Let’s Be Surgical…with Dr. Chu
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This is Let's Be Clear with Shannon Doherty. Hi, everyone. Welcome to another episode of Let's Be Clear with Shannon Doherty. So one of the main things about me doing this podcast is that I really wanted to reach the cancer community and help them.

have the opportunity to bring on incredibly special doctors that I'm fortunate enough to have access to because I live in Los Angeles. I go to Cedars-Sinai, so I have access to the best. And currently I have really good insurance that allows me to afford them. And today I have on the exceptional brain surgeon, Dr. Raichu, who is

I adore and thank you for taking time out of, I know, what is a very, very, very busy schedule for you to drive all the way to Malibu and hang out with me. And you brought me treats. True. Thanks so much for having me. It's a pleasure to be here. Yeah. So can you tell us, you know, your title, exactly what you do, just fill everybody in. Right.

So I'm one of the brain tumor surgeons at Cedars. We have neurosurgeons have different subspecialties. I don't really do like a lot of spine surgery or something. Some, but do mostly brain tumor work. There are times in our department we'll have like a chair who runs the department and then a clinical chief. One's supposed to be like a quality officer and things. So that's the kind of thing that I do right now besides the brain tumor work.

I've been at Cedars for 19 years. I hope I've learned something by now. I think you have. I'm pretty sure you have. I mean, you did go into my brain, so I hope you learned a lot. Yes, that's true. And so what got you started in this particular field? And can you explain a little bit more in depth of, is it just oncology surgery that you do? Is it more broad than that? Mm-hmm.

became a neurosurgeon because I lost a bet. My

I looked at you like, did you just say that? And you did. It's the delivery, yeah. My father was a doctor. And so I kind of grew up in that house knowing that kind of stuff. You would go on a lot of calls at night to help people and stuff. It just became something that I became interested in. And then you would, you know, as a kid, go into his pockets at the end of the day. And I would find, he was a gastroenterologist, you know. Yes. Like bowel stuff. And I would find a picture of someone's colon. It was kind of interesting and stuff like that. And so when I was growing up, it just...

did a lot of stuff for science and just, it was kind of a natural pathway. I didn't really decide to be a neurosurgeon until a lot later, but going to medical school seems something that was very natural for how I grew up. Like, I can't really imagine going through my dad's pockets and seeing photos of colons and stuff and thinking, well, this is cool. This is what I need to get into. And yet you did. What was it about it? I

I guess it was just something that was both familiar and then just something I gradually found interesting. I mean, I liked science kind of stuff.

And then who doesn't find the brain fascinating? So I felt like when I was looking at that stuff, there's a ton with cardiothoracic surgery that was starting to be replaced, that people were doing more and more things endovascularly from inside the blood vessels, like stents in the coronary arteries. Now they can even replace a valve for some people from inside that surgeons were going to become more and more obsolete.

Whereas there's still a lot of role for brain tumor surgeons. We haven't really fixed everything yet. I don't know what's going to happen in my lifetime, but we haven't really fixed everything yet that, that surgery is still required. I'm so fascinated by the conversation of like AI and what that, what that role is particularly in surgery. Is there a role for AI in, in surgery? Probably some. I mean, I think there's some part where the, the,

The easier target is probably like AI and its interaction with neuroradiology, like making sure we find all the abnormalities on the scan and even having AI screen some of the scans and trigger that to be read by a person as opposed to put out answers more quickly when a scan is normal. For surgery, it's a little harder. I mean, there are robotic surgery platforms available.

for other specialties that sometimes they'll use that for a thoracic surgery or an abdominal surgery, but there isn't a tremendous role for robotic surgery yet in neurosurgery. I mean, I have to be the robot. So some of these things have, you know, sub-millimeter accuracy and a brain that's moving and pulsing as we operate. It's not really clear that AI can pull all those things off yet. I don't think I would want a robot robot.

cutting open my brain and working on it. That would scare me because it's the human that I'm putting my trust in and the human that's feeling the compassion or the stress or the pressure or whatever it is to ensure that you have the best result possible. Whereas a robot isn't

They aren't programmed for that. For me, I believe that a human is always going to go the extra mile to ensure that their patient has a favorable outcome. I think that makes a lot of sense. Probably a lot of people would feel that way, right? That they want that person there. And there are some of these robotic surgeries like thoracic. The surgeon is in the room, but they're not really right at the patient. They're far away at a control console. And I don't know. It just doesn't feel the same to me. Maybe I'm just...

Too old-fashioned, maybe. I'm not used to it yet. Well, then I'm old-fashioned right there with you. And you have, obviously, incredibly steady hands. Do you do something to protect them at all costs? Because those hands are worth a lot of money.

Well, I don't do anything super risky with them. I snowboard some, and I used to wear a wrist brace more, but I think I don't try to do any wild things anymore, so I don't really put them at risk too much. So you're not doing any double flips anymore? No, no. Not taking the high ramp? I'm not sure I ever did double flips on purpose. On purpose? Right, they're the mistake. Oops, oops, oops. So I think how we met was very interesting because...

I fell down, as you know, like a day or two days before Christmas. And Dr. Pirro said, you should go in for a CT. I did. It showed some things in my brain. He was concerned. He then said, you're going, we need an MRI. I did the MRI. And then it was kind of an instant, okay, here's what's going on. You have METs. And there's one that we feel we can do.

operate on and the others will radiate. And we want to operate mainly to get the pathology, correct? Yes. And he had you already picked out. He's worked with you before and he was like, this is the best and you're going to him. And we set up, I remember your office was like, do you want to come in?

It's like, no. Again, is there a Zoom? Is that possible? And I'm so now used to Zoom from COVID. And so we Zoomed. And what was it? Like four or five days later, I was getting operated on? Right. Yeah. Well, fortunately, we managed to get it set up kind of quickly. And you're right. When Dr. Piro calls, I answer quickly. Yeah. And we've known each other for a while. Yeah.

It is, yeah, different in this world where there's more and more of these, you know, video possible visits and things like that. Certainly with the pandemic, there's multiple people that I've, you know, met over video and then at surgery shook their hand finally and said, it's nice to meet you. It's kind of strange. Yeah. I had friends that said, what do you mean you haven't actually met him in person? Don't you want to shake his hand in person before you say yes? Yeah.

And don't you want to make sure that he's a kind, compassionate person? And my response was no. All I care about is this. Like, are his hands steady? Is he the best? Is he going to, you know, take really good care of me in a surgical way? But then when I met you, you were very kind and very compassionate. And even though I had psyched myself into believing that

that I was not going to come out okay. I really did not think that I would be fine. I was pretty sure that I was going to die. That really short time period, I had to go over everything with my estate planner and my attorneys and make sure that my will was in place and that my trust was secure and who got what. I mean, it was a frantic time going also through a separation. It was pretty nuts. And

And, and that's how paranoid I was of, of dying. And then if I didn't die, I would be paralyzed. And you were, I think you told me the worst that would happen was maybe I would lose mobility of my right foot, but that physical therapy would most likely fix it. And then I asked you,

to please while you're in there dissecting Bob, the tumor that we took out, that you took out. I asked you if you could please touch the part of the brain that allowed me to instantly speak six languages fluently. And I got to tell you, you didn't do it. Yeah. I'm not, I'm not happy with you over that. Yeah. That is one of my failures. Definitely. Is that like a real thing? Because obviously it's something that I saw in Grey's Anatomy. Yeah.

where I think it was Amelia, who was also a brain surgeon, had to get a very large tumor removed and she woke up

speaking perfect German. And so that's where I got the idea from. And it's not that she had spoken German before? I think she had spoken German before, yes. But I just assumed it didn't matter. Well, sometimes that, unfortunately, neurosurgeons can do in a way. So it's hard to give someone a new language. It's hard to plug you into the matrix and really get something new.

That's disappointing. Yeah, sure. But once in a while, people who grow up speaking a certain language, it's so rooted in their brain as their primary language that if they have some other language affecting things, other languages they learned can turn down for a little bit.

So I've had a patient who grew up speaking French and English. And, you know, most of us are wired for our left side of the brain to have most of language and memory, even totally left-handed people. Still more than half of them have language on the left-hand side. It's just something how the brain is wired.

But this patient had a brain tumor on the right, and he had more like French language sites on the left side and more English language sites on the right side. So when they first did his surgery, that's kind of what happened. He wasn't speaking English. He was only speaking French. And his wife was confused as to what was going on. He never speaks French to me. But that language kind of turned down for a little bit as the body had to heal. Did he retain it?

You just had to tap back into some of these things to kind of reawaken these centers. So sometimes when we do these surgeries that have more of a motor impact, that's what we talk about, like physical therapy to retrain the area of the brain and the connections to get stronger. We try not to take away anything permanently, obviously. But sometimes if you're, it kind of depends on our risk benefit ratio. If we have a tumor that looks like a malignancy and we have to carve it out, we have to take some risks sometimes to take it out. Well, yeah.

Next time. Next time. We don't want any next times. I know. We don't. We don't. I do remember that when I woke up, you were standing over me. And I believe the very first question I asked you was, what's wrong with me? And you said nothing. And I couldn't believe it. And then...

I think a little later, you know, I struggled with my right hand of like holding a glass. A good majority of that was because of the steroids. Steroids make me crazy. I do not do well on steroids at all. So remember, I kept on trying to

Take myself off the steroids. Like quickly. And I guess the brain would swell and then the right hand would get worse. And now everything is obviously great. Terrific. Yeah. It's good to know. You did a good job. Once in a while. That day. So I remember also, didn't you ask me what kind of music I wanted? And I said, I'm going to be asleep. Like whatever music makes you...

you know, do the best job. What did you, do you remember what you listened to? Cause I know I'm one of a lot of people, so I don't expect you to know this answer, but I'm just curious. A couple. Well, I mean, so usually we ask a little bit something, what you might like to listen to that helps calm you as the anesthetic kicks in. Once you're totally asleep, we can,

Play whatever rave music we want or something. Is it? So, I mean, what is your go-to? Do you like rock and roll? Do you like classical? Sometimes it's like an old school hip hop playlist, like has a lot of Snoop Dogg or something like that. Just something to keep people moving. I mean, I think there's like different philosophies. I know some surgeons who like total silence in their operating room and they

don't want music and they, they want the anesthesiologist to listen to every single little thing they have to say and stuff like that. And that's fine for me. I feel like, you know, obviously the music's not blaring, but I can concentrate and it helps the other people in the room if it's not total silence, you know? Right. It keeps the energy up. Yeah. I think that's what it is. An energy and a movement level, I think works better for me.

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You gave me a photo because I asked you and you gave me a photo of my brain. Can you, what was that surgery like for you? What was that particular surgery that you did on me? What were the reasons why we did it besides the pathology, all of that? And then,

you know i can explain why i named him bob oh good i get to hear this finally i've been waiting so uh fortunately with your brain number there's only a few spots and some of them were tiny so some of them were ones that were really ideal for this idea of focused radiation sometimes we'll say radio surgery it's almost a gimmicky term though like focus radiation as if to replace surgery but

If we have a dot that's a millimeter or two, sometimes we can't really find that at surgery. So the radiation can target that based on the MRI. You had one spot that was a little bigger, and there's both this idea of it's a little bigger, we can eradicate it better with surgery.

And the worry is that sometimes when you stir up a metastasis, you kind of leave little cells somewhere or can even, if you're not careful about it, spread tumor around. So we usually would do at least some form of radiation afterwards, but we and a couple other centers have been tinkering with the idea of the radiation up front. So you kind of like almost like sterilize the tumor beforehand so that even if a cell escapes, it's been radiated and hopefully it won't set up root again.

That can give Dr. Piro tremendous oncologists a tremendous advantage to have a sample of the current disease.

So if we take something out and we analyze receptors, we get to know a lot more. Right. And that's one of the things that probably I hope has helped you and may help you more is that idea of like finding what the molecular signature is allowing targeted therapies and exactly your scenario, not all guesswork. I mean, there's always a little bit of tinkering with the regimen, but not all guesswork. Some like logical things like this is a very patient directed, patient oriented therapy.

treatment strategy. Yes. So when you saw Bob, I named him Bob because I'm, I don't know, I don't really view Bob's as very scary. Bob's are usually really nice and affable. So I didn't want Bob to be scary, but you had to leave. You couldn't get all of Bob out. Do you

Do you remember why that was? There were a couple of cells towards the motor area. So for your scenario is a little complicated because it wasn't, you know, totally on the surface of the brain. So we had to kind of get to the area. These are sort of the questions I didn't ask until now. So I'm learning along with our listeners. I'm actually learning about my own surgery because I do remember you just said motor skills. And I remember looking at you also and saying, stop if you're going to,

if it's going to change me as me, as the way that my brain works, the way that I process speaking, mobility, all of that. So, and obviously you were going to, whether I said something to you or not. So it was not, because I always pictured Bob right at like the top of my head right here, just sitting on top of my brain, but that's not the case. Yeah, that's where the incision is. I have a prop. Do you mind if I? Yeah. So this is a...

A little model that I have. Sometimes you'll have a tumor that's really on the surface that all we have to do is really carve it out from here. And that's what I thought mine was. Right. Not quite. So yours was in between the two halves of the brain. So we had to crawl around here. The safest route is to crawl around here and not touch or take out any of this stuff and take it out from the inside there. So did you go horizontal and then just still kind of pry this open a little bit to try to get to Bob?

Well, sometimes we do different things for the scalp and for the skull inside. So it can be very cosmetic to do a horizontal or coronal incision like this because things get all covered up. And then underneath, we do what we need to do. So we fashioned a craniotomy. That's where you make a window in the skull. We can put the skull back on with little titanium bars that don't set off metal detectors. It's not like we use a big metal plate or anything. So you have your own skull back on.

But we can create a window in the skull where we need to work and it doesn't have to match the incision.

And that's what you did to me. Right. It feels good up there, right? It feels normal. Yeah, no, it feels normal. Sometimes when you go for the MRI, they take the wand. Sure. And right here, it beeps a little bit. Does it attach? It does attach. I'm like, well, I have brain surgery. So you weren't able to get him completely out because he was a little deeper in and wrapped around where the mobility would be. Can you explain that a little bit more? Sure. So our brains have different areas that have...

power and neurons that function a certain way. So the brain is largely mapped out. We know a lot where our primary language center is. We know where our primary understanding is. There's this part of the brain that has a lot of motor function and it's kind of mapped out that our face area is more this way, our hand area is more this way, and our leg area is more this way.

And so there was a tiny layer, you know, we took out just about everything, but there's a tiny layer right on that motor area for the leg. And there's starting to look like if we work too hard, we might have,

A lot of leg or foot weakness. And sometimes we have to decide exactly how much we want to tolerate, especially since that site had been radiated already and things like that. So I think that kind of allowed this idea of can we do the maximal safe resection? So obviously in order to get the rest of him, I guess we radiated Bob and all the other meds again after surgery.

just to make sure that Bob was dead. Yeah. I don't think Bob needed another dose, but you're right, the other dots. The other dots did. I'm so glad I did not. I mean, I was scared enough, but knowing to that extent, which is interesting because I'm sure that you have patients who want to know every little detail. How is that for you as a doctor to explain? Do you find that it makes them more nervous?

Well, I think you're right. I think some people want all the details. And my presumption is that if they're asking lots of these detailed questions, they're the type of person that feels reassured by it. Right. I think you're right. Sometimes I kind of have to do a lot of feeling out and not say too much. And once in a while, I've had people where I talk a little bit about what we have to do. They say, stop, that's enough. I don't want to know everything you do. I just want to know what I'm going to feel. But the part when I'm asleep, I don't want to know everything that happens. Everyone's different.

And for you, how many operations would you say you do in one week? It depends. I mean, it could be as many as seven or eight. And then there are weeks that I have more administrative or teaching duties, and it's less than that, yeah. And with those seven or eight, how many are very high risk? Maybe 60%, 70%? And what percentage was I of high risk? Mm-hmm.

You were pretty high risk. I mean, there are people where we have a tumor near a language center that we have to wake them up in the middle of surgery to test language. Oh, I've seen that on Grey's Anatomy also. Sure. There's a lot of stuff in there. Some of those stories, some of those things are part real. It's true. Fortunately, we didn't have to do that for you. But sometimes that obviously is a little bit element of risk. And then there are probably things that some of my colleagues perform more like

like a craniotomy for a ruptured aneurysm, that's higher risk of, of, you know, big blood loss and stuff. I mean, there's kind of sometimes the difference between like the brain risk and then the risk to the overall medical risk to the patient. So,

I mean, I had some risk, but fortunately it wasn't the highest risk thing. And then some of the things they do are kind of straightforward or more straightforward. If it's some tiny little benign tumor on the surface of the brain, like a meningioma, or sometimes if people have a certain need for chemotherapy and their cerebral spinal floor, there's a port that I can put in. That's a pretty simple surgery. So sometimes some of those seven or eight are not that hard.

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Hi everybody, it's Savannah got 3 from the today show as we head back to work back to school back to everything we want to help you turn your to do list into your today last your morning routine healthy meals and workout plans we've got you covered so you can take it all on with simple solutions to help you through the day everything you need to know before heading out the door so join us every morning on NBC because every day needs today.

Now.

Do you do anything before a surgery to get ready? Do you meditate? Do you go back over the file and all the x-rays? What is your routine before a surgery? Well, I don't come in from the bar.

I should. Could you imagine if like your doctor reeked of vodka? There are stories about people, but you know. Not at Cedars. No. So yeah, I probably should meditate more and I probably should practice a little more mindfulness. I do feel like I achieve that more by reviewing everything and making sure I know all the ins and outs before I walk into that room. That to me is more reassuring, I think.

When you're operating, and I don't want this to sound self-important in any way, but I am curious that when you operate on someone like me, or I'm sure some people that you've operated on that are well-known, is there an extra layer of pressure? I know that you care about everybody's life, but if you slip and do something, what's

it's going to come out that you were my surgeon. Is there any kind of a, or do you just really, it's not about who the person is in the sense of a name. It's about the fact that you have a human there and it's your responsibility. And I know that that's how you feel, but I'm just curious about any added pressure. Well, I mean, there's sometimes some pressure. We just try not to think about it too much.

And you're right. I'm thinking about, you know, you and your career when you're in that room, or I'm thinking about some CEO and that person's career in that room, or I'm thinking about someone as a mom and has kids and kind of have to both think about that a little in the background, but try not to make it like overwhelm me. Right. I'm there for a job that I've done many times before, and I just have to put on my game face and get that job done well. Yeah.

Make sure everybody's fine no matter what the deal is. God, you're so confident. Maybe over, maybe overconfident. No, I don't think so. It's like the perfect, you're really honestly the perfect balance. And I can tell you if ever I need brain surgery again, it's always going to be you. Let's hope I don't need it. Right. That's our other job is to do so much surveillance we keep you out of the operating room. Right. It's a little more fun for me than it is for you. Probably, yes, obviously. But as we know...

protocols stop working. It's not anything wrong with the medicine. It's that cancer changes. It's why I think there's not a cure yet because it's a living thing that's constantly changing and evolving. And I can't really even remember the particulars of my cancer, but I know that

Whatever I was prior to the surgery, we discovered that I had turned positive in one area that then allowed me to go on to a totally different protocol that I wasn't eligible for prior. Right. Which really tells you how important getting a sample of that tumor and doing that pathology and really dissecting it can be incredibly helpful because all of a sudden you have a brand new protocol that's open to you.

But at the end of the day, eventually a protocol will stop working. I don't really know of anyone who's been on the same protocol at stage four for 20 plus years. They eventually all wear off. So at some point for somebody like me who has a tendency to develop METs, there might be some point where I have to see you again because the radiation may not be able to handle it.

Right. There's a chance. I hope we can stay with that off for a long time, but there's a chance. Me too. Part of it is a lot of these frequent MRIs, like you've been being able to put up with and do your counting and stuff that hopefully we can find little spots and pick them off before they need surgery. But,

But you're right. There's always some consideration for additional surgery. And I agree with you. I mean, cancer has a reputation. It has for a reason because it evolves and it takes a therapy and just, it takes one pocket of cells that doesn't respond well to that theory to start to grow. And suddenly you need something different. It is, again,

that part of current cancer care to really be both personalized, but also to update what we're looking at every now and then. Sometimes we need another sample of something from somewhere because if the molecular signal changes a little bit like it did for you, and now you qualify for a targeted therapy, we didn't think you qualified before. We've just changed everything. We just disrupted everything. Right. It's great that you had that. And then obviously there's the incredible clinical trials that are happening everywhere.

Do you see for stage four patients that it spreads more to organs or more to brains and

Everything's a little different. I mean, melanoma tends to have some predilection for the brain. We think part of that is because our skin actually has a common origin of site as our neural tissue. And so we think that's part of the reason why. There's some cancers that go to the brain less frequently, like colon cancer or endometrial cancer. Although as people are starting to survive better and better for their primary tumors, we're starting to see more of those metastases than we used to see.

When I started at Cedars at 19 years ago, that was very uncommon. But we're starting to see more of those things because people survive longer from their primary cancer. Right.

I mean, cancer is just a whole other beast to me. I didn't really have a lot of experience with cancer, not a lot of friends that had cancer. And I was certainly, I thought, incredibly healthy up until 2015 when I got diagnosed with cancer. To know where the breast cancer spreads, sometimes people do have it spread to the brain much faster than the organs. I had a good friend that it spread to her organs really quickly where

where everything just started shutting down and she shut down. She just didn't want to keep going through it. So when you go home, because you have people's lives in your hands, does it impact the way that you view life? From everything I've heard, you're a wonderful father, a wonderful husband. Does it make you appreciate life more? Do you look at things as being much more precious or

Or do you have to sometimes leave some of that behind in the hospital and try to be as normal as possible? Yeah, I think it ends up being some mixed moments, I think. I think some of it is, you know, when you see someone who had a particularly, you know, hard time, then you want to go home and just hug your kids for a little bit and hug your wife for a little bit.

But you're right, I don't want to totally expose the kids to every little thing on my mind because I see some troublesome things and I want them to be kids. They hear stuff. Sometimes, you know, I'm on the phone with somebody and they're like screaming in the background and stuff like that. But I try not to expose them to everything and just

But I think that's part of the thing, maybe a little how I grew up too, is like they're curious. I have something like this at home. Like what is that and what picture do I have with me and things like that. It gets a little tricky. I can't totally keep them out of the loop, but I try not to expose them to everything. Are they fascinated by your job though? Sometimes. Right now what we usually say is like dad takes out lumps out of someone's head to make it like a little simple and sound a little more innocent. Yeah.

Do you hope, because I know a lot of parents who are doctors or attorneys, they want their children to follow in their footsteps. Do you feel that way at all? No, I mean, I think. Because you followed in your dad's footsteps. I did. I also felt like my parents expected it of me. But I feel like going into medicine in the first place is a little bit of a hard pathway unless someone really, really loves it.

And going into neurosurgery even more so. So when I meet students, sometimes I'll ask them if that's basically the only thing on the planet that'll keep them happy as a job. And if there's something else, you probably should think about it because it's just a hard pathway and a hard life. You know, me answering phone calls at Mammoth and stuff like that. It's just one of those things. And where did you, did you grow up here in Los Angeles? Yeah.

I grew up in Newport Beach. That's where Dr. Merhide grew up, too. We went to rival high schools. Oh, that's funny. It's entertaining. May I ask what school you went to? All things that people normally ask before they get brain surgery. And I didn't ask you anything, I think. Yeah, I think once you knew Piro's recommendation, you were fine.

Yeah, I just also, thank God it was so quick, so quick of a turnaround. Because I think if I had had time to ruminate on it longer, I would have had a lot more questions. But, you know, going through a separation when you're right about to go into brain surgery, my thoughts were on that. They weren't even on that.

Anything else? So now I'm asking you all the questions that normally people ask their brain surgeon. Sometimes they do before. Right. I went to a little school up north called Stanford, and then I went to UC San Diego for medical school. God, I can't believe it. Stanford. Somewhere. Just a little school. Right. Just Stanford. No big deal. Beforehand, those weren't the questions, huh? No, it was...

I think it was looking in your eyes via Zoom, you showed zero fear. And a lot of people like doctors to be very huggy, like my mom, right? She had an aneurysm and then she just had a new aneurysm. And one of your colleagues, Dr. Gonzalez, did her last one. And

He's perfect for her. And he's a wonderful, amazing doctor also at Cedars. She has a lot of questions and she really needs somebody like the doctor to literally hold her hand. And she likes them to be very warm and affectionate. Not that you aren't warm, but I prefer my doctors to be much more analytical and

not distant, but I have a weird thing about crossing over. Even though Piro and I are very good friends, when we go to dinner, we don't talk cancer. We don't talk medicine. And when I am in this clinic as a patient,

it, there's no hugging. There's no, there's none of that because now, now you're my doctor and I'm a patient and I just want you to give it to me straight. And I don't want any emotion whatsoever because if somebody else has emotion, I'm going to get emotional and I don't like doing that in front of people. It's just, I don't get any of my test results in person anymore. I, I like everything over the phone so that I don't have to check myself and monitor my, my reaction and,

to the news, I will put on a smiley face when somebody tells me your cancer has spread just to make sure that the nurse standing next to my doctor doesn't feel bad for me. Because I don't like the pity. I don't like the sad look. I don't like any of that. And also, I don't want to get wrapped up into those emotions. For me, it's

It's very hard. And lately I've had a lot more of those emotions, which has thrown me off because I'm going to go to an interesting that you said about that I'm getting my MRIs always on time because you called me and you had a conversation with me and you said you need to go get your MRIs more often. And I pushed back and was like, no, I think

I think that this is okay. And for most people, and I think even for myself, I should listen. And I, and I did, I started ramping it up a lot more. I have a weird ability to know when a protocol has stopped working. There's just something there's, there's a twitch that happens. There's a feeling in my bones. There's, I just get, I get a little off and I instantly know, okay, the protocol is no longer working. And I,

a couple of days later, I'll go for the MRI and the PET. And sure enough, it'll be a super tiny spot. I think now, because I've started considering that a lot more and I go more often and get the MRIs, my mentality is slowly changing. So before where I wanted my doctors to just be very concise and straightforward with me and finding that

I'm getting more scared and more aware of what's going on in my body. I'm wanting more conversations with my doctors. I'm wanting my test a lot more often because maybe it's the reality. Maybe I was able to push reality off a little bit and say, okay,

If anybody can beat it, it's me and it's fine. And I'm just going to keep on these protocols. And eventually they'll have another one and another one and another one. But when you start going through protocols a little bit faster because your cancer is getting more aggressive or whatever the reason, you definitely just start checking in more and getting more fearful. It's a really...

So now, now if I had brain surgery with you, well, now I don't need to ask you because I've asked you everything, but I would, I would be a lot more, I think, attentive at this point in time in my life. Do you find it easier to deal with the people that are more like me or the ones who ask a lot of questions?

I think in the middle somewhere. I mean, I think sometimes people hang on to too many questions and sometimes like unimportant questions. So I don't know, there's someone coming up with a surgery with a benign tumor that's asking exactly how long she's going to be off from work and like, you know, can I do this like eight weeks from surgery? I don't know those things, right? We have to get you through the process to know those things and see how you recover and stuff like that. It can get tough when we're focusing on

you know, steps like very, very far away. I know that sometimes that's the people's like kind of control or almost like a soothing mechanism. But sometimes all we can do is get to that one next step and then see where it goes from there. Well, yeah. I mean, people want to, people want to feel like they're going to be normal very quickly, but you just, you never know what can happen. And by the way, just as a side note, I do do my MRIs on schedule, but sometimes if I feel like,

Sometimes if I feel something off, I will go before I'm supposed to go in because I want to catch it as quickly as humanly possible. So like I'm scheduling for another one quickly. So just because I'm like, well, why not? Now I understand. But again, it's that reality is sort of sinking in a little bit more where you go,

God, why do I want to wait until something gets bigger? Why not make radiation a little bit easier, smaller, like get in there, get it handled quicker, change your protocol quicker, or sign up for a clinical trial and have a chance of actually getting into a clinical trial quicker.

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There are questions for you, sir. Oh, my. After brain surgery, how quickly can you tell if someone is going to have lasting problems like loss of mobility or memory or et cetera? You should know something basically instantly. As we wake you up from surgery, you start to know what's going on.

By that first night, you know, first 24 hours, if you're doing well and you're speaking well, moving well, usually that means that everything's going to be fine. So the dangerous things happen early. For you mentally to know that you're waking up and you're going to a very difficult surgery, but you still have to, you know, put on a happier face perhaps for your children or if you lose a patient during surgery and you still, how do you handle that?

that? Well, I don't know if I have perfect answers for that, but I think that some things compartmentalize themselves a little bit. Like the times that I have a surgery first thing in morning, I have to check in so early. It's not like I can take the kids to school or something anyway. So the times I do are naturally a day like today, we're not clearly not operating right now. And I could take the kids to school and kind of be more the regular person for a little bit.

You're right. When there are things that happen at surgery, it's particularly tough. I also think there's a part where some amount of that decompression at work before I go home, first of all, might help keep me out of a car accident or something.

And second, just try not to bring it all into the house, like to be at work and reflective and, you know, what happened today? What can we do better next time? And try to make those processes happen, you know, right afterwards and early so that it doesn't try to roll over and everything. I mean, it rolls over a little, but try to limit the effect of it. When a patient is sent to you, do you get them at stage one or does that usually mean that they're...

further advanced. Right. So most people are sent to me when they know they have a brain metastasis, right? So none of those people are going to be stage one, but we also treat primary brain tumors called gliomas. They're more less common than metastases, but sometimes people might have a lower grade or a higher grade glioma. And that's a tumor that started in the brain itself. There are a lot of patients who don't have benign brain tumors if they have a glioma as an adult.

That's more common in children. But also there's a common tumor not of the brain itself, but the coverings of the brain, the meninges and meningiomas are fairly common tumors and are usually benign. So there's kind of this variety of depending on what the pathology is. And the most important question that I can think to ask you is,

When you made that incision, you looked at my brain. Did it just wow you? It was amazing. It was amazing. In fact, do you remember one of the times you made fun of me? No. That I gave you a picture of your brain. Yes, do you have it? And it was only printed on a regular paper. And you said, this is not up to snuff. It was a copy. So then I had to do the photo, the real photo. Oh, my. I cannot believe you brought me this.

Oh, you know, you're going to have to explain all of this that's happening. That's wild. What is this? Did you like leave a cotton swab or something in my brain? No, no, no, no. I didn't leave something. So sometimes we'll use these cotton paddies to try and protect various areas of the brain. This one is really like they open the dura, the coverings of the brain, and this is to keep it hydrated. But this is so like if there's a big vein here, we don't accidentally touch it or interfere. And then we take that stuff out afterwards.

You don't have any extra surprises in there. Have you ever left something in a brain? No. And you'll never admit it. I didn't ask that question. But, you know, obviously that's part of what we have to be cautious about. And that's why, too, people in the operating room that help us, like, help count these little cotinoids and make sure we know and we have everything that we started with and all that jazz. I only asked that question because, once again, I saw it on Grey's Anatomy. On Grey's. And they were doing the counting, and they came up short. Yes. You know, you're actually one of those people who hasn't really –

for much. We have patients, you know, call with billions of questions or ask for like several refills of pain medicine. You're not that type of person who's really asked for a whole lot of things. No, I got off the pain meds immediately pretty much. And I, you know, unfortunately kept on trying to take myself off the steroids and you kept telling me to go back on like brain swelling is a real thing after brain surgery. But yeah, I'm not a big pain pill person.

person. It's, I don't, I don't like to feel out of control, which is also some of the fear of being put under. I'm one of those that I'm a control freak. I like to know everything that's happening in the moment. And I kind of feel that with pain pills, it dulls. It just dulls my ability to be quick and process quickly.

And I don't like that at all. Has cancer ever touched you personally with a family member, a loved one, a friend? Actually, yes. I mean, my father died from glioblastoma, a malignant brain tumor. You would think that would be my interesting story, how I got into it. But it was when I was already a neurosurgeon.

But then it was this thing that was odd. It was kind of like I didn't realize I'd been working, you know, more than a decade in neurosurgery to rally all these troops around me and try to help my dad. But, you know, he was 84, so it's like a lot tougher for a lot of treatments when you're that age. But you didn't do that. No. No. I had one of my buddies do it. Right. That'd be too much. And even if it weren't too much for me, I mean, that's considered a conflict, it's

Right. What pressure on your buddy? Yeah, a lot of pressure on my buddies. It's true. I mean, if I had a buddy or a family member or somebody that, well, you can't because of the conflict of interest, but somebody that I would definitely want someone closer to me operating on, like my mother, for instance, but at the same time, wow, what pressure. Yeah, it's definitely some pressure on them. It's true.

Have you ever canceled a scheduled surgery because you didn't feel physically or emotionally at your best? Hmm. I can't say that I've done that per se. The closest I came to that actually was, and a patient still remembers that they needed what's called a ventriculoperitoneal shunt or a VP shunt. I did postpone one because my wife was in labor.

And so forever, they always remember when the twins were born because my wife was in labor. I brought her in and then, you know, things calmed down. I did the surgery, I think, a day later or something. But they remember that. That's a pretty good reason to postpone. So you never postponed for, like, you never just woke up and said, I'm not feeling this today. I think not as simple as that. You know, I think...

Just have to, if even I have a little ache or something, I have to find a way to do the job. That's what's funny. Someone was just saying something about calling out sick. And then, you know, sometimes it feels like as a neurosurgeon, I can't call in sick. I can call in dismembered. But whoever's there is sicker than I am. So I need to, you know...

Get it going, I think. You know, I've had a virus or something, and if it's super bad and it happens to hit on a day of surgery, I guess I would have to do something. But I think fortunately, you know, I don't operate every single day of the week, so sometimes it hits on a day when I'm not that busy or something. Is there anything that you would say to people like me that are looking at having brain meds or a tumor surgery?

Going in a surgery that would possibly help them the questions that they should ask I have the utmost respect for doctors because the education the how hard they work and

Their work ethic is absolutely insane to me. So I have nothing but respect for all doctors. But that doesn't mean that I think every doctor that you meet is the right doctor for you. And I do believe in getting a second, third opinion. Well, I think you're right. It's always reasonable to have a second opinion. It can't really hurt. I think that it's different if you're

Kansas City, there's kind of only one place to go for something like brain tumors. But in a lot of these cities, there are multiple places. Sometimes I make the comment that in New York, people tend to stick in their borough and they won't really go to these other hospitals per se. But in Los Angeles, one of the tricky things is you can, if you're tricky about it, you can schedule three in-person visits at academic centers in the same day if you schedule it right. It's just tricky. And maybe too many opinions is bad. I mean, it's hard to get six people to agree on anything.

So when I've had people see six surgeons, yeah, the plan's not going to be the same from all of them. But a second opinion is pretty reasonable. I think that sometimes people will...

ask questions about their surgery and things, but it's fair to ask, you know, how many times have you done this before? How regularly do you perform this surgery? Right. There is someone out in the Valley that says they do complex brain, complex spine, complex vascular surgery, all of those things that one person and they're not attached to a big hospital. But I think that some people that's suspicious and some people, they don't really pick up on that. Right. Like at our academic medical center, those are three different people.

Yeah. Nobody can do all that, but I don't think everyone picks up on this stuff. That would, that would be a red flag for me. Yeah. Well, you're smart about this stuff. I know that, you know, you follow up with me and,

And you will call me and you will text me and say, you know, hey, you know, this was the result in your MRI and I think we need to do this and this and this. And, you know, you're definitely not shy about putting your opinion out there. But do you, which I deeply appreciate, by the way, I want to say thank you. You're welcome. Do you have a lot of hope for the future of cancer treatment? Mm-hmm. Mm-hmm.

I do. I mean, I think that a lot of our different techniques are getting better over time. I mean, surgeries are getting a little bit less invasive, a little bit less risk. We're kind of balancing better who we take to surgery and what we do. I think there's a lot of an older philosophy in medicine of the MRI has to look perfect.

But once in a while, if the MRI looks perfect and the patient's doing a lot worse, are we really accomplishing the right task now that we have more and more treatments for whatever kind of pocket of cells we have?

And clearly the whole idea of chemotherapy, targeted therapy, immunotherapy is all changing dramatically. We have agents coming up, you know, faster and faster and things that didn't exist before. So I think there's a lot of hope. I mean, it's hard to really search for that elusive cure because the cure implies also like one treatment fits all and all these cancers are a little different and all these molecular signatures are a little different, but there are more and people, more and more people going into a long-term remission of

The difference with the word remission being disease is quiet, but we're still watching. We shouldn't be so arrogant to say, you're fine, you can go live your life. But, you know, we hope to get more and more people to the point where they can come off therapies and just be watched. Yeah, it's, you know, it's very interesting. I have so many people that have been recently where everybody tells me that,

oh, there's this place and they're curing. And then they're curing cancer and they don't take insurance, but it's amazing. And then when you start delving into, some of them are just scams. And the others are, their results are favorable for a completely different cancer. And you're like, well, okay, I get that maybe they helped this person with

cancer, but my cancer is different. So that three phase targeted therapy that this person has all of a sudden come up with may not actually do a thing on me or, you know, like immunotherapy doesn't work on my particular cancer as of right now because of the negative positive side

All of that stuff that I'm still not ever clear on. It's tricky. It is. It's really tricky. People always ask me which kind I have. And I'm like, I don't know. I'll put you on the phone with my doctor. He'll explain it better than me. All right. Well, are you going? Do you have to go to the hospital now? I should go to the hospital. Some patients to see later. Yeah. You do? Yeah. Well, thank you. I honestly am really happy that

I met you and that based off of that Zoom meeting, you filled me with as much confidence as I was ever going to have going into that surgery and that you didn't overcomplicate it for me because it's way more fun finding everything out now. It's way more fun. Dr. Chu, thank you so much for being here. Thank you very much. Great to be here. All right, guys. That is the wonderful, amazing Dr. Ray Chu at Cedars-Sinai.

I don't know. If you've got anything going on with the brain, please go to Dr. Chu. If you can, get into him. He's wonderful. If not, I'm sure they have amazing recommendations. And I hope that we were able to either soothe or answer questions that anybody had. And always feel free to go in the Let's Be Clear website.

Instagram and send me questions because I have no fear about harassing this incredibly busy man with text messages to try to answer some questions. You don't mind that, do you? I don't mind at all. You don't do that enough. You don't play the brain tumor card. I actually made one, though. I'm not promising it's going to get you out of tickets, but... No. Oh, keep doing well. I'm here for you. This is unbelievable. I'm pulling this card. You should pull it. I should pull it. Do you know, I...

I'm very odd about telling people who are listening in when I pull a cancer card because some people are like, they get upset about it. But I do remember I was at this very busy, kind of when everything first started going on with me. And it's when things progressed and got into stage four. And I was trying to find a way to come to terms with it and...

to have a sense of humor. And as this wonderful woman, Jan, recently said to me, she said, you seem like you are holding hands with cancer. And it's an interesting way to go through your journey with it. And I guess I was holding hands with humor and cancer. And we went to this restaurant in Santa Monica called Wally's. And they were packed. But they have this

dish there with truffles and I just was craving it and we sat down and I think it took the waiter a really long time to come over they were packed so I was totally understanding but then he stopped by and he said and and they know who I am there because I've been there a bunch and um and it was all in the press about you know going to stage four and he said I'm so sorry we're so slammed but

I'm going to get right to you. And I said, it's okay. It's not like I, you know, I'm on a time schedule or anything with cancer. Oh man. And he stopped and he looked at me and I started laughing and I went, I'm so sorry. I didn't mean that. I'm just playing with you. And he goes, Oh my God, I'll take your order right now. And I'm like, no, no, no, no, no. I'd be mad if you took my order. Like I'm just trying to find the humor. I'm trying to figure out how to make it normal for me where I'm

Where I can make jokes. And maybe the jokes is, I know it's to help me and relax my anxiety about having cancer, but it's also to relax other people's anxiety who just read stuff randomly about me and then see me and they're like, you know, like this weekend I was at this amazing event. People were like, oh my God, you look so good. Now I know what I look like compared to what I used to look like, you know? So,

I know that a large group of people assume that once you start getting to my stage of cancer, that you really start deteriorating quite fast.

So my brand of humor and sometimes mentioning cancer is to also make them feel a little bit more comfortable with it so that people don't tiptoe around me. And once I start being self-deprecating about myself and about cancer, I feel as if that wall has been taken down and now everybody can just go on in a normal way. So instead of...

doing the cancer card. I actually prefer the brain. It's different. It is different and it's far better. I'm into this card. So thank you. Thank you. All right. I'm going to let you go to work. Thank you, Dr. Chu. And thank you everybody for tuning in to Let's Be Clear with Shannon Doherty. See you next time.

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