foreign [Music] thank you for taking time from your busy day to watch this special presentation from the El Paso County Medical Society I'm Dr Joel Hendricks president of the El Paso County Medical Society and it is my hope that you will find our program of great interest educational and informative about the medical care provided by some of our best physicians in our country right here in the Borderland from all of us at the El Paso County Medical Society please enjoy tonight's program [Music] thank you many of us or our friends or our family have heard the words you have cancer it's always a shock and then you think now what wouldn't it be nice if someone took your hand and showed you where to go what to do who to talk to and most importantly what questions to ask scientific advances are revolutionizing the approach to cancer treatment leading to a very specialized medical care for each individual and we have experts talking about personal Cancer Care and more importantly navigation what do you do once you hear those words where do you go and how do you figure out what to do this evenings program is underwritten by tenet the hospitals of Providence and a big thank you to the El Paso County Medical Society and all the doctors who have been bringing the show to you for over 26 years I'm Catherine Berg and you're tuned into the El Paso position [Music] thank you [Music] thanks for joining us today we're going to be talking about cancer navigation in the El Paso region what does that mean navigating for patients is a very difficult thing to do again if you've been diagnosed with cancer you kind of don't hear anything else for a while when the doctor talks to you and so you go back home and then you start assessing what is it that I do so with us this evening we have Dr Raul Loya who is a radiologist and then we have Dr Robert prioto who is an oncologist and he is the class clown of the group he Giggles but if you were here about 20 minutes ago you'd understand why and throughout the show hope we'll have a little bit of fun with this and then we have Claudia Sanchez who is a nurse who is the patient Navigator and we're going to learn all kinds of stuff from you um if you could Dr Loya explain to us what it is that you do all day every day there's a radiation oncologist there's a radiologist there are differences in these words but a lot of people get them mixed up it's kind of like if you have an optometrist and you have an ophthalmologist it's like well they're kind of the same thing right so if you can explain what you do and that way it's kind of easier for the audience to kind of wrap their hands about what we're going to be talking about this evening of course yes so as a radiologist throughout my shift I interpret every study that comes in the hospital that doesn't uh necessarily mean every studies and oncology study I interpret studies from the ER I interpret studies that are follow-up oncology studies cancer studies I interpret all sorts of things but my specialty within Radiology for example is body radiology and so I try to focus on uh studies that are targeted towards abdomen and pelvis and within those we have a lot of oncology follow-ups and it's very important for me to give the information to uh referring providers such as Dr Prieto about how the the cancer may be progressing in a patient or how uh cancer is uh responding to treatment so we take that very seriously we always compare studies and we try to give the best information possible to our oncologists I love that you said we compare studies I always think that's so important and so really when you're talking about the abdomen and pelvis this is organs you specialize in organs and trying to read the different cancers or growth on organs so I appreciate your explanation on that uh Dr Prieto when you're talking about you're an oncologist that's also a loaded word right you deal with so many things um and some people like to call the discipline Hematology Oncology Etc but when you're looking at your specialty as an oncologist do you have something that you kind of Bear Down on or is it all oncology so there's different uh fields in oncology um some oncologists specialize in in one or two uh specialty fields and they become experts at that usually in big Cancer Centers uh say like MD Anderson in our UT Southwestern they have oncologists that specialize say in in breast care or lung cancer or Urology Oncology here in El Paso what we have primarily are General Medical oncologist Community Based medical oncologist most of us are also trained in hematology because there's a good overlap in both Fields both from hematology to oncology um and so explain what hematology is hematology is a study of blood and the overlap between hematology and oncology is the fact that there's a good amount of hematology whereby cancer arises leukemius lymphomas those are all considered hematology based hypocancers we call them fluid Cancers and then we have the other side which is the medical oncology and it's the solid organ disease process of cancer there we find Lung cancers pancreatic cancers breast cancers cancers of a hedonic region brain tumors brain cancers um kidney cancer is liver cancer so basically anything that is a solid organ that develops cancer okay okay and I and I asked the question about hematology because I feel like there is and I know we're not going to focus on that today but there are so many more tests now that do involve a blood test to see what it is that we may or may not have very beginning stages there's also uh genetic testing Etc I know we're not going to focus on it but that's always a question that people have so we'll talk a little bit about that okay excellent uh Claudia this is your show because this is all about patient navigation when you started this specialty um what is it exactly that that you do and that that's the question what do you do all day every day right um but really your relationship with patients and I think also your relationship with the family members too right the patients have questions and the family members sometimes are the ones that ask the other questions because a patient sometimes are still in shock so if you kind of explain what it is that that your role is I'm glad you brought up the family in this because um when someone is diagnosed with cancer it affects the entire family and so my job is to make sure that the patient understands what they have okay and also for the family to understand what is it that's what's going to happen from here on out okay they have decisions to make okay and we're there to to provide that those kinds of answers to them we're here to explain to them treatment options so that they can make an informed decision as to what it is that they're going to do there's a lot of different treatment options available for some cancers not all of them you know some are very straightforward you know they just need one thing but um it involves other things that happen you know there's symptoms or side effects that occur with treatments and so we're here to provide education about that and how are we going to manage those symptoms how are we going to manage the side effects when do we have to call the the doctor when do we go to the emergency room um you know things that um and and not just the physical we're looking at the social aspects so we're trying to break down barriers so there's individuals that maybe they don't need anything at all from us you know they're good sometimes you know we explain things to them and they're like okay and then that's it they don't really need anything from us you know we call them how are you doing and everything's fine but then there are some other individuals that they don't know how to make a decision because they don't understand what is being offered to them okay they don't understand the the process or sometimes they delay things because they don't have transportation to their treatment you know they they don't they don't uh maybe they they're they don't get scheduled for something and they just kind of like well you know I didn't get that scheduled so were they or this or they schedule it way far out and it can be done it needs to be done immediately and so as a navigator that's our job to let them know like no no we can do this sooner let me get help for you let me um you know break those barriers so that you can get your treatment in a timely manner so that you'll have a better outcome at the end of the day that makes all the sense in the world it can be overwhelming it is overwhelming not can be it really is overwhelming and then there's that whole idea that analysis what is it paralysis by analysis it's like there's so many options sometimes that you don't know where to go and you think well tomorrow make that decision then tomorrow turns into next week etc etc um you know one one thing that Claudia said that is so important um is the informed decision informed decision and informed decision making that many people because of the word cancer just get paralysis you say and then they're not sure um the information that they're hearing how much of that they have to act on right and many patients end up basically uh following a course of plan simply because the doctor said so without understanding ramifications without questioning many times so informed decision making is terribly important I think that's one of the things where our Navigator can really come in to hand hold that patient that family and explain that there are options um I mean not too long ago last week actually I had a patient in my clinic with a pancreatic cancer and I was planning all sorts of different studies to get them staged planning referrals to surgeons radiation and the patient basically stops me on track and tells me I don't want any treatment oh my goodness and I said this is still curable disease he says I don't want any treatment he says uh my medical problems um why I'm in life he says uh I just don't want any of that so I had to go through a pretty lengthy explanation of what his uh Choice was at that point or what his desire was um and um her family was present and so we had a very very lengthy conversation about the pros and cons of his choice and then the pros and cons of following an aggressive treatment course right um what he was giving up um by uh not doing what I was recommending um was age and factor in that situation so he's uh he was in he was younger actually okay so he was not uh like an older older person um still solid immediately where my head goes if you're you know 70 80 90 it's like uh that's right um and and part of the reason that I felt so um apprehensive and just sitting and saying okay well you don't want anything that's let you go was the fact that his age was still um uh very reasonable um where where he could proceed with treatments and tolerate them where there was still projection of significant lifespan ahead where he would derive benefits from the therapies at the end of the day at the end of the conversation basically he still said You know I hear you I understand you he says and I still am holding to what I told you um and I said you know I mean I think you understood the conversation well enough I think I feel comfortable that you understand the consequences of your decision and then the uh the different choices that I've discussed with you and so I have to respect um your choice at this point because you have autonomy and I have to respect that autonomy right right I mean informed decision making and and that's what I basically ended up documenting in my note I mean after a linked discussion um the patient uh uh through informed decision making decided to forego any aggressive treatments very sad from my perspective as a doctor okay because you want to intervene um have a very positive effect in a person's life hopefully something that results in a cure and in this particular case um you have to allow that person to exercise their their free choice right yeah your whole goal is to help people and for the lack of a better word fix them cure them absolutely possible I can imagine doctors we'd like to do that okay surgeons especially like to do that yeah Dr Laurie's like yes um I have a question that that kind of is going to lead into almost everything else that we're talking about and I know we we sort of try to figure out how to ask this question before the program started but the status of oncology services in El Paso now and I I would love for the audience to know where we are now compared to a decade ago two decades ago um years ago and I'm going to say two decades ago was depending on the cancer and Claudia you you had a perfect way of describing it some cancers are you know this is what you have this is what we need do and boom a lot of them are very clear a lot of them are not um and so people would leave town to find different options of treatment so and I'm going to throw that to any of one who wants to take that on uh Dr Laurie I think that you immediately chimed in earlier but the services that we have in El Paso when I say Services the treatment options the doctors the different facilities that we have where are we now in 2023 when it comes to that yeah no at Providence we have uh two women's centers that focus on diagnosing women diseases in particular breast cancer and so uh we have the most up-to-date technology we provide 3D breast Imaging and at the same time uh if we localize something that is suspicious to us for example calcifications oh that's me yes going to your clinic and that's what they found out and boom boom boom so we provided uh 3D guided uh Imaging uh with with a biopsy so that's very stereotactic biopsy with Community goodness gracious yeah and even uh in our Joe Battle facility we have it so that we receive and we view the specimen right away real time real time really while you're there so before so I had that done over a decade ago so that's nice but perhaps we had to take 12 cores right now uh say the patient is at higher risk of bleeding and in our first two course we see that we have what we needed then we can stop there nice okay and so that's something that um stereotactic biopsies is something if you can explain what that is too because your radio radiologist um you have you're basically in a mammogram yes real time as the biopsy is being done because that's how you can see where you need to go to explain that to the audience because I think people don't understand that they think okay how how is a biopsy guided how do you know exactly where to go um and I think it's fascinating what people don't know no very important you bring up a great point then I'll take a step back okay so in mammograms a lot of what we're trying to look for is very very early stages of cancer and that's why we do the screening and we take a look at calcification some of the calcifications are have a benign morphology but some have a suspicious morphology and so we do the mammogram and then the calcifications we would not be able to see them on ultrasound bingo so we have to do a biopsy that uh that in which we are able to see what we're targeting and that's where the stereotactic got it biopsy a mammogram got a biopsy comes in we're able to see the calcifications and Target them with our stereotactic guidance um so we have a mammogram guided biopsy in which we're taking out a par a portion of the calcifications okay um so let's switch switch body parts now so let's talk about prostate of course biopsies uh because that's a smaller group I mean you're looking at a prostate the size of a walnut if that's still appropriate um so when you're doing biopsies of a prostate because again it's a small organ and then biopsies in general how how is that done yeah so that that also we have Advanced Imaging here uh you know Paso as well so it used to be that that urologist would do a lot of the biopsies and some would be multiple biopsies in every part of the prostate gland now we have uh specifically at Sierra Providence we have an MRI a 3T MRI in which we can take a look at the prostate in specific and we can localize at least a suspicious lesion and then diural just can specifically specifically Target that region nice for for higher yield right oh I like that higher yeah and Claudia this kind of comes uh to your questioning too now so we talked at the beginning of the program that okay you have cancer that is something that now the biopsies have been taking now that there is a diagnosis what are the most common cancers that you find you need to navigate people through um and again going back to there's some that are cut and dry and there's some that are not so just in your practice in your years of doing this which cancers are the ones that are like oh there are a lot of different options I don't know how to go through this what type of cancers are those usually well um breast is still a big one okay okay um because their treatment is long sometimes okay and again there's a lot of different faces and and um you know issues that come up um there's there are the GYN cancers so ovarian cancer deodorant cancers all of those um they also sometimes they have to have radiation and some of them have to have chemotherapy surgery so there's a lot of steps you know to try and get that person to be cured right okay um colon cancer you know is another one because and all of these cancers you have to also think about um what it does to the body image okay right so sometimes with colon cancer if the patient needs a colostomy you know um you know that's explain what a colostomy is for those that don't know yes that's that's just a pouch that comes out you know through the stomach okay where you collect the the stool okay and sometimes that's temporary and sometimes it can be permanent okay but it is something that the the patient has to deal with now you know right um and it's body image you know there's a lot of things that come along with it you know maybe they have to change their diet you know there's so there's a lot of Education that goes along with that okay and then not only that but sometimes they all still need chemotherapy or radiation or you know so um those are probably some of the most difficult head and neck cancers as well oh yeah okay right again a lot of a lot of these cancers where you know we have we're dealing with body image issues and um you know there's a change in their status or maybe the patient can no longer work so you know there's now there's Financial exactly issues needs its own Navigator right you know there are so many questions on that um yeah or 50. yes you know and that's one of those because I know this is a medical program and a lot of doctors and I'm glad that you say that a lot of doctors like oh that let me let me focus on the medical stuff absolutely but that's part of a true reality and where a navigator would come in because there are times like well is this less expensive and is this not expensive you know and it kind of goes through that um I'd like to talk a little bit about staging so when you hear the words you have can answer and sometimes you have the stage and sometimes you don't and so and you can kind of bounce back and forth radiologist doctor um so when you're looking at breast cancer and you had a great Point sometimes you know if it's very localized it's stage one but let's talk about there are so many different Cancers and they're all staged differently like a stage two breast cancer is very different than a stage two like pancreatic cancer or lung cancer Etc how is that done and I'm kind of looking at you Dr pieto I'm going to have you start but as the person who kind of figures out the staging and imaging how how do you find out what the stages are and what do they mean and so what they mean that's a beautiful question because I quiz residents on this all the time oh look at you good job so um staging is basically uh the evaluation that goes when a person gets diagnosed with cancer to determine how far extend extensive vet can that cancer has invaded the body or how much it is spread in the body because it relates directly with prognosis on the patient and all the different sites they're different staging criteria um what we try to accomplish with the staging is that there is a certain survivability uh associated with each stage that one can say for stage one breast cancer we are going to see very similar survival patterns uh as with a stage one calling cancer but the staging evaluation may be a little bit different okay um because of the different organ side the different parameters that go into the staging criteria now the staging itself is basically a joint effort that is Nationwide now International as a matter of fact so a stage one or stage two breast cancer here in the U.S here in El Paso is defined the same way say in Mexico it was staged differently before so um years years before decades before um there were there were more it was more Regional more National interesting okay okay um good 40 years ago the international commission encantor okay got together and uh along with the American Joint Commission on cancer devised uh strategy to basically have a more uniform way of stage encounters that has meaning okay and the meaning is basically which are salvageable cancers and which are Cancers that are too far spread for cure so it relates to um the prognosis that that is associated with the disease which then basically uh translates to the treatment strategy that we're going to follow okay I mean um and that's where you come back in too that's where she navigation and that's where Dr Loya comes in also okay because uh as an oncologist I get the pathology report saying that this person has a tumor um in the lung that has a cancer adenocarcinoma and I say well I can see the chest x-ray with a tumor that is this size but has it already spread into the lymph nodes in the mid-test area has it gone beyond that um and so that's where I recruit the help from my buddy here uh to get me CT scans maybe even something as our modern nowadays is a pet scan okay and I mean all those Technologies are available here in El Paso okay so people can get basically what is the standard of care uh Nationwide here in El Paso in that regard exactly and Dr Laura I'm going to bring that to you too so we're talking about the different scans you've got the mri's got the pet scans we talked already about mammography a little bit about ultrasounds but in general and I know I'd like to get to lung cancer screening too because that's for me that's relatively new but in your world of all of these imagings um and again as a navigator what do people know to ask for or do they simply come to you and say just figure out what you need to do um do they know what tests to ask for or is that just something that's that's automatic when they come see you so the the most widespread used it would be CT okay and then uh combine that with petiti and one of the most important jobs that we have as Radiologists is to describe what we see and describe it well so that's what to do exactly so that he knows um what staging the patient is on for example he was talking about a pancreatic cancer patient and is he treatable well my job is to tell him is a tumor confined to the pancreas only or is that tumor already touching the vessels nearby that's very important to him that's one of my of the most important jobs I have that's staging um and then yes he would order for um for a brother staging CT chest to see if that cancer has gone to the lungs or I can see uh down in the pelvis if that cancer has gone there or to deliver examples like that that's a lot of pressure I mean really I mean if you're looking it's like oh um I have a lymph node questions I feel like with so many cancers lymph nodes are taken and uh either biopsied or somehow to see if there's some kind of a diagnosis as spreading and that's something that's always been interesting to me so if you have some kind of a breast cancer your diagnosis for example there's a sentinel Sentinel node right The Sentinel node and then other lymph nodes Explain how and why lymph nodes are also taken with certain types of cancers to check them out yes of course so like for your example you have a breast cancer a breast Mass the path to with in which the the cancer is going to spread is through our lymphatic system and the closest to chains are the axilla and a chain we have here in the mid chest internal memory a chain so there's a chain there's chains of lymph nodes correct okay and I bring that up because that it helps explain the Sentinel no it's a nice way to graphically look at it so so the the first lymph node in that chain closest to the tumor is our Sentinel lymph node okay so um the way a surgeon would be able to localize it and remove it remove that first one to see if that one is involved is uh we inject radio Tracer at least in the in the breast and the radio Tracer goes to that first lymph node and the surgeon is able to use a radar localized where the Tracer is and remove it and he's able to see if that lymph node is involved so here's my curiosity too and you say the lymph node is or isn't involved I'm and again pardon my ignorance on this is there a a mass in that lymph node is there how do you how can you say is there a chemical reaction in there is it you send a fluid in there and it turns bright whatever how do you know if a lymph node is involved very important two most important things for lymph nodes are size okay morphology the formula the form of it okay if a lymph node is less than one centimeter in short axis in its width we we assume it's not involved unless the morphology has changed okay uh lymph node has fat in the middle fatty Hyland like a normal lymph node like you and me have has right in the middle okay the the lymph node that that may have cancer loses that fatty hyalum becomes round and it's all it becomes like dark it's no longer fat in the middle and if we see that either bigger than one centimeter okay or if it lost its normal morphology then we report to Dr Prieto hey we're concerned this is suspicious of of cancer involvement in the in this lymph node okay very nicely explained actually um and in general Dr Pedro I'm going to ask this of you how many lymph nodes are usually taken so when you're talking about this chain and I know there's an underarm lymph nodes there's one in the middle of the chest there's groin lymph nodes um how many lymph nodes are usually taken does that depend on what the original staging may have been or does that also helped stage the cancer that helps stage the cancer as a matter of fact that's the pathologic staging procedures that we carry out um let's take for instance the breast again okay and so um we have the tumor the surgeon goes in to remove that tumor injects that radio Tracer die follows the uh the the course of how that Tracer moves through the lymphatic vessels into the lymphatic chain um sees basically with it with a radio Tracer that one or two or three of those lymph nodes take that uh dye or that material he extracts those he actually plucks those lymph nodes out symptom for pathology analysis and it's a pathologist who tells us if that lymph node or those lymph nodes are involved um uh by the cancer cells okay okay and so um so we have the the appearance maybe before surgery that there's already abnormal features to those lymph nodes that we already suspect we can say very likely those are affect it but we need in most cases the pathologist to tell us that yes in fact they are affected at that point we have pathologic confirmation that that lymph node is affected and then we can basically tell the patient with certainty that their breast tumor has this lymph node or these many lymph suspected the surgeon when they do surgery they explore basically the chain or the region to feel for lymph nodes that may be enlarged right okay it's usually a physical exam and um if they feel bulkiness in those lymph nodes uh or the texture of the lymph node is in durated then they basically say these are suspicious lymph nodes we take them out right um depending on the on the body part also okay I mean there are what we call Regional lymph nodes that come all kind of in a cluster together okay chain so to speak the chain exactly right you just strip that out um in a different um organ say for instance a colon the colon is divided into sections and when they remove the section of colon has the tumor in question right they remove that whole wedge that comes with it and all the lymph nodes that come in that tissue become the candidate lymph nodes so I should have asked this first so I'm going to back myself up for a little bit so to explain what the lymphatic system does for us and when we take all these lymph nodes out is there you know is there an issue with that are there any problems with that so on this note because lymph nodes are so involved what does the lymphatic system do I mean again they're they're everywhere and I always think of draining they're they're in charge of draining um so explain it the way you'd like to explain it yes and so the the lymphatic system in the body is basically uh primarily responsible for maintaining homeostasis from immune um from from uh insults to the body so it's in the immune system basically and it's there uh to capture anything that is uh deranged in terms of how the body is functioning deranged I like your wordings yes it's an insult and it's deranging no but it but it makes sense because again we talk about it all the time but we don't talk about the function of them absolutely you know and so the sir uh the the lymphatic vessels along with the lymph nodes okay uh take care of draining all sorts of fluids and rebalancing fluids in the body as well but in that process also uh it recognizes what is for and what it does not belong there be it an infection okay or a cancer um or maybe even perhaps becoming a dysfunctional immune system okay whereby the immune system starts attacking the body for whatever reason and you start having these uh lymphatic areas getting inflamed enlarged okay in most normal cases the lymphatic system is there to guard what is happening in the body altogether right right um when a cancer shows up obviously uh the immune system recognizes that as something foreign something very uh offensive and starts to try and mount a reaction against it um initially it may be right at the local level where the tumor is arising okay but sometimes it's not capable of targeting things right then and there and so the cancer cells start migrating through the channels into the chains right into a lymph node to populate that lymph node Nest there um it's all communication it's all communities it's all communication in the body you know from an immune perspective um you say well you remove those lymph nodes what's going to happen well the body has amazing capabilities of regenerating and regrouping basically um from an immune perspective there's not much danger in that regard um whatever you remove chances are that in time will be reconstituted again but in some cases especially uh when surgeries extensive surgeries are done say in the groin areas or in the axilla basically where appendages meet the core of the body then you can have problems um that result thereafter especially when their surgery and radiation therapy involved whereby the lymphatic drainage reconstitution is not as effective or efficient and then you end up problems with problems of swelling of that limb okay uh condition we call lymphedema that is very very uh known especially in very common patients um and so that's where navigation comes into play also that that's a perfect transition uh to Claudia um so I was thinking too as you were speaking Because treatment happens in so many stages again there's the direct one perhaps sometimes you can do surgery everything's gone you're done um but now we're looking two of the residual effects of certain types of treatment and so Claudia I would love for you to brag about what you do brag about the hospitals of Providence brag about this program um when you start with a patient and their family and they are now going through different types of treatment let's just say case study let's pretend that somebody has had surgery they are going through chemotherapy right now then radiation is on the way but there are things that come up and even though they have you know figured out what it is what course of treatment there is now are they still able to call you during the course of their treatment and say you know what this is going on I'm not sure if this is okay what do I do how do I deal with it who do I call talk a little bit about that and navigating people through different stages of their treatments absolutely so um you know initially we do all the teaching you know the chemotherapy um but also we're we're teaching them about you know what to look out for you know so toxicities of the chemotherapy you know what to do about them um and then as well as like lymphedema okay so these are complications that can happen not not immediately sometimes it's something that they need to be on the lookout for for the rest of their lives essentially um and but we we reassure them and we tell them that the first sign that you see this you know you need to let me know you need to let your doctor know and then you know because there are there are things that you can do about it you know your doctor will refer you to the therapist you know there's uh occupational therapists that can help with with the lymphedema treatments um other things like if you're having nausea vomiting you know because of your chemotherapy you know what is it that we're going to do we're going to help you with nutrition evaluations that's also important these are all considered rehab rehabilitative and supportive services that that uh that we are able to provide okay and that we are able to guide them and to to say you know what you're having this issue you know there's something we can do about it you don't have to live like this you know there is something that we can help you with and it's part of that that education making sure that they do reach out to you or do you all proactively reach out to the patients like there is there a schedule yes well we we do both you know because there are some patients that are you know very much they call us for everything you know that's great no and you know you have to so typically um I try to follow them closely after they've had their chemotherapy especially you know their chemotherapy like I'll call them see how did they tolerate it um if they're coming to our Clinic okay because we do infusions said at the hospitals of Providence for chemotherapy so I try to meet with them while they're there and just to make sure I you know make sure they're doing okay um and and then after that if they have have completed their treatment Sometimes they come back to our clinic for poor catholicious you know these are just lines that are put in place and that's where they're receiving their chemotherapy and um sometimes those lines are not removed after they're completed their treatment they're left in place because now they're in cancer surveillance and they may stay in in that place you know for a few few years sometimes two three years sometimes it depends on the oncologist it depends on what kind of cancer they've had if it's a cancer that maybe you know there's a chance that it might come back and they might need more treatment so we we watch them and and that's where we continue the surveillance part that's where we explain to the the patient that yes you have this don't you know you need to have it cleaned out you need to have it flushed periodically because there are some patients that don't know and then they don't come back and then the cancer comes back and now we want to use it and there's we can't use that anymore okay so there's teaching that is involved about survivorship you know right what happens after you're completed your treatments um so we we do we try to to keep in touch with our patients calling them monitoring them um and of course always telling them you know if you have any questions please you know call us reach out to us um and like I said there are some patients that they're fine they don't really need us but then there so that there is someone that you can call you know and to me I'd imagine that the relationship right there is priceless when you have someone that you know well I know Claudia I've talked to her a couple of times and would you mind if I called her I think that in and of itself just the idea whether you need it or not just the idea that you're there is priceless um and I know when we talked about the beginning of the show we're talking about the beginning of okay you have cancer now what but I love hearing that there is follow through and even if a treatment lasts six months to a year that you're still around two or three years from now if something looks a little bit funny if you know however that goes um you know one of the things that uh with The Navigators okay and and Claudia is one in the team of Navigators that are available there but um many times the patient is reluctant to call the doctor the doctor's clinic or they call them they say well they never give you the message yeah absolutely that's what I'm saying the relationship exactly right and there's um basically no barrier in that regard with The Navigators they feel comfortable they feel that it's a buddy who's really there to hold them uh to to hold their back basically um and the beauty here is basically that the patient very easy to communicate with them but then there The Navigators are very easy to communicate with us the doctors um and to let us know this patient um is calling and having this problem and this is what I told them but I think you need to see them so you you are bringing up a great point and I have that as one of my questions too so there are the the patient the doctor so if the patient comes to Claudia and let's say it's something that's really shy really intimidated in general um that's where that's what is that relationship there with the patient Navigators and with the doctors in general how does that work with the oncologists with the surgeons with Radiologists Etc are you the first line that comes to the doctors at that point sometimes yes in the rah-rah of the patient so to speak representing the patient sometimes we are because again some patients I mean they live with something because they think that well you know I guess this is normal you know or they don't want to call the doctor to bother them because they're really busy you know so so that's the reason everybody want to talk to me no this is super important that we did we talk about this because I think I know people who just thought well you know it's been four months since I've had this and I don't know and then you know then honestly literally sometimes it's too late yes so talk a little bit about that that you are the conduit so to speak you are the the the in between the vehicle nice word between the patient and the doctors right so again you know we reach out to the physician you know this is what's going on with the patient and sometimes they're like okay what we need to order this or let them know this and so we relay messages back and forth in between and and not just to the oncologist sometimes the clinics you know sometimes the patient really needs another biopsy right you know so we we are there to schedule those patients and and call the scheduling department and sometimes there's issues with an insurance company right you know and and so there's been times that I've called insurance companies you know to get authorizations for certain you know procedures that need to happen ASAP and um sometimes you know it's it's no one's fault but sometimes you know like scheduling departments or other places they don't understand that this is something that's very urgent you know so and the patients they don't know to say that you know they're like okay well they gave me the appointment until a month from now I guess you know why this is it but there's other things that we can do you know can we find them uh you know can they be scheduled somewhere else um so there are things that we are able to do as Navigators because we have a lot of resources that are at our disposal I mean we can make phone calls I mean that's our job and sometimes um patients sometimes are at work you know and they can't be making all these calls so again you know I tell them please you know I can help you with certain things I can make those calls for you so that you don't have to you know you know take time off from work because you know it's taking an hour to get through an insurance company or Medicare you know and and so we're able to to help with those issues transportation is another big one you know you brought that up earlier um and that's a great Point too um years ago I worked with the American Cancer Society was there for 12 years and one of the uh the big programs that I really loved with road to recovery and we had volunteers that used to take cancer patients back and forth and again if you're doing radiation it's every day for weeks months on end sometimes um on that note and let's do talk a little bit we were talking about insurance but just let's talk a little bit about and I know it's hard on a medical show when it costs too much to do a b and c where does the Navigator come in on finding resources then for patients and I know it's a hard question and it's different but you know that is part of the reality again so you're kind of nodding too so feel free to chime in on that see that's where she gets yes so there are a lot of foundations that are available to our patients okay um it could be a different sometimes it's it's very cancer site specific so there are like for instance the the lymphoma and Leukemia Association Society um you know there's there's lots out there but again you have to be able to to know and to look for it you know and now we have internet and we can do all of this but there are some patients that they're not well versed exactly with this you know they don't have the time they don't have the energy okay because a lot of them they just don't feel good you know the treatment's not making them feel the diseases that making them feel well and it's overwhelming and it is overwhelming to say that word over and over again yeah it just it just is it is it is so we we are able to we we also have a social worker as part of our of our navigations team and so she's also a resource to us you know she understands when we don't know what does Medicare Medicaid do you know she's there to help with that um so we're very lucky in that sense that we we have we're able to move we're able to to find resources sometimes it's just locally you know there are some foundations here um so Statewide um and and all across the nation you know there there is so we are able to help some patients with that and and sometimes it takes time and sometimes we're not very successful right away because they they run out of funds but you know we're persistent so if we check again you know and uh yeah and so you know so yeah but it is tough it's really tough out there one of the things that I have to say here in El Paso uh is the I think that there's a lot of involvement with the um I think local government agencies okay um we are lucky that way we are asking I agree okay um um there are um programs in the city in the county of El Paso um that extend services for people who are either uninsured or underinsured um and as long as there are residents within the county okay those resources are available okay um and and it's all furnished basically through uh local city county state and some federal grants as well um and so for patients who get diagnosed with cancer who are uninsured or underinsured I mean the world Falls not just by by the disease itself but then how am I gonna how am I gonna Finance this or how am I going to get the care and I have insurance I don't have money I don't have a wealthy Uncle okay yeah and sometimes you don't know again you don't know what you don't know right that phrase is so specific in this situation um and that's where cloudy and her team the patient navigating team comes in to try to figure out what it is at this particular patient absolutely and I think um as Navigators say um and especially with the social worker involved there's a network within the city um that they know that if we cannot provide the care here because you're not insured okay we can always refer them to this other place okay where they can get these uh resources going um I mean I don't know if I can make mention of uh Texas Tech UMC okay make mention of it yeah okay people might be able to find helpful absolutely I mean UMC basically being the uh County Hospital and Texas Tech basically providing uh the County residents uh the support services both of them offer um programs for those who are underinsured or uninsured so that that's where those patients get referred to to continue their their cancer Journey right agree um and the social workers and Navigators in those facilities take over where our Navigators basically hand off okay they don't drop off they just hand off so that someone else can can take over and I'm going to bring this back to Dr Loya as well because again um when we're looking through treatment and there has to be I'm assuming re-imaging along the way when people are going through treatment so we're now looking at someone who is undergoing chemotherapy and now has the tumor shrunk enough for surgery I've heard that so many different times so I'd like for you to pick it up on that so we talked a lot about diagnosing in the very beginning and now take it from the radiologist who is looking at something you know you've got your your your base I guess once the tumor was a certain size and now we're three months in chemotherapy and there is more imaging talk a little bit about that because I I this is going so fast and we only have like three minutes left but I want to talk quickly about that of how you re-image and then re-diagnose during treatment very very important uh and for the community to know we have people like Claudia because follow-up is one of the most important things um sometimes we see people that get lost to follow up and maybe the tumor is now you know bigger on our right study right but yeah as as it concerns to us it's very important again to describe everything we see not only has a tumor uh shrunken or maybe grown but the characteristics of it maybe it's the same size but maybe now it's that tissue maybe it's not viable tumor anymore nice yeah that would be the Hope right correct yeah so um yeah we we do see a lot of follow-ups okay sometimes three months sometimes six months but very important to be as a team on the same page on the same page to have the priors like we had before um so yes very important for that Community to know um yes once someone's diagnosed with cancer it it meets you know the world is falling but very important to have a team like this because um they're not alone you know and and the follow-up is going to be very very important exactly and a team like this is gonna it's gonna help with that a lot well I love this team that everybody is together with here I I want to say thank you so much again for being here uh Dr Loya again radiologist the the Imaging guy uh Dr Prieto who's the oncologist and then Claudia Sanchez who is the patient Navigator who helps along with everything um if you received your uh actually I'm getting the screening I don't we have time for that but if you can get screened get screened for whatever it is it makes such a difference when you're diagnosed early staging Etc um if you just tuned in there are several places that you can watch this program once again there is pbselpasso.org there's also EPC Ms just think of the acronym of the El Paso County Medical Society they have this program on their website and then also YouTube Good Old Fashion YouTube that has been around for a while now I just YouTube dot com and if you just look up the words the El Paso physician you can find this program and several other programs as well so that's one of those places that I go to all the time to find research and figure out what's going on but a big thank you to the hospitals of Providence for doing the show for underwriting the show and as always the El Paso County Medical Society for again doing the show for over 26 years I'm Katherine Berg and this has been the El Paso physician [Music] [Music] thank you [Music] [Music] [Music] [Music] [Music] foreign [Music] [Music] foreign [Music] thank you [Music] foreign [Music]