Latest / Resiliency Radio with Dr. Jill Carnahan, MD / 325: Resiliency Radio with Dr. Jill: Comfort Always: Healing in the Age of Technology with Dr. Alan Cohen

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325: Resiliency Radio with Dr. Jill: Comfort Always: Healing in the Age of Technology with Dr. Alan Cohen · Resiliency Radio with Dr. Jill Carnahan, MD

• 0:01
  Dr. Jill Carnahan: Welcome to Resiliency Radio, your go to podcast for the most cutting edge insights integrative and functional medicine.
• 0:07
  Dr. Jill Carnahan: I'm your host, Dr. Jill and with each episode we dive into the heart of healing and personal transformation.
• 0:14
  Dr. Jill Carnahan: Join me as I interview medical experts, world leaders, thought leaders and innovators of all types as we journey on our way to optimal healing and human performance.
• 0:24
  Dr. Jill Carnahan: Today you are in for such a treat with Dr. Alan Karl Cohen.
• 0:28
  Dr. Jill Carnahan: He's the author of Comfort Always and he's a long term pediatric neurosurgeon with some great stories and inspirational thoughts for us today.
• 0:37
  Dr. Jill Carnahan: Stay tuned.
• 0:38
  Dr. Jill Carnahan: I will introduce him in just a moment.
• 0:40
  Dr. Jill Carnahan: Before I do, just a couple words of wisdom.
• 0:43
  Dr. Jill Carnahan: First of all, if you are looking for a functional medicine expert to help you on your healing journey, we are accepting new patients at my clinic, Flat Iron Functional medicine in Louisville, Colorado.
• 0:53
  Dr. Jill Carnahan: Just give us a call at 303-993-7910 or visit my website www.jillcarnahan.com for information services.
• 1:04
  Dr. Jill Carnahan: I have two providers who are absolutely spectacular and work with me in all cases and you can get in for an intro call with them if you want to check it out or just schedule an appointment and we would love to see you and help you on your journey.
• 1:17
  Dr. Jill Carnahan: Second is Dr. Jill.
• 1:18
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• 1:22
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• 1:28
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• 1:53
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• 1:57
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• 2:01
  Dr. Jill Carnahan: And that is all@doctor Jill health.com okay, let's introduce our guest.
• 2:05
  Dr. Jill Carnahan: Dr. Alan Cohen is a nationally recognized pediatric neurosurgeon, author, educator and innovator in minimally invasive neurosurgery.
• 2:14
  Dr. Jill Carnahan: Over the course of his career, he's authored more than 250 journal articles, book chapters and books, delivered hundreds of national lectures, and contributed extensively to the Advancing of field of pediatric neurosurgery.
• 2:25
  Dr. Jill Carnahan: His award winning textbook, Pediatric Neurosurgery Tricks of the Trade received top honors from both association of American Publishers and the British Medical Association.
• 2:34
  Dr. Jill Carnahan: He has served in editorial leadership roles for major neurosurgical journals and is widely recognized for his work in pediatric brain tumors and many surgical interventions.
• 2:44
  Dr. Jill Carnahan: Now his latest book, Comfort Always Is for the General Public.
• 2:48
  Dr. Jill Carnahan: Healing in the Age of Technology.
• 2:50
  Dr. Jill Carnahan: You're going to love this book and love this interview.
• 2:52
  Dr. Jill Carnahan: Let's join Dr. Alan Cohen.
• 2:55
  Dr. Jill Carnahan: Dr. Cohen, we get a lot of requests on Resiliency Radio for guests and we have some amazing people.
• 3:00
  Dr. Jill Carnahan: And I because we have so many requests, I have to say no a lot of times.
• 3:03
  Dr. Jill Carnahan: But when I got the request from your team, it was an absolute yes because I love your philosophy, I love what you do, and I can't wait to get to know you better today.
• 3:13
  Dr. Jill Carnahan: What I love to start with guest is how did you get to where you're at now as far as how did you always know you were going to be a doctor?
• 3:20
  Dr. Jill Carnahan: How did you get into medicine?
• 3:21
  Dr. Jill Carnahan: And, and then the field of pediatric neurosurgery, which is so poignant in so many ways.
• 3:25
  Dr. Jill Carnahan: How did you get into that field?
• 3:28
  Dr. Jill Carnahan: Tell us a little bit about your journey.
• 3:31
  Dr. Alan Cohen: Well, thank you.
• 3:32
  Dr. Alan Cohen: It's an interesting story.
• 3:33
  Dr. Alan Cohen: I actually never knew that there was a field of pediatric neurosurgery when I was in medical school.
• 3:39
  Dr. Alan Cohen: And I end up being a pediatric neurosurgeon for the past 40 years.
• 3:43
  Dr. Alan Cohen: I grew up in Poughkeepsie, New York, a small town up the Hudson river.
• 3:50
  Dr. Alan Cohen: And my dad was a strong influence in my life.
• 3:52
  Dr. Alan Cohen: He was an ophthalmologist and he would take me when I was a teenager to watch him do his microsurgery.
• 3:58
  Dr. Alan Cohen: And it was really very interesting.
• 4:00
  Dr. Alan Cohen: I wanted to be like him.
• 4:02
  Dr. Alan Cohen: Then I realized he was a major figure in the community and I could never live up to those expectations.
• 4:08
  Dr. Alan Cohen: And so I had to choose something else.
• 4:10
  Dr. Alan Cohen: And I went to medical school.
• 4:12
  Dr. Alan Cohen: I was in public schools and somehow miraculously got into Harvard.
• 4:16
  Dr. Alan Cohen: Wow.
• 4:17
  Dr. Alan Cohen: And I was way over my head there.
• 4:19
  Dr. Alan Cohen: Everybody was a genius.
• 4:20
  Dr. Alan Cohen: I didn't know what I was doing there.
• 4:22
  Dr. Alan Cohen: And I went to medical school at Cornell.
• 4:26
  Dr. Alan Cohen: And as I said in medical school, I started out internal medicine.
• 4:30
  Dr. Alan Cohen: I enjoyed that.
• 4:31
  Dr. Alan Cohen: But I became very interested in the nervous system.
• 4:35
  Dr. Alan Cohen: And I didn't even know that there was a field of pediatric neurosurgery.
• 4:38
  Dr. Alan Cohen: But I did my residency in New York at nyu and I came under the influence of a guy Named Fred Epstein, who was a larger than life figure.
• 4:46
  Dr. Alan Cohen: And basically I said I'd like to be like him.
• 4:49
  Dr. Alan Cohen: And so I went into pediatric neurosurgery, some people say, because I had mental ability of a five year old.
• 4:55
  Dr. Alan Cohen: But I get along well with little kids.
• 4:58
  Dr. Alan Cohen: And it's a fascinating field because my particular interest is in pediatric brain tumors.
• 5:06
  Dr. Alan Cohen: And brain tumors have the unusual distinction of being the number one cause of cancer death in children.
• 5:13
  Dr. Alan Cohen: Brain cancer, it's the number one solid tumor in childhood.
• 5:19
  Dr. Alan Cohen: And it's a field where you become very intimately related with the child and the family, you become a member of the family.
• 5:26
  Dr. Alan Cohen: And it's a very powerful field.
• 5:29
  Dr. Alan Cohen: And I've spent most of my career working and writing with academic people about technical advances in my field, which have been great.
• 5:39
  Dr. Alan Cohen: This is the first time I decided to try to write for the general public and what I've done, I kept a diary over the years and the decades and some fascinating cases that are there.
• 5:49
  Dr. Alan Cohen: And I decided this time to write about the non technical things that we deal with in neurosurgery, particularly in pediatric neurosurgery, that make the field so special.
• 6:00
  Dr. Jill Carnahan: Wow, I love that.
• 6:01
  Dr. Jill Carnahan: And like I said, I knew I would love getting to know you.
• 6:03
  Dr. Jill Carnahan: It so resonates because in my recent book I talked about faith and science, right?
• 6:08
  Dr. Jill Carnahan: And to me it's kind of like the right brain, left brain, the practice of medicine as far as the science, the research, all of this incredible knowledge that brings to us the best technology, the best treatments.
• 6:19
  Dr. Jill Carnahan: But if we don't have that heart side, which is the connection with the patient, the trust that you build between the family.
• 6:25
  Dr. Jill Carnahan: And for you, as a pediatric neurosurgeon, you're treating more than just a patient because you got the parents and the patient and maybe other family members.
• 6:31
  Dr. Jill Carnahan: And it's so important, I believe, especially in your field, that trust, like you said, you're part of the family.
• 6:37
  Dr. Jill Carnahan: And I can't wait for people to get a hold of a copy or a book.
• 6:41
  Dr. Jill Carnahan: It's called Comfort Always.
• 6:42
  Dr. Jill Carnahan: We're going to talk about that today because I really think that now more than ever, science, medicine, you and I, we need to look beyond just the science and go to how do we integrate the heart, the connection, the humanity of medicine and the science together.
• 6:58
  Dr. Jill Carnahan: Because I think true healing brings them together.
• 7:01
  Dr. Jill Carnahan: Tell us a little bit about your perspective on that and why you chose now to write Comfort Always.
• 7:07
  Dr. Alan Cohen: Well, I think our perspective is very similar.
• 7:09
  Dr. Alan Cohen: You talk about faith and science and I have this book Comfort always where I talk about what I think is the forgotten art of humanity in the age of modern technology.
• 7:21
  Dr. Alan Cohen: And the idea is that technology treats the disease, but humanity heals the patient.
• 7:26
  Dr. Alan Cohen: And I think you need a combination of both of those.
• 7:29
  Dr. Alan Cohen: And in my field, the stories are riveting.
• 7:32
  Dr. Alan Cohen: They're much more intense than anything you would see on television.
• 7:36
  Dr. Alan Cohen: These are patient stories.
• 7:37
  Dr. Alan Cohen: Some of them go back 30, 40 years.
• 7:39
  Dr. Alan Cohen: Some of my patients are now adults with children of their own.
• 7:43
  Dr. Alan Cohen: And it's a real treat to be an older pediatric neurosurgeon, be able to follow the lives of the patients that I've cared for over the decades.
• 7:51
  Dr. Jill Carnahan: How amazing.
• 7:52
  Dr. Jill Carnahan: And I bet you have story after story of what happened.
• 7:56
  Dr. Jill Carnahan: And how much do you believe that?
• 7:59
  Dr. Jill Carnahan: You obviously had incredible technology and you have written so many research articles and been well published, but how much, if you had to give a percentage, do you think was your relationship with the patients in their healing?
• 8:11
  Dr. Jill Carnahan: Like how much we can say the technology was of course important and your skill as a surgeon, but where do we draw that line between just the relationship and the trust that we build being part of the healing process?
• 8:23
  Dr. Alan Cohen: Yeah, I think it's extremely important and it's not something that people don't know about, but what we have now is an ability with technology to do things that couldn't be done in the operating room even a few decades ago.
• 8:36
  Dr. Alan Cohen: We have the MRI and the CT and lasers and ultrasound and intraoperative MRI and things that are adjuncts that help us get through cases and cure tumors that couldn't be cured before and prolong life where it couldn't have been prolonged even decades ago.
• 8:53
  Dr. Alan Cohen: There are major advances, but what happens, it's the same thing with AI, with artificial intelligence.
• 9:00
  Dr. Alan Cohen: If it's not managed carefully, it has the ability to drive a wedge between the doctor and the patient and the family.
• 9:07
  Dr. Alan Cohen: And that's all I'm doing, is trying to remind people about the importance of the non technical aspects of patient care.
• 9:14
  Dr. Alan Cohen: The simple things like kindness and compassion and empathy and optimism, hope, things like that.
• 9:21
  Dr. Alan Cohen: You can't quantify it.
• 9:22
  Dr. Alan Cohen: But empathy is something that may be hard to describe, but when it's not there, the patient, the family, they know that it's not there.
• 9:30
  Dr. Alan Cohen: And I think it's the combination that are synergistic, humanity and technology.
• 9:35
  Dr. Alan Cohen: And we tend to forget the former.
• 9:38
  Dr. Alan Cohen: And that's my attempt to try to remind people in this book how brilliantly.
• 9:43
  Dr. Jill Carnahan: Spoken as a true expert would.
• 9:46
  Dr. Jill Carnahan: I really love that and could not agree more.
• 9:49
  Dr. Jill Carnahan: And could you Share a time or two where maybe like a patient case, obviously your book is full of them, so I hope people could get a copy of that.
• 9:56
  Dr. Jill Carnahan: But if you can think back of some of the real significant ones and maybe where someone came in and the family obviously most of the time is terrified it's their beloved child and how that, you know, conversation and giving them the hope or the options of what you could offer shifted.
• 10:13
  Dr. Jill Carnahan: Do you want to give us a couple like just sample vignettes on some of those cases?
• 10:19
  Dr. Alan Cohen: Well, sure.
• 10:20
  Dr. Alan Cohen: You know, what I've noted over the years is that probably one of the most difficult things I ever have to do is to tell a family, I'm sorry to give you this news, but your child has a brain tumor.
• 10:32
  Dr. Alan Cohen: Because I know that it's going to forever change the lives of the child and the family.
• 10:38
  Dr. Alan Cohen: And it's never easy, it's never gotten easy.
• 10:41
  Dr. Alan Cohen: It's always emotionally intense.
• 10:43
  Dr. Alan Cohen: But we can do things now that we couldn't do before.
• 10:46
  Dr. Alan Cohen: And I think it's important to develop this bond between the doctor and the patient and the family.
• 10:51
  Dr. Alan Cohen: There's a tendency for people want to sugarcoat and give good information.
• 10:56
  Dr. Alan Cohen: No one wants to break bad news to people.
• 10:58
  Dr. Alan Cohen: But I think the importance of the doctor, patient, family relationship is to create that bond which can last for decades to become a member of the family that develop the trust that's necessary for us to go ahead and fight these difficult battles together.
• 11:17
  Dr. Alan Cohen: One example of a case that was particularly memorable to me is the second chapter about a girl named Abigail.
• 11:27
  Dr. Alan Cohen: I got a phone call, I was working at Boston Children's Hospital at the time from a mother who lived out of state who had a two month old daughter.
• 11:37
  Dr. Alan Cohen: Before the baby was born, she was diagnosed with a genetic disorder, down syndrome.
• 11:45
  Dr. Alan Cohen: And then worse than that, they did an ultrasound while the baby's still in the mother's uterus and showed a giant brain tumor in the left hemisphere of the brain.
• 11:56
  Dr. Alan Cohen: And it appeared to be a malignant brain tumor.
• 11:59
  Dr. Alan Cohen: They continued to follow it with ultrasounds and MRI is done even before the baby was born.
• 12:05
  Dr. Alan Cohen: And it was a malignant brain tumor that filled the hemisphere of the brain and this two month, this baby before she was born.
• 12:13
  Dr. Alan Cohen: So they made a plan to have the baby go home with the parents for hospice care so that they wouldn't live the short life that she had in the ICU and made sense the family.
• 12:26
  Dr. Alan Cohen: You can imagine how unbelievably difficult it would be to make plans to bury their unborn child when she was born and they took her on trips to the ocean so that she could touch the sand and see the ocean, thinking that the next time they would be back there would be to bury her.
• 12:44
  Dr. Alan Cohen: She was born, she was doing poorly.
• 12:46
  Dr. Alan Cohen: The tumor got even bigger.
• 12:48
  Dr. Alan Cohen: But then she started getting a little better.
• 12:50
  Dr. Alan Cohen: And the mother, who worked as a nurse, a neurology neurosurgery nurse, said, gee, this doesn't seem right.
• 12:55
  Dr. Alan Cohen: She called us, we took a look at the baby and thought we didn't want to give her a death sentence.
• 13:00
  Dr. Alan Cohen: We thought it was reasonable enough to take a look, even though these fetal brain tumors are usually bad actors.
• 13:06
  Dr. Alan Cohen: And we operated and it was a giant brain tumor, but it was benign.
• 13:10
  Dr. Alan Cohen: It was a benign tumor and were able to remove it.
• 13:14
  Dr. Alan Cohen: And who knew that was going to happen?
• 13:17
  Dr. Alan Cohen: That was 11 years ago.
• 13:18
  Dr. Alan Cohen: She's now in the fifth grade, she has two boyfriends and she's adored by her parents and her friends.
• 13:25
  Dr. Alan Cohen: And stories like that you just can't see on television.
• 13:29
  Dr. Alan Cohen: It's just a human endeavor, this resilience that the strength of this family is remarkable.
• 13:34
  Dr. Alan Cohen: And those are the stories I've tried to tell in this book because they're very intimate and very personal and very powerful.
• 13:43
  Dr. Jill Carnahan: Hey guys, Just a quick interruption for this episode to remind you if you haven't yet got a copy of Unexpected Finding Resilience through Functional Medicine, Science and Faith, you can find my book anywhere books are sold.
• 13:54
  Dr. Jill Carnahan: If you prefer to get a signed copy, just order that off drjillhealth.com and I will personally sign that to you if you just write that in the notes.
• 14:02
  Dr. Jill Carnahan: But let's get back to this amazing show with Dr. Alan Cohen.
• 14:07
  Dr. Jill Carnahan: And again, this is full of this.
• 14:08
  Dr. Jill Carnahan: So if you guys are out there again, we're going to give you a website where to find this.
• 14:11
  Dr. Jill Carnahan: But I highly recommend this is going to be my next read for sure.
• 14:15
  Dr. Jill Carnahan: Dr. Cohen, as you talk about that, what you were faced with was the medical system says, X, Y, Z, this is fatal, this is going to happen and this is the outcome.
• 14:26
  Dr. Jill Carnahan: And you had to at some point say, what else is possible?
• 14:30
  Dr. Jill Carnahan: Could there be a possibility that this crazy scenario could actually have a good outcome?
• 14:36
  Dr. Jill Carnahan: How often have you found that open mindedness and curiosity about what else is possible?
• 14:41
  Dr. Jill Carnahan: Take it to an outcome like you just described where the medical system gives us a pretty much, you know, this is not going to go well.
• 14:47
  Dr. Jill Carnahan: And then you see something different because you believe that there might be some possibility of hope.
• 14:53
  Dr. Alan Cohen: There was a professor named William Osler who was one of the founding fathers of Johns Hopkins in the 1880s and he was a brilliant man.
• 15:02
  Dr. Alan Cohen: And he said that the good physician treats the disease, the great physician treats the patient who has the disease.
• 15:10
  Dr. Alan Cohen: And I think that's the thing that gets lost in this era of technology.
• 15:14
  Dr. Alan Cohen: And so, yeah, I mean, you know, not every case can be cured, but I think optimism is what we would call a moral imperative because words can help heal and we can't cure everybody, but we can do things, we can treat pain, we can control disease, we can prolong life.
• 15:33
  Dr. Alan Cohen: And I think what's important is not to give false hope, but to give some type of optimism so that you can work with the family, so that every patient should want to come back to visit the doctor, even when the news is not good, because there's always something to do together.
• 15:47
  Dr. Alan Cohen: It's that bond that we tend to forget, the bond between doctor and patient.
• 15:52
  Dr. Alan Cohen: One of the things that I notice is that in my era when I started, we didn't have the electronic medical record.
• 15:59
  Dr. Alan Cohen: And that's a, you know, computer based system where we can share information across the world about patient care.
• 16:07
  Dr. Alan Cohen: And it's really made major advances for us, but it's also got its problems.
• 16:13
  Dr. Alan Cohen: You know, it's a lot of information put in by the residents is copied and paste.
• 16:17
  Dr. Alan Cohen: It's garbage in, garbage out.
• 16:19
  Dr. Alan Cohen: And some of the ICD codes, the international classification of diseases are crazy, like sucked into a jet engine.
• 16:29
  Dr. Alan Cohen: Follow up visit.
• 16:30
  Dr. Alan Cohen: These are true codes.
• 16:31
  Dr. Jill Carnahan: I know, right?
• 16:31
  Dr. Alan Cohen: Yes, it's unbelievable.
• 16:34
  Dr. Alan Cohen: And, and so the problem is, what I think is, the problem is that we've got great strides from the technology, but technology treats the disease and we've tended to forget the simple things, the non technical things that make us physicians and make us human.
• 16:48
  Dr. Alan Cohen: And for example, sometimes if you go visit your doctor, you'll notice that the doctor will be sitting at the computer typing information into the computer.
• 16:58
  Dr. Alan Cohen: Sometimes you can look at the back of your doctor's head and you feel like an afterthought.
• 17:02
  Dr. Alan Cohen: The doctor is a caregiver, a health caregiver.
• 17:05
  Dr. Alan Cohen: The patient is a client.
• 17:06
  Dr. Alan Cohen: That's the business of medicine.
• 17:08
  Dr. Alan Cohen: Now my doctor is very good, but if we forget about that, we forget about the need to lay on the hands and the art of healing.
• 17:16
  Dr. Alan Cohen: And it's a lost art.
• 17:18
  Dr. Alan Cohen: And I think this is just a book to remind people of the power of that art, the art of healing.
• 17:24
  Dr. Jill Carnahan: So well said.
• 17:25
  Dr. Jill Carnahan: I can't get over sometimes recently when I get patients that have come from the er, have come from a doctor visit and they'll, you know, we'll talk and I'll say, oh, you had abdominal pain to the exam in your belly.
• 17:35
  Dr. Jill Carnahan: And sometimes the answer is no, they didn't touch me.
• 17:39
  Dr. Jill Carnahan: And that's really sad because I think, like your subtitle, healing in the Age of Technology.
• 17:44
  Dr. Jill Carnahan: So many medical students and interns are, you know, plugged into their phones and their apps, checking medical databases and open AI evidence and those kinds of things, which are great resources that we have now.
• 17:56
  Dr. Jill Carnahan: But if they forget the art of connection with a human, which is the patient in front of us or the physical exam, how have you seen over your 40 years that change to where this kind of like you said, with the ehr, but also just the amount of things we can do, whether it's imaging or technology interventions.
• 18:13
  Dr. Jill Carnahan: Have you seen, I'm assuming you've worked with residents and students for many years.
• 18:17
  Dr. Jill Carnahan: Have you seen the generations change in how they're appearing in their rotations?
• 18:22
  Dr. Alan Cohen: Yeah, and we can do things.
• 18:23
  Dr. Alan Cohen: In other words, someone comes in with a complaint, we can now go to imaging.
• 18:28
  Dr. Alan Cohen: We can get imaging of the entire body.
• 18:30
  Dr. Alan Cohen: We can send a barrage of lab tests, we can look at things on a molecular level.
• 18:34
  Dr. Alan Cohen: But we tend to forget the power of the bedside history and physical exam.
• 18:39
  Dr. Alan Cohen: Common sense.
• 18:40
  Dr. Alan Cohen: And a lot of what we do, we get information, we see little shadows that may or may not be significant.
• 18:45
  Dr. Alan Cohen: We tend to forget the importance of working at the bedside.
• 18:49
  Dr. Alan Cohen: So it's just something that's just common sense.
• 18:51
  Dr. Alan Cohen: But the more I see it, the more it's real.
• 18:53
  Dr. Alan Cohen: It's real and I think people need to be reminded of it.
• 18:56
  Dr. Alan Cohen: That's the main purpose.
• 18:58
  Dr. Jill Carnahan: So well said.
• 18:59
  Dr. Jill Carnahan: One of the thought, as you were talking earlier, is so often we have randomized controlled trials and we have these incredible data points that we bring into our practice.
• 19:08
  Dr. Jill Carnahan: But then who is really that n of 1?
• 19:10
  Dr. Jill Carnahan: Who is that one patient?
• 19:11
  Dr. Jill Carnahan: And do they fit on the curve from these things?
• 19:14
  Dr. Jill Carnahan: How do you balance great randomized, high quality trials that are bringing us evidence to use and also the fact that each patient is a very individual situation.
• 19:24
  Dr. Jill Carnahan: Is there a philosophy or perspective on that you have to share?
• 19:29
  Dr. Alan Cohen: And that's exactly the point.
• 19:30
  Dr. Alan Cohen: You know, everybody wants to have evidence based medicine.
• 19:33
  Dr. Alan Cohen: There's a lot of crazy things now on the Internet, cures for autism that really shouldn't be even thought about.
• 19:40
  Dr. Alan Cohen: And randomized trials certainly have a role.
• 19:43
  Dr. Alan Cohen: But one of the things that we see in my field, for example, is that we categorize brain tumors by calling them A name like meningioma or glioblastoma or medulloblastoma.
• 19:53
  Dr. Alan Cohen: We look at it under a microscop.
• 19:55
  Dr. Alan Cohen: Now we have next generation sequencing.
• 19:58
  Dr. Alan Cohen: We can look at the molecular levels of these tumors, and we can develop designer drugs that are more potent against the tumor and less toxic to the patient.
• 20:07
  Dr. Alan Cohen: A major advance.
• 20:08
  Dr. Alan Cohen: But the technology has gone so far and so quick that these diseases can be categorized into subcategories and then subcategories into further categories.
• 20:20
  Dr. Alan Cohen: And so there's not enough patients in each one of these subcategories to be able to draw meaningful conclusions.
• 20:25
  Dr. Alan Cohen: So it's a balance of using this technology along with common sense.
• 20:29
  Dr. Alan Cohen: And I think some of the older doctors are the ones who use fewer tests, or as we use these tests, we use them with some common sense because we see all sorts of shadows.
• 20:40
  Dr. Alan Cohen: And just because something shows up on an imaging study, we treat the patient, not the X ray.
• 20:47
  Dr. Jill Carnahan: Excellent.
• 20:48
  Dr. Jill Carnahan: I couldn't agree more.
• 20:49
  Dr. Jill Carnahan: And I really like that.
• 20:50
  Dr. Jill Carnahan: I have a 30 something with a recurrent neuroblastoma.
• 20:52
  Dr. Jill Carnahan: And similarly, I'm just following as the primary.
• 20:54
  Dr. Jill Carnahan: So I'm not the expert, but there's a very unique drug for his cell type.
• 20:59
  Dr. Jill Carnahan: Obviously that's.
• 21:00
  Dr. Jill Carnahan: But when we talked through that, were talking about the evidence, and it's very weak because there's so few that are.
• 21:06
  Dr. Jill Carnahan: Exactly.
• 21:06
  Dr. Alan Cohen: That's exactly the problem.
• 21:07
  Dr. Alan Cohen: Yeah.
• 21:08
  Dr. Jill Carnahan: So totally understand that.
• 21:11
  Dr. Jill Carnahan: I want to shift just now because we have a lot of doctors who listen to us and professionals that are in this field or searching for answers and motivation and encouragement.
• 21:19
  Dr. Jill Carnahan: One of the other things I see in our field is so many physicians, partially because of bureaucracy and productivity and EMRs and a lot of things we just talked about losing their love for medicine.
• 21:32
  Dr. Jill Carnahan: They're feeling burnout, they're feeling exhausted, and they're spending more hours charting than actually with the patients.
• 21:38
  Dr. Jill Carnahan: Any thoughts on how we can encourage our colleagues?
• 21:41
  Dr. Jill Carnahan: Because I think your thoughts on the book Comfort always, and my thoughts as well in practice is if we can really have that connection with patients, it brings back the joy.
• 21:51
  Dr. Jill Carnahan: Like, I love going to work every day, I love my job, and I would never change it for anything.
• 21:55
  Dr. Jill Carnahan: But I've done less of that disconnect and more of the connection.
• 21:59
  Dr. Jill Carnahan: What words could you give to young physicians to maybe avoid that burnout trap?
• 22:05
  Dr. Alan Cohen: I think you gave it to young and older physicians.
• 22:07
  Dr. Alan Cohen: It's difficult to manage, and I think you have to find a balance.
• 22:11
  Dr. Alan Cohen: The electronic health record is a major help, but it's also a source of burnout.
• 22:16
  Dr. Alan Cohen: And we spend hours in the evenings and nights charting and copying and pasting, and it's very easy to burn out.
• 22:24
  Dr. Alan Cohen: And I think you have to remember, a thousand years ago, there was a guy my monitor studies who famously said, may I never forget that the patient is a fellow creature in pain.
• 22:35
  Dr. Alan Cohen: May I never consider him merely a vessel of disease.
• 22:38
  Dr. Alan Cohen: And if we revert back to the patient as the primary focus, then we put up with some of this.
• 22:43
  Dr. Alan Cohen: But it is a problem.
• 22:45
  Dr. Alan Cohen: It needs to be harnessed.
• 22:48
  Dr. Alan Cohen: The EHR computer technology, artificial intelligence.
• 22:52
  Dr. Alan Cohen: It's going to make major strides in our ability to treat, but it has to be balanced and it has to be regulated.
• 22:58
  Dr. Alan Cohen: And that's going to be the challenge in the future.
• 23:01
  Dr. Jill Carnahan: Wow.
• 23:01
  Dr. Jill Carnahan: It's so true.
• 23:02
  Dr. Jill Carnahan: It's interesting because I think maybe six to 12, maybe 18 months ago, as I started hearing AI and AI in medicine and radiology, it's profound and amazing.
• 23:10
  Dr. Jill Carnahan: And there's a piece of me that was like, whoa, am I going to have a job?
• 23:13
  Dr. Jill Carnahan: Like, truly?
• 23:14
  Dr. Jill Carnahan: And then I realized, oh, wait, that connection that I have, my patient relationships, there's no way that I will ever outsource those relationships.
• 23:22
  Dr. Jill Carnahan: And it's so powerful that I think that will be the thing that will continue to advance and will continue to get better ability.
• 23:30
  Dr. Jill Carnahan: I think the complex pattern recognition that we are gifted with as physicians probably will be somewhat outsourced to AI because it can do it better with more data.
• 23:39
  Dr. Jill Carnahan: But again, that connection will never change.
• 23:43
  Dr. Alan Cohen: You know, when I was started out, we didn't have computers, we didn't have cell phones, and.
• 23:48
  Dr. Alan Cohen: And AI was in its fetal state.
• 23:51
  Dr. Alan Cohen: And now it's coming rapidly down.
• 23:54
  Dr. Alan Cohen: And, you know, people, famous people.
• 23:56
  Dr. Alan Cohen: Stephen Hawking, brilliant scientist, said that AI may lead to the end of civilization.
• 24:03
  Dr. Alan Cohen: And it's scary because these are smart people.
• 24:05
  Dr. Alan Cohen: I think it has a role in my field.
• 24:07
  Dr. Alan Cohen: In other words, if I have an unusual mri, I can look at it and try to make a differential diagnosis, show it to my colleagues.
• 24:15
  Dr. Alan Cohen: But what I can also do is, if I had 10,000 MRIs with similar pictures, AI can help me make the diagnosis.
• 24:23
  Dr. Alan Cohen: I don't think it's going to replace the physician, the surgeon, but it's unbelievable what it can do.
• 24:29
  Dr. Alan Cohen: And there was a guy, Gary Kasper, Gary Kasparov, the Russian grandmaster in chess, said something to the effect that AI is not going to replace humans, but people who use AI will replace those who don't.
• 24:43
  Dr. Alan Cohen: And I think we've got to embrace that technology because it's there.
• 24:47
  Dr. Alan Cohen: We just Embrace it and then regulate it.
• 24:49
  Dr. Jill Carnahan: Fantastic.
• 24:50
  Dr. Jill Carnahan: I could agree more because it's really exciting with.
• 24:53
  Dr. Jill Carnahan: Speaking of technologies, you talked about just a little bit of this.
• 24:55
  Dr. Jill Carnahan: I always think it's like this exponential advance in technology in our lives and more so with you.
• 25:00
  Dr. Jill Carnahan: Looking over the 40 years you've been practicing, what are some of the most exciting things you've seen in the last decade or so in regards to pediatric, especially brain tumors?
• 25:11
  Dr. Alan Cohen: Well, we have microsurgical techniques.
• 25:13
  Dr. Alan Cohen: We have an intraoperative MRI scan so that we can, when there's a question, is there residual tumor around the corner?
• 25:20
  Dr. Alan Cohen: We can take a picture before the patient wakes up.
• 25:23
  Dr. Alan Cohen: And particularly if it's a young child who's intubated for the surgery, we can get a follow up MRI before the child wakes up so we don't have to re intubate the patient.
• 25:34
  Dr. Alan Cohen: So that takes some of the guesswork out.
• 25:37
  Dr. Alan Cohen: We have neuromonitoring where we can put electrodes on the brain, we can stimulate the brain and look for responses, and it helps make surgery safer.
• 25:46
  Dr. Alan Cohen: There are lots.
• 25:46
  Dr. Alan Cohen: We have endoscopes and exoscopes, small tubes, the same way the general surgeons take out the gallbladder or the appendix.
• 25:53
  Dr. Alan Cohen: We can go deep in the ventricles of the brain with minimal invasiveness and take out selected tumors.
• 25:59
  Dr. Alan Cohen: But it's also important to remember that someone famous said that a fool with a tool is still a fool.
• 26:06
  Dr. Alan Cohen: And so you got to remember that it's not the instrument that's going to do the job, it's the person who's using it.
• 26:12
  Dr. Jill Carnahan: So true.
• 26:13
  Dr. Jill Carnahan: I never forget the book, and I'm blanking on the author, but it was the man who mistook his wife for a hat.
• 26:19
  Dr. Alan Cohen: Oliver Sacks.
• 26:20
  Dr. Jill Carnahan: Yes.
• 26:20
  Dr. Jill Carnahan: Thank you.
• 26:20
  Dr. Jill Carnahan: My favorites.
• 26:22
  Dr. Alan Cohen: Yeah.
• 26:23
  Dr. Jill Carnahan: And, and the point of that was these brain tumors can manifest with very unusual behaviors and things depending on the area.
• 26:31
  Dr. Jill Carnahan: Is there any particular case or story that you could tell us about an unusual presentation of a brain tumor in a child?
• 26:40
  Dr. Alan Cohen: Well, there was another child who was a little baby, went to see his pediatrician for a newborn visit and he had a big head.
• 26:51
  Dr. Alan Cohen: He would look fine.
• 26:53
  Dr. Alan Cohen: He was two months old.
• 26:55
  Dr. Alan Cohen: And the pediatrician said, you know, it looks pretty good, but I'm just confused why the head should be so big.
• 27:01
  Dr. Alan Cohen: So she obtained a CT of the head.
• 27:03
  Dr. Alan Cohen: And the CT showed a giant tumor filling one hemisphere of the brain, multiple cysts and solid tumor and a big head.
• 27:14
  Dr. Alan Cohen: And again, the diagnosis was made that this was a malignant brain tumor.
• 27:19
  Dr. Alan Cohen: And we decided to go in and make a diagnosis.
• 27:22
  Dr. Alan Cohen: The family, as you can imagine, was distraught.
• 27:25
  Dr. Alan Cohen: And went and opened up the head and we had a real foul smell.
• 27:31
  Dr. Alan Cohen: And it turned out that this wasn't a tumor at all.
• 27:34
  Dr. Alan Cohen: With all the technology, with all the technology that we have with the MRI and high resolution optics, this was an infection.
• 27:41
  Dr. Alan Cohen: It was a multiloculated brain abscess, an infection which were able to remove, treat with antibiotics.
• 27:47
  Dr. Alan Cohen: And now this was a.
• 27:48
  Dr. Alan Cohen: When he was a baby, now he's graduated from high school.
• 27:52
  Dr. Alan Cohen: So were completely wrong with the diagnosis, with all our technology.
• 27:55
  Dr. Alan Cohen: And so I think you always have to have an open mind with everything.
• 28:00
  Dr. Alan Cohen: There's a differential diagnosis, but medicine is an art of probability and we always want to have certainty, but a lot of what we do is based on uncertainty.
• 28:11
  Dr. Alan Cohen: And as long as you have a differential diagnosis, you keep everything there so that if you're wrong, you find your way back.
• 28:19
  Dr. Alan Cohen: But, you know, that made a huge difference in this poor kid's life.
• 28:22
  Dr. Alan Cohen: He's a healthy kid who's now graduated from college, from high school.
• 28:26
  Dr. Jill Carnahan: Yeah.
• 28:27
  Dr. Jill Carnahan: Unbelievable.
• 28:28
  Dr. Jill Carnahan: So one thing in my field, I do a lot of environmental medicine and infectious cases and things.
• 28:34
  Dr. Jill Carnahan: And I often find that if there's a hidden infection like the case you just talked about, or a toxic exposure like mold or metals or something in the environment, even now, nanoparticulate from exhaust, it can really affect the body, but also the brain.
• 28:48
  Dr. Jill Carnahan: Children are a little more resilient because they don't have life burden.
• 28:51
  Dr. Jill Carnahan: But I remember reading a study 2001, which is now over 20 years, where cord blood of infants in Canada showed over 200 chemicals at birth.
• 28:59
  Dr. Jill Carnahan: So they're kind of coming into the world with us.
• 29:01
  Dr. Jill Carnahan: Do you see?
• 29:02
  Dr. Jill Carnahan: I know you're a surgeon, so you're maybe not looking as much as that, but do you have any insights or thoughts on how the environmental toxic load or some things we're exposed to might be affecting brain tumors in children?
• 29:12
  Dr. Alan Cohen: Yeah, it's scary what goes on when we learn about these elements that we can find in the blood.
• 29:19
  Dr. Alan Cohen: And I don't know the answer.
• 29:20
  Dr. Alan Cohen: The only thing that we know that's associated with the development of malignant brain tumors and external factor is ionizing radiation.
• 29:29
  Dr. Alan Cohen: But there are other things that we just don't know enough about it now.
• 29:32
  Dr. Alan Cohen: In fact, you know, for over 100 years we've been taking out brain tumors and we still know very little.
• 29:37
  Dr. Alan Cohen: Now we can look at them on a molecular level, but we still don't know the best available treatments.
• 29:42
  Dr. Alan Cohen: Many of the Tumors that were fatal uniformly can be treated and many can be cured, but not all.
• 29:48
  Dr. Alan Cohen: And when I was in training, leukemia was the number one cause of cancer death in kids.
• 29:55
  Dr. Alan Cohen: And now acute lymphoblastic leukemia can be cured in up to 95% of cases.
• 29:59
  Dr. Alan Cohen: And a lot of advances have been made in the treatment of brain tumors, but not as many.
• 30:05
  Dr. Alan Cohen: There's still a lot of room to go.
• 30:06
  Dr. Alan Cohen: One of the problems in pediatric brain tumors is that there are so many different types, these embryonal tumors that kids are born with, that there's not enough information about it.
• 30:16
  Dr. Alan Cohen: And so federal funding tends to go for the adult tumors, the glioblastoma, the tumor that killed Senator McCain and Senator Kennedy.
• 30:25
  Dr. Alan Cohen: But we don't have that in kids because there are so many different types of tumors.
• 30:28
  Dr. Alan Cohen: And so we need to support research in this area.
• 30:32
  Dr. Alan Cohen: It's coming forward and it's coming quickly.
• 30:34
  Dr. Alan Cohen: But that's going to be the challenge for the future.
• 30:36
  Dr. Alan Cohen: The challenge is not going to be the surgical techniques.
• 30:39
  Dr. Alan Cohen: We've got that.
• 30:39
  Dr. Alan Cohen: It's going to be making a better diagnosis and finding better treatments interesting.
• 30:44
  Dr. Jill Carnahan: And maybe we'll find that in utero exposure or mother, like there's something there that we will actually see because we're starting to see those patterns generationally on, you know, mother might be exposed to.
• 30:54
  Dr. Jill Carnahan: Well, we know for like uterine and breast cancer, there's often those correlations.
• 30:58
  Dr. Jill Carnahan: So maybe at some point, since these develop frequently in utero, it'll be interesting.
• 31:04
  Dr. Alan Cohen: And genetics plays a huge role too.
• 31:06
  Dr. Alan Cohen: We're learning a lot more about that with molecular biology.
• 31:09
  Dr. Jill Carnahan: Yeah, those little snips that create difficulty with detecting cancer cells and those kinds of things, for sure.
• 31:16
  Dr. Jill Carnahan: Well, you're a surgeon, a scientist, an educator, a leader, and you've been doing this for so long.
• 31:20
  Dr. Jill Carnahan: How do you think your definition of success has changed over the 40 years you've been in practice from coming out of medical school to now?
• 31:28
  Dr. Alan Cohen: Well, I mean, our goal is to prolong life, to celebrate life, to forestall death and to improve the quality of life if we can't cure the child and just to develop that, to be able to.
• 31:41
  Dr. Alan Cohen: The goal is to take the child and return him or her back to their life, to their family.
• 31:47
  Dr. Alan Cohen: And one of the nice things about this is we're not dealing with minor, like an ingrown toenail.
• 31:52
  Dr. Alan Cohen: These are life threatening illnesses.
• 31:54
  Dr. Alan Cohen: And it's not me, it's a whole team of oncologists and critical care specialists and radiologists and nursing staff.
• 32:01
  Dr. Alan Cohen: It's a whole team that bonds together.
• 32:03
  Dr. Alan Cohen: And when we have a tough time, the team gets depressed too.
• 32:06
  Dr. Alan Cohen: I mean, it takes a toll on everybody.
• 32:08
  Dr. Alan Cohen: But we work as a team and that's one of the nice things about being in a big medical center, that you're not there alone.
• 32:14
  Dr. Alan Cohen: But I feel my job as a pediatric neurosurgeon is to develop that relationship with the child.
• 32:20
  Dr. Alan Cohen: And that's what I try to do.
• 32:22
  Dr. Jill Carnahan: Amazing.
• 32:24
  Dr. Jill Carnahan: Well, as we start to close the interview, I would love to ask you, is there anything that surprised you about writing the book?
• 32:30
  Dr. Jill Carnahan: I mean, it sounds like you had some of these in a journal for over your practice, but as you actually sat down to write it, was there any pattern that emerged or thought that happened or thing that surprised you in writing the book?
• 32:41
  Dr. Alan Cohen: Oh my God.
• 32:42
  Dr. Alan Cohen: Yeah.
• 32:42
  Dr. Alan Cohen: You know, I've written many articles for journals, research journals, and sometimes they get accepted, sometimes they get rejected.
• 32:51
  Dr. Alan Cohen: It's depressing to get the rejections or ask for revisions.
• 32:55
  Dr. Alan Cohen: And it's hard work.
• 32:57
  Dr. Alan Cohen: But writing for the general public, for publishers is completely different.
• 33:01
  Dr. Alan Cohen: And so what I had to do is do this in the evenings after cases, late at night.
• 33:07
  Dr. Alan Cohen: And that's why it took several years to do this, because I had to put these stories together.
• 33:11
  Dr. Alan Cohen: But writing it is just part of it.
• 33:12
  Dr. Alan Cohen: Then you try to get it published and you know, the publishers want to see the autobiography of Taylor Swift.
• 33:20
  Dr. Alan Cohen: And here I am, a schlub pediatric neurosurgeon.
• 33:24
  Dr. Alan Cohen: So you have to.
• 33:25
  Dr. Alan Cohen: Sometimes you write to publishers and they won't even open the email.
• 33:28
  Dr. Alan Cohen: So it's a different world.
• 33:29
  Dr. Alan Cohen: And I think it's just like anything in life, perseverance is what's important.
• 33:33
  Dr. Alan Cohen: You just have to keep trying.
• 33:36
  Dr. Jill Carnahan: I am so glad you did.
• 33:37
  Dr. Jill Carnahan: And like I said, I personally cannot wait to get my hands on your book.
• 33:40
  Dr. Jill Carnahan: If people who are listening want to know more, where to find you, where to get a copy of your book, where can they go?
• 33:46
  Dr. Alan Cohen: I hope you like it.
• 33:47
  Dr. Alan Cohen: It's on Amazon.
• 33:48
  Dr. Alan Cohen: Comfort Always.
• 33:49
  Dr. Jill Carnahan: Perfect.
• 33:49
  Dr. Jill Carnahan: Yeah, Comfort Always.
• 33:51
  Dr. Jill Carnahan: And the subtitle is Healing in the age of technology.
• 33:55
  Dr. Jill Carnahan: Dr. Alan Cohen, it has been an absolute pleasure to have you on.
• 33:59
  Dr. Jill Carnahan: I hope many people hear this.
• 34:00
  Dr. Jill Carnahan: Guys, if you're listening and you know someone who might benefit, please do share this episode.
• 34:05
  Dr. Jill Carnahan: I want to get this book in the hands of as many people as possible and thank you for your decades long work in this field and for just bringing the humanity back to medicine.
• 34:16
  Dr. Alan Cohen: Thank you so much.
• 34:17
  Dr. Alan Cohen: Dr. Jill.
• 34:19
  Dr. Jill Carnahan: Hey guys.
• 34:19
  Dr. Jill Carnahan: I don't know about you, but this may be one of my favorite episodes of Resiliency Radio.
• 34:24
  Dr. Jill Carnahan: I just love Dr. Cohen's heart for children and for his work in the world and that healing connection.
• 34:30
  Dr. Jill Carnahan: I hope you've enjoyed this episode and if it's touched your heart, please go out, check out his book, and then share this episode with a friend.
• 34:38
  Dr. Jill Carnahan: If you haven't yet subscribed or liked or hit the bell to be notified of future episodes here on YouTube, please do so.
• 34:44
  Dr. Jill Carnahan: If you're anywhere else where you listen to podcasts, please do stop by and leave us a review.
• 34:48
  Dr. Jill Carnahan: It helps us to reach more people.
• 34:50
  Dr. Jill Carnahan: As you know, we have new episodes out every week, so I look forward to seeing you next week for a new episode of Resiliency Radio.
• 34:57
  Dr. Jill Carnahan: Until then, make it a great day.