August 25, 2024 • 26 mins
CredentialsPositions
Board Certifications
Education and Training
- Professor, Department of Medicine at NYU Grossman Long Island School of Medicine
- Director, Cardio-Oncology Program, NYU Langone Health
- Site Director, Cardio-Oncology Program, NYU Langone Hospital - Long Island
Board Certifications
- American Board of Internal Medicine (Adv Heart Failure & Transplant Cardio), 2012
- American Board of Internal Medicine (Cardiovascular Disease), 2010
- American Board of Internal Medicine - Internal Medicine, 2007
Education and Training
- Fellowship, Icahn School of Medicine at Mount Sinai, Heart Failure & Cardiac Transplant, 2011
- Fellowship, Icahn School of Medicine at Mount Sinai, Cardiovascular Disease, 2010
- Residency, Albert Einstein College of Medicine, Internal Medicine, 2007
- Fellowship, Columbia University Medical Center, Clinical Pharmocology, 2005
- MD from Robert Wood Johnson Med School, 2003
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
The following is a paid podcast. iHeartRadio's hosting of this
podcast constitutes neither an endorsement of the products offered or
the ideas expressed.
Speaker 2 (00:09):
The following program is brought to you by NYU Land
Going Health. It's Katz's Corner with doctor Aaron Katz. You're
trusted expert in men's health, providing straight talk on a
wide range of men's health topics and advice on how
to live your healthiest life. Now on seven to ten
WOOR It's the Chairman of Urology at NYU Land Gone Hospital,
(00:32):
Long Island. Here is doctor Aaron Katz.
Speaker 3 (00:36):
Well, good morning everyone, and welcome again to Katz's Corner
here on wr iHeartRadio. So glad you could join us,
and today we have a wonderful show for you that's
not just geared for men, but for everyone, especially for
those that have been dealing with some sort of cancer,
that have had treatment for cancer and how that treatment
(00:59):
of their answer, whether it be chemotherapy, immune therapy, radiation,
maybe surgery can affect your heart. And we have developed
here at NYU a new program and a new director
of cardio Oncology. Cardiooncology, a new way and a new
(01:19):
division and a new program here that is really geared
to help manage and evaluate those patients that are dealing
with cardiac issues related to to cancer therapy. And to
help us with this discussion, I've asked Michelle Bloom, who
is an expert in cardio oncology and heart failure, and
(01:41):
she has been recently named and joined the NYU Landgone
Health System as the director of the cardio Oncology Program,
which specializes again to give care to patients with heart
health throughout cancer treatment and even in survivorship. She holds
an academic appointment as the professor in the Department of
(02:02):
Medicine and a member in the Division of Cardiology. She
has a tremendous history of taking care of patients. Before
coming to NYU, she was at Stonybrooks. She's also been
involved in taking care of patients who have had cardiac
heart transplants in the city years ago, and we are
so fortunate to have her here as part of our
(02:24):
NYU land Going system. She sees patients in the city
and I'm really looking forward to talking with you. Michelle.
Thank you so much for joining us here on Kats's
Corner this morning.
Speaker 4 (02:35):
Thank you so much for having me. It's really exciting
to be here, and this is really one of my
first times doing something like this at NYU, So it's
exciting to be here.
Speaker 3 (02:44):
Yes, And when I heard about this program, I was like, Wow,
we have to have her on the show. And maybe
you can start out, Michelle and just tell us a
little bit about Actually, maybe you can talk about your
own background and how you started getting an interest in
this cardio oncology a field.
Speaker 4 (03:04):
Sure, So I am a cardiologist by trade. I laugh
about that because I often have to remind my patients
that I'm not an oncologist, because I see a lot
of patients with cancer in my everyday, day to day practice.
But I am a cardiologist and I actually specialize in
heart failure, which means that I generally take care of
(03:27):
a lot of very sick patients with heart failure, including,
as you mentioned before, those sometimes who need a heart
transplant or a mechanical heart device like a leftventricular assist device.
And that's really not essentially what we're talking about today,
but that's my general practice. But it's actually kind of
interesting how I got into cardio oncology because I knew
(03:48):
I was going into medicine from the time I was
a very very small child. I was in elementary school,
and I knew I was going to be a doctor.
I wasn't entirely sure what I wanted to do, but
a lot of how I I sort of got to
where I am today was shaped based on my experiences
with my two grandfathers, who both actually wound up dying
(04:08):
of complications related to cancer. When I was very little,
I mean we're talking maybe nine or ten years old,
I was very intimately involved with my paternal grandfather's medical
care as it related to his colon cancer. But then
later in medical school, interestingly, my maternal grandfather was diagnosed
(04:29):
with pancreatic cancer, and as part of his treatment, he
got chemotherapy that wound up affecting his heart function, and ironically, ultimately,
instead of dying of the pancreatic cancer which was predicted,
he wound up living, you know, passed his on colleges predictions,
but he ultimately wound up dying of heart failure. And
(04:49):
that was at a very critical time in my training.
When I was a medical student, I used to study
in his room actually, because he was at the hospital
where I went to medical school. So I think in
retrospect a lot of that sort of shaped my interest
in the oncology aspects of cardiac care. And then I
wound up taking care of a lot of those particular
types of patients when I was doing my cardiology training,
(05:11):
and so that sort of sparked, really, you know, my
career trajectory in that way.
Speaker 3 (05:17):
The whole field of cardio oncology. I mean, to me,
that's relatively new. You know, I've been taking care of
cancer patients since the early nineteen nineties and have certainly
have seen some of these side effects from some of
the treatments that we give patients. But you know, tell
us a little bit about the field. Is it relatively new?
And actually you know what types of you know, actually
(05:42):
what is cardiooncology?
Speaker 4 (05:44):
Yeah, so it's interesting. It's actually not such a new specialty.
But I will say, what is new is people's awareness
of it. I think that over the last two decades
cardiooncology has existed in some way, shape or form. But
I would say really over the last five to ten
years is when it really kind of blew up and
it took center stage. Because I think that as cancer
(06:07):
patients were starting to survive longer, and treatments were starting
to just become much more complicated. But cancer, the paradigm
of cancer started to be more of a chronic condition,
you know. I think that that field like cardiology, became
more relevant to oncologists and to patients themselves because you
(06:28):
realize that you can impact on these patients in a
very meaningful way where ultimately, once patients survive their cancer,
they're going through their cancer treatment that you can really favorably,
you know, change their trajectory and really allow them to
survive well passed you know what they would have otherwise.
So I think it's not a new specialty, but but
(06:50):
I do think to your point, people are much more
aware of it over the last decade or so. An
answer to your question, what is cardio oncology, I think
it's a really really important thing to define for your
listeners because I think that it used to be that.
I think when you said the word cardiooncology, people would
just assume it with cancer in the heart. But that's
not at all what it is. It's really I always
(07:12):
tell my patients it's like the marriage of cancer and
the heart. It's like there's so much intersection between the
two fields that I think people really don't understand what
the connection is. So there's really three major parts of cardiooncology. One,
I think is important to know that the risk factors
for heart disease and cancer are very similar. In other words,
(07:35):
people are smokers, high blood pressure, or high cholesterol. All
the things that predispose you to cancer are also going
to predispose you to cardiac disease. And so it's not
a surprise that the two diseases sort of travel together,
so we often see one with the other rather than without.
The second thing is a lot of patients that are
(07:56):
diagnosed with cancer have pre existing issues with their hearts.
For example, they had a history of heart failure, or
they have a history of blockages in the arteries or
valve disease or something like that, and then they get
diagnosed with cancer and a lot of that gets forgotten,
and so the field of cardioloncology brings that back to
the center, so that we are watching for those things
(08:17):
and making sure that we're dealing with those things, and
so that that doesn't interfere with the cancer treatment and
also ultimately doesn't you know, make patients sicker. Or make
patients not be able to continue their cancer treatment. And
I think the third thing, and probably the major sort
of definition of the field of cardooncology is I think
(08:39):
just talking about all these cancer treatments like you were
saying before, and what effect they can directly or indirectly
have on the heart. And I think that we'll talk
about that a little more later, but those three things
I think make up the crux of what we mean
when we say cardiooncology.
Speaker 3 (08:55):
That's so important. I mean, you would think that this
should have been established years ago, beare because you're absolutely right.
You know, when we are looking at our patients with cancer,
sometimes we get so focused on the cancer that we
forget about the other major organs in the body, like
the heart and how is this cancer treatment going to
affect the heart and should they even have treatment at
(09:16):
all depending upon what their cardiac risk factors are. And
then the other thing that you mentioned it's just so interesting,
is the risk factors. I mean, obesity and high blood
pressure and hyperlipidemia and smoking. All of these are risk
factors for cancer obviously, and of course the risk factors
for the heart. So the marriage of the two of
them really come together and should be housed under some
(09:40):
you know, under a program like you have. So I
guess the next question would be, you know, the types
of heart issues that cancer patients are thinking about? What
types of heart issues are they? I mean you mentioned
heart failure. I guess there's also things like arrhythmias and
things like that. I mean there are other other things
(10:01):
in the heart that cancer patient should be thinking about.
Speaker 4 (10:04):
Yeah, I mean there's a whole spectrum. I think it
starts from the way beginning of really just thinking about
people that are at risk, Like we kind of talked
about already, people that have risk factors where they don't
actually have heart disease yet, but those are patients that
we look at from a different lens because they're at
an increased risk of developing an issue. In HEARTFAY, we
(10:26):
talk a lot about this thing called two hit hypothesis,
and what we mean by that is sometimes a person
can have risk factors or something happen and that puts
them out a risk, but the heart is still okay,
and then all of a sudden, something else happens and
it sort of sets up the perfect storm. So when
people have risk factors like the ones we talked about
high blood pressure, diabetes, high cholesterol. Especially when those risk
(10:50):
factors are not addressed and not well controlled, then all
of a sudden, you throw in a cancer diagnosis and
some cancer therapy, and all of a sudden, it kind
of sets the patient up for an adverse event. So
those patients specifically, you know, we oftentimes see those patients
in our clinic or regular general cardiologists are going to
(11:10):
see those patients and we see what it's really really
important for those patients to be watched very closely. But
then of course there's a whole other spectrum of heart
issues that can occur relatives to cancer therapy. For example,
valve disease like tightening of the valve or leaking of
the valve, issues with the sack around the heart called
(11:30):
the paracardium that can get thickened or diseased. Heart failure,
of course, which is you know, my particular specialty, where
the heart either gets very weak and can't pump you know,
oxygen and blood to the body appropriately, or gets very
stiff and can't relax, and all of that leads to
heart failure symptoms and bad outcomes. So really there's a
(11:52):
whole lot of things. There's a rhythmia like like you mentioned,
which is abnormal heart rhythms that are common with certain
types of chemotherapy and other types of cancer therapy. So
we watch for those and we we we manage those
appropriately depending on the situation. So there's a whole lot
of sort of runs the gamut. There's a whole lot
of patients that we see for many different reasons in
(12:14):
a cardio oncology clinic.
Speaker 3 (12:16):
Yeah, I'm just wondering, do you think many of the
what types of cancer therapies are most likely going to
affect the heart? Is it is it chemo, is it radiation,
or is it just or immune therapy or viral therapies
that sometimes we use, or it could be could be
any of those things.
Speaker 4 (12:34):
Yeah, it could be any of those things, and sometimes
it actually has to do with the combination. So so
we sort of talked about already, But I sort of
look at these things in a in a way that
sort of like sets up the framework for risk. So
I think of it as there's patient risk factors and
then there's cancer risk factors. And so the patient risk
(12:57):
factors we've talked about multiple times already. Today, the high
blood pressure, diabetes, all the things that you know that
you know will predispose a patient. But then the cancer
related factors have to do specifically with well, what kind
of chemotherapy are they going to get, what dose of
that chemotherapy? Are they going to combine it with immune therapy?
Are they going to combine it with radiation therapy? That's
(13:19):
in the field of the heart. So it's not just
about what the therapy is. It's not just about the
patients themselves, but it's really, i think, the whole combination,
and that's really the crux of how we determine risk
and how we decide who should be seen and how
often they should be followed in that kind of thing.
So it's really very it's very individualized field because there's
(13:41):
so many different factors at play, so not everybody that gets,
you know, a certain type of chemotherapy, of course, is
going to have a heart issue. It has to do with,
you know, definitely the risk factor profile and how it's given,
the doses and all of that. So it's it's a
little complicated and nuanced, but that's sort of how think
about it.
Speaker 3 (14:01):
If you just waken up in the morning here on
Katsa's corner. We're talking with doctor Michelle Bloom, who is
professor in the Department of Medicine and a member of
the Division of Cardiology and an expert in cardio oncology
and heart failure. If you are listening and you or
your loved one may need a consultation with doctor Bloom,
please give her a call. The number is, and I'll
(14:22):
announce it again at the end of the show is
five to one six six ' six ' three forty
four point eighty. That number again is five to one
six six ' sixty three four four eight zho. And
you know, Michelle, we've been talking a lot about patients
that are undergoing chemotherapy or radiation and have cancer and
(14:43):
how it may affect the heart. I wonder, let's say
that the average person out there is doesn't have a
known history of any heart issues, they're not taking any
heart medications, but now they've been faced with this diagnosis
of a prostate can or a breast cancer or a lymphoma,
and may need some intensive therapy which may affect the heart.
(15:07):
I mean, if you read all the side effects of
any of these combinations or even single modalities, somewhere along
the line there's going to be some potential interference with
the heart where maybe it's an electrical interference as an
arrhythmia or something else in the heart. Should they you know,
when does somebody need to see someone like yourself, a
cardio oncologist. When would you raise the suspicion maybe even
(15:32):
somebody that let's say does not have underlying or known
past the cardiac issues, would you would you see them
in your practice as well.
Speaker 4 (15:41):
Yeah, it's a very very good question, and I think
it's not an easy question to answer because truthfully, the
answer is not the same for everybody. So for sure,
if we would confern, you know, even people like we
said that don't have a known history, A lot of
people don't have a known history of a cardiac event.
They haven't had a heart attack, they haven't had a
(16:02):
valve problem, they've been kind of okay. And a lot
of those patients either are just being treated by their
general interness or they're being treated by a general cardiologist
just for preventative care. So I think the answer is
easier for people that already have a known issue. Right,
if you have a history of anything cardiac related, then
(16:23):
to me, I think it's plug and play. It's a
no brainer. You should definitely be evaluated because really there's
such a huge spectrum of toxicities with the cancer therapies
that somebody like that should definitely be seen. I think
the nuance and the difficulty of answering your question is
in the people that don't have a known history. I
(16:44):
think those are the people where a good internist or
a good general cardiologist would be able to help decide
with the patient and with the oncologists sometimes about whether
that patient would benefit from the expertise of some like
me or someone from my team, or whether they're better
suited for you know, for example, preventative cardiologists. We have
(17:07):
a huge preventative cardiology program at NYU based in Manhattan,
and a lot of the patients with cancer, particularly the
prostate cancer patients and the breast cancer patients are being
seen by many of those preventative cardiologists because, as you know,
they have a lot of metabolic issues with the you know,
with the prostate therapies and the breast cancer therapies. So
(17:30):
I think a lot of it will kind of depend
on how your team and you sort of feel about
your risk because certainly not every patient that is undergoing
cancer therapy needs to see a cardiologist, but there are
probably more patients that should than are seeing a cardiologist.
If that makes sense, Yes.
Speaker 3 (17:48):
It certainly does. And I wonder, you know, when you're
going through the therapy, let's say, and you do develop
a heart condition. And I know you can't make a
generalized statement about everyone, but are these conditions can they
be reversible? So let's say somebody is going through chemotherapy.
Maybe you can give us an example of someone, you know,
(18:09):
even a patient of yours, has gone through chemo. They
had a hard issue. Now the chemo is over. Is
the is the heart issue that they developed during the
cancer treatment? Is that short lived? Is it reversible or
is that something that someone would have to be to
live with from then on in?
Speaker 2 (18:26):
You know?
Speaker 4 (18:26):
Yeah, So again, not a one size fits all answer.
I take care of I mean, I've been taking care
of some patients for over a decade and many of
those patients had an issue at the beginning with chemotherapy
and have gotten much better. And you know, to be honest,
a lot of those patients had even near reversal or
(18:48):
complete reversal of whatever it is they had. It very
much depends on what it is. So, for example, there
are certain types of chemotherapy that might lead to what
we call a cardiomiappe, which is a weakening of the
heart muscle, and that might lead to heart failure symptoms.
And in some of those cases it doesn't go away,
(19:08):
it gets worse, and then you know, we're talking about
advanced therapies like a heart transplant or a mechanical heart.
But those are the extreme situations. There are many, many
patients where they are diagnosed with the weak heart and
with early interventions by somebody like me or people from
my team, the heart failure team, so those patients can
(19:29):
go on to have some recovery, complete recovery, or at
the very least live along productive, you know, otherwise healthy life.
But I think the key to all of this, and
this is the reason why I'm so passionate about what
I do, is the earlier we can identify these things,
the better chance we have at recovery or improvement in survival.
(19:52):
So we know, for example, with heart failure patients, that
if you intervene very very early after the heart has
an you have a much higher likelihood of making that
patient's heart function better or completely you know, reversing that
heart dysfunction, Whereas if you diagnose these patients later, then
(20:12):
you're much less likely to have success with the treatment.
Not to say we don't still treat, but you know,
we have much better success the earlier we intervene and
the earlier we note the issue, which is why we're
so passionate about getting you know, patients and their doctors
and there are other healthcare providers to refer early, because
(20:33):
the earlier we identified, the better.
Speaker 3 (20:35):
Chance we have an extremely important message. I mean, that
is a big message right there, to get in early,
you know, especially if you are undergoing cancer therapy and
there is an underlying heart issue, to see you before
these issues start to get in early, to assess the
patient and evaluate you. And which leads me to my
next question, which is a type of test that you
(20:55):
would do? You know, and again we're making generalizations here,
but let's say typically you you have a patient and
maybe they have some underlying you know, cardiac issues, they're
going to undergo maybe chemo or radiation or immune therapy.
Are there specific types of tests that you would typically
recommend for these types of patients.
Speaker 4 (21:13):
Yeah, so you know, we base these decisions on again,
what the risk is, what type of cancer therapy. The
question is going to get what we know about their
past cardiac history. I would say the majority of patients,
if not all, of our patients, will at the very
least get an electric cardiogram, which your patients know it
as your listeners know it as an EKG, which looks
(21:36):
at the heart rhythm and can tell us a lot
about the health of the heart. And most patients will
get something called an echo cardiogram, which is an ultrasound
of the heart. It's live pictures of the beating heart,
and that tells us a ton of information about the
heart function, how sick the heart is, how it relaxes,
how it pumps, how the valves look, and those types
(21:57):
of things very often will do even before a patient
starts their cancer therapy, because that gives us a baseline.
It tells us what they start with, so that we
have something to compare it to if there's an issue,
you know, during the cancer treatment or down the line
when patients have survived their cancer treatment. So I would
say the majority of those patients get at least one
(22:18):
or both of those tests. And then there are blood
tests that we do, and then in certain circumstances, you know,
we'll do other testing, for example, cardiac MRI when we
need a better look at the muscle of the heart
and whether they're scarring or anything like that, or stress
testing depending on whether a patient is having symptoms or
we want to better identify their risks. So there are
(22:41):
a bunch of different tests that we do, but we
really individualize it when we see patients in the office.
Speaker 3 (22:46):
Are there any specific heart healthy diets or supplements that
you would suggest for patients when they're undergoing therapy?
Speaker 4 (22:54):
I mean, I think that in general, also the same
thing I say for all of my patients, which is,
but the more healthier lifestyle you can live and the
more plant based you can make your diet. I mean, listen,
I don't think anybody is perfect, and we all have
indiscretions in our lives, including me, But I think the
more you can lean toward a plant based diet and
(23:16):
the more you can lean toward an active lifestyle, the
better off in general you're going to be. And I
think the oncologists would generally agree with that. Also.
Speaker 3 (23:24):
Yeah, yeah, for sure, you've been a cardiologist for some time.
Not to put you on the spot here, But what
do you do to stay healthy?
Speaker 4 (23:31):
You know, it's a good question. I'm glad you asked.
So I try to practice what I preach. Again, I'm
not perfect, and I'm quite busy. I have three boys
at home that keep me active and busy and don't
give me a lot of free time. But I try
to exercise most days of the week. And when I'm exercising,
(23:51):
I usually do one of two things. Either I am
on my peloton riding, and I usually try to do
that three or four times a week in the morning
before we're For the other days, I try to go
at least one or two times a week to a
pilates class, which really just brings me a lot joy.
You know. I try to live a healthy lifestyle in
terms of my eating most of the time, you know,
(24:14):
because I'm if I'm preaching this to patients, I may
as well.
Speaker 3 (24:18):
I know, as I walk the walk, right, No, I agree,
and I do the same thing to be honest. I mean,
I'm i'd like to swim. I go to the gym
almost every day or if I can, and I swim
maybe two or three times a week, and try to
eat as you mentioned a Mediterranean heart healthy diet. And
you know in moderation. Everything is in moderation, right, I
mean you don't you know? Will I ever have a pizza? Sure,
(24:41):
you know, or steak every once in a while. Sure,
I think in moderation, but I think it's important to
keep your heart healthy with aerobic exercise and we die.
The two basic things that I tell my patients is
diet and exercise. You did mention before we end the show,
and again I want to thank you so much, and
if you've been listening, I just want to give out
doctor Bloom's number one more time. Who is our director
(25:04):
of our cardio oncology program here at the NYU Langone
School of Medicine on Long Island as well as she sees.
Do you see patients in the city too, Michelle, or
is it just that here too.
Speaker 4 (25:15):
I am going to be seeing patients actually in Long
Island at both the Promutter Cancer Center here as well
as in the cardiology offices. But also I will be
in the city at both the cardiology office and the
Promutter Cancer Center, so patients can see me in a
variety of different places depending on their geographic wishes. So yes,
(25:38):
I will be in the city.
Speaker 3 (25:40):
Yeah, and the number again is five to one six.
This will be good. I guess this number is good
for both locations, but please call five to one six
six six three forty four eighty. That's five one six
sixty sixty three four four eight zero. And thank you
so much, Michelle. That's Michelle Bloom, renowned expert in cardio oncology,
the directorctor of the cardio Oncology program here at NYU
(26:03):
Land going for the entire system. We are so fortunate
to have you. Thank you so much, Michelle. Really appreciate
you coming on with us for having me my pleasure. Well,
that's the end of the show. Everyone tune in every
Sunday here on Katz's Corner. We'll be back next week
with a great show. Have a great day everyone. This
is doctor Aaron Katts.
Speaker 2 (26:21):
You've been listening to Katz's Corner. Come back every week
to hear more straight talk on a wide range of
men's health topics and advice on how to live your
healthiest life.
Speaker 1 (26:32):
The proceeding was a paid podcast. iHeartRadio's hosting of this
podcast constitutes neither an endorsement of the products offered or
the ideas expressed,
The following is a paid podcast. iHeartRadio's hosting of this
podcast constitutes neither an endorsement of the products offered or
the ideas expressed.
Speaker 2 (00:09):
The following program is brought to you by NYU Land
Going Health. It's Katz's Corner with doctor Aaron Katz. You're
trusted expert in men's health, providing straight talk on a
wide range of men's health topics and advice on how
to live your healthiest life. Now on seven to ten
WOOR It's the Chairman of Urology at NYU Land Gone Hospital,
(00:32):
Long Island. Here is doctor Aaron Katz.
Speaker 3 (00:36):
Well, good morning everyone, and welcome again to Katz's Corner
here on wr iHeartRadio. So glad you could join us,
and today we have a wonderful show for you that's
not just geared for men, but for everyone, especially for
those that have been dealing with some sort of cancer,
that have had treatment for cancer and how that treatment
(00:59):
of their answer, whether it be chemotherapy, immune therapy, radiation,
maybe surgery can affect your heart. And we have developed
here at NYU a new program and a new director
of cardio Oncology. Cardiooncology, a new way and a new
(01:19):
division and a new program here that is really geared
to help manage and evaluate those patients that are dealing
with cardiac issues related to to cancer therapy. And to
help us with this discussion, I've asked Michelle Bloom, who
is an expert in cardio oncology and heart failure, and
(01:41):
she has been recently named and joined the NYU Landgone
Health System as the director of the cardio Oncology Program,
which specializes again to give care to patients with heart
health throughout cancer treatment and even in survivorship. She holds
an academic appointment as the professor in the Department of
(02:02):
Medicine and a member in the Division of Cardiology. She
has a tremendous history of taking care of patients. Before
coming to NYU, she was at Stonybrooks. She's also been
involved in taking care of patients who have had cardiac
heart transplants in the city years ago, and we are
so fortunate to have her here as part of our
(02:24):
NYU land Going system. She sees patients in the city
and I'm really looking forward to talking with you. Michelle.
Thank you so much for joining us here on Kats's
Corner this morning.
Speaker 4 (02:35):
Thank you so much for having me. It's really exciting
to be here, and this is really one of my
first times doing something like this at NYU, So it's
exciting to be here.
Speaker 3 (02:44):
Yes, And when I heard about this program, I was like, Wow,
we have to have her on the show. And maybe
you can start out, Michelle and just tell us a
little bit about Actually, maybe you can talk about your
own background and how you started getting an interest in
this cardio oncology a field.
Speaker 4 (03:04):
Sure, So I am a cardiologist by trade. I laugh
about that because I often have to remind my patients
that I'm not an oncologist, because I see a lot
of patients with cancer in my everyday, day to day practice.
But I am a cardiologist and I actually specialize in
heart failure, which means that I generally take care of
(03:27):
a lot of very sick patients with heart failure, including,
as you mentioned before, those sometimes who need a heart
transplant or a mechanical heart device like a leftventricular assist device.
And that's really not essentially what we're talking about today,
but that's my general practice. But it's actually kind of
interesting how I got into cardio oncology because I knew
(03:48):
I was going into medicine from the time I was
a very very small child. I was in elementary school,
and I knew I was going to be a doctor.
I wasn't entirely sure what I wanted to do, but
a lot of how I I sort of got to
where I am today was shaped based on my experiences
with my two grandfathers, who both actually wound up dying
(04:08):
of complications related to cancer. When I was very little,
I mean we're talking maybe nine or ten years old,
I was very intimately involved with my paternal grandfather's medical
care as it related to his colon cancer. But then
later in medical school, interestingly, my maternal grandfather was diagnosed
(04:29):
with pancreatic cancer, and as part of his treatment, he
got chemotherapy that wound up affecting his heart function, and ironically, ultimately,
instead of dying of the pancreatic cancer which was predicted,
he wound up living, you know, passed his on colleges predictions,
but he ultimately wound up dying of heart failure. And
(04:49):
that was at a very critical time in my training.
When I was a medical student, I used to study
in his room actually, because he was at the hospital
where I went to medical school. So I think in
retrospect a lot of that sort of shaped my interest
in the oncology aspects of cardiac care. And then I
wound up taking care of a lot of those particular
types of patients when I was doing my cardiology training,
(05:11):
and so that sort of sparked, really, you know, my
career trajectory in that way.
Speaker 3 (05:17):
The whole field of cardio oncology. I mean, to me,
that's relatively new. You know, I've been taking care of
cancer patients since the early nineteen nineties and have certainly
have seen some of these side effects from some of
the treatments that we give patients. But you know, tell
us a little bit about the field. Is it relatively new?
And actually you know what types of you know, actually
(05:42):
what is cardiooncology?
Speaker 4 (05:44):
Yeah, so it's interesting. It's actually not such a new specialty.
But I will say, what is new is people's awareness
of it. I think that over the last two decades
cardiooncology has existed in some way, shape or form. But
I would say really over the last five to ten
years is when it really kind of blew up and
it took center stage. Because I think that as cancer
(06:07):
patients were starting to survive longer, and treatments were starting
to just become much more complicated. But cancer, the paradigm
of cancer started to be more of a chronic condition,
you know. I think that that field like cardiology, became
more relevant to oncologists and to patients themselves because you
(06:28):
realize that you can impact on these patients in a
very meaningful way where ultimately, once patients survive their cancer,
they're going through their cancer treatment that you can really favorably,
you know, change their trajectory and really allow them to
survive well passed you know what they would have otherwise.
So I think it's not a new specialty, but but
(06:50):
I do think to your point, people are much more
aware of it over the last decade or so. An
answer to your question, what is cardio oncology, I think
it's a really really important thing to define for your
listeners because I think that it used to be that.
I think when you said the word cardiooncology, people would
just assume it with cancer in the heart. But that's
not at all what it is. It's really I always
(07:12):
tell my patients it's like the marriage of cancer and
the heart. It's like there's so much intersection between the
two fields that I think people really don't understand what
the connection is. So there's really three major parts of cardiooncology. One,
I think is important to know that the risk factors
for heart disease and cancer are very similar. In other words,
(07:35):
people are smokers, high blood pressure, or high cholesterol. All
the things that predispose you to cancer are also going
to predispose you to cardiac disease. And so it's not
a surprise that the two diseases sort of travel together,
so we often see one with the other rather than without.
The second thing is a lot of patients that are
(07:56):
diagnosed with cancer have pre existing issues with their hearts.
For example, they had a history of heart failure, or
they have a history of blockages in the arteries or
valve disease or something like that, and then they get
diagnosed with cancer and a lot of that gets forgotten,
and so the field of cardioloncology brings that back to
the center, so that we are watching for those things
(08:17):
and making sure that we're dealing with those things, and
so that that doesn't interfere with the cancer treatment and
also ultimately doesn't you know, make patients sicker. Or make
patients not be able to continue their cancer treatment. And
I think the third thing, and probably the major sort
of definition of the field of cardooncology is I think
(08:39):
just talking about all these cancer treatments like you were
saying before, and what effect they can directly or indirectly
have on the heart. And I think that we'll talk
about that a little more later, but those three things
I think make up the crux of what we mean
when we say cardiooncology.
Speaker 3 (08:55):
That's so important. I mean, you would think that this
should have been established years ago, beare because you're absolutely right.
You know, when we are looking at our patients with cancer,
sometimes we get so focused on the cancer that we
forget about the other major organs in the body, like
the heart and how is this cancer treatment going to
affect the heart and should they even have treatment at
(09:16):
all depending upon what their cardiac risk factors are. And
then the other thing that you mentioned it's just so interesting,
is the risk factors. I mean, obesity and high blood
pressure and hyperlipidemia and smoking. All of these are risk
factors for cancer obviously, and of course the risk factors
for the heart. So the marriage of the two of
them really come together and should be housed under some
(09:40):
you know, under a program like you have. So I
guess the next question would be, you know, the types
of heart issues that cancer patients are thinking about? What
types of heart issues are they? I mean you mentioned
heart failure. I guess there's also things like arrhythmias and
things like that. I mean there are other other things
(10:01):
in the heart that cancer patient should be thinking about.
Speaker 4 (10:04):
Yeah, I mean there's a whole spectrum. I think it
starts from the way beginning of really just thinking about
people that are at risk, Like we kind of talked
about already, people that have risk factors where they don't
actually have heart disease yet, but those are patients that
we look at from a different lens because they're at
an increased risk of developing an issue. In HEARTFAY, we
(10:26):
talk a lot about this thing called two hit hypothesis,
and what we mean by that is sometimes a person
can have risk factors or something happen and that puts
them out a risk, but the heart is still okay,
and then all of a sudden, something else happens and
it sort of sets up the perfect storm. So when
people have risk factors like the ones we talked about
high blood pressure, diabetes, high cholesterol. Especially when those risk
(10:50):
factors are not addressed and not well controlled, then all
of a sudden, you throw in a cancer diagnosis and
some cancer therapy, and all of a sudden, it kind
of sets the patient up for an adverse event. So
those patients specifically, you know, we oftentimes see those patients
in our clinic or regular general cardiologists are going to
(11:10):
see those patients and we see what it's really really
important for those patients to be watched very closely. But
then of course there's a whole other spectrum of heart
issues that can occur relatives to cancer therapy. For example,
valve disease like tightening of the valve or leaking of
the valve, issues with the sack around the heart called
(11:30):
the paracardium that can get thickened or diseased. Heart failure,
of course, which is you know, my particular specialty, where
the heart either gets very weak and can't pump you know,
oxygen and blood to the body appropriately, or gets very
stiff and can't relax, and all of that leads to
heart failure symptoms and bad outcomes. So really there's a
(11:52):
whole lot of things. There's a rhythmia like like you mentioned,
which is abnormal heart rhythms that are common with certain
types of chemotherapy and other types of cancer therapy. So
we watch for those and we we we manage those
appropriately depending on the situation. So there's a whole lot
of sort of runs the gamut. There's a whole lot
of patients that we see for many different reasons in
(12:14):
a cardio oncology clinic.
Speaker 3 (12:16):
Yeah, I'm just wondering, do you think many of the
what types of cancer therapies are most likely going to
affect the heart? Is it is it chemo, is it radiation,
or is it just or immune therapy or viral therapies
that sometimes we use, or it could be could be
any of those things.
Speaker 4 (12:34):
Yeah, it could be any of those things, and sometimes
it actually has to do with the combination. So so
we sort of talked about already, But I sort of
look at these things in a in a way that
sort of like sets up the framework for risk. So
I think of it as there's patient risk factors and
then there's cancer risk factors. And so the patient risk
(12:57):
factors we've talked about multiple times already. Today, the high
blood pressure, diabetes, all the things that you know that
you know will predispose a patient. But then the cancer
related factors have to do specifically with well, what kind
of chemotherapy are they going to get, what dose of
that chemotherapy? Are they going to combine it with immune therapy?
Are they going to combine it with radiation therapy? That's
(13:19):
in the field of the heart. So it's not just
about what the therapy is. It's not just about the
patients themselves, but it's really, i think, the whole combination,
and that's really the crux of how we determine risk
and how we decide who should be seen and how
often they should be followed in that kind of thing.
So it's really very it's very individualized field because there's
(13:41):
so many different factors at play, so not everybody that gets,
you know, a certain type of chemotherapy, of course, is
going to have a heart issue. It has to do with,
you know, definitely the risk factor profile and how it's given,
the doses and all of that. So it's it's a
little complicated and nuanced, but that's sort of how think
about it.
Speaker 3 (14:01):
If you just waken up in the morning here on
Katsa's corner. We're talking with doctor Michelle Bloom, who is
professor in the Department of Medicine and a member of
the Division of Cardiology and an expert in cardio oncology
and heart failure. If you are listening and you or
your loved one may need a consultation with doctor Bloom,
please give her a call. The number is, and I'll
(14:22):
announce it again at the end of the show is
five to one six six ' six ' three forty
four point eighty. That number again is five to one
six six ' sixty three four four eight zho. And
you know, Michelle, we've been talking a lot about patients
that are undergoing chemotherapy or radiation and have cancer and
(14:43):
how it may affect the heart. I wonder, let's say
that the average person out there is doesn't have a
known history of any heart issues, they're not taking any
heart medications, but now they've been faced with this diagnosis
of a prostate can or a breast cancer or a lymphoma,
and may need some intensive therapy which may affect the heart.
(15:07):
I mean, if you read all the side effects of
any of these combinations or even single modalities, somewhere along
the line there's going to be some potential interference with
the heart where maybe it's an electrical interference as an
arrhythmia or something else in the heart. Should they you know,
when does somebody need to see someone like yourself, a
cardio oncologist. When would you raise the suspicion maybe even
(15:32):
somebody that let's say does not have underlying or known
past the cardiac issues, would you would you see them
in your practice as well.
Speaker 4 (15:41):
Yeah, it's a very very good question, and I think
it's not an easy question to answer because truthfully, the
answer is not the same for everybody. So for sure,
if we would confern, you know, even people like we
said that don't have a known history, A lot of
people don't have a known history of a cardiac event.
They haven't had a heart attack, they haven't had a
(16:02):
valve problem, they've been kind of okay. And a lot
of those patients either are just being treated by their
general interness or they're being treated by a general cardiologist
just for preventative care. So I think the answer is
easier for people that already have a known issue. Right,
if you have a history of anything cardiac related, then
(16:23):
to me, I think it's plug and play. It's a
no brainer. You should definitely be evaluated because really there's
such a huge spectrum of toxicities with the cancer therapies
that somebody like that should definitely be seen. I think
the nuance and the difficulty of answering your question is
in the people that don't have a known history. I
(16:44):
think those are the people where a good internist or
a good general cardiologist would be able to help decide
with the patient and with the oncologists sometimes about whether
that patient would benefit from the expertise of some like
me or someone from my team, or whether they're better
suited for you know, for example, preventative cardiologists. We have
(17:07):
a huge preventative cardiology program at NYU based in Manhattan,
and a lot of the patients with cancer, particularly the
prostate cancer patients and the breast cancer patients are being
seen by many of those preventative cardiologists because, as you know,
they have a lot of metabolic issues with the you know,
with the prostate therapies and the breast cancer therapies. So
(17:30):
I think a lot of it will kind of depend
on how your team and you sort of feel about
your risk because certainly not every patient that is undergoing
cancer therapy needs to see a cardiologist, but there are
probably more patients that should than are seeing a cardiologist.
If that makes sense, Yes.
Speaker 3 (17:48):
It certainly does. And I wonder, you know, when you're
going through the therapy, let's say, and you do develop
a heart condition. And I know you can't make a
generalized statement about everyone, but are these conditions can they
be reversible? So let's say somebody is going through chemotherapy.
Maybe you can give us an example of someone, you know,
(18:09):
even a patient of yours, has gone through chemo. They
had a hard issue. Now the chemo is over. Is
the is the heart issue that they developed during the
cancer treatment? Is that short lived? Is it reversible or
is that something that someone would have to be to
live with from then on in?
Speaker 2 (18:26):
You know?
Speaker 4 (18:26):
Yeah, So again, not a one size fits all answer.
I take care of I mean, I've been taking care
of some patients for over a decade and many of
those patients had an issue at the beginning with chemotherapy
and have gotten much better. And you know, to be honest,
a lot of those patients had even near reversal or
(18:48):
complete reversal of whatever it is they had. It very
much depends on what it is. So, for example, there
are certain types of chemotherapy that might lead to what
we call a cardiomiappe, which is a weakening of the
heart muscle, and that might lead to heart failure symptoms.
And in some of those cases it doesn't go away,
(19:08):
it gets worse, and then you know, we're talking about
advanced therapies like a heart transplant or a mechanical heart.
But those are the extreme situations. There are many, many
patients where they are diagnosed with the weak heart and
with early interventions by somebody like me or people from
my team, the heart failure team, so those patients can
(19:29):
go on to have some recovery, complete recovery, or at
the very least live along productive, you know, otherwise healthy life.
But I think the key to all of this, and
this is the reason why I'm so passionate about what
I do, is the earlier we can identify these things,
the better chance we have at recovery or improvement in survival.
(19:52):
So we know, for example, with heart failure patients, that
if you intervene very very early after the heart has
an you have a much higher likelihood of making that
patient's heart function better or completely you know, reversing that
heart dysfunction, Whereas if you diagnose these patients later, then
(20:12):
you're much less likely to have success with the treatment.
Not to say we don't still treat, but you know,
we have much better success the earlier we intervene and
the earlier we note the issue, which is why we're
so passionate about getting you know, patients and their doctors
and there are other healthcare providers to refer early, because
(20:33):
the earlier we identified, the better.
Speaker 3 (20:35):
Chance we have an extremely important message. I mean, that
is a big message right there, to get in early,
you know, especially if you are undergoing cancer therapy and
there is an underlying heart issue, to see you before
these issues start to get in early, to assess the
patient and evaluate you. And which leads me to my
next question, which is a type of test that you
(20:55):
would do? You know, and again we're making generalizations here,
but let's say typically you you have a patient and
maybe they have some underlying you know, cardiac issues, they're
going to undergo maybe chemo or radiation or immune therapy.
Are there specific types of tests that you would typically
recommend for these types of patients.
Speaker 4 (21:13):
Yeah, so you know, we base these decisions on again,
what the risk is, what type of cancer therapy. The
question is going to get what we know about their
past cardiac history. I would say the majority of patients,
if not all, of our patients, will at the very
least get an electric cardiogram, which your patients know it
as your listeners know it as an EKG, which looks
(21:36):
at the heart rhythm and can tell us a lot
about the health of the heart. And most patients will
get something called an echo cardiogram, which is an ultrasound
of the heart. It's live pictures of the beating heart,
and that tells us a ton of information about the
heart function, how sick the heart is, how it relaxes,
how it pumps, how the valves look, and those types
(21:57):
of things very often will do even before a patient
starts their cancer therapy, because that gives us a baseline.
It tells us what they start with, so that we
have something to compare it to if there's an issue,
you know, during the cancer treatment or down the line
when patients have survived their cancer treatment. So I would
say the majority of those patients get at least one
(22:18):
or both of those tests. And then there are blood
tests that we do, and then in certain circumstances, you know,
we'll do other testing, for example, cardiac MRI when we
need a better look at the muscle of the heart
and whether they're scarring or anything like that, or stress
testing depending on whether a patient is having symptoms or
we want to better identify their risks. So there are
(22:41):
a bunch of different tests that we do, but we
really individualize it when we see patients in the office.
Speaker 3 (22:46):
Are there any specific heart healthy diets or supplements that
you would suggest for patients when they're undergoing therapy?
Speaker 4 (22:54):
I mean, I think that in general, also the same
thing I say for all of my patients, which is,
but the more healthier lifestyle you can live and the
more plant based you can make your diet. I mean, listen,
I don't think anybody is perfect, and we all have
indiscretions in our lives, including me, But I think the
more you can lean toward a plant based diet and
(23:16):
the more you can lean toward an active lifestyle, the
better off in general you're going to be. And I
think the oncologists would generally agree with that. Also.
Speaker 3 (23:24):
Yeah, yeah, for sure, you've been a cardiologist for some time.
Not to put you on the spot here, But what
do you do to stay healthy?
Speaker 4 (23:31):
You know, it's a good question. I'm glad you asked.
So I try to practice what I preach. Again, I'm
not perfect, and I'm quite busy. I have three boys
at home that keep me active and busy and don't
give me a lot of free time. But I try
to exercise most days of the week. And when I'm exercising,
(23:51):
I usually do one of two things. Either I am
on my peloton riding, and I usually try to do
that three or four times a week in the morning
before we're For the other days, I try to go
at least one or two times a week to a
pilates class, which really just brings me a lot joy.
You know. I try to live a healthy lifestyle in
terms of my eating most of the time, you know,
(24:14):
because I'm if I'm preaching this to patients, I may
as well.
Speaker 3 (24:18):
I know, as I walk the walk, right, No, I agree,
and I do the same thing to be honest. I mean,
I'm i'd like to swim. I go to the gym
almost every day or if I can, and I swim
maybe two or three times a week, and try to
eat as you mentioned a Mediterranean heart healthy diet. And
you know in moderation. Everything is in moderation, right, I
mean you don't you know? Will I ever have a pizza? Sure,
(24:41):
you know, or steak every once in a while. Sure,
I think in moderation, but I think it's important to
keep your heart healthy with aerobic exercise and we die.
The two basic things that I tell my patients is
diet and exercise. You did mention before we end the show,
and again I want to thank you so much, and
if you've been listening, I just want to give out
doctor Bloom's number one more time. Who is our director
(25:04):
of our cardio oncology program here at the NYU Langone
School of Medicine on Long Island as well as she sees.
Do you see patients in the city too, Michelle, or
is it just that here too.
Speaker 4 (25:15):
I am going to be seeing patients actually in Long
Island at both the Promutter Cancer Center here as well
as in the cardiology offices. But also I will be
in the city at both the cardiology office and the
Promutter Cancer Center, so patients can see me in a
variety of different places depending on their geographic wishes. So yes,
(25:38):
I will be in the city.
Speaker 3 (25:40):
Yeah, and the number again is five to one six.
This will be good. I guess this number is good
for both locations, but please call five to one six
six six three forty four eighty. That's five one six
sixty sixty three four four eight zero. And thank you
so much, Michelle. That's Michelle Bloom, renowned expert in cardio oncology,
the directorctor of the cardio Oncology program here at NYU
(26:03):
Land going for the entire system. We are so fortunate
to have you. Thank you so much, Michelle. Really appreciate
you coming on with us for having me my pleasure. Well,
that's the end of the show. Everyone tune in every
Sunday here on Katz's Corner. We'll be back next week
with a great show. Have a great day everyone. This
is doctor Aaron Katts.
Speaker 2 (26:21):
You've been listening to Katz's Corner. Come back every week
to hear more straight talk on a wide range of
men's health topics and advice on how to live your
healthiest life.
Speaker 1 (26:32):
The proceeding was a paid podcast. iHeartRadio's hosting of this
podcast constitutes neither an endorsement of the products offered or
the ideas expressed,
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