November 4, 2025 • 23 mins
In this powerful episode of Live Well with UCI Health, Ryan Manno from KOST 103.5 sits down with Dr. Hari Keshava, a fellowship-trained thoracic surgeon and assistant professor at UCI School of Medicine, to discuss the leading cause of cancer-related deaths in the U.S.—lung cancer. Dr. Keshava shares life-saving insights on:
- Why lung cancer is often detected too late
- Who should get screened and how often
- The importance of low-dose CT scans
- The stigma around smoking and how it affects screening
- Genetic factors and familial lung cancer
- Breakthroughs in robotic surgery, immunotherapy, and clinical trials
- The emerging concerns around vaping and lung health
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
All right, welcome to the next installment of Live Well
(00:02):
with UCI Health. I am Ryan Mano from Coast one
of three point five iHeartRadio. Please to be joined today
by doctor Hari Keshava, Fellowship trained, Board certified thoracic surgeon
who specializes in the treatment of lung cancer.
Speaker 2 (00:14):
Thank you very much for having me.
Speaker 3 (00:15):
Thank you.
Speaker 1 (00:16):
I'm not done, no doctor, now, no, no, you didn't
do all this work for nothing. He'sy an Assistant professor
in the Division of Thoracic Surgery at the UCI Irvine
School of Medicine and a member of the American College
of Surgeons and the Society of Thoracic Surgery.
Speaker 2 (00:29):
Thank you very much. Thank you God. That was a
great introduction.
Speaker 4 (00:32):
Thank you sir. It's a pleasure to have you here.
Speaker 1 (00:34):
And really quick one before we get into lung cancer
and all this stuff. We've been doing this for a while.
No doctor has ever come and sat with us and said,
I just got out of the operating room.
Speaker 4 (00:43):
But you did.
Speaker 2 (00:44):
That is true. I just got out of the operating.
Speaker 3 (00:46):
Room, unbelievable this morning and changed did my hair, yeah,
and it came here, put on my coat and came
here for this. I'm excited to be here, and we're
excited to be doing this.
Speaker 1 (00:57):
Yeah, so let's talk about lung cancer. It is the
leading cause of cancer related deaths in both men and
women in the US.
Speaker 3 (01:05):
Why so, Yeah, you're exactly right. It is the leading
cause of cancer related death. And the main reason is, unfortunately,
with lung cancer, we don't really do a good job
of finding it early.
Speaker 2 (01:17):
When I say that, I mean as.
Speaker 3 (01:18):
A society, there's no real good symptoms for lung cancer.
Speaker 2 (01:23):
So if patients have symptoms.
Speaker 3 (01:24):
Whether that's a cough or they're coughing blood, let's say
these are usually later stages are found later in cancer
and cancer screening and lung cancer screening. Unfortunately, with the screening,
we don't we're not screening as many patients as we'd
like to early enough so we can find it early
and potentially deal with it early. So that's unfortunately, the
(01:45):
real reason why lung cancer is the leading cause of
cancer related death. And of course we've had a lot
of people in our country who have smoked and who
still currently smoke, and that's the leading reason for developing
lung cancer.
Speaker 2 (01:59):
But there is hope, right, there is hope here.
Speaker 1 (02:02):
I know a lot of the advancements you've made. But
let's do talk about the screening. Who should be screened
and when.
Speaker 2 (02:09):
So for lung cancer screening, we do it with a
low dose.
Speaker 3 (02:13):
CT scan, which is a scan of the chest where
we look for long abnormalities, lung nodules, lung masses. For
patients that are fifty to eighty years old who have
smoked in the past, we call it a twenty pack
here smoking history. And when I say smoked in the past,
meaning it within the last fifteen years or are current smokers.
Speaker 2 (02:35):
For those people, we offer lung.
Speaker 3 (02:38):
Cancer screening in that right now, those are the patients
that we screen.
Speaker 4 (02:41):
Okay, got it? And what is a pack here?
Speaker 3 (02:45):
A pack here is essentially it's a pack of cigarettes
per day for a year.
Speaker 4 (02:52):
Okay.
Speaker 3 (02:53):
So it's if a person smokes, I say I smoke
a pack a day and I've been doing it for
thirty years, we say that it's a thirty pack.
Speaker 2 (03:00):
You're smoking history.
Speaker 3 (03:02):
And let's say someone says, oh, I smoke a half
a pack a day and I've done that for twenty years.
They say there's a ten pack yere smoking history. Because
now it's half a pack times a number of years
got it. But as you may imagine or as you
can think about it, there's so much of a recall
bias there because some people will be like, oh, yeah,
(03:22):
I smoked a pack a day, and then I stopped
smoking for a couple of months and started smoking a
half a pack. So it can be really difficult for
patients to tell us how much they're actually smoking and
to really quantify that, especially cigarettes. And then of course
people might not realize remember how when they first started smoking,
or hey, I started in college and I stopped a
little bit, then I started back again when I had
(03:44):
some stressful times at work, and so there's all these
start and stop so they might not remember when they
actually started smoking. So these are some issues that come
about with this.
Speaker 4 (03:52):
And I would think too.
Speaker 1 (03:53):
I mean, some people may even try to downplay it
because if they don't want to admit that this is
how much they've smoked, or.
Speaker 3 (04:00):
You bring up actually a very interesting point, and this
is actually a big issue also with lung cancer screening,
is that we have a stigma behind it. We have
a stigma because of like exactly what you said, where
people will feel a little bit of shame. They're like, oh,
I kind of did this to myself, or when I
smoked and I feel bad, they might downplay it. So
(04:22):
we see this actually in a lot of populations. We
have a lot of different people. We treat here people
from other countries, Vietnamese, Chinese, but we also see this
in the veteran population, and that's a population of course
where if you remember, we used to actually give people
cigarettes to smoke right when they went to Vietnam war,
(04:43):
and we used to give them cigarettes because we didn't
kind of know any better as a society.
Speaker 2 (04:47):
So I think that shame part.
Speaker 3 (04:49):
Of it is now we should not think that way.
It's not a shameful thing. We actually want to be
able to help patients and screen them fine cancer early.
We know it's a cant are causing agent, especially with
cigarette smoking, so patients shouldn't feel shame from this.
Speaker 1 (05:05):
They're you're not there to like judge them, You're there
to find it and fix it exactly.
Speaker 3 (05:10):
You're exactly right. We're not here to judge, We're not
here for any of that. We find it early because
if we find it early, we can deal with it.
Speaker 2 (05:16):
Right.
Speaker 3 (05:17):
I'm a surgeon, and if we can find it at
stage one, I can remove it and potentially be cancer free.
Speaker 2 (05:24):
Yeah, so that's the goal here.
Speaker 1 (05:25):
Yeah, and it is wild you bring up, you know
how we used to give people cigarettes. I mean I
can picture old magazine ads like the eight out of
ten doctors recommend you know, camel or whatever.
Speaker 4 (05:36):
It's like, what how far we've come?
Speaker 2 (05:38):
We've come a long way.
Speaker 3 (05:39):
And I remember in if you could even talk to
some of the older physicians, people used to smoke in
the hospital. Oh my god, I trained out in Cleveland
and they had areas with ashtrays like outside of patient room.
So we just didn't know much about it, right, We thought, oh,
it could help with various different issues.
Speaker 2 (05:56):
So we've learned a lot about it. We've learned how it.
Speaker 3 (05:58):
Is a a carcinogenic substance, especially cigarette smoking. So now
we know we should be screening those patients get screened.
Speaker 4 (06:06):
How often should people get screened?
Speaker 3 (06:08):
So patients should get screened every year? If you're between
that fifty to eighty years old, you smoked for twenty years,
twenty pack years, you should be getting screened every year.
Speaker 2 (06:19):
Okay.
Speaker 1 (06:19):
In terms of the screening itself, what is that process
you come in you're getting screened? How long does it take,
what happens, what's the process.
Speaker 2 (06:29):
It's a good question.
Speaker 3 (06:30):
So with screening, as we talked about, is for patients
that are fifty to eighty that have smoked for twenty years,
twenty pack years and our current smoker are quit within
the last fifteen years, so that's the criteria. So when
you get screened for lung cancer, we do a CT scan,
a CT scan of the chest. So what does that entail.
(06:51):
It's in the hospital or it's in an imaging center
where you go and you sit in a what's called
a CT scanner, which is not a claustrophobic like MRI.
It's actually pretty open and they do a quick scan
using really really low dose radiation to see the chest,
(07:11):
the lungs, and they even look at the chest wall
everything from essentially the bottom of the neck to the
top of the abdomen to make sure we get the
whole lungs. And that CT scanner is a really quick
scan about thirty seconds oh my, and maybe if they
have to redo one.
Speaker 2 (07:26):
Of them, they'll do me a minute.
Speaker 3 (07:28):
It's kind of in and out, and at that point
they can look at lung nodules, lung masses.
Speaker 2 (07:35):
The lungs, even the heart.
Speaker 3 (07:36):
We can look at other structures potentially other issues, chest
wall issues. Specifically for lung cancer, we look for those
lung nodules, lung masses, and we can see both lungs.
Speaker 1 (07:47):
So it's non invasive, it's not scary, it's there's no
you don't even feel it.
Speaker 4 (07:50):
It's in and out.
Speaker 3 (07:52):
You're exactly right. It's non invasive. It's not even like
a blood test. Yeah, it's in and out. It's a
low dose CT scan, meaning low dose of radiation. So
when we talk about radiation exposure, it's the equivalent of
a plane flight from LA to New York. It's about
that much radiation exposures for pretty minimal, but we get
a really good understanding of what's going on in your
(08:14):
chest and the lungs.
Speaker 1 (08:16):
Moving away from cigarettes and smoking, what about some other factors, right, well,
even secondhand smoke or environmental you know, whether it's pollution
or exposure to radon or things like that.
Speaker 3 (08:29):
You're exactly right, So you bring up other things that
can cause lung cancer. So second hand smoke, we do
know about it, especially if you've had a large amount
of secondhand smoke exposure. Radon is the second most leading
cause of lung cancer. And we see this a lot
in patients that grew up in the Midwest because they
have a lot of radon that's coming from the soil
(08:49):
there where houses were built. So that's something we do see.
We're actually learning a lot more about familial inheritance of
lung cancer and familial lung cancer if you look at
some other countries out like especially in Taiwan. They've done
a study out there where they actually found that outside
(09:09):
of smoking, that family history of lung cancer was a
leading reason someone.
Speaker 2 (09:14):
May develop lung cancer. Really correct.
Speaker 4 (09:17):
Yeah, so let's talk about that for a second.
Speaker 1 (09:20):
My are you know the host of the show that
I host, Ellen k she lost her mom to non
smoking lung cancer. So are you are you saying that
that's potentially a genetic thing?
Speaker 2 (09:30):
It potentially is.
Speaker 3 (09:31):
In the Taiwanese community, they actually found a gene this
EGFR mutation, Okay, And we see this amongst a lot
of Asian populations, or amongst not even just Asians, but
amongst other populations where they found that there is a
familial component to that. And we're actually studying that now
at UC Irvine. I'm actually i actually have a study
where we are doing a clinical trial of screening with
(09:54):
a CT scan of non smoking non smokers, but if
they had a family history of lung cancer, we'll be
screening them now to see if there is this familial component,
even here on the West in the United States.
Speaker 4 (10:06):
Fascinating.
Speaker 1 (10:08):
Since since you guys have and I say you guys
as a collective, you know, doing what it is that
you do. Since these screening tools have gotten better and
progressed and people are doing it earlier and doing it
more often, have you noticed an increase or seen a
decrease in deaths?
Speaker 3 (10:23):
We have actually, and this is not just from screening
actually alone, but with lung cancer in general, we've actually
seen a market improvement, improvement of survival even over time.
So we're finding it early, We're doing a better job
of screening people. We actually have better treatments now also
as well. So as a surgeon, I do a lot
(10:43):
of minimally invasive robotic surgery, so we can get people
out of the hospital very quickly, do some advanced surgeries
even minimally invasive. And on the other side of it,
we've gotten very good on radiation techniques when patients might
need radiotherapy or radiation therapy, and of course chemotherapy and aminotherapy.
You've probably heard about chemotherapy and agents newer ones. There's
(11:07):
newer imminotherapies and these targeted agents where we can target
the genetic mutation that the patient may have for their cancer.
So we've gotten so much better from the treatment standpoint
as well as the detection.
Speaker 2 (11:19):
So now people are living longer with lung cancer.
Speaker 4 (11:22):
What was you know before some of the stuff was there.
Speaker 1 (11:25):
What was the most common way to treat lung cancer
prior to all of these wonderful.
Speaker 3 (11:30):
Things you just described, So it would just be kind
of the generic chemotherapy, so wouldn't be anything that was
very specific to a patient. Now we talk about patient
centered medicine, patient centered care. Before it was just you
kind of you take whatever you can get and you
just give it to the patients hopefully it works. But
now if we can find it early, get it out
with radiation or surgery, if we can test it, we
(11:54):
do genetic testing of the tumor, then we can actually
find a targeted treatment for the tumor, and we have
more specific agents. So I think we're getting to this
more patient centered care which is great for patients.
Speaker 1 (12:07):
Yeah, and it's got to be exciting for you as
somebody who's given your life to treating this like to
find these things on the horizon that are still coming.
Speaker 2 (12:14):
Oh, it's amazing to see.
Speaker 3 (12:16):
Even since when I finished my training and started here
at UCI, during this time, I've seen care trained tremendously.
Where I'm seeing patients with stage four lung cancer that
are living long enough to now come and see a surgeon,
or where I'm taking them out. Sorry when I say them,
I mean taking the cancer out. I'm taking the cancer
out and seeing them live a long time because I
(12:37):
took it out, they got on a targeted therapy. And
so it's fascinating to see lung cancer care change this much.
Speaker 1 (12:44):
Yeah, that's so cool, and that's got to feel so good.
I mean, I'm so involved of surgeons and what you
guys do because the satisfaction that you must have when
when you look at someone and you saved their life,
that is exciting.
Speaker 2 (12:57):
That's one of the things.
Speaker 3 (12:58):
Yeah, it's we do a lot of teaching and training here, right.
We teach medical students, we train residents and fellows. That's
actually one of the the joys of what we do
is actually showing the medical students, showing the residents and
the trainees that hey, after we remove the cancer, I
see them back in clinic man next week, two years later.
They're doing great hugs and these types of things. And
(13:21):
I think it resonates the patients, with our trainees, with me,
of course, and like you said, it gives me goosebumps
every time I see a patient, like let's say two
three years out cancer free, just doing.
Speaker 2 (13:33):
The run of the mill checkup type thing.
Speaker 4 (13:34):
What a cool. Oh gosh, that's awesome.
Speaker 1 (13:36):
So let's talk about let's talk about you get screened.
You there's a nodule detected, or you know, you see something,
what are the what are the next steps there?
Speaker 3 (13:45):
So before we get to that, I'm actually going to
talk about so getting screened. Any physician or primary care
provider can screen. So if you're a patient, you know, hey,
you've smoked in the past yourself, or you know your
family member has, you want to get them screened. They're
fifty to eighty smoked over twenty years a pack per day,
(14:07):
get screened. So any your primary care doctor could do it.
Or we have like a lung nodule program. If you
don't know where to go, we have a phone number,
or a lot of places do, but we have one
where you can call and you get to get to
one of our providers and they'll get screened. Now, after
you've gotten screened, if you have a CT scan with
an abnormality, like you said, a lung nodule, a lung mass,
(14:31):
or any other abnormality, then you can kind of now
see your primary care or you go see like a
pulmonologist or even a thoracic surgeon.
Speaker 2 (14:38):
I get a lot of people that come and see
me that have a lung nodule.
Speaker 3 (14:42):
At that point, we kind of look at it see
if it's something that looks a little bit more suspicious,
we might go for a biopsy. After having a visit
a biopsy, we can either do that bronchoscopically where we
go through the airway or we do a needle kind
of from out side in try to get some tissue
to get a diagnosis, and if we get a diagnosis
(15:06):
of cancer, then we go forward. We'll try we'll get
some more scans, potentially a PET scan. Potentially you'll see
me for a surgical resection or potentially even my oncology colleagues,
if you need some sort of chemotherapy, amunotherapy, and we'll kind.
Speaker 2 (15:21):
Of go from there.
Speaker 3 (15:22):
Yeah, patients can have lung nodules for a multitude of reason.
It doesn't have to be for cancer alone. You can
have it for fungal infections, you can have it for
what we call granulomas, which are benign entities. So we
got to make sure we're dealing with cancer, of course
first and foremost.
Speaker 4 (15:39):
I you know, I'm just thinking back again.
Speaker 1 (15:41):
I shared that story about Ellen K's mom and for
for years she was part of various clinical trials, you know,
experimental things.
Speaker 4 (15:48):
Can we talk about the importance of clinical trials?
Speaker 3 (15:50):
Yes, of course, clinical trials are crucial for the treatment
for patients and also for the advancement of the field.
Speaker 2 (15:59):
So that you kind of get a you for one there,
What does that mean?
Speaker 3 (16:02):
So we're a comprehensive cancer center, so we have different providers,
like for let's say, for lung cancer, you have a surgeon,
a radiation oncologist, an oncologist. We also get palliative care,
physical therapy, all these types of things, so we can
provide all that. On top of that, we also provide
we have clinical trials. That's what kind of really sets
(16:23):
some of these cancer centers apart. Yeah, is these clinical
trials can be really focused on the patient specifically to
their own cancer. If they have a certain genetic mutation,
we can have trials for that. And these trials give
patients and options for treatments. They also, like I said,
help further the field because we learn more about it
make sure it works well. But it really is part
(16:46):
of the care for patients with cancer. Now more and
more and more we have clinical trials from all different stages.
We have surgical clinical trials to targeted therapies, ammunotherapies, radiation,
We even have reiki.
Speaker 2 (16:58):
We do we all these things.
Speaker 3 (16:59):
Yeah, we're doing reiki for patients with maybe pain or
chronic pain. We try reiki therapy. So we have clinical
trials and all these things. Yeah, and so these this
is something that I really talk to them about, my
talk to clinical trials about talk to patients about these
clinical trials because I think it's something that can really
(17:21):
help patients.
Speaker 1 (17:22):
Do you find that that when you bring that up,
when you start going down that road, do you find
willingness or hesitation?
Speaker 2 (17:29):
Because I think both you do yeah, I think both.
Speaker 3 (17:31):
I think some people are really inclined to go through
clinical trials. Like you bring up ellen Ka, I've also
listened to growing up in La Yeah a long time.
That's great and I'm happy that she was able to
kind of be part of this and from the clinical
trial standpoint with her family. But some patients are all
(17:52):
about it. Okay, we get patient, We get people that
read about it. They know friends and family or friends
and friends of family that have gone through clinical trials.
They understand it. They read about it on the internet,
which is fine, which is great. And there's some people
that are really hesitant. Right. There are some populations of
people that might just be skeptical about clinical trials.
Speaker 2 (18:14):
They feel like they're being experimented on. There's that entity.
Speaker 3 (18:17):
I think this is something that I really explained to
the patient, right. I talk to them about the pros
and cons, why we're doing it, why we do certain
clinical trials. And some people are really for it, or
if they weren't before, now they are. And some people,
you know what, I just don't want it, and that's fine.
I think that's the beauty. Patients can choose to be
part of a clinical trial or not, and if they're not,
(18:39):
we still treat them.
Speaker 2 (18:40):
We still treat patients all the time.
Speaker 3 (18:42):
They're not part of clinical trials, and if they are,
they get new potentially newer treatments that we're going to
be out in the future.
Speaker 1 (18:50):
It's exciting what you guys are doing at UCI Health.
What would you say, doctor too. I don't know anyone
maybe that's watching or has a family member who did smoke,
and it's hesitant to get screened or to even even
go down the road of maybe I should.
Speaker 3 (19:06):
Yeah, it's it's I know, it's difficult, and I think
we brought up that shame issue. I know people think
that way or they think, oh, there's nothing wrong with me,
or I don't care, it's nothing I could really do
about it. I think people got to understand there is
something that can be done, shouldn't feel shameful about it.
If we find it early. Even if you don't want surgery,
(19:26):
then you can go to radiation. If you don't want radiation,
we can go to surgery.
Speaker 2 (19:29):
Right. There's so many options that we can that we have.
Speaker 3 (19:32):
There's really no downside, I feel, and just a screen
is just a CT scan.
Speaker 2 (19:36):
It's literally you just go you sit.
Speaker 3 (19:39):
In a not even a tube, it's a it's just
like a quick scan, and we know a lot about
what's going on in your body. We know a lot
about if you have a lung nodule or not, if
you have a pneumonia, potentially we can take care of that.
Speaker 4 (19:52):
Yeah.
Speaker 3 (19:52):
So I think there's really really minimal downside and a
lot of upside to getting screened.
Speaker 1 (19:58):
And it's it's so fascinating, I think, and you really
think about breathing. We take it so for granted. You
know what I'm saying, Like it's one of those you
have to do it. No one's ever like I'm so
happy I'm breathing.
Speaker 2 (20:07):
Yeah, you know, it's one of those things.
Speaker 3 (20:09):
You don't think about it until you have problems, right,
And unfortunately, like we talked about with lung cancer, when
you start having problems, the likely you're at a later
stage is higher. Right, then you might not be seeing
a surgeon because it's not in an earlier stage. So
these are the problems, that's why you might not have symptoms.
A lot of people say, oh, you know, I feel fine,
(20:30):
I'm going to work or I'm still working out. I'm
not an oxygen none of these things, so I don't
need to be screened.
Speaker 2 (20:36):
That's the problem.
Speaker 3 (20:37):
There's no symptoms here, so we have to be able
to find it early, even when you have no symptoms,
any symptomatic.
Speaker 1 (20:44):
Because at that time it's there, but the symptoms don't
present until later.
Speaker 3 (20:47):
Correct, and if it's still there, we can we can
do something about it earlier. Wow, that's the main thing
I want I tell patients that we can do something
about it earlier.
Speaker 4 (20:55):
Yeah. Really good.
Speaker 1 (20:56):
You know one other one we didn't bring up, and
maybe you have thoughts on this is I know that
you know, vaping has become like a really you know,
popular thing. Now, what are you seeing with that?
Speaker 2 (21:05):
That's so you bring up a very interesting point.
Speaker 3 (21:09):
Especially in the younger population, we are seeing a lot
more people that vape ease cigarettes. Currently we don't have
enough data, okay, and unfortunately that's the problem with data, right.
It takes a long time to have enough data to
really extrapolate what's happening for especially from a cancer standpoint.
(21:29):
That being said, we know tobacco is a carcentergen it
can cause cancer, where other non cancerous issues that do
happen with vaping. There's a lot of what we call
vaping related lung injury, where it's a diffuse lung injury,
where we see even really young patients have lung injury
where they're in the hospital needing oxygen otherwise healthy people.
(21:51):
So we do know that there are problems with vaping,
that there can be issues, specifically with the lung cancer.
I think we're learning more and more about it. We're
learning how much is like, how much do people vape?
Even I think just even quantifying that, right you see
these kids they're just going, going, going, and what does
that even mean as a cartridge the same as a pack.
(22:13):
I think these are things we're learning more and more,
especially from the exposure standpoint. I could tell you it's
probably not good for you, Yes, I think that's probably
safe to say right there. But from a true lung
cancer risk, we're learning more and more, and especially if
you have had lung cancer, you smoked in the past,
and you're trying to quit using vaping. I think it's
(22:34):
great hopefully you can get to that quit standpoint. But
if you're just starting up vaping, especially for the young
young people out there, I hope I don't see you
in the future as as a patient but I think
we will be seeing more and more of that in
the future, and unfortunately we might be seeing more later
stage just because of the way I think it is.
Speaker 2 (22:54):
Yeah, with vaping interesting.
Speaker 4 (22:56):
We you guys are doing great work at UCIL. Thank
you so much. I really this has been fascinating.
Speaker 1 (22:59):
You're you're great and uh I know you'll continue to
do great things and help people breathe easier and better.
Speaker 2 (23:04):
Thank you for longer. Thank you, it's the goal here.
Thank you very much.
All right, welcome to the next installment of Live Well
(00:02):
with UCI Health. I am Ryan Mano from Coast one
of three point five iHeartRadio. Please to be joined today
by doctor Hari Keshava, Fellowship trained, Board certified thoracic surgeon
who specializes in the treatment of lung cancer.
Speaker 2 (00:14):
Thank you very much for having me.
Speaker 3 (00:15):
Thank you.
Speaker 1 (00:16):
I'm not done, no doctor, now, no, no, you didn't
do all this work for nothing. He'sy an Assistant professor
in the Division of Thoracic Surgery at the UCI Irvine
School of Medicine and a member of the American College
of Surgeons and the Society of Thoracic Surgery.
Speaker 2 (00:29):
Thank you very much. Thank you God. That was a
great introduction.
Speaker 4 (00:32):
Thank you sir. It's a pleasure to have you here.
Speaker 1 (00:34):
And really quick one before we get into lung cancer
and all this stuff. We've been doing this for a while.
No doctor has ever come and sat with us and said,
I just got out of the operating room.
Speaker 4 (00:43):
But you did.
Speaker 2 (00:44):
That is true. I just got out of the operating.
Speaker 3 (00:46):
Room, unbelievable this morning and changed did my hair, yeah,
and it came here, put on my coat and came
here for this. I'm excited to be here, and we're
excited to be doing this.
Speaker 1 (00:57):
Yeah, so let's talk about lung cancer. It is the
leading cause of cancer related deaths in both men and
women in the US.
Speaker 3 (01:05):
Why so, Yeah, you're exactly right. It is the leading
cause of cancer related death. And the main reason is, unfortunately,
with lung cancer, we don't really do a good job
of finding it early.
Speaker 2 (01:17):
When I say that, I mean as.
Speaker 3 (01:18):
A society, there's no real good symptoms for lung cancer.
Speaker 2 (01:23):
So if patients have symptoms.
Speaker 3 (01:24):
Whether that's a cough or they're coughing blood, let's say
these are usually later stages are found later in cancer
and cancer screening and lung cancer screening. Unfortunately, with the screening,
we don't we're not screening as many patients as we'd
like to early enough so we can find it early
and potentially deal with it early. So that's unfortunately, the
(01:45):
real reason why lung cancer is the leading cause of
cancer related death. And of course we've had a lot
of people in our country who have smoked and who
still currently smoke, and that's the leading reason for developing
lung cancer.
Speaker 2 (01:59):
But there is hope, right, there is hope here.
Speaker 1 (02:02):
I know a lot of the advancements you've made. But
let's do talk about the screening. Who should be screened
and when.
Speaker 2 (02:09):
So for lung cancer screening, we do it with a
low dose.
Speaker 3 (02:13):
CT scan, which is a scan of the chest where
we look for long abnormalities, lung nodules, lung masses. For
patients that are fifty to eighty years old who have
smoked in the past, we call it a twenty pack
here smoking history. And when I say smoked in the past,
meaning it within the last fifteen years or are current smokers.
Speaker 2 (02:35):
For those people, we offer lung.
Speaker 3 (02:38):
Cancer screening in that right now, those are the patients
that we screen.
Speaker 4 (02:41):
Okay, got it? And what is a pack here?
Speaker 3 (02:45):
A pack here is essentially it's a pack of cigarettes
per day for a year.
Speaker 4 (02:52):
Okay.
Speaker 3 (02:53):
So it's if a person smokes, I say I smoke
a pack a day and I've been doing it for
thirty years, we say that it's a thirty pack.
Speaker 2 (03:00):
You're smoking history.
Speaker 3 (03:02):
And let's say someone says, oh, I smoke a half
a pack a day and I've done that for twenty years.
They say there's a ten pack yere smoking history. Because
now it's half a pack times a number of years
got it. But as you may imagine or as you
can think about it, there's so much of a recall
bias there because some people will be like, oh, yeah,
(03:22):
I smoked a pack a day, and then I stopped
smoking for a couple of months and started smoking a
half a pack. So it can be really difficult for
patients to tell us how much they're actually smoking and
to really quantify that, especially cigarettes. And then of course
people might not realize remember how when they first started smoking,
or hey, I started in college and I stopped a
little bit, then I started back again when I had
(03:44):
some stressful times at work, and so there's all these
start and stop so they might not remember when they
actually started smoking. So these are some issues that come
about with this.
Speaker 4 (03:52):
And I would think too.
Speaker 1 (03:53):
I mean, some people may even try to downplay it
because if they don't want to admit that this is
how much they've smoked, or.
Speaker 3 (04:00):
You bring up actually a very interesting point, and this
is actually a big issue also with lung cancer screening,
is that we have a stigma behind it. We have
a stigma because of like exactly what you said, where
people will feel a little bit of shame. They're like, oh,
I kind of did this to myself, or when I
smoked and I feel bad, they might downplay it. So
(04:22):
we see this actually in a lot of populations. We
have a lot of different people. We treat here people
from other countries, Vietnamese, Chinese, but we also see this
in the veteran population, and that's a population of course
where if you remember, we used to actually give people
cigarettes to smoke right when they went to Vietnam war,
(04:43):
and we used to give them cigarettes because we didn't
kind of know any better as a society.
Speaker 2 (04:47):
So I think that shame part.
Speaker 3 (04:49):
Of it is now we should not think that way.
It's not a shameful thing. We actually want to be
able to help patients and screen them fine cancer early.
We know it's a cant are causing agent, especially with
cigarette smoking, so patients shouldn't feel shame from this.
Speaker 1 (05:05):
They're you're not there to like judge them, You're there
to find it and fix it exactly.
Speaker 3 (05:10):
You're exactly right. We're not here to judge, We're not
here for any of that. We find it early because
if we find it early, we can deal with it.
Speaker 2 (05:16):
Right.
Speaker 3 (05:17):
I'm a surgeon, and if we can find it at
stage one, I can remove it and potentially be cancer free.
Speaker 2 (05:24):
Yeah, so that's the goal here.
Speaker 1 (05:25):
Yeah, and it is wild you bring up, you know
how we used to give people cigarettes. I mean I
can picture old magazine ads like the eight out of
ten doctors recommend you know, camel or whatever.
Speaker 4 (05:36):
It's like, what how far we've come?
Speaker 2 (05:38):
We've come a long way.
Speaker 3 (05:39):
And I remember in if you could even talk to
some of the older physicians, people used to smoke in
the hospital. Oh my god, I trained out in Cleveland
and they had areas with ashtrays like outside of patient room.
So we just didn't know much about it, right, We thought, oh,
it could help with various different issues.
Speaker 2 (05:56):
So we've learned a lot about it. We've learned how it.
Speaker 3 (05:58):
Is a a carcinogenic substance, especially cigarette smoking. So now
we know we should be screening those patients get screened.
Speaker 4 (06:06):
How often should people get screened?
Speaker 3 (06:08):
So patients should get screened every year? If you're between
that fifty to eighty years old, you smoked for twenty years,
twenty pack years, you should be getting screened every year.
Speaker 2 (06:19):
Okay.
Speaker 1 (06:19):
In terms of the screening itself, what is that process
you come in you're getting screened? How long does it take,
what happens, what's the process.
Speaker 2 (06:29):
It's a good question.
Speaker 3 (06:30):
So with screening, as we talked about, is for patients
that are fifty to eighty that have smoked for twenty years,
twenty pack years and our current smoker are quit within
the last fifteen years, so that's the criteria. So when
you get screened for lung cancer, we do a CT scan,
a CT scan of the chest. So what does that entail.
(06:51):
It's in the hospital or it's in an imaging center
where you go and you sit in a what's called
a CT scanner, which is not a claustrophobic like MRI.
It's actually pretty open and they do a quick scan
using really really low dose radiation to see the chest,
(07:11):
the lungs, and they even look at the chest wall
everything from essentially the bottom of the neck to the
top of the abdomen to make sure we get the
whole lungs. And that CT scanner is a really quick
scan about thirty seconds oh my, and maybe if they
have to redo one.
Speaker 2 (07:26):
Of them, they'll do me a minute.
Speaker 3 (07:28):
It's kind of in and out, and at that point
they can look at lung nodules, lung masses.
Speaker 2 (07:35):
The lungs, even the heart.
Speaker 3 (07:36):
We can look at other structures potentially other issues, chest
wall issues. Specifically for lung cancer, we look for those
lung nodules, lung masses, and we can see both lungs.
Speaker 1 (07:47):
So it's non invasive, it's not scary, it's there's no
you don't even feel it.
Speaker 4 (07:50):
It's in and out.
Speaker 3 (07:52):
You're exactly right. It's non invasive. It's not even like
a blood test. Yeah, it's in and out. It's a
low dose CT scan, meaning low dose of radiation. So
when we talk about radiation exposure, it's the equivalent of
a plane flight from LA to New York. It's about
that much radiation exposures for pretty minimal, but we get
a really good understanding of what's going on in your
(08:14):
chest and the lungs.
Speaker 1 (08:16):
Moving away from cigarettes and smoking, what about some other factors, right, well,
even secondhand smoke or environmental you know, whether it's pollution
or exposure to radon or things like that.
Speaker 3 (08:29):
You're exactly right, So you bring up other things that
can cause lung cancer. So second hand smoke, we do
know about it, especially if you've had a large amount
of secondhand smoke exposure. Radon is the second most leading
cause of lung cancer. And we see this a lot
in patients that grew up in the Midwest because they
have a lot of radon that's coming from the soil
(08:49):
there where houses were built. So that's something we do see.
We're actually learning a lot more about familial inheritance of
lung cancer and familial lung cancer if you look at
some other countries out like especially in Taiwan. They've done
a study out there where they actually found that outside
(09:09):
of smoking, that family history of lung cancer was a
leading reason someone.
Speaker 2 (09:14):
May develop lung cancer. Really correct.
Speaker 4 (09:17):
Yeah, so let's talk about that for a second.
Speaker 1 (09:20):
My are you know the host of the show that
I host, Ellen k she lost her mom to non
smoking lung cancer. So are you are you saying that
that's potentially a genetic thing?
Speaker 2 (09:30):
It potentially is.
Speaker 3 (09:31):
In the Taiwanese community, they actually found a gene this
EGFR mutation, Okay, And we see this amongst a lot
of Asian populations, or amongst not even just Asians, but
amongst other populations where they found that there is a
familial component to that. And we're actually studying that now
at UC Irvine. I'm actually i actually have a study
where we are doing a clinical trial of screening with
(09:54):
a CT scan of non smoking non smokers, but if
they had a family history of lung cancer, we'll be
screening them now to see if there is this familial component,
even here on the West in the United States.
Speaker 4 (10:06):
Fascinating.
Speaker 1 (10:08):
Since since you guys have and I say you guys
as a collective, you know, doing what it is that
you do. Since these screening tools have gotten better and
progressed and people are doing it earlier and doing it
more often, have you noticed an increase or seen a
decrease in deaths?
Speaker 3 (10:23):
We have actually, and this is not just from screening
actually alone, but with lung cancer in general, we've actually
seen a market improvement, improvement of survival even over time.
So we're finding it early, We're doing a better job
of screening people. We actually have better treatments now also
as well. So as a surgeon, I do a lot
(10:43):
of minimally invasive robotic surgery, so we can get people
out of the hospital very quickly, do some advanced surgeries
even minimally invasive. And on the other side of it,
we've gotten very good on radiation techniques when patients might
need radiotherapy or radiation therapy, and of course chemotherapy and aminotherapy.
You've probably heard about chemotherapy and agents newer ones. There's
(11:07):
newer imminotherapies and these targeted agents where we can target
the genetic mutation that the patient may have for their cancer.
So we've gotten so much better from the treatment standpoint
as well as the detection.
Speaker 2 (11:19):
So now people are living longer with lung cancer.
Speaker 4 (11:22):
What was you know before some of the stuff was there.
Speaker 1 (11:25):
What was the most common way to treat lung cancer
prior to all of these wonderful.
Speaker 3 (11:30):
Things you just described, So it would just be kind
of the generic chemotherapy, so wouldn't be anything that was
very specific to a patient. Now we talk about patient
centered medicine, patient centered care. Before it was just you
kind of you take whatever you can get and you
just give it to the patients hopefully it works. But
now if we can find it early, get it out
with radiation or surgery, if we can test it, we
(11:54):
do genetic testing of the tumor, then we can actually
find a targeted treatment for the tumor, and we have
more specific agents. So I think we're getting to this
more patient centered care which is great for patients.
Speaker 1 (12:07):
Yeah, and it's got to be exciting for you as
somebody who's given your life to treating this like to
find these things on the horizon that are still coming.
Speaker 2 (12:14):
Oh, it's amazing to see.
Speaker 3 (12:16):
Even since when I finished my training and started here
at UCI, during this time, I've seen care trained tremendously.
Where I'm seeing patients with stage four lung cancer that
are living long enough to now come and see a surgeon,
or where I'm taking them out. Sorry when I say them,
I mean taking the cancer out. I'm taking the cancer
out and seeing them live a long time because I
(12:37):
took it out, they got on a targeted therapy. And
so it's fascinating to see lung cancer care change this much.
Speaker 1 (12:44):
Yeah, that's so cool, and that's got to feel so good.
I mean, I'm so involved of surgeons and what you
guys do because the satisfaction that you must have when
when you look at someone and you saved their life,
that is exciting.
Speaker 2 (12:57):
That's one of the things.
Speaker 3 (12:58):
Yeah, it's we do a lot of teaching and training here, right.
We teach medical students, we train residents and fellows. That's
actually one of the the joys of what we do
is actually showing the medical students, showing the residents and
the trainees that hey, after we remove the cancer, I
see them back in clinic man next week, two years later.
They're doing great hugs and these types of things. And
(13:21):
I think it resonates the patients, with our trainees, with me,
of course, and like you said, it gives me goosebumps
every time I see a patient, like let's say two
three years out cancer free, just doing.
Speaker 2 (13:33):
The run of the mill checkup type thing.
Speaker 4 (13:34):
What a cool. Oh gosh, that's awesome.
Speaker 1 (13:36):
So let's talk about let's talk about you get screened.
You there's a nodule detected, or you know, you see something,
what are the what are the next steps there?
Speaker 3 (13:45):
So before we get to that, I'm actually going to
talk about so getting screened. Any physician or primary care
provider can screen. So if you're a patient, you know, hey,
you've smoked in the past yourself, or you know your
family member has, you want to get them screened. They're
fifty to eighty smoked over twenty years a pack per day,
(14:07):
get screened. So any your primary care doctor could do it.
Or we have like a lung nodule program. If you
don't know where to go, we have a phone number,
or a lot of places do, but we have one
where you can call and you get to get to
one of our providers and they'll get screened. Now, after
you've gotten screened, if you have a CT scan with
an abnormality, like you said, a lung nodule, a lung mass,
(14:31):
or any other abnormality, then you can kind of now
see your primary care or you go see like a
pulmonologist or even a thoracic surgeon.
Speaker 2 (14:38):
I get a lot of people that come and see
me that have a lung nodule.
Speaker 3 (14:42):
At that point, we kind of look at it see
if it's something that looks a little bit more suspicious,
we might go for a biopsy. After having a visit
a biopsy, we can either do that bronchoscopically where we
go through the airway or we do a needle kind
of from out side in try to get some tissue
to get a diagnosis, and if we get a diagnosis
(15:06):
of cancer, then we go forward. We'll try we'll get
some more scans, potentially a PET scan. Potentially you'll see
me for a surgical resection or potentially even my oncology colleagues,
if you need some sort of chemotherapy, amunotherapy, and we'll kind.
Speaker 2 (15:21):
Of go from there.
Speaker 3 (15:22):
Yeah, patients can have lung nodules for a multitude of reason.
It doesn't have to be for cancer alone. You can
have it for fungal infections, you can have it for
what we call granulomas, which are benign entities. So we
got to make sure we're dealing with cancer, of course
first and foremost.
Speaker 4 (15:39):
I you know, I'm just thinking back again.
Speaker 1 (15:41):
I shared that story about Ellen K's mom and for
for years she was part of various clinical trials, you know,
experimental things.
Speaker 4 (15:48):
Can we talk about the importance of clinical trials?
Speaker 3 (15:50):
Yes, of course, clinical trials are crucial for the treatment
for patients and also for the advancement of the field.
Speaker 2 (15:59):
So that you kind of get a you for one there,
What does that mean?
Speaker 3 (16:02):
So we're a comprehensive cancer center, so we have different providers,
like for let's say, for lung cancer, you have a surgeon,
a radiation oncologist, an oncologist. We also get palliative care,
physical therapy, all these types of things, so we can
provide all that. On top of that, we also provide
we have clinical trials. That's what kind of really sets
(16:23):
some of these cancer centers apart. Yeah, is these clinical
trials can be really focused on the patient specifically to
their own cancer. If they have a certain genetic mutation,
we can have trials for that. And these trials give
patients and options for treatments. They also, like I said,
help further the field because we learn more about it
make sure it works well. But it really is part
(16:46):
of the care for patients with cancer. Now more and
more and more we have clinical trials from all different stages.
We have surgical clinical trials to targeted therapies, ammunotherapies, radiation,
We even have reiki.
Speaker 2 (16:58):
We do we all these things.
Speaker 3 (16:59):
Yeah, we're doing reiki for patients with maybe pain or
chronic pain. We try reiki therapy. So we have clinical
trials and all these things. Yeah, and so these this
is something that I really talk to them about, my
talk to clinical trials about talk to patients about these
clinical trials because I think it's something that can really
(17:21):
help patients.
Speaker 1 (17:22):
Do you find that that when you bring that up,
when you start going down that road, do you find
willingness or hesitation?
Speaker 2 (17:29):
Because I think both you do yeah, I think both.
Speaker 3 (17:31):
I think some people are really inclined to go through
clinical trials. Like you bring up ellen Ka, I've also
listened to growing up in La Yeah a long time.
That's great and I'm happy that she was able to
kind of be part of this and from the clinical
trial standpoint with her family. But some patients are all
(17:52):
about it. Okay, we get patient, We get people that
read about it. They know friends and family or friends
and friends of family that have gone through clinical trials.
They understand it. They read about it on the internet,
which is fine, which is great. And there's some people
that are really hesitant. Right. There are some populations of
people that might just be skeptical about clinical trials.
Speaker 2 (18:14):
They feel like they're being experimented on. There's that entity.
Speaker 3 (18:17):
I think this is something that I really explained to
the patient, right. I talk to them about the pros
and cons, why we're doing it, why we do certain
clinical trials. And some people are really for it, or
if they weren't before, now they are. And some people,
you know what, I just don't want it, and that's fine.
I think that's the beauty. Patients can choose to be
part of a clinical trial or not, and if they're not,
(18:39):
we still treat them.
Speaker 2 (18:40):
We still treat patients all the time.
Speaker 3 (18:42):
They're not part of clinical trials, and if they are,
they get new potentially newer treatments that we're going to
be out in the future.
Speaker 1 (18:50):
It's exciting what you guys are doing at UCI Health.
What would you say, doctor too. I don't know anyone
maybe that's watching or has a family member who did smoke,
and it's hesitant to get screened or to even even
go down the road of maybe I should.
Speaker 3 (19:06):
Yeah, it's it's I know, it's difficult, and I think
we brought up that shame issue. I know people think
that way or they think, oh, there's nothing wrong with me,
or I don't care, it's nothing I could really do
about it. I think people got to understand there is
something that can be done, shouldn't feel shameful about it.
If we find it early. Even if you don't want surgery,
(19:26):
then you can go to radiation. If you don't want radiation,
we can go to surgery.
Speaker 2 (19:29):
Right. There's so many options that we can that we have.
Speaker 3 (19:32):
There's really no downside, I feel, and just a screen
is just a CT scan.
Speaker 2 (19:36):
It's literally you just go you sit.
Speaker 3 (19:39):
In a not even a tube, it's a it's just
like a quick scan, and we know a lot about
what's going on in your body. We know a lot
about if you have a lung nodule or not, if
you have a pneumonia, potentially we can take care of that.
Speaker 4 (19:52):
Yeah.
Speaker 3 (19:52):
So I think there's really really minimal downside and a
lot of upside to getting screened.
Speaker 1 (19:58):
And it's it's so fascinating, I think, and you really
think about breathing. We take it so for granted. You
know what I'm saying, Like it's one of those you
have to do it. No one's ever like I'm so
happy I'm breathing.
Speaker 2 (20:07):
Yeah, you know, it's one of those things.
Speaker 3 (20:09):
You don't think about it until you have problems, right,
And unfortunately, like we talked about with lung cancer, when
you start having problems, the likely you're at a later
stage is higher. Right, then you might not be seeing
a surgeon because it's not in an earlier stage. So
these are the problems, that's why you might not have symptoms.
A lot of people say, oh, you know, I feel fine,
(20:30):
I'm going to work or I'm still working out. I'm
not an oxygen none of these things, so I don't
need to be screened.
Speaker 2 (20:36):
That's the problem.
Speaker 3 (20:37):
There's no symptoms here, so we have to be able
to find it early, even when you have no symptoms,
any symptomatic.
Speaker 1 (20:44):
Because at that time it's there, but the symptoms don't
present until later.
Speaker 3 (20:47):
Correct, and if it's still there, we can we can
do something about it earlier. Wow, that's the main thing
I want I tell patients that we can do something
about it earlier.
Speaker 4 (20:55):
Yeah. Really good.
Speaker 1 (20:56):
You know one other one we didn't bring up, and
maybe you have thoughts on this is I know that
you know, vaping has become like a really you know,
popular thing. Now, what are you seeing with that?
Speaker 2 (21:05):
That's so you bring up a very interesting point.
Speaker 3 (21:09):
Especially in the younger population, we are seeing a lot
more people that vape ease cigarettes. Currently we don't have
enough data, okay, and unfortunately that's the problem with data, right.
It takes a long time to have enough data to
really extrapolate what's happening for especially from a cancer standpoint.
(21:29):
That being said, we know tobacco is a carcentergen it
can cause cancer, where other non cancerous issues that do
happen with vaping. There's a lot of what we call
vaping related lung injury, where it's a diffuse lung injury,
where we see even really young patients have lung injury
where they're in the hospital needing oxygen otherwise healthy people.
(21:51):
So we do know that there are problems with vaping,
that there can be issues, specifically with the lung cancer.
I think we're learning more and more about it. We're
learning how much is like, how much do people vape?
Even I think just even quantifying that, right you see
these kids they're just going, going, going, and what does
that even mean as a cartridge the same as a pack.
(22:13):
I think these are things we're learning more and more,
especially from the exposure standpoint. I could tell you it's
probably not good for you, Yes, I think that's probably
safe to say right there. But from a true lung
cancer risk, we're learning more and more, and especially if
you have had lung cancer, you smoked in the past,
and you're trying to quit using vaping. I think it's
(22:34):
great hopefully you can get to that quit standpoint. But
if you're just starting up vaping, especially for the young
young people out there, I hope I don't see you
in the future as as a patient but I think
we will be seeing more and more of that in
the future, and unfortunately we might be seeing more later
stage just because of the way I think it is.
Speaker 2 (22:54):
Yeah, with vaping interesting.
Speaker 4 (22:56):
We you guys are doing great work at UCIL. Thank
you so much. I really this has been fascinating.
Speaker 1 (22:59):
You're you're great and uh I know you'll continue to
do great things and help people breathe easier and better.
Speaker 2 (23:04):
Thank you for longer. Thank you, it's the goal here.
Thank you very much.
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I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Ruthie's Table 4
For more than 30 years The River Cafe in London, has been the home-from-home of artists, architects, designers, actors, collectors, writers, activists, and politicians. Michael Caine, Glenn Close, JJ Abrams, Steve McQueen, Victoria and David Beckham, and Lily Allen, are just some of the people who love to call The River Cafe home. On River Cafe Table 4, Rogers sits down with her customers—who have become friends—to talk about food memories. Table 4 explores how food impacts every aspect of our lives. “Foods is politics, food is cultural, food is how you express love, food is about your heritage, it defines who you and who you want to be,” says Rogers. Each week, Rogers invites her guest to reminisce about family suppers and first dates, what they cook, how they eat when performing, the restaurants they choose, and what food they seek when they need comfort. And to punctuate each episode of Table 4, guests such as Ralph Fiennes, Emily Blunt, and Alfonso Cuarón, read their favourite recipe from one of the best-selling River Cafe cookbooks. Table 4 itself, is situated near The River Cafe’s open kitchen, close to the bright pink wood-fired oven and next to the glossy yellow pass, where Ruthie oversees the restaurant. You are invited to take a seat at this intimate table and join the conversation. For more information, recipes, and ingredients, go to https://shoptherivercafe.co.uk/ Web: https://rivercafe.co.uk/ Instagram: www.instagram.com/therivercafelondon/ Facebook: https://en-gb.facebook.com/therivercafelondon/ For more podcasts from iHeartRadio, visit the iheartradio app, apple podcasts, or wherever you listen to your favorite shows. Learn more about your ad-choices at https://www.iheartpodcastnetwork.com
The Joe Rogan Experience
The official podcast of comedian Joe Rogan.