Phone: 512-238-0762

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May 23, 2020

Dr. Douglas Rivera Talks Modern Radiation Oncology with Dr. Mistry and Dr. Jacomides

Speaker 1: 

Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry: 

Hello and welcome to the Armor Men’s Health Hour. I’m Dr. Mistry, your host, here with my cohost Donna Lee.

Donna Lee: 

Hello Dr. Mistry!

Dr. Mistry: 

The effervescent Donna Lee.

Donna Lee: 

That’s right. The bubbly and super funny Donna Lee.

Dr. Mistry: 

And unlike most weeks, this time we have guests.

Donna Lee: 

Yay. Finally, finally out of Corona quarantine. Finally we feel comfortable recording next to each other. We’re joined by our newest partner, Dr. Lucas Jacomides. Welcome back, Lucas.

Dr. Jacomides: 

Thank you so much. Great to be here in full PPE.

Dr. Mistry: 

Does it feel, does it feel pretty good but being back to work a little bit?

Dr. Jacomides: 

A little bit, yes. It’s great to be back.

Dr. Mistry: 

That’s right. You know, we’ve been called essential workers.

Dr. Jacomides: 

Yes. Just like the essential people, the red shirted people from Star Trek.

Dr. Mistry: 

That’s right. We are essential to…we’re the first ones to can be sacrificed I guess.

Dr. Jacomides: 

Right. That’s what we do, that’s what we do. Sacrifice for you all our loved ones out there.

Donna Lee: 

That’s right.

Dr. Mistry: 

That’s right. I am a board certified urologist. So is Dr. Jacomides, and Donna Lee is just board certifiable.

Donna Lee: 

I’m just a board certified cohost.

Dr. Mistry: 

That’s right.

Dr. Jacomides: 

She’s bored and she’s certificated.

Donna Lee: 

I have an award that I brought to the studio.

Dr. Mistry: 

Oh my Lord. Excellence in podcasting. Excellent. Thank you very much.

Donna Lee: 

You’re welcome.

Dr. Mistry: 

We have been very fortunate to bring you this show for almost a year. It is a show that’s dedicated towards men’s health issues and other health issues that affect men and really here to showcase kind of the amazing holistic practice of urology that I think that we are able to provide citizens of Austin and throughout Texas. And we have lots of partners out there that are our physician partners, you know.

Donna Lee: 

We’ve had a lot of them on the show, but lately it’s just been you and me, yuking it up.

Dr. Mistry: 

I know. And Lucas, I think you’ll agree that having a really important or stable of referring doctors that can help us co-manage patients has been a really important part of our success.

Dr. Jacomides: 

I think it’s very important to let people know that we’re open, it’s safe, it’s okay to come back. And I think this quarantine and this crisis is, can be much more amplified tragically if people don’t get the routine care they need. So we’re required to keep it going.

Dr. Mistry: 

I think last week we talked about how cancer diagnoses, cardiovascular disease diagnoses and other kinds of health concerns have been drastically undertreated during this Corona quarantine. And I’m really not looking forward to what the health effects of our society are going to be. Prostate cancer is a really good example of what we treat. And today we’re joined by one of our great physician referral partners, Dr. Douglas Rivera from Austin Cancer Center. Welcome, Doug.

Dr. Rivera: 

Thanks for having me.

Dr. Mistry: 

Oh, well thank you. It is not known by a lot of our patients what a radiation oncologist does. I thought maybe you could talk a little bit about your education and kind of what the scope of a radiation oncologist is.

Dr. Rivera: 

We really don’t do too much. This will be a short talk.

Dr. Jacomides: 

Alright, thank you.

Dr. Mistry: 

Just save lives.

Dr. Rivera: 

Yeah. So radiation oncology is oncology, a specialty, so we treat cancer patients. But radiation in particular is this modality where we’re using X-rays to treat prostate cancer or any other cancer for that matter. I trained in Nevada, did medicine at Columbia University, and then I did my radiation oncology training at Duke university. Prior to moving to Austin a number of years ago, about 15 years ago, and been here in practice ever since.

Dr. Mistry: 

Columbia and Duke, that doesn’t sound like Baylor College of Medicine, does it?

Donna Lee: 

Stop. Stop it.

Dr. Mistry: 

Are those accredited universities then?

Dr. Rivera: 

Not really…

Donna Lee: 

Just barely.

Dr. Rivera: 

…because they’re back east…[inaudible]. They’re really not that good.

Dr. Mistry: 

Okay, well, that’s right. East Coast.

Donna Lee: 

You and Baylor.

Dr. Mistry: 

Yeah. You know, you have to support the home team.

Dr. Jacomides: 

By the way, I don’t, y’all can’t see Dr. Rivera on the radio, but I’ve been watching a lot of Ozark on Netflix lately. Have you been watching that?

Dr. Rivera: 

I’ve heard about it.

Donna Lee: 

You should watch it.

Dr. Jacomides: 

You are, you very much look like the assassin Nelson from Ozark. I can’t help but notice that.

Donna Lee: 

That’s funny. Yeah I can see that.

Dr. Mistry: 

Well that’s comforting.

Dr. Jacomides: 

But don’t let those people dissuade you to go see Dr. Rivera, he’s not out to kill you. He’s out to help you, to cure you and your cancer.

Dr. Mistry: 

And you’re part of a very large cancer group here in town called Austin Cancer Center. Why don’t you tell us about Austin Cancer Center?

Dr. Rivera: 

Yeah, so Austin Cancer Center has been around for a few decades now, but we’re a multi specialty group comprised of medical oncologists, which do the, you know, drugs, systemic treatment we talk about that stuff that goes through the IV or pills for our cancer. The radiation oncologist ourselves, then we have a few other specialists, um, neuroncologists who kind of specializes in that. And then, also gynecologic oncology for cervical and other female malignancies and then also have some breast surgeons.

Dr. Mistry: 

You know, when we’re talking about cancer treatments with patients, it’s a ton of bricks that land on them the moment that we are, I guess, given the task of diagnosing them with cancer. As we go through our choices for treatment, a lot of them, a lot of our patients kind of default back to this idea that, you know, cancer control it’s either cutting, burning, or poisoning. None of these things sound great because we’re all just trying to treat, right. We’re trying to cure and try to solve a problem. And we’ve been given these different tools and I think a lot of people come when they hear about radiation treatments, they come with a lot of baggage when it comes to understanding what they’re going to experience. Maybe you could give us some background on, you know, historically how did we know that radiation kills cancer and what are some of the big successes in terms of treatment that radiation allows for?

: 

Well, it goes back a long time. Actually Madame Curie back in the earliest part of the 20th century was first started using radiation. So actually it was dermatologist actually that used radiation to treat skin cancers. Since then, you know, obviously the advent of computers go to imaging, you know, being able to kind of get to deep body sources much easier. And there’s been a lot of, you know, improvements in technology will allow us to do what we do and then what we gonna have done what we’re doing now, you know, clearly 20 years ago or longer. The one thing I get for a lot of folks as they say, “Hey, if we treat my prostate with with radiation, is this going to melt away? Right?” It’s really not like that. It’s actually an organ preserving type of treatment. And I kind of use the analogy of when we treat anal cancer, which to be a surgical thing and that’s now basically radiation with a little bit of sensitizing chemotherapy because the idea is you want to preserve the rectum. I mean everyone wants to keep it, they want to poop normally right? Not with a bag. So that’s really changed that same is true for head and neck things and also even even brain tumors that you can do treat those things without melting the brain away. And so what I tell folks, if you get prostate radiation, at least, you know, if you were to get imaging, you know, a year later for example, they would not necessarily know that you had radiation. Your prostate will still still be there. The way that works is that radiation, you know, goes in there and in a perfect world selectively kills the cancer cells and it doesn’t harm the normal cells. It was thought that that was because of the radiation, you know, hurt the DNA of those cells. But we also know now I think this is something that over the last couple of years there is also an immunologic component to that. And that’s something that’s kind of the kind of most interesting thing that we’re starting to see over the last two or three years, so we think there’s a couple of different ways of why that works so well.

Dr. Mistry: 

The organ preserving aspects of radiation I think are really key for people to understand. It’s not going to leave like a huge cavity inside your body. I’ve really been fascinated just over the last 20 years of practicing medicine how different radiation looks today than it looked for our parents or you know, our, our medical predecessors. You’re not just standing in front of a big ray gun that’s just shooting at you. Right?

Dr. Rivera: 

That’s right. I think…

Dr. Jacomides: 

Could you, though, if you want?

Dr. Rivera: 

You could.

Donna Lee: 

It sounds like a party.

Dr. Rivera: 

You could definitely do something like that, but the way we’re using it now, what makes it so special is that every day we’re taking a picture of that prostate, you know, getting it lined up within a millimeter every single day, and then delivering this very focal treatment. You know, it can be very, very precise. In fact, in some things when we’re treating just a modality called CyberKnife that we use, you know, we’re treating a 4 millimeter area. I mean, it’s, it can be that, that targeted. In general with prostate radiation leads these today, you know, we treat it similarly to prostatectomy in a sense that we’re trying to treat the whole gland.

Dr. Jacomides: 

Yeah. It’s amazing. Like you brought up, I mean 50 years ago and all these disasters with cobalt radiation and people tend to think about, anecdotally what did so-and-so have and how bad they did if they remember what their dad had. And so I’m sure that’s part of the whole concept of, you know, taking the vision of a plutonium rod out of someone’s head and saying, “We’re going to be precise. We’re going to do just this organ and only within millimeters of your tumor.” I mean, that’s certainly what people are seeking right now because certainly when we get the diagnosis out to people, it’s an overwhelming, like, “I feel fine, there’s nothing wrong with me,” for prostate cancer specifically. And now you’ve told me I have this horrible cancer and I need to get it treated. And you know, it’s a question of what now and you know that you need to get this out versus you need to get radiation. It’s certainly like quandary what to tell people.

Dr. Mistry: 

So radiation is absolutely an amazing evolving technology when it comes to treating cancers. People still come with baggage about what radiation does to people. Maybe you could speak to, I guess specifically the development of other cancers. So you know, in our minds when you’re exposed to radiation, this is not necessarily a cancer curative issue in some people’s minds, but may, it may be a cancer causing issue, but we haven’t seen a tremendous amount of secondary cancers from radiation therapy. And, I guess maybe you could talk about how concerned should people be about those kinds of things?

Dr. Rivera: 

Yeah, it is a concern I think particularly for folks that are, that are younger, we certainly know in kids in developing young adults, because of their risk of developing is 50, 60 years. That’s more of a concern. Even then, the rates are very, very low. We don’t typically talk about it in the group of patients that are either having bladder cancer or prostate cancer…

Dr. Mistry: 

….because they’re older.

Dr. Rivera: 

…because they’re older. Yeah. So the, not only are we much better now keeping things very focused, I mean, we used to treat almost the whole body sometimes with some of these areas. You know, lymphoma is a very classic one retreat from the neck all the way down into the pelvis, and that’s a huge area. So a component of second malignancies they call it, you’re getting a cancer later on from radiation would be how much area you’re treating, and also the doses and things. And so things are fairly targeted now, you know, very little areas, a lot less radiation for, to surrounding tissues, so that’s really driven that down, and then also, you know, because most people don’t have 60 years ahead of them, often times they don’t really manifest anything.

Dr. Mistry: 

Well that’s a great discussion. Thanks a lot Doug for joining us today. We’re going to have you back for another segment where we talk specifically about prostate cancer. Donna Lee, do we have any time to tell people how to get ahold of us?

Donna Lee: 

No. Call us during the week at (512) 238-0762. We’ll be right back.

: 

The Armor Men’s Health Hour will be right back. If you have questions for Dr. Mistry, email him at armormenshealth@gmail.com.

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