WEBVTT
00:00:08.240 --> 00:00:11.919
Hi everyone and welcome to Doctors Unscripted.
00:00:12.240 --> 00:00:16.480
Today I'm very pleased to present to you our guest, Dr.
00:00:16.640 --> 00:00:18.160
Victoria Mandalares.
00:00:18.800 --> 00:00:19.120
Dr.
00:00:19.359 --> 00:00:25.199
Mandalaris is a medical oncologist working at the Cedars Cancer Center of the MUHC.
00:00:25.519 --> 00:00:38.880
She completed her internal medicine and medical oncology residencies at Ben Gill and then went on to complete a two-year fellowship at the Princess Margaret Cancer Center in gynecologic care and drug development.
00:00:39.200 --> 00:00:50.719
She specializes in the treatment of GI and gynee cancers, and she's the principal investigator on several phase one to three clinical trials investigating novel therapeutics.
00:00:51.119 --> 00:00:58.880
She's had the privilege of enrolling cancer patients on innovative trials, with some patients being the first in the world globally to participate.
00:00:59.439 --> 00:01:11.120
She also holds the position of assistant professor at Miguel, and she serves as a program director of the Medical Oncology Residency where she served from 2020 to 2025.
00:01:11.519 --> 00:01:19.680
In this capacity, she won the Emerging Leader Award in 2022 for the pioneering work she accomplished as program director.
00:01:20.480 --> 00:01:27.120
Her research includes transformational studies for identification of treatment biomarkers in gynecologic cancers.
00:01:27.439 --> 00:01:38.000
And she's currently focused on developing a database of rare gynecologic cancers, for which she secured the Cedars Cancer Foundation Henry Shabata Fellowship Award in 2021.
00:01:38.640 --> 00:01:55.120
And finally, she also sits on the Human Resources Committee of the Canadian Association of Medical Oncologists and received their Volunteer of the Year Award in 2025 for organizing the first ever National Medical Oncology Career Fair for Medical Oncology Trainees.
00:01:55.439 --> 00:01:56.000
Fantastic.
00:01:56.640 --> 00:02:00.879
That's a long brief bio for somebody who's not that many years in practice, I think.
00:02:00.959 --> 00:02:05.840
And I I dare say I think you are probably the most junior person I've had on this podcast.
00:02:06.000 --> 00:02:06.480
Welcome.
00:02:06.640 --> 00:02:09.840
Actually, on that note, how how long have you been in practice?
00:02:10.080 --> 00:02:11.599
Um, I've been in practice now.
00:02:11.680 --> 00:02:14.719
I started in 2017, so it's eight and a half years.
00:02:14.960 --> 00:02:16.159
Okay, eight and a half years.
00:02:16.319 --> 00:02:16.879
Fantastic.
00:02:17.039 --> 00:02:17.680
Well, welcome.
00:02:17.919 --> 00:02:18.639
Tell me about it.
00:02:18.719 --> 00:02:22.319
So tell me a little bit about your journey to get to where you are now.
00:02:22.719 --> 00:02:28.879
Yeah, so I have to say um it wasn't a very um obvious journey.
00:02:29.120 --> 00:02:34.080
When I started in medical school, I was convinced I wanted to be um a family physician.
00:02:34.159 --> 00:02:34.319
Okay.
00:02:34.560 --> 00:02:45.680
And just by a series of events where randomly I get I kept getting put onto rotations in oncology, I realized, oh, maybe this isn't as depressing as everybody makes it out to be.
00:02:45.840 --> 00:02:52.719
Um and so then at the very last minute, I decided to apply into internal medicine uh when CARMS was rolling around.
00:02:52.960 --> 00:03:00.240
And I think the most important thing is that every step of the way, I had somebody who really encouraged me and mentored me.
00:03:00.479 --> 00:03:03.199
So when I was applying into internal medicine, Dr.
00:03:03.280 --> 00:03:08.240
Michael Seabag, who works here, was very um happy about it, encouraging.
00:03:08.319 --> 00:03:10.960
I'd worked with him wonderfully on the ward.
00:03:11.120 --> 00:03:16.800
And now we're colleagues, and I tell them every day that every time I see him, that the reason why I'm here is because of him.
00:03:16.960 --> 00:03:20.319
And then just every step of the way, there's somebody who kind of guided me.
00:03:20.400 --> 00:03:24.639
So I think finding that those people, those mentors is so, so important.
00:03:24.800 --> 00:03:36.159
You know, even my fellowship in Toronto is a medical oncologist here who said, you have to do this, who helped me set it up and really So you found there was support to help you get set up because that's so important.
00:03:36.319 --> 00:03:39.280
Those couple of years of fellowships could be career-defining.
00:03:39.520 --> 00:03:40.000
Absolutely.
00:03:40.159 --> 00:03:41.120
It's so important.
00:03:41.360 --> 00:03:51.439
It's um, I think even more so important to keep an open mind because gynecologic cancers were really not on my radar at all, especially in Quebec.
00:03:51.520 --> 00:03:56.240
It's mostly the gynecologic oncology surgeons here who treat those cancers.
00:03:56.400 --> 00:04:03.680
Um, but I was convinced that there was really an unmet need from a medical oncology point of view and that it could be a really good niche for me in terms of my career.
00:04:03.840 --> 00:04:05.759
And it's something that I've just really come to love.
00:04:05.919 --> 00:04:08.879
So I think keeping an open mind is really important as well.
00:04:09.199 --> 00:04:12.639
And uh and prior to medical school, did you do an undergrad degree?
00:04:12.879 --> 00:04:13.199
I did.
00:04:13.360 --> 00:04:18.480
I did um an undergrad degree in microbiology and immunology uh at McGill as well.
00:04:18.879 --> 00:04:28.160
Um I wasn't sure that I wanted to pursue medicine, and I felt going into medicine right out of SASIP was a little bit intimidating.
00:04:28.319 --> 00:04:31.120
So I really appreciated those extra three years.
00:04:31.279 --> 00:04:34.480
And it taught me, you know, the basics of science.
00:04:34.639 --> 00:04:44.000
It taught me to love lab work, but it also taught me that I needed a little bit more of a camaraderie, a little bit more of a um teamwork.
00:04:44.160 --> 00:04:51.759
I found I really liked the lab, but I found it sometimes a little bit isolating uh in terms of working on projects by myself.
00:04:52.000 --> 00:04:57.199
So um that's kind of what made me see that medicine would be, I think, a better fit for me.
00:04:57.439 --> 00:04:59.759
And uh are you are you from Montreal?
00:04:59.839 --> 00:05:04.000
Were you always, you always had the intention of coming back here even after your fellowship training?
00:05:04.240 --> 00:05:04.959
Yes, yes.
00:05:05.120 --> 00:05:07.439
So um I'm born and raised in Montreal.
00:05:07.519 --> 00:05:10.720
So are my parents, uh, my grandparents immigrated from Greece.
00:05:11.040 --> 00:05:18.319
So um I'm part of that uh generation where, you know, a lot of hopes were put on me.
00:05:18.560 --> 00:05:20.959
Um and very, very close-knit family.
00:05:21.360 --> 00:05:26.879
So uh again, you know, the plan, yes, when I left for fellowship was to come back to Montreal.
00:05:27.040 --> 00:05:29.279
It happened in a bit of a roundabout way.
00:05:29.360 --> 00:05:34.720
Uh, but again, I was open to staying in Toronto if there were options uh for me there as well.
00:05:34.959 --> 00:05:39.360
But at the end of the day, I'm really happy to be back home and you know, life changes.
00:05:39.439 --> 00:05:45.439
I have nieces and nephews now who I love dearly, and I I can't really imagine living too far away from them.
00:05:45.519 --> 00:05:49.920
So there's something really nice about coming home after being away for a couple of years.
00:05:50.240 --> 00:05:50.720
Absolutely.
00:05:51.279 --> 00:05:56.160
Now, if I remember correctly, you said something about your first year though, there wasn't a PEM here.
00:05:56.399 --> 00:05:56.800
That's right.
00:05:57.040 --> 00:05:59.120
So you were at the lake shore.
00:05:59.360 --> 00:05:59.680
Yes.
00:06:00.000 --> 00:06:02.720
So that's that's one of the complicated things about our system, right?
00:06:02.879 --> 00:06:13.519
Because you're obviously highly trained and highly skilled, and and I'm sure they wanted you here very badly, but unfortunately, we're stuck with these limited number of slots for physicians.
00:06:13.680 --> 00:06:14.000
Yes.
00:06:14.319 --> 00:06:20.000
Yeah, and that's something else that I learned that evolves so quickly because when I left, there was a PEM for I see.
00:06:20.240 --> 00:06:27.439
And that was part of the the reasoning for me to replace the only person here who is treating gynecologic cancers when he retired, Dr.
00:06:27.519 --> 00:06:28.480
Sturgeon.
00:06:28.800 --> 00:06:38.720
And um when the PEM schedule came out, they kind of decided that, oh, the MUHC doesn't need that many oncologists.
00:06:38.959 --> 00:06:44.480
So his position essentially was abolished uh while I was doing my okay.
00:06:44.720 --> 00:06:46.480
I had to kind of pivot again.
00:06:46.560 --> 00:06:48.319
I kept my my mind open.
00:06:48.560 --> 00:06:53.759
There was um a Mat Leaf replacement that was needed at the lake shore.
00:06:53.920 --> 00:06:57.759
Um, and I I knew the person who was going on Mat Leaf quite well.
00:06:57.920 --> 00:07:03.360
And so, you know, I reached out um to them and they were very happy to have me.
00:07:03.519 --> 00:07:05.519
I was there full-time for three years.
00:07:05.759 --> 00:07:09.759
Um, and it was really just a formative time for me.
00:07:10.079 --> 00:07:13.199
I really loved my my time there.
00:07:13.360 --> 00:07:20.720
Um the I think major decision factor for me switching over to the MUHC was that I couldn't do clinical trials there.
00:07:20.800 --> 00:07:24.000
And that's what I had trained in, and that's what I really wanted to do.
00:07:24.160 --> 00:07:27.519
So it was not an easy decision to make the change.
00:07:27.839 --> 00:07:32.879
Were you able when you were working at the lake shore, were you able to work here as well?
00:07:33.199 --> 00:07:33.600
I was.
00:07:33.759 --> 00:07:43.680
So I got an associate physician, and so I was here one day a week, which was nice because um I could see many more gynecologic cancer cases.
00:07:43.759 --> 00:07:46.079
Um, and again, that's what I did my fellowship in.
00:07:46.160 --> 00:07:48.480
Uh, whereas at the lakeshore there weren't that many.
00:07:48.639 --> 00:08:00.240
Um, but it also kept me in touch with all of the oncologists here and um also kind of gave me visibility when it when the PEM actually did open up and I applied.
00:08:00.560 --> 00:08:02.160
I think that's a great strategy.
00:08:02.319 --> 00:08:05.120
And and uh we're fortunate that we're able to do that, right?
00:08:05.279 --> 00:08:14.079
Cross-appoint people quite easily from other in from other centers outside the the university center and and sort of slowly integrate people in.
00:08:14.240 --> 00:08:16.079
So that worked out well for you finally.
00:08:16.240 --> 00:08:17.920
So how long have you been here full-time?
00:08:18.240 --> 00:08:21.279
So in May, it'll be five years that I'm here full-time.
00:08:21.600 --> 00:08:21.759
Yeah.
00:08:21.920 --> 00:08:22.240
Okay.
00:08:22.480 --> 00:08:29.439
And you're already, um, from what I read in your bio, you're already sort of leading clinical trials, even phase one.
00:08:29.600 --> 00:08:33.039
So phase one, for those who are not aware, are basically really, really early.
00:08:33.120 --> 00:08:41.360
Uh, these are sort of are you doing first in humans or first in can you tell us a little bit about what you're doing in terms of phase one trials?
00:08:41.440 --> 00:08:44.080
Because that's really impressive that you're doing that so early in your career.
00:08:44.399 --> 00:08:51.200
Yeah, so so I have to say I during my training, I did have um background in drug development at Princess Margaret.
00:08:51.360 --> 00:09:01.120
So it really let me immerse myself in the the field of the you know, um, inception of medications really from the very beginning.
00:09:01.279 --> 00:09:07.360
So from bench to to to bedside, really, that's what I was doing during my fellowship.
00:09:07.519 --> 00:09:10.240
So it wasn't so foreign to me when I started here.
00:09:10.399 --> 00:09:13.840
Um, the other aspect of it is that with um Dr.
00:09:14.000 --> 00:09:22.879
Sally, who runs the phase one unit um and is the director of Symoncology, uh, we've really built a very strong phase one unit with a very strong team.
00:09:22.960 --> 00:09:27.759
So it would be impossible for me to do what I'm doing without that support network.
00:09:27.919 --> 00:09:31.279
Um, but yes, um, we have trials that are first in human.
00:09:31.440 --> 00:09:38.240
We have uh um trials where we, like you said, in my bio, enrolled the first patients globally.
00:09:38.399 --> 00:09:52.320
Um, a lot of these medications um are um medications that are put first in class in terms of um treatments that are not really well known to oncology.
00:09:52.480 --> 00:09:55.120
So things like radioligand um therapies.
00:09:55.200 --> 00:09:55.360
Okay.
00:09:55.679 --> 00:10:06.639
Um we have uh other trials where the drugs are more the mechanism is more well known, but now we're trying it for the first time in certain tumor types or certain combinations.
00:10:06.879 --> 00:10:12.960
Um but it's not as complicated as it seems when you have a really good team behind you.
00:10:13.360 --> 00:10:13.840
Wonderful.
00:10:14.080 --> 00:10:15.200
That's very, very impressive.
00:10:15.360 --> 00:10:17.840
And you have a great team here at the Cedars Center.
00:10:17.919 --> 00:10:20.399
I mean, it's an impressive, impressive group.
00:10:20.720 --> 00:10:30.799
Just just, you know, I don't want to dwell on this, but what would you say to the women listening to this podcast in terms of gyne cancers, just just sort of more, you know, curious.
00:10:30.960 --> 00:10:35.759
Uh what should women be looking out for that they may not know about?
00:10:36.159 --> 00:10:44.480
I mean, I think women's health in general is just something that is so underrepresented, even in your just usual annual checkup.
00:10:44.720 --> 00:10:52.159
And I don't think that's the fault of the doctors, you know, when we're talking about things that we should be looking out for, even of the patients.
00:10:52.320 --> 00:10:56.240
I think there's just so such a lack of information out there.
00:10:56.480 --> 00:11:07.200
Um, in my field, unfortunately, what we see is a lot of patients who are young coming in with cervical cancer, which nowadays is a completely preventable disease.
00:11:07.440 --> 00:11:22.799
Um, so, you know, we're lucky in developed countries that we have vaccination programs uh against HPB, which is the major cause of cervical cancer, um, as well as well established well-established screening programs.
00:11:23.200 --> 00:11:35.519
Um, but I think, you know, just in terms of women's health in general, unfortunately, it's something for the, you know, female listeners that are out there that we're you have to really advocate for yourself.
00:11:35.600 --> 00:11:46.080
Um, make sure that, you know, you're following up with your screenings, that um, if you have any concerns, that you make sure that whatever doctor that you're speaking to takes it seriously.
00:11:46.320 --> 00:11:50.000
And if if women are getting their regular PAP tests, is that good enough?
00:11:50.240 --> 00:11:52.480
Um, it's good enough if they're staying up to date.
00:11:52.639 --> 00:11:54.240
We catch the lesions early.
00:11:54.320 --> 00:12:01.360
Um, and so um, you know, we prevent it from actually becoming a cancer, which is the most important part.
00:12:01.600 --> 00:12:11.600
Other cancers where we might see later in life, um like ovarian cancer or endometrial cancer, for instance, um, uh a lot of times have very nonspecific symptoms.
00:12:11.679 --> 00:12:27.600
And we've seen a lot of patients who've been diagnosed with advanced ovarian cancer uh really in a bad way because, you know, people are just not sensitized to the kinds of very innocuous symptoms they cause, bloating, constipation, stuff that you can attribute easily to other things.
00:12:27.759 --> 00:12:39.840
So again, I think it just goes back to really advocating for yourself and making sure that your concerns are taken seriously, because we have really good evidence from studies that show that women's concerns are often just brushed aside.
00:12:39.919 --> 00:12:48.159
And, you know, there's this bias in medicine that women tend to be more emotional or complain more, and that, you know, at the end of the day, they really have a serious problem.
00:12:48.399 --> 00:12:57.120
Is this a uh, you know, I'm just thinking back of obviously, you know, fertility has advanced a lot in the last, whatever, 20 years.
00:12:57.360 --> 00:13:01.200
Do you see more with all the fertility treatments that people have had?
00:13:01.360 --> 00:13:06.080
Are is that something that's on the rise, these kinds of cancers, or is there no, there's no correlation?
00:13:06.399 --> 00:13:08.720
I can't say, you know, the risk is is small.
00:13:08.879 --> 00:13:18.799
Um, you know, there are some studies that are showing that maybe there's a small increased risk, but I can't say that's really um the driving force uh behind these cancers.
00:13:18.960 --> 00:13:37.440
Um but at the same time, you know, the increased uptake of fertility treatments, again, I think is part of the problem that, you know, part of our usual yearly health questionnaire with our GP, if you're lucky enough to have one, doesn't include things that might be important to the patient in terms of the reproductive health.
00:13:37.519 --> 00:13:47.360
I mean, it's simple things like your AMH levels, what's your ovarian reserve like, you know, if especially in medicine, is this something that you should be thinking about seriously?
00:13:47.600 --> 00:13:50.720
Because most of us don't have normal career paths.
00:13:50.879 --> 00:14:07.759
When I was in residency, my friends had already finished their undergrads and other fields and had started working and bought houses and had mortgages and, you know, were planning the rest of their lives, or I was just trying to survive through my internal medicine callships.
00:14:08.080 --> 00:14:18.320
So I think just at least having that information to know what to do about it is really important and it's something that's it's just not built into the system.
00:14:27.200 --> 00:14:31.039
This podcast is being brought to you by the MUHC Foundation.
00:14:31.200 --> 00:14:41.919
The MUHD Foundation funds cutting-edge research at both the MUHC and its research institute and supports excellence in patient care for millions of Quebecers.
00:14:42.399 --> 00:14:54.879
You can follow them on social media or take a look at their website at www.muhcou-n-d-a-t-i-o-n.com, muhc foundation.com.
00:15:03.759 --> 00:15:04.559
Do you have a partner?
00:15:04.720 --> 00:15:05.279
I don't have a partner.
00:15:05.519 --> 00:15:06.320
You don't have a partner.
00:15:06.559 --> 00:15:16.559
And um, you know, certainly when I was going through residency, fertility was a topic commonly discussed amongst residents and young staff for the same for the exact reason that you mentioned.
00:15:16.639 --> 00:15:18.399
You know, we have different career paths.
00:15:18.559 --> 00:15:27.840
We start our our jobs, we start sort of our real life as a as a grown-up that's no longer studying and no longer has exams, much later than everyone else.
00:15:28.000 --> 00:15:31.600
So fertility becomes an issue as you delay it.
00:15:31.759 --> 00:15:38.480
Uh, is that still that is still a concern for sort of people in your your sort of cohort?
00:15:39.200 --> 00:15:39.679
Absolutely.
00:15:39.840 --> 00:15:40.799
Absolutely, 100%.
00:15:41.279 --> 00:15:47.919
And I feel like every other friend that I speak to who's had a baby has gone through some kind of fertility treatment.
00:15:48.080 --> 00:15:58.559
Um and so, you know, what the reason is, is it because they're delaying uh having children, or is it because we're in such high stress um environments?
00:15:58.960 --> 00:16:00.240
There's been really good studies.
00:16:00.399 --> 00:16:10.639
There was a study, I think, out of uh the annals of surgery that showed that female surgeons, um, especially if they didn't cut back their hours, had worse pregnancy outcomes.
00:16:10.879 --> 00:16:16.879
So, or even just becoming pregnant, you know, and carrying through a baby to term, the miscarriage rates were higher.
00:16:17.039 --> 00:16:24.720
So I think it's definitely something that is top of mind for a lot of us in medicine, if we do want children.
00:16:24.960 --> 00:16:27.840
I don't think it's talked about enough.
00:16:28.240 --> 00:16:29.440
Yeah, I agree with you.
00:16:29.679 --> 00:16:37.679
Uh, and and uh it is something I I must I do make a point when I have female residents and uh actually not even just female.
00:16:37.840 --> 00:16:50.159
I was with our our cohort of cardiology fellows the other day, males and females, and it's actually the males too, because a lot of them have partners who are also waiting until the male finishes, right?
00:16:50.320 --> 00:16:54.480
And so everybody's sort of delayed, and I think it does affect everyone.
00:16:54.720 --> 00:16:59.120
And so, so what can one do?
00:16:59.519 --> 00:17:03.519
Yeah, so I think just getting the information to start with is is really powerful.
00:17:03.679 --> 00:17:19.039
Um, like I said, you know, I know some people who had just started going through the steps for fertility treatments with their partner and were really surprised to find out that even in their early 30s, their obarian reserve was very low.
00:17:19.279 --> 00:17:25.599
Um, you know, so just having that information can help guide you and make a lot of choices.
00:17:25.759 --> 00:17:28.960
Um personally, I uh froze my eggs.
00:17:29.119 --> 00:17:30.319
It was not an easy process.
00:17:31.279 --> 00:17:31.599
Yeah.
00:17:31.759 --> 00:17:34.000
And it's not a guarantee either, you know.
00:17:34.160 --> 00:17:36.799
Um so how what does I don't know much about that?
00:17:36.960 --> 00:17:39.519
So, so can I ask how old were you when you froze your eggs?
00:17:39.599 --> 00:17:41.599
So I was probably a little bit older than I should have been.
00:17:41.759 --> 00:17:44.160
I was 36 37.
00:17:44.640 --> 00:17:51.279
Um, but you know, again, it's it's financially, it's not something that's covered by healthcare.
00:17:51.440 --> 00:18:00.319
Um it is it's it's costly, it costs a few thousand dollars when you're in residency trying to decide whether you're gonna pay for your royal college exam.
00:18:00.640 --> 00:18:00.880
Yes.
00:18:01.119 --> 00:18:06.480
Or if using your eggs that you know costs about the same amount of of money.
00:18:06.720 --> 00:18:10.000
Um, so and and it's not a guarantee.
00:18:10.160 --> 00:18:17.920
Um, it's kind of like buying an insurance policy and then your house catching fire and finding out they'll only cover 60% of the the cost.
00:18:19.920 --> 00:18:27.839
So um, so and then it's it's also time consuming and it's not something that you can plan for uh in an organized way.
00:18:28.000 --> 00:18:50.319
So I was already on staff at the lakeshore and having to reJID clinics and um So you're you're giving you while you were working, you were giving yourself injections, I imagine, to stimulate Yeah, doing injections uh at one point twice a day um to stimulate um the the follicles uh to grow.
00:18:50.559 --> 00:18:58.000
And then uh every couple days, ultrasounds at the fertility clinic um to see how things were progressing.
00:18:58.160 --> 00:19:09.839
So that meant appointments and waiting and while you wait, while you patients waiting is a meaning clinic, uh and then the actual retrieval where you can't work that day, you should work the day after.
00:19:10.000 --> 00:19:17.039
Um, but you don't know when that date's gonna be because they tell you a day or two before, okay, you're ready to go.
00:19:18.079 --> 00:19:22.559
So then at the very last minute, again, rejigging clinics, moving patients.
00:19:22.880 --> 00:19:25.920
So uh the whole process took about two weeks.
00:19:26.079 --> 00:19:28.240
Um, and and it was stressful.
00:19:28.640 --> 00:19:36.640
I believe it, but but I imagine it's really stressful and probably painful and and you know, everything and uncomfortable, all of these things, I imagine.
00:19:36.799 --> 00:19:36.960
Yeah.
00:19:37.200 --> 00:19:41.759
But I guess there's a sense of relief after that, is there?
00:19:42.079 --> 00:19:44.160
There's there's a minor sense of relief.
00:19:44.400 --> 00:19:52.400
Minor sense of relationship I would say, you know, especially as a physician, like I know the stats, I know what what the outcome can be.
00:19:52.640 --> 00:19:56.160
Um, it it's nice to know that there's a possible option.
00:19:56.319 --> 00:20:01.920
Yes, but also at the same time, you know that there's a chance that it might not work out.
00:20:02.240 --> 00:20:18.480
So um it buys you some time, I would say, but at a certain point, you have to, especially, you know, if you want to carry a pregnancy fully determined, you have to decide at what age is that going to be um optimal at, especially if you don't have a partner.
00:20:18.640 --> 00:20:18.799
Yeah.
00:20:19.039 --> 00:20:26.720
Because, you know, when I froze my eggs, the idea was that it would be to give me a chance to find a partner.
00:20:27.039 --> 00:20:27.359
Partner.
00:20:27.680 --> 00:20:33.759
And I still don't have a partner, and I have to kind of make decisions about would you consider having a child on your own?
00:20:33.839 --> 00:20:37.119
I know it's a very personal question, but I've definitely considered it.
00:20:37.200 --> 00:20:38.319
And I have friends who have done it.
00:20:38.480 --> 00:20:38.559
Okay.
00:20:38.880 --> 00:20:45.200
So, you know, I think more women are kind of heading down that route for many reasons.
00:20:45.440 --> 00:20:58.880
Um, but um, they also, which is very interesting, make you meet with a psychologist before you go through this process just to make sure that from a mental health point of view, you're in the right space to be doing all of this.
00:20:59.039 --> 00:21:05.599
And what she said to me is that people feel that life has to unfold in a certain order.
00:21:05.839 --> 00:21:08.880
And, you know, you meet somebody, you get married, you have kids.
00:21:09.119 --> 00:21:11.279
And she said, but really it doesn't.
00:21:11.519 --> 00:21:12.000
It doesn't.
00:21:12.160 --> 00:21:12.640
That's right.
00:21:12.799 --> 00:21:13.920
That's just institutional.
00:21:14.079 --> 00:21:16.079
That's just that's artificial, right?
00:21:16.559 --> 00:21:16.880
Yeah.
00:21:17.119 --> 00:21:18.400
And good for you though.
00:21:18.480 --> 00:21:19.599
That's really impressive.
00:21:19.759 --> 00:21:20.000
Yeah.
00:21:20.240 --> 00:21:20.720
Really it is.
00:21:20.880 --> 00:21:22.400
And would you so what would you consider?
00:21:22.799 --> 00:21:34.960
I mean, looking back, what would you tell somebody who's, you know, going, you know, doing a long residency that's going to allow them to emerge from all this at age 36, 37?
00:21:35.599 --> 00:21:40.319
What would would you, you know, and they're let's say they're on their own, you know, they're 30, 31.
00:21:40.480 --> 00:21:43.680
Would you, would you cons think that they should consider this?
00:21:44.000 --> 00:21:53.839
I would say if they feel like they want to have children in the future, this is something that's really important to them, then I would definitely freeze my eggs.
00:21:53.920 --> 00:21:56.240
I I would I should have done it a lot ear earlier.
00:21:56.480 --> 00:21:57.200
When would you have done it?
00:21:57.359 --> 00:21:58.400
When would it be an ideal time?
00:21:58.720 --> 00:21:59.759
Yeah, I probably.
00:22:00.160 --> 00:22:03.599
Probably not during the um year I was studying for the internal medicine.
00:22:05.039 --> 00:22:06.160
That would be horrible.
00:22:07.200 --> 00:22:15.359
But but maybe after, you know, definitely if I if I look back in my early 30s, it would have been a better time to to do it.
00:22:15.599 --> 00:22:28.160
And you know, the financial costs, like we especially coming from a an immigrant background, you know, like debt is such a horrible thing, but you make it up so fast when you make it up so fast once you start working as staff.
00:22:28.400 --> 00:22:34.960
So, you know, that like$5,000 that it cost me to do all of this, like it's a drop in the bucket.
00:22:35.119 --> 00:22:41.039
And, you know, I I feel like I was worried about it back then, but I would tell my younger self, don't worry about it.
00:22:41.359 --> 00:22:41.920
Don't worry about it.
00:22:42.000 --> 00:22:42.720
No, that's right.
00:22:42.799 --> 00:22:45.519
Those few thousand dollars are not going to make a difference in your life.
00:22:45.680 --> 00:22:57.119
I find though, still, it always surprises me to this day because I, you know, it is a topic I bring up with female residents, and as I said, even with, you know, with male residents, I kind of often get sort of blank stares.
00:22:57.200 --> 00:23:00.720
Like I get the sense people don't really believe it will happen to them.
00:23:00.880 --> 00:23:13.359
You know, there's this sort of sense of, yeah, I've I think women in medicine have always been people who've accomplished what they've wanted to accomplish and probably have certain control over their lives.
00:23:13.519 --> 00:23:20.240
And the sense I get is that people are kind of thinking, you know, I have a friend who had a kid at 37, then they had no trouble.
00:23:20.480 --> 00:23:22.960
You know, there's always going to be sort of someone like that.
00:23:23.119 --> 00:23:30.000
Um the real fertility, you know, peaks in your early to mid-20s, if I'm correct, right?
00:23:30.240 --> 00:23:34.880
Yeah, I think the stat is something like after 28, it starts to fall.
00:23:35.039 --> 00:23:36.400
Um, it's a real thing.
00:23:36.640 --> 00:23:38.000
It's a real thing for sure.
00:23:38.240 --> 00:23:41.440
Um, it's not very, again, it's not something that's very well studied.
00:23:41.759 --> 00:23:42.640
It's not very well studied.
00:23:42.880 --> 00:23:43.039
Yeah.
00:23:43.200 --> 00:23:49.279
So is it possible that, you know, in your later 30s, you'll have a child with without any complications?
00:23:49.519 --> 00:23:51.119
Absolutely, it's possible.
00:23:51.279 --> 00:23:55.599
Uh, freezing eggs is just like I said, a little bit more of an insurance policy.
00:23:55.680 --> 00:24:00.400
Or embryo is even better if you have a partner and you just kind of have to be more stable.
00:24:00.720 --> 00:24:18.720
Um, but um, you know, I I just think again, it's something that needs to be worked into just like the general health questionnaire for for women and men, you know, because there is the aspect of male infertility as well.
00:24:18.880 --> 00:24:20.880
So it's something that you really want.
00:24:21.039 --> 00:24:25.359
There's nothing wrong with asking your GP just for an AMH blood test.
00:24:25.519 --> 00:24:28.559
Um, and it'll give you an idea of your is that done routinely?
00:24:28.799 --> 00:24:29.359
It's not.
00:24:29.519 --> 00:24:30.000
It's not.
00:24:30.160 --> 00:24:30.400
Yeah.
00:24:30.640 --> 00:24:31.359
Is that an expensive?
00:24:31.599 --> 00:24:32.240
Why is it not done?
00:24:32.319 --> 00:24:35.759
Is it expensive or it's a little, it's not costly.
00:24:35.839 --> 00:24:41.759
I don't think it's, you know, thousands of dollars, but it's definitely more expensive than like a thyroid profile.
00:24:41.920 --> 00:24:44.240
Um, but I think just people don't think of it.
00:24:44.400 --> 00:24:47.680
I think it's like again, it's not worked into the teaching in medical school.
00:24:47.759 --> 00:24:47.920
Okay.
00:24:48.319 --> 00:24:53.440
The um, you know, the information we have about women's health in general is dismal.
00:24:53.759 --> 00:24:57.599
Um, the amount of research money that goes towards it is dismal.
00:24:57.759 --> 00:25:03.519
Um, I heard something along the lines of there's more funds that go into research for erectile disposal.
00:25:05.279 --> 00:25:09.759
There is for endometriosis, which is such a huge problem for for women.
00:25:10.079 --> 00:25:12.079
That's another cause of infertility.
00:25:12.160 --> 00:25:16.240
And, you know, a substantial proportion of women suffer from endometriosis.
00:25:16.400 --> 00:25:23.440
So I just might think, but nobody, there's no screening, there's no there, there's nothing that's being done proactively.
00:25:23.599 --> 00:25:29.920
It's something that we retroactively act on when a couple or a woman is experiencing infertility.
00:25:30.079 --> 00:25:32.240
So I just think it goes back to systems.
00:25:32.480 --> 00:25:33.119
Yes.
00:25:33.440 --> 00:25:36.799
So hopefully, I mean, there's more, there are more and more women in medicine.
00:25:36.960 --> 00:25:40.720
I think the medical classes are now predominantly more females than males, right?
00:25:41.119 --> 00:25:42.000
Women are majority.
00:25:42.079 --> 00:25:43.920
So hopefully that is going to change, right?
00:25:44.000 --> 00:25:45.279
There's a lot, a lot of work.
00:25:45.440 --> 00:25:53.279
And I know this institution and the foundation here is really, really supportive of women's health and trying to advance that within the institution.
00:25:53.440 --> 00:25:56.400
Because then there's the other side, which is the menopause side.
00:25:56.480 --> 00:25:56.559
Yeah.
00:25:56.720 --> 00:26:00.720
And perimenopause that has many, many unanswered questions as well, right?
00:26:00.880 --> 00:26:21.039
So as women, you know, there's the and when you think about it, you're you're working alongside colleagues, you know, as as you told us, you know, you're getting injections going from ultrasound, and your male colleagues are just kind of going, yeah, on with their day, you know, with absolutely, you know, completely unbothered by anything.
00:26:21.119 --> 00:26:25.119
And here you are with these hormonal shifts and ultrasounds and tests.
00:26:25.200 --> 00:26:30.240
And so you're living a very different life during this period than your male colleagues.
00:26:30.640 --> 00:26:31.839
Absolutely, absolutely.
00:26:32.000 --> 00:26:35.839
I mean, the truth is the system was set up for men who had wives at home.
00:26:36.079 --> 00:26:39.200
Men's to it's but not more.
00:26:39.839 --> 00:26:46.079
Another statistic by 2036, so in 10 years, there'll be more female doctors than men in the system.
00:26:46.400 --> 00:26:53.359
Um, so you know, it's it's I think something, a system that has to change that will take some time.
00:26:53.519 --> 00:27:03.200
But I think as women, we can start adjusting the way we act, you know, and a part of that is at the lakeshore, I was very lucky to have a very good team.
00:27:03.440 --> 00:27:11.440
And so, you know, I was very open with my nurses, with our admins, what was happening, why I had to, you know, ship my clinics around.
00:27:11.599 --> 00:27:16.960
And they were so, so supportive and so happy for me that I was doing this and so helpful.
00:27:17.039 --> 00:27:26.160
And so it's just a matter, I think, of being more open about these kinds of things and also the people on the receiving end being more supportive and helpful as well.
00:27:26.240 --> 00:27:32.240
So it's much as the male colleague is not going through this, if you say, Hey, can you cover me on the call day?
00:27:32.400 --> 00:27:35.759
Like it would be really nice to be able to have that support.
00:27:36.240 --> 00:27:37.119
To have that support.
00:27:37.359 --> 00:27:42.400
Thank you for sharing that with us because this is you know very important and something that we don't talk about often.
00:27:42.480 --> 00:27:45.440
So I really appreciate you you telling us about this.
00:27:45.599 --> 00:27:47.039
What do you do for fun?
00:27:47.920 --> 00:27:49.680
Because you're obviously working really hard.
00:27:49.839 --> 00:27:51.039
That's so yeah, yeah.
00:27:51.119 --> 00:27:52.160
Well, I just got a new puppy.
00:27:52.400 --> 00:27:53.920
Oh, that's an amazing what kind of puppy?
00:27:54.079 --> 00:27:55.359
So it's called a cockleer.
00:27:55.599 --> 00:27:58.880
He's uh cross between a cocker spaniel and a cavalier of King Charles.
00:27:58.960 --> 00:27:59.759
Uh yeah.
00:27:59.920 --> 00:28:01.920
And so that's been taking up all my time.
00:28:02.079 --> 00:28:02.400
Yes.
00:28:02.559 --> 00:28:07.279
Um, also reminding me of my residency days because I'm waking up several times.
00:28:09.200 --> 00:28:20.480
So I don't think I've been this tired since internal medicine, but um that's like really right now uh what is bringing much joy to my life.
00:28:20.640 --> 00:28:25.279
And other than that, like I said, I have my my nieces and my nephews and my family around.
00:28:25.440 --> 00:28:30.799
And um, you know, being a big Greek family, we take uh a lot of joy in each other.
00:28:30.880 --> 00:28:32.880
And yeah, terrific, terrific.
00:28:33.119 --> 00:28:33.920
One last question.
00:28:34.000 --> 00:28:35.680
What would you tell your younger self?
00:28:35.839 --> 00:28:40.880
Here you are, very accomplished, you've gotten, I think, where you want to be, right?
00:28:40.960 --> 00:28:42.880
It sounds you have a brilliant career.
00:28:43.039 --> 00:28:44.720
What would you tell your younger self?
00:28:45.039 --> 00:28:49.119
I would tell my younger self that you don't have to do it all alone.
00:28:49.279 --> 00:29:02.960
You know, I think as women, especially in medicine, we really want to portray this um facade of strength because there's so many prejudices against us, being weak, um, not being able to hack it.
00:29:03.119 --> 00:29:10.400
And so I would tell my younger self that you'd be surprised how many people are will want to be supportive of you and to ask for help.
00:29:10.720 --> 00:29:12.160
That's that's wonderful.
00:29:12.400 --> 00:29:13.519
Really, thank you so much.
00:29:14.400 --> 00:29:17.599
Thank you for really discussing this very personal topic with us.
00:29:17.759 --> 00:29:22.799
Congratulations on all your accomplishments after just so few years into your career.
00:29:22.960 --> 00:29:26.960
So, thank you so much for sharing your story with us and continued success.
00:29:27.279 --> 00:29:27.599
Thank you.
00:29:27.680 --> 00:29:28.880
Thanks, Nadia, for having me.
00:29:29.119 --> 00:29:29.359
Thank you.
00:29:29.440 --> 00:29:32.400
And to our listeners, I wish you all a great day.
00:29:45.519 --> 00:29:50.400
We also would appreciate it if you could take a moment to rate the show or leave a review.
00:29:50.559 --> 00:29:52.319
Thanks so much for listening.
00:00:08.240 --> 00:00:11.919
Hi everyone and welcome to Doctors Unscripted.
00:00:12.240 --> 00:00:16.480
Today I'm very pleased to present to you our guest, Dr.
00:00:16.640 --> 00:00:18.160
Victoria Mandalares.
00:00:18.800 --> 00:00:19.120
Dr.
00:00:19.359 --> 00:00:25.199
Mandalaris is a medical oncologist working at the Cedars Cancer Center of the MUHC.
00:00:25.519 --> 00:00:38.880
She completed her internal medicine and medical oncology residencies at Ben Gill and then went on to complete a two-year fellowship at the Princess Margaret Cancer Center in gynecologic care and drug development.
00:00:39.200 --> 00:00:50.719
She specializes in the treatment of GI and gynee cancers, and she's the principal investigator on several phase one to three clinical trials investigating novel therapeutics.
00:00:51.119 --> 00:00:58.880
She's had the privilege of enrolling cancer patients on innovative trials, with some patients being the first in the world globally to participate.
00:00:59.439 --> 00:01:11.120
She also holds the position of assistant professor at Miguel, and she serves as a program director of the Medical Oncology Residency where she served from 2020 to 2025.
00:01:11.519 --> 00:01:19.680
In this capacity, she won the Emerging Leader Award in 2022 for the pioneering work she accomplished as program director.
00:01:20.480 --> 00:01:27.120
Her research includes transformational studies for identification of treatment biomarkers in gynecologic cancers.
00:01:27.439 --> 00:01:38.000
And she's currently focused on developing a database of rare gynecologic cancers, for which she secured the Cedars Cancer Foundation Henry Shabata Fellowship Award in 2021.
00:01:38.640 --> 00:01:55.120
And finally, she also sits on the Human Resources Committee of the Canadian Association of Medical Oncologists and received their Volunteer of the Year Award in 2025 for organizing the first ever National Medical Oncology Career Fair for Medical Oncology Trainees.
00:01:55.439 --> 00:01:56.000
Fantastic.
00:01:56.640 --> 00:02:00.879
That's a long brief bio for somebody who's not that many years in practice, I think.
00:02:00.959 --> 00:02:05.840
And I I dare say I think you are probably the most junior person I've had on this podcast.
00:02:06.000 --> 00:02:06.480
Welcome.
00:02:06.640 --> 00:02:09.840
Actually, on that note, how how long have you been in practice?
00:02:10.080 --> 00:02:11.599
Um, I've been in practice now.
00:02:11.680 --> 00:02:14.719
I started in 2017, so it's eight and a half years.
00:02:14.960 --> 00:02:16.159
Okay, eight and a half years.
00:02:16.319 --> 00:02:16.879
Fantastic.
00:02:17.039 --> 00:02:17.680
Well, welcome.
00:02:17.919 --> 00:02:18.639
Tell me about it.
00:02:18.719 --> 00:02:22.319
So tell me a little bit about your journey to get to where you are now.
00:02:22.719 --> 00:02:28.879
Yeah, so I have to say um it wasn't a very um obvious journey.
00:02:29.120 --> 00:02:34.080
When I started in medical school, I was convinced I wanted to be um a family physician.
00:02:34.159 --> 00:02:34.319
Okay.
00:02:34.560 --> 00:02:45.680
And just by a series of events where randomly I get I kept getting put onto rotations in oncology, I realized, oh, maybe this isn't as depressing as everybody makes it out to be.
00:02:45.840 --> 00:02:52.719
Um and so then at the very last minute, I decided to apply into internal medicine uh when CARMS was rolling around.
00:02:52.960 --> 00:03:00.240
And I think the most important thing is that every step of the way, I had somebody who really encouraged me and mentored me.
00:03:00.479 --> 00:03:03.199
So when I was applying into internal medicine, Dr.
00:03:03.280 --> 00:03:08.240
Michael Seabag, who works here, was very um happy about it, encouraging.
00:03:08.319 --> 00:03:10.960
I'd worked with him wonderfully on the ward.
00:03:11.120 --> 00:03:16.800
And now we're colleagues, and I tell them every day that every time I see him, that the reason why I'm here is because of him.
00:03:16.960 --> 00:03:20.319
And then just every step of the way, there's somebody who kind of guided me.
00:03:20.400 --> 00:03:24.639
So I think finding that those people, those mentors is so, so important.
00:03:24.800 --> 00:03:36.159
You know, even my fellowship in Toronto is a medical oncologist here who said, you have to do this, who helped me set it up and really So you found there was support to help you get set up because that's so important.
00:03:36.319 --> 00:03:39.280
Those couple of years of fellowships could be career-defining.
00:03:39.520 --> 00:03:40.000
Absolutely.
00:03:40.159 --> 00:03:41.120
It's so important.
00:03:41.360 --> 00:03:51.439
It's um, I think even more so important to keep an open mind because gynecologic cancers were really not on my radar at all, especially in Quebec.
00:03:51.520 --> 00:03:56.240
It's mostly the gynecologic oncology surgeons here who treat those cancers.
00:03:56.400 --> 00:04:03.680
Um, but I was convinced that there was really an unmet need from a medical oncology point of view and that it could be a really good niche for me in terms of my career.
00:04:03.840 --> 00:04:05.759
And it's something that I've just really come to love.
00:04:05.919 --> 00:04:08.879
So I think keeping an open mind is really important as well.
00:04:09.199 --> 00:04:12.639
And uh and prior to medical school, did you do an undergrad degree?
00:04:12.879 --> 00:04:13.199
I did.
00:04:13.360 --> 00:04:18.480
I did um an undergrad degree in microbiology and immunology uh at McGill as well.
00:04:18.879 --> 00:04:28.160
Um I wasn't sure that I wanted to pursue medicine, and I felt going into medicine right out of SASIP was a little bit intimidating.
00:04:28.319 --> 00:04:31.120
So I really appreciated those extra three years.
00:04:31.279 --> 00:04:34.480
And it taught me, you know, the basics of science.
00:04:34.639 --> 00:04:44.000
It taught me to love lab work, but it also taught me that I needed a little bit more of a camaraderie, a little bit more of a um teamwork.
00:04:44.160 --> 00:04:51.759
I found I really liked the lab, but I found it sometimes a little bit isolating uh in terms of working on projects by myself.
00:04:52.000 --> 00:04:57.199
So um that's kind of what made me see that medicine would be, I think, a better fit for me.
00:04:57.439 --> 00:04:59.759
And uh are you are you from Montreal?
00:04:59.839 --> 00:05:04.000
Were you always, you always had the intention of coming back here even after your fellowship training?
00:05:04.240 --> 00:05:04.959
Yes, yes.
00:05:05.120 --> 00:05:07.439
So um I'm born and raised in Montreal.
00:05:07.519 --> 00:05:10.720
So are my parents, uh, my grandparents immigrated from Greece.
00:05:11.040 --> 00:05:18.319
So um I'm part of that uh generation where, you know, a lot of hopes were put on me.
00:05:18.560 --> 00:05:20.959
Um and very, very close-knit family.
00:05:21.360 --> 00:05:26.879
So uh again, you know, the plan, yes, when I left for fellowship was to come back to Montreal.
00:05:27.040 --> 00:05:29.279
It happened in a bit of a roundabout way.
00:05:29.360 --> 00:05:34.720
Uh, but again, I was open to staying in Toronto if there were options uh for me there as well.
00:05:34.959 --> 00:05:39.360
But at the end of the day, I'm really happy to be back home and you know, life changes.
00:05:39.439 --> 00:05:45.439
I have nieces and nephews now who I love dearly, and I I can't really imagine living too far away from them.
00:05:45.519 --> 00:05:49.920
So there's something really nice about coming home after being away for a couple of years.
00:05:50.240 --> 00:05:50.720
Absolutely.
00:05:51.279 --> 00:05:56.160
Now, if I remember correctly, you said something about your first year though, there wasn't a PEM here.
00:05:56.399 --> 00:05:56.800
That's right.
00:05:57.040 --> 00:05:59.120
So you were at the lake shore.
00:05:59.360 --> 00:05:59.680
Yes.
00:06:00.000 --> 00:06:02.720
So that's that's one of the complicated things about our system, right?
00:06:02.879 --> 00:06:13.519
Because you're obviously highly trained and highly skilled, and and I'm sure they wanted you here very badly, but unfortunately, we're stuck with these limited number of slots for physicians.
00:06:13.680 --> 00:06:14.000
Yes.
00:06:14.319 --> 00:06:20.000
Yeah, and that's something else that I learned that evolves so quickly because when I left, there was a PEM for I see.
00:06:20.240 --> 00:06:27.439
And that was part of the the reasoning for me to replace the only person here who is treating gynecologic cancers when he retired, Dr.
00:06:27.519 --> 00:06:28.480
Sturgeon.
00:06:28.800 --> 00:06:38.720
And um when the PEM schedule came out, they kind of decided that, oh, the MUHC doesn't need that many oncologists.
00:06:38.959 --> 00:06:44.480
So his position essentially was abolished uh while I was doing my okay.
00:06:44.720 --> 00:06:46.480
I had to kind of pivot again.
00:06:46.560 --> 00:06:48.319
I kept my my mind open.
00:06:48.560 --> 00:06:53.759
There was um a Mat Leaf replacement that was needed at the lake shore.
00:06:53.920 --> 00:06:57.759
Um, and I I knew the person who was going on Mat Leaf quite well.
00:06:57.920 --> 00:07:03.360
And so, you know, I reached out um to them and they were very happy to have me.
00:07:03.519 --> 00:07:05.519
I was there full-time for three years.
00:07:05.759 --> 00:07:09.759
Um, and it was really just a formative time for me.
00:07:10.079 --> 00:07:13.199
I really loved my my time there.
00:07:13.360 --> 00:07:20.720
Um the I think major decision factor for me switching over to the MUHC was that I couldn't do clinical trials there.
00:07:20.800 --> 00:07:24.000
And that's what I had trained in, and that's what I really wanted to do.
00:07:24.160 --> 00:07:27.519
So it was not an easy decision to make the change.
00:07:27.839 --> 00:07:32.879
Were you able when you were working at the lake shore, were you able to work here as well?
00:07:33.199 --> 00:07:33.600
I was.
00:07:33.759 --> 00:07:43.680
So I got an associate physician, and so I was here one day a week, which was nice because um I could see many more gynecologic cancer cases.
00:07:43.759 --> 00:07:46.079
Um, and again, that's what I did my fellowship in.
00:07:46.160 --> 00:07:48.480
Uh, whereas at the lakeshore there weren't that many.
00:07:48.639 --> 00:08:00.240
Um, but it also kept me in touch with all of the oncologists here and um also kind of gave me visibility when it when the PEM actually did open up and I applied.
00:08:00.560 --> 00:08:02.160
I think that's a great strategy.
00:08:02.319 --> 00:08:05.120
And and uh we're fortunate that we're able to do that, right?
00:08:05.279 --> 00:08:14.079
Cross-appoint people quite easily from other in from other centers outside the the university center and and sort of slowly integrate people in.
00:08:14.240 --> 00:08:16.079
So that worked out well for you finally.
00:08:16.240 --> 00:08:17.920
So how long have you been here full-time?
00:08:18.240 --> 00:08:21.279
So in May, it'll be five years that I'm here full-time.
00:08:21.600 --> 00:08:21.759
Yeah.
00:08:21.920 --> 00:08:22.240
Okay.
00:08:22.480 --> 00:08:29.439
And you're already, um, from what I read in your bio, you're already sort of leading clinical trials, even phase one.
00:08:29.600 --> 00:08:33.039
So phase one, for those who are not aware, are basically really, really early.
00:08:33.120 --> 00:08:41.360
Uh, these are sort of are you doing first in humans or first in can you tell us a little bit about what you're doing in terms of phase one trials?
00:08:41.440 --> 00:08:44.080
Because that's really impressive that you're doing that so early in your career.
00:08:44.399 --> 00:08:51.200
Yeah, so so I have to say I during my training, I did have um background in drug development at Princess Margaret.
00:08:51.360 --> 00:09:01.120
So it really let me immerse myself in the the field of the you know, um, inception of medications really from the very beginning.
00:09:01.279 --> 00:09:07.360
So from bench to to to bedside, really, that's what I was doing during my fellowship.
00:09:07.519 --> 00:09:10.240
So it wasn't so foreign to me when I started here.
00:09:10.399 --> 00:09:13.840
Um, the other aspect of it is that with um Dr.
00:09:14.000 --> 00:09:22.879
Sally, who runs the phase one unit um and is the director of Symoncology, uh, we've really built a very strong phase one unit with a very strong team.
00:09:22.960 --> 00:09:27.759
So it would be impossible for me to do what I'm doing without that support network.
00:09:27.919 --> 00:09:31.279
Um, but yes, um, we have trials that are first in human.
00:09:31.440 --> 00:09:38.240
We have uh um trials where we, like you said, in my bio, enrolled the first patients globally.
00:09:38.399 --> 00:09:52.320
Um, a lot of these medications um are um medications that are put first in class in terms of um treatments that are not really well known to oncology.
00:09:52.480 --> 00:09:55.120
So things like radioligand um therapies.
00:09:55.200 --> 00:09:55.360
Okay.
00:09:55.679 --> 00:10:06.639
Um we have uh other trials where the drugs are more the mechanism is more well known, but now we're trying it for the first time in certain tumor types or certain combinations.
00:10:06.879 --> 00:10:12.960
Um but it's not as complicated as it seems when you have a really good team behind you.
00:10:13.360 --> 00:10:13.840
Wonderful.
00:10:14.080 --> 00:10:15.200
That's very, very impressive.
00:10:15.360 --> 00:10:17.840
And you have a great team here at the Cedars Center.
00:10:17.919 --> 00:10:20.399
I mean, it's an impressive, impressive group.
00:10:20.720 --> 00:10:30.799
Just just, you know, I don't want to dwell on this, but what would you say to the women listening to this podcast in terms of gyne cancers, just just sort of more, you know, curious.
00:10:30.960 --> 00:10:35.759
Uh what should women be looking out for that they may not know about?
00:10:36.159 --> 00:10:44.480
I mean, I think women's health in general is just something that is so underrepresented, even in your just usual annual checkup.
00:10:44.720 --> 00:10:52.159
And I don't think that's the fault of the doctors, you know, when we're talking about things that we should be looking out for, even of the patients.
00:10:52.320 --> 00:10:56.240
I think there's just so such a lack of information out there.
00:10:56.480 --> 00:11:07.200
Um, in my field, unfortunately, what we see is a lot of patients who are young coming in with cervical cancer, which nowadays is a completely preventable disease.
00:11:07.440 --> 00:11:22.799
Um, so, you know, we're lucky in developed countries that we have vaccination programs uh against HPB, which is the major cause of cervical cancer, um, as well as well established well-established screening programs.
00:11:23.200 --> 00:11:35.519
Um, but I think, you know, just in terms of women's health in general, unfortunately, it's something for the, you know, female listeners that are out there that we're you have to really advocate for yourself.
00:11:35.600 --> 00:11:46.080
Um, make sure that, you know, you're following up with your screenings, that um, if you have any concerns, that you make sure that whatever doctor that you're speaking to takes it seriously.
00:11:46.320 --> 00:11:50.000
And if if women are getting their regular PAP tests, is that good enough?
00:11:50.240 --> 00:11:52.480
Um, it's good enough if they're staying up to date.
00:11:52.639 --> 00:11:54.240
We catch the lesions early.
00:11:54.320 --> 00:12:01.360
Um, and so um, you know, we prevent it from actually becoming a cancer, which is the most important part.
00:12:01.600 --> 00:12:11.600
Other cancers where we might see later in life, um like ovarian cancer or endometrial cancer, for instance, um, uh a lot of times have very nonspecific symptoms.
00:12:11.679 --> 00:12:27.600
And we've seen a lot of patients who've been diagnosed with advanced ovarian cancer uh really in a bad way because, you know, people are just not sensitized to the kinds of very innocuous symptoms they cause, bloating, constipation, stuff that you can attribute easily to other things.
00:12:27.759 --> 00:12:39.840
So again, I think it just goes back to really advocating for yourself and making sure that your concerns are taken seriously, because we have really good evidence from studies that show that women's concerns are often just brushed aside.
00:12:39.919 --> 00:12:48.159
And, you know, there's this bias in medicine that women tend to be more emotional or complain more, and that, you know, at the end of the day, they really have a serious problem.
00:12:48.399 --> 00:12:57.120
Is this a uh, you know, I'm just thinking back of obviously, you know, fertility has advanced a lot in the last, whatever, 20 years.
00:12:57.360 --> 00:13:01.200
Do you see more with all the fertility treatments that people have had?
00:13:01.360 --> 00:13:06.080
Are is that something that's on the rise, these kinds of cancers, or is there no, there's no correlation?
00:13:06.399 --> 00:13:08.720
I can't say, you know, the risk is is small.
00:13:08.879 --> 00:13:18.799
Um, you know, there are some studies that are showing that maybe there's a small increased risk, but I can't say that's really um the driving force uh behind these cancers.
00:13:18.960 --> 00:13:37.440
Um but at the same time, you know, the increased uptake of fertility treatments, again, I think is part of the problem that, you know, part of our usual yearly health questionnaire with our GP, if you're lucky enough to have one, doesn't include things that might be important to the patient in terms of the reproductive health.
00:13:37.519 --> 00:13:47.360
I mean, it's simple things like your AMH levels, what's your ovarian reserve like, you know, if especially in medicine, is this something that you should be thinking about seriously?
00:13:47.600 --> 00:13:50.720
Because most of us don't have normal career paths.
00:13:50.879 --> 00:14:07.759
When I was in residency, my friends had already finished their undergrads and other fields and had started working and bought houses and had mortgages and, you know, were planning the rest of their lives, or I was just trying to survive through my internal medicine callships.
00:14:08.080 --> 00:14:18.320
So I think just at least having that information to know what to do about it is really important and it's something that's it's just not built into the system.
00:14:27.200 --> 00:14:31.039
This podcast is being brought to you by the MUHC Foundation.
00:14:31.200 --> 00:14:41.919
The MUHD Foundation funds cutting-edge research at both the MUHC and its research institute and supports excellence in patient care for millions of Quebecers.
00:14:42.399 --> 00:14:54.879
You can follow them on social media or take a look at their website at www.muhcou-n-d-a-t-i-o-n.com, muhc foundation.com.
00:15:03.759 --> 00:15:04.559
Do you have a partner?
00:15:04.720 --> 00:15:05.279
I don't have a partner.
00:15:05.519 --> 00:15:06.320
You don't have a partner.
00:15:06.559 --> 00:15:16.559
And um, you know, certainly when I was going through residency, fertility was a topic commonly discussed amongst residents and young staff for the same for the exact reason that you mentioned.
00:15:16.639 --> 00:15:18.399
You know, we have different career paths.
00:15:18.559 --> 00:15:27.840
We start our our jobs, we start sort of our real life as a as a grown-up that's no longer studying and no longer has exams, much later than everyone else.
00:15:28.000 --> 00:15:31.600
So fertility becomes an issue as you delay it.
00:15:31.759 --> 00:15:38.480
Uh, is that still that is still a concern for sort of people in your your sort of cohort?
00:15:39.200 --> 00:15:39.679
Absolutely.
00:15:39.840 --> 00:15:40.799
Absolutely, 100%.
00:15:41.279 --> 00:15:47.919
And I feel like every other friend that I speak to who's had a baby has gone through some kind of fertility treatment.
00:15:48.080 --> 00:15:58.559
Um and so, you know, what the reason is, is it because they're delaying uh having children, or is it because we're in such high stress um environments?
00:15:58.960 --> 00:16:00.240
There's been really good studies.
00:16:00.399 --> 00:16:10.639
There was a study, I think, out of uh the annals of surgery that showed that female surgeons, um, especially if they didn't cut back their hours, had worse pregnancy outcomes.
00:16:10.879 --> 00:16:16.879
So, or even just becoming pregnant, you know, and carrying through a baby to term, the miscarriage rates were higher.
00:16:17.039 --> 00:16:24.720
So I think it's definitely something that is top of mind for a lot of us in medicine, if we do want children.
00:16:24.960 --> 00:16:27.840
I don't think it's talked about enough.
00:16:28.240 --> 00:16:29.440
Yeah, I agree with you.
00:16:29.679 --> 00:16:37.679
Uh, and and uh it is something I I must I do make a point when I have female residents and uh actually not even just female.
00:16:37.840 --> 00:16:50.159
I was with our our cohort of cardiology fellows the other day, males and females, and it's actually the males too, because a lot of them have partners who are also waiting until the male finishes, right?
00:16:50.320 --> 00:16:54.480
And so everybody's sort of delayed, and I think it does affect everyone.
00:16:54.720 --> 00:16:59.120
And so, so what can one do?
00:16:59.519 --> 00:17:03.519
Yeah, so I think just getting the information to start with is is really powerful.
00:17:03.679 --> 00:17:19.039
Um, like I said, you know, I know some people who had just started going through the steps for fertility treatments with their partner and were really surprised to find out that even in their early 30s, their obarian reserve was very low.
00:17:19.279 --> 00:17:25.599
Um, you know, so just having that information can help guide you and make a lot of choices.
00:17:25.759 --> 00:17:28.960
Um personally, I uh froze my eggs.
00:17:29.119 --> 00:17:30.319
It was not an easy process.
00:17:31.279 --> 00:17:31.599
Yeah.
00:17:31.759 --> 00:17:34.000
And it's not a guarantee either, you know.
00:17:34.160 --> 00:17:36.799
Um so how what does I don't know much about that?
00:17:36.960 --> 00:17:39.519
So, so can I ask how old were you when you froze your eggs?
00:17:39.599 --> 00:17:41.599
So I was probably a little bit older than I should have been.
00:17:41.759 --> 00:17:44.160
I was 36 37.
00:17:44.640 --> 00:17:51.279
Um, but you know, again, it's it's financially, it's not something that's covered by healthcare.
00:17:51.440 --> 00:18:00.319
Um it is it's it's costly, it costs a few thousand dollars when you're in residency trying to decide whether you're gonna pay for your royal college exam.
00:18:00.640 --> 00:18:00.880
Yes.
00:18:01.119 --> 00:18:06.480
Or if using your eggs that you know costs about the same amount of of money.
00:18:06.720 --> 00:18:10.000
Um, so and and it's not a guarantee.
00:18:10.160 --> 00:18:17.920
Um, it's kind of like buying an insurance policy and then your house catching fire and finding out they'll only cover 60% of the the cost.
00:18:19.920 --> 00:18:27.839
So um, so and then it's it's also time consuming and it's not something that you can plan for uh in an organized way.
00:18:28.000 --> 00:18:50.319
So I was already on staff at the lakeshore and having to reJID clinics and um So you're you're giving you while you were working, you were giving yourself injections, I imagine, to stimulate Yeah, doing injections uh at one point twice a day um to stimulate um the the follicles uh to grow.
00:18:50.559 --> 00:18:58.000
And then uh every couple days, ultrasounds at the fertility clinic um to see how things were progressing.
00:18:58.160 --> 00:19:09.839
So that meant appointments and waiting and while you wait, while you patients waiting is a meaning clinic, uh and then the actual retrieval where you can't work that day, you should work the day after.
00:19:10.000 --> 00:19:17.039
Um, but you don't know when that date's gonna be because they tell you a day or two before, okay, you're ready to go.
00:19:18.079 --> 00:19:22.559
So then at the very last minute, again, rejigging clinics, moving patients.
00:19:22.880 --> 00:19:25.920
So uh the whole process took about two weeks.
00:19:26.079 --> 00:19:28.240
Um, and and it was stressful.
00:19:28.640 --> 00:19:36.640
I believe it, but but I imagine it's really stressful and probably painful and and you know, everything and uncomfortable, all of these things, I imagine.
00:19:36.799 --> 00:19:36.960
Yeah.
00:19:37.200 --> 00:19:41.759
But I guess there's a sense of relief after that, is there?
00:19:42.079 --> 00:19:44.160
There's there's a minor sense of relief.
00:19:44.400 --> 00:19:52.400
Minor sense of relationship I would say, you know, especially as a physician, like I know the stats, I know what what the outcome can be.
00:19:52.640 --> 00:19:56.160
Um, it it's nice to know that there's a possible option.
00:19:56.319 --> 00:20:01.920
Yes, but also at the same time, you know that there's a chance that it might not work out.
00:20:02.240 --> 00:20:18.480
So um it buys you some time, I would say, but at a certain point, you have to, especially, you know, if you want to carry a pregnancy fully determined, you have to decide at what age is that going to be um optimal at, especially if you don't have a partner.
00:20:18.640 --> 00:20:18.799
Yeah.
00:20:19.039 --> 00:20:26.720
Because, you know, when I froze my eggs, the idea was that it would be to give me a chance to find a partner.
00:20:27.039 --> 00:20:27.359
Partner.
00:20:27.680 --> 00:20:33.759
And I still don't have a partner, and I have to kind of make decisions about would you consider having a child on your own?
00:20:33.839 --> 00:20:37.119
I know it's a very personal question, but I've definitely considered it.
00:20:37.200 --> 00:20:38.319
And I have friends who have done it.
00:20:38.480 --> 00:20:38.559
Okay.
00:20:38.880 --> 00:20:45.200
So, you know, I think more women are kind of heading down that route for many reasons.
00:20:45.440 --> 00:20:58.880
Um, but um, they also, which is very interesting, make you meet with a psychologist before you go through this process just to make sure that from a mental health point of view, you're in the right space to be doing all of this.
00:20:59.039 --> 00:21:05.599
And what she said to me is that people feel that life has to unfold in a certain order.
00:21:05.839 --> 00:21:08.880
And, you know, you meet somebody, you get married, you have kids.
00:21:09.119 --> 00:21:11.279
And she said, but really it doesn't.
00:21:11.519 --> 00:21:12.000
It doesn't.
00:21:12.160 --> 00:21:12.640
That's right.
00:21:12.799 --> 00:21:13.920
That's just institutional.
00:21:14.079 --> 00:21:16.079
That's just that's artificial, right?
00:21:16.559 --> 00:21:16.880
Yeah.
00:21:17.119 --> 00:21:18.400
And good for you though.
00:21:18.480 --> 00:21:19.599
That's really impressive.
00:21:19.759 --> 00:21:20.000
Yeah.
00:21:20.240 --> 00:21:20.720
Really it is.
00:21:20.880 --> 00:21:22.400
And would you so what would you consider?
00:21:22.799 --> 00:21:34.960
I mean, looking back, what would you tell somebody who's, you know, going, you know, doing a long residency that's going to allow them to emerge from all this at age 36, 37?
00:21:35.599 --> 00:21:40.319
What would would you, you know, and they're let's say they're on their own, you know, they're 30, 31.
00:21:40.480 --> 00:21:43.680
Would you, would you cons think that they should consider this?
00:21:44.000 --> 00:21:53.839
I would say if they feel like they want to have children in the future, this is something that's really important to them, then I would definitely freeze my eggs.
00:21:53.920 --> 00:21:56.240
I I would I should have done it a lot ear earlier.
00:21:56.480 --> 00:21:57.200
When would you have done it?
00:21:57.359 --> 00:21:58.400
When would it be an ideal time?
00:21:58.720 --> 00:21:59.759
Yeah, I probably.
00:22:00.160 --> 00:22:03.599
Probably not during the um year I was studying for the internal medicine.
00:22:05.039 --> 00:22:06.160
That would be horrible.
00:22:07.200 --> 00:22:15.359
But but maybe after, you know, definitely if I if I look back in my early 30s, it would have been a better time to to do it.
00:22:15.599 --> 00:22:28.160
And you know, the financial costs, like we especially coming from a an immigrant background, you know, like debt is such a horrible thing, but you make it up so fast when you make it up so fast once you start working as staff.
00:22:28.400 --> 00:22:34.960
So, you know, that like$5,000 that it cost me to do all of this, like it's a drop in the bucket.
00:22:35.119 --> 00:22:41.039
And, you know, I I feel like I was worried about it back then, but I would tell my younger self, don't worry about it.
00:22:41.359 --> 00:22:41.920
Don't worry about it.
00:22:42.000 --> 00:22:42.720
No, that's right.
00:22:42.799 --> 00:22:45.519
Those few thousand dollars are not going to make a difference in your life.
00:22:45.680 --> 00:22:57.119
I find though, still, it always surprises me to this day because I, you know, it is a topic I bring up with female residents, and as I said, even with, you know, with male residents, I kind of often get sort of blank stares.
00:22:57.200 --> 00:23:00.720
Like I get the sense people don't really believe it will happen to them.
00:23:00.880 --> 00:23:13.359
You know, there's this sort of sense of, yeah, I've I think women in medicine have always been people who've accomplished what they've wanted to accomplish and probably have certain control over their lives.
00:23:13.519 --> 00:23:20.240
And the sense I get is that people are kind of thinking, you know, I have a friend who had a kid at 37, then they had no trouble.
00:23:20.480 --> 00:23:22.960
You know, there's always going to be sort of someone like that.
00:23:23.119 --> 00:23:30.000
Um the real fertility, you know, peaks in your early to mid-20s, if I'm correct, right?
00:23:30.240 --> 00:23:34.880
Yeah, I think the stat is something like after 28, it starts to fall.
00:23:35.039 --> 00:23:36.400
Um, it's a real thing.
00:23:36.640 --> 00:23:38.000
It's a real thing for sure.
00:23:38.240 --> 00:23:41.440
Um, it's not very, again, it's not something that's very well studied.
00:23:41.759 --> 00:23:42.640
It's not very well studied.
00:23:42.880 --> 00:23:43.039
Yeah.
00:23:43.200 --> 00:23:49.279
So is it possible that, you know, in your later 30s, you'll have a child with without any complications?
00:23:49.519 --> 00:23:51.119
Absolutely, it's possible.
00:23:51.279 --> 00:23:55.599
Uh, freezing eggs is just like I said, a little bit more of an insurance policy.
00:23:55.680 --> 00:24:00.400
Or embryo is even better if you have a partner and you just kind of have to be more stable.
00:24:00.720 --> 00:24:18.720
Um, but um, you know, I I just think again, it's something that needs to be worked into just like the general health questionnaire for for women and men, you know, because there is the aspect of male infertility as well.
00:24:18.880 --> 00:24:20.880
So it's something that you really want.
00:24:21.039 --> 00:24:25.359
There's nothing wrong with asking your GP just for an AMH blood test.
00:24:25.519 --> 00:24:28.559
Um, and it'll give you an idea of your is that done routinely?
00:24:28.799 --> 00:24:29.359
It's not.
00:24:29.519 --> 00:24:30.000
It's not.
00:24:30.160 --> 00:24:30.400
Yeah.
00:24:30.640 --> 00:24:31.359
Is that an expensive?
00:24:31.599 --> 00:24:32.240
Why is it not done?
00:24:32.319 --> 00:24:35.759
Is it expensive or it's a little, it's not costly.
00:24:35.839 --> 00:24:41.759
I don't think it's, you know, thousands of dollars, but it's definitely more expensive than like a thyroid profile.
00:24:41.920 --> 00:24:44.240
Um, but I think just people don't think of it.
00:24:44.400 --> 00:24:47.680
I think it's like again, it's not worked into the teaching in medical school.
00:24:47.759 --> 00:24:47.920
Okay.
00:24:48.319 --> 00:24:53.440
The um, you know, the information we have about women's health in general is dismal.
00:24:53.759 --> 00:24:57.599
Um, the amount of research money that goes towards it is dismal.
00:24:57.759 --> 00:25:03.519
Um, I heard something along the lines of there's more funds that go into research for erectile disposal.
00:25:05.279 --> 00:25:09.759
There is for endometriosis, which is such a huge problem for for women.
00:25:10.079 --> 00:25:12.079
That's another cause of infertility.
00:25:12.160 --> 00:25:16.240
And, you know, a substantial proportion of women suffer from endometriosis.
00:25:16.400 --> 00:25:23.440
So I just might think, but nobody, there's no screening, there's no there, there's nothing that's being done proactively.
00:25:23.599 --> 00:25:29.920
It's something that we retroactively act on when a couple or a woman is experiencing infertility.
00:25:30.079 --> 00:25:32.240
So I just think it goes back to systems.
00:25:32.480 --> 00:25:33.119
Yes.
00:25:33.440 --> 00:25:36.799
So hopefully, I mean, there's more, there are more and more women in medicine.
00:25:36.960 --> 00:25:40.720
I think the medical classes are now predominantly more females than males, right?
00:25:41.119 --> 00:25:42.000
Women are majority.
00:25:42.079 --> 00:25:43.920
So hopefully that is going to change, right?
00:25:44.000 --> 00:25:45.279
There's a lot, a lot of work.
00:25:45.440 --> 00:25:53.279
And I know this institution and the foundation here is really, really supportive of women's health and trying to advance that within the institution.
00:25:53.440 --> 00:25:56.400
Because then there's the other side, which is the menopause side.
00:25:56.480 --> 00:25:56.559
Yeah.
00:25:56.720 --> 00:26:00.720
And perimenopause that has many, many unanswered questions as well, right?
00:26:00.880 --> 00:26:21.039
So as women, you know, there's the and when you think about it, you're you're working alongside colleagues, you know, as as you told us, you know, you're getting injections going from ultrasound, and your male colleagues are just kind of going, yeah, on with their day, you know, with absolutely, you know, completely unbothered by anything.
00:26:21.119 --> 00:26:25.119
And here you are with these hormonal shifts and ultrasounds and tests.
00:26:25.200 --> 00:26:30.240
And so you're living a very different life during this period than your male colleagues.
00:26:30.640 --> 00:26:31.839
Absolutely, absolutely.
00:26:32.000 --> 00:26:35.839
I mean, the truth is the system was set up for men who had wives at home.
00:26:36.079 --> 00:26:39.200
Men's to it's but not more.
00:26:39.839 --> 00:26:46.079
Another statistic by 2036, so in 10 years, there'll be more female doctors than men in the system.
00:26:46.400 --> 00:26:53.359
Um, so you know, it's it's I think something, a system that has to change that will take some time.
00:26:53.519 --> 00:27:03.200
But I think as women, we can start adjusting the way we act, you know, and a part of that is at the lakeshore, I was very lucky to have a very good team.
00:27:03.440 --> 00:27:11.440
And so, you know, I was very open with my nurses, with our admins, what was happening, why I had to, you know, ship my clinics around.
00:27:11.599 --> 00:27:16.960
And they were so, so supportive and so happy for me that I was doing this and so helpful.
00:27:17.039 --> 00:27:26.160
And so it's just a matter, I think, of being more open about these kinds of things and also the people on the receiving end being more supportive and helpful as well.
00:27:26.240 --> 00:27:32.240
So it's much as the male colleague is not going through this, if you say, Hey, can you cover me on the call day?
00:27:32.400 --> 00:27:35.759
Like it would be really nice to be able to have that support.
00:27:36.240 --> 00:27:37.119
To have that support.
00:27:37.359 --> 00:27:42.400
Thank you for sharing that with us because this is you know very important and something that we don't talk about often.
00:27:42.480 --> 00:27:45.440
So I really appreciate you you telling us about this.
00:27:45.599 --> 00:27:47.039
What do you do for fun?
00:27:47.920 --> 00:27:49.680
Because you're obviously working really hard.
00:27:49.839 --> 00:27:51.039
That's so yeah, yeah.
00:27:51.119 --> 00:27:52.160
Well, I just got a new puppy.
00:27:52.400 --> 00:27:53.920
Oh, that's an amazing what kind of puppy?
00:27:54.079 --> 00:27:55.359
So it's called a cockleer.
00:27:55.599 --> 00:27:58.880
He's uh cross between a cocker spaniel and a cavalier of King Charles.
00:27:58.960 --> 00:27:59.759
Uh yeah.
00:27:59.920 --> 00:28:01.920
And so that's been taking up all my time.
00:28:02.079 --> 00:28:02.400
Yes.
00:28:02.559 --> 00:28:07.279
Um, also reminding me of my residency days because I'm waking up several times.
00:28:09.200 --> 00:28:20.480
So I don't think I've been this tired since internal medicine, but um that's like really right now uh what is bringing much joy to my life.
00:28:20.640 --> 00:28:25.279
And other than that, like I said, I have my my nieces and my nephews and my family around.
00:28:25.440 --> 00:28:30.799
And um, you know, being a big Greek family, we take uh a lot of joy in each other.
00:28:30.880 --> 00:28:32.880
And yeah, terrific, terrific.
00:28:33.119 --> 00:28:33.920
One last question.
00:28:34.000 --> 00:28:35.680
What would you tell your younger self?
00:28:35.839 --> 00:28:40.880
Here you are, very accomplished, you've gotten, I think, where you want to be, right?
00:28:40.960 --> 00:28:42.880
It sounds you have a brilliant career.
00:28:43.039 --> 00:28:44.720
What would you tell your younger self?
00:28:45.039 --> 00:28:49.119
I would tell my younger self that you don't have to do it all alone.
00:28:49.279 --> 00:29:02.960
You know, I think as women, especially in medicine, we really want to portray this um facade of strength because there's so many prejudices against us, being weak, um, not being able to hack it.
00:29:03.119 --> 00:29:10.400
And so I would tell my younger self that you'd be surprised how many people are will want to be supportive of you and to ask for help.
00:29:10.720 --> 00:29:12.160
That's that's wonderful.
00:29:12.400 --> 00:29:13.519
Really, thank you so much.
00:29:14.400 --> 00:29:17.599
Thank you for really discussing this very personal topic with us.
00:29:17.759 --> 00:29:22.799
Congratulations on all your accomplishments after just so few years into your career.
00:29:22.960 --> 00:29:26.960
So, thank you so much for sharing your story with us and continued success.
00:29:27.279 --> 00:29:27.599
Thank you.
00:29:27.680 --> 00:29:28.880
Thanks, Nadia, for having me.
00:29:29.119 --> 00:29:29.359
Thank you.
00:29:29.440 --> 00:29:32.400
And to our listeners, I wish you all a great day.
00:29:45.519 --> 00:29:50.400
We also would appreciate it if you could take a moment to rate the show or leave a review.
00:29:50.559 --> 00:29:52.319
Thanks so much for listening.
