Leah's Story Part 1 #cancerinsider

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Welcome to episode 44 of the Cancer Pod. Today I'm talking with my friend and co-host of the Cancer Pod, Dr. Lea Sherman. Better known to our regular listeners as Lea. Dr. Sherman is a naturopathic physician who was board certified in naturopathic oncology. She was a clinician in an integrative cancer hospital when she herself was diagnosed with cancer.

Tina 0:19

Today she discusses the discovery and evolution of her diagnosis. So stick around and you'll find out how Leah became our cancer insider. I'm Dr Tina Kaczor and as Leah likes to say I'm the science-y one

Leah 0:31

and I'm Dr Leah Sherman and on the cancer inside

Tina 0:35

And we're two naturopathic doctors who practice integrative cancer care

Leah 0:39

But we're not your doctors

Tina 0:41

This is for education entertainment and informational purposes only

Leah 0:46

do not apply any of this information without first speaking to your doctor

Tina 0:50

The views and opinions expressed on this podcast by the hosts and their guests are solely their own

Leah 0:56

Welcome to the cancer pod

October... you know what that means

Leah 1:15

Hey, Tina

Tina 1:18

Leia

Leah 1:20

It's not technically October, but we're recording this to be released in October, and you know what that means?

Tina 1:26

It means it's Breast Cancer Awareness Month

Leah 1:31

Yep. And

Tina 1:34

and liver cancer awareness month.

Leah 1:35

That's right.

Tina 1:36

Yes. And I happen to know that you have in depth experience on both of those counts.

Leah 1:42

right. I was just gonna say something like that. Yeah. So, um, today's episode, it's all about me, hashtag Cancer Insider.

Tina 1:53

I was gonna, say hashtag get to know your podcaster.

Leah 1:55

There you go. Whatever. So whatever Oh, this is the cancer pod. Live and unscripted. Um, So in honor of breast cancer awareness month, and just a little bit of trivia, I mentioned this to you before. We're recording this today on September 26th, which is the eight year chemo anniversary. I started chemo on September 2014. So

Tina 2:22

All right.

Leah 2:23

there you go.

Tina 2:24

since then have not, I'm knocking on wood. You haven't had to do it again.

Leah 2:29

But I am sitting here waiting for results of an breast MRI that I got last week, and I'm kind of a little I'm a little nervous.

Tina 2:38

Scan anxious.

Leah 2:39

I'm a little anxious. Yeah. I'm anxious because I used to, well I still get my treatment in Arizona where I was initially diagnosed and treated where I also happened to work back in the day and I would get results like super, super fast.

Tina 2:54

Mm-hmm.

Leah 2:55

And I also had access to a portal. And now I got my MRI here by way of orders through my Arizona oncologist. Um, but I don't have a portal here cause I don't have a doctor here. And

Tina 3:07

so you have to wait until you get a phone call or a

Leah 3:10

I don't know, I don't know what's going on. I don't know, but I'm starting to get a little nervous. What was funny, and it's not really funny, it's just me being funny, is after the mri they're like, Oh, where were, Did you get your previous ones? Because, we need to get records so that we can compare. And I was like, Oh, at CTCA in Arizona. And he was like, Where? And I'm like, Cancer Treatment Centers of America in, you know, near Phoenix, Arizona. And he's like, Oh, what's that? I'm like, You've never heard of Cancer Treatment Centers of America I'm like, it's like the commercials, cuz people always said that to me. They're always like, Oh, you work at that place where the commercials are? And I'm like, I don't know. I don't watch regular tv. I've never seen the commercials. And so I pulled that on him and he is like, I don't know, I don't watch regular TV

Tina 3:54

Oh, wow. Sure.

Leah 3:55

but I thought everybody at least had heard of it, so I was wrong. But yes, so I don't know what's going on anyways, so I'm having a little scan anxiety, which I normally don't have because I usually get my results so fast. I mean, I get like a little bit nervous beforehand, but talk myself out of it anyways.

Tina 4:12

Yeah. Scanxiety is

Leah 4:14

Yeah, and I actually told a radiologist that that's what patients experience, and he was like, Oh, I'd never heard that. I'm like, Really? Because you're the cause of it.

Tina 4:25

Yeah, well, well, I dunno if they're personally the cause, but the delays in getting the results to the person,

Leah 4:32

yes.

Tina 4:32

those, whatever those little hurdles are,

Leah 4:35

I don't

Tina 4:35

it does seem like the radiologist, as soon as it gets put into the chart note, there should be like something that goes straight out, whether it's a text saying your result is in the portal, or there's a phone call right away.

Leah 4:45

but I don't only have a portal and I don't have a, because I don't have a primary care doctor here, so I have to wait for my oncologist to reach out.

Tina 4:53

your oncologist in Arizona ordered it.

Leah 4:54

Mm-hmm.

Tina 4:55

Wouldn't it be in the portal that you usually access when you're over there?

Leah 4:58

Ooh. I don't know. I'll check

Tina 5:01

Those interstate portals?

Leah 5:03

Well, I would think that, no, maybe. Who knows? Anyways, we're really getting off the subject except for the fact that the subject is me. So you are gonna interview me in this episode of the Cancer Pod

Tina 5:13

So here we are with Leah Sherman in a scan anxious moment, raw

Leah 5:21

scan. Anxious scan. Anxious moment. Ooh, I like that. Ski anxious.

Tina 5:29

Uh, I, I've never heard that. I think we might have just made it up, but I'm sure we're not the first

Leah 5:33

to say? Scan anxious.

Tina 5:35

scant anxious

Leah 5:36

I'm time trademarking that right now.

Tina 5:39

hashtag anxious. All

Leah 5:41

I'm hashing it. Okay, let, say I be serious.

Tina 5:45

all right. So, so in

Why the word "prevention" is bothersome

Tina 5:46

the grand scheme of things, I mean, I'm just gonna, I'm gonna start talking for you. I know one of the words you don't like, or one of the ways you don't like phrasing what we do in naturopathic medicine, or what nutritionist do, or anyone who's doing lifestyle diet kind of stuff is saying that if you do X, Y, and Z, you're preventing cancer.

Leah 6:05

Hate it.

Tina 6:06

tell us why.

Leah 6:07

Um, because I don't, I don't feel like cancer can necessarily be prevented. I believe in risk reduction because I'm not including myself as one of these people. Even though when I was diagnosed, my husband and I were both on a, um, Cancer prevention diet because he has a really strong family history of cancer. And so I'm like, I'm putting us on this cancer prevention diet cuz I didn't believe in the fact that it was actually risk reduction. So, yeah, I don't think because how many patients have you had who are like lifelong vegans and exercises? I mean, exercisers, athletes, exercisers anyways, you know, like there often are patients who are like, I have been healthy my entire life. I've done all the right things and I still got cancer. Um, there are things, you know, screenings and whatnot to help to further reduce your risk. But we've had patients who have had screaming mammograms or they've had colonoscopies been deemed all clear and then maybe six months later they have cancer.

Tina 7:15

Right. Which is, which is hard to hear because it's kind of disempowering in a way, right?

Leah 7:21

We do what we can do to reduce our risk, but to flat out say you can prevent cancer. I mean, babies are born and don't do anything wrong and they develop cancer. Like, how do you prevent that? I don't know. I just, it's my pet peeve. But yeah.

Tina 7:40

So, yes, I, I'm with you on this Preventative medicine and prevention in medicine is used differently than we use it on the street, so to speak. So it's not taken in a literal sense. So even the US preventative services task force thing, it's interesting because they don't mean prevent as an, it will never happen. They use the word prevent in lieu of risk reduction. So it's not literal, but I'm with you. I think when people hear prevent, they do think that if they do everything right, cancer will not happen to them. And that's a fallacy of course, because cancer can happen in otherwise perfectly healthy people. Um, we're gonna get letters on that comment,

Leah 8:27

I'm sure, I'm sure. And you know, I just had a patient that I was sitting down with and she had a new diagnosis of cancer and really going through her life and trying to figure out what it was that she did that caused her cancer.

Tina 8:43

Mm-hmm.

Leah 8:44

like, You did nothing. I mean, the patient has breast cancer and I was like, the number one thing. You did was you were born female,

Tina 8:53

Mm-hmm.

Leah 8:54

right? I mean, that's your greatest risk of getting Breast cancer is the fact that, one is born female.

Tina 9:01

Mm-hmm.

Leah 9:03

you know, it's like to see patients who are, and I mean, I did it myself, not in a blamey way. My my way of like being like, Ooh, I wonder what I did to flip the switch. It wasn't like I wanna blame myself. I was like kind of just backtracking through my history of excessive exposures through art school back in the day and all these, you know, whatever. I was like, Ooh, what did I do? You know? But it wasn't blame me,

Tina 9:26

Mm-hmm. Yeah. Yeah. And, and the thing about risk reduction is that's what, once someone goes through treatment and, and you're looking to see how to prevent a recurrence, it is smart to look at the list of possible risk factors and see which ones you identify with and say, Is that something I could do something about? Right? So if one of the risk factors is having a family history of breast cancer, for example, well you can't do much about that. You just acknowledge it, Okay, move on. But if the risk factor,

Leah 9:57

But you get your appropriate screenings, right? I mean, you, you follow up with your doctor and you make sure you do all the appropriate screenings that need to be done for whatever your cancer may be,

Tina 10:06

right? Good point. If there is a risk factor, um, like excessive alcohol intake and you're like, Well, that is risk factor for breast cancer. And I drank a lot then just going forward and not to. Blame yourself for what you've done in your past, but going forward, you know that, so you can now decide whether or not to take that risk in your future. You know, I, I think it's a good idea for people to acknowledge the, the risk factors and see them as risk factors, not like if I do everything correct, I'll never get cancer, cuz that's not correct.

Leah 10:37

right?

Tina 10:38

One analogy I always use is you do lifestyle measures, you do dietary measures, you do all these things, and then you make them habit and you forget about it. it's not like you eat well because of cancer, you eat well because it's good for your body. Sometimes cancer is a wake up call. Like Sammy Peterson who we just interviewed, the dietician, talked about how a lot of folks will start eating better after their diagnosis. And we know that's true. but this is what I'm thinking. Risk reduction is no different than when you get in your car and you go down the street in your. Get in your car, you buckle yourself in because it reduces your risk of dying in an accident. You adjust the mirrors, you make sure the seat's proper, you stop, you look left, right, and left again at the corners. I mean, you do all these little things that are risk reduction and hopefully you get to your destination safely. And it's not that you can't get in an accident, and it's not that random events can't happen as you're going down the road, but you're reducing your risk of that happening as you, do a routine act like get in your car and go to the store. I kind of think of risk reduction for diseases the same way you create certain habits, eating well, exercising, getting solid sleep, and then you just move on. But it doesn't guarantee anything.

Leah 11:45

And that's, I mean, I talk to my patients when I see them for their survivorship appointments. I talk to them about like, these are recommendations that are out there for reducing your risk of recurrence, but they're also a way to reduce your risk of diabetes and hypertension. Like, you know, So I let them know that it's, it's good for you for all kinds of things. So,

Tina 12:09

Yeah,

Leah 12:10

yeah,

Tina 12:11

the one nice thing is, is risk reduction as far as lifestyle and diet goes. It's risk reduction for cancer, cancer, recurrence, dementia, cardiovascular disease, diabetes. I mean, it's all one. It's not like there's different methods for each disease type. So that is a, That's a good point.

Back to Leah's story...

Tina 12:26

All right. Back to you.

Leah 12:27

back to me.

Tina 12:28

Let's talk about you.

Leah 12:29

What's up? What do you wanna know?

Tina 12:31

okay. So when you had your diagnosis, You went through full conventional care and then had naturopathic medicine alongside that. Correct.

Leah 12:39

Yes. Yeah.

Tina 12:41

And there was no delay in your care.

Leah 12:43

Oh, no, no. And because of where I was treated, it wasn't just because I worked there, like they moved fast. I'm assuming it's still the same way, but, because it was a, at the time, it's different now at ctca, but, it's kind of a destination hospital people would come from other states. When I first started working there, it was mostly people for second opinions, advanced cancers. And so, they moved fast because people were coming in from somewhere else and they needed to get imaging and work, you know, further workup done, there so that they could get their treatment plan. So I was diagnosed on September 18th and yeah, got my port placed and started treatment on the 26th. I think I got my port placed that morning. I think it was, No, maybe I got port placed. I don't remember. Anyways, it all happened fast.

Tina 13:32

Yeah. The reason I'm saying that is because about a year ago, maybe it's almost two years ago, you know, with, uh, the last couple years have been a bit of a time warp in any case. Um, there was a paper that came out that talked about alternative therapies and how the outcomes and cancer were worse when people did alternative therapies, or even, I think they even said alternative and complimentary therapies.

Leah 13:57

But it was alternative that they meant?

Tina 14:00

Yeah, and if you parsed through the actual data, it was only outcomes were worse. But only in the group of people who delayed the time to, they started conventional treatment. Doesn't matter whether they did alternative, they did nothing at all. If they delayed time till they started the conventional treatment, their outcomes were worse. It had nothing to do with any other treatment, except the only that stayed true in that data when you looked at it, that delay of conventional treatment leads to worse outcomes.

Leah 14:31

Well, I mean, from the time that I first noticed. A lump and I was told it was a fibro adenoma. That was years. So there was delay. Um, and then there was another delay when I had my mammogram when I started working at C T C A and they're like, Yeah, there's this one area, you know, it, you know, it looks a little suss, you know, So come back in. I can't remember if it was three months, to get,

Tina 15:02

did they happen to give you a buyer Adss category number for that?

Leah 15:06

I don't remember if they did, it would be in my portal. But, um, but yeah, there was su there was something where there, it was like, we're gonna check this out again with an ultrasound And then within three months, my dad was diagnosed with liver cancer. And then, Was hospitalized for like five or six weeks and then he died. And so my whole world was like, I was the last thing that mattered.

Tina 15:32

Mm-hmm.

Leah 15:33

and then I had been planning to get married before. We didn't know my dad was gonna die so fast. Um, sounds horrible, but we didn't, we really didn't know. and so we were trying to plan my getting married while he was in the hospital so that he and my mom could like watch it on like Skype or whatever was like big in the day. And, um, he died and I took one day off from work, planned my wedding in Vegas, and we were married like, two weeks after his funeral. So he died on April 29th. His funeral was May 3rd, and we've got married on May 18th. So like my lump didn't matter. Like that was the last thing. And I remember the mammo tech, I kept running into her in the cafeteria and she's like, Dr. Sherman, you need to go for your follow up. And I'm like, I know, I know, I know. Down the hall.

The "Oh, *^#!" moment

Leah 16:26

Yeah, I get it, I get it. until I noticed, I noticed like kind of an enlarged lymph node in the shower and I was like, That's weird. but didn't think anything of it cuz I was like, Oh, maybe it's just from shaving or whatever. And then there was a red patch on my breast. It was kind of red. And I remember saying something to my director and I was like, Cuz she and I would talk about stuff, whatever. It's not like I was being inappropriate talking about my breast. But um, and she was just like, you know, make an appointment with your primary care. And I was like, Okay, that's. Probably a good idea. And the next day I woke up, the redness was gone and I lifted my arm and there was a pucker over that spot where there was the little alleged fibro adenoma. And I was like, I am fucked. I knew exactly what was going on. I was like, I'm screwed. And so I went to see my PCP on that Monday and she was like, Well, I don't think it's cancer, but we'll send you for your diagnostic anyways. Well, you know, you work at a cancer center, we're just kinda, Have you worked up? And I got worked up and I got worked up. I didn't get worked up personally, but I I got the workup. And I remember the radiologist who I knew because I worked there, he came in the room and he was really nervous. And he's talking to me and he's like the nicest man. And he was like, So, I mean, There's like a 10% chance it's not cancer. I'm like looking at the screen and I'm thinking Oh my god, that's so cancer.

Tina 17:58

Did it look like a speculated mass? And speculated just for the listeners speculated is highly suspicious because it it means that it's not round like a fibro adenoma, but it has little projections coming out of it that kind of reach into the nearby tissue. And then generally speaking, that would be a high birads category. Birads is a system that radiologists use to communicate to the ordering physician the level of their suspicion and what the next step should be. So on the mammogram report, everybody has a birads number, B I R A D S. And it's good for women to look at that because sometimes I've had women tell me their story and come to find out the follow up wasn't done properly. Like the radiologist said one thing, their primary care physician did another thing. Take that BIRADS number into account or maybe overwrote it in their opinion. I don't know what happened, but it's something that I think all women should know when they get a mammogram.

Leah 18:50

So, um, my tumor was not seen on mammogram. It was the ultrasound that they were looking at. So when I looked at the ultrasound, you could see it had blood flow and stuff. I mean, it just was very very stereotypical. I should say very classic high. Hi, I'm, I'm a breast cancer looking, ultrasound, when I had been getting my screenings Previously, there wasn't that whole oh, dense breast, you need to get an ultrasound. That was just kind of being talked about, but it wasn't standard of care in any way. um, I always had to like push to get that, but I wouldn't always get it. I mean, yeah. So my, my tumor was not seen on screening mammogram except for in, in hindsight they could look back and say Oh yeah, that's what, where it was?

Tina 19:37

Right, right. That's often the case where they're like, We can see it in previous ones, but they didn't think anything of it at the time, in real time. But yours was invasive ductal carcinoma,

Leah 19:47

Yeah.

Tina 19:48

not lobular.

Leah 19:49

Nope.

Tina 19:49

The reason I'm asking you is lobular carcinoma classically does not show up on a mammogram,

Leah 19:54

Oh, right. Yeah, no. Um, I think it was just because my breast tissue was so incredibly dense.

Tina 20:00

Okay. And when they told you it was a fibro adenoma years prior, did they biopsy it or would, was it just It looks like a fibro adenoma and we're gonna leave it.

Leah 20:09

It looks like a fibro adenoma and I can stick a needle in it if you want, is what I was told. And I was like, Nah, I'm good.

Tina 20:19

Okay,

Leah 20:21

I was in residency, I was like, I've got dance breasts. I've had lumps my entire life. I've had like, what abs? It was so tiny. It was so, it wasn't, it was barely palpable. It was really mobile. It was hard to track down in a breast exam because it would just kind of zing away. yeah, I just, I. it was one of those things like, why would I have breast cancer? Like, please, why, like, why would I, why would I have breast cancer? You know, just like when because, Because you were born female. That's why.

Tina 20:54

Yeah. That's why I was curious about some of the, some of the history in there because. A presumed fibro adenoma is different sometimes people do get them biopsied, and they're told it. It's a fibro adenoma because there's a pathology To show them that that's a little different than a presumption your case.

Leah 21:09

So when I had all of my workup and I started chemo, I had this crazy contraption, I don't remember what it was called. It was some sort of way of looking at breast tissue that was kind of like a mammogram, but you had to stay still for like 10 minutes. I can't remember what the machine was called, but I remember I had already gotten one cycle. My port was still fresh on the right side and they used this contraption to look at my breast on, I think, I don't remember if they did it both sides, but definitely on the right side cuz I remember it pulling down on that port and it was, I cried during the exam because it was so uncomfortable. And they noticed in that exam that there was something in my right breast and they did biopsy it and it was a fibroma

Tina 22:01

Okay.

Leah 22:02

But I was like so ready to have both my breast, I was just like, this is a horrible way for me to live. I am gonna be anxious every single day, anytime there is some sort of lump or bump or whatever. And I just wanted to have them both removed and I ended up opting just for the left. So, but I still think for peace of mind,

Tina 22:20

Mm-hmm.

Leah 22:21

I don't know.

Tina 22:22

But you didn't go on to

Leah's treatment

Tina 22:23

have that done. What did you have?

Leah 22:25

I had a, a left mastectomy. No, and my, breast surgeon, he was very into me having a lumpectomy, but I had such small volume breasts that I knew that a lumpectomy plus radiation would just be, I mean, a lumpectomy on my breast previously would've been a shark bite. I mean, it would've just been a lot. So when I met with Dr. Brown, who was my plastic surgeon, he basically was like, It's hard to work with that tissue after a lumpectomy and then radiation because of the size of my breast and everything. He's like, That would be very, very difficult to have good cosmetic results. yeah, we did the the left side mast.

Tina 23:10

And then you had plastic surgery.

Leah 23:12

On both sides. Yeah. I had, um, to kind of, I didn't get huge implants, but the left side was a little larger than what my, my native breast was. And so we kind of put a tiny little implant on the right to kind of even them out.

Tina 23:26

Okay. And you tolerated all this pretty well, The surgical process.

Leah 23:30

everything with the anesthesia, apparently I don't tolerate anesthesia.

Tina 23:33

surgical complications?

Leah 23:35

nothing related. Well, oh dude, I totally did. I lost my voice from surgery.

Tina 23:42

Oh,

Leah 23:42

I had to go to speech therapy. Like every weird thing that could happen, kind of happened to me. Not every weird thing, but a lot of weird things. So I lost my voice after my initial surgery.

Tina 23:53

it was this due to physical damage to your vocal cord.

Leah 23:56

I think it was, I was ho and I went to see the E E N T and he's looking and everything and he's just like, I guess it's from the anesthesia. I'm like, because it happens. I have a girlfriend that it happened to as well, and it took her a long time to recover. But um, yeah, so I had that, but breast wise, I had these teardrop shape, gummy bear implants, and on the left side it rotated twice. So I had two different reconstructions following reconstruction revisions because the implant went from being up and down or whatever to horizontal.

Tina 24:35

Oh.

Leah 24:35

it was deformed looking and yeah, so that happened two times. No fault of the surgeon, it's just what my body did. And so the second surgery, he's like, I'm gonna put in a round implant because when it rotates it's still round

Tina 24:49

Right

Leah 24:50

We need to get Dr. Brown on here and have him talk cuz he's amazing. Yeah. And up. I'm gonna put a link in the show notes because he's got a bazillion followers on the TikTok and on the Instagram. So, um, y'all go follow him,

Working during treatment

Tina 25:04

All right, So let me ask you this. Throughout this whole time you were doing naturopathic medicine, I mean, obviously you're eating well, you're taking care of yourself, you're naturopath. Uh, maybe if anything, you work a lot, you don't take time off for self.

Leah 25:17

me.

Tina 25:19

I'm just saying, you know, this is my guess. If anything was not naturopathic, it would be probably your tendency to work.

Leah 25:26

For sure.

Tina 25:26

Okay.

Leah 25:28

No, absolutely. No, no, no, no. That's true. I mean, you mean well, I worked throughout my treatment. I took Friday was I took off, but it wasn't really because I came in like at seven before my port access and I checked all my emails.

Tina 25:43

Mm-hmm.

Leah 25:44

laughing cuz it's so stupid. yeah, I checked my emails, answered, emails did work, and then I went and got my airport accessed, did my infusion passed out? I can't tell you really what happened during any of my infusions. I had plans, grand plans to like watch, housewives at Beverly Hills and all this like trash tv. none of that happened. I slept.

Tina 26:13

Well, and you know, is, this is something we should talk about. Like, so when people go through treatment, doesn't matter what they're going through exactly, whether it's surgery, the radiation time, or the chemotherapy time, there's a certain amount of wanting normalcy and, and having a normal day, and in your case going to work and helping other people through their, their treatment, was a normal day. That that's what you do. there's a fine line between wanting to keep the normalcy and exhausting yourself unduly because of kind of, uh, you know, must do kind of idea. So that balance between relaxing and taking care of yourself and resting and proper balance, it's kind of hard to pull off, I think. Isn't.

Leah 26:56

Um, I felt that if anyone understood. What I was going through, it was the people that I worked with.

Tina 27:05

Mm.

Leah 27:06

So in a lot of ways, my life stayed normal at work. I mean, there were the weird moments where like somebody that I barely knew would see me walking down the hall with my scarf and my drawn on eyebrows, my big earrings, and be like, You look so beautiful. And I'm thinking You never said that to me before. Like, what's going on?

Tina 27:26

Mm-hmm.

Leah 27:27

I don't trust you.

Tina 27:28

Mm-hmm.

Leah 27:29

mean, they try, they didn't know what else to say. And so like, I got a lot of weird responses from people, but I just felt like things were normal. Um, I, I felt like I got support. I un like people I worked with understood. They may not have known from personal experience, but just from having worked with other cancer patients, I had my mom. We flew her in to kind of help out a little bit. Um, but my dad had died that April, so I was so careful as to like what I could share with her because I knew that she was reliving everything. and then my husband wasn't working and I felt he might be listening, but I felt, and I think I've expressed this to him before, but it was just this deer in headlights. Like he didn't know what to do, right? I mean, he, we had, we'd known each other for a long time, but we had just gotten married. He had just moved down to Arizona, from Oregon and like a month later we bought a house. And the day that we moved in was the day I started chemo. So it was a lot for him. So work just made sense. Just being at work was like,

Tina 28:48

Uhhuh,

Leah 28:48

it was my, it was my escape from reality by being surrounded by people with cancer, who, who got me, you know? And I wouldn't share it with all my patients. I mean, it wasn't until I lost my hair, that people knew what I was going through. But I remember having one patient who knew I had just gotten married and she knew I was Jewish. And so when I started wearing the scarves, she thought it was cuz I was like an, like an orthodox or something. She thought it had to do with my religion. And I was like, No, I have cancer. I'm getting chemo. But I thought it was so cute. she's like, Well I knew you just got married and I knew you were Jewish.

Tina 29:28

you're like, no,

Leah 29:30

no. So

Tina 29:32

Yeah,

Leah 29:33

what was the question?

Tina 29:34

So let me ask you,

Leah 29:35

Yes,

Tina 29:35

for our listeners,

What did you do during treatment?

Tina 29:37

as far as what you did, you, you kept up some routine. your workplace happened to be a place of. Emotional comfort, social comfort, which was good. So it wasn't just a diversion, it was almost like living your reality in a very comfortable place.

Leah 29:52

Yes and no. Cause I did start to get anxious when I'd have a new patient who came in with a more advanced breast cancer, and then you have to look up their past records in order to know, you know, what's going on. And seeing that this patient was diagnosed at the same stage that I was,

Tina 30:10

Mm-hmm.

Leah 30:11

they have advanced cancer. So, Those moments were difficult. but everything else was, I thought it was really good for me. I thought it was good because it kept my brain sharp. Like even when I started going through menopause and having massive brain farts, I knew my job because I kept using that, you know? So, it was just, I thought it was a good thing. I do think I did work too much. I know the, um, even the hospitalists had offered me a bed on the inpatient floor in case I needed it to take a nap or take a break, and I was like, No, I'm good. I'm good. So I kind of dismissed that, you

Tina 30:48

Mm-hmm.

Leah 30:49

I didn't do a fabulous job of taking care of myself.

Tina 30:52

Mm-hmm.

Leah 30:53

Is that what you're getting? Is that what you're trying to say to me, Tina

Tina 30:56

I have, I have no motives here.

Leah 31:00

But I will say, and I have said this before, and I don't know if I've said this on our podcast, I found myself managing a lot of people's emotions around my cancer looking back on my Tumblr that I kept that, where I was trying to do vlogs and put little posts up, there's actually a post about that, that it's exhausting trying to manage other people's feelings.

Tina 31:24

So you mean people who care about you, who their own reaction, and now you find yourself in a way trying to comfort them

Leah 31:32

Mm-hmm.

Tina 31:33

instead of the other way around?

Leah 31:34

Yeah. And not that I was like looking, you know, me. I mean, it's not like I was looking for sympathy or for comfort or whatever, but I didn't need. On my plate when I'm trying to figure out how to take care of myself, which is something that I've never really been, No, I'm not gonna say I'd never been good at. I think in my twenties I was pretty good at like hashtag Laya first, you know, Seriously, because I was still in that whole like, you know,

Tina 32:06

20 something

Leah 32:07

something phase where, you know, 20 something,

Tina 32:10

20 something. No children. Let's be

Leah 32:11

No children. not married. Yeah. No responsibility. Yeah. Nope. But so I, I went through that for my twenties and thirties. It was like kind of, you know, me first and then, yeah. Anyways, so it was nice to go and like, help my patients and distract myself from myself because I was working with my patients, but at the same time, I wasn't, I don't know. Yeah, I wasn't really, I was doing the right things in terms of I was taking my supplements, I was eating well, I would, wasn't exercising cuz I was so fricking tired. But,

Tina 32:46

Mm-hmm. but you were doing what you could.

Leah 32:48

I was doing what I could and I was active at work. I mean, you're walking all over the place. I know. I sound like my patients now where I'm like, that doesn't count as exercise. I think I did a squat challenge too. I like, I remember a friend was doing some sort of Instagram squat challenge and I was like, I'm gonna do this too. And so I'd do squats every day and that was my exercise.

Surgery? Chemo? Radiation?

Tina 33:08

So

Leah 33:08

Mm-hmm.

Tina 33:09

you you had surgery, right? Then radiation, then chemotherapy,

Leah 33:15

I had chemo. I had chemotherapy and surgery. I did not have radiation.

Tina 33:20

Oh, sure. Because you had the mastectomy.

Leah 33:23

Yeah. But I had a really close anterior margin. And so there was a question as to whether or not I should, I needed radiation. And my radiation oncologist, who is awesome, consulted with her colleagues at, um, Sloan Kettering And, um, everyone decided like, Nope, there's really, there's no need for the radiation. So I did not have that.

Tina 33:48

Yeah.

Leah 33:48

and I didn't have any positive lymph nodes.

Tina 33:50

okay. The stage itself though, was considered stage two

Leah 33:54

Stage two. Yeah. It was initially stage two B, but then. I talked, I switched. I didn't switch. My oncologist left and I got a new oncologist there and she was like, You're stage two A. I'm like, Okay. So sold I'll take it.

Tina 34:12

So that means, so, so for the listener, that means that it was based on size, it became stage two, the size of the actual tumor rather than the lymph node involvement.

Leah 34:21

Yeah, it shrunk a little. Plus, I think it was like, I'll butted up. It was, I think it was butted up to like a big, fibrocystic mass, so I think it felt bigger, like clinically, it felt bigger than, it did once it was removed

Tina 34:35

Okay, so you had chemotherapy, then surgery, which entailed the mastectomy and implant and that was it.

Leah 34:43

and then Tamoxifen.

Tina 34:46

Right? Until the continual tamoxifen right after that.

Lumpectomy vs. Mastectomy

Leah 34:49

Yeah.

Tina 34:50

So for our listeners, I think it's important to point out the role of radiation in breast cancer specifically. Many years ago, the reason Lumpies became the more likely surgery to happen than mastectomy. Cause once upon a time it was always mastectomy Leia, your. Particular scenario is a little different because you you elected to have the mastectomy. A lumpectomy would have meant radiation. So usually what happens, it's lumpectomy and radiation equals mastectomy in a general sense. Of course, there are exceptions to that rule. There's other things going on. But in a general sense, the reason Lumpies became popular is because especially when women have larger breasts, a lumpectomy can be done and, and not lose the entire breast during surgery. So

Leah 35:36

Right. And I think, yeah, for women who do have a larger volume breast, a lumpectomy would be completely appropriate. But I, I asked for images of women with small volume breasts who've had lumpies and, you know, radiation and reconstruction and there really wasn't anything. And then I did let everyone does, and I looked on the Google, and I mean, yeah. So, you know, people can always talk to their surgeons and ask them specifically, you know, talk to your plastic surgeon, talk to your breast surgeon and say, I wanna see images. I was very small. and so it seriously would've. A major deformity on me. so I, and I don't think I mentioned this, I had a nipple sparing mastectomy. So that means they take a little sample from behind your nipple and they test it and make sure that it doesn't have cancer, and then you keep your nipple and hope that it stays on because it, there is a risk that the tissue won't be viable and you'll lose the nipple anyways. But yeah, mine stuck around. So

Tina 36:39

Mm-hmm.

Leah 36:41

I don't know. I, I guess I, I guess I was fortunate in that way.

Tina 36:46

Well, and I think this is really important to have the talk. Now, when someone might be listening before their diagnosis or they're talking with their friends, they can share this information. But I have had a lot of women come to me as an naturopathic doctor and say, I decided a long time ago, I'm never doing radiation. the plan was they were supposed to get a lumpectomy plus radiation in their mind. They're like, Oh, I'm not doing radiation. But they didn't have this conversation with the surgeon in time. And they get their lumpectomy and, I encourage anyone who has some kind, hard, fast rule, I will never kind of things to go ahead and say that upfront because it might change the treatment. So if someone says, I will never do radiation, cuz I, again, I've had women come into my office and do that more than once. all I can say is then you need to talk to the surgeon about a mastectomy rather than a lumpectomy

Leah 37:37

But the mastectomy won't guarantee that they won't have radiation because when they do the sentinel lymph node, it could come back positive and then radiation would be on the table. So that's why I say I just kind of like. I kind of rolled the dice. I mean, I wasn't opposed. I didn't want radiation. I mean, who the hell wants radiation? Nobody wants radiation. But I was prepared, right? I had my naturopathic tools

Tina 38:01

Mm-hmm.

Leah 38:02

when I was diagnosed and started treatment, I had been studying for my oncology boards, and that got pushed aside. And so I kept joking that this is my board exam, right? Like I should know what to do. And so I knew what I was gonna do with each phase of my treatment. I knew medical oncology, but then patients with vanish, right? They get taken away. They get their surgery. I don't know what happens until whatev, however many weeks was it? Three weeks later, they return to medical oncology or they go to radiation oncology.

Tina 38:42

Mm-hmm.

Leah 38:43

The radiation of oncology was a little bit less of a mystery because I would follow with my patients, make sure that their skin was healthy, you know, all of that kind of stuff. Um, but surgery was a big mystery. So I had plans for each phase, whatever the phase would be. I had a naturopathic doctor that I ran my plans by who kind of reigned me in a little bit, you know? But I didn't want radiation, but I was ready for radiation because it's my job to know what to do.

Tina 39:15

Right?

Leah 39:16

And everything I went through, I thought, I can use this my practice.

Tina 39:22

Mm.

Leah 39:23

I can come up with ways of taking glutamine, you know, like I can tell someone, Well, it doesn't really dissolve that well, you know, like, I have this experience of whatever it is that I'm doing, Stop taking your B vitamins. Yes, they do. They smell disgusting. If you can't tolerate them, it's okay. You know, don't put them in your closet because your closet will end up smelling like B vitamins, you know? And like I had all these things happen that I'm like, Wait a minute, I got something for you. You

Tina 39:52

Mm-hmm.

Leah 39:53

I, like I said, I didn't want radiation, but I was ready for it if I needed it. When they told me it's not necessary, I was like, Oh, thank God,

Tina 40:04

right.

Leah 40:05

But if I needed it, I would've gotten it. I, it's kind of like what Amy Rothenberg said, right? You wanna make sure you are doing everything possible so that you don't ever look back and say, should a would acuta

Tina 40:20

I totally, totally agree. Yeah. And when I was stressing the lumpectomy versus mastectomy, lumpectomy will require radiation. Mastectomy may require it depending on the surgical outcome. So there's, there's one where it's a given, there's the other where it's a maybe,

Leah 40:37

Mm-hmm.

Tina 40:37

and it, and I guess, you know, being forthright through the whole time, just, just being really forthright with the medical oncologist, the surgical oncologist, or whoever you're working with. And if that person isn't, Welcoming, comforting, Easy to talk to, they're not listening. Then I would advise people to change it to someone who does.

Leah 40:57

Mm-hmm.

Tina 40:58

I know there's not a lot of time and it's not always feasible. And depending on where you live and on the system and even on your insurance company, it may not be feasible. But if you can find people you really trust, cuz you're trust, you're

Second opinions... needed?

Tina 41:12

entrusting them a lot.

Leah 41:13

Yeah. And I mean, the second opinion thing is, is huge. I did not go for a second opinion because I mean, I worked at a cancer center and I was comfortable with everyone that I worked with. Um, It came to my dad. I kind of wanted him to, but he trusted his doctors. I guess I have a lot of regret cuz I didn't push him to get a second opinion.

Tina 41:42

Mm.

Leah 41:43

Um, cuz his treatment was pretty harsh and I strongly believe it was the treatment he was gonna die from his cancer. But the treatment really accelerated it, um, because of, he did not get standard of care. I think they did some sort, It was a teaching university and I think they did something that was a little experimental. It wasn't standard. I remember telling my oncologist what was going on and he was like, Oh, it should be fine. And then when I told him what happened, he. He just had this look in his eyes and I was like, Oh my God, what did I do? Why didn't I push for a second opinion?

Tina 42:25

I think that getting a second opinion makes a lot of sense. almost always in your scenario. I mean, it was pretty clear what was gonna happen. Not everyone gets chemo before surgery.

Leah 42:36

I mean, if they're trying to shrink the tumor, I think cuz they were aiming for lumpectomy, so they were really hoping that the tumor shrunk like significantly. Which it shrunk somewhat. But yeah, I think if they're trying to preserve the breast, it's obviously

Tina 42:53

Yeah. Yes.

Leah 42:55

people get surgery first. There was that whole controversy as to. Outcomes, whether you get surgery first or not. And that turned out to be

Tina 43:04

Yeah.

Leah 43:05

who we,

Tina 43:06

Yeah. And I don't think we use the official term. It is neoadjuvant chemotherapy.

Leah 43:11

That's what I had. Neoadjuvant chemotherapy.

To be continued...

Leah 43:21

Hey everybody. Apparently I have a lot to say about my cancer experience, so we're gonna be picking this up in a part two, which will come out next week. So tune in next week for more stories from a hashtag Cancer insider. On that note, I'm Dr. Lea Sherman. and this is the Cancer Pod

43:47

Thanks for listening to the cancer pod. Remember to subscribe, review and rate us wherever you get your podcasts. Follow us on social media for updates, and as always, this is not medical advice. These are our opinions. Talk to your doctor before changing anything related to your treatment plan. The cancer pod is hosted by me, Dr. Lea Sherman. And by Dr. Tina Caer music is by Kevin McLeod. See you next time.