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Caitlin Whyte (Host): Welcome to In Their Words, brought to you by the UPMC Pinnacle Foundation and UPMC in Central Pennsylvania. In this inspiring episode, we share highlights from the powerful doctor Q and A panel that concluded UPMC Memorial's Walk With Docs Event in York, Pennsylvania. After a beautiful evening of connection and community, women's cancer survivors gathered for an open, heartfelt conversation with the medical professionals who have walked beside them, literally and figuratively.

You'll hear from Doctors Mudge, Cream, Martyr, and DeRobertis, along with Lydia Flinner, Senior CRNP, And Julie Justice, CRNP, as they respond to a variety of thoughtful questions, share expert insights, and reflect on the remarkable strength and resilience of the women they serve. Let's listen in.

KimberLee Mudge, MD: I started my clinicals and my first rotation, my first night, I was on call for surgery. And it was love at first sight. And those of you that know me may know that I'm very action-driven. I don't stop that much and I'm a visual learner. So, Surgery really struck a chord with me. And for a while, I was passionate about being a general surgeon, but then contemplated Plastic Surgery.

But right about that time, there was kind of an epiphany that there really was nobody who targeted women's health issues. And every ounce of medicine, every anatomy book, everything we studied was about male physiology. And so, at the same time, it was really at the pivotal moment where general surgeons were choosing to become subspecialists. So, I paired both of those and the realization that if I was a plastic surgeon, I had to take care of drunks in the middle of the night. So, I kind of rerouted and enrolled in a fellowship program at the inception of fellowship programs. And the rest is history.

So, I came back to York because I had trained at WellSpan. At the time, it York Hospital. When I was a resident in training surgeon, women went to the operating room, underwent general anesthesia for a breast biopsy. And when they woke up, the first thing they did was feel their chest because they signed a consent that gave the surgeon the option of doing a mastectomy while they were asleep. So, biopsy to mastectomy in one setting. So, that was daunting. And right during my first year of residency, they decided a partial mastectomy with radiation was equivalent. When I started practice that year or the following year, the sentinel node biopsy became a thing. And during that time, silicone implant reconstructions came back on the table as an option. So, we started doing skin-sparing mastectomies. And now, we're doing nipple-sparing mastectomies in the right setting. And now, we're actually considering in some patient populations not worrying about sentinel node biopsies. So within my surgical lifetime, I feel like I've seen the gamut.

Sabrina Martyr, MD: In the world of Medical-Oncology, we've kind of moved towards more personalized medicine. So yes, before, we had one-size-fits-all, right? Everybody went through the same thing. And as research came along, we started realizing that even among one cancer type, you have many different variants of cancers that all behave differently.

And so now, we've gotten to the place where we're now doing molecular testing on everybody's tumors to try to see, you know, if your cancer doesn't respond to one treatment, what are the other pathways that we can use to then treat the patient? And all in the hopes that we're being more targeted so that we're minimizing toxicities as we go along.

And it's been an exciting time to practice medicine because the more time progresses, the more of these mutations that we're finding, the more we're able to subspecialize all patients and treat them individually. I think that's a pretty good advance in breast cancer care, and it's happening in other cancers as well.

Leah Cream, MD: I have seen tremendous progress in Oncology. And I'm about to go to my 25th medical school reunion. And the drugs I used every day now weren't even available. I didn't learn about them in medical school. So, that's the wonderful thing about this field, is that every month there's something new, and the pace of the science is just exponential.

And the biggest kind of breakthroughs have been targeted therapy. So, as Dr. Martyr said, it's not one-size-fits-all. And the standard we had in the '80s and '90s was cytotoxic chemotherapy that kills cancer cells because they're dividing more quickly than normal cells. But that type of treatment affects the whole body. And now, we have targeted therapies, which really exploit differences between cancer cells and normal cells. So, there's much less toxicity because it is very specific to the cancer cell, something that's different in the cancer cell than the rest of the body. And most oncologists kind of traced that to 2005 when we had the biggest study showing that Herceptin that treats HER2 positive breast cancer came out and people were just speechless, you know, the 30,000 oncologists at that meeting. And that led to multiple changes along that line.

Lydia Flinner: So, there are a lot of things that come to mind, but one of them predominantly is just being a nurse practitioner in this field. These are really highly specialized fields and I feel really fortunate to be a complement to Dr. Mudge in our office, because we definitely bring very different things to the table. And also, genetic testing is the wave of the future. I think we are certainly testing nearly every patient-- we are testing every patient-- who wants to have genetic testing and it is sometimes carving out their care and surveillance. So, I think that's a big part of what we do now also.

Guest 2: Because of all these things that are happening from the front down, people are living longer. And living longer also means that we have to learn how to manage long-term toxicities or treatment. So, I love seeing subspecialties come up of like Cardio-Oncology, right? A lot of people still get Adriamycin. A lot of people still get Herceptin. And how can we cure your cancer, but make sure that you have a life worth living and that you don't have heart failure. Or we're really focusing on things like lymphedema management, those things that didn't happen before, because we just wanted you to live, right? But now, we're getting really good at helping you live. So, how do we help you live well? And I love to see that shift in focus, not just from treating the cancer, but from treating you and what's important to you and how to maximize treating the cancer versus giving you the life that you really want to live.

My favorite day at the office is when I get to tell you I don't need to see you anymore, right? I mean, that's the real reason we're here, that you've made it through your treatment, you've made it through surveillance, and I get to say goodbye to you.

Lydia Flinner: New to our office, but will probably never lose its excitement for me are my Fridays, my tattoo clinic day. I love being that last completion step on someone's journey.

Leah Cream, MD: What I enjoy most about this work is the relationships with patients. And we have just this unique privilege in Oncology to see people sometimes every two weeks, every three weeks. some patients I've been seeing them monthly for years because they have metastatic disease. So, it's a real relationship. And I really love each of my patients in different ways, and they make me smile and challenge me in all kinds of ways. And I learn a lot, I learn a lot from my patients. But certainly, my favorite thing to do, of course, is give good news, to tell somebody that their scans have improved or looked better.

And I also love it that I generally have something new to offer people that I didn't have a couple months ago. So, especially women with metastatic breast cancer are living years and years and living very well, you know, with people not even really being able to tell what they're going through. So, those are some of the best moments.

Sabrina Martyr, MD: So, being an oncologist is an immense privilege. Medicine in general is a profession where you meet somebody who's a complete stranger and they have to speak to you about very intimate things right away that you would not normally tell somebody else, right? But one of the things that bring me the greatest reward is when patients come in with a new diagnosis and they're scared and they're anxious and it's essentially been an earthquake that happened beneath their feet and being able to just give them options and let them know that it's not the end right at this moment, that we have options. I can take them from where they are, and they can still thrive. That's one of my most rewarding feelings when I take care of my patients.

And again, Oncology is a very hard field. Obviously, we have a lot of success stories. All success stories today. But when a patient comes to you the first time, they don't feel like it's a success story. They feel the immense burden that their world has just been shattered.

KimberLee Mudge, MD: There was a woman that used to work, when I was an independent provider. And her office was right across the hall from where I would have my initial consultation with patients. And she would always say, "I don't know how it happens that these patients come in and they're so scared and by the time that they leave, sometimes they're actually laughing."

It's the time that you have that first encounter, and sometime during that consultation there's a transfer of energy and you come to a common ground, and it's just immensely rewarding. And at that point, that connection is initiated, trust is shared. And then, from there, the relationship grows. And the perfect day for me is when I can come into the room and know that patient and know their family, have relationships, husband, wives, and just know that we've created a friendship. And it all started with breast cancer.

Sabrina Martyr, MD: I always try to encourage patients to also try to be positive when you've gotten a diagnosis. It's easy to let depression get to you. But I do think that if you have a positive outlook, you tend to do better. Maybe this is all anecdotal, but one of the things I try to let my patients know is, yes, it's a terrible journey that you're starting, but also come prepared to fight because I think it does help when you're saying words of affirmation to yourself and get positive.

KimberLee Mudge, MD: There's a point in time when the patient has to take ownership of their health. We can do surgeries. We can provide radiation therapy. We have medicines to help. But the patient has to meet us in the middle and take ownership of where they are and where they need to be.

And so, there is a form of medicine rolling out called lifestyle medicine, and it's really as it sounds where you have to own your own presence. So, eating healthfully, the plant-based nutrition, exercising, doesn't have to be joining a gym, walking, socialization, spiritual health, restorative sleep, incredibly important. And avoidance of substances, that doesn't mean you can't have a beer. But it is about moderation and doing things in perspective, keeping your weight under control. And the plant-based nutrition is a huge thing. I'm just selecting that out because we just ate plant-based dinner.

But we're seeing cancer. When I started practice, it was a rarity to have a patient in their 30s with breast cancer, and I would say a third of my patients are in their 30s. And this isn't just breast, colorectal, GYN, it's real. And they're getting younger and younger and younger. I just took care of a patient who was 21. They're thinking it's quality of life issues, although she was as skinny as they come. But a lot of studies are suggesting processed foods, preservatives are huge.

And so, COVID was a start. You know, the good that came out of COVID was people started walking and people started growing vegetables and buying eggs from a local farmer. And that's kind of where it starts. And I can go on a whole historic tangent about wellness, but I won't bore you, but it is real. And so at some point, longevity and coping with the disease and treatment, you have to own it yourself.

Host: Thank you for listening to In Their Words. We're grateful you joined us to hear from this incredible group of survivors as they courageously shared their questions and experiences. Their voices remind us of the power of community and the importance of walking together through life's greatest challenges.

If this episode touched you, please consider leaving us a rating and review. It helps others discover these important conversations. And if you know someone who might benefit from hearing these voices of strength and resilience, please share this episode with them. Until next time, this is In Their Words, brought to you by the UPMC Pinnacle Foundation and UPMC in Central PA.