Live Long and Well with Dr. Bobby
Let's explore how you can Live Long and Well with six evidence based pillars: exercise, good sleep, proper nutrition, mind-body activities, exposure to heat/cold, and social relationships. I am a physician scientist, Ironman Triathlete, and have a passion for helping others achieve their best self.
Live Long and Well with Dr. Bobby
#50 Navigating Serious Illness: Eight Crucial Lessons
Visit drbobbylivelongandwell.com
to sign up for his free October 2nd workshop on how to focus your energy on the habits that truly improve health and longevity—without making it your full-time job.
In this deeply personal episode, Dr. Bobby reflects on his wife's cancer diagnosis and shares eight powerful lessons for anyone navigating the uncertainty of a serious illness. With insights from Dr. Helen Eshed, a board-certified gynecologic oncologist and Gail’s treating physician, this conversation blends personal experience with expert guidance to help you feel more prepared, empowered, and informed—whether for yourself or someone you love.
Together, they discuss when and why to seek a second opinion, including the importance of trusting your gut and asking your doctor how frequently they handle cases like yours. Dr. Bobby emphasizes the importance of finding a quarterback—a single provider who can oversee and coordinate all aspects of care, a role often filled by the medical oncologist or, in fortunate cases like Gail’s, by a specialist like Dr. Eshed who guides every step of the journey. They explore the nuanced role of the primary care physician, who may not lead cancer care but is critical in managing other chronic conditions and general health during treatment.
Dr. Bobby and Dr. Eshed also confront the flood of non-evidence-based treatments patients often encounter. Supplements, restrictive diets, and alternative therapies may be well-intentioned, but many lack credible evidence and can even interfere with medical treatments. Dr. Eshed underscores the importance of open communication with your doctor to discern helpful integrative therapies—such as acupuncture or massage—from those that may be harmful. If you’re unsure, bring it to your physician and evaluate together.
Another theme they unpack is the human need for agency during illness. Dr. Bobby highlights a randomized controlled trial in colon cancer survivors showing that a structured exercise program led to a 28% improvement in recurrence-free survival over eight years. This suggests that lifestyle changes like physical activity can make a real difference, even after diagnosis. But as he cautions, not everything promising on the internet is supported by research—so choose wisely and stay grounded in science.
They also touch on the emotional and spiritual dimensions of illness. From the rollercoaster of diagnoses to unexpected rituals like a gratitude ceremony for Gail’s uterus, Dr. Bobby emphasizes the value of community, spiritual support, and patient-centered rituals that help bring meaning to the process. Resources like survivorship counseling and disease-specific nonprofits can offer both information and connection during the journey.
Finally, they discuss the often-overlooked financial impact of serious illness. With treatments like surgery and immunotherapy costing thousands—even hundreds of thousands—of dollars, Dr. Bobby encourages listeners to proactively ask about costs, insurance coverage, and out-of-pocket maximums to avoid being blindsided.
Takeaways:
- Ask the right questions early—about your diagnosis, treatment options, prognosis, and whether your doctor has experience with your specific condition.
- Look for credible, evidence-based interventions that support your care rather than distract from it—especially when you're tempted to chase internet cures.
- Build a strong, multi-layered support system—medical, emotional, spiritual, and financial—to help you weather the journey ahead with resilience and clarity.
Visit drbobbylivelongandwell.com
to sign up for his free October 2nd workshop on how to focus your energy on the habits that truly improve health and longevity—without making it you
eventually, you or a loved one are likely to get a serious illness and embark upon an uncharted journey, a journey that may be filled with uncertainty and fear. Having experienced this journey with patients and with family, there are eight lessons that might help you Join me in this discussion. Hi, I'm Dr Bobby DuBois and welcome to Live Long and Well, a podcast where we will talk about what you can do to live as long as possible and with as much energy and vigor that you wish. Together, we will explore what practical and evidence-supported steps you can take. Come join me on this very important journey and I hope that you feel empowered along the way. Important journey and I hope that you feel empowered along the way. I'm a physician, ironman, triathlete and have published several hundred scientific studies. I'm honored to be your guide.
Speaker 1:Welcome, my dear listeners, to episode number 50, navigating a Serious Illness. If it hasn't already happened to you, it likely will at some point. Either you or a loved one may feel well, but then something happens. Diagnostic tests are performed and a serious diagnosis is shared with you Perhaps cancer or MS or lupus or Parkinson's disease, or serious heart or kidney failure, or a rare illness in a child. You are suddenly in very uncharted territory. How can you navigate this serious illness? I hope that after listening to this discussion, you'll have some tangible steps that you might take and that might help you, and that you'll feel a bit more like the navigator on this journey.
Speaker 1:Well, I've been thinking about this episode topic for a long time, as it's a really important one. It increased in relevance a few months ago and I want to tell you my personal story. Gail, my wife, and the love of my life had uterine bleeding one Sunday night. Now in medical training the teaching was bleeding in a postmenopausal woman is cancer until proven otherwise. So off to the ER we went. The ultrasound showed thickening of the uterine lining. The next day she got a biopsy and soon thereafter we learned that it was endometrial cancer. Mri CT scans showed significant spread and we had the diagnosis ultimately of stage 4 endometrial cancer. Gail's cancer journey had begun. She had extensive surgery and just finished her six courses of chemotherapy, now on to radiation therapy and three years of a newly approved immunotherapy.
Speaker 1:Gail is doing well and we are truly optimistic about the future. During the course of this journey, we've experienced the eight lessons, or eight issues, that I'd like to share with you. There are many others of these topics I could discuss, but that's enough for now. I will also be joined by Dr Helen Eshed in the next segment. I want to welcome Dr Helen Eshed. To Live Long and Well. Dr Eshed is board certified in obstetrics and gynecology and gynecologic oncology. In obstetrics and gynecology and gynecologic oncology, she takes care of women with gynecologic cancers like cervical uterine and ovarian. She did her fellowship in gynecologic oncology at Columbia Cornell, her residency at UC Davis Medical School in Albany and went to Dartmouth for her undergraduate education. And, very importantly, she's Gail's doctor and guide on her cancer journey. Thank you so much for being here today and for all the care and support you're giving the love of my life, dr Ashed, welcome. Any thoughts before?
Speaker 2:we just dive in. Thank you for having me. I love taking care of your wife and I appreciate the opportunity to talk through everything with you.
Speaker 1:Dr Shedd focuses on gynecologic cancers, but the topic for Decay, which is navigating a serious illness, applies to really any serious illness cancer or Parkinson's disease, heart failure, copd, whatever. So when somebody gets a difficult diagnosis, when should they consider getting a second opinion?
Speaker 2:I think it varies from person to person. Your comfort level with a second opinion. You know, anytime you get a diagnosis that's new, especially if it's something major. It can be a really scary time in your life and I think it's important that you feel very comfortable with the physician you're working with. You feel comfortable with the recommendations you're being given, and that's gonna vary from person to person. Some people need to hear similar recommendations from multiple people and some people immediately feel comfortable with their doctor and feel comfortable moving forward with the plan that's put in place. So I think it's very variable person to person. I also think to some extent you have to rely on your doctor. Your doctor will know this is something that I can take care of or this is something where you need to go to a specialty center. This is something rare and unusual that needs to be directed to a hub, and when they think that it's something that you need to seek a subspecialty center or you can get your care right at home.
Speaker 1:Right. You made a couple of really important points. You know part of it is your comfort with your doctor. Do you get a sense that this is some problem that they see all the time and to the extent that sense in your gut that might say I probably don't need a second opinion. You know, one question I often ask a specialist is how often do you see this problem? Or how often do you operate on this problem? And if they say, well, a couple of years, I would say it's time to start shopping. If it's I see this all the time and you feel good that this is a person you can interact with, I would say you may not need a second opinion.
Speaker 1:Now we did exactly that. We felt completely comfortable with you, both Gail and I you both Gail and I and for us time was of the essence, because she had advanced cancer and waiting a couple of weeks to get a specialty visit and then getting on that person's schedule, it might've been four or eight weeks before we had an operation and we weren't willing to take the risks that things could have spread during that time. So we chose not to get a second opinion. Now, if there's a recurrence and we're looking for a clinical trial. Okay, maybe then we'll get a second opinion, but I think for now we're great. Okay, so somebody decides they really want a second opinion. How do you decide whether it's just good enough to get the doctor down the street or do I need to go to the Mecca, whether it's MD Anderson for cancer or Hopkins for some rare disorder? How do you make that decision?
Speaker 2:I think you ask your doctor. You know, if you ask me, if you said to me I want to get a second opinion, I want to see if there's any other options out there, then I can tell you, based on what's going on with you medically. If you put 100 of me in front of you, we're all going to tell you the same thing. Then you go to the doctor next door and if there's something you're seeking in particular from that person a different personality, you know are you getting a second opinion to confirm the information you're being given or it's not a good match? You and the physician that you're meeting with that can determine who would be the best person to see if you want a second opinion. Also, I can tell you okay, this is really rare and they have trials a good program in sarcoma at this location or a good program in some very niche, rare disease type at any place, and that could be anywhere in the country, depending on what's going on with you medically.
Speaker 1:So let's shift gears. One of the critical pieces of navigating a serious illness is having a quarterback, somebody who kind of oversees all aspects of your care. A worst case scenario in some respects might be breast cancer. Your primary care doctor or the gynecologist feels a lump, or you come to them with a lump. Then you get a diagnosis, so you're off to the breast surgeon to remove the lump and look at lymph nodes and then you're going to get referred to an oncologist and then likely not likely, but depending upon the diagnosis you may need radiation therapy. That's yet another doctor. You might end up with breast reconstruction. So now you're visiting with the plastic surgeon.
Speaker 1:It seems scary not to have one person I mean Gail, if you have to have a cancer, you know a gynecologic cancer in some respects is better from a coroner's standpoint because you, you are everything you are. You were the surgeon, you did the big surgery, you're doing the chemo and the immunotherapy, you're, you know, overseeing the radiation therapy and you're going to be seeing her for the next bunch of years, hopefully next bunch of decades. But for so many other illnesses it doesn't naturally fit into one quarterback. Any guidance for folks.
Speaker 2:Right. I think this is incredibly challenging and it's definitely one of the reasons that I love gynecologic oncology and I'm happy to be in this field, because you really take ownership of the entire situation from the very beginning. So it is difficult. We're unique in gynecologic oncology that we do the surgery, that we do the chemo and that we do the surveillance over time. And there are other cancers or other disease processes where you're going to involve multiple subspecialties.
Speaker 2:You mentioned breast cancer. So typically for breast cancer the medical oncologist would be the quarterback and it depends on the disease process. But the breast cancer, typically again the medical oncologist makes the plan. And breast cancer, typically again the medical oncologist makes the plan and they'll tell you based on a whole it's very complex these days, but a whole bunch of different factors Do you start with a surgery, do you start with chemo, do you need radiation, do you need an oral, and they'll guide you step by step and then afterwards they'll tell you who's going to be the one monitoring you over time. All cancers. They're going to follow you over time until you're five years cancer-free and the medical oncologist would take the role of the quarterback.
Speaker 1:What about your PCP, your primary care doctor? Is there a role in these serious illnesses for them to be the quarterback, or is it such a unique set of knowledge skills that it would be hard?
Speaker 2:oncologist, but the PCP still has a really important role because even when you have cancer, you might have high blood pressure or heart failure or diabetes or any of a number of other medical problems, or you can get sick just like anyone else. You can get a cold or the flu or an upper respiratory tract infection or pneumonia, and so then your primary care physician is going to work hand in hand with your oncologist. If it's related to immunosuppression from therapy or something that is either directly related to cancer or the therapies being given for cancer, then your oncologist is going to play an active role. But if it's something unrelated, then your primary care physician is going to play an active role. And I actually think you know having all of the other medical problems that any one person has in good control is incredibly helpful in terms of how well people do and how healthy they are through treatment and recovery in their life.
Speaker 1:The next topic is sort of near and dear to my heart and kind of the backbone of this podcast, as my listeners will know. You know, where is there evidence, where is there not? How can we make sure that we're doing stuff that actually works? This happens to all of us. You know we hear something on the radio and a new way to lose weight or a new way to, you know, feel stronger after the gym, and you know we're chasing after that shiny object.
Speaker 1:This gets magnified when people get a diagnosis that's life-threatening, it's cancer, it's, you know, end-stage kidney disease, and they feel emotionally out of control that this is a disease that's happened to them. They can't control it, and so they grasp for something that they can control. I think it's just very natural. We want agency, we want to be able to do something. If I do this, I'm going to beat this disease. You know fill in the blanks what the disease is, so it's totally understandable.
Speaker 1:The problem is, is that by talking to friends and reading articles and going on the internet, you know you're going to hear about oh, this special diet gets rid of the cancer and people live so much longer, or you need these supplements to support this disease you've got? Or how about these you know IV vitamins that you see driving down the street at these storefront places, or hyperbaric oxygen, you know, and people are grasping for something to give them a sense that I can do this, I will get better, but in most of certainly the cases I just mentioned, you know, there's no evidence to support them. How do patients I'm sure this happens all the time, I mean it happened with Gail and we came to you and got some guidance how do you counsel people? You know what to read, what not to read, and then how do they separate the hype from you? Know something to read, what not to read? And then how do they separate the hype from you? Know something that might actually help?
Speaker 2:I think this is a challenge and I think it's very common. I think people around you love you and care about you, and so you're going to get all kinds of advice from family and friends. And then between AI and the internet and there's this constant feed of information, and what will actually be helpful and what won't is difficult to navigate. It's very difficult to navigate. I think that, essentially, when you want to incorporate other complementary medicine or care into your cancer care, it's important to talk directly with your doctor. As open as your communication can be, I think, the more successful it's going to be for you. And there are times that holistic complementary medicines are very helpful and there are times they can actually be detrimental. So there are times that supplements, for instance, be detrimental. So there are times that supplements, for instance, can impact metabolism pathways and keep chemo in your system longer or flush it out faster, and it can actually impact your cancer care negatively, even though you're trying to help yourself. So some of these high-dose vitamin supplements can actually be incredibly detrimental. So it's important that you let your doctor know.
Speaker 2:I want to give this a try. This is what I read. What do you think and see where to go from there and rely on your doctor to give you guidance. On the other hand, some of the toxicities from treatment and that sort of thing. You can get tremendous benefit from massage, acupuncture, hyperbaric oxygen can impact wound healing. There are times that these other care can be beneficial and you really have to take it kind of a step at a time. It's an individual plan that unfolds. Same thing with complementary and alternative medicine. You have to have a really honest discussion with your physician about what will and will not be helpful in your care.
Speaker 1:That makes a lot of sense. So we're not going to dive into this topic too much because I'm going to make it a topic for a whole nother episode. But it's the issue of the power of positive thinking. You know, when people say I will pray for you, or you have such a strong spirit, I know you're going to, you know, win this battle, and I want to explore what's the evidence to support it or not support it. Do you have any just sort of off-the-cuff thoughts about this?
Speaker 2:Definitely. I think that your journey is not just that a physical medical, it's not just a plug and play. That is not how health works at all. I think your mental, emotional, physical well-being all plays into your journey. And I think positive thinking, I think minimizing your stress, I think general self-care, good sleep, eating well, having a good support system all of these things play into your outcome. We know some things directly, like cortisol levels, is detrimental, but overall, I think that it's not so simple. As you have this, you do this, everything will be better. It's definitely more complex than that and the mental and emotional component is huge. There's tremendous resources for that too. There are social workers. There are tons of systems in place to help with your entire journey. But positive thinking, I think it's huge. I think it's absolutely huge.
Speaker 1:Well, this is a great tip off to the next episode that will be coming down. Dr Ashed, thanks so much for joining me today and for being Gail's quarterback on her cancer journey.
Speaker 2:Thank you so much for having me. I care very deeply for your wife and I'm happy that she's doing well. It's good to talk.
Speaker 1:Wonderful, thank you, my discussion with Dr Ashed. We discussed several of the eight topics when to consider a second opinion and who to see, finding a quarterback to oversee all aspects of your care, the role of your primary care doctor and the desire for agency to do something, which can lead to believing in treatments that don't really have evidence to support them. But there are a few more of these topics I want to go through with you. First, number one make sure you have the right diagnosis. Make sure that you know is it really MS or Parkinson's, or what specific subtype of cancer it might be, type of cancer it might be. Ask your doctor how certain are you of the diagnosis? Ask could additional testing help us understand what's going on? Without the right diagnosis, the therapy may not be appropriate for you and, depending upon the answers to those questions, you may feel certainty. You may feel like you're on the right path. But if you're feeling uncertain, that may be a time for a second opinion. Lesson thought number two ask lots of questions of your doctor. Don't be shy. I might suggest you write down the questions in advance and bring a listener with you, because sometimes, when you are facing an illness, it's hard to listen and retain that information. So bring a spouse, bring a friend, bring somebody that can be there and take notes and listen. Ask your doctor what's my prognosis? Not just the average, what does the average person experience? But what about the tail of the curve? What is the long-term possible survival with this diagnosis? So it's not just the average you might be interested in, but how many people do? Extremely well, clearly. What are my treatment options? What are the risks of each one of them, the benefits, the costs? Here's an interesting one. Are we going for a cure? Is this a disease we can cure, or is it a disease we're just going to palliate? That's very helpful for you to know, emotionally and from an educational and intellectual standpoint. Are there clinical trials to consider Now? If the therapy is pretty routine and understood, maybe not now, but if there's a relapse or things aren't going well, then maybe. Then it's a time to consider a clinical trial. And with all these questions you may run out of time. The doctor may be just too busy, so ask to have another appointment, perhaps even a telehealth appointment.
Speaker 1:Lesson number three anticipate a roller coaster of emotions. Be resilient, if possible. As the saying goes, it's a marathon, not a sprint. We thought initially with the ultrasound that Gail had something that was confined to her uterus, but then the MRI showed it was way beyond the uterus. And then when surgery happened, we weren't sure if surgery could even remove the cancer. Turned out surgery was very successful in doing that. Her lung CT showed nodules. We thought these were just old things and not related to the cancer. But with chemotherapy they got smaller and so what was a stage 3 cancer became a stage four cancer. So anticipate that the journey ahead of you will have twists and turns. Anticipate that roller coaster.
Speaker 1:Fourth, find where you can have agency, where you feel like you have something you can do. That would be proactive and put you in a sense of control, because it is very natural to feel out of control that the disease is happening to you. So for many illnesses and for many people, exercise can have a role. Nutrition might have an important role. Exercise can have a role. Nutrition might have an important role. Really interesting study that looked at patients with colon cancer that were in remission.
Speaker 1:They had had adjuvant therapy and they were doing really well. And they asked the question if you exercise, will you have a greater survival, greater likelihood that the cancer won't come back? There were about 900 people in the study, so it was quite a bit, and one half got a structured exercise program, one half did not. They just got some health education sessions. They followed them for about eight years and what they found is the people who exercised had a 28% better likelihood of not having a recurrence. That's really a big deal. Now, will it happen for other diseases? We don't know, but at least here's one where people were able to do something and change the trajectory of their illness. But, as I discussed with Dr Hachette, in a goal of trying to take control, to be proactive, there will be many things you will run across on the internet and social media and hearing from friends that may sound remarkable claims to cure your disease but, frankly, may not have any evidence to support them. Gail ran across a video that talked about cancer and how you can't have any sugar because sugar feeds the cancer. As I am a doctor and have a health background, I could walk her through this show, her other research and made her understand that wasn't really a fear that she should have.
Speaker 1:Number five create a support system. You may not have the strength emotionally or physically to do it yourself, so have other people prepare it for you. But there are multiple layers of a support system. It isn't just one aspect of what you might need. On the medical side, a close friend of mine was diagnosed with kidney cancer and he's a lawyer. But as soon as he heard the diagnosis, his ability to focus and make decisions really pretty much shut down. So for him, his adult daughter stepped in, found places for therapy, found him a clinical trial. That was just right for him and he's doing really, really well. So you may need a support system to help you with some of the medical issues. Clearly, on the emotional side, it's critically important to have a support system For Gail. I hope I am her rock. I'm also her medical guide, but I hope I am her rock. Get as many emotional support folks in your corner as possible.
Speaker 1:Third, this is not something I was trained to think about and that's the spiritual side. The help you might need Now. It isn't just prayer. It isn't prayer that others might do, it isn't prayer that you might do. That, of course, could be very important for you. But there's another spiritual side. Our daughter, rachel, realized that Gail was going to undergo a large surgery. Her uterus and ovaries and everything would be removed and it would be a really big deal and a deal that could be frightening and sadness provoking. Rachel came up with this idea, which was extraordinary to do a ceremony with her female friends and relatives to thank her uterus. She was going to lose her uterus, but that uterus had provided multiple babies and had served her so well in her life. So Rachel helped Gail turn what was a sad and scary surgery into something that at least had a component of gratitude connected to it.
Speaker 1:Gail, before each chemotherapy round, has had a telehealth with a woman who underwent treatment for ovarian cancer many years ago, is doing well and counsels folks. So there's a blessing, there's general guidance, so that's a whole side of care that you might not have thought about. I certainly hadn't thought about it. And of course, there's the educational side. There are many patient support organizations by disease and they can give you lots of information about the illness and it's also, of course, emotional support.
Speaker 1:And, lastly, prepare for the costs. The costs can be high. They can be hopefully not so high for you. Gail is on Medicare and she has a Medigap plan. But we received a bill when she had her surgery and that was outpatient surgery and it was $189,000 for the outpatient surgery. And she's on this new immunotherapy and it's $12,000 every three weeks immunotherapy and it's $12,000 every three weeks. So in our case we were very fortunate that Medicare and the Medigap policy pretty much paid for everything so far and likely will continue to do so. So our out-of-pocket expenses may be very, very little.
Speaker 1:But try to find out so you're not surprised. And it adds another stress level. Sometimes it's hard to know exactly what it will cost for cancer in a cancer center. There often are people that will walk you through that. They will have checked with your insurance company and give you a pretty good sense of it. Do ask the question, do try to understand sense of it. Do ask the question, do try to understand. You may have deductibles, you may have co-pays. Hopefully you have an out-of-pocket maximum so at some point you will be protected from additional costs. So keep that in mind.
Speaker 1:Well, it's time to summarize you or a loved one may develop a serious illness and the fear, the uncertainty and many other emotions are truly to be expected. I've walked through eight steps or issues that can help you feel at least a bit more in control and be more of the navigator of your own illness, and I hope you found this useful. Please let me know, please share the podcast with others and, as I mentioned on a previous podcast, I'm going to be doing a free live workshop on October 2nd at 6 pm Central, and it's really, how do we take all the things that I've talked about, things that will improve your health and wellness but not turn it into a full-time job how to practically figure out what to focus on, perhaps what not to worry about? Please go to my website, drbobbilivelongandwellcom, and you can sign up. Sign up for the newsletter, which will also give you more information.
Speaker 1:As always, I hope you live long and well with the knowledge that if something bad does happen to you or a loved one, you have a few new tools to help you. To help you. Newsletter on practical and scientific ways to improve your health and longevity. Please visit me at drbobbilivelongandwellcom. That's, doctor, as in D-R Bobby. Live long and wellcom.