Pain 101: Understanding the Basics

LEAH 0:00

Exhausting,

Tina 0:01

tugging,

LEAH 0:02

cruel,

Tina 0:03

pinching,

LEAH 0:04

freezing.

Tina 0:05

blinding,

LEAH 0:06

Taut

Tina 0:07

burning,

LEAH 0:08

gnawing,

Tina 0:09

suffocating,

LEAH 0:11

quivering,

Tina 0:12

radiating,

LEAH 0:13

splitting,

Tina 0:14

nauseating,

LEAH 0:16

grueling,

Tina 0:17

unbearable,

LEAH 0:18

wretched.

Tina 0:19

heavy.

LEAH 0:21

so today we're talking about pain and how you can talk to your doctor about your pain.

Tina 0:27

And we're gonna touch on why nobody should be suffering with so many options on how to control it.

LEAH 0:33

So stick around.

Tina 0:35

I'm Dr Tina Kaczor and as Leah likes to say I'm the science-y one

LEAH 0:39

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

Tina 0:43

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

LEAH 0:47

But we're not your doctors

Tina 0:49

This is for education entertainment and informational purposes only

LEAH 0:53

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

Tina 0:58

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

LEAH 1:04

Welcome to the cancer pod

Introduction

LEAH 1:22

Hey Tina.

Tina 1:23

Hi, Leah.

LEAH 1:24

We're talking about pain baby. We're talking about you and me. I dunno. I'm trying to think of a pain song. I'm sure there is one. So yeah, we're talking about pain.

Tina 1:34

Yeah, I was gonna say they're mostly heartache songs, I'm pretty sure.

LEAH 1:36

Oh yeah.

Tina 1:38

Well, I hope our intro wasn't too dark.

LEAH 1:40

Well, the words that we were using in our intro, that's from the, um, McGill pain questionnaire. That is a tool that doctors can use to help to figure out what type of pain someone is experiencing, because I guess we're all familiar with, like, I don't, I'm sure it's got a name. The little faces. The faces of pain.

Tina 2:02

Yes, yes. The faces of pain that are on the wall in most hospitals from smiley face to, you know,

LEAH 2:08

We'll find a picture. We'll post it.

Tina 2:09

Well, I can give you a picture I just wrote on it. I made it into little goofy characters because the person in the bed is staring at it all day, and because it's not so much to look at, I took a little marker and put mustaches and beards and ears and stuff on all of them.

LEAH 2:22

Nice. Yeah. So that, and that's supposed to be, you know, kind of a universal scale of assessing pain. But I like the, um, the words in the McGill questionnaire because they're words that you don't commonly think of, but then when you read it, In the context of pain, it's like, oh yeah, I get it.

Tina 2:42

Yeah, and that goes into what we're gonna talk about today, which is in order to get relief of your pain, how you communicate your pain to your physicians. All of your caretakers, whoever they are, will help you get relief and help you get relief sooner than later so that there's less guesswork as to what's causing it. And.

LEAH 3:00

And there are different kinds of pain. I mean, there's acute pain, which A lot of the time is what one experiences from going through treatment. Um, and then there's chronic pain as well, which also occurs, and we'll go into more depth like in other episodes cuz this is just kind of our basics episode.

Tina 3:16

Mm-hmm.

LEAH 3:17

But, um, I think it's kind of hard for people to find the right words, the right descriptor words.

Tina 3:24

And honestly, I think the more pain you're in, the harder it is to be articulate. I mean, it's like, it just hurts. I mean, I've had that in my office where I'm asking people and I'm trying not to prompt people with words cause I don't wanna put them in their mouth. Right. You want the the descriptors to come organically from the person like, What do they feel? And if I start saying, is it stabbing, is it achy? And then I feel like I'm creating, less precision in figuring it out. So yes, the more precise someone can be, the better.

LEAH 3:54

Yeah, and as you mentioned prior to us recording, like we are taught, you know, specific things to ask regarding pain in terms of, the timing of the pain, you know, what makes it better or worse, and those kinds of things. And I mean, I definitely use that and for. Words, I think cuz I experienced pain with treatment, like various pains. Um, I think when you come up, when you hit the right word, like I think of that crushing pain that I felt in my fingertips, which I didn't really know was gonna happen except then I remembered I had a patient years before who had experienced that and talked about, oh, it feels like my hands were smashed in car doors.

Tina 4:34

Mm-hmm.

LEAH 4:35

And so when I use that with, when I hear patients trying to explain like, well, it's not numbness and tingling, and I'm like, is it like your fingers were smashed in car doors? And every once in a while they're like, yeah. And other times it's like, no, that's not,

Tina 4:49

Right.

LEAH 4:50

but you know, like I have that where I'm like, does it happen to feel like, and when they're like, yes, that's it. I'm like, yeah, I got it. I gotcha.

Tina 5:00

Yeah. Yeah. And so then, you know, then you know the quality of it. Of the pain, which helps with getting the right pain management for that person.

LEAH 5:09

Yeah. And then what one might experience from a certain treatment might not be what someone else experiences like the, the, the quality, the type of the pain. Pain. It's like incredibly personal and somebody may experience pain from a treatment that it isn't really common.

Tina 5:27

What do you mean? Gimme an example?

LEAH 5:29

So like somebody may experience like a pain after a surgery or a pain, you know, with a certain chemotherapy where it might just be a rare side effect. And so it's not something that people experience all the time. Um, or it may be something else is going on and maybe it's not like directly obvious. Um, I don't know. Maybe something, maybe an instrument was left during surgery. I mean, it could be anything.

Tina 5:56

That's a horrible thought, but yes.

LEAH 5:58

I, well, I'm just trying to think of an example, but like, you know, it could be something where it's just like, don't have someone dismiss your pain, is what I'm getting at. Even if it's not a typical pain after your procedure, after your treatment, if you are experiencing it, speak up. And if someone isn't listening, you know, find somebody who, who does listen.

Tina 6:18

Yeah, and we were actually taught, ask about pain levels at every visit with every patient, so I always had that as part of my sit down, even if someone never had pain before. It's like, is there any. Any pain. And a lot of people will reframe it and they don't like the word pain. They're like, well, it's not really pain, it's discomfort. And that's again, where the adjectives can come in handy for me to understand what they mean and of course, get more descriptive, which we'll talk about. Tools to do that in a little bit. Um,

You're not doing drugs, just taking them

Tina 6:45

I'm just gonna say out of the gates, if someone's has pain during treatment, acute pain, this is where drugs come in handy for acute situations.

LEAH 6:54

This is what drugs are for.

Tina 6:55

This is what drugs are for getting through tough times. It's true. You know, for chronic pain it's a whole nother ballgame. And we, you, you do drugs if you must, but

LEAH 7:06

You don't do drugs, you take drugs, Tina?

Tina 7:08

yeah. You do drugs,

LEAH 7:10

No.

Tina 7:11

you know,

LEAH 7:11

I think of doing drugs as like schedule one illicit stuff. Taking, taking medications. You're taking medications, you're doing drugs.

Tina 7:23

I think it would all as a, as a similar really.

LEAH 7:25

Well, and I mean, they can be right, because a lot of the pain medications can be drugs of abuse. But, um, but I had a patient who she was getting, palliative care and was afraid to take, I guess it's all kind of palliative care, right? I mean, I, we have to take palliative out of the picture of it being like, end of life. But, she has metastatic cancer and is, you know, Going through her treatments has this horrible chronic pain, um, from her cancer. And she was afraid to take whatever pain medication that they had prescribed because she didn't wanna become addicted. And I sat down and talked to her about like, if you use it as prescribed, Like, don't worry about it. Like she heard about it as, you know, a street drug and like you hear about like, famous people dying with from this medication or, you know, because they abuse it. And I'm like, does taking this medication control your pain.

Tina 8:24

Yeah, and to your point, when it comes to the opioids, when you are in pain, they work differently than when people are not in pain and they're actually abusing the drug. And getting high on the streets kind of thing. That's a whole nother ballgame. When you are in pain, you may not have as much of the effects on your mental state that people do when they are not in pain. So it's one of those things that people need to understand about opioids and that's, the oxycodone and the and even fentanyl when it is used properly in people who have pain, it's completely different. I have some people who have cognitive issues with it because it is a. A noted side effect, but I have other patients who never had any cognitive changes on these drugs, and that's because they needed it. So it's a, it's a totally different scenario than people taking it and abusing it on the streets.

LEAH 9:14

But that's what we learned back in the day in farm class, that if somebody needs it, That you know, you can't become addicted if you need it, but that was proven false.

Tina 9:24

Right. it can still be addictive. Um, but you may not get high. You, you are unlikely to get high. From it. It's like any drug, right? Like some people have a horrible reaction to it and you know, hallucinate and have delusions and other people are like, nothing happens except my pain is dulled.

LEAH 9:40

I think that's a lot of, that's also the metabolism, right? because of the way that it's metabolized through the liver. Um, those kinds of drugs, that if you have some sort of altered metabolism of the, what is it, two D six cyp, two D six um, then you might not be getting relief from it because your body's not processing it the way the drug was designed.

Tina 10:01

Right. And well, and that's, that's another one of those reasons to be as precise as possible with your descriptors. It is because opioids don't work for a lot of different types of pain. There's a lot of types of pain that opioids just won't touch, and so they're not appropriate.

LEAH 10:16

So, yeah, so we're, yeah, so we'll focus kind of on some of the, the words, the kind of algorithm for talking

Referred pain

LEAH 10:23

about pain. Um, you know, location is a really important thing to talk about, but then you also have referred pain. And so that can make things tricky. Someone can have, um, like mid-back pain because of something that's going on viscerally, like with, you know, their gallbladder or their liver or something, you know, their spleen. You know, you can have pain refer. So someone might be going to get treated for their back pain and going to the chiropractor and getting massages and it might have nothing to do. It could be something with their pancreas.

How self-diagnosis can derail your practitioner

Tina 10:55

Yeah, and you know, my thought is this, from a clinician's standpoint, the hardest cases for me to diagnose properly are those who are diagnosing themselves. So when patients came in and said, oh, I have kidney pain and this is why I think I have kidney pain, it comes in my low back, and it radiates and it does this, and like they come in with their diagnosis, it was much less confusing as a practitioner when people just come in. Without diagnosing themselves and give me the most thorough history possible of their pain so that I can assess what is actually going on, because they might have Googled it or figured it out, but it might be three different scenarios that I'll present similarly, and I'm, I'm so busy. Thinking about the fact that this is their kidney, it's almost distracting to come in with a self-diagnosis. It's fine to leave it till the end of the visit, that's a little word of advice for patients. If you want a good diagnosis, come in with a lot of descriptors and a lot of, of history, but do not label it. With a diagnosis because you will pull or push your doctor's thinking do it at the end. If you don't hear them say what you think it is, then be like, well, could it be my kidneys? you know if that's what you think it is? And the reason I say this is, is I know that this happens. It's just human nature. we like to, you know, respect the patient's wisdom as well. You know, so maybe they're right. You know, it can be distracting and it can, there can be some red herrings on there too, cuz you might talk yourself into, Saying some things that may or may not be all that relevant, so just stick to the story.

LEAH 12:21

And, and sometimes it's not even somebody coming in about pain that they're coming in because they can't sleep. And then as you talk to them, you're like, they're like, oh, I tried melatonin. Nothing works. And um, it turns out that it's because of pain.

Tina 12:36

Mm-hmm.

LEAH 12:37

But that might not be their focus because as we went back to. Saying before, like, you know, talk about your pain, like, address your pain. Don't, don't suck it up.

Tina 12:46

Yeah, and you know why you don't suck it up. And even if it's discomfort, you don't suck it up. You don't just deal with it, especially acutely, it's immune suppressive When you are in pain, it causes your blood pressure to go up. It causes your cortisol to go up. When your natural endogenous cortisol goes up, it's an immune suppressive. Event. So getting rid of your pain can be helpful for the rest of the parameters. I've actually had people come in with a new diagnosis of high blood pressure because they didn't address their pain. So their pain was severe enough to affect their blood pressure. They get put on a blood pressure medication. They still have their pain. Now their blood pressure can't go up because they're on a med to, to keep it down. So being stoic is not in your favor, especially acutely. I mean, of course, chronically as well, but acutely, this is why I say do what you have to, to address the pain. During treatment time because the immunosuppressive effects, the sleep disturbance, the mood changes. Cuz if we all get a little cranky when we're uncomfortable, that's just the way it is.

LEAH 13:45

You looking at me? looking at me.

Tina 13:49

looking directly at you, Leah, so, um, I think it's really important, I mean, and my patients are yours too, to an extent are selected cuz they're seeing a naturopathic physician. Right. So oftentimes they're averse to taking too many medications. They don't wanna take medications, and that's why I say that's what meds are for. we said this in our nausea episode as well, it's like, you know, there are times when a little me medication gets you through these tough spots, and that's okay. We're not here to put people on meds for life. I mean, that's, part of what we don't wanna do. If we can help it, if it, if it's chronic pain, then. We'll talk about, you know, the three ways of getting relief from pain in general.

LEAH 14:31

And, and I mean, it's not only opioids obviously, that address pain in terms of medications. I mean, you have, um, you know, you have things like ibuprofen and Tylenol and you can alternate those. So, I mean, there, there are other things as well, but some. Conditions, people can't take certain medications for whatever reason. So yeah, because I've had patients who, you know, they're totally fine with being able to take something like Tylenol, but they're, they don't wanna take anything that's not natural. So

Tina 15:00

Right, right, right.

The three main ways to get relief

Tina 15:03

And there's, there's. Really three ways to get relief from pain within cancer care. If you can remove the source, you know, for example, surgery on a tumor that's pressing on nerves or the tumor itself is painful. So that kind of idea of treat the source of the pain, can you remove the source? And then pain perception, which is what you hinted at with the nerve pain. That's why opioids don't work for nerve pain. Really. You're better off taking medications that. interfere with the signals to the brain, the perception of the pain. So things like Neurontin for nerve pain. Yeah. And so change the perception of pain. So you, you don't feel it as much cuz pain is like you said, subjective. we feel pain differently each of us. And it's not completely, what are those, what are I wanna say inner in your head, you know what I mean? Like some people are like, oh, she's super sensitive to pain or he's super sensitive and this person's not, you know, it's not about that. Some of it is physiological. Like you are wired to be sensitive to pain. Some people can feel visceral pain, like the pain in their gut much more so than other people, so one person could get an ulcer and not even know it, and the other person has gastritis, just a little bit of erosion, and then it's painful. So some of it's hard wiring, literally, like how is your nervous system wired? Some of it's physiological, like how do your neurotransmitters get produced and metabolized at the site of the pain, whether that's. Wherever that is in your body. So nerve endings are what signal the pain, whether it's on your skin surface, in your viscera, in your back. There's nerve endings that then tell the brain you're in pain and what's going on at that site, at that nerve synapse is partially at least genetic, partially your diet and what, what you have on board. But a lot of it is genetic glutamate is a, classic example. Glutamate is at the nerve synapse and it causes more Sensitive pain signals for people, and this is genetic. You, inherit those tendencies. and then the brain, you know, the mind body. You can overcome the perception of some pain or discomfort by using mind body techniques.

LEAH 16:59

Yeah, and that's kind of one of the, the main integrative modalities that you will see in cancer centers. When addressing pain, but, um, we gotta take a break. We gotta pause and we'll come back and keep talking about pain.

Tina 17:13

And discomfort for those who don't wanna admit they're in pain.

LEAH 17:16

All right. We'll be back.

PQRST for communicating your pain

Tina 17:27

All right, so we mentioned what is best for the doctor to hear is your best attempt at describing what's going on, and from our perspective as clinicians trying to hear the most accurate version of your pain so we can address it appropriately. We use what is called P Q R S T. P Q R S T is universal. This is something that is done in all. Doctor's offices. This is your conventional doctor, your naturopath, your physical therapist, right? The nurses, everybody knows P Q R S T. And P stands for what? Provokes the pain, what makes it happen? Are there positions? Is it something that you do, that triggers it? What makes it better? What makes it worse? So provocation. Palliation. So keeping some kind of diary helps, this is the time of day that I have the most pain. It happens this long after I eat, or it happens in the night or whatever. Um, the next is quality. The cue is for quality. What's the quality of the pain? And we talked about that already. Like what are your adjectives? How can you describe the pain?

LEAH 18:28

So, and I have issue with the, the number scale, because one person's four can be someone else's 10. And when I go in, I always tell, like when I go into urgent care or whatever, I tell the provider, I never give pain a 10 because I, I know in my head there is possibly worse pain in the world. But you know, and I, I used to feel like I had a higher tolerance for pain. And now, especially like with my neuropathy and my feet, like, I feel like I have less tolerance for pain because it's so like hyper sensitive. And so when I went in for my broken toes, the MA was like, oh, you know, are you having pain right now? And I literally was not having pain at that moment, but if I were to walk, I would've had pain. And so I felt like my entire appointment, it was dismissed because at that moment that they asked me, I wasn't having pain.

Tina 19:22

Oh,

LEAH 19:23

what I mean?

Tina 19:24

Okay. Yep, yep.

LEAH 19:26

So yeah, the, the number system part, I think is, um, it's one of the hardest things for me. And so what I usually do is I think of the pain that I have, give it a number in my head and then double it. And if, and then that's kind of my way of being like, well, it's like a three, but if I doubled it, would it be a six? it's not. So yeah, that's probably right. Or if I double it and it would be the worst pain ever. Yeah, that's accurate.

Tina 19:56

it, it brings up a really good point, and that is that the one to 10 scale is subjectivity on top of subjectivity, right? Pain is subjective. And then we will rate pain according to our life experiences. Right. So if you've had, let's just say I actually did have this, I had a patient who was run over by a van,

LEAH 20:14

It's horrible.

Tina 20:15

it's horrible. Broke her pelvis several places. Like there's, she was an excruciating pain. I'm gonna guess, you know, objectively, from my perspective, she had to be a nine or 10 out of a 10. And you know, when I ask her about the pain of her surgery, In her context, having lived through that pain, you know, she doesn't have much pain, if you give her a scale of one to 10, she would say three, maybe four. And I mean, to another person who's never been through excruciating pain, that might be an eight or nine. And then you have the perception of pain being different in each person. So it's, it's completely and utterly subjective, the the one to 10 scale.

LEAH 20:50

right. Because like a three or four could be really painful to someone. And a doctor hears that and they're like, oh, you're not really in pain.

Tina 20:56

Right. Right. A three or four could be enough to keep you up all night, but the doctor doesn't know that. So I think when they do the one to 10 scale, it's only useful in that person. In other words, Leah Sherman, if you come to my office and you say, you know, this week you have a four out of a 10, and next week's two out of 10, I'm gonna assume you have half the pain next week. Right. So it's only. Valid for the person at hand. I think it's only valid for trending. So watching a trend in one

LEAH 21:24

Sure.

Tina 21:25

if you go to urgent care and you see some doctor you've never known before and they ask you zero to 10, it's fairly meaningless. I mean, really that means how do they know what that means? so yeah, to your point, it is not the most useful way. Maybe those little faces are better in that sense which one of these little faces do I feel like, how miserable do I feel at the moment? So anyways, pq, R s T, the R is region and radiation. So the region, when you broke your toe, raise your foot and did it radiate. and if you went to the urgent care and you, did say, yes, it hurts. And they would say, does it go up your leg or anything? They would know if there was nerve damage with that break. Right? So radiation often indicates there's nerve involvement. so this is, where is your pain? Does it go anywhere? Does it travel? Do you get another pain somewhere else at the same time? And then the severity scale, which we just touched on, zero to 10 or the faces or, or just what does it make you do? Like I have pain, I have to lie down. Or I have pain and I have to sit down or whatever, so, so that helps understand the severity how is this disrupting your life,

LEAH 22:27

Right. Yeah. So if it's a three or four out of 10, but. It's preventing you from doing something that you need to do in your day-to-day. That's important,

Tina 22:40

right? So it's almost more important to tell. What the result is of your pain? Like what happens? I have pain, so I can't stand up in the kitchen, that gives a better gauge to the clinician, how it limits your actual movements or how it limits And then the last is timing. You know, the, when did it start? How long does it last each time? Does it recur? Does it, is it intermittent or is it consistent? And so does it happen every day, every week, randomly, So that timing is really important too. So the pq, R s T, if you think about that before your visit, because we all know that there's a lot of reasons it may not. Be top of mind to be super articulate during the visit. Think about this beforehand. Go in with this thought out, and that way you'll be able to give a really thorough history, which helps you get relief sooner

And, "O" for Other

Tina 23:32

than later.

LEAH 23:32

And I think also, I'm gonna add an O to that and I think there probably is an O, but I think other symptoms that also go along, um, I've had pain where it's so bad, I tell people like I can taste it.

Tina 23:44

Taste the pain.

LEAH 23:45

yeah, like, like certain pains. It's just such a bad pain. I don't know what it that is, but I can taste the pain. you can have pain that also results with weakness. And so again, that could be like a nerve involvement type thing. Um, obviously pain can provoke nausea. it can affect your appetite. Which as we know in cancer care, that is a huge thing, to, you know, have to manage because we don't want anyone to have their appetites affected and lose weight and then not be able to go do treatments. And, obviously it can affect sleep. but then also someone can present with anxiety, and that can be from pain or anticipation of, you know, that pain is gonna happen once I get this treatment. And so, There are other symptoms that also go along with pain, and I think those need to be, considered.

Tina 24:34

Yeah, I think that's a, that's a really good point cuz I think of some of the medications that are used to help with pain or some of the natural agents that help with pain and they not only help with pain perception, so they can help you change the perception of the pain. They can also be helpful for the anxiety. And, and a classic example as you know, the what the chemo's going to do. And so it's normal to have some anxiety. Actually, I think it's hardwired in us when you're gonna go through something that's gonna be uncomfortable or have a negative feedback in the way of discomfort afterwards to have some anxiety. Your sympathetic nervous system kicks in like, ugh, not again. So I think that. That's a really good point to talk about mood changes and make sure that that's part of the whole picture, because sometimes the medication or the natural agent can help with both pain and anxiety.

LEAH 25:19

Right.

ASCO booklet on cancer pain management

Tina 25:20

I wanna mention that there is a really, really good booklet by the American Society of Clinical Oncology called Managing Cancer Related Pain, and it's about 32 pages long PDF. But it really is thorough in understanding it from a patient perspective and how to get relief. And ASCO also is the entity that creates cancer.net and cancer.net has an app for mobile devices. So they even have ways of, tracking everything that we're talking about, the P Q R S T in a very accessible way. On your phone or on paper. So you can check out their website, cancer.net. You can also from that website find their, their app, which is cancer.net app. and that PDF that I mentioned, managing Cancer Related Pain from ASCO Answers. Um, really useful and a great place to get a lot more information than we can fit into one podcast.

LEAH 26:17

Yeah. And it breaks everything down. It breaks everything down and, it's simple to understand. It's not gonna be overwhelming.

Tina 26:24

Yes, it's meant for patients, not for docs. So it's accessible. So should we take a break and then come back?

LEAH 26:31

Sure.

Winding down...

LEAH 26:40

All right, so we are back and you know, there's like so much that we can go into about pain. Like we could do multiple episodes, but we are gonna do one more episode, at least for this pod. unless you want like a three hour episode.

Tina 26:57

No, when we, when we have our own channel on Sirius Satellite Radio, we can do that,

LEAH 27:01

Oh sure. yeah. Yeah, that's totally, but, but yeah, so I know people are like, yeah, but what can I do about my pain? And so we'll talk more about what we do with our patients in terms of helping to manage their pain and related side effects. so in this episode we covered how to talk to your provider about the pain that you're experiencing. at the beginning we used some words that are part of a questionnaire that we will link to, the McGill Pain questionnaire and. Yeah, look through those words. If you're experiencing pain and you don't feel like you're getting it through to your doctor, use some of those words.

Tina 27:47

Yeah. And if for some reason you don't think your doctor's taking it seriously enough, really emphasize how it's changing your day-to-day life, I think that that gets everyone's attention cuz nobody really wants your quality of life to be diminished. And so if you frame it in such a way to say this is what's happening and you know, I think that we also have a, uh, tendency across the board to not wanna be vulnerable or weak or look. Like, we're not handling things well. but I would emphasize that once the door closes and you're in the doctor's office, please just bear the whole story and don't try to be anything more than real with them.

LEAH 28:23

And I think pain, there's also a big cultural component when trying to get a patient's. History because, some people will never want to show that they are in pain because it's a sign of weakness. So if you're a caregiver and you know this about the person that you know, your loved one, convey that to the doctor that, oh yeah, they're dismissing it, but they, that's what they do. Cuz you can't control the pain if you're not getting the full picture as to what's going on.

Tina 28:55

Yeah, and I know a lot of our colleagues also listen to our podcast. And so if you're a clinician of any kind and you are, your perception is that this couple in front of you, um, perhaps the person who's going through. Treatment or who has a history of cancer is underestimating their discomfort. You can, as the practitioner turn to their partner, their wife, their husband, whatever, whoever's with them, their loved one. And say, from your perspective, what's your perception of their pain? Do you think that they have more pain than they're saying? I mean, I, I have done that because some people are super stoic and that's just who they are. And they're not gonna admit, they're just gonna, you know, grin and bear it. And so sometimes it helps.

LEAH 29:34

Don't suck it up.

Tina 29:35

Don't suck it up. It's not in your best interest. You know what Daffy Duck said in Looney Tunes? Daffy Duck has his beak kind of to the side, I believe. Looks at the camera and says, I don't like pain. It hurts me.

LEAH 29:48

that's so true. The

Tina 29:50

And he says that so sincerely with Earnest, you know, I don't like pain. It hurts me.

LEAH 29:55

The wisdom of the duck.

Tina 29:56

Yep. There was a lot of wisdom in Looney Tunes.

LEAH 30:04

So we got another

Shout out!

LEAH 30:06

rating. We got another rating on on the apple.

Tina 30:09

yes. Tell me it's five stars.

LEAH 30:11

I think it was five stars.

Tina 30:12

Yeah.

LEAH 30:13

Yeah. So if you're listening, if you like what you hear, leave us a rating, leave us a review.

Tina 30:20

Can I, can I tell people who aren't attuned to ratings and this kind of thing that only five stars counts? In other words, if you're gonna give us four stars or less, please email us and say why we need improvement and how we can improve Because honestly and truly people think like it's a grading system. They're like, ah, a minus. Cause there's room for improvement, which is fine. That's totally legitimate. We definitely have room for improvement. But the way ratings work online isn't quite the way we graded papers in school with, with that kind of honesty. It's either you give five stars cuz you love them or you give one star cuz you hate it. Everything else in between, just kind of. Monkeys with us.

LEAH 30:57

Don't monkey with us

Tina 30:58

I'm just saying, you know, if it's less than five stars, just reach out and tell us why

LEAH 31:02

and reach out anyways. Send us an email, the cancer pod gmail.com. Let us know what's going on. Let us know what you think. We like to get mail. We'll read your letter online if, if you want,

Tina 31:15

Yeah.

LEAH 31:16

and if you buy us a coffee to help us pay for all of the, the,

Tina 31:21

Production, the heavy production,

LEAH 31:23

the heavy production. If you want us to maintain this heavy production quality, buy us a coffee or two and we'll give you a little shout out. We'll say. Hey, thanks for buying us a coffee.

Tina 31:35

Yes, and if you like some podcast out there, and it's not as high quality as ours is because you know, we, we do actually spit shine this thing. So we do try to keep it a high quality audio for you. But there's an app called Overcast for those people who don't do it. Just so you know. If you like the content but not the quality, go to Overcast. You can listen to us over there too, by the way.

LEAH 31:55

No way. So there could be a poorly sounding podcast and you listen to it on Overcast and they fix it even though the person themselves didn't fix it.

Tina 32:06

Yeah,

LEAH 32:07

Dude did not know this. You learned something every day. Okay, so on that note, I'm Dr. Lea Sherman,

Tina 32:15

and I'm Dr. Tina Kaser.

LEAH 32:16

And this is the Cancer Pod.

Tina 32:18

Until next time.

32:19

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.