#82. Dr. Join Luh--Zapping Tumors & Breaking Barriers: A Doctor's Tale

The journey from trailer park to radiation oncology doesn't follow a conventional path, but Dr. Join Luh's remarkable story proves that passion and perseverance can lead to extraordinary destinations. Born in California but raised primarily in Galveston, Texas after his parents' separation, Dr. Luh shares how his early experiences—including watching his single mother work at a medical center while attending night school—sparked his interest in medicine.

What follows is a fascinating exploration of medical evolution, as Dr. Luh takes us through his education at Texas A&M, his internal medicine training, and ultimately his discovery of radiation oncology. He vividly describes the technological transformation of cancer treatment—from the days of drawing treatment fields on X-ray films with wax pencils to today's sophisticated AI-assisted planning systems that allow for precise "dose painting" of radiation. This technological revolution has fundamentally changed patient outcomes by enabling higher tumor doses without damaging surrounding healthy tissues.

Beyond the medicine, Dr. Luh offers a compelling perspective on practicing in rural Humboldt County, where he's built a life and career spanning nearly two decades. He challenges common misconceptions about rural healthcare, noting that Humboldt had advanced technology like IMRT and PET-CT scanning before some university medical centers. His enthusiasm for the region's extraordinary quality of life—where one can "go fishing, play golf, go surfing, and mountain bike all in one day"—makes a powerful case for rural medicine as not just a career choice, but a lifestyle upgrade.

Considering a move to somewhere with cleaner air, less traffic, and world-class natural beauty? Dr. Luh's story might just convince you that sometimes the most rewarding professional opportunities are found outside major metropolitan areas. Listen now to discover how this radiation oncologist found his perfect match in California's spectacular North Coast.

Transcript

Speaker 1 0:30

Ladies and gentlemen, friends and neighbors, this is Scott Hammond with 100% Humboldt Podcast, and my new best friend, dr Joyne Liu. Hi, hey there, how's it going? It's going good. Hey, joyne, tell us your story. What do you?

Speaker 2 0:44

do? I am a radiation oncologist. I joke that I'm the guy you never want to see professionally.

Speaker 1 0:50

Yeah, better socially Correct, and you're always a nice guy socially. I see you sometimes. Well, thanks.

Speaker 2 0:58

So tell us the join story some time in not far from downtown San Diego and some of the older apartment complexes there, and at six months my mom took me to Hong Kong.

Speaker 1 1:21

Oh, wow.

Speaker 2 1:22

And I lived there for about three years. How about that? Cantonese was actually my first language.

Speaker 1 1:27

Is that right? Okay, you said you were born in Chula Vista, right Well?

Speaker 2 1:31

when we came back, we ended up buying a condo in Chula Vista, yeah, and so I was there until I was about six years old.

Speaker 1 1:39

Okay, any memories of Chula Vista?

Speaker 2 1:41

Lots, yeah Lots, of dirt bike rides through canyons that were undeveloped, that are now Mountains that are now covered with condos and townhouses Crazy.

Speaker 1 1:52

Yeah, east Lake is all gone.

Speaker 2 1:53

Mm-hmm.

Speaker 1 1:54

So, as we talked before, I grew up north of that in National City, california, in the 60s and 70s and it was even more canyons and more dirt and more scrub and a fun place to go, ride motorcycles, shoot guns and camp out, yes, and do all the things that young guys like to do. That we were crazy and we'd camp out in the middle of nowhere, in the back of Potter Valley and Indian or what was it called Deerhorn Valley, and just not very safe.

Speaker 1 2:22

The space was there. The space was there and the times were different. So, after Chula Vista, where'd you wind up living? Galveston, texas.

Early Life in Texas

Speaker 2 2:30

Oh, sorry to hear that Well, it was an interesting time. We moved there in 1978. My mom and dad had just separated, so she was starting a new life as a single mom and went to night school and trained to be a laboratory technician. So she worked at the University of Texas Medical Branch Okay In Galveston.

Speaker 1 2:50

In Galveston. They wrote a song about Galveston. Yes, glenn Campbell. Glenn Campbell, yeah, shout Campbell. Glenn Campbell, yeah, shout out to Glenn. Yes. And Craig Lemster, who was a good friend of ours that just passed locally, who was a huge Glenn, I would even say fan. He played all his music, played with his daughter, debbie and her band Right, and this guy was an aficionado.

Speaker 2 3:09

Yeah.

Speaker 1 3:09

He used to work on cars for Chuck Norris and all the guys down in Redondo. Wow yeah, especially for an auto. Shout out to Craig, anyway, yeah. So Galveston, that's a different. There's hurricanes there and stuff right.

Speaker 2 3:21

Yes. Every summer we had to get ready for hurricane season and a lot of people don't know this, but our first year and a half to two years in Galveston were spent living in a trailer park, so I can actually say I'm trailer park trash. That's okay, and it was actually a great place to be. It was a very tight knit community. I got to know all the kids my age. We ride our dirt bikes all over the neighborhood.

Speaker 2 3:44

This was a trailer park that was right next to the seawall Boulevard, so it was walking distance to the beach, yeah, so after school or on weekends I could just walk on over, you know, play in the water. It was almost like being on beachfront property.

Speaker 1 3:58

That's cool. So it's miles of beach right. It's quite beautiful, yes.

Speaker 2 4:02

Yeah, brown water though, but it's the Mississippi River Delta sediment.

Speaker 1 4:06

Okay, yeah, I think I remember seeing some video on some of the larger ships that would come in and they would create wakes that people would surf on Right being an old wannabe surfer, that looked really fun. They would surf a wave for like a mile. Yeah, it wouldn't be a big wave, but it would be consistent.

Speaker 2 4:24

Right, definitely not as big as what we get in California.

Speaker 1 4:26

Yeah, and not as big as on the bar there. So you went to high school there as well.

Speaker 2 4:31

Yeah. So I went from elementary school all the way through high school, there and um, and then, after that, went off to Texas A&M university for my undergrad. Uh, was there? College station, college station, texas. Wow, you're, you're. You're an Aggie. Yes, I'd still probably wear my Aggie ring.

Speaker 1 4:48

Wow, I have respect for that Cause. I used to, uh, go to College Station Really For work. Okay, yeah, we were the cable system there and the headquarters was right there in College Station.

Speaker 2 5:00

How about that? Wow I don't meet any people. Oh, you've been to the Dixie Chicken. Dixie Chicken Come on now, Come on y'all. That was the yeah, and right next door was Dudley's Draw, so it's funny that undergrads would all hang out at Dixie Chicken and all the grad students would go to Guddly's Draw. That was like a bar. Right, it was a bar, and yeah they served.

Speaker 1 5:23

I never had any fried chicken there. You were just there to drink beer. Yeah, of course. Yeah, right, they have a burrito place. That was there that they had. It's also at UCSB, at Santa Barbara. It had an F, it was called oh really good burrito. It was cross town, it was like as big as a newspaper, a Sunday paper, okay, and they had a motorcycle on the wall. Am I ringing any bells? I, it was called. It'll come to me, okay, end of the show or after, I'll text you. Yeah, but amazing, really nice people. You know, as a Californian, they respect success and I had some and I was immediately adopted into the family and still have great friends there.

Speaker 2 6:00

Yeah. Yeah, I still keep in touch with some of the locals there. I got my mom made sure I was part of a church group so they kind of took me in and looked after me, because I didn't have a car my freshman year and it was a neat place to spend my undergraduate years.

Speaker 1 6:16

That's great. Yeah, no, great people I'm so impressed with and one of the pastimes that I remember for social hour they would after work, they would compare small towns. Have you ever been to Conroe Texas? Yeah, have you ever been to Alexandria? Where's that? You got, let me, and then the story would come Alexandria, where's that? Then the story would come. You know, because there's a million little towns. There are, yeah. There's an Alexandria Louisiana Right, that's true, and don't forget, don't mess with Texas.

Speaker 2 6:41

That's right and I bet you've had a Whataburger Many, many times, because they're open 24 hours, so it's a great place to go in the wee hours of the morning.

Speaker 1 6:52

After we've had three beers. Yes, I love that, so you might be in a position to judge this what a burger or In-N-Out burger.

Speaker 2 7:01

Depends on what you're looking for. There's, you know, one thing I'll say about In-N-Out burgers they're fresh vegetables, it's like a crisp burger and it tastes great. And it tastes great Whataburger. If you like the mustard flavor and more the pickly, you know, aspect of the burger, then you can't go wrong with a Whataburger. Yeah, and when I think of Whataburger, I think of 2 am in the morning. Yeah, you know being hungry and just having the munchies and it's delicious because you have every bit of munchies.

College Years at Texas A&M

Speaker 1 7:32

That tastes better, yeah, yeah, no, I think you're right. I think In-N-Out does grill their buns in kind of some butter spread, so they have that more crispy and certainly the fresh ingredients, absolutely. Remember my first one. It was in Camarillo, california, and I go, this is we're just down there for a snack afternoon. I go, this is delicious, bob. Oh, there's 10 of them now in LA and now there's you know, a million. They have them in Dallas, I think too. Yeah, they've come to Texas, right? Anyway, so A&M, let's talk about A&M. And what is it? Giga Maggie's, giga Maggie's.

Speaker 2 8:09

Yeah, is it that's? Is it? Is that the signal? It's, it's? You know a few people that weren't familiar with the symbol, you know, especially hitchhikers you know would try to hitchhike, and people just say gig'em and they just drive on by.

Speaker 1 8:22

Wait, come back. Yeah, so there's a whole short of calling Aggies a cult. There's a cult-like aspect to this school. That is the tree where you're supposed to get married under, the is it some old tree?

Speaker 2 8:40

on campus? Yeah, there's well, there's one thing is that All Britain Tower that's the big clock tower on campus You're supposed to kiss your girlfriend, I guess, under the tower. Okay, that was a tradition. I wasn't that familiar with the marriage thing, just because at that time it just seemed so far away in my mind.

Speaker 1 9:00

I just want to get a degree and get out of here. Yeah, no, I really. What a great little town. A lot of good memories and good guys that I worked with, and we ate at a lot of different restaurants around there and over in Bryan, and they have a Carnegie Library over there there, as they do in many small towns in America. Right, we got to uh see that, but anyway, uh, enough said. So what'd you study at at uh A&M? I was a boring biology major.

Speaker 2 9:27

Ah, and with the, with the idea that I would apply to medical school, it was something an interest I had since high school. A lot of it had to do with my mom working at the medical center in my hometown, and so that kind of fostered my interest in medicine. And so with the biology major, you know, I had a side job as a laboratory technician. I washed, you know, test tubes and flasks in a lab and did some scut work there and actually pledged a fraternity while I was there too. It was called Triangle and it was a geeky fraternity for architects, engineers and scientists. So I fit right in.

Speaker 1 10:03

I'm part of the geek fraternity who isn't? Yeah, that's cool. So how were your grades?

Speaker 2 10:09

They were modest. Freshman year was hard. It was an adjustment. In high school I did very well because I got homework assignments. So as long as I did my homework assignments I'd do fine on the sea and nobody's looking over your shoulder. And you go to class. Professor doesn't care whether you're there or not. They give you a reading assignment. Nobody cares whether you do the reading assignment or not. So I kind of dilly-dallied my first few months of my fall semester and by the time midterms came around I was like, oh my God, I haven't even cracked open a book.

Speaker 1 10:55

Oh, I have this test. Yes, yeah, and these are halls of like 200 people, right?

Speaker 2 11:00

at a yes, and especially your introductory 101 courses.

Speaker 1 11:03

General. Ed's going to be all huge classes, right?

Speaker 2 11:07

what a great tradition, though, and good sports tradition yeah, I, every one of us has the fight song memorized. I will never forget it for the rest of my life. You run into another Aggie. You guys can get together and we can sing it word for word the mark of a good school cult.

Speaker 1 11:23

Yes, so did you go to Aggie football and basketball games?

Speaker 2 11:27

Mostly the football games, and we would stand up for all the football games. Nobody ever sat down.

Speaker 1 11:31

Nobody sits, Nobody sits. So you can see the stadium from Nick. Ball games Nobody ever sat down, Nobody sits, Nobody sits. So you can see the stadium from Nick from like miles away. It stands above the floor of Kyle Field.

Speaker 2 11:39

Kyle.

Speaker 1 11:39

Field and it's, it's right by the airport in fact, yes, when we fly in. Yes, yeah, interesting. Yeah, no, I I'll get off of A&M. So after A&M it tells me you went to University of Texas.

Speaker 2 11:51

Yes, I actually took a little hiatus. I finished college in three years. Most of it was because of the college credits that transferred from Galveston College that I took when I was in high school. Nice, I had a great high school counselor that talked about dual credit. If I took AP courses I could get a concurrent credit at the community college. By the time I graduated from high school I had 52 credit hours, and so that's a year of college right there, yeah, and I could have graduated in two if I, if I, studied a little bit harder. But I uh managed to do in three. So I took a. Uh, I didn't get into med school the first time. So what I did was I did a study abroad project in Taiwan and got a grant from the Ministry of Education in Taiwan to study Mandarin and culture over there.

Speaker 1 12:41

Did you?

Speaker 2 12:41

already speak the language. I spoke Cantonese. Cantonese, but I wasn't very fluent in Mandarin, so my inspiration to learn was I ran into this white guy who was actually a Fiji frat rat, who spoke and read Mandarin fluently, and I was so impressed. I was like, if this guy can do it, I need to do this. Was he an?

Speaker 1 13:01

A&M or was he overseas.

Speaker 2 13:02

He was an A&M.

Speaker 1 13:03

Okay, yeah.

Speaker 2 13:04

Fiji frat rat. Yeah, that could speak and read Mandarin Chinese and I was like you're better than me, I need to do this. He could do it, I could do it.

Speaker 1 13:13

Yeah, yeah, one person could do it, another can do it, right? My favorite, one of my favorite movies called the Anthony Hopkins and Alec Baldwin, what is it called? I'll think of that too. Yep, so a lot of brain explosions going on in my brain, but I'll come back to that.

Medical Training and Meeting His Wife

Speaker 2 13:32

So you ended up going to San Antonio. Yes, so I ended up uh, uh, you know, applying to medical school again, did the MCAT, again, got smart, took Kaplan to help me prepare for the uh, the exam. Nice, uh, and uh, ended up being accepted to the university of Texas, san Antonio. And so I spent four years there and um, uh, yeah, and it was. It was uh, again. Another mind-opening experience, because again it was that you're called upon to learn a huge amount of information in a very short period of time. Right, like trying to drink out of a fire hydrant, oh boy. And so if you think of college being anywhere between 12 to 15 semester hours being a full course load, when you're in medical school, particularly during those first two years, that's equivalent to about 24 semester hours. So that's a lot of class, a lot of lectures, a lot of reading.

Speaker 1 14:23

You're always grinding all seven days a week, probably, right? Wow, did you think about oncology then, or were you just internal medicine, or-.

Speaker 2 14:31

You know that's a great question, because when I was an undergrad, thinking about becoming a doctor, I had no idea that there were so many specialties out there. My perception of a doctor was what I saw in my pediatrician. You know somebody that had their own private office see patients on an outpatient basis. When I had, you know, an encounter, you know, a need for a surgical procedure, I might see somebody in the hospital, but it was a very limited view. So it wasn't until they I started going through the various rotations during a third year, where you're exposed to all the various specialties, that I started learning about the different ones that were out there, and even then you don't get exposed to all of them.

Speaker 2 15:14

Different ones that were out there, and even then you don't get exposed to all of them. It's mostly like internal medicine, general surgery, family practice, obgyn. You know those main ones. The other specialties, like dermatology, radiology, pathology, kind of fall into the background, and oncology was considered a subspecialty of internal medicine, so you didn't necessarily get exposed to those right away, and so I'd always had an interest in blood diseases as a kid.

Speaker 2 15:39

Some of it was because of my upbringing as a Jehovah's Witness. And since they didn't accept blood transfusions I always thought, okay, what can I do to help develop blood substitutes? So that kind of got my interest in the hematology side and from there that kind of overlapped with oncology, because a lot of hematologists are also trained in oncology Interesting. But when I signed up for the oncology awards, the faculty on that service was both a radiation oncologist and a hematologist and a medical oncologist. Wow. And he for some reason he took a special interest in what I was going to do with my future and he really, really wanted me to explore radiation oncology. And so he was an interesting guy. He was in his 60s, tan, muscular, had undergone some plastic surgery to look younger. He was like your true alpha male physician and so for a lot of us younger students he was like our hero. He was like I want to be like him, like the bro, yeah. And so I'd see him at the gym working out and he wanted me to schedule a rotation with him and I kept putting it off, thinking I was going to go into cardiology or nephrology or emergency medicine or something like that. Er was really popular at that time. So a ton of people were applying to do an ER medicine because it was so glamorous and I'd keep running into him in the gym. He kept saying join, when are you going to spend a month with me? Come and hang out, yeah.

Speaker 2 17:06

And so I finally did in my fourth year and discovered the wonders of radiation oncology, especially that most medical students aren't exposed to, it's not part of the core curriculum. And so it was like wow, this is a very highly technology based specialty. There's a lot of patient contact, you develop patient relationships, you have to know geometry, you have to be able to think in three dimensions and in a lot of ways it gets to your core of your desire of playing video games because you're like zapping a tumor, right. So. But at the same time, my mission for med school was to become what they call a real doctor, someone that could do field medicine. You know that didn't have to write lie on technology.

Speaker 2 17:48

So I was like I was kind of uncomfortable. Going straight into radiation oncology, let me, let me learn how to be a real doctor. Going straight into radiation oncology, let me learn how to be a real doctor. So the chair at the time, who was my faculty told me fine, why don't you go do an internal medicine residency and after you're done, come here and do radiation oncology and treat it as a subspecialty and do another residency? Yes, and because even beyond internal medicine there's a lot of fellowships you can do cardiology, nephrology, medical oncology with hematology, and a lot of these fellowships can range between, you know, two to four years in length.

Speaker 1 18:24

So they kind of pay your way?

Speaker 2 18:25

Yes, they do. And so I would only have to do, like another four years of radiation oncology if I did an internal medicine residency, I see. So I said, fine, I'll do that. So I ended up matching into an internal medicine residency in Galveston, texas, back to my hometown at UTMB. Got to see your mom? Yes, I did.

Speaker 2 18:44

And I made the biggest mistake of my life. I thought I'd live rent-free with my mom during that internship year. It didn't work out so well, and I'll tell you why. Because when I left home as a high school student to go to college, I really didn't spend any meaningful time at home after that. It was mostly summer vacations or holidays, sure. And so I went back to live with her as a 26-year-old medical school graduate. She expected things to be just like the way things were when I was in high school, of course, that I would be home for dinner at a certain time, right when, when, when you can get home, and it's like I don't know when I'm gonna get home. I'm gonna get home when the work gets done and I might not come home tonight, right, you know. And so that that didn't work out too well. So after my internship year I got my own apartment um and lived in penalty things. Things got a lot better after that that's story.

Speaker 1 19:33

Hey, if you're just joining us, have Dr Joy Liu, my new best friend, here on 100% Humble Podcast. I want to go to St Joseph Providence here in a minute. I want to talk about oncology and gosh I imagine you're no stranger to death and to pathology and the people that are involved in the personal part of that and then maybe talk about your community involvement, because I almost see you in a community role. That is, it's really deep, because I think you make you're accessible and you're approachable and you make medicine real, because you're you know you can talk about it. And hey, I have a question, hey, I have a minute. What do you got? And so that I think that is that's priceless. So I'm not sure where to start on that. I guess you then went back into radiology and did your fellowship there.

Speaker 2 20:29

Right Separate residency in radiation oncology. It's interesting you said radiology because that's not a mistake, because radiation oncology used to's interesting, you said radiology because that's not a mistake, because radiation oncology used to be a subspecialty from radiology and we're still board certified under the American Board of Radiology. But a lot of people confuse us.

Speaker 1 20:47

However, it's different.

Speaker 2 20:49

Right, we don't interpret films or radiographic studies like a radiologist does. You're zapping things, right. So our field used to be known as therapeutic radiology as opposed to diagnostic radiology. Okay, and then in the late 1990s, early 2000s, we kind of flipped over to the field of radiation oncology. Okay, good difference. Yeah, good distinction, right.

Speaker 2 21:11

And so, yes, I ended up moving back to San Antonio. So very, very important you know life event I ended up meeting my wife in Galveston Texas, during my internal medicine residency, and she was actually just a year behind me. I met her at an internship welcoming party, so I was already in my second year of internal medicine residency. She was starting her intern year. I stalked her for about a year because she was a tall Asian female and got the gumption to ask her out finally after a year, and then we were an item. So it ended up happening.

Speaker 2 21:49

After I finished my internal medicine residency, I ended up staying behind in Galveston and got hired as an emergency medicine faculty at UTMV Galveston. How about that? So I worked for two years to stay behind for a year while she finished her third year of internal medicine residency, and then, when she went off to WashU to do her allergy fellowship. I stayed on for another year to make enough money to where I could save up, pay off my student loans and go visit her every month. Thank you, southwest airlines. Yeah, where was she at? She was at Wash U in St Louis, st Louis.

Speaker 1 22:24

Okay.

Speaker 2 22:25

Okay, and then, and so we were uh, we were in, we dated for two years. We were engaged for two years during the um, the um second year in engagement. I did my two years in the emergency department, moved back to San Antonio and then started my radiation oncology residency. Wow, did she follow you then? Well, she still had one more year left of fellowship. So it wasn't until after I finished my first year of radiation oncology that we got married. And then she still had another month left of training after we got married and then after that she moved in with me in San Antonio, so long distance for a minute. Yes, it was Wow, and I have Southwest Airlines to thank for making it affordable for me to go visit her Right right.

Speaker 1 23:09

Yeah, we forget what that's like because United you got to it's 500 bucks to get on the plane. Yes, up here. Well, I exaggerate. No, I don't, I'm not exaggerating at all. And yes, your wife is very tall. She is. And remind me I want to talk to you about after the show. Somebody suggested she might be a great podcast guest. She could very well be. Yes.

Speaker 2 23:30

Yeah.

Evolution of Radiation Oncology Technology

Speaker 1 23:30

She seems very gracious. I've met her, of course, a time or two. So talk to me about oncology and the people you work with, the tech and the patients, and how the tech has come. I'm guessing a long ways like everything else, right Absolutely.

Speaker 2 23:49

And my cell phone does better things, I imagine radiation oncology is doing great things For sure, when I started my training in 2003 in San Antonio, we were still using flip phones, and you know look how far we've come there. And so when I started my training with radiation oncology, a lot of the techniques we were using to treat patients would be viewed as crude. Today, I can remember, in treating people with head and neck cancer, the way we would design our fields is we take an X-ray of you know of the side front, and then we'd have that X-ray film put on an X-ray viewer that you'd put up and we'd take a wax pencil and draw our fields based on bony anatomy Wow, anatomy. Now, fast forward.

Speaker 2 24:34

We use a technique called intensity modulated radiation therapy, or IMRT, and that requires that a person get a CT scan and then you outline the volumes, slice by slice, what you want to treat, and then you outline the adjacent lymph nodes or tissues at risk. That would get a lower dose. So it's mapping everything. Yes, it's what we call dose painting. It's an art now, almost, and you're really able to stratify the levels of doses that people get in their body, versus just blasting everything with the same dose of radiation. That's amazing.

Speaker 2 25:12

So AI has got to be playing into this soon, if it hasn't already, in terms of the tech and bringing in new, I guess, new knowledge Absolutely, or connecting knowledge that we have the skills to be able to outline the sites that we wanted to treat, and we got very good at using a mouse in order to trace, you know, tumor slice by slice, and then come up with the volume that we're actually going to be treating. Now. Fast forward now and over 15 years into practice you know this August will be 18 years here in Humboldt we're now seeing products that will do contouring for you. So you just basically have the CT scan to map out the patient's anatomy and you run the program and it automatically contours the structures for you. Now you still have to check it because AI can still make mistakes. So I'm still a little bit on the fence about whether it really saves me time, because almost always I have to make a few adjustments here and there.

Speaker 1 26:19

Really Okay. So it's not the answer quite yet.

Speaker 2 26:22

Not quite yet.

Speaker 1 26:24

So what's typical then? So let's say, joe Blow has cancer, you did the mapping, this person is sedated and then they sit under some sort of a laser tool or radiation. What are the mechanics typically of a typical, you know, run-of-the-mill treatment Sure?

Speaker 2 26:47

So, obviously, after seeing a patient for consult and discussing their treatment, doing a physical exam and doing all the things any other doctor would do in the clinic setting physical exam and doing all the things any other doctor would do in the clinic setting they come back and do a simulation session where we actually do the CT scan to visualize the area that we're going to treat and that's where they get the famous tattoos. And so there are dots no larger than the mole that we use to line up to laser pointers in the room. So we know how to set them up externally and they usually get fit into a cradle that conforms to their body, that they can just kind of fit into, so that each day they come in for treatment they're in the same position as they were when they got their CT scan. And so after the CT scan is done, I do my work in outlining the area that I want to treat and outlining the areas that I don't want treated as well, because we also have what we call avoidance structures. The planning takes about a week to do so. Typically after the simulations it's at least a week or two before they actually get their first dose of radiation, because after I'm done with my outlining or setting up the beams, or drawing the shapes that I want.

Speaker 2 27:53

What I do ends up going to a dosimetrist, which is a profession where they take what I've drawn and decide okay, what energy of radiation do we need to be able to reach this tumor and achieve what Dr Liu wants? Are those the painters you were talking about? Well, I do the painting, you're the painting, but they're the ones that actually say okay, what angles do we need to use? What dose penetration do we need to use? What dose penetration do we need? You know how do we modulate rotating around a patient via a gantry that directing the radiation to the patient, and you have to make sure that there's no issues with collision, because the table that they're on can be adjusted in different angles and it's going around the patient. And within each beam there's leafs that shape the beam and you can modulate the intensity of the beam within the beam.

Speaker 2 29:06

So, just like vectors that we learned in high school about how multiple lines can affect the shape or the direction of where a line is going to go, sure, a beam can be modulated in multiple different angles to give you a shape of radiation that you want Interesting.

Speaker 1 29:23

Huh, yeah, I can see my wife when she's Joni, when you like, she's nerding up on this, it's coming. I love this. So is it typically effective? Is it more effective with this new modality? Well, new levels of modalities.

Speaker 2 29:40

It is because it allows us to give a higher dose without harming normal tissue. Used IMRT more commonly was that we had to limit how much radiation we gave because we had to respect the tolerance that the normal tissues had to the radiation before the side effects would become intolerable. So now, with more focused treatments and the technology to be able to deliver more conformal treatments, you're able to give a higher dose without worrying about the surrounding tissues, because typically, when you know someone fails radiation, the usual culprit is you weren't able to give a high enough dose.

Speaker 1 30:25

I see, I see, is it fair to ask the question how does our tech compare to, say, stanford or Cal or UCLA, absolutely.

Speaker 2 30:33

I was actually quite impressed when I first came here in 2007, because we already had IMRT capabilities here. Most rural communities did not have that in 2007. Wow, and I was very impressed that we actually had a PET-CT scanner. We didn't even have one at the university in San Antonio that was functional, that we could use for treatment planning. So when I came here, we actually had a lot of referrals from UCSF and Stanford of patients that would go down there and come up here, yeah, and they would refer them right back to us. Wow, now come around to 2014, 2015,. We couldn't really say the same thing, because things started, our machines got really old and, thanks to a lot of the fundraising efforts that were done through the hospital and the work of Paul McGinty, who was our former chief philanthropy officer, we were able to raise the like stereotactic radio surgery, stereotactic body radiation things that we used to have to refer out that we could now keep here at Humboldt.

Speaker 1 31:41

Wow, that's mind-blowing.

Cancer Treatment Process Explained

Speaker 2 31:44

So hey, if you're just joining us, my friend Dr John Liu, and telling us about his journey, his story and medicine, no-transcript are employed and most of them either through Mad River or Open Door Clinic or through the province health system and it's really a function of number one the declining Medicare reimbursements making it really hard to be independent and a lot more regulatory burden in staying independent, forcing a lot of physician practices to just throw their hands up and say just employ me and give me a check every month. So this is true nationally.

Speaker 1 33:31

It is true, nationally, yeah, so you have Providence underwriting your insurance, your office, your everything Right.

Speaker 2 33:40

Yeah, far easier. Yes, but it does come with a cost, you know, in terms of autonomy and the ability to start your practice. A lot of people don't know this about my practice is that we are an independent physician group, we have a contract with a province health St Joseph hospital, and that that contract has been in place since 1978. Is this you and others?

Speaker 1 34:02

Yes.

Speaker 2 34:04

The whole team, or just Right. So Dr Michael Harmon was the one that recruited me to come here. He's still here and I really thank him for building a practice that allowed me to stay here for close to 18 years and counting Wow.

Speaker 1 34:18

Yeah, you stuck around. I did, glad you have. So how about personal stories, without HIPAA violations or names, but have some of the those folks made an impact on your life, the ones that you've been able to help and maybe those that you haven't?

Speaker 2 34:35

Absolutely. I you know cancer affects people of all walks of life, so I've met the entire spectrum of people here in Humboldt County. You know people who are very well resourced, people who are homeless and everything in between and it really gave me an accelerated you know taste of the people here. And that's probably been one of the most rewarding things about being here was meeting the people, seeing the difference that we've been able to make. Even if we weren't able to cure them, we were unsuccessful in eradicating the cancer, it still felt rewarding to be there for them and, you know, be with them during their journey, to educate them and to let them know what to expect in the future and get them connected to the resources that they needed Sure Of which I think I would guess there's plenty.

Speaker 2 35:29

Yes.

Speaker 1 35:29

There may be doctor shortages, but not necessarily community health groups to help resource people Palliative care, whatever.

Speaker 2 35:39

Right. Obviously there's challenges in that arena as well, but when you get to know when you've been here for almost 18 years you get to know where all the nooks and crannies are and know where you can call in a favor, so that you know what normally would take months, you know ends up taking a couple days to do.

Speaker 1 35:57

I had Dr Frack as part, one of my early guests. Michael Frack, and did you guys work together much?

Speaker 2 36:02

We did, we did. In fact, he was one of the first people I met. Oh, is that right? I always joke that when I first moved here, I didn't know where he was employed or where he was, because there was always a new project that he was working on. So I had a collection of business cards from him of all the various roles that he had.

Speaker 1 36:18

Shout out to you, Michael.

Speaker 2 36:19

Yeah.

Speaker 1 36:21

Yeah, amazing guy, really really fun. So, as an advocate for not only for medicine, but also for Humboldt and for Providence, you're kind of out there, you're on some, are you on some boards? I assume that you serve? You're connected to the foundation, clearly, yes, and to Destination Humboldt with me.

Speaker 2 36:40

Right, yes.

Speaker 1 36:41

So let's talk about that Destination, let's go there. Sure, never served on a board, I'm on a board. It's cool. We bring doctors to Humboldt and ask them to stay for at least five years, yes, and pay their med bills. Right, did I catch the mission about? That's pretty close. Yes, it's under contract. Yes, but I think it's been amazing. I mean, dan Dan Hain down in Fortuna is our GP, right, johnny? And I shout out Dan, good job down there.

Speaker 2 37:09

Absolutely. He's a graduate from our family medicine residency program. So, it was a perfect example of how we grow our own medical expertise and he's going nowhere and just expanding his caseload.

Speaker 1 37:20

a primary care- physician that I was able to refer to him.

Speaker 2 37:35

And so they're really appreciative of me. So I thank Dan Hain for making me look really good.

Speaker 1 37:41

And me. I'm 65 years old, up in McKinleyville with no doctor, it's like in Joni and our 20-year-old Micah. So he's come to the table and it seems like it's really good care so far. So we're pretty happy. Yes, hey, so that part of our show where we ask you a couple of questions about Humboldt. You ready, absolutely. You got a day off. You can do whatever you want with your bride. You guys do whatever. We'll pay for it. What do you go do? Let me.

Speaker 2 38:07

Oh yeah, we have to use the bell.

Providence Health and Physician Recruitment

Speaker 1 38:10

Sorry, I forgot the bell Quiz time. Oh, and you're looking for one of these. Oh hey, it's a Dick Taylor Kraft chocolate 73%, dark brown butter, nibs and sea salt and pretty dang good. But you haven't earned it yet, so we'll just put that right there. You're tempting me Keep an eye on that right there, do you guys?

Speaker 2 38:30

like chocolate we do Well, especially my wife Maddie, also known as Dr Madeline Ramos. She's a big aficionado of chocolate, especially dark chocolate.

Speaker 1 38:44

Does she like theirs? She does, she's a big fan, maddie, this is your day. Well, we'll see how he does. Yeah, I think most wives like chocolate. Joni's told me that she goes. Most women like chocolate I go. I didn't say it. It's not a gender statement on my part, I'm just repeating it.

Speaker 2 38:57

So question number one Okay.

Speaker 1 38:59

You got a day, do whatever you want. What are you going to do in Humboldt? You got your day off.

Speaker 2 39:07

They don't even want you to call the office, or suit up or anything, so you can do what you want with Maddie, what are? Usually it starts with a nice breakfast, so there's a lot of choices If we're going to stay in. She makes the best scrambled eggs soft, fluffy, just right. And Chris the bacon, it's heavenly. And then she does this pressed coffee that's strong and very, very, very, very rich. That's strong and very, very, very, very rich. Um, so if we stayed home, we would do that, if we wanted to go out for breakfast. There's a lot of choices.

Speaker 2 39:43

You know, um, I'm a, I'm a big donut fan, you know. So, um, uh, a side story, I, I, you know, growing up in Galveston, texas, I love donuts. Glazed donuts are one of my favorite. Um, uh, you know, you know vices, and so some of my favorite donuts are McIntosh Farms makes some really great donuts and a really very rich breakfast. Up in Arcata, yes, up in Arcata, yeah, big breakfast, yes, yes, I love the chalet, the chalet omelet. I used to get my kids there, you know, at the Eureka location, when they had that kind of thatched roof location, right, but the Cutton location is great. They have one of the best omelets. Happy Donuts is great as well, and so, yeah, lots of choices in terms of having a big, hearty breakfast. Oh, renata's Creperie too is also a favorite. Oh, really good.

Speaker 1 40:30

Yeah, yeah, yeah, good, okay. So you started with the breakfast. What do we do with the rest of the day?

Speaker 2 40:35

So, uh, we, we, we love the outdoors, so, uh, we'll either take a hike through the Arcadia community forest I live just a block away from the forest, oh perfect. I mountain bike there all the time, so I know like the back of my hand my wife runs it all the time, very cool. Yeah, we love Trinidad so we'll probably do some hikes in Trinidad. You know, walk around there and you know, and so if it's just her and me she doesn't get in the water that much, but she's really into the exploration via hiking.

Speaker 1 41:05

Sure. And we could do a lot here. Yes, right over here on the mountain I get to use my prop there's lots of hiking right over. See right where I'm pointing. Tons of hiking. Yeah, my wife's turned me into a whole bunch of places I'd never been. Yes, and she's still it was mine. She and her friend Sarah is still exploring Prairie Creek. It's just endless. The state park is full of crazy stuff.

Speaker 2 41:28

Question number two Okay.

Speaker 1 41:30

It's the end of the day you've been hiking. Where are you going?

Speaker 2 41:29

to take Maddie for dinner.

Speaker 1 41:30

Okay, it's the end of the day You've been hiking. Where are you going to take Maddie for dinner, because it's on 100% Humboldt podcast.

Speaker 2 41:37

Yes, yes, so we have a lot of favorites. We love Moonstone Grill for the view. Their ribeyes are amazing.

Speaker 1 41:47

Oh, really so tender.

Speaker 2 41:48

They're the best. We love the Larapins. We're a big fan of that. The second floor you know intimate setting. I know Fred Moore's a big fan of that place as well and we've had a lot of departmental parties there too. I bet you have. Yeah, yeah, it's a great place. We love Seagrill. Seagrill is a great place as well. Their prime rib is good and they have great seafood selections. Their prime rib is good and they have great seafood selections. Humboldt Bay Bistro is also a nice place that we enjoy going to for, you know, upper scale. We also for late later night dining. We love Tandoori Bites. Their butter chicken is amazing, delicious.

Speaker 1 42:27

Yes, I had no idea what that was until I had it. It's really good. They said our friends Peter and Sarah Starr from the club. They love Szechuan Gardens up in North Town Arcata. Yes, they're from New York and they said that rivals any Chinese you can eat in New York.

Speaker 2 42:42

Yes, my youngest son loves that place. My middle son has actually worked there as a server before, and so we know the owners really well and they really do make authentic Chinese food. We know the owners really well and they really do make authentic Chinese food, so that's usually our go-to if we want something. You know spicy and you know very, very authentic. They have a lot of spice there?

Speaker 1 43:00

Yes, they do, it's good, it's good. Question number three Coffee joint. If you could have any coffee on or off duty, what's your go-to?

Speaker 2 43:12

That's a great question. Seems like donuts have to go with coffee, right? Yes, yes, they do, and a lot of times I'll just be lazy and just buy the coffee from wherever I get the donuts, and my two favorite are Happy Donuts and Donut Mill. Don's Donuts and Arcata. They make great apple fritters, but as far as glazed donuts, happy donuts wins, and then a very close second with the donut mill. But as far as coffee, I'm pretty easy to please If it comes to a fancy coffee. If you're going to ask what I'm going to get at Starbucks, it's usually if it's hot and I want something sweet, I'll usually get a frappuccino, a caramel frappuccino, sure, you know. But if I want something that's going to wake me up in the morning, I'll get the Pike's Place roast from Starbucks. But I have been to. I love Jitterbean. They make great iced coffee. I've been to Dutch Brothers. I don't go there as often.

Speaker 1 44:28

Sure, uh, I've been to Dutch brothers.

Speaker 2 44:31

Um, I don't, I don't go there as's it's.

Speaker 1 44:32

There's only 20 or so locations, but they're um magical where they started the mission district and they have three sizes small, medium, large and you could pick from 15 uh different beans and, wow, they're all custom pour overs. So they, I see, takes about eight or nine minutes to get your coffee. Sure, but you're every time you the notes and you could actually taste the coffee wow, wow. Nothing bitter, that doesn't even exist. There's a pretty good coffee. So coffee snobs unite. Well, hey, congrats on the. You've answered all the questions correctly Wonderful.

Speaker 2 45:05

I didn't know there was right or wrong. There isn't Thank you.

Speaker 1 45:09

So what do you see as our future opportunity in medicine as a public and how could we get involved? Websites what would you say the average Joe or Mary could do to help medicine and Humboldt now and going forward?

Life in Humboldt: Food and Coffee

Speaker 2 45:28

Yeah, I think number one is recruitment and just optimizing our search engines. People I talk to about how wonderful Humboldt County is do a search and they read about the homelessness, the drugs, the so-called pollution. Come on, this is not a polluted place, but they read about the bird droppings near Moonstone Beach and they get all freaked out about that. But they read about the bird droppings near Moonstone Beach and they get all freaked out about that. And so there's got to be some way we can optimize the searches for this area, because if you actually come here and see the beauty and the natural resources we have, you'll get hooked. I mean, and I'm so glad that the Providence is now doing independent recruiting for Humboldt County rather than making it a systemic recruitment effort, because a lot of the people from the system have never been here and they just treat us like another number.

Speaker 2 46:25

When Mike Harmon recruited me, because he's independent, he had the freedom to put me up wherever, put me up in Trinidad during my interview. So I woke up every morning during my first trip to Humboldt, overlooking the Pacific Ocean, seeing the Trinidad lighthouse and actually meeting some fishermen that were trying to sell Dungeness crab and getting my first taste of fresh Dungeness crab, oh man. And so I was like you know what? This being a place where a lot of people come to retire, I could start that process right now. Sure, why wait? Mike's a smart guy he is.

Speaker 1 46:57

He's a good recruiter. It's really true. It's like I don't know what you would lack as a doctor or somebody in the field to come up here. I met a guy last night. He's a surge tech and he's traveling, but he's took a full-time job sticking around, yeah, awesome. Staying in a beautiful home in blue Lake.

Speaker 2 47:20

Yeah. Last night we were 70 degrees and perfect and right Like oh, you can't beat the weather here, oh, I mean compared to Texas, where I'll say I sweat a lot less now, oh sure, and I don't have to deal with the heat and humidity. You don't need an air conditioner here, no, and so you do. It's opening windows. I love it. Your windows come open.

Speaker 1 47:36

Absolutely. Yeah, it's really true. I remember it being 99 and 99 at seven in the morning in Houston.

Speaker 2 47:43

Just miserable.

Speaker 1 47:44

It's like Right. How do you guys live down here, florida? Forget about it, right dude.

Speaker 2 47:49

Yeah, yeah, and I tell people that that was changed my mindset in terms of the environment. You know, in Texas you got fire ants, you got mosquitoes, you got rattlesnakes, you got sticker burrs. The environment's not friendly to you, so no wonder you're not an environmentalist. Yeah, you just want to pour concrete everywhere and so you move here and it's like it's cool, I can lay on the grass and fire ants aren't going to eat me up or mosquitoes aren't going to eat me up, right? You know, yeah, there's mountain lions and bears, but they stay away. But it's not like an immediate threat, no, and so it's like, wow, I like being outdoors, let's preserve the environment. Yeah, so total change in mindset.

Speaker 1 48:29

There's no bad weather, just bad clothing for the weather, correct, so you could go out all year long. And yeah, now you mentioned Trinidad, it is the benchmark for fresh air in America. Yes, it's, it's, I read that or heard that. Yeah, because of that, that Gulf of Alaska wind that comes in, absolutely that pure air. It's funny with nine kids that those that come back to visit go down Dad this air is. I remember this smell and what hits them. Come back, yeah or no, maybe not, but the air that they get hit with and the smell of the ocean even in McKinleyville is stunning Scenic Drive and Trinidad and, for sure you know, sumig, formerly Patrick's Point.

Speaker 2 49:16

Yes.

Speaker 1 49:17

Gosh, it's all within 10 minutes from where we live. It's like when you live next to Disneyland. You should go once in a while.

Speaker 2 49:25

Right For sure, you know it's pretty cool to take advantage of that. I tell people that Humboldt is one of the places where you can go fishing, you can play golf, you can go surfing, you can go mountain biking, you can do all those things in one day, oh yeah, you know, if you want to do all those things in the Bay Area or in LA, you better be a billionaire with a helicopter to take you to all those places.

Speaker 1 49:46

Yeah, where would you go? I can't even. You know the ocean, I don't. That's a great question.

Speaker 2 50:01

So how do we, as how do we get involved in medicine locally? How can we donate to the foundation or to Destination Humboldt? I suppose there's people that have money or resources they could donate. That'd be one thing with recruitment and retention and helping doctors that are here stay, and also it's a great recruiting tool for the pipeline of primary care doctors that are being trained here to stay and have their career here in Humboldt.

Speaker 1 50:23

That's a big deal that is.

Speaker 2 50:25

And also there's a lot of patient support organizations here too. I'd like to call it the Breast Gin and Health Project, based in Arcata, supports women with both gynecologic and breast cancers, connecting them to resources to help them get through the journey of their cancer treatments. People, you know, not just patients. You know people who may be food insecure, housing insecure, you know, for education, you know just so many ways to give people a helping hand that they can support. But, you know, in the medical arena you know, there's the St Joseph's Hospital Foundation. Our Humboldt-Del Norte County Medical Society is also an organization for physicians that citizens can, you know, here in Humboldt, can engage with and get information from and also see what they can do to help, you know, tie new physicians to members in the community and I think some of the efforts that the St Joe Hospital Foundation is doing in involving board members with some of the recruitment visits is going to be a great idea.

Speaker 1 51:39

Yeah, yeah, come and see Old Town. Come to Trinidad, right. Stay up in Trinidad, right. Airbnb, yes, and Laraband's not bad and you could eat there every night if you want. When you move here, you could, yes, yes, seven days a week. So my question then is, or my comment is the foundation also is an arm for money that comes in and then equipment that's bought? Yes, that is desperately needed, right, or there just wasn't a, but they're able to talk about that like the robot, the surge robot.

Supporting Healthcare in Humboldt County

Speaker 2 52:14

Yes, so we have. For years we've the surgeons here have wanted a da Vinci robot. Da Vinci yeah, so that's the allows urologists to do prostatectomies. You know thoracic surgeons and abdominal surgeons to do minimally invasive surgeries as well, and you know, interestingly, not only is it a great technology to have because it's a better service line to patients, but it's also a retention tool for surgeons to say, hey, I want to stay in a community that can give me the technologies I need to offer the best care for my patients. It's also a good recruiting tool because when new graduates, you know, come from the academic centers and they come over here and they can see I can practice in a rural community to have access to state-of-the-art technology that I can offer, I mean these guys must get tremendous I would guess tremendous support once they land Right.

Speaker 2 53:18

And that's where the foundation is great, because you know, we know that health systems are all challenged with difficult financial times and the foundation is the way for the local community to say this is what we want, yeah, and we're going to enable you to get this technology, yeah, yeah.

Speaker 1 53:35

We're going to get this for the OB unit or whatever. I remember it's a cradle or a bed for babies. Oh, that's cool, we could buy that. So two last questions. Can you review real quick with us, the sisters, and how they got here with $19 and 1918 or whatever?

Speaker 2 53:52

it is Right, I think it was 60 cents. 60 cents, which is probably in today's dollars, it'd be about $2,000.

Speaker 1 53:57

Yeah and they were amazing to start this little hospital with nothing, and these Catholic sisters that loved people and loved God and did an amazing work and started this thing, and it is what it is and it's going to be something special even as we talk. Um, and lastly, my last question for you what do you want to be remembered for, Joyn, your legacy, your tombstone? Uh, what are we saying at your um, your celebration?

Speaker 2 54:47

of life. That's. That's a great question comforting patients and reassuring them, um, you know I, I, I, obviously, you know I, I want to be known for being, you know, a loyal husband, father. You know I raised three kids here. I still have a high schooler and a and a middle schooler here and, um, you know, just, uh, uh also, perhaps, um, you know, uh, uh, having had, uh, uh, an interest in music. You know I'm in a band, uh, as well.

Speaker 1 55:17

And so you're a rock and roll guy.

Speaker 2 55:19

Yeah, and it's all a function of being here in Humboldt. You know it probably wouldn't have happened anywhere else.

Speaker 1 55:22

That's funny, I love it. What do you do?

Speaker 2 55:24

you play guitar or bass, uh, rhythm guitar.

Speaker 1 55:27

Okay, yeah, yeah, that's cool. Well, I'm going to sign off and then thank you in a minute. So, hey, thanks for joining us this time on 100% Humboldt, and you could help me if you wanted to. If you like the show, like us, make comments, youtube, all the stuff. But hey, right now, north Coast Journal has Best of Humboldt under the bonus section, best Podcast. We made the final three. What do you think of that? Congratulations, yeah, thanks, and you could vote through June 30th and we'd love your vote and if this is a blessing to you, then you could say thank you back if you want to do that. Having said that, dr Joyn Liu, appreciate you, thank you. Thank you for being on the show. It was fun, all right, hey.