Latest / Mane AF / EP #4 Tyler Mane Got Breast Cancer. This Is the Doctor He Calls His Superhero

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EP #4 Tyler Mane Got Breast Cancer. This Is the Doctor He Calls His Superhero · Mane AF

• Dr Sroka Intro & Outro: what did I do this week to piss you off? I pissed you off. yes, you did. And then you being pissed off made me pissed off. So we sort of had a piss-off. Yeah. We had a piss off. I was trying to record a video. And what did you say to me? Something really shitty. Yeah. What was it? I told you you were a shallow person. Yeah, you sure as hell did. Why did I say that? You said that your husband was a shallow person. I said that you were trying to act like you were doing deep thoughts with Tyler Mane But you were really just shallow. And I apologized for saying that because I was my. my. I was being shitty. You were. And then you tried to tell me how to do my my my my recording that I was doing. Yeah, well, I was right on that. You should have listened to me. Bullshit. Bullshit. And then I'm going into what am I going into? Where was we walking into? Chemotherapy. Yes. Like I wasn't stressed enough. I'm having heard I did not bring him a burrito today. What did I bring you, Tyler? Holy shit. Who does this? A frozen Spanish rice pack. Yeah, it was for your ankle. For my ankle. Yeah. Better than a burrito. So you put the rice on my ankle. In the middle of chemo theater. And everybody was looking at me like, what the hell? Yeah. Hi, I'm Tyler Mane And I'm Renae Geerlings. And this is Mane AF. The podcast where we talk about midlife, marriage, mayhem, and the wake-up calls that make you stop and ask what really matters now. Today we're talking to my oncologist about something we never expected to become part of our story, male. Breast cancer. We'll get into the science, the fear, the questions people are afraid to ask, and what happens when your body becomes the thing that fully gets your attention. Because midlife has a way of waking you up. Sometimes gently, sometimes not. But we're here to talk about it honestly, with humor, art, and probably a little bit of oversharing. Welcome to Mane AF. I think we got it. Today we have my oncologist coming on. I'm so excited because out of all the doctors I've ever had. In my lifetime, she is by far the coolest. Yeah. Just the way she explains stuff. Yeah, we actually both really dug her when we got to the first the first meeting with her, which was a pretty daunting meeting and we all came out of there. What do you call that first meeting? It it's called a an appointment. Consultation. Consultation, yes. The consultation or whatever. Yeah, it was way more. Yeah. It was an appointment. You were all But just the way she explains stuff using the cool, you know, because you're expecting all of that technical jargon. And she comes and she puts a piece of paper in front of you, starts writing upside down and upside down. You'll hear us say that a bunch of times I'm sure. We love we we keep we can't stop talking about that. But yeah, and she explains it. In really cool cool terms. And analogies, because I love analogies. Yes. And you and her nerd it out and I would I'm it's gonna be pretty much like we're gonna have today. I'm gonna be in the middle, they're gonna be sitting talking all the time, and I'm gonna be going, uh-huh, uh-huh, yeah, yeah, good, good. And I won't get a word in edgewise, but that's okay. And today we're gonna talk about what happens in midlife. When you get that wake up call, where one day you say, Well, at least I'm healthy. God, yes. And the next day You're not. You find out you're not. And then you have shit to deal with. Yeah. How the hell do you make life changing decisions when the doctor has the statistics, the internet has a hundred thousand choices? And you're the one who has to live with the decision. We were very fortunate to find Dr. Nicole Sroka to guide us on my journey. Mane AF: would like to welcome to Mane AF Dr. Nicole Sroka MD, who received her bachelor's degree in molecular biology from the University of Wisconsin in Madison, Wisconsin. Woot. She then earned her medical degree from the University of Wisconsin School of Medicine and Public Health. She is a board-certified general surgeon specializing in breast surgery. Dr. Sroka is a member of the Society of Surgical Oncology, American Society of Clinical Oncology, American Society of Breast Surgeons, and the Southeastern Surgical Society. Dr. Sroka has developed new oncoplastic techniques over her career to minimize scarring and improve cosmesis of the breast, both for benign and malignant surgeries. She has developed new localizing techniques and specializes in minimally invasive procedures. She has experience with hidden scars and nipple sparing for small and large breasts. She incorporates functional and alternative treatment throughout her process. She is dedicated to providing personalized breast cancer care and focuses on quality time. versus quantity, which we can speak to from experience. I guess the one thing I didn't that that's not on here too is I did do a fellowship in surgical oncology. So at Sloan Kettering in New York. So Wow. First of all, let's just how did this become your specialty? Totally unplanned. Totally not planned at all. So I I knew I always wanted to do surgery in medical school and everybody That knew me, that's that was what I w wanted to do. And then I went into general because that's kind of like your entry point. And then the question was, where do you want to go from there? And I originally wanted to do plastics. But when I was coming through, it was sort of the time where everybody wanted to do plastics because Dr. 90210 was big and there were like 4,000 applicants for 400 spots. And for plastics, I wanted to do breast cancer reconstruction. It was something that I fell in love with in medical school. And I was like, this would be awesome. Well I went to a very small surgical program. And so trying to get into one of these high powered plastics without it was hard. It's just the so I didn't get in my first year of applying. And my attending was like, Well, what do you want to do? Cause now you got a year off. And I'm like, I don't know. And he's like, Well, what do you want to do in plastics? I said, I want to do breast cancer reconstruction. He goes, Well, why don't you do a breast fellowship and learn about the the sort of underlying etiology that you've got to repair? And I'm like, I mean, sense. But by that point, all the fellowships were they'd already interviewed and things like that. And so I ended up getting a slot at Memorial Sloan Kettering. it was an amazing opportunity. And so I got to go to New York for a year and I learned under the people that literally wrote the book, they were amazing, amazing people. and then when I got out, it was like, do I still want to do plastics? And it's kind of, I feel like, you know, when when you think you know which way you want to go, and then There's other plans for you. Like kind of like God's got other plans for you. Yeah. sometimes he just gently pushes and then other times you chip and fall and skin your knees. And I feel like this was trip and falling and skinning my knees because that's so not what I thought I would be doing, but it's where I was supposed to be. But you love surgery. I love it's always gonna do surgery. And how much time do you spend? I mean, because l like we said, you spent so much time with Tyler, and we take the time that you guys need because that's the right thing to do. It makes it less scary. It really does. And do you have a lot of couples come in, or is it just usually are you usually talking to one person? Cause like I when when we first went in there, I said, honey, because I usually go to the doctor's appointments by myself. But I said, Honey, for this one, you need to come. Yeah. Cause as soon as I hear that word, I'm just gonna go blank. Yep. And I'm not gonna hear anything else. yeah. But when you came in and was were explaining it, and then you start writing upside down. We have talked about that a million times. And and it's just so cool. And and the way the way you explain, would you okay? Should we have our kind of walk through? Could you walk through some of the words you use? Because the words you use were so cool. I was like You really can relate to this. Well I the the problem is when you go to medical school you are like in indoctrinated into all of this like it's literally laugh. Like all these words are Latin direct, right? And so you're you're taught that it this is how we all have to speak. And then when you get in the real world and you start talking like that, nobody has a clue what you're talking about, right? And so they forget to teach you translation backwards, right? And so when I see people doing it, I'm like, they're not I I feel like it comes across sometimes oversimplified or condescending or like just incomplete and and it it's Frustrating to me because the concepts are very straightforward and simple. It's the terms that are hard. And once you define the terms, then everything else makes sense, right? But you got to start at the foundation. And that's what takes the time. Like, where does breast cancer start? How does how does it start? Like, if we don't define the basics, then when we talk about, well, how are we going to make sure it never comes back? If you don't know who this is that we're dealing with. Then everything that people throw at you, everything that people are saying, you need to do this, you need to do this, you need to do this, the why is important. Right. Right? Yeah. Yeah. Super important. So we start at the beginning. Yeah. It was it was a nice walkthrough and and some of the terminology. What what was the the the the you were called things what did she call them? The it had fast moving Buggers or we had the couch potato. yeah, the couch and the Jeffrey Dahmer. And the Jeffrey Dahmer. And I was we were like, I know how I don't want the Jeffrey Dahmer, I don't think. We don't. We don't want Jeffrey Dahmer. They're bad. We have explorers, we got couch potatoes, we got wimps, we got bullies, and we got everybody in between. Right. And and treatment is really dependent on who found you. Cause I know you didn't go looking for them. And so your your energy was so amazing. So high I wanted the couch potato, but no, I didn't get the Jeffrey Dahmer. you did. Well, I got the one that looked nice on the outside, but wanted to eat you on the inside. Right. I got the fast moving. Which kind of sounds like Jeffrey. It was that was I'm pretty sure that that was the Jeffrey Dahmer. It's not that he was like he didn't come out swinging. He didn't come out saying like he was Really, really, really aggressive. He came out looking like he was gonna be okay. And then we ran that molecular test on him and he came back, Jeffrey Dahmer. He looked nice on the outside. He just wanted to eat you on the inside. Yeah. Whereas the other one was the one with the Mohawk and the pink tutu that really just sits on the couch and hangs out. That was what we wanted. That's what we did the Mohawk wearing. But it's appropriate that you know Michael Myers got a Jeffrey Dahmer in some ways. I think Michael Myers can take Jeffrey Dahmer. I think so. Well, I think he is somebody else. Yeah, that's right. He's yeah, he's it didn't last long. So bad. We let's let's talk about this. So So Tyler did have sort of an interesting progression. And we appreciated you coming in with a very optimistic attitude, which is great. and you said right away. I suspect it's a stage one. And you were correct. I correct. And then I remember the next after the lymph nodes were taken, you came back into the room and you said, so congratulations, it's a stage one. And there was this heavy butt in the room. Well, it was yeah, because remember we That was when we found out the onchetype Right. Cause you had gone and had the the the What we alluded to the mass removed. And so I we already had what we needed to run it. So I was like, while we were doing the surgery, let's just find that out. Yeah. And of course the whole time I'm going, please, please, please, just throw the sky bone. Just come back to couch potato. And I was like, Okay, of course you didn't. Of course you didn't. Now I gotta go tell you. Yeah. That part sucks. But but the flip side is is if you know now, yeah, you do what you need to do. So he doesn't be he doesn't come back. Exactly. And that's the for the whole chemo. And that's what I was we were fight. I was struggling. I was on the struggle bus for that. I know you would be. But I the what one thing I want to ask is, would it have been better if I would have come to you with the lump still in me, or like how like that is one question that's been really eating away at me going. Should I not have had it removed? Cause like I went into the surgeon, he he was a like is he a general surgeon? General surgeon. And he said, Yeah, he's a great guy. And it w it was he he was like, Yeah, you probably want that removed. I go, Hell yeah, I want that removed. The next morning we were in there removing it. I mean, that's awesome. That is great. Like it was so fast moving. Yeah. Where I didn't have time to stress and think and worry about it. I might have slowed it down a little bit at the start just to grab that piece of information. Right. get a mammogram, get a biopsy, figure out who this guy is. A mammogram? good thing I avoided that. Cause she would, that's the one thing she said. if every man had to get a mammogram, they'd change those mammograms. That that would be a much better procedure very quickly. We'd still end up in surgery, but then we would we would have saved a second surgery because we would have known at that point it was cancer. We would have known. margins and then we would have taken a lymph node at the same time like we did in two separate procedures. So right. So instead of a biopsy using an ultrasound and a core, we you just did the surgery. I think ultimately we we ended up in the same place we were going to. and it wouldn't have changed who this guy is, right? He was going to be Jeffrey Dahmer no matter no matter what. it just is a little bit it's just a little different order. So I don't think you need to worry about it. Yeah. Because I think it just is two different ways of doing the same thing. Perfect. Now, n s saying the biopsy, I've heard that sometimes biopsies, if you do a biopsy, it can leak some of the stuff into the so can it do that? Or is that a myth? It's not a myth. It is based on a different breast cancer, a different cancer, not breasts. It's ovarian cancer. So ovarian cancer can kind of spread like wildfire. And so if you touch it and you move it, it can just no matter where it lands, it can kind of implant and do that. And when the early physicians operating on cancer, you we're talking 30s, 40s, 50s, 1900s, they saw that process and it was like, could any cancer do that? And so that's where the ideas of, hey, if we biopsy this, are we gonna track it? Is it gonna seed the track? And even when I started training, like my internship and residency many, many, many years ago, we always had to make the incision over the cancer because we were worried about tracking. So there was a lot of of That thought process even in the late 90s, early 2000s. and so that's sort of gone away for breast because breast doesn't do that. Like the way I like to think about it. So here's one of my weird analogies, right? Yeah. Give it to us. I live for analies. Lay it on us. So if if I I I I kind of use like us as an example. So if I picked you up and I put you in the middle of Wyoming with no survival gear, would you make it? And I you didn't know anything about like, okay. New York debutante, never been outside, never gone camping. I pick her and I put her in the middle of Wyoming and she's gonna make it. that'd be tough. Probably not. Right. But if I take a survivalist and I put him in the middle of Wyoming, he's gonna have a fire, he's gonna have food. It's gonna be a lovely vacation for him because it's what he lives for, right? if I take a if I take you and I drop you off on the moon, are you gonna make it? That's a hard no. probably not. Oxygen is a important thing. If I had a suit. Correct. If you had training and everything else, right? Yeah. So I take a breast cancer cell and I put it in a different part of the breast. It could even be hard for that breast cancer cell to make it in a different part of the breast, unless it went there on its own. If I take a breast cancer cell and I put it into a lymph node, it's like me putting you on the moon. It's a completely different environment, right? It's got to recreate breast environment in that lymph node, which is a completely different environment. And so until it's ready, until it has a suit, until it has training, until it it's unlocked the ability to live someplace other than breast, it's not gonna, it's not gonna do that. Not gonna do that. Now, there's bacteria that can live anywhere, right? Like they even like sent it into outer space, came back, it still alive, right? And so there's cancer cells and that similar analogy that you no matter where you put it, it would survive. But that's not the norm, that's the exception. The norm is until a cancer is ready to live someplace else, it's Going to. It has to turn on the right tools to be able to survive wherever it's. Yeah. And so biopsing doesn't increase the risk of it spreading, but it is, I must, it's a very common, it's very common. I think we all I I tell people the same thing probably 10 times a week. So it's not you're not alone in thinking that because that's out there. That's what everybody thinks. And we thought that too in medicine up until like 20, 25 years ago, really. So I'm sure someone will come and no, that's not true, but it is. Like seriously. It's but but now we know it's not. Well, I trust you more than the online trolls. I mean, it's just so so to me, like your cancer wasn't in your lymph nodes, it wasn't ready to live in the lymph nodes. At least that's our perception, our basic kind of understanding. It didn't get there yet. but is anybody gonna bet your life on that? Well And also because even though it wasn't in the lymph nodes, which is generally the first place it travels, doesn't it? We still, because of his high onchetype had to get the full PET scan and and check everything else out because this was one of those guys that could have skipped the line and just busted out somewhere else. So how in like this is it's so fascinating to me. My brain just kind of I'm so n nerding out. It's so interesting how every different type of cancer in a different like ovarian behaves one way, bone behaves another way. the variables, though, right? Because of the onca type. and that is like when we saw the treatment PDF that's basically, you know, for this type of cancer, these are all the variables. This is the the type of tumor it is, this is the onchetype for it. These are the variations of treatment for each of these things. It's like this Venn diagram that you have to kind of start laying things over, right? It becomes like it's so overwhelming as a lay person, but it's also so fascinating how but how does a a breast cancer cell then it must mutate, right? In some way to then become able to live in and it goes to bone typically, right? It's got its favorites. Yep. So remember, every time a cancer cell divides, it has got to copy broken DNA. And when you copy broken DNA, it's like trying to copy a corrupted file on your computer. What's going to happen? It's going to get more corrupted. It's going to get more broken every time it it it copies itself. And so as these cancer cells are continuously growing and dividing, more and more mistakes come up. And some of those mistakes turn on the ability to make new blood vessels. Some of them will turn on the ability to travel via the bloodstream instead of the lymphatic system. Some of them Will turn on how to live in a liver, how to live in a bone, or how to live in somewhere else. Right. So increased is another one, right? Is that not breast? no. It's that but that's that's with the with the BRC2 gene mutation that he has. He now also has to watch. Yeah. So so many. Overachiever. That's all I'm I know. I am I am an overachiever. In a lovely fashion. But can I win at a casino? Hell no. We were just there. Nope. What was really, really hard for him was essentially hearing, we got it all. Your PET scan is clean. The tumor is gone. You are to every indication cancer free. But but and that was the big word. The big word, but but we still heavily recommend you do chemotherapy. Can you explain us a little? And I know this isn't necessarily your it's good. It's good. Yeah. These are questions I we we have to talk about. And one of the reasons our visits are long. But so let's talk about the PET scan. Everybody thinks if they have a negative PET scan that there's no cancer anymore. The problem is PET scan can only see cancers that are about five millimeters in size or larger, which is still very small. It's like a half a tic tac. Half a tic tac doesn't sound very big, except there could be three million cancer cells that live in a half a tic tac. So if we do a PET scan and you're negative, that means you don't have a colony of three million cancer cells in one specific place in your body. It doesn't mean that there isn't a cancer cell single or a hundred thousand cancer cells. So a negative PET scan is amazing, but it doesn't mean there's not a cancer cell out there. And when we looked at the onchetype with it being the Jeffrey Dahmer subtype, okay, knowing that it could bypass the main system and it's gonna try and be a butthole about things, right? Are we going to bank that that PET scan is a hundred percent accurate? No, nobody's gonna bet because your life is the bet, right? Nobody's gonna bet someone's life. That that PET scan is is perfect because we know it's not. and so then it becomes well, how many layers of protection do you need to make sure that we've attacked this thing in so many ways? So that if there was a hundred thousand cancer cells or one cancer cell, because one, that we've accounted for its weakness and we've blasted it. And that way you get to move on with the rest of your life. And this guy gets to stay dead forever. And that's why we did the chemo, and that's why. We talk about estrogen blockade. And that's why you're gonna go to the radiation doctor tomorrow, because you need all of these layers, right? Based on who found you to make sure that we've reduced the chance of its survival so low that you do great. Yes. Stay standard bucket. You were freaking me out at the beginning there when you say there could be more there, but you can't you brought it back around and brought it back around. I love that. Okay. I'm gonna be fine, baby. You are gonna be you got more of me. And in so and then you also brought up the estrogen blockers. So let's let's talk about male breast cancer specifically. I mean, we know Tyler's an overachiever. Yes. Male breast cancer is rare. Rare. How it's one percent of all breast cancers. The the number I saw was one in seven hundred and fifty men could be diagnosed with breast cancer in their life. However if you're The outcomes are tend to be worse for men. Yep. because we don't we don't talk about it very much. and so and and then there's also so many surprises. Didn't know men had breasts was one of the things we heard, which is kind of funny, but I can see. And or also have in the BRCA too gene, which you go from less than one percent to what percent? Lord, now you're gonna put I think it's just about seven. Seven. Yeah. I was gonna say it's around that. Yeah. Yeah. That's still a pretty low number. How did I win that lottery too? We mentioned you're an overachiever. Right? How many male breast Okay, go ahead. How many male breast cancer cases have you seen in your I mean I've probably done twelve, fifteen. They're not I mean again, they kind of come in spurts. So We used to have maybe one or two every every year and then I c I kinda went several years without them. I don't know. I'm sure they were still happening, but I think again, men want to go to men, women want to go to women as far as physicians go and w men don't want to come into a office they think is gonna be solid pink, which mine is not. It is not. I don't mind pink. She's using my microphone and that's my microphone cord that I got. Especially for me, but I let her use it this 'cause I usually sit Yes. Pink is now his color. It is. Hey, it's the new black. It is. Yeah. It's a new black. It is. but no, so I think so. For a while, I think a lot I didn't see as many just because I think they were going to other places, but I had three this year. wow. Including you. So again, they they're they happen. It's just there's only 3,000 cases a year in the United States of male breast cancers. So they you you see them. You you we see a lot of men come in with. palpable areas. And thankfully a lot of them are gynecomastia, which is why I think a lot of men get diagnosed a little bit late. They think it's just male breast tissue development because of all the medications that they're on, or lipomas or so they just sort of think it's nothing and then and I think also, you know, like Tyler was saying, it's it's a little emasculating was the word that he used. He really kind of was just hoping it would go away. But like you said, too, we don't really know why I got it. Yes, I have the BRCA II but then also I have been doing the TRT because I was getting a little sluggish and I wanted to be back optimal. And then there was my few years of taking in some alcohol. Did a little bit of that. So I had a few things that could contribute to it, but you made me feel Better about it is that we don't know how, right? You can kind of drive yourself crazy. You can. I mean, it all boils down to one single stupid cell that you didn't even know existed. Out of the 39 trillion cells that make you you. I mean, this is how crazy this is. Had a mistake and it couldn't fix it. And that mistake compounded by another mistake over here and another mistake over here and another mistake over here. And the fact your one of your main repair systems, which is BRCA two, wasn't functioning as efficiently. You didn't repair your mistakes as efficiently as everybody else's, and just in one cell, they happened in the wrong spots. Wow. Can you you can't control that? Can't control it. Yeah. and men aren't getting mammograms every year like women do. We don't know teach men how to look for it. What what are symptoms that men should be looking for aside from a a lump, possibly? I think that's probably the only symptom that they have. I mean, really, it's a hard lump, a change in the nipple, a change to the skin around the nipple. sometimes you can get almost like eczema, it looks like on the tip of the nipple, and that can be an early sign of male breast cancer. but a lot of times you present as a mass and it's a mass that tends to go ignored for a little while because again, is it You think it's gonna go away as like there's a lump here that that's not supposed to be there. It's gonna go away. I'm not supposed to have a lump and right. Yeah. And and the last thing on my mind was that it would be Yeah, 'cause that's girls do. Yeah. Is but is male breast cancer biologically different from female breast cancer, or is it just in the way we treat it because of their hormones in their body? That's a great question. And that's I think a part where we're Kind of behind on stuff, right? Because most of the way we treat male breast cancer is based on female studies. Because that's where we did all the studies. Some of the studies. Ironically, and we were talking about this before, it's kind of antithetical to most things which were studied generally on men. Mm-hmm as the We retrofitted it for women. Right. And I think we're doing the reverse here. Yeah. Yeah. And it's just because Because there's so many less male breast cancer cases, how are you going to make a randomized clinical double-blinded controlled trial looking at X versus Y? And the number of patients that you could possibly get on it per year in the entire country is 3,000. Right. Yeah. It would take forever. Yeah. So we end up compiling all these smaller studies to try to get some numbers. we know that most male breast cancers are going to be estrogen receptor positive. Which is also another thing that that is surprising because a lot of men or a lot of people don't realize that men do have estrogen and that testosterone can be turned into estrogen. That was that was for us crazy. Can you talk about that a little bit? yeah. So yeah. So two two places men get estrogen from. The first one is fat cells. So fat cells take cholesterol, which is I know it's which I had which I had a lot of until I started shrinking it down. Well, I mean, we but you had fat in your fat cells. Yes. We lost the fat in the fat cells, which is fantastic. I wish I could lose mine. It follows me home every day. But well, it does. And anyway, but the fat still is still there even when we're thin, right? So the fat cell itself is taking cholesterol and through this really convoluted pathway is spitting out a little estrogen. Now, compared to what women have, I think I probably said this it's one of my favorite, it's my dad's favorite saying it's a mouse fart in a windstorm. Yeah. Right. Like women have these hurricane four-scale winds of estrogen and men they have this little mouse tube. and so it's okay. It's all right. but from at least these fat cells. But then we can also convert testosterone into estrogen through the aromatase kind of pathway. And so you can have these two different ways to get estrogen. Now, do you think that that could have been exaggerated with my TRT that I was taking or so great question. And I was doing I I actually was thinking it might come up today. So I'm not gonna lie, I t googled it this morning to try to figure that out. I did. I was studying like while I drying my hair upside down in the bathroom, like from what I can understand, yeah, there is a pathway in which testosterone does can be converted through aromatase into estrogen. And so when we're talking about people that have been on testosterone replacement therapy and have had breast cancer and want to go back on their testosterone, there's nothing out there in the literature that says you can. I think most medical oncologists would say probably not. Because you can convert at that testosterone back into estrogen. And if your cancer needs estrogen to live, which yours does, then the last thing that we want it to have is estrogen. am I supposed to be stopping your testosterone? Yeah. Unless you talk to your medical oncologist. Well, and that's a conversation. I've been dropping it back, but 'cause there's no data on it. That's the problem. There's just no That and that's the that's the hard part about male breast cancer. There's a lot of things that come up in the real world that there's no data on. Yeah. And so I I I don't disagree. Having testosterone is extremely important. And is there a way you can prevent estrogen or testosterone from converting into estrogen? There is, but I think that's something that like the medical oncologists and you just you you have to have a good relationship with your medical oncologist because you're like, this is what I need. And he's like, Well, this is what you can have. And how do we make the two sort of meet in the middle? Right. Some right. Yeah. Cause he he yeah. We we kind of did you meet in the middle? That's well, that is that is the ongoing conversation. I pulled well just wait. I pulled back and it's good. And we're we're testing it. I'm gonna get the test back tomorrow. We're seeing where it's at. but mine was so, so low. Right. You know, mine was at the very low end of being okay. Right. And and our doctor that we got for he's he deals with hormone replacements and stuff like that. wanted to bring it to optimal. And and I wanted to too, you know, because I was feeling sluggish and everything. So now I'm trying to figure now I have this tug of war, yeah. Tug of war going, what do I do? And to your point, there's no absolute. So there's a little bit of Taking on an acceptable risk, kind of like doing chemo, right? Because the odds of hit of the cancer coming back without chemo were twenty-seven percent. The odds of it coming back statistically with the chemo are eight percent. Seven. Seven percent. Or less. Seven or less. Or less. So you're dealing with population level statistical numbers and trying to make a a kind of a A guess for yourself with acceptable risk. We need to do an entire episode on hormones. What hormones do what hormones do? Hormone replacement, having to lose your hormones because of cancer therapy. This is because now I'm freaking out, going, Do I pull it all the way back? But if I pull it all the way back I didn't see any good, good evidence there either. Like everything I saw says just there the they. I don't I don't know who they are, because remember, I'm just the mechanic. It's it's the same people who decide what we should be wearing. They what are they wearing? Yeah, but the these are the they that that probably know the research and the data. But the thing is is that there the data isn't there. Right. So we know that that testosterone can be converted to estrogen. We don't know how much of it really is converted to estrogen theoretically, and whether or not you can combat that conversion and whether or not everybody does it in the same volume. And when you're really low in in in tea and you're just trying to get back to what would be normal for your age, then again, it but but I see the same issues in women with estrogen, right? It's yeah or progesterone. Or so I think that there is a lot of unexplained areas because it's scary to to do that research. Because what if you're wrong? What if you give randomize and you give people hormones and all of a sudden their cancer recurs and you can't like There's some real world consequences to doing these studies. And I think that's part of the reason some of that data may not exist. Low incoming. Yeah, because that's like, I don't wanna it's do no harm, right? yeah. Yeah. Yeah. But on the other hand, if you're doing a trial where you are hoping something is going to help someone and you give someone a placebo, right. I mean, there's kind of part and parcel of we have to find out if it works by finding out when it when it doesn't. Yeah, it's just this is it is, but placebo would never activate a cancer in a hormone. Right. That's that's the rub. And so I think Yeah, that would be the reverse of trying to get a drug to get rid of it compared to this was just something to give it back to. Right. Yeah. But don't want. So yeah, really, really complex interactions in our body and you know, s we think that we I mean we think that we know so much and we do know so much, but every time we learn, we're still in kindergarten. Right. Like I I truly I truly believe that just we are just on the verge of of understanding all of everything that's going on and how everything interacts. And and while we've made huge progress and huge strides in all of it, I mean we're still just babies and In understanding how cancer works and how to tear it apart. It also seems to me, and I'm not in the field, but like the more we learn, the more we learn about what we don't know because it just opens all these doors for more possibilities and more questions and more Yeah. Well, and like you said, like had this been ten years ago, it would have been a different story for me. It would have been probably all coming off because it was the fast moving onchetype And now we're doing Different steps where it's not as evasive. Yeah. yeah. Invasive. Invasive. See, she corrects me all the time. I I wasn't gonna correct you, you asked. In your mind, you were going, he said it wrong again. We got breast conservation therapy and men. Yeah, right? Why not? Like, why can't we do this? We we have so much data with women. Like, why can't and I and I think part of it was like, Well, they don't really have that much breast tissue, so why does it matter? Well, they have nipples. Yeah, they have areola, they like to take their shirts off. Like, it's kind of weird not having the nipple. Yeah. Yeah, I I for my women that don't have nipples, I understand I I I take nipples all the time. But to not even offer men the same option just because it was never done doesn't sit right with me. And I've spoken to some men that have had it done years ago when they've had the one side removed and still have the one and You know, that and what do you do with that? Yeah. What do you do with that? And and just this weekend at the convention, we were I was talking to a gentleman whose father had male breast cancer. And it went on for so long. The only reason that he really realized it is his nipple inverted and then he goes, something is wrong here. And then he went in and got checked and it was stage four. And then he didn't last very long after that. So I'm I'm advocating for everybody just check. Check yourself. Yeah, do it. Check. And if you feel something, say something. Get your say something. Because you are your best advocate for your body and your health. And and and I thank her every day because had she not said to me, get your ass in there and go see somebody. You know, I've in a day. Per day. Surprise me. You know, and then I've gone through, I think, is it Seven doctors and a genetic counselor so far to get to where we are now. And then now I've got a radiologist. Is it radio? Is it a radiation? Radiation tomorrow. But is he called a radiologist? No, what would he call it? Radiation oncologist. Radiation oncologist. What's the difference between radiation and radiology? Radiology is the x-rays and the CT scans and the PET scans. So they're the ones that read the actual images. Radiation oncologists are the people that actually. Dose the energy beam to kill cancer. But you did you did touch on something that today was your final chemotherapy treatment. Yes. He rang the bell. Yes. But is that the end? Yeah. That's my question. Like I'm it it is it was kind of bittersweet. This. But they did have a superhero sign. They did. Did they? We should have taped over it said villain because I'm never the superhero. I'm the villain. Super villain is way more fun. But the day you took out Jeffrey Dahmer. You didn't Took him out. So when someone finishes chemo or radiation and everybody around them thinks, Great, you're done, close that book, when is someone from your perspective, when are they actually done? Are they ever actually done? Yeah. So cover your ears, Tyler. Well, yes and no. So I think It's it you're right, it's bittersweet. And and you're not you're not wrong because everybody around you and you're correct is gonna start going back to normal, right? It's it's done, you did it, hooray, everybody's relieved, life moves on, and you're trying to fit back into the life that all you've wanted to do is fit back into over the last six months, right? Like I just want normal back. I want to be normal. That is what I'm doing all this for. And then the next day happens and you're like, I don't, I don't feel normal yet. Cause like I'm questioning, am I all good? Cause I was like always going, I'm all good. Right. Am I all good? You know? And then now ringing that bell, I'm like, wait a minute. I know I got the next five days, six days. There's going to be some rough patches there before I start coming back and starting to heal. And but but the good thing is, like when I had my hips done, it was one and done. I knew I was on the road to recovery as soon as I had it done. This was the first round of chemo. I had it. I was like f starting to feel better and I'm like, shit, I gotta go back there in a week. Right. Right and then it was four days, three days. What I gotta go sit back in that chair. it's been crazy. So I'm waiting to see what happens this time. Hopefully nothing. Hopefully nothing. Yeah. But to answer your question, right now the cancer's here, right? And every you can't see around it because it's here. It gets here. And then one little thing will happen and it'll be here again. And that's usually when you call me. Because we're expecting it. So it's usually when you call me. And we get you in and we talk, okay, what's going on? And then we run the test to prove that you're okay. Because I believe in positive affirmation. There's I do too. Thanks. That disagree with me. But if I can you've spent enough time of your life dwelling on this diagnosis, if it takes one study to say you're good and this thing can go back here, let's do it. Yeah. Why would you not do it? Now eventually it gets so far back here that it becomes part of your past, not ruling your future, but it one little bump and it And you're like, okay. So is it ever done? It becomes a part of who you are, becomes a part of your past. It doesn't rule your future. You will look back on it. It is now part of the story, but it doesn't need to be ruling the future. Does that make sense? That does. I'll tell you, like at the beginning when I had that, every little I she can testify. Every little A campaign is like, do I have some other kind of cancer? What the heck's going on? Any kind of twitch. I'm like, I I was freaking out. And then I just I was like, I got no, settle down, chill out. It's all good. Yeah. And he stays on tamoxifen for five years. And why do we choose five years? Because on average, a cancer can survive about four and a half years without estrogen. And so if you come off of tamoxifen early and there's somebody out floating around in your universe, what's going to happen? Well, you're going to have estrogen back. And what's going to happen to that cancer cell that's been holding its breath beyond hoping beyond all hope that you're going to give it estrogen so it can wake back up and start doing stuff. It will. And then it figured out now you know, now it knows that you know that's a weakness form. And one of the first things it likes to do is to find a workaround. So you need to be on this medicine longer than a cancer can hold its breath so that when you come off of this medicine, there's nobody out there that can reactivate, right? Right. Now, do all cancers hold their breath for four and a half years? No. There's a small subgroup in women that we found again. Men is hard to talk about because we just don't have the data. But for women, there's a small subgroup that can hold the breath a little longer than five years. And so I have some of my patients that are on estrogen blockade for 10 years. Since he has the BRCA2 mutation, could it start all over somewhere else because he doesn't have the repair mechanic? So BRCA wherever it's turned on, we have to monitor, right? Right. Because those tissues are in so they're accumulating mutations faster. So we know BRCA two is turned on in the breasts, the ovaries, we don't have to worry about that for you because you don't have any. the prostate and a little bit in the pancreas, but not as much as BRCA one. So so BRC one's worse than BRC2 for pancreatic pink pink Yeah and for breast and ovarian I can't even say that word. Yeah BRCA one, but weirdly enough, BRCA1 doesn't increase the risk of male breast cancer very much. Isn't that weird? Really? Yeah it's weird. But BRCA2 does. I don't know. It's weird. I had to look that up this morning too to make sure I was remembering correctly. But yeah. Well, thank you. Yes. So to answer your question, I know you're gonna need five years of estrogen blockade. And so the first two and a half years, they're important for the little bit of faster growing guys because they don't take as long to come back. So we take a we we take a deep breath at about two and a half to three years because that's when the majority of these early recurrences happen. We take a deep breath at five years because hey, we've been on estrogen suppression, we're coming off of it, and we're gonna we're gonna take a deep breath. but we always monitor, right? It my husband told me once, I trust, I just need to verify. So we always trust but verify. Hey, we trust that it's gone. I want you living like it's gone, but I'm always gonna be checking. Remember, I told you we adopted you. Yes. Yes, yes, yes. I did. And now just like just talking about it, I'm like, I'm starting to But but but anytime something comes up, we prove that it's not and we move on. And the longer we go without recurrence, the less likely it is to happen. Yeah. And when you say w I'm sorry, when you say when something comes up, what are symptoms to look for? Gosh, everybody's different. So some people will come in with left shoulder pain. Someone will come in with back pain. No, this was right. See, I this was left shoulder pain. I said left. I said left on purpose. bad. But but we do so we do the image and we we do the test and we say, look, see, it's this. It's the fact that, yes, everything is a little bit inflamed. Yes, you just take chemotherapy, which can cause neuropathy. Yes, you've put your body through the ringer over the years with with your career. And so maybe some of that is coming out with that chemo dose or with the way you were sitting in that chair for all those hours. Right. We we address the problem and we move on. So And the the funny thing is is the longer that we go and the more that we prove your innocence, the less nerve wracking the other things become. We learn what normal is again. We learn to trust normal. Your body betrayed you. You don't trust him. So at this point, everything's gonna come up. The more we give trust back to your body that this isn't the cancer, that's just a freeing kind of thing. And and it happens. It's just time. We're just you're in you're in the beginning. Once treatment is over. Yeah. In your opinion. In your scientific opinion. What matters most? Is it sleep? Is it diet? Is it is it lifestyle? Avoiding the booze. What what can we control versus what we can't? So I think there's you could dive into a rabbit hole in this one. Right. Like deep dive. so there is a lot of data out there looking at lifestyle modification right now. and how it can impact recurrence risks for breast cancer. And so a lot of it is stuff that we're being told by our primary cares to do anyway, right? Like get good sleep, like keep your right, which isn't always possible. But yeah, making sure you get your eight hours of sleep, working out four to five times a week with they I think they said like 155 minutes with 75 minutes of them. I have memory for numbers apparently. vigorous high intensity workouts. Okay. I do that. I was gonna say, you've got that. you know, eating healthy, low glycemic index foods. Now, does that mean you don't get the cookie that's in front of you? No, that's not what that means. I brought you the cookie. You take our doctors sourdough cookies are okay. And we are gonna eat them later. So so yes, but in general, we want you healthy lifestyle, you know, lots of fruit and vegetables, decreased inflammatory things, you know, low sugars. Alcohol is a tough one because it's part of our social nature. there is a link between alcohol and breast cancer. And part of it is because alcohol turns to sugar in your bloodstream. Well, don't look at me like that. I quit drinking. Right. So that increased sugar, what happens to it? Well, if you don't use it, it turns to fat. What happens to fat? It makes estrogen. So So you spend your days sitting across from people who in suddenly realize that their life is not unlimited. How does that affect you? How has that changed you? And even the way that you live your own life. That's Hard, right? Because you gotta go home and be a mom and be a wife and be normal and when you have a bad day and you have to there there are bad stories still. And it you you appreciate everything a little bit more, right? You try not to sweat the small stuffs, but then inadvertently I I pick a fight with my husband over the stupidest thing because I need to unlet steam and he totally will call me on it. Yes, he calls me on it. and he's right, and I will never say it again, but no, I will. see, that's you picking a fight with that's me picking a fight with you. I also pick fights. I did I did pick a fight this morning. yes, you did. yes. our podcast is a lot about midlife. Right. And we talk about All the things start. God, we're not talking about twenties. No, those days are gone. These are the days where you're still you're still taking care of your kids who are now adult or potentially close. Some people some people have kids later, so they're still dealing with their children. Parents start to age or pass away. now is time to really start thinking about retirement. plans or all of that stuff. It's weird. And then now you've also got like cholesterol and hormones and all this stuff. It's so hard to figure out like how how to deal with it. And now we have the internet. yeah. this is what drives me crazy. Yeah. So do you think That you have seen a difference. I guess the question is, have you seen a difference in the patients coming in in the last 20 years since the advent of Google? Okay. And and how so? yeah. I mean, some good, some bad, right? So I Google can be both. It's it's nice when people can kind of they they Google the words, they try to figure out what's going on. And and so they at least some of them sometimes you come in with kind of a basic and we we can build on it. But then there's the dark side of Google, right? Because when you Google something, you're dying of some kind of rare something. and now AI just lies. Yeah, they do because they want you happy. So you keep using them. my AI and I have to have a conversation. Like, I don't need stop it. Yeah, we I yell at him daily. helps. Yeah, it does. It does. Stop. It does. It's funny. I actually have a rule that's for all intents and purposes, don't make stuff up. Yeah. Like you have to prove it. Yeah. And if you can't, just say I don't know. Correct. Yes. But carry on. But anyway, so and then and then the forums. And then the, I think the the misinformation that has been spread lately and the there's a big mistrust, I think, in in medicine right now. And and it's it's hard because somebody can present some kind of logical thought process or the pseudoscience and spew a few facts and I spend 35 40 minutes trying to disprove something because they saw it before I talked to them. Yeah. Well and and that's that's hard. That's all over the internet. You know, I I mean on Instagram there's people saying you cure cancer this way, you can cure cancer that way. And it is just ridiculous the stuff that some of these people are saying and they're coming in with what they're saying is scientific proof or studies and it was with three people or you know and and and I'm like it it's not a clinically based trial you you that you can verify. Right. And I I just I don't like that. I mean how do how do you deal with a patient when something is As we were talking about some some modalities earlier and you were like, Well, that's actually kind of interesting. There is some evidence, but it hasn't nothing has been proven. Right. So how do you walk someone through that? it's a slippery slope, right? Because we talk about it and we talk about my my big thing is is there is this very big push on gut health, and I can make my diet alkaline, and cancer cells don't like an alkaline diet, and therefore I don't have to take Estrogen blockades. I don't have to take chemotherapy. I'm just gonna make my my body alkaline. And and yes, on a bench study, cancer cells don't do well in an alkaline environment, but neither does the rest of you. So your kidneys bite you every step of the way so that it can keep your body at an optimal pH. Meanwhile, you're putting all this stuff in your body to try to make your body alkaline, which you can't you can't do because your kidneys will just. filter it out. and we put all this faith in it, but it's not sustainable. And it will not change the DNA of that cancer cell back to normal, nor is it good enough to kill every single cancer cell that they have. And so, but on a bench study, it kills cancer cells. So trying to translate yeah, trying to translate like like lab work into the human body, it it it doesn't work. A petri dish is different than your breasts. Now, I'm not saying that gut health isn't important and I'm not saying that that should play shouldn't play any role at all, but it shouldn't play the only role. And I think we've gotten into this weird dichotomy where it's either or. There's never a together, right? Like, why can't we do Western medicine that's that's got double randomized control trial with 10,000 people and we've got molecular data and we've got all of these things that say this works. And we've got gut health, which we know is important and we know it decreases inflammation. We know we to watch our cortisol because that affects blood sugars and all the other things. Why can't we do it all? Why do we have to choose? Why do why can't it be like a synergistic approach instead of an either or? And that's what I tell patients. I'm fine bringing in some of these other things, but you have to be fine bringing in this these things too. And we've kind of we got to kind of compromise here because if we don't, it's it's not gonna work. And I've been to Right. Unfortunately, too many funerals. And and and that's that's the problem because the life is the bet. And you don't get a rewinding, you don't get a do or yeah. And and and that's what I dislike about the internet too, is they'll say, they're doing this holistic stuff, but they're forgetting to say, I'm also doing the chemotherapy. Right. You know, because they're pushing this narrative. Yeah. Which is or or doing whatever immunotherapy or whatever. Yeah. And they're doing the mix, but they don't say that. Yeah. Yeah. Which is crazy. And it's a disservice because if you don't really dive in and you don't do as much research, then you're gonna get led astray and you're not gonna do well. And it and it's because somebody portrayed something not quite as honest as they could. Right. It's frustrating. Well, and often they're selling something. That I did not say that. I I mean it's that's just the frustrating thing is you get, you know, people sending you all these reels. And I think what What happens is they watch the beginning and they go, my gosh, this is great news. And they don't watch all the way to the end to see that we're really just shilling stuff. We would we would like to tell you this is bad so that you will buy my product. That is very frustrating. It's an ad. Yeah. Yeah. So do you see patients become so afraid of chemotherapy, radiation, all of that, that they're actually more afraid of it than the cancer itself? Yeah, we do. And it People will avoid coming in, they'll avoid their workup, they'll avoid everything because they think that that's what we're gonna tell them. And then, or they'll avoid, I've had patients avoid chemotherapy, avoid radiation, and six months later, a year later, we're right back where we started from. And and it and and they feel like I'm giving him notes. Yeah, he that's okay. I'm writing him notes in school. Taking them away. She's she's giving you sweet nothings. and so So then they kind of go, well, now I want to do everything. And you just hope that we haven't lost containment at that point. Right. So I have a question for you. Well, well, wait. I I'm sorry. I'm sorry. This is on that. Okay, go ahead. So is mine. Okay, then you but you no, you nope, nope, nope, nope. Ladies first. Ladies first. Okay. when someone sees information online, what would you have them? try to use as a filter or what kind of criteria would you have them use to assess the information they're getting? Right. So there's a a lot of really good education websites out there with breast cancer, right? We've we've got almost too much information, but you go to someplace trust you go to Mayo Clinic, go to Sloan Kettering, go to Cleveland Clinic, go to I mean, you can go to breastcancer.org. Like there are NSABP, and I mean there's does that have the right initials? I don't know. I don't know. I just spouted it out, right? So came out. I believed you. Wow. So I was like, is that is that the one I meant to say? NCCN guidelines. Like there are places where you can find good information. One of the things we always provide too with our patients is there is a I call it my breast cancer Bible book because it gets revised every couple of years. It was written by a surgical oncol or an oncology nurse from hospital here in Atlanta. And Like it goes through everything and it's it it's verified, documented, it's got the references and I think that that's missing. That's why I make sure people get it. So that just here, read read. Yeah, you you sent me home with a lot of reading material. Well she took the book. She wanted the book kid. She had the dyslexic kid the book and I handed it to her going So yeah, just to just to kind of double down on that question. Lord, yeah. When someone says something online, usually online, that where they say, Well, there are studies that prove this. There's been so much mis so much information out there regarding these things that peop they know people want to learn about it. And there are some trials coming down the pipeline with some of these agents trying to look at it. So one of the one of the good things sometimes the internet does is it brings information, it brings possibilities, and and sometimes it brings trials. Now, whether those trials will make it past the initial investigation stage, it all depends on how they work or not. And if they don't work, then they don't. Right. But And they're kicked out. But I think a lot of a lot of places are trying like breast cancer.org would probably be another place that's a little more open into looking at or even mentioning and kind of gathering information on some of these other these other medicines that are a little bit kind of alternative, would you say? Would that be it? Yeah, because like I'm not gonna go to tractor supply and get ivermectin. And you were saying you can't use methylene blue for you can, and it's still a very acceptable thing. But when we do a lot of our surgeries when our when I was injecting methylene blue, if you eject it too close to the skin, plastic surgeon seeing skin necrosis, because it hoards oxygen, it loves oxygen and it steals it from the tissue. so I don't use it in surgery anymore for the reason that I was having a lot of skin issues. And I'm I'm not saying everybody does. It's just for me, it wasn't Right. My partner used the blue dye and she was fine using the blue dye and the radioactive dye. But it does sound to me like something that I don't want to be injecting or drinking. What do you wish the average person understood about why we rely on the scientific method to prove that something works? So yeah, because you that makes sense? It does. It's a really hard question to answer though. That's the whole point of the scientific method, right? Right. Is double randomized controlled trials where one side doesn't know what the other side is doing. So nobody can make a judgment. Nobody can see something that's not there. we really base we try to take all the the variables and just deal with facts. Like placebo's hard too, right? Because placebo says I feel better and Give you anything, right? Right. So how do you factor that into whether something works or not? But I think you can see, especially with breast cancer, survival rates go up every year. Yeah. Recurrence risks go down every year, right? Like people were dying of breast cancer in the 1970s and 80s, left and right. And all we had was mastectomy and these horrible deformed chest walls because we're taking muscle and lymph nodes and all the things. And today Today we have a small little incision that you can't find and your breast looks normal and survival rates are through the roof, like ninety percent plus survival rates. And we're not losing as many women, which is amazing. We still too lose too many, but if we want proof that that works, you just that's proof that it works. Right. It works. That in forty years the the mortality rate has just taken a nose dive. Right. Now, would you say the ones that you lose? I I hate to go here, but Have their breast cancer progressed so far and they hadn't got it checked or is the problem is that we wrote a rule book for breast cancer. The cancer didn't read it. Right. Right. So cancer's gonna do whatever cancer wants to do. And it's so out of our control because again, it's one stupid cell that has one mutation that makes whatever we do, it doesn't work for that one stupid cell. Right. And and you can't can't control for it. You can't we try to control for everything and you you you can't. And so you can do everything right and it sucks, but and it could still come back. And it could there's there's no rhyme or reason to it other than One stupid cell did something we didn't want it to do and it out it outplayed our therapy, right? there's some cancers that are just evil incarnate. And even though the the textbooks and the rule books and the studies all say that this regimen is exactly what you need, doesn't do poop to this cancer. Just laughs at it, right? So like I said, we're still early on. We're learning stuff and we're finding these little tweaks like Keytruda Keytruda was amazing for triple negative breast cancers. It was a breast cancer that we had no target for. And now we're teaching our immune system how to fight triple negative breast cancer. It's amazing. So I think. We're getting better, but there's still those oddballs and cancer's still gonna do whatever they want. And so we always gotta try to stay a step ahead of it. Yeah. Right? Like Well, mine's not. Yours not. Yours is. Mine's mine's just other people's. Yours is mine's gone. Yours is dead in a bucket in the basement. Exactly. Now, what was it? I I had a test where they tested it for cancers in my blood. Is that the Natera? Was that Natera? That was the Signatera. Signatera. So it's correct. We were okay. So I had I got the results of that today and there were like no cancer in the blood. So that's another good thing. Right. But again, it's a little bit of a wide net. So we test every so often. Three months. Right. Yeah. Initially, and then we go to six months. So signature is awesome because part of the problem with our technology is that we can't see on a microscopic level, right? We can see PET scans as good as we got for looking everywhere from a radiologic level, but we still need Five millimeters. Right. Signatera is looking at circulating, and and there's more than Signatura. There's like two or three other four other ones coming out, but they're looking at circulating tumor DNA or circulating tumor markers that we derived from your specific cancer. Right. So fingerprint. Your cancer has a fingerprint. Right. Exactly. This is the perfect way to look at it. And we're testing your bloodstream to see if we can see the fingerprint for the cancer. And so yes, that's what we want to see. We don't want to see any circulating tumor DNA because that or tumor markers or whatever, because that means that right now there's no active cancer. Right. I left no fingerprints. I'm a good serial killer. His kitchen is clean. Correct. So correct. But but when people say, Well, how do I know? How do I know? Maybe this is the way. It's a very new test and we're still learning where we can incorporate it in screening. And I actually had a conversation with another breast surgeon talking about doing a clinical trial through our our hospital system to try to, you know, where do we use this and how do we use this? And which people should we be testing it on? Those kinds of things. and so it's to me that's where, you know, systemic screening is going, like whole body screening. Like, is it safe to come off this medicine? If we come off the medicine, all of a sudden you have a circulating Something come back positive, you're going right back on the medicine. Yeah. Do you you know what I mean? Like early, early detection. so I it's I think it's early. There's the the oncologist will poo-poo. I get so excited about these things. The oncologists are like, Nikki, there is no documented survival benefit yet. I'm like, Yeah, but it logically, if you don't if you prevent those things from coming back even on a a blood that's gotta have survival benefits at some point, there's no cancer. You stopped it. if there was one wake up call that you wish people would hear before they became your patient, what would it be? So, because men, you're not going to get screening annually. You, I think, are less likely to say something because it you feel a little bit embarrassed about it. I men, it's see something and say something. I mean, it's, you know what? Don't, don't, don't think it's It's it's not usual. We all know it's a lump. Just come in and get checked. What's the worst thing that we can say? It's nothing? Okay, great. That's fantastic. But if it is something, even if it's kind of camastic, because that's usually the thing when men feel something that it is, at least you know what it is. There's treatments for it. There's we can change medicines around to make it get better. I mean, there's stuff we can do, but but if we sit and just ignore it, that's part of the reason that men's Cancers are diagnosed later, that's their mortality rate's a little bit higher, that 'cause again, we don't find it till it is stage four. And then what do we do? Right. Right. So men at see something, say something. And women, Your mammogram. Get your mammogram. I am seeing so much push online now against mammograms. It's frustrating to me. It's very frustrating. and I get the well, it's radiation. Okay. But if you take a plane flight from here to New York, you're getting less radiation in that mammogram than you would be in that airplane. What do you think it is when you have to stand there and hold your arms out? X-ray. Just sitting in the airplane. Being in forty thirty thousand feet, you're getting let's not say that because I fly every weekend somewhere. my god. And I'm doing the and I'm doing higher rate. And I'm doing the scanner and everything. I know, yeah. Yeah. So flight flight attendants do a higher rate of breast cancer. They do, because they're up in the and thyroid cancer because low grade radiation exposure increases your risk of both. but they fly, I mean, they're the air further, like they live up there. I'm I'm in there quite a bit. I'm starting to feel like so I'm saying it's so and yeah, but so so mammograms, I I think they're they are getting a bad rap. you know, mammograms, the amount of radiation you're getting gets less and less and less, and the images are getting better and better and better and better. so right now there's there's nothing out there that works. Better to find this guy. Well, thank you so much for coming. Yeah, thank you so much. I greatly appreciate it and I want to say thank you for bringing these cookies. But now I do have another thing about sugar. I gotta say about the sugar. Okay, yeah. I was do I saw a thing that I had to send to her because it was so sad. Sad that a lady you you eat your cookie and I'm gonna get my cookie, and we have one for you too. These are and and what but first of all, these are sourdough chocolate chip cookies. Prescribed by the doctor. Prescribed by the doctor. Well I say, you know what, we do all of this because we want to live. And living is more than just not dying. So what is life without a cookie? Amen. So I cheers to that. Exactly. Cheers to that. That's why I have a good year. There we go. But yeah, we saw online. Uh-huh. I'm gonna wait to take my wait to take my bite. I've already had one. They're amazing. Mine's gonna be gone by the time you're done. But we saw this thing where a woman listened to people that online and went on cut out all sugars and and and carbohydrates. And carbohydrates and left it for several months and it just got worse and she ended up passing away from it. It's like well also she dropped so much weight and so much strength. Yeah she dropped so much weight and strength went down to to ninety-six pounds, I think like that. It it's ridiculous the stuff that people Listen to and follow online, which that that drives me crazy. It it's all about control. I'm gonna take a bite. You may take a I'll talk, you can you can chew. So it's control, right? I I can control how much sugar I put in my body. I can control not having a glass of wine. I have no control over the cancer. Right. But this I have control over. And so it is a very common. I've I I've had patients, they got rid of every piece of plastic Tupperware in their house because. That is something life modification wise. You should be heating up everything in a microwave if you're doing it in glass or porcelain, because plastics give forever chemicals into food and micro plastics, all that stuff. All the things. So definitely microwave and glass. That's that's easy. but all the sugars and my God, you you haven't had ice cream in in two years. And I mean, kudos to you. I am not that strong. But again, why did we do this? Why did you go through sitting in that chair all those times? Like and and why why do we go through taking estrogen blockade and the surgeries and and the checks? I mean, we have to live. And I think that gets lost in the need for control. Like, I can't imagine a world where I couldn't have my cookie and glass of wine. Some people don't like sweets, so they're fine with that. But still an aesthetic lifestyle is. Or again, living, whatever living means. Right. Like, don't restrict because of the fear the k the cancer has boxed you in. Like, I need you. Crews are very smart. Living is not just not dying. It's enjoying. It is enjoying. Yeah. And we need you living. Because you've been just not dying. Yes. So we need living. There's a difference. And it you'll get there. You're gonna be awesome. Cause I got a lot of cookies over there. You do. Thank you so much for those. And your wife will have the recipe. there we go. Mm-hmm. I like that. Awesome. Mm-hmm. Thank you so much for that. Thank you so much for being on our podcast and explaining everything. It's been an eye opener. Hopefully it's been an eye op eye opener for you at home. And if you have any questions, please reach out to us and we will do our best to find the answers from someone who knows. Exactly. Dr Sroka Intro & Outro: As always, we are Tyler Mane and Renae Geerlings, and this is Mane AF. Stay tuned for more conversations together with friends about our wild ride from growing up in small towns to landing in the bright lights of Hollywood, only to find ourselves smack in the middle of midlife mayhem. We'll see you next time. Until then. Answer those wake-up calls.