May 5, 2023 • 29 mins
On this episode of Five to Thrive Live, integrative medicine physician, Heidi Rula joins us to share tips for discussing integrative therapies with your oncologist and strategies for assembling an integrative team.
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Any health related information on the followingshow provides general information only. Content presented
on any show by any host orguests should not be substituted for a doctor's
advice. Always consult your physician beforebeginning any new diet, exercise, or
treatment program. Welcome to five toThrive Live, a podcast about thriving for
(00:44):
those who have been affected by cancerand chronic disease. I am doctor Lisa
Schuler and I co host five toThrive Live with my good friend Carolyn Gazella.
You can find out all of ourpast podcasts on any major podcast outlet,
and you can also find the scheduleon our website, which is I
thriveplan dot com. So today we'regoing to be talking about the very important
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but sometimes difficult conversations that patients havewith their oncologists when they want to incorporate
integrative medicine or integrative therapies into theircancer care. And sometimes these conversations can
go quite well, but other timespatients are met with quite a bit of
resistance and can feel very isolated orfrankly turned off and confused. So we're
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going to try to work our waythrough this. Our guest today is doctor
Heidi Rula, and she's going toshare some of her tips and strategies for
how to negotiate these conversations to agood outcome. Doctor Rula joined Ironwood Cancer
and Research Centers in twenty eighteen tolaunch the Integrative Oncology program. She's board
certified in family Medicine and in IntegrativeMedicine. She's also trained in functional medicine
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and in medical acupuncture. Before wetalk tid though, I do want to
thank our sponsors who make five toThrive Live possible. First, Guya Rbs,
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at Pure Formulas dot com. Nowto you, Heide, doctor Rula,
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Welcome to five to Thrive Live.Well, thank you for having me.
This is an honor to be onyour podcast. Indeed, well, I'm
excited that you're here, and youknow, we like to get to know
our guests a little bit first.So you are a family medicine physician.
What led you down the path ofintegrative medicine. Well, you know,
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I really had to do with acancer diagnosis than my mother. I was
about four years out in practice asa family doctor and kind of had you
know, when you go to medicalschool, you kind of come out all
kind of bright eyed and bushy tailsand really thinking that you have all the
answers because you've learned so much.Your brain is full of knowledge, and
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you feel like you can fix everybodyfrom what you learn. And then as
you kind of make your way throughpatient care, you kind of run into
all these situations where you feel youdon't have good tools to help people.
And that really kind of came toa forefront when my mother was diagnosed with
a terminal form of colon cancer,and so it was really kind of working
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with her and my frustrations in termsof the limitations of what I had to
offer as a conventional family doctor.That really kind of led me off on
this path. To back up alittle bit, you know, I kind
of grew up my mother was aGerman immigrant, and we really didn't get
a lot of conventional medical care asa with a lot of folk remedies and
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just you know a lot of kindof natural good foods and those type of
things, and so, um,my mother really wasn't one to um to
engage much in the conventional healthcare system. And so when she was diagnosed with
cancer UM, she had kind ofdecided she would do conventional care because that
would kind of extend her life andallow her to see her grandchildren a little
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bit more. UM. But butshe really didn't want to have any of
the any of the treatment side effectsbe treated with more medicines. She didn't
want you know, medicines on topof medicine UM. And so she was
looking to me as a physician toguide her in what she could use outside
of just giving her more pharmaceutical medicinesto deal with with the with the treatment
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issues and UM. And I didn'treally have much to offer. So that
really, UM, you know,took me to a place of somewhat of
disenchantment. I think with conventional medicinethat you know, here I was,
you know, the person that matteredthe most. I didn't have what I
needed to be able to help her. And so that kind of when my
mother passed UM, we did abouttwo two and a half years of UM,
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a kind of end of life care, and so when she passed,
I really kind of had to decidewhich direction I wanted to go in medicine.
Did I even want to be aphysician anymore? That was certainly something
that entered my mind, and um, that kind of led me into the
integrated medicine program because again, youknow, my mother was looking for other
remedies that I just really didn't havethe knowledge of, and so so it
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kind of again fulfilled that need.Um, and so I did the fellowship
and integrated medicine and that really kindof got me off and running, and
you know, looking at you know, things like functional medicine, root causes
again, how to you know,treat illness in in a different way than
just pharmaceutical medications and m So againI really kind of launched my my kind
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of lifelong interest and be able tolook at help with maybe a different lands,
with multiple lanses, to be ableto again have more have more tools
to meet the needs of each patientsthey as they come through the door.
Yeah. Well, and I'm gladthat you opted for a proactive response to
your situation and hopefully your mother benefitedfrom that as well. So, you
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know, I want to get rightinto the topic tonight. Not all oncologists
are open to their patients using integrativeor natural therapies as a part of their
cancer treatment. So even when somebodyis partaking of the recommended standard of care,
many oncologists are very resistant to them. Also using even mind body therapies.
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In some cases, dietary changes,often dietary supplements are dismissed. And
you know, sometimes this is welljustified, and sometimes this is more of
an attitude rather than a careful considerationon the part of the oncologists. Why
do you think oncologists are more orless resistant to people incorporating integrative therapies?
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And I just want to preface youranswer by saying, I know you're going
to generalize. You're not speaking aboutevery oncologist, but for those who are
resistant, what do you think thatresistance is about. Yeah, I think,
you know, the resistance to kindof looking at other healing systems is
number one. I just think alack of knowledge. You know, in
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medical school, we kind of getour knowledge all from kind of one source,
you know, in terms of youknow, kind of more pharmaceutical based
clinical trials. They're very structured,double blinded, ceple control trials, and
so so when we're looking at someof these other kind of therapies coming from
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other healing systems, it really generallyisn't in their kind of pipeline of information
that they've been able to process andfeel comfortable utilizing. Um. And so
I think when you know, again, I think, you know, there's
always some of these, you know, studies that will kind of pop up
and say, you know, patientsdid poor if they were on you know,
a certain supplement or so, andI think they grab on to some
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of the negative data out there andthen disregard everything else because that's certainly it
certainly is easier, um, youknow, if you don't have to really
dig deep and kind of really kindof get to the bottom of like what's
what's helpful, what's not helpful,because it's a little overwhelming just to kind
of, I think, manage allthat's coming out of kind of mainstream um
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you know, um, you know, education and so so to kind of
add this whole another layer, Ithink just seems like again, I think
it's too much, you know forthem to kind of be able to develop
any mastery. So they feel comfortablein a certain lane, and so that's
the lane that they want to travelin. That's kind of the sense I
get, and everything else seems alittle dangerous yeah, yeah, I would
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agree with that. I think that'su you know, in my mind,
when I'm encountering this attitude on thepart of oncologists, I do sort of
just give them a little bit ofslack in the sense that they are operating
actually from a perspective of acting ontheir patient's best behalf. Just because they
don't know this area, they're notreally willing to endorse anything in there,
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and I think from their perspective,that feels like they're doing the right thing
for their patient. On the otherhand, you and I know that there
are many things that patients can useconcurrently with their chemotherapy, the radiation,
even some of these newer biologics thatcan be very helpful for them. So,
if someone's meeting with this resistance fromtheir oncologists about integrative therapies, and
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let's say they're working with an integrativepractitioner who's recommended something that's very you know
that least has some level of evidenceor as we like to say, a
relatively good benefit to risk ratio,meaning more likely have benefit very low risk
of harm. How can they discussthis in a way that would optimize their
chances of having it endorsed with bytheir oncologists. Well, I think number
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one is just you know, um, I think just putting it out there
that this is something that's very importantto them in their care and they're hoping
to develop a partnership with their physicianand kind of bring in again, you
know, that they have somebody whoyou know is trained in this and is
willing to bring forward kind of anykind of evidence or um that can help
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them and making developing a comfort thatthe patient is going to be okay.
But I think, you know,if a patient kinds strong and says that
this is the type of care Iwant, and I want to know whether
or not you're on board with meor not, you know, I think
that certainly can can really kind oflet the physician know that this this really
isn't an option for you for meto just kind of shut you down and
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say, you know, you can'thave this care. I think that you
have to, you know, workon developing kind of those collaborative relationships.
And I think when you when youidentify your care team, I'm you want
to, you know, make surethat you can have a partnership with you
know, you're oncologists, your radiationoncologists, and I just find that more
and more UM, as integrative medicineis really becoming more mainstream and part of
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you care and all these major kindof academic centers where physicians are getting trained
UM, that there is now alittle bit more of an acceptance that that's
you know, that this is somethingthat can be helpful for patients. So
you still have some of the oneswho are resistant, but I'm just finding
that there's a greater number of physiciansover the last twenty some years that I've
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been kind of working kind of inthis field that again, more and more
are kind of going to UM,you know, they consult me, you
know, to kind of help theirpatients to kind of navigate that in a
safe way, because they don't wantthe patients to kind of try to figure
it out on their own, becausethere can be some that falls with that
as well. So so again Ithink that there's there's really a trend some
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more acceptance and kind of conventional kindof uh, you know, oncology care
just kind of say Okay, maybeI'm maybe I'm not the expert in this,
but you know, I do feelcomfortable with Again, a lot of
times that's will kind of find differentproviders in the community that they know kind
of what their practice styles are oncethey've kind of shared a number of patients
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with and the more they feel comfortablethat they're going to keep the patient safe,
the more they're willing to work withthat patient. Yeah, I think
that that's true. I think thereis a growing openness. And I think
one of the things that you said, which I'm going to underscore, is
that the importance of people who arereceiving treatment advocating for themselves, so you
know, not just sort of takingwhatever the oncologist says and giving up right
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away, but trying to forward theconversation and just see where it goes.
Because some times the initial resistance maysound kind of strong or come across as
being fairly strong. But then,as you're suggesting, when the patient describes
their desire for it, why they'rewanting to do it, who they're getting
the advice from, there may besome openness there. So I think it's
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important yet to have that conversation.You know. Where this really comes up
a lot, though, is withdietary supplements. This to me, is
still the biggest trigger for oncologists.Something they're very nervous about generally speaking again
and making a big generalization. Sowhat do you advise your patients about or
how do you advise your patients aboutdietary supplement use specifically during let's say chemotherapy
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or radiation. Well, I meanthere's you know, there's so many nuances
to kind of you know, recommendationsfor dietary supplements in terms of you know,
what chemo they're getting, what theirpatient's current state is, what their
what their other health you know,you know, conditions are so so I
think that really you want to havea partner, you know, who can
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guide you through this to to tryto navigate this on your own as a
patience, you know, as you'regoing through care and you don't feel well.
You know, it's really you know, it's really important, I think
to have somebody who can kind ofguide you through this, who you know,
has the expertise, because I don'tthink there's one kind of blanket you
know, you know, statements youwant to make, you know, for
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anybody in terms of what what supplementsare best for chemotherapy, but there's some
that you know will utilize um,you know, to again to help prevent
neuropathy to support your digestive track,you know, like you probiotics and sometimes
you know, glutamine and those typeof things might be you know, supportive
for patients and so again, butthere's some areas that you want to use
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this, some areas you don't.UM. So I think that they can
be incredibly beneficial for patients. UMthat they want to make sure that there's
no drug interactions because sometimes you know, some of these supplements can interfere with
how a drug is metabolized. Imean, especially herbals you know, tend
to have some impact on how yourliver will clear some of these medications.
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So so you don't want to justkind of do it on your own,
UM where you know, you justread something that you thought it was good,
but you know, you really haveto make sure that it's good for
your specific you know, chemotherapy agentsor immuno therapy agents, things like that.
So so I think there really requiressome expertise UM to kind of get
to get some input on that.You know, radiation again, I think
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you know, there's I'm a littlebit more limited on what I recommend during
radiation, but I do recommend supplementsduring radiation again, I think the general
sense by you know, the radiationoncologists is you know, they want to
you know, avoid high dose antioxidantsbecause they feel that oxidation is a way
that you know, cancer cells areare killed and you know, in part
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as part of the treatment, andso they don't want to interfere with how
that oxidative process will take out cancercells. And so so yeah, I
think you know, there's you know, some debate in the literature about that,
but again and generally try to youknow, fall on the side of
safety with that and help patients,um and and make sure that the radiation
oncologists is comfortable with that too.UM. So that so that um again
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we're managing side effects. We're keepingyou know, the digestive track in the
skin and you know, and energyand things like that. Um, you
know, supported as patients are goingthrough treatment. I think anything real incredibly
beneficial. UM that patients I thinkhave a much better cancer treatment experience if
they can get some of these sideeffects you know, proactively, um,
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you know managed so that again youknow, you have less toxicity, have
these therapies on your healthy tissues.So but again I think there's a strong
place for it, but that itreally needs to be um carefully, um
decided, and again not just blanketedwith you know, ten different supplements that
be very targeted in terms of whatyou're trying to achieve with each supplement.
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So you've mentioned a couple of timespartnering with your care provider, and you
mentioned also having a team. Sowho should be on somebody's team? And
how do you advise patients to goabout collecting their team of providers? Yeah,
I mean again I think it's youknow, what's available in your community.
I mean each community it has,you know, you know, access
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to a different set. Obviously,when your big metropolitan area you have kind
of a greater depth of people,you know, natropathic oncologists, you know,
like yourself, And so I thinkthe naturopathic world has really kind of
come a long way in terms ofthey now have a specialization you know,
for kind of cancer care with thenatural natropathic ecology fields. So again a
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lot of times that can be akind of a great partner, you know,
for you Integrative medicine is really kindof a place too, So it's
either kind of a na tropathic oncologistor an integrated medicine or a combination of
those, and then looking at someof the other fields. You know,
it's like acupuncture can be incredibly helpfulto you know, deal with some of
the side effects to kind of helpkeep your energy up, you know,
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as you're going through treatment, dealwith nausea. So you know, if
you have the ability to have anacupuncturist, you know as as part of
that, somebody who can help youkind of on a mind body level,
you know, is great. Soif you again you know, things like
you know, yoga and um inany type of uh you know, taichi
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and some of these kind of mindbody movement you know therapies, if you
have access to that, you know, that can be you know, a
great partner to have. And Ithink counseling, you know, counseling.
My patients really do better if theyreally have a counselor to work with,
especially if they have you know,a prolonged treatment course or a very advanced
stage of cancer, um you know, somebody that kind of really help deal
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with the emotional impact of their illness. I think patients do so much better
if they can really you know,work on processing some of the emotions with
a professional versus just family alone.So again I think, you know,
bringing somebody like that in so Iwould say so again, so if we
kind of look at this, youknow, somebody in that integrated medicine naturopathic
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oncology space would be a very greatpartner to help you on the supplement side.
And a lot of times, youknow, those providers can also again
work on some of the kind ofmind body you know, helping you connect
with different resources to do guided meditation, guided imagery, you know, some
of these other very kind of supportivetherapy that can really improve you know,
how what your experience is through throughtreatment. But if you have an ac
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counsel would be you know, reallya great person to kind of have,
you know, on your care team. And if you know, I think
Chinese medicine with the acupuncture also iskind of a great partnership to have if
you have the ability to include that. Yeah good, Yeah, those are
all those also really good. Andyou know, a patient who's proactively seeking
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these individuals out to help them throughtheir journey of cancer treatment is more likely
than not somebody who's somewhat empowered.And I think being an empowered patient is
really important especially when somebody's diagnosed withcancer, which is an overwhelming diagnosis.
People get just thrust into the medicalsystem big time and can feel very disempowered,
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disenfranchised their life has turned upside down. So it can be a very
startling experience and disorienting experience. AndI think it's important and really actually kind
of an integral part of their healingprocess to regain a sense of empowerment through
that. So I'm wondering if you, since you work with people who are
going through this disease as well,what you or how you approach this sense
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of becoming more empowered with your patients. Yeah, I think, you know,
I really kind of talk to themkind of just about the awareness that
you know that you know, goingthrough cancers thing where you just feel like
you, you know, are inthat area of loss of control. You
know, you're used to kind oftaking charge and kind of making all these
decisions and now you're kind of inthis kind of whirlwind of you know,
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procedures and appointments and again you reallyfeel like you're not kind of you know,
running kind of the show anymore.And so you know, you know,
talk to them about kind of theareas where they can have impact,
right, you know again looking atthings like nutrition, looking at things like
mind body, um, you knowagain, I think all of those things
can be helpful looking at kind ofagain, what can we do on that
natural side maybe to manage some ofthose those treatment side effects. Um.
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I think all of those areas arewhere you know, patients can you know,
have that have that they have thatinput on kind of how you know,
their care is delivered. And Ithink again that gives them, you
know, that peace that they havecontrol over while they're out there in this
other strange world where they're kind ofbeing bounced around from you know, treatment
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to treatment and kind of you knowagain, I think it's a area where
most people, you know, reallydon't have much understanding of kind of this
whole medical world. Many times,when you're diagnosed with cancer, it may
be the first time you really kindof had any you know, significant um,
you know, kind of input fromin terms of you know, from
the medical system, you know,taking part in your care. So now
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all of a sudden, this iskind of your day to day life.
And that's you know, that's ahard place because it's all new language.
It solves you it's an all newkind of world for patients to have to
deal with. So again, Ithink finding those areas where you can have
an impact on your health can besomething that gives you a little bit of
control in a kind of a verychaotic time. Yeah, I think that's
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well said. So, you know, speaking of empowered, you are a
family physician, family medicine physician,an integrated medicine physician. How empowered do
you feel when you're talking with youroncology colleagues? Do you feel like you're
accepted? Do you feel like youhave to say is valued? Or do
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you have to kind of assert findways to assert your own worth in their
eyes? And are those covers?Can those conversations be difficult for you?
Um? Well, again, I'min a you know, a very big
organization. So we have fifteen officersacross the Phoenix you know, Metro,
and so I work with a youknow, a large number of oncologists and
you know, I've been you know, with kind of our organization now for
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five years, so I have developedrelationships with a lot of the oncologists and
so many of them at this pointreally kind of see me as a you
know, a great resource. Youknow, you know, a partner with
them and to help deal with youknow, patients who again maybe have needs
that you know, again are outsideof their scope, and patients have so
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many questions about you know, theuse of dietary supplements. It's great for
them to go here, you know, go see doctor Ruler. That's not
really my area, but she's gonnayou know, give you some recommendations and
keep you safe. So I havedevelops kind of that's a I think the
oncologists that I've worked with really umkind of know that. Again, I'm
not there to kind of pull patientsoff the treatment or guide them off,
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but really to kind of help thembe able to have the best experience as
they're going through their conventional cancer care. They're still you know, again,
I get a lot of referrals fromprobably you know, maybe twenty percent of
our of the docs, and thenyou know, some of the others are
just you know, they start graduallydeveloping a comfort with you. Patients can
kind of self refer into my services. So again, sometimes we'll get patients
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from providers who generally aren't one torefer to me. Um. I haven't
you know, really had any kindof I haven't had any real pushback.
You know, the organized organization hasstrongly really kind of recommended me to you
know, be part of the team. So when you have kind of leadership
kind of putting UM, you know, my position as one that um,
(25:56):
you know is beneficial for the wholeorganization, it really sets the tone in
terms of how the others perceive you. So it can help when you have
leadership really kind of backing you inkind of the care that you can add,
um, you know, to patients. So so I've been very fortunate,
UM in our organization that I haven'tyou know, had a lot of
UM, you know, haven't anybodycalling me up and you know, angry
(26:19):
that I'm doing you know, treatmentX, Y or Z for their patients,
UM, which has been wonderful becauseI certainly have colleagues who are in
especially reasons some regions of the countryI think are a much more conservative,
um, you know, in termsof just acceptance to to kind of having
UM kind of integrative you know,medicine, Integrative oncology is part of cancer
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care. UM. So I don'tseem to get the same pushback that UM
that some of my colleagues and otherparts of the country seem to get so,
um, I guess I'm very fortunatewith us. Yeah, that's that
is well, it sounds like it'salso in no small measure due to your
own tenacity and your presence in theorganization and doing good work with your patients,
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which I think is important to youknow, results speak loudly in this
world, for sure, So wehave you know, I think I think
when physicians, you know, haveyou know, a challenging patient and you
know you you kind of you know, um, kind of partner in with
them and help that patient through abig challenge and they get that feedback,
(27:22):
I think it goes goes a longway to getting more referral on other challenging
patients for sure. Yeah, becausethey again I think physicians really at the
core want their patients to do well, and when they see that happening,
whatever the differential was, then that'swhat they're going to try to apply to
more of their patients. So well, good work, and thank you so
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much for doing that and for beinghere this evening. We are kind of
at a time, so we'll haveto finish up our conversation. But where
can our listeners find you if theyhappen to be in the greater Phoenix area.
So I'm I'm with Ironwood Cancer andResearch Centers. We're at IRONWOODCARC dot
com and so we have you know, if you go onto our web page,
(28:07):
we have all our social media channelsFacebook LinkedIn all of those on there,
so we you know, we createa lot of virtual content or we
have a lot of video in ourlibrary route supportive care topics. So it's
a great resource for patients to kindof check out, you know, to
again listen to a lot of ourtalks that we've done. That our topics
(28:30):
very relevant to patients as their pointthrough cancer treatment. And what was that
website again, Ironwood CRC dot com, IRONWOODCRC dot com. Wonderful. Well,
thank you so much. It's beena great show. Thanks for taking
time to join me tonight. Andthat wraps up this episode if I've to
thrive live. So we'd like tothank again our sponsors, Guya Herbs,
(28:52):
provider of exceptional quality pottical products Cognizancethat are colling to help enhance memory,
focus and attention. Im you apostbiotic for immune support. Doctor Hira's Probiotics
Award winning pre and probiotic formulas proThrivers, wellness, sleep, created specifically
for thrivers. And thank you allfor joining us. May you each experience
(29:15):
joy, laughter and love. It'stime to thrive, everyone say
Any health related information on the followingshow provides general information only. Content presented
on any show by any host orguests should not be substituted for a doctor's
advice. Always consult your physician beforebeginning any new diet, exercise, or
treatment program. Welcome to five toThrive Live, a podcast about thriving for
(00:44):
those who have been affected by cancerand chronic disease. I am doctor Lisa
Schuler and I co host five toThrive Live with my good friend Carolyn Gazella.
You can find out all of ourpast podcasts on any major podcast outlet,
and you can also find the scheduleon our website, which is I
thriveplan dot com. So today we'regoing to be talking about the very important
(01:08):
but sometimes difficult conversations that patients havewith their oncologists when they want to incorporate
integrative medicine or integrative therapies into theircancer care. And sometimes these conversations can
go quite well, but other timespatients are met with quite a bit of
resistance and can feel very isolated orfrankly turned off and confused. So we're
(01:30):
going to try to work our waythrough this. Our guest today is doctor
Heidi Rula, and she's going toshare some of her tips and strategies for
how to negotiate these conversations to agood outcome. Doctor Rula joined Ironwood Cancer
and Research Centers in twenty eighteen tolaunch the Integrative Oncology program. She's board
certified in family Medicine and in IntegrativeMedicine. She's also trained in functional medicine
(01:56):
and in medical acupuncture. Before wetalk tid though, I do want to
thank our sponsors who make five toThrive Live possible. First, Guya Rbs,
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created for thrivers. Pro Thrivers Sleepis available through your healthcare provider or online
at Pure Formulas dot com. Nowto you, Heide, doctor Rula,
(03:32):
Welcome to five to Thrive Live.Well, thank you for having me.
This is an honor to be onyour podcast. Indeed, well, I'm
excited that you're here, and youknow, we like to get to know
our guests a little bit first.So you are a family medicine physician.
What led you down the path ofintegrative medicine. Well, you know,
(03:53):
I really had to do with acancer diagnosis than my mother. I was
about four years out in practice asa family doctor and kind of had you
know, when you go to medicalschool, you kind of come out all
kind of bright eyed and bushy tailsand really thinking that you have all the
answers because you've learned so much.Your brain is full of knowledge, and
(04:15):
you feel like you can fix everybodyfrom what you learn. And then as
you kind of make your way throughpatient care, you kind of run into
all these situations where you feel youdon't have good tools to help people.
And that really kind of came toa forefront when my mother was diagnosed with
a terminal form of colon cancer,and so it was really kind of working
(04:39):
with her and my frustrations in termsof the limitations of what I had to
offer as a conventional family doctor.That really kind of led me off on
this path. To back up alittle bit, you know, I kind
of grew up my mother was aGerman immigrant, and we really didn't get
a lot of conventional medical care asa with a lot of folk remedies and
(05:01):
just you know a lot of kindof natural good foods and those type of
things, and so, um,my mother really wasn't one to um to
engage much in the conventional healthcare system. And so when she was diagnosed with
cancer UM, she had kind ofdecided she would do conventional care because that
would kind of extend her life andallow her to see her grandchildren a little
(05:23):
bit more. UM. But butshe really didn't want to have any of
the any of the treatment side effectsbe treated with more medicines. She didn't
want you know, medicines on topof medicine UM. And so she was
looking to me as a physician toguide her in what she could use outside
of just giving her more pharmaceutical medicinesto deal with with the with the treatment
(05:46):
issues and UM. And I didn'treally have much to offer. So that
really, UM, you know,took me to a place of somewhat of
disenchantment. I think with conventional medicinethat you know, here I was,
you know, the person that matteredthe most. I didn't have what I
needed to be able to help her. And so that kind of when my
mother passed UM, we did abouttwo two and a half years of UM,
(06:11):
a kind of end of life care, and so when she passed,
I really kind of had to decidewhich direction I wanted to go in medicine.
Did I even want to be aphysician anymore? That was certainly something
that entered my mind, and um, that kind of led me into the
integrated medicine program because again, youknow, my mother was looking for other
remedies that I just really didn't havethe knowledge of, and so so it
(06:34):
kind of again fulfilled that need.Um, and so I did the fellowship
and integrated medicine and that really kindof got me off and running, and
you know, looking at you know, things like functional medicine, root causes
again, how to you know,treat illness in in a different way than
just pharmaceutical medications and m So againI really kind of launched my my kind
(06:57):
of lifelong interest and be able tolook at help with maybe a different lands,
with multiple lanses, to be ableto again have more have more tools
to meet the needs of each patientsthey as they come through the door.
Yeah. Well, and I'm gladthat you opted for a proactive response to
your situation and hopefully your mother benefitedfrom that as well. So, you
(07:23):
know, I want to get rightinto the topic tonight. Not all oncologists
are open to their patients using integrativeor natural therapies as a part of their
cancer treatment. So even when somebodyis partaking of the recommended standard of care,
many oncologists are very resistant to them. Also using even mind body therapies.
(07:46):
In some cases, dietary changes,often dietary supplements are dismissed. And
you know, sometimes this is welljustified, and sometimes this is more of
an attitude rather than a careful considerationon the part of the oncologists. Why
do you think oncologists are more orless resistant to people incorporating integrative therapies?
(08:07):
And I just want to preface youranswer by saying, I know you're going
to generalize. You're not speaking aboutevery oncologist, but for those who are
resistant, what do you think thatresistance is about. Yeah, I think,
you know, the resistance to kindof looking at other healing systems is
number one. I just think alack of knowledge. You know, in
(08:28):
medical school, we kind of getour knowledge all from kind of one source,
you know, in terms of youknow, kind of more pharmaceutical based
clinical trials. They're very structured,double blinded, ceple control trials, and
so so when we're looking at someof these other kind of therapies coming from
(08:50):
other healing systems, it really generallyisn't in their kind of pipeline of information
that they've been able to process andfeel comfortable utilizing. Um. And so
I think when you know, again, I think, you know, there's
always some of these, you know, studies that will kind of pop up
and say, you know, patientsdid poor if they were on you know,
a certain supplement or so, andI think they grab on to some
(09:13):
of the negative data out there andthen disregard everything else because that's certainly it
certainly is easier, um, youknow, if you don't have to really
dig deep and kind of really kindof get to the bottom of like what's
what's helpful, what's not helpful,because it's a little overwhelming just to kind
of, I think, manage allthat's coming out of kind of mainstream um
(09:35):
you know, um, you know, education and so so to kind of
add this whole another layer, Ithink just seems like again, I think
it's too much, you know forthem to kind of be able to develop
any mastery. So they feel comfortablein a certain lane, and so that's
the lane that they want to travelin. That's kind of the sense I
get, and everything else seems alittle dangerous yeah, yeah, I would
(09:58):
agree with that. I think that'su you know, in my mind,
when I'm encountering this attitude on thepart of oncologists, I do sort of
just give them a little bit ofslack in the sense that they are operating
actually from a perspective of acting ontheir patient's best behalf. Just because they
don't know this area, they're notreally willing to endorse anything in there,
(10:22):
and I think from their perspective,that feels like they're doing the right thing
for their patient. On the otherhand, you and I know that there
are many things that patients can useconcurrently with their chemotherapy, the radiation,
even some of these newer biologics thatcan be very helpful for them. So,
if someone's meeting with this resistance fromtheir oncologists about integrative therapies, and
(10:43):
let's say they're working with an integrativepractitioner who's recommended something that's very you know
that least has some level of evidenceor as we like to say, a
relatively good benefit to risk ratio,meaning more likely have benefit very low risk
of harm. How can they discussthis in a way that would optimize their
chances of having it endorsed with bytheir oncologists. Well, I think number
(11:09):
one is just you know, um, I think just putting it out there
that this is something that's very importantto them in their care and they're hoping
to develop a partnership with their physicianand kind of bring in again, you
know, that they have somebody whoyou know is trained in this and is
willing to bring forward kind of anykind of evidence or um that can help
(11:30):
them and making developing a comfort thatthe patient is going to be okay.
But I think, you know,if a patient kinds strong and says that
this is the type of care Iwant, and I want to know whether
or not you're on board with meor not, you know, I think
that certainly can can really kind oflet the physician know that this this really
isn't an option for you for meto just kind of shut you down and
(11:52):
say, you know, you can'thave this care. I think that you
have to, you know, workon developing kind of those collaborative relationships.
And I think when you when youidentify your care team, I'm you want
to, you know, make surethat you can have a partnership with you
know, you're oncologists, your radiationoncologists, and I just find that more
and more UM, as integrative medicineis really becoming more mainstream and part of
(12:18):
you care and all these major kindof academic centers where physicians are getting trained
UM, that there is now alittle bit more of an acceptance that that's
you know, that this is somethingthat can be helpful for patients. So
you still have some of the oneswho are resistant, but I'm just finding
that there's a greater number of physiciansover the last twenty some years that I've
(12:41):
been kind of working kind of inthis field that again, more and more
are kind of going to UM,you know, they consult me, you
know, to kind of help theirpatients to kind of navigate that in a
safe way, because they don't wantthe patients to kind of try to figure
it out on their own, becausethere can be some that falls with that
as well. So so again Ithink that there's there's really a trend some
(13:05):
more acceptance and kind of conventional kindof uh, you know, oncology care
just kind of say Okay, maybeI'm maybe I'm not the expert in this,
but you know, I do feelcomfortable with Again, a lot of
times that's will kind of find differentproviders in the community that they know kind
of what their practice styles are oncethey've kind of shared a number of patients
(13:28):
with and the more they feel comfortablethat they're going to keep the patient safe,
the more they're willing to work withthat patient. Yeah, I think
that that's true. I think thereis a growing openness. And I think
one of the things that you said, which I'm going to underscore, is
that the importance of people who arereceiving treatment advocating for themselves, so you
know, not just sort of takingwhatever the oncologist says and giving up right
(13:54):
away, but trying to forward theconversation and just see where it goes.
Because some times the initial resistance maysound kind of strong or come across as
being fairly strong. But then,as you're suggesting, when the patient describes
their desire for it, why they'rewanting to do it, who they're getting
the advice from, there may besome openness there. So I think it's
(14:16):
important yet to have that conversation.You know. Where this really comes up
a lot, though, is withdietary supplements. This to me, is
still the biggest trigger for oncologists.Something they're very nervous about generally speaking again
and making a big generalization. Sowhat do you advise your patients about or
how do you advise your patients aboutdietary supplement use specifically during let's say chemotherapy
(14:39):
or radiation. Well, I meanthere's you know, there's so many nuances
to kind of you know, recommendationsfor dietary supplements in terms of you know,
what chemo they're getting, what theirpatient's current state is, what their
what their other health you know,you know, conditions are so so I
think that really you want to havea partner, you know, who can
(15:03):
guide you through this to to tryto navigate this on your own as a
patience, you know, as you'regoing through care and you don't feel well.
You know, it's really you know, it's really important, I think
to have somebody who can kind ofguide you through this, who you know,
has the expertise, because I don'tthink there's one kind of blanket you
know, you know, statements youwant to make, you know, for
(15:24):
anybody in terms of what what supplementsare best for chemotherapy, but there's some
that you know will utilize um,you know, to again to help prevent
neuropathy to support your digestive track,you know, like you probiotics and sometimes
you know, glutamine and those typeof things might be you know, supportive
for patients and so again, butthere's some areas that you want to use
(15:45):
this, some areas you don't.UM. So I think that they can
be incredibly beneficial for patients. UMthat they want to make sure that there's
no drug interactions because sometimes you know, some of these supplements can interfere with
how a drug is metabolized. Imean, especially herbals you know, tend
to have some impact on how yourliver will clear some of these medications.
(16:06):
So so you don't want to justkind of do it on your own,
UM where you know, you justread something that you thought it was good,
but you know, you really haveto make sure that it's good for
your specific you know, chemotherapy agentsor immuno therapy agents, things like that.
So so I think there really requiressome expertise UM to kind of get
to get some input on that.You know, radiation again, I think
(16:30):
you know, there's I'm a littlebit more limited on what I recommend during
radiation, but I do recommend supplementsduring radiation again, I think the general
sense by you know, the radiationoncologists is you know, they want to
you know, avoid high dose antioxidantsbecause they feel that oxidation is a way
that you know, cancer cells areare killed and you know, in part
(16:52):
as part of the treatment, andso they don't want to interfere with how
that oxidative process will take out cancercells. And so so yeah, I
think you know, there's you know, some debate in the literature about that,
but again and generally try to youknow, fall on the side of
safety with that and help patients,um and and make sure that the radiation
oncologists is comfortable with that too.UM. So that so that um again
(17:18):
we're managing side effects. We're keepingyou know, the digestive track in the
skin and you know, and energyand things like that. Um, you
know, supported as patients are goingthrough treatment. I think anything real incredibly
beneficial. UM that patients I thinkhave a much better cancer treatment experience if
they can get some of these sideeffects you know, proactively, um,
(17:41):
you know managed so that again youknow, you have less toxicity, have
these therapies on your healthy tissues.So but again I think there's a strong
place for it, but that itreally needs to be um carefully, um
decided, and again not just blanketedwith you know, ten different supplements that
be very targeted in terms of whatyou're trying to achieve with each supplement.
(18:06):
So you've mentioned a couple of timespartnering with your care provider, and you
mentioned also having a team. Sowho should be on somebody's team? And
how do you advise patients to goabout collecting their team of providers? Yeah,
I mean again I think it's youknow, what's available in your community.
I mean each community it has,you know, you know, access
(18:29):
to a different set. Obviously,when your big metropolitan area you have kind
of a greater depth of people,you know, natropathic oncologists, you know,
like yourself, And so I thinkthe naturopathic world has really kind of
come a long way in terms ofthey now have a specialization you know,
for kind of cancer care with thenatural natropathic ecology fields. So again a
(18:51):
lot of times that can be akind of a great partner, you know,
for you Integrative medicine is really kindof a place too, So it's
either kind of a na tropathic oncologistor an integrated medicine or a combination of
those, and then looking at someof the other fields. You know,
it's like acupuncture can be incredibly helpfulto you know, deal with some of
the side effects to kind of helpkeep your energy up, you know,
(19:12):
as you're going through treatment, dealwith nausea. So you know, if
you have the ability to have anacupuncturist, you know as as part of
that, somebody who can help youkind of on a mind body level,
you know, is great. Soif you again you know, things like
you know, yoga and um inany type of uh you know, taichi
(19:32):
and some of these kind of mindbody movement you know therapies, if you
have access to that, you know, that can be you know, a
great partner to have. And Ithink counseling, you know, counseling.
My patients really do better if theyreally have a counselor to work with,
especially if they have you know,a prolonged treatment course or a very advanced
stage of cancer, um you know, somebody that kind of really help deal
(19:53):
with the emotional impact of their illness. I think patients do so much better
if they can really you know,work on processing some of the emotions with
a professional versus just family alone.So again I think, you know,
bringing somebody like that in so Iwould say so again, so if we
kind of look at this, youknow, somebody in that integrated medicine naturopathic
(20:14):
oncology space would be a very greatpartner to help you on the supplement side.
And a lot of times, youknow, those providers can also again
work on some of the kind ofmind body you know, helping you connect
with different resources to do guided meditation, guided imagery, you know, some
of these other very kind of supportivetherapy that can really improve you know,
how what your experience is through throughtreatment. But if you have an ac
(20:38):
counsel would be you know, reallya great person to kind of have,
you know, on your care team. And if you know, I think
Chinese medicine with the acupuncture also iskind of a great partnership to have if
you have the ability to include that. Yeah good, Yeah, those are
all those also really good. Andyou know, a patient who's proactively seeking
(21:00):
these individuals out to help them throughtheir journey of cancer treatment is more likely
than not somebody who's somewhat empowered.And I think being an empowered patient is
really important especially when somebody's diagnosed withcancer, which is an overwhelming diagnosis.
People get just thrust into the medicalsystem big time and can feel very disempowered,
(21:23):
disenfranchised their life has turned upside down. So it can be a very
startling experience and disorienting experience. AndI think it's important and really actually kind
of an integral part of their healingprocess to regain a sense of empowerment through
that. So I'm wondering if you, since you work with people who are
going through this disease as well,what you or how you approach this sense
(21:48):
of becoming more empowered with your patients. Yeah, I think, you know,
I really kind of talk to themkind of just about the awareness that
you know that you know, goingthrough cancers thing where you just feel like
you, you know, are inthat area of loss of control. You
know, you're used to kind oftaking charge and kind of making all these
decisions and now you're kind of inthis kind of whirlwind of you know,
(22:10):
procedures and appointments and again you reallyfeel like you're not kind of you know,
running kind of the show anymore.And so you know, you know,
talk to them about kind of theareas where they can have impact,
right, you know again looking atthings like nutrition, looking at things like
mind body, um, you knowagain, I think all of those things
can be helpful looking at kind ofagain, what can we do on that
natural side maybe to manage some ofthose those treatment side effects. Um.
(22:34):
I think all of those areas arewhere you know, patients can you know,
have that have that they have thatinput on kind of how you know,
their care is delivered. And Ithink again that gives them, you
know, that peace that they havecontrol over while they're out there in this
other strange world where they're kind ofbeing bounced around from you know, treatment
(22:55):
to treatment and kind of you knowagain, I think it's a area where
most people, you know, reallydon't have much understanding of kind of this
whole medical world. Many times,when you're diagnosed with cancer, it may
be the first time you really kindof had any you know, significant um,
you know, kind of input fromin terms of you know, from
the medical system, you know,taking part in your care. So now
(23:18):
all of a sudden, this iskind of your day to day life.
And that's you know, that's ahard place because it's all new language.
It solves you it's an all newkind of world for patients to have to
deal with. So again, Ithink finding those areas where you can have
an impact on your health can besomething that gives you a little bit of
control in a kind of a verychaotic time. Yeah, I think that's
(23:41):
well said. So, you know, speaking of empowered, you are a
family physician, family medicine physician,an integrated medicine physician. How empowered do
you feel when you're talking with youroncology colleagues? Do you feel like you're
accepted? Do you feel like youhave to say is valued? Or do
(24:02):
you have to kind of assert findways to assert your own worth in their
eyes? And are those covers?Can those conversations be difficult for you?
Um? Well, again, I'min a you know, a very big
organization. So we have fifteen officersacross the Phoenix you know, Metro,
and so I work with a youknow, a large number of oncologists and
you know, I've been you know, with kind of our organization now for
(24:23):
five years, so I have developedrelationships with a lot of the oncologists and
so many of them at this pointreally kind of see me as a you
know, a great resource. Youknow, you know, a partner with
them and to help deal with youknow, patients who again maybe have needs
that you know, again are outsideof their scope, and patients have so
(24:47):
many questions about you know, theuse of dietary supplements. It's great for
them to go here, you know, go see doctor Ruler. That's not
really my area, but she's gonnayou know, give you some recommendations and
keep you safe. So I havedevelops kind of that's a I think the
oncologists that I've worked with really umkind of know that. Again, I'm
not there to kind of pull patientsoff the treatment or guide them off,
(25:08):
but really to kind of help thembe able to have the best experience as
they're going through their conventional cancer care. They're still you know, again,
I get a lot of referrals fromprobably you know, maybe twenty percent of
our of the docs, and thenyou know, some of the others are
just you know, they start graduallydeveloping a comfort with you. Patients can
kind of self refer into my services. So again, sometimes we'll get patients
(25:33):
from providers who generally aren't one torefer to me. Um. I haven't
you know, really had any kindof I haven't had any real pushback.
You know, the organized organization hasstrongly really kind of recommended me to you
know, be part of the team. So when you have kind of leadership
kind of putting UM, you know, my position as one that um,
(25:56):
you know is beneficial for the wholeorganization, it really sets the tone in
terms of how the others perceive you. So it can help when you have
leadership really kind of backing you inkind of the care that you can add,
um, you know, to patients. So so I've been very fortunate,
UM in our organization that I haven'tyou know, had a lot of
UM, you know, haven't anybodycalling me up and you know, angry
(26:19):
that I'm doing you know, treatmentX, Y or Z for their patients,
UM, which has been wonderful becauseI certainly have colleagues who are in
especially reasons some regions of the countryI think are a much more conservative,
um, you know, in termsof just acceptance to to kind of having
UM kind of integrative you know,medicine, Integrative oncology is part of cancer
(26:40):
care. UM. So I don'tseem to get the same pushback that UM
that some of my colleagues and otherparts of the country seem to get so,
um, I guess I'm very fortunatewith us. Yeah, that's that
is well, it sounds like it'salso in no small measure due to your
own tenacity and your presence in theorganization and doing good work with your patients,
(27:02):
which I think is important to youknow, results speak loudly in this
world, for sure, So wehave you know, I think I think
when physicians, you know, haveyou know, a challenging patient and you
know you you kind of you know, um, kind of partner in with
them and help that patient through abig challenge and they get that feedback,
(27:22):
I think it goes goes a longway to getting more referral on other challenging
patients for sure. Yeah, becausethey again I think physicians really at the
core want their patients to do well, and when they see that happening,
whatever the differential was, then that'swhat they're going to try to apply to
more of their patients. So well, good work, and thank you so
(27:45):
much for doing that and for beinghere this evening. We are kind of
at a time, so we'll haveto finish up our conversation. But where
can our listeners find you if theyhappen to be in the greater Phoenix area.
So I'm I'm with Ironwood Cancer andResearch Centers. We're at IRONWOODCARC dot
com and so we have you know, if you go onto our web page,
(28:07):
we have all our social media channelsFacebook LinkedIn all of those on there,
so we you know, we createa lot of virtual content or we
have a lot of video in ourlibrary route supportive care topics. So it's
a great resource for patients to kindof check out, you know, to
again listen to a lot of ourtalks that we've done. That our topics
(28:30):
very relevant to patients as their pointthrough cancer treatment. And what was that
website again, Ironwood CRC dot com, IRONWOODCRC dot com. Wonderful. Well,
thank you so much. It's beena great show. Thanks for taking
time to join me tonight. Andthat wraps up this episode if I've to
thrive live. So we'd like tothank again our sponsors, Guya Herbs,
(28:52):
provider of exceptional quality pottical products Cognizancethat are colling to help enhance memory,
focus and attention. Im you apostbiotic for immune support. Doctor Hira's Probiotics
Award winning pre and probiotic formulas proThrivers, wellness, sleep, created specifically
for thrivers. And thank you allfor joining us. May you each experience
(29:15):
joy, laughter and love. It'stime to thrive, everyone say
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