Why Lung Cancer Screening Matters More Than You Think

WEBVTT
00:00:24.629 --> 00:00:25.989
Welcome to Doc Discussions.
00:00:26.070 --> 00:00:26.390
I'm Dr.
00:00:26.469 --> 00:00:28.869
Jason Edwards and I'm here with Lola Brand and Dr.
00:00:28.949 --> 00:00:30.070
Kristen Fisher.
00:00:30.309 --> 00:00:30.789
Welcome.
00:00:31.189 --> 00:00:31.509
Welcome.
00:00:31.589 --> 00:00:31.829
Thank you.
00:00:32.469 --> 00:00:32.789
Yeah.
00:00:32.869 --> 00:00:38.629
So Lola is the head of our lung cancer screening program, and Kristen is a pulmonologist here.
00:00:38.869 --> 00:00:43.670
Um Kristen, can you tell us a little bit about yourself, where you're from, how you got here?
00:00:44.149 --> 00:01:05.670
So I grew up in Alton, Illinois, and did my medical school at SIU in Springfield, Illinois, and residency in Indiana, and then came back for fellowship at Washington University and then took the job here in 2018 after I finished, or 2017 actually, after I finished fellowship.
00:01:05.750 --> 00:01:08.949
And so I've been a pulmonologist here now for over eight years.
00:01:09.189 --> 00:01:09.909
Yeah, very good.
00:01:09.990 --> 00:01:12.710
And you went to medical school with Ryan Reedy and John Holtz.
00:01:12.949 --> 00:01:13.189
I did.
00:01:13.430 --> 00:01:13.909
I sure did.
00:01:13.990 --> 00:01:17.349
We were all three of us were in the same class, as well as Ryan's wife.
00:01:17.590 --> 00:01:17.990
Very good.
00:01:18.229 --> 00:01:19.030
That's a strong class.
00:01:19.109 --> 00:01:20.710
I mean, those are those are some great doctors.
00:01:21.990 --> 00:01:26.870
Are all of the uh SIU uh physicians um as highly touted as you guys are?
00:01:27.109 --> 00:01:28.469
I I thought I I hope so.
00:01:28.629 --> 00:01:29.510
I think so.
00:01:29.750 --> 00:01:34.390
Um obviously they're the ones who are around here, but yeah, it was quite ironic.
00:01:34.549 --> 00:01:37.510
I feel like when uh I had been in practice for about a year when Dr.
00:01:37.590 --> 00:01:44.150
Reedy came and um I was like, oh wow, we were in the same class, and then now with him doing thoracic surgery, we work pretty closely together.
00:01:44.390 --> 00:01:47.349
Yeah, great guy, great surgeon, as is John Holson for sure.
00:01:47.590 --> 00:01:48.870
Yes, John's great as well.
00:01:49.189 --> 00:01:51.030
And and Lola, where are you from originally?
00:01:51.349 --> 00:01:52.549
Waterloo, Illinois.
00:01:52.709 --> 00:01:52.950
Okay.
00:01:53.189 --> 00:02:03.109
Grew up on a farm, went to nursing school at Barnes Hospital School of Nursing, came here in '87 and have been here since then in multiple um positions.
00:02:03.269 --> 00:02:03.429
Yeah.
00:02:03.590 --> 00:02:09.030
Nursing on the floor, case management, and now for the last several years and the lung screening program.
00:02:09.349 --> 00:02:09.509
Okay.
00:02:09.670 --> 00:02:11.829
Now, what kind of farm was it that you grew up on?
00:02:12.150 --> 00:02:18.629
Um, we had pigs, cows, sheep, yeah, farm, uh grain farm, yeah, trucking business.
00:02:19.509 --> 00:02:20.709
Hampshire pigs.
00:02:20.949 --> 00:02:22.870
Oh, they had all kinds of pigs.
00:02:23.110 --> 00:02:23.189
Yeah.
00:02:23.509 --> 00:02:23.670
Yeah.
00:02:23.750 --> 00:02:25.750
They pigs get big, they're like 800 pounds.
00:02:25.909 --> 00:02:27.990
And so yeah, very good.
00:02:28.230 --> 00:02:29.269
Um, okay.
00:02:29.509 --> 00:02:35.030
And so Lola, can you tell us a little bit about the lung cancer screening program we have here?
00:02:35.349 --> 00:02:42.629
Okay, so the lung screening program has certain guidelines that has been set down by the United States Preventative Service Task Force.
00:02:42.789 --> 00:02:51.669
You have to be between the ages of 50 and 77 if you're a Medicare or a Medicare Advantage plan, 50 to 80 if you have a commercial plan.
00:02:51.830 --> 00:03:00.150
You have to have a current cigarette smoking history or quit smoking cigarettes within the past 15 years and have a 20-pack year history.
00:03:00.469 --> 00:03:08.069
Been seen by a physician who has documented that you are asymptomatic of any kind of lung cancer symptoms.
00:03:08.310 --> 00:03:10.949
And then we just set you up for the CAT scan.
00:03:11.030 --> 00:03:12.629
It's a very simple test.
00:03:12.949 --> 00:03:15.750
Um, and the result letter is sent out by myself.
00:03:15.830 --> 00:03:19.909
The doctor should be calling with the test results, and we just do that on an annual basis.
00:03:20.629 --> 00:03:21.109
Very good.
00:03:21.270 --> 00:03:25.990
And um, you you always have a great interaction with our mutual patients, and we very much appreciate you.
00:03:26.550 --> 00:03:31.349
You're a detail-oriented um uh nurse navigator, and and I think it makes a huge difference.
00:03:31.509 --> 00:03:32.629
So thanks for everything you do.
00:03:32.949 --> 00:03:33.430
Thank you.
00:03:33.669 --> 00:03:39.349
Um, Kristen, what are some of the early warning signs um that somebody may have a lung cancer?
00:03:39.430 --> 00:03:40.870
What do people present with?
00:03:41.669 --> 00:03:55.430
Um so typically, unfortunately, once which is why the lung cancer screening program is so important that a lot of times, unfortunately, by the time somebody has symptoms, it is a little bit more advanced than what we would like to capture.
00:03:55.669 --> 00:04:05.189
But some early symptoms, and sometimes you can find it early if it's something that's maybe obstructing an airway, which the patient may be short of breath or coughing up blood.
00:04:05.349 --> 00:04:08.310
Um, sometimes there's chest wall pain.
00:04:08.469 --> 00:04:10.469
Um, not coughing.
00:04:10.629 --> 00:04:19.110
Sometimes I've found it before with patients coming in with a cough, which is why I'm pretty careful about making sure that we get in mean that I get imaging on appropriate patients.
00:04:19.430 --> 00:04:20.230
Yeah, you're right.
00:04:20.310 --> 00:04:26.310
And most of these are caught at stage three or four, and so that's why you've got a screen, even if you have no symptoms.
00:04:26.550 --> 00:04:26.870
Correct.
00:04:27.029 --> 00:04:35.110
Sometimes you get lucky and a small lung cancer is next to a windpipe, and there's a little bit of bleeding, and you catch it before it takes off.
00:04:35.269 --> 00:04:40.789
But um it's it's a sneaky cancer that can really grow um without symptoms.
00:04:41.350 --> 00:04:49.990
Um you know, smoking's the most common cause um for lung cancer, and it's the vast majority of patients.
00:04:50.149 --> 00:04:55.269
What are some other things um, if you're not a smoker, um, that could lead to a lung cancer?
00:04:55.830 --> 00:05:12.549
So exposures, um, a lot of patients with uh prior asbestos exposure, radon exposure, other chemical exposures and things like that can place patients exposure to carcinogens, uh, can place patients at risk for cancer.
00:05:12.710 --> 00:05:14.629
Age in itself is a risk factor.
00:05:14.789 --> 00:05:25.190
So, you know, always following pulmonary nodules that are sometimes incidentally found, even in in um patients who are non-smokers are important in following appropriate guidelines for follow-up.
00:05:25.429 --> 00:05:31.509
Uh, there is an increased risk after the age of 65 specifically, family history for lung cancer.
00:05:31.909 --> 00:05:35.350
Do you think that's genetic or do you think it's secondhand smoke or a little bit of both?
00:05:35.669 --> 00:05:36.629
Probably a little bit of both.
00:05:36.789 --> 00:05:56.950
I definitely think there are a subset of patients that probably have some genetic predisposition because some of those patients I've seen in, and I'm sure you've seen them as well, that have had kind of multiple adenocarcinomas, in which case, you know, and and not maybe not even be, you know, that advanced in age or, you know, you can't really identify it.
00:05:57.029 --> 00:05:59.269
Although it's sometimes hard to pin down exposures.
00:05:59.429 --> 00:06:05.590
I find that it's really difficult sometimes because people don't always remember, you know, certain exposures that they've had in their lifetime.
00:06:05.909 --> 00:06:07.509
Yeah, yeah, for sure.
00:06:07.750 --> 00:06:13.990
Um, and radon gas is a, I think, a bigger deal in Missouri than it is in most places because of the limestone.
00:06:14.070 --> 00:06:14.950
Is that right?
00:06:15.669 --> 00:06:16.789
I believe so, yes.
00:06:17.029 --> 00:06:17.429
Yeah.
00:06:17.669 --> 00:06:22.549
Um, and so that you can buy a radon gas um kit and test your house.
00:06:22.629 --> 00:06:24.789
It's relatively cheap or have an expert do it.
00:06:24.870 --> 00:06:27.590
But it's uh I think usually when you buy a house, it's mandatory.
00:06:27.990 --> 00:06:28.230
It is.
00:06:28.309 --> 00:06:32.070
They'll give you a measurement when you buy a house and especially if it's a basement, right?
00:06:32.309 --> 00:06:32.629
Exactly.
00:06:32.710 --> 00:06:36.789
And it has to be below a certain level, otherwise, I think there's issues with selling it.
00:06:37.110 --> 00:06:38.950
Yeah, which is uh very good.
00:06:39.110 --> 00:06:41.110
Um you you mentioned lung nodules.
00:06:41.269 --> 00:06:43.269
Why do so many people in St.
00:06:43.429 --> 00:06:44.629
Louis have lung nodules?
00:06:44.950 --> 00:06:47.110
It has to do with where we live geographically.
00:06:47.350 --> 00:07:02.389
There's a fungus in the soil here called histoplasma, and it tends to cause a lot of pulmonary nodules because people will breathe it in, your body kills it, leaves behind, you know, evidence of it being there previously.
00:07:02.470 --> 00:07:12.870
But the problem is, is although it's very common to find, you can't tell a difference as a physician when you look at a scan between one of those nodules typically and one that could be an early lung cancer.
00:07:13.029 --> 00:07:37.190
So although the vast majority of nodules that we find incidentally end up being benign, you have to appropriately follow them in order to ensure that this is not an early lung cancer, because obviously, as we've discussed earlier, by the time somebody's symptomatic, it may be more advanced, and therefore finding it at an early stage in which it can be potentially cured is very important.
00:07:37.669 --> 00:07:39.190
Yeah, yeah, for sure.
00:07:39.429 --> 00:07:46.389
Um, I used to live in Kentucky and it's on the Ohio River Valley, and they have the same thing on the Mississippi and Ohio River Valley and the Missouri.
00:07:46.549 --> 00:07:49.830
And so um, so there's a lot of lung nodules out there.
00:07:49.909 --> 00:08:02.070
So, you know, most of the time when you have a lung nodule, it's not cancer, but you need the tincture of time to kind of discriminate uh histoplasmosis nodule won't grow, you know, uh over time typically, whereas the lung cancer will.
00:08:02.389 --> 00:08:16.389
Yeah, and you know, it depends, you know, valley fever for people that live out west, you know, um, there's other endemic fungi throughout the US, but there's specific areas such as here where it tends to be a little bit more concentrated.
00:08:16.710 --> 00:08:19.269
Now, uh uh valley fever I'm totally unaware of.
00:08:19.429 --> 00:08:20.230
What is that?
00:08:20.470 --> 00:08:27.269
So that is coccidiomycosis, which is another type of endemic of fungus, and it's typically in Arizona, California.
00:08:27.429 --> 00:08:36.309
And so sometimes when I have patients that may live part of the year in Arizona and part of the year here will find them, it tends to make people a little sicker.
00:08:36.470 --> 00:08:55.029
So some people actually have, you know, a fever and cough with it, but it will leave behind these nodules or even sometimes even bigger than a nodule that you makes when you first see their CT scans, you're you know, you might think that somebody has lung cancer, but it ends up just being a prior fungal infection.
00:08:55.269 --> 00:08:55.669
Huh.
00:08:55.909 --> 00:08:58.710
And usually from the histoplasma, people don't really feel sick.
00:08:58.950 --> 00:08:59.910
No, it rarely.
00:09:00.070 --> 00:09:02.389
Occasionally, somebody can have active infection.
00:09:02.470 --> 00:09:08.790
That's usually in somebody who has um something wrong with their immune system, that they're compromised in some way.
00:09:09.029 --> 00:09:14.950
Sometimes it can still happen in healthy individuals, but most of the time it doesn't need to be treated, even in those cases.
00:09:15.110 --> 00:09:17.029
Most people don't even know they have it.
00:09:17.670 --> 00:09:20.550
Um, yeah, that that's been my experience as well.
00:09:20.710 --> 00:09:30.550
Um, and um so there's so we talk about these nodules and um the low-dose um screening for the high-risk individuals.
00:09:30.950 --> 00:09:40.550
Um the um what's the difference between catching one of these nodules early versus you know, catching the tumor when you have a clinical symptom?
00:09:41.190 --> 00:09:47.910
There's a big difference in terms of prognosis, and you would be able to answer this better than I would.
00:09:48.230 --> 00:09:58.950
But if a cancer can be found in an early stage, such as a stage one, it can either be removed or radiated, um, depending on what is the best choice for that particular patient.
00:09:59.029 --> 00:10:07.269
And the patients tend to do great versus if it's more advanced, then it's gonna involve, you know, potentially chemotherapy or immunotherapy.
00:10:07.350 --> 00:10:20.389
And um, and it's a little bit, it's a lot more for the patient, and you know, it's it's a lot more involved and a greater chance of recurrence afterwards than if it's caught early and dealt with whenever it's a small nodule.
00:10:20.710 --> 00:10:20.950
Yeah.
00:10:21.110 --> 00:10:41.029
I it I think, you know, out of all the cancers we screen for, which is breast, prostate, colon, and lung, um, and cervical cancer, um, you know, you have one of the biggest deltas between, you know, catching it early versus late, just because patients um have such a rough time um when it's caught in stage three or four.
00:10:41.269 --> 00:10:55.990
But the new immunotherapies and the targeted therapies that the medical oncologists use, cure rates have improved for stage three and four patients, but it's improved from like, you know, if if if you look at the whole lot of them from like 20% to 30%.
00:10:56.389 --> 00:10:58.790
And so it's still not great odds.
00:10:58.950 --> 00:11:04.149
Um so you see patients before I do typically.
00:11:04.389 --> 00:11:05.269
I typically do.
00:11:05.509 --> 00:11:11.590
And you know, you're the one a lot of times that um will even diagnose um the cancer.
00:11:11.750 --> 00:11:13.269
How do you diagnose the cancer?
00:11:13.350 --> 00:11:14.790
Like what procedures do you do?
00:11:15.110 --> 00:11:20.710
Yeah, so I t I do a procedure called a bronchoscopy, which is a scope of the lungs.
00:11:20.870 --> 00:11:29.910
And there's different ways of doing um biopsies in order to um using different tools while I'm doing that in order to try to find the nodule.
00:11:29.990 --> 00:11:31.750
But there's multiple ways of doing a biopsy.
00:11:31.830 --> 00:11:39.990
I typically think of when I explain this to patients, there's really three different ways you can get at trying to determine what exactly a spot is.
00:11:40.070 --> 00:11:45.670
So this would be a spot that may be growing and maybe a spot that's large enough that I'm concerned about it to begin with.
00:11:45.910 --> 00:11:52.710
Um, and you can, I always tell people you can biopsy it from the inside out or outside in.
00:11:52.950 --> 00:12:07.910
And I do it from the inside out, which means that the patient is put under anesthesia and I put a scope into their lungs, similar to how somebody would get like a colonoscopy if they were only it's, you know, or an endoscopy, but it's in the lungs, not into the GI tract.
00:12:08.149 --> 00:12:15.269
And then using different technology, sometimes there is something that we do called navigational broncoscopy, where you can create a 3D map.
00:12:15.350 --> 00:12:24.870
There's robots now, which we may be getting soon here, um, where you can try to get at the spot and um and get a diagnosis that way.
00:12:25.110 --> 00:12:27.670
So you kind of like go through all the windpipes.
00:12:28.230 --> 00:12:29.269
You create it's like a map.
00:12:29.350 --> 00:12:40.149
So it's kind of like a video game, sort of where you, you know, follow that it will, you know, show a target on a screen that looks like, you know, I always say the green ball, and you can navigate out to it and try to get to it.
00:12:40.310 --> 00:12:47.990
And then if there's any concern for lymph node involvement, there's ultrasounds that we can use through a scope or basically taking very tiny biopsies.
00:12:48.149 --> 00:12:56.550
The other way is that what I mentioned, which was from the outside end, which is the radiologist will do this called a CT guided biopsy where a patient will be in a CT scanner.
00:12:56.629 --> 00:13:06.389
And this one they don't have to be put under anesthesia for, and they can stick a very tiny numb up the patient and stick a very tiny needle in through the chest wall and get and get a diagnosis that way.
00:13:06.470 --> 00:13:08.710
And then the third way is obviously surgically.
00:13:08.870 --> 00:13:14.230
So just depending on the situation depends on which way we may go about offering a biopsy.
00:13:14.389 --> 00:13:15.670
So typically that is what happens.
00:13:15.830 --> 00:13:29.670
Typically, I'll I'll be referred a patient at the time in which a nodule, you know, either I find the nodule whenever I'm doing screening or working them up for someone something else, or the primary care doctor um will send it.
00:13:29.750 --> 00:13:40.470
Loa's very good about identifying patients on and you know, if somebody has an incidental scan in the emergency room and making sure those patients get in to see somebody, you know, with the to do the appropriate workup.
00:13:40.550 --> 00:13:46.710
And then um after I figure out what the diagnosis is, then I refer them to the next step.
00:13:47.110 --> 00:13:47.509
Yeah.
00:13:47.750 --> 00:13:50.389
Um, so a couple technical questions.
00:13:50.629 --> 00:13:57.670
Um so the the lung is in a way kind of like a balloon, and you know, when you stick a needle in it, sometimes that balloon can deflate.
00:13:58.070 --> 00:13:59.910
And we call that a pneumothorax.
00:13:59.990 --> 00:14:00.710
Um, correct?
00:14:00.790 --> 00:14:01.350
Is that the right term?
00:14:01.590 --> 00:14:02.710
That is the correct term, yes.
00:14:02.950 --> 00:14:11.670
And um, and so is the rate of a pneumothorax um lower with a bronchoscopy than it is to with a CT guided biopsy?
00:14:11.830 --> 00:14:11.990
Yes.
00:14:12.230 --> 00:14:16.230
Okay, yeah, that's that's because that's pretty rare to have it from a bronchoscopy.
00:14:16.550 --> 00:14:17.029
It is pretty rare.
00:14:17.110 --> 00:14:20.070
I think it's said in the literature at somewhere one to two percent.
00:14:20.230 --> 00:14:33.750
Um the the the way I think about it, the differences between the two, is that a CT guided biopsy though has a little bit higher yield, meaning that there's a little, but it just depends on the nodule too.
00:14:33.830 --> 00:14:35.110
It really depends on where it's at.
00:14:35.350 --> 00:14:45.509
But the, you know, the the chance of getting the diagnosis, like say it's cancer and getting back that it is cancer, is a little bit higher yield with that versus a broncoscopy.
00:14:45.590 --> 00:14:52.070
So all of this has to be taken with the lens of the person doing it if you think you really got adequate sampling or not when you did it.
00:14:52.149 --> 00:15:08.070
Um, but broncoscopy technology is improving, and that's why I had mentioned there's some newer tech techniques out there and and um and so we all adapt with the times and and try to constantly try to seek the latest technology in order to try to um get a better biopsy.
00:15:08.389 --> 00:15:11.910
Okay, so now I'm gonna ask you a question that's that's a little bit of a curveball.
00:15:11.990 --> 00:15:12.149
Okay.
00:15:12.310 --> 00:15:12.629
Yeah.
00:15:12.790 --> 00:15:20.230
Um, so they're talking about um these AI robots doing surgery and it's kind of all the rave.
00:15:20.629 --> 00:15:23.269
Um, do you think that will come to reality?
00:15:23.350 --> 00:15:26.629
I mean, it's kind of it's you know, it's kind of hard to bet against Elon Musk, right?
00:15:26.710 --> 00:15:35.590
You kind of feel like a fool, but they're you know, they're talking about um these these robots being able to perform surgeries potentially better than humans.
00:15:35.830 --> 00:15:37.509
What do you what do you think about that?
00:15:37.830 --> 00:15:38.710
I don't know.
00:15:39.590 --> 00:15:40.790
That's a great honest answer.
00:15:41.110 --> 00:15:41.590
I don't know.
00:15:41.750 --> 00:15:48.230
I think that I think that it has a way to go before we would ever get to that point.
00:15:48.470 --> 00:15:56.629
I think that there's great ways of using that type of technology to assist the human and being able to do what needs to be done.
00:15:56.790 --> 00:16:16.470
So I think that I think that the reality of what would probably happen, let's say for a bronchoscopy and trying to help me better get a get a better sample, get to the get it better, would be using AI to help direct things, but still being controlled by ultimately a human having to make real life decisions at the time.
00:16:16.550 --> 00:16:18.870
Because I think we all know AI gets a little wonky.
00:16:19.269 --> 00:16:27.269
And I just have to say, from my experience using it for I use it for documentation purposes, it does some strange things sometimes.
00:16:27.430 --> 00:16:31.750
So I do not think that it is at the point of which that we're anywhere close to that.
00:16:31.830 --> 00:16:40.070
But I do see where I do see AI coming into effect is assisting us to be able to do our jobs better, not replacing us doing it.
00:16:40.230 --> 00:16:41.590
So so like the co-pilot, right?
00:16:41.750 --> 00:16:42.389
Yeah, the co-pilot.
00:16:42.950 --> 00:16:46.870
Like like it can say, come up with a plan and I can look at it and be like, okay, yeah, that makes sense.
00:16:46.950 --> 00:16:47.190
Yeah.
00:16:47.350 --> 00:16:49.029
And use it to help me get there.
00:16:49.190 --> 00:16:57.110
But at the end of the day, you still have to have somebody that's able to make make sure it's not gonna go into crazy computer land and do something strange.
00:16:57.509 --> 00:17:02.230
Because they can hallucinate, I think is the term they use, where they just kind of go off res and start doing some work.
00:17:02.550 --> 00:17:08.230
Well, yeah, occasionally I'll have some stuff show up in notes that I'm like, what's this talking about?
00:17:08.629 --> 00:17:08.950
Yeah.
00:17:09.190 --> 00:17:11.589
Well, thanks for kind of giving your input into this.
00:17:11.829 --> 00:17:13.910
And so a last question.
00:17:14.389 --> 00:17:23.509
When patients are diagnosed with a cancer, what advice do you give them about how to psychologically deal with it?
00:17:23.750 --> 00:17:27.109
Because I think in many ways, the first two weeks are kind of the worst.
00:17:27.430 --> 00:17:27.750
It is.
00:17:27.829 --> 00:17:31.269
It I think the uncertainty is really hard.
00:17:31.670 --> 00:17:55.990
And I think that it's a little bit different on the level in which, you know, those of us like Lowell and I on kind of the front end and dealing with this kind of stuff, what what they're experiencing, by the time they get to the oncologist, they kind of have most of the time they've had the chance to kind of wrap their head around the fact that they, you know, that, you know, the patient has cancer and kind of really looking forward to like getting the answer, like what's gonna happen next.
00:17:56.150 --> 00:18:02.630
But I have at the stage where somebody comes in and they're, you know, I'm like, well, I see this spot and I'm worried about it, but we don't know what it is.
00:18:02.789 --> 00:18:05.990
And that that part is very difficult to handle.
00:18:06.069 --> 00:18:07.350
Um, I think psychologically.
00:18:07.509 --> 00:18:11.190
Some people do really well with it and some people it's very nerve-wracking.
00:18:11.269 --> 00:18:16.230
And the whole process of sometimes us following nodules and saying, like, well, we don't, you know, it looks okay right now.
00:18:16.390 --> 00:18:17.509
We're gonna wait a few more months.
00:18:17.589 --> 00:18:20.230
Like, sometimes that waiting that few months is really hard.
00:18:20.390 --> 00:18:24.230
And so what I always tell people is like, let's just take this step by step.
00:18:24.390 --> 00:18:26.069
Like there's only so much we can control.
00:18:26.230 --> 00:18:30.549
I try to gauge when I'm talking to somebody how much information they want to know.
00:18:30.710 --> 00:18:34.710
Some people want to know the minute that that spot's found, like, what's the worst case scenario?
00:18:34.870 --> 00:18:47.350
And if they want me to take them down the rabbit hole, I'll go down that way and I'll say, well, you know, worst case scenario, this is probably, you know, as long as we get, you know, this back and it doesn't look like it's spread anywhere, you know, this is probably a stage one.
00:18:47.430 --> 00:18:49.269
And this is kind of what that looks like.
00:18:49.430 --> 00:18:57.029
We might be talking about surgery, or if it's a patient that I don't think is a surgical candidate, we might, you know, or maybe they don't want to have surgery, we'll be talking about radiation.
00:18:57.110 --> 00:19:05.430
And I don't give them a ton of information about that because I feel like, you know, you do a great job, for example, of going through radiation with the patients, but I give them an idea of what that looks like.
00:19:05.589 --> 00:19:09.990
And so for some people, they want to know that information, some people don't want to know that information.
00:19:10.150 --> 00:19:14.630
So I think as a as a, you just have to try to gauge like how much they want to know.
00:19:14.710 --> 00:19:19.430
But I'll answer as many questions as somebody has if that helps them kind of process a situation.
00:19:19.589 --> 00:19:22.950
Sometimes knowing, like, well, what are we gonna do if it is this?
00:19:23.110 --> 00:19:25.029
And I'll be like, look, we're not gonna go down this way.
00:19:25.110 --> 00:19:28.870
We don't even know if this is this might be something that's gonna go away on the next scan.
00:19:29.029 --> 00:19:31.430
But if it does, this is what you're looking at.
00:19:31.589 --> 00:19:34.630
And I think that sometimes helps people be able to know like what they're facing.
00:19:34.950 --> 00:19:48.950
And I think that's a sign of a great doctor that knows their patients and kind of knows like, I know them, I know their personality, I know this is kind of how much they can take right now, and it's not gonna be healthy for them to kind of go down this road.
00:19:49.589 --> 00:19:57.269
And, you know, I I I think the serenity prayer is really great for a lot of things in life.
00:19:57.509 --> 00:20:09.269
And it's that a lot of things are out of your control, and you've got to somehow find peace in life knowing that you can kind of only control a couple things, and you you're better off focusing on that.
00:20:09.509 --> 00:20:14.789
The mind, it most of the time works against you, and it'll just take off, and you gotta try to keep it reined in.
00:20:14.870 --> 00:20:22.710
And I I think that's great advice um to try to stay busy, to maybe go for a walk, kind of wear your body out so your mind's not working so hard against you.
00:20:22.789 --> 00:20:26.549
But it's it's for people out there who just get a cancer diagnosis.
00:20:26.710 --> 00:20:31.750
I mean, it's the first couple weeks are just the toughest, and you've got to not let your mind break you down.
00:20:31.910 --> 00:20:32.710
But it's tough.
00:20:32.789 --> 00:20:34.870
I mean, even knowing that it's it's still not easy.
00:20:35.190 --> 00:20:35.509
It's tough.
00:20:35.589 --> 00:20:44.309
And I, you know, it's it's hard because although we see people go through this, I don't think anybody really understands what it's like unless they've been through it.
00:20:44.390 --> 00:20:49.509
And so I as as empathetic as I try to be, I I do recognize that it's it's tough.
00:20:49.910 --> 00:20:50.950
It's tough for people.
00:20:51.110 --> 00:20:59.509
And um, it makes it all the more important to have people on the front end of it that are so kind and empathetic, like you two.
00:20:59.750 --> 00:21:03.269
And so I I thank you both, uh Lola Brand and Dr.
00:21:03.350 --> 00:21:07.269
Kristen Fisher for all the uh great work you do for our patients.
00:21:07.990 --> 00:21:16.630
I would just like to add that the lung screenings are a free exam under most patients, insurance the in that it's a preventive exam.
00:21:16.870 --> 00:21:22.470
So there's no cost to patients to get that for the every on an annual basis.
00:21:22.630 --> 00:21:31.110
If they have to come back for a CAT scan because they did find a nodule, those costs will go under their diagnostic benefits.
00:21:31.269 --> 00:21:40.950
But I think people need to be aware that this is something their insurance companies do cover fully, and hopefully that will lure more people into coming in and getting the lung screenings.
00:21:41.269 --> 00:21:45.990
Lola, is there a way that they could contact you or your office or the lung cancer screening program?
00:21:46.470 --> 00:21:46.789
Yep.
00:21:46.950 --> 00:21:51.269
My phone number is 314-205-6550.
00:21:51.350 --> 00:21:53.190
Please call, leave me a message.
00:21:53.350 --> 00:21:59.110
I will work out on getting orders from your physicians, explaining the procedure and getting you set up.
00:21:59.430 --> 00:22:02.470
Oh, well, thanks so much for being an advocate for so many of our patients, Lola.
00:22:02.789 --> 00:22:02.950
Thank you.
00:22:03.110 --> 00:22:03.670
Yeah, thank you, Lola.
00:22:03.910 --> 00:22:06.150
Lola, we'll always make sure we're on our toes.
00:22:06.549 --> 00:22:07.190
I appreciate that.
00:22:07.269 --> 00:22:07.910
She does a great job.
00:22:08.150 --> 00:22:09.110
She do a good job, too.
00:22:09.269 --> 00:22:13.029
Yeah, yeah, I think we got a great team from top to bottom, and I'm thankful for everybody.
00:22:13.269 --> 00:22:13.670
All right.
00:22:13.750 --> 00:22:15.269
Well, that's it for Doc Discussions.
00:22:15.509 --> 00:22:16.789
Thanks for listening.