're NOTE Confidence: 0.9929231 00:51:52.270 --> 00:51:53.870 having a tough time carrying NOTE Confidence: 0.9929231 00:51:53.870 --> 00:51:55.230 a basket of of laundry NOTE Confidence: 0.9929231 00:51:55.230 --> 00:51:56.290 up and down the stairs. NOTE Confidence: 0.9929231 00:51:56.510 --> 00:51:57.710 But we also know that NOTE Confidence: 0.9929231 00:51:57.710 --> 00:51:59.310 there's a direct correlation between NOTE Confidence: 0.9929231 00:51:59.310 --> 00:52:00.989 sarcopenia and an increased risk NOTE Confidence: 0.9929231 00:52:00.989 --> 00:52:01.650 of falls. NOTE Confidence: 0.9909939 00:52:02.735 --> 00:52:03.535 And the last thing you NOTE Confidence: 0.9909939 00:52:03.535 --> 00:52:04.655 need to do after a NOTE Confidence: 0.9909939 00:52:04.655 --> 00:52:06.094 cancer diagnosis is fall and NOTE Confidence: 0.9909939 00:52:06.094 --> 00:52:07.075 fracture your hip. NOTE Confidence: 1 00:52:07.535 --> 00:52:08.035 So NOTE Confidence: 0.99775565 00:52:08.575 --> 00:52:09.455 I need to be able NOTE Confidence: 0.99775565 00:52:09.455 --> 00:52:11.395 to prescribe you an exercise NOTE Confidence: 0.99775565 00:52:11.455 --> 00:52:12.415 plan. Now this is not NOTE Confidence: 0.99775565 00:52:12.415 --> 00:52:13.395 the time for CrossFit. NOTE Confidence: 0.9948296 00:52:14.415 --> 00:52:15.215 This is not the time NOTE Confidence: 0.9948296 00:52:15.215 --> 00:52:16.255 to flip tires and swing NOTE Confidence: 0.9948296 00:52:16.255 --> 00:52:17.695 sledgehammers. I pick on CrossFit NOTE Confidence: 0.9948296 00:52:17.695 --> 00:52:18.390 all the time. NOTE Confidence: 0.96931964 00:52:19.029 --> 00:52:19.910 But to be able to NOTE Confidence: 0.96931964 00:52:19.910 --> 00:52:21.589 work with a physical therapist, NOTE Confidence: 0.96931964 00:52:21.589 --> 00:52:23.109 somebody who is trained and NOTE Confidence: 0.96931964 00:52:23.109 --> 00:52:23.750 to be able to take NOTE Confidence: 0.96931964 00:52:23.750 --> 00:52:24.969 you through a progressive NOTE Confidence: 0.9699707 00:52:25.829 --> 00:52:27.049 strength training program. NOTE Confidence: 0.91006327 00:52:27.670 --> 00:52:29.430 And sometimes, I'm working with NOTE Confidence: 0.91006327 00:52:29.430 --> 00:52:30.710 folks, and, again, if they NOTE Confidence: 0.91006327 00:52:30.710 --> 00:52:32.305 are still fatigued from chemo NOTE Confidence: 0.91006327 00:52:32.305 --> 00:52:33.985 or they're still fatigued from NOTE Confidence: 0.91006327 00:52:33.985 --> 00:52:34.485 radiation, NOTE Confidence: 0.9944458 00:52:35.025 --> 00:52:35.985 and they say, well, how NOTE Confidence: 0.9944458 00:52:35.985 --> 00:52:37.525 am I going to exercise NOTE Confidence: 0.9944458 00:52:37.585 --> 00:52:38.245 at all? NOTE Confidence: 0.99575806 00:52:38.625 --> 00:52:40.065 Well, you know what? We NOTE Confidence: 0.99575806 00:52:40.065 --> 00:52:41.205 can start with NOTE Confidence: 0.99609375 00:52:41.585 --> 00:52:42.485 very simple NOTE Confidence: 0.8182373 00:52:48.520 --> 00:52:49.660 bodyweight exercises. NOTE Confidence: 0.99902344 00:52:50.520 --> 00:52:51.340 Just practicing NOTE Confidence: 0.89070636 00:52:51.719 --> 00:52:52.620 sit to stands, NOTE Confidence: 0.9854126 00:52:53.000 --> 00:52:54.120 or maybe I would have NOTE Confidence: 0.9854126 00:52:54.120 --> 00:52:56.300 you do some banded exercises, NOTE Confidence: 0.9854126 00:52:56.440 --> 00:52:57.320 but to do that in NOTE Confidence: 0.9854126 00:52:57.320 --> 00:52:57.820 sitting NOTE Confidence: 0.9872233 00:52:58.785 --> 00:52:59.844 versus in standing. NOTE Confidence: 0.9996745 00:53:00.464 --> 00:53:01.905 So there are plenty of NOTE Confidence: 0.9996745 00:53:01.905 --> 00:53:02.405 ways NOTE Confidence: 1 00:53:02.864 --> 00:53:03.605 to modify NOTE Confidence: 0.9919085 00:53:04.145 --> 00:53:05.905 an exercise plan, but I NOTE Confidence: 0.9919085 00:53:05.905 --> 00:53:06.565 have to NOTE Confidence: 0.9892334 00:53:07.105 --> 00:53:08.224 meet you, and I have NOTE Confidence: 0.9892334 00:53:08.224 --> 00:53:09.344 to listen to you, and NOTE Confidence: 0.9892334 00:53:09.344 --> 00:53:10.065 I have to hear what NOTE Confidence: 0.9892334 00:53:10.065 --> 00:53:11.940 your concerns are to figure NOTE Confidence: 0.9892334 00:53:11.940 --> 00:53:13.560 out how I can individualize NOTE Confidence: 0.9892334 00:53:13.780 --> 00:53:15.640 that exercise plan to you. NOTE Confidence: 0.9996338 00:53:15.940 --> 00:53:16.920 At the same time, NOTE Confidence: 0.91130185 00:53:18.099 --> 00:53:20.099 exercise, again, we've no. We NOTE Confidence: 0.91130185 00:53:20.099 --> 00:53:21.300 now have the evidence that NOTE Confidence: 0.91130185 00:53:21.300 --> 00:53:22.020 shows that every NOTE Confidence: 0.8676758 00:53:22.820 --> 00:53:23.320 exercise NOTE Confidence: 0.9975586 00:53:24.020 --> 00:53:26.280 can combat cancer related fatigue. NOTE Confidence: 0.9642334 00:53:26.614 --> 00:53:27.275 So, again, NOTE Confidence: 0.98710126 00:53:27.655 --> 00:53:29.255 people might say, well, I'm NOTE Confidence: 0.98710126 00:53:29.255 --> 00:53:30.375 tired, so I don't feel NOTE Confidence: 0.98710126 00:53:30.375 --> 00:53:31.114 like exercising. NOTE Confidence: 0.9688785 00:53:31.815 --> 00:53:33.335 So, again, we're not training NOTE Confidence: 0.9688785 00:53:33.335 --> 00:53:35.335 for an Ironman triathlon here, NOTE Confidence: 0.9688785 00:53:35.335 --> 00:53:36.694 but starting with a ten NOTE Confidence: 0.9688785 00:53:36.694 --> 00:53:37.994 minute walk after breakfast, NOTE Confidence: 0.9984131 00:53:39.335 --> 00:53:40.375 and then a ten minute NOTE Confidence: 0.9984131 00:53:40.375 --> 00:53:41.594 walk after lunch, NOTE Confidence: 0.9949618 00:53:42.840 --> 00:53:43.880 and then a ten minute NOTE Confidence: 0.9949618 00:53:43.880 --> 00:53:45.720 walk after dinner. I wasn't NOTE Confidence: 0.9949618 00:53:45.720 --> 00:53:46.600 a math major, but that NOTE Confidence: 0.9949618 00:53:46.600 --> 00:53:47.560 still adds up to thirty NOTE Confidence: 0.9949618 00:53:47.560 --> 00:53:48.520 minutes over the course of NOTE Confidence: 0.9949618 00:53:48.520 --> 00:53:49.800 the day, and that's what NOTE Confidence: 0.9949618 00:53:49.800 --> 00:53:51.580 we're what we're striving for. NOTE Confidence: 0.9949618 00:53:51.720 --> 00:53:53.000 And as you start to NOTE Confidence: 0.9949618 00:53:53.000 --> 00:53:54.700 get more energy back, NOTE Confidence: 0.9906616 00:53:55.045 --> 00:53:56.085 then you can turn that NOTE Confidence: 0.9906616 00:53:56.085 --> 00:53:57.225 into one singular NOTE Confidence: 0.9977214 00:53:57.685 --> 00:53:58.985 thirty minute walk. NOTE Confidence: 0.9822006 00:54:00.245 --> 00:54:02.085 I think, again, it's important NOTE Confidence: 0.9822006 00:54:02.085 --> 00:54:03.364 that we talk about short NOTE Confidence: 0.9822006 00:54:03.364 --> 00:54:04.565 term goals and long term NOTE Confidence: 0.9822006 00:54:04.565 --> 00:54:05.065 goals. NOTE Confidence: 0.9810771 00:54:06.005 --> 00:54:07.445 If your long term goal NOTE Confidence: 0.9810771 00:54:07.445 --> 00:54:08.850 is to get back to NOTE Confidence: 0.9810771 00:54:08.850 --> 00:54:10.130 what your prior level of NOTE Confidence: 0.9810771 00:54:10.130 --> 00:54:11.490 activity was, maybe you were NOTE Confidence: 0.9810771 00:54:11.490 --> 00:54:13.250 running five k's or ten NOTE Confidence: 0.9810771 00:54:13.250 --> 00:54:14.450 k's, or maybe you, you NOTE Confidence: 0.9810771 00:54:14.450 --> 00:54:15.490 know, your goal is that NOTE Confidence: 0.9810771 00:54:15.490 --> 00:54:16.450 you wanna go hike the NOTE Confidence: 0.9810771 00:54:16.450 --> 00:54:17.190 Grand Canyon. NOTE Confidence: 0.9995117 00:54:17.570 --> 00:54:18.070 Fantastic. NOTE Confidence: 0.99382323 00:54:18.930 --> 00:54:20.370 Let's work on that. But NOTE Confidence: 0.99382323 00:54:20.370 --> 00:54:21.570 before you hike the Grand NOTE Confidence: 0.99382323 00:54:21.570 --> 00:54:22.690 Canyon, you need to be NOTE Confidence: 0.99382323 00:54:22.690 --> 00:54:24.150 able to hike Sleeping Giant. NOTE Confidence: 0.98222214 00:54:26.444 --> 00:54:27.164 So we have to come NOTE Confidence: 0.98222214 00:54:27.164 --> 00:54:28.625 up with short term goals, NOTE Confidence: 0.98222214 00:54:28.684 --> 00:54:29.184 achievable NOTE Confidence: 0.9613444 00:54:29.484 --> 00:54:30.765 short term goals before we NOTE Confidence: 0.9613444 00:54:30.765 --> 00:54:31.645 can get to that long NOTE Confidence: 0.9613444 00:54:31.645 --> 00:54:32.385 term goal. NOTE Confidence: 0.99262697 00:54:33.325 --> 00:54:34.785 Again, I already talked about, NOTE Confidence: 0.9878174 00:54:35.325 --> 00:54:37.025 reducing, the risk of sarcopenia. NOTE Confidence: 0.94155276 00:54:37.730 --> 00:54:39.170 And, again, we've we're we're NOTE Confidence: 0.94155276 00:54:39.170 --> 00:54:41.030 talking about speech therapists tonight. NOTE Confidence: 0.987635 00:54:41.489 --> 00:54:43.010 Full disclosure, I'm married to NOTE Confidence: 0.987635 00:54:43.010 --> 00:54:44.049 a speech therapist, so I'm NOTE Confidence: 0.987635 00:54:44.049 --> 00:54:46.049 contractually obligated to talk about NOTE Confidence: 0.987635 00:54:46.049 --> 00:54:46.869 speech therapy. NOTE Confidence: 0.8979241 00:54:47.809 --> 00:54:49.809 But, yes, speech therapists can NOTE Confidence: 0.8979241 00:54:49.809 --> 00:54:51.170 do swallow evals. They can NOTE Confidence: 0.8979241 00:54:51.170 --> 00:54:51.989 do a FEES, NOTE Confidence: 0.973999 00:54:52.344 --> 00:54:53.805 in order to be able NOTE Confidence: 0.973999 00:54:53.864 --> 00:54:54.844 to find out, NOTE Confidence: 0.9846436 00:54:55.305 --> 00:54:56.925 do you have a constrictor, NOTE Confidence: 0.9912258 00:54:57.385 --> 00:54:58.745 in your esophagus because of NOTE Confidence: 0.9912258 00:54:58.745 --> 00:55:00.185 radiation therapy? And if so, NOTE Confidence: 0.9912258 00:55:00.185 --> 00:55:00.685 where NOTE Confidence: 0.99450684 00:55:01.225 --> 00:55:02.205 is that constrictor? NOTE Confidence: 0.9890137 00:55:02.745 --> 00:55:04.025 And so then they can NOTE Confidence: 0.9890137 00:55:04.025 --> 00:55:06.025 make the appropriate treatments based NOTE Confidence: 0.9890137 00:55:06.025 --> 00:55:06.685 on that. NOTE Confidence: 0.9980469 00:55:08.010 --> 00:55:08.510 Alright. NOTE Confidence: 0.9890137 00:55:08.890 --> 00:55:10.010 And just so you know, NOTE Confidence: 0.9890137 00:55:10.010 --> 00:55:10.730 if you do come to NOTE Confidence: 0.9890137 00:55:10.730 --> 00:55:12.250 clinic, Scott has a backpack NOTE Confidence: 0.9890137 00:55:12.250 --> 00:55:13.610 that's always full of bands. NOTE Confidence: 0.9890137 00:55:13.610 --> 00:55:15.530 So he always has patients NOTE Confidence: 0.9890137 00:55:15.530 --> 00:55:16.650 up in the room, in NOTE Confidence: 0.9890137 00:55:16.650 --> 00:55:17.310 the doorway, NOTE Confidence: 0.99210614 00:55:17.690 --> 00:55:19.290 you know, finding contraptions to NOTE Confidence: 0.99210614 00:55:19.290 --> 00:55:20.170 get people up and moving. NOTE Confidence: 0.99210614 00:55:20.170 --> 00:55:21.130 He even makes me walk NOTE Confidence: 0.99210614 00:55:21.130 --> 00:55:22.250 at lunchtime all the time. NOTE Confidence: 0.99210614 00:55:22.250 --> 00:55:23.755 So he is gonna get NOTE Confidence: 0.99210614 00:55:23.755 --> 00:55:24.335 you moving. NOTE Confidence: 0.99346924 00:55:25.355 --> 00:55:26.475 Alright. So moving into the NOTE Confidence: 0.99346924 00:55:26.475 --> 00:55:27.455 more long term, NOTE Confidence: 0.99104816 00:55:27.755 --> 00:55:28.255 survivorship, NOTE Confidence: 0.9958903 00:55:28.875 --> 00:55:30.155 conversations that I might have. NOTE Confidence: 0.9958903 00:55:30.155 --> 00:55:30.655 So, NOTE Confidence: 0.9931946 00:55:31.594 --> 00:55:33.435 I always say it's turning NOTE Confidence: 0.9931946 00:55:33.435 --> 00:55:34.495 the page. So NOTE Confidence: 0.99880373 00:55:34.950 --> 00:55:36.469 when you're recovering from those NOTE Confidence: 0.99880373 00:55:36.469 --> 00:55:38.410 acute side effects of radiation, NOTE Confidence: 0.9818997 00:55:39.430 --> 00:55:40.890 maybe you have the difficulty NOTE Confidence: 0.9818997 00:55:40.950 --> 00:55:43.109 swallowing, the acid reflux, you're NOTE Confidence: 0.9818997 00:55:43.109 --> 00:55:44.550 eating a soft diet, you're NOTE Confidence: 0.9818997 00:55:44.550 --> 00:55:46.330 relying on smoothies or milkshakes NOTE Confidence: 0.9818997 00:55:46.390 --> 00:55:47.450 to kinda get through, NOTE Confidence: 0.996875 00:55:48.469 --> 00:55:50.250 once you feel like that NOTE Confidence: 0.92209244 00:55:50.765 --> 00:55:52.705 resolves, right, usually, I say, NOTE Confidence: 0.92209244 00:55:52.844 --> 00:55:54.445 six months, people start feeling, NOTE Confidence: 0.92209244 00:55:54.445 --> 00:55:55.725 like, back to a new NOTE Confidence: 0.92209244 00:55:55.725 --> 00:55:56.925 normal where they're kind of NOTE Confidence: 0.92209244 00:55:57.005 --> 00:55:58.364 their energy is coming back. NOTE Confidence: 0.92209244 00:55:58.364 --> 00:55:59.565 You know, nutrition's a little NOTE Confidence: 0.92209244 00:55:59.565 --> 00:56:00.305 bit easier. NOTE Confidence: 0.99921876 00:56:01.005 --> 00:56:02.445 But I teach them how NOTE Confidence: 0.99921876 00:56:02.445 --> 00:56:03.965 to turn the page when NOTE Confidence: 0.99921876 00:56:03.965 --> 00:56:05.730 it comes to going from NOTE Confidence: 0.99921876 00:56:05.730 --> 00:56:07.410 acute care and side effect NOTE Confidence: 0.99921876 00:56:07.410 --> 00:56:10.230 management to long term prevention NOTE Confidence: 0.9885254 00:56:10.530 --> 00:56:11.270 and wellness. NOTE Confidence: 0.9914958 00:56:11.570 --> 00:56:12.530 So that's kind of a NOTE Confidence: 0.9914958 00:56:12.530 --> 00:56:13.030 tricky, NOTE Confidence: 0.9403076 00:56:14.130 --> 00:56:15.250 conversion and kind of a NOTE Confidence: 0.9403076 00:56:15.250 --> 00:56:15.750 tricky, NOTE Confidence: 0.9980469 00:56:17.570 --> 00:56:18.930 path for people to figure NOTE Confidence: 0.9980469 00:56:18.930 --> 00:56:19.670 out themselves. NOTE Confidence: 0.9772949 00:56:20.130 --> 00:56:20.985 Right? So NOTE Confidence: 0.982959 00:56:21.785 --> 00:56:23.225 So addressing eating challenges when NOTE Confidence: 0.982959 00:56:23.225 --> 00:56:24.585 returning to work. So some NOTE Confidence: 0.982959 00:56:24.585 --> 00:56:26.525 people are teachers, some are, NOTE Confidence: 0.9881897 00:56:27.225 --> 00:56:30.045 doctors themselves, some are parents, NOTE Confidence: 0.9881897 00:56:30.185 --> 00:56:31.165 work from home, NOTE Confidence: 0.99433595 00:56:32.105 --> 00:56:33.885 people sitting down all day, NOTE Confidence: 0.93185425 00:56:35.369 --> 00:56:36.969 pilots. You know, we've seen NOTE Confidence: 0.93185425 00:56:36.969 --> 00:56:37.950 it all. Electricians, NOTE Confidence: 0.9727858 00:56:38.250 --> 00:56:39.130 people that have to eat NOTE Confidence: 0.9727858 00:56:39.130 --> 00:56:39.690 on the back of their NOTE Confidence: 0.9727858 00:56:39.690 --> 00:56:41.130 truck when they go back NOTE Confidence: 0.9727858 00:56:41.130 --> 00:56:42.969 to work. So part of NOTE Confidence: 0.9727858 00:56:42.969 --> 00:56:44.170 my job is figuring out, NOTE Confidence: 0.9727858 00:56:44.170 --> 00:56:45.609 okay. Well, what's your meal NOTE Confidence: 0.9727858 00:56:45.609 --> 00:56:47.210 planning looking like? Your grocery NOTE Confidence: 0.9727858 00:56:47.210 --> 00:56:48.730 shopping? Who's home? What's your NOTE Confidence: 0.9727858 00:56:48.730 --> 00:56:50.250 support system? You know? Can NOTE Confidence: 0.9727858 00:56:50.250 --> 00:56:51.765 you afford groceries? Groceries? NOTE Confidence: 0.9942322 00:56:52.065 --> 00:56:53.105 All those things kind of NOTE Confidence: 0.9942322 00:56:53.105 --> 00:56:54.085 come into play. NOTE Confidence: 0.9915248 00:56:55.585 --> 00:56:57.364 Reducing risk of nutritional deficiencies. NOTE Confidence: 0.9915248 00:56:57.585 --> 00:56:58.484 Right? So, NOTE Confidence: 0.9775662 00:56:59.265 --> 00:57:00.465 this is something I'm always NOTE Confidence: 0.9775662 00:57:00.465 --> 00:57:01.825 looking at. That's why we NOTE Confidence: 0.9775662 00:57:01.825 --> 00:57:03.185 check lab work, and we're NOTE Confidence: 0.9775662 00:57:03.185 --> 00:57:04.145 looking at all of the NOTE Confidence: 0.9775662 00:57:04.145 --> 00:57:05.344 data in the computer all NOTE Confidence: 0.9775662 00:57:05.344 --> 00:57:05.925 the time. NOTE Confidence: 0.9845635 00:57:06.690 --> 00:57:08.210 But, obviously, the stomach and NOTE Confidence: 0.9845635 00:57:08.210 --> 00:57:09.890 the small intestine and the NOTE Confidence: 0.9845635 00:57:09.890 --> 00:57:11.410 esophagus are all very important NOTE Confidence: 0.9845635 00:57:11.410 --> 00:57:12.790 for digestion and absorption. NOTE Confidence: 0.999167 00:57:13.410 --> 00:57:14.130 So we have to look NOTE Confidence: 0.999167 00:57:14.130 --> 00:57:15.010 at all these things to NOTE Confidence: 0.999167 00:57:15.010 --> 00:57:15.890 make sure you're getting what NOTE Confidence: 0.999167 00:57:15.890 --> 00:57:16.550 you need. NOTE Confidence: 0.9973959 00:57:17.170 --> 00:57:18.230 Adequate hydration. NOTE Confidence: 0.98099315 00:57:18.575 --> 00:57:19.775 Right? So if you're somebody NOTE Confidence: 0.98099315 00:57:19.775 --> 00:57:21.155 after, you know, esophagectomy, NOTE Confidence: 0.8739929 00:57:22.495 --> 00:57:23.795 and after a chemoradiation NOTE Confidence: 0.9848633 00:57:24.255 --> 00:57:25.695 and you can't tolerate the NOTE Confidence: 0.9848633 00:57:25.695 --> 00:57:27.235 same amount of volume NOTE Confidence: 0.9928057 00:57:27.695 --> 00:57:29.455 that you once could, it's NOTE Confidence: 0.9928057 00:57:29.455 --> 00:57:31.135 gonna rely on you sipping NOTE Confidence: 0.9928057 00:57:31.135 --> 00:57:33.160 liquids throughout the day. Right? NOTE Confidence: 0.9928057 00:57:33.380 --> 00:57:34.660 Some people are not natural NOTE Confidence: 0.9928057 00:57:34.660 --> 00:57:36.100 water drinkers. I'll admit it. NOTE Confidence: 0.9928057 00:57:36.100 --> 00:57:37.140 I'm a dietitian, and I NOTE Confidence: 0.9928057 00:57:37.140 --> 00:57:38.740 hate drinking water. So that NOTE Confidence: 0.9928057 00:57:38.740 --> 00:57:39.540 that would be a big NOTE Confidence: 0.9928057 00:57:39.540 --> 00:57:40.660 challenge for me. Right? But NOTE Confidence: 0.9928057 00:57:40.660 --> 00:57:42.100 we also have people who NOTE Confidence: 0.9928057 00:57:42.100 --> 00:57:43.060 are talking in front of NOTE Confidence: 0.9928057 00:57:43.060 --> 00:57:43.860 a group of people. They NOTE Confidence: 0.9928057 00:57:43.860 --> 00:57:45.060 can't use the bathroom every NOTE Confidence: 0.9928057 00:57:45.060 --> 00:57:47.115 five minutes. So it's making NOTE Confidence: 0.9928057 00:57:47.115 --> 00:57:49.035 sure that people have the NOTE Confidence: 0.9928057 00:57:49.035 --> 00:57:50.075 the strategies and the tips NOTE Confidence: 0.9928057 00:57:50.075 --> 00:57:51.115 that they need to kinda NOTE Confidence: 0.9928057 00:57:51.115 --> 00:57:51.915 get back to what they NOTE Confidence: 0.9928057 00:57:51.915 --> 00:57:52.395 need to do. NOTE Confidence: 0.98817664 00:57:53.915 --> 00:57:55.195 Weight management. This could be NOTE Confidence: 0.98817664 00:57:55.195 --> 00:57:56.175 gaining, maintaining, NOTE Confidence: 0.9951172 00:57:56.475 --> 00:57:56.975 losing. NOTE Confidence: 0.99771726 00:57:57.675 --> 00:57:59.135 Obviously, in the gastroesophageal NOTE Confidence: 0.9995117 00:57:59.595 --> 00:58:00.975 population, it's more NOTE Confidence: 0.98561317 00:58:01.400 --> 00:58:03.080 gaining weight or maintaining or NOTE Confidence: 0.98561317 00:58:03.080 --> 00:58:05.000 building lean body mass. But NOTE Confidence: 0.98561317 00:58:05.000 --> 00:58:06.220 in many other diagnoses, NOTE Confidence: 0.9745718 00:58:06.600 --> 00:58:08.040 that is weight loss that NOTE Confidence: 0.9745718 00:58:08.040 --> 00:58:09.720 people need. So it kinda NOTE Confidence: 0.9745718 00:58:09.720 --> 00:58:10.780 goes both ways. NOTE Confidence: 0.99890625 00:58:11.960 --> 00:58:13.500 And then managing other comorbidities. NOTE Confidence: 0.993811 00:58:13.800 --> 00:58:15.285 Right? So as mentioned, a NOTE Confidence: 0.993811 00:58:15.285 --> 00:58:17.045 lot of, like, precursors and NOTE Confidence: 0.993811 00:58:17.045 --> 00:58:18.645 conditions that are common amongst NOTE Confidence: 0.993811 00:58:18.645 --> 00:58:19.145 gastroesophageal NOTE Confidence: 0.9787516 00:58:19.445 --> 00:58:21.945 patients is acid reflux. Right? NOTE Confidence: 0.9787516 00:58:22.165 --> 00:58:24.005 So, you know, some people NOTE Confidence: 0.9787516 00:58:24.005 --> 00:58:24.805 come in and they have NOTE Confidence: 0.9787516 00:58:24.805 --> 00:58:26.244 a new diagnosis of diabetes NOTE Confidence: 0.9787516 00:58:26.244 --> 00:58:28.269 after treatment, or they have NOTE Confidence: 0.9787516 00:58:28.269 --> 00:58:30.210 new kidney disease from chemotherapy, NOTE Confidence: 0.9995117 00:58:30.670 --> 00:58:31.650 or they, NOTE Confidence: 0.993237 00:58:32.109 --> 00:58:33.390 they now have these big NOTE Confidence: 0.993237 00:58:33.390 --> 00:58:34.990 conditions along with being a NOTE Confidence: 0.993237 00:58:34.990 --> 00:58:36.589 cancer survivor that they're left NOTE Confidence: 0.993237 00:58:36.589 --> 00:58:37.890 to manage on their own. NOTE Confidence: 0.993237 00:58:37.950 --> 00:58:39.569 So having an oncology dietitian NOTE Confidence: 0.993237 00:58:39.630 --> 00:58:40.769 that knows the treatments, NOTE Confidence: 0.99975586 00:58:41.405 --> 00:58:42.545 knows the side effects, NOTE Confidence: 0.996303 00:58:42.925 --> 00:58:44.685 knows the safety of food NOTE Confidence: 0.996303 00:58:44.685 --> 00:58:45.505 and swallow, NOTE Confidence: 0.99424523 00:58:45.885 --> 00:58:47.244 and then also knows how NOTE Confidence: 0.99424523 00:58:47.244 --> 00:58:48.605 to manage diabetes and heart NOTE Confidence: 0.99424523 00:58:48.605 --> 00:58:49.825 disease and lower cholesterol NOTE Confidence: 0.9678875 00:58:50.205 --> 00:58:52.145 and blood pressure, that's huge. NOTE Confidence: 0.9678875 00:58:52.365 --> 00:58:53.645 So you don't wanna just NOTE Confidence: 0.9678875 00:58:53.645 --> 00:58:54.845 go to another dietitian out NOTE Confidence: 0.9678875 00:58:54.845 --> 00:58:55.885 in the community because they NOTE Confidence: 0.9678875 00:58:55.885 --> 00:58:57.025 might not know the oncology NOTE Confidence: 0.9678875 00:58:57.220 --> 00:58:58.260 perspective and you feel kind NOTE Confidence: 0.9678875 00:58:58.260 --> 00:58:59.620 of like, oh, is this NOTE Confidence: 0.9678875 00:58:59.620 --> 00:59:00.760 what I should be following? NOTE Confidence: 0.9678875 00:59:00.820 --> 00:59:02.100 Right. It's looking at the NOTE Confidence: 0.9678875 00:59:02.100 --> 00:59:03.380 whole picture. So I really NOTE Confidence: 0.9678875 00:59:03.380 --> 00:59:04.900 try in this, like, long NOTE Confidence: 0.9678875 00:59:04.900 --> 00:59:06.580 term survivorship visit. So maybe NOTE Confidence: 0.9678875 00:59:06.580 --> 00:59:07.860 somebody who finished treatment five NOTE Confidence: 0.9678875 00:59:07.860 --> 00:59:08.680 years ago, NOTE Confidence: 0.9652797 00:59:09.060 --> 00:59:09.780 they might come to me NOTE Confidence: 0.9652797 00:59:09.780 --> 00:59:11.060 and say, really, my main NOTE Confidence: 0.9652797 00:59:11.060 --> 00:59:12.280 concern is my diabetes, NOTE Confidence: 0.98028886 00:59:12.585 --> 00:59:13.305 but I don't know what NOTE Confidence: 0.98028886 00:59:13.305 --> 00:59:14.185 I can do with the NOTE Confidence: 0.98028886 00:59:14.185 --> 00:59:15.224 history that I have and NOTE Confidence: 0.98028886 00:59:15.224 --> 00:59:16.205 what should I avoid. NOTE Confidence: 0.98583984 00:59:18.105 --> 00:59:19.945 And then, obviously, reviewing evidence NOTE Confidence: 0.98583984 00:59:19.945 --> 00:59:21.805 based nutrition guidelines. So, NOTE Confidence: 0.9864868 00:59:22.505 --> 00:59:23.865 how do we optimize health? NOTE Confidence: 0.9864868 00:59:23.865 --> 00:59:25.244 How do we improve outcomes NOTE Confidence: 0.9864868 00:59:25.305 --> 00:59:26.850 after a diagnosis specific to NOTE Confidence: 0.9864868 00:59:26.850 --> 00:59:28.150 the type that you had? NOTE Confidence: 0.98397166 00:59:29.250 --> 00:59:30.850 Obviously, a plant dominant diet. NOTE Confidence: 0.98397166 00:59:30.850 --> 00:59:32.050 I'm sure you've heard it. NOTE Confidence: 0.98397166 00:59:32.050 --> 00:59:33.890 Right? Mediterranean, more fruits and NOTE Confidence: 0.98397166 00:59:33.890 --> 00:59:35.570 veggies. But for somebody who NOTE Confidence: 0.98397166 00:59:35.570 --> 00:59:36.870 has difficulty swallowing, NOTE Confidence: 0.99198693 00:59:37.250 --> 00:59:38.450 you're not eating a kale NOTE Confidence: 0.99198693 00:59:38.450 --> 00:59:40.610 salad. Right? So how do NOTE Confidence: 0.99198693 00:59:40.610 --> 00:59:42.204 we how do we connect NOTE Confidence: 0.99198693 00:59:42.204 --> 00:59:43.484 the dots? How do we NOTE Confidence: 0.99198693 00:59:43.484 --> 00:59:44.685 help you be the best NOTE Confidence: 0.99198693 00:59:44.685 --> 00:59:45.744 version of yourself, NOTE Confidence: 0.7866211 00:59:46.045 --> 00:59:46.704 but also NOTE Confidence: 0.9675856 00:59:47.005 --> 00:59:47.964 how do you tolerate it NOTE Confidence: 0.9675856 00:59:47.964 --> 00:59:49.085 and not be miserable at NOTE Confidence: 0.9675856 00:59:49.085 --> 00:59:49.744 the same time? NOTE Confidence: 0.99784714 00:59:51.085 --> 00:59:52.365 Were you drinking lots of NOTE Confidence: 0.99784714 00:59:52.365 --> 00:59:53.484 alcohol before you had the NOTE Confidence: 0.99784714 00:59:53.484 --> 00:59:53.984 diagnosis? NOTE Confidence: 0.9886649 00:59:54.285 --> 00:59:56.125 Right? And are you trying NOTE Confidence: 0.9886649 00:59:56.125 --> 00:59:57.860 to figure out how much NOTE Confidence: 0.9886649 00:59:57.860 --> 00:59:59.060 is okay to drink now, NOTE Confidence: 0.9886649 00:59:59.060 --> 01:00:00.740 or have you stopped? Right? NOTE Confidence: 0.9886649 01:00:00.740 --> 01:00:02.020 All these different things that NOTE Confidence: 0.9886649 01:00:02.020 --> 01:00:02.840 we talk about. NOTE Confidence: 0.99934894 01:00:03.540 --> 01:00:05.380 Processed meat is a big NOTE Confidence: 0.99934894 01:00:05.380 --> 01:00:05.880 conversation NOTE Confidence: 0.9972534 01:00:06.180 --> 01:00:07.220 too. We know that, NOTE Confidence: 0.98764104 01:00:07.940 --> 01:00:09.380 deli meats and bacon and NOTE Confidence: 0.98764104 01:00:09.380 --> 01:00:11.525 sausage are directly linked to NOTE Confidence: 0.98764104 01:00:11.525 --> 01:00:13.684 colorectal cancer risk. Right? So NOTE Confidence: 0.98764104 01:00:13.684 --> 01:00:14.724 that's a conversation I have NOTE Confidence: 0.98764104 01:00:14.724 --> 01:00:15.605 a lot of peep people NOTE Confidence: 0.98764104 01:00:15.605 --> 01:00:16.724 too. So if you're eating NOTE Confidence: 0.98764104 01:00:16.724 --> 01:00:17.924 turkey deli meats every day, NOTE Confidence: 0.98764104 01:00:17.924 --> 01:00:19.365 I'd say, hey. Let's replace NOTE Confidence: 0.98764104 01:00:19.365 --> 01:00:20.664 it with something else. Right? NOTE Confidence: 0.9607486 01:00:22.430 --> 01:00:23.870 And lastly, it's just addressing NOTE Confidence: 0.9607486 01:00:23.870 --> 01:00:25.550 any challenges that make consuming NOTE Confidence: 0.9607486 01:00:25.550 --> 01:00:26.530 the type of diet, NOTE Confidence: 0.68341064 01:00:26.990 --> 01:00:28.610 difficult so swallowing difficulty, NOTE Confidence: 0.95359296 01:00:28.910 --> 01:00:30.430 maybe a stricture that develops NOTE Confidence: 0.95359296 01:00:30.430 --> 01:00:31.070 and you need to get NOTE Confidence: 0.95359296 01:00:31.070 --> 01:00:31.970 something dilated, NOTE Confidence: 0.92562866 01:00:32.750 --> 01:00:35.325 needing foods pureed, needing baby NOTE Confidence: 0.92562866 01:00:35.325 --> 01:00:36.845 food sometimes as we can NOTE Confidence: 0.92562866 01:00:36.845 --> 01:00:38.285 kind of incorporate into recipes. NOTE Confidence: 0.92562866 01:00:38.285 --> 01:00:39.885 So, it's definitely not a NOTE Confidence: 0.92562866 01:00:39.885 --> 01:00:41.025 one size fits all. NOTE Confidence: 0.8452497 01:00:44.205 --> 01:00:45.325 And then again, for the NOTE Confidence: 0.8452497 01:00:45.325 --> 01:00:46.925 from the physical perspective for NOTE Confidence: 0.8452497 01:00:46.925 --> 01:00:48.625 for long term health, NOTE Confidence: 0.9787842 01:00:49.170 --> 01:00:50.369 you know, again, one of NOTE Confidence: 0.9787842 01:00:50.369 --> 01:00:51.250 the things that I really NOTE Confidence: 0.9787842 01:00:51.250 --> 01:00:52.690 try to consult my my NOTE Confidence: 0.9787842 01:00:52.690 --> 01:00:54.710 patients on is, you know, NOTE Confidence: 0.99560547 01:00:55.250 --> 01:00:56.369 exercise is not a dirty NOTE Confidence: 0.99560547 01:00:56.369 --> 01:00:57.410 word. Exercise is not a NOTE Confidence: 0.99560547 01:00:57.410 --> 01:00:58.390 four letter word. NOTE Confidence: 0.9964844 01:00:59.569 --> 01:01:01.190 And so how can we NOTE Confidence: 1 01:01:01.809 --> 01:01:02.309 integrate NOTE Confidence: 1 01:01:02.985 --> 01:01:03.485 exercise NOTE Confidence: 0.99957275 01:01:04.025 --> 01:01:05.785 into your daily routine to NOTE Confidence: 0.99957275 01:01:05.785 --> 01:01:06.825 be able to make this NOTE Confidence: 0.99957275 01:01:06.825 --> 01:01:07.705 a part of your daily NOTE Confidence: 0.99957275 01:01:07.705 --> 01:01:08.205 routine NOTE Confidence: 0.9732616 01:01:08.825 --> 01:01:09.865 for, you know, for the NOTE Confidence: 0.9732616 01:01:09.865 --> 01:01:10.585 rest of your life, for NOTE Confidence: 0.9732616 01:01:10.585 --> 01:01:11.465 the balance of your life? NOTE Confidence: 0.9732616 01:01:11.465 --> 01:01:12.905 And, again, the you know, NOTE Confidence: 0.9732616 01:01:12.905 --> 01:01:14.665 you've we've all heard about NOTE Confidence: 0.9732616 01:01:14.665 --> 01:01:15.865 the challenge trial, I think, NOTE Confidence: 0.9732616 01:01:15.865 --> 01:01:16.905 at this point that was NOTE Confidence: 0.9732616 01:01:16.905 --> 01:01:18.105 released last year. And, yes, NOTE Confidence: 0.9732616 01:01:18.105 --> 01:01:19.670 this was in patients with NOTE Confidence: 0.9732616 01:01:19.670 --> 01:01:21.589 with GI cancer, but I NOTE Confidence: 0.9732616 01:01:21.589 --> 01:01:22.390 feel like this was the NOTE Confidence: 0.9732616 01:01:22.390 --> 01:01:23.130 holy grail. NOTE Confidence: 0.9636896 01:01:23.750 --> 01:01:24.630 Like, this is the thing NOTE Confidence: 0.9636896 01:01:24.630 --> 01:01:26.390 we've been waiting for to NOTE Confidence: 0.9636896 01:01:26.390 --> 01:01:26.890 definitively NOTE Confidence: 0.94421387 01:01:27.190 --> 01:01:29.450 show that exercise, that prolonged NOTE Confidence: 0.94421387 01:01:29.670 --> 01:01:31.130 exercise actually improves NOTE Confidence: 1 01:01:31.589 --> 01:01:32.089 survival NOTE Confidence: 0.9885254 01:01:32.390 --> 01:01:32.890 outcomes. NOTE Confidence: 0.999442 01:01:33.595 --> 01:01:34.315 But how do you do NOTE Confidence: 0.999442 01:01:34.315 --> 01:01:35.135 that practically? NOTE Confidence: 0.9728875 01:01:35.435 --> 01:01:36.635 Well, I just had this NOTE Confidence: 0.9728875 01:01:36.635 --> 01:01:37.835 conversation with with one of NOTE Confidence: 0.9728875 01:01:37.835 --> 01:01:38.555 the folks that we had NOTE Confidence: 0.9728875 01:01:38.555 --> 01:01:40.095 yesterday in clinic about, NOTE Confidence: 0.99902344 01:01:40.955 --> 01:01:42.335 an accountability partner. NOTE Confidence: 0.94714355 01:01:42.955 --> 01:01:44.015 She's a school teacher, NOTE Confidence: 0.9829834 01:01:44.395 --> 01:01:45.435 and and she says, I NOTE Confidence: 0.9829834 01:01:45.435 --> 01:01:46.940 know I should be walking NOTE Confidence: 0.99802244 01:01:47.480 --> 01:01:49.160 for exercise, but I just NOTE Confidence: 0.99802244 01:01:49.160 --> 01:01:50.780 don't go for a walk. NOTE Confidence: 0.99738955 01:01:51.160 --> 01:01:52.040 And I said, well, you NOTE Confidence: 0.99738955 01:01:52.040 --> 01:01:53.240 know, is there anybody that NOTE Confidence: 0.99738955 01:01:53.240 --> 01:01:54.300 you work with NOTE Confidence: 0.9938151 01:01:54.920 --> 01:01:56.599 that, you know, maybe two NOTE Confidence: 0.9938151 01:01:56.599 --> 01:01:58.080 days a week after school, NOTE Confidence: 0.9938151 01:01:58.080 --> 01:01:59.640 you know, you can go NOTE Confidence: 0.9938151 01:01:59.640 --> 01:02:00.285 for a walk NOTE Confidence: 0.9397614 01:02:00.765 --> 01:02:02.285 after after school before you NOTE Confidence: 0.9397614 01:02:02.285 --> 01:02:03.325 go home. Because we all NOTE Confidence: 0.9397614 01:02:03.325 --> 01:02:04.704 know once we go home, NOTE Confidence: 0.9397614 01:02:04.924 --> 01:02:06.125 we've gotta make dinner. And NOTE Confidence: 0.9397614 01:02:06.125 --> 01:02:07.164 if you've got little kids, NOTE Confidence: 0.9397614 01:02:07.164 --> 01:02:08.125 you've gotta get them to NOTE Confidence: 0.9397614 01:02:08.125 --> 01:02:09.244 soccer practice or you gotta NOTE Confidence: 0.9397614 01:02:09.244 --> 01:02:10.365 help them with math homework. NOTE Confidence: 0.9397614 01:02:10.365 --> 01:02:11.244 And God help you if NOTE Confidence: 0.9397614 01:02:11.244 --> 01:02:12.125 you've gotta if you can NOTE Confidence: 0.9397614 01:02:12.125 --> 01:02:13.750 figure out sixth grade math NOTE Confidence: 0.9397614 01:02:13.750 --> 01:02:14.890 now because I can't. NOTE Confidence: 0.99609375 01:02:15.910 --> 01:02:17.190 So it's so much harder NOTE Confidence: 0.99609375 01:02:17.190 --> 01:02:18.010 to exercise NOTE Confidence: 0.98137206 01:02:18.710 --> 01:02:19.990 when you go home. But NOTE Confidence: 0.98137206 01:02:19.990 --> 01:02:21.130 if you can do that NOTE Confidence: 0.9926758 01:02:21.430 --> 01:02:22.410 right from work NOTE Confidence: 0.96542966 01:02:22.710 --> 01:02:24.890 or you change at work NOTE Confidence: 0.9998047 01:02:25.245 --> 01:02:26.045 and you go to the NOTE Confidence: 0.9998047 01:02:26.045 --> 01:02:27.585 gym on your way home NOTE Confidence: 0.96097004 01:02:27.965 --> 01:02:29.245 and you have somebody to NOTE Confidence: 0.96097004 01:02:29.245 --> 01:02:30.625 meet there at the gym, NOTE Confidence: 0.96097004 01:02:30.845 --> 01:02:31.965 and you better show up NOTE Confidence: 0.96097004 01:02:31.965 --> 01:02:32.845 because if you don't, you're NOTE Confidence: 0.96097004 01:02:32.845 --> 01:02:34.205 gonna get an angry text. NOTE Confidence: 0.96097004 01:02:34.205 --> 01:02:35.665 So to have an accountability NOTE Confidence: 0.96850586 01:02:36.285 --> 01:02:36.785 partner, NOTE Confidence: 0.9956752 01:02:37.970 --> 01:02:39.809 again, helps as far as NOTE Confidence: 0.9956752 01:02:39.809 --> 01:02:41.029 making integrating NOTE Confidence: 0.976888 01:02:41.329 --> 01:02:43.569 exercise into into your daily NOTE Confidence: 0.976888 01:02:43.569 --> 01:02:44.069 routine. NOTE Confidence: 0.95247155 01:02:44.369 --> 01:02:45.569 Again, like I was alluding NOTE Confidence: 0.95247155 01:02:45.569 --> 01:02:47.250 to before about short term NOTE Confidence: 0.95247155 01:02:47.250 --> 01:02:48.369 goals and long term goals, NOTE Confidence: 0.95247155 01:02:48.369 --> 01:02:49.410 I think it's so important NOTE Confidence: 0.95247155 01:02:49.410 --> 01:02:51.105 that we're thinking about what's NOTE Confidence: 0.95247155 01:02:51.105 --> 01:02:52.225 important to you and what NOTE Confidence: 0.95247155 01:02:52.225 --> 01:02:53.205 do you wanna do. NOTE Confidence: 0.9975586 01:02:53.505 --> 01:02:54.005 Again, NOTE Confidence: 0.9247936 01:02:54.465 --> 01:02:55.665 hike the Grand Canyon or NOTE Confidence: 0.9247936 01:02:55.665 --> 01:02:56.945 you wanna take that that NOTE Confidence: 0.9247936 01:02:56.945 --> 01:02:59.285 beach vacation. Great. So, again, NOTE Confidence: 0.9247936 01:02:59.505 --> 01:03:00.545 you wanna go on that NOTE Confidence: 0.9247936 01:03:00.545 --> 01:03:01.365 beach vacation. NOTE Confidence: 0.9549805 01:03:01.665 --> 01:03:02.705 You wanna go you wanna NOTE Confidence: 0.9549805 01:03:02.705 --> 01:03:04.380 go to the Bahamas. Great. NOTE Confidence: 0.97318894 01:03:04.680 --> 01:03:06.140 We've gotta work on proximal NOTE Confidence: 0.97318894 01:03:06.280 --> 01:03:07.480 strength to be able to NOTE Confidence: 0.97318894 01:03:07.480 --> 01:03:07.980 lift NOTE Confidence: 0.8643799 01:03:08.520 --> 01:03:09.660 that overhead, NOTE Confidence: 0.94358724 01:03:11.080 --> 01:03:11.960 you know, as your luggage NOTE Confidence: 0.94358724 01:03:11.960 --> 01:03:13.480 into the overhead bin. So NOTE Confidence: 0.94358724 01:03:13.480 --> 01:03:15.020 I can make anything functional. NOTE Confidence: 0.99166167 01:03:16.994 --> 01:03:18.275 And so, again, it's all NOTE Confidence: 0.99166167 01:03:18.275 --> 01:03:19.315 about trying to figure out NOTE Confidence: 0.99166167 01:03:19.315 --> 01:03:20.454 ways of, like, NOTE Confidence: 0.9645996 01:03:20.915 --> 01:03:22.755 increasing cardio and increasing strength NOTE Confidence: 0.9645996 01:03:22.755 --> 01:03:23.255 training, NOTE Confidence: 0.9397549 01:03:24.674 --> 01:03:25.795 you know, but to do NOTE Confidence: 0.9397549 01:03:25.795 --> 01:03:27.474 it practically and to do NOTE Confidence: 0.9397549 01:03:27.474 --> 01:03:29.160 it fun. And I, again, NOTE Confidence: 0.9397549 01:03:29.160 --> 01:03:30.200 I will you know, where NOTE Confidence: 0.9397549 01:03:30.200 --> 01:03:30.920 I think I feel like NOTE Confidence: 0.9397549 01:03:30.920 --> 01:03:32.200 we're admitting all of our, NOTE Confidence: 0.9397549 01:03:32.200 --> 01:03:34.220 like, our our our insecurities NOTE Confidence: 0.9397549 01:03:34.440 --> 01:03:35.240 and all the things that NOTE Confidence: 0.9397549 01:03:35.240 --> 01:03:36.359 we don't do. You don't NOTE Confidence: 0.9397549 01:03:36.359 --> 01:03:37.660 drink water, apparently. NOTE Confidence: 0.9984654 01:03:38.680 --> 01:03:39.400 And I don't go to NOTE Confidence: 0.9984654 01:03:39.400 --> 01:03:40.060 a gym. NOTE Confidence: 0.9615914 01:03:41.595 --> 01:03:42.475 I know. I don't have NOTE Confidence: 0.9615914 01:03:42.475 --> 01:03:43.775 time. I got three kids, NOTE Confidence: 0.9615914 01:03:43.915 --> 01:03:44.955 and so I don't have NOTE Confidence: 0.9615914 01:03:44.955 --> 01:03:45.915 time to go to the NOTE Confidence: 0.9615914 01:03:45.915 --> 01:03:47.275 gym, so I have to NOTE Confidence: 0.9615914 01:03:47.275 --> 01:03:48.575 exercise at home. NOTE Confidence: 0.9949544 01:03:48.875 --> 01:03:49.755 My bike is set up NOTE Confidence: 0.9949544 01:03:49.755 --> 01:03:50.255 downstairs NOTE Confidence: 0.9822591 01:03:50.715 --> 01:03:52.155 on the trainer. I have NOTE Confidence: 0.9822591 01:03:52.155 --> 01:03:53.910 free weights in the basement. NOTE Confidence: 0.9822591 01:03:53.970 --> 01:03:56.150 I do bodyweight exercises downstairs, NOTE Confidence: 0.97857666 01:03:56.610 --> 01:03:57.890 and I'm either doing that NOTE Confidence: 0.97857666 01:03:57.890 --> 01:03:59.190 before I go to work NOTE Confidence: 0.97857666 01:03:59.330 --> 01:04:00.690 or I do that when NOTE Confidence: 0.97857666 01:04:00.690 --> 01:04:01.830 the kids go to bed. NOTE Confidence: 0.98616964 01:04:02.450 --> 01:04:04.130 And that's my life, and NOTE Confidence: 0.98616964 01:04:04.130 --> 01:04:05.090 that's what I have to NOTE Confidence: 0.98616964 01:04:05.090 --> 01:04:06.705 do. Now other people, if NOTE Confidence: 0.98616964 01:04:06.705 --> 01:04:07.585 you have the ability to NOTE Confidence: 0.98616964 01:04:07.585 --> 01:04:08.385 go to the gym and NOTE Confidence: 0.98616964 01:04:08.385 --> 01:04:09.585 you're a gym person, that's NOTE Confidence: 0.98616964 01:04:09.585 --> 01:04:10.705 great. But, again, when I'm NOTE Confidence: 0.98616964 01:04:10.705 --> 01:04:12.545 designing these exercise plans for NOTE Confidence: 0.98616964 01:04:12.545 --> 01:04:13.745 you, I need to talk NOTE Confidence: 0.98616964 01:04:13.745 --> 01:04:15.025 to you, and I need NOTE Confidence: 0.98616964 01:04:15.025 --> 01:04:16.305 to know. Are you a NOTE Confidence: 0.98616964 01:04:16.305 --> 01:04:16.965 gym person? NOTE Confidence: 0.99749076 01:04:17.840 --> 01:04:18.640 You're not a gym are NOTE Confidence: 0.99749076 01:04:18.640 --> 01:04:20.000 you a gym person? You're NOTE Confidence: 0.99749076 01:04:20.000 --> 01:04:20.960 a gym person. Are you NOTE Confidence: 0.99749076 01:04:20.960 --> 01:04:21.780 a gym person? NOTE Confidence: 0.9475879 01:04:22.800 --> 01:04:24.320 Sometimes. So see right here, NOTE Confidence: 0.9475879 01:04:24.320 --> 01:04:25.120 we have to have this NOTE Confidence: 0.9475879 01:04:25.120 --> 01:04:27.200 conversation about, you know, are NOTE Confidence: 0.9475879 01:04:27.200 --> 01:04:28.000 you a gym person or NOTE Confidence: 0.9475879 01:04:28.000 --> 01:04:29.140 you're not a gym person? NOTE Confidence: 0.96329755 01:04:30.240 --> 01:04:31.525 And so and the other NOTE Confidence: 0.96329755 01:04:31.525 --> 01:04:33.365 thing too again is making NOTE Confidence: 0.96329755 01:04:33.365 --> 01:04:34.645 sure when we're thinking about NOTE Confidence: 0.96329755 01:04:34.645 --> 01:04:36.405 quality of life, you know, NOTE Confidence: 0.96329755 01:04:36.405 --> 01:04:37.125 what do you wanna get NOTE Confidence: 0.96329755 01:04:37.125 --> 01:04:38.085 back to? You wanna get NOTE Confidence: 0.96329755 01:04:38.085 --> 01:04:38.985 back to work? NOTE Confidence: 0.9689331 01:04:39.765 --> 01:04:40.805 You wanna get back to NOTE Confidence: 0.9689331 01:04:40.805 --> 01:04:42.185 school? You know? NOTE Confidence: 0.9839952 01:04:42.805 --> 01:04:43.685 You wanna just get back NOTE Confidence: 0.9839952 01:04:43.685 --> 01:04:44.905 to playing with your grandkids. NOTE Confidence: 0.9839952 01:04:45.045 --> 01:04:46.510 So, again, so much of NOTE Confidence: 0.9839952 01:04:46.510 --> 01:04:47.530 what we're doing, NOTE Confidence: 0.9778137 01:04:48.950 --> 01:04:50.310 in survivorship as well as NOTE Confidence: 0.9778137 01:04:50.310 --> 01:04:51.770 our own individual, NOTE Confidence: 0.9451497 01:04:53.110 --> 01:04:55.030 dietary practice and PT practice NOTE Confidence: 0.9451497 01:04:55.030 --> 01:04:56.410 is that, you know, NOTE Confidence: 0.9959961 01:04:56.950 --> 01:04:58.730 our goals are your goals. NOTE Confidence: 0.9751587 01:05:01.184 --> 01:05:01.984 So I'm not gonna go NOTE Confidence: 0.9751587 01:05:01.984 --> 01:05:03.105 through all these, but I NOTE Confidence: 0.9751587 01:05:03.105 --> 01:05:04.065 just wanted to we just NOTE Confidence: 0.9751587 01:05:04.065 --> 01:05:05.285 wanted to list some providers NOTE Confidence: 0.9751587 01:05:05.345 --> 01:05:07.444 in that survivorship network. So, NOTE Confidence: 0.9751587 01:05:07.585 --> 01:05:08.625 you know, it could be NOTE Confidence: 0.9751587 01:05:08.625 --> 01:05:10.785 smoking cessation counselor, your primary NOTE Confidence: 0.9751587 01:05:10.785 --> 01:05:12.164 care, your oncologist, NOTE Confidence: 0.9411011 01:05:13.170 --> 01:05:15.109 social worker, lymphedema therapist. NOTE Confidence: 0.991333 01:05:15.490 --> 01:05:16.869 The list goes on. So NOTE Confidence: 0.991333 01:05:17.089 --> 01:05:18.309 it's really definitely NOTE Confidence: 0.9841425 01:05:18.609 --> 01:05:20.450 a team a team job NOTE Confidence: 0.9841425 01:05:20.450 --> 01:05:21.190 and multidisciplinary NOTE Confidence: 0.97344005 01:05:21.490 --> 01:05:22.450 job because I don't pretend NOTE Confidence: 0.97344005 01:05:22.450 --> 01:05:23.890 to be a professional in NOTE Confidence: 0.97344005 01:05:23.890 --> 01:05:25.890 PT. He doesn't pretend to NOTE Confidence: 0.97344005 01:05:25.890 --> 01:05:27.525 know everything about nutrition, but NOTE Confidence: 0.97344005 01:05:27.525 --> 01:05:28.565 we know that we have NOTE Confidence: 0.97344005 01:05:28.565 --> 01:05:29.444 each other right across the NOTE Confidence: 0.97344005 01:05:29.444 --> 01:05:30.405 hall that we can use NOTE Confidence: 0.97344005 01:05:30.405 --> 01:05:31.145 for a resource. NOTE Confidence: 0.9932398 01:05:33.365 --> 01:05:34.085 And then how do you NOTE Confidence: 0.9932398 01:05:34.085 --> 01:05:35.285 get connected with us? So NOTE Confidence: 0.9932398 01:05:35.285 --> 01:05:36.645 if you are interested in NOTE Confidence: 0.9932398 01:05:36.645 --> 01:05:38.164 a referral to survivorship, you NOTE Confidence: 0.9932398 01:05:38.164 --> 01:05:39.444 can self refer. You can NOTE Confidence: 0.9932398 01:05:39.444 --> 01:05:40.744 have your provider refer. NOTE Confidence: 0.9927907 01:05:41.349 --> 01:05:43.109 We have our scheduler, Kiki, NOTE Confidence: 0.9927907 01:05:43.109 --> 01:05:44.230 who is reaching out to NOTE Confidence: 0.9927907 01:05:44.230 --> 01:05:45.349 patients and getting you on NOTE Confidence: 0.9927907 01:05:45.349 --> 01:05:46.010 our schedule. NOTE Confidence: 0.9797276 01:05:46.550 --> 01:05:47.910 So we travel again to NOTE Confidence: 0.9797276 01:05:47.910 --> 01:05:49.270 the different cancer centers. We NOTE Confidence: 0.9797276 01:05:49.270 --> 01:05:50.730 go to Derby, Guilford, NOTE Confidence: 0.9877777 01:05:51.030 --> 01:05:52.490 North Haven, and New Haven, NOTE Confidence: 0.9877777 01:05:52.630 --> 01:05:53.910 and we travel on Wednesdays, NOTE Confidence: 0.9877777 01:05:53.910 --> 01:05:54.710 and it's a full day NOTE Confidence: 0.9877777 01:05:54.710 --> 01:05:55.210 clinic. NOTE Confidence: 0.9998047 01:05:55.510 --> 01:05:56.890 The visits are two hours. NOTE Confidence: 0.9566162 01:05:57.405 --> 01:05:59.005 You spend time, thirty minutes, NOTE Confidence: 0.9566162 01:05:59.005 --> 01:06:00.285 with each provider. So we NOTE Confidence: 0.9566162 01:06:00.285 --> 01:06:01.885 kinda just, like, either move NOTE Confidence: 0.9566162 01:06:01.885 --> 01:06:03.265 you or we move around, NOTE Confidence: 0.99986047 01:06:04.125 --> 01:06:05.565 and we address concerns from NOTE Confidence: 0.99986047 01:06:05.565 --> 01:06:06.305 every angle. NOTE Confidence: 0.9995117 01:06:06.765 --> 01:06:07.805 You can call the number NOTE Confidence: 0.9995117 01:06:07.805 --> 01:06:08.305 yourself. NOTE Confidence: 0.98933595 01:06:09.085 --> 01:06:10.445 Again, we left our emails NOTE Confidence: 0.98933595 01:06:10.445 --> 01:06:11.245 here too, and you can NOTE Confidence: 0.98933595 01:06:11.245 --> 01:06:12.119 always ask us for our NOTE Confidence: 0.98933595 01:06:12.119 --> 01:06:13.559 contact information after if you NOTE Confidence: 0.98933595 01:06:13.559 --> 01:06:14.940 if you can't get this. NOTE Confidence: 0.9862644 01:06:16.440 --> 01:06:17.559 And then just some resources. NOTE Confidence: 0.9862644 01:06:17.559 --> 01:06:18.279 Again, I don't know if NOTE Confidence: 0.9862644 01:06:18.279 --> 01:06:19.079 they were gonna send out NOTE Confidence: 0.9862644 01:06:19.079 --> 01:06:20.039 the slides to you guys NOTE Confidence: 0.9862644 01:06:20.039 --> 01:06:20.859 when you left, NOTE Confidence: 0.99831814 01:06:21.319 --> 01:06:22.680 but we just put down NOTE Confidence: 0.99831814 01:06:22.680 --> 01:06:24.359 some nutrition resources. The American NOTE Confidence: 0.99831814 01:06:24.359 --> 01:06:25.799 Institute for Cancer Research is NOTE Confidence: 0.99831814 01:06:25.799 --> 01:06:26.700 a great resource. NOTE Confidence: 0.9526367 01:06:27.174 --> 01:06:28.095 It has, like, a healthy NOTE Confidence: 0.9526367 01:06:28.095 --> 01:06:28.835 ten challenge, NOTE Confidence: 0.9998047 01:06:29.855 --> 01:06:31.075 which is fun for patients. NOTE Confidence: 0.99226886 01:06:31.695 --> 01:06:33.475 I put some recipe resources, NOTE Confidence: 0.99226886 01:06:33.775 --> 01:06:34.275 cookbooks, NOTE Confidence: 0.98205566 01:06:35.455 --> 01:06:36.735 and then Scott threw in NOTE Confidence: 0.98205566 01:06:36.735 --> 01:06:37.055 some, NOTE Confidence: 1 01:06:37.775 --> 01:06:38.275 exercise NOTE Confidence: 1 01:06:38.815 --> 01:06:40.115 resources as well. NOTE Confidence: 0.97441405 01:06:42.069 --> 01:06:43.109 I think that's the last NOTE Confidence: 0.97441405 01:06:43.109 --> 01:06:44.650 slide. Right? I think so. NOTE Confidence: 0.95273435 01:06:45.109 --> 01:06:46.569 Does anybody have any questions? NOTE Confidence: 0.8334961 01:06:52.309 --> 01:06:52.809 Yeah. NOTE Confidence: 0.6628418 01:06:54.775 --> 01:06:55.275 Oh, NOTE Confidence: 0.9798584 01:06:56.135 --> 01:06:57.415 if if you don't eat NOTE Confidence: 0.9798584 01:06:57.415 --> 01:06:59.175 bacon, but maybe once every NOTE Confidence: 0.9798584 01:06:59.175 --> 01:07:00.695 three months, that is that NOTE Confidence: 0.9798584 01:07:00.695 --> 01:07:01.195 okay? NOTE Confidence: 0.99906415 01:07:02.215 --> 01:07:03.175 I get that question all NOTE Confidence: 0.99906415 01:07:03.175 --> 01:07:04.295 the time. So it's really NOTE Confidence: 0.99906415 01:07:04.455 --> 01:07:05.355 it's minimizing NOTE Confidence: 0.9987386 01:07:05.895 --> 01:07:07.655 the risk. Right? So if NOTE Confidence: 0.9987386 01:07:07.655 --> 01:07:09.015 you're eating bacon once every NOTE Confidence: 0.9987386 01:07:09.015 --> 01:07:09.755 three months, NOTE Confidence: 0.9844109 01:07:10.160 --> 01:07:11.520 I'm if that gives you NOTE Confidence: 0.9844109 01:07:11.520 --> 01:07:12.480 quality of life and that NOTE Confidence: 0.9844109 01:07:12.480 --> 01:07:13.680 makes you happy, I'm not NOTE Confidence: 0.9844109 01:07:13.680 --> 01:07:14.800 gonna tell you to stop NOTE Confidence: 0.9844109 01:07:14.800 --> 01:07:16.720 doing that. It's really people NOTE Confidence: 0.9844109 01:07:16.720 --> 01:07:18.400 who it's every morning. It's NOTE Confidence: 0.9844109 01:07:18.400 --> 01:07:19.440 an every other day thing. NOTE Confidence: 0.9844109 01:07:19.440 --> 01:07:20.720 It's an every weekend thing, NOTE Confidence: 0.9844109 01:07:20.720 --> 01:07:21.600 and they don't really like NOTE Confidence: 0.9844109 01:07:21.600 --> 01:07:22.880 the bacon. It's just there. NOTE Confidence: 0.9844109 01:07:22.880 --> 01:07:24.000 They smell it. They wanna NOTE Confidence: 0.9844109 01:07:24.000 --> 01:07:25.295 eat it. Right? But that's NOTE Confidence: 0.9844109 01:07:25.295 --> 01:07:26.255 me kind of giving the NOTE Confidence: 0.9844109 01:07:26.255 --> 01:07:27.615 options. Okay. Could you do NOTE Confidence: 0.9844109 01:07:27.615 --> 01:07:28.815 a vegan bacon? I've tried NOTE Confidence: 0.9844109 01:07:28.815 --> 01:07:29.695 it. It's not very good, NOTE Confidence: 0.9844109 01:07:29.695 --> 01:07:31.135 but some people really like NOTE Confidence: 0.9844109 01:07:31.135 --> 01:07:32.895 it. It's crunchy. It's still NOTE Confidence: 0.9844109 01:07:32.895 --> 01:07:34.195 kinda got the salt flavoring. NOTE Confidence: 0.9844109 01:07:34.255 --> 01:07:36.335 So it's just minimizing risk. NOTE Confidence: 0.9844109 01:07:36.335 --> 01:07:37.635 Right. And, NOTE Confidence: 0.99183875 01:07:39.540 --> 01:07:41.460 with regard to colon cancer, NOTE Confidence: 0.99183875 01:07:41.460 --> 01:07:42.760 I know that's a little NOTE Confidence: 0.99183875 01:07:42.980 --> 01:07:44.740 further down. Yeah. But, NOTE Confidence: 0.99831814 01:07:45.460 --> 01:07:46.820 I've read that red meat NOTE Confidence: 0.99831814 01:07:46.820 --> 01:07:48.520 is really not good NOTE Confidence: 0.9794478 01:07:48.900 --> 01:07:50.100 for the colon. And is NOTE Confidence: 0.9794478 01:07:50.100 --> 01:07:51.540 that something that I should NOTE Confidence: 0.9794478 01:07:51.540 --> 01:07:52.040 avoid? NOTE Confidence: 0.99938965 01:07:53.165 --> 01:07:54.765 Yeah. So the recommendation is NOTE Confidence: 0.99938965 01:07:54.765 --> 01:07:55.805 to limit to under twelve NOTE Confidence: 0.99938965 01:07:55.805 --> 01:07:57.325 ounces of red meat per NOTE Confidence: 0.99938965 01:07:57.325 --> 01:07:57.825 week. NOTE Confidence: 0.9951172 01:07:59.405 --> 01:07:59.905 Generally, NOTE Confidence: 1 01:08:00.445 --> 01:08:01.984 I tell people to minimize NOTE Confidence: 0.9867871 01:08:02.605 --> 01:08:03.645 as much as they can. NOTE Confidence: 0.9867871 01:08:03.645 --> 01:08:04.765 You know, once a week NOTE Confidence: 0.9867871 01:08:04.765 --> 01:08:06.720 is usually better for cardiac NOTE Confidence: 0.9867871 01:08:06.720 --> 01:08:07.520 health, you know, if you NOTE Confidence: 0.9867871 01:08:07.520 --> 01:08:09.220 have history of cardiovascular disease. NOTE Confidence: 0.9777473 01:08:10.000 --> 01:08:11.040 But, really, the goal is NOTE Confidence: 0.9777473 01:08:11.040 --> 01:08:12.240 to move towards a more NOTE Confidence: 0.9777473 01:08:12.240 --> 01:08:13.440 plant forward diet. I say NOTE Confidence: 0.9777473 01:08:13.440 --> 01:08:15.040 plant forward not meaning vegan. NOTE Confidence: 0.9777473 01:08:15.040 --> 01:08:15.840 You do not have to NOTE Confidence: 0.9777473 01:08:15.840 --> 01:08:16.960 eat all vegan foods and NOTE Confidence: 0.9777473 01:08:16.960 --> 01:08:18.180 only beans and nuts. NOTE Confidence: 0.99553424 01:08:18.935 --> 01:08:20.535 Red meats can absolutely fit. NOTE Confidence: 0.99553424 01:08:20.535 --> 01:08:21.895 Obviously, if your iron is NOTE Confidence: 0.99553424 01:08:21.895 --> 01:08:23.175 low and your weight is NOTE Confidence: 0.99553424 01:08:23.175 --> 01:08:24.854 low, we might incorporate some NOTE Confidence: 0.99553424 01:08:24.854 --> 01:08:25.915 pork or red meat. NOTE Confidence: 0.98339844 01:08:26.375 --> 01:08:28.475 But in general, it's minimizing NOTE Confidence: 0.98339844 01:08:28.695 --> 01:08:29.814 not to exceed the twelve NOTE Confidence: 0.98339844 01:08:29.814 --> 01:08:31.159 ounces per week. So for NOTE Confidence: 0.98339844 01:08:31.159 --> 01:08:32.119 women, that might be three NOTE Confidence: 0.98339844 01:08:32.119 --> 01:08:33.639 servings a week. For men, NOTE Confidence: 0.98339844 01:08:33.639 --> 01:08:34.540 maybe two. NOTE Confidence: 0.99432373 01:08:35.560 --> 01:08:37.159 But pork, beef, and lamb NOTE Confidence: 0.99432373 01:08:37.159 --> 01:08:38.199 are all considered the red NOTE Confidence: 0.99432373 01:08:38.199 --> 01:08:38.939 meat sources. NOTE Confidence: 0.98371327 01:08:39.400 --> 01:08:40.760 So just minimize as much NOTE Confidence: 0.98371327 01:08:40.760 --> 01:08:41.560 as you can not to NOTE Confidence: 0.98371327 01:08:41.560 --> 01:08:42.520 exceed that amount, but I NOTE Confidence: 0.98371327 01:08:42.520 --> 01:08:43.479 would say once a week NOTE Confidence: 0.98371327 01:08:43.479 --> 01:08:44.520 or once every other week NOTE Confidence: 0.98371327 01:08:44.520 --> 01:08:45.239 if you feel like you NOTE Confidence: 0.98371327 01:08:45.239 --> 01:08:45.880 need to keep it in NOTE Confidence: 0.98371327 01:08:45.880 --> 01:08:47.145 the diet. Okay. NOTE Confidence: 0.8640747 01:08:47.525 --> 01:08:48.824 Okay. Thank you. Yeah. NOTE Confidence: 0.963501 01:08:52.485 --> 01:08:53.385 Anybody else? NOTE Confidence: 0.9085519 01:08:58.580 --> 01:08:59.700 Thank you, Scott and Natalie. NOTE Confidence: 0.9085519 01:08:59.700 --> 01:09:00.360 That's awesome. NOTE Confidence: 0.93354934 01:09:00.979 --> 01:09:02.500 Actually, the reminder for body NOTE Confidence: 0.93354934 01:09:02.500 --> 01:09:03.860 weight exercises is great even NOTE Confidence: 0.93354934 01:09:03.860 --> 01:09:04.360 for NOTE Confidence: 0.9689623 01:09:04.820 --> 01:09:06.420 the caregivers and health care NOTE Confidence: 0.9689623 01:09:06.420 --> 01:09:07.700 providers here because that's pretty NOTE Confidence: 0.9689623 01:09:07.700 --> 01:09:08.420 much all I can do NOTE Confidence: 0.9689623 01:09:08.420 --> 01:09:08.900 at the end of a NOTE Confidence: 0.9689623 01:09:08.900 --> 01:09:10.120 long clinic. But, NOTE Confidence: 0.99591064 01:09:11.625 --> 01:09:13.385 but I think from the NOTE Confidence: 0.99591064 01:09:13.385 --> 01:09:14.585 the other set of questions NOTE Confidence: 0.99591064 01:09:14.585 --> 01:09:15.864 that very often come up NOTE Confidence: 0.99591064 01:09:15.864 --> 01:09:16.364 about NOTE Confidence: 0.9837728 01:09:16.744 --> 01:09:19.244 diet and exercise and lifestyle NOTE Confidence: 0.9837728 01:09:19.304 --> 01:09:20.985 modifications, I think one of NOTE Confidence: 0.9837728 01:09:20.985 --> 01:09:22.844 the challenges we have as NOTE Confidence: 0.9348614 01:09:23.790 --> 01:09:25.229 physicians and scientists in the NOTE Confidence: 0.9348614 01:09:25.229 --> 01:09:26.510 community trying to answer some NOTE Confidence: 0.9348614 01:09:26.510 --> 01:09:27.409 of these questions, NOTE Confidence: 0.9286412 01:09:28.349 --> 01:09:29.570 I'll give you an anecdotal NOTE Confidence: 0.9286412 01:09:29.710 --> 01:09:30.449 story is NOTE Confidence: 0.9585937 01:09:30.829 --> 01:09:32.929 the guys who discovered that NOTE Confidence: 0.95590645 01:09:33.550 --> 01:09:35.309 smoking causes lung cancer, the NOTE Confidence: 0.95590645 01:09:35.309 --> 01:09:36.670 two famous guys called Doll NOTE Confidence: 0.95590645 01:09:36.670 --> 01:09:37.785 and Hill. And it was NOTE Confidence: 0.95590645 01:09:37.785 --> 01:09:39.184 a very simple study. They NOTE Confidence: 0.95590645 01:09:39.184 --> 01:09:40.465 took a bunch of people NOTE Confidence: 0.95590645 01:09:40.465 --> 01:09:41.445 who died from NOTE Confidence: 0.9618845 01:09:42.064 --> 01:09:43.744 different things, and they showed NOTE Confidence: 0.9618845 01:09:43.744 --> 01:09:44.864 that if you smoked, you NOTE Confidence: 0.9618845 01:09:44.864 --> 01:09:45.824 had higher risk of lung NOTE Confidence: 0.9618845 01:09:45.824 --> 01:09:46.704 cancer. And if you didn't NOTE Confidence: 0.9618845 01:09:46.704 --> 01:09:47.744 smoke, you didn't have lung NOTE Confidence: 0.9618845 01:09:47.744 --> 01:09:49.585 cancer. Very simple study. But NOTE Confidence: 0.9618845 01:09:49.585 --> 01:09:50.804 that set the NOTE Confidence: 0.8786011 01:09:51.229 --> 01:09:53.150 this whole precedence because prior NOTE Confidence: 0.8786011 01:09:53.150 --> 01:09:53.970 to this study, NOTE Confidence: 0.93858457 01:09:54.590 --> 01:09:56.110 physicians were advertising that you NOTE Confidence: 0.93858457 01:09:56.110 --> 01:09:56.990 should smoke and this is NOTE Confidence: 0.93858457 01:09:56.990 --> 01:09:58.430 the lifestyle thing. And if NOTE Confidence: 0.93858457 01:09:58.430 --> 01:09:59.550 you remember the old cigarette NOTE Confidence: 0.93858457 01:09:59.550 --> 01:10:00.590 ads and stuff like that. NOTE Confidence: 0.93858457 01:10:00.590 --> 01:10:01.090 Right? NOTE Confidence: 0.9112142 01:10:01.950 --> 01:10:03.470 And Doll and Hill never NOTE Confidence: 0.9112142 01:10:03.470 --> 01:10:04.610 won a Nobel Prize NOTE Confidence: 0.9941464 01:10:05.045 --> 01:10:06.325 Because the problem with a NOTE Confidence: 0.9941464 01:10:06.325 --> 01:10:07.845 lot of these lifestyle things NOTE Confidence: 0.9941464 01:10:07.845 --> 01:10:09.225 is they're all associative. NOTE Confidence: 0.99960935 01:10:09.845 --> 01:10:11.225 There is no way to NOTE Confidence: 0.9713726 01:10:11.765 --> 01:10:13.765 prove that smoking causes lung NOTE Confidence: 0.9713726 01:10:13.765 --> 01:10:14.965 cancer, which the only way NOTE Confidence: 0.9713726 01:10:14.965 --> 01:10:16.165 we can prove things most NOTE Confidence: 0.9713726 01:10:16.165 --> 01:10:17.140 of the time is if NOTE Confidence: 0.9713726 01:10:17.140 --> 01:10:18.180 I take a hundred people NOTE Confidence: 0.9713726 01:10:18.180 --> 01:10:18.900 and tell them to smoke, NOTE Confidence: 0.9713726 01:10:18.900 --> 01:10:19.620 and I take a hundred NOTE Confidence: 0.9713726 01:10:19.620 --> 01:10:20.500 people and tell them not NOTE Confidence: 0.9713726 01:10:20.500 --> 01:10:21.380 to smoke, and then follow NOTE Confidence: 0.9713726 01:10:21.380 --> 01:10:22.340 them up for twenty years NOTE Confidence: 0.9713726 01:10:22.340 --> 01:10:23.620 and see that the hundred NOTE Confidence: 0.9713726 01:10:23.620 --> 01:10:25.140 people that smoke got lung NOTE Confidence: 0.9713726 01:10:25.140 --> 01:10:26.100 cancer, and the hundred people NOTE Confidence: 0.9713726 01:10:26.100 --> 01:10:27.140 that didn't smoke didn't get NOTE Confidence: 0.9713726 01:10:27.140 --> 01:10:28.340 lung cancer. And that's not NOTE Confidence: 0.9713726 01:10:28.340 --> 01:10:29.620 ethical. That's never gonna happen. NOTE Confidence: 0.9713726 01:10:29.620 --> 01:10:30.740 You're never gonna be able NOTE Confidence: 0.9713726 01:10:30.740 --> 01:10:31.554 to do it. And the NOTE Confidence: 0.9713726 01:10:31.554 --> 01:10:32.594 problem with a lot of NOTE Confidence: 0.9713726 01:10:32.594 --> 01:10:33.335 the lifestyle, NOTE Confidence: 1 01:10:33.715 --> 01:10:34.215 diet NOTE Confidence: 0.67529297 01:10:34.675 --> 01:10:35.175 modifications NOTE Confidence: 0.9877708 01:10:35.795 --> 01:10:37.074 is that we are never NOTE Confidence: 0.9877708 01:10:37.074 --> 01:10:37.875 gonna be able to have NOTE Confidence: 0.9877708 01:10:37.875 --> 01:10:39.715 these randomized studies to be NOTE Confidence: 0.9877708 01:10:39.715 --> 01:10:40.675 able to give you this NOTE Confidence: 0.9877708 01:10:40.675 --> 01:10:41.494 very definitive NOTE Confidence: 0.97776693 01:10:41.954 --> 01:10:42.914 sort of advice of do NOTE Confidence: 0.97776693 01:10:42.914 --> 01:10:44.195 this or don't do this. NOTE Confidence: 0.97776693 01:10:44.195 --> 01:10:45.494 But at the same time, NOTE Confidence: 0.9638265 01:10:45.870 --> 01:10:47.389 now because we have large NOTE Confidence: 0.9638265 01:10:47.389 --> 01:10:48.750 cohort studies where we can NOTE Confidence: 0.9638265 01:10:48.750 --> 01:10:50.050 do some of these associated NOTE Confidence: 0.9638265 01:10:50.110 --> 01:10:51.010 studies, we have NOTE Confidence: 0.97820926 01:10:51.389 --> 01:10:53.870 reasonably strong recommendations of, hey. NOTE Confidence: 0.97820926 01:10:53.870 --> 01:10:55.550 We roughly think that this NOTE Confidence: 0.97820926 01:10:55.550 --> 01:10:56.989 sort of activity is gonna NOTE Confidence: 0.97820926 01:10:56.989 --> 01:10:57.870 have you give you a NOTE Confidence: 0.97820926 01:10:57.870 --> 01:10:59.310 higher likelihood of doing this NOTE Confidence: 0.97820926 01:10:59.310 --> 01:11:00.345 sort of thing, or doing NOTE Confidence: 0.97820926 01:11:00.345 --> 01:11:01.145 this is gonna give you NOTE Confidence: 0.97820926 01:11:01.145 --> 01:11:02.825 a lower likelihood. But it's NOTE Confidence: 0.97820926 01:11:02.825 --> 01:11:03.864 never gonna be a strong NOTE Confidence: 0.97820926 01:11:03.864 --> 01:11:05.385 recommendation, and that's kind of NOTE Confidence: 0.97820926 01:11:05.385 --> 01:11:05.885 why, NOTE Confidence: 0.95262146 01:11:07.225 --> 01:11:08.905 when we from the health NOTE Confidence: 0.95262146 01:11:08.905 --> 01:11:09.945 care team are giving you NOTE Confidence: 0.95262146 01:11:09.945 --> 01:11:11.305 this advice, it's gonna be NOTE Confidence: 0.95262146 01:11:11.305 --> 01:11:11.805 mostly NOTE Confidence: 0.945085 01:11:12.500 --> 01:11:13.620 like what Natalie said is, NOTE Confidence: 0.945085 01:11:13.620 --> 01:11:14.739 like, a piece of bacon NOTE Confidence: 0.945085 01:11:14.739 --> 01:11:15.699 every three months is probably NOTE Confidence: 0.945085 01:11:15.699 --> 01:11:16.500 not gonna kill you, but NOTE Confidence: 0.945085 01:11:16.500 --> 01:11:16.979 if you eat it every NOTE Confidence: 0.945085 01:11:16.979 --> 01:11:17.939 day, you're probably gonna have NOTE Confidence: 0.945085 01:11:17.939 --> 01:11:20.020 a problem. Right? And it's NOTE Confidence: 0.945085 01:11:20.020 --> 01:11:21.460 very much likely gonna be NOTE Confidence: 0.945085 01:11:21.460 --> 01:11:22.520 that sort of advice. NOTE Confidence: 0.96301854 01:11:23.380 --> 01:11:24.420 The converse of that is NOTE Confidence: 0.96301854 01:11:24.420 --> 01:11:25.860 the data that Scott presented NOTE Confidence: 0.96301854 01:11:25.860 --> 01:11:27.545 where the exercise data was NOTE Confidence: 0.96301854 01:11:27.545 --> 01:11:29.225 a randomized trial. We took NOTE Confidence: 0.96301854 01:11:29.225 --> 01:11:29.725 patients, NOTE Confidence: 0.9324646 01:11:30.425 --> 01:11:32.125 gave this group of patients NOTE Confidence: 0.9324646 01:11:32.185 --> 01:11:33.705 structured exercise. This group of NOTE Confidence: 0.9324646 01:11:33.705 --> 01:11:35.405 patients didn't get structured exercise. NOTE Confidence: 0.9324646 01:11:35.625 --> 01:11:36.125 And NOTE Confidence: 0.9572754 01:11:36.425 --> 01:11:37.645 the folks that exercise NOTE Confidence: 0.93533933 01:11:38.104 --> 01:11:39.625 live longer than the folks NOTE Confidence: 0.93533933 01:11:39.625 --> 01:11:40.729 who didn't get exercise. And NOTE Confidence: 0.93533933 01:11:40.729 --> 01:11:41.770 this is very clear. In NOTE Confidence: 0.93533933 01:11:41.770 --> 01:11:43.150 fact, the benefit from exercise NOTE Confidence: 0.9995117 01:11:43.610 --> 01:11:44.890 is more than the benefit NOTE Confidence: 0.9995117 01:11:44.890 --> 01:11:45.630 from chemotherapy. NOTE Confidence: 0.98876953 01:11:46.010 --> 01:11:47.930 Just imagine that. Right? Patients NOTE Confidence: 0.98876953 01:11:47.930 --> 01:11:49.070 who got colon cancer, NOTE Confidence: 0.965396 01:11:50.090 --> 01:11:51.450 they all got this study NOTE Confidence: 0.965396 01:11:51.450 --> 01:11:52.729 all got chemotherapy. But if NOTE Confidence: 0.965396 01:11:52.729 --> 01:11:53.689 you see the if you NOTE Confidence: 0.965396 01:11:53.689 --> 01:11:55.204 see the trials where patients NOTE Confidence: 0.965396 01:11:55.204 --> 01:11:56.564 had surgery for colon cancer NOTE Confidence: 0.965396 01:11:56.564 --> 01:11:57.525 and then got chemo and NOTE Confidence: 0.965396 01:11:57.525 --> 01:11:58.405 then didn't, and you see NOTE Confidence: 0.965396 01:11:58.405 --> 01:11:59.445 the amount of benefit the NOTE Confidence: 0.965396 01:11:59.445 --> 01:12:00.184 chemo gave, NOTE Confidence: 0.95731354 01:12:00.485 --> 01:12:01.925 the amount of benefit that NOTE Confidence: 0.95731354 01:12:01.925 --> 01:12:03.604 the exercise gave was more NOTE Confidence: 0.95731354 01:12:03.604 --> 01:12:04.564 than the benefit that the NOTE Confidence: 0.95731354 01:12:04.564 --> 01:12:05.925 chemo gave. And so that NOTE Confidence: 0.95731354 01:12:05.925 --> 01:12:06.965 gives us a lot of NOTE Confidence: 0.95731354 01:12:06.965 --> 01:12:08.564 evidence, and Scott can now NOTE Confidence: 0.95731354 01:12:08.564 --> 01:12:09.840 go around saying exercise is NOTE Confidence: 0.95731354 01:12:10.080 --> 01:12:11.599 hundred percent gonna work for NOTE Confidence: 0.95731354 01:12:11.599 --> 01:12:12.639 you because we know that NOTE Confidence: 0.95731354 01:12:12.639 --> 01:12:14.239 for sure. Right? But for NOTE Confidence: 0.95731354 01:12:14.239 --> 01:12:15.280 many things, it's very hard NOTE Confidence: 0.95731354 01:12:15.280 --> 01:12:16.239 for us to very make NOTE Confidence: 0.95731354 01:12:16.239 --> 01:12:18.320 these strong recommendations, especially for NOTE Confidence: 0.95731354 01:12:18.320 --> 01:12:20.000 diet and lifestyle modifications because NOTE Confidence: 0.95731354 01:12:20.000 --> 01:12:21.139 it's very hard to randomize NOTE Confidence: 0.95731354 01:12:21.199 --> 01:12:22.659 some of this stuff. But NOTE Confidence: 0.98015136 01:12:23.185 --> 01:12:24.625 as we we go through NOTE Confidence: 0.98015136 01:12:24.625 --> 01:12:25.925 this stuff, this is actually NOTE Confidence: 0.949923 01:12:26.225 --> 01:12:27.665 the most important part of NOTE Confidence: 0.949923 01:12:27.665 --> 01:12:28.945 fighting the cancer. It's as NOTE Confidence: 0.949923 01:12:28.945 --> 01:12:30.225 important as the surgery and NOTE Confidence: 0.949923 01:12:30.225 --> 01:12:31.585 the radiation. And that's kind NOTE Confidence: 0.949923 01:12:31.585 --> 01:12:32.784 of where actually having the NOTE Confidence: 0.949923 01:12:32.784 --> 01:12:33.284 bespoke NOTE Confidence: 0.95562464 01:12:33.824 --> 01:12:35.520 advice for you and not NOTE Confidence: 0.95562464 01:12:35.520 --> 01:12:36.560 just eat a plant based NOTE Confidence: 0.95562464 01:12:36.560 --> 01:12:37.680 diet. And we know that NOTE Confidence: 0.95562464 01:12:37.680 --> 01:12:39.200 maybe with esophageal cancer, you NOTE Confidence: 0.95562464 01:12:39.200 --> 01:12:40.240 can't have the kale salad NOTE Confidence: 0.95562464 01:12:40.240 --> 01:12:42.080 and therefore, actually, having that NOTE Confidence: 0.95562464 01:12:42.080 --> 01:12:43.280 bespoke advice is kind of NOTE Confidence: 0.95562464 01:12:43.280 --> 01:12:44.320 what we're trying to give NOTE Confidence: 0.95562464 01:12:44.320 --> 01:12:45.620 our patients over here. NOTE Confidence: 0.8814453 01:12:46.720 --> 01:12:48.354 Yeah. Just to be clear, NOTE Confidence: 0.8449707 01:12:48.814 --> 01:12:50.755 smoking is bad. Yes. Figure NOTE Confidence: 0.42773438 01:12:54.175 --> 01:12:54.675 out. NOTE Confidence: 0.82218426 01:12:56.175 --> 01:12:57.395 Smoking is bad. NOTE Confidence: 0.85899913 01:12:58.495 --> 01:12:59.535 There's a lot of causal NOTE Confidence: 0.85899913 01:12:59.535 --> 01:13:00.655 inference. You know, the the NOTE Confidence: 0.85899913 01:13:00.655 --> 01:13:02.370 medical oncologists are obsessed with NOTE Confidence: 0.85899913 01:13:02.530 --> 01:13:04.130 clinical trials. We say things NOTE Confidence: 0.85899913 01:13:04.130 --> 01:13:05.410 like, there's never been a NOTE Confidence: 0.85899913 01:13:05.410 --> 01:13:06.689 clinical trial that said a NOTE Confidence: 0.85899913 01:13:06.689 --> 01:13:08.050 parachute will save you a NOTE Confidence: 0.85899913 01:13:08.050 --> 01:13:08.550 lot. NOTE Confidence: 0.84194946 01:13:10.290 --> 01:13:11.990 So smoking, hundred percent. NOTE Confidence: 0.9206679 01:13:12.930 --> 01:13:14.050 Thanks, Ed. He he also NOTE Confidence: 0.9206679 01:13:14.050 --> 01:13:15.270 is a lung surgeon, NOTE Confidence: 0.8998142 01:13:15.650 --> 01:13:17.775 so he it's very important. NOTE Confidence: 0.8998142 01:13:17.835 --> 01:13:19.354 No. But, yes, smoking's bad. NOTE Confidence: 0.8998142 01:13:19.354 --> 01:13:20.314 I've never I never claimed NOTE Confidence: 0.8998142 01:13:20.314 --> 01:13:21.215 that it's not. NOTE Confidence: 0.99543107 01:13:22.235 --> 01:13:23.435 Any other questions for Scott NOTE Confidence: 0.99543107 01:13:23.435 --> 01:13:24.095 and Natalie? NOTE Confidence: 0.97509766 01:13:24.715 --> 01:13:25.595 If not, thank you very NOTE Confidence: 0.97509766 01:13:25.595 --> 01:13:26.735 much. That's really awesome. NOTE Confidence: 0.9651082 01:13:30.620 --> 01:13:31.820 We're gonna move to the NOTE Confidence: 0.9651082 01:13:31.820 --> 01:13:33.340 next and most exciting part NOTE Confidence: 0.9651082 01:13:33.340 --> 01:13:34.700 of the segment of the NOTE Confidence: 0.9651082 01:13:34.700 --> 01:13:36.160 the the session, which is NOTE Confidence: 0.9651082 01:13:36.220 --> 01:13:37.340 gonna be run by doctor NOTE Confidence: 0.9651082 01:13:37.340 --> 01:13:38.780 Deepika Karki and doctor Derek NOTE Confidence: 0.9651082 01:13:38.780 --> 01:13:39.520 Yac. Deepika? NOTE Confidence: 0.93413633 01:13:43.205 --> 01:13:44.885 Deepika, you wanna introduce doctor NOTE Confidence: 0.93413633 01:13:44.885 --> 01:13:45.385 Yac? NOTE Confidence: 0.98795575 01:13:52.005 --> 01:13:53.525 Hi, everyone. It's me again, NOTE Confidence: 0.98795575 01:13:53.525 --> 01:13:54.025 Deepika. NOTE Confidence: 0.9953613 01:13:54.780 --> 01:13:56.000 So with me, I have NOTE Confidence: 0.9634277 01:13:56.380 --> 01:13:58.240 a leading global health expert, NOTE Confidence: 0.82666016 01:13:58.780 --> 01:13:59.680 doctor Yan, NOTE Confidence: 0.9944526 01:14:00.700 --> 01:14:02.460 and we walked on the NOTE Confidence: 0.9944526 01:14:02.460 --> 01:14:04.220 same road. So we thought NOTE Confidence: 0.9944526 01:14:04.220 --> 01:14:05.979 of, like, just doing it NOTE Confidence: 0.9944526 01:14:05.979 --> 01:14:06.720 in a very NOTE Confidence: 0.947876 01:14:07.275 --> 01:14:08.574 conversational style, NOTE Confidence: 0.99902344 01:14:09.035 --> 01:14:10.395 just sharing what we went NOTE Confidence: 0.99902344 01:14:10.395 --> 01:14:10.895 through, NOTE Confidence: 0.9861816 01:14:11.435 --> 01:14:12.795 how our journey was like, NOTE Confidence: 0.9861816 01:14:12.795 --> 01:14:14.475 and just to give you NOTE Confidence: 0.9861816 01:14:14.475 --> 01:14:16.094 an overview and just answer NOTE Confidence: 0.9995931 01:14:16.395 --> 01:14:17.755 questions you may have for NOTE Confidence: 0.9995931 01:14:17.755 --> 01:14:18.255 us. NOTE Confidence: 0.92715305 01:14:18.635 --> 01:14:19.915 So, doctor Yag, I'll let NOTE Confidence: 0.92715305 01:14:19.915 --> 01:14:20.655 you begin. NOTE Confidence: 0.9574382 01:14:21.630 --> 01:14:22.530 Well, thank you. NOTE Confidence: 0.5824585 01:14:23.390 --> 01:14:24.750 And I think I'll get NOTE Confidence: 0.5824585 01:14:24.750 --> 01:14:25.250 started. NOTE Confidence: 0.9737549 01:14:26.510 --> 01:14:27.729 Working? Great. NOTE Confidence: 0.9895935 01:14:28.350 --> 01:14:29.970 Well, first, what a privilege NOTE Confidence: 0.9895935 01:14:30.030 --> 01:14:31.250 to be here. NOTE Confidence: 0.8683756 01:14:32.030 --> 01:14:33.810 Thank you to your particularly NOTE Confidence: 0.8683756 01:14:33.950 --> 01:14:36.210 doctor Beaufort, doctor Du, wonderful NOTE Confidence: 0.99576825 01:14:36.655 --> 01:14:37.475 to see you. NOTE Confidence: 0.9165039 01:14:38.175 --> 01:14:38.675 And, NOTE Confidence: 0.9816162 01:14:39.695 --> 01:14:41.455 also, it's always a chance NOTE Confidence: 0.9816162 01:14:41.455 --> 01:14:43.075 to show gratitude for the NOTE Confidence: 0.82788086 01:14:43.775 --> 01:14:44.275 incredible, NOTE Confidence: 0.98323137 01:14:45.375 --> 01:14:46.814 support we get here. I NOTE Confidence: 0.98323137 01:14:46.814 --> 01:14:47.854 was looking at the list NOTE Confidence: 0.98323137 01:14:47.854 --> 01:14:49.215 of the huge range of NOTE Confidence: 0.98323137 01:14:49.215 --> 01:14:50.655 people it takes to, NOTE Confidence: 0.9470825 01:14:51.055 --> 01:14:52.354 get us through this. NOTE Confidence: 0.98814106 01:14:52.710 --> 01:14:54.090 And there was only one NOTE Confidence: 0.98814106 01:14:54.150 --> 01:14:55.750 one group missing. I would NOTE Confidence: 0.98814106 01:14:55.750 --> 01:14:57.110 have liked maybe two pages NOTE Confidence: 0.98814106 01:14:57.110 --> 01:14:58.410 of oncology nurses, NOTE Confidence: 0.9980469 01:14:59.750 --> 01:15:00.250 who NOTE Confidence: 0.82299805 01:15:00.550 --> 01:15:01.690 I I became convinced NOTE Confidence: 0.9663086 01:15:02.070 --> 01:15:02.810 were angels, NOTE Confidence: 0.9897461 01:15:03.990 --> 01:15:04.950 to get through all this NOTE Confidence: 0.9897461 01:15:04.950 --> 01:15:05.450 stuff. NOTE Confidence: 0.98706055 01:15:06.425 --> 01:15:06.925 Well, NOTE Confidence: 0.93391925 01:15:08.104 --> 01:15:08.925 I'm not sure, NOTE Confidence: 0.9632324 01:15:09.865 --> 01:15:11.325 where to begin. So I'm NOTE Confidence: 0.80615234 01:15:11.785 --> 01:15:12.285 a NOTE Confidence: 0.9605957 01:15:13.305 --> 01:15:14.845 doctor trained in South Africa. NOTE Confidence: 0.9629069 01:15:15.785 --> 01:15:17.145 I'll explain why that's quite NOTE Confidence: 0.9629069 01:15:17.145 --> 01:15:18.825 interesting. I spent many years NOTE Confidence: 0.9629069 01:15:18.825 --> 01:15:20.045 at the World Health Organization. NOTE Confidence: 0.98217773 01:15:20.930 --> 01:15:21.970 And one of my tasks NOTE Confidence: 0.98217773 01:15:21.970 --> 01:15:23.410 was working on the tobacco NOTE Confidence: 0.98217773 01:15:23.410 --> 01:15:23.910 treaty. NOTE Confidence: 0.9752333 01:15:26.050 --> 01:15:27.490 So very aware that it NOTE Confidence: 0.9752333 01:15:27.490 --> 01:15:29.110 is the largest single preventable NOTE Confidence: 0.9752333 01:15:29.170 --> 01:15:30.050 cause of death in the NOTE Confidence: 0.9752333 01:15:30.050 --> 01:15:31.189 world still today. NOTE Confidence: 0.9209798 01:15:31.490 --> 01:15:32.770 I won't get back into NOTE Confidence: 0.9209798 01:15:32.770 --> 01:15:33.195 that. NOTE Confidence: 0.8831218 01:15:33.755 --> 01:15:35.054 I trained as an epidemiologist, NOTE Confidence: 0.9980469 01:15:36.314 --> 01:15:36.814 and NOTE Confidence: 0.7373047 01:15:37.835 --> 01:15:38.335 spent NOTE Confidence: 0.92055666 01:15:39.275 --> 01:15:40.735 many years in global health, NOTE Confidence: 0.97229004 01:15:41.435 --> 01:15:42.814 looking at cancer trends, NOTE Confidence: 0.9276611 01:15:43.275 --> 01:15:45.275 never realizing that one day NOTE Confidence: 0.9276611 01:15:45.275 --> 01:15:46.655 it will become very personal. NOTE Confidence: 0.9995117 01:15:47.510 --> 01:15:48.390 When I was in South NOTE Confidence: 0.9995117 01:15:48.390 --> 01:15:48.890 Africa, NOTE Confidence: 0.9751674 01:15:50.150 --> 01:15:51.590 one of the programs that NOTE Confidence: 0.9751674 01:15:51.590 --> 01:15:52.070 I was, NOTE Confidence: 0.99658203 01:15:52.550 --> 01:15:53.450 involved with NOTE Confidence: 0.97324216 01:15:53.910 --> 01:15:55.930 was the esophageal cancer program, NOTE Confidence: 0.98333514 01:15:57.270 --> 01:15:58.390 in the eastern part of NOTE Confidence: 0.98333514 01:15:58.390 --> 01:16:00.070 the country, which has some NOTE Confidence: 0.98333514 01:16:00.070 --> 01:16:01.750 of the highest esophageal cancer NOTE Confidence: 0.98333514 01:16:01.750 --> 01:16:03.145 death rates in the world. NOTE Confidence: 0.98333514 01:16:03.145 --> 01:16:04.505 And I then began to NOTE Confidence: 0.98333514 01:16:04.505 --> 01:16:05.405 realize that NOTE Confidence: 0.8496704 01:16:05.784 --> 01:16:06.925 this is a squamous NOTE Confidence: 0.69140625 01:16:07.385 --> 01:16:07.885 cell. NOTE Confidence: 0.8989036 01:16:08.985 --> 01:16:10.344 The belt stretches all the NOTE Confidence: 0.8989036 01:16:10.344 --> 01:16:12.205 way from eastern South Africa NOTE Confidence: 0.8989036 01:16:12.344 --> 01:16:12.824 through, NOTE Confidence: 0.92126465 01:16:13.145 --> 01:16:14.585 the eastern seaboard all the NOTE Confidence: 0.92126465 01:16:14.585 --> 01:16:15.385 way up through, NOTE Confidence: 0.92407227 01:16:15.890 --> 01:16:16.470 to Kenya. NOTE Confidence: 0.9855957 01:16:17.570 --> 01:16:18.790 And to this day, NOTE Confidence: 0.97713214 01:16:19.330 --> 01:16:20.930 the it is the number NOTE Confidence: 0.97713214 01:16:20.930 --> 01:16:22.290 one cause of cancer death NOTE Confidence: 0.97713214 01:16:22.290 --> 01:16:23.110 in Kenya. NOTE Confidence: 0.9716797 01:16:24.370 --> 01:16:24.870 And NOTE Confidence: 0.9023659 01:16:26.770 --> 01:16:28.370 I mention that because I'll NOTE Confidence: 0.9023659 01:16:28.370 --> 01:16:29.170 I'll come back to it NOTE Confidence: 0.9023659 01:16:29.170 --> 01:16:29.670 later. NOTE Confidence: 0.96017456 01:16:31.905 --> 01:16:32.945 So I I I came NOTE Confidence: 0.96017456 01:16:32.945 --> 01:16:33.985 here. I was privileged to NOTE Confidence: 0.96017456 01:16:33.985 --> 01:16:35.745 be at the Yale, School NOTE Confidence: 0.96017456 01:16:35.745 --> 01:16:36.465 of Public Health for a NOTE Confidence: 0.96017456 01:16:36.465 --> 01:16:37.505 number of years before doing NOTE Confidence: 0.96017456 01:16:37.505 --> 01:16:38.385 a whole bunch of other NOTE Confidence: 0.96017456 01:16:38.385 --> 01:16:39.905 things, not realizing I would NOTE Confidence: 0.96017456 01:16:39.905 --> 01:16:41.685 come back as a patient NOTE Confidence: 0.961792 01:16:42.064 --> 01:16:43.045 several times. NOTE Confidence: 0.971734 01:16:44.145 --> 01:16:45.365 First for melanoma, NOTE Confidence: 0.9975586 01:16:46.020 --> 01:16:47.000 then for prostate, NOTE Confidence: 0.9749756 01:16:47.540 --> 01:16:48.439 then for esophagus, NOTE Confidence: 0.9007813 01:16:48.820 --> 01:16:50.820 and then fairly minor thing, NOTE Confidence: 0.84375 01:16:51.620 --> 01:16:53.220 basal cell just two weeks NOTE Confidence: 0.84375 01:16:53.220 --> 01:16:53.720 ago. NOTE Confidence: 0.95825195 01:16:54.660 --> 01:16:56.100 So I've become a cancer NOTE Confidence: 0.95825195 01:16:56.100 --> 01:16:56.600 textbook, NOTE Confidence: 0.9678548 01:16:57.140 --> 01:16:58.580 and, it gives me a NOTE Confidence: 0.9678548 01:16:58.580 --> 01:16:59.080 chance NOTE Confidence: 0.9847005 01:16:59.460 --> 01:17:00.439 to look at, NOTE Confidence: 0.96659344 01:17:00.895 --> 01:17:01.854 first of all, the value NOTE Confidence: 0.96659344 01:17:01.854 --> 01:17:03.375 of early diagnosis and high NOTE Confidence: 0.96659344 01:17:03.375 --> 01:17:04.354 quality treatment, NOTE Confidence: 0.97010636 01:17:04.975 --> 01:17:06.094 which we are privileged to NOTE Confidence: 0.97010636 01:17:06.094 --> 01:17:08.114 have here, at Yale. NOTE Confidence: 0.9786218 01:17:08.574 --> 01:17:10.415 And secondly, to start reflecting NOTE Confidence: 0.9786218 01:17:10.415 --> 01:17:12.094 on, what is it that NOTE Confidence: 0.9786218 01:17:12.094 --> 01:17:13.215 we could be doing more NOTE Confidence: 0.9786218 01:17:13.215 --> 01:17:15.054 broadly. And, so when I NOTE Confidence: 0.9786218 01:17:15.054 --> 01:17:16.114 was first diagnosed, NOTE Confidence: 0.9687056 01:17:17.670 --> 01:17:19.430 it was obviously a huge NOTE Confidence: 0.9687056 01:17:19.430 --> 01:17:20.469 shock. I thought I just NOTE Confidence: 0.9687056 01:17:20.469 --> 01:17:20.969 had NOTE Confidence: 0.9539088 01:17:21.510 --> 01:17:22.950 a hiatus hernia that my NOTE Confidence: 0.9539088 01:17:22.950 --> 01:17:23.989 father had, and he had NOTE Confidence: 0.9539088 01:17:23.989 --> 01:17:25.270 reflux, and it just seemed NOTE Confidence: 0.9539088 01:17:25.270 --> 01:17:26.570 that was probably it. NOTE Confidence: 0.97663224 01:17:27.989 --> 01:17:29.590 I must also mention that NOTE Confidence: 0.97663224 01:17:29.590 --> 01:17:30.250 I think NOTE Confidence: 0.91389495 01:17:31.385 --> 01:17:32.585 the shop to me was NOTE Confidence: 0.91389495 01:17:32.585 --> 01:17:33.705 big, but I think it NOTE Confidence: 0.91389495 01:17:33.705 --> 01:17:35.385 was even greater to my NOTE Confidence: 0.91389495 01:17:35.385 --> 01:17:36.125 wife, Yasmin. NOTE Confidence: 0.98720706 01:17:36.665 --> 01:17:37.864 And I think we don't NOTE Confidence: 0.98720706 01:17:37.864 --> 01:17:39.785 put up the power of NOTE Confidence: 0.98720706 01:17:39.785 --> 01:17:41.385 carers and loved ones as NOTE Confidence: 0.98720706 01:17:41.385 --> 01:17:42.745 being one of the most NOTE Confidence: 0.98720706 01:17:42.745 --> 01:17:45.005 important support throughout the process. NOTE Confidence: 0.930013 01:17:45.465 --> 01:17:46.560 But support that NOTE Confidence: 0.9229879 01:17:46.960 --> 01:17:48.640 that also often suffers in NOTE Confidence: 0.9229879 01:17:48.640 --> 01:17:49.680 ways when you ask how NOTE Confidence: 0.9229879 01:17:49.680 --> 01:17:50.479 are you doing, you were NOTE Confidence: 0.9229879 01:17:50.479 --> 01:17:51.439 saying how are you doing, NOTE Confidence: 0.9229879 01:17:51.439 --> 01:17:52.240 I'm sure if you ask NOTE Confidence: 0.9229879 01:17:52.240 --> 01:17:53.120 the carer, they'll say they're NOTE Confidence: 0.9229879 01:17:53.120 --> 01:17:54.160 doing well, but actually they NOTE Confidence: 0.9229879 01:17:54.160 --> 01:17:55.520 may be taking greater strain NOTE Confidence: 0.9229879 01:17:55.520 --> 01:17:56.640 because they have the same NOTE Confidence: 0.9229879 01:17:56.640 --> 01:17:58.800 concerns about recurrence or what's NOTE Confidence: 0.9229879 01:17:58.800 --> 01:17:59.760 coming on or is this NOTE Confidence: 0.9229879 01:17:59.760 --> 01:18:01.460 symptom something related to it. NOTE Confidence: 0.9606746 01:18:03.545 --> 01:18:05.225 I have to say that, NOTE Confidence: 0.9606746 01:18:05.545 --> 01:18:06.344 I don't want to say NOTE Confidence: 0.9606746 01:18:06.344 --> 01:18:07.625 it negatively, but, NOTE Confidence: 0.9400353 01:18:08.665 --> 01:18:10.905 I I was privileged not NOTE Confidence: 0.9400353 01:18:10.905 --> 01:18:12.025 to go through the torture NOTE Confidence: 0.9400353 01:18:12.025 --> 01:18:13.165 with doctor Du. NOTE Confidence: 0.98217773 01:18:13.784 --> 01:18:14.764 I didn't experience NOTE Confidence: 0.99853516 01:18:15.304 --> 01:18:16.205 any of it. NOTE Confidence: 0.943191 01:18:16.890 --> 01:18:17.930 It was actually for me, NOTE Confidence: 0.943191 01:18:17.930 --> 01:18:18.650 I hate to say it, NOTE Confidence: 0.943191 01:18:18.650 --> 01:18:20.729 but quite an amazingly pleasant NOTE Confidence: 0.943191 01:18:20.729 --> 01:18:22.490 experience coming in, lying in, NOTE Confidence: 0.943191 01:18:22.490 --> 01:18:23.689 having a very short sleep, NOTE Confidence: 0.943191 01:18:23.689 --> 01:18:24.990 and out hours again, NOTE Confidence: 0.99869794 01:18:26.490 --> 01:18:27.689 and going through the chemo NOTE Confidence: 0.99869794 01:18:27.689 --> 01:18:28.750 at the same time. NOTE Confidence: 0.97425425 01:18:29.305 --> 01:18:30.685 I do think in retrospect NOTE Confidence: 0.97425425 01:18:30.745 --> 01:18:31.945 that one of the important NOTE Confidence: 0.97425425 01:18:31.945 --> 01:18:32.445 factors NOTE Confidence: 0.937779 01:18:33.064 --> 01:18:34.765 which you mentioned in the NOTE Confidence: 0.937779 01:18:34.825 --> 01:18:35.885 exercise program NOTE Confidence: 0.98017037 01:18:36.425 --> 01:18:37.305 was that if you look NOTE Confidence: 0.98017037 01:18:37.305 --> 01:18:38.845 at the exercise literature, NOTE Confidence: 0.9844622 01:18:39.305 --> 01:18:40.505 not yet in the colon NOTE Confidence: 0.9844622 01:18:40.505 --> 01:18:42.025 and esophageal field, but in NOTE Confidence: 0.9844622 01:18:42.025 --> 01:18:43.405 the breast cancer world, NOTE Confidence: 0.9944411 01:18:44.320 --> 01:18:46.000 the evidence on high levels NOTE Confidence: 0.9944411 01:18:46.000 --> 01:18:47.439 of activity while you are NOTE Confidence: 0.9944411 01:18:47.439 --> 01:18:48.500 going through chemo NOTE Confidence: 0.93847656 01:18:49.120 --> 01:18:50.340 seem pretty conclusive NOTE Confidence: 0.99728733 01:18:50.800 --> 01:18:51.920 that you will lower the NOTE Confidence: 0.99728733 01:18:51.920 --> 01:18:53.140 levels of side effects NOTE Confidence: 0.9938151 01:18:53.600 --> 01:18:55.120 and lower the levels of NOTE Confidence: 0.9938151 01:18:55.120 --> 01:18:55.620 remission. NOTE Confidence: 0.96607566 01:18:56.395 --> 01:18:57.435 Now we know in colon NOTE Confidence: 0.96607566 01:18:57.435 --> 01:18:59.755 about remission and survival. We NOTE Confidence: 0.96607566 01:18:59.755 --> 01:19:00.795 haven't yet looked at it NOTE Confidence: 0.96607566 01:19:00.795 --> 01:19:01.835 during chemo. And, of course, NOTE Confidence: 0.96607566 01:19:01.835 --> 01:19:02.955 it's difficult to be doing NOTE Confidence: 0.96607566 01:19:02.955 --> 01:19:04.255 exercise. I'm a swimmer. NOTE Confidence: 0.9887288 01:19:04.875 --> 01:19:06.235 And, one of the first NOTE Confidence: 0.9887288 01:19:06.235 --> 01:19:06.554 things, NOTE Confidence: 0.93202037 01:19:07.435 --> 01:19:08.795 doctor Bofors said to me NOTE Confidence: 0.93202037 01:19:08.795 --> 01:19:08.955 was, NOTE Confidence: 0.89331055 01:19:10.460 --> 01:19:11.760 I'll never forget it. NOTE Confidence: 0.9067654 01:19:12.139 --> 01:19:13.179 And, of course, you know NOTE Confidence: 0.9067654 01:19:13.179 --> 01:19:14.320 you'll never swim again. NOTE Confidence: 0.9527893 01:19:15.420 --> 01:19:16.860 And for me that was NOTE Confidence: 0.9527893 01:19:16.860 --> 01:19:18.380 a big shock. I had NOTE Confidence: 0.9527893 01:19:18.380 --> 01:19:19.340 a I had my last NOTE Confidence: 0.9527893 01:19:19.340 --> 01:19:19.840 swim NOTE Confidence: 0.9689636 01:19:20.300 --> 01:19:21.979 with, friends out in the NOTE Confidence: 0.9689636 01:19:21.979 --> 01:19:23.120 Long Island Sound. NOTE Confidence: 0.9433594 01:19:23.824 --> 01:19:24.324 And, NOTE Confidence: 0.9400499 01:19:25.025 --> 01:19:26.064 and then at the end NOTE Confidence: 0.9400499 01:19:26.064 --> 01:19:27.685 of surgery and chemotherapy, NOTE Confidence: 0.98723495 01:19:28.385 --> 01:19:29.505 I swam around the Statue NOTE Confidence: 0.98723495 01:19:29.505 --> 01:19:30.064 of Liberty, NOTE Confidence: 0.9991862 01:19:30.465 --> 01:19:31.364 as a celebration. NOTE Confidence: 0.92807955 01:19:32.784 --> 01:19:33.824 Now I mention that because NOTE Confidence: 0.92807955 01:19:33.824 --> 01:19:35.505 I'm probably lucky I continue NOTE Confidence: 0.92807955 01:19:35.505 --> 01:19:36.625 to swim, and many people NOTE Confidence: 0.92807955 01:19:36.625 --> 01:19:37.425 would not be able to NOTE Confidence: 0.92807955 01:19:37.425 --> 01:19:38.250 do it. But I mention NOTE Confidence: 0.92807955 01:19:38.330 --> 01:19:39.150 for two reasons. First, NOTE Confidence: 0.88916016 01:19:41.210 --> 01:19:42.890 never forget swimming is a NOTE Confidence: 0.88916016 01:19:42.970 --> 01:19:44.189 also a great alternative NOTE Confidence: 0.92944336 01:19:44.490 --> 01:19:45.790 with muscle strengthening, NOTE Confidence: 0.99555 01:19:46.490 --> 01:19:48.170 but it also eliminates a NOTE Confidence: 0.99555 01:19:48.170 --> 01:19:49.610 lot of the gravity issues NOTE Confidence: 0.99555 01:19:49.610 --> 01:19:51.210 that people face, in doing NOTE Confidence: 0.99555 01:19:51.210 --> 01:19:52.170 a lot of pounding on NOTE Confidence: 0.99555 01:19:52.170 --> 01:19:52.750 the streets. NOTE Confidence: 0.8811035 01:19:53.525 --> 01:19:55.465 But secondly, swimming is also NOTE Confidence: 0.8811035 01:19:55.604 --> 01:19:57.304 for me a metaphor of, NOTE Confidence: 0.9247559 01:19:58.085 --> 01:20:00.185 having a goal, something to NOTE Confidence: 0.96197647 01:20:01.045 --> 01:20:02.244 take part in with friends NOTE Confidence: 0.96197647 01:20:02.244 --> 01:20:03.685 and colleagues on the beach. NOTE Confidence: 0.96197647 01:20:03.685 --> 01:20:05.364 And the camaraderie, I think, NOTE Confidence: 0.96197647 01:20:05.364 --> 01:20:06.744 becomes very important. NOTE Confidence: 0.8997803 01:20:09.260 --> 01:20:10.780 And really, I think the NOTE Confidence: 0.8997803 01:20:10.780 --> 01:20:11.099 last, NOTE Confidence: 0.9517415 01:20:12.139 --> 01:20:13.579 it's three years now since NOTE Confidence: 0.9517415 01:20:13.579 --> 01:20:14.079 diagnosis. NOTE Confidence: 0.7817383 01:20:14.860 --> 01:20:15.340 And, NOTE Confidence: 0.9454854 01:20:16.619 --> 01:20:17.420 one of, for me, one NOTE Confidence: 0.9454854 01:20:17.420 --> 01:20:18.699 of the most important things NOTE Confidence: 0.9454854 01:20:18.699 --> 01:20:19.439 was to NOTE Confidence: 0.9970703 01:20:20.445 --> 01:20:21.325 really look at one of NOTE Confidence: 0.9970703 01:20:21.325 --> 01:20:22.465 the elements missing NOTE Confidence: 0.94873047 01:20:23.085 --> 01:20:24.625 in the National Cancer Institute NOTE Confidence: 0.94873047 01:20:24.765 --> 01:20:25.265 survivorship NOTE Confidence: 0.8533203 01:20:25.645 --> 01:20:27.185 list where they talk about, NOTE Confidence: 0.9667969 01:20:28.365 --> 01:20:30.445 issues of physical, mental, social NOTE Confidence: 0.9667969 01:20:30.445 --> 01:20:32.785 well-being. They miss one word. NOTE Confidence: 0.99433595 01:20:33.330 --> 01:20:34.869 And the word is spiritual. NOTE Confidence: 0.9779663 01:20:36.130 --> 01:20:37.330 I think that's something I NOTE Confidence: 0.9779663 01:20:37.330 --> 01:20:38.150 gained a greater NOTE Confidence: 0.7022705 01:20:38.610 --> 01:20:39.510 sense of, NOTE Confidence: 0.9194336 01:20:40.610 --> 01:20:42.449 the importance of the spirit NOTE Confidence: 0.9194336 01:20:42.449 --> 01:20:43.270 and the meaning. NOTE Confidence: 0.6464844 01:20:43.650 --> 01:20:44.150 And NOTE Confidence: 0.97835284 01:20:45.545 --> 01:20:46.604 I started reading, NOTE Confidence: 0.9909668 01:20:47.864 --> 01:20:48.685 several times, NOTE Confidence: 0.9130588 01:20:49.864 --> 01:20:51.244 Viktor Frankl's book, NOTE Confidence: 0.97220284 01:20:51.864 --> 01:20:53.145 on the meaning and purpose NOTE Confidence: 0.97220284 01:20:53.145 --> 01:20:53.724 of life. NOTE Confidence: 0.9863281 01:20:54.264 --> 01:20:55.885 And you'll find in it, NOTE Confidence: 0.8992075 01:20:56.505 --> 01:20:57.784 a quote which he repeats NOTE Confidence: 0.8992075 01:20:57.784 --> 01:20:59.625 several times by Nietzsche, which NOTE Confidence: 0.8992075 01:20:59.625 --> 01:21:01.005 is that, if NOTE Confidence: 0.9802595 01:21:01.439 --> 01:21:03.099 if you know the why NOTE Confidence: 0.9802595 01:21:03.360 --> 01:21:04.800 of your life, you can NOTE Confidence: 0.9802595 01:21:04.800 --> 01:21:06.820 overcome almost any how. NOTE Confidence: 0.99593836 01:21:08.479 --> 01:21:09.760 And he went on to NOTE Confidence: 0.99593836 01:21:09.760 --> 01:21:10.960 become one of the great NOTE Confidence: 0.99593836 01:21:10.960 --> 01:21:11.460 therapists, NOTE Confidence: 0.96293944 01:21:12.719 --> 01:21:14.820 after leaving Auschwitz and surviving, NOTE Confidence: 0.9248047 01:21:16.535 --> 01:21:18.375 To apply his idea about NOTE Confidence: 0.9248047 01:21:18.375 --> 01:21:19.595 the importance of meaning NOTE Confidence: 0.9941406 01:21:19.975 --> 01:21:20.715 in developing NOTE Confidence: 0.95458984 01:21:21.575 --> 01:21:22.854 a purpose in life for NOTE Confidence: 0.95458984 01:21:22.854 --> 01:21:23.915 cancer patients. NOTE Confidence: 0.9472351 01:21:25.095 --> 01:21:26.854 And recorded over the years NOTE Confidence: 0.9472351 01:21:26.854 --> 01:21:27.835 before he died, NOTE Confidence: 0.95675224 01:21:28.455 --> 01:21:29.814 how you can have two NOTE Confidence: 0.95675224 01:21:29.814 --> 01:21:30.715 cancer patients, NOTE Confidence: 0.97680664 01:21:31.800 --> 01:21:33.900 exactly the same diagnostic criteria. NOTE Confidence: 0.991096 01:21:34.840 --> 01:21:36.040 They may only differ in NOTE Confidence: 0.991096 01:21:36.040 --> 01:21:37.079 terms of having a sense NOTE Confidence: 0.991096 01:21:37.079 --> 01:21:37.960 of what they wanted to NOTE Confidence: 0.991096 01:21:37.960 --> 01:21:38.780 live for. NOTE Confidence: 0.99869794 01:21:39.960 --> 01:21:41.420 And it could be something NOTE Confidence: 0.99869794 01:21:41.479 --> 01:21:41.979 as NOTE Confidence: 0.9818905 01:21:42.920 --> 01:21:44.360 intimate and personal as your NOTE Confidence: 0.9818905 01:21:44.360 --> 01:21:46.054 loved one, Or it could NOTE Confidence: 0.9818905 01:21:46.054 --> 01:21:47.175 be some big meaning in NOTE Confidence: 0.9818905 01:21:47.175 --> 01:21:48.215 life. And, NOTE Confidence: 0.97329533 01:21:48.935 --> 01:21:49.975 I think about that a NOTE Confidence: 0.97329533 01:21:49.975 --> 01:21:51.094 lot and the privilege that NOTE Confidence: 0.97329533 01:21:51.094 --> 01:21:52.054 I went through to go NOTE Confidence: 0.97329533 01:21:52.054 --> 01:21:53.255 through therapy that I know NOTE Confidence: 0.97329533 01:21:53.255 --> 01:21:54.854 my brothers and sisters in NOTE Confidence: 0.97329533 01:21:54.854 --> 01:21:56.455 Africa just don't have access NOTE Confidence: 0.97329533 01:21:56.455 --> 01:21:57.755 to. They have virtually NOTE Confidence: 0.9248744 01:21:58.300 --> 01:22:00.380 no diagnostic capability, no treatment NOTE Confidence: 0.9248744 01:22:00.380 --> 01:22:02.300 capability and so on. And NOTE Confidence: 0.9248744 01:22:02.300 --> 01:22:03.920 so while my initial, NOTE Confidence: 0.95703125 01:22:04.939 --> 01:22:06.880 why was certainly related NOTE Confidence: 0.9562564 01:22:07.500 --> 01:22:08.880 to my wife, my son, NOTE Confidence: 0.9562564 01:22:08.939 --> 01:22:10.140 hoping to make it to NOTE Confidence: 0.9562564 01:22:10.140 --> 01:22:11.660 his graduation, which I didn't NOTE Confidence: 0.9562564 01:22:11.660 --> 01:22:12.860 actually think I was going NOTE Confidence: 0.9562564 01:22:12.860 --> 01:22:13.760 to do because NOTE Confidence: 0.912913 01:22:14.675 --> 01:22:15.955 the first diagnosis you think, NOTE Confidence: 0.912913 01:22:15.955 --> 01:22:16.675 you look at the data NOTE Confidence: 0.912913 01:22:16.675 --> 01:22:17.395 and you think, oh, my NOTE Confidence: 0.912913 01:22:17.395 --> 01:22:18.995 God, that's it. Well, he's NOTE Confidence: 0.912913 01:22:18.995 --> 01:22:20.695 graduating next month. So NOTE Confidence: 0.9451172 01:22:20.995 --> 01:22:23.495 that's one that's ticked off. NOTE Confidence: 0.886213 01:22:24.915 --> 01:22:26.115 And now I think I NOTE Confidence: 0.886213 01:22:26.115 --> 01:22:27.555 turn to the second part NOTE Confidence: 0.886213 01:22:27.555 --> 01:22:29.095 of one's life. And NOTE Confidence: 0.9995117 01:22:29.930 --> 01:22:30.830 one of the great NOTE Confidence: 0.9660819 01:22:31.930 --> 01:22:33.930 rabbis of the twelfth century, NOTE Confidence: 0.9660819 01:22:33.930 --> 01:22:35.150 Hillel, said, NOTE Confidence: 0.93856376 01:22:36.170 --> 01:22:37.050 if I'm not for me, NOTE Confidence: 0.93856376 01:22:37.050 --> 01:22:37.850 who is for me? You NOTE Confidence: 0.93856376 01:22:37.850 --> 01:22:38.830 may know the quote. NOTE Confidence: 0.9719238 01:22:39.370 --> 01:22:40.490 But he went on to NOTE Confidence: 0.9719238 01:22:40.490 --> 01:22:42.090 ask the next question, and NOTE Confidence: 0.9719238 01:22:42.090 --> 01:22:43.710 if I'm only for me, NOTE Confidence: 0.99853516 01:22:44.095 --> 01:22:44.835 what am NOTE Confidence: 0.9962333 01:22:45.135 --> 01:22:46.495 I? And I interpret that NOTE Confidence: 0.9962333 01:22:46.495 --> 01:22:47.155 as being NOTE Confidence: 0.98048705 01:22:47.695 --> 01:22:48.735 that I've been lucky enough NOTE Confidence: 0.98048705 01:22:48.735 --> 01:22:49.935 to come through. Now how NOTE Confidence: 0.98048705 01:22:49.935 --> 01:22:51.854 do I take this? And NOTE Confidence: 0.98048705 01:22:51.854 --> 01:22:52.975 with Deepika and I, I NOTE Confidence: 0.98048705 01:22:52.975 --> 01:22:53.935 know we both share the NOTE Confidence: 0.98048705 01:22:53.935 --> 01:22:55.375 need and the desire to NOTE Confidence: 0.98048705 01:22:55.375 --> 01:22:56.910 make sure that people who NOTE Confidence: 0.98048705 01:22:56.910 --> 01:22:58.530 don't have a Yale access NOTE Confidence: 0.9849175 01:22:58.990 --> 01:23:00.510 can actually have access to NOTE Confidence: 0.9849175 01:23:00.510 --> 01:23:02.370 better quality cancer care. NOTE Confidence: 0.9724121 01:23:03.150 --> 01:23:04.510 And I've been in Kenya NOTE Confidence: 0.9724121 01:23:04.510 --> 01:23:06.370 recently at a cancer center NOTE Confidence: 0.9724121 01:23:06.430 --> 01:23:06.930 where NOTE Confidence: 0.980896 01:23:08.104 --> 01:23:09.784 the only treatment of people NOTE Confidence: 0.980896 01:23:09.784 --> 01:23:11.725 with, esophageal cancer NOTE Confidence: 0.8955078 01:23:12.185 --> 01:23:13.705 is a surgical stent to NOTE Confidence: 0.8955078 01:23:13.705 --> 01:23:15.645 keep the ability to swallow NOTE Confidence: 0.8955078 01:23:15.945 --> 01:23:17.005 and chemotherapy NOTE Confidence: 0.9842122 01:23:17.945 --> 01:23:20.585 supported by real oncology nurse NOTE Confidence: 0.9842122 01:23:20.585 --> 01:23:21.085 angels. NOTE Confidence: 0.9935608 01:23:21.625 --> 01:23:22.585 And that's not the way NOTE Confidence: 0.9935608 01:23:22.585 --> 01:23:23.400 it should be. NOTE Confidence: 0.9334717 01:23:23.719 --> 01:23:24.600 If we think of the NOTE Confidence: 0.9334717 01:23:24.600 --> 01:23:26.060 progress we made in AIDS, NOTE Confidence: 0.96313477 01:23:26.600 --> 01:23:27.560 we used to say that NOTE Confidence: 0.96313477 01:23:27.560 --> 01:23:28.439 we would never be able NOTE Confidence: 0.96313477 01:23:28.439 --> 01:23:29.960 to apply these complex treatments NOTE Confidence: 0.96313477 01:23:29.960 --> 01:23:31.400 across Africa. They would never NOTE Confidence: 0.96313477 01:23:31.400 --> 01:23:32.199 be able to handle it. NOTE Confidence: 0.96313477 01:23:32.199 --> 01:23:33.800 Well, they do. And millions NOTE Confidence: 0.96313477 01:23:33.800 --> 01:23:35.179 are living because of it. NOTE Confidence: 0.96313477 01:23:35.320 --> 01:23:36.360 I hope and I know NOTE Confidence: 0.96313477 01:23:36.360 --> 01:23:37.640 that we share this. We NOTE Confidence: 0.96313477 01:23:37.640 --> 01:23:39.100 want to make sure that NOTE Confidence: 0.96313477 01:23:39.375 --> 01:23:40.575 it's not just us who NOTE Confidence: 0.96313477 01:23:40.575 --> 01:23:42.495 benefit, but it's our brothers NOTE Confidence: 0.96313477 01:23:42.495 --> 01:23:43.075 and sisters NOTE Confidence: 0.97680664 01:23:43.695 --> 01:23:44.435 elsewhere. Thanks. NOTE Confidence: 0.86382586 01:23:50.575 --> 01:23:51.900 Well, it's pretty hard to NOTE Confidence: 0.86382586 01:23:51.900 --> 01:23:54.300 follow with amazing words that NOTE Confidence: 0.86382586 01:23:54.300 --> 01:23:55.360 doctor Yaj said. NOTE Confidence: 0.9529758 01:23:56.380 --> 01:23:57.900 So I am Deepika Karki. NOTE Confidence: 0.9529758 01:23:57.900 --> 01:23:59.200 I'm also a medically NOTE Confidence: 0.97249347 01:23:59.660 --> 01:24:01.420 trained doctor. I trained far NOTE Confidence: 0.97249347 01:24:01.420 --> 01:24:01.920 away NOTE Confidence: 0.99853516 01:24:02.300 --> 01:24:03.040 in Nepal, NOTE Confidence: 0.9975891 01:24:03.420 --> 01:24:04.640 the land of Himalayas. NOTE Confidence: 0.9987305 01:24:05.655 --> 01:24:07.434 And talking about my country, NOTE Confidence: 0.9922282 01:24:07.814 --> 01:24:10.074 it's blessed with wonderful mountains, NOTE Confidence: 0.9922282 01:24:10.215 --> 01:24:10.715 but NOTE Confidence: 0.99794227 01:24:11.094 --> 01:24:13.514 we still struggle for basic NOTE Confidence: 0.99794227 01:24:13.574 --> 01:24:14.395 health services. NOTE Confidence: 0.9421658 01:24:15.415 --> 01:24:16.934 And, when I was diagnosed NOTE Confidence: 0.9421658 01:24:16.934 --> 01:24:18.054 I was diagnosed when I NOTE Confidence: 0.9421658 01:24:18.054 --> 01:24:20.189 was twenty five. This is NOTE Confidence: 0.9421658 01:24:20.189 --> 01:24:21.150 my fifth year, NOTE Confidence: 0.82177734 01:24:23.150 --> 01:24:23.650 anniversary NOTE Confidence: 0.9769694 01:24:24.430 --> 01:24:25.650 of beating cancer. NOTE Confidence: 0.99902344 01:24:26.030 --> 01:24:27.330 And when I was diagnosed, NOTE Confidence: 0.99902344 01:24:27.390 --> 01:24:28.450 I was so young NOTE Confidence: 0.7963867 01:24:28.910 --> 01:24:29.410 that, NOTE Confidence: 0.99761283 01:24:30.350 --> 01:24:31.310 when I went for the NOTE Confidence: 0.99761283 01:24:31.310 --> 01:24:32.930 endoscopy, it was just NOTE Confidence: 0.9979803 01:24:33.724 --> 01:24:35.085 assuming that I just had NOTE Confidence: 0.9979803 01:24:35.085 --> 01:24:36.364 a very bad episode of NOTE Confidence: 0.9979803 01:24:36.364 --> 01:24:36.864 gastritis NOTE Confidence: 0.9482422 01:24:37.405 --> 01:24:38.684 because I was just starting NOTE Confidence: 0.9482422 01:24:38.684 --> 01:24:39.664 my intern year. NOTE Confidence: 0.9763581 01:24:40.125 --> 01:24:41.324 And the people who scoped NOTE Confidence: 0.9763581 01:24:41.324 --> 01:24:42.525 me were, like, all residents, NOTE Confidence: 0.9763581 01:24:42.525 --> 01:24:43.564 and they were just like, NOTE Confidence: 0.9763581 01:24:43.564 --> 01:24:45.184 we're not gonna find anything. NOTE Confidence: 0.9763581 01:24:45.405 --> 01:24:46.284 You know, you're just not NOTE Confidence: 0.9763581 01:24:46.284 --> 01:24:47.724 eating right. But when they NOTE Confidence: 0.9763581 01:24:47.724 --> 01:24:49.264 put the scope in, like, NOTE Confidence: 0.9763581 01:24:49.380 --> 01:24:50.420 they were all, you know, NOTE Confidence: 0.9763581 01:24:50.420 --> 01:24:51.239 oh my god. NOTE Confidence: 0.9530584 01:24:51.939 --> 01:24:53.780 And I distinctly remember my NOTE Confidence: 0.9530584 01:24:53.780 --> 01:24:55.699 father walking in and them NOTE Confidence: 0.9530584 01:24:55.699 --> 01:24:56.199 saying, NOTE Confidence: 0.9068441 01:24:57.300 --> 01:24:58.340 you take a day off. NOTE Confidence: 0.9068441 01:24:58.340 --> 01:24:59.639 You just go and rest. NOTE Confidence: 0.9068441 01:24:59.780 --> 01:25:00.739 And I was happy to NOTE Confidence: 0.9068441 01:25:00.739 --> 01:25:01.939 get a day off. And NOTE Confidence: 0.9068441 01:25:01.939 --> 01:25:03.300 just like I I rushed NOTE Confidence: 0.9068441 01:25:03.300 --> 01:25:05.000 to my boyfriend, now husband. NOTE Confidence: 0.9551251 01:25:05.405 --> 01:25:06.045 Was just like, oh, I NOTE Confidence: 0.9551251 01:25:06.045 --> 01:25:06.765 got a day off. Like, NOTE Confidence: 0.9551251 01:25:06.765 --> 01:25:08.385 they just did an endoscopy. NOTE Confidence: 0.9551251 01:25:08.525 --> 01:25:10.285 My father was crying the NOTE Confidence: 0.9551251 01:25:10.285 --> 01:25:11.645 whole weekend, not letting me NOTE Confidence: 0.9551251 01:25:11.645 --> 01:25:12.145 know NOTE Confidence: 0.9675293 01:25:12.604 --> 01:25:14.045 what they told him. I NOTE Confidence: 0.9675293 01:25:14.045 --> 01:25:16.625 didn't know until I underwent NOTE Confidence: 0.9059245 01:25:16.925 --> 01:25:17.905 a CT scan NOTE Confidence: 0.9086914 01:25:18.685 --> 01:25:19.185 that NOTE Confidence: 0.97522783 01:25:19.540 --> 01:25:21.400 was followed by the pathology NOTE Confidence: 0.97522783 01:25:21.620 --> 01:25:23.880 reports with which showed squamous, NOTE Confidence: 0.8132324 01:25:25.300 --> 01:25:25.800 cancer. NOTE Confidence: 0.9996745 01:25:26.260 --> 01:25:27.380 And they put me on NOTE Confidence: 0.9996745 01:25:27.380 --> 01:25:27.880 chemotherapy NOTE Confidence: 0.9975586 01:25:28.260 --> 01:25:29.080 rather quick NOTE Confidence: 0.83447266 01:25:29.699 --> 01:25:30.199 because, NOTE Confidence: 0.96559364 01:25:30.820 --> 01:25:31.939 because I was blessed, and NOTE Confidence: 0.96559364 01:25:31.939 --> 01:25:32.900 my father was in the NOTE Confidence: 0.96559364 01:25:32.900 --> 01:25:34.635 medical field too. And me NOTE Confidence: 0.96559364 01:25:34.635 --> 01:25:36.635 myself was a doctor in NOTE Confidence: 0.96559364 01:25:36.635 --> 01:25:38.155 training so I could get NOTE Confidence: 0.96559364 01:25:38.155 --> 01:25:39.454 my treatment quick. NOTE Confidence: 0.9864502 01:25:39.994 --> 01:25:40.814 But Nepal, NOTE Confidence: 0.98324925 01:25:41.275 --> 01:25:42.635 we didn't even have PET NOTE Confidence: 0.98324925 01:25:42.635 --> 01:25:44.474 scan, so there was nothing NOTE Confidence: 0.98324925 01:25:44.474 --> 01:25:46.554 that could even help me NOTE Confidence: 0.98324925 01:25:46.554 --> 01:25:47.454 see the extent NOTE Confidence: 0.92575073 01:25:47.880 --> 01:25:49.240 to which the cancer was NOTE Confidence: 0.92575073 01:25:49.240 --> 01:25:50.300 eating my body. NOTE Confidence: 0.9990932 01:25:51.080 --> 01:25:52.120 So I had to travel NOTE Confidence: 0.9990932 01:25:52.120 --> 01:25:52.780 to India. NOTE Confidence: 0.996875 01:25:53.720 --> 01:25:54.939 I went there. It was NOTE Confidence: 0.9945023 01:25:55.240 --> 01:25:56.280 around the time of the NOTE Confidence: 0.9945023 01:25:56.280 --> 01:25:57.580 second wave of COVID. NOTE Confidence: 0.9954529 01:25:58.280 --> 01:25:59.560 So we went there. We NOTE Confidence: 0.9954529 01:25:59.560 --> 01:26:00.700 stayed there for NOTE Confidence: 1 01:26:01.240 --> 01:26:02.220 over a month NOTE Confidence: 0.95458984 01:26:02.760 --> 01:26:03.885 where I where I, NOTE Confidence: 0.90030926 01:26:04.604 --> 01:26:05.804 did up did my PET NOTE Confidence: 0.90030926 01:26:05.804 --> 01:26:06.304 scan, NOTE Confidence: 0.9794922 01:26:07.085 --> 01:26:09.724 underwent radiation therapy, very bad NOTE Confidence: 0.9794922 01:26:09.724 --> 01:26:11.405 experience, by the way. I NOTE Confidence: 0.9794922 01:26:11.405 --> 01:26:12.864 had to get admitted thrice NOTE Confidence: 0.98913574 01:26:13.244 --> 01:26:14.625 because I couldn't swallow. NOTE Confidence: 0.99112374 01:26:15.085 --> 01:26:16.784 It was this burning pain NOTE Confidence: 0.99112374 01:26:17.070 --> 01:26:18.189 from my throat all the NOTE Confidence: 0.99112374 01:26:18.189 --> 01:26:19.250 way to my stomach, NOTE Confidence: 0.9889323 01:26:19.710 --> 01:26:20.750 and I love to eat. NOTE Confidence: 0.9889323 01:26:20.750 --> 01:26:22.130 Like, I love my NOTE Confidence: 0.9932454 01:26:22.590 --> 01:26:24.290 rice, lentils, chicken. NOTE Confidence: 0.9800415 01:26:24.830 --> 01:26:25.950 Like, I love my food. NOTE Confidence: 0.9800415 01:26:25.950 --> 01:26:26.850 I couldn't eat. NOTE Confidence: 0.99709904 01:26:27.710 --> 01:26:29.229 And then when I when NOTE Confidence: 0.99709904 01:26:29.229 --> 01:26:30.270 I went to India, I NOTE Confidence: 0.99709904 01:26:30.270 --> 01:26:31.470 was just this girl who NOTE Confidence: 0.99709904 01:26:31.470 --> 01:26:32.210 had never NOTE Confidence: 0.9321289 01:26:32.745 --> 01:26:34.364 traveled outside of Nepal, NOTE Confidence: 0.9995117 01:26:34.665 --> 01:26:35.864 just happy to be on NOTE Confidence: 0.9995117 01:26:35.864 --> 01:26:37.324 that first international NOTE Confidence: 0.9909668 01:26:37.625 --> 01:26:38.125 flight. NOTE Confidence: 0.99970704 01:26:38.585 --> 01:26:39.965 But when I came back, NOTE Confidence: 0.99986047 01:26:40.344 --> 01:26:41.625 I was a girl with NOTE Confidence: 0.99986047 01:26:41.625 --> 01:26:42.364 no hair NOTE Confidence: 0.94677734 01:26:42.905 --> 01:26:44.505 who couldn't even, like, swallow NOTE Confidence: 0.94677734 01:26:44.505 --> 01:26:45.645 a sip of water, NOTE Confidence: 0.9970703 01:26:46.479 --> 01:26:47.219 who just desperately NOTE Confidence: 0.9910034 01:26:48.000 --> 01:26:49.920 wanted to look pretty. And NOTE Confidence: 0.9910034 01:26:49.920 --> 01:26:51.920 my grandmother used all of NOTE Confidence: 0.9910034 01:26:51.920 --> 01:26:53.199 her savings to buy me NOTE Confidence: 0.9910034 01:26:53.199 --> 01:26:54.739 the best wig in town. NOTE Confidence: 0.9962269 01:26:55.040 --> 01:26:56.479 It was this plastic wig, NOTE Confidence: 0.9962269 01:26:56.479 --> 01:26:57.699 but it made me look NOTE Confidence: 0.9962269 01:26:57.920 --> 01:26:58.420 pretty. NOTE Confidence: 0.9729004 01:26:58.960 --> 01:27:00.179 And I came back, NOTE Confidence: 0.9966682 01:27:00.479 --> 01:27:01.995 and I couldn't even go NOTE Confidence: 0.9966682 01:27:01.995 --> 01:27:03.514 back to get my surgery NOTE Confidence: 0.9966682 01:27:03.514 --> 01:27:04.635 done in India because I NOTE Confidence: 0.9966682 01:27:04.635 --> 01:27:05.295 was so, NOTE Confidence: 0.99869794 01:27:06.715 --> 01:27:08.475 like, in shock from the NOTE Confidence: 0.99869794 01:27:08.475 --> 01:27:08.975 radiation NOTE Confidence: 0.94731796 01:27:09.514 --> 01:27:10.715 because it was so painful NOTE Confidence: 0.94731796 01:27:10.715 --> 01:27:12.235 the first time around. I NOTE Confidence: 0.94731796 01:27:12.235 --> 01:27:13.695 couldn't go back. So NOTE Confidence: 0.9457194 01:27:14.074 --> 01:27:15.755 I got operated back in NOTE Confidence: 0.9457194 01:27:15.755 --> 01:27:17.810 Nepal by amazing doctors. NOTE Confidence: 0.99609375 01:27:18.350 --> 01:27:19.650 And after my surgery, NOTE Confidence: 0.9998372 01:27:20.189 --> 01:27:21.710 I remember speaking to my NOTE Confidence: 0.9998372 01:27:21.710 --> 01:27:22.210 doctor NOTE Confidence: 0.95562065 01:27:22.590 --> 01:27:23.710 the next day after my NOTE Confidence: 0.95562065 01:27:23.710 --> 01:27:25.250 surgery saying thank you. NOTE Confidence: 0.9902874 01:27:26.270 --> 01:27:27.710 But then after that, when NOTE Confidence: 0.9902874 01:27:27.710 --> 01:27:29.070 I started speaking again, I NOTE Confidence: 0.9902874 01:27:29.070 --> 01:27:31.095 developed this hoarse voice. So NOTE Confidence: 0.9902874 01:27:31.095 --> 01:27:32.295 my voice has never been NOTE Confidence: 0.9902874 01:27:32.295 --> 01:27:33.275 the same since. NOTE Confidence: 0.9996338 01:27:34.935 --> 01:27:36.155 So after my surgery, NOTE Confidence: 0.88171387 01:27:36.854 --> 01:27:37.515 the first, NOTE Confidence: 0.9977583 01:27:37.815 --> 01:27:39.195 meal that I could have NOTE Confidence: 0.9977583 01:27:39.495 --> 01:27:41.495 was literally just one spoon NOTE Confidence: 0.9977583 01:27:41.495 --> 01:27:41.995 of, NOTE Confidence: 0.9066162 01:27:42.615 --> 01:27:43.435 milk pudding. NOTE Confidence: 0.9535776 01:27:43.895 --> 01:27:45.640 And I was broken because NOTE Confidence: 0.9535776 01:27:45.640 --> 01:27:46.920 I love to eat. So NOTE Confidence: 0.9535776 01:27:46.920 --> 01:27:47.800 I was just, oh my NOTE Confidence: 0.9535776 01:27:47.800 --> 01:27:49.320 god. So what I'll never NOTE Confidence: 0.9535776 01:27:49.320 --> 01:27:50.200 be able to have that NOTE Confidence: 0.9535776 01:27:50.200 --> 01:27:51.720 slice of pizza or, you NOTE Confidence: 0.9535776 01:27:51.720 --> 01:27:53.160 know, a plate full of NOTE Confidence: 0.9535776 01:27:53.160 --> 01:27:54.840 my, like, rice and lentils NOTE Confidence: 0.9535776 01:27:54.840 --> 01:27:55.340 again? NOTE Confidence: 0.9763364 01:27:56.040 --> 01:27:57.720 But, like, fast forward now, NOTE Confidence: 0.9763364 01:27:57.720 --> 01:27:58.965 I can eat as much NOTE Confidence: 0.9763364 01:27:58.965 --> 01:28:00.005 as I want, like, how NOTE Confidence: 0.9763364 01:28:00.005 --> 01:28:01.445 much I want. So I NOTE Confidence: 0.9763364 01:28:01.445 --> 01:28:02.725 love that, you know, it NOTE Confidence: 0.9763364 01:28:02.725 --> 01:28:03.465 got better. NOTE Confidence: 0.9998372 01:28:03.845 --> 01:28:05.305 And in terms of physical NOTE Confidence: 0.9998372 01:28:05.365 --> 01:28:05.865 therapy, NOTE Confidence: 0.9678819 01:28:06.485 --> 01:28:07.685 I love to work out. NOTE Confidence: 0.9678819 01:28:07.685 --> 01:28:08.825 I love to lift. NOTE Confidence: 0.955411 01:28:09.365 --> 01:28:10.885 So, like, I I couldn't NOTE Confidence: 0.955411 01:28:10.885 --> 01:28:12.450 do anything back then, of NOTE Confidence: 0.955411 01:28:12.450 --> 01:28:12.950 course. NOTE Confidence: 0.9758572 01:28:13.330 --> 01:28:14.610 But now I can lift NOTE Confidence: 0.9758572 01:28:14.610 --> 01:28:16.070 almost my body weight. NOTE Confidence: 0.9776001 01:28:16.370 --> 01:28:17.330 I so I think, yeah, NOTE Confidence: 0.9776001 01:28:17.330 --> 01:28:18.710 there's progress there. NOTE Confidence: 0.9071742 01:28:19.090 --> 01:28:20.530 But as doctor Yatch was NOTE Confidence: 0.9071742 01:28:20.530 --> 01:28:21.010 saying, like, NOTE Confidence: 0.9811581 01:28:22.530 --> 01:28:24.290 so, yeah, after my training, NOTE Confidence: 0.9811581 01:28:24.290 --> 01:28:25.330 I came here. I'm working NOTE Confidence: 0.9811581 01:28:25.330 --> 01:28:26.450 as a researcher at the NOTE Confidence: 0.9811581 01:28:26.450 --> 01:28:27.104 Mayo Clinic NOTE Confidence: 0.96451825 01:28:27.505 --> 01:28:28.325 down in Jacksonville, NOTE Confidence: 0.9992676 01:28:28.864 --> 01:28:30.085 and I got my NOTE Confidence: 0.98083496 01:28:30.625 --> 01:28:31.125 follow-up, NOTE Confidence: 0.98833555 01:28:32.064 --> 01:28:34.545 endoscopy done, like, a month NOTE Confidence: 0.98833555 01:28:34.545 --> 01:28:36.705 back. I got follow-up CT NOTE Confidence: 0.98833555 01:28:36.705 --> 01:28:37.825 scan done a month back NOTE Confidence: 0.98833555 01:28:37.825 --> 01:28:39.665 at Mayo, and everything looks NOTE Confidence: 0.98833555 01:28:39.665 --> 01:28:40.110 clean. NOTE Confidence: 0.92397463 01:28:40.909 --> 01:28:42.830 And I'm happy, like, for NOTE Confidence: 0.92397463 01:28:42.830 --> 01:28:45.090 me, my family, everywhere, everyone. NOTE Confidence: 0.98046875 01:28:45.550 --> 01:28:47.229 But what really breaks my NOTE Confidence: 0.98046875 01:28:47.229 --> 01:28:48.610 heart is to think of NOTE Confidence: 0.98046875 01:28:48.750 --> 01:28:49.889 people back home. NOTE Confidence: 0.9996745 01:28:50.510 --> 01:28:51.810 Because after my NOTE Confidence: 1 01:28:52.189 --> 01:28:52.689 diagnosis NOTE Confidence: 0.99694824 01:28:53.150 --> 01:28:54.850 and after my surgery, NOTE Confidence: 0.99800247 01:28:55.554 --> 01:28:57.414 I realized the need to NOTE Confidence: 0.99800247 01:28:57.635 --> 01:28:59.474 connect with people who didn't NOTE Confidence: 0.99800247 01:28:59.474 --> 01:28:59.974 have NOTE Confidence: 1 01:29:00.434 --> 01:29:01.175 the facilities NOTE Confidence: 0.9940491 01:29:01.715 --> 01:29:03.235 and the resources as I NOTE Confidence: 0.9940491 01:29:03.235 --> 01:29:04.614 was privileged with. NOTE Confidence: 0.9220703 01:29:04.994 --> 01:29:07.014 So I opened an online NOTE Confidence: 0.8919949 01:29:07.969 --> 01:29:10.290 website, Nepal Can Chat, where NOTE Confidence: 0.8919949 01:29:10.290 --> 01:29:11.670 I connect with fellow NOTE Confidence: 0.9907966 01:29:12.130 --> 01:29:13.969 Nepalese cancer survivors who are NOTE Confidence: 0.9907966 01:29:13.969 --> 01:29:15.090 on the same journey as NOTE Confidence: 0.9907966 01:29:15.090 --> 01:29:15.590 myself. NOTE Confidence: 0.97612303 01:29:16.050 --> 01:29:17.429 I talk to them. I NOTE Confidence: 0.97612303 01:29:17.570 --> 01:29:19.010 share with them my journey, NOTE Confidence: 0.97612303 01:29:19.010 --> 01:29:21.110 like, just sharing with them NOTE Confidence: 0.96532845 01:29:21.570 --> 01:29:23.185 the steps of care that NOTE Confidence: 0.96532845 01:29:23.185 --> 01:29:24.465 I got, like, the places NOTE Confidence: 0.96532845 01:29:24.465 --> 01:29:25.505 that I went to for NOTE Confidence: 0.96532845 01:29:25.505 --> 01:29:27.185 my PET scan or my NOTE Confidence: 0.96532845 01:29:27.185 --> 01:29:29.185 surgery or my chemo, my NOTE Confidence: 0.96532845 01:29:29.185 --> 01:29:31.344 radiation, and just talking about NOTE Confidence: 0.96532845 01:29:31.344 --> 01:29:33.205 them, about the basics NOTE Confidence: 0.89746094 01:29:33.665 --> 01:29:34.710 gives them hope. NOTE Confidence: 0.988474 01:29:35.430 --> 01:29:36.950 You know? And that really NOTE Confidence: 0.988474 01:29:36.950 --> 01:29:38.710 makes me happy, and that NOTE Confidence: 0.988474 01:29:38.710 --> 01:29:40.310 really makes me feel like NOTE Confidence: 0.988474 01:29:40.310 --> 01:29:41.530 I'm making a difference. NOTE Confidence: 0.9770508 01:29:42.150 --> 01:29:42.469 And, NOTE Confidence: 0.9727663 01:29:43.189 --> 01:29:44.729 I talk to people and, NOTE Confidence: 0.9727663 01:29:44.950 --> 01:29:46.630 you know, just just small NOTE Confidence: 0.9727663 01:29:46.630 --> 01:29:48.104 things. Like, for example, I NOTE Confidence: 0.9727663 01:29:48.104 --> 01:29:49.304 was talking to this patient NOTE Confidence: 0.9727663 01:29:49.304 --> 01:29:50.905 the other day who said NOTE Confidence: 0.9727663 01:29:50.905 --> 01:29:51.864 that she went to a NOTE Confidence: 0.9727663 01:29:51.864 --> 01:29:53.545 doctor saying she felt like NOTE Confidence: 0.9727663 01:29:53.545 --> 01:29:54.505 there was something on her NOTE Confidence: 0.9727663 01:29:54.505 --> 01:29:56.104 throat and, like, they just NOTE Confidence: 0.9727663 01:29:56.104 --> 01:29:57.965 did, like, a basic thyroid NOTE Confidence: 0.9727663 01:29:58.025 --> 01:29:59.465 panel because, you know, there's NOTE Confidence: 0.9727663 01:29:59.465 --> 01:30:00.184 a lot of things on NOTE Confidence: 0.9727663 01:30:00.184 --> 01:30:01.784 our throat. But everything was NOTE Confidence: 0.9727663 01:30:01.784 --> 01:30:03.030 clean and, like, they did NOTE Confidence: 0.9727663 01:30:03.030 --> 01:30:03.530 nothing. NOTE Confidence: 0.96101886 01:30:04.150 --> 01:30:05.989 And now they finally scoped NOTE Confidence: 0.96101886 01:30:05.989 --> 01:30:06.489 her, NOTE Confidence: 0.9831649 01:30:06.790 --> 01:30:07.909 and she's in her, like, NOTE Confidence: 0.9831649 01:30:07.909 --> 01:30:09.429 stage two. They diagnosed her NOTE Confidence: 0.9831649 01:30:09.429 --> 01:30:10.790 with stage two. So, you NOTE Confidence: 0.9831649 01:30:10.790 --> 01:30:12.070 know, if only she had NOTE Confidence: 0.9831649 01:30:12.070 --> 01:30:13.210 been scoped earlier, NOTE Confidence: 0.9858747 01:30:14.070 --> 01:30:14.949 that would have made a NOTE Confidence: 0.9858747 01:30:14.949 --> 01:30:15.770 huge difference. NOTE Confidence: 0.99728733 01:30:16.585 --> 01:30:17.625 And, you know, it's things NOTE Confidence: 0.99728733 01:30:17.625 --> 01:30:19.005 like that that really NOTE Confidence: 0.9746094 01:30:19.465 --> 01:30:21.304 makes me feel like there's NOTE Confidence: 0.9746094 01:30:21.304 --> 01:30:22.684 so much to be done, NOTE Confidence: 0.9952218 01:30:23.064 --> 01:30:25.244 and we're privileged here. Like, NOTE Confidence: 0.9952218 01:30:25.385 --> 01:30:26.744 I'm I'm assuming that all NOTE Confidence: 0.9952218 01:30:26.744 --> 01:30:27.804 of you got your NOTE Confidence: 0.9794922 01:30:28.104 --> 01:30:29.304 therapy here at Yale, which NOTE Confidence: 0.9794922 01:30:29.304 --> 01:30:30.344 is one of the leading NOTE Confidence: 0.9794922 01:30:30.344 --> 01:30:32.340 cancer centers, and I was NOTE Confidence: 0.9794922 01:30:32.500 --> 01:30:33.699 privileged enough to get my NOTE Confidence: 0.9794922 01:30:33.699 --> 01:30:36.119 follow-up scans at Mayo. But NOTE Confidence: 0.9794922 01:30:36.260 --> 01:30:38.179 people there in those low NOTE Confidence: 0.9794922 01:30:38.179 --> 01:30:39.560 and middle income countries NOTE Confidence: 0.98501587 01:30:40.099 --> 01:30:41.880 are really struggling with, like, NOTE Confidence: 0.98501587 01:30:41.939 --> 01:30:43.000 the first step, NOTE Confidence: 0.9133301 01:30:43.460 --> 01:30:44.760 just knowing the diagnosis. NOTE Confidence: 0.9361318 01:30:45.780 --> 01:30:47.159 So I think that's what, NOTE Confidence: 0.9361318 01:30:47.255 --> 01:30:49.415 you know, doctor Ipiaj and NOTE Confidence: 0.9361318 01:30:49.415 --> 01:30:50.074 I, like, NOTE Confidence: 0.94059247 01:30:50.534 --> 01:30:51.915 really aspire to NOTE Confidence: 0.9293213 01:30:52.295 --> 01:30:53.114 help with. NOTE Confidence: 0.9741082 01:30:53.415 --> 01:30:55.175 And, we're writing actually a NOTE Confidence: 0.9741082 01:30:55.175 --> 01:30:57.415 piece on chemo parts, and NOTE Confidence: 0.9741082 01:30:57.415 --> 01:30:58.614 that's something that I'm really NOTE Confidence: 0.9741082 01:30:58.614 --> 01:30:59.994 excited about to share. NOTE Confidence: 0.9740862 01:31:00.600 --> 01:31:02.360 But, yeah, I think, like, NOTE Confidence: 0.9740862 01:31:02.360 --> 01:31:03.720 here, everything is moving at NOTE Confidence: 0.9740862 01:31:03.720 --> 01:31:05.260 such a fast pace where NOTE Confidence: 0.9740862 01:31:05.479 --> 01:31:07.080 we have, like, people, like, NOTE Confidence: 0.9740862 01:31:07.080 --> 01:31:07.580 dedicated NOTE Confidence: 0.9108073 01:31:08.280 --> 01:31:08.780 nutritionists, NOTE Confidence: 0.9744466 01:31:09.240 --> 01:31:11.400 like, physical therapists coming here NOTE Confidence: 0.9744466 01:31:11.400 --> 01:31:13.240 and guiding us, talking about NOTE Confidence: 0.9744466 01:31:13.240 --> 01:31:14.625 short term and short term NOTE Confidence: 0.9744466 01:31:14.625 --> 01:31:15.685 and long term NOTE Confidence: 0.969752 01:31:16.064 --> 01:31:18.545 survivorship. But over there, it's NOTE Confidence: 0.969752 01:31:18.785 --> 01:31:20.305 survivorship is just like, you NOTE Confidence: 0.969752 01:31:20.305 --> 01:31:21.905 know, something out of the NOTE Confidence: 0.969752 01:31:21.905 --> 01:31:22.405 picture. NOTE Confidence: 0.9826898 01:31:22.865 --> 01:31:24.385 You know? Just being scoped, NOTE Confidence: 0.9826898 01:31:24.385 --> 01:31:26.305 just having the first test NOTE Confidence: 0.9826898 01:31:26.305 --> 01:31:28.064 is something that people are NOTE Confidence: 0.9826898 01:31:28.064 --> 01:31:30.060 struggling with. So, yes, the NOTE Confidence: 0.9826898 01:31:30.060 --> 01:31:31.600 world is changing, but NOTE Confidence: 0.93082684 01:31:32.060 --> 01:31:32.880 it's, I think, NOTE Confidence: 0.8354492 01:31:33.260 --> 01:31:33.760 like, NOTE Confidence: 0.9749581 01:31:34.380 --> 01:31:35.180 it it it should be NOTE Confidence: 0.9749581 01:31:35.180 --> 01:31:36.160 changing everywhere NOTE Confidence: 0.9747993 01:31:36.700 --> 01:31:37.979 and not just, you know, NOTE Confidence: 0.9747993 01:31:37.979 --> 01:31:39.100 just at a very fast NOTE Confidence: 0.9747993 01:31:39.100 --> 01:31:40.620 pace somewhere and just at NOTE Confidence: 0.9747993 01:31:40.620 --> 01:31:41.900 a very slow pace somewhere, NOTE Confidence: 0.9747993 01:31:41.900 --> 01:31:43.575 but I think we're definitely NOTE Confidence: 0.9747993 01:31:43.575 --> 01:31:44.555 making progress. NOTE Confidence: 0.99423826 01:31:45.175 --> 01:31:46.795 And to add to, like, NOTE Confidence: 0.99902344 01:31:47.335 --> 01:31:48.795 the silent survivors NOTE Confidence: 0.93222654 01:31:49.175 --> 01:31:50.875 who are definitely our family, NOTE Confidence: 0.94226074 01:31:51.335 --> 01:31:52.935 my amazing husband is here NOTE Confidence: 0.94226074 01:31:52.935 --> 01:31:53.755 in the audience. NOTE Confidence: 0.96850586 01:31:54.375 --> 01:31:56.075 We dated for eleven years. NOTE Confidence: 0.9998047 01:31:56.460 --> 01:31:57.840 And when I was diagnosed, NOTE Confidence: 0.97421604 01:31:58.300 --> 01:31:59.760 he could have just said, NOTE Confidence: 0.97421604 01:32:00.060 --> 01:32:01.020 I don't wanna be with NOTE Confidence: 0.97421604 01:32:01.020 --> 01:32:02.380 you anymore because who would NOTE Confidence: 0.97421604 01:32:02.380 --> 01:32:03.360 want this luggage? NOTE Confidence: 0.9261977 01:32:03.740 --> 01:32:05.360 But he married me and NOTE Confidence: 0.9261977 01:32:05.500 --> 01:32:06.860 we're happily married. It it NOTE Confidence: 0.9261977 01:32:06.860 --> 01:32:08.880 will be our thirtieth anniversary NOTE Confidence: 0.9261977 01:32:09.180 --> 01:32:09.920 this year. NOTE Confidence: 0.8998047 01:32:10.325 --> 01:32:11.785 And just having his support NOTE Confidence: 0.96606445 01:32:12.165 --> 01:32:13.705 means so much to me NOTE Confidence: 0.96606445 01:32:14.005 --> 01:32:15.785 and my amazing friend, Missy. NOTE Confidence: 0.98427325 01:32:16.485 --> 01:32:17.685 Like, I just can't thank NOTE Confidence: 0.98427325 01:32:17.685 --> 01:32:19.525 you enough. And my parents NOTE Confidence: 0.98427325 01:32:19.525 --> 01:32:20.345 back home NOTE Confidence: 0.8905945 01:32:20.725 --> 01:32:22.645 who, like, missed their daughter NOTE Confidence: 0.8905945 01:32:22.645 --> 01:32:23.705 who's here struggling, NOTE Confidence: 0.96351206 01:32:24.405 --> 01:32:26.260 you know, to find her NOTE Confidence: 0.96351206 01:32:26.260 --> 01:32:27.380 stand here in a foreign NOTE Confidence: 0.96351206 01:32:27.380 --> 01:32:27.880 land, NOTE Confidence: 0.9316406 01:32:28.260 --> 01:32:29.000 but also NOTE Confidence: 0.968967 01:32:29.460 --> 01:32:31.060 thinking about me every day NOTE Confidence: 0.968967 01:32:31.060 --> 01:32:32.840 because they have seen, NOTE Confidence: 0.99559325 01:32:33.219 --> 01:32:34.659 like, the days when I NOTE Confidence: 0.99559325 01:32:34.659 --> 01:32:36.360 had my first hair fall, NOTE Confidence: 0.99559325 01:32:36.580 --> 01:32:37.699 the days when I couldn't NOTE Confidence: 0.99559325 01:32:37.699 --> 01:32:39.080 swallow a sip of water NOTE Confidence: 0.9572754 01:32:39.699 --> 01:32:41.595 to be, you know, figuring NOTE Confidence: 0.9572754 01:32:41.595 --> 01:32:42.735 it all out today NOTE Confidence: 0.9193929 01:32:43.275 --> 01:32:44.715 just makes me really happy, NOTE Confidence: 0.9193929 01:32:44.715 --> 01:32:45.215 and, NOTE Confidence: 0.99902344 01:32:46.075 --> 01:32:47.375 we all can do it. NOTE Confidence: 0.98950195 01:32:47.835 --> 01:32:49.055 I know it's us, NOTE Confidence: 0.96316963 01:32:49.435 --> 01:32:51.115 like, under who are undergoing NOTE Confidence: 0.96316963 01:32:51.195 --> 01:32:51.775 we underwent NOTE Confidence: 0.9165853 01:32:52.315 --> 01:32:53.215 chemo, radiation, NOTE Confidence: 0.79709345 01:32:53.915 --> 01:32:55.435 surgery, everything, but it's our NOTE Confidence: 0.79709345 01:32:55.435 --> 01:32:55.535 family who are actually fighting NOTE Confidence: 0.79709345 01:32:55.535 --> 01:32:55.635 that silent battle. And thank NOTE Confidence: 0.79709345 01:32:55.635 --> 01:32:56.255 you so much everyone NOTE Confidence: 0.9440918 01:32:57.250 --> 01:32:58.949 fighting that silent battle. NOTE Confidence: 0.9722222 01:32:59.409 --> 01:33:00.530 And thank you so much NOTE Confidence: 0.9722222 01:33:00.530 --> 01:33:01.989 everyone for showing up. NOTE Confidence: 0.93255615 01:33:09.685 --> 01:33:10.965 Thank you, Deepika and Derek. NOTE Confidence: 0.93255615 01:33:10.965 --> 01:33:11.765 That was really, NOTE Confidence: 0.7241211 01:33:12.485 --> 01:33:13.545 hard rendering. NOTE Confidence: 0.99542236 01:33:15.045 --> 01:33:16.405 I'm gonna open this up NOTE Confidence: 0.99542236 01:33:16.405 --> 01:33:17.705 for opportunity to NOTE Confidence: 0.9863281 01:33:18.165 --> 01:33:18.645 ask, NOTE Confidence: 0.9723535 01:33:20.405 --> 01:33:21.925 Deepika or any any one NOTE Confidence: 0.9723535 01:33:21.925 --> 01:33:23.449 of us questions. But, also, NOTE Confidence: 0.9723535 01:33:23.449 --> 01:33:24.330 if there's anyone in the NOTE Confidence: 0.9723535 01:33:24.330 --> 01:33:25.370 audience who wants to share NOTE Confidence: 0.9723535 01:33:25.370 --> 01:33:26.830 some of their journeys, please NOTE Confidence: 0.9934082 01:33:27.210 --> 01:33:27.870 take this. NOTE Confidence: 0.71346766 01:33:35.865 --> 01:33:37.064 Oh, I know. Gotta do NOTE Confidence: 0.71346766 01:33:37.064 --> 01:33:38.505 so. Stop to speak. Oh, NOTE Confidence: 0.71346766 01:33:38.505 --> 01:33:39.005 okay. NOTE Confidence: 0.99102783 01:33:39.945 --> 01:33:41.725 Several people have made references NOTE Confidence: 0.99102783 01:33:41.945 --> 01:33:42.925 to high incidence NOTE Confidence: 0.98391384 01:33:43.465 --> 01:33:44.825 of this type of cancer, NOTE Confidence: 0.98391384 01:33:44.825 --> 01:33:46.125 I believe, in Africa NOTE Confidence: 0.9978376 01:33:46.905 --> 01:33:48.505 and other areas. Do they NOTE Confidence: 0.9978376 01:33:48.505 --> 01:33:49.325 know why? NOTE Confidence: 0.97818154 01:33:53.040 --> 01:33:53.680 I don't know if you NOTE Confidence: 0.97818154 01:33:53.680 --> 01:33:54.560 want me to just give NOTE Confidence: 0.97818154 01:33:54.560 --> 01:33:56.000 a comment on on Africa. NOTE Confidence: 0.97818154 01:33:56.000 --> 01:33:57.140 I mean, I so, NOTE Confidence: 0.8881836 01:33:58.560 --> 01:33:59.460 it's squamous NOTE Confidence: 0.60253906 01:34:00.080 --> 01:34:00.580 cell. NOTE Confidence: 0.8799513 01:34:01.360 --> 01:34:02.880 So it's, I had I NOTE Confidence: 0.8799513 01:34:02.880 --> 01:34:04.375 had no You had squamous NOTE Confidence: 0.8799513 01:34:04.375 --> 01:34:05.335 as well. So in the NOTE Confidence: 0.8799513 01:34:05.335 --> 01:34:07.115 case of squamous cell, NOTE Confidence: 0.938916 01:34:07.575 --> 01:34:09.175 the the major theories are NOTE Confidence: 0.938916 01:34:09.175 --> 01:34:11.595 a combination of alcohol, tobacco, NOTE Confidence: 0.90372926 01:34:11.975 --> 01:34:13.415 hot drinks, which is interesting. NOTE Confidence: 0.90372926 01:34:13.415 --> 01:34:14.715 And we're talking about drinking NOTE Confidence: 0.90372926 01:34:14.854 --> 01:34:16.375 drinks at very hot temperature. NOTE Confidence: 0.90372926 01:34:16.375 --> 01:34:17.595 I mean, very high temperatures. NOTE Confidence: 0.8448622 01:34:17.939 --> 01:34:18.580 And then there are a NOTE Confidence: 0.8448622 01:34:18.580 --> 01:34:20.280 range of fungal contaminants, NOTE Confidence: 0.9851888 01:34:21.060 --> 01:34:22.340 that ground some of the NOTE Confidence: 0.9851888 01:34:22.340 --> 01:34:22.840 foods. NOTE Confidence: 0.93436104 01:34:23.300 --> 01:34:24.520 Those are some of the NOTE Confidence: 0.93436104 01:34:24.580 --> 01:34:25.400 major ones. NOTE Confidence: 0.9382324 01:34:26.100 --> 01:34:27.239 I think there's another, NOTE Confidence: 0.9128906 01:34:28.180 --> 01:34:29.960 aspect. We don't fully know NOTE Confidence: 0.9164551 01:34:30.500 --> 01:34:32.600 the full epidemiology and causes NOTE Confidence: 0.97509766 01:34:33.265 --> 01:34:34.545 in many of the countries NOTE Confidence: 0.97509766 01:34:34.545 --> 01:34:35.905 because the the level of NOTE Confidence: 0.97509766 01:34:35.905 --> 01:34:36.885 research support NOTE Confidence: 0.99658203 01:34:37.425 --> 01:34:38.405 is nowhere NOTE Confidence: 0.98526 01:34:38.785 --> 01:34:40.305 near, say, many of the NOTE Confidence: 0.98526 01:34:40.305 --> 01:34:41.285 other major cancers. NOTE Confidence: 0.9759845 01:34:44.945 --> 01:34:46.380 But to add to some NOTE Confidence: 0.9759845 01:34:46.380 --> 01:34:47.500 of the stories about the NOTE Confidence: 0.9759845 01:34:47.500 --> 01:34:48.700 disparities that we're seeing in NOTE Confidence: 0.9759845 01:34:48.700 --> 01:34:49.500 different parts of the world, NOTE Confidence: 0.9759845 01:34:49.500 --> 01:34:51.180 the truth is that these NOTE Confidence: 0.9759845 01:34:51.180 --> 01:34:52.540 disparities in different parts of NOTE Confidence: 0.9759845 01:34:52.540 --> 01:34:53.979 the world also exist within NOTE Confidence: 0.9759845 01:34:53.979 --> 01:34:56.220 our our communities and even NOTE Confidence: 0.9759845 01:34:56.220 --> 01:34:57.680 with folks here. Not everyone NOTE Confidence: 0.9759845 01:34:57.740 --> 01:34:59.020 here is actually getting the NOTE Confidence: 0.9759845 01:34:59.020 --> 01:35:00.405 same access to care, and NOTE Confidence: 0.9759845 01:35:00.485 --> 01:35:01.364 that's a large part of NOTE Confidence: 0.9759845 01:35:01.364 --> 01:35:01.965 the work we are trying NOTE Confidence: 0.9759845 01:35:01.965 --> 01:35:02.965 to do is making sure NOTE Confidence: 0.9759845 01:35:02.965 --> 01:35:04.405 we try to get equal NOTE Confidence: 0.9759845 01:35:04.405 --> 01:35:05.525 access to care for every NOTE Confidence: 0.9759845 01:35:05.525 --> 01:35:07.064 different thing from early diagnosis, NOTE Confidence: 0.9759845 01:35:07.204 --> 01:35:08.564 which is a very important NOTE Confidence: 0.9759845 01:35:08.564 --> 01:35:10.085 component to it to making NOTE Confidence: 0.9759845 01:35:10.085 --> 01:35:10.985 sure you have, NOTE Confidence: 1 01:35:11.445 --> 01:35:11.945 adequate NOTE Confidence: 0.991649 01:35:12.870 --> 01:35:14.550 access to the different components NOTE Confidence: 0.991649 01:35:14.550 --> 01:35:15.429 of the care that you NOTE Confidence: 0.991649 01:35:15.429 --> 01:35:16.710 need to get, to then, NOTE Confidence: 0.991649 01:35:16.710 --> 01:35:17.830 of course, the higher end NOTE Confidence: 0.991649 01:35:17.830 --> 01:35:19.030 stuff with the newer drugs NOTE Confidence: 0.991649 01:35:19.030 --> 01:35:20.729 and the newer technology that's NOTE Confidence: 0.991649 01:35:20.870 --> 01:35:22.330 changing the the landscape. NOTE Confidence: 0.9772949 01:35:23.110 --> 01:35:24.630 Every every aspect of this NOTE Confidence: 0.9772949 01:35:24.630 --> 01:35:26.250 is important, and different NOTE Confidence: 0.99762833 01:35:26.665 --> 01:35:27.784 folks are in in this NOTE Confidence: 0.99762833 01:35:27.784 --> 01:35:29.385 group are paying attention to NOTE Confidence: 0.99762833 01:35:29.385 --> 01:35:30.685 these different parts of NOTE Confidence: 0.999163 01:35:31.145 --> 01:35:32.665 getting access to the different NOTE Confidence: 0.999163 01:35:32.665 --> 01:35:33.645 aspects of NOTE Confidence: 0.98779297 01:35:34.185 --> 01:35:36.125 very complicated treatment here. NOTE Confidence: 0.88949585 01:35:43.660 --> 01:35:44.780 We're just following up on NOTE Confidence: 0.88949585 01:35:44.780 --> 01:35:45.660 on that comment. NOTE Confidence: 0.97915417 01:35:46.300 --> 01:35:46.939 I don't know if you NOTE Confidence: 0.97915417 01:35:46.939 --> 01:35:47.900 have anything to say about NOTE Confidence: 0.97915417 01:35:47.900 --> 01:35:49.280 the rural urban, NOTE Confidence: 0.949351 01:35:49.979 --> 01:35:51.580 divide, especially in this country, NOTE Confidence: 0.949351 01:35:51.580 --> 01:35:53.635 but but worldwide. But I NOTE Confidence: 0.949351 01:35:53.635 --> 01:35:55.175 think that's something that's increasingly NOTE Confidence: 0.949351 01:35:55.235 --> 01:35:57.074 coming to light, here in NOTE Confidence: 0.949351 01:35:57.074 --> 01:35:58.534 America is a differential. NOTE Confidence: 0.96711224 01:36:02.594 --> 01:36:03.554 Certainly. I mean, I think NOTE Confidence: 0.96711224 01:36:03.554 --> 01:36:05.074 the rural urban divide is NOTE Confidence: 0.96711224 01:36:05.074 --> 01:36:06.514 always gonna be there. Folks NOTE Confidence: 0.96711224 01:36:06.514 --> 01:36:07.875 in rural spaces are gonna NOTE Confidence: 0.96711224 01:36:07.875 --> 01:36:09.060 have to travel longer NOTE Confidence: 0.9645147 01:36:09.520 --> 01:36:11.600 further to get to centers NOTE Confidence: 0.9645147 01:36:11.600 --> 01:36:13.939 of coordinated care. And that, NOTE Confidence: 0.9645147 01:36:14.000 --> 01:36:15.760 I think, is gonna be NOTE Confidence: 0.9645147 01:36:15.760 --> 01:36:17.300 a problem that's not easily NOTE Confidence: 0.9645147 01:36:17.360 --> 01:36:18.580 solved simply because NOTE Confidence: 0.960941 01:36:18.960 --> 01:36:20.720 you kind of to have NOTE Confidence: 0.960941 01:36:20.720 --> 01:36:22.000 different people with different sorts NOTE Confidence: 0.960941 01:36:22.000 --> 01:36:23.275 of expertise coming to one NOTE Confidence: 0.960941 01:36:23.275 --> 01:36:24.475 place to work together, you NOTE Confidence: 0.960941 01:36:24.475 --> 01:36:25.995 kind of geographically have to NOTE Confidence: 0.960941 01:36:25.995 --> 01:36:27.275 be there. But in a NOTE Confidence: 0.960941 01:36:27.275 --> 01:36:28.635 rural area where you have NOTE Confidence: 0.960941 01:36:28.635 --> 01:36:30.175 to then travel large distances NOTE Confidence: 0.960941 01:36:30.235 --> 01:36:31.675 to get there, sure, telehealth NOTE Confidence: 0.960941 01:36:31.675 --> 01:36:32.555 and those sort of things NOTE Confidence: 0.960941 01:36:32.555 --> 01:36:33.755 will address some of these NOTE Confidence: 0.960941 01:36:33.755 --> 01:36:35.354 issues. But it's gonna be NOTE Confidence: 0.960941 01:36:35.354 --> 01:36:36.075 a it's gonna be a NOTE Confidence: 0.960941 01:36:36.075 --> 01:36:37.535 mixture of trying to address, NOTE Confidence: 0.9893663 01:36:39.619 --> 01:36:41.060 getting to the community and NOTE Confidence: 0.9893663 01:36:41.060 --> 01:36:43.159 having outreach there, which NOTE Confidence: 0.96061355 01:36:43.460 --> 01:36:44.979 folks are trying. But that NOTE Confidence: 0.96061355 01:36:44.979 --> 01:36:46.520 will then dilute the expertise NOTE Confidence: 0.96061355 01:36:46.659 --> 01:36:48.500 with bringing folks down here. NOTE Confidence: 0.96061355 01:36:48.500 --> 01:36:49.619 And at least at Yale, NOTE Confidence: 0.96061355 01:36:49.619 --> 01:36:51.075 we've kind of tried to NOTE Confidence: 0.96061355 01:36:51.235 --> 01:36:52.995 balance that out where places NOTE Confidence: 0.96061355 01:36:52.995 --> 01:36:54.915 of highly complex surgeries are NOTE Confidence: 0.96061355 01:36:54.915 --> 01:36:56.435 often done here or very NOTE Confidence: 0.96061355 01:36:56.435 --> 01:36:57.555 few places in New Haven. NOTE Confidence: 0.96061355 01:36:57.555 --> 01:36:58.595 But we try to give NOTE Confidence: 0.96061355 01:36:58.595 --> 01:36:59.335 our chemotherapies NOTE Confidence: 0.9750917 01:36:59.635 --> 01:37:01.395 and systemic therapies out into NOTE Confidence: 0.9750917 01:37:01.395 --> 01:37:02.915 the community where we're trying NOTE Confidence: 0.9750917 01:37:02.915 --> 01:37:03.715 to get it easier. If NOTE Confidence: 0.9750917 01:37:03.715 --> 01:37:04.515 you have to come every NOTE Confidence: 0.9750917 01:37:04.515 --> 01:37:05.475 week for treatment, you don't NOTE Confidence: 0.9750917 01:37:05.475 --> 01:37:07.120 have to travel in into NOTE Confidence: 0.9750917 01:37:07.120 --> 01:37:08.400 New Haven and find parking NOTE Confidence: 0.9750917 01:37:08.400 --> 01:37:09.840 in there. Right? But but NOTE Confidence: 0.9750917 01:37:09.840 --> 01:37:11.040 for big surgeries and for NOTE Confidence: 0.9750917 01:37:11.040 --> 01:37:12.320 complex care, you kind of NOTE Confidence: 0.9750917 01:37:12.320 --> 01:37:13.200 need to come to center NOTE Confidence: 0.9750917 01:37:13.200 --> 01:37:14.560 of excellence. So that's kind NOTE Confidence: 0.9750917 01:37:14.560 --> 01:37:15.440 of the way we're trying NOTE Confidence: 0.9750917 01:37:15.440 --> 01:37:16.400 to balance some of these NOTE Confidence: 0.9750917 01:37:16.400 --> 01:37:17.760 things out. There's no simple NOTE Confidence: 0.9750917 01:37:17.760 --> 01:37:19.300 answer, I'm sure. But yeah. NOTE Confidence: 0.9750917 01:37:19.520 --> 01:37:20.500 Yeah. So NOTE Confidence: 0.8782823 01:37:21.325 --> 01:37:22.365 I work with the commission NOTE Confidence: 0.8782823 01:37:22.365 --> 01:37:24.145 on cancer, which is NOTE Confidence: 0.71014404 01:37:24.925 --> 01:37:26.225 the biggest cancer organization, NOTE Confidence: 0.9744873 01:37:27.325 --> 01:37:29.325 United States, and and that's NOTE Confidence: 0.9744873 01:37:29.325 --> 01:37:31.265 front and center of of NOTE Confidence: 0.9492375 01:37:31.645 --> 01:37:33.564 our concern. And because places NOTE Confidence: 0.9492375 01:37:33.564 --> 01:37:35.560 are closing down and there's NOTE Confidence: 0.9492375 01:37:35.560 --> 01:37:36.940 the access to NOTE Confidence: 0.9847005 01:37:37.560 --> 01:37:39.400 even base providers is becoming NOTE Confidence: 0.9847005 01:37:39.400 --> 01:37:40.440 more and more limited. And NOTE Confidence: 0.9847005 01:37:40.440 --> 01:37:41.479 so I think there's a NOTE Confidence: 0.9847005 01:37:41.479 --> 01:37:43.240 real push to try to NOTE Confidence: 0.9847005 01:37:43.240 --> 01:37:43.740 have NOTE Confidence: 0.9909105 01:37:44.280 --> 01:37:46.920 relationships between smaller hospitals and NOTE Confidence: 0.9909105 01:37:46.920 --> 01:37:48.520 bigger hospitals so that they NOTE Confidence: 0.9909105 01:37:48.520 --> 01:37:50.125 can have a single standard NOTE Confidence: 0.9909105 01:37:50.125 --> 01:37:51.665 of care and have clinicians NOTE Confidence: 0.9909105 01:37:51.804 --> 01:37:53.804 that move throughout a network. NOTE Confidence: 0.9909105 01:37:53.804 --> 01:37:54.304 And NOTE Confidence: 0.9789063 01:37:54.764 --> 01:37:56.844 there's some evidence that patients NOTE Confidence: 0.9789063 01:37:56.844 --> 01:37:58.604 that that do travel actually NOTE Confidence: 0.9789063 01:37:58.604 --> 01:38:00.284 experience better outcomes. So trying NOTE Confidence: 0.9789063 01:38:00.284 --> 01:38:01.979 to decide what care is NOTE Confidence: 0.9789063 01:38:01.979 --> 01:38:04.080 appropriate for what care environment, NOTE Confidence: 0.99194336 01:38:04.620 --> 01:38:06.000 but it is and NOTE Confidence: 0.97698104 01:38:07.020 --> 01:38:08.620 not to be political, it NOTE Confidence: 0.97698104 01:38:08.620 --> 01:38:09.439 is actually NOTE Confidence: 0.9964122 01:38:09.900 --> 01:38:11.820 one of the health things NOTE Confidence: 0.9964122 01:38:11.820 --> 01:38:13.360 that seems to have bipartisan NOTE Confidence: 0.9964122 01:38:13.580 --> 01:38:15.645 support right now is improving NOTE Confidence: 0.9964122 01:38:15.645 --> 01:38:17.165 the fate of the of NOTE Confidence: 0.9964122 01:38:17.165 --> 01:38:18.545 the rural population NOTE Confidence: 0.9743164 01:38:18.925 --> 01:38:20.064 in terms of health care. NOTE Confidence: 0.85614485 01:38:25.645 --> 01:38:26.925 I just also very keen NOTE Confidence: 0.85614485 01:38:26.925 --> 01:38:28.525 to have other people's views NOTE Confidence: 0.85614485 01:38:28.525 --> 01:38:29.724 in Deepika as well on NOTE Confidence: 0.85614485 01:38:29.724 --> 01:38:31.050 on something as we we NOTE Confidence: 0.85614485 01:38:31.050 --> 01:38:32.250 we were starting to talk NOTE Confidence: 0.85614485 01:38:32.250 --> 01:38:32.750 about, NOTE Confidence: 0.95048016 01:38:33.610 --> 01:38:35.729 once you've completed treatment and NOTE Confidence: 0.95048016 01:38:35.809 --> 01:38:36.309 you, NOTE Confidence: 0.96435547 01:38:36.969 --> 01:38:37.469 into NOTE Confidence: 0.88461024 01:38:37.929 --> 01:38:40.170 our survival mode or patient NOTE Confidence: 0.88461024 01:38:40.170 --> 01:38:41.849 expert load. The word often NOTE Confidence: 0.88461024 01:38:41.849 --> 01:38:42.349 is NOTE Confidence: 0.9095126 01:38:42.650 --> 01:38:44.010 a bit, difficult to think NOTE Confidence: 0.9095126 01:38:44.010 --> 01:38:44.969 what's the best word for NOTE Confidence: 0.9095126 01:38:44.969 --> 01:38:45.469 it. NOTE Confidence: 0.99306643 01:38:46.005 --> 01:38:47.205 But I just wonder how NOTE Confidence: 0.99306643 01:38:47.205 --> 01:38:48.905 common many of you experience NOTE Confidence: 0.98651123 01:38:49.205 --> 01:38:50.485 long term side effects or NOTE Confidence: 0.98651123 01:38:50.485 --> 01:38:51.705 permanent side effects. NOTE Confidence: 0.9604492 01:38:52.165 --> 01:38:52.485 And, NOTE Confidence: 0.96208847 01:38:53.284 --> 01:38:54.405 I I, I mean, the NOTE Confidence: 0.96208847 01:38:54.405 --> 01:38:55.925 two that, I've I've certainly NOTE Confidence: 0.96208847 01:38:55.925 --> 01:38:57.545 experienced is peripheral neuropathy. NOTE Confidence: 0.96559834 01:38:58.405 --> 01:38:59.130 And I think that was NOTE Confidence: 0.96559834 01:38:59.290 --> 01:39:00.810 the platinum base of my NOTE Confidence: 0.96559834 01:39:00.810 --> 01:39:01.310 chemotherapy. NOTE Confidence: 0.96215326 01:39:02.969 --> 01:39:04.090 There were benefits to me. NOTE Confidence: 0.96215326 01:39:04.090 --> 01:39:05.370 I'm a cold water swimmer, NOTE Confidence: 0.96215326 01:39:05.370 --> 01:39:06.409 so I couldn't feel the NOTE Confidence: 0.96215326 01:39:06.409 --> 01:39:07.290 ice on the bottom of NOTE Confidence: 0.96215326 01:39:07.290 --> 01:39:08.510 my feet in the swimming. NOTE Confidence: 0.96215326 01:39:08.570 --> 01:39:09.530 So there actually was a NOTE Confidence: 0.96215326 01:39:09.530 --> 01:39:10.830 nice benefit, but, NOTE Confidence: 0.9822998 01:39:11.290 --> 01:39:12.090 and I think all of NOTE Confidence: 0.9822998 01:39:12.090 --> 01:39:13.070 you going through NOTE Confidence: 0.9940709 01:39:13.685 --> 01:39:15.364 any platinum therapy will will NOTE Confidence: 0.9940709 01:39:15.364 --> 01:39:16.265 remember those NOTE Confidence: 1 01:39:16.805 --> 01:39:17.305 incredible NOTE Confidence: 0.9810689 01:39:17.845 --> 01:39:19.285 shocks of ice and cold NOTE Confidence: 0.9810689 01:39:19.285 --> 01:39:20.325 water and the gloves and NOTE Confidence: 0.9810689 01:39:20.325 --> 01:39:21.604 all that. But I'd love NOTE Confidence: 0.9810689 01:39:21.604 --> 01:39:22.645 to hear whether we have NOTE Confidence: 0.9810689 01:39:22.645 --> 01:39:24.345 any greater insights into NOTE Confidence: 0.9388835 01:39:24.725 --> 01:39:25.705 the long term, NOTE Confidence: 0.9586589 01:39:27.125 --> 01:39:28.245 ways that we might reduce NOTE Confidence: 0.9586589 01:39:28.245 --> 01:39:29.550 it. And the second is NOTE Confidence: 0.9586589 01:39:29.650 --> 01:39:30.570 pneumonitis, which, NOTE Confidence: 0.89857703 01:39:31.530 --> 01:39:32.489 can come and go and NOTE Confidence: 0.89857703 01:39:32.489 --> 01:39:33.610 it can be caused by NOTE Confidence: 0.89857703 01:39:33.610 --> 01:39:35.050 lots of other things. But NOTE Confidence: 0.89857703 01:39:35.050 --> 01:39:36.890 just a love since, many NOTE Confidence: 0.89857703 01:39:36.890 --> 01:39:37.850 of you have been through NOTE Confidence: 0.89857703 01:39:37.850 --> 01:39:39.050 this and to get a NOTE Confidence: 0.89857703 01:39:39.050 --> 01:39:39.770 sense of, you know, is NOTE Confidence: 0.89857703 01:39:39.770 --> 01:39:40.729 this are these issues that NOTE Confidence: 0.89857703 01:39:40.729 --> 01:39:41.630 affected you? NOTE Confidence: 0.8111572 01:39:42.650 --> 01:39:43.550 Affect you. NOTE Confidence: 0.99853516 01:39:49.475 --> 01:39:50.775 I mean, for me, NOTE Confidence: 0.9320984 01:39:51.555 --> 01:39:52.835 as evident as it is NOTE Confidence: 0.9320984 01:39:52.835 --> 01:39:54.695 my voice, which was, like, NOTE Confidence: 0.9320984 01:39:54.755 --> 01:39:56.035 the sourness of voice which NOTE Confidence: 0.9320984 01:39:56.035 --> 01:39:57.415 I had after my surgery. NOTE Confidence: 0.98713565 01:39:57.990 --> 01:39:59.030 And the second thing that NOTE Confidence: 0.98713565 01:39:59.030 --> 01:40:00.390 I have is, like, this NOTE Confidence: 0.98713565 01:40:00.390 --> 01:40:01.770 late dumping syndrome. NOTE Confidence: 0.9429077 01:40:02.229 --> 01:40:03.510 Like, I keep having these NOTE Confidence: 0.9429077 01:40:03.510 --> 01:40:04.729 episodes of hypoglycemia. NOTE Confidence: 0.9959147 01:40:05.830 --> 01:40:07.189 And I don't know if NOTE Confidence: 0.9959147 01:40:07.189 --> 01:40:08.970 it's common for everyone, but NOTE Confidence: 0.9959147 01:40:09.110 --> 01:40:10.650 I don't feel hunger anymore. NOTE Confidence: 0.9370117 01:40:11.110 --> 01:40:12.170 I'm never hungry. NOTE Confidence: 0.9559143 01:40:12.585 --> 01:40:13.705 So it's not that feeling NOTE Confidence: 0.9559143 01:40:13.705 --> 01:40:15.225 of hunger. And I have NOTE Confidence: 0.9559143 01:40:15.225 --> 01:40:16.985 forgotten what feeling hungry feels NOTE Confidence: 0.9559143 01:40:16.985 --> 01:40:18.344 like. So I just eat NOTE Confidence: 0.9559143 01:40:18.344 --> 01:40:19.545 because, you know, like, I NOTE Confidence: 0.9559143 01:40:19.545 --> 01:40:20.344 have to eat at a NOTE Confidence: 0.9559143 01:40:20.344 --> 01:40:22.425 particular time. And sometimes if NOTE Confidence: 0.9559143 01:40:22.425 --> 01:40:23.785 I forget, like, and I NOTE Confidence: 0.9559143 01:40:23.785 --> 01:40:24.745 skip a meal, then I NOTE Confidence: 0.9559143 01:40:24.745 --> 01:40:26.364 just go into this severe NOTE Confidence: 0.9559143 01:40:26.425 --> 01:40:26.925 hypoglycemic NOTE Confidence: 0.99138933 01:40:27.225 --> 01:40:28.560 episode where I can feel NOTE Confidence: 0.99138933 01:40:28.640 --> 01:40:29.840 my heart pounding, and I NOTE Confidence: 0.99138933 01:40:29.840 --> 01:40:31.360 just need to get something NOTE Confidence: 0.99138933 01:40:31.360 --> 01:40:32.640 really quick to eat. So NOTE Confidence: 0.99138933 01:40:32.640 --> 01:40:33.840 I think that is something NOTE Confidence: 0.99138933 01:40:33.840 --> 01:40:34.340 that NOTE Confidence: 0.99746096 01:40:35.040 --> 01:40:36.740 is really concerning for myself. NOTE Confidence: 0.99975586 01:40:37.120 --> 01:40:37.920 So if you could NOTE Confidence: 0.93173826 01:40:38.720 --> 01:40:39.680 I'm gonna give it to NOTE Confidence: 0.93173826 01:40:39.680 --> 01:40:41.140 Scout and Natalie for this. NOTE Confidence: 0.93173826 01:40:41.439 --> 01:40:41.965 Do you want me to NOTE Confidence: 0.93173826 01:40:41.965 --> 01:40:43.104 start or you to start? NOTE Confidence: 0.9603516 01:40:43.885 --> 01:40:45.085 Well, I'll, yeah, I'll start NOTE Confidence: 0.9603516 01:40:45.085 --> 01:40:46.945 with the the neuropathy question. NOTE Confidence: 0.9677582 01:40:47.725 --> 01:40:49.324 Yeah. Neuropathy is a is NOTE Confidence: 0.9677582 01:40:49.324 --> 01:40:51.324 a maddening side effect because NOTE Confidence: 0.9677582 01:40:51.324 --> 01:40:52.685 there's no perfect cure for NOTE Confidence: 0.9677582 01:40:52.685 --> 01:40:53.185 it. NOTE Confidence: 0.93377686 01:40:54.810 --> 01:40:56.810 My approach to neuropathy is NOTE Confidence: 0.93377686 01:40:56.810 --> 01:40:57.790 actually a multimodal, NOTE Confidence: 1 01:40:58.729 --> 01:40:59.229 approach. NOTE Confidence: 0.99365234 01:41:00.250 --> 01:41:01.710 I'm actually a big proponent NOTE Confidence: 0.99365234 01:41:01.770 --> 01:41:03.630 of soft tissue massage NOTE Confidence: 1 01:41:04.170 --> 01:41:05.070 to your feet NOTE Confidence: 0.97201025 01:41:05.689 --> 01:41:07.229 to try to and, obviously, NOTE Confidence: 0.97201025 01:41:07.290 --> 01:41:08.574 we know that it's, you NOTE Confidence: 0.97201025 01:41:08.574 --> 01:41:09.454 know, like, we know that NOTE Confidence: 0.97201025 01:41:09.454 --> 01:41:10.574 it's nerve and it's not NOTE Confidence: 0.97201025 01:41:10.574 --> 01:41:12.814 vascular, but just the act NOTE Confidence: 0.97201025 01:41:12.814 --> 01:41:14.175 of giving yourself a deep NOTE Confidence: 0.97201025 01:41:14.175 --> 01:41:15.074 tissue massage NOTE Confidence: 0.99853516 01:41:15.375 --> 01:41:16.114 does increase NOTE Confidence: 0.9839681 01:41:16.415 --> 01:41:17.534 blood flow to the area. NOTE Confidence: 0.9839681 01:41:17.534 --> 01:41:18.755 It's helping with mitochondrial, NOTE Confidence: 0.9222412 01:41:20.014 --> 01:41:21.074 turnover. And NOTE Confidence: 0.7766927 01:41:21.375 --> 01:41:22.094 and also to NOTE Confidence: 0.97021484 01:41:22.880 --> 01:41:24.179 especially if you have neuropathy NOTE Confidence: 0.9941031 01:41:24.479 --> 01:41:25.840 in your fingers as well NOTE Confidence: 0.9941031 01:41:25.840 --> 01:41:27.280 as your feet, you're giving NOTE Confidence: 0.9941031 01:41:27.280 --> 01:41:28.739 yourself that input NOTE Confidence: 0.9735786 01:41:29.119 --> 01:41:31.520 that you need. And sometimes NOTE Confidence: 0.9735786 01:41:31.520 --> 01:41:32.800 what I will recommend to NOTE Confidence: 0.9735786 01:41:32.800 --> 01:41:34.000 my patients, you know, if NOTE Confidence: 0.9735786 01:41:34.000 --> 01:41:35.599 their caregiver will buy into NOTE Confidence: 0.9735786 01:41:35.599 --> 01:41:37.040 it is to say, have NOTE Confidence: 0.9735786 01:41:37.040 --> 01:41:37.780 the caregiver NOTE Confidence: 0.9573242 01:41:38.625 --> 01:41:40.324 give your feet a massage, NOTE Confidence: 0.9995117 01:41:40.625 --> 01:41:41.364 and you NOTE Confidence: 0.9877116 01:41:41.905 --> 01:41:42.965 close your eyes. NOTE Confidence: 0.99921125 01:41:44.064 --> 01:41:45.264 Because if you take your NOTE Confidence: 0.99921125 01:41:45.264 --> 01:41:47.025 vision out of it, then NOTE Confidence: 0.99921125 01:41:47.025 --> 01:41:48.005 you can see NOTE Confidence: 0.9690918 01:41:48.385 --> 01:41:49.744 or you can't see, and NOTE Confidence: 0.9690918 01:41:49.744 --> 01:41:51.284 so you have to feel NOTE Confidence: 0.9951172 01:41:51.585 --> 01:41:52.085 more. NOTE Confidence: 0.99994576 01:41:52.490 --> 01:41:54.010 Where do you have sensation? NOTE Confidence: 0.99994576 01:41:54.010 --> 01:41:55.150 Do you have sensation NOTE Confidence: 0.9711914 01:41:55.850 --> 01:41:56.810 on your heel when you NOTE Confidence: 0.9711914 01:41:56.810 --> 01:41:57.610 start to lose it in NOTE Confidence: 0.9711914 01:41:57.610 --> 01:41:58.750 the middle of your foot? NOTE Confidence: 0.95530194 01:41:59.290 --> 01:42:00.250 Or do you have sensation NOTE Confidence: 0.95530194 01:42:00.250 --> 01:42:01.290 in the the middle of NOTE Confidence: 0.95530194 01:42:01.290 --> 01:42:02.330 your foot and you start NOTE Confidence: 0.95530194 01:42:02.330 --> 01:42:03.689 to lose it around the NOTE Confidence: 0.95530194 01:42:03.689 --> 01:42:04.830 balls of your feet? NOTE Confidence: 0.9723873 01:42:06.235 --> 01:42:07.115 And so I will have NOTE Confidence: 0.9723873 01:42:07.115 --> 01:42:08.075 my patients do that as, NOTE Confidence: 0.9723873 01:42:08.075 --> 01:42:08.955 like, a warm up. And NOTE Confidence: 0.9723873 01:42:08.955 --> 01:42:09.755 then when I get you NOTE Confidence: 0.9723873 01:42:09.755 --> 01:42:11.195 in clinic, in my PT NOTE Confidence: 0.9723873 01:42:11.195 --> 01:42:13.195 clinic, I'm throwing everything at NOTE Confidence: 0.9723873 01:42:13.195 --> 01:42:14.815 you. I am putting you NOTE Confidence: 0.9723873 01:42:15.115 --> 01:42:16.395 on the the AirX on NOTE Confidence: 0.9723873 01:42:16.395 --> 01:42:18.315 our, on an AirX balance NOTE Confidence: 0.9723873 01:42:18.315 --> 01:42:19.890 pad, and I am having NOTE Confidence: 0.9723873 01:42:19.890 --> 01:42:21.330 you do single leg stance. NOTE Confidence: 0.9723873 01:42:21.330 --> 01:42:22.370 And I am also throwing NOTE Confidence: 0.9723873 01:42:22.370 --> 01:42:23.410 a ball at you, and NOTE Confidence: 0.9723873 01:42:23.410 --> 01:42:24.790 I'm asking you questions. NOTE Confidence: 0.96981275 01:42:25.970 --> 01:42:27.729 And, again, I'm gonna have NOTE Confidence: 0.96981275 01:42:27.729 --> 01:42:28.530 you do that with your NOTE Confidence: 0.96981275 01:42:28.530 --> 01:42:29.570 eyes open and with your NOTE Confidence: 0.96981275 01:42:29.570 --> 01:42:30.390 eyes closed NOTE Confidence: 0.99780273 01:42:31.090 --> 01:42:32.710 to challenge those nerves NOTE Confidence: 0.9899292 01:42:34.055 --> 01:42:35.195 to wake back up. NOTE Confidence: 1 01:42:35.575 --> 01:42:36.075 So NOTE Confidence: 0.9998372 01:42:36.615 --> 01:42:37.835 that's my approach. NOTE Confidence: 0.9690639 01:42:38.215 --> 01:42:39.415 I'm also a big proponent NOTE Confidence: 0.9690639 01:42:39.415 --> 01:42:40.075 of acupuncture. NOTE Confidence: 0.99121094 01:42:41.575 --> 01:42:43.655 So I'm very much of NOTE Confidence: 0.99121094 01:42:43.655 --> 01:42:44.475 the nonpharmacological, NOTE Confidence: 0.9007162 01:42:45.495 --> 01:42:46.795 noninvasive approach. NOTE Confidence: 0.99902344 01:42:47.175 --> 01:42:47.675 So NOTE Confidence: 0.98327637 01:42:48.429 --> 01:42:50.030 those are my my takes NOTE Confidence: 0.98327637 01:42:50.030 --> 01:42:51.090 on on neuropathy. NOTE Confidence: 0.94110614 01:42:52.030 --> 01:42:53.469 Textured stuff. Don't you do, NOTE Confidence: 0.94110614 01:42:53.469 --> 01:42:54.110 like, a texture? I do NOTE Confidence: 0.94110614 01:42:54.110 --> 01:42:55.070 some I do some texture NOTE Confidence: 0.94110614 01:42:55.070 --> 01:42:56.110 stuff too. She she's such NOTE Confidence: 0.94110614 01:42:56.110 --> 01:42:57.090 a good work wife. NOTE Confidence: 0.8611382 01:42:57.630 --> 01:42:58.829 She reminds me all all NOTE Confidence: 0.8611382 01:42:59.309 --> 01:43:00.750 yes. I appreciate that. NOTE Confidence: 0.9523112 01:43:01.705 --> 01:43:03.385 Again, especially, like, again, for NOTE Confidence: 0.9523112 01:43:03.385 --> 01:43:04.344 the hands, like, if you've NOTE Confidence: 0.9523112 01:43:04.344 --> 01:43:06.045 got neuropathy in the hands. NOTE Confidence: 0.97489697 01:43:06.905 --> 01:43:07.705 And this is a great NOTE Confidence: 0.97489697 01:43:07.705 --> 01:43:08.665 game if you've got little NOTE Confidence: 0.97489697 01:43:08.665 --> 01:43:09.965 kids or you got grandkids. NOTE Confidence: 0.82540894 01:43:10.745 --> 01:43:12.985 Get a bucket of top NOTE Confidence: 0.82540894 01:43:13.225 --> 01:43:14.045 like, a Tupperware, NOTE Confidence: 0.9803874 01:43:14.905 --> 01:43:16.585 and fill it with lentil NOTE Confidence: 0.9803874 01:43:16.585 --> 01:43:17.085 beans. NOTE Confidence: 0.90148926 01:43:18.800 --> 01:43:19.620 And then, NOTE Confidence: 0.971258 01:43:20.160 --> 01:43:21.200 especially if you wanna make NOTE Confidence: 0.971258 01:43:21.200 --> 01:43:22.479 it into a game, you NOTE Confidence: 0.971258 01:43:22.479 --> 01:43:24.180 put ten marbles in there NOTE Confidence: 0.971258 01:43:24.479 --> 01:43:25.760 or you put ten pennies NOTE Confidence: 0.971258 01:43:25.760 --> 01:43:26.420 in there. NOTE Confidence: 0.95745564 01:43:26.720 --> 01:43:27.920 Again, you need to go NOTE Confidence: 0.95745564 01:43:27.920 --> 01:43:28.960 and you need to find NOTE Confidence: 0.95745564 01:43:28.960 --> 01:43:30.080 the pennies, and you are NOTE Confidence: 0.95745564 01:43:30.080 --> 01:43:31.840 relying on sensation and you NOTE Confidence: 0.95745564 01:43:31.840 --> 01:43:33.120 can't see them. So, again, NOTE Confidence: 0.95745564 01:43:33.120 --> 01:43:34.704 you're challenging proprioception NOTE Confidence: 0.976756 01:43:36.684 --> 01:43:37.645 and you do it and NOTE Confidence: 0.976756 01:43:37.645 --> 01:43:39.164 you have your grandkid time NOTE Confidence: 0.976756 01:43:39.164 --> 01:43:40.045 you to see how long NOTE Confidence: 0.976756 01:43:40.045 --> 01:43:40.925 it takes you to do NOTE Confidence: 0.976756 01:43:40.925 --> 01:43:42.204 that. And it's like, okay, NOTE Confidence: 0.976756 01:43:42.204 --> 01:43:43.564 grandpa, it took you twenty, NOTE Confidence: 0.976756 01:43:43.564 --> 01:43:44.525 you know, a minute and NOTE Confidence: 0.976756 01:43:44.525 --> 01:43:45.724 twenty five seconds to do NOTE Confidence: 0.976756 01:43:45.724 --> 01:43:47.264 that. And then you switch NOTE Confidence: 0.9606771 01:43:47.645 --> 01:43:48.684 that they do it and NOTE Confidence: 0.9606771 01:43:48.684 --> 01:43:50.739 you time them. Now your NOTE Confidence: 0.9606771 01:43:50.739 --> 01:43:52.360 therapy has become a game. NOTE Confidence: 0.9963867 01:43:54.500 --> 01:43:56.199 Yeah. He's pretty cool. Alright. NOTE Confidence: 0.99869794 01:43:56.979 --> 01:43:58.040 So the dumping NOTE Confidence: 0.9828288 01:43:58.420 --> 01:44:00.420 syndrome. So, obviously well, not NOTE Confidence: 0.9828288 01:44:00.420 --> 01:44:02.020 obviously, but there's early dumping, NOTE Confidence: 0.9828288 01:44:02.020 --> 01:44:03.219 and then there's late dumping. NOTE Confidence: 0.9828288 01:44:03.219 --> 01:44:04.665 Usually, early dumping is, like, NOTE Confidence: 0.9828288 01:44:04.825 --> 01:44:06.505 within thirty to sixty minutes NOTE Confidence: 0.9828288 01:44:06.505 --> 01:44:07.705 after eating, and then late NOTE Confidence: 0.9828288 01:44:07.705 --> 01:44:08.985 dumping could be two hours, NOTE Confidence: 0.9828288 01:44:08.985 --> 01:44:10.285 three hours after eating. NOTE Confidence: 0.99677736 01:44:11.705 --> 01:44:13.805 For these types of issues, NOTE Confidence: 0.9835717 01:44:14.265 --> 01:44:15.305 a lot of times, like, NOTE Confidence: 0.9835717 01:44:15.305 --> 01:44:17.064 main recommendations that I make NOTE Confidence: 0.9835717 01:44:17.064 --> 01:44:18.665 is small frequent meals like NOTE Confidence: 0.9835717 01:44:18.665 --> 01:44:20.200 you're doing. Right? So you NOTE Confidence: 0.9835717 01:44:20.200 --> 01:44:21.080 don't a lot of people NOTE Confidence: 0.9835717 01:44:21.080 --> 01:44:22.280 don't feel hunger. That's very NOTE Confidence: 0.9835717 01:44:22.280 --> 01:44:22.780 common. NOTE Confidence: 0.99798584 01:44:23.160 --> 01:44:24.120 So it's eating around the NOTE Confidence: 0.99798584 01:44:24.120 --> 01:44:25.160 clock. It's trying to eat NOTE Confidence: 0.99798584 01:44:25.160 --> 01:44:26.939 small portions every three hours NOTE Confidence: 0.99798584 01:44:27.080 --> 01:44:28.780 to regulate blood sugar control. NOTE Confidence: 0.9980469 01:44:30.120 --> 01:44:32.120 It's not drinking liquids with NOTE Confidence: 0.9980469 01:44:32.120 --> 01:44:32.620 food. NOTE Confidence: 0.98012656 01:44:33.305 --> 01:44:33.945 If you think of, like, NOTE Confidence: 0.98012656 01:44:33.945 --> 01:44:35.064 a water slide, if you NOTE Confidence: 0.98012656 01:44:35.064 --> 01:44:35.785 if you go down a NOTE Confidence: 0.98012656 01:44:35.785 --> 01:44:36.585 water slide with water, you're NOTE Confidence: 0.98012656 01:44:36.585 --> 01:44:37.465 gonna go a lot faster. NOTE Confidence: 0.98012656 01:44:37.465 --> 01:44:38.985 Right? So, if you can NOTE Confidence: 0.98012656 01:44:38.985 --> 01:44:40.505 separate liquids and solids, it NOTE Confidence: 0.98012656 01:44:40.505 --> 01:44:41.545 does help to slow down NOTE Confidence: 0.98012656 01:44:41.545 --> 01:44:42.845 the digestion a bit, NOTE Confidence: 0.9956787 01:44:43.625 --> 01:44:45.325 because the dumping is really NOTE Confidence: 0.9956787 01:44:45.600 --> 01:44:46.960 the food is moving very, NOTE Confidence: 0.9956787 01:44:46.960 --> 01:44:48.239 very quickly from the stomach NOTE Confidence: 0.9956787 01:44:48.239 --> 01:44:49.380 to the to the intestine. NOTE Confidence: 0.99246913 01:44:49.840 --> 01:44:50.880 And that rate that it's NOTE Confidence: 0.99246913 01:44:50.880 --> 01:44:52.159 moving through, it's causing an NOTE Confidence: 0.99246913 01:44:52.159 --> 01:44:54.420 influx with, you know, liquids NOTE Confidence: 0.99246913 01:44:54.479 --> 01:44:56.179 and a change in electrolytes. NOTE Confidence: 0.99246913 01:44:56.239 --> 01:44:57.280 So there's a lot of NOTE Confidence: 0.99246913 01:44:57.280 --> 01:44:59.040 things happening. So one is NOTE Confidence: 0.99246913 01:44:59.040 --> 01:45:00.594 small frequent meals. Two is NOTE Confidence: 0.99246913 01:45:00.594 --> 01:45:02.295 separating liquids and solids. NOTE Confidence: 0.9983724 01:45:03.074 --> 01:45:04.215 Three is minimizing NOTE Confidence: 0.9995117 01:45:04.755 --> 01:45:05.735 or avoiding NOTE Confidence: 0.8972575 01:45:06.114 --> 01:45:07.974 simple sugar, so, like, juices, NOTE Confidence: 0.8972575 01:45:08.195 --> 01:45:08.695 sodas, NOTE Confidence: 0.9914551 01:45:09.474 --> 01:45:11.094 lots of candy pastries NOTE Confidence: 0.97947365 01:45:11.395 --> 01:45:13.255 because that influx of sugar NOTE Confidence: 0.97947365 01:45:13.510 --> 01:45:14.950 causes more of those symptoms. NOTE Confidence: 0.97947365 01:45:14.950 --> 01:45:16.330 You might feel really lethargic, NOTE Confidence: 0.97947365 01:45:16.550 --> 01:45:17.510 tired, like you have to NOTE Confidence: 0.97947365 01:45:17.510 --> 01:45:18.310 lay down, you have the NOTE Confidence: 0.97947365 01:45:18.310 --> 01:45:20.229 sweats. That's usually because you NOTE Confidence: 0.97947365 01:45:20.229 --> 01:45:21.030 went out for an ice NOTE Confidence: 0.97947365 01:45:21.030 --> 01:45:22.150 cream cone, you know, with NOTE Confidence: 0.97947365 01:45:22.150 --> 01:45:23.189 your kids. You ate too NOTE Confidence: 0.97947365 01:45:23.189 --> 01:45:24.390 fast, and then you have NOTE Confidence: 0.97947365 01:45:24.390 --> 01:45:25.925 those symptoms. So what I NOTE Confidence: 0.97947365 01:45:25.925 --> 01:45:26.725 say is you don't have NOTE Confidence: 0.97947365 01:45:26.725 --> 01:45:28.005 to avoid those things, but NOTE Confidence: 0.97947365 01:45:28.005 --> 01:45:29.445 if you can pair the NOTE Confidence: 0.97947365 01:45:29.445 --> 01:45:30.645 ice cream or a small NOTE Confidence: 0.97947365 01:45:30.645 --> 01:45:31.785 portion of a sweet NOTE Confidence: 0.96056414 01:45:32.165 --> 01:45:34.165 with, like, a fiber rich NOTE Confidence: 0.96056414 01:45:34.165 --> 01:45:35.625 food, like, a it's complicated. NOTE Confidence: 0.96056414 01:45:35.765 --> 01:45:36.885 Soluble fiber is like a NOTE Confidence: 0.96056414 01:45:36.885 --> 01:45:38.645 softening fiber. If you can NOTE Confidence: 0.96056414 01:45:38.645 --> 01:45:39.845 pair those things together, it NOTE Confidence: 0.96056414 01:45:39.845 --> 01:45:41.020 helps to slow down the NOTE Confidence: 0.96056414 01:45:41.020 --> 01:45:42.080 absorption of the sugar, NOTE Confidence: 0.9991862 01:45:42.540 --> 01:45:43.500 and can really help the NOTE Confidence: 0.9991862 01:45:43.500 --> 01:45:44.000 symptoms. NOTE Confidence: 0.99543643 01:45:46.220 --> 01:45:47.260 You can lay down for NOTE Confidence: 0.99543643 01:45:47.260 --> 01:45:49.180 fifteen minutes after eating to NOTE Confidence: 0.99543643 01:45:49.180 --> 01:45:50.080 kind of, like, NOTE Confidence: 0.99921525 01:45:50.460 --> 01:45:52.380 not make gravity work against NOTE Confidence: 0.99921525 01:45:52.380 --> 01:45:53.835 you. So some people find NOTE Confidence: 0.99921525 01:45:53.835 --> 01:45:54.955 that when they lay back NOTE Confidence: 0.99921525 01:45:54.955 --> 01:45:55.995 or just relax on the NOTE Confidence: 0.99921525 01:45:55.995 --> 01:45:57.115 couch for ten to fifteen NOTE Confidence: 0.99921525 01:45:57.115 --> 01:45:58.175 minutes after eating NOTE Confidence: 0.9622003 01:45:58.475 --> 01:45:59.835 a small portion, obviously, not NOTE Confidence: 0.9622003 01:45:59.835 --> 01:46:01.115 laying flat, but that could NOTE Confidence: 0.9622003 01:46:01.115 --> 01:46:02.155 help to slow down the NOTE Confidence: 0.9622003 01:46:02.155 --> 01:46:03.675 rate of the digestion too. NOTE Confidence: 0.9622003 01:46:03.675 --> 01:46:04.795 So lots of tips and NOTE Confidence: 0.9622003 01:46:04.795 --> 01:46:06.000 tricks, lots of, like, NOTE Confidence: 0.98467344 01:46:06.720 --> 01:46:08.640 fiber kind of, things we NOTE Confidence: 0.98467344 01:46:08.640 --> 01:46:09.840 can do. Like, if you NOTE Confidence: 0.98467344 01:46:09.840 --> 01:46:10.800 don't eat a diet rich NOTE Confidence: 0.98467344 01:46:10.800 --> 01:46:11.840 in soluble fiber, which is NOTE Confidence: 0.98467344 01:46:11.840 --> 01:46:12.900 found in, like, oatmeal, NOTE Confidence: 0.99403214 01:46:13.600 --> 01:46:15.460 beans, pumpkin puree, NOTE Confidence: 0.9837405 01:46:16.160 --> 01:46:16.880 that kind of thing, we NOTE Confidence: 0.9837405 01:46:16.880 --> 01:46:18.160 can use, like, psyllium fiber NOTE Confidence: 0.9837405 01:46:18.160 --> 01:46:19.040 husk, and we can use, NOTE Confidence: 0.9837405 01:46:19.040 --> 01:46:21.380 like, Metamucil wafers before meals NOTE Confidence: 0.9837405 01:46:21.555 --> 01:46:22.675 to try to slow down NOTE Confidence: 0.9837405 01:46:22.675 --> 01:46:24.275 the rate of digestion. So NOTE Confidence: 0.9837405 01:46:24.275 --> 01:46:25.575 lots of things to try, NOTE Confidence: 0.9837405 01:46:25.635 --> 01:46:27.415 but combinations of things help. NOTE Confidence: 0.9837405 01:46:27.635 --> 01:46:28.375 Thank you. NOTE Confidence: 0.86987305 01:46:30.035 --> 01:46:32.215 Thanks, Natalie. Kevin. Okay. Just NOTE Confidence: 0.86987305 01:46:32.275 --> 01:46:34.275 tell one one thought about NOTE Confidence: 0.86987305 01:46:34.275 --> 01:46:35.255 all these supportive NOTE Confidence: 0.98950195 01:46:35.590 --> 01:46:37.270 care things, which is very NOTE Confidence: 0.98950195 01:46:37.270 --> 01:46:38.630 important, I think, in terms NOTE Confidence: 0.98950195 01:46:38.630 --> 01:46:39.130 of, NOTE Confidence: 0.9895562 01:46:39.750 --> 01:46:41.750 survivorship and and the burden NOTE Confidence: 0.9895562 01:46:41.750 --> 01:46:43.450 of of, of cancer. NOTE Confidence: 0.99833983 01:46:44.710 --> 01:46:46.729 You know, acupuncture and massage NOTE Confidence: 0.8054199 01:46:47.110 --> 01:46:49.350 cost money and many times, NOTE Confidence: 0.9935303 01:46:49.670 --> 01:46:50.970 not covered by insurance. NOTE Confidence: 0.9460486 01:46:51.854 --> 01:46:52.894 It's actually one of the NOTE Confidence: 0.9460486 01:46:53.054 --> 01:46:54.094 I just wanted to highlight NOTE Confidence: 0.9460486 01:46:54.094 --> 01:46:55.295 because this is one of NOTE Confidence: 0.9460486 01:46:55.295 --> 01:46:56.655 the really nice things about NOTE Confidence: 0.9460486 01:46:56.655 --> 01:46:58.414 my cancer center at Park NOTE Confidence: 0.9460486 01:46:58.414 --> 01:47:00.275 Avenue Medical Center, which is NOTE Confidence: 0.9460486 01:47:00.414 --> 01:47:01.554 because of philanthropic NOTE Confidence: 0.9463501 01:47:01.854 --> 01:47:03.854 support and, the support of NOTE Confidence: 0.9463501 01:47:03.854 --> 01:47:05.235 the community, actually, NOTE Confidence: 0.9692383 01:47:06.094 --> 01:47:06.835 through donors. NOTE Confidence: 0.9296875 01:47:07.230 --> 01:47:08.130 We can provide NOTE Confidence: 0.98136395 01:47:08.670 --> 01:47:10.190 things like acupuncture to our NOTE Confidence: 0.98136395 01:47:10.190 --> 01:47:10.690 patients, NOTE Confidence: 0.9448242 01:47:11.070 --> 01:47:11.570 covered, NOTE Confidence: 0.97961426 01:47:12.190 --> 01:47:13.790 for two years, even two NOTE Confidence: 0.97961426 01:47:13.790 --> 01:47:14.930 years after treatment. NOTE Confidence: 0.98461914 01:47:15.870 --> 01:47:16.350 So, NOTE Confidence: 0.9370524 01:47:16.670 --> 01:47:17.790 doctor Yac, I think you're NOTE Confidence: 0.9370524 01:47:17.790 --> 01:47:19.170 out of that window, but NOTE Confidence: 0.98147243 01:47:19.655 --> 01:47:21.195 this is something which is NOTE Confidence: 0.98147243 01:47:21.255 --> 01:47:23.255 hugely valuable for our patients NOTE Confidence: 0.98147243 01:47:23.255 --> 01:47:24.375 and, you know, to the NOTE Confidence: 0.98147243 01:47:24.375 --> 01:47:26.375 point about structured exercise, something NOTE Confidence: 0.98147243 01:47:26.375 --> 01:47:27.255 we still need to work NOTE Confidence: 0.98147243 01:47:27.255 --> 01:47:27.995 on because, NOTE Confidence: 0.9610596 01:47:29.255 --> 01:47:31.015 also insurance doesn't cover that NOTE Confidence: 0.9610596 01:47:31.015 --> 01:47:32.880 either. Right? So it's something NOTE Confidence: 0.9610596 01:47:32.880 --> 01:47:34.239 to really focus on how NOTE Confidence: 0.9610596 01:47:34.239 --> 01:47:35.199 we can make these things NOTE Confidence: 0.9610596 01:47:35.199 --> 01:47:35.939 more accessible. NOTE Confidence: 0.9642625 01:47:38.080 --> 01:47:39.760 Yes. And so to follow-up NOTE Confidence: 0.9642625 01:47:39.760 --> 01:47:40.239 with that, NOTE Confidence: 0.9940918 01:47:40.800 --> 01:47:42.159 that's why one of the, NOTE Confidence: 0.9702691 01:47:42.719 --> 01:47:44.000 the resources that's up there NOTE Confidence: 0.9702691 01:47:44.000 --> 01:47:45.300 is the Livestrong program, NOTE Confidence: 1 01:47:46.025 --> 01:47:46.525 because NOTE Confidence: 0.97194475 01:47:47.304 --> 01:47:48.104 I a lot and a NOTE Confidence: 0.97194475 01:47:48.104 --> 01:47:49.485 lot of times, I'll use NOTE Confidence: 0.97194475 01:47:49.625 --> 01:47:51.625 PT physical therapy as the NOTE Confidence: 0.97194475 01:47:51.625 --> 01:47:52.985 bridge to get ready for NOTE Confidence: 0.97194475 01:47:52.985 --> 01:47:54.344 the Livestrong program because the NOTE Confidence: 0.97194475 01:47:54.344 --> 01:47:56.665 Livestrong program is free. It's NOTE Confidence: 0.97194475 01:47:56.665 --> 01:47:58.445 free for any cancer survivor, NOTE Confidence: 0.9897461 01:47:59.170 --> 01:48:00.130 and it is a it's NOTE Confidence: 0.9897461 01:48:00.130 --> 01:48:02.550 a structured twelve week exercise NOTE Confidence: 0.9897461 01:48:02.610 --> 01:48:03.110 program. NOTE Confidence: 0.98490715 01:48:03.890 --> 01:48:05.490 So, yes, I'm also very NOTE Confidence: 0.98490715 01:48:05.490 --> 01:48:07.729 cognizant of the the burden NOTE Confidence: 0.98490715 01:48:07.729 --> 01:48:09.090 of, of cost, NOTE Confidence: 0.86357963 01:48:09.570 --> 01:48:11.355 and financial toxicity that So NOTE Confidence: 0.86357963 01:48:11.355 --> 01:48:12.095 many of our cancer NOTE Confidence: 0.9683533 01:48:12.475 --> 01:48:14.155 survivors, you know, you know, NOTE Confidence: 0.9683533 01:48:14.155 --> 01:48:15.375 are susceptible to. NOTE Confidence: 0.93110657 01:48:15.835 --> 01:48:17.195 So I'm also always looking NOTE Confidence: 0.93110657 01:48:17.195 --> 01:48:18.715 for those free services wherever NOTE Confidence: 0.93110657 01:48:18.715 --> 01:48:20.475 possible. Yep. Yeah. That looks NOTE Confidence: 0.93110657 01:48:20.475 --> 01:48:20.975 strong. NOTE Confidence: 0.6841169 01:48:23.675 --> 01:48:23.972 That's right. That's right. That's NOTE Confidence: 0.6841169 01:48:23.972 --> 01:48:24.235 right. That's right. That's right. NOTE Confidence: 0.6841169 01:48:24.235 --> 01:48:25.515 That's right. YMCA and I NOTE Confidence: 0.6841169 01:48:25.515 --> 01:48:26.655 think some of it otherwise NOTE Confidence: 0.6841169 01:48:26.715 --> 01:48:27.060 also. NOTE Confidence: 0.96125346 01:48:30.020 --> 01:48:31.140 Yeah. So these these are NOTE Confidence: 0.96125346 01:48:31.140 --> 01:48:32.340 really great discussions. And if NOTE Confidence: 0.96125346 01:48:32.340 --> 01:48:33.220 you just take a step NOTE Confidence: 0.96125346 01:48:33.220 --> 01:48:33.960 back is, NOTE Confidence: 0.9075928 01:48:34.500 --> 01:48:35.400 very often, NOTE Confidence: 0.9565827 01:48:36.260 --> 01:48:37.939 we especially in the early NOTE Confidence: 0.9565827 01:48:37.939 --> 01:48:39.620 stages of your diagnosis and NOTE Confidence: 0.9565827 01:48:39.620 --> 01:48:40.660 when we're when we're trying NOTE Confidence: 0.9565827 01:48:40.660 --> 01:48:41.985 to figure out whether the NOTE Confidence: 0.9565827 01:48:41.985 --> 01:48:43.265 cancer can be cured or NOTE Confidence: 0.9565827 01:48:43.265 --> 01:48:45.345 even treated. And often, a NOTE Confidence: 0.9565827 01:48:45.345 --> 01:48:46.225 lot of the stuff that NOTE Confidence: 0.9565827 01:48:46.225 --> 01:48:47.365 we do are like, hey. NOTE Confidence: 0.9565827 01:48:47.585 --> 01:48:48.485 These are the NOTE Confidence: 0.9909105 01:48:48.945 --> 01:48:50.145 battle scars that you have NOTE Confidence: 0.9909105 01:48:50.145 --> 01:48:50.945 to take on for the NOTE Confidence: 0.9909105 01:48:50.945 --> 01:48:52.385 fight against cancer. But it's NOTE Confidence: 0.9909105 01:48:52.385 --> 01:48:53.505 only later on that some NOTE Confidence: 0.9909105 01:48:53.505 --> 01:48:54.865 of us are starting to NOTE Confidence: 0.9909105 01:48:54.865 --> 01:48:55.365 appreciate NOTE Confidence: 0.9987793 01:48:56.000 --> 01:48:56.900 that some of these NOTE Confidence: 0.99934894 01:48:57.439 --> 01:48:58.260 things are either NOTE Confidence: 0.9790918 01:48:58.800 --> 01:49:01.840 addressed through lifestyle modifications, things NOTE Confidence: 0.9790918 01:49:01.840 --> 01:49:02.400 that you have to do, NOTE Confidence: 0.9790918 01:49:02.400 --> 01:49:03.439 and things you kind of NOTE Confidence: 0.9790918 01:49:03.439 --> 01:49:04.320 have to just live with NOTE Confidence: 0.9790918 01:49:04.320 --> 01:49:05.460 as you get through this. NOTE Confidence: 0.9321289 01:49:06.000 --> 01:49:06.960 And there are two aspects NOTE Confidence: 0.9321289 01:49:06.960 --> 01:49:08.500 to that. Right? One is, NOTE Confidence: 0.99497527 01:49:09.675 --> 01:49:10.955 as our treatments are getting NOTE Confidence: 0.99497527 01:49:10.955 --> 01:49:13.115 better, there are more and NOTE Confidence: 0.99497527 01:49:13.115 --> 01:49:14.475 more of folks like you NOTE Confidence: 0.99497527 01:49:14.475 --> 01:49:15.595 who are getting through this NOTE Confidence: 0.99497527 01:49:15.595 --> 01:49:16.715 and now having to deal NOTE Confidence: 0.99497527 01:49:16.715 --> 01:49:17.595 with this in the longer NOTE Confidence: 0.99497527 01:49:17.595 --> 01:49:19.195 term. At the same time, NOTE Confidence: 0.99497527 01:49:19.195 --> 01:49:20.475 we are trying to also NOTE Confidence: 0.99497527 01:49:20.475 --> 01:49:21.295 make our treatments NOTE Confidence: 0.978889 01:49:21.850 --> 01:49:23.770 more precise, more specific, more NOTE Confidence: 0.978889 01:49:23.770 --> 01:49:25.370 accurate so that we don't NOTE Confidence: 0.978889 01:49:25.370 --> 01:49:26.650 have these battle scars to NOTE Confidence: 0.978889 01:49:26.650 --> 01:49:27.390 face. But NOTE Confidence: 0.92148435 01:49:28.250 --> 01:49:29.610 cancers, as we have talked NOTE Confidence: 0.92148435 01:49:29.610 --> 01:49:30.570 about, cancer is still a NOTE Confidence: 0.92148435 01:49:30.570 --> 01:49:32.090 deadly illness, and we still NOTE Confidence: 0.92148435 01:49:32.090 --> 01:49:33.390 need to fight through this. NOTE Confidence: 0.9406738 01:49:34.250 --> 01:49:35.229 And probably NOTE Confidence: 0.90445966 01:49:35.610 --> 01:49:37.390 I'll use this opportunity to NOTE Confidence: 0.90445966 01:49:37.665 --> 01:49:38.165 ask NOTE Confidence: 0.94621396 01:49:38.625 --> 01:49:39.905 folks since you've actually gone NOTE Confidence: 0.94621396 01:49:39.905 --> 01:49:41.104 through this journey. I think NOTE Confidence: 0.94621396 01:49:41.104 --> 01:49:42.385 it'll actually be really great NOTE Confidence: 0.94621396 01:49:42.385 --> 01:49:43.824 to have if anyone is NOTE Confidence: 0.94621396 01:49:43.824 --> 01:49:45.264 willing or interested to to NOTE Confidence: 0.94621396 01:49:45.264 --> 01:49:46.564 reach out to us to NOTE Confidence: 0.94621396 01:49:46.704 --> 01:49:48.864 help us walk this journey NOTE Confidence: 0.94621396 01:49:48.864 --> 01:49:50.224 with others because there's nothing NOTE Confidence: 0.94621396 01:49:50.224 --> 01:49:52.000 better than actually having someone NOTE Confidence: 0.94621396 01:49:52.000 --> 01:49:53.040 who's gone through this journey NOTE Confidence: 0.94621396 01:49:53.040 --> 01:49:54.479 talk through a patient who's NOTE Confidence: 0.94621396 01:49:54.479 --> 01:49:55.920 got newly diagnosed cancer. And NOTE Confidence: 0.94621396 01:49:55.920 --> 01:49:57.040 it it doesn't have to NOTE Confidence: 0.94621396 01:49:57.040 --> 01:49:57.760 be a lot. It could NOTE Confidence: 0.94621396 01:49:57.760 --> 01:49:59.120 be just answering a couple NOTE Confidence: 0.94621396 01:49:59.120 --> 01:50:00.240 of questions. Any sort of NOTE Confidence: 0.94621396 01:50:00.240 --> 01:50:01.120 support, I think, would be NOTE Confidence: 0.94621396 01:50:01.120 --> 01:50:02.320 really great for our patients. NOTE Confidence: 0.94621396 01:50:02.320 --> 01:50:02.570 And, NOTE Confidence: 0.9770633 01:50:03.725 --> 01:50:04.765 just feel free to reach NOTE Confidence: 0.9770633 01:50:04.765 --> 01:50:05.725 out to us. And even NOTE Confidence: 0.9770633 01:50:05.725 --> 01:50:06.765 if you just put put NOTE Confidence: 0.9770633 01:50:06.765 --> 01:50:07.485 on your name and how NOTE Confidence: 0.9770633 01:50:07.485 --> 01:50:08.285 we can contact you, and NOTE Confidence: 0.9770633 01:50:08.285 --> 01:50:09.985 we'll try and work towards NOTE Confidence: 0.9770633 01:50:10.045 --> 01:50:11.245 figuring out how we can NOTE Confidence: 0.9770633 01:50:11.245 --> 01:50:12.465 connect you all to, NOTE Confidence: 0.99609375 01:50:13.085 --> 01:50:13.585 patients NOTE Confidence: 0.9691298 01:50:13.965 --> 01:50:15.660 to grow this group. And, NOTE Confidence: 0.9691298 01:50:15.820 --> 01:50:17.500 hopefully, we'll have this more NOTE Confidence: 0.9691298 01:50:17.500 --> 01:50:18.700 frequently. So as the group NOTE Confidence: 0.9691298 01:50:18.700 --> 01:50:19.820 grows, then we can share NOTE Confidence: 0.9691298 01:50:19.820 --> 01:50:21.979 experiences and practical tips on NOTE Confidence: 0.9691298 01:50:21.979 --> 01:50:23.020 how to deal with some NOTE Confidence: 0.9691298 01:50:23.020 --> 01:50:23.979 of the problems that we're NOTE Confidence: 0.9691298 01:50:23.979 --> 01:50:24.479 facing. NOTE Confidence: 0.9904785 01:50:26.060 --> 01:50:27.520 Any last words or comments? NOTE Confidence: 0.9904785 01:50:27.580 --> 01:50:28.700 Pam, do you have anything NOTE Confidence: 0.9904785 01:50:28.700 --> 01:50:29.850 you'd like to say? NOTE Confidence: 0.9846075 01:50:34.115 --> 01:50:35.635 I'll just say thank you NOTE Confidence: 0.9846075 01:50:35.635 --> 01:50:37.255 to everybody for the speakers NOTE Confidence: 0.9846075 01:50:37.314 --> 01:50:38.995 and for everyone coming tonight. NOTE Confidence: 0.9846075 01:50:38.995 --> 01:50:39.795 I think this was a NOTE Confidence: 0.9846075 01:50:39.795 --> 01:50:40.295 really NOTE Confidence: 0.9941406 01:50:40.675 --> 01:50:42.615 wonderful, very special event. NOTE Confidence: 0.9677979 01:50:43.314 --> 01:50:44.275 If I put on the NOTE Confidence: 0.9677979 01:50:44.275 --> 01:50:45.475 hat of kind of being NOTE Confidence: 0.9677979 01:50:45.475 --> 01:50:46.870 a a leader in the NOTE Confidence: 0.9677979 01:50:46.870 --> 01:50:48.410 cancer center, I wanna just NOTE Confidence: 0.9763093 01:50:49.430 --> 01:50:50.630 reassure all of you that NOTE Confidence: 0.9763093 01:50:50.630 --> 01:50:52.390 survivorship is a priority for NOTE Confidence: 0.9763093 01:50:52.390 --> 01:50:53.750 the cancer center. In fact, NOTE Confidence: 0.9763093 01:50:53.750 --> 01:50:54.790 that we are in the NOTE Confidence: 0.9763093 01:50:54.790 --> 01:50:56.310 process of looking for someone NOTE Confidence: 0.9763093 01:50:56.310 --> 01:50:56.970 to lead NOTE Confidence: 0.9488119 01:50:57.350 --> 01:50:59.190 supportive care and survivorship. It's NOTE Confidence: 0.9488119 01:50:59.190 --> 01:51:00.010 a new position. NOTE Confidence: 0.98811287 01:51:00.615 --> 01:51:01.975 So please expect that a NOTE Confidence: 0.98811287 01:51:01.975 --> 01:51:03.335 lot of these services will NOTE Confidence: 0.98811287 01:51:03.335 --> 01:51:05.095 evolve and really be better NOTE Confidence: 0.98811287 01:51:05.095 --> 01:51:06.854 defined under an umbrella where NOTE Confidence: 0.98811287 01:51:06.854 --> 01:51:08.455 you can really have and NOTE Confidence: 0.98811287 01:51:08.455 --> 01:51:10.155 I think Scott and, NOTE Confidence: 0.99565685 01:51:10.615 --> 01:51:11.814 you guys can Natalie can NOTE Confidence: 0.99565685 01:51:11.814 --> 01:51:12.775 speak to this as well. NOTE Confidence: 0.99565685 01:51:12.775 --> 01:51:13.895 I think we're really looking NOTE Confidence: 0.99565685 01:51:13.895 --> 01:51:15.115 to grow this program NOTE Confidence: 0.95703125 01:51:15.720 --> 01:51:16.220 and, NOTE Confidence: 0.9969005 01:51:16.760 --> 01:51:18.120 and and get some patient NOTE Confidence: 0.9969005 01:51:18.120 --> 01:51:19.239 input. So I think it's NOTE Confidence: 0.9969005 01:51:19.239 --> 01:51:20.600 a really exciting time. I NOTE Confidence: 0.9969005 01:51:20.600 --> 01:51:21.479 think we look to you NOTE Confidence: 0.9969005 01:51:21.479 --> 01:51:22.380 all to help NOTE Confidence: 0.99600923 01:51:22.840 --> 01:51:24.200 us kind of guide that NOTE Confidence: 0.99600923 01:51:24.200 --> 01:51:25.320 ship and and make sure NOTE Confidence: 0.99600923 01:51:25.320 --> 01:51:26.600 that we're getting it right. NOTE Confidence: 0.99600923 01:51:26.600 --> 01:51:27.560 So thank you. What a NOTE Confidence: 0.99600923 01:51:27.560 --> 01:51:28.840 special event. Thank you very NOTE Confidence: 0.99600923 01:51:28.840 --> 01:51:29.340 much. NOTE Confidence: 0.9486306 01:51:33.912 --> 01:51:35.272 If you haven't already put NOTE Confidence: 0.9486306 01:51:35.272 --> 01:51:36.152 words in the wall of NOTE Confidence: 0.9486306 01:51:36.152 --> 01:51:37.592 hope, please do end with NOTE Confidence: 0.9486306 01:51:37.592 --> 01:51:39.032 that. Thank you, Deepika, and NOTE Confidence: 0.9486306 01:51:39.032 --> 01:51:39.477 thank you